[Two cases of urinary retention secondary to aseptic meningitis].

We report two rare cases of urinary retention secondary to aseptic meningitis. Case I was in a 13-year-old boy admitted to the pediatric department due to aseptic meningitis. Eight days after his admission, urinary retention developed and cystometry showed atonic bladder. Case 2 was in a 18-year-old woman consulted the urological department with a chief complaint of urinary retention accompanied with high fever, headache and vomiting. The spinal fluid examination and cystometry revealed aseptic meningitis and atonic bladder, respectively. In both cases, the patients were treated with conservative therapy and bladder dysfunction was resolved after a few weeks. Eleven cases of urinary retention secondary to aseptic meningitis have been reported in the previous literature.

Cerebral oxygen and glucose metabolism in glycogen storage disease with normal acid maltase: case report.

A 26-year-old male with cardiomyopathy, cervical muscle weakness and mental retardation was diagnosed as having glycogen storage disease with normal acid maltase on the basis of his clinical, pathological and biochemical findings. Positron emission tomography showed that cerebral oxygen metabolism was normal, while cerebral glucose metabolism was decreased in the cerebral cortexes. The decrease of the glucose metabolic rate may reflect an abnormality of cerebral glucose metabolism in this disorder and may be related to mental retardation, which is one of the characteristic symptoms.

Assessment of autonomic function in myotonic dystrophy by spectral analysis of heart-rate variability.

We analyzed by means of autoregressive spectral analysis the spontaneous beat-to-beat heart-rate variability (HRV) of 10 myotonic dystrophy (MD) patients (4 men and 6 women, aged 37-53 years) and 10 age- and sex-matched healthy, sedentary humans (control) at rest in the supine position. All MD patients had no cardiac conduction disturbances (i.e., atrioventricular or intraventricular conduction defects) on 12-lead electrocardiogram and were able to walk and perform daily activities. In the MD group, the total power, the power of the low-frequency component (a marker of sympathetic and vagal modulation of heart rate) and that of the high-frequency component (a marker of vagal modulation of heart rate) were smaller than those in the control group (P < 0.01, P < 0.05 and P < 0.05, respectively). The results of this study suggest that the cardiovascular autonomic nervous system contributing to the HRV may be disturbed even in the MD patients who can walk and perform daily activities. Therefore, one must give careful consideration to the cardiovascular autonomic dysfunction, as well as the cardiac conduction disturbance in the MD patients.

[A case of glycogen storage disease with normal acid maltase accompanied with the abnormal platelet function].

Glycogen storage disease with normal acid maltase first reported by Danon et al. was characterized clinically by mental retardation, cardiomyopathy, and proximal myopathy. Since the first report, 17 patients have been reported including 5 patients from Japan. In this paper we described a 26-year-old man who had dilatated cardiomyopathy with a pacemaker implanted at age 22 years. He was admitted to our hospital complaining of easy fatigability in February 1992. Neurological findings showed that he had mental retardation. Serum CK, GOT, GPT and aldolase levels were elevated. Histopathological study of biopsied skeletal muscle showed intracytoplasmic vacuoles with increased acid phosphatase and slightly increased PAS positive material. Electron microscopic study revealed numerous glycogenosomes (autophagic vacuoles containing glycogen). These pathological findings were similar to acid maltase deficiency, but activities of carbohydrate metabolic enzyme including acid maltase activity were normal in the biopsied muscle. From these results, he was diagnosed as having glycogen storage disease with normal acid maltase. We also found abnormal platelet function and glycogen accumulation in the platelets, which have not been previously described. The disease is probably a systemic disorder affecting not only skeletal and cardiac muscles, but platelets.

The occurrence of different types of spinal tumours in one patient. A case report and review of the literature.

Three histologically different types of spinal tumours were found in a 16-year old girl. Each tumour was detected independently at a distant region. They were two intramedullary ependymomas at C3 and T2, two schwannomas at the C6 and C7 root, and one intradural meningioma at T7. All tumours were successfully removed by a two-stage operation without adding neurological deficits. In this paper the findings of metrizamide myelography, metrizamide CT, intravenous enhanced CT and MRI are presented. The application of these various neuroradiological methods made it possible to confirm the precise location and the nature of the tumour in order to operate safely.

[A classification of the herniated cervical disc based on metrizamide CT].

In 202 surgical cases of anterior fusion of cervical spine, there were 150 cases in which disc herniation was the responsible lesion. According to metrizamide CT (met. CT) findings of these 150 cases, we proposed to classify the herniated cervical disc into 7 types. In the 150 cases there were 103 men and 47 women. Seventy-seven had single disc lesion, 57 had the two and 6 had three disc lesions. The most frequent involvement was of C 5/6 in 107 cases (51.2%). The next was of C 6/7 in 50 cases (23.9%) and the third was of C 4/5 in 36 (17.2%). Primarily herniated discs were classified into soft or hard disc. The soft discs were classified into medial, mediolateral and lateral type according to the direction of the protrusion of the disc. Each of the three types indicates that herniated disc compresses the median portion of the cord, lateral part of the cord and root simultaneously and root alone, respectively. The hard discs were classified into central, bilateral and unilateral types. The central type means the case in which the cord was compressed by the centromedian part of the posterior aspect of the vertebral body. The unilateral and bilateral type indicate that lateral portion of the cord and root were simultaneously compressed by the disc unilaterally or bilaterally. The other one was combined type. The combined type is that which belongs neither of the types noted above. In the soft disc group there were 37 cases (17.7%) of medial type, 28 (12.4%) of mediolateral and 8 (3.8%) of lateral type.(ABSTRACT TRUNCATED AT 250 WORDS)

[Surgical treatment of the herniated cervical disc--a consideration on the choice of operative method following our experience with 200 patients].

There is a controversy on the surgical treatment for the so-called cervical herniated disc. Recently operators choosing the anterior approach have increased in more and more. However, considering the historical view of the treatment of disc disease, it is obvious that the posterior approach is also an important method, especially in the cases combined with the stenotic cervical spinal canal. During the past five years 200 patients of cervical herniated disc disease were operated in our clinic by using our newly devised instruments and new materials. We studied the relation between the operative approach, the extent of interbody fusion and the surgical results. The social adaptation of the operated patients was also examined especially by comparing the short follow-up with the long one. Regardless of surgical approach, the percentage of the good recovery is higher (10% at the most) in the short follow-up than that in the long observation. The consequence is thought to show that the social adaptation deteriorates as the time goes on. Based on these results, the historical aspects and the technical problems of anterior and posterior approach were reviewed, focusing especially the controversial points. On the other hand, presenting our opinion on the surgical approach, we showed how the surgical problems have been solved and other complications lowered by introducing our new technique. Consequently, we stress that it is insignificant to discuss whether we should choose the anterior approach or the posterior approach. Finally, in case of criticizing the surgical results, it is reemphasized that we should think over not only the simple operative results, but also the aspect of social adaptation.

[Spinal epidural malignant lymphoma--report of two cases and review of the literature].

Spinal epidural lymphoma is rarely found in Japan, comparing with Europe and America. We experienced two cases, who were suffered from intractable pain and gait disturbance. In both cases, a wide laminectomy and partial removal of the epidural tumor were performed because of the deteriorated paraparesis. After that, they were able to walk without support. These epidural tumors were supposed to be primary spinal epidural lymphomas, judging from the clinical course and some other examinations, that is, Gallium scintigram and CT scan, etc. There were few reports that mentioned CT findings of spinal lymphomas. In our two cases, we got the characteristic CT findings of spinal lymphomas. In case 1, plain CT demonstrated a high density mass at epidural space extending into the intra- and extra-foraminal region. CT scan following intravenous injection showed the tumor enhancement remarkably and homogeneously. Bone erosion was not found even on plain CT, in both cases. These findings were thought to be different from those of metastatic tumors. It may be possible to diagnose and decide the therapeutic planning preoperatively, when we get these characteristic CT findings of spinal lymphomas.

[Neuroradiological evaluation of benign extramedullary tumors in the high cervical region and at the foramen magnum].

Twelve cases of benign extramedullary tumors in the high cervical region and at the foramen magnum were experienced during past five years among eighty all spinal and paraspinal tumors. The diagnosis of masses in this region is very difficult because of the variety of clinical course, symptoms and neurological findings as pointed out by many reporters. Also in our cases, 70% of the patients complained of the deteriorated motor weakness of the upper or lower extremities on admission, though they had noticed the onset of slight neck or occipital pain a few years ago. Neurological examination on admission clearly showed the symptom of myelopathy except in two cases with a tumor at the foramen magnum and C1 level. The percentage of positive findings of plain X-rays was 50%, that of metrizamide myelography was 92% and that of IV. e. CT and met. e. CT was 100%. NMR-CT was performed in 2 cases, and in one of them it was useful in confirming the tumor configuration and extension. Five interesting cases were described mainly from the neuroradiological aspects. Finally the differentiation between meningioma and neurinoma was discussed from the aspects of myelogram, CT and NMR-CT. As already pointed out, it is most important not to forget the existence of tumors in this region when one comes across the confused symptoms, afterwards not to overlook the slight positive neurological and neuroradiological findings.

[Measurement of the normal cervical spinal cord in metrizamide CT myelography].

The shape of the spinal cord is the most important factor in diagnosis of spinal disorders by metrizamide CT myelography (met. CT). Even in cases where the spinal cord looks normal in shape its size might be abnormal, for example in cases with spinal cord atrophy, syringomyelia, intramedullary tumor and several other conditions. In detecting the slightest abnormality in such cases, it is absolutely necessary to have in hand the knowledge of the normal size of the spinal cord at each level. We measured, therefore, the sagittal and transverse diameters of the cervical spinal cord in 55 patients with no known lesions on met. CT. Comparing our results with those by others, we found some differences as to the size of the spinal cord. We assume that these differences are due to the differences in resolution of the CT scanners used. The size of the spinal cord tends to measure larger with a CT scanner with high resolution than with others. Previous authors reported that the size of the spinal cord would vary by window center settings. Our experimental results indicate, however, that window center settings do not significantly affect the measurements. It is concluded that the normal values of the spinal cord dimensions at each level somewhat differ by CT equipments used. One should have normal values with one's own equipment in hand in order to take full advantage of this sophisticated diagnostic technique.

[Spinal intradural arachnoid cyst. Report of five cases and a review of the literature].

Five cases of intradural arachnoid cysts were reported. Two rare cases were in cervical region, other three cases in thoracic region. Clinical and radiological findings were discussed in 67 cases including ours. All our cases with chronic clinical course except one showing spastic para- or tetraparese, sensory disturbance and gait disturbances were not much different to other reported cases in neurological findings. Plain radiography, tomography and intravenous enhanced CT were not effective. In all of the cases spinal CT was performed following metrizamide myelography. Only one cyst failed to detect during metrizamide myelography, but a metrizamide CT revealed the intradural arachnoid cyst even in this case. Vonofakos says that metrizamide myelogram failed to found the arachnoid cysts, however, we could confirm them by performing metrizamide CT about 3 hours after conventional myelography. Moreover reconstruction technique was very effective in ascertaining the shape and the extention of the tumors. Especially it is recommended to do delayed metrizamide CT with ReView technique in order to show the detailed relation between the cyst and the spinal cord. In conclusion, we emphasize the accurate neurological examination, the importance of total myelography and the improvement of fluoroscopic technique in myelography and CT scanning.

[Diagnostic value of CT in spinal cord neurinomas].

The computed tomography (CT) in examination of the spine and spinal cord has rapidly advanced and its diagnostic value has been well documented. It is widely accepted that CT is very useful for the diagnosis of the spinal neurinomas, especially of dumb-bell tumors. In the last two years we have experienced with 11 cases of spinal neurinomas. These include 1 accessory neurinoma, 7 cervical neurinomas of dumb-bell type, 2 thoracic dumb-bell neurinomas, 1 intradural neurinoma in the conus medullaris and multiple neurofibromas in the cauda equina in one patient. The age distributed from 24 to 52 years, with an average of 41.5. In all of these patients except one, metrizamide CT was performed following a total myelography. In most of the cases, CT with and without an intravenous contrast medium injection was also carried out. The conventional radiologic examinations including plain radiography, tomography and angiography were done in most of the patients. Comparing with the results of those examinations, we reached the following conclusions: (1) metrizamide CT can disclose the superior border of the tumor which is often not visualized by conventional ascending myelography. The reconstruction CT clearly outlines the whole extent of the tumor. (2) The bony changes associated with a dumb-bell neurinoma, for example, the widening of the intervertebral foramen, can be found by plain CT in much earlier stage than by the plain roentgenogram. The findings can be more clearly using a "ReView" software program. (3) The extraspinal part of the dumb-bell tumor is shown in CT by an intravenous enhancement as a slightly high-dense, homogeneous mass with CT-number of approximately 70 HU. The capsule of the tumor is a little more enhanced in the most cases. (4) It is recommended to do a metrizamide CT with "ReView" technique when a tumor in the cauda equina is suspected on conventional myelography. (5) A tumor near the foramen magnum or in the upper cervical region is often overlOoked on metrizamide myelography. When a tumor in these regions is highly suspected on neurological examinations, it is also recommended to perform a metrizamide CT about 3 hours after conventional myelography.

[Computed tomographic metrizamide myelography in Chiari malformation in adult--special reference to the diagnostic values of reconstruction CT].

Three adult patients with a clinical diagnosis of Chiari malformation were examined by computed tomography after intrathecal injection of metrizamide via the lumbar route. In all patients Chiari malformation was demonstrated as a soft tissue oval mass at the level of C1-C2 vertebral body that was intradural and posterior to the medulla and the upper cervical spinal cord. These findings were more accurately visualized in saggital and in frontal reconstructed CTs. In one patient the spinal cord was measurably enlarged at the upper thoracic level. A delayed scan was obtained in another case at 24 hours after the injection and the syrinx was remained opacified whereas the density of cerebrospinal fluid and parenchyma decreased. In the third patient no abnormality of the cord was demonstrated either in CT or myelography. High resolution CT, especially reconstruction-CT appears to be more reliable than myelography and should be the examination of choice in the diagnosis of Chiari malformation.

[Total myelography with metrizamide through the lumbar route (author's transl)].

Total myelography with metrizamide at a concentration of 270 mgI/ml was carried out via lumbar puncture in 170 consecutive patients. Good opacification and/or diagnostic value was obtained in the lumbar, thoracic and cervical region at 88.8%, 77.6% and 72.4% respectively. Unsatisfactory results were mostly due to the poor technique of physicians and x-ray technicians. Also it was inadequate to perform this study in some lesions, such as ruptured arterio-venous malformation and occification of posterior longitudinal ligament. Several cases with previous oil myelography showed poor results, because the remaining of Myodil disturbed a good spreading of the newly injected media. It was requested to evacuate oily contrast media prior to metrizamide myelography. One of the most important clues to a successful myleography was to make dilusion of contrast media as little as possible, and the use of high concentration of metrizamide (250-270 mgI/ml) seemed to be tolerated. It was also important to avoid excessive movement of the patient and the rapid transit of the contrast media to the level of interest. It was recommended to study the entire spinal subarachnoid space as a whole. In sixty-three patients out of 170, one or more abnormal myelographical findings were detected at unexpected level. Immediately after the examination the patients were encouraged to drink a large quantity of diuretic beverages such as tee, juice or coffee for the purpose of reducing side effects. As Potts and coworkers and Eldevik and associates reported, it was recognized that the overhydration could reduce the severe side effects after the metrizamide myelography.

Computed tomography of cerebral cavernous hemangiomas.

Four cases of histologically verified cerebral cavernous hemangiomas are presented. In one case, computed tomography (CT) showed well demarcated areas of high density, with slight enhancement and no significant mass effect. However, in the other three cases, the CT findings were similar to those encountered in hematomas, low grade gliomas, or meningiomas. Thus, although CT in cerebral cavernomas is informative in most cases, it does not offer specific diagnostic signs.

Computed tomography with giant intracranial aneurysms.

Five patients with giant intracranial aneurysms were studied by computed tomography. Secondary intracranial changes such as hemorrhage, cerebral infarction and communicating hydrocephalus are easily demonstrated by computed tomography. In addition, computed tomography provides precise information concerning the actual size and location of large but partially thrombosed or calcified aneurysm to better advantage than angiography.