著者
Ai NISHIYAMA Hidetaka WAKABAYASHI Shinta NISHIOKA Ayano NAGANO Ryo MOMOSAKI
出版者
The Japan Neurosurgical Society
雑誌
Neurologia medico-chirurgica (ISSN:04708105)
巻号頁・発行日
pp.oa.2019-0002, (Released:2019-05-22)
参考文献数
23
被引用文献数
1

Our aim was to clarify the nutritional status and energy intake needed for activities of daily living (ADL) improvement among convalescent stroke patients. This retrospective cohort study of stroke patients used data from the Japan Rehabilitation Nutrition Database. Mean energy intake per ideal body weight was 26 kcal/kg/day at 1 week after hospitalization. Patients were divided into two groups according to energy intake: ≥26 kcal/kg/day (high) and <26 kcal/kg/day (low). ADL was evaluated using Functional Independence Measure (FIM), and nutritional status was evaluated using the mini nutritional assessment short form score. We created an inverse probability weighted (IPW) model using propensity scoring to control and adjust for patient characteristics and confounders at the time of admission. The analysis included 290 patients aged 78.1 ± 7.8 years. There were 165 patients with high energy intake and 125 patients with low energy intake. FIM score was significantly higher in the high group compared with the low group (median 113 vs 71, P <0.001). FIM efficiency was also higher in the high group (median 0.31 vs 0.22, P <0.001). FIM efficiency was significantly higher in the high energy intake group than in the low energy intake group after adjustment by IPW (median 0.31 vs 0.25, P = 0.011). Nutritional status improvement was also higher in the high energy intake group after adjustment by IPW (60.6% vs 45.2%, P <0.001). High energy intake was associated with higher FIM efficiency and nutritional status improvement at discharge among convalescent stroke patients.
著者
Rintaro HASHIZUME
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.ra.2017-0018, (Released:2017-06-07)
参考文献数
98
被引用文献数
8

Diffuse intrinsic pontine glioma (DIPG) is a rare but uniformly fatal cancer of the brain, with peak incidence in children of 5–7 years of age. In contrast to most types of human cancer, there has been no significant improvement in treatment outcomes for patients with DIPG. Since DIPG occurs in the brainstem, a vital region of the brain, there are no surgical options for providing relief to patients, and chemotherapy as well as radiation therapy provide palliative relief at best. To date, more than 250 clinical trials evaluating radiotherapy along with conventional cytotoxic chemotherapy, as well as newer biologic agents, have failed to improve the dismal outcome when compared with palliative radiation alone. The recent discovery of somatic oncogenic histone gene mutations affecting chromatin regulation in DIPG has dramatically improved our understanding of the disease pathogenesis in DIPG, and these findings have stimulated the development of novel therapeutic approaches targeting epigenetic regulators for disease treatment. This review will discuss about the role of histone modification in chromatin machinery and epigenetic therapeutic strategies for the treatment of DIPG.
著者
Zheng ZHANG Wenwei REN Bei SHAO Huiqin XU Jianhua CHENG Qiongzhang WANG Yingying GU Beilei ZHU Jincai HE
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.2016-0188, (Released:2017-02-10)
参考文献数
34
被引用文献数
2

Whether leukoaraiosis burden retards short-term recovery after minor stroke is unclear. We investigated the association between leukoaraiosis and early recovery of neurological function after a first minor ischemic stroke in 217 acute stroke patients (National Institutes of Health Stroke Scale (NIHSS) score ≤5). Leukoaraiosis severity was graded according to the Fazekas scale and categorized into none to mild (0–2; n = 143) or severe (3–6; n = 74) groups. NIHSS and Minimum Mental State Examination (MMSE) were assessed at baseline and at 30 days. Univariate analysis revealed that the severe leukoaraiosis group was older in age (P < 0.001) and had fewer low MMSE patients than non-mild group at baseline (39.1% vs 55.9%, P = 0.003). However, the MMSE improved in none to mild group but not in the severe group at 30-day (15.4% vs 36.5%, P < 0.001). At 30-day, the severe leukoaraiosis group had higher NIHSS scores than the none-mild group (P = 0.04). Multiple linear regression analyses demonstrated that leukoaraiosis severity and admission NIHSS were independently associated with the NIHSS score on day 30 (P = 0.034, 95% CI 0.004–0.091 and P = 0.001, 95% CI 0.011–0.04). Binary regression analyses showed that leukoaraiosis severity and admission MMSE were significantly associated with MMSE (dichotomized) at 30-day (OR 2.1, P < 0.01, 95% CI 1.7–2.6 and OR 5.1, P < 0.01, 95% CI 2.1–12.8). Leukoaraiosis burden is an independent predictor of worse short-term functional and cognitive recovery after a minor ischemic stroke.
著者
Jun MARUYA Keiichi NISHIMAKI Jun-ichi NAKAHATA Hiroko SUZUKI Yasuo FUJITA Takashi MINAKAWA
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.48, no.3, pp.114-117, 2008 (Released:2008-03-25)
参考文献数
19
被引用文献数
4 5

A 43-year-old woman suffered clinical brain death after severe head injury. The patient met the criteria for the diagnosis of clinical brain death on Day 3. Aggressive hemodynamic and respiratory managements coupled with triple hormone therapy were performed at the family’s request, resulting in continued cardiac activity for a prolonged period. Spinal reflexes and automatisms were observed until cardiac arrest. Ventilatory support was discontinued on Day 168, when cardiac death was confirmed, and her kidneys and eyeballs were removed for transplantation. The patient survived for 165 days after the diagnosis of clinical brain death, which is an extremely prolonged period of somatic support for an adult patient after brain death. An extensive and informed discussion on the end-of-life treatment of clinically brain-dead patients is urgently required in Japan to establish treatment guidelines for such patients.
著者
Takufumi YANAGISAWA Ryohei FUKUMA Ben SEYMOUR Koichi HOSOMI Haruhiko KISHIMA Takeshi SHIMIZU Hiroshi YOKOI Masayuki HIRATA Toshiki YOSHIMINE Yukiyasu KAMITANI Youichi SAITOH
出版者
The Japan Neurosurgical Society
雑誌
Neurologia medico-chirurgica (ISSN:04708105)
巻号頁・発行日
pp.st.2018-0099, (Released:2018-07-12)
参考文献数
41

A brachial plexus root avulsion (BPRA) causes intractable pain in the insensible affected hands. Such pain is partly due to phantom limb pain, which is neuropathic pain occurring after the amputation of a limb and partial or complete deafferentation. Previous studies suggested that the pain was attributable to maladaptive plasticity of the sensorimotor cortex. However, there is little evidence to demonstrate the causal links between the pain and the cortical representation, and how much cortical factors affect the pain. Here, we applied lesioning of the dorsal root entry zone (DREZotomy) and training with a brain–machine interface (BMI) based on real-time magnetoencephalography signals to reconstruct affected hand movements with a robotic hand. The DREZotomy successfully reduced the shooting pain after BPRA, but a part of the pain remained. The BMI training successfully induced some plastic changes in the sensorimotor representation of the phantom hand movements and helped control the remaining pain. When the patient tried to control the robotic hand by moving their phantom hand through association with the representation of the intact hand, this especially decreased the pain while decreasing the classification accuracy of the phantom hand movements. These results strongly suggested that pain after the BPRA was partly attributable to cortical representation of phantom hand movements and that the BMI training controlled the pain by inducing appropriate cortical reorganization. For the treatment of chronic pain, we need to know how to modulate the cortical representation by novel methods.
著者
Chang-Hyun LEE Jae Hoon CHO Seung-Jae HYUN Sang Hoon YOON Ki-Jeong KIM Hyun-Jib KIM
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.52, no.2, pp.106-108, 2012 (Released:2012-02-24)
参考文献数
12
被引用文献数
2 6

A 76-year-old woman presented with an extremely rare case of symptomatic gas-containing disc herniation manifesting as left posterolateral thigh pain and ankle dorsiflexion motor weakness. The diagnosis was L3-4 vacuum disc associated with epidural pneumorrhachis. The patient underwent partial hemilaminectomy and cyst incision. After incising the cyst, the thecal sac and root were decompressed sufficiently. Vacuum disc is a common phenomenon in the elderly rarely associated with pneumorrhachis and is usually asymptomatic. Symptomatic epidural gas-containing herniated discs with the vacuum phenomenon are very rare. Gas aspiration should be considered, but excision of the gas-containing herniated disc should be performed in patients with neurological deficits, frequent recurrence, or difficult location to approach.
著者
Kazuhiro ANDO Hitoshi HASEGAWA Bumpei KIKUCHI Shoji SAITO Jotaro ON Kohei SHIBUYA Yukihiko FUJII
出版者
The Japan Neurosurgical Society
雑誌
Neurologia medico-chirurgica (ISSN:04708105)
巻号頁・発行日
pp.oa.2019-0051, (Released:2019-07-04)
参考文献数
14

We retrospectively reviewed the cases of three patients with infectious intracranial aneurysms (IIAs), and discuss the indications for surgical and endovascular treatments. We treated two men and one woman with a total of six aneurysms. The mean age was 43.3 years, ranging from 36 to 51 years. One patient presented initially with an intraparenchymal hemorrhage, one with mass effect, and the other one had four aneurysms (one causing subarachnoid hemorrhages and the other causing delayed intraparenchymal hemorrhages). The average size of all aneurysms was 12.2 mm (range, 2–50 mm). They were preferentially located in the distal posterior cerebral artery, and then, in the middle cerebral artery. All cases were caused by infective endocarditis. We selected endovascular treatments for five aneurysms and treated all but one within 24 h from detection. One aneurysm was treated by combined therapy with endovascular intervention and surgery. After treatment, none of the IIAs presented angiographical recurrence or re-bleeding. If feasible, endovascular treatment is probably the first choice, but a combined surgical and endovascular approach should be considered if surgery or endovascular treatment alone are not feasible. The method of treatment should be individualized. For cases with high risk of aneurysm rupture, treatment should be performed as soon as possible.
著者
Etsuro MORI Masatsune ISHIKAWA Takeo KATO Hiroaki KAZUI Hiroji MIYAKE Masakazu MIYAJIMA Madoka NAKAJIMA Masaaki HASHIMOTO Nagato KURIYAMA Takahiko TOKUDA Kazunari ISHII Mitsunobu KAIJIMA Yoshihumi HIRATA Makoto SAITO Hajime ARAI
出版者
The Japan Neurosurgical Society
雑誌
Neurologia medico-chirurgica (ISSN:04708105)
巻号頁・発行日
vol.52, no.11, pp.775-809, 2012 (Released:2012-11-25)
参考文献数
253
被引用文献数
149 209

Among the various disorders manifesting dementia, gait disturbance, and urinary incontinence in the elderly population, idiopathic normal pressure hydrocephalus (iNPH) is becoming of great importance. After the publication of the first edition of the Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus in 2004 (the English version was published in 2008), clinical awareness of iNPH has risen dramatically, and the number of shunt surgeries has increased rapidly across Japan. Clinical and basic research on iNPH has increased significantly, and more high-level evidence has since been generated. The second edition of the Japanese Guidelines was thus published in July 2011, to provide a series of timely evidence-based recommendations related to iNPH. The revision of the Guidelines has been undertaken by a multidisciplinary expert working group of the Japanese Society of Normal Pressure Hydrocephalus in conjunction with the Japanese Ministry of Health, Labour and Welfare research project on “Studies on the epidemiology, pathophysiology, and treatment of normal pressure hydrocephalus.” This English version of the second edition of the Guidelines was made to share these ideas with the international community and to promote international research on iNPH.
著者
Hideaki MASUZAWA Norio NAKAMURA Kimiyoshi HIRAKAWA Keiji SANO Masanori MATSUNO Hiroaki SEKINO Koji MII Yuji ABE
出版者
The Japan Neurosurgical Society
雑誌
Neurologia medico-chirurgica (ISSN:04708105)
巻号頁・発行日
vol.16pt1, no.1, pp.77-90, 1976 (Released:2006-12-28)
参考文献数
40
被引用文献数
6 12

Translational acceleration head injury experiment was performed on 12 Japanese monkeys and one baboon using a HYGE sled and a slider-impactor system. All the monkeys became concussed by force ranging 241 to 366G in slider average acceleration and two of them died of concussion (fatal or irreversible concussion). The fatal concussion animals as well as the delayed death ones showed almost unexceptionally rib and clavicle fractures and mediastinal hemorrhage. Subarachnoid hemorrhage seen in six animals were not correlated with the outcome. We were unable to produce visible brain lesions, such as brain contusion, subdural hematoma, or intracerebral hematoma, by using pure translational acceleration impacts to the head. It should be misleading to draw a human or primate head injury tolerance limit from the fatal concussion level. Interestingly seven monkeys showed spontaneous eyelid blinking and four showed pupillary light reaction immediately post-impact and at least six animals showed “normal” EEG activity ten seconds after the impact. The cause of concussion was discussed and the role of cardiorespiratory supression by the primary shock is suggested.
著者
Hiroshi KARIBE Toshiaki HAYASHI Ayumi NARISAWA Motonobu KAMEYAMA Atsuhiro NAKAGAWA Teiji TOMINAGA
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.st.2017-0058, (Released:2017-07-05)
参考文献数
65
被引用文献数
8

In recent years, instances of neurotrauma in the elderly have been increasing. This article addresses the clinical characteristics, management strategy, and outcome in elderly patients with traumatic brain injury (TBI). Falls to the ground either from standing or from heights are the most common causes of TBI in the elderly, since both motor and physiological functions are degraded in the elderly. Subdural, contusional and intracerebral hematomas are more common in the elderly than the young as the acute traumatic intracranial lesion. High frequency of those lesions has been proposed to be associated with increased volume of the subdural space resulting from the atrophy of the brain in the elderly. The delayed aggravation of intracranial hematomas has been also explained by such anatomical and physiological changes present in the elderly. Delayed hyperemia/hyperperfusion may also be a characteristic of the elderly TBI, although its mechanisms are not fully understood. In addition, widely used pre-injury anticoagulant and antiplatelet therapies may be associated with delayed aggravation, making the management difficult for elderly TBI. It is an urgent issue to establish preventions and treatments for elderly TBI, since its outcome has been remained poor for more than 40 years.
著者
Eiji ITO Syuntaro TAKASU Kenichi HATTORI
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.57, no.3, pp.144-148, 2017 (Released:2017-03-15)
参考文献数
28
被引用文献数
4

Sinus pericranii (SP) located in the superior eyelid is an unusual clinical presentation. Here, we report a case of 72-year-old woman with an unruptured cerebral aneurysm presented with an SP located in the left superior eyelid. The SP was found to have a dominant venous outflow from the bilateral frontal region with an arterialized blood flow pattern on color Doppler ultrasonography (CDUS). During the aneurysmal surgery, intraoperative monitoring of the dominant venous outflow with CDUS was useful for the prevention of venous outflow obstruction. Physicians should carefully consider intracranial vascular anomalies in the differential diagnosis of vascular lesions of the superior eyelid.
著者
中村 克己 粟 博志 朝倉 哲彦
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.23, no.3, pp.239-244, 1983 (Released:2006-11-10)
参考文献数
41

This 66-year-old farmer had a one year history of headache and visual disturbance. On admission, he was severely emaciated and blood examination showed leukocytosis. Precontrast CT showed a low density area in the right frontal lobe. Postcontrast CT demonstrated a high density area in the right frontal base and a multilobular ring-like enhancement in the right frontal lobe. The lesion was diagnosed as brain abscess and was treated by antibiotics. The patient's general condition, however, became worse and signs of cerebral herniation appeared. A large right fronto-temporal decompressive craniotomy was done and the pus in the cavity was aspirated with a needle through the dura. The pus was cultured in Sabouraud's dextrose agar and Aspergillus was identified. Amphotericin B was administered, but the patient expired on the 12th day after operation. Autopsy revealed a fistula formation between the sphenoidal sinus and the frontal base, and the sphenoidal sinus was filled with pus. A large brain abscess with multiple cavities existed in the right frontal lobe, and from it numerous Aspergillus were microscopically recognized. Aspergillus was not found in other organs including the lungs. It was assumed that the primary lesion of aspergillosis was in the sphenoidal sinus which then invaded the frontal base via the fistula to form a multilobular abscess in the frontal lobe.
著者
Satoshi MAESAWA Epifanio BAGARINAO Masazumi FUJII Miyako FUTAMURA Toshihiko WAKABAYASHI
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.ra.2015-0302, (Released:2016-02-29)
参考文献数
81
被引用文献数
4

Cutting-edge neuroimaging technologies can facilitate preoperative evaluation in various neurosurgical settings. Surgery for gliomas and epilepsy requires precise localization for resection due to the need to preserve (or perhaps improve) higher cognitive functions. Accordingly, a hodological approach should be taken that considers subcortical networks as well as cortical functions within various functional domains. Resting state functional magnetic resonance imaging (fMRI) has the potential to provide new insights that are valuable for this approach. In this review, we describe recent developments in network analysis using resting state fMRI related to factors in glioma and epilepsy surgery: the identification of functionally dominant areas, evaluation of cognitive function by alteration of resting state networks (RSNs), glioma grading, and epileptic focus detection. One particular challenge that is close to realization is using fMRI for the identification of sensorimotor- and language-dominant areas during a task-free resting state. Various RSNs representative of the default mode network demonstrated at least some alterations in both patient groups, which correlated with behavioral changes including cognition, memory, and attention, and the development of psychosis. Still challenging is the detection of epileptic foci and propagation pathways when using only network analysis with resting state fMRI; however, a combined method with simultaneous electroencephalography has produced promising results. Consequently, network analysis is expected to continue to advance as neuroimaging technology improves in the next decade, and preoperative evaluation for neurosurgical parameters through these techniques should improve parallel with them.
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 9

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
FODSTAD Harald
出版者
日本脳神経外科学会
雑誌
Neurologia medico-chirurgica (ISSN:04708105)
巻号頁・発行日
vol.22, no.7, pp.577-581, 1982-07-15
被引用文献数
2

Cart Peter Thunberg (1743-1828), a student of the famous Swedish botanist Cart Linne, visited Nagasaki and Edo in 1775-76. During his stay in Japan, he collected and named numerous plants and so has been called the father of Japanese botany. But he also taught western medicine to Japanese colleagues and introduced mercury in the treatment of syphilis. More than any person before him, he introduced Japan to the outside world. Thunberg deserves the credit of being the pioneer of occidental medicine and science in Japan.
著者
Youichi SAITOH
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.52, no.7, pp.451-456, 2012 (Released:2012-07-25)
参考文献数
36
被引用文献数
1 2

The use of electrical motor cortex stimulation (EMCS) for post-stroke pain was established in Japan and has spread globally. EMCS has been used for the treatment of neuropathic pain, Parkinson's syndrome, and recovery of motor paresis. Since 2000, repetitive transcranial magnetic stimulation (rTMS) has been developed for the treatment of various neurological disorders. rTMS is a non-invasive method with almost no adverse effects. In the USA, rTMS of the left dorsolateral prefrontal cortex was approved for the treatment of major depression in 2008. rTMS of the primary motor cortex (M1) has been studied worldwide for the treatment of neuropathic pain, Parkinson's disease, motor paresis after stroke, and other neurological problems. New methods and devices for rTMS therapy are under development, and rTMS of the M1 is likely to be established as an effective therapy for some neurological disorders. The present review discusses EMCS and rTMS of the M1 concisely.
著者
Yuzo TERAKAWA Naohiro TSUYUGUCHI Katsuyuki NUNOMURA Naoaki MURAYAMA Masahito FUJISHIGE Akinori YAMAMURA Toshio NAKAGAWA Kazuo HASHI
出版者
The Japan Neurosurgical Society
雑誌
Neurologia medico-chirurgica (ISSN:04708105)
巻号頁・発行日
vol.47, no.10, pp.486-488, 2007 (Released:2007-10-25)
参考文献数
18
被引用文献数
20 22

A 63-year-old man presented with hypoglycemia-induced hemiparesis manifesting as diffusion-weighted magnetic resonance (MR) imaging changes in the splenium of the corpus callosum and internal capsule which disappeared after glucose administration. Clinicians should be aware that hypoglycemia can cause reversible splenium abnormalities on MR imaging, although the underlying mechanism still remains unclear, as this may be helpful in the differential diagnosis of hypoglycemia-induced hemiparesis and stroke.
著者
横田 裕行 中沢 省三 志村 俊郎 木村 昭男 山本 保博 大塚 敏文
出版者
The Japan Neurosurgical Society
雑誌
Neurologia medico-chirurgica (ISSN:04708105)
巻号頁・発行日
vol.31, no.13, pp.881-886, 1991 (Released:2006-07-19)
参考文献数
26
被引用文献数
4 6

Hypothalamic and pituitary hormone levels were measured in 56 patients meeting the criteria of brain death proposed by the Japanese Ministry of Welfare. Pituitary hormone releasing tests were carried out in 39 patients. In addition, cerebral angiography and transcranial Doppler (TCD) were performed in 13 and six patients, respectively, just after hormone measurements. Serum hypothalamic and pituitary hormone levels were inconsistently high based on the half life time in the presumed absence of cerebral blood flow shown by angiography. The responses to releasing hormones were normal in 16 patients. TCD detected cerebral blood flow in the middle cerebral artery or ophthalmic artery in three patients who showed non-filling on angiography. Postmortem microscopic examination of the hypothalamus and anterior pituitary lobe revealed normal structure and cells intermingled with lytic changes and necrosis. This series suggests that some part of the hypothalamus and hypophysis may still be alive after brain death, although the function of these regions may be clinically insignificant.
著者
Kazumichi YOSHIDA Susumu MIYAMOTO SMART-K Study Group
出版者
The Japan Neurosurgical Society
雑誌
Neurologia medico-chirurgica (ISSN:04708105)
巻号頁・発行日
pp.st.2019-0188, (Released:2019-11-09)
参考文献数
21

With recent advances in medical treatments for carotid artery stenosis (CS), indications for carotid surgery should be more carefully considered for asymptomatic CS (ACS). Accurate stratification of ACS should be based on the risk of cerebral infarction, and subgroups of patients more likely to benefit from surgical treatment should be differentiated. Magnetic resonance imaging (MRI) offers a non-invasive, accurate modality for characterizing carotid plaque. Intraplaque hemorrhage (IPH) seems the most promising feature of vulnerable plaque detectable by MRI. Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) is a type II membrane protein of the C-type lectin family with an extracellular domain that can be proteolytically cleaved and released as a soluble form (sLOX-1). This sLOX-1 plays a key role in the pathogenesis of atherosclerosis, and elevated sLOX-1 concentrations correlate with thin or ruptured fibrous caps in patients with acute coronary syndrome. This ongoing study aims to clarify the incidence of ischemic stroke in patients with ACS and IPH confirmed by MRI, and to assess whether sLOX-1 could provide a biomarker for risk of future ischemic events. The study population comprises patients with ACS (>60% area stenosis) associated with MRI-diagnosed IPH receiving follow-up under medical treatment. Primary endpoints comprise transient ischemic attack, stroke or amaurosis resulting from concerned CS. Secondary endpoints comprise any stroke or surgical treatment for progressive luminal stenosis. The target number of patients is 120 and the observational period is 36 months. The study results could help identify individuals with ACS who are refractory to medical therapy.
著者
長谷川 洋 尾藤 昭二 藤原 正昭 大槻 秀夫 中田 宗朝 小橋 二郎
出版者
The Japan Neurosurgical Society
雑誌
Neurologia medico-chirurgica (ISSN:04708105)
巻号頁・発行日
vol.23, no.11, pp.891-895, 1983 (Released:2006-11-10)
参考文献数
23
被引用文献数
2 1

Three cases in which massive pneumocephalus caused a grave postoperative neurological deterioration are presented. Two of the three patients underwent suboccipital craniectomy for posterior fossa tumors. One patient developed tension pneumocephalus immediately after the surgery due to uncontrolled drainage of cerebrospinal fluid (CSF) during surgery and prolonged use of nitrous oxide for anesthesia. The other patient developed massive pneumocephalus the day after the surgery, caused by excess drainage of CSF from an epidural drain and entry of air from the ventriculostomy. The third patient developed tension pneumocephalus following surgery for large bilateral chronic subdural hematomas due to failure of re-expansion of the chronically compressed brain and plugging of the drainage tube. All three patients were successfully treated by aspiration of air under pressure and replacement of air with normal saline. Tension pneumocephalus should be considered in the differential diagnosis of acute postoperative neurological deterioration, especially in the presence of a CSF drainage device.