[The efficiency of cilostazol for cerebral vasospasm following subarachnoid hemorrhage].

Delayed ischemic deficit following subarachnoid hemorrhage(SAH)is a major source of morbidity and mortality after rupture of an intracranial aneurysm. Once symptomatic cerebral vasospasm has occured, available treatments do not provide good outcomes for all patients. Symptomatic vasospasm results in serious sequelae for 10-15% of patients and the etiology and pathogenesis remain unclear. Cilostazol is a specific inhibitor of cAMP(cyclic adenosine monophosphate)phosphodiesterase, and is used for treating ischemic symptoms of peripheral vascular disease. Cilostazol has various actions, such as inhibiting vascular smooth muscle proliferation, and increasing nitric oxide(NO)levels derived from endothelial cells. The present study included 81 patients with SAH caused by ruptured cerebral aneurysms treated in two hospitals between June, 2008 and September, 2009. All patients were treated with clipping surgery, and were classified into two groups: 25 patients who received cilostazol from postoperative day 1 to 14 or 28; and 56 control patients. Clinical symptoms due to cerebral vasospasm and frequency of severe spasm were compared between each of the groups. The frequencies of severe spasm appearing on angiography(age>65)and symptomatic cerebral vasospasm were lower in the cilostazol group than in controls. These findings suggest that cilostazol may prevent symptomatic cerebral vasospasm after subarachnoid hemorrhage.

A case of lymphoplasmacyte-rich meningioma of the jugular foramen.

Lymphoplasmacyte-rich meningioma (LPRM), the most rare variant of meningiomas, features extensive lymphoplasmacytic infiltrates. Although the jugular foramen (JF) is occasionally involved by several types of tumor, such as paragangliomas and schwannomas, meningioma in the JF is an infrequent disease. Here we present an extremely rare case of LPRM found in the JF. A 55-year-old woman complained of paresis in her right eyelid and palsy in the right side of her lip. Hoarseness and dysphagia also occurred in the following month. Radiologic examinations disclosed a mass lesion in the right JF, and the tumor was operatively removed. Microscopically, the tumor was composed of extensive lymphoplasmacytic infiltration with mild vascular proliferation and scattered sheets of epithelioid cells with plump cytoplasm. Although the obvious whorl formation or psammoma bodies were not observed, by immunochemistry the epithelioid cells were positive for epithelial membrane antigen and also progesterone receptor, indicating a meningothelial cell origin. Considering the histological and radiologic findings, we finally diagnosed the case as LPRM, making this the second reported case of LPRM in the JF.