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BACKGROUND: Recent studies have indicated that injuries such as muscle tears modify the microstructural integrity of muscle, leading to substantial alterations in measured diffusion parameters. Therefore, the fractional anisotropy (FA) value decreases. However, we hypothesized that soft tissue, such as muscle tissue, undergoes reversible changes under conditions of compression without fiber injury. PURPOSE: To evaluate the FA change due to compression in muscle tissue without fiber injury. MATERIAL AND METHODS: Diffusion tensor imaging (DTI) was performed on both feet of 10 healthy volunteers (mean age = 35.0 ± 10.39 years; age range = 23-52 years) using a 3.0-T magnetic resonance imaging (MRI) scanner with an eight-channel phased array knee coil. An MRI-compatible sphygmomanometer was applied to the individuals' lower legs and individuals were placed in a compressed state. Then, rest intervals of 5 min were set in re-rest state after compression. The FA value, apparent diffusion coefficient (ADC), and eigenvalues (λ1, λ2, λ3) of the gastrocnemius and soleus muscle were measured at each state. RESULTS: The mean FA values increased in all muscles in a compressed state, while the mean λ3 decreased. In all muscles, significant differences were found between the rest and compressed states in terms of mean FA and λ3 (P < 0.0001). CONCLUSION: We confirmed the reversibility of the DTI metrics, which suggests that there was no muscle injury during this study. In cases of compression without fiber injury, the FA value increases, because fibers are strongly aligned in the longitudinal direction.
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Imagem de Tensor de Difusão , Imageamento por Ressonância Magnética , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Imagem de Tensor de Difusão/métodos , Anisotropia , Imagem de Difusão por Ressonância Magnética , Fibras Musculares Esqueléticas , Músculo Esquelético/diagnóstico por imagemRESUMO
Positional vertebral artery occlusion(PVAO)is a mechanical occlusion of the extracranial vertebral artery(VA)due to physiological movement of the head and neck. However, only a few cases of mechanical VA compression due to routine flexion-extension of the neck have been reported. We present a unique case of PVAO due to neck extension with an occipital condylar spur. A 78-year-old man was admitted to our hospital for sudden onset of right hemiparesis and dysarthria. Magnetic resonance imaging(MRI)revealed bilateral occipital and cerebellar infarctions and vessel occlusion extending from the VA to the basilar artery. Mechanic thrombectomy resulted in partial recanalization. Computed tomography angiography(CTA)performed the next day showed spontaneously recanalized left VA with some wall irregularity. CTA in the neck-extended position revealed a severely compressed left VA in its V3 segment, which was attributed to the left occipital condylar spur with degenerative changes of the condyle-C1 facet. Cervical MRI also showed a pseudotumor from the lower clivus to the odontoid process that indicated mechanical stress on the occipitocervical ligaments. An occiput to C2 fusion was performed to stabilize and avoid dynamic vascular compression. Postoperative CTA revealed no evidence of restricted flow with flexion or extension movements of the neck. It should be noted that physiological head and neck movements accompanied by condylar degenerative changes could be a cause of vertebrobasilar insufficiency.
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Artéria Vertebral , Insuficiência Vertebrobasilar , Idoso , Humanos , Imageamento por Ressonância Magnética , Masculino , Pescoço , Osso Occipital/diagnóstico por imagem , Osso Occipital/cirurgia , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/cirurgia , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/etiologia , Insuficiência Vertebrobasilar/cirurgiaRESUMO
OBJECTIVE: The surgical resection of craniovertebral junction(CVJ)meningioma is challenging because of the neighboring brainstem, lower cranial nerves, and vertebral artery(VA). Moreover, encasement of the VA by the tumor can raise the risk of complications and require cautious manipulation during surgery. CASE: A 46-year-old woman presented with a one-year history of neck pain. She had temporal hemiplegia and numbness on her left side. Magnetic resonance imaging(MRI)showed a CVJ meningioma pushing the brainstem from the right vertebral side and encasing the right VA. Digital subtraction angiography(DSA)showed two feeding arteries arising from the right VA and a sunburst sign. The right VA was the dominant side but did not have the right posterior inferior cerebellar artery(PICA). The anterior spinal artery(ASA)was dominant in the left VA. We performed a balloon test occlusion(BTO)for 20 min and it did not cause any complications;therefore, we occluded the VA using endovascular coils. After 4 days, we removed the meningioma in the prone position, using a far-lateral approach and C1-laminectomy. The laterally located meningioma pushed the brainstem. After detaching the tumor from the dura, we cut the encased VA and the tumor was resected safely(Simpson grade II). Postoperatively, she developed temporal thermal hypoalgesia on the left side of her body. Magnetic resonance imaging showed a microinfarction in the medulla. CONCLUSION: If the VA test occlusion provides a clear result, pre-operative endovascular sacrifice of the VA encased by CVJ meningioma is a feasible treatment strategy.
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Embolização Terapêutica , Neoplasias Meníngeas , Neoplasias da Medula Espinal , Feminino , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Vasculares , Artéria VertebralRESUMO
BACKGROUND: Direct oral coagulants (DOAC) have been shown to decrease the frequency of intracerebral hemorrhage (ICH) compared with warfarin. However, the precise characteristics, such as the size and locations of the hemorrhage, and outcome and onset time of ICH in patient taking DOAC are not fully elucidated. METHODS: We retrospectively analyzed the characteristics of symptomatic patients with ICH taking either DOAC or warfarin between January 2012 and December 2015. RESULTS: Out of 400 consecutive patients with ICH, 15 patients were DOAC-ICH and 24 patients were warfarin-ICH. DOAC-ICH was observed in 6 patients with 10 mg of rivaroxaban, 5 patients with 15 mg of rivaroxaban, and 1 patient with 10 mg of apixaban, 5 mg of apixaban, 30 mg of edoxaban, and 60 mg of edoxaban. Prothrombin time was well controlled in most of the warfarin-ICH patients (83.3%). The locations of ICH were similar in both groups; however, median ICH volume was significantly smaller in DOAC-ICH patients than in warfarin-ICH patients (P < .01) and ICH around basal ganglia seemed to show great difference between the groups. DOAC-ICH patients showed better neurological outcome at the time of discharge than warfarin patients (P < .01), and the ratio of good prognosis was significantly higher in the DOAC-ICH patients than in the warfarin-ICH patients (P < .01). The onset of warfarin-ICH was frequently observed in the morning and evening, whereas DOAC-ICH did not show any specific onset time. CONCLUSIONS: Patients with DOAC-ICH showed smaller ICH volume and better clinical outcomes than patients with warfarin-ICH, and DOAC-ICH did not show any specific onset peak.
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Anticoagulantes/efeitos adversos , Hemorragia Cerebral/induzido quimicamente , Pirazóis/efeitos adversos , Piridinas/efeitos adversos , Piridonas/efeitos adversos , Rivaroxabana/efeitos adversos , Tiazóis/efeitos adversos , Varfarina/efeitos adversos , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Hemorragia Cerebral/diagnóstico por imagem , Ritmo Circadiano , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tempo de Protrombina , Pirazóis/administração & dosagem , Piridinas/administração & dosagem , Piridonas/administração & dosagem , Estudos Retrospectivos , Fatores de Risco , Rivaroxabana/administração & dosagem , Tiazóis/administração & dosagem , Fatores de Tempo , Resultado do Tratamento , Varfarina/administração & dosagemRESUMO
BACKGROUND: The spinal trigeminal nucleus is a cranial nerve which extends caudally from the medulla to the upper cervical segment of the spinal cord. An upper cervical lesion can cause pain or dysesthesia of the face sparing the central area, which is called onion-skin pattern. CASE PRESENTATION: We present a rare case of a 73-year-old man with cervical ossification of the posterior longitudinal ligament(OPLL)causing onion-skin pattern dysesthesia. No other brain lesion was detected by MRI. He had received adequate medication for six months, but his dysesthesia persisted. Cervical radiographic studies showed OPLL with slight instability at the C2-3 level and mild spinal cord compression at the C3 vertebral level. The lesion was considered solely responsible for the onion-skin pattern dysesthesia, and it resulted in posterior cervical decompression. Immediately after the surgery, his dysesthesia disappeared. CONCLUSION: The onion-skin pattern dysesthesia could have been caused by the C2-3 lesion.
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Ossificação do Ligamento Longitudinal Posterior , Parestesia , Idoso , Vértebras Cervicais , Descompressão Cirúrgica , Humanos , Ligamentos Longitudinais , Masculino , Ossificação do Ligamento Longitudinal Posterior/complicações , Osteogênese , Parestesia/etiologiaRESUMO
BACKGROUND: External carotid artery (ECA) positioned laterally to the internal carotid artery (ICA) at the level of the common carotid artery (CCA) bifurcation is occasionally encountered during carotid endarterectomy (CEA). This study aimed to determine the frequency of this phenomenon and provide technical tips for performing CEA. METHODS: The study included 199 consecutive patients (209 carotid arteries) who underwent CEA at Otaru Municipal Medical Center in 2007-2014. The position of the ECA with respect to the ICA at the CCA bifurcation was preoperatively rated as either lateral or normal, using three-dimensional computerized tomographic angiography (3-D CTA) anteroposterior projections. Postoperative diffusion-weighted images (DWIs), and postoperative 3-D CTA images were reviewed. RESULTS: Among the 209 carotid arteries with atherosclerosis, 11 instances (5.3 %) of lateral position of the ECA were detected in 11 patients. Ten of these arteries (91 %) were right-sided (odds ratio 11.1; 95 % confidence interval 1.38-88.9). Wider longitudinal exposure of the arteries was used during CEA, and the CCA and ECA were rotated clockwise or counter clockwise. The ICA lying behind the ECA along the surgical access route was then pulled out laterally and moved to the shallow surgical field. Cross-clamping, arteriotomy, plaque removal, and wall suturing were performed as usual. No cerebral infarcts were detected on postoperative DWIs, and 3-D CTA revealed no CCA and ICA kinking. CONCLUSIONS: Lateral position of the ECA is not extremely rare in patients undergoing CEA for atherosclerosis and may be a congenital variation, although this is still controversial. CEA can be performed safely if the arteries from the CCA to the ICA are rotated, and the ICA is moved to the shallow surgical field under wider longitudinal exposure. Although no postoperative cerebral infarcts were detected, the risk of artery-to-artery embolism resulting from artery repositioning prior to plaque removal should be taken into consideration.
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Variação Anatômica , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Primitiva/anatomia & histologia , Artéria Carótida Externa/anormalidades , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas , Idoso , Idoso de 80 Anos ou mais , Doenças das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Externa/diagnóstico por imagem , Artéria Carótida Interna/anatomia & histologia , Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Angiografia Cerebral , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/epidemiologia , Angiografia por Tomografia Computadorizada , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Imageamento Tridimensional , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologiaRESUMO
Leptomeningeal metastasis is a rare entity and its diagnosis is often difficult. Moreover, evidence-based therapeutic strategies have not yet been established. A 52-year-old woman presented with high fever and was diagnosed with bacterial meningitis at first examination;although her fever was alleviated, she experienced motor weakness in both of her lower extremities. Ga scintigraphy highlighted the hot-spot areas of the disease in the cranial bone. She was then transferred to our department. Open biopsy of the skull showed metastasis of the cancer. Chest CT results indicated right breast cancer and Gd-DTPA imaging showed obvious enhancement of the pia mater around the conus medullaris and cauda equina. However, cerebrospinal fluid(CSF)cytological examination did not show the presence of any positive cells;consequently, mastectomy was performed in the thoracic surgical department. The severity of paraparesis and pain in her legs increased;however, repeat MRI 1 month later showed no evidence of any change. Therefore, we performed biopsy of the cauda equina and arachnoid lesions. The pathological diagnosis was metastasis of breast cancer with positive human epidermal growth factor receptor 2(HER2)immunological staining. The results of a repeat cytological examination of the CSF during the surgery were negative. Local radiotherapy(25 Gy/5 Fr)as a monotherapy was selected for the patient, because her family did not approve of the combination of radiotherapy and chemotherapy. The severity of both paraparesis and limb pain decreased immediately after the radiotherapy.
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Neoplasias da Mama/patologia , Cauda Equina/patologia , Neoplasias Meníngeas/radioterapia , Paraparesia/etiologia , Neoplasias do Sistema Nervoso Periférico/radioterapia , Neoplasias da Mama/química , Neoplasias da Mama/radioterapia , Cauda Equina/cirurgia , Feminino , Gadolínio DTPA , Humanos , Imageamento por Ressonância Magnética , Neoplasias Meníngeas/secundário , Neoplasias Meníngeas/cirurgia , Pessoa de Meia-Idade , Neoplasias do Sistema Nervoso Periférico/secundário , Neoplasias do Sistema Nervoso Periférico/cirurgia , Receptor ErbB-2/análiseRESUMO
BACKGROUND: Although mechanical thrombectomy for acute ischemic stroke has a high recanalization rate, procedurally challenging lesions remain in approximately 10% of the cases. Type III aortic arches, due to their anatomical configuration, are a fundamental problem impacting this procedure. This study aimed to determine whether optimal catheter selection for type III aortic arches, using magnetic resonance angiography (MRA)-based road mapping of the para-aortic transfemoral access route, reduces the time required for mechanical thrombectomy. METHODS: We retrospectively evaluated 203 consecutive patients who underwent mechanical thrombectomy at multiple centers between April 2018 and July 2022. Twenty-three patients were diagnosed with a type III aortic arch using MRA-based road mapping performed to visualize the para-aortic access route before neuro-interventional procedures. Among the 23 patients with type III aortic arches, 10 received a Simmons-type catheter (initial Simmons group) and 13 received a JB-2-type catheter® (initial JB-2 group) as their first inner catheter. The time required for mechanical thrombectomy was compared between the groups. RESULTS: Compared with the initial JB-2 group, the initial Simmons group exhibited a significantly shorter "puncture-to-recanalization time" (105 vs. 53 min, p = 0.009) and "door-to-recanalization time" (164 vs. 129 min, p = 0.032). CONCLUSIONS: Optimal catheter selection by identifying the aortic arch before mechanical thrombectomy using MRA-based road mapping effectively reduced the mechanical thrombectomy time. This suggests that even in type III aorta cases, appropriate catheter selection may shorten the mechanical thrombectomy time and improve acute ischemic stroke prognosis.
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Importance: Cell therapy is a promising treatment approach for stroke and other diseases. However, it is unknown whether MultiStem (HLCM051), a bone marrow-derived, allogeneic, multipotent adult progenitor cell product, has the potential to treat ischemic stroke. Objective: To assess the efficacy and safety of MultiStem when administered within 18 to 36 hours of ischemic stroke onset. Design, Setting, and Participants: The Treatment Evaluation of Acute Stroke Using Regenerative Cells (TREASURE) multicenter, double-blind, parallel-group, placebo-controlled phase 2/3 randomized clinical trial was conducted at 44 academic and clinical centers in Japan between November 15, 2017, and March 29, 2022. Inclusion criteria were age 20 years or older, presence of acute ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] score of 8-20 at baseline), confirmed acute infarction involving the cerebral cortex and measuring more than 2 cm on the major axis (determined with diffusion-weighted magnetic resonance imaging), and a modified Rankin Scale (mRS) score of 0 or 1 before stroke onset. Data analysis was performed between May 9 and August 15, 2022. Exposure: Patients were randomly assigned to either intravenous MultiStem in 1 single unit of 1.2 billion cells or intravenous placebo within 18 to 36 hours of ischemic stroke onset. Main Outcomes and Measures: The primary end points were safety and excellent outcome at day 90, measured as a composite of a modified Rankin Scale (mRS) score of 1 or less, a NIHSS score of 1 or less, and a Barthel index score of 95 or greater. The secondary end points were excellent outcome at day 365, mRS score distribution at days 90 and 365, and mRS score of 0 to 1 and 0 to 2 at day 90. Statistical analysis of efficacy was performed using the Cochran-Mantel-Haenszel test. Results: This study included 206 patients (104 received MultiStem and 102 received placebo). Their mean age was 76.5 (range, 35-95) years, and more than half of patients were men (112 [54.4%]). There were no between-group differences in primary and secondary end points. The proportion of excellent outcomes at day 90 did not differ significantly between the MultiStem and placebo groups (12 [11.5%] vs 10 [9.8%], P = .90; adjusted risk difference, 0.5% [95% CI, -7.3% to 8.3%]). The frequency of adverse events was similar between treatment groups. Conclusions and Relevance: In this randomized clinical trial, intravenous administration of allogeneic cell therapy within 18 to 36 hours of ischemic stroke onset was safe but did not improve short-term outcomes. Further research is needed to determine whether MultiStem therapy for ischemic stroke has a beneficial effect in patients who meet specific criteria, as indicated by the exploratory analyses in this study. Trial Registration: ClinicalTrials.gov Identifier: NCT02961504.
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Isquemia Encefálica , Transplante de Células-Tronco Hematopoéticas , AVC Isquêmico , Acidente Vascular Cerebral , Adulto , Masculino , Humanos , Idoso , Adulto Jovem , Feminino , AVC Isquêmico/complicações , Isquemia Encefálica/complicações , Acidente Vascular Cerebral/tratamento farmacológico , Método Duplo-Cego , Transplante de Células-Tronco , Resultado do TratamentoRESUMO
Predicting outcomes after mechanical thrombectomy (MT) remains challenging for patients with acute ischemic stroke (AIS). This study aimed to explore the usefulness of machine learning (ML) methods using detailed apparent diffusion coefficient (ADC) analysis to predict patient outcomes and simulate the time limit for MT in AIS. A total of 75 consecutive patients with AIS with complete reperfusion in MT were included; 20% were separated to test data. The threshold ranged from 620 × 10-6 mm2/s to 480 × 10-6 mm2/s with a 20 × 10-6 mm2/s step. The mean, standard deviation, and pixel number of the region of interest were obtained according to the threshold. Simulation data were created by mean measurement value of patients with a modified Rankin score of 3-4. The time limit was simulated from the cross point of the prediction score according to the time to perform reperfusion from imaging. The extra tree classifier accurately predicted the outcome (AUC: 0.833. Accuracy: 0.933). In simulation data, the prediction score to obtain a good outcome decreased according to increasing time to reperfusion, and the time limit was longer among younger patients. ML methods using detailed ADC analysis accurately predicted patient outcomes in AIS and simulated tolerance time for MT.
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OBJECTIVE: Although cervical spondylotic myelopathy (CSM) can be easily diagnosed using magnetic resonance imaging (MRI), prediction of surgical effect using preoperative radiological examinations remains difficult. In previous studies, it was reported that diffusion tensor imaging (DTI) may be used for the prediction of surgical effect; however, these studies did not consider the influences of spinal cord compression even though the values of DTI indexes can be distorted by compressive lesions in patients with CSM. Therefore, it is uncertain whether preoperative DTI indexes can actually predict the surgical effect. The aim of this study was to investigate DTI metrics that are hardly affected by spinal cord compression and can accurately predict neurological status after decompressive surgery. METHODS: Twenty-one patients with CSM who underwent surgery and 10 healthy volunteers were enrolled in this study. The subjects underwent cervical MRI, and values of DTI indexes including axial diffusivity (AD), radial diffusivity (RD), apparent diffusion coefficient (ADC), and fractional anisotropy (FA) were recorded at each intervertebral level. Further, the Japanese Orthopaedic Association (JOA) score of each patient with CSM was recorded before and after surgery for neurological status evaluation. Preoperative and postoperative values of DTI indexes were compared, and correlations between preoperative DTI parameters and postoperative neurological recovery were assessed. RESULTS: After surgery, the lesion-adjacent (LA) ratios of RD and ADC increased (p = 0.04 and p = 0.062, respectively), while the LA ratio of FA decreased (p = 0.075). In contrast, the LA ratio of AD hardly changed. A negative correlation was observed between preoperative LA ratio of AD and JOA recovery rate 6 months after surgery (r = -0.379, p = 0.091). Based on preoperative LA ratio of AD, the patients were divided into a low AD group and a high AD group, and JOA recovery rate 6 months after surgery was found to be higher in the low AD group than in the high AD group (p = 0.024). CONCLUSION: In patients with CSM, preoperative LA ratio of AD is seldom affected by spinal cord compression, and it negatively correlates with JOA recovery rate 6 months after surgery.
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BACKGROUND: Advanced glycation end products (AGEs) have been implicated as important factors in the pathogenesis of diabetic vascular complication. The aim of this study is to reveal the effect of AGEs on permeability of brain microvascular endothelial cells (BMECs) in order to assess its role in diabetic vascular complications. METHODS: Permeability was determined by the flux of fluorescein isothiocyanate (FITC)-labeled dextran (4-kDa molecular weight) through endothelial cell monolayers on a transwell system and was compared between bovine BMECs (BBMECs) and bovine aortic endothelial cells (BAECs). The effect of AGEs on permeability was investigated in terms of the role of vascular endothelial growth factor (VEGF) and reactive oxygen species (ROS). RESULTS: Permeability and VEGF expression were significantly increased by the addition of 100 µg/mL of glycer-AGEs in BBMECs. They also tended to be increased in BAECs, but not enough to make a significant difference. Simultaneous treatment with an anti-VEGF antibody suppressed the AGE-enhanced permeability. Furthermore, simultaneous treatment with a free radical scavenger, edaravone, also suppressed the AGE-enhanced permeability and the increase in VEGF mRNA levels and AGE-induced intracellular ROS overproduction. CONCLUSIONS: These results suggest that BMECs are more susceptible than aortic endothelial cells to AGE-enhanced permeability and that AGE-enhanced permeability is dependent on VEGF expression induced by ROS over production.
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Encéfalo/irrigação sanguínea , Encéfalo/metabolismo , Transtornos Cerebrovasculares/metabolismo , Angiopatias Diabéticas/metabolismo , Células Endoteliais/metabolismo , Produtos Finais de Glicação Avançada/metabolismo , Estresse Oxidativo/fisiologia , Fator A de Crescimento do Endotélio Vascular/genética , Animais , Bovinos , Linhagem Celular , Permeabilidade da Membrana Celular/fisiologia , Transtornos Cerebrovasculares/etiologia , Transtornos Cerebrovasculares/fisiopatologia , Angiopatias Diabéticas/fisiopatologia , Produtos Finais de Glicação Avançada/toxicidade , Microcirculação/fisiologiaRESUMO
We report a case of longstanding asymptomatic direct carotid-cavernous fistula (CCF) which caused fatal subarachnoid hemorrhage (SAH). A 91-year-old female with no history of previous head trauma and optic symptoms presented acute subarachnoid hemorrhage. Angiography revealed a left direct carotid-cavernous fistula draining only into the contralateral cavernous sinus with leptomeningeal venous reflux and small varix on the pontine bridging vein. The affected cavernous sinus was markedly dilated and there was no septum between the left cavernous sinus and the internal carotid artery. The patient underwent transvenous coil embolization for intercavernous sinus and leptomeningeal venous reflux was successfully obliterated and opacification of the varix was diminished. The past history of this patient and angiographical findings strongly suggest long standing asymptomatic CCF caused SAH.
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Fístula Carótido-Cavernosa/complicações , Hemorragia Subaracnóidea/etiologia , Idoso de 80 Anos ou mais , Angiografia Digital , Fístula Carótido-Cavernosa/diagnóstico por imagem , Fístula Carótido-Cavernosa/terapia , Embolização Terapêutica , Evolução Fatal , Feminino , Humanos , Tomografia Computadorizada por Raios XRESUMO
[Background and Purpose] Clot location and range predict clinical outcomes for acute ischemic stroke (AIS). We developed a new technique for visualizing occlusion clots, namely, the DEpicting blood clot and MRA using Phase contrast angiography with Image Calculation for Thrombectomy (DEPICT) method. The purpose of this study was to assess the clinical usefulness of DEPICT. [Methods] We used DEPICT in 36 AIS patients to obtain MRA and black blood images with 1-min phase contrast angiography (PCA). We created the black blood images by subtracting the MRA from the T1WI using the source image of PCA. We evaluated the motion artifact, detectability of clot, and precision in location and range compared these to that of susceptibility vessel sign in T2*WI and measured contrast ration (CR) of clot between the cistern and brain tissue. Motion artifact was visually evaluated using a 3-point scale. Detectability and precision of the location and range of occlusion clots were assessed by comparison with findings from digital subtraction angiography (DSA). Gwet's AC1 and kappa statistics were used to assess inter-observer agreement. [Results] DEPICT showed significant robustness for motion artifact compared with T2*WI (p = 0.0026, Wilcoxon signed-rank test). DEPICT showed 100% detectability for the clot. Further, DEPICT showed higher Gwet's AC1 and kappa statistic values with DSA than T2*WI. CR demonstrated a positive value. [Conclusions] DEPICT technique based on 1-min PCA offers both MRA and black blood T1W images that can be used to accurately evaluate both location and range of the clot.
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AVC Isquêmico , Trombose , Angiografia Digital/métodos , Meios de Contraste , Humanos , Isquemia , Angiografia por Ressonância Magnética/métodos , Imageamento por Ressonância Magnética , Trombose/diagnóstico por imagemRESUMO
BACKGROUND: Microscope-integrated near-infrared indocyanine green (ICG) videoangiography (VA) is an effective method of intraoperative blood-flow assessment and identification of plaque location during carotid endarterectomy (CEA). However, the validity of ICG-VA during CEA for patient with near occlusion has not been elucidated. METHODS: Thirty-four CEA procedures were performed between June 2009 and December 2017 for patient with near occlusion, which are more than 95% stenosis. The lesions were classified into three groups according to the diameter of distal ICA compared with ipsilateral external carotid artery (ECA), as normal diameter (>100%), moderate diameter reduction (50-100%), severe diameter reduction (<50%). Five mg of ICG was injected intravenously before arteriotomy, and ICG-VA was taken to identify the distal end of the plaque. Depiction of the distal end and its accuracy were retrospectively reviewed. RESULTS: There were 18 cases with normal diameter group, 14 cases with moderate diameter reduction group, and 2 cases with severe diameter reduction group. All but one case in the severe diameter reduction group showed apparent distal end signal which were confirmed by arteriotomy afterward. CONCLUSIONS: The present study clearly denotes that ICG-VA can visualize the carotid plaque distal end during the CEA, even with the patient with near occlusion. However, it should be noted that there may be a difficulty in visualization of the distal plaque end for patient with severely collapsed distal ICA.
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Estenose das Carótidas , Endarterectomia das Carótidas , Placa Aterosclerótica , Artérias Carótidas , Estenose das Carótidas/cirurgia , Humanos , Verde de Indocianina , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/cirurgia , Estudos RetrospectivosRESUMO
BACKGROUND: Recent clinical trials demonstrated the efficacy of thrombectomy for ischemic stroke against acute large vessel occlusion (LVO). To overcome the problem with excessive examination time for diagnosis of cerebral perfusion and/or the use of contrast agent to determine penumbra, we adopted a new magnetic resonance imaging technique named Acute Stroke Assessment using rapid Pseudo-continuous arterial spin labeling (ASAP-ASL) method. METHODS: The study included healthy volunteers and clinical patients. The signal to noise ratio (SNR) and acquisition time were compared with various numbers of signal average (NSA) of rapid pseudo-continuous arterial spin labeling (pCASL) using the 10-mm thick slice width and narrow scan range focusing the level of basal ganglia by healthy volunteers. After applying clinically acceptable protocol for ASAP-ASL, we then checked image qualities and an accuracy of the method by comparing with the angiographical imaging obtained from the clinical patients regarding the degree of consistency. RESULTS: NSA were compared between two and fourteen, and 10 NSA was decided to be introduced for clinical use (1 minutes and 17 second) for obtaining clinically acceptable image, which was shorter than the time required for ordinary whole brain pCASL (approximately 5 minutes). In the clinical study, the occlusion site estimated by ASAP-ASL showed high correlation with that of digital subtraction angiography (κ=0.63-0.79). CONCLUSIONS: ASAP-ASL method requires approximately one minutes to obtain clinically relevant brain perfusion imaging which can successfully identify ischemic region in LVO patients.
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Angiografia por Ressonância Magnética , Acidente Vascular Cerebral , Encéfalo , Circulação Cerebrovascular , Humanos , Imageamento por Ressonância Magnética , Marcadores de Spin , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , TrombectomiaRESUMO
AIM: The aim of the present study was to investigate the effects of individualized nutritional treatment on the activities of daily living of acute stroke patients. METHODS: This was a randomized controlled study. The eligibility criteria were acute stroke, age >65 years and the presence of malnutrition risk. Between September 2016 and December 2017, 128 patients were assigned to either the standard or intensive group (individualized nutritional treatment). The intensive group received energy that was calculated using the Harris-Benedict equation. The main outcome measures were the total functional independence measurement gain from the time of assignment to the time of discharge from the recovery hospital or at 3 months after the stroke onset, and motor and cognitive functional independence measurement gains. RESULTS: Compared with the standard group, the intensive group had significantly higher median energy intake (P < 0.001); significantly greater functional independence measurement gains in the total score (42 vs. 22; P = 0.02) and motor subscore (P = 0.01), but similar cognitive subscore. CONCLUSION: Individualized nutritional treatment improved the activities of daily living of older acute stroke patients with malnutrition risk. Geriatr Gerontol Int 2019; â¢â¢: â¢â¢-â¢â¢.
Assuntos
Desnutrição/dietoterapia , Estado Nutricional , Acidente Vascular Cerebral/terapia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Ingestão de Energia , Feminino , Avaliação Geriátrica , Humanos , Japão , Masculino , Avaliação Nutricional , Avaliação de Resultados em Cuidados de Saúde , Alta do Paciente , Recuperação de Função Fisiológica , Fatores de Risco , Reabilitação do Acidente Vascular CerebralRESUMO
BACKGROUND: Diffusion tensor imaging (DTI) is widely used; however, most of the prior studies have resulted in presurgical decreased fractional anisotropy (FA) values in patients with cervical spondylotic myelopathy (CSM). We used ZOOM DTI and could acquire highly accurate FA values during perioperative periods, which indicated different insights than preceding studies. The objective of this study was to assess the perioperative FA change in patients with CSM and determine the prognostic factor. METHODS: Twenty-eight patients with CSM and healthy control subjects were enrolled in this study. Twenty patients (71%) had intracordal high intensity before surgery. All patients underwent decompressive surgery. ZOOM DTI and the Japanese Orthopaedic Association (JOA) assessment were performed before and after surgery. The region of interest was manually contoured to omit the surrounding cerebrospinal fluid. The axial plane of the most stenotic cervical level was assessed. RESULTS: FA values before surgery and at 1 week after surgery, and FA values at 1 week after surgery and at 6 months after surgery differed significantly as determined. The FA values of patients with intracordal high intensity significantly decreased after surgery and significantly increased from 1 week to 6 months, whereas those of patients without intracordal high intensity did not significantly change. JOA scores at 6 months after surgery (13.1) improved significantly compared with JOA scores before surgery (10.8). Only FA values at 1 week after surgery had a significant positive relationship with JOA scores presurgery and at 6 months after surgery. CONCLUSIONS: The presurgical FA value in patients with CSM did not differ from that of normal control subjects, but significantly decreased after surgery, and significantly increased 6 months after surgery. We concluded that the postsurgical FA value approximates the proper state of the damaged cord and the presurgical FA value includes a masked effect as an aligned fiber effect because of compression by degenerative construction. Only the FA value at 1 week had a significant positive relationship with the JOA score presugery and at 6 months, which established that the postsurgical FA value may be a more accurate prognostic factor than the presurgical FA value.
RESUMO
A rare case of Mollaret meningitis characterized by four recurrent episodes of aseptic meningitis during a three-year period is reported. The patient showed a high fever and severe headache accompanied by a high level of cerebrospinal fluid (CSF) cytokines, such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α). The symptoms and high CSF cytokines were resolved immediately after introducing indomethacin treatment. Reactivation of the latent virus is considered to be the cause of this rare disease, and indomethacin is believed to inhibit the periodic abnormal generation of eicosanoid in the brain, resulting in a reduction in the fever and subsequent inflammation.
Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Líquido Cefalorraquidiano/química , Citocinas/análise , Indometacina/uso terapêutico , Inflamação/tratamento farmacológico , Meningite Asséptica/tratamento farmacológico , Adulto , Humanos , Inflamação/diagnóstico , Masculino , Meningite Asséptica/diagnóstico , Doenças Raras , Resultado do TratamentoRESUMO
We present a case of double-crushed L5 nerve root symptoms caused by inside and outside of the spinal canal with spur formation of the lumbosacral transitional vertebra (LSTV). A 78-year-old man presented with 7-year history of moderate paresis of his toe and left leg pain when walking. Magnetic resonance imaging (MRI) revealed spinal stenosis at the L3/4 and 4/5 spinal levels and he underwent wide fenestration of both levels. Leg pain disappeared and 6-min walk distance (6MWD) improved after surgery, however, the numbness in his toes increased and 6MWD decreased 9 months after surgery. Repeated MR and 3D multiplanar reconstructed computed tomography (CT) images showed extraforaminal impingement of the L5 root by bony spur of the left LSTV. He underwent second decompression surgery of the L5/S via the left sided Wiltse approach, resulting in the improvement of his symptoms. The impingement of L5 spinal nerve root between the transverse process of the fifth lumbar vertebra and the sacral ala is a rare entity of the pathology called "far-out syndrome (FOS)". Especially, the bony spur formation secondary to the anomalous articulation of the LSTV (LSPA) has not been reported. These articulations could be due to severe disc degeneration, following closer distance and contact between the transverse process and the sacral ala. To our knowledge, this is the first report describing a case with this pathology and may be considered in cases of failed back surgery syndromes (FBSS) of the L5 root symptoms.