Cerebral aneurysm induced by giant cell arteritis: a case report

A rare case of giant cell arteritis inducing an aneurysmal dilatation in the peripheral branch of the middle cerebral artery was presented. The lesion was solitary and no extra-cerebral vasculature was involved. The literature of giant cell arteritis and of similar disorders involving the intracranial arteries was reviewed.

[Measurement of ventricular fluid pressure and brain tissue pressure in acute experimental communicating hydrocephalus (author's transl)]

Malabsorption of cerebrospinal fluid was made experimentally by the administration of neutral carbon black suspension into the lateral ventricles of 22 adult cats. The compartmental analysis of intracranial pressure at the intraventricular fluid and tissue pressure in the cerebral white matter was carried out in the early stage of the communicating hydrocephalus. Following results were obtained: 1) Cerebrospinal fluid pressure from the lateral ventricle was always significantly higher than that from the brain tissue during the process of ventricular expansion. 2) Water content in the cerebral white matter was correspondingly increased when the pressure difference with greater value in ventricular fluid pressure was maintained. However tissue water content was decreased definitively when such pressure values at two compartments were equalized due to augment of the tissue pressure component. 3) Decreasing of cerebral blood flow demonstrated in spite of relatively higher value of cerebral perfusion pressure. From these findings the authors speculated that a higher pressure in the ventricular system will be a driving force, by which the enlargement of ventricular system was induced.

[Surgical treatment of upper cervical chordoma (author's transl)]

Treatment of upper cervical chordoma is generally considered to be difficult one, because of serious troubles in supporting cranio-spinal junction after the surgery and at the recurrence. Clinical course of a 22-year-old man with chordoma originated from C2 vertebral body was reported, and the operation for such a condition were discussed with emphasis on the mode of craniovertebral fixation. Simple subtotal removal of the vertebral chordoma was carried out by posterior approach at the first operation. The second one was necessary fourteen months later for recurrence of the tumor. At the second surgery, in addition to the tumor removal, posterior fusion between the occipital bone and the C4 lamina was performed with homologous iliac bone graft, the center of which was kept slightly lateral to the lesion. This procedure of fixation not only enabled a sufficient removal of the residual tumor without loosening the bone graft, but also shortened the bedridden time following the subsequent operations for the recurrence, and finally resulted in an excellent recovery in his clinical symptoms. It is considered to be important to select the most adequate approach of surgery, including fixation technique, according to the extension of the tumor. We would emphasize the usefulness of paramedian posterior fusion of the cranio-spinal junction for such a condition of wide tumor invasion in the high cervical region.

The analysis of the intracranial pressure by the concept of the driving pressure from the vascular system

In order to understand the pathogenesis of intracranial hypertension, the intracranial pressure (ICP) has usually been studied with the concept of volumetric pressure. In other words, the ICP is held to derive from the volume of the intracranial elements (e.g., brain, blood and cerebrospinal fluid). In this paper, the authors propose a new concept of the so-called driving pressure and apply it to both clinical and experimental studies. The driving pressure (DP) consists of the combined pressure continuously exerted on the ICP by the arterial pressure (ADP) and venous pressure (VP) systems.

Adrenoleukodystrophy. A correlative analysis of computed tomography and radionuclide studies

A discrepancy in location of abnormality has been noted between computed tomography (CT) and radionuclide studies in patients with adrenoleukodystrophy (ALD). Radionuclide concentration occurs only in the periphery of the lesion or area of acute demyelinating process and no concentration is seen in the area af gliosis whereas gliosis appears as a low-density lesion in the CT scan. Forward migration of radionuclide uptake in the follow-up study is another characteristic feature of this disease.

The use of pulmonary scintigraphy for endobronchial foreign bodies

Pulmonary scintigraphy using 99mTc-MAA clearly demonstrated a perfusion defect in the entire left lung of an 11-month-old girl with endobronchial foreign body. Other initial examinations, including a chest roentgenogram, showed only minimal changes. Repeated pulmonary scintigraphy 24 hr after endoscopic removal of a peanut fragment from the left main stem bronchus demonstrated almost normal blood flow in the left lung. The well-known physiological explanation for diminished pulmonary blood flow due to endobronchial foreign bodies is as follows; alveolar hypoxia caused by hypoventilation due to bronchial check-valve obstruction leads to a pulmonary vasoconstriction with resultant diminution of the regional perfusion. Furthermore, the increase in alveolar pressure caused by bronchial check-valve obstruction may play a significant role in decreased pulmonary blood flow.

Orthopantomography of the cervical spine

The authors describe the application of orthopantomography to study of the intervertebral foramina of the cervical spine in patients with cervical spondylosis. Other structures such as the lateral mass of the cervical spine can be studied by altering the speed of the rotating film holder, which in two changes the width of the arch of the focal layer.

Spontaneous disappearance of a cerebral arteriovenous malformation in infancy. Case report

The authors report a case of the disappearance of an arteriovenous malformation in infancy, demostrated by follow-up angiography performed 7 months after the original angiograms. Some possible mechansims whereby a cerebral arteriovenous anomaly is thrombosed are discussed.

[Effect of generalized edema on blood flow distribution in the brain]

The correlation between increase in brain tissue pressure and cerebral blood flow distribution was studied in generalized brain edema induced by water intoxication in cats. Brain tissue pressure increased as the brain edema progressed. The intracranial vascular component was suggested to play a certain role in the volume buffering capacity at increased intracranial pressure. Transtentorial redirection of carotid blood flow observed in the early stages of water intoxication, is related to tissue pressure gradients. The meaning of tissue pressure gradients for blood flow distribution is discussed.

The single dye passage. A new technique for the study of cerebral blood flow distribution

A method is described which permits studying regional blood flow distribution throughout a given organ by injecting a dye into one artery supplying said organ and inducing circulatory arrest during the dye injection.