Toward Capturing Scientific Evidence in Elderly Care: Efficient Extraction of Changing Facial Feature Points.

To capture scientific evidence in elderly care, a user-defined facial expression sensing service was proposed in our previous study. Since the time-series data of feature values have been growing at a high rate as the measurement time increases, it may be difficult to find points of interest, especially for detecting changes from the elderly facial expression, such as many elderly people can only be shown in a micro facial expression due to facial wrinkles and aging. The purpose of this paper is to implement a method to efficiently find points of interest (PoI) from the facial feature time-series data of the elderly. In the proposed method, the concept of changing point detection into the analysis of feature values is incorporated by us, to automatically detect big fluctuations or changes in the trend in feature values and detect the moment when the subject's facial expression changed significantly. Our key idea is to introduce the novel concept of composite feature value to achieve higher accuracy and apply change-point detection to it as well as to single feature values. Furthermore, the PoI finding results from the facial feature time-series data of young volunteers and the elderly are analyzed and evaluated. By the experiments, it is found that the proposed method is able to capture the moment of large facial movements even for people with micro facial expressions and obtain information that can be used as a clue to investigate their response to care.

[Two Cases of Late-onset Brain Edema after Craniotomy for Unruptured Intracranial Aneurysms Suspected to be due to an Allergic Reaction to Arachnoid Plasty Material].

We report two rare cases of late-onset brain edema after craniotomy for clipping or coating of unruptured intracranial aneurysms, possibly due to an allergic reaction to topically applied fibrin glue or gelatin sponge used for arachnoid plasty to cover the opened sylvian cistern. Both patients were women in their 60s with an allergic predisposition and both followed a similar clinical course. A slight fever and headache persisted during the postoperative period. Five to six weeks after surgery without complications, MR images showed an extensive T2 prolongated region in the white matter around the operative field, indicative of vasogenic edema, with mass effect and meningeal enhancement around the sylvian fissure that had been covered with gelatin sponge and sprayed fibrin glue. Swelling of the cerebral cortex around the sylvian fissure subjected to arachnoid plasty was also observed. Blood tests showed the absence of an inflammatory reaction and cerebrospinal fluid examination showed lymphocytosis that was considered to be due to an aseptic meningeal reaction or meningitis. Clinical symptoms and imaging findings steadily improved with the administration of steroids and antiallergic agents. Delayed brain edema may occur around the arachnoid plasty area despite an uneventful chronic postoperative period, which could be due to an allergic reaction to locally administered fibrin glue or gelatin sponge. Thus, the application of arachnoid plasty using fibrin glue and gelatin sponge in patients with a predisposition to allergies needs to be carefully considered.

[Unruptured Aneurysm Arising from the Proximal End of the Duplicate Origin of the Middle Cerebral Artery].

We report a rare case of an unruptured aneurysm arising from the junction between the internal carotid artery(ICA)and duplicate origin of the middle cerebral artery(MCA). A 49-year-old man who presented with vertigo was admitted to our hospital. Subsequent MR and CT angiograms revealed an incidental aneurysm arising from the proximal end of the duplicate origin of the left MCA. He underwent clipping via the distal transsylvian approach. The aneurysm projected to the posterior direction and several perforators from the two M1 segments were attached to the neck of the aneurysm, which made neck dissection very difficult. Approaching the space from the posterior/lateral direction to reach the M1 segment, the aneurysm neck was successfully dissected and clipped without sacrificing any perforators or stenosis of parent vessels. The postoperative course was uneventful, and the patient was discharged within 2 weeks. Duplicate origin of the MCA has been confused with a fenestration of the proximal M1 segment or terminal segment of the ICA. In this condition, two MCA branches arise separately from the terminal segment of the ICA and fuse early to form an arterial ring at the proximal M1 segment. An aneurysm originating from this anomaly has never been described. However, some aneurysms associated with this type of origin may have incorrectly been reported as those associated with proximal MCA or terminal ICA fenestrations. We summarize the cases that are similar to our case of duplicate origin of the MCA with an aneurysm, and discuss the precise diagnosis and significant intraoperative problems that were described in the literature.

Usefulness of the Atherosclerosis Risk Score for Patients With Acute Infarction in the Lenticulostriate Artery Region.

Background and purpose Internal carotid artery intima-media thickness (IMT) and pulse wave velocity (PWV) are risk factors of cerebrovascular disease and coronary artery disease. They are known as independent predictors of arteriosclerotic disease. It has been reported that IMT and PWV are useful factors for predicting stroke subtype and/or outcome. Coronary artery disease onset is proportional to atherosclerosis progression, and the Framingham Risk Score (FRS) and Suita score (SS) are standard risk predictors. This study examined whether FRS and SS can be useful for patient outcomes with acute infarction in the lenticulostriate artery (LSA) region without special tests or invasive procedures while using IMT or PWV as predictive factors. Methods We screened 629 consecutive patients with ischemic stroke and reviewed 84 patients with acute infarction in the LSA region who were admitted between January 2018 and December 2020. An early deterioration (ED) group was defined. In addition, the clinical characteristics, FRS, SS, treatment therapy, and neurovascular findings were evaluated. Results FRS and SS (FRS: 11.6 vs. 8.3, p < 0.01, SS: 58.2 vs. 53.7, p = 0.01, respectively), pre-symptomatic modified Rankin Scale (mRS) (p = 0.03), mRS at discharge (p < 0.01), and deterioration of manual muscle test (MMT) (<0.01) were significantly higher in patients in the ED (34 patients) group than in the no-ED group (54 patients). FRS and SS were correlated with mRS deterioration (FRS: r = 0.47; p < 0.01, SS: r = 0.23; p = 0.03). Among the laboratory parameters, total cholesterol (TC) (p < 0.01) and low-density lipoprotein cholesterol (LDL-C) (p < 0.01) were significantly higher in the ED group, and no significant differences in any acute therapeutic interventions. Conclusion Atherosclerosis risk scores, such as FRS and SS, may be useful for predicting outcomes in patients with acute LSA-region infarctions within 48 hours of onset.

Pseudohypoxic Brain Swelling after Unilateral Burr Hole Drainage: A Novel Case Report.

An 85-year-old man underwent emergency right trepanation and drainage for a symptomatic chronic subdural hematoma. Pseudohypoxic brain swelling (PHBS) was suspected because magnetic resonance imaging revealed diffuse brain swelling. Although cerebrospinal fluid (CSF) leakage was not obvious during or after surgery, most of the reported PHBS cases have leaked CSF during craniotomy or spine surgery. PHBS has not been previously reported in patients without obvious CSF leakage or after unilateral burr hole drainage. Herein, we report an extremely rare case with a literature review investigating its pathogenesis and clinical features.

Current status of a helicopter transportation system on remote islands for patients undergoing mechanical thrombectomy.

BACKGROUND: Mechanical thrombectomy (MT) is standard treatment for acute ischemic stroke (AIS) with large-vessel occlusion within 6 h of symptom onset to treatment initiation (OTP). Recent trials have extended the therapeutic time window for MT to within 24 h. However, MT treatment remains low in remote areas. Nagasaki Prefecture, Japan has many inhabited islands with no neurointerventionalists. Our hospital on the mainland is a regional hub for eight island hospitals. We evaluated clinical outcomes of MT for patients with AIS on these islands versus on the mainland. METHODS: During 2014-2019, we reviewed consecutive patients with AIS who received MT at our hospital. Patients comprised the Islands group and Mainland group. Patient characteristics and clinical outcomes were compared between groups. RESULTS: We included 91 patients (Islands group: 15 patients, Mainland group: 76 patients). Seven patients (46.7%) in the Islands group versus 43 (56.6%) in the Mainland group achieved favorable outcomes. Successful recanalization was obtained in 11 patients (73.3%) on the islands and 67 (88.2%) on the mainland. The median OTP time in the Islands was 365 min. In both the Islands and Mainland groups, the OTP time and successful recanalization were associated with functional outcome. The modified Rankin Scale (mRS) score at 90 days ≤2 was obtained in two patients and mRS = 3 in four patients among eight patients with OTP time >6 h. CONCLUSIONS: Few patients with AIS on remote islands have received MT. Although patients who underwent MT on the islands had longer OTP, the clinical outcomes were acceptable. OTP time on remote islands must be shortened, as this is related to functional outcome. In some cases with successful recanalization, a favorable outcome can still be obtained even after 6 h. Even if OTP exceeds 6 h, it is desirable to appropriately select patients and actively perform MT.

A Case of Relapsing Polychondritis Initiating with Unexplained Fever.

Relapsing polychondritis (RP) is a rare autoimmune disease affecting the multiple organ system. Here, we describe a case of RP initially presenting with high fever. The patient was referred to our hospital for further examination of fever of unknown origin (FUO). On admission, the patient reported dry cough in addition to fever. On physical examination, her red, swollen ears were noted, attributed on histology to inflammation with auricular perichondritis. She was diagnosed with RP and treated with oral prednisone (50 mg/day); her fever and auricular inflammation resolved. The patient no longer reported cough and body temperature returned to normal and the elevated levels of C-reactive protein (CRP) were normalized. In this case, identification of the origin of fever was a challenge because of unspecific symptoms; however, awareness of the systemic manifestations of RP may lead to the prompt diagnosis and therapeutic intervention.