著者

Noriko HIRAO Takashi MORISHITA Kazuya SAITA Tomohiro TAKAGI Shinsuke FUJIOKA Tooru INOUE

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.8, no.1, pp.445-450, 2021 (Released:2021-08-06)

参考文献数

15

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Dystonia is a movement disorder that has various treatment options. For primary dystonia, stereotactic procedures such as deep brain stimulation (DBS) have demonstrated favorable outcomes. For secondary dystonia, however, the treatment outcomes remain inconclusive, and the heterogeneous etiological background is considered to contribute to the poor outcomes of the disease. Here, we report a rare pediatric case of post-stroke focal dystonia treated with conventional radiofrequency ventro-oral (Vo) thalamotomy. The patient was an 11-year-old girl with secondary focal dystonia in her right hand. The dystonia was considered to result from a stroke lesion in the putamen due to vasculitis following varicella-zoster virus infection. We hypothesized that the infarction of the putamen resulted in hyperactivity in the thalamus, and, thus, performed a radiofrequency Vo thalamotomy. Markedly decreased muscle tone in her right hand was noted immediately after surgery. However, the improvement was temporary, as her symptoms returned to baseline level by the 6-month follow-up. Although the observed improvement was temporary in this case, our findings may elucidate the possible mechanisms of secondary focal dystonia. Further studies are needed to establish an effective surgical treatment for secondary focal dystonia.

著者

Toshiyasu OGATA Hiroshi ABE Kazuhiro SAMURA Omi HAMADA Masani NONAKA Mitsutoshi IWAASA Toshio HIGASHI Hiroyuki FUKUDA Etsuji SHIOTA Yoshio TSUBOI Tooru INOUE

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.oa.2015-0209, (Released:2015-10-28)

参考文献数

11

被引用文献数

1 19

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The efficacy of hybrid assistive limb (HAL) rehabilitation in the acute phase of stroke remains unclear. The purpose of this study was to evaluate the outcomes of patients with acute intracranial hemorrhage (ICH) who were treated with or without HAL rehabilitation. Among 270 patients with acute ICH from 2009 to 2014, 91 patients with supratentorial ICH were included in this retrospective study. Of these, 14 patients (HAL group) received HAL rehabilitation at approximately 1 week after ICH occurrence, while the remaining 77 patients received usual rehabilitation without HAL (N-HAL group). We obtained various patient data from the hospitals where the patients were moved to for further rehabilitation. Statistical comparisons were performed for the characteristics of the ICH patients, and outcomes between the HAL and N-HAL groups. There were no differences in outcomes between the HAL and N-HAL groups. However, patients with right ICH in the HAL group exhibited a significant association with a functional independence measure (FIM) score of ≥ 110 compared with patients in the N-HAL group (HAL group: 81.8%, N-HAL group: 43.9%, P = 0.04). In patients with right ICH, HAL rehabilitation was associated with improved outcomes as evaluated by the FIM score. Thus, HAL rehabilitation may improve outcomes of acute ICH in appropriately selected patients.

著者

Takato TAJIRI Kyongsong KIM Toyohiko ISU Fumiaki FUJIHARA Takao KITAMURA Takeshi TAKAHASHI Takahito SUZUKI Masanori ISOBE Tooru INOUE

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0112, (Released:2023-03-01)

参考文献数

28

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In idiopathic tarsal tunnel syndrome (TTS), walking seems to make symptoms worse. The findings imply that an ankle movement dynamic component may have an impact on the etiology of idiopathic TTS. We describe how the ankle movement affects the nerve compression caused by the surround tissue, particularly the posterior tibial artery. We enrolled 8 cases (15 sides) that had TTS surgery after tarsal tunnel (TT) MRI preoperatively. Dorsiflexion and plantar flexion were the two separate ankle positions used for the T2* fat suppression 3D and MR Angiography of TT. Based on these findings, we looked at how the two different ankle positions affected the posterior tibial artery's ability to compress the nerve. Additionally, we assessed the posterior tibial artery's distorted angle. We divided the region around the TT into four sections: proximal and distal to the TT and proximal half and distal half to the TT. Major compression cause was posterior tibial artery. Most severe compression point was proximal half in the TT in all cases without one case. In each scenario, the nerve compression worsens by the plantar flexion. The angle of the twisted angle of the posterior tibial artery was significantly worsened by the plantar flexion. In idiopathic TTS, deformation of posterior tibial artery was the primary compression component. Nerve compression was exacerbated by the plantar flexion, and it was attributable with the change of the distorted angle of the posterior tibial artery. This could be a contributing factor of the deteriorating etiology by walking in idiopathic TTS.

著者

Hiroharu KATAOKA Susumu MIYAMOTO Kuniaki OGASAWARA Koji IIHARA Jun C. TAKAHASHI Jyoji NAKAGAWARA Tooru INOUE Etsuro MORI Akira OGAWA On Behalf of the JET-2 Investigators

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.55, no.6, pp.460-468, 2015 (Released:2015-06-15)

参考文献数

19

被引用文献数

3 49

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The purpose of this study is to determine the true threshold of cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) for subsequent ischemic stroke without extracranial-intracranial (EC-IC) bypass surgery in patients with hemodynamic ischemia due to symptomatic major cerebral arterial occlusive diseases. Patients were categorized based on rest CBF and CVR into four subgroups as follows: Group A, 80% < CBF < 90% and CVR < 10%; Group B, CBF < 80% and 10% < CVR < 20%; Group C, 80% < CBF < 90% and 10% < CVR < 20%; and Group D, CBF < 90% and 20% < CVR < 30%. Patients were followed up for 2 years under best medical treatment by the stroke neurologists. Primary and secondary end points were defined as all adverse events and ipsilateral stroke recurrence respectively. A total of 132 patients were enrolled. All adverse events were observed in 9 patients (3.5%/year) and ipsilateral stroke recurrence was observed only in 2 patients (0.8%/year). There was no significant difference among the four subgroups in terms of the rate of both primary and secondary end points. Compared with the medical arm of the Japanese EC-IC bypass trial (JET) study including patients with CBF < 80% and CVR < 10% as a historical control, the incidence of ipsilateral stroke recurrence was significantly lower in the present study. Patients with symptomatic major cerebral arterial occlusive diseases and mild hemodynamic compromise have a good prognosis under medical treatment. EC-IC bypass surgery is unlikely to benefit patients with CBF > 80% or CVR > 10%.

著者

Tetsuya UEBA Omi HAMADA Toshiyasu OGATA Tooru INOUE Etsuji SHIOTA Yoshiyuki SANKAI

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.53, no.5, pp.287-290, 2013 (Released:2013-05-24)

参考文献数

18

被引用文献数

10 50

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Acute phase rehabilitation is an important treatment for improving the functional outcome of patients after stroke. The present cohort study analyzed the feasibility and safety of acute phase rehabilitation using the hybrid assistive limb robot suit in 22 patients, 7 males and 15 females (mean age 66.6 ± 17.7 years). Neurological deterioration, mortality, or other accidents were recorded as adverse events. Baseline characteristics of each patient were recorded at the first hybrid assistive limb rehabilitation. Hybrid assistive limb rehabilitation was conducted for 12.1 ± 7.0 days with the patients in stable condition. Acute phase hybrid assistive limb rehabilitation was performed a total of 84 times with no adverse events recorded except for orthostatic hypotension. Good functional outcomes were obtained in 14 patients. Orthostatic hypotension was observed during the first hybrid assistive limb rehabilitation in four patients, and was significantly associated with intracerebral hemorrhage (p = 0.007) and lower Brunnstrom stage (p = 0.033). Acute phase rehabilitation using the hybrid assistive limb suit is feasible and safe. Patients with intracerebral hemorrhage and lower Brunnstrom stage should be carefully monitored for orthostatic hypotension.