- 著者
- 宮田 悠 中原 一郎 太田 剛史 松本 省二 定政 信猛 石橋 良太 五味 正憲 坂 真人 岡田 卓也 西 秀久 園田 和隆 高下 純平 渡邉 定克 永田 泉
- 出版者
- 一般社団法人 日本脳卒中の外科学会
- 雑誌
- 脳卒中の外科 (ISSN:09145508)
- 巻号頁・発行日
- vol.44, no.2, pp.145-150, 2016 (Released:2016-06-07)
- 参考文献数
- 13
- 被引用文献数
- 11 10
We report a case of repeated cerebral infarction caused by internal carotid artery (ICA) dissection triggered by an elongated styloid process, a form of Eagle syndrome. A 41-year-old man presented with sudden, mild left hemidysesthesia. Magnetic resonance imaging (MRI) revealed a small acute cerebral infarction in the right parietal cortex and insular cortex. Magnetic resonance angiography and digital subtraction angiography (DSA) revealed a right-sided ICA dissection distal to the carotid bifurcation. Idiopathic carotid artery dissection was suspected, and the patient was prescribed aspirin and observed. However, 5 months after the initial cerebral infarction, he had a second episode of left hemiparesis and confusion accompanied by occlusion of the right ICA. Because the area of impaired perfusion in the right hemisphere was greater than that suggested by the diffusion-weighted images of head MRI and clinical status was worse than expected, we performed acute revascularization with aspiration of the thrombus and stenting to treat the carotid dissection. Recanalization with thrombolysis of cerebral infarction (TICI)-grade IIB was achieved. Computed tomographic (CT) angiography combined with analysis of bony structures revealed close proximity of the right ICA and an elongated styloid process with its tip directed toward the dissection. In an angiographic suite, a dynamic cone beam CT was performed with the head of the patient variedly rotated and tilted; the carotid artery dissection appeared to be triggered by the elongated styloid process. Resection of this process was performed to prevent recurrence of the cerebral infarction. Under the guidance of a navigation system, the elongated styloid process, which was located ventral to the anterior belly of the digastric muscle, was cut 3 cm from the tip. The patient was discharged on postoperative day 8 without medical problems, and no recurrence was observed for 12 months after the surgery.
【背景】脳卒中受け入れ病院では、組織的なチーム医療提供体制の整備が不可欠如である。申請者は、脳卒中のチーム医療をICTで支援する<タスカル/TQM (Total Quality Management)プログラム>を開発してき。【目的】日本の約15-30施設に<タスカル/TQMプログラム>を導入し、 導入前後の診療への影響を評価し、様々な病院での<タスカル/TQMプログラム>の有効性とそれに関連する因子解明する。【予想される結果と意義】病院の状況に即した<タスカル/TQMプログラム>の運用方法が明らかとなることで、様々な病院での脳卒中の診療プロセスの改善に貢献できる。
- 著者
- 関川 千鶴子 松本 省二
- 出版者
- 日本診療情報管理学会
- 雑誌
- 診療情報管理 : 日本診療情報管理学会誌 (ISSN:18837972)
- 巻号頁・発行日
- vol.31, no.2, pp.46-52, 2019-12