Antitumor activity against intracranial malignant teratoma by combination chemotherapy with cisplatin and etoposide was evaluated in experimental and clinical studies. A human teratoma cell line (Tera 2) was exposed in vitro to cisplatin and/or etoposide, after which cell growth inhibition and alterations of deoxyribonucleic acid (DNA) histograms were observed. The results indicated that a synergistic cytotoxic effect was achieved by use of both agents in combination. Four cases of recurrent intracranial germ-cell tumor (three malignant teratomas and one germinoma) were treated with cisplatin and etoposide. With this combination therapy, regression of the tumor was observed in all four cases (three complete and one partial), for a total response rate of 100%. During a follow-up period of 9 to 22 months, no recurrence or progression has been noted in three of these cases.

Fig. 1 Axial (A), coronal (B), and sagittal (C) computed tomography scans with contrast medium showing the destroyed petrous bone, the internal carotid artery and the aneurysm (arrow), which are exposed to the right middle ear, and a massive hematoma in the right middle ear. 578Neurol Med Chir (Tokyo) 50, 578¿580, 2010 AbstractA 60-year-old man presented with a rare case of pseudoaneurysm in the petrous internal carotid artery (ICA) caused by chronic otitis media manifesting as right otorrhagia after the earpick procedure. Computed tomography showed the destroyed petrous bone; the ICA and the aneurysm, which were exposed to the right middle ear; and a massive hematoma in the right middle ear. Right carotid angiography revealed a pseudoaneurysm arising from the ICA coursing through the middle ear. Two weeks later, the right ICA was trapped after external carotid artery-middle cerebral artery bypass surgery using a vein graft. A biopsy specimen was obtained from the middle ear and the histological diagnosis was inflammatory disease. Pseudoaneurysm often causes sudden massive aural bleeding. The appropriate management strategy may be exclusion of the pseudoaneurysm with revascularization to avoid leaving foreign material in the infected middle ear.

A 25-year-old woman presented with complaints of nausea and headache. She had been treated with a ventriculoperitoneal shunt for hydrocephalus when she was 7 months old. Her bilateral optic discs showed moderate atrophy. Right visual acuity allowed only perception of hand movement and left visual acuity was 0.02 (1.2). Computed tomography (CT) showed mild ventricular dilation but no periventricular lucency. Intracranial pressure (ICP) was not high when the shunt valve was punctured. Her visual acuity deteriorated 5 days after the consultation. She was referred again 8 days after the first consultation. The bilateral optic discs were completely pale. Both pupils were dilated on admission, and the bilateral direct light reflexes were absent. The patient could slightly detect only green light stimulus. CT showed moderate enlargement of the ventricle. ICP was 47 cmH 2 O when the shunt valve was punctured. Shuntgraphy showed obstruction of the shunt at the distal end of peritoneal catheter. Emergent total shunt revision was performed. She could detect dark stimulus and the still-dilated left pupil had recovered direct light reflex on the next day. The visual acuity was 0.01 (0.7) on the left 6 months after the operation, although she was blind in the right eye and the bilateral optic discs were completely pale. Visual loss associated with shunt failure remains a major morbidity in shunted congenital hydrocephalus. Early diagnosis and shunt revision may allow visual recovery.

A 73-year-old male presented with a glioblastoma that was detected at the initial stage in the developmental process. He suffered cerebral infarction. Follow-up magnetic resonance (MR) imaging showed no abnormality. Ten months later, he had transient right hemiparesis. Diffusion-weighted and fluid-attenuated inversion recovery (FLAIR) MR imaging showed a hyperintense area in the left frontal lobe. The diagnosis was cerebral infarction and antiplatelet drug treatment was begun. The patient's right hemiparesis subsided. Ten days later, right hemiparesis reappeared. Diffusion-weighted and FLAIR MR imaging showed an enlarged hyperintense area in the left frontal lobe. Three weeks after the onset of right hemiparesis, MR imaging revealed an irregular ring-enhanced mass lesion that had further increased in size. The diagnosis was brain abscess and antibiotic treatment was initiated. However, the lesion did not respond and had further enlarged 5 weeks after the onset of right hemiparesis. The lesion was partially removed and the histological diagnosis was glioblastoma with Ki-67 labeling index of 26%. After surgical treatment, the patient received irradiation of 60 Gy and chemotherapy with temozolomide. Follow-up MR imaging showed regrowth of the tumor and aggravation of edema. The rapid progression of the tumor ultimately resulted in the patient's death 12 months after the onset of right hemiparesis. Diffusion-weighted imaging is a good method for the early detection of glioblastoma.

Background and Purpose Pyramidal tract Wallerian degeneration has been detected on magnetic resonance imaging (MRI) as T 2 -weighted high-intensity areas. We analyzed the relation between the extent of brain stem Wallerian degeneration and activities of daily living (ADL) after supratentorial hemorrhagic stroke.Methods Twenty-six patients with supratentorial hemorrhage were examined on the coronal T 2 -weighted image of the pons 3 months or later after stroke, and the percentage of Wallerian degeneration in the pons was calculated. The patients were divided into three groups. In group A (n=6), MR films were taken 3 to 6 months from the onset, and the ADL assessment was done within 2 months from the MRI. In group B (n=ll), MR films were taken 3 to 6 months from the onset, and the ADL assessment was done within 10 months from the MRI (mean, 15.5 months from the onset). In group C (n=9), MR films were taken after 10 to 17 months (mean, 12.0 months) from the ictus, and the ADL assessment was done

A 66-year-old female with a 3-year history of left trigeminal neuralgia presented with an unusual left cerebellopontine angle meningioma associated with asymptomatic syringomyelia at the C2 to C4 levels diagnosed by magnetic resonance (MR) imaging. Two months after total tumor removal, the syrin gomyelia had diminished without shunting. MR images are useful as a basis for early diagnosis of syringomyelia.

Two patients with subarachnoid hemorrhage recovered consciousness after intrathecal baclofen administration using an implanted intrathecal baclofen pump delivering 50 mg per day using a simple infusion mode. Intrathecal baclofen resulted in significant reduction of spasticity 3 months after the implantation. Case 1 was reduced to a completely bedridden state with spasticity and could slightly move her fingers following commands. However, the patient could eat food and wash her face with minimal assistance at 3 months after the implantation, and could stand up in the parallel bars with assistance and speak several words at 8 months. Case 2 was in a completely bedridden state at 10 months after onset and could neither drink water nor follow instructions. However, the patient became oriented and could eat by herself within 3 to 4 weeks of implantation. She could walk with a cane and use the stairs with minimal assistance at 2 and 3 months after implantation. The patient could speak fluently within 6 months of implantation. Flatulence and dysuria happened during the screening test, but these symptoms were not repeated after implantation of a pump-catheter-system and continuous intrathecal baclofen infusion. Continuous intrathecal baclofen infusion caused both improvement in muscle tone and spasms and consciousness recovery from the vegetative state. This therapy is a strong candidate treatment for patients with spasticity and consciousness disturbance.

Sixteen pediatric patients with brainstem glioma were treated with a combination of interferon-beta, 1-(4-amino-2-methyl-5-pyrimidinyl)-methyl-3-(2-chloroethyl)-3-nitroso ure a hydrochloride (ACNU), and radiation therapy (IAR therapy). All patients received 1-1.5 million IU/day of interferon-beta intravenously for 1 week of each 6-week cycle. In addition, ACNU (2-3 mg/kg) was given on the 2nd day of each cycle. Conventional focal irradiation (1.5-2 Gy/day for 5 days to a total dosage of 40-60 Gy) was administered beginning on day 3. Patients underwent at least two 6-week cycles. Adverse effects included nausea, vomiting, and myelosuppression, but were mild and transient. Response to treatment was evaluated by the reduction in tumor size measured on postcontrast computed tomographic scans and magnetic resonance images. Responses occurred in 10 of 11 patients with the intrinsic type of brainstem glioma, including three complete and seven partial responses. Two of five patients with exophytic type gliomas partially responded. The median survival was 15.7 months, a remarkable improvement over the natural course of this disease. These results indicate that IAR therapy is a useful primary treatment for pediatric patients with brainstem gliomas.