Importance of the initial grade of subarachnoid hemorrhage in the patients with the age of 80 years and older from a single center analysis.

In the developed countries, especially Japan, elderly population is rapidly increasing, but outcomes of elderly patients with the age of 80 years and older suffering from subarachnoid hemorrhage (SAH) remain still unclear. We retrospectively reviewed the medical records of nontraumatic SAH patients aged 80 years and older, who were hospitalized in a single center between 1998 and 2009. There were 28 patients (80-90 years old and 75% female), representing 5.9% of all non-traumatic SAHs (n = 474). Of those, 16 patients received an intervention (ten clipping and six endovascular coiling) and the remaining 12 patients were managed conservatively. The median survival time of intervention group was 110 days and that of conservative group 49 days (p = 0.12, log rank analysis). Cox's proportional hazards model yielded two variables, the Japan Coma Scale (JCS) grade on admission ( hazard ratio: 2.93 [p = 0.009]) and conservative treatment (hazard ratio: 2.14 [p = 0.054]). In the outcome of the modified Rankin Scale between these two groups, logistic regression analysis had significant variable; the JCS grade on admission (odds ratio: 280, [p = 0.020]). In the elderly patients with good initial clinical condition, an acute intervention may have good outcome.

Disappearance of gadolinium enhancement in a chemoresistant astrocytoma of the tectum after high-dose interferon beta.

Interferon beta 6 million units per week was administered to a patient with an aggressive astrocytoma in the tectum that was resistant to cisplatin, etoposide, vinblastine, and the oral alkylating agent temozolomide. The tumor was immunopositive for O6-methylguanine-DNA methyltransferase (MGMT). Interferon beta caused the disappearance of the gadolinium-enhanced lesion in the tectum. Interferons have apoptotic and antiangiogenic effects on tumor cells, and the lesion's disappearance may have been induced by complexes of these effects. Administration of interferon beta might have a favorable effect on tectal gliomas that are immunopositive for MGMT and resistant to chemoradiotherapy including temozolomide.

Outcomes of 24 patients with subarachnoid hemorrhage aged 80 years or older in a single center.

OBJECTIVE: In the developed countries, elderly population is rapidly increasing, but outcomes of elderly patients with subarachnoid hemorrhage (SAH) remain unclear. PATIENTS AND METHODS: We retrospectively reviewed the medical records of non-traumatic SAH patients aged 80 years or older, who were hospitalized in a single center between 2000 and 2005. RESULTS: There were 24 patients (80-92 years old and 83% female), representing 8.8% of all non-traumatic SAHs (n=272). Of those, six patients received an intervention (five clipping and one endovascular coiling) and the remaining 18 patients were managed conservatively. The patients who received an intervention were younger and had a better consciousness at presentation. Early mortality rate within 30 days after SAH was higher in the conservative group (61% [11/18] and 17% [1/6], p=0.155). At 6 months, mortality rate was significantly higher in the conservative group (83% [15/18] and 33% [2/6], p=0.038), and independence rate was higher in the intervention group (33% [2/6] and 0% [0/18], p=0.054). Logistic regression analysis showed that age and degree of consciousness on admission were significant predictor of outcome in 4 weeks, and that receiving intervention was significant predictor of outcome in 6 months. CONCLUSION: In elderly SAH patients with good clinical condition at presentation, an active intervention may improve the outcome.

Familial lateral temporal lobe epilepsy confirmed with intracranial electroencephalography and successfully treated by surgery.

Documentation of familial epilepsy is of paramount importance for identification of epilepsy-associated genes, elucidation of pathomechanisms of epilepsy, and development of treatment of epilepsy. We report a Japanese family with 5 members with lateral temporal lobe epilepsy beginning around the second decade of life. All seizures were intractable to medical treatment, and four patients underwent surgical treatment following long-term monitoring by intracranial electroencephalography with subdural electrodes, which revealed neocortical origins for the seizure. These four patients were successfully treated with surgery. The clinical features of this familial temporal lobe epilepsy seem to be different from those of previously reported types of familial temporal lobe epilepsy.

Combination therapy with rituximab and temozolomide for recurrent and refractory primary central nervous system lymphoma.

High-dose methotrexate-based chemotherapy has extended survival in patients with primary central nervous system lymphoma (PCNSL). However, although salvage treatment is necessary in recurrent and refractory PCNSL, this has not been standardized. We herein describe the efficacy of a combination of rituximab and temozolomide (TMZ) in two consecutive patients with recurrent and refractory PCNSL. Based on the immunohistochemical study, case 1 had a non-germinal center B-cell-like (non-GCB) subtype, was positive for bcl-2 and negative for O6-methylguanine-DNA methyltransferase (MGMT). Case 2 was GCB subtype, bcl-2-, and MGMT+. Because of the positive expression of MGMT, interferon-beta was additionally given in case 2. Complete responses and partial responses were obtained after the third and fourth cycles of combination therapy, respectively. This was maintained for 12 months, with acceptable toxicity. The combination of rituximab and TMZ was effective in tumors with different immunohistochemical profiles. This combination therapy warrants further study in a larger population.

A mechanism of acquiring temozolomide resistance during transformation of atypical prolactinoma into prolactin-producing pituitary carcinoma: case report.

BACKGROUND AND IMPORTANCE: The case presented here describes the clinical evolution of a pituitary carcinoma from an atypical prolactinoma after temozolomide (TMZ) treatment. The mechanism of acquisition of TMZ resistance was analyzed. CLINICAL PRESENTATION: A 60-year-old woman with atypical prolactinoma had been treated for 7 years with multiple therapies, including dopamine agonists, surgical intervention (5 times), conventional radiotherapy, and radiosurgery. The patient deteriorated as a result of tumor enlargement. Ten cycles of TMZ therapy, 200 mg/m for 5 days every 4 weeks, improved the patient's performance status and caused tumor shrinkage. Six months after discontinuation of TMZ, the tumor progressed into pituitary carcinoma with tumor regrowth and intraventricular dissemination. TMZ therapy was ineffective this time. A sixth surgery and salvage chemotherapy failed to improve the patient's condition, and she died 9 years after the first diagnosis. Throughout the treatment course, O6-methyl-guanine-DNA methyltransferase (MGMT) was immunonegative in the tumor specimens, including the TMZ-refractory pituitary carcinoma. Mutation of p53 was identified in both the atypical prolactinoma and pituitary carcinoma. In contrast, major differences were noted for mismatch repair protein MSH6 immunostaining: Although MSH6 was diffusely immunopositive in the atypical adenoma, it became immunonegative when the tumor evolved into TMZ-refractory pituitary carcinoma. CONCLUSION: Loss of MSH6 occurred during the progression from an atypical prolactinoma to a pituitary carcinoma, which may have caused resistance to TMZ treatment. This case suggests that preserving MSH6 function is essential for responsiveness to TMZ treatment in MGMT-negative and p53-mutated atypical pituitary adenoma or pituitary carcinoma.

Chronic recanalization of dissection of the distal anterior cerebral artery: case report and review of the literature.

The natural history of atraumatic idiopathic dissection of the distal anterior cerebral artery is still unclear. We present a 38-year-old man who had dissection of the left A(2) segment of this vessel associated with subintimal hematoma and infarction. Because of complete stroke in acute stage, he did not undergo surgery. About three months later, administration of aspirin (100 mg/day) was started. At nine months, magnetic resonance angiography revealed complete recanalization of the A(2) dissection. To assess the outcome of dissection, we should observe the patient for at least one year.

Co-transfection of EYFP-GH and ECFP-rab3B in an experimental pituitary GH3 cell: a role of rab3B in secretion of GH through porosome.

Recently, in order to elucidate the role of rab3B in porosome, we have observed the incorporation of rab3B in the secretion of GH through porosome under confocal laser scanning microscopy (CLSM). Transfected cells with GH-EYFP fusion protein and rab3B-ECFP fusion protein were observed under CLSM, which showed the colocalization of EYFP-GH and ECFP-rab3B in the budding configuration of secretory process. These structural and functional images of rab3B imply the incorporation of rab3B in the secretion of GH through porosome.

Hyperventilation-stage electroencephalography in lateral temporal lobe epilepsy.

BACKGROUND: To observe spike activity in electroencephalograms (EEGs), patients with symptomatic partial epilepsy are rarely monitored during the hyperventilation stages. CASE: A 38-year-old woman suffered from a ruptured arteriovenous malformation in the left temporal lobe. One and a half years later, the patient experienced her first generalized convulsion. EEG showed small spikes in the posterior of the left temporal lobe, which was observed during the hyperventilation and posthyperventilation stages. Because the location of the spikes correlated with the site of the lesion as observed from radiographic findings, she was diagnosed with lateral temporal lobe epilepsy. Drug treatment resulted in no further convulsive episodes and the patient has since returned to work. CONCLUSION: EEG recordings during hyperventilation should be regarded as an effective technique in analyzing epilepsy because of its ease and cost-effectiveness compared with other methods such as single-photon emission computed tomography.

Long-term remission of cyclic Cushing's disease that was diagnosed and treated surgically in non-active phase.

Cyclic Cushing's disease is a rare clinical entity that is defined as a periodic excessive production of adrenocorticotropic hormone (ACTH) and cortisol. Only 42 cases with cyclic Cushing's disease have been reported in the literature. The diagnosis is very difficult because of the fluctuating secretion of ACTH and cortisol. We report a 78-year-old woman with a pituitary adenoma presenting with cyclic Cushing's disease. In the present case, several interesting issues are pointed out: 1) MRI study detected the presence of an adenoma and selective venous sampling in the cavernous sinus disclosed the hypersecretion of ACTH from a pituitary adenoma. These neuroimaging and endocrinological studies were helpful for the diagnosis, even in the remission phase. 2) The disease was in the long-term remission phase after transsphenoidal surgery despite the high recurrence rate in this clinical entity, although it recurred four years later. Even in the remission phase of cyclic Cushing's disease, meticulous endocrinological and neuroimaging examinations can reveal the presence of a pituitary adenoma, which should be treated surgically.

Anatomical constraints on visualization of the human hippocampus using echo-planar imaging.

Reliable visualization of the hippocampus on echo-planar imaging (EPI) is essential in analyzing memory function using functional magnetic resonance imaging. However, the hippocampal area is notoriously prone to susceptibility artifacts caused by structures at the skull base, and avoiding such artifacts by appropriately selecting the subjects for a study is of practical importance. To elucidate factors affecting the extent of the artifacts we obtained EPI in a total of 62 hippocampi from 31 healthy volunteers and evaluated various anatomical measurements possibly associated with the quality of the images. The hippocampal head was sufficiently well demonstrated on 40 of 62 images (65%), and there were two parameters that significantly differed between the good (n=40) and poor (n=22) imaging studies: The vertical diameter (DV) of the opening of the internal acoustic meatus (IAM) and the pneumatization rate of the sphenoid sinus (RP-SS). From logistic regression analysis with the stepwise method, in addition to these two factors, the distance between the hippocampal body and IAM (Dhippo-IAM) and the distance between the hippocampal head and the middle cranial fossa at the skull base (Dhippo-base) were extracted. DV-IAM, RP-SS, and Dhippo-base were negatively correlated with the good imaging of the hippocampal head. On the other hand, Dhippo-IAM was positively correlated. These easily measurable parameters will be helpful in selecting subjects and in increasing the efficiency of hippocampal visualization in studies on human memory function.