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A questionnaire about convulsions and other adverse events after vaccination was sent to doctors who administered a diphtheria-pertussis-tetanus (DPT) vaccine (the first dose) or a measles vaccine between April 1, 1995 and December 31, 1997 in Takamatsu City to children with convulsions. DPT and measles vaccines were administered to 300 and 339 such children, respectively. Many of them had febrile seizures, the last of which had occurred before more than 1 year. Among them, 175 cases were administered with DPT and 180 with measles vaccine. There were recurrences of febrile convulsions after immunization in 2 (1.1%) of the cases given DPT and 3 (1.7%) of those given measles vaccination. According to the data of the Monitoring System for Adverse Events Following Immunization (the Ministry of Health and Welfare of Japan), the incidence of convulsion after immunization in healthy children between April 1, 1996 and September 30, 1997 was 0.4% after the first dose of DPT vaccination and 0.3% after measles vaccination. In comparison, the incidence was higher in children who had had febrile convulsions before more than one year. Especially, the rate of convulsions after measles vaccinations was significantly higher (p < 0.05) in children with febrile convulsions. These results suggest that the measles vaccination should be administered with caution to the children with previous febrile convulsions.

A form of disseminated necrotizing leukoencephalopathy and the shaping process of calcification was observed by CT scan in a 9-year-old boy with intracranial germ cell tumor who had received systemic combined chemotherapy, brain radiation, and intraventricular administration of methotrexate and bleomycin for the meningeal involvement of tumor cells. He was admitted to our hospital complaining of hemiparesis and gait instability. Hormonal examination revealed abnormality of high serum HCG and testosterone. An initial CT scan showed a ring enhancing lesion in the right side of the caudate head. He received a course of irradiation, which was 5,000 rads locally, and combined chemotherapy using cisplatin, vinblastine and bleomycin for ectopic germ cell tumor. Unfortunately, consecutive CT examinations revealed that the tumor recurred with hormonal abnormality and ventricular seeding of tumor cells. Therefore, the patient received two courses of irradiation, which were each 3,000 rads locally, and intraventricular administration of methotrexate and bleomycin via an Ommaya tube at about one year intervals. However, 23 months after the first irradiation, a serial CT scan revealed an abnormal diffuse low density area in the deep white matter of the frontal lobe, predominantly the paraventricular region. Furthermore, 31 months after the first irradiation, a serial CT scan revealed fine and granular calcification in the above mentioned lesion. The Hounsfield number of high density areas was 103.00 in the round calcification of the left parietotemporal lobes. Finally, 34 months after the first irradiation, a serial CT scan revealed large round calcifications in the left temporal lobe and right occipital lobe. The patient died three years and six months after the initial symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

This is an autopsy case report of a 52-year-old woman with a brain abscess presenting as an intracerebral gas shadow on CT scan. She was admitted to our facility in June 1977, with disorientation and motor weakness of the right upper extremities. CT scan revealed two separate mass lesions in the frontal and occipital lobes on the left side. She was diagnosed as having metastatic carcinoma, and was treated by tumor removal, radiation therapy, and intraneoplastic local chemotherapy. Seventeen months later, she was readmitted with decreased mental activity, hemiconvulsion of the right side and high fever. CT scan revealed a peculiar round gas shadow on the left side of the temporal lobe. Ventricular drainage produced a cloudy cerebrospinal fluid with a protein concentration of more than 400 mg/dl and a leucocyte count of 138,200. An anaerobic culture of the ventricular cerebrospinal fluid revealed Escherichia coli. At that time, the lateral ventricle was irrigated several times with antibiotics. Unfortunately, however, she died one year after readmission. An autopsy was performed shortly after death, at which time serial coronal sectioning of the brain confirmed the CT scan findings presenting as an intracerebral gas shadow, and further demonstrated extension of the brain abscess from the left temporal lobe to the temporal horn of the lateral ventricle. The lesion in the left temporal lobe included yellowish pus with partially brownish capsules. A gas-containing brain abscess confirmed by CT scan and autopsy is rarely seen. The Hounsfield unit obtained from the abscess cavity by utilizing serial CT scan sometimes represents a condition requiring urgent treatment for brain abscess.