Intracranial aneurysms associated with arteriovenous malformations

✓ Nine cases of intracranial aneurysm associated with cerebral arteriovenous malformation (AVM) were found in a total of 140 patients with cerebral AVM (6.4%). Radical operation was performed for both angioma and aneurysm in eight cases and for aneurysm only in one case. The suitability of surgical treatment of both aneurysm and angioma is discussed.

Brain tumor with ipsilateral cerebral hemiatrophy in children

A series of six cases of cerebral tumor with ipsilateral cerebral hemiatrophy, including four cases admitted at our institute, were studied. Various common clinical features were noted in these six cases. The mechanism whereby ipsilateral hemiatrophy of the cerebrum arises from brain tumor has been discussed on the basis of symptomatologic and clinicopathologic findings noted in these 6 cases. 1) The onset of the disease was between 8 and 14 years of age with a mean of 11 years and 8 months; thus all the 6 patients being juvenile. 2) Presenting symptoms developed from 1 year and 2 months to 4 years before admission, with an average of 2 years and 1 month. The clinical course was therefore relatively chronic in every case. 3) Presenting symptoms were: decline of school work, hemiparesis and loss of consciousness. These symptoms were all progressive throughout the course. The principal symptoms were hemiparesis, hemihypoesthesia, character and emotional changes, deterioration of mental faculties and behavioral abnormalities. No sign or symptom of significant increase of intracranial pressure were observed in any case. 4) Ipsilateral cerebral hemiatrophy on the tumor side was evidenced by carotid angiography and by pneumoencephalography. 5) The common site of tumor in this series was the thalamus and its surrounding areas. 6) The tumor was invariably a pinealoma which seemed to be ectopic in every case. 7) The obtained histopathological findings suggest that the ipsilateral cerebral hemiatrophy was due to thinning of the cerebral cortex with degeneration and disappearance of ganglion cells, demyelination in the subcortex and destruction of axons. Our speculated mechanism of ipsilateral cerebral hemiatrophy due to thalamic tumor is that thalamic tumor causes the degeneration and disappearance of thalamic ganglion cells and nerve fibers, consequently occurring secondary Waller's degeneration of afferent and projecting fibers from the thalamus as well as retrograde degeneration of efferent fibers, thus resulting in an extensive atrophy of the cerebral cortex and subcortical tissue.

[Intraventricular extravasation of contrast media through ruptured intracranial aneurysm--report of two cases (author's transl)]

Extravasation of contrast media through ruptured intracranial aneurysm has been reported as an unusual case. Among the reported cases, a ventricular opacification is very rare, and in such cases, the prognosis is worst. In this paper, two cases with an aneurysm bleeding into the ventricular system were reported. Case 1. A 37-year-old woman was admitted because of severe headache and disturbance of consciousness. On admission, she was deeply comatose with decerebrate rigidity. Carotid angiogram taken 2 hours and 30 minutes after the attack revealed an aneurysm of the anterior communicating artery and an extravasation of contrast media into the lateral ventricle. Although a continuous ventricular drainage was instituted immediately, the patient died after five days. Case 2. A 33-year-old man suddenly developed severe headache with subsequent loss of consciousness. Two hours after the onset, the patient was admitted in comatose state. Angiography taken 3 hours after the attack demonstrated an aneurysm of the anterior communicating artery. The posterior horns of the lateral ventricles were opacificated. The patient died after 24 hours. In case 1, it was interesting that a remarkable stenosis of the cisternal portion of the internal carotid artery was demonstrated at the 2nd carotid angiography (lateral view), but the third carotid angiography taken after the continuous ventricular drainage showed a complete recovery from the stenosis. This stenosis was supposed to be caused by a compression of the internal carotid artery against the interclinoid ligamentum. Moreover, a rapid enlargement of the aneurysm was noticed by repeated angiography.

L-asparaginase and in vitro lymphocyte blastogenesis. Cell membrane alteration as possible mechanism of inhibitory effect

Lymphocytes which were incubated with Erwinia carotovaraL-asparaginase for only 1 hour were found to be markedly non-responsive to soluble antigens and moderately non-responsive to allogeneic cells or phytohaemagglutinin. When lymphocytes were exposed to antigen first, the inhibitory effect of L-asparaginase was markedly diminished, whereas exposure of lymphocytes to the enzyme prior to contact with antigen resulted in almost complete inhibition of blastogenesis. These observations suggest that L-asparaginase acts on the cell membrane causing impairment of antigen or mitogen binding, and that this is responsible for its inhibitory effect.