著者

山田 哲久 名取 良弘 今本 尚之

出版者

日本神経救急学会

雑誌

日本神経救急学会雑誌 (ISSN:16193067)

巻号頁・発行日

vol.26, no.2, pp.32-37, 2014-07-11 (Released:2015-05-02)

参考文献数

11

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Sudden intense headache commonly develops in subarachnoid hemorrhage. Subarachnoid hemorrhage can be easily diagnosed using head computed tomography (CT) or head magnetic resonance imaging (MRI). We treated two patients with subarachnoid hemorrhage who could not be diagnosed on the basis of imaging findings. We diagnosed them with subarachnoid hemorrhage after performing lumbar puncture. Here, we report the case findings.Case 1: An 82-year-old manHe developed sudden intense headache while going to eat at home. Head CT did not reveal a clear subarachnoid hemorrhage. The iso-intensity mass was seen in basal cistern by head MRI. However, head magnetic resonance angiography (MRA) revealed an aneurysm in the anterior communicating artery. Cerebrospinal fluid extracted after lumbar puncture was clear. We considered the patient to have an unruptured cerebral aneurysm.Case 2: A 38-year-old womanShe developed sudden intense headache and vomited twice while relaxing at home. The iso-intensity mass was seen in basal cistern by head MRI. However, head MRA revealed an aneurysm in the right internal posterior communication artery. Cerebrospinal fluid extracted after lumbar puncture had a light red color. We considered the patient to have subarachnoid hemorrhage due to a ruptured cerebral aneurysm, and performed emergency clipping and craniotomy.Consideration and conclusionWe think that performing an imaging examination in all patients with headache is unnecessary. We performed an imaging examination only when we suspected subarachnoid hemorrhage after analyzing a patient’s medical history. If subarachnoid hemorrhage is suspected in a case with no abnormal imaging findings, lumbar puncture should be considered.

著者

北國 圭一 千葉 隆 河村 保臣 西山 恭平 畑中 裕己 園生 雅弘

出版者

日本神経救急学会

雑誌

日本神経救急学会雑誌 (ISSN:16193067)

巻号頁・発行日

vol.26, no.2, pp.38-41, 2014-07-11 (Released:2015-05-02)

参考文献数

26

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We here report the clinical features of three patients presenting with isolated cerebellar nodulus infarction. All suddenly developed nausea, vomiting and walking difficulty. Two experienced horizontal, to-and-fro vertigo. On admission, two could not walk. Motion exacerbated nausea and vomiting for three patients. None of them showed typical cerebellar signs, including dysarthria, dysmetria, or decomposition. Nystagmus was lacking in two. For all three patients, diffusion-weighted image of MRI revealed an isolated, small, high-intensity lesion in the cerebellar nodulus. Symptoms spontaneously resolved over a few days with no residual signs. It is now known that isolated vertigo, or “pseudovestibular syndrome”, without limb ataxia or dysarthria can occur following cerebellar infarction, especially those in the PICA region. A number of recent reports rate that the same syndrome can also be caused by infarction localized at the cerebellar nodulus. This suggests that the cerebellar nodulus must be involved with the vestibular system. Horizontal to-and-fro vertigo might be characteristic of nodular infarction. We believe MRI is necessary for every patient who presents with sudden-onset nausea, vomiting and walking difficulty, even without nystagmus, rotatory vertigo, or limb ataxia.

著者

柴田 頌太 眞山 英徳 小野 さやか 崎山 快夫

出版者

日本神経救急学会

雑誌

日本神経救急学会雑誌 (ISSN:16193067)

巻号頁・発行日

vol.28, no.3, pp.30-34, 2016-06-11 (Released:2016-09-01)

参考文献数

12

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A 49-year-old man with progressive dysarthria and weakness of the lower extremities was brought to our hospital. He had been diagnosed previously with myasthenia gravis (MG) and was awaiting treatment. Clinical features supported the diagnosis of MG exacerbation, and we started oral prednisolone and pyridostigmine. Although his symptoms responded well to the initial treatment, abnormally agitated behavior appeared on the seventh day after admission. He developed a high fever, generalized weakness, and respiratory disturbance that required intubation. He was diagnosed as having an MG crisis and was treated with plasma exchange therapy and methyl-prednisolone pulse therapy (1 g/day), along with intravenous immunoglobulin therapy. His symptoms improved, and he was extubated on day 21. During the crisis episode, it was revealed that he was dependent on antipsychotics and was abusing large quantities of various drugs from multiple hospitals.We report the case of a patient with MG, along with drug dependence, who experienced a crisis, presumably triggered by symptoms of withdrawal from antipsychotics. A careful review of a patient’s medication history is crucial, especially in drug-dependent patients, considering their underlying risks.

著者

鶴田 啓亮 關 匡彦 井上 剛 至田 洋一 淺井 英樹 倉 知彦 中野 健一 川井 廉之 前川 尚宜 福島 英賢 奥地 一夫

出版者

日本神経救急学会

雑誌

日本神経救急学会雑誌 (ISSN:16193067)

巻号頁・発行日

vol.28, no.3, pp.35-39, 2016-06-11 (Released:2016-09-01)

参考文献数

10

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Cerebral Fat Embolism (CFE) is known as potentially fatal complication of bone fracture. Patients with CFE develop variable and nonspecific clinical manifestations like a headache and disturbance of consciousness. Brain MRI has been reported to be the most sensitive method for diagnosing CFE, but conventional MR sequence is not sufficient for detecting CFE because some kind of pathological changes shows similar findings. We report a 74-year-old female with unstable pelvic fractures and diffuse axonal injury from traffic accident subsequently associated with cerebral fat embolism successfully diagnosed using susceptibility-weighted imaging (SWI). Brain MRI performed on day 6 revealed multiple high intensity lesions on diffusion-weighted imaging (DWI) in gray-white matter interface which may indicate cytotoxic edema due to DAI. We confirmed the diagnosis of CFE to find the presence of numerous petechial hemorrhages located predominantly in the white matter on SWI.