Two Cases of Mycotic Aneurysm with Intracerebral Hematoma

Mycotic aneurysms are produced by an infected embolus from vegetations on the heart valves in bacterial endocarditis, which breaks off and lodges in the cerebral blood vessels. The wall of the embolized vessel becomes infected, invasion by inflammatory cells and necrosis of the wall are often followed by rupture and formation of a aneurysmal sac. These aneurysms are very are in incidence and are usually located more peripherally in the vascular tree than berry aneurysms, are more irregular in shape and are not necessarily located at bifurcations. Recently we experienced a case of mycotic aneurysm with intracerebral hematoma which had developed in a subacute bacteria endocarditis patient. The patient was 44 years old male patient with dilated right pupil and left hemiplegia. He was treated surgically by evacuation of intracerebral hematoma and excision of mycotic aneurysm. We also experienced another case of mycotic aneurysm with intracerebral hematoma in 17 years old male patient who had been suffered from fever of unknown origin. He was also treated surgically. We now reports 2 cases of mycotic aneurysm with intracerebral hematoma with a brief review of the literatures.

A Study for the Determination of the Lumbar Intervertebral Discs

Although transitional vertebrae are relatively frequent in limbosacral area, it is generally accepted that one cannot state whether the transition is due to lumbarization of S1 or sacralization of L5 from simple lumbar X-ray film alone. However, for the practical purpose, the author attempted to obtain a possible method to determine the level of the lumbosacral spine in simple X-ray films through the analysis of the 100 operated patients and 25 lumbago and/or sciatica patients. Furthermore to determine the level of the intervertebral disc space in post-operative films, a silver clip was attached near the operated region and reviewed the post-operative findings in simple lumbar X-ray films. The results were as follows : 1) To determine the level of the interverbral disc space in simple lumber X-ray films, origin of the psoas muscle shadow can be utilized as a landmark with about 80% accuracy. But if one leave the silver clip at the operated region, he can state the level in 100% accuracy with the information of pre-operative symptoms. 2) Sacralization was 10% in operated cases, 6% in non-operated cases and lumbarization was 6% in operated cases, 3.2% in non-operated cases. Spina bifida was 12% in operated cases, 11.2% in non-operated cases. Lumbar rib was 2% in all of operated and non-operated cases.

Radiological Study of the Transverse Processes of the Lumbar Spine

The purpose of this study is to analyze the statistics of length and obliquity of the transverse processes, transitional vertebra, spina bifida and lumbar rib in the lumbar spine A-P films of 500 cases by random sample. The length of the transverse process was compared with the shortest distance of from the outmost point of it to the vertical line which was given at the spinous process of the corresponding vertebral body. The obliquity of the transverse process was represented by angle shaped by the central vertical line of the vertebral body and the central line of its transverse process. Transitional vertebra were identified by counting down from the C1 or T1 vertebral body. No difficulty was encountered in distinguishing spina bifida and lumbar rib. The results were as follows: 1. In the typical lumbar spine, the length of the L3 transverse process was the longest of all the transverse processes except for that of L5 and the direction of the transverse process was horizontal in the L1, L2 and L3 but a little oblique upward in the L4 and L5. 2. Lumbarization was slightly higher than sacralization in incidence. 3. The incidence of spina bifida was 11.8% and mainly observed in male. 4. The incidence of lumbar rib was 1.8% and all were attached to the L1.

A Case of Spontaneous Intracerebral Hematoma in Childhood

Spontaneous intracerebral hemorrhage is generally very uncommon in young adult life. Moreover in infancy or childhood. The etiology of spontaneous intracerebral hemorrhage has been discussed in some detail, but the exact underlying causes, in many cases, remain in doubt. The clinical and radiological characteristics are same as ones of intracerebral hemorrhage in adulthood and the traditional methods in diagnostic approach of treatment are still available. We recently experienced a case of spontaneous intracerebral hematoma mainly located in the lateral portion of the basal ganglia in a 12 years old boy. He was admitted to our hospital through the emergency room with suddenly developed left side hemiplegia. There was no evidence of head trauma. Right side carotid angiogram revealed the hematoma. Upon surgery a large hematoma was noted in the lateral portion of the basal ganglia and its complete removal was quite possible. Recovery of the motor disturbance was discernibly rapid and he was discharged on foot on the postoperative 45th day.

A Case of Neurocutaneous Melanosis

In 1861, Rokitansky first reported a unusual syndrome compatible with neurocutaneous melanosis, but it was coined by Van Bogaert in 1948. Neurocutaneous melanosis is a very much rare and less well-known member of phakomatoses. A review of the published material showed that only 40 cases of this syndrome had been reported until 1968 by Fox. It has been defined as a congenital disease which is manifested by parallel development of benign melanotic pigmentation of central nervous system and pigmented nevi of the skin. We have recently experienced a case of neurocutaneous melanosis. A 23 years old female was admitted to our hospital with complaints of generalized cafe au lait spots and giant nevi on the back and the left thigh accompanying severe headache, vomiting and right hearing disturbance. Diagnostic studies did not suggest any intracranial space-taking lesion except for evident hydrocephalus. Under the impression of Von Recklinghausen disease with right acoustic neurinoma the posterior fossa exploration was performed but no space talking lesion was noted. Numberous dark black-brownish pimentation was spread over the leptomeninges of the cisterna magna, brain stem, and right cerebellum. The increased intracranial pressure signs were completely relieved by ventriculo-atrial shunt. On biopsy it was identified as leptomeningeal melanin pigmentation. Detail consideration of neueurocutaneous melanosis was introduced with review of ever reported cases.

A Case of Pituitary Abscess

Intrasellar or pituitary abscess was first reported about a century ago, after then once relatively common but now is rare. Since 1925, about 50 cases have been reported in the literatures, of which characters were variable, but clinical very similar to one of pituitary tumor. So they were often diagnosed preoperatively as pituitary tumor. Several pathogenic factors were postulated in relation to clinical aspects. We had recently experienced a case of pituitary abscess combined with chromophobe adenoma. A 28 years old clerkman was admitted to our hospital with complaints of impared ejaculation and visual disturbance. Clinical aspects and diagnostic studies gave us a strong impression of pituitary tumor. Upon surgery we found a cystic mass in pituitary region, of which aspiration showed whitish-gray, tenacious and liquid material. Many polymorphous leukocytes were noted by direct smear, but no microorganisms were detected in culture. He had postoperatively suffered from transient polyuria and polydipsia, which soon disappeared under the medication of Esidrex. He was discharged from this hospital with recommendation of radiation therapy. Clinical features and treatment were also discussed with review of ever reported cases.