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PCNA (proliferating cell nuclear antigen) is said to be present specifically in the nucleus of proliferating cells. The PCNA labeling index (PCNA LI) of astrocytic tumors was measured and compared with histological types or prognosis. The specimens from 44 patients were fixed in a 10% formalin solution, and embedded in paraffin. The 3 microns-sections were stained immunohistochemically with anti-PCNA monoclonal antibody (PCIO, Novocastra) using an ABC method. The percentage of PCNA-positive-cells was determined by counting 2000 cells, and identified as PCNA LI. All of the PCNA-positive-cells showed diffuse nucleoplasmic staining. The averages of PCNA LIs in each pathological type were calculated and evaluated statistically. Although differences in averages of PCNA LIs among pilocytic, gemistocytic, fibrillary astrocytoma were not significant, there was a significant difference between anaplastic astrocytoma and glioblastoma. The relationship between PCNA LIs and the prognoses for 43 patients was studied. Forty-three patients were classified into 3 groups (over 22%, 7 to less than 22%, and less than 7%) according to PCNA LIs. The survival data in the 3 groups were analyzed, and differed significantly in the survival rates. Furthermore, twenty-three patients of anaplastic astrocytoma and glioblastoma were classified into two groups (over 22% and less than 22%). Likewise, the two groups differed significantly. In summary, pathological type and prognosis were closely related to PCNA LI in astrocytic tumors. Therefore, we thought measurement of PCNA LI would make it more possible to analyze clinically the proliferating activity of astrocytic tumors, and to care for patients more effectively.

A 37-year-old man had received cervical spinal-cord injury 20 years previously. Recently, he complained of progressive spastic gait and was shown to have fracture dislocation of the C5 vertebral body which compressed the spinal cord posteriorly. He also had a syrinx from the C5 to C2 vertebral level. Postoperatively, this syrinx disappeared after anterior decompression of the C4 and C5 vertebral bodies. Such a case as this has never been reported, and this case may give a suggestion for surgical treatment of syringomyelia, because it is very natural that the most reasonable treatment of any disease is removal of the cause.

A 58-year-old man was admitted to our hospital upon his request for an operation on a hemifacial spasm that had developed twelve years ago. The hemifacial spasm on the left side was the only positive neurological findings at the time of admission. However, a pre-operative neuroradiological examination revealed a meningioma originating in the falco-tentorial junction. Left neurovascular decompression was initially performed and was followed by the excision of the tumor through a right parietooccipital approach. The pathological diagnosis was meningothelial meningioma. The patient was discharged with no neurological deficit. There have been only a few reports on pineal meningioma and even now this type of tumor is considered to be rare. Some similar cases reported in the literature are reviewed. The clinical aspects, clinical features and the pathological entity are discussed.

A rare case of acute epidural hematoma of the posterior fossa caused by forehead impact is reported. This 36-year-old man fell from a truck and hit his face. He was conscious and was brought to our center 30 minutes after the injury. On admission, a contused wound of the right forehead was noticed. He was restless and had severe pain in the neck and upper extremities. Skull X-ray showed a linear fracture of the frontal bone and computed tomography (CT) scan was normal. He continued to be restless and sudden respiratory arrest and pupillary dilation occurred 10 hours after the admission. A CT scan revealed a lenticular high density area in the left posterior fossa which extended to the supratentorial region. The 4th ventricle was compressed and displaced to the right and also the quadrigeminal and ambient cisterns were not visualized at all. Immediate surgery disclosed a 30 g epidural hematoma of the left posterior fossa and the supratentorium and the clot was completely evacuated. The source of bleeding could not be identified. Opening of the dura revealed contusion in the occipital lobe. He died on the 17th postoperative day. The possible mechanism in the production of the posterior fossa hematoma in this case is discussed.

The authors recently operated on a boy four years of age with acute epidural hematoma showing an extravasation on the cerebral angiogram. The hematoma (hematoma volume 125 ml) was evacuated 7 hours after the head injury. The postoperative course was quite uneventful, and he was discharged a month after surgery without any neurologic deficits. The authors reviewed the literature and found 4 cases of acute epidural hematoma with extravasations in infants and children. In all cases the operative results were good. The age incidence and frequency of occurence overall for acute epidural hematomas, extravasations on cerebral angiograms and their mechanism, and the length of time from injury to operation were also discussed. It should be emphasized that, for acute epidural hematoma in infants and children, the early diagnosis and early surgery are essential to save the patients.

We describe a patient with established systemic lupus erythematosus (SLE) in whom an intracerebral hemorrhage developed secondary to a ruptured aneurysm of the lenticulostriate artery (LSA). A 24-year-old woman with a four-year history of SLE was admitted to the department of internal medicine of Iwate Medical University for the treatment of lupus nephritis in 1985. She suddenly complained of severe headache and nausea, and soon lost consciousness. The computed tomographic scan revealed intracerebral hemorrhage in the left front-temporal region and subarachnoid hemorrhage. Left common carotid angiography demonstrated a 3 X 3 mm aneurysm of the LSA and displacement of other LSAs and anterior cerebral artery. The incidence of intracerebral hemorrhage in SLE was about ten percent in the reported central nervous system SLE, and it seemed that the prognosis of SLE with intracerebral hemorrhage was poor. The mechanisms of the intracerebral hemorrhage and the aneurysmal formation in SLE seemed to be due to lupus angiitis, but without clinical, radiologic and pathologic correlation. In operation, a ruptured aneurysm without neck was found in LSA and extirpated. In the pathological study, there was transmural angiitis, which fibrinoid necrosis, elastic tissue disruption and infiltration of inflammatory cells were found. Inflammatory cells were chiefly lymphohistiocytic with some polymorphonuclear leukocytes. It seemed that pathologic studies confirmed transmural angiitis with secondary aneurysm formation.

We present a case of isolated fourth ventricle which developed after massive ventricular hemorrhage, due to a ruptured cerebral aneurysm. In an adult an isolated fourth ventricle seems to be very rare, also the symptom of unconsciousness and respiratory arrest and the rapid development in this case seemed very unusual. The aqueductal occlusion was considered to be related to the intraventricular hematoma which remained as clots over a 2-month-period of time. This case was a 57-year-old woman admitted to our hospital in a state of coma. CT showed a massive ventricular hematoma and right carotid angiogram showed an aneurysm of the anterior communicating artery. Bilateral ventricular drainage was performed because of progressive decerebrate rigidity. Since consciousness gradually arose to the Japan Coma Scale 3, clipping of the neck of the aneurysm was performed 25 days after onset. Premature rupture occurred during the operation. After surgery, CT Showed ring-like high densities due to the premature rupture of aneurysm in both lateral ventricles, and also in the fourth ventricle as well. Although the lateral ventricles drainage functioned effectively, the fourth ventricle showed remarkable gradual dilatation. The patient was stuporous, but respiratory arrest occurred suddenly 43 days after onset. Since it was considered that the intraventricular hematoma blocked the aqueduct, the same as in the outlet of the fourth ventricle and that the dilated fourth ventricle compressed the brain stem, the ventriculostomy was performed through suboccipital craniectomy. The cerebellar hemispheres showed remarkable swelling bilaterally, and no cerebrospinal fluid was found in the cisterna magna.(ABSTRACT TRUNCATED AT 250 WORDS)

A 43-year-old female was admitted showing abnormal feeling in the left eye region. Left facial hypesthesia and quadrantic hemianopsia of left eye were the detectable neurological findings. A plain skull x-ray film revealed a double floor and dilatation of the sella turcica. The tomogram of the sella turcica demonstrated a dilatation of superior orbital fissure. Caudocranial projection revealed a dilatation of foramen ovale. A computerized tomography scan revealed a slightly high density tumor which was enhanced slightly with a contrast medium in the parasellar region and left middle fossa. Carotid angiogram demonstrated the displacement of the left carotid fork to the upper and lateral direction. However, no other sign was found. The sinogram of cavernous sinus clearly demonstrated an indentation in the left cavernous sinus. The endocrinological tests were almost normal except for hyperprolactinemia. A trigeminal neurinoma and a pituitary tumor were suspected. The tumor was totally removed and was histologically diagnosed as a cavernous angioma. At operation it seems to be extracerebral in the middle fossa and originate in the cavernous sinus. Diagnostic problems endocrine findings and the origin are discussed.

The purpose of this paper is to obtain the correlation between CT scan findings and neurogenic gastrointestinal bleeding in hypertensive intracerebral hemorrhage. Fifty patients with hypertensive intracerebral hemorrhage were operated upon during past nearly 3 years in our clinic. Of these, 27 patients (54%) showed macroscopic gastrointestinal bleeding (GI-bleeding) demonstrated by stomach catheter after the onset of hypertensive intracerebral hemorrhage. GI-bleeding was about 46% in the survived patients and about 77% in the expired ones. Most patients revealed neurogenic GI-bleeding within 9 days (85.2%) and more than half of the cases (51.9%) in 4 to 6 days after the onset. Neurogenic GI-bleeding was frequently complicated in patients with disturbed consciousness, over 60 gram hematoma (particularly 60-80 gram hematomas), severe ventricular hemorrhage and right-sided hematomas. It was also exclusively observed in patients with extension of hemorrhage into the midbrain and recurring hypertensive intracerebral hemorrhage.

We tried to examine the growth pattern of meningeal gliomatosis (MG) by using an experimental MG model. C6 rat glioma cells (3 X 10(5)/0.1 ml) were injected percutaneously into the cisterna magna of rats. Seven days after inoculation, the brains and spinal cords were removed and processed for morphological observation. Light microscopic findings showed that numerous tumor cells had invaded the spinal cord parenchyma directly and/or via the Virchow-Robin spaces. In contrast, a small amount of tumor cells had spread horizontally on the surface of the spinal cord. By transmission electron microscopy, discontinuity of the basal lamina (of the marginal glia) was found, and some tumor cells were found to have protruded their processes into the spinal cord parenchyma. A basal lamina-like granular material was observed in the vicinity of these areas, indicating the breakdown of the basal lamina. Scanning electron microscopic findings further supported the speculation concerning the penetration of the pia mater by tumor cells through the small pores which had blunt margins. From these ultrastructural observations, we speculated that some chemical membranolytic factors might play an important role in MG.

Two patients who had cerebral aspergillosis with massive intracerebral hemorrhage were presented. Case I was a 59-year-old woman who had slight mental retardation. There was swelling in the left forehead, from which mucosal cysts of frontal sinus had been removed 2 years before her admission. She had a diagnosis of subdural abscess and radical operation was performed. Aspergillus was found in the abscess histologically. Three months after the operation, CT scan revealed multiple abscess in bilateral frontal lobe. When she lost consciousness suddenly 4 months after the operation, CT scan showed a huge intracerebral hematoma. Case 2 was a 16-year-old girl who suffered from immunological dysfunction caused by more than 6 months antibiotics-steroid treatment for pneumonitis. She lost her consciousness after complaints of severe headache. CT scan showed a heterogeneous high density area with severe brain edema in the left temporal lobe. The removal of hematoma was performed immediately. The level of her consciousness improved, but she died of the complication of DIC and renal failure 14 days after the hemorrhage. Autopsy revealed a number of aspergillomas in lungs, kidneys, gastrointestinal tract, liver and pancreas. Marked necrosis and a number of aspergillus hyphae which invaded and penetrated the wall of cerebral vessels were found in the brain tissue. It was presumed that such a huge intracerebral hematoma was caused by direct invasion and penetration into the brain of aspergillus from the blood vessels. The diagnosis of cerebral aspergillosis is made mainly by the pathological examination of the tissue obtained at surgery or autopsy.(ABSTRACT TRUNCATED AT 250 WORDS)

The authors described a case of multiple arteriovenous malformations of the left parietal lobe and the left cerebellar hemisphere, and presented a review of literature. A 42-year-old right-handed man was admitted to our Dept. of Neurosurgery on October 20, 1983, with left facial pain and occipitalgia. He had an episode of subarachnoid hemorrhage ten years ago, however, its etiology was not clear at neurological examination. This brief episode of pain began on the left side of his face about 9 years ago and has been gradually increasing. Although he has been treated with trigeminal nerve blocks several times, relapses were almost always evident within 6 months after those nerve blocks. On admission, there were no abnormal findings at neurological and physical examination. A CT scan with contrast medium infusion revealed two small AVMs on the left parietal region and on the left cerebellar hemisphere. A four-vessels cerebral angiogram confirmed the presence of two AVMs and fenestration of the left vertebral artery. The angiogram also revealed that his severe left trigeminal neuralgia had been caused by elongation of the anterior pontine segment of left SCA which was the main feeder of the cerebellar AVM. Two stages of surgical operations were carried out at two months interval. The first operation was total removal of the cerebellar AVM and microvascular decompression for the left trigeminal nerve. The second was total removal of the left parietal AVM. The postoperative course was uneventful, and angiographically the AVMs completely disappeared. The patient was discharged without any neurological deficits on March 11, 1984.(ABSTRACT TRUNCATED AT 250 WORDS)

A 67-year-old female was admitted to our hospital because of unconsciousness after severe headache on April 7, 1986. On admission, the patient was semicomatose with anisocoria and absence of light reflex. Computed tomography showed subarachnoidal hemorrhage with intraventricular clots. Right carotid angiogram revealed that the left anterior cerebral artery was filled from the right side through the anterior communicating artery and a saccular aneurysm in anterior communicating artery. On left-side carotid angiogram, neither the left internal carotid artery nor the intracranial arteries were visualized. She died on the 15th hospital day. Complete absence of the left internal carotid artery and hypoplasia of the left A1 portion were verified at autopsy. Sixteen cases of agenesis of the unilateral internal carotid artery have been associated with cerebral aneurysms in the literature. Absence of internal carotid artery was discussed in relation to aneurysm formation.

This case report deals with transverse sinus thrombosis accompanied by intracerebellar hemorrhage. A 33-year-old woman had sudden onset of headache, vomiting, and disturbance of consciousness. Computed Tomography (CT) scan showed left intracerebellar hematoma, while vertebral angiography revealed no visualization of the transverse sinus and cerebellar cortical veins on the left side. Evacuation of the intracerebellar hematoma along with decompression of the posterior fossa was carried out. Findings of the histopathological examination of the operation specimen showed the cortical veins to be filled with fresh thrombus and softened cerebellar parenchyma mixed with many small clots. Until now, cases such as hemorrhagic infarction in the cerebellum, due to transverse sinus thrombosis have not yet been reported. It is considered that there is much more collateral circulation in the infratentorial region rather than in the supratentorial region. This indicates that cerebellum hemorrhagic infarction rarely occurs due to transverse sinus thrombosis. In our case, the inflammation of the cortical veins (thrombophlebitis) was thought to have disturbed the collateral circulation in the cerebellum.

There are 5 reported cases of meningioma complicated by chronic subdural hematoma so far as we reviewed. Considering frequency of occurrence, association of meningioma and chronic subdural hematoma is very rare. Recently, we experienced with a case of convexity menigioma complicated by chronic subdural hematoma. The patient was a 61-year-old woman who complained of headache and numbness of the left hand. She received hysteromyomectomy 28 years before but had no past history of trauma of the head. She suffered from frequent profound pain in both orbits for one year, and she consulted a neighboring practitioner due to occurrence of numbness of the left hand and malaise. Then, CT scan revealed abnormalities, so that she was referred to our center. On admission, neurological oxamination revealed no abnormalities but plain X-ray film of the skull showed a round destruction in the right parieral bone. CT scan showed a round high density area of 3 cm in diameter in the right parietal region, this is markedly enhanced with contrast media. There is a crescent-shaped low density area extending forward from the high density area. The body of the right lateral ventricle is totally collapsed. Selective arteriography of the right external carotid revealed tumor stain in the parietal region. Therefore, under the diagnosis of association of chronic subdural hematoma and convexity meningioma, craniotomy of the right frontal, parietal and temporal regions was carried out and a meningioma of 10 g, and a subdural hematoma with its capsule touching the maningioma were entirely extirpated.(ABSTRACT TRUNCATED AT 250 WORDS)