Anterior Cerebral Artery Dissection in a Patient With Autosomal Dominant Polycystic Kidney Disease.

Intracranial artery dissection secondary to autosomal dominant polycystic kidney disease is far less common than cerebral aneurysm. A 55-year-old man presented a sudden onset of headache and disturbed consciousness caused by ischemic stroke in the bilateral frontal lobes with minor subarachnoid hemorrhage. The bilateral anterior cerebral arteries were firstly occluded and re-perfused with irregular narrowing and dilation in 3 days after stroke onset, indicating dissection. He was diagnosed with autosomal dominant polycystic kidney disease by abdominal CT findings and by his family history though his renal function was almost normal. Dissection in the anterior cerebral artery has not been reported previously, while some cases with dissection in the vertebral and extracranial arteries were reported in autosomal dominant polycystic kidney disease. His family also had a history of aortic dissection and subarachnoid hemorrhage. Intracranial artery dissection may be a manifestation of systemic arteriopathy with familial clustering in autosomal dominant polycystic kidney disease. Strict antihypertensive treatment is needed in these cases.

Compensatory contribution of the contralateral pyramidal tract after stroke.

Stroke is a leading cause of long-term disability with early accelerated followed by gradual recovery during the first 6 months after the ictus. The most important mechanism concerning early recovery is thought to be brain plasticity provided by anatomical and functional reorganization of the central nervous system after injury. Recent advances in noninvasive, functional brain imaging techniques provided some insight indicating the contribution of ipsilateral uncrossed corticospinal tracts in motor recovery after stroke. Since motor tracts vary considerably among subjects, the ratio of contralateral corticospinal tract fibers and their interhemispheric control versus the amount and function of ipsilateral corticospinal tract fibers may affect the scale of motor recovery after stroke. Further studies are needed to clarify the mechanisms of motor recovery after stroke in humans.

Emphysema detected by lung cancer screening with low-dose spiral CT: prevalence, and correlation with smoking habits and pulmonary function in Japanese male subjects.

OBJECTIVE: Screening with low-dose spiral CT is a promising new tool for early lung cancer detection. A study was undertaken to assess the prevalence of emphysema detected by CT screening, and to assess the correlation between the extent of emphysema and the severity defined according to the recently published Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. METHODS: After informed consent, CT screening and pulmonary function tests were performed on 615 men between the ages of 40 and 69. Severity of emphysema was assessed visually. Only the pulmonary function data for male subjects were analysed because there were too few female subjects with emphysema. RESULTS: Emphysema was detected in 30.5% of current smokers, 14.1% of former smokers and 3.0% of non-smokers. In male current smokers, airflow obstruction (FEV(1)/FVC < 0.7) was seen in 18.1% of subjects with mild emphysema, and in 33.3% of subjects with moderate emphysema. FEV(1) values were less than 80% of the predicted normal in 8.5% of subjects with mild emphysema, and 28.6% of subjects with moderate emphysema. The percentage of male subjects with emphysema equivalent to GOLD stage 0 was 90.0% for subjects in their 40s, 82.5% for those in their 50s, and 68.2% for those in their 60s. CONCLUSION: A considerable percentage of the subjects with emphysema as detected by CT screening had GOLD stage 0. CT screening assists in detecting early-stage emphysema.