Acquired intraventricular arachnoid cyst of the third ventricle--case report.

A 35-year-old male showed slow progression of dilation of the lateral ventricles and third ventricle. He had undergone surgery for third ventricular colloid cyst and ventriculoperitoneal shunting when he was 3 years old. Computed tomography revealed progression of triventricular dilation. He underwent endoscopic fenestration of the arachnoid cyst and endoscopic third ventriculostomy. The postoperative course was good. Arachnoid cysts within the third ventricle are rare. Endoscopic treatment of an arachnoid cyst within the third ventricle is less invasive and effective for arachnoid cysts within the third ventricle associated with hydrocephalus.

[Case of the jugular phlebectasia accompanied by the brachial plexopathy].

This article reports a case of a 59-year-old male who suffered from left brachial plexopathy occurring at night in bed. He had experienced multiple surgical courses of thyroid tumor resection including neck dissection and had presented left secondary jugular phlebectasia Jugular phlebectasia is mainly congenital and sometimes secondarily induced by compression, mechanical ventilation, trauma, thrombosis, etc. Brachial plexopathy is usually caused by neck and arm trauma, additionally caused by iatrogenic nerve and vessel injury. To our knowledge, this is the first report of brachial plexopathy accompanied by ipsilateral jugular phlebectasia. We hypothesized the etiology of this case through multimodal examinations and reviewed the literature about jugular phlebectasia and brachial plexopathy.

Severe QT interval prolongation associated with moxifloxacin: a case report.

INTRODUCTION: The QT interval prolongation is an adverse effect associated with moxifloxacin. This adverse effect can lead to potentially life-threatening arrhythmias such as Torsades de pointes. We describe a case of severe QT interval prolongation associated with moxifloxacin which may cause the development of Torsades de pointes. There have been no reported case of severe corrected QT interval prolongation caused by moxifloxacin in the patient of normal heart rate. CASE PRESENTATION: In an 85-year-old Japanese woman, oral moxifloxacin 400 mg daily was initiated for the forearm cellulitis. On the sixth day of oral moxifloxacin administration, monitor electrocardiogram showed prolongation of the corrected QT interval to 523 ms at a rate of 40 beats/min. Electrocardiogram before moxifloxacin therapy showed the corrected QT interval to 460 ms at a rate of 72 beats/min. On the sixth day after moxifloxacin discontinuance, monitor electrocardiogram showed the corrected QT interval to 432 ms at a rate of 70 beats/min. CONCLUSION: This case suggests that electrocardiogram monitoring during moxifloxacin therapy may be necessary in the patients even if they do not have high risk factors for QT interval prolongation.

Cerebrospinal fluid ferritin in chronic hydrocephalus after aneurysmal subarachnoid hemorrhage.

OBJECTIVES: Subarachnoid hemorrhage (SAH) is a common cause of chronic hydrocephalus. Blood in the subarachnoid space is intracranially metabolized to bilirubin and iron, and free iron is thereafter detoxified by ferritin. However, no studies have reported the relationship between intracranial heme metabolism and chronic hydrocephalus after SAH. The goal of this prospective study was to clarify the relationship between intracranial heme metabolism and chronic hydrocephalus after SAH. METHODS: The authors measured the levels of bilirubin, iron and ferritin in the cerebrospinal fluid (CSF) of 70 consecutive patients with aneurysmal SAH of Fisher computed tomography Group III, and determined the relationship between these substances' levels and hydrocephalus requiring ventriculoperitoneal shunting. RESULTS: The CSF concentrations of ferritin and inflammatory cells were significantly higher in shunted patients (n = 27) than in non-shunted patients (n = 43) on Days 3 and 4 (p < 0.05 in ferritin and p < 0.01 in inflammatory cells) and 11 to 14 (p < 0.005 in ferritin) post-SAH. These results were independent of other clinical factors. The occurrence of chronic hydrocephalus was not affected by the extent of the intracranial heme metabolism in terms of the bilirubin and iron levels. CONCLUSIONS: This is the first study to show that patients who subsequently had chronic hydrocephalus requiring CSF shunting were associated with higher CSF levels of ferritin in the acute stage of SAH. Higher CSF ferritin levels may not reflect the amount of blood in the subarachnoid space that was intracranially metabolized, but rather more intense subarachnoid inflammatory reactions which may cause chronic hydrocephalus after SAH.

[Effectiveness of kampo medicine gorei-san-ryo for chronic subdural hematoma in very elderly patients].

Chronic subdural hematoma (CSDH) is mainly a disease of the elderly. Widespread use of CT and MRI has resulted in the discovery of CSDH cases with no or minimum symptoms in the elderly. Treatment is by surgical evacuation, although small hematoma may resolve spontaneously. Treatment of CSDH in elderly patients of more than 80 years of age with minimum symptoms is still undetermined. Many conservative treatments such as those with steroids and diuretics have been reported with some good results. Conservative treatment cannot become the procedure of choice for fear of side effects. We report successful treatment for CSDH cases among the very elderly with a Kampo medicine (Japanese traditional herbal medicine). Among a total eleven cases, four were recurrent after surgical evacuation and seven showed significant hematoma with minimal symptoms. Gorei-san-ryo, a Kampo medicine, was administered for 3 to 12 months. Some cases showed rapid hematoma resolution after administration. Only one of them required subsequent surgical intervention. This conservative treatment with Kampo medicine for CSDH may be a potential alternative to surgery especially for the elderly.

Intracranial heme metabolism and cerebral vasospasm after aneurysmal subarachnoid hemorrhage.

BACKGROUND AND PURPOSE: The goal of this prospective study was to clarify the potential role of an inducible heme-metabolizing enzyme, heme oxygenase (HO)-1, and an inducible iron-detoxifying protein, ferritin, in cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). METHODS: The authors measured the levels of bilirubin and iron, which are by-products of HO-1, and the ferritin levels in the cerebrospinal fluid in 39 consecutive patients with aneurysmal SAH of Fisher computed tomography group III, and determined the relationship between these by-products of HO-1 or ferritin and vasospasm. RESULTS: Fourteen of 39 patients (35.9%) developed asymptomatic vasospasm, while 6 patients (15.4%) developed symptomatic vasospasm. The levels of ferritin, bilirubin, and iron were all significantly elevated after SAH. The levels of ferritin and bilirubin were significantly higher in patients with no vasospasm than in patients with asymptomatic and symptomatic vasospasm on days 5 through 7 (P<0.05, respectively) and on days 11 through 14 (P<0.025 in bilirubin) after SAH. However, no significant difference was observed in the iron levels between these patient groups. CONCLUSIONS: This is the first study to show that higher levels of bilirubin and ferritin in the cerebrospinal fluid after SAH were associated with no vasospasm in clinical settings. These findings support the concept that the induction of HO-1 and ferritin may be an intrinsic regulatory mechanism that acts against cerebral vasospasm.

Relationships between head fixation pins for radiosurgery and the skull bone--usefulness of a torque wrench.

BACKGROUND: In stereotactic radiosurgery (SRS), fixation devices are secured to the patient's head with pins. However, there have been no standards for the use of such pins, which must be inserted with appropriate torque based on the surgeon's clinical judgment. Therefore, the pins may sometimes be tightened excessively and penetrate too deeply into the patient's skull. PURPOSE: To improve safety in SRS, a torque wrench was used for pin insertion. The usefulness of the torque wrench was then evaluated by examining the relationships between the pins and skull bone and identifying differences according to the wrench used and the patient's bone thickness. METHODS: CT images of patients who had previously undergone SRS were used to assess the relationships between the pins and skull bone. Differences according to the wrench used and pin insertion site were investigated. RESULTS: Compared with a standard wrench, use of the torque wrench decreased the insertion depth of pins in the skull bone. In terms of site, pins in the forehead were inserted more deeply. No differences related to the frontal sinus were observed. CONCLUSION: The use of a torque wrench improved safety during pin insertion for SRS procedures.