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1.
Neurol Med Chir (Tokyo) ; 50(7): 592-4, 2010.
Article in English | MEDLINE | ID: mdl-20671389

ABSTRACT

A 21-year-old woman presented with an intramedullary spinal cord germinoma and a history of gait disturbance and elimination disorder. Magnetic resonance (MR) imaging demonstrated two isolated lesions, one located within the medulla between T9 and T11, and another at the cauda equina (L2 to L3 levels). After partial reduction of the intramedullary mass, histological findings revealed that the tumor was typical germinoma. Further MR imaging revealed no evidence of intracranial germinoma. Combined chemotherapy (carboplatin and etoposide) and whole spine radiation were performed. Follow-up MR imaging showed that the enhanced mass at the L2-L3 levels had disappeared. No recurrence of the tumor has been detected 3 years after the operation, and no dissemination into the cranial area was detected. Cisplatin and etoposide chemotherapy combined with radiotherapy is recommended for primary spinal germinoma, and is effective for inhibition of both tumor dissemination and recurrence.


Subject(s)
Germinoma/diagnosis , Germinoma/surgery , Neoplasms, Multiple Primary/diagnosis , Neoplasms, Multiple Primary/surgery , Spinal Cord Neoplasms/diagnosis , Spinal Cord Neoplasms/surgery , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Chemotherapy, Adjuvant , Combined Modality Therapy , Female , Germinoma/pathology , Germinoma/radiotherapy , Humans , Lumbar Vertebrae , Neoplasms, Multiple Primary/pathology , Neoplasms, Multiple Primary/radiotherapy , Radiotherapy, Adjuvant , Spinal Cord/pathology , Spinal Cord/surgery , Spinal Cord Neoplasms/pathology , Spinal Cord Neoplasms/radiotherapy , Thoracic Vertebrae , Young Adult
2.
Surg Neurol ; 65(3): 304-7; discussion 307, 2006 Mar.
Article in English | MEDLINE | ID: mdl-16488259

ABSTRACT

BACKGROUND: We describe the first case of Tolosa-Hunt syndrome that is associated with C3 and C4 aneurysms. CASE DESCRIPTION: The patient, a female aged 58 years, had diplopia and right retroorbital pain. Magnetic resonance imaging revealed an enlargement of the hypophysis and bilateral cavernous sinuses, particularly on the right side. Cerebral angiography demonstrated ICA aneurysms of the left C3 and right C4 portions. These symptoms were immediately alleviated after initiation of prednisolone therapy, but recurred after the dose was tapered off. Radiological examination revealed an enlargement of the hypophysis whereas the right C4 aneurysm had decreased in size and no blood flow was apparent in the ipsilateral ophthalmic artery. A biopsy was performed and the results showed a focal inflammatory change. Steroid therapy was represcribed, and after a follow-up period of 10 months without therapy, the patient has been free of symptoms. CONCLUSION: We conclude that bilateral ICA aneurysms might be directly induced by inflammatory infiltration into intracavernous ICAs.


Subject(s)
Carotid Artery Diseases/surgery , Carotid Artery, Internal/surgery , Cavernous Sinus/surgery , Cervical Vertebrae , Pituitary Diseases/surgery , Tolosa-Hunt Syndrome/surgery , Carotid Artery, Internal/pathology , Cavernous Sinus/pathology , Cerebral Angiography , Cervical Vertebrae/pathology , Cervical Vertebrae/surgery , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Middle Aged , Pituitary Diseases/diagnosis , Pituitary Gland/pathology , Pituitary Gland/surgery , Tolosa-Hunt Syndrome/diagnosis
3.
Neuropathology ; 24(3): 219-27, 2004 Sep.
Article in English | MEDLINE | ID: mdl-15484700

ABSTRACT

Pathological changes of cerebral microvessels in transient ischemia were investigated by scanning electron microscopy of vascular corrosion casts. Wistar rats were treated with middle cerebral artery (MCA) occlusion for 30 min, 1 h, 3 h, 4 h, 5 h or 7 h and subsequent reperfusion for 2 h. The ultrastructures of the cast were observed and computer-aided montage micrographs were obtained for visualization of the whole microvasculature in the ischemic brain hemisphere. Avascular areas representing ischemic areas were detected in the frontotemporal cortex and caudate putamen in the groups from 30 min to 5 h occlusion. Extravasation of the resin, which probably corresponded to the leakage of plasma or hemorrhage, was seen as spheroidal, conglomerative, large massive and worm-like types. The spheroidal type, which probably indicated a small leakage or minor hemorrhage, began to appear in the 30-min occlusion group. The conglomerative type, which probably indicated a larger leakage or moderate hemorrhage, appeared in the 3- to 5-h occlusion groups. The large massive and worm-like types, which probably indicated a significant hemorrhage, appeared in the 4- and 5-h occlusion groups. The number of these extravasations increased significantly in the 4-h occlusion group. Arterioles near the avascular area frequently showed vasospastic appearances, such as corrugations, fusiform indentations of endothelial nuclei, continuous circulatory constrictions and severe narrowing with interrupted branches. Arteriolar vasospasm possibly caused prolonged hypoperfusion even if reperfusion was achieved. The capillaries had a thin stringy appearance in the 4- and 5-h occlusion groups. These changes seemed to relate closely with increased intracranial pressure by brain edema or hemorrhage. The present study suggested that the risk of brain edema or hemorrhagic infarction increased beyond 3 h of MCA occlusion, and vasospasm of the arterioles might participate in stroke pathophysiology.


Subject(s)
Brain Ischemia/pathology , Cerebral Cortex/blood supply , Corrosion Casting/methods , Imaging, Three-Dimensional/methods , Microscopy, Electron, Scanning , Animals , Arterial Occlusive Diseases/pathology , Arterial Occlusive Diseases/physiopathology , Brain Ischemia/etiology , Cerebral Cortex/ultrastructure , Microcirculation/pathology , Microcirculation/ultrastructure , Microscopy, Electron, Scanning/methods , Rats , Rats, Wistar
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