著者

Takahiro OTA Shogo DOFUKU Masayuki SATO

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.69-72, 2022-12-31 (Released:2022-04-01)

参考文献数

11

被引用文献数

2

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Posterior inferior cerebellar artery (PICA) variations are well recognized; however, their mechanisms have not been well understood. Primitive lateral basilovertebral anastomosis (PLBA) was described in 1948 by Padget and is one of the embryological transient longitudinal channels in the hindbrain. This study reports a PICA aneurysm associated with PLBA. A 48-year-old man presented with subarachnoid hemorrhage. Cerebral angiography showed a 3.6-mm fusiform aneurysm with a bleb of the left PICA just at the origin of the PICA from the vertebral artery. Furthermore, a direct anterior inferior cerebellar artery (AICA) -PICA anastomosis parallel to the basilar artery was revealed. This direct anastomosis between the AICA and PICA is explained by the partial persistence of PLBA. Variations in the three cerebellar arteries and vertebrobasilar junction can be caused by persistence of PLBA.

著者

Masayuki Ueda Marie Tsunogae Hiroshi Saito Takeya Suzuki Takahiro Ota

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.5621-20, (Released:2020-09-19)

参考文献数

14

被引用文献数

4

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A 24-year-old female patient was admitted for a right frontal intracranial hematoma with an uncal herniation due to a ruptured arteriovenous malformation and therefore underwent emergency surgery. Neuroimaging revealed left-sided midbrain notching against the tentorium, indicating Kernohan's notch phenomenon. She denied experiencing any short-term neurological deficits but right-sided delayed hemiparkinsonism developed 18 months later. Dopamine transporter tracer uptake was severely reduced in the left striatum, suggesting nigrostriatal degeneration secondary to Kernohan's notch. Uncal herniations are potentially fatal, but surgery can save the patient's life and improve the functional outcomes. Clinicians should therefore be aware of delayed hemiparkinsonism as a rare complication of Kernohan's notch phenomenon.

著者

Kiyoshi Shikino Tsutomu Mito Yoshiyuki Ohira Daiki Yokokawa Yota Katsuyama Takahiro Ota Eri Sato Yuta Hirose Shiho Yamashita Shingo Suzuki Kazutaka Noda Takanori Uehara Masatomi Ikusaka

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.0085-22, (Released:2022-07-05)

参考文献数

39

被引用文献数

5

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Objective Difficult patient encounters (DPEs) are defined as encounters with patients causing strong negative feelings in physicians. In primary care settings, DPEs account for approximately 15% of visits among outpatients. To our knowledge, this is the first epidemiological study of DPEs in Japan. Methods We conducted a survey of 8 physicians (5.0±2 years of clinical experience) who examined first-visit patients ≥15 years old with clinical symptoms at the Department of General Medicine in Chiba University Hospital and 4 community hospitals over a 2-month period since December 2015. Materials We evaluated 10-Item Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10) scores (DPE ≥31 points; non-DPE ≤30 points) and patient age, sex, and presence of psychological or social problems. Results The valid response rate was 98.9% (94/95) and 98.4% (189/192) in the university and community hospitals, respectively. The percentage of DPEs was 39.8% (37/93) and 15.0% (26/173) in the university and community hospitals, respectively; the percentage of DPEs was significantly higher at the university hospital than at the community hospitals (p<0.001). The proportion of patients with psychosocial problems was significantly higher in the DPE group than in the non-DPE group (93.7% vs. 40.4%, p<0.001). Conclusion Our findings were similar to those reported in primary care settings in other countries in community hospital outpatient and general internal medicine departments, where patients are mostly non-referrals, although the values were higher in university hospital general medicine departments, where patients were mostly referrals. Patients involved in DPEs have a high rate of psychological and social problems.

著者

Shogo DOFUKU Daisuke SATO Rika NAKAMURA Shotaro OGAWA Seiei TORAZAWA Masayuki SATO Takahiro OTA

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0164, (Released:2022-10-13)

参考文献数

30

被引用文献数

4

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Middle meningeal artery embolization (MMAE) for chronic subdural hematoma (CSDH) is a novel, minimally invasive treatment. The indications and treatment practices for MMAE are variable and remain controversial. This study aimed to evaluate a strategy involving sequential MMAE after burr hole surgery for treating recurrent CSDH. We performed a retrospective analysis of data from consecutive patients who had undergone MMAE using liquid embolic agents within approximately 2 weeks after burr hole surgery for recurrent CSDH from September 2020 to March 2022. We analyzed patient characteristics, procedural details, CSDH recurrence after MMAE, surgical rescue, and complications. Six of the nine patients who underwent MMAE for CSDH recurrence were male, and the median age was 85 (range, 70-94) years. Five of the nine patients were being administered antithrombotic agents. The median duration between the burr hole surgery and MMAE procedure was 10 (range, 3-25) days. Anterior and posterior convexity branches were targeted for embolization using low-concentration N-butyl cyanoacrylate (NBCA), and the abnormal vascular networks with a cotton wool appearance disappeared after embolization in all cases. The NBCA distribution was observed by high-resolution computed tomography during the procedure; in three of nine cases, the NBCA penetrated not only the MMA but also the inner membrane. No recurrence, surgical rescue, or complications were observed in any patient during the median follow-up period of 3 months. As a minimally invasive treatment for recurrent CSDH, sequential MMAE after burr hole surgery may be a safe and effective option for preventing recurrence.

著者

Shogo DOFUKU Masayuki SATO Takashi AOKA Rika NAKAMURA Kenta OHARA Takahiro OTA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.10, pp.191-195, 2023-12-31 (Released:2023-06-26)

参考文献数

31

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We report a rare case of isolated internal carotid artery occlusion complicated by central retinal artery occlusion that was successfully treated with mechanical thrombectomy for internal carotid artery occlusion. A 59-year-old man visited the emergency room because of right monocular blindness. Magnetic resonance imaging showed multiple acute small embolic infarctions in the right frontal lobe, and magnetic resonance angiography revealed right internal carotid artery occlusion without the associated occlusion of the circle of Willis, which indicates the patency of the anterior and middle cerebral arteries. An electrocardiogram showed atrial fibrillation. Therefore, we performed mechanical thrombectomy with a stent retriever under continuous manual aspiration with a balloon-guiding catheter and confirmed complete recanalization, anterograde flow in the right ophthalmic artery, and retinal brush. The procedure was completed without complications, and the patient noticed an improvement in visual acuity immediately after the procedure. When a patient with atrial fibrillation complains of monocular blindness, it is important to consider internal carotid artery occlusion due to cardioembolism, to perform an examination promptly, and to consider early treatment, including mechanical thrombectomy.

著者

Shota Fukuda Hiroyuki Watanabe Masao Daimon Yukio Abe Akihiro Hirashiki Kumiko Hirata Hiroshi Ito Masumi Iwai-Takano Katsuomi Iwakura Chisato Izumi Takayuki Hidaka Toshinori Yuasa Kazuya Murata Satoshi Nakatani Kazuaki Negishi Kazuhiro Nishigami Tomoko Nishikage Takahiro Ota Akihiro Hayashida Konomi Sakata Nobuhiro Tanaka Satoshi Yamada Kazuhiro Yamamoto Junichi Yoshikawa

出版者

日本循環器学会

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.76, no.5, pp.1177-1181, 2012 (Released:2012-04-25)

参考文献数

27

被引用文献数

27 67

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Background: The recently developed real-time 3-dimensional echocardiography (RT3DE) is a promising imaging method to quantify cardiac chamber volumes and their functions in clinical practice. However, normal reference values of RT3DE parameters have not been fully investigated in a large, healthy Japanese population. Methods and Results: This study consisted of 410 healthy subjects aged from 20 to 69 years who had a RT3DE at one of the 23 collaborating institutions. All subjects had no history of cardiac disease and no risk factors. The mean values in men and women were as follows: 50±12ml/m2 and 46±9ml/m2 for left ventricular (LV) end-diastolic volume index, 19±5ml/m2 and 17±4ml/m2 for end-systolic volume index, 61±4% and 63±4% for ejection fraction, 64±12g/m2 and 56±11g/m2 for mass index, 23±6ml/m2 and 24±6ml/m2 for left atrial (LA) maximum volume index, 10±3ml/m2 and 10±3ml/m2 for minimum volume index, and 58±6% and 58±6% for percent volume change. LV sizes decreased with age, whereas LV mass index did not change. LA sizes slightly increased with age. Conclusions: This multicenter investigation determined normal reference values for LV and LA sizes, and their functional parameters on RT3DE in a large, healthy Japanese population. The results of the present study support the use of RT3DE for the diagnosis and management of cardiovascular disease. (Circ J 2012; 76: 1177-1181)