[A case of Coexistent Persistent Trigeminal and Hypoglossal Arteries Manifested with Neurovascular Compression Syndrome by Hypertension].

A 70-year-old woman visited our hospital with hypertension, diplopia, and right orbital pain. Neurological examination revealed right ophthalmoplegia. CT angiography and MRI identified a right persistent trigeminal artery (PTA), right persistent hypoglossal artery, and bovine aortic arch. The right internal carotid artery (ICA) was displaced laterally in the cavernous sinus due to the bifurcation of the PTA. Compression of the right oculomotor nerve, right trochlear nerve, and first division of the right trigeminal nerve by the elongated right ICA was noted and considered a potential cause of the ophthalmoplegia and orbital pain. Symptoms improved with normalization of blood pressure. During embryonic development, the right posterior communicating artery and bilateral vertebral arteries were aplastic or hypoplastic, which suggests that these carotid-basilar anastomoses may have remained as supply routes to provide sufficient blood flow to the posterior cerebral circulation. This is an extremely rare case of embryological implications manifested with neurovascular compression syndrome. (Received 6 January, 2022; Accepted 17 February, 2022; Published 1 June, 2022).

Analysis of Recurrent Stroke Volume and Prognosis between Warfarin and Four Non-Vitamin K Antagonist Oral Anticoagulants' Administration for Secondary Prevention of Stroke.

OBJECTIVE: We investigated recurrent stroke volume with nonvalvular atrial fibrillation (NVAF) patients treated with non-vitamin K antagonist oral anticoagulants (NOACs) about clinical backgrounds and number of recurrent stroke. METHODS: We administered 4 NOACs, dabigatran, rivaroxaban, apixaban, and edoxaban in 101 postcardioembolic strokes with NVAF. In a retrospective study, we measured recurrent stroke volume with magnetic resonance imaging volumetric software and compared them between 10 vitamin K anticoagulant (VKA: warfarin) cases and 13 NOAC cases under anticoagulant therapy. RESULTS: Of 101 cases, 31 were started with a VKA and switched to NOACs after 10 recurrent strokes. Other 70 cases were directly started with NOACs and 13 cases with NOACs as first anticoagulants had recurrent stroke. The frequency of recurrent stroke during anticoagulant therapy is not different between the VKA group and the 3 NOACs group. Recurrent stroke volume is significantly larger in the VKA group (26.4 cm3) than in the NOACs group (1.2 cm3). CONCLUSIONS: Secondary prevention with NOACs after stroke might be more beneficial than a VKA by reducing recurrent infarct volume.

[Assessment of nausea and vomiting during FEC regimen for breast cancer after the novel antiemetic agent - introduction using MASCC antiemesis tool].

Chemotherapy-induced nausea and vomiting(CINV)is one of the side effects causing significant psychological and physical suffering in patients receiving chemotherapy. Because CINV often impairs patients' quality of life and leads to discontinuation of treatments, antiemetic therapy has been considered important. The MASCC Antiemesis Tool(MAT)was proposed for the assessment of acute and delayed nausea and vomiting after, we evaluated the actual situation of nausea and vomiting for Japanese patients. In a previous investigation, even conventional antiemesis therapy was a highly effective treatment during the acute phase, but the control of nausea and vomiting during the delayed phase proved difficult. Recently, a new5 -HT3 receptor blocker(palonosetron)and an NK1 receptor blocker(aprepitant) were introduced, and an effective treatment of nausea and vomiting for the delayed phase is non expected. In this examination, we evaluated the usefulness of the new antiemetic drugs(palonosetron and aprepitant)in 12 prospective patients with breast cancer(40-69 years old, median age 53 years old)for whom FEC therapy was given as an ambulant treatment using MAT. No vomiting occurred in the acute and delayed phase. Nausea during the acute phase was controlled, and was mild during the delayed phase, also. It was confirmed that the onset of acute and delayed nausea and vomiting were relieved by the newantiemetic agents compared with the previous MAT evaluation.