The present study was carried out to clarify the anatomical changes of lumbar intervertebral discs by aging. Anterior height, posterior height, anteroposterior diameter of intervertebral discs were measured on 512 normal plain lateral radiographs of lumbosacral spine. And the indices of disc wedging and relative disc height were calculated. There was a cephalocaudal gradient of increase in the indices of disc wedging in all age groups. The indices of relative disc height were constant at all lumbar levels. These suggest that the lower disc is more wedge shaped and the height of discs changes in the constant ratio with that of vertebral body.
Aging* ; Humans ; Intervertebral Disc* ; Spine

A K+-channel blocker, 4-aminopyridine(4-AP) increases neurotransmitter release from motor nerve terminals and has been shown to restore neuromuscular transmission in the myasthenic syndrome. It has been reported that the intravenous injection of 4-AP in the myasthenic patients caused many central adverse effects including anxiety and restlessness, but did not affect the blood pressure. The aim of this study was to observe the effect of intracerebroventricularly administered 4-AP on the blood pressure and to elucidate the mechanism of the action in urethane-anesthetized rabbits. Intracerebroventricular(icv) 4-AP produced pressor effects in a dose-dependent fashion, but intravenous(iv) 4-AP of the same dose did not altered the blood pressure. Tetraethylammonium, a K+-channel blocker which differs from 4-AP structurally, had little effect on the blood pressure, but 3,4-diaminopyridine, another derivative of the aminopyridine, produced pressor effect similar to 4-AP. The pressor effect of icv 4-AP was not affected by the treatment with iv phenoxybenzamine and chlorisondamine, and in bilateral adrenalectomized rabbits. These results suggest that the 4-AP pressor effect is not related to the periphral sympathetic nerve nor adrenal gland. The pretreatment with icv phentolamine and prazosin did not altered the 4-AP pressor. However, the icv 4-AP pressor effect was significantly attenuated by the treatment with icv yohimbine, and significantly potentiated by the treatment with icv clonidine. The treatment with icv diltiazem markedly inhibited the icv 4-AP pressor effect. It is concluded that 4-AP-sensitive K+-channels in rabbit brain might play a role in the regulation of blood pressure and that the 4-AP pressor effect is closely related to the central alpha2-adrenoceptors and L-type calcium channels.
4-Aminopyridine* ; Adrenal Glands ; Anxiety ; Arterial Pressure* ; Blood Pressure ; Brain ; Calcium Channels, L-Type ; Chlorisondamine ; Clonidine ; Diltiazem ; Humans ; Injections, Intravenous ; Neurotransmitter Agents ; Phenoxybenzamine ; Phentolamine ; Prazosin ; Psychomotor Agitation ; Rabbits ; Tetraethylammonium ; Yohimbine

We report a case of pseudoaneurysm formation after aneurysmal clipping. An aneurysm, which was located on the beginning of orbitofrontal artery, was clipped and wrapped with Surgicel(R) and fibrin glue. Four weeks later, an enlarged aneurysm was detected at the same site on postoperative angiography. We could not find a new aneurysm in the second operation except inflated wrapping region. And clip had been slipped from the original aneurysmal neck. So we concluded that a new aneurysm was a pseudoaneurysm made with surgicel and fibrin glue. And it had been formed from continuous minor leakage caused by slipped clip.
Aneurysm* ; Aneurysm, False* ; Angiography ; Arteries ; Fibrin Tissue Adhesive ; Neck

Although the incidence of intracranial multiple aneurysms are not low, the occurrence of multiple aneurysms more than three developing on the ipsilateral carotid artery is quite rare. We present a patient with five aneurysms on the left internal carotid artery. Four aneurysms arising from the left internal carotid artery underwent microsurgical clipping and wrapping, and remnant superior hypophyseal artery aneurysm was treated by using coil embolization. Incidence and risk factors for management of multiple aneurysms were investigated with the literature review.
Aneurysm ; Arteries ; Carotid Arteries ; Carotid Artery, Internal ; Humans ; Incidence ; Risk Factors

The authors introduced a new approach for clipping of the incidental aneurysm of the middle cerebral artery (MCA) and reported the clinical results. We retrospectively reviewed 26 patients with 27 incidental MCA aneurysms who were treated from January 2010 to December 2012. All clippings were performed through a small temporal craniotomy and linear skin incision. Follow-up imaging showed complete occlusion of 26 aneurysms (96.3%), residual neck in one (3.7%). In one case, residual neck of the aneurysm did not grow on serial follow up. In one of 26 cases (3.8%), approach-related complication was retraction injury of the temporal cortex. Two patients developed postoperative infarction on the MCA territories due to vasospasm and on the cerebellum due to unknown causes. These were not approach-related complications. Operation time was 95 min-250 min (mean 143 min). There were no complications of temporal muscle atrophy, scar deformity, paresthesia, or pain around the scalp incision and frontalis palsy. This approach offers good surgical possibilities and little approach related morbidity in the clipping of incidental MCA aneurysms.
Aneurysm* ; Atrophy ; Cerebellum ; Cicatrix ; Congenital Abnormalities ; Craniotomy* ; Follow-Up Studies ; Humans ; Infarction ; Middle Cerebral Artery* ; Neck ; Paralysis ; Paresthesia ; Retrospective Studies ; Scalp ; Skin* ; Temporal Muscle

OBJECTIVE: To report an observational investigation of small high attenuated foci in computed tomography (CT) scan followed by brain parenchymal catheterization. METHODS: From January 2011 to March 2015, we retrospectively reviewed the 381 patients who had undergone brain catheterization in our clinic and enrolled the patients who had newly developed high attenuation foci in the postoperative CT scans. The brain CT scans were reviewed about the lesion location, Hounsfield Unit (HU) and the time of appearance. RESULTS: Twenty seven of 381 patients had high attenuation foci in CT scans after the procedure. The location of high density lesions was as follows: parenchyma in 9 (33.3%) cases, ventricle in 5 (18.5%), combined in parenchyma and ventricle in 13 (48.1%). The lesions were identified in the catheter tract in parenchymal type, and catheter-lodged frontal horn or choroid plexus in ventricular type. We could not find the calcific foci before the catheter removal, and those were found after removal in all cases. The time of appearance after the removal was variable from 0 to 14 days (mean 4.2, median 3). The regular rules of HU change in CT scans were not found as times go on. CONCLUSION: The high attenuation foci in CT scans were bone dust originated from skull during operation. Although these lesions did not make troubles, we should clean the operation field before the insertion of brain catheter and we may use another material, like Surgicel to seal up the burr hole instead of bone dust in the end of operation.
Animals ; Bone Transplantation ; Brain* ; Calcinosis ; Catheterization* ; Catheters* ; Choroid Plexus ; Dust ; Horns ; Humans ; Retrospective Studies ; Skull ; Tomography, X-Ray Computed

The aim of this study was to evaluate the clinical effect of a continuous infusion of urokinase in cerebral stoke patients who were late admitted over 6 hours after onset. From January to December in 2008, acute cerebral stroke patients (n=143) treated with intravenous urokinase infusion (Group I, n=93) or not (Group II, n=50) after 6 hours and within 72 hours of stroke onset were reviewed. Continuous intravenous infusion of urokinase was done for 5 days. The clinical outcome for each patient was evaluated by using the modified National Institutes of Health Stroke Scale (NIHSS) on admission and on the day of discharge. The NIHSS score was decreased at discharge compared with admission in the urokinase treatment group (Group I; from 4.8+/-2.2 to 3.8+/-1.9; p=0.002). There was an improvement in the patients who initiated urokinase treatment within 24 hours from stroke onset in Group I (from 5.1+/-1.9 to 3.9+/-1.5; p=0.04). In patients with initiated urokinase treatment within 24 hours from stroke onset, intravenous urokinase infusion could be an effective modality in acute ischemic stroke patients admitted later than 6 hours after onset.
Brain ; Humans ; Infusions, Intravenous ; National Institutes of Health (U.S.) ; Stroke ; Urokinase-Type Plasminogen Activator

The pathogenesis of juxtafacet cysts is closely related to degenerative instability of the lumbar spine and degenerative changes in the ligamentum flavum and the facet joint. A 56-year-old man presented with severe right thigh pain and numbness for 1 month after a laminar fracture of the L4 spine. Magnetic resonance imaging revealed a heterogenous cystic mass surrounding the facet joint between the fourth and fifth lumbar vertebrae on the right side. Conservative therapy was unsuccessful and the lesion was removed by surgical decompression alone without fusion. The histological examination showed a fragmented, cystic wall-like structure composed of myxoid degenerative tissue without lining epithelium. Here we present this case of a ganglion cyst that appeared to be associated with facet joint instability.
Decompression, Surgical ; Epithelium ; Ganglion Cysts ; Hypesthesia ; Ligamentum Flavum ; Lumbar Vertebrae ; Magnetic Resonance Imaging ; Spine ; Synovial Cyst ; Thigh ; Zygapophyseal Joint

This article aimed to investigate the incidence rate and possible risk factors for catheter-induced hemorrhage (CIH) after brain parenchymal catheterization. Between January 2011 and March 2013, 381 patients (572 punctures) who underwent brain parenchymal catheterization were retrospectively evaluated. All patients were checked by computerized tomography scan for the detection of hemorrhage within 48 hours after catheter insertion. CIH was defined as any evidence of new hemorrhage on the post-procedural computerized tomography scan. The incidence rate and the possible risk factors were analyzed by surgeon (4 different surgeons performed the procedures), characteristics of the catheter device, and patient background. Of 381 patients, 572 punctures were performed and CIH developed in 122 puncture cases (122/572, 21.3%). The risk factors related to CIH were Glasgow Coma Scale (GCS) score < or =8 (p<0.01) and prothrombin time international normalized ratio (PT INR) > or =1.3 (p=0.038). The amount of hemorrhage was minimal without additional operations. A low GCS score and high PT INR are implicated as potential risk factors for CIH after brain parenchymal catheterization. Careful and delicate operative technique can help to reduce postoperative complications in these patients.
Brain ; Catheterization ; Catheters ; Cerebral Hemorrhage ; Drainage ; Glasgow Coma Scale ; Hemorrhage ; Humans ; Incidence ; International Normalized Ratio ; Postoperative Complications ; Prothrombin Time ; Punctures ; Retrospective Studies ; Risk Factors

Computerized tomography angiography (CTA) and magnetic resonance angiography (MRA) have been frequently used as non-invasive methods for the evaluation of cerebral vessels. The use of an invasive therapeutic method, transfemoral carotid angiography (TFCA), has also recently increased. The complication rate after TFCA is reported to be 0.9 % to 4%, and it is continuously decreasing. We experienced 2 patients who underwent TFCA as a diagnostic tool. The embolic type of cerebral infarction, which occurred within 30 hours, was diagnosed with performing diffusion weighted MRI (DW-MRI). One patient developed temporary dysphasia and motor weakness, but the patient improved after 2 days. The other patient presented with an altered mentality and motor weakness with some permanent deficits. TFCA is a less invasive method for treating cerebral vessels, and because this is a popular therapeutic modality, the frequency of complications will increase. Clinicians should bear in mind that complications may occur when performing TFCA and so they should be prepared to deal with them.
Angiography ; Aphasia ; Cerebral Infarction ; Diffusion Magnetic Resonance Imaging ; Humans ; Magnetic Resonance Angiography ; Ursidae