Purification and Characterization of Guanine Aminohydrolase from Rat Cerebrum

Guanine aminohydrolase(GAH;EC 3. 5. 4. 3.) was partially purified 122-fold from rat cerebrum to a specific activity of 7.22 in its per mg protein with a recovery of 7.47% by fractionation with ammonium sulfate, chromatography on DEAE-cellulose and hydroxyapatite, gel filtration on Sephadex G-200, and isoelectric focusing(pH4-6). The molecular weight of partially purified rat cerebral guanine aminohydrolase was estimated to be 110,000. But, in the cerebral cytosol, a rather higher molecular weight form of the enzyme was identified. The activity of the higher molecular weight form of guanine aminohydrolase was increased by dialyzing the cytosol, and it was converted into the lower molecular weight form(M.W.110,000) by addition of 2-mercaptoethanol. The reaction velocity of partially purified guanine aminohydrolase of rat cerebrum disclosed a hyperbolic curve, with its KM being 6.0uM at pH 8.0. The preparation showed high substrate specificity:among the purine nucleotides, nucleosides and bases with amino group, only guanosine and guanine were deaminated by the enzyme, and the reaction rate of the enzyme displayed by guanosine was less than 10% of that by guanine. When observed under the equimolar concentration of the substrate, hypoxanthine as well as inosine inhibited the activity of the rat cerebral guanine aminohydrolase by 9.4 and 7.8%, respectively, while 5-aminoimidazole-4-carboxamide inhibited the activity of it by 38%. The activity was inhibited by p-hydroxymercuric benzoate as well. Complete loss of its activity was observed after 30 minutes incubation at 60 degrees C, suggesting the preparation was heat labile.

Collateral Circulation on the Neck after Common Carotid Ligation(Bosniak's Plexus)

The importance of the suboccipital plexus(Bosniak's Plexus) described by Bosniak in 1963, is emphasized. This rich anastomatic network is formed by the deep and ascending cervical arteries and nuchal brances of the vertebral artery. We experienced this Bosniak's plexus after common carotid artery aneurysm.

Two Cases of Traumatic Aerocele Combined by Persistent CSF Rhinorrhea

We have experienced two cases of intracerebral aerocele combined by persistent traumatic cerebrospinal fluid rhinorrhea. All of two cases were diagnosed incidentally during observation in simple skull X-ray films. We performed craniotomy for the repair of the dural fistula and treated successfully. Authors discussed the possible mechanisms of the intracerebral aerocele briefly.

Membraneous Occlusion of Cerebral Aqueduct

Aqueductal obstruction has been an interesting entity among hydrocephalic patients because of its possible permanent cure by interventriculostomy alone, eliminating the need of external shunt problem. Recently we have experienced four such cases as following. Case 1: A 21 years old female was admitted due to headache and deteriorating visual acuity. Positive neurologic findings were bilateral papilledema and rapidly deteriorating visual acuity. Conray ventriculogram revealed bilateral symmetrical hydrocephalus with obstruction at the distal portion of the aqueduct. Suboccipital craniectomy was performed. Cisterna magna and fourth ventricle were dried. With 3.5cm upwards advancement of Nelaton tube from the orbex, resistence was felt. And with further advancement, giving sensation of membrane was felt. We confirmed good passage of C.S.F. and closed without the tube remained. The patient was discharged two weeks later with much improvement clinically. Case 2: A 20 years old male was admitted due to sudden onset of coma. Positive neurologic findings were bilaterally dilated pupil, increased DTRs, and positive toe signs. Conray ventriculogram revealed marked hydrocephalic pattern with cupping like obstruction at the distal portion of the cerebral aqueduct. Operative findings were the same as in case 1, but rubber catheter was remained in the cerebral aqueduct. Post-operative course revealed high fever due to pneumonia, but much clinical improvement was achieved until discharge. Case 3: A 6 years old girl was admitted due to unsteady gait and headache. Neurologic findings were bilateral papilledema, hyperactive DTRs, positive toe sings and generally disturbed cerebellar function. Radiologic and surgical findings were the same as in case 1, but a tube was remained in situ. Post-operative state revealed satisfactory. Case 4: A 14 years old boy was admitted due to headache and unsteady gait. Positive neurologic findings were hyperactive DTRs, positive toe signs and disturbed it, cerebellar function. Conray ventriculogram revealed marked hydrocephalus and obstruction at the mid-portion of aqueduct. Proximal aqueduct was markedly dilated. Suboccipital craniectomy was performed, when 3.7cm advancement of the tube, resistance was felt, but giving sensation of membrance rupture was not felt. So the tube was remained in situ. Post-operative state revealed drowsy consiousness, right lateral gaze palsy and transient C.S.F. leakage. Surgical mortality was zero, and the complications of case 4 were supposed due to inadequate placement of the tube. From these, we feel that simple membraneous puncture without catheter tube placement may be better if surgeon feels the giving sensation of membrance puncture when the tube advancement to make C.S.F. passage. Otherwise, the catheter may be well left in situ.

Membraneous Occlusion of Cerebral Aqueduct

Aqueductal obstruction has been an interesting entity among hydrocephalic patients because of its possible permanent cure by interventriculostomy alone, eliminating the need of external shunt problem. Recently we have experienced four such cases as following. Case 1: A 21 years old female was admitted due to headache and deteriorating visual acuity. Positive neurologic findings were bilateral papilledema and rapidly deteriorating visual acuity. Conray ventriculogram revealed bilateral symmetrical hydrocephalus with obstruction at the distal portion of the aqueduct. Suboccipital craniectomy was performed. Cisterna magna and fourth ventricle were dried. With 3.5cm upwards advancement of Nelaton tube from the orbex, resistence was felt. And with further advancement, giving sensation of membrane was felt. We confirmed good passage of C.S.F. and closed without the tube remained. The patient was discharged two weeks later with much improvement clinically. Case 2: A 20 years old male was admitted due to sudden onset of coma. Positive neurologic findings were bilaterally dilated pupil, increased DTRs, and positive toe signs. Conray ventriculogram revealed marked hydrocephalic pattern with cupping like obstruction at the distal portion of the cerebral aqueduct. Operative findings were the same as in case 1, but rubber catheter was remained in the cerebral aqueduct. Post-operative course revealed high fever due to pneumonia, but much clinical improvement was achieved until discharge. Case 3: A 6 years old girl was admitted due to unsteady gait and headache. Neurologic findings were bilateral papilledema, hyperactive DTRs, positive toe sings and generally disturbed cerebellar function. Radiologic and surgical findings were the same as in case 1, but a tube was remained in situ. Post-operative state revealed satisfactory. Case 4: A 14 years old boy was admitted due to headache and unsteady gait. Positive neurologic findings were hyperactive DTRs, positive toe signs and disturbed it, cerebellar function. Conray ventriculogram revealed marked hydrocephalus and obstruction at the mid-portion of aqueduct. Proximal aqueduct was markedly dilated. Suboccipital craniectomy was performed, when 3.7cm advancement of the tube, resistance was felt, but giving sensation of membrance rupture was not felt. So the tube was remained in situ. Post-operative state revealed drowsy consiousness, right lateral gaze palsy and transient C.S.F. leakage. Surgical mortality was zero, and the complications of case 4 were supposed due to inadequate placement of the tube. From these, we feel that simple membraneous puncture without catheter tube placement may be better if surgeon feels the giving sensation of membrance puncture when the tube advancement to make C.S.F. passage. Otherwise, the catheter may be well left in situ.

A Case of Chopstick in the Left Optic Foramen without Injury to the Optic Nerve

A 20-year-old, male patient was admitted to the Department of Neurosurgery, Seoul National University Hospital, complaining of painful swelling of the left orbit. Two days before admission, patient sustained piercing of an aluminium chopstick at his left upper eyelid by his friend accidentally. Fluttered friend tried to pull out the chopstick manually but only broke its proximal portion. On neurologic and ophthalmologic exam, he was fully conscious and free from neurologic deficits at all. His visual acuity was as usual and examination of fundi, extraocular muscle functions, visual field and pupillary light reflex were all within normal limit. Subconjuctival hemorrhage and chemosis were positive findings. Skull X-rays including optic foramen view revealed broken distal part of the chopstick, about 7cm in length, which passed through the left lateral orbit and left optic foramen to reach sellar region across the midline. Emergency Kronlein-Berke's lateral orbitotomy was performed and the chopstick was removed without difficulty. Postoperatively patient showed good recovery and presented quite normal and usual eye function.

A Case of Chopstick in the Left Optic Foramen without Injury to the Optic Nerve

A 20-year-old, male patient was admitted to the Department of Neurosurgery, Seoul National University Hospital, complaining of painful swelling of the left orbit. Two days before admission, patient sustained piercing of an aluminium chopstick at his left upper eyelid by his friend accidentally. Fluttered friend tried to pull out the chopstick manually but only broke its proximal portion. On neurologic and ophthalmologic exam, he was fully conscious and free from neurologic deficits at all. His visual acuity was as usual and examination of fundi, extraocular muscle functions, visual field and pupillary light reflex were all within normal limit. Subconjuctival hemorrhage and chemosis were positive findings. Skull X-rays including optic foramen view revealed broken distal part of the chopstick, about 7cm in length, which passed through the left lateral orbit and left optic foramen to reach sellar region across the midline. Emergency Kronlein-Berke's lateral orbitotomy was performed and the chopstick was removed without difficulty. Postoperatively patient showed good recovery and presented quite normal and usual eye function.

Angiography of the Posterior Fossa

Our study was designed for two purpose. The first purpose was to evaluate the incidence of the visualization of the identifiable vessels of the posterior fossa on the vertebral angiography and its significance in the diagnosis of the supra and infratentorial lesions. The second purpose is by measuring the position of the important angiographic landmarks of the posterior fossa on the vertebral angiography to obtain their normal value and to investigate the correlation between the change of the position of the landmarks and the supra and infratentorial lesions. 91 cases of vertebral angiogram performed at Seoul National University Hospital from June 1974 to September 1976 were reviewed. The results were as follows: 1. Generally the vessels of the injected site showed better visualization than the vessels of the opposite site on the Towne's projection and the lateral projection showed better visualization than the Towne's projection with respect to each vessel of the injected site. 2. Reflux of contrast media down the contralateral vertebral artery was seen in about 33% of cases. On the lateral projection, posterior inferior cerebellar artery, precentral cerebellar vein and inferior vermian vein showed high incidence of visualization, which were important in the diagnosis of the posterior fossa lesions. On the Towne's projection posterior choroidal artery, posterior pericallosal artery, precentral cerebellar vein, superior vermian vein and anterior pontomesencephalic vein showed very low incidence of visualization. 3. For the better visualization of the vessels of the posterior fossa, injection with constant and high pressure, precise serialogram, subtraction and magnification techniques were needed. 4. On the lateral projection the normal value of the distance between the dorsum sellae the basilar artery was 6.0mm (3.0mm-10.0mm), and the distance between the midpoint of the clivus and the basilar artery was 3.5mm (1.5mm-10.0mm), and the distance between the anterior rim of the Foramen Magnum and the vertebral was 9.5mm (1.0mm-19.0mm). In some cases of craniopharyngioma the tip of the basilar artery was displaced posteriorly and in the most cases of the space occupying lesions of the posterior fossa the basilar artery was displaced anteriorly and compressed to the clivus. 5. On the lateral projection normal value of the distance between the choroidal point and the clivus/IOP line was 9.5mm (1.0mm-19.0mm). Normal value of the projection of the distance between the anterior rim of the Foramen Magnum and the point on the clivus/IOP line crossed by a perpendicular line from the choroidal point to the length of the clivus/IOP line was 39% (28%-49%) and in 78% of cases within the range of 35%-43%. Generally in the most cases of the space occupying lesions of the posterior compartment of the posterior fossa the choroidal point was displaced anteriorly, and in the most cases of the space occupying lesions of the anterior compartment of the posterior fossa the choroidal point was displaced posteriorly, and in the most cases of the supratentorial space occupying lesions the choroidal point showed no change. 6. On the lateral progection distance between the copular point and the clivus/IOP line was 7.5mm (1.0mm-11.5mm). In the most cases of the space occupying lesions of the posterior fossa it was over 11.5mm. 7. On the Towne's view the normal position of the bifurcation point of the basilar artery was 0.3mm left from the midline and its normal range was 3mm left and right from the midline. In the most cases of the cerebellopontine angle tumors and some cases of large cerebellar hemispheric tumors the bifurcation point of the basilar artery was displaced to the opposite of the tumors. 8. On the Towne's projection the maximal width of the ambient segments of the posterior cerebral arteries was 41.0mm (32.0mm-52.0mm) and the minimal width of the quadrigeminal segments of the posterior cerebral arteries was 17.0mm (6.0mm-28.0mm). In the cases of brain stem tumors the widths of the both ambient and quadrigeminal segments were widened, and in the most cases of posterior fossa lesions showing the upward supratentorial herniation and in the all cases of the pineal tumors the width of the quadrigeminal segments of the posterior cerebral artery was widened. 9. On the lateral projection the normal value of the distance between the C-C point and the Twining's line was 11.2mm (5.0mm-17.0mm). The normal value of the proportion of the distance between the tuberculum sellae and the point on the Twining's line was 50%(45%~54%) and in 76% of cases within the range of 49%~51%. In the most cases of the pineal tumors, thalamic tumors and the tumors of the anterior compartment of the posterior fossa the C-C point was displaced posteriorly, and in the cases of the tumor of the posterior compartment of the posterior fossa the C-C point was displaced anteriorly. 10. On the Towne's projection the normal value of the angle between the midline and the line connection the torcular Herophili and the copular point was 11?6?20?. In the most cases of the cerebellopontine angle tumors and some cases of the cerebellar hemispheric tumors the angle was closed, and in some cases of the cerebellar vermis tumors the angle was opened. 11. In the most of the vascular diseases of the posterior fossa the values of the measurements of the anatomical landmarks of the posterior fossa were within normal limit.

A Case of Hutchinson Type Neuroblastoma

Metastasis of neuroblastoma into the central nervous system is well known, but, in fact, rare clinically. Recently we had experienced one such case, which was characterized by sudden onset of paraplegia and blindness and delayed appearance of radiologic findings. A 7 years old Korean boy was admitted to the pediatric ward of the Seoul National University Hospital on September 28, 1975 due to sudden onset of paraplegia. All physical, laboratory and simple thoracic spine X-ray findings were normal except for albuminocytologic dissociation in the C.S.F. Guillain-Barre syndrome was suspected and steroid therapy was recommended. On November 10, 1975, he was readmitted due to sudden loss of visual acuity bilaterally. At first all radiologic examinations revealed no clue to the lesion. After 4 months from the onset, there appeared typical pedicular destruction of the thoracic spine and confirmed it as neuroblastoma by surgery.

A Case of Combined Spinal and Cerebral Cysticerosis

Cerebral cysticercosis is relatively common along the regional distribution of the world, but spinal cysticercosis is extremely rare. Furthermore combined forms of the two are not ever reported in the literature. Recently we have experienced a case, which was characterized by mental confusion, gait disturbance and urinary and fecal incontinence of 6 years' duration in 45 years old woman. We found these simultaneous two lesions by myelography and conray ventriculography and carried out surgical removal of the two lesions successfully.

Clinical Analysis of Intracerebral Hematoma

Seventy cases of intracerebral hematomas were analysed, forty-six of spontaneous origin and remainder of traumatic one, which had been experienced in Seoul National University Hospital between March, 1970 and June, 1975. The results were as follows: A. Among forth-six cases of spontaneous intracerebral hematomas, twenty-six cases(52%) were primary intracerebral hematomas, normotensive or hypertensive, seven aneurismal ruptures(15%), seven arteriovenous malformations(15%), two cerebral rete mirabilies, one tumor bleeding, one leukemia, one idiopathic thrombocytopenic and one due to other blood dyscrasia. 1. Among twenty-six cases of primary intracerebral hematomas, angiography was performed in all and fourteen cases were operated. The sites of hemorrhage were as follows: a. Putaminal hemorrhage:17 cases(65%)(two cases associated with intraventricular hematoma). b. Thalamic hemorrhage:5 cases(19%)(two cases associated with intraventricular hematoma). c. Subcortical hemorrhage:4 cases(16%). 2. Overall mortality among twenty-six cases was forty-six per cent;operative mortality was forty-three per cent, and non-operative, fifty per cent. 3. Age, mode of onset, level of consciousness at the time of surgery and the site of hematoma were all important factors for surgical result. Surgical intervention seemed to be most favorable in patients who had verbal communication with subcortical or localized putaminal hematoma. 4. Normotensive group was worse than hypertensive one with conservative treatment, but the former was more benefited than the latter with surgery. 5. Intracerebral hematomas due to aneurismal rupture, arteriovenous malformation and others were also influenced with above mentioned factors, but the nature of underlined disease was of prime importance. B. Among twenty-four operated cases of traumatic intracerebral hematomas: 1. Five cases(21%) showed classical lucid interval with variable duration from thirty minutes to forty-eight hours. 2. Temporal lobe was most frequently involved(63%). 3. Lateral blow was predominant than axial low, and contrecoup than coup lesion. 4. Overall mortality was twenty-nine percent. 5. Age, lucid interval, preoperative level of consciousness and associated cerebral contusion or subdural hematoma were important factors for prognosis, but the preoperative level of consciousness was of prime importance.

A Case of Posterior Migrating of Herniated Lumbar Nucleus Pulposus Over the Cauda Equina

Recently we had experienced a case of posterior migration of herniated lumbar nucleus pulposus over the cauda equina, simulating a cord tumor clinically and radiologically. But we could hardly find any previous case report on it. A 35 years old man was admitted to our ward due to paraparesis on July 17, 1975. He had a history of back sprain five years ago with intermittently appearing mild lumbago. Two weeks prior to admission, there appeared severe left leg pain and soon resulted in paraparesis. Preoperative positive neurologic findings were paraparesis with left side foot drop, hypesthesia on the left L4, 5 and S1 dermatome and bilaterally decreased ankle and knee jerks. Myelogram revealed complete block at L2-3 with suspicious indentation filling defect at left L-5 interspace. C.S.F. protein value marked 738mg%. On operation, the dural sac was compressed by a posteriorly overriding mass on it at the L2-3 level. The mass was traced to its origin from the left side of the L2-3 interspace and into the ruptured posterior longitudinal ligament with a narrow pedicle. L4-5 interspace revealed a typically protruding type disc lesion. These were composed of degenerated nucleus pulposus on histological examination.

Brain abscess Associated with Tetralogy of Fallot

The incidence of brain abscess in congenital heart disease marks 4-6%. Of these, tetralogy of Fallot is the most common congenital heart disase. We had experienced 2 cases of brain abscess associated with tetralogy of Fallot among 32 cases Of brain abscess from March -'57 to September-'74. Case 1;A 10 years old boy was admitted to our hospital in March-'66 because of headaches and vomiting. He had a history of Potts' operation under the impression of tetralogy of Fallot at the age of 5. Findings of clinical examination and diagnostic studies gave us an impression of a huge cystic mass in the right posterior temporo-occipital area. We aspirated about 80cc of pus, but no microoraganisms were noted on direct smear and culture. Case 2;A 7 years old boy was admitted to our hospital in August-'74 because of headaches and fever. He had been suffered from tetralogy of Fallot from the age of 3 without any surgical intervention. We made a burr hole on the right anterior temporal area under the impression of right posterior fronto-temporal mass, and aspirated about 15cc of pus. Multiple Gram positive cocci were noted on direct smear, but nothing on culture.

A Case of Dumb-bell Shaped Spinal Ganglioneuroblastoma

The ganglioneuroblastoma is a rare tumor originating from the sympathetic chain. Both cytologically and biologically it is intermediate between the highly malignant neuroblastoma and the benign gauglioneurinoma. The predilection site of neuroblastoma is adrenal medulla, but ganglioneuroblastoma and ganglioneurinoma are frequently located in the retroperitoneum and mediastinum. We have recently experienced the dumb-bell shaped ganglioneuroblastoma at L-2 and 3 level. A 2 year-old-girl was admitted to Seoul National University hospital on May-1975 with complaints of lumbar back pain and kyphosis for 6 months. She had normal motor and sphincter function. Neurological examination showed normal. Simple lumbar spine X-ray showed the widening of interpedicular distance and erosion of the pedicle at L-2 and L-3. On lateral view scalloping of posterior border of L-2 was found. Lumbar puncture and myelography were failed. Total laminectomy at L-2, L-3 was done. Dumb-bell shaped mass was seen half in the extradural intraspinal space and half in the extraspinal space with pedicle in the widened intervertebral foramen. The mass was adult thumb-tip sized, dark grayish tan color, nodular surfaced, and well encapsulated. The tissue diagnosis was ganglioneuroblastoma. Post-operatively urinary secretion of vanyl-mandelic acid level was normal limit.