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OBJECTIVES: To clarify a characteristic of dynamic stability during gait in idiopathic normal pressure hydrocephalus (iNPH) and Parkinson's disease (PD), and to explore the association between dynamic stability and disease severity in each disease. MATERIALS AND METHODS: The 5-m gait of 36 iNPH (precerebrospinal fluid drainage), 20 PD (medicated state), and 25 healthy controls (HC) were evaluated using three-dimensional motion analysis. Ambulatory dynamic stability was defined as the ability to maintain the extrapolated center of mass within the base of support at heel contact, with the distance between the two referred to as the margin of stability (MOS). RESULTS: Anteroposterior direction (AP) MOS was significantly larger in the iNPH and PD groups than in the HC group; no significant difference was found between the iNPH and PD groups. Mediolateral direction (ML) MOS was significantly larger in the iNPH and PD groups than in the HC group and significantly larger in the iNPH group than in the PD group. In the iNPH group, the disease severity was positively correlated with only ML MOS. In the PD group, the disease severity was positively correlated with the AP MOS and ML MOS. CONCLUSIONS: Dynamic stability in iNPH increases in AP and ML, and it may be associated with not only iNPH-associated gait disturbance but also with a voluntarily cautious gait strategy. Dynamic stability in PD only increased in AP, and this may be associated with PD symptoms. These findings will help physicians understand the difference in pathological gait including dynamic stability between patients with iNPH and PD.
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Trastornos Neurológicos de la Marcha , Hidrocéfalo Normotenso , Enfermedad de Parkinson , Marcha , Trastornos Neurológicos de la Marcha/etiología , Humanos , Hidrocéfalo Normotenso/complicaciones , Enfermedad de Parkinson/complicaciones , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVES: We evaluated the perceived and actual changes in gait and balance function immediately after cerebrospinal fluid (CSF) shunting in patients with idiopathic normal pressure hydrocephalus (iNPH), including those with mild cases. MATERIALS AND METHODS: Ninety-nine iNPH patients were assessed using the timed Up and Go (TUG) and Functional Gait Assessment (FGA) before and 1-week after CSF shunting and their perceived changes were assessed on a Global Rate of Change (GRC) scale. Minimal clinically important differences (MCIDs) were calculated using a receiver operating characteristic (ROC) curve method using GRC scores. RESULTS: In all patients (n = 99), the TUG value postoperatively was significantly faster than the preoperative value (difference; 3.1 ± 4.6 s, p < 0.001), and the postoperative FGA score was significantly better than the preoperative score (difference; 3.8 ± 3.3 points, p < 0.001). In the TUG <15 s group (n = 51), the postoperative FGA score was significantly improved (difference; 3.3 ± 2.9 points, p < 0.001), whereas the TUG value was only slightly improved (difference; 0.6 ± 1.6 s, p = 0.008). The ROC curve MCIDs of GRC ≥2 points, which is the recommended level of improvement, were 1.7 s (16.5%) for the TUG and 4 points (20.0%) for the FGA in all patients (n = 99) and the TUG <15 s group (n = 51). CONCLUSIONS: FGA can be used to confirm treatment effects, including perceived and actual changes after CSF shunting, in patients with mild iNPH. Our results can help clinicians to determine the clinical significance of improvements in gait and balance function immediately after CSF shunting in individual patients with iNPH.
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Derivaciones del Líquido Cefalorraquídeo/tendencias , Trastornos Neurológicos de la Marcha/cirugía , Marcha/fisiología , Hidrocéfalo Normotenso/cirugía , Percepción/fisiología , Equilibrio Postural/fisiología , Anciano , Anciano de 80 o más Años , Derivaciones del Líquido Cefalorraquídeo/métodos , Femenino , Trastornos Neurológicos de la Marcha/diagnóstico , Trastornos Neurológicos de la Marcha/fisiopatología , Humanos , Hidrocéfalo Normotenso/diagnóstico , Hidrocéfalo Normotenso/fisiopatología , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
Research has recently been focused on high-performance next-generation batteries to replace secondary batteries due to capacity limitations and safety concerns. The Mg secondary battery is one candidate to realize high energy density storage batteries for practical applications. Ni and Co typically exhibit desirable electrochemical characteristics; therefore, we have attempted to synthesize new rock-salt compositions, Mg xNi yCo zO2 ( x + y + z ≤ 2.0), as cathode materials for Mg rechargeable batteries, and investigated their crystal structures and electrochemical characteristics. The materials were synthesized by the reverse coprecipitation method. Powder X-ray diffraction and transmission electron microscopy analyses showed the obtained samples were a single phase of the rock-salt structure with the space group Fm3Ì m. The vacancies at the metal sites were estimated by Rietveld analysis to determine the new chemical composition of Mg xNi yCo zâ¡2- x- y- zO2 (0.41 < x < 0.64, 0.82 < y < 1.23, 0.24 < z < 0.61). Charge-discharge tests indicated the discharge characteristics varied according to the Mg composition and the Ni/Co ratio. The Co and Mg compositions were considered to facilitate the insertion/deinsertion of Mg2+. The present new material has the potential to be a superior cathode material for Mg secondary batteries by first-principles calculations.
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Epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) resistance is one of the most important problems in lung cancer therapy. Lung adenocarcinoma with EGFR-TKI resistance was reported to have higher abilities of invasion and migration than cancers sensitive to EGFR-TKI, but the function of matrix metalloproteinases (MMPs) has not been explored in EGFR-TKI-resistant lung adenocarcinoma. This study aims to clarify the significance of MMP-1 in EGFR-TKI-resistant lung adenocarcinoma. From the results of in vitro studies of migration and invasion assays using EGFR-TKI-sensitive and -resistant cell lines and phosphorylation antibody arrays using EGF and rapamycin, we first demonstrate that overexpression of MMP-1, which might follow activation of a mammalian target of rapamycin (mTOR) pathway, plays an important role in the migration and invasion abilities of EGFR-TKI-resistant lung adenocarcinoma. Additionally, immunohistochemical studies using 89 cases of lung adenocarcinoma demonstrate that high expression of MMP-1 is significantly correlated with poor prognosis and factors such as smoking history and the subtype of invasive mucinous adenocarcinoma. These are consistent with the results of this in vitro study. To conclude, this study provides insights into the development of a possible alternative therapy manipulating MMP-1 and the mTOR signaling pathway in EGFR-TKI-resistant lung adenocarcinoma.
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Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/enzimología , Resistencia a Antineoplásicos , Receptores ErbB/antagonistas & inhibidores , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/enzimología , Metaloproteinasa 1 de la Matriz/metabolismo , Terapia Molecular Dirigida , Inhibidores de Proteínas Quinasas/uso terapéutico , Adenocarcinoma/patología , Adenocarcinoma del Pulmón , Anciano , Línea Celular Tumoral , Movimiento Celular/genética , Resistencia a Antineoplásicos/genética , Receptores ErbB/metabolismo , Femenino , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , Humanos , Neoplasias Pulmonares/patología , Masculino , Metaloproteinasa 1 de la Matriz/genética , Análisis Multivariante , Invasividad Neoplásica , Inhibidores de Proteínas Quinasas/farmacología , ARN Mensajero/genética , ARN Mensajero/metabolismo , Transducción de Señal , Serina-Treonina Quinasas TOR/metabolismoRESUMEN
BACKGROUND: To date, there have been no reports regarding the necessity or methods of reconstruction for cases where the orbital periosteum remains even though the orbital floor bone has been resected in primary reconstruction after total maxillectomy. This study investigated the reconstruction methods for infraorbital wall reconstruction in patients with residual orbital periosteum. METHODS: This was a retrospective cohort study at a single center from June 2010 to June 2019. The following two main cohorts were evaluated: non-reconstruction and reconstruction groups (reconstructed with fascia or costal cartilage) according to whether the orbital floor was reconstructed after total maxillectomy with residual orbital periosteum. The main outcomes were the deviation of the globe evaluated using computed tomography images and subjective signs of diplopia obtained from medical records. RESULTS: Enophthalmos occurred in all five cases in the non-reconstruction group, and diplopia appeared in four cases. In five out of six cases in the reconstruction group, deviation of the globe was not observed. Exophthalmos occurred in one case reconstructed with costal cartilage. Diplopia was not observed in the reconstruction group. In the statistical assessment, a significant difference was observed in the globe deviation between the two groups (P = 0.004). CONCLUSIONS: In cases where the orbital periosteum remains, it is necessary to actively reconstruct the infraorbital wall. Moreover, we believe that the reconstruction with fascia is convenient and useful because it is less invasive, the surgical procedure is simple, and the fascia can be collected from the same surgical field when the flap is elevated. LEVEL OF EVIDENCE: 4 (retrospective cohort study).
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Enoftalmia , Fracturas Orbitales , Procedimientos de Cirugía Plástica , Humanos , Procedimientos de Cirugía Plástica/efectos adversos , Periostio , Estudios Retrospectivos , Colgajos Quirúrgicos/cirugía , Órbita/diagnóstico por imagen , Órbita/cirugía , Enoftalmia/cirugía , Fracturas Orbitales/cirugíaRESUMEN
Replacement of a usual medication with a remarkably effective medication might result in a dramatic improvement for a specific disease. However, an abrupt change in medication might bring about other challenges. Herein, we report the case of an 84-year-old man who developed severe hyponatremia after the abrupt discontinuation of prolonged ultra-high topical steroid use. At the time of visiting the emergency department, he had been treating chronic eczema with the medication dupilumab for three months. We initially considered this newly started medication as the cause of the problem. However, dupilumab has not been reported to be connected to any electrolyte or endocrine disorder (e.g., syndrome of inappropriate anti-diuretic hormone secretion), and severe hyponatremia did not improve by the administration of high volume of NaCl. Thus, we reconsidered alternative causes for this hyponatremia and checked the patient's history of medication. He had been prescribed clobetasol propionate 0.05% by the dermatologist until one month before arriving at the emergency department. In addition, he had completely stopped using topical steroids for the last two weeks because his dermal condition had substantially improved. His cortisol level was low, substantiating a diagnosis of adrenal insufficiency. Hydrocortisone administration improved both hyponatremia and his symptoms. Therefore, when a patient with newly administered medication presents with new symptoms, we recommend that differential diagnosis include a medical review of the patient's last three months of medication and the conditions of use including how the topical agents were used.
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BACKGROUND: Gait-balance disturbances are core symptoms of idiopathic normal pressure hydrocephalus (iNPH). However, the rehabilitation effects of cerebrospinal fluid (CSF) shunting along with other treatment or no further treatment (natural course [NC]) for iNPH are unknown. OBJECTIVES: This study evaluated whether dynamic equilibrium gait training (DEGT) can improve gait-balance functions after CSF shunting of patients with iNPH compared to standard exercise (SE) and NC. Furthermore, it investigated the incidence of falls. METHODS: A total of 70 patients with iNPH who underwent CSF shunting were randomly assigned to 6 weeks of DEGT (n = 23), 6 weeks of SE (n = 23), or NC (n = 24). Evaluation was performed at baseline (preoperatively) and at 1 week, 7 weeks (postintervention), and 6 months postoperatively (follow-up). Outcomes were measured using the functional gait assessment (FGA), 10-m walk test, timed up-and-go test, life-space assessment (LSA), and fall incidence. RESULTS: A total of 65 participants completed the study. During the intention-to-treat analysis, the DEGT group demonstrated significant recovery of gait-balance functions according to only the FGA at postintervention and follow-up compared to the SE and NC groups; however, recovery of the SE group did not differ from that of the NC group. The DEGT group had a significantly lower fall incidence than the other groups at follow-up. Significantly better LSA results were observed for all groups at follow-up compared to baseline; however, no difference in LSA results were observed between groups. CONCLUSIONS: DEGT in addtion to CSF shunting can facilitate the recovery of gait-balance function and reduce the fall incidence of iNPH patients.
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Hidrocéfalo Normotenso , Humanos , Hidrocéfalo Normotenso/diagnóstico , Derivaciones del Líquido Cefalorraquídeo , Marcha , Evaluación de Resultado en la Atención de Salud , Procedimientos NeuroquirúrgicosRESUMEN
Here, we propose a two-step pervaporation system with a high-silica CHA (chabazite) membrane, which has sufficient resistance to water and acid, to demonstrate the extraction and condensation of the formic acid formed by electroreduction of CO2. The kinetic diameters of water and formic acid are similar and smaller than the pore size of CHA, while the hydrated electrolyte ions (e.g., K+ and Cl-) are larger than the pore size of CHA. Consequently, the electrolyte ions are separated from the mixture of water and formic acid in the first desalination process, and then water molecules are easily removed from the mixture in the second dehydration process. From 300 ml of an approximately 3 wt% formic acid aqueous solution containing 0.5 M KCl, 10 ml of 18.2 wt% formic acid was obtained.
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Reports describing the treatment of non-union of the distal phalanx of the thumb are limited. We present the case of a 45-year-old man who developed a symptomatic non-union after an open fracture of the distal phalanx of the thumb. He was treated with a reverse dorso-ulnar vascularised fascial metacarpal bone flap. Bone union was achieved 3 months post surgery, and he was well at 7 months post surgery. The reverse dorso-ulnar fascial metacarpal bone flap is an alternative to consider in patients with non-union of the distal phalanx of the thumb. Level of Evidence: Level V (Therapeutic).
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Falanges de los Dedos de la Mano , Huesos del Metacarpo , Masculino , Humanos , Persona de Mediana Edad , Pulgar/cirugía , Huesos del Metacarpo/diagnóstico por imagen , Huesos del Metacarpo/cirugía , Colgajos Quirúrgicos , Arteria CubitalRESUMEN
MgMn2O4 with a tetragonal spinel structure shows promise as a positive-electrode material in magnesium rechargeable batteries (MRBs), which have drawn considerable attention as post lithium-ion batteries. However, the material currently suffers from poor cycle performance. In this study, we attempt to improve the cycle performance of MgMn2O4 via the Zr modification of its particle surface. X-ray photoelectron spectroscopy and energy-dispersive X-ray spectroscopy demonstrate that the surface modification is successfully performed by immersing MgMn2O4 powder into a Zr-containing aqueous solution, followed by heat treatment. However, Zr segregation is observed at high Zr concentration. Furthermore, structural analyses using synchrotron X-rays indicate that the Zr modification has an influence on the bulk structure of the MgMn2O4 powder. The positive-electrode properties of the powders are investigated using discharge/charge cycle tests, which show that Zr modification can drastically improve the cycle performance and coulombic efficiency. These improvements are supposed to be due to suppression of an unexpected reaction by the Zr-surface modification and lower structural distortion after the modification. These findings clearly demonstrate the significant potential of surface modification as a method for obtaining high-performance MRBs.
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BACKGROUND: This study aimed to investigate whether dynamic gait stability differs between idiopathic normal-pressure hydrocephalus with high- and low-fall-risk. METHODS: Participants comprised 40 idiopathic normal-pressure hydrocephalus patients and 23 healthy-controls. Idiopathic normal-pressure hydrocephalus patients were divided into those with high-fall-risk (n = 20) and low-fall-risk (n = 20) groups using the cut-off score of ≤14/30 for fall-risk on the Functional Gait Assessment. Dynamic stability during gait was assessed by three-dimensional motion analysis. Dynamic stability was defined as the ability to maintain an extrapolated center of mass within the base of support at heel contact, with the distance between the two defined as the margin of stability. Conscious motor control was assessed by the Movement-Specific Reinvestment Scale. FINDINGS: Anteroposterior and mediolateral margin of stabilities were significantly larger in both idiopathic normal-pressure hydrocephalus groups than in healthy-controls. The mediolateral margin of stability was significantly higher in the high-fall-risk group than in the low-fall-risk group; whereas, the anteroposterior margin of stability did not differ between idiopathic normal-pressure hydrocephalus groups. The Movement-Specific Reinvestment Scale was significantly higher in the high-fall-risk group than in the low-fall-risk group. INTERPRETATION: Idiopathic normal-pressure hydrocephalus patients with have high forward and lateral dynamic stability during gait regardless of their fall-risk. In particular, idiopathic normal-pressure hydrocephalus patients with high-fall-risk may consciously maintain lateral dynamic stability to a greater extent than those with low-fall-risk. These findings highlight a conscious motor control component in the pathological gait of idiopathic normal-pressure hydrocephalus, and provide clues for rehabilitation and fall prevention strategies in idiopathic normal-pressure hydrocephalus patients.
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Hidrocéfalo Normotenso , Marcha , Humanos , Equilibrio Postural , Factores de RiesgoRESUMEN
In this work, we focus on Mg-Fe-O and Mg-Ni-O with Mg-rich compositions as positive-electrode materials for magnesium rechargeable batteries, and prepare them by a thermal decomposition of precipitates obtained by a solution method. It is indicated from X-ray diffraction patterns that the Mg-Fe-O and Mg-Ni-O samples have the spinel and rocksalt structures, respectively. X-ray absorption near edge structures indicate that Fe and Ni are trivalent and divalent, respectively, in the Mg-rich oxides. From charge/discharge cycle test, it is demonstrated that the Mg-Fe-O shows higher discharge capacity than the other and then has good cycle performance while keeping a discharge capacity over 100 mA h g-1. To gain deeper understanding on a relationship between the electrode properties and the crystal structure of the Mg-Fe-O, the crystal structure is investigated by a Rietveld refinement using a synchrotron X-ray diffraction profile and an analysis on total correlation functions. It is indicated from these studies that a vacant octahedral site in the spinel structure is partially occupied by the excess Mg in the synthesized sample. This structural feature might result in a stable charge/discharge cycle performance of the Mg-rich Mg-Fe-O.
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A simple water treatment system consisting of a deep UV light (λ = 222 nm) source, a mesoporous TiO2/boron-doped diamond (BDD) photocatalyst, and a BDD electrode was prepared and used to decompose sulfamethoxazole (SMX) in an advanced oxidation process. The mesoporous TiO2/BDD photocatalyst used with the electrochemical treatment promoted SMX decomposition, but the mesoporous TiO2/BDD photocatalyst alone had a similar ability to decompose SMX as photolysis. Fragments produced through photocatalytic treatment were decomposed during the electrochemical treatment and fragments produced during the electrochemical treatment were decomposed during the photocatalytic treatment, so performing the electrochemical and photocatalytic treatments together effectively decomposed SMX and decrease the total organic carbon concentration to a trace.
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Contaminantes Químicos del Agua , Purificación del Agua , Boro , Diamante , Electrodos , Oxidación-Reducción , SulfametoxazolRESUMEN
Lightning strikes cause nitrogen to dissolve in water and form reactive nitrogen and oxygen species, which form natural fertilizers that can be absorbed through plant roots. Such processes during rainstorm events can be simulated by applying plasma to a solution. Plasma-activated water (PAW) has great potential as a source of various dissolved reactive chemical species. Different mixtures of species are produced using different solution compositions. Here, basil seeds were grown in PAW to prevent blooms of Chlorella vulgaris and ion chromatography and UV-vis spectroscopy were used to quantify reactive ions. NO2 -, NO3 -, and H2O2 were found to be key to the antialgal effect. Secondary reactive ions such as peroxynitrite (ONOO-, ONOOH) were also involved. The antialgal effect was strongly related to the pH around the algal cells. Acidification was predominantly caused by the generation of NO2 - and H2O2. After two weeks monitoring basil growth, the antifungal properties were preserved, few reactive oxygen species formed in the plasma zone, and only reactive nitrogen species were transformed into reactive peroxynitrite ions. The pH around the cells was determined using an iridium oxide microelectrode. The PAW antialgal mechanism depended on acidic conditions (pH 2.2, at which peroxynitrite can be generated) under which ONOOH penetrated the algal cell membranes, destroying the cells and preventing growth. This practical and sustainable PAW process allows a surprising amount of fertilizer to be generated with an antialgal effect that could be used in various eco-friendly agricultural processes under ambient conditions.
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Absolute pitch (AP) is known as the ability to recognize and label the pitch chroma of a given tone without external reference. The neural mechanism and its asymmetry of AP musicians remain unclear. We herein report a 41-year-old AP musician who developed a right putaminal hemorrhage. On a postoperative day 5, a fluid-attenuated inversion recovery image revealed the rest of the hematoma and edematous lesion at the right white matter between the Heschl's gyrus and other cortices. Diffusion tensor tractography with the region of interest at the Heschl's gyrus was performed. In the left hemisphere, the anterior part of the arcuate fiber and middle longitudinal fasciculus were observed. However, these connections were absent in the right hemisphere, but her AP ability was maintained. Our case suggested that the fibers from the right Heschl's gyrus to the right frontal lobe via the right ventral stream is not associated with AP.
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Corteza Auditiva/diagnóstico por imagen , Lóbulo Frontal/diagnóstico por imagen , Música , Percepción de la Altura Tonal/fisiología , Hemorragia Putaminal/cirugía , Adulto , Corteza Auditiva/fisiología , Vías Auditivas/diagnóstico por imagen , Vías Auditivas/fisiología , Imagen de Difusión Tensora , Femenino , Lóbulo Frontal/fisiología , Humanos , Imagen por Resonancia Magnética , Hemorragia Putaminal/diagnóstico por imagen , Hemorragia Putaminal/fisiopatología , Hemorragia Putaminal/rehabilitaciónRESUMEN
Subacute subdural hematoma (SASDH) is a neurotraumatic entity. There are few reports of chronological changes of cerebral blood flow (CBF) on arterial spin labeling (ASL) and subcortical low intensity (SCLI) on fluid-attenuated inversion recovery (FLAIR) images of magnetic resonance imaging (MRI) observations from the injury onset, deterioration, to post-surgery. We reported a SASDH patient presenting postoperative cerebral hyperperfusion (CHP) syndrome with chronological changes of those findings. An 85-year-old woman fell and presented right ASDH. She was treated conservatively due to no neurological deficits. On day 3, ASL image revealed increased CBF against brain compression. On day 7, the CBF was normalized on ASL image, but SCLI was confirmed. On day 14, SCLI was strengthened. Then she developed left hemiparesis due to brain compression by SASDH. Considering age and comorbidities, we performed endoscopic hematoma removal under local anesthesia, and her neurological deficits improved after the surgery. On postoperative day 1, she newly presented left upper limb paresis. MRI revealed increased CBF and enhanced SCLI. We diagnosed CHP syndrome, and antihypertensive treatment improved the symptoms gradually. However, SCLI had been consistently observed, and CBF easily changed depending on the blood pressure, suggesting dysfunction of the CBF autoregulation. We showed the endoscopically treated SASDH patient with CBF's chronological changes on ASL images and SCLI on FLAIR images. Long-time brain compression would lead to dysfunction of the CBF autoregulation, and we should be careful about CHP syndrome after the endoscopic surgery for SASDH.
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PURPOSE: With the aging population in Japan, the prediction of ambulance transports is needed to save the limited medical resources. Some meteorological factors were risks of ambulance transports, but it is difficult to predict in a classically statistical way because Japan has 4 seasons. We tried to make prediction models for ambulance transports using the deep learning (DL) framework, Prediction One (Sony Network Communications Inc., Tokyo, Japan), with the meteorological and calendarial variables. MATERIALS AND METHODS: We retrospectively investigated the daily ambulance transports and meteorological data between 2017 and 2019. First, to confirm their association, we performed classically statistical analysis. Second, to test the DL framework's utility for ambulance transports prediction, we made 3 prediction models for daily ambulance transports (total daily ambulance transports more than 5 or not, cardiopulmonary arrest (CPA), and trauma) using meteorological and calendarial factors and evaluated their accuracies by internal cross-validation. RESULTS: During the 1095 days of 3 years, the total ambulance transports were 5948, including 240 CPAs and 337 traumas. Cardiogenic CPA accounted for 72.3%, according to the Utstein classification. The relation between ambulance transports and meteorological parameters by polynomial curves were statistically obtained, but their r2s were small. On the other hand, all DL-based prediction models obtained satisfactory accuracies in the internal cross-validation. The areas under the curves obtained from each model were all over 0.947. CONCLUSION: We could statistically make polynomial curves between the meteorological variables and the number of ambulance transport. We also preliminarily made DL-based prediction models. The DL-based prediction for daily ambulance transports would be used in the future, leading to solving the lack of medical resources in Japan.
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BACKGROUND: Acute bilateral thalamic infarction is rare, and occlusion of the artery of percheron (AOP) may be one of its reasons. AOP occlusion results in an acute disturbance of consciousness, but mutism due to AOP occlusion is rare. We described a mutism patient with bilateral thalamic infarction presumably due to AOP occlusion. We also performed cerebral blood flow (CBF) evaluation by N-isopropyl-p-[123I]-iodoamphetamine single-photon emission computed tomography (123I-IMP-SPECT) as well as neural fiber evaluation by diffusion tensor tractography, discussing the mechanism of mutism. CASE DESCRIPTION: A 92-year-old woman presented a gradual deterioration of consciousness. Diffusion-weighted images revealed high-intensity areas at the bilateral thalami, and we diagnosed AOP occlusion. We administered a recombinant tissue plasminogen activator. On day 14, her Glasgow Coma Scale score was 11 (E4V1M6), and she did not present any apparent paresis. She was mute but cognitively alert, although she could communicate by nodding or facial expression. 123I-IMP-SPECT showed CBF increase in the bilateral cerebellum and CBF decrease in the infarcted bilateral thalami and frontal lobes. Diffusion tensor tractography revealed the bilateral dentatothalamo-cortical tracts (DTCs). However, the tracts terminated at the parieto-occipital cortex, but not at the frontal cortex. She still had mutism on day 30. CONCLUSION: We reported the bilateral thalamic infarction patient presumably due to AOP occlusion, who presented mutism. The discontinuity of the bilateral DTCs resulted in her mutism, and our results supported the hypothesis that the cerebellum plays a significant role in uttering, associated with the bilateral DTCs.
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It is important to assess the cerebral arteries near the clip after cerebral aneurysm clipping. Contrast-enhanced computed tomography angiography has side effects of contrast medium and radiation exposure. Time-of-flight magnetic resonance angiography (TOF-MRA) is a fast and non-invasive method, but clip-induced artifact limits the assessment around the clip. Recently, 3 tesla MRA with ultrashort echo time called SILENT MRA (GE Healthcare Life Sciences, UK) has been reported to have the potential to overcome these disadvantages. We herein present consecutive 19 cerebral aneurysm patients treated by clipping and evaluated using SILENT MRA. The 19 patients (15 women and 4 men) underwent TOF-MRA and SILENT MRA during the same scan session. Two neurosurgeons independently assessed the visibility of the mother vessel at the clipping site in TOF-MRA and SILENT MRA. We also investigated the factors related to visibility in SILENT MRA. All patients' mother vessels were not described in TOF-MRA, and that of 16 patients (84%) were described in SILENT MRA. Overall agreement was 100% in the two neurosurgeons, and the fixed marginal kappa = 1.00 (95% CI: 0.36-1.00). Univariate analysis revealed that larger aneurysm dome and long clip blade length contributed to the visibility of the mother vessel in SILENT MRA. (p = 0.023, 0.007, each). In conclusion, SILENT MRA can be applied for the assessment of the arteries and aneurysm neck remnants near the clip. Using clips with long blade and ligation with its tip would be related to the visibility of the mother vessels in SILENT MRA.
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Aneurisma Intracraneal , Angiografía por Resonancia Magnética , Angiografía de Substracción Digital , Arterias Cerebrales , Medios de Contraste , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/cirugía , Masculino , MadresRESUMEN
BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is characterized by acute neurological symptoms and vasogenic edema, and most patients wholly recover. We report a unilateral PRES patient characterized by a gradual onset followed by propofol infusion syndrome (PRIS) due to general anesthesia therapy. CASE DESCRIPTION: A 32-year-old woman had ovarian dysfunction treated by Kaufmann's treatment for 17 years. Three years ago, she developed seizures, and photophobia and myoclonus sometimes occurred. This time, she had strong photophobia and nausea for 3 months and then developed tonic-clonic seizures for 3 min. Her blood pressure and laboratory test on admission were all within normal limits. She presented no neurological deficits at admission, but the T2-weighted image (T2WI) showed a high-intensity area (HIA), and arterial spin labeling (ASL) image described cerebral blood flow (CBF) increase in the left parieto-occipital region. We diagnosed PRES and started anticonvulsants, antihypertensive, and steroid pulse therapy. However, her aphasia and neuroimaging findings worsened, so we started general anesthesia treatment with propofol on day 29. On day 32, she suddenly developed multiple organ dysfunctions due to PRIS. After intensive care with other sedatives over 2 months, the systemic status and neurological symptoms gradually improved almost as before the onset. On day 90, HIA in the T2WI in the lesion became small, and CBF was severely downregulated in the ASL image. CONCLUSION: Unilateral PRES's pathophysiology and the association with the female hormone remain unknown. Some patients undergo gradual onset and long-term courses, and we should care for PRIS during PRES treatment.