Surgical Improvement of Neuropathy-Induced Calf Muscle Hypertrophy and Creatine Kinase Elevation: A Case Report.

Peripheral neuropathy and radiculopathy often result in skeletal muscle disorders, typically leading to muscle atrophy. Concurrent muscle hypertrophy or persistently elevated creatine kinase (CK) is rare. While muscle hypertrophy is commonly observed in myogenic diseases, such as muscular dystrophy, acromegaly, inflammatory myopathies, and hypothyroidism, reports of muscle hypertrophy caused by neuropathy are infrequent. We encountered a patient with persistently elevated CK levels and unilateral lower leg muscle hypertrophy associated with neuropathy. The patient had cauda equina syndrome symptoms and pain in the left lower leg. Lumbar spine magnetic resonance imaging (MRI) revealed central spinal stenosis, which was believed to be the cause of the symptoms. Lower-limb MRI revealed high signal intensity in the gastrocnemius muscle on fat-suppressed T2-weighted imaging. Surgical treatment improved the radiculopathy, hypertrophy, and pain in the left lower leg. During the one-year follow-up, improvement was confirmed with both MRI and nerve conduction studies. Calf muscle hypertrophy associated with neuropathy has been reported; however, no reports have demonstrated pre- and postoperative changes with MRI and nerve conduction studies. We report a patient with lower leg muscle hypertrophy and persistent CK elevation associated with neuropathy, along with a literature review.

Spontaneous Intracranial Hypotension Discovered Following Cerebral Venous Thrombosis: A Case Report and Review of the Literature.

Cerebral venous thrombosis (CVT) is a rare complication of spontaneous intracranial hypotension (SIH). We encountered a case where SIH was discovered after the diagnosis of CVT, suggesting the occurrence of CVT during the acute phase of SIH. We report this rare case of isolated cortical vein thrombosis in the acute phase of SIH. A 48-year-old woman taking low-dose oral contraceptives presented with neck pain, headache, and right-sided weakness. Magnetic resonance imaging and digital subtraction angiography confirmed isolated cortical vein thrombosis. No other specific imaging abnormalities were noted. The patient was initially treated with anticoagulation. Subsequent worsening of her orthostatic headache led to the diagnosis of SIH, with diffuse dural enhancement on gadolinium-enhanced T1-weighted imaging. An epidural blood patch was performed, resulting in a favorable outcome with no neurological deficits. Although CVT can occur in the acute phase of SIH, particularly in patients with thrombophilia, the lack of characteristic imaging findings associated with SIH often complicates the diagnosis.

Endovascular treatment of acute atherothrombotic internal carotid artery occlusion associated with persistent primitive hypoglossal artery.

Persistent primitive hypoglossal artery is a relatively rare anatomical variation and a type of persistent carotid-basilar anastomosis. Acute internal carotid artery occlusion associated with persistent primitive hypoglossal artery is rare, and atherothrombotic occlusion is extremely rare. We present a case of acute atherothrombotic internal carotid artery occlusion associated with persistent primitive hypoglossal artery that was successfully treated by endovascular treatment. A 70-year-old male with a history of left internal carotid artery stenosis was transferred to our hospital by ambulance because of abnormal behaviors and aphasia. He was diagnosed with cerebral infarction and left internal carotid artery occlusion. Left carotid angiography revealed the persistent primitive hypoglossal artery arising from the cervical internal carotid artery and complete internal carotid artery occlusion distal to the origin of the persistent primitive hypoglossal artery. Therefore, we performed endovascular treatment. Mechanical thrombectomy was performed under minimal flow arrest with consideration of brain ischemia causing coma. After additional balloon angioplasty, recanalization was achieved, and the patient's symptoms improved. During the 1.5-year follow-up period, no recurrence or restenosis was observed. This report provides evidence that atherosclerotic internal carotid artery stenosis associated with persistent primitive hypoglossal artery can occur even distal to the origin of the persistent primitive hypoglossal artery and that the lesion may become acutely occluded, leading to acute stroke. Endovascular treatment considering brain ischemia was effective in this case.

Posterior reversible encephalopathy syndrome mimicking subacute ischemic stroke: a case report.

Posterior reversible encephalopathy syndrome, an acute onset neurological syndrome, is among the conditions that must be differentiated from stroke. Herein, we report a rare case of posterior reversible encephalopathy syndrome mimicking subacute ischemic stroke. A 68-year-old man was transferred by ambulance to our hospital because of visual disturbance. He showed left homonymous hemianopsia. Magnetic resonance imaging (diffusion-weighted imaging and fluid-attenuated inversion recovery imaging) revealed high signal intensity in the right occipital lobe. We suspected subacute cerebral infarction. After admission, he developed cortical blindness and increased blood pressure. Fluid-attenuated inversion recovery imaging revealed high signal intensity and elevated apparent diffusion coefficient values in the bilateral occipital lobes. We diagnosed the patient with posterior reversible encephalopathy syndrome. Antihypertensive treatment improved his clinical symptoms. Careful imaging assessment, including of changes over time, is important for diagnosing posterior reversible encephalopathy syndrome.

Separate origins of the left internal and external carotid arteries from the aorta in a patient with intracerebral hemorrhage.

Agenesis of the left common carotid artery with separate origins of the left internal and external carotid arteries from the aorta is an extremely rare anomaly. This anomaly is typically asymptomatic unless associated with other conditions. We report a case of separate origins of the left internal and external carotid arteries from the aorta in a patient with intracerebral hemorrhage. A 42-year-old man was transferred to our hospital by ambulance because of left hemiparesis. Computed tomography scan revealed right putaminal hemorrhage. Computed tomography angiography and digital subtraction angiography demonstrated independent origins of the left internal carotid artery and external carotid artery from the aortic arch. Right internal carotid angiography revealed blood supply to the left anterior cerebral artery and middle cerebral artery via the anterior communicating artery. The separate origins of the left internal and external carotid arteries from the aorta may cause hemodynamic stress to the contralateral side, leading to right intracerebral hemorrhage.

Preparation of magnetic molecularly imprinted polymers for bisphenol A and its analogues and their application to the assay of bisphenol A in river water.

Magnetic molecularly imprinted polymers (M-MIPs) for bisphenol A (BPA) and its structural analogues have been prepared by a multi-step swelling and polymerization method using uniformly-sized magnetic particles as a shape template. Binding experiments and Scatchard analyses revealed that two classes of binding sites were formed on M-MIP(BPA). The retention and molecular-recognition properties of M-MIPs for BPA and its structural analogues were evaluated using a mixture of phosphate buffer and acetonitrile or a mixture of water and acetonitrile as a mobile phase by LC. M-MIPs for BPA and [²H16]BPA (BPA-d16), M-MIP(BPA) and M-MIP(BPA-d16), showed almost the same imprinting factors for BPA, while M-MIP for bisphenol B (2,2-bis(4-hydroxyphenyl)butane, BPB), M-MIP(BPB), gave the moderate imprinting factor for BPA. Furthermore, M-MIP(BPB) was applied for the selective extraction and determination of BPA in environmental water samples. The concentration of BPA in river water samples was determined to be 68 ng/L.