Trial of a new operative method for recurrent chronic subdural hematoma

A new operative method for treating recurrent chronic subdural hematoma is presented. This method consists of complete obliteration of the subdural hematoma cavity and conversion of the hematoma cavity into epidural space. The procedure was carried out in three patients with recurrent chronic subdural hematoma, all of whom made a complete recovery.

Contralateral pterional approach for carotid-ophthalmic aneurysm: usefulness of high resolution metrizamide or blood computed tomographic cisternography

Four carotid-ophthalmic aneurysms were treated through a contralateral pterional approach. Three of these aneurysms were clipped successfully. Because awareness of the size and shape of the optic chiasm is crucial for the success of this approach, we used metrizamide or blood cisternography with a high resolution computed tomographic scanner. With this technique, the shape of the optic chiasm was delineated before operation to make certain that the prechiasmatic space was large enough for the aneurysm to be approached.

[Subdural hematoma from arterial rupture -mechanism of arterial rupture in minor head injury]

Five cases of subdural hematoma from arterial rupture (SDH-AR) are described and other 39 reported cases are reviewed. The average age of the patient is 59 and male to female ratio is 2:1. Fifty two percent of the patients have history of recent head injuries most of which are trivial. A very few patient have initial loss of consciousness. Approximately half of the patients with history of head trauma have long lucid interval (average of 7 days). Those patients without history of head trauma have spontaneous onset of the symptoms and some of the have acute onset of headache and loss of consciousness, simulating cerebrovascular accident. Natural history of the SDH-AR is progressing deterioration of the symptoms, resulting in coma and death. Skull fracture is seldom demonstrated in the patients with SDH-AR. Angiography shows and extracerebral avascular mass over the cerebral convexity with marked midline shift. In 3 cases including our 2 cases, extravasation of the contrast medium from the cortical artery is observed and this is a useful finding for making diagnosis of this disease. Computerized tomography reveals high density extracerebral mass with remarkable mass effect. Craniotomy discloses subdural clot and spurting arterial rupture from a branch of the cortical artery around the Sylvian fissure. In some cases, subarachnoid hemorrhage is observed but in none of the cases, cerebral contusion or laceration is present. It is presumed that the mechanism of the arterial rupture is gliding movement of the brain within the skull upon injury, tearing an arterial twig with dural attachment. Hypertension, arteriosclerosis and brain atrophy may be important contributing factors to this mechanism. Pseudoaneurysm of the cortical artery caused by closed head injury is also associated with this mechanism and may explain delayed sudden onset of the symptoms in some patients with SDH-AR.

Superior and inferior vena cava flow velocity in patients with anomalous pulmonary vein connection

The superior and inferior vena cava flow velocities (SVC and IVC flow velocities) of 3 patients with anomalous pulmonary vein connection were recorded with the Doppler flowmeter catheter. The cases consisted of a patient with partial anomalous pulmonary vein connection to the SVC (Case 1), one with total anomalous pulmonary venous connection to the SVC (Case 2), and one with partial anomalous pulmonary vein connection to the IVC (Case 3). The SVC and IVC recordings of these patients were compared with those of 10 normal subjects, 20 patients with atrial septal defect and 150 patients with other heart diseases. The SVC and IVC flow velocities in the latter group of 180 patients showed a biphasic pattern, having systolic (S) and diastolic (D) waves, the peak S wave occurring around midsystole. In Cases 1 and 2, the SVC flow velocity showed a markedly delayed peak S wave, similar to the pattern of the pulmonary vein flow velocity; this pattern was also seen in the IVC flow velocity in Case 3. This abnormal pattern could be useful in diagnosing anomalous pulmonary vein connection.

Tadpole of the clawed frog, Xenopus laevis, as an experimental intermediate host of Angiostrongylus cantonensis

Frogs and toads, as paratenic hosts, are known to be sources of human angiostrongyliasis. The present investigation was carried out to examine the role of the tadpole as an experimental intermediate host. First-, second-, and third-stage larvae were found in tadpoles of Xenopus laevis from the 1st, 14th, and 18th days, respectively, after exposure to the first-stage larva of Angiostrongylus cantonensis. Third-stage larvae collected from a frog which had metamorphosed from an exposed tadpole reached maturity and oviposited in an albino rat. This is the first demonstration that a vertebrate, the tadpole of X. laevis, can serve as an experimental intermediate host of A. cantonensis.

Systolic time intervals in progressive muscular dystrophy

Indirect systolic time intervals corrected for heart rate were measured at rest, during, and immediately after the isometric handgrip exercise in 70 patients with progressive muscular dystrophy, and these were compared with the values of normal subjects. Those with dystrophy included 47 patients with Duchenne type, 19 with limb girdle type and 4 with facioscapulohumeral type, and each type was subdivided into 2 groups by the severity of the skeletal muscle involvement: 1) mild group, included patients who were still able to walk, 2) severe group, included those who were restricted to wheel chair or confined to bed. Over a half of the patients of the severe Duchenne type group had a longer pre-ejection period (PEP), shorter left ventricular ejection time (LVET), and larger PEP/LVET ratio at rest than the normal group. Increased PEP/LVET ratio during and after isometric handgrip exercise was observed in the severe group of Duchenne type. The patients with limb girdle type, and facioscapulohumeral type showed no significant difference in values of the systolic time intervals at rest and during handgrip exercise compared with the normal subjects. The measurements of resting and exercise systolic time intervals may be useful for clinical recognition of latent left ventricular functional impairement in subjects with progressive muscular dystrophy.

Homovanillic acid in human cerebrospinal fluid.--Its concentration gradient and reduced levels in patients with epilepsy

The homovanillic acid (HVA) concentrations in the lumbar cerebrospinal fluid (CSF) were determined in 38 epileptic and 39 control patients. The mean concentration of HVA was 23.9 ng/ml +/- 2.8 SEM for the epileptic group and 30.2 ng/ml +/- 2.1 SEM for the control group, respectively. Thus, HVA was significandly reduced in the patients with epilepsy compared with the controls. The mean HVA in the female patients was higher than in the male patients in both groups but this failed to reach statistical significance. There was no apparent relationship between the degree of reduced HVA concentration and other clinical indexes of the epilepsy (age, type and frequency of seizures, and anticonvulsant medication). For the determination of concentration gradient of HVA three fractions of the spinal CSF were obtained from 11 patients. A pronounced gradient of HVA concentration was found with a ratio of 1 : 1.46 : 1.97 for the first, second and third fractions. This suggests that a standardized conditions for collecting CSF should be employed to study HVA levels in humans.

Neuroepithelial Cyst of the cerebellar vermis

A cyst located in the cerebellar vermis and causing obstructive hydrocephalus is described. The wall of the cyst was lined with ciliated and non-ciliated cuboidal epithelial cells which were completely invested by a basement membrane.