Outcomes in patients with ischemic cerebrovascular disease.

An analysis was conducted to determine at discharge the outcomes associated with risk factors in 246 patients with ischemic cerebrovascular disease who were admitted within 48 hours after the onset of the disease. Statistical analysis in this study disclosed that atrial fibrillation was a significant risk factor contributing to the worse outcomes among the subtypes of the ischemic cerebrovascular disease.

Asymptomatic hyponaturemia in a patient with mild head injury due to syndrome of inappropriate diuretic hormone--a case report.

Hyponatremia is commonly seen in patients with severe and moderate head injury, but it is rarely reported in those with mild head injury. The authors report a patient with mild head injury who presented with data typical of inappropriate secretion of antidiuretic hormone (SIADH), but showed no clinical deterioration. Though the clinical significance of this condition is unclear, the true incidence of this pathology might well be found to be higher than expected, should it receive more clinical and/or serological attention. Continuing clinical assessment will be needed to determine the significance of this condition in relation to that in patients with SIADH following the various causes reported previously.

MR findings in isolated oculomotor nerve palsy associated with infectious mononucleosis caused by Epstein-Barr virus infection.

A 20-year-old man presented with fever, bilateral swelling of the cervical and inguinal lymph nodes, and splenomegaly. Later he noted diplopia. CSF was unremarkable. High serum antibodies to Epstein-Barr virus (EBV) were discovered. MRI revealed an abnormal lesion in the right third cranial nerve, which was considered to be the pathological lesion associated with his clinically apparent oculomotor nerve dysfunction.

Acute subdural hematoma without subarachnoid hemorrhage due to ruptured intracranial aneurysm--case report.

A 54-year-old female presented with acute subdural hematoma secondary to rupture of an intracranial aneurysm. She was admitted with acute onset of severe headache, nausea, and vomiting. There was no past history of head trauma. Computed tomography demonstrated a left subdural hematoma with extension along the tentorium in the absence of subarachnoid or intraparenchymal hemorrhage. Angiography revealed an aneurysm of the internal carotid-posterior communicating artery which was oriented posterolaterally. Uneventful clipping was performed and the patient was discharged from hospital without neurological deficits. The possibility of aneurysmal subdural hematoma should be considered in the absence of trauma.

Traumatic occlusion of the anterior cerebral artery--case report.

A 71-year-old female presented with posttraumatic occlusion of the anterior cerebral artery (ACA) after a road accident in which she was hit in the mid-frontal region. Initial computed tomography (CT) demonstrated frontal skull fractures and pneumocephalus. High density areas were also identified in the right basal cisterns, suggesting traumatic subarachnoid hemorrhage. She was alert on admission, but with attendant shock due to crush wounds. Her condition rapidly deteriorated and an emergency amputation of her left leg was performed. After aggressive treatment with transfusion and infusion, her systolic pressure increased to 120 mmHg. Her consciousness remained disturbed. Serial CT disclosed hemorrhagic infarction in the entire medial side of the right frontal lobe. Magnetic resonance angiography demonstrated decreased flow voids in the bilateral A1 segments and right ACA, and a basilar artery aneurysm, which was unruptured clinically. Three weeks after the injury, she regained consciousness. Six months later, she had motor aphasia and left upper extremity weakness. The clinicopathological mechanism causing the traumatic occlusion of the ACA in the present case was probably dissecting aneurysm.

[A case of tongue cancer effectively treated with tegafur].

We administered a slow-release formulation of tegafur (SF-SP) to a patient with cancer of the tongue. We would like to report the findings of this case which showed clear improvement. SF-SP was administered at 800 mg/day to a 58 year-old male for cancer of the tongue (T4N1). By the 17th day after the start of SF-SP administration, the tumor had shrunk, and by the 37th day the submandibular lymph nodes could not be located by touch. At the completion of the test on the 60th day, no cancer cells were detected. Following the completion of the test, there have been no symptoms of recurrence and a complete response was observed. At present, we are continuing administration of SF-SP and making observations.

Clinical analysis of nineteen patients with traumatic subdural hygromas.

Nineteen patients with traumatic subdural hygroma (TSH) who were admitted between 1988 and 1992, were reviewed. Diagnosis of TSH was made by serial computerized tomography (CT) after initial head injury, and patients were followed for up to 19 months after head injury. The patients ranged in age from 53 to 91 years (mean 75.6 yrs). Fifteen patients were treated conservatively, and 4 patients underwent surgery. Patients had disturbance of consciousness (transient in 5 cases, persisting in 3 cases), headache (10 cases), vomiting (6 cases), and vertigo (2 cases). TSH began to develop within 24 hs in 10 patients after initial head injury, and in 13 (68%) of 19 patients, TSH was demonstrated within 72 hs after the initial head injury. Chronic subdural hematoma (CSH) developed in 5 (26%) of 19 patients and 2 patients underwent surgery. In 15 patients, who were treated conservatively, TSH disappeared in 10 patients, and decreased in 4 patients, but remained unchanged in 1 patient. Clinically, 11 patients improved. Three patients remained unchanged. One patient, who had cerebral contusion, died of pneumonia. In 4 patients, who underwent surgery, including 2 patients with CSH, TSH disappeared in all patients. Two patients improved, and 1 patient was unchanged. Another patient, who had cerebral contusion and normal pressure hydrocephalus, died. In general, clinical outcome was satisfactory, except for the patients who had accompanying parenchymal lesions before or after head injury. Surgical treatment was limited to the patients who had rapidly enlarging TSH and neurological deterioration.

Acute obstructive hydrocephalus due to an unruptured basilar bifurcation aneurysm associated with bilateral internal carotid occlusion--a case report.

A patient with a higherly positioned and large basilar bifurcation aneurysm associated with bilateral internal carotid occlusion was described. A 63 year-old man was admitted to Yokokura Hospital with disturbed consciousness and mild left hemiparesis. On admission, an initial plain CT-scan showed an acute obstructive hydrocephalus with periventricular lucency caused by an abnormal lesion in the anterior part of the third ventricle. An emergency ventriculo-peritoneal shunt was inserted. The postoperative course was uneventful. The patient regained his consciousness with normal motor function by the following day. Postoperative cerebral angiography disclosed a large basilar bifurcation aneurysm at a higher position, 19 mm from the dorsum sellae. Bilateral internal carotid occlusion had occurred, but rich collateral blood supply from the vertebro-basilar artery via the bilaterally enlarged posterior communicating arteries to the anterior circulation was observed. This rich collateral blood supply to the vertebrobasilar artery might be responsible for the development of the aneurysmal formation due to the increased hemodynamic stress.

Incidentally identified multiple low-intensity areas on T2-weighted images by MR imaging.

Multiple small lesions of low intensity on T2-weighted images identified by MR imaging were observed in four patients. There were no definite associations between the patients' clinical symptoms and the lesions. MR imaging showed multiple, small areas with slightly high and/or low-intensities on T1-weighted images, and low intensities on T2-weighted images. IN two patients these low intensity areas were increased in size with field echo images. These MR studies indicate that multiple ruptures and/or hemorrhagic infarctions of microaneurysms may occur in the brain without any clinical manifestations.

Clinical analysis of traumatic subarachnoid hemorrhage.

Traumatic subarachnoid hemorrhage (TSAH) is regarded as a poor prognostic factor of primary brain stem injury. The aim of the present study is to describe the results of a clinical analysis of 15 patients with TSAH who were hospitalized between March, 1987 and April, 1990. They were classified into three groups on the basis of the initial level of consciousness evaluated by Glasgow Coma Scale (GCS) scores. Fourteen patients had TSAH in the sylvian fissures, while in five the location was the cortical sulci. Four patients had TSAH in the ambient and quadrigeminal cisterns, and another four patients had TSAH in the prepontine and interpeduncular cisterns. TSAH localized to the suprasellar cistern was found in three patients, and five patients were found to have TSAH only in the sylvian fissures. Other accompanying intracranial lesions were as follows: acute subdural hematoma in five patients. Intracerebral hematoma in four and cerebral contusion in three. Three patients, one in the severest group and two in the severe group, had fatal outcomes. The cause of death was more closely associated with the accompanying intracranial lesion than the TSAH. One patient had a fair outcome, and 11 patients had a favorable outcome. In the present study, the outcome was generally good in the patients who had TSAH in a confined area, such as the sylvian fissures or cortical sulci.