We describe three rare cases of dissecting aneurysms in the anterior cerebral artery (ACA) treated by surgical reconstruction, and reviewed 79 previously reported cases with the ACA dissecting aneurysm. We found that 35 (77.8%) of 45 patients with ischemic event and 15 (40.5%) of 37 patients with hemorrhagic event were treated conservatively, with 11.4%(4/35 cases) and 13.3%(2/15) risk of bleeding and rebleeding, respectively. Furthermore, half of these patients died. The other 32 patients were treated surgically, and their outcome was favorable, especially after surgical reconstruction. Simultaneous treatment of both hemorrhagic and ischemic events is essential. We recommend early treatment with revascularization for patients with ACA dissection that has hemorrhaged and for patients presenting with signs of clinical deterioration with ischemic event.

BACKGROUND: Phosphenes, flashes of light, are a visual phenomenon experienced by patients with ophthalmological disease and normal individuals. CASE REPORT: We report here a 68-year-old woman in whom phosphenes appeared in the left visual field due to compression of the right optic nerve by an aneurysm of the anterior communicating artery. RESULTS: The symptom decreased dramatically after clipping of the aneurysm. CONCLUSION: Phosphenes may be an important early sign of vascular compression neuropathy of the optic nerve.

Neonatal hypoxic-ischemic encephalopathy (HIE) is the most frequent neurological disease in the perinatal period. Its major cause is oxidative stress, which induces DNA peroxidation and apoptotic neuronal death. We examined 8-hydroxy-2'-deoxyguanosine (8-OHdG) expression to evaluate brain damage in neonatal HIE and the therapeutic effect of edaravone, a free radical scavenger. Using high-performance liquid chromatography and immunohistochemistry, the 8-OHdG levels of neonatal HIE model Sprague-Dawley rats which were subjected to left common carotid artery ligation and 2-hour hypoxia, significantly increased after 24-48 hours of HI insult, but decreased after 72 hours. Moreover, the number of apoptotic cells with terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling and karyorrhexis significantly increased after 24-72 hours of HI insult. In a therapeutic experiment, edaravone was administered intraperitoneally (9 mg/kg) after HI insult every 24 hours. Edaravone reduced both the apoptotic neuronal cell number and 8-OHdG expression after 24-48 hours of HI. From a double immunofluorescent study, DNA peroxidation occurred in apoptotic neuronal cells with 8-OHdG expression. Edaravone may inhibit the number of apoptotic neuronal cells and 8-OHdG expression within 48 hours after HI insult.

We report a 68-year-old woman who experienced visual hallucinations diagnosed as peduncular hallucinosis (PH) following microvascular decompression for trigeminal neuralgia. Postoperative MRI showed only ischemic oedema of the left cerebellar hemisphere due to retraction. Our case first reveals that PH can be induced without direct brainstem injury, instead possibly by a cerebellar lesion.

We report a case in which hemorrhage occurred in an asymptomatic falx meningioma known beforehand, after the internal use of low-dose aspirin for 16 months. Our case is the second one in which hemorrhage from a meningioma may have been induced by aspirin prophylaxis. On the other hand, aspirin may have promoted the enlargement of spontaneous hemorrhage from meningioma. Furthermore, inadequate control of hypertension may have been another cause of hemorrhage. Although it is difficult to solely attribute intratumoral hemorrhage to aspirin, we have to be careful when prescribing aspirin for patients who have asymptomatic meningioma.

A radiation-induced cerebellar glioma is extremely rare, and the etiology of such a tumor is unknown. We report a rare case of hemorrhagic cerebellar anaplastic glioma occurring 12 years after prophylactic cranial radiotherapy for acute lymphocytic leukemia. We discuss the etiologies of the radiation-induced hemorrhagic cerebellar glioma as a secondary malignancy after radiotherapy.

We report here a rare case of supratentorial ectopic cortical ependymoma. This tumor was localized in the left angular gyrus, occurred with intratumoral hemorrhage, was attached to the dura mater, exhibited no continuity with the ventricular system, showed distinctive pathological features (perivascular pseudo-rosette formations and firework-like giant rosette formations), and finally transformed to a glioblastoma-like high-grade lesion. A cortical ependymoma should be considered in the differential diagnosis of supratentorial cortical tumors with intraparenchymal hemorrhage and high vascularity, even if not in contact with the ventricular system. Although malignant transformation is unusual in cortical ependymoma, close observation and adjunctive radiotherapy are strongly recommended after the excision.

BACKGROUND: We frequently experience difficulty in scalp adaptation on cranioplastic surgery, particularly after wound infection, because of scalp atrophy, poor nutritional condition, and tense suture. CASE DESCRIPTION: We report our valuable experience of scalp expansion being effective for cranioplastic surgery due to a postinfection large calvarial defect after the removal of a convexity meningioma. CONCLUSIONS: If there is some anxiety about scalp adaptation preoperatively, it may be wise to perform a 2-stage cranioplasty, including tissue expansion with a scalp expander, instead of a hasty 1-stage cranioplasty.

A 40-year old conscious man developed central neurogenic hyperventilation (CNH). He had tumor dissemination to the brainstem 10 months after undergoing partial removal of a pineal glioblastoma. To the best of our knowledge, this is the first report of CNH caused by the cerebrospinal fluid dissemination of a tumor. The authors suggest that multiple lesions from an infiltrative tumor in the brainstem may give rise to CNH and further our understanding of the pathogenesis of CNH.

A 51-year-old woman presented with a fourth ventricle meningioma manifesting as a 2-week history of dizziness and vomiting. Computed tomography (CT) and magnetic resonance (MR) imaging revealed a round mass lesion in the fourth ventricle. Thallium-201 chloride single photon emission computed tomography (201TlCl SPECT) showed high and rapid uptake on the early image and rapid washout on the delayed image. The preoperative diagnosis of meningioma could be established based on these findings. Total removal of the tumor was successfully performed. 201TlCl SPECT is useful for the preoperative diagnosis of fourth ventricle meningioma combined with CT, MR imaging, and angiography.

We retrospectively studied 133 patients with subarachnoid hemorrhage (SAH) to assess whether there was any gender disparity in serum electrolytes levels throughout the clinical course. Serum concentrations of sodium and potassium were measured in all patients, while catecholamines or antidiuretic hormone were assessed in a number of cases. Female SAH-patients had lower potassium level (3.29+/-0.47 mEq/L) than did male patients (3.68+/-0.38) on the first day of SAH. This gender disparity continued to the beginning of the chronic phase and disappeared several months later. Mean serum sodium level was lower in the male group than in the female group throughout the clinical course. Mean serum levels of adrenaline and antidiuretic hormone were characterized by their prominent high value on the first day. Serum potassium levels were inversely related to serum levels of catecholamines, especially adrenaline, during the acute and subacute phases, particularly on the first day.

The present study was designed to assess the relationship between the presence of focal brain aedema and serum concentrations of atrial natriuretic peptide (ANP) or brain natriuretic peptide (BNP) in patients with subarachnoid haemorrhage (SAH). Serum levels of ANP and BNP were measured at six different time periods (Day 1, 2, 3, 4 to 7, 8 to 14, and 15 to 25) in 61 SAH-patients. Focal brain aedema, which was caused by an intracerebral haematoma associated with SAH or surgical complications, was found in eight SAH-patients by means of consecutive CT scans. The mean serum ANP and BNP levels in patients with focal brain aedema were significantly higher than those in patients without focal brain aedema between Days 4 and 14. These findings suggest that focal brain aedema may have some role in the pathogenesis of an excessive secretion of ANP and BNP during the subacute phase of SAH.

Usually, dementia, gait disturbance and urinary incontinence are an integral part of the clinical presentation of normal pressure hydrocephalus (NPH). However, NPH with transient visual cognitive disorders has not been reported previously. We herein describe an extremely rare case of NPH that presented with transient visual cognitive disorders and long lasting visual memory disturbances that subsided after CSF shunting. A 38-years-old man developed transient prosopagnosia, topographical disorientation, color vision disturbance, and visual objective agnosia that progressed over 5 years. Magnetic resonance images showed ventriculomegaly with ischemic lesions in the paraventricular deep white matter. ECD-SPECT showed a reduction of the cerebral blood flow (CBF) in the periventricular deep white matter. Three months after CSF shunting, the radiological findings normalized with dramatic improvement of the extremely rare symptoms.

The purposes of this review are to clarify the effect of hypothermia therapy on focal cerebral ischemia in rats, and to consider the relevancy of its application to human focal cerebral ischemia. Since 1990, 26 reports confirming the brain-protecting effect of hypothermia in rat focal cerebral ischemia models have been published. Seventy-four experimental groups in these 26 reports were classified as having transient middle cerebral arterial occlusion (MCAO) with mild hypothermia (group A; 43 groups), permanent MCAO with mild hypothermia (group B; 14 groups), permanent MCAO with deep hypothermia (group C; 8 groups) and transient or permanent MCAO with mild hyperthermia (group D; 9 groups). The results were evaluated as the % infarct volume change caused by hypothermia or hyperthermia compared with the infarct volume in normothermic animals. The effectiveness was confirmed in 36 (83%) of the 43 groups in group A, 10 (71%) of the 14 in group B, and six (75%) of the eight in group C. The infarct volume of eight of the nine groups in group D was markedly aggravated. The percent infarct volume change was 55.3%+/- 27.1% in group A, 57.6%+/- 24.7% in group B, 60.8%+/- 45.5% in group C, and 189.7%+/- 89.4% in group D. For effective reduction of the infarct volume, hypothermia should be started during ischemia or within 1 h, at latest, after the beginning of reperfusion in the rat transient MCAO model. However, it is not clear whether this neuroprotective effect of hypothermia can also be observed in the chronic stage, such as several months later. Keeping the body temperature normothermic in order to avoid mild hyperthermia seems to be rather important for not aggravating cerebral infarction. Clinical randomized studies on the efficacy of mild hypothermia for focal cerebral ischemia and sophisticated mild hypothermia therapy techniques are mandatory.

BACKGROUND: Subarachnoid hemorrhage (SAH) often causes a prolongation of the corrected QT (QTc) interval during the acute phase. The aim of the present study was to examine independent risk factors for QTc prolongation in patients with SAH by means of multivariate analysis. METHOD: We studied 100 patients who were admitted within 24 hours after onset of SAH. Standard 12-lead electrocardiography (ECG) was performed immediately after admission. QT intervals were measured from the ECG and were corrected for heart rate using the Bazett formula. We measured serum levels of sodium, potassium, calcium, adrenaline (epinephrine), noradrenaline (norepinephrine), dopamine, antidiuretic hormone, and glucose. RESULTS: The average QTc interval was 466 +/- 46 ms. Patients were categorized into two groups based on the QTc interval, with a cutoff line of 470 ms. Univariate analyses showed significant relations between categories of QTc interval, and sex and serum concentrations of potassium, calcium, or glucose. Multivariate analyses showed that female sex and hypokalemia were independent risk factors for severe QTc prolongation. Hypokalemia (<3.5 mmol/l) was associated with a relative risk of 4.53 for severe QTc prolongation as compared with normokalemia, while the relative risk associated with female sex was 4.45 as compared with male sex. There was a significant inverse correlation between serum potassium levels and QTc intervals among female patients. CONCLUSION: These findings suggest that female sex and hypokalemia are independent risk factors for severe QTc prolongation in patients with SAH.

BACKGROUND: The authors recently reported that nuclear accumulation of basic fibroblast growth factor (bFGF) demonstrated a significant correlation with recurrence of pituitary adenomas. The current study sought to determine whether nuclear bFGF accumulation was a predictor of survival in patients with astrocytic tumors. METHODS: The authors examined 52 patients with primary astrocytic tumors. Immunohistochemical assays for bFGF, fibroblast growth factor receptor 1 (FGFR1), and proliferating cell nuclear antigen were performed. Immunoreactivity of bFGF in nuclei was recorded in terms of the bFGF nuclear index (NI), which was calculated as the percentage of tumor cells with nuclear immunoreactivity. Western blot analysis of bFGF in nuclear fractions was performed. RESULTS: The bFGF NI had a mean value of 35.1% and was < 30%(low NI) in 27 patients and >or= 30%(high NI) in 25 patients. In all cases, FGFR1 immunoreactivity was observed in the cytoplasm but not in the nucleus. Western blot analysis indicated that the nuclear fractions from tumor specimens with high NI contained high-molecular-weight bFGF. Univariate analyses showed that age, tumor histology, gender, and bFGF NI were significantly correlated with patient survival. Multivariate analyses demonstrated that NI had the greatest influence (P = 0.0073) on survival rate, compared with age (P = 0.0083) and gender (P = 0.0492). Compared with low NI, high NI was associated with a relative risk of 3.292. CONCLUSIONS: The findings of the current study suggest that bFGF NI may be a useful predictor of survival in patients with astrocytic tumors.

Vascular endothelial growth factor (VEGF) is known to be a mediator of angiogenesis and vascular permeability. A cystic component and haemorrhage are often found in pituitary adenomas. We assessed the VEGF expression based on immunohistochemical examinations in 48 pituitary adenomas. All the adenomas showed some VEGF immunoreactivity mainly in the cytoplasm of tumour cells. Of the 48 adenoma-cases, 16 cases had a strong VEGF immunoreactivity, 26 cases had a moderate one, and 6 cases had a weak one. On the MR images, a cystic component was found in 16 cases (33.3%), and a haemorrhage was found in 18 cases (37.5%). The VEGF immunoreactivity had a significant relationship with the cystic component but not the haemorrhage, size, recurrence, or HE classification. These findings suggest that VEGF plays any potential role in the pathogenesis of cystic formation in pituitary adenomas.

The aim of this study was to assess the subcellular localization of basic fibroblast growth factor (bFGF) and fibroblast growth factor receptor 1 (FGFR1) in pituitary adenomas. We studied 61 patients who had primary pituitary adenomas and underwent operation. The immunohistochemistry for bFGF, FGFR1, and MIB-1 was examined in paraffin-embedded tissues. The bFGF immunoreactivity in the nucleus was recorded as the bFGF nuclear index, which was calculated as the percentage of tumor cells with the bFGF immunoreactivity in the nuclei when more than 1000 tumor cells were examined. Recurrent adenomas were found in 7 patients during follow-up periods ranging from 8 to 134 months (mean, 57.2). The recurrent adenomas had significantly larger mean bFGF nuclear indices (74.8 +/- 28.8%) than the nonrecurrent adenomas (25.4 +/- 32.1%, P = 0.0003). The bFGF nuclear index also correlated significantly with the maximum tumor diameters and the invasiveness to the cavernous sinuses (Knosp grade) in the adenomas. The cytoplasmic FGFR1 immunoreactivity was inversely correlated (P < 0.02) with maximum tumor diameter. Neither cytoplasmic bFGF, cytoplasmic FGFR1, nor MIB-1 staining index showed any relationship with the recurrence of pituitary adenomas. These findings suggest that the nuclear accumulation of bFGF plays an important role in the progression of pituitary adenomas without its receptors.

Propionibacterium acnes are gram-positive pleomorphic rods that grow under an anaerobic condition. They are the most frequent inhabitants of sebaceous glands of skin, hair follicles, mouth, upper respiratory tract, and as a frequent contaminant in laboratory cultures. Propionibacterium acnes is an underestimated but significant cause of postneurosurgical infection, especially in the presence of foreign bodies such as shunt systems. We present a rare case with a postoperative subdural empyema in which the only pathogen isolated was Propionibacterium acnes. In our case, the clinical course was atypically rapid. The most effective antibiotic therapy for Propionibacterium acnes infections has not been established. However, high dose penicillin in combination with surgical drainage and removal of foreign bodies is recommended as the treatment of choice.

Although pituitary adenomas often recur, a reliable predictor for their recurrences has not yet been established. The aim of this study is to assess the utility of the nuclear accumulation of basic fibroblast growth factor (bFGF) as a predictor for the recurrence of pituitary adenomas. We studied 64 patients who had primary pituitary adenomas and underwent operations. The immunohistochemistry for bFGF and MIB-1 was retrospectively examined in paraffin-embedded tissues. The bFGF immunoreactivity in the cytoplasm was assigned one of four grades and the bFGF immunoreactivity in the nucleus was recorded as the bFGF nuclear index (NI), which was calculated as a percentage of tumor cells with the bFGF immunoreactivity in the nuclei in more than 1000 tumor cells. Recurrent adenomas were found in 7 patients during follow-up periods ranging from 8 to 134 months (mean: 57.3). Kaplan-Meier analysis demonstrated that high bFGF NI (>30%) correlated with poor recurrence free rate (p < 0.02). We assessed the relative contribution of bFGF NI to recurrence free by using multivariate (Cox's proportional hazards model) analyses with variable factors. Multivariate analysis showed that only bFGF NI was a potential predictor of recurrence free, independent of all other variables. High bFGF NI (>30%) had a relative risk of 8.9, with a 95% confidence interval of 1.0-74.9 (p < 0.05). We suggest that the bFGF NI may be a potentially useful predictor for the recurrence of pituitary adenomas.