[Primary pineal embryonal carcinoma occurring in a middle aged man].

A case of a primary pineal embryonal carcinoma occurring in a middle aged man is reported. A 42-year-old man suffering from headache and nausea was referred to our department. A neurological examination revealed that he had Parinaud's sign. Head CT and MRI showed a tumor in the pineal region. He was operated on using the occipital trans-tentorial approach. The tumor was partially removed and an intra-operative specimen was used to diagnose a kind of germ cell line tumor. However, the tumor was diagnosed afterwards as a pure embryonal carcinoma. Three courses of PE chemotherapy followed by 30 Gy of whole craniospinal irradiation and 30 Gy of extended local irradiation were completed. An MRI showed the tumor to be in complete remission. Despite careful follow-up with chemotherapy every three months, a re-operation and linac radio-surgery, the tumor recurred, and disseminated. The patient died due to an intra-tumoral hemorrhage. A pure primary pineal embryonal carcinoma occurring in a middle-aged person has never been reported previously in detail.

Usefulness of MRA in the Treatment of Dural AVM.

SUMMARY: We report 5 cases of dural AVMs, in which MRA images were considered very useful for evaluating the effectiveness of treatments, such as transvenous embolization therapy. MRA by time of flight method (TOF) with contrast medium for dural AVMs involving the cavernous sinus (dural CCFs) is necessary to assess the caliber of superior ophthalmic veins (SOVs) prior to treatment as well as immediately after treatment and during follow-up. MRA for dural AVM at the transverse-sigmoid sinus is useful for verifying thrombosed sinus in the dural AVM prior to transvenous embolization therapy and necessary to determine the approach to the nidus of the dural AVM(2).

Cardiac malignant fibrous histiocytoma metastasizing to the brain: development of multiple neoplastic cerebral aneurysms.

We report a case in which bilateral occipital brain metastases and neoplastic cerebral aneurysms developed from primary cardiac malignant fibrous histiocytoma. The origin of metastases was confirmed at autopsy. The clinical presentation, radiographic features, and autopsy findings are presented along with a histopathologic analysis of the tumor.

Ciliated epithelial cell cluster in Rathke's cleft cyst--report of two cases.

The authors report two cases of symptomatic Rathke's cleft cyst. Cytological examination of the cyst contents identified clusters of ciliated epithelial cells. Rathke's cleft cyst is normally defined by mucoid fluid in the cyst cavity and cyst wall biopsy. However, intraoperative cytology was found useful in diagnosis and deciding operative strategy.

[Monoamine metabolism after transient global ischemia. Mechanism of delayed postischemic hypoperfusion].

During the period of recirculation following transient global ischemia, an initial hyperemia is succeeded by a secondary decrease in cerebral blood flow, termed "delayed postischemic hypoperfusion." It has been suggested that this phenomenon can lead to additional brain damage after the initial ischemic insult. One proposed mechanism of delayed postischemic hypoperfusion is increased cerebrovascular smooth muscle tone. Release of vasoactive amines, formation of vasoactive products of arachidonic acid metabolism, and disturbance of calcium ion homeostasis in cerebrovascular smooth muscle may contribute to postischemic vasoconstriction. In this study, monoamine metabolism following transient global ischemia was investigate. Mongolian gerbils subjected to 15 minutes of temporal bilateral common carotid artery occlusion and up to 6 hours of recirculation were employed as a model of transient global ischemia. In this model, secondary energy failure reportedly occurs after 6 hours of recirculation. Regional cerebral concentrations of monoamines and their metabolites were determined by high-performance liquid chromatography with electrochemical detection. After 4 to 6 hours of recirculation, accumulation of vasoactive amine, 5-hydroxytryptamine, its major metabolite, 5-hydroxyindole acetic acid, and its precursor amino acid, tryptophan were detected. This finding strongly suggests a postischemic increase in both synthesis and release of this amine, which may explain postischemic vasoconstriction. Moreover, increased dopamine synthesis and release after 1 hour of recirculation was suggested. As dopamine release is reported to increase cerebral glucose utilization, its elevation may contribute to an increase in cerebral energy demand after ischemia. Thus, the brain becomes relatively ischemic and secondary ischemic cell damage occurs.

Surgical treatment of Sturge-Weber syndrome--case report.

It is well known that when Sturge-Weber syndrome manifests with seizures in early infancy, hemiparesis develops early, seizures become intractable, and motor weakness and mental retardation are progressive. In North America and Europe, early surgical intervention is recommended in such cases. However, neurosurgical management of Sturge-Weber syndrome has not been reported in Japan. The authors describe a 4-month-old boy with Sturge-Weber syndrome accompanied by intractable seizures who was successfully treated by a two-stage hemispherectomy. Two years postoperatively he remains free of seizures and is active, although his psychomotor development is moderately retarded. Surgical treatment of Sturge-Weber syndrome, including long-term results, is discussed in detail.

[Intramedullary schwannoma with extradural extension: case report].

Intramedullary schwannoma without evidence of von Recklinghausen's disease is extremely rare. Only 23 cases have been reported in the literature. A 42-years-old woman with transverse type myelopathy at the level of Th 6, was referred to our department. Myelography showed diffuse swelling of the thoracic cord. Delayed myelo CT scan revealed the existence of syrinx at C 6 and Th 10 spinal cord level. On NMR spin echo image, high intensity signal with an ovoid shape was visualized in Th 7-8 spinal cord parenchyma and the syrinx was verified below the level of C 5. Based on these findings, she was diagnosed as having Th 7-8 intramedullary spinal cord tumor. Th 6 to Th 9 laminectomy followed by the complete removal of well encapsulated tumor was performed. The rostral and caudal pole of the tumor was found to be located intramedullary. The tumor at the level of Th 7-8, extended not only to the extramedullary space but also to the extradural space. Histopathological examination revealed that the specimen was Antoni A type neurinoma. She showed good recovery. Following hypotheses have been postulated on the cytogenesis of intramedullary schwannoma in the literature: Central displacement of Schwann cells during embryonic development. Schwann cells ensheathing aberrant intramedullary nerve fibers. Schwann cells along the intramedullary perivascular nerve plexus. A critical area where posterior root loose their sheath on entering the pia mater. Transformation of pial cells of neuroectodermal origin into Schwann cells. The cytogenesis of these reported cases may not be identical.(ABSTRACT TRUNCATED AT 250 WORDS)

[Brain stone. A case report].

A 43-year-old woman with an abnormally calcified shadow in right temporal lobe as seen on the plain skull films is reported. She was free of any neurological deficit except a recent episode of generalized tonic clonic convulsive seizures. Clinical observations, including EEG have proved unhelpful. Despite intensive neuro-radiological examinations, it only revealed the existence of a dumb-bell shaped calculus measuring 17 x 10 mm in right temporal lobe. Operation and histo-pathological examination were carried out. The mass was a hard calculus, surrounded by minimal perifocal gliosis, and was easy to separate from the normal brain tissue. The decalcified specimen was identified as a collection of PAS positive spherical lamellar particles without any diagnostic cell or structure. After the operation, the calcified shadow was disappeared and the patient is free from seizure. Based on these findings, the calculus can be classified as a very rare category, "idiopathic brain stone".

Cerebrovascular endothelial cell culture: metabolism and synthesis of 5-hydroxytryptamine.

The presence of 5-hydroxytryptamine was investigated in cultured and propagated cerebrovascular endothelium using immunohistochemistry and high pressure liquid chromatography. These studies demonstrate that the endothelium has the ability to take up and metabolize 5-hydroxytryptamine as well as to synthesize this amine from its precursor L-tryptophan, thus providing evidence for extraneural synthesis of 5-hydroxytryptamine in the central nervous system.