Nō to shinkei = Brain and nerve
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In cerebral circulation, it is suspected that neurogenic or myogenic mechanism protect blood vessel and blood-brain barrier during sudden increase in arterial pressure. To discriminate metabolic mechanism from neurogenic and myogenic mechanism, complete cerebral venous occlusion model of cat was used to obtain high venous pressure. In twenty-one anesthetized cats, 0.3 ml of cyanoacrylate were injected into anterior part of SSS to occlude SSS and cortical vein. ⋯ Correlation between ICP and arterial diameter is obvious. The dominant mechanism of cerebral blood flow control is metabolic, not neurogenic and myogenic. Increase of ICP, dilatation of vein and dilatation of artery with increasing ICP are consistent with the theory.(ABSTRACT TRUNCATED AT 250 WORDS)
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Review Case Reports
[Ruptured cerebral aneurysm associated with coarctation of the aorta].
We present a 33-year-old female who had a ruptured aneurysm at the trifurcation of the right middle cerebral artery accompanied by coarctation of the aorta. The aneurysm was successfully clipped 15 hours after the attack of subarachnoid hemorrhage and approximately 3 months later the coarctation was surgically treated. Many authors reported that the incidence of cerebral aneurysm was higher in the patients with coarctation than the general population. ⋯ These findings suggested that the growth and rupture of aneurysm in the patient with coarctation are related to the hypertension and atherosclerosis. Treatment of the patients with intracranial ruptured aneurysm accompanied by coarctation should begin with the clipping of the aneurysm, and then the coarctation surgically repaired. If the aneurysm is unruptured coarctation should be repaired first, and then the aneurysm clipped.
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This paper reviews long-term follow-up studies of 78 hydrocephalic patients with myelomeningocele. Seventy-eight (95%) out of 82 patients with myelomeningocele had hydrocephalus. CT, MRI, CT cisternography, and monitoring of intracranial pressure (ICP) with infusion methods were performed to evaluate the indication of shunt insertion or shunt independency. ⋯ The mean value of Evans' index was 48% in this group. Six patients had progressive signs and symptoms of hydrocephalus and were shunted. ICP monitoring and studies of CSF dynamics revealed abnormal findings in ten out of 14 cases in spite of preservation of good intelligence.(ABSTRACT TRUNCATED AT 400 WORDS)
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The clinical picture of spinal epidural hematoma is usually characterized by the sudden onset of pain and acute paraplegia within a few hours. The reports of chronic spinal epidural hematoma above the lumbar level is extremely rare. Here we added one case whose hematoma was at cervical level. ⋯ Left vertebral angiogram showed that a part of posterior cerebral venous blood drained to cervical vertebral plexus. This finding suggested his epidural bleeding was venous in origin. Rupture of internal vertebral venous plexus that has no valves was considered as the source of spinal epidural hematoma.(ABSTRACT TRUNCATED AT 250 WORDS)
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38 autopsied cases of cerebral sinus-vein thrombosis (CSVT) in our institute were studied. In this study, special attention was paid for the evolution and fate of venous thrombus. 18 cases showed hemorrhagic infarction or intracerebral hematoma (group 1; G 1). In contrast, no cerebral parenchymal changes were observed in the other 20 cases (group 2; G 2). ⋯ This study suggested: (1) CV or DV occlusion may play an important role for the advent of cerebral parenchymal changes in CSVT. (2) Gradual thrombus evolution after the onset is one of possible causes of slow clinical deteoration after the onset. Therefore, prevention of these thrombus propagation with anti-platelet drugs or fibrinolotic therapy should be recommended for the treatment of CSVT. On the contrary, hyperosmolar agents and diuretics may produce potential risk of dehydration, and as a result, accelerate secondary thrombus extension.