[A case of brugada syndrome presenting with syncope transferred by ambulance to a neurosurgical hospital].

Brugada syndrome is a known cause of sudden death. We report a case of Brugada syndrome who was transferred by ambulance to our neurosurgical hospital. An 18-year-old male suddenly lost consciousness and collapsed at his home. His mother urgently called for an ambulance because there was atypical absence of consciousness for several minutes. Because the Japan Coma Scale (JCS) and the consciousness level was about 10 on arrival by ambulance, the emergency services suspected brain concussion, so transported him to our neurosurgical hospital. However, the JCS reached a level of 1 in the emergency room. Both skull X-P and a brain CT scan were performed but no abnormalities were observed, such as bone fracture or hematoma camed by cerebral contusion of the skull. We recognized a saddle-back ST elevation in the V3 portion and an atypical corved ST elevation in the V1-V2 portion based on the findings of electrocardiograms. As a result of the above findings, we suspected that the patient may have Brugada syndrome and the patient was therefore hospitalized and carefully followed up. We finally diagnosed the patient to have Brugada syndrome after consulting with a circulatory organ internal medicine specialist during the patient's hospitalization. Since, Brugada syndrome is a disease that may result in sudden death, further steps, such as an ICD (implantable cardioverter defibrillator) are thus considered to be necessary in this case.

[Study of multiple cerebral aneurysms comprised of both ruptured and unruptured aneurysm--an analysis of incidence rate with respect to site and size].

The purpose of this investigation was to study the incidence rate of rupture with respect to the site and size of multiple cerebral aneurysms that include both ruptured and unruptured aneurysms. Site and size were investigated in 58 cases of this type of multiple cerebral aneurysm. All cerebral aneurysms were examined with MR angiography, 3D-CT angiography and digital subtraction angiography, as well as seeing measured using 3D-CT or digital subtraction angiography. As regards the site of the 58 ruptured cerebral aneurysms under study, 18 were internal carotid aneurysms (C2 or C3: 4 cases, IC-PC: 12 cases, IC-ancho.: 1 case, IC terminal: 1 case), 25 were anterior communicating aneurysms, 10 were middle cerebral aneurysms, 4 were anterior cerebral aneurysms and 1 case was a VA-PICA aneurysm. The ruptured internal carotid aneurysms were 4.0-21.0 mm in size, the anterior communicating aneurysms were 1.8-13 mm, the middle cerebral aneurysms were 2.0-21.3 mm, the anterior cerebral aneurysms were 3.2-9.1 mm, and the VA-PICA aneurysm was 4.4 mm. The sites of the 89 unruptured cerebral aneurysms break down as follows: 29 were internal carotid aneurysms (C2 or C3: 4 cases, IC-PC: 10 cases, IC-ancho.: 10 cases, IC terminal: 5 cases), 18 were anterior communicating aneurysms, 34 were middle cerebral aneurysms, and there were 5 cases of posterior circulation aneurysm. In size, the unruptured internal carotid aneurysms were 1.0-18.3 mm, the anterior communicating aneurysms were 1.0-6.5 mm, the middle cerebral aneurysms were 1.0-10.3 mm, the anterior cerebral aneurysms were 1.0-3.3 mm, and the posterior circulation aneurysms were 2.2-17.3 mm. Out of 58 ruptured cerebral aneurysms, 44 were of the largest size category, and 53 (91.4%) were in the largest size category and/or anterior communicating aneurysms. The accumulated incidence rate of rupture of anterior communicating aneurysms rose suddenly upon reaching 2 mm in size, and after reaching 3 mm, these aneurysms accounted for a nearly uniform 55%-60% of the incidence rate of rupture. The accumulated incidence rate of rupture of IC-PC aneurysms rose drastically at 4 mm in size with the data describing a parabolic slope when graphed. IC-PC aneurysms represented a uniform 55% of the incidence rate of rupture after reaching 8 mm in size. The accumulated incidence rate of rupture of middle cerebral aneurysms rose in a gently sloping parabola beginning at 4 mm, and stabilized at 20% upon reaching 10 mm. These results suggest that each site is associated with a characteristic size and rate of aneurismal rupture. Special attention should thus be paid to large and anterior communicating aneurysms when operating on multiple cerebral aneurysms.