記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Intracerebral hemorrhage (ICH) is a devastating hemorrhagic event and is associated with high mortality or severe neurological sequelae. Age-associated differences in hematoma location for nonlobar ICH are not well known. The aims of the present study were to elucidate the relationship between age and hematoma location and to assess the differences in small-vessel disease (SVD) burden as a potential surrogate marker for longstanding hypertension among various hematoma locations. METHODS: From September 2014 through July 2019, consecutive patients with acute, spontaneous ICH were retrospectively enrolled from a prospective registry. Magnetic resonance imaging was performed during admission, and the total SVD burden score (including microbleeds, lacunes, enlarged perivascular spaces, and white matter hyperintensities) was calculated. The relationships of hematoma location with aging and SVD burden were assessed by using multivariate logistic regression analyses. RESULTS: A total of 444 patients (156 women [35%]; median age 69 [interquartile range 59-79] years; National Institutes of Health Stroke Scale score 9 [17][3-17]) were enrolled in the present study. Multivariate logistic regression analyses showed that advanced age was independently associated with thalamic (odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.19-1.84, p < 0.001 for 10-year increment) and lobar hemorrhage (OR: 1.58, 95% CI: 1.19-2.09, p = 0.002) and was independently and negatively related to putaminal hemorrhage (OR: 0.55, 95% CI: 0.44-0.68, p < 0.001). The total SVD burden score was independently and positively associated with thalamic hemorrhage (OR: 1.27, 95% CI: 1.01-1.59, p = 0.045) and negatively with lobar hemorrhage (OR: 0.74, 95% CI: 0.55-0.99, p = 0.042), even after adjusting by age, but not with putaminal hemorrhage (OR: 0.91, 95% CI: 0.73-1.14, p = 0.395). CONCLUSION: Putaminal, thalamic, and lobar hemorrhages are prone to occur in specific ages and SVD states: putaminal in young patients, thalamic in old and high SVD burden patients, and lobar hemorrhages in old and low SVD burden patients. Susceptibility to bleeding with aging or severe SVD accumulation seems to differ considerably among brain locations.

DOI： 10.1159/000515411

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Introduction Endovascular treatment for acute ischemic stroke with acute large-vessel occlusion (ALVO) has established benefits, and rapid treatment is vital for mechanical thrombectomy in ALVO. Time from onset of stroke to groin puncture (OTP) is a practical and useful clinical marker, and OTP should be shortened to obtain the maximum benefit of thrombectomy. Objective The aim of the present study was to assess the impact of early treatment of anterior circulation stroke within three hours after symptom onset and to evaluate the role of OTP in determining outcomes after endovascular therapy. Methods Consecutive patients with acute stroke due to major artery (internal carotid or middle cerebral arteries) occlusion who underwent endovascular recanalization between March 2014 and January 2017 were retrospectively evaluated. Patients were stratified by OTP into three categories: 0-≤3 h, >3-≤6 h, and >6 h. The primary outcome measure was a 90-day modified Rankin scale score of 0-2 (good outcome). Results Data were analyzed from 100 patients (mean age, 76.6 years; mean National Institutes of Health Stroke Scale score, 17). Groin puncture occurred within 0-≤3 h in 51 patients, >3-≤6 h in 28, and >6 h in 21. Median OTP in each group was 126 min (range, 57-168 min), 238 min (range, 186-360 min) and 728 min (range, 365-1492 min), respectively. On multivariable logistic regression analysis, category of OTP represented an independent predictor of patient outcome (adjusted odds ratio, 0.48; 95% confidence interval, 0.25-0.93; p = 0.029). Conclusions OTP is a prehospital and in-hospital workflow-based indicator. In this single-center study, OTP was found to independently affect functional outcomes after endovascular stroke treatment.

DOI： 10.1177/1591019917747247

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIMS: Transplantation of bone marrow mononuclear cells (BMMCs) exerts neuroprotection against cerebral ischemia. We examined the therapeutic timepoint of allogeneic BMMC transplantation in a rat model of focal cerebral ischemia, and determined the effects of repeated transplantation outside the therapeutic window. MAIN METHODS: Male Sprague-Dawley rats were subjected to 90 minute focal cerebral ischemia, followed by intravenous administration of 1 × 10(7) allogeneic BMMCs or vehicle at 0, 3 or 6 h after reperfusion or 2 × 10(7) BMMCs 6 h after reperfusion. Other rats administered 1 × 10(7) BMMCs at 6 h after reperfusion received additional BMMC transplantation or vehicle 9 h after reperfusion. Infarct volumes, neurological deficit scores and immunohistochemistry were evaluated 24 or 72 h after reperfusion. KEY FINDINGS: Infarct volumes at 24 h were significantly decreased in transplantation rats at 0 and 3 h, but not at 6 h, after reperfusion, compared to vehicle-treatment. Even high dose BMMC transplantation at 6h after reperfusion was ineffective. Repeated BMMC transplantation at 6 and 9h after reperfusion reduced infarct volumes and significantly improved neurological deficit scores at 24 and 72 h. Immunohistochemistry showed repeated BMMC transplantation reduced ionized calcium-binding adapter molecule 1, 4-hydroxy-2-nonenal and 8-hydroxydeoxyguanosine expression at 24 and 72 h after reperfusion. SIGNIFICANCE: Intravenous allogeneic BMMCs were neuroprotective following transient focal cerebral ischemia, and the therapeutic time window of BMMC transplantation was >3 h and <6 h after reperfusion in this model. Repeated transplantation at 6 and 9 h after reperfusion suppressed inflammation and oxidative stress in ischemic brains, resulting in improved neuroprotection.

DOI： 10.1016/j.lfs.2013.12.016

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIMS: Pre-treatment with statins is known to ameliorate ischemic brain damage after experimental stroke, and is independent of cholesterol levels. We undertook pre- vs post-ischemic treatment with atorvastatin after focal cerebral ischemia in rats. MAIN METHODS: Male Sprague-Dawley rats underwent transient 90-min middle cerebral artery occlusion (MCAO). Atorvastatin (20mg/kg/day) or vehicle was administered orally. Rats were divided into vehicle-treated, atorvastatin pre-treatment, atorvastatin post-treatment, and atorvastatin continuous-treatment groups. In the pre-treatment, rats were given atorvastatin or vehicle for 7 days before MCAO. In the post-treatment, rats received atorvastatin or vehicle for 7 days after MCAO. Measurement of infarct volume, as well as neurological and immunohistochemical assessments, were done 24h and 7 days after reperfusion. KEY FINDINGS: Each atorvastatin-treated group demonstrated significant reductions in infarct and edema volumes compared with the vehicle-treated group 24h after reperfusion. Seven days after reperfusion, infarct volumes in the post-treatment group and continuous-treatment group (but not the pre-treatment group) were significantly smaller than in the vehicle-treated group. Only the continuous-treatment group had significantly improved neurological scores 7 days after reperfusion compared with the vehicle group. Post-treatment and continuous-treatment groups had significantly decreased lipid peroxidation, oxidative DNA damage, microglial activation, expression of tumor necrosis factor-alpha, and neuronal damage in the cortical ischemic boundary area after 7 days of reperfusion. SIGNIFICANCE: These results suggest that continuous oral administration (avoiding withdrawal) with statins after stroke may reduce the extent of post-ischemic brain damage and improve neurological outcome by inhibiting oxidative stress and inflammatory responses.

DOI： 10.1016/j.lfs.2013.11.018

PubMed

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記述言語：英語   出版者・発行元：The Japanese Society of Cerebral Blood Flow and Metabolism  

Aims: Previous studies suggest that both statins and calcium-channel blockers inhibit cardiovascular and cerebrovascular diseases by their pleiotropic effects, such as antioxidation and anti-inflammatory actions. By using stroke-prone spontaneously hypertensive rats (SHRSPs), the isolated effect of each pharmaceutical has been reported, but the effect of a combination of both pharmaceuticals has not been reported. In this study, we evaluated combination therapy of atorvastatin and amlodipine for its efficacy in preventing stroke in the SHRSP model. Main Methods: We initiated treatment of SHRSPs at 8 weeks of age with atorvastatin (2 mg/kg), amlodipine (1 mg/kg), a combination of atorvastatin (2 mg/kg) and amlodipine (1 mg/kg), or vehicle. Measurement of physiological parameters and immunohistochemical assessments for oxidative stress and inflammation were done at each group. Key findings: At 13 weeks of age, the combination therapy group showed greater inhibition of an antioxidation and anti-inflammatory marker than the vehicle group, although there were no differences in blood pressure. Significance: Our study suggests that the combination therapy of atorvastatin and amlodipine may protect against hypertension-induced stroke by the additive effect of the antioxidation and the anti-inflammatory action of the both agents.

DOI： 10.16977/cbfm.25.2_23

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その他リンク： http://search.jamas.or.jp/link/ui/2015176453

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

DOI： 10.1272/jnms.76.323

Scopus

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: In this study, we histopathologically assessed left atrial appendages (LAAs) resected during surgical treatment for atrial fibrillation (AF) to elucidate the mechanism of intra-LAA thrombus formation in valvular AF. METHODS: The clinicopathological study of resected LAA was made on 56 valvular AF cases: 28 with mitral regurgitation (MR), 3 with mitral stenosis, and 25 with mitral stenosis and MR. Pathological findings of thrombi in LAA were compared with clinical features, including history of valvular diseases and embolism, and findings of echocardiography. Results were analyzed using chi2 test, Fisher exact method, or Welch t test. RESULTS: Two types of mural thrombi were found in LAA: membranous (M)-thrombi and polypoid-shape (P)-thrombi. M-thrombi were found on LAA endocardium in 48 (86%) patients. All of the P-thrombi were observed on preexisting M-thrombi. More patients showed thrombi in the LAA orifice than in the tip (P < .001), especially in cases of MR (21 patients; P < .01). By echocardiography, MR flow was classified into 3 directions: toward the roof, anteroseptal, or posterolateral wall of the left atrium. Patients with MR jet flow against the posterolateral wall near the LAA entrance had a higher risk of LAA thrombi (P = .007). CONCLUSIONS: Instability of M-thrombi, including surface rupture before complete organization, relates to P-thrombi formation that results in high incidence of embolism in AF patients.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: A histopathological assessment of left atrial appendages (LAA) resected during surgical treatment for atrial fibrillation (AF) was made, with the aim of improving the prediction of postoperative AF recurrence. METHODS AND RESULTS: This clinicopathological study involved 57 surgical cases of valvular AF and 34 age- and sex-matched control autopsy cases with a history of sinus rhythm. LAA from the cases with valvular AF showed greater hypertrophy of cardiomyocytes (p<0.0001), greater nuclear enlargement (p<0.0001), more bizarre nuclei (BN; p<0.0001), and more intercellular fibrosis (ICF; p<0.001). Partial disarray of cardiomyocytes and fatty infiltration were recognized in both the AF and control groups. Thirty-seven cases had maintained sinus rhythm after surgery from 7 months to 10 years. AF recurred within a month of surgery in 17 and after a month in 3; there was no significant difference in histopathological features between them. These 20 cases had more cellular hypertrophy (p<0.025), nuclear enlargement (p<0.025), BN (p<0.01), and ICF (p<0.025) than those who maintained sinus rhythm after surgery. CONCLUSIONS: The histopathological findings for LAA reflected the underlying valvular diseases; however, the most reliable predictors of postoperative AF recurrence were hypertrophy of cardiomyocytes, bizarre shaped nuclei, and extensive ICF.

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本病理学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：KARGER  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：KARGER  

Web of Science

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(株)にゅーろん社  

虚血性脳卒中の原因として椎骨動脈解離(以下sVAD)が疑われた症例のなかには、最終的に動脈硬化性変化と診断されるものもある。今回、虚血性脳卒中で入院しMRA所見からsVADが疑われた患者30例をsVAD確定診断群(15例)とsVAD疑診群(15例)に分けて患者データを比較することにより、sVADとアテローム硬化の鑑別に役立つデータは何か検討した。その結果、確定診断群は疑診群に比べて平均年齢が有意に若く、糖尿病合併例の割合と冠疾患合併例の割合が有意に低いという特徴が認められた。

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

Vertigo and nausea suddenly developed in a 33-year-old man without a relevant medical history. He reported that he had had throbbing headaches for 1 month. On admission, neurological examination revealed dysarthria, right Horner syndrome, and hypoesthesia of the left side of the face and of the left side of the body below the neck. Initial magnetic resonance imaging of the brain showed no areas of abnormal intensity on diffusion-weighted imaging, but magnetic resonance angiography showed a stringlike structure of the right vertebral artery. Acute infarction due to right vertebral artery dissection was diagnosed. Heparin sodium was immediately administered intravenously. Three days after symptom onset, magnetic resonance imaging-diffusion-weighted imaging of the brain clearly showed a high-intensity area in the right lateral medulla oblongata, a finding that confirmed the clinical diagnosis. This case emphasizes that vertebral artery dissection should be considered in patients with vertigo, especially young patients without risk factors for cerebrovascular disorders. The clinical history and neurological examination remain fundamental aspects of patient assessment in the era of advanced neuroimaging.&lt;br&gt;

DOI： 10.1272/manms.7.175

CiNii Books

CiNii Research

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(株)にゅーろん社  

著者らのSCUにおけるrt-PAの使用状況と有効性について、使用時期で前半(n=11)と後半(n=11)に分け、比較検討した。その結果、患者の年齢は前半が74±13歳、後半が69±13歳であり、後半で若年の傾向がみられた。慎重投与の有無は前半でありの割合が多い傾向にあった。病型、発症から治療までの平均時間は前半後半ともほぼ同様の結果であった。治療効果は入院時のNIHSSでは後半でやや重症症例が多かったが、24時間後のNIHSSでは後半で有効例が多かった。退院時の有効例(mRS 0-1)は前半18%、後半55%で、死亡例(mRS 6)は前半36%、後半0%であり、後半で治療成績が良かった。この成績はJ-ACT、市販後使用成績調査と比較しても良好な結果であった。累積症例数と使用時期、SCUスタッフ数を検討すると人員の充実に伴って使用ペースも増加していた。尚、いずれの期間も症候性頭蓋内出血は0例であった。

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記述言語：日本語   出版者・発行元：日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：(株)ライフ・サイエンス  

脳梗塞急性期に対して使用されたクロピドグレルの有用性を後ろ向きに検討した。急性期脳梗塞または一過性脳虚血発作(TIA)で入院し、7日以内にクロピドグレルの投与を開始した、非心原性の脳血管障害患者19例を対象とした。合併症は、高血圧症は19例全員が有し、喫煙の習慣のある症例は8例であった。急性期治療としての静注剤は、オザグレルナトリウムが13例、アルガトロバンが7例に使用された。クロピドグレルは、入院後平均3.1日目に投与された。入院時NIHSSとmRSは有意に改善した。凝固線溶系マーカーと血小板系マーカーは上昇した。白血球数、血小板数、肝機能検査値に異常変動はみられなかった。機能検査値では、ALTで正常範囲内での上昇を認めたが、他の肝酵素値に有意な変動はなかった。クロピドグレルを第一選択薬とした急性期治療は安全であることが示唆された。

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記述言語：日本語   出版者・発行元：日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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