Endoscopic third ventriculotomy improves parkinsonism following a ventriculo-peritoneal shunt in a patient with non-communicating hydrocephalus secondary to idiopathic aqueduct stenosis.

We report a 47-year-old woman who manifested ocular motility disorder, bilateral pyramidal signs, and severe parkinsonism after a ventriculo-peritoneal shunt for non communicating hydrocephalus secondary to idiopathic aqueduct stenosis. The ocular motility disorder consisted of severe vertical gaze palsy and convergence retraction nystagmus. Parkinsonism included not only bradykinesia but also resting tremor and cogwheel rigidity. On the other hand, striatal uptake did not decrease in (18)F-dihydroxyphenylalanine positron emission tomography, and anti-Parkinsonian drugs were not effective. 99mTc-ethyl cysteinate dimer bicisate single-photon emission computed tomography and F-18 fluorodeoxyglucose positron emission tomography revealed wide-ranged frontal cerebral cortical dysfunction due to midbrain dysfunction. Moreover, endoscopic third ventriculotomy markedly improved the clinical symptoms as well as the frontal cerebral cortical flow. A neural network formation known as the 'cortico-basal ganglia loop,' which intimately connects the frontal lobe with the basal ganglia, is possibly associated with the Parkinsonism observed in our patient.

Five-band microwave radiometer system for non-invasive measurement of brain temperature in new-born infants: system calibration and its feasibility.

Recent simulation studies have shown that a technique of multi-frequency microwave radiometry is feasible for non-invasive measurement of deep brain temperatures in the new-born infants. A five-band microwave radiometer system has been developed, and its operation in a normal electromagnetic environment is checked. Five receivers operating with a waveguide antenna and at center frequencies of 1.2, 1.65, 2.3, 3.0 and 3.6 GHz (0.4 GHz bandwidth) are calibrated using a temperature-controlled water-bath. Temperature resolutions obtained for each receiver are 0.183, 0.273, 0.148, 0.108 and 0.118 K, respectively. A temperature retrieval simulation based on these resolutions and the previously proposed algorithm shows that the confidence interval, as produced by thermal noise, is 0.62 K for the retrieved central brain temperature. If the conductivity of brain is estimated wrong by 10 %, this will result in an error of 0.3-0.4 K. The result of this work is encouraging for realization of radiometric measurement of temperature profile in a baby's head.

Genes for phytochrome A in horseradish: isolation of cDNAs and analysis of expression during light-induced formation of adventitious shoots from hairy roots.

Three cDNAs for phytochrome A (phyA), designated ArPHYA1, ArPHYA2 and ArPHYA3, respectively, were isolated from a cDNA library prepared from proximal parts of the hairy roots of horseradish (Armoracia rusticana). The level of phyA was higher in those parts than in any other parts of hairy roots. The amino acid sequences deduced from the cDNAs were quite similar, with stronger homology to the product of PHYA of Arabidopsis thaliana than to products of genes for phytochromes of many other plant species. Levels of transcripts in roots and tubers were higher than those in leaves and petioles. The levels in hairy roots were highest at the proximal ends and increased with increased duration of culture in darkness. Furthermore, the levels in proximal parts decreased by 25-50% after light irradiation. The elevated levels of transcripts of PHYA genes at the proximal ends of hairy roots are discussed with reference to the light-induced formation of adventitious shoots.

[Magnetic resonance imaging of Kernohan's notch in chronic subdural hematoma].

Compression of the crus cerebri against the free edge of the tentorium contralateral to a supratentorial mass, the so-called Kernohan's notch, can be a cause of false localizing sign. Kernohan's notch has been thoroughly studied clinically and pathologically, but not radiographically. The authors describe a case of left chronic subdural hematoma, which resulted in left hemiparesis caused by Kernohan's notch. Injury to the contralateral cerebral peduncle was clearly shown by magnetic resonance imaging (MRI) performed in the postoperative period. A 43-year-old man was transferred to our hospital in deep coma with dilated pupils, unreactive to light. Computed tomography (CT) scans obtained on admission revealed a left chronic subdural hematoma and a midline shift to the right. After drainage and irrigation of the left chronic subdural hematoma through a single burr hole, his clinical condition improved gradually. But 1 month after the operation, mild left hemiparesis still persisted. MRI T2-weighted images demonstrated an abnormally increased signal area in the right cerebral peduncle. T1-weighted coronal images showed the anatomical relationship between the hypointense lesion in the right cerebral peduncle and tentorial edge. Three-dimensional-MRI (3D-MRI) clearly demonstrated the surface image of Kernohan's notch. We emphasize the utility of 3D-MRI for detecting evidence of brain stem injury, such as Kerno han's notch.

Aneurysms located at the horizontal segment of the anterior cerebral artery or the middle cerebral artery.

Aneurysms at the horizontal segment of the middle cerebral artery or anterior cerebral artery are relatively rare. The characteristics of 13 cases were analyzed retrospectively. Six of the 13 cases had multiple aneurysms, nine had aneurysmal rupture, and three of these nine were complicated by intracerebral hematoma. Neck clipping of the aneurysm was performed in 11 cases and four developed new cerebral infarction in the territory of the perforating arteries. Overall mortality and morbidity was 15% and 38%, respectively. The outcome for patients with aneurysms at these sites was evidently poorer than for those with aneurysms at other sites.

[A case of infected subdural hematoma complicating chronic subdural hematoma in a healthy adult man].

The authors report a case of so-called "infected subdural hematoma" as a complication of chronic subdural hematoma. The patient was a 55-year-old man who had sustained a small laceration of the forehead in a traffic accident on March 29, 1995. No fractures were detected on skull roentgenograms, and general and neurological examinations failed to reveal any abnormal findings. In early August 1995, the patient began to experience headaches, and on August 5 he developed a fever of 38 degrees C. On August 8 he suffered a left motor seizure and was admitted to our hospital. Laboratory studies revealed a peripheral leukocyte count of 10,800/mm3 and a C-reactive protein level of 18.1 mg/dl. Computed tomography scans showed a thick right fronto-parietal subdural low density mass and a thin left frontal subdural low density mass. An emergency operation was performed via a single right fronto-parietal burr hole. A chronic subdural hematoma containing slightly yellowish, bloody, purulent fluid was found beneath an outer membrane. The hematoma was irrigated with physiological saline containing antibiotics, and a drain was inserted into the subdural space. A subdural membrane was also present on the left but it contained no pus. Aggressive antibiotic therapy was performed, and the patient was discharged without any neurological deficit. Histologically the membrane was determined to be the outer membrane of a typical chronic subdural hematoma. Enterococcus faecalis, which has rarely been reported to cause infection of the central nervous system, was detected in a bacterial culture of the pus. Systemic investigation showed no evidence of otorhinologic or other focal infection. The above clinical findings suggested that hematogenous seeding of a chronic subdural hematoma had occurred in this patient. Subdural empyema arising from hematogenous seeding to a pre-existing subdural hematoma by an infection is very rare, but this type of complication must be kept in mind not only in the elderly, infants, and compromised hosts, but in patients without complications as well.

[Adult-onset aqueductal stenosis caused by membranous occlusion in the aqueduct: a case report].

The authors report a case of adult-onset aqueductal stenosis caused by membranous occlusion of the aqueduct. The patient was a 35-year-old man, who suffered from progressive headache. On admission, computed tomography (CT) scan showed marked dilatations of the lateral and third ventricles. Midsagittal T1-weighted magnetic resonance imaging (MRI) scan showed a membranous occlusion at the lower end of the aqueduct, with dilatation of the proximal aqueduct and elevation of the tectum. Midsagittal cine-MRI demonstrated the cerebrospinal fluid flow in the aqueduct. The patient was diagnosed as having hydrocephalus resulting from membranous stenosis of the aqueduct by MRI. A ventriculo-peritoneal shunt operation was performed and his symptoms improved markedly. The membranous occlusion of the aqueduct is a rare cause of hydrocephalus. The etiology and therapy of aqueductal stenosis are discussed.

[A case of cranial hypertrophic pachymeningitis with intracranial hemorrhage].

A case of cranial hypertrophic pachymeningitis of unknown etiology in a patient with 15-year history of headaches, cranial nerve palsies, and gait disturbance is reported. A 77-year-old woman was brought to our institute in a coma. CT revealed intracerebral hemorrhage in the right temporal lobe and thickening of the falx and tentorium. Fifteen years previously the patient had undergone CT scanning because of headaches, cranial nerve palsies, and progressive gait disturbance and a thickened tentorium, mild hydrocephalus and edematous change in the right temporal lobe had been reported. Since the etiology of her symptoms was unclear at the time, she did not receive adequate treatment. Her symptoms gradually progressed thereafter, and her visual acuity and hearing deteriorated. MR imaging in 1994 showed the thickened tentorium as a hypointense area with hyperintense edges on Gd-DTPA enhanced images. Angiography revealed narrowing of posterior portion of the superior sagittal sinus. The patient's condition rapidly deteriorated due to the intracranial hypertension and she subsequently died. Autopsy revealed a thickened tentorium with xanthochromic surface. This hypertrophic change was also seen in the dura mater of the posterior and middle cranial fossa. Microscopic examination of the thickened tentorium revealed extensive fibrous tissue with a chronic inflammatory infiltrate, predominantly of lymphocytes. No specific lesions were revealed by staining with hematoxylin-eosin, PAS, Gram's or Ziehl-Neelsen stains. The patient had no inflammatory or infectious diseases of other organs, and a diagnosis of idiopathic cranial hypertrophic pachymeningitis of unknown etiology was made. Considering the above findings, the thickened tentorium depicted as a hypointense area on the T1- and T2-weighted images and the Gd-enhanced edges of the tentorium are thought to be represent fibrous tissue and inflammatory regions, respectively.

Choroid plexus carcinoma in the lateral ventricle--case report.

A 68-year-old male presented with choroid plexus carcinoma in the left lateral ventricle manifesting as dysarthria and gait disturbance. Magnetic resonance imaging showed a homogeneously enhanced mass in the trigone of the left lateral ventricle. Selective left posterior cerebral arteriography showed the tumor was fed by the left medial posterior choroidal artery. Detailed examinations found no evidence of an extraneural primary focus. He underwent partial removal of the tumor followed by local Lineac irradiation (50 Gy). After irradiation, the serum level of carcinoembryonic antigen decreased and the size of the residual tumor was reduced.

[A case of dural arteriovenous malformation in the anterior fossa associated with an occlusion of the unilateral middle cerebral artery with moyamoya phenomenon].

The authors report a case of dural arteriovenous malformation (dAVM) in the anterior fossa that was associated with an occlusion of the unilateral middle cerebral artery with Moyamoya phenomenon. The patient was a 79-year-old man referred to our department with an episode of consciousness disturbance and headache. Computed tomography scan showed intracerebral hematoma in the left frontal lobe, combined with left frontal subdural hematoma and subarachnoid hemorrhage. Angiography revealed dAVM in the left anterior fossa, fed by the bilateral ethmoidal and the bilateral middle meningeal arteries, and draining into the superior and inferior sinuses through the pial veins with vascular sacs. While angiography revealed an occlusion of the right middle cerebral artery (M1 portion) good collaterals via leptomeningeal anastomosis had developed. T1-weighted magnetic resonance (MR) images showed an intracerebral hematoma as a low intensity area, and flow-void areas were indicative of vascular sacs. Time-of-flight MR angiography also clearly showed dAVM in the left anterior fossa. Co-existence of an occlusion of an intracranial major artery and dAVM in this location has not been reported previously and it was speculated that this association had occurred by chance.

User interface design and evaluation for electronic medical record system.

A user interface for an electronic medical record system (EMRS) is proposed. A pen-based device adopted for data input and the GUI windows layout simulate conventional paper forms, so that doctors can quickly grow accustomed to the EMRS. A comparison study shows the proposed interface does not significantly delay the examination, even when used in hospitals with many outpatients.

[A case of hemangioblastoma in the thalamus].

Supratentorial hemangioblastoma is encountered very rarely. About 80 cases in all have been reported. The authors present a case of supratentorial hemangioblastoma in the thalamus with gradually enlarging cysts. The patient was a 45-year-old man with complaints of left hemiparesis and headache. Computed tomographic scans of the brain showed a cystic mass with mural nodule in the right thalamus. Left vertebral angiography demonstrated a vascular tumor fed by a thalamogeniculate artery. A right temporo-parietal craniotomy was performed and the tumor was totally resected through the transcortical approach. The histological diagnosis was hemangioblastoma. Post-operative course was good except for a minor complication of the left lower quadrant homonymous hemianopsia and left hemiparesis which had disappeared at the time of discharge.

[A case of brain abscess of the basal ganglia which resulted in disastrous outcome due to ventricular ruptures].

A case of deep-seated brain abscess that ruptured twice into the ventricle and resulted in death is presented. A 45-year-old man had experienced pyrexia and headache for 3 days before admission. On admission he was somnolent (GCS: 13) but there were no abnormal neurological findings except nuchal rigidity and Kernig's sign. Computed tomography (CT) scan showed a ring enhanced mass near the left caudate head and dilated ventricles. In comparison with CT performed at the former hospital it was diagnosed that a rupture into the ventricle of the brain abscess had occurred. Ventricular drainage was performed at once and white purulent cerebrospinal fluid was obtained. Thereafter, he was treated with some antibiotics and his conditions seemed to stabilize for a while. Serial CT images demonstrated that the size of the abscess seemed to be enlarging. Just when we planned to undertake stereotactic aspiration, the second ventricular rupture occurred and he died. According to this case, it is suggested that once a deep-seated brain abscess near the ventricular system is suspected, it should be aspirated by means of CT-guided stereotactic surgery immediately.

[Two cases of traumatic intracerebral pneumocephalus].

Two cases of traumatic intracerebral pneumocephalus, a rare complication of head trauma, are presented. Case 1: A 14-year-old boy had a strong concussion in his forehead due to a motorbike accident. Slightly obtunded on admission showing GCS 10, he became conscious in several days. Head CT performed after 17 days showed a round air image in the right frontal lobe which kept increasing in size thereafter. Bilateral frontal craniotomy was performed 31 days after the injury. A craniodural defect with a herniated brain was found in the superior wall of the posterior ethmoid sinus and repaired. Case 2: A 55-year-old man received a left forehead concussion when his motorbike ran into a car from behind. Although he had been conscious ever since admission, head CT after 15 days showed a round air image in the left frontal lobe. MRI demonstrated the air to be located in the cerebral parenchyma distinctly and the brain to have herniated into the frontal sinus. As the air showed a tendency to increase in volume and mild psychic and memory disturbances appeared, bilateral frontal craniotomy was performed 34 days after the injury. A craniodural defect with a herniated brain was detected in the posterior wall of the frontal sinus and repaired. These two patients showed a small amount of cerebrospinal fluid (CSF) rhinorrhea before the operation. Following the surgical repair, no recurrence of pneumocephalus and CSF rhinorrhea has been seen in either case. Intracerebral pneumocephalus secondary to closed head trauma was thought to have been due to herniation of contused brain into a craniodural defect.(ABSTRACT TRUNCATED AT 250 WORDS)

[Epileptogenicity and neurotoxicity induced by intra-amygdaloid injection of various excitatory amino acids in rats].

The electroencephalographic and histopathological changes following intra-amygdaloid injection of excitatory amino acids were examined in rats. Limbic seizure status was induced after injection of kainic acid (KA), domoic acid (DA), quisqualic acid (QA), alpha-allo-kainic acid (ALLO-KA) and D-glutamic acid (D-GA). The excitatory effect was found to be in the following order: KA > DA >> QA > ALLO-KA >> D-GA. D-GA caused only a transient paroxysmal discharge on EEG. However, seizure was not induced by an injection of L-glutamic acid (L-GA), D-aspartic acid (D-AA) and L-aspartic acid (L-AA). The minimum epileptogenic doses of these amino acids were defined and intra-amygdaloid injection of these doses were performed. Seven days following the injections, histopathological study was performed. These injection resulted in various degree of degeneration and neuronal cell loss of the pyramidal cells in the ipsilateral hippocampus in the following order of severity: DA > or = KA > D-GA > ALLO-KA > QA. These results indicate absence of correlation between epileptogenicity and histopathological changes. Non epileptogenic amino acids induced no pathological changes of hippocampus or the injected site. These results suggest that the severity of hippocampal damage induced by intra-amygdaloid injection of amino acids depends not only on the magnitude of the induced limbic seizure status but also on the difference of neuropharmacological properties of those amino acids in terms of the interaction with their receptors. Further studies are necessary to elucidate the mechanism of actions of these excitatory amino acids in relation to their receptor subtypes.

[Effectiveness of local delivery of ofloxacin using controlled-release strips (PT-01) in periodontal patients. Part 2. Successive delivery system and combination with scaling].

Four different sites were randomly selected in each periodontal patient and divided into four group: PT-01-treated site (A), PT-01 treatment combined with scaling (S + A), placebo-treated site (P) and placebo treatment combined with scaling (S + P). PT-01 and the placebo were applied to the periodontal pocket weekly on days 0 to 28, and clinical and microbiological evaluations were made. The results obtained were as follows: 1. Weekly changes in plaque index, plus discharge and mobility of the tooth were not observed in any group. 2. In gingival index, bleeding on probing, pocket depth and gingival crevicular fluid, significant improvement was found in A in comparison with P and in S + A in comparison with S + P. 3. In total number of subgingival bacteria and in the ratio of motile rods and spirochetes to the total number of bacteria, significant reduction was found in A in comparison with P and in S + A in comparison with S + P.