The Role of Aquaporin 1 in Water Retention Mechanism of Arachnoid Cysts: Insights from 3 Case Reports.

BACKGROUND Although arachnoid cysts are common lesions, the pathogenesis of their continuous growth remains unclear. We aimed to identify the role of aquaporins in arachnoid cyst specimens. CASE REPORT We selected 3 cases from our own facility and examined arachnoid cyst wall specimens, which were sampled intraoperatively. Patients presented with variable symptoms, a 52-year-old man with a "heavy sensation" in the head and dysesthesia on the left hand, a 68-year-old man with unsteady gait, and finally a 26-year-old woman with a history of intermittent headaches for 10 years. Intraoperative specimens were obtained and examined. Evaluation techniques were light microscopy, immunohistochemical staining for aquaporin, and electron microscopy. Light microscopy showed that cells were arranged in epithelium-like structures forming several thick lamellae, with visible connective tissue among them. Under electron microscopic examination, cells with many or few cell organelles and with spindle-like nuclei were arranged in lamellar or flattened structures. Many vacuolizations were seen in between. Interdigitation of cells and many desmosomes were observed. All 3 cases were positive for aquaporin 1. CONCLUSIONS Our study showed that water transportation through aquaporin 1 has a potential role in the formation and expansion of arachnoid cysts.

Proposal for a Simple Equation for Limb Muscle Weight Calculation.

BACKGROUND Although body mass index (BMI) is currently being utilized frequently as an indicator of obesity, it provides little information concerning body composition; key components such as fat and muscle cannot be differentiated. It is especially non-sensitive in identifying muscle mass, which can be challenging to examine without the use of radiologic methods. We sought to identify whether biometric values such as upper arm subcutaneous fat thickness/circumference could provide an adequate indicator of muscle mass. MATERIAL AND METHODS Patients admitted to our clinic for various causes were retrospectively studied in 95 consecutive cases. Physical parameters including upper arm subcutaneous fat thickness, upper arm circumference, weight, and height were measured. Then, values such as limb muscle weight (LMWDXA) and total fat weight (FWDXA) were obtained from dual-energy X-ray absorptiometry. Pearson's correlation coefficients were calculated and linear regression analysis was conducted. RESULTS Neither upper arm subcutaneous fat thickness nor upper arm circumference was correlated with LMWDXA. FWDXA also showed a correlation with BMI (r=0.823, P<0.001). LMWDXA also significantly correlated with measured body weight (BWm)-BMI (r=0.719, P<0.001). CONCLUSIONS From our analytic data we propose an equation for calculating muscle mass, designated the Simple Muscle Weight (SMW): SMW=289.2×(BWm-BMI)+3631. SMW calculation has potential for use as an easy and simple first-line diagnostic tool to identify diminished muscle mass.

Antinuclear antibody, is it a risk factor for cerebral ischemia? Magnetic resonance image analysis, a preliminary study.

Magnetic resonance images (MRI) of 103 patients were examined to reveal whether positive antinuclear antibody is a risk factor for cerebral ischemia. The most common MRI formation was the presence of small high-intensity spots. The prevalence of hypertension and diabetes mellitus was significantly low. Although seven cases had no medical risk factors; they showed an abnormal MRI reading. Eleven cases exhibited signs of cerebral stroke. Positive antinuclear antibody cases are suggested to be part of the antiphospholipid antibody syndrome. Various types of cerebral arterial occlusion may occur, showing lacuna, atheroma generation, and a recurrent major vessel occlusion.

Bilateral chronic subdural hematoma cases showing rapid and progressive aggravation.

BACKGROUND: We have analyzed the records of our own hospitalized cases of bilateral chronic subdural hematoma (cSDH) to reveal the prognosis. METHODS: Ninety-eight cases of cSDH were operated at our hospital over a 6-year period, in which 14 cases were classified as being bilateral. Among these 14 cases, 6 cases showed a rapid and aggressive clinical course. Therefore, complicated risk factors, the initial data on coagulofibrinolytic examination, magnetic resonance imaging appearance, and prognosis were analyzed. RESULTS: Of the 6 cases, 5 showed a rapid aggravation as they awaited surgery. The period of the aggravation since the initial diagnosis harboring cSDH was 19 to 54 hours. One case was at first neurologically free from any disturbance but 17 hours later experienced a generalized seizure. All 6 cases experienced consciousness disturbance. In addition, 3 of them manifested oculomotor palsy. Two cases showed an abnormality of coagulofibrinolytic activity. No significant risk factors were revealed. In 4 cases, T(2)-weighted images (T2WIs) revealed the hematoma of a mixed high and low intensity, indicating that the hematoma consisted of both liquid and solid parts of a freshly formed blood clot. In 2 cases, the hematoma showed a low intensity in T(1)-weighted image (T1WI), indicating a recent bleeding of a significant amount. CONCLUSION: The bilateral cases of cSDH should be treated as early as possible with simultaneous decompression of bilateral hematoma pressure, even if the patient shows minimal neurologic deficits. Mixed high and low intensity in T2WI or low intensity in T1WI is the most predictable factor to show rapid aggravation.

Incomplete oculomotor nerve palsy caused by an unruptured internal carotid-anterior choroidal artery aneurysm--case report--.

A 59-year-old woman visited our institute with the chief complaint of dizziness which persisted whenever she tried to focus on objects. She had not experienced apparent double vision and had no history of intracranial bleeding. Neurological examination revealed no abnormality except for exotropia at the mid-position and at upper gaze. Cerebral angiography revealed that the intracranial portion of the left internal carotid artery ran more horizontally and also identified an unruptured left internal carotid-anterior choroidal artery (IC-AChA) aneurysm of 3.0 mm diameter. The aneurysm at the origin of the AChA was confirmed during surgery. The proximal lateral wall of the aneurysm was in contact with the oculomotor nerve. This contact was released after complete obliteration of the aneurysm. The exotropia resolved 3 months later. Oculomotor nerve palsy usually indicates the presence of internal carotid-posterior communicating artery (IC-PcomA) aneurysm. Since sacrifice of the AChA will result in severe neurological deficits, accurate neuroimaging information is needed prior to the operation. Conventional angiography and/or three-dimensional computed tomography angiography should be performed to ascertain whether the aneurysm is an IC-PcomA or IC-AChA aneurysm, even if some neurosurgeons insist that conventional angiography is not always needed before surgery for an unruptured aneurysm.

Microvascular decompression for hemifacial spasm caused by the vertebral artery: a simple and effective transposition method using surgical glue.

BACKGROUND: Microvascular decompression for the treatment of trigeminal neuralgia and hemifacial spasm (HFS) has been established and has brought about excellent results. However, recurrence or lack of relief from the symptoms was experienced in some cases in which the nerve root or root exit zone were compressed by the vertebral (VA) and basilar arteries. We experienced a severe HFS case, mainly caused by a compression with the tortuous VA. A more simple transposition technique of the offending VA using surgical glue is reported. METHODS: A 64-year-old male had been suffering from HFS for six years. The tortuous right VA with anterior inferior cerebellar arteries (AICA) was considered to be responsible for his vascular compression syndrome. The VA was carefully and slowly dislocated away from the pontomedullary junction toward the cranial base. Then the arteriosclerotic portion of the VA wall was chosen, where a small piece of Surgicel (ETHICON, Inc., Somerville, NJ) is placed beforehand so as to use a minimum amount of glue (Biobond; Mitsubishi Pharma Corp., Osaka, Japan). Until the glue is hardened, the VA is held away from the brain stem. After this procedure, the ordinary transposition of AICA branches was added. RESULTS: The annoying HFS completely disappeared immediately after the operation. CONCLUSION: The advantage of our method is the simplicity of the procedure. It requires less space and time while the other methods using tapes, strips, and clips need a greater working space and more time.

[Two cases of transient global amnesia (TGA) immediately after coronary angiography: pathogenesis of the primary TGA].

Two cases of transient global amnesia (TGA) following coronary angiography are reported. Nonionic contrast media was used and injected at room temperature. Both cases showed sudden amnesia about 15 minutes after the left ventriculography. A clinical feature was typical to TGA, showing repeated questions with retrograde and antegrade memory disturbance without any other neurological abnormality. Diffusion-weighted images (DWI) of magnetic resonance imaging revealed no fresh lesion in both cases. The patients recovered from TGA attack within 24 hours. Some cases have been reported which display a manifested TGA following cerebral or coronary angiography. In these situations, embolism, the effect by the contrast media was suspected as the cause of TGA. Since most TGA cases in a classical meaning (primary TGA) showed no abnormality in both DWI and T2-weighted image (T2WI), the cerebral ischemia was not really considered to be the cause of the condition. Therefore, the pathogenesis of the TGA is suggested to be much more functional rather than anatomically abnormal. The pathogenesis of the primary TGA was thought to be some kind of hypersensitivity to the external stress or the stress reaction of the hippocampal cell. This stress may lead to cellular depolarization and the following repolarization (spreading depression), which showed transient abnormality in DWI and not a permanent abnormality in T2WI.

[A case of solitary and unilateral trochlear nerve palsy due to a blunt head impact].

A case of solitary and unilateral trochlear nerve palsy following a minor, blunt head impact is reported. A 72-year-old man fell down backwards from the top of a staircase having 13 steps and hit his right parietal head and shoulder. Routine neurological examination revealed no remarkable findings, however, the subject complained of double vision when he focused downwards. The computed tomography four hours after the initial impact showed a localized small high-density lesion on the left quadrigminal cistern. The magnetic resonance imaging also indicated subarachnoid bleeding expressed by the low-intensity area in T2 weighted images in the same place. There was no evidence of any contusion within the midbrain. Hess chart test clearly showed solitary left superior oblique muscle palsy. The manner of the injury was thought to be quite typical, since he had hit his right parietal area up-side-down when falling, that is, the accelerated force acted as an impact against the firm floor. This impact caused the midbrain concussion against the cerebellar tentorial notch resulting in a localized subarachnoid hemorrhage which caused the unilateral trochlear nerve palsy.

Familial hypercholesterolemia: a family who suffered cerebral infarction over three successive generations.

A certain family with a history of familial hypercholesterolemia (FH) in which several members suffered cerebral infarction (CI) for 3 successive generations is reported. The first case is a 54-year-old female who suffered from medial longitudinal fasciculus syndrome caused by a lesion on the pons. The second case is the son of the first case and is a 28-year-old male who suffered from left hemiparesis by a lesion on the corona radiata. The third case is the mother of the first case and is a 77-year-old female who suffered from dizziness as a result of cerebellar lacunae. All 3 patients showed a marked elevation of their serum cholesterol level without any apparent history of coronary heart disease (CHD). Our cases are peculiar and unique because the patients are of 3 successive generations who suffer from CI without any apparent history of CHD. Moreover, the latter generations are having CI at younger ages. The mechanism of CI was thought to be the occlusion of the arteriole by the increased viscosity associated with other risk factors rather than the apparent arteriosclerosis in our cases. Although FH is often associated with a high incidence of CHD, the information about the occurrence of CI has not always been available. The patients may suffer from CI more frequently than was previously thought. We hope to point out the need for such FH patients to be carefully monitored and to be treated as a high-risk group for CI as well as CHD.