We report a case of spontaneous vertebral arteriovenous fistula manifesting pulsating tinnitus with left cervical bruit. A 50-year-old woman presented with pulsatile tinnitus of unknown duration. ...Angiography revealed a simple and direct fistula between the second segment of the left vertebral artery and the epidural venous system. The fistula was well visualized by intra vascular ultra sound (IVUS). Balloon catheters were used for regulating blood flow during coil embolization, which successfully obliterated the fistula, with subsequent control of the symptoms. Postoperative course (18 months) was uneventful.
We report a case of metastatic seeding glioblastoma in a 67-year-old female patient, which has progressed from gemistocytic astrocytoma along the trajectory of a Stereotactic brain biopsy. Generally, ...Stereotactic biopsy is thought to be safe, easy and accurate for the histological comfirmation of brain tumors and it carries a low risk of complication. Common complications include intracranial hemorrhage, brain swelling, and infection. But a rare complication of tumor seeding following biopsy can occur. However, tumor seeding as a result of biopsy has beenreported or discussed in only a few publications. The seeding of tumor cells along the trajectory of the biopsy mayoccur to some extent during every biopsy. This has been reported to occur in animal models. However, seededtumor cells usually do not grow into a clinically significant bulk of tumor. The growth of seeded tumor cells proba-bly depends on the cytokinetic characteristics of the cells, the number of tumor cells, cell adhesiveness, cell growthpotential, the fertility of the host, and the degree of malignancy. The more malignant the tumor type, the higher therisk of tumor seeding. These factors should keep in mind to help avoid these complications and device strategies to minimize tumorseeding.
To determine the indication for surgical management in poor-grade aneurysm patients, we analyzed 1095 patients with World Federation of Neurological Societies (WFNS) Grade IV/V aneurysm admitted ...within 48 hours after subarachnoid hemorrhage (SAH) between Jan. 1989 and Dec. 2000, retrospectively. Nineteen patients who were operated on between Day 4 and Day 9 and 16 patients who underwent coil embolization were excluded from this study. There were 397 patients aged <60 years, 327 patients aged 60-69 years, and 336 patients aged ≥70 years. Surgical treatment was done between Day 0 and Day 3 in 678 patients (early surgery (ES)), Day 10 or beyond in 164 patients (late surgery (LS)); 218 patients did not undergo surgical management. The latter 2 groups of patients were designated non-early surgery (non-ES). The outcome was evaluated with GOS at 3 months after SAH. Rebleeding developed in 56 patients within 24 hours of admission and in 47 patients 24 hours after admission. It was difficult to assign patients with rebleeding within 24 hours to ES or non-ES. These patients were, therefore, excluded from ES and non-ES and designated early management group (EMG) and non-early management group (non-EMG), respectively. In the analysis of Grade IV, 47.9% of ES and 50% of LS in the <60 years age group showed Good Recovery (GR). In contrast, the proportions of GR were 49.5% in EMG and 35.2% in non-EMG (P=0.0345). Among the 60-69 years age group, the rates of GR were 26.9% and 35.3% in ES and LS, respectively; and 28.0% and 24.0% in EMG and non-EMG, respectively. Among the ≥70 years age group, the incidence of GR was 10.1% and 14.6% in ES and LS, respectively; and 10.6% and 8.4% in EMG and on-EMG, respectively. Regarding the Grade V, among the <60 years age group, only 10.6% of ES resulted in GR. Although the incidence of GR was not statistically different between ES and LS, 25.0% of LS showed GR. The incidence of GR was 9.8% and 10.9% in EMG and non-EMG, respectively. Among the 60-69 years age group, the proportions of GR were 12.2% and 17.6% in ES and LS, respectively; 11.8% and 6.0% in EMG and non-EMG, respectively. Among the ≥70 years age group, only 1.3% of ES and 1.3% of EMG showed GR. No patients showed GR in LS or non-EMG. The outcome of LS was possibly better than that of ES because some patients who did not recover well in the late stage had less chance to undergo surgery. In contrast, EMG might show better results than non-EMG because patients in non-EMG often presented in poor general condition, contraindicating surgery. Considering these 2 possibilities, we conclude that early surgery benefits patients aged <60 years with Grade IV. Late surgery following good response from conservative therapy is suggested in patients with Grade IV and aged <70years and the≥70years age group of Grade IV.
Anoxic depolarization (AD) is one of the major physiological characteristics in the ischemic core. The effect of mild hypothermia on the appearance of AD and subsequent brain injury following ...profound ischemia is studied to evaluate the protective mechanism of hypothermia against severe ischemia. Sprague-Dawley rats were subjected to transient ischemia by hypotension (50-20 mmHg) and bilateral carotid artery occlusion (BCA-O) for 20 min in normothermia and 30 min in hypothermia. The temperature of body and temporal muscles was maintained at 37.5°C and 36.5°C in normothermia and 33.0°C and 31.0°C in hypothermia, respectively. Recording of the DC potential shift and electrocorticogram and monitoring of the cortical blood flow (CoBF) with a laser Doppler flowmeter were done epidurally on the right parietal cortex. The right parietal cortex pathology was examined 24 h after ischemia in normothermia and after 30 days in hypothermia. AD appeared in all seven normothermic rats with a fall in the CoBF to 9%-10% of the control flow. However, in spite of CoBF reduction to 8%-9% of the control flow, it did not appear in five hypothermic rats. Intra-ischemic CoBF was not statistically different between these two groups. AD appeared with the CoBF decreasing to 4%-5% of the control flow in seven hypothermic rats. Intra-ischemic CoBF in hypothermic rats exhibiting AD was significantly lower than the other two groups. The interval between BCA-O and the appearance of AD in hypothermic rats was 5.1 ± 0.3 min (mean ± SE), which was significantly longer than the 2.2 ± 0.5 min observed in normothermia (p < 0.0005). Of seven normothermic rats exhibiting AD, two died within 24 h and four revealed massive neuronal injury. Of seven hypothermic rats with AD, four died between day 2 and day 13, and one revealed diffuse cerebral infarction. However, no severe ischemic injury or ischemic death was observed in all five hypothermic rats without AD. The incidence of severe neuronal injury or ischemic death was significantly lower in hypothermic rats without AD compared with normothermic rats with AD (p < 0.02) or hypothermic rats with AD (p < 0.05). Although mild hypothermia delays AD, it is suggested that raising the cerebral blood flow threshold for AD appearance has a key role in the hypothermic protection of a severely ischemic area such as the ischemic core. Neurol Res 1999; 21: 670-676
Thrombolytic therapy for acute ischemic stroke is an effective intervention in the reduction of the development of brain edema, tissue injury, and post-stroke morbidity and mortality. In this study, ...the effect of the treatment with tissue-type plasminogen activator (tPA) on the non-specific transport mechanisms of the blood-brain barrier (BBB) was investigated in vitro under control conditions and after hypoxia (1-6 h) and reoxygenation (0.5-18 h). Monolayers of an immortalized rat brain endothelial cell line (GP8) were subjected to hypoxia to induce a decrease in the cellular level of high energy phosphate esthers and an increase in that of lactate. The rate of fluid-phase endocytosis was determined by Lucifer yellow uptake fluorometrically. Hypoxia and reoxygenation resulted in time-dependent increases in Lucifer yellow uptake by brain endothelial cells. Co-incubation with tPA, in concentrations of 1-10 μg/ml, significantly decreased the non-specific transport both under normoxic and hypoxic conditions. This effect of tPA could not be prevented by serine protease antagonist pretreatment. Thrombolytic agent tPA may contribute to the maintenance of the integrity of the BBB after ischemic insults.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The preventive effect of the serine protease inhibitor FUT-175 (nafamostat mesilate), a potent inhibitor of the complement system, against vasospasm was evaluated in 34 high risk patients with thick ...and diffuse subarachnoid hemorrhage (SAH) demonstrated by computed tomography corresponding to Fisher group 3. All patients underwent surgery within 96 hours following SAH and received the thromboxane A_2 synthetase inhibitor, OKY-046, as part of standard care.
Symptomatic basilar artery stenosis invariably has poor prognosis owing to limited treatment options. Modernized stent system delivery technology has paved the way for treating tortuous vascular ...segments of intracranial system. The authors hereby report on the use of intracranial stent to treat basilar artery stenosis. A-61-year old man presented with one month history of recurrent dizziness and dysarthria. He remained symptomatic despite having oral antiplatelets. Magnetic resonance image showed pontine ischemic lesion. Stenosis of proximal portion of basilar artery was detected by magnetic resonance angiography (MRA). Although balloon angioplasty was performed, restenosis was demonstrated by MRA four months later. Stenting was then performed with excellent angiographic results, and there were no procedural complications. The availability of new flexible intravascular stents, allowing access to tortuous proximal intracranial vessels, provides a new therapeutic approach to basilar artery stenosis cases. However long term follow-up is advised to assess the durability of this approach.
The effects of oxygen inhalation (FiO
2
= 0.4-0.5) and/or induced hypertension (⊿MBP = around 20%) on the cortical oxygen tension (CoPO
2
) and the cortical oxidative metabolism (NADH/NAD redox ...state) in acute focal ischaemia were studied in 44 rabbits. CoPO
2
was recorded by a polarographical method and NADH/NAD redox state was measured with a compensated fluorometerlreflectometer. The acute focal ischaemia was induced by the occlusion of the middle cerebral artery. With oxygen inhalation, CoPO
2
improved 24.8 ± 23.2% (mean ± SD) in ischaemic areas where CoPO
2
decreased to less than 40% of control. The oxygen inhalation also partially improved NADH levels in ischaemia by 1.5 ± 7.6% in 8 rabbits, where NADH elevated 17.6 ± 12.1% from the normal stage. CoPO
2
and NADH redox level in ischaemia were also improved by induced hypertension. ⊿CoPO
2
/⊿MBP were 1.29 ± 1.53%/mmHg in the severely ischaemic area (< 20% of control), 1.52 ± 0.93 in the moderately ischaemic area (20-40% of control)f and 1.03 ± 0.62 in the mildly ischaemic area (>40% of control), respectively. ⊿NADH/⊿MBP were statistically greater in the ischaemic area than in the normal cortex (p < 0.005). It is concluded that mild hyperoxia and induced hypertension both of which are easily employed not only can improve cortical oxygen tension but also partially restore the oxidative metabolism in acute focal ischaemia.
The changes of oxidative metabolism in mitochondria with hypoxia, anoxia and ischaemia were studied by a compensated fluorometer/reflectometer in rabbits. The NADH redox state exponentially increased ...with the decrease of cortical oxygen tension (CoPO
2
) which was recorded simultaneously under systemic hypoxia or anoxia. This correlation was statistically significant (p < 0.001). It is suggested that oxidative metabolism in mitochondria can be improved by rather small increases of CoPO
2
in a severely ischaemic area. Focal cerebral ischaemia was induced by occlusion of the middle cerebral artery (MCA-O) through a transorbital approach. The NADH promptly increased with MCA-O and reached a maximal level (29.9% from the control level on average) at 20-110 s of MCA-O. Then, it partially improved to 21.2% from the control level after 5 min of MCA-O, which was statistically less than the maximal reduction level. After 5 min of MCA-O, it was shown to be stable for up to 30 min of MCA-O. It appears that the partial recovery of the NADH redox state in the acute phase of arterial occlusion occurs because of the improvement of the collateral circulation demonstrated previously. This suggests one pathophysiological mechanism for transient ischaemic attacks.
The preventive effect of the serine protease inhibitor FUT-175 (nafamostat mesilate), a potent inhibitor of the complement system, against vasospasm was evaluated in 34 high risk patients with thick ...and diffuse subarachnoid hemorrhage (SAH) demonstrated by computed tomography corresponding to Fisher group 3. All patients underwent surgery within 96 hours following SAH and received the thromboxane A2 synthetase inhibitor, OKY-046, as part of standard care. FUT-175 (40-160 mg/day) was administered during the initial 4 days following surgery. 455 patients treated without FUT-175 in the Nagasaki SAH Data Bank (non-FUT group) formed the control group. FUT-175 significantly decreased the incidence of symptomatic vasospasm in patients with severe neurological grade (Hunt and Hess grade 3, p < 0.02; Hunt and Hess grade 4, p < 0.02). The incidence of favorable outcome was 76.5% in the FUT group and 60.4% in the non-FUT group, but not statistically different. However, when patients of Hunt and Hess grade 5 were excluded, the FUT group had a significantly improved outcome (p < 0.05). This study suggests that FUT-175 has an additive effect to OKY-046 in preventing vasospasm in high risk patients with severe SAH.
PDF
