Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 5 de 5
Filter
Add more filters










Database
Publication year range
1.
Neurol Med Chir (Tokyo) ; 52(5): 346-9, 2012.
Article in English | MEDLINE | ID: mdl-22688074

ABSTRACT

A 31-year-old male presenting with intracranial hemorrhage manifesting as deep coma and anisocoria underwent immediate emergency surgery. Three-dimensional computed tomography (CT) angiography revealed stenosis of the right middle cerebral artery (MCA) and perfusion CT immediately after the surgery suggested severe hypoperfusion in the right MCA territory. Postoperative angiography demonstrated right unilateral moyamoya disease. We predicted that brain edema and intracranial pressure (ICP) elevation occurring after the hemorrhage might result in cerebral infarction. Hyperosmotic drugs were contraindicated by dehydration. Therefore, therapeutic hypothermia was induced that controlled the ICP. We considered that the increased ICP, dehydration, vasospasm, and shrinkage of the ruptured vessel comprised the pathogenesis of acute cerebral ischemia after intracranial bleeding. Cerebral hemodynamics should be evaluated during the acute phase of cerebral hemorrhage to prevent subsequent cerebral infarction.


Subject(s)
Brain Ischemia/etiology , Cerebral Hemorrhage/etiology , Infarction, Middle Cerebral Artery/complications , Intracranial Hypertension/etiology , Moyamoya Disease/complications , Acute Disease , Adult , Brain Edema/etiology , Brain Edema/prevention & control , Brain Edema/therapy , Brain Ischemia/diagnosis , Brain Ischemia/therapy , Cerebral Angiography/methods , Cerebral Hemorrhage/diagnosis , Cerebral Hemorrhage/surgery , Humans , Hypothermia, Induced/methods , Infarction, Middle Cerebral Artery/diagnosis , Infarction, Middle Cerebral Artery/physiopathology , Intracranial Hypertension/prevention & control , Intracranial Hypertension/therapy , Male , Moyamoya Disease/diagnosis , Moyamoya Disease/physiopathology , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Postoperative Complications/therapy , Tomography, X-Ray Computed/methods
2.
Eur Radiol ; 22(11): 2382-91, 2012 Nov.
Article in English | MEDLINE | ID: mdl-22653285

ABSTRACT

OBJECTIVES: To detect symptomatic hemispheres during the postoperative course of subarachnoid haemorrhage (SAH) using arterial spin labelling (ASL). METHODS: Eighteen patients with aneurysmal SAH were included; four exhibited symptomatic vasospasm postoperatively. All patients underwent ASL on days 9-10 (single time-point ASL). Nine patients underwent serial measurements of ASL (serial ASL) on days 1-2, 9-10 and 13-21, and seven patients also underwent imaging on days 4-7. CBF in the posterior part of the MCA territory was measured, and the ipsilateral/contralateral ratio of CBF was calculated. Differences between symptomatic hemispheres and others underwent ROC analysis. RESULTS: Single time-point ASL revealed that CBF(day9-10) and CBF(i/c_day9-10) were significantly lower in symptomatic hemispheres than in asymptomatic hemispheres (P < 0.001). Serial ASL was significantly decreased on CBF(day4-7) compared with CBF(day1-2) and on CBF(day9-10) compared with CBF(day4-7), and significantly increased on CBF(day13-21) compared with CBF(day9-10). ROC analysis of single time-point ASL revealed that AUC for CBF(day9-10) was 0.95, significantly higher than CBF(i/c_day9-10) (P < 0.001). ROC analysis of serial ASL showed that AUC for CBF(day9-10) was 0.93 and significantly higher than CBF(day9-10/day1-2) and CBF(i/c_day9-10) (P < 0.001). CONCLUSIONS: Single time-point ASL revealed significant CBF reduction in symptomatic hemispheres compared with asymptomatic hemispheres. Serial ASL showed time-dependent CBF changes after SAH. KEY POINTS : • MR arterial spin labelling (ASL) can non-invasively assess cerebral blood flow (CBF) • ASL revealed significant CBF reduction in symptomatic hemispheres compared with asymptomatic hemispheres • Serial ASL measurements enable observation of time-dependent CBF changes after SAH • ASL is non- invasive and suitable for serial repeated examinations.


Subject(s)
Subarachnoid Hemorrhage/physiopathology , Vasospasm, Intracranial/diagnosis , Adult , Aged , Arteries/physiopathology , Cerebrovascular Circulation , Diagnostic Imaging/methods , Female , Humans , Male , Middle Aged , ROC Curve , Spin Labels , Subarachnoid Hemorrhage/complications , Time Factors , Vasospasm, Intracranial/physiopathology
3.
Neurol Med Chir (Tokyo) ; 49(7): 320-4, 2009 Jul.
Article in English | MEDLINE | ID: mdl-19633407

ABSTRACT

Carotid artery stenting (CAS) is an effective and less invasive alternative to carotid endarterectomy for internal carotid artery (ICA) stenosis, but the guiding catheter is often technically difficult to introduce into the common carotid artery (CCA) in patients with concomitant atherosclerotic disease in the peripheral vessels or aorta. A new pull-through technique between the superficial temporal artery (STA) and the brachial artery was used to deliver the guiding catheter into the CCA safely and steadily. An 83-year-old male presented with repeated transient left hemiparesis caused by severe stenosis of the origin of the right ICA. He also had severe systemic atherosclerotic disease with occlusion of the bilateral femoral arteries. The innominate artery branched at an acute angle from the aorta. Therefore, catheterization of the right CCA seemed to be impossible using a conventional approach. The guidewire introduced from the right STA was lassoed by a loop snare wire and pulled out of the left brachial artery, forming the pull-through system. The guiding catheter could be introduced into the CCA from the left brachial artery over this guidewire. Subsequently, successful stent placement was performed under the distal protection. This new technique may facilitate safe and stable CAS even in patients with a severely tortuous access route due to concomitant atherosclerotic disease.


Subject(s)
Brachial Artery/surgery , Carotid Artery, Internal/pathology , Carotid Stenosis/surgery , Catheterization, Peripheral/methods , Stents , Temporal Arteries/surgery , Aged, 80 and over , Atherosclerosis/complications , Carotid Artery, Common/surgery , Carotid Artery, Internal/surgery , Carotid Stenosis/complications , Carotid Stenosis/pathology , Humans , Male
4.
No Shinkei Geka ; 34(10): 1027-32, 2006 Oct.
Article in Japanese | MEDLINE | ID: mdl-17052015

ABSTRACT

Identification of unknown primary tumors in patients with brain metastasis is a continued diagnostic challenge. Several clinical reports have suggested that 18F-flouorodeoxyglucose positron emission tomography (FDG PET) is useful for detecting them. PET has incomparable abilities to determine the metabolic activity of tissues. But it needs the assistance of higher-resolution, anatomic information. CT is the easiest and highest-resolution tomographic modality to be integrated into PET imaging. Because of this, the market for PET devices has shifted so dramatically toward PET-CT. We report a case to show that FDG PET-CT was able to detect an unknown primary tumor. A 75-year-old female underwent resection of a left cerebellar tumor. The histological diagnosis was adenocarcinoma metastasis. Conventional systemic evaluation (chest radiography, chest and abdomen CT, abdominal sonography, and so on) did not show any pathologic image. FDG PET-CT was then carried out. A hypermetabolic focus was revealed in the left hilum. In conclusion, from now on, FDG PET-CT will be considered as the first diagnostic process for patients presenting brain metastasis with an unknown primary tumor.


Subject(s)
Cerebellar Neoplasms/secondary , Neoplasms, Unknown Primary/diagnosis , Positron-Emission Tomography/methods , Tomography, X-Ray Computed/methods , Aged , Female , Fluorodeoxyglucose F18 , Humans , Lung Neoplasms/diagnosis
5.
No Shinkei Geka ; 32(9): 929-35, 2004 Sep.
Article in Japanese | MEDLINE | ID: mdl-15529770

ABSTRACT

From the beginning of the 17th Century, anatomists started to elucidate numerous tracts and fasciculi of the brain using fiber dissection techniques. Due to the complexities associated with tissue preparation and the time-consuming nature of traditional techniques the popularity of this method has gradually declined with the advent of modern neuroimaging techniques such as MRI. Many novel approaches to deep brain lesions have recently been devised following the development of skull base surgery. In comparison, the study of functional neuroanatomy has been relatively neglected. Understanding how neuronal fibers in the brain interconnect and communicate neuronal functions is critical when performing surgery for malignant glioma and epilepsy, as brain parenchyma has to be resected and neuronal fibers are interrupted. In the preoperative planning process we have applied anatomical studies using brain fiber dissection techniques. Brain fiber dissection offers the advantage of exposing association, commissural and projection fibers of cerebral white matter in three dimensions. Brain fiber dissection appears useful for assisting neurosurgeons to acquire neurosurgical skills and become familiar with neuroanatomical features. The techniques and significance of brain fiber dissection are described herein.


Subject(s)
Brain/pathology , Nerve Fibers/pathology , Neurosurgical Procedures/methods , Brain/physiology , Brain Mapping , Brain Neoplasms/surgery , Epilepsy/surgery , Glioma/surgery , Humans , Magnetic Resonance Imaging
SELECTION OF CITATIONS
SEARCH DETAIL
...