The occurrence of rebleeding a long time after the first hemorrhagic episode was not uncommon. Furthermore, the change in which hemisphere and the type of bleeding that occurred after the first episode suggested the difficulty encountered in the prevention of repeated hemorrhage.

No abstract

Objectives-To evaluate the influences of chronic alcohol consumption on brain volume among social drinkers, as it is well known that alcohol misusers have a high risk of brain shrinkage. Methods-Frontal lobe volumes on MRI were compared with the current alcohol habits of consecutive 1432 non-alcoholic subjects. Results-After adjusting for other variables, age was found to be the most powerful promoting factor for the shrinkage with a odds ratio of 2.8 (95% confidence interval (95% CI) 1.23-3.06) for each 10 years of age. Regarding alcohol habit, 667 of the subjects were abstainers, and 157, 362, and 246 of the subjects were light (average 88.2 g ethanol/week), moderate (181.2 g/week), and heavy (418.1 g/week) drinkers, respectively. Moderate alcohol consumption did not increase the incidence of frontal lobe shrinkage (odds ratio 0.98; 95% CI 0.73-1.33), whereas heavy drinkers were at a higher risk compared with abstainers (1.80; 1.32-2.46). The contributory rate of alcohol consumption for frontal lobe shrinkage was 11.3%. Conclusion-The brain tends to shrink physiologically with age. Heavy alcohol consumption seems to exaggerate this shrinkage in social drinkers. Moderate alcohol consumption does not seem to aVect brain volume. (J Neurol Neurosurg Psychiatry 2001;71:104-106)

Non‐traumatic intracranial arterial dissection has been accepted as a unique entity of ‘cerebral infarction in otherwise healthy young adults’, and is particularly prevalent in Western countries. A recent data collection and analysis have revealed additional clinical features. The nationwide study in Japan conducted in 1996 has provided new information on the natural history and current treatment of intracranial dissecting aneurysms in Japan. The incidence of symptomatic dissection was found to be much higher in the vertebrobasilar system than in the carotid system. The mean age of the patients was 51.3 years. Patients with carotid lesions were younger (mean 43.8 years). The male/female ratio was 2 : 1. Fifty‐eight percent of patients presented with subarachnoid hemorrhage. Recurrence was more frequent in patients with subarachnoid hemorrhage (14%) than in patients with no hemorrhage (4.2%). Common radiological findings were dilatation, ‘pearl and string’ sign and narrowing of the affected artery. Surgical treatment involved a variety of procedures including proximal occlusion, entrapment, wrapping and endovascular embolization. Patients with subarachnoid hemorrhage (61%) underwent surgical treatment more frequently than patients with no hemorrhage (17%). Good recovery was achieved in 64% of all patients. Outcome was better in patients with no subarachnoid hemorrhage compared with those with hemorrhage.

UMIN000009176.

A 47-year-old woman was admitted because of hypermenorrhea. Transvaginal ultrasonography revealed an ovarian tumor and myoma uteri, and total hysterectomy with bilateral salpingo-oophorectomy was performed. Histology revealed signet-ring cell carcinoma in the right ovary. In order to find out the primary site of this tumor, gastroendoscopy was performed after the operation, and showed a IIc lesion in the lower body of the stomach; biopsy specimens showed signet-ring cell carcinoma similar to that in the right ovary. Total gastrectomy revealed that the lesion was an early gastric cancer confined to the mucosa, but there was lymphatic invasion slightly beneath the muscularis mucosa, with regional lymph node metastasis. In the light of a review of the seven cases of early gastric cancer with Krukenberg tumor previously reported, lymphatic metastasis seemed to be the most likely pathway of ovarian metastasis in early gastric cancers.

was no history of trauma. A chest radiograph showed a left pleural effusion (fig 1). A plain computed tomographic (CT) scan showed a left pleural effusion with high density areas Abstract suspicious of blood. There was no evidence The case history is presented of a 61 year of an aneurysm. Numerous subcutaneous old man with von Recklinghausen's disease tumours were seen on the face, trunk, and who developed a spontaneous haemo-limbs. There were no abnormal neurological thorax. In spite of being asymptomatic findings although there was tachycardia for five days after drainage, he died as a (170/min) and the blood pressure was 120/ result of fatal sudden re-bleeding. The post 80 mm Hg. Atrial fibrillation was observed mortem examination showed dissection on the ECG and the haemoglobin level was and rupture of the left subclavian artery. 11.2 g/dl. Microscopically, disarrangement of An intercostal drainage tube was inserted and smooth muscle and decrease of elastic approximately 1000 ml of blood was removed. fibre was observed in the ruptured artery. After drainage the serous bloody discharge deHaemothorax in patients with von Reck-creased to below 100 ml per day. Radiologically linghausen's disease may require thora-there was no evidence of an increase in the cotomy, even if the condition of the patient pleural effusion. appears to be stable.Five days after admission he suddenly col- (Thorax 1997;52:577-578) lapsed and his blood pressure was unrecordable. Although cardiopulmonary resuscitation Keywords: haemothorax, von Recklinghausen's disease, was immediately performed, he died. Blood neurofibromatosis.did not flow out from the chest drainage tube. The chest radiograph taken two hours before cardiac arrest also showed no increase in the Von Recklinghausen's disease is transmitted by pleural effusion. an autosomal dominant gene and is charThe post mortem examination revealed acterised by multiple skin tumours and ab-about 4000 ml of blood in the thoracic cavity. normal cutaneous pigmentation. Benign The tumorous lesion with haematoma, about Department of schwannomas, osseous system involvement, 5 cm in diameter, in the apex was thought to five days after drainage but who died due to served at the ruptured portion. Neurofibromas sudden re-bleeding. The cause of arterial rup-were not seen at the ruptured portion. Hachioji Medicalture was different from those previously re-

Endovascular embolization of the middle meningeal artery was performed in two cases of refractory chronic subdural haematoma (CSDH) after repeated burr hole and irrigation surgeries. The embolization prevented expansion of the CSDH in both cases, and the haematoma disappeared completely in one case. The expansion of CSDH is considered to result from repeated bleeding from the macrocapillaries on the haematoma capsule. Embolization of the middle meningeal artery appears to be useful to eliminate the blood supply to this structure.