著者

Masaoki Hidaka Masaya Kumamoto Tatsuya Suenaga Ayaka Itsuji Yuka Kanazawa Seiji Goto Hitonori Takaba Takanari Kitazono

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.62, no.1, pp.113-118, 2023-01-01 (Released:2023-01-01)

参考文献数

16

被引用文献数

1

---

A 30-year-old man admitted with renal dysfunction (serum creatinine, 8.19 mg/dL) was diagnosed with immunoglobulin A nephritis through a renal biopsy. He was treated with intravenous methylprednisolone pulse therapy and urgent hemodialysis, and eventually, he underwent maintenance hemodialysis. On day 108, he developed amnesia. Magnetic resonance imaging revealed bilateral basal ganglia lesions. Wernicke encephalopathy (WE) was diagnosed based on decreased serum thiamine concentration (12.8 μg/dL; reference range, 24-66 μg/dL). Thiamine replacement therapy was initiated, but the Wernicke-Korsakoff syndrome persisted. Careful monitoring of thiamine is required in patients undergoing dialysis. In addition, patients with WE may exhibit bilateral basal ganglia lesions.

著者

Sohei Yoshimura Masatoshi Koga Shoichiro Sato Kenichi Todo Hiroshi Yamagami Masaya Kumamoto Ryo Itabashi Tadashi Terasaki Kazumi Kimura Yoshiki Yagita Yoshiaki Shiokawa Kenji Kamiyama Satoshi Okuda Yasushi Okada Shunya Takizawa Yasuhiro Hasegawa Tomoaki Kameda Satoshi Shibuya Yoshinari Nagakane Yasuhiro Ito Hideki Matsuoka Kazuhiro Takamatsu Kazutoshi Nishiyama Kyohei Fujita Teppei Kamimura Daisuke Ando Toshihiro Ide Takeshi Yoshimoto Masayuki Shiozawa Soichiro Matsubara Yoshitaka Yamaguchi Naoto Kinoshita Takayuki Matsuki Junji Takasugi Keisuke Tokunaga Kyoko Higashida Kazunari Homma Kazuomi Kario Shoji Arihiro Kazunori Toyoda for the SAMURAI Study Investigators

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-18-0067, (Released:2018-06-01)

参考文献数

27

被引用文献数

34

---

Background:We determined the 2-year long-term risk-benefit profile in patients with stroke or transient ischemic attack (TIA) receiving warfarin or direct oral anticoagulants (DOACs) for nonvalvular atrial fibrillation (NVAF) using a prospective, multicenter, observational registry in Japan.Methods and Results:NVAF patients within 7 days after onset of ischemic stroke/TIA were enrolled in 18 stroke centers. Outcome measures included ischemic and bleeding events and death in the 2-year follow-up period. We enrolled 1,116 patients taking either warfarin (650 patients) or DOACs (466 patients) at acute hospital discharge. DOAC users were younger and had lower National Institutes of Health Stroke Scale, CHADS2and discharge modified Rankin Scale scores than warfarin users (P<0.0001 each). Incidences of stroke/systemic embolism (adjusted hazard ratio, 1.07; 95% CI, 0.66–1.72), all ischemic events (1.13; 0.72–1.75), and ischemic stroke/TIA (1.58; 0.95–2.62) were similar between groups. Risks of intracranial hemorrhage (0.32; 0.09–0.97) and death (0.41; 0.26–0.63) were significantly lower for DOAC users. Infection was the leading cause of death, accounting for 40% of deaths among warfarin users.Conclusions:Stroke/TIA patients receiving DOACs for secondary prevention were younger and had lower stroke severity and risk indices than those receiving warfarin. Estimated cumulative incidences of stroke and systemic embolism within 2 years were similar between warfarin and DOACs users, but those of death and intracranial hemorrhage were significantly lower among DOAC users.