著者

中谷 充 川口 務 竹内 誠

出版者

一般社団法人 日本脳卒中の外科学会

雑誌

脳卒中の外科 (ISSN:09145508)

巻号頁・発行日

vol.35, no.2, pp.119-123, 2007 (Released:2008-08-26)

参考文献数

17

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When dural arteriovenous fistula (DAVF) is associated with leptomeningeal venous drainage (LMVD), most cases have venous hypertension and concomitant venous congestion in the same areas due to reduced venous circulation. On the other hand, some cases in the DAVF with LMVD have no low-perfusion area. We studied this phenomenon. The subjects were 25 patients with DAVF. Of them, 16 cases had LMVD. Eleven had a low-perfusion area but 5 had no low-perfusion area. We analyzed this phenomenon in 5 cases. Two cases had anterior cranial fossa DAVF, 2 had tentorium DAVF, and 1 had transverse-sigmoid sinus DAVF. The characteristics of these DAVF are: 1) extra-sinusal type or pure leptomeningeal venous drainage, 2) low shunt flow, 3) existence of accessory route.

著者

内沢 隆充 今田 慶行 鎌田 孝篤 佐々木 都子 目時 典文 萩井 譲士 前田 尚孝 舘山 俊太 畑中 光昭

出版者

一般社団法人 日本脳卒中の外科学会

雑誌

脳卒中の外科 (ISSN:09145508)

巻号頁・発行日

vol.39, no.2, pp.127-132, 2011 (Released:2011-07-26)

参考文献数

8

被引用文献数

1

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We report a new computed tomographic (CT) finding of hyperacute ischemic stroke. We examined the CT findings of patients with acute ischemic stroke within 3 h of onset by using a very narrow CT window width. The CT number (Hounsfield unit, HU) of the ischemic area was decreased by only 1 or 2 units. The areas of decreased CT number were larger than the hyperintense areas observed in magnetic resonance imaging diffusion-weighted images (MRI-DWI). These areas were not detected as so called “early CT signs” of acute ischemia on conventional CT. We examined 3 patients of hyperacute stroke, and treated them with tissue-plasminogen activator within 3 h of onset. Their narrow-window CT examination revealed low-density areas that were not detected in the conventional study. After arterial recanalization and resolution of ischemic symptoms, these low-density areas reduced and the CT number was normalized. When recanalization did not occur, these areas showed signs of infarction. A low-density area in a narrow-window CT study may be a hypo-perfused area and include reversible ischemic area (or penumbra).

著者

小林 繁樹 佐藤 章 古口 徳雄 水流 京子 和田 政則 宮田 昭宏 中村 宏 渡辺 義郎 八木下 敏志行

出版者

一般社団法人 日本脳卒中の外科学会

雑誌

脳卒中の外科 (ISSN:09145508)

巻号頁・発行日

vol.32, no.1, pp.13-18, 2004 (Released:2007-06-12)

参考文献数

14

被引用文献数

6 7

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Indication of early treatment remains controversial for patients in poor clinical condition (Hunt & Kosnik Grade 4 or 5) after subarachnoid hemorrhage (SAH). Since 1997, we have adopted endovascular treatment using Guglielmi detachable coil (GDC) as a treatment option for these patients. In this study, we compared clinical courses of the cases treated in 1990-1996 to those treated in 1997-2002 to evaluate the efficacy of changes in treatment strategy. Between 1990 and 2002, 130 cases with SAH in Grade 4 and 5 underwent angiography as candidates of early aggressive treatment in our hospital. For the 63 cases in 1990-96 (Group 1), treatment options were early and intensively delayed craniotomy surgery and conservative management, while for the 67 cases in 1997-2002 (Group 2), GDC embolization at acute stage was added to these 3 treatment options. We compared the 2 groups of patients in terms of clinical courses and outcomes, assessed with Glasgow Outcome Scale Score (GOS) at discharge. The percentage of the patients in which aneurysm was occluded at acute stage increased from 67% in Group 1 to 87% in Group 2 for Grade 4 and from 33% to 52% for Grade 5. In Group 2, 44% of Grade 4 and 83% of Grade 5 patients were treated by GDC embolization. The outcomes of the cases in both Grade 4 and 5 were better in Group 2 than in Group 1. That is, for Grade 4 cases, the percentage of Good Recovery (GR) significantly increased from 7% in Group 1 to 27% in Group 2. And for Grade 5 cases, good outcome (GR or MD) increased from 5% in Group 1 to 18% in Group 2. Two patients recovered completely from Grade 5 in Group 2, both of which were treated with GDC while none in Group 1 recovered completely from Grade 5. The incidence of symptomatic vasospasm was not changed between Group 1 (20%) and Group 2 (16%). The introduction of GDC embolization extended the indication of early treatment for severe SAH patients because it was less invasive and, as a consequence, improved the outcome of those patients.