著者

星山 栄成 高野 雅嗣 竹川 英宏 宍戸 宏行 永山 正雄 小野 一之 平田 幸一

出版者

一般社団法人 日本神経救急学会

雑誌

Journal of Japan Society of Neurological Emergencies & Critical Care (ISSN:24330485)

巻号頁・発行日

vol.31, no.2, pp.69-73, 2019-08-23 (Released:2019-08-24)

参考文献数

11

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A 42-year-old male patient was admitted to our hospital because of generalized convulsive status epilepticus (GCSE), disturbance of consciousness, and shock. He had cardiopulmonary arrest after arrival our hospital, but he was return of spontaneous circulation as soon as cardiopulmonary resuscitation. He had disseminated intravascular coagulation (DIC) and multiple organ dysfunction. From the time of admission, we managed about the patient's breathing, circulation, body temperature. We also administrated sodium valproate 400mg, levetiracetam 1,000mg daily, and continuous use of midazolam to status epilepticus. In addition, he underwent continuous renal replacement therapy because of acute renal failure. The electroencephalogram showed scattered delta waves. Brain MR images showed hyper-intense lesions at bilateral pallidum and thalami, which led to a diagnosis of hypoxic encephalopathy associated with long-term GCSE. On day 13, he started tracking our fingers with his eyes. On day 34, he was able to obey commands and he was transferred to the general ward. GCSE is known to exhibit various organ dysfunctions. In this case, there was a history of epilepsy and had developed on GCSE, but as a result of the clinical examination, it was considered epilepsy-related organ dysfunction because the cause of multiple organ dysfunction was not clear.

著者

岩崎 晶夫 高嶋 良太郎 鈴木 圭輔 竹川 英宏 鈴木 綾乃 鈴木 紫布 平田 幸一

出版者

一般社団法人日本脳神経超音波学会

雑誌

Neurosonology:神経超音波医学 (ISSN:0917074X)

巻号頁・発行日

vol.29, no.1, pp.8-12, 2016 (Released:2016-06-24)

参考文献数

29

被引用文献数

1

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Purpose: An increased prevalence of patent foramen ovale (PFO) has been reported in patients with migraine with aura compared with non-migraine subjects. This study aimed to investigate the prevalence of PFO in Japanese patients with migraine. Methods: Fifty-four consecutive patients with migraine were recruited from the headache outpatient clinic of our department. Migraine was diagnosed according to the International Classification of Headache Disorders, second edition. Patients were divided into migraine with aura (MWA) and migraine without aura (MWOA) groups. Transcranial ultrasound was performed, while contrast agent was injected intravenously with the Valsalva maneuver. PFO was diagnosed if micro-embolic signals in the right middle cerebral artery were identified soon after injection of contrast agent and Valsalva load release. Results: No significant differences in patient characteristics were observed between the MWOA group (n=22) and MWA group (n=32). The prevalence of PFO was 46.3% among all migraine patients, 56.3% in the MWA group, and 31.8% in the MWOA group. Patients with MWA thus tended to show a higher prevalence of PFO compared to those with MWOA (p = 0.077). Conclusion: The tendency toward an increased prevalence of PFO in the MWA group in this study suggests a possible association between MWA and PFO.

著者

西平 崇人 鈴木 圭輔 竹川 英宏 中村 利生 岩崎 晶夫 平田 幸一

出版者

日本神経学会

雑誌

臨床神経学 (ISSN:0009918X)

巻号頁・発行日

vol.54, no.10, pp.819-823, 2014-10-01 (Released:2014-10-24)

参考文献数

17

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症例は45歳男性である.後頭部痛と吐き気の後,左方向への傾きが出現した.神経学的には左へのtruncal lateropulsion以外に異常はなかった.頭部MRIでは左延髄下部外側に急性期梗塞をみとめ,臨床・画像所見から左椎骨動脈解離による機序が考えられた.第6病日に右第10胸髄以下の温痛覚障害,左顔面発汗低下,左縮瞳が出現し,頭部MRIでは梗塞巣が拡大していた.脊髄小脳路の障害によりtruncal lateropulsionが,外側脊髄視床路の最外側部の障害により胸髄以下の温痛覚障害が出現したと推察された.本症例は延髄外側の臨床症状と障害部位との関連を理解する上において貴重な症例と考えられた.

著者

竹川 英宏 塚原 由佳 平田 幸一

出版者

日本神経治療学会

雑誌

神経治療学 (ISSN:09168443)

巻号頁・発行日

vol.34, no.3, pp.199-203, 2017 (Released:2017-10-14)

参考文献数

20

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Ischemic stroke, accounting for approximately 60% of all strokes, is classified into lacunar infarction, atherothrombotic brain infarction, cardiogenic cerebral embolism and others. Lacunar infarction and atherothrombotic brain infarction are mainly caused by arterial thrombus and cardiogenic cerebral embolism results from venous clot formation. In patients with acute ischemic stroke, neurological symptoms should be frequently assessed by NIH stroke scale (NIHSS) in order to perform thrombolytic therapy with recombinant tissue–type plasminogen activator (rt–PA). NIHSS is a simple scale for assessing neurological symptoms, which can be reliably performed by nursing staff. Blood pressure lowering therapy is basically not required in acute ischemic stroke ; however, blood pressure should be kept below 180/105mmHg and repeated blood pressure monitoring is needed, when intravenous rt–PA is considered.Because recurrence and complicating diseases are not rare in acute ischemic stroke, in addition to vital sign monitoring, careful attention should be given to Cushing phenomenon, worsening of neurological signs, infection such as pneumonia, deep vein thrombosis, fall, convulsion and abnormal respiration. Assessment of swallowing function, including repetitive saliva swallowing test and modified water swallow test, and oral care are effective in preventing pneumonia. To achieve a favorable outcome of patients with acute ischemic stroke, the cooperation of all the medical staff involved in stroke medicine is needed. Particularly, appropriate nursing care is essential in detailed observation and management of patients with acute ischemic stroke.

著者

江幡 敦子 竹川 英宏 大門 康寿 小林 祥泰

出版者

獨協医科大学

雑誌

Dokkyo journal of medical sciences (ISSN:03855023)

巻号頁・発行日

vol.33, no.1, pp.105-110, 2006-03-25

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脳梗塞の早期治療は重要だが,超急性期のtissue plasminogen activator (t-PA)の他に,早期治療の有効性は証明されていない.われわれは,t-PA適応のないアテローム血栓性梗塞の早期治療の有効性について検討した.対象はJSSRS脳卒中急性期患者データベースに登録された127例のアテローム血栓性梗塞で,発症から当院到着までを発症一来院時間とし,発症3〜6時間の早期来院,6時間以降の非早期来院に分類し,退院時のmodified Rankin Scale (mRS)およびNIHSS改善度を求めた.退院時mRSに差はなかったが,NIHSS改善度はそれぞれ1.9±3.5,1.6±6.4であり,早期来院で有意に改善した.近年,"Brain Attack"の重要性が唱えられているが,t-PA適応に外れた場合でも早期に来院,治療をすることの重要性の一部を裏付けたものと考えられた.