Focal brain edema and natriuretic peptides in patients with subarachnoid hemorrhage.

Central salt wasting syndrome may be caused by pathological increases in serum natriuretic peptides after subarachnoid hemorrhage (SAH). However, it is unclear as to why the serum concentration of atrial natriuretic peptide (ANP) or brain natriuretic peptide (BNP) increases in the subacute phase of SAH. The present study was designed to assess the correlation between focal brain edema and serum concentration of ANP or BNP in patients with SAH. Focal brain edema was found in 8 SAH-patients and peaked between days 4 and 7 of SAH. The mean serum ANP and BNP levels in patients with focal brain edema were significantly higher than those in patients without focal brain edema between days 4 and 14 of SAH. These results suggest that focal brain edema might correlate with increased levels of ANP and BNP in the subacute phase of SAH.

Vascular endothelial growth factor expression in pituitary adenomas.

Vascular endothelial growth factor (VEGF) is known to be a mediator of angiogenesis and vascular permeability. A cystic component and hemorrhage are often found in pituitary adenomas. In the present study we assess the VEGF expression based on immunohistochemical examinations in 48 pituitary adenomas. All the adenomas showed some VEGF immunoreactivity mainly in the cytoplasm of tumor cells. Of the 48 adenoma-cases, 16 cases had a strong VEGF immunoreactivity, 26 cases had a moderate one, and 6 cases had a weak one. On the MR images, a cystic component was found in 16 cases (33.3%), and a hemorrhage was found in 18 cases (37.5%). The VEGF immunoreactivity had a significant relationship with the cystic component but neither the hemorrhage, size, recurrence, or HE classification. These findings suggest that VEGF might play a potential role in the pathogenesis of cystic formation in pituitary adenomas.

Characteristic phosphorylation of the extracellular signal-regulated kinase pathway after kainate-induced seizures in the rat hippocampus.

Extracellular signal-regulated kinase (ERK) pathways play a crucial role in cell growth and long-lasting neuronal plasticity. Several studies have shown that phosphorylated-ERK (p-ERK) significantly increases after kainic acid (KA) administration. However, little or no information is available about the spatial distribution of p-ERK after KA-induced seizures. We herein show that KA-induced seizures significantly increase p-ERK in both neurons and astrocytes in rat brain using Western blots and immunohistochemistry. A strong immunoreactivity for p-ERK was induced in the dentate hilar neurons and CA3 neurons 30 mins and 6 hrs after KA injection. In addition, immunoreactivity for p-ERK was seen in astrocytes 6 hrs after KA injection. 72 hrs after KA injection, all pyramidal neurons had died. These findings suggest that the ERK pathway participates in the KA-induced neurotoxicity in the rat hippocampus.

Female gender as a risk factor for hypokalemia and QT prolongation after subarachnoid hemorrhage.

Subarachnoid hemorrhage (SAH) often causes hypokalemia and QT prolongation. The sex disparities among 73 patients with SAH and 96 control subjects were examined. On the first day of SAH, the mean serum potassium level was significantly lower and the mean corrected QT interval was significantly longer in the female SAH group compared with either the female control or male SAH group. These findings suggest female susceptibility to hypokalemia and QT prolongation after SAH.

Evaluation of spontaneous intracranial hypotension: assessment on ICP monitoring and radiological imaging.

We describe two recent cases of spontaneous intracranial hypotension. A 38-year-old woman developed a severe postural headache. Magnetic resonance imaging (MRI) showed marked dural enhancement. Histopathological findings of dural biopsy showed numerous dilated vessels in the dura, rather than hypertrophic change. Lumber CSF pressure was 5 cmH2O and RI cisternography suggested CSF leakage. A 58-year-old woman with postural headache and vertigo had bilateral subdural haematoma associated with diffuse dural enhancement on MRI. Lumber CSF monitoring confirmed persistent low pressure ranging from 0-5 cm H2O. MRI myelography revealed multiple CSF pouches along the whole spinal axis. CSF leakage was demonstrated on Radioisotope (RI) cisternography. Both cases described in this report were diagnosed as spontaneous intracranial hypotension caused by CSF leakage from spinal meningeal diverticula and were successfully treated by intravenous Factor XIII administration.

Cisternal MHPG level inversely correlates with Glasgow coma scale after aneurysmal subarachnoid hemorrhage.

We measured the concentrations of monoamines and amino acids in the cisternal cerebrospinal fluid obtained from 15 patients after aneurysmal subarachnoid hemorrhage. Based on the Glasgow Coma Scale (GCS), the patients were divided into two conscious (GCS always 14 or better from the third post-operative day to Day 12; n = 8) and unconscious groups (n = 7). We examined the concentrations of monoamines and amino acids between the two groups and evaluated the correlation between the concentrations and the GCS at CSF sampling. The concentration of MHPG was significantly higher in the unconscious than in the conscious group from Days 4 to 12. A significant inverse correlation was observed between the MHPG concentration and the GCS (r = approximately 0.635, p < 0.0001). Measuring the cisternal MHPG concentration may be useful for estimating convalescence after subarachnoid hemorrhage.

[Thallium-201 single photon emission tomography of intracranial angiomas].

We herein describe thallium-201 single photon emission tomography (T1-201 SPECT) findings in three cases with intracranial angioma. One of the lesions which was associated with chronic encapsulated intracerebral hematoma showed moderate accumulation of T1-201, but, others demonstrated no accumulation. The usefulness and limitations of T1-201 SPECT in differential diagnosis of intracranial mass lesions are discussed.

Solitary fibrous tumor of the meninges in the posterior cranial fossa: magnetic resonance imaging and histological correlation--case report.

A 58-year-old female presented with a rare case of intracranial solitary fibrous tumor (SFT) manifesting as progressive ataxic gait and hearing loss on the left persisting for 6 months with recent symptoms of increased intracranial pressure. Computed tomography demonstrated a large isodense irregular-shaped mass in the left posterior cranial fossa. T2-weighted magnetic resonance imaging showed two components appearing as very low intensity and high intensity. Extreme-lateral suboccipital craniotomy was performed. Gross total resection was achieved except for some dural attachment in the jugular foramen. All symptoms and signs subsided after surgery. Histological, immunohistochemical, and electron microscopic examinations led to a diagnosis of SFT. The strongly hypointense areas on the T2-weighted images were hypocellular region characterized by disorganized spindle cells and thick bands of collagen. The hyperintense areas on the T2-weighted images were hypercellular region mimicking hemangiopericytoma. Strong immunoreactivity for CD34 was also helpful in the diagnosis. Electron microscopy revealed absence of pinocytic vesicles and dense laminae which are characteristic of hemangiopericytoma. The magnetic resonance imaging appearance of SFT seems to be pathognomonic.

Cystic schwannoma of the orbit: case report.

BACKGROUND: Cystic lesions of the orbit have diverse clinical findings and histopathological features. We report an orbital schwannoma composed of a single cyst. CASE DESCRIPTION: A 62-year-old woman with an intraconal cystic tumor in the left orbital cavity is described. The cystic tumor was totally removed and the pathological diagnosis of the cyst wall was schwannoma composed of both Antoni type A and B. CONCLUSIONS: A rare case of cystic schwannoma of the orbit is reported. This case may contribute to an improved preoperative differential diagnosis for cystic lesions of the orbit.

Identification of the DNA binding surface of H-NS protein from Escherichia coli by heteronuclear NMR spectroscopy.

The DNA binding domain of H-NS protein was studied with various N-terminal deletion mutant proteins and identified by gel retardation assay and heteronuclear 2D- and 3D-NMR spectroscopies. It was shown from gel retardation assay that DNA binding affinity of the mutant proteins relative to that of native H-NS falls in the range from 1/6 to 1/25 for H-NS(60-137), H-NS(70-137) and H-NS(80-137), whereas it was much weaker for H-NS(91-137). Thus, the DNA binding domain was defined to be the region from residue A80 to the C-terminus. Sequential nuclear Overhauser effect (NOE) connectivities and those of medium ranges revealed that the region of residues Q60-R93 in mutant protein H-NS(60-137) forms a long stretch of disordered, flexible chain, and also showed that the structure of the C-terminal region (residues A95-Q137) in mutant H-NS(60-137) was nearly identical to that of H-NS(91-137). 1H and 15N chemical shift perturbations induced by complex formation of H-NS(60-137) with an oligonucleotide duplex 14-mer demonstrated that two loop regions, i.e. residues A80-K96 and T110-A117, play an essential role in DNA binding.

Large empty sella with an intrasellar herniation of an elongated third ventricle. Case report.

A 73-year-old female presented with a large empty sella with herniation of an elongated third ventricle concomitant with herniation of the surrounding subarachnoid space into the sella, manifesting as visual impairment and amenorrhea without galactorrhea. Magnetic resonance imaging and computed tomography cisternography clearly showed the large empty sella, without evidence of either hydrocephalus or benign intracranial hypertension, which is extremely rare.

Differential modulation by the endothelium of contractile responses to 5-hydroxytryptamine, noradrenaline, and histamine in the rabbit isolated basilar artery.

1. To assess modification by endothelium, we determined the contractile responses of intact rings from rabbit basilar artery to histamine, noradrenaline and 5-hydroxytryptamine (5-HT) and compared them with Triton X-100-treated and NG-nitro-L-arginine (L-NNA)-treated preparations. 2. Among the agonists examined histamine caused the strongest contraction of vascular smooth muscles and noradrenaline the weakest one. The present results are consistent with the basal release of endothelial-derived relaxing factor (EDRF). 3. 5-HT caused a much greater modification than the one expected from basal release of EDRF, suggesting that the release is induced by 5-HT, in contrast to the previous results. Our findings also indicate that 5-HT could induce the release of both contracting factor (EDCF) and EDRF from the endothelium.

Sturge-Weber disease: operative indications and surgical results.

Patients with Sturge-Weber disease with epilepsy refractory to medical therapy have been reported to develop slowly progressive neurological deficits and ultimately become moderately or severely disabled. We studied six patients with Sturge-Weber syndrome including its incomplete form. Three out of six patients with Sturge-Weber syndrome revealed evolution of calcified angioma on computed tomography. All of the three cases developed medically intractable seizures. Total and/or subtotal hemispherectomy was performed for these three cases. The surgery was effective for controlling seizures in all three cases except one with infantile spasm with hypsarrythmia on electroencephalogram who is still on anticonvulsant. Although the unremitting deterioration in mental retardation and hemiparesis was not effectively prevented by the surgery possibly because the timing of surgery was delayed in one case, the surgery not only stopped the frequent medically-intractable seizures, but also dramatically prevented the psychomotor deterioration in the other case. Although the role of surgical treatment for the patients with Sturge-Weber syndrome remains poorly defined, one can expect excellent results if the indications for surgery are carefully analyzed and hemispherectomy is performed on an individual basis.

Tuberculoma of the cerebellum--case report.

A 25-year-old female presented with a 1-month history of headache and vomiting. Computed tomography revealed several enhanced nodules with surrounding edema in the right cerebellum. A T2-weighted magnetic resonance image showed heterogeneous high signal intensity throughout the right cerebellar hemisphere. A tuberculin skin test was positive and the erythrocyte sedimentation rate was slightly high, but there was no other clinical evidence of a tuberculous process. The histological diagnosis of the surgical specimen was tuberculoma. The combination of surgery and antituberculosis chemotherapy eradicated the cerebellar lesions.

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.