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3 0 0 0 OA Arterial spin labeling MR perfusion image in differentiating metabolic encephalopathy from non-convulsive status epilepticus in a patient with generalized periodic discharges with triphasic morphology

著者
Hiroshi Oketani Takato Morioka Satoshi Inoha Kenji Miki Takafumi Shimogawa Nobutaka Mukae Ayumi Sakata Hiroshi Shigeto Koji Yoshimoto
出版者
JAPAN EPILEPSY SOCIETY
雑誌
Epilepsy & Seizure (ISSN:18825567)
巻号頁・発行日
vol.15, no.1, pp.59-66, 2023 (Released:2023-09-26)
参考文献数
17
被引用文献数
3
Introduction: Arterial spin labeling (ASL) magnetic resonance (MR) perfusion imaging is useful for diagnosing non-convulsive status epilepticus (NCSE) as it visualizes ictal hyperperfusion in epileptically activated areas.Case report: A 94-year-old woman presented with inability to communicate. An electroencephalogram revealed generalized periodic discharges with triphasic morphology. However, as her liver and kidney function were normal, it was difficult to distinguish metabolic encephalopathy from NCSE. ASL showed not only diffuse hypoperfusion in the cerebral parenchyma, instead of ictal hyperperfusion, but also marked appearance of arterial transit artifact in the major arteries, probably due to stagnant flow. The patient was therefore diagnosed with hyperammonemic encephalopathy (ammonia level 128 mg/dL) induced by constipation. Along with normalization of the ammonia level, the mental status and ASL findings improved.Conclusion: In this case, ASL helped visualize the decreased blood flow and velocity secondary to hypometabolism. The addition of ASL to conventional MR images may be useful in differentiating metabolic encephalopathy from NCSE, particularly in neuroemergency situations.

1 0 0 0 OA A Presenile Patient with Filar Lipoma Who Developed Tethered Spinal Cord Syndrome Triggered by Lumbar Canal Stenosis

著者
Hiroshi OKETANI Katsumi HARIMAYA Teruaki ONO Kazushige TERADO Satoshi INOHA Satoshi O. SUZUKI Takato MORIOKA
出版者
The Japan Neurosurgical Society
雑誌
NMC Case Report Journal (ISSN:21884226)
巻号頁・発行日
vol.10, pp.109-113, 2023-12-31 (Released:2023-04-21)
参考文献数
19
Lumbar canal stenosis (LCS) has been reported as a precipitating factor by which a tethered spinal cord, which is asymptomatic during childhood, develops into tethered cord syndrome (TCS) in adulthood. However, only a few reports on surgical strategies for such cases are available. A 64-year-old woman presented with unbearable pain in the left buttock and dorsal aspect of the thigh approximately 1 year ago. Magnetic resonance imaging showed cord tethering with a filar-type spinal lipoma and LCS due to the thickening of the ligamentum flavum at the L4-5 vertebral level. Five months after the decompressive laminectomy for the treatment of LCS, an untethering surgery was performed at the dural cul-de-sac at the S4 level. The severed end of the filum was elevated rostrally by 7 mm, and the pain subsided postoperatively. This case study shows that surgeries for both lesions should be indicated for adult-onset TCS triggered by LCS.