Associations between oral health status and short-term functional outcomes in hospitalized patients aged over 65 years with acute ischemic stroke: a retrospective observational study.

OBJECTIVE: To assess the associations between oral health status and short-term functional outcomes in hospitalized patients aged over 65 years with acute ischemic stroke. MATERIALS AND METHODS: This retrospective observational analysis included older adult patients (age, ≥ 65 years) admitted for acute ischemic stroke. The oral health status at admission was evaluated using the Oral Health Assessment Tool (OHAT). Patients were categorized into the normal oral health (OHAT score, 0-2) or poor oral health (OHAT score, ≥ 3) group. Stroke severity, Functional Oral Intake Scale (FOIS), and medical history were compared. Multivariate analysis was used to determine the association between the OHAT score and modified Rankin Scale (mRS) score at discharge, FOIS score at discharge, and length of hospital stay. RESULTS: The study comprised 129 patients (mean age: 78.8 ± 7.7 years). The poor oral health group (n = 22) had a higher stroke severity and lower FOIS scores than the normal oral health group (n = 107). The poor oral health group exhibited significantly higher rates of moderate to severe disability at discharge (odds ratio = 9.18, 95% confidence interval [CI]: 1.74-48.30, P = 0.009), lower FOIS scores at discharge (ß = -0.96, 95% CI: -1.71 to -0.20, P = 0.014), and longer hospital stays (ß = 10.70, 95% CI: 0.80-20.61, P = 0.034) than the other group. CONCLUSION: In older patients with acute ischemic stroke, poor oral health status at admission was associated with worse short-term functional outcomes, including increased disability, dysphagia, and longer hospital stay. CLINICAL RELEVANCE: Assessing and addressing the oral health status of this population can potentially improve short-term functional outcomes and enhance comprehensive stroke care.

Assessment of coding-based frailty algorithms for long-term outcome prediction among older people in community settings: a cohort study from the Shizuoka Kokuho Database.

OBJECTIVES: To assess the applicability of Electronic Frailty Index (eFI) and Hospital Frailty Risk Score (HFRS) algorithms to Japanese administrative claims data and to evaluate their association with long-term outcomes. STUDY DESIGN AND SETTING: A cohort study using a regional government administrative healthcare and long-term care (LTC) claims database in Japan 2014-18. PARTICIPANTS: Plan enrollees aged ≥50 years. METHODS: We applied the two algorithms to the cohort and assessed the scores' distributions alongside enrollees' 4-year mortality and initiation of government-supported LTC. Using Cox regression and Fine-Gray models, we evaluated the association between frailty scores and outcomes as well as the models' discriminatory ability. RESULTS: Among 827,744 enrollees, 42.8% were categorised by eFI as fit, 31.2% mild, 17.5% moderate and 8.5% severe. For HFRS, 73.0% were low, 24.3% intermediate and 2.7% high risk; 35 of 36 predictors for eFI, and 92 of 109 codes originally used for HFRS were available in the Japanese system. Relative to the lowest frailty group, the highest frailty group had hazard ratios [95% confidence interval (CI)] of 2.09 (1.98-2.21) for mortality and 2.45 (2.28-2.63) for LTC for eFI; those for HFRS were 3.79 (3.56-4.03) and 3.31 (2.87-3.82), respectively. The area under the receiver operating characteristics curves for the unadjusted model at 48 months was 0.68 for death and 0.68 for LTC for eFI, and 0.73 and 0.70, respectively, for HFRS. CONCLUSIONS: The frailty algorithms were applicable to the Japanese system and could contribute to the identifications of enrollees at risk of long-term mortality or LTC use.

Tissue Protrusion With Attenuation Is Associated With Ischemic Brain Lesions After Carotid Artery Stenting.

Background and Purpose- Tissue protrusion between stent struts is frequently observed on optical frequency domain imaging evaluation after carotid artery stenting, but its clinical relevance is unclear. We aimed to investigate the association between the characteristics of tissue protrusion assessed by optical frequency domain imaging and brain lesions identified by diffusion-weighted imaging after carotid artery stenting. Methods- Sixty-five consecutive patients who underwent optical frequency domain imaging after protected carotid artery stenting were enrolled in the study. Cross-sectional optical frequency domain images within the stented segments were evaluated at 0.125-mm intervals. Magnetic resonance imaging was performed 1 to 10 days after treatment. The characteristics of tissue protrusion were compared between patients with and without new ipsilateral brain lesions on posttreatment magnetic resonance imaging. Results- Tissue protrusion was observed in 62 patients (95%). New brain lesions were observed in 24 patients (37%). In the multivariate analysis, the presence of protrusion with attenuation (odds ratio, 2.94 [95% CI, 1.05-8.68] P=0.04) was associated with new brain lesions after carotid artery stenting. Conclusions- The presence of protrusion with attenuation assessed by optical frequency domain imaging was associated with ipsilateral brain lesions after carotid artery stenting. Prevention or treatment of protrusions with attenuation may reduce ischemic brain lesions after carotid artery stenting.

A Case of Delayed Intraparenchymal Hemorrhage Due to Hyperperfusion After Flow Diverter Treatment.

Delayed intraparenchymal hemorrhage (DIPH) is one of the complications of flow diverter (FD) treatment, however, the mechanism is unclear. We present the case of a 54-year-old woman with a partially thrombosed large internal carotid artery aneurysm. She presented intraparenchymal hemorrhage in the right parietal lobe three days after the successful FD treatment. We performed endoscopic hematoma removal, and then her consciousness disturbance was fully recovered. IMP single-photon emission computed tomography showed significant increase of cerebral blood flow in the right hemisphere. We diagnosed DIPH associated with hyperperfusion after FD treatment. It is necessary to consider that DIPH due to hyperperfusion may occur after FD treatment.

Subtypes of overtime work and nurses' fatigue, mental status, and work engagement: A latent class analysis of Japanese hospital nurses.

AIMS: To clarify the subgroups of overtime work motivations and to determine how fatigue, mental status, and work engagement differ among the subgroups. DESIGN: Cross-sectional. METHODS: Questionnaires were distributed to 1,075 full-time nurses working in four hospitals in Japan from October 2015 - February 2016. Nurses were categorized into subgroups of overtime work motivation by latent class analysis. An analysis of covariance was conducted to examine how fatigue, mental status, and work engagement differ among subgroups. RESULTS/FINDINGS: We identified five types of overtime workers differing greatly in fatigue, mental status, and work engagement. CONCLUSIONS: Even when nurses worked approximately the same work hours, the difference in motivation corresponded to different degrees of fatigue, mental status, and work engagement. When introducing policies to reduce overtime work, managers should consider the different groups of overtime workers, as effective measures may differ.

Tailored Strategies in Carotid Artery Stenting to Avoid Periprocedural Complications.

Carotid artery stenting (CAS) has been widely accepted as a valuable therapeutic alternative to carotid endarterectomy (CEA) for high-grade carotid stenosis. Because carotid revascularization including CAS is usually performed in patients with minimal or no neurological deficits, utmost care should be taken to avoid periprocedural complications. The major concerns associated with CAS are embolic stroke, hyperperfusion syndrome (HPS), and perioperative myocardial infarction.Plaque characteristics, cerebral blood flow (CBF) in the affected cerebral hemisphere, and concomitant coronary artery disease prior to CAS are all important to assess the risks of these complications and are routinely evaluated.Tailored CAS is planned based on findings of preoperative evaluation, as follows. (1) If the plaque component is thought vulnerable, proximal embolic protection methods, use of a closed-cell-type stent, or referral to CEA should be considered to avoid embolic complications. (2) If patients have severe CBF impairment, staged angioplasty is an effective strategy to prevent postoperative HPS. (3) If concomitant cardiac diseases are present, the optimal treatment sequence should be discussed between cardiologists and neurointerventionalists.These tailored strategies based on preoperative risk evaluations may lead to safer procedures and better clinical outcome in CAS patients.

The effect of quality of overtime work on nurses' mental health and work engagement.

AIM AND BACKGROUND: Recent research has suggested that the reasons why nurses work overtime hours exert differential effects on the overall impact of the work. This study aimed to clarify why nurses work overtime, and whether well-being effects differed by reason, at both the ward and individual level. METHODS: Participants were 1,075 permanent nurses from 54 wards. Overtime reasons' distribution and impact on nurses were examined by a multilevel structural equation modelling approach. RESULTS: Nurses typically worked overtime due to a pressure to conform, high workload and to enhance self-development. Involuntary overtime work demonstrated a detrimental effect on mental health and work engagement at both the ward and individual level, whereas voluntary overtime work exerted a beneficial effect on well-being. CONCLUSIONS: The distribution and impact of overtime work differed by the reasons for working the overtime. IMPLICATIONS FOR NURSING MANAGEMENT: These results suggest the importance of assessing the reasons for overtime, aside from the length of overtime hours. When trying to reduce overtime work, hospital managers and nurse managers need to advance the plan by ward as a whole, and also carefully assess the reasons for overtime.

Nrf2 activator ameliorates hemorrhagic transformation in focal cerebral ischemia under warfarin anticoagulation.

BACKGROUND AND PURPOSE: Oxidative stress has been reported to be a main cause of neuronal cell death in ischemia reperfusion injury (IRI). Nuclear factor-erythroid 2-related factor 2 (Nrf2) is an important factor involved in anti-oxidative responses. We previously reported that bardoxolone methyl (BARD), an Nrf2 activator, prevented damage induced by IRI. In this study, we investigated the effect of BARD on hemorrhagic transformation in the context of blood brain barrier (BBB) protection. METHODS: Mice received pre-treatment with warfarin (4.0 mg/kg, p.o.). IRI was subsequently induced 18 h after the warfarin administration by transient middle cerebral artery occlusion (MCAO) for 6 h. BARD (0.06, 0.2, 0.6 or 2.0 mg/kg) or saline was injected intravenously immediately after reperfusion. The infarct volume, neurological score, intracranial hemorrhage volume, and BBB permeability were evaluated 24 h after MCAO. The survival rate and behavioral functional recovery were evaluated for 7 days following IRI. Furthermore, the effects of BARD on BBB components were investigated by western blotting and immunostaining analysis. RESULTS: BARD suppressed warfarin-mediated increases in the intracranial hemorrhage volume without affecting the infarct volume. BBB permeability was also suppressed by administration of BARD. Western blotting showed that BARD increased expression of BBB components such as endothelial cells, pericytes, and tight junction proteins. Furthermore, immunostaining showed that BARD induced localization of Nrf2 to endothelial cells and pericytes. CONCLUSIONS: BARD suppressed the exacerbation hemorrhage caused by warfarin pretreatment and ameliorated BBB disruption by protecting endothelial cells, pericytes, and tight junction protein expressions. These results indicate that Nrf2 activators may be an effective therapy against hemorrhagic transformation caused by anticoagulant drugs.

Psychosocial Factors of Overtime Work in Relation to Work-Nonwork Balance: a Multilevel Structural Equation Modeling Analysis of Nurses Working in Hospitals.

PURPOSE: Few studies have investigated the impact of psychosocial factors on overwork and employee well-being while taking into account the complex relationships between such factors and the effect of workplace. The present study aimed to examine the association between psychosocial factors of overtime work and work-nonwork balance using a multilevel structural equation modeling (SEM) technique. METHODS: A survey was conducted among nurses working in three hospitals (n = 603) in Japan. After confirming the constructs of the factors by confirmatory factor analysis (CFA) and exploratory factor analysis (EFA), a multilevel SEM was conducted to investigate the direct and indirect effects of involuntary and voluntary overtime work on work-nonwork balance at both individual and workplace levels. RESULTS: Both involuntary and voluntary overtime work factors were further differentiated into two factors (four factors in total). Involuntary overtime work directly decreased work-nonwork balance on both levels; voluntary overtime work had a direct positive effect. However, voluntary overtime work had a negative indirect effect on work-nonwork balance satisfaction. CONCLUSIONS: The use of multilevel SEM techniques to evaluate the association of clinical factors with work-nonwork balance demonstrated that involuntary overtime work has a negative effect on work-nonwork balance and voluntary overtime work had a positive direct effect but a negative indirect effect.

Mortality risk in current and new antipsychotic Alzheimer's disease users: Large scale Japanese study.

INTRODUCTION: We studied the mortality risk of long term and new antipsychotic drug use in Alzheimer's disease (AD) patients in Japan to determine improved treatment protocols. METHODS: This 24-week prospective cohort study included 10,079 Japanese AD patients (female, 69%; average age, 81 years) under routine clinical care in 357 medical sites. The antipsychotic medication history was varied (63.7% were long-term users). Mortality rates and odds ratio were analyzed (initial 10 weeks and from 11-24 weeks). RESULTS: The antipsychotic exposed group with shorter treatment periods had a higher mortality risk compared to controls. The newly prescribed users (antipsychotic treatment started during the follow-up) showed increased mortality (9.4% during the 11-24 week period). CONCLUSIONS: New use of antipsychotic drugs represents a distinct risk for mortality; those on long-term antipsychotic therapy seem to be at less risk. The warning issued 10 years earlier on antipsychotics use for AD patients should be reviewed.

Delayed Stenosis in the Intracranial Vessels following Endovascular Treatment for Acute Stroke.

PURPOSE: To evaluate delayed stenosis of the vessels after endovascular thrombectomy using magnetic resonance (MR) angiography. MATERIALS AND METHODS: Of 82 consecutive patients who underwent successful endovascular treatment for acute intracranial large vessel occlusion between October 2010 and October 2014 at a single institution, 57 patients for whom 3-month radiologic follow-up examinations using MR angiography were available were included in the analysis. MR angiography images were assessed to detect delayed stenosis, which was defined as a decrease in the diameter of treated vessels > 50% compared with MR angiography images obtained 24 hours after endovascular treatment. RESULTS: MR angiography images obtained 3 months after endovascular treatment revealed delayed stenosis of treated vessels in five (8.8%) of 57 patients. All cases of delayed stenosis were asymptomatic and occurred in the middle cerebral artery (MCA). Further serial radiologic follow-up showed gradual improvement of all delayed stenosis over 12 months. CONCLUSIONS: Endovascular treatment poses a risk of delayed stenosis of treated vessels, especially in the MCA. MR angiography is a useful modality in long-term follow-up to evaluate delayed stenosis after endovascular treatment.

Analysis of impact of geographic characteristics on suicide rate and visualization of result with Geographic Information System.

AIM: The aim of our study was to understand the geographic characteristics of Japanese communities and the impact of these characteristics on suicide rates. METHODS: We calculated the standardized mortality ratio from suicide statistics of 3318 municipalities from 1972 to 2002. Correlation analysis, multi-regression analysis and generalized additive model were used to find the relation between topographic and climatic variables and suicide rate. We visualized the relation between geographic characteristics and suicide rate on the map of Wakayama Prefecture, using the Geographic Information System. RESULTS: Our study showed that the geographic characteristics of each community are related with its suicide rate. The strongest factor among the geographic characteristics to increase the suicide rate was the slope of the habitable land. CONCLUSIONS: It is necessary to take the characteristics of each community into consideration when we work out measures of suicide prevention. Visualization of the findings on the local map should be helpful to promote understanding of problems and to share the information among various parties in charge of suicide prevention.

Effect of overweight/obesity and metabolic syndrome on frailty in middle-aged and older Japanese adults.

Background: The potential for developing frailty exists in middle-aged and older adults. While obesity and metabolic syndrome (MetS) increase the risk of frailty in older adults, this relationship remains unclear in middle-aged adults, who are prone to developing lifestyle-related diseases. Objective: To examine the effect of overweight/obesity and MetS on frailty development in middle-aged and older Japanese adults using real-world data. Methods: This nationwide cohort study used exhaustive health insurance claims data of 3,958,708 Japanese people from 2015 to 2019 provided by the Japan Health Insurance Association. Participants aged ≥35 and < 70 years who received health checkups in 2015 were included. Multivariate logistic regression was used to assess the effect of body mass index (BMI) and MetS or MetS components (i.e., diabetes, hypertension, and dyslipidemia) in 2015 on frailty risk assessed using the hospital frailty risk score in 2019. Additionally, a subgroup analysis was performed to examine the interaction effects of MetS components and 4-year weight change (%) on frailty risk among participants who were overweight and obese (BMI ≥25 kg/m2). Results: In 2019, 7204 (0.2%) and 253,671 (6.4%) participants were at high and intermediate frailty risks, respectively. Obesity and MetS were independently associated with intermediate/high frailty risk (odds ratio (OR) 1.36, p < 0.05; OR 1.23, p < 0.05, respectively) and high frailty risk (OR 1.80, p < 0.05; OR 1.37, p < 0.05, respectively) in all participants. Although all MetS components were frailty risk factors, these effects diminished with age in both sexes. Subgroup analysis of patients with diabetes revealed that 5%-10% weight loss was associated with reduced frailty risk in both sexes. Conclusions: Obesity, MetS, and MetS components were independent frailty risk factors in middle-aged and older Japanese adults. Weight loss of up to 10% over 4 years prevented frailty in patients with diabetes who were overweight and obese.

Haptoglobin phenotype predicts cerebral vasospasm and clinical deterioration after aneurysmal subarachnoid hemorrhage.

Vasospasm (VS) and delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) are thought to greatly affect prognosis. Haptoglobin (Hp) is a hemoglobin-binding protein expressed by a genetic polymorphism (1-1, 2-1, and 2-2). Our objects were to investigate whether the Hp phenotype could predict the incidence of cerebral infarction, favorable outcome, clinical deterioration by DCI, and angiographical VS after aneurysmal SAH. Ninety-five consecutive patients who underwent clipping or coil embolization were studied. Favorable functional outcome was defined as a modified Rankin Scale score of 0-2 at 3 months. Angiographical VS was diagnosed based on cerebral angiography findings performed between days 7 and 10 after SAH. The Hp 2-2 group had a significantly greater risk of angiographical VS than that of Hp 2-1 and 1-1 groups combined on univariate (odds ratio [OR]: 3.60, confidence interval [CI]: 1.49-8.67, P = .003) and multivariate logistic regression analyses after being adjusted for age, sex, Fisher groups, and other risk factors (OR: 3.75, CI: 1.54-9.16, P = .004). The Hp 2-2 group also showed the tendency of a greater risk of clinical deterioration by DCI with marginal significance on univariate and age- and sex-adjusted analyses (univariate OR: 2.46, CI: .90-6.74, P = .080; age- and sex-adjusted OR: 2.46, CI: .89-6.82, P = .080) but not after being adjusted for other multiple risk factors. The Hp 2-2 group was not associated with the favorable 3-month outcome and cerebral infarction (univariate: P = .867, P = .209; multivariate: P = .905, P = .292). The Hp phenotype seems to be associated with a higher rate of angiographical VS and clinical deterioration by DCI but does not affect the incidence of cerebral infarction and favorable outcome.

Short-Term Outcomes of Surgery and Rehabilitation on Activities of Daily Living after Displaced Femoral Neck Fractures: Structural Equation Modeling.

In order to explore the factors affecting patients' level of activities of daily living (ADL) on discharge after undergoing bipolar hemiarthroplasty or total hip arthroplasty for displaced femoral neck fractures at an acute care hospital, patient data were analyzed with the following statistical tools: multiple regression analysis (MRA), structural equation modeling (SEM), and simultaneous analysis of several groups (SASG). The Barthel Index (BI) on discharge was set as the objective variable, while age, sex, degree of dementia, BI on admission, number of days from admission to surgery, surgical option, and number of rehabilitation units per day were set as explanatory variables. Factors such as age, sex, degree of dementia, BI on admission, and number of rehabilitation units per day were significant in MRA. While not significant in MRA, the number of days from admission to surgery was significant in SEM. According to the SASG, the number of rehabilitation units per day was significant for patients without dementia but not for patients with dementia. Analysis of real-world data suggests that early surgery and rehabilitation affect ADL on discharge to a greater degree than the surgical method. For patients without dementia, longer daily rehabilitation was significantly associated with better ADL on discharge.

Transitions of Activities of Daily Living Status among Inpatients with Subacute Stroke: A Latent Class Approach.

Objectives: This study investigated the transition patterns of activities of daily living (ADL) status based on the Functional Independence Measure (FIM) motor and cognitive items in patients who experienced subacute stroke. Methods: In this single-site, retrospective investigation, 1592 FIM samples were collected during the hospitalization of 373 stroke patients who were admitted between April 2018 and March 2020. FIM item levels were transformed from seven to three (FIM1-2, Complete Dependence; FIM3-5, Modified Dependence; FIM6-7, Independence). FIM samples were classified by latent class modeling into six latent ADL states based on the independence levels of FIM motor and cognitive items. We created an ADL status transition diagram based on the FIM sample's probability of belonging to each status at different hospitalization timepoints. Results: Transition diagrams for each ADL status at admission revealed distinct patterns. In two ADL statuses for which patients required full assistance in FIM motor items, the patients remained motor-dependent without achieving independence on discharge. In contrast, patients in transition from the other four ADL statuses largely achieved independence in motor items by the time of discharge. The time required to reach higher ADL status varied according to the initial ADL status at admission; the slowest improvement was observed in statuses initially classified as needing the most assistance, whereas many patients achieved transition within 3 months from admission. Conclusions: Based on the characteristics of patient ADL status and timing of its changes, the classification of ADL status and visualization of ADL transition can contribute to improved treatment.

Multimorbidity patterns in the working age population with the top 10% medical cost from exhaustive insurance claims data of Japan Health Insurance Association.

Although the economic burden of multimorbidity is a growing global challenge, the contribution of multimorbidity in patients with high medical expenses remains unclear. We aimed to clarify multimorbidity patterns that have a large impact on medical costs in the Japanese population. We conducted a cross-sectional study using health insurance claims data provided by the Japan Health Insurance Association. Latent class analysis (LCA) was used to identify multimorbidity patterns in 1,698,902 patients who had the top 10% of total medical costs in 2015. The present parameters of the LCA model included 68 disease labels that were frequent among this population. Moreover, subgroup analysis was performed using a generalized linear model (GLM) to assess the factors influencing annual medical cost and 5-year mortality. As a result of obtaining 30 latent classes, the kidney disease class required the most expensive cost per capita, while the highest portion (28.6%) of the total medical cost was spent on metabolic syndrome (MetS) classes, which were characterized by hypertension, dyslipidemia, and type 2 diabetes. GLM applied to patients with MetS classes showed that cardiovascular diseases or complex conditions, including malignancies, were powerful determinants of medical cost and mortality. MetS was classified into 7 classes based on real-world data and accounts for a large portion of the total medical costs. MetS classes with cardiovascular diseases or complex conditions, including malignancies, have a significant impact on medical costs and mortality.

CD40 amplifies Fas-mediated apoptosis: a mechanism contributing to emphysema.

Excessive apoptosis and prolonged inflammation of alveolar cells are associated with the pathogenesis of pulmonary emphysema. We aimed to determine whether CD40 affects alveolar epithelial cells and endothelial cells, with regard to evoking apoptosis and inflammation. Mice were repeatedly treated with agonistic-anti CD40 antibody (Ab), with or without agonistic-anti Fas Ab, and evaluated for apoptosis and inflammation in lungs. Human pulmonary microvascular endothelial cells and alveolar epithelial cells were treated with agonistic anti-CD40 Ab and/or anti-Fas Ab to see their direct effect on apoptosis and secretion of proinflammatory molecules in vitro. Furthermore, plasma soluble CD40 ligand (sCD40L) level was evaluated in patients with chronic obstructive pulmonary disease (COPD). In mice, inhaling agonistic anti-CD40 Ab induced moderate alveolar enlargement. CD40 stimulation, in combination with anti-Fas Ab, induced significant emphysematous changes and increased alveolar cell apoptosis. CD40 stimulation also enhanced IFN-γ-mediated emphysematous changes, not via apoptosis induction, but via inflammation with lymphocyte accumulation. In vitro, Fas-mediated apoptosis was enhanced by CD40 stimulation and IFN-γ in endothelial cells and by CD40 stimulation in epithelial cells. CD40 stimulation induced secretion of CCR5 ligands in endothelial cells, enhanced with IFN-γ. Plasma sCD40L levels were significantly increased in patients with COPD, inversely correlating to the percentage of forced expiratory volume in 1 s and positively correlating to low attenuation area score by CT scan, regardless of smoking history. Collectively CD40 plays a contributing role in the development of pulmonary emphysema by sensitizing Fas-mediated apoptosis in alveolar cells and increasing the secretion of proinflammatory chemokines.

Trigeminal Neuralgia Caused by Dural Arteriovenous Fistula of the Transverse-Sigmoid Sinus without Vessel Compression at Root Entry Zone.

Objective: The vessel compression at the root entry zone (REZ) of trigeminal nerve is a common cause of trigeminal neuralgia (TN). We report a rare case of TN caused by dural arteriovenous fistula (DAVF) of the transverse-sigmoid sinus without vessel compression at REZ. Case Presentation: A 45-year-old woman presented with right side tinnitus and was diagnosed as a DAVF of the right transverse-sigmoid sinus (Borden Type I). After that, the facial pain in the right maxillary nerve area appeared and was getting worse. DSA revealed an enlargement of the artery of foramen rotundum (AFR) as one of the feeding arteries. MRI revealed no evidence of vascular compression at REZ. The patient was treated with transarterial embolization (TAE) with Onyx via the branches of the middle meningeal artery (MMA) and occipital artery (OA). The AFR decreased in size and the facial pain was improved. However, the DAVF and the facial pain were recurred. Finally, the DAVF was completely embolized with transvenous embolization (TVE). During 1-year follow-up period, the patient remained free of pain without recurrence. Conclusion: The compression of the maxillary nerve by the AFR might result in TN, because the pain diminished after shrinkage of the AFR by the endovascular treatment.