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Neurologia Medico-chirurgica

Kouhei Nii, Ritsurou Inoue, Yusuke Morinaga, Takafumi Mitsutake, Hayatsura Hanada
Stent-assisted coil embolization (SACE) is used to address wide-necked or complex aneurysms. However, periprocedural and/or late in-stent thrombosis (IST) elicit neurological events. We investigated the incidence and timed the development of acute IST during SACE with braided- or laser-cut stents in a retrospective study. Between May 2013 and April 2018, we evaluated 11 ISTs that occurred in the course of 185 SACE procedures (self-expandable laser-cut stent, n = 128; braided stent, n = 57). The onset of IST was measured from the time of stent placement...
August 30, 2018: Neurologia Medico-chirurgica
Takafumi Tanei, Yasukazu Kajita, Satoshi Maesawa, Daisuke Nakatsubo, Kosuke Aoki, Hiroshi Noda, Shigenori Takebayashi, Norimoto Nakahara, Toshihiko Wakabayashi
The long-term effects of motor cortex stimulation (MCS) and spinal cord stimulation (SCS) remain unknown. To identify the long-term effects after MCS or SCS and determine any associated predictive factors for the outcomes. Fifty patients underwent MCS (n = 15) or SCS (n = 35) for chronic neuropathic pain. The degree of pain was assessed preoperatively, at 1, 6, and 12 months after surgery, and during the time of the last follow-up using Visual Analog Scale (VAS). Percentage of pain relief (PPR) was calculated, with "long-term effect" defined as PPR ≥ 30% and the presence of continued pain relief over 12 months...
August 30, 2018: Neurologia Medico-chirurgica
Satoru Yonekura, Takayuki Anno, Nobuyuki Kobayashi
We report a case of head injury with posterior reversible encephalopathy syndrome (PRES), followed by Guillain-Barré syndrome (GBS). A 74-year-old man was brought to our hospital after a fall. Computed tomography revealed intracranial hemorrhage. Magnetic resonance imaging showed bilateral reversible intensities with features of vasogenic edema in parietooccipital areas, suggesting PRES. After admission, weakness and areflexia of extremities and respiratory muscles developed gradually, which favored a diagnosis of GBS...
August 3, 2018: Neurologia Medico-chirurgica
Tomoo Watanabe, Yasuyuki Kawai, Asami Iwamura, Naoki Maegawa, Hidetada Fukushima, Kazuo Okuchi
Traumatic brain injury (TBI) is a leading cause of death and disability in trauma patients. Patients with TBI frequently sustain concomitant injuries in extracranial regions. The effect of severe extracranial injury (SEI) on the outcome of TBI is controversial. For 8 years, we retrospectively enrolled 485 patients with the blunt head injury with head abbreviated injury scale (AIS) ≧ 3. SEI was defined as AIS ≧ 3 injuries in the face, chest, abdomen, and pelvis/extremities. Vital signs and coagulation parameter values were also extracted from the database...
September 15, 2018: Neurologia Medico-chirurgica
Kenji Sugiyama, Takao Nozaki, Tetsuya Asakawa, Tetsuro Sameshima, Schinichiro Koizumi, Hisaya Hiramatsu, Hiroki Namba
Deep brain stimulation (DBS) is used to treat symptoms by modulating the cortico-striato-thalamo-cortical (CSTC) loop in the central nervous system (CNS), and attempts to research loop circuit disorders have been globally initiated among the intractable neurological and psychiatric disorders. DBS treatment has been evaluated for all these newly found CNS loop circuit disorders. In 2011, neurosurgical treatments for psychiatric disorders were renamed from "psychosurgery" to "neurosurgery for psychiatric disorders (NPD)" by the World Society for Stereotactic and Functional Neurosurgery (WSSFN)...
September 15, 2018: Neurologia Medico-chirurgica
Naotaka Usui, Akihiko Kondo, Naoki Nitta, Takayasu Tottori, Yushi Inoue
The amygdala and uncus are located close to important neurovascular structures. We describe a safe technique for resection of amygdala and uncus. Under general anesthesia, the patient is positioned supine, with the head rotated approximately 20 degrees to the unoperated side and slightly extended. By using a trans-anterior T1 subpial approach, the inferior horn of the lateral ventricle is opened, and hippocampectomy is performed. We treat an imaginary plane formed by the inferior circular sulcus of the insula, the endorhinal sulcus, and the inferior choroidal point as the upper border of amygdalar resection...
September 15, 2018: Neurologia Medico-chirurgica
Takatsugu Abe, Kuniyasu Niizuma, Atsushi Kanoke, Daisuke Saigusa, Ritsumi Saito, Akira Uruno, Miki Fujimura, Masayuki Yamamoto, Teiji Tominaga
We performed metabolomic analyses of mouse brain using a transient middle cerebral artery occlusion (tMCAO) model with Matrix Assisted Laser Desorption/Ionization (MALDI)-mass spectrometry imaging (MSI) to reveal metabolite changes after cerebral ischemia. We selected and analyzed three metabolites, namely creatine (Cr), phosphocreatine (P-Cr), and ceramides (Cer), because these metabolites contribute to cell life and death. Eight-week-old male C57BL/6J mice were subjected to tMCAO via the intraluminal blockade of the middle cerebral artery (MCA) and reperfusion 60 min after the induction of ischemia...
September 15, 2018: Neurologia Medico-chirurgica
Kensuke Takada, Yoshinori Maki, Masanori Kinosada, Ryota Ishibashi, Masaki Chin, Sen Yamagata
Metronidazole induced encephalopathy (MIE), an encephalopathy brought by an antibiotic, is characterized with cerebellar dysfunction, altered mental status and extrapyramidal symptoms. MIE can result in an acute manifestation, but MIE has not been reported as a stroke mimic. An 86-year-old patient undergoing metronidazole therapy for Clostridium difficile enteritis presented to our hospital with sudden disoriented status and motor weakness of the left extremities. Computed tomography (CT) was unrevealing of intracranial hemorrhagic change, and CT angiography did not show any apparent major occlusion or stenosis of the intracranial vessels...
September 15, 2018: Neurologia Medico-chirurgica
Takufumi Yanagisawa, Ryohei Fukuma, Ben Seymour, Koichi Hosomi, Haruhiko Kishima, Takeshi Shimizu, Hiroshi Yokoi, Masayuki Hirata, Toshiki Yoshimine, Yukiyasu Kamitani, Youichi Saitoh
A brachial plexus root avulsion (BPRA) causes intractable pain in the insensible affected hands. Such pain is partly due to phantom limb pain, which is neuropathic pain occurring after the amputation of a limb and partial or complete deafferentation. Previous studies suggested that the pain was attributable to maladaptive plasticity of the sensorimotor cortex. However, there is little evidence to demonstrate the causal links between the pain and the cortical representation, and how much cortical factors affect the pain...
August 15, 2018: Neurologia Medico-chirurgica
Daisuke Maruyama, Hiroharu Kataoka, Tetsu Satow, Hisae Mori, Yoshiro Ito, Eika Hamano, Shunichi Tanaka, Taichi Ishiguro, Hidekazu Chikuie, Jun C Takahashi
Antithrombotic treatment has substantial risks, even in pediatric patients. We retrospectively evaluated the management and outcomes of consecutive pediatric patients who underwent neurosurgical treatment for cerebrovascular disease with cardiovascular disease between 1998 and 2017. Patients were divided into patients with comorbid cardiovascular disease (group I); and patients with cardiovascular disease as a primary disease of intracranial complication, without (group IIa) or with (group IIb) extracorporeal circulations...
August 15, 2018: Neurologia Medico-chirurgica
Yasuhisa Kanematsu, Junichiro Satomi, Masaaki Korai, Toshiyuki Okazaki, Izumi Yamaguchi, Yoshiteru Tada, Masaaki Uno, Shinji Nagahiro, Yasushi Takagi
Surgery for- and endovascular treatment of vertebral artery (VA) dissecting aneurysms involving the origin of the posterior inferior cerebellar artery (PICA) remain challenging. Their ideal treatment is complete isolation of the aneurysm by surgical or endovascular trapping plus PICA reconstruction. However, postoperative lower cranial nerve palsy and medullary infarction are potential complications. We report four patients with VA dissecting aneurysms involving the PICA origin who were treated by occipital artery (OA)-PICA bypass followed by proximal occlusion of the VA and clip ligation of the PICA origin instead of trapping...
August 15, 2018: Neurologia Medico-chirurgica
Ichiro Takumi, Masataka Akimoto, Kouhei Hironaka, Koji Adachi, Takashi Kon, Takashi Matsumori, Yuichiro Tanaka, Akio Morita
This technical note aims to demonstrate the usefulness, indications and its limitations of augmentation technique by bipedicle galeo-pericranial rotation flap and by monopedicle galeo-pericranial flap, both in STA (superficial temporal artery) branch compromised hosts in salvage frontotemporal cranioplasty. Although these flaps are not always idealistically vascularized owing to accidental injuries to the STA branches during previous surgeries, they are properly augmenting after salvage frontotemporal craniotomy when infection is not active...
August 15, 2018: Neurologia Medico-chirurgica
Ayumu Yamaoka, Kei Miyata, Naofumi Bunya, Hirotoshi Mizuno, Hideto Irifune, Naoya Yama, Yukinori Akiyama, Takeshi Mikami, Masahiko Wanibuchi, Nobuhiro Mikuni
In blunt cerebrovascular injury, reported traumatic basilar artery occlusions have involved dissection of the basilar artery, distal embolization due to traumatic vertebral artery dissection, or entrapment of the basilar artery into the clivus fracture. To date, however, there are no reports of traumatic basilar artery entrapment without a clivus fracture. Here, we report the first case of traumatic basilar artery occlusion caused by entrapment into an originally existing bone defect. A 67-year-old man with a history of treatment for intracranial aneurysm suffered multiple traumatic injuries in a fall...
August 15, 2018: Neurologia Medico-chirurgica
Fumiaki Kanamori, Takashi Yamanouchi, Yuya Kano, Naoki Koketsu
Although vascular complications after head trauma is well recognized, basilar artery entrapment within the longitudinal clivus fracture is rare. A 69-year-old man presented with progressive disturbance of consciousness and right hemiplegia after trauma. Computed tomography scan showed a right-sided acute subdural hematoma and multiple skull fractures, including a longitudinal clivus fracture. Magnetic resonance imaging revealed basilar artery occlusion and a small infarction at the ventral part of the pons...
August 15, 2018: Neurologia Medico-chirurgica
Toshio Matsushima, Shigeaki Kobayashi, Tooru Inoue, Alice S Rhoton, Alexander L Vlasak, Evandro de Oliveira
Dr. Rhoton's key philosophies included "Keep working hard.", "Make surgery more accurate, gentle and safe", "We want perfect anatomical dissections, because we want perfect surgical operations", "Competence without compassion is worthless. Compassion without competence is meaningless", "Neurosurgeons share a great professional gift; our lives have yielded an opportunity to help mankind in a unique and exciting way" and "There is no finish line for this effort"...
July 15, 2018: Neurologia Medico-chirurgica
Juntaro Matsumoto, Toyohiko Isu, Kyongsong Kim, Naotaka Iwamoto, Kazuyoshi Yamazaki, Masanori Isobe
Superficial peroneal nerve (S-PN) entrapment neuropathy (S-PNEN) is comparatively rare and may be an elusive clinical entity. There is yet no established surgical procedure to treat idiopathic S-PNEN. We report our surgical treatment and clinical outcomes. We surgically treated 5 patients (6 sites) with S-PNEN. The 2 men and 3 women ranged in age from 67 to 91 years; one patient presented with bilateral leg involvement. Mean post-operative follow-up was 25.3 months. We recorded their symptoms before- and at the latest follow-up visit after surgery using a Numerical Rating Scale and the Japan Orthopedic Association score to evaluate the affected area...
July 15, 2018: Neurologia Medico-chirurgica
Yutaro Yamamoto, Nobuyoshi Sasaki, Kosuke Kumagai, Satoru Takeuchi, Terushige Toyooka, Naoki Otani, Kojiro Wada, Yoshitaka Narita, Koichi Ichimura, Hiroki Namba, Kentaro Mori, Arata Tomiyama
Glioblastoma (GBM) still carries a poor prognosis due to the refractoriness against antitumor drugs. Temozolomide (TMZ), one of the few standard therapy drugs against GBM worldwide, has only limited effect due to acquired TMZ resistance of GBM. Therefore, development of novel therapeutic methods to overcome the TMZ resistance of GBM is urgent. The brain is the most cholesterol-rich organ in the human body, so modulation of cholesterol in tumor cells originating from the brain including GBM may be a tumor-specific therapeutic strategy including enhancement of TMZ effects...
July 15, 2018: Neurologia Medico-chirurgica
Hidemichi Ito, Masashi Uchida, Taigen Sase, Yuichiro Kushiro, Daisuke Wakui, Hidetaka Onodera, Hiroshi Takasuna, Hiroyuki Morishima, Kotaro Oshio, Yuichiro Tanaka
This study sought to analyze the incidence of contralateral microembolic infarctions (MIs) on diffusion-weighted imaging (DWI) following protected carotid artery stenting (CAS) and compared the difference of risk factors between ipsilateral and contralateral lesions. From April 2010 to March 2017, 147 CASs in 140 patients were performed. All the patients underwent DWI within 1 week before and 24 hrs after the procedures. CAS was successfully completed in 145 (98.6%) of the 147 procedures. Forty-nine (33.8%) patients with new MIs revealed on postprocedural DWI were enrolled...
July 15, 2018: Neurologia Medico-chirurgica
Hideaki Abe, Manabu Natsumeda, Yu Kanemaru, Jun Watanabe, Yoshihiro Tsukamoto, Masayasu Okada, Junichi Yoshimura, Makoto Oishi, Yukihiko Fujii
Histone H3 mutations are frequently found in diffuse midline gliomas (DMGs), which include diffuse intrinsic pontine gliomas and thalamic gliomas. These tumors have dismal prognoses. Recent evidence suggests that one reason for the poor prognoses is that O6 -methylguanine-DNA methyltransferase (MGMT) promoter frequently lacks methylation in DMGs. This review compares the epigenetic changes brought about by histone mutations to those by isocitrate dehydrogenase-mutant gliomas, which frequently have methylated MGMT promoters and are known to be sensitive to temozolomide...
July 15, 2018: Neurologia Medico-chirurgica
Yoichi Yoshida, Takaki Hiwasa, Toshio Machida, Eiichi Kobayashi, Seiichiro Mine, Jun Matsushima, Masaki Takiguchi, Yasuo Iwadate
Recent clinical research has revealed a significant correlation between atherosclerosis, one of the primary etiologies of ischemic stroke, and the immune system. Assuming that "disease-specific autoantibodies are produced in the sera of patients with ischemic stroke," we investigated multiple arteriosclerosis-related antibodies using the serological identification of antigens by recombinant cDNA expression cloning (SEREX), an established method for identifying antigenic proteins. We either screened a human aortic endothelial cell cDNA library or conducted protein array screening using the sera from patients with ischemic stroke, such as carotid artery stenosis or transient ischemic attack (TIA)...
July 15, 2018: Neurologia Medico-chirurgica
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