The present study deals with the factors affecting the prognosis in the acute stage of 29 cases with hypertensive thalamic hemorrhage diagnosed by CT scan. It was thought that the following factors were significantly related to the outcome of the patients who were unable to lead daily life, remained in vegetative state or died: (1) consciousness level was below 10 in the so-called 3-3-9 formula, (2) bilateral Babinski's signs were observed, (3) localization of the hematoma was all the thalamic nuclei type, (4) hematoma volume was above 10 ml, (5) the maximum dimension of hematoma was over 30 or 35 mm, maximum width over 30 mm, maximum length over 25 mm and maximum height over 30 or 40 mm, and (6) the ventricles were dilatated. The prognosis had no significant relationship with the age of the patients, the side of the hematoma, the presence or the absence of ventricular penetration of the hematoma, or the existence of midline shift. We believe that in the acute stage of hypertensive thalamic hemorrhage, the prognosis can be forecasted by neurological findings, accurate calculation of the hematoma volume and size, localization of the hematoma and presence or absence of ventricular dilatation as determined by CT scan.
SUMMARY The acute onset of symptoms of severe cervical radiculo-myelopathy in four patients with athetoid-dystonic cerebral palsy is reported. Neurological and radiological examination showed that the spondylotic changes of the cervical spine were responsible for new neurological deficits leading to the patients being bedridden. Dystonic-athetoid neck movements may cause excessive axial neck rotation as well as flexion and extension movements of the spine. These repetitive exaggerated movements may result in early degenerative changes of the vertebrae which may enhance the radiculo-myelopathy. The four patients were treated with an anterior discectomy with interbody fusion. They were bedridden pre-operatively but all have since been able to walk with or without a cane. It is concluded that early anterior decompression with interbody fusion is a treatment of choice for cervical spondylotic radiculo-myelopathy in association with athetoid cerebral palsy.Trauma as a cause of cervical spondylosis, with or without neurological deficits, has often been proposed. Reports allude to a causal relationship between movement disorders of the neck and the development of cervical spondylosis, but this relationship has not been clearly established. We have observed the acute onset of cervical radiculomyelopathy in four patients with athetoid-dystonic cerebral palsy. After myelography, all patients were treated surgically. Cse reportsCase 1 A 41-year-old woman with athetoid movements since the age of 10 years had undergone a complicated delivery with umbilical cord prolapse, and did not walk alone until the age of 4 years. When aged 40 years she first noted neck and shoulder pain with a numb feeling in the ulnar aspect of the hands. One month later she suddenly developed arm and shoulder pain bilaterally with weakness and tonic spasm of the legs. Since then she had been bedridden. She was referred to us 3 weeks later. She denied urinary or faecal incontinence throughout the course of her illness. Address Neurological examination revealed generalised athetoid-dystonic movements. No muscle atrophy was noted but she was barely able to extend her arms or to raise her legs from the bed. The right limbs were weaker than the left. She could not stand by herself. There was hypoalgesia in the distribution of C7-C8 bilaterally. Deep tendon reflexes were hyperactive throughout, and bilateral extensor plantar responses were elicited with occasional extensor spasms.Cervical spine radiographs showed a narrow canal (narrowest antero-posterior diameter, 11X5 mm at C3-C4 level) and narrowed disc space at the level of C3-C4. Myelography confirmed a disc protrusion with a partial block at the level of C3-C4. She underwent anterior discectomy with the removal of osteophytes, under the operating microscope. No interbody fusion was performed. Athetoid-dystonic movements were controlled with 2-25 g of levodopa daily. She regained strength in the arms and legs and stood at the 14th postoperative day. Two months after operation her neurological status...
The sagittal diameter of the cervical spinal canal on roentgenograms in normal adult Japanese aged 15 years or over, 505 males and 492 females, was investigated to define the normal distribution and lower limit. Lateral roentgenograms of cervical spinal canals were taken at a constant focus-film distance of 1.5 m. The mean ± SD magnification coefficient was 1.17 ± 0.02. The mean ± SD sagittal diameters of the cervical spinal canals at each vertebral level were: C-1, 21.0 ± 2.2 mm; C-2, 18.0 ± 1.7 mm; C-3, 15.8 ± 1.5 mm; C-4, 15.2 ± 1.5 mm; C-5, 15.3 ± 1.5 mm; C-6, 15.7 ± 1.5 mm; and C-7, 15.9 ± 1.4 mm. The lowest mean — 2 SD values were: C-1, 16.6 mm; C-2, 14.6 mm; C-3: 12.8 mm; C-4, 12.2 mm; C-5, 12.3 mm; C-6, 12.7 mm; and C-7, 13.1 mm. The smallest diameter was at the C-4 level, but there was no significant difference between values at the C-4 and C-5 levels. Males had significantly larger diameters than females (mean difference 0.8 mm) (p < 0.01). Younger subjects had greater diameters than older subjects. The incidence of spondylotic changes was 40.1% in subjects aged 50-59 years, 57.7% in those aged 60-69 years, and 76.6% in those aged 70-79 years. Males had a higher incidence than females. Os sification of the posterior longitudinal ligament was observed in 2.1% of all subjects. This study sug gests that patients with a sagittal diameter in the cervical spinal canal of less than 12 mm have a high risk of cervical myelopathy.
Visually evoked unit responses of the tectum were studied in the squirrel monkey. The results showed that the superior colliculus had a definite functional laminar organization. Units responding to diffuse light were found in the upper part of the stratum grineum superficiale, units having antagonistically segregated receptive fields in the middle portion, and units sensitive to moving objects in the lower portion as well as in the stratum opticum. Retinotopic projection was also observed. The pretectal region contained mainly "tonic-on" and "inhibitory" units. No specific localization was observed in the distribution of these units.
Two cases of moyamoya disease associated with persistent primitive trigeminal artery (PTA) are reported. The first patient was a 44-year-old man who experienced a sudden severe headache brought about by an intracerebral hematoma in the left temporoparietal lobe. Four-vessel study showed a right-sided PTA and moyamoya disease. The second patient was a 56-year-old woman with similar symptoms and a hematoma in the right temporoparietal lobe. Four-vessel study showed a left-sided PTA and moyamoya disease. Among the 212 PTA cases reported in the literature, none has been associated with moyamoya disease. Moreover, there are no cases of moyamoya disease among the 119 cases of persistent primitive hypoglossal artery (PHA), which is thought to be a vascular anomaly fundamentally similar to PTA. None of the 907 cases of moyamoya disease reported in Japan has been associated with either PTA or PHA. Nonetheless, the embryonic stage when PTA or PHA normally disappears partially overlaps that period when moyamoya-like vascular anomalies have been thought to arise. The possible developmental relationship between these two varieties of vascular abnormality is discussed.
The authors present 19 cases of cervical spondylotic myelopathy in patients with developmentally narrow canal treated by microsurgical anterior osteophytectomy with interbody fusion, with follow-up periods of 1 to 8 years (mean 38 months). Postoperatively, the lower limb function, evaluated by Nurick's six-grade classification, improved two or three grades in 16 cases, one grade in two cases, and remained unchanged in one case. The upper limb function, evaluated by the authors' own four-grade classification, improved two or three grades in 11 cases, one grade in seven cases, and remained unchanged in one case. No deterioration caused by the osteophytectomy was seen. During the follow-up period, spondylolisthesis appeared 31 months postoperatively in one patient and soft disc hernia occurred 66 months postoperatively in another; these two patients were treated by a second operation and cervical traction, respectively. The authors conclude that anterior osteophytectomy with interbody fusion is applicable as a surgical treatment of cervical spondylotic myelopathy even where developmental canal stenosis is present.
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