記述言語：英語   掲載種別：研究論文（学術雑誌）  

The ring finger protein 213 (RNF213) susceptibility gene has been detected in more than 80% of Japanese and Korean patients with moyamoya disease (MMD), a bilateral internal carotid artery (ICA) occlusion. Furthermore, RNF213 has been detected in more than 20% of East Asians with atherosclerotic ICA stenosis. In this study, we evaluated the frequency of RNF213 mutations in congenital occlusive lesions of the ICA system. This case series was conducted jointly at four university hospitals. Patients with a family history of MMD, quasi-MMD, or related diseases were excluded. Ten patients were diagnosed with abnormal ICA or middle cerebral artery (MCA) angiogenesis. Patients with neurofibromatosis were excluded. Finally, nine patients with congenital vascular abnormalities were selected; of these, five had ICA deficiency and four had twig-like MCA. The RNF213 c.14576G > A mutation was absent in all patients. Therefore, the RNF213 c.14576G > A mutation may not be associated with ICA and MCA congenital dysplasia-rare vascular anomalies making it difficult to study a large number of cases. However, an accumulation of cases is required for accurate determination. The results of this study may help differentiate congenital vascular diseases from MMD.

DOI： 10.1038/s41598-021-01623-6

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掲載種別：研究論文（学術雑誌）  

A mutation in RNF213 (c.14576G>A), a gene associated with moyamoya disease (>80%), plays a role in terminal internal carotid artery (ICA) stenosis (>15%) (ICS). Studies on RNF213 and cerebral aneurysms (AN), which did not focus on the site of origin or morphology, could not elucidate the relationship between the two. However, a report suggested a relationship between RNF213 and AN in French-Canadians. Here, we investigated the relationship between ICA saccular aneurysm (ICA-AN) and RNF213. We analyzed RNF213 expression in subjects with ICA-AN and atherosclerotic ICS. Cases with a family history of moyamoya disease were excluded. AN smaller than 4 mm were confirmed as AN only by surgical or angiographic findings. RNF213 was detected in 12.2% of patients with ICA-AN and 13.6% of patients with ICS; patients with ICA-AN and ICS had a similar risk of RNF213 mutation expression (odds ratio, 0.884; 95% confidence interval, 0.199–3.91; p = 0.871). The relationship between ICA-AN and RNF213 (c.14576G>A) was not correlated with the location of the ICA and bifurcation, presence of rupture, or multiplicity. When the etiology and location of AN were more restricted, the incidence of RNF213 mutations in ICA-AN was higher than that reported in previous studies. Our results suggest that strict maternal vessel selection and pathological selection of AN morphology may reveal an association between genetic mutations and ICA-AN development. The results of this study may form a basis for further research on systemic vascular diseases, in which the RNF213 (c.14576G>A) mutation has been implicated.

DOI： 10.3390/genes12101468

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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：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: To examine the relationship between trap location and cerebral infarction in the anterior choroidal artery (AChA) region and associated risks in ruptured internal carotid artery blood blister-like aneurysm (BLA) treatment with high-flow bypass and lesion trapping. METHODS: We included 26 patients diagnosed with BLAs and treated with high-flow bypass and trapping. We examined clinical characteristics including age, aneurysm trap location, final prognosis, cerebral infarction on postoperative magnetic resonance imaging, and modified Rankin Scale score at discharge. We also searched the literature for similar studies. RESULTS: The modified Rankin Scale score at discharge was 0-2 in 20 patients, 3-5 in 2 patients, and 6 in 2 patients. In 19/26 patients (73.1%), the trapped segment was between the posterior communicating (PcomA) and the ophthalmic arteries. In 2 patients (7.7%), the trapped segment included the PcomA and the AChA; in 4 patients (15.4%), the trapped segment was within the PcomA. In these patients, the PcomA was occluded, and blood from the high-flow bypass flowed out to the AChA alone. No patient showed cerebral infarction. Our systematic review identified 70 patients. Of all 96 patients, 12 had AChA cerebral infarction; however, the infarction affected the prognosis of only 2 patients. CONCLUSIONS: When treating BLAs with high-flow bypass and lesion trapping, the frequency of AChA cerebral infarction is low even when the PcomA is occluded, leaving the AChA as the only outflow vessel during high-flow bypass. However, PcomA occlusion may be associated with risks when treating patients with advanced arteriosclerosis near C1-2.

DOI： 10.1016/j.wneu.2021.06.084

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Quasi-moyamoya disease (QMMD) is moyamoya disease (MMD) associated with additional underlying diseases. Although the ring finger protein 213 (RNF213) c.14576G>A mutation is highly correlated with MMD in the Asian population, its relationship to QMMD is unclear. Therefore, in this study the authors sought to investigate the RNF213 c.14576G>A mutation in the genetic diagnosis and classification of QMMD. METHODS: This case-control study was conducted among four core hospitals. A screening system for the RNF213 c.14576G>A mutation based on high-resolution melting curve analysis was designed. The prevalence of RNF213 c.14576G>A was investigated in 76 patients with MMD and 10 patients with QMMD. RESULTS: There were no significant differences in age, sex, family history, and mode of onset between the two groups. Underlying diseases presenting in patients with QMMD were hyperthyroidism (n = 6), neurofibromatosis type 1 (n = 2), Sjögren's syndrome (n = 1), and meningitis (n =1). The RNF213 c.14576G>A mutation was found in 64 patients (84.2%) with MMD and 8 patients (80%) with QMMD; no significant difference in mutation frequency was observed between cohorts. CONCLUSIONS: There are two forms of QMMD, one in which the vascular abnormality is associated with an underlying disease, and the other in which MMD is coincidentally complicated by an unrelated underlying disease. It has been suggested that the presence or absence of the RNF213 c.14576G>A mutation may be useful in distinguishing between these disease types.

DOI： 10.3171/2021.5.FOCUS21182

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記述言語：英語  

To the best of our knowledge, we report a case of MEN2A complicated by moyamoya syndrome. A 52-year-old woman presented with vertigo. Magnetic resonance angiography (MRA) revealed bilateral supraclinoid stenosis of the internal carotid artery and abnormal moyamoya-like vessels around the basal ganglia. She had a heterozygous variant of RNF213, which is the susceptibility gene for moyamoya disease. She had also previously received diagnoses of medullary thyroid carcinoma (MTC) at age 23 and left-sided pheochromocytoma (PHEO) at age 41. Genetic testing revealed heterozygosity for a mutation at codon 634 in exon 11 (TGC-TTC mutation; p.Cys634Phe) of the Ret gene. Intracranial vascular stenosis may have been caused by a genetic mutation of RNF213 and hypersecretion of catecholamines by MEN2A. Physicians should recognize that MEN2A can be present with moyamoya syndrome.

DOI： 10.3389/fendo.2021.703410

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Petrous internal carotid aneurysm (PA) concomitant with a mass lesion and cranial nerve palsy is relatively rare. Flow-diverter stent implantation is now widely used as an alternative treatment for PA. However, alternative treatments sometimes cannot be used because of tortuosity of the carotid artery, allergies to contrast material, and high costs. The outcomes of different treatment methods should therefore be assessed. Here, we review the available literature on treatments for PA. METHODS: In a search using the terms "aneurysm", "carotid artery", and "petrous" on PubMed, MEDLINE, and databases such as OvidSP, 221 articles were identified. We also performed a literature review and discuss and compare the causes, symptoms, treatment methods, and clinical outcomes of PA. RESULTS AND CONCLUSIONS: Onset of secondary aneurysm was generally heralded by bleeding (p<0.001), while onset of primary aneurysm was heralded by cranial nerve deficit (p= 0.0014). Outcomes after treatment of 34 cranial nerve palsies in 25 patients are reported.

DOI： 10.1272/jnms.JNMS.2020_87-407

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Carotid artery stenosis is elicited by atherosclerosis and is the main cause of cerebral thrombosis. Flow-mediated endothelial vasodilation (FMD) can be measured noninvasively to assess vascular endothelial function related to atherosclerosis. The pulse wave velocity (PWV) is used to evaluate the vascular media involved in atherosclerosis. We investigated the relationship between these measurements in 75 consecutive patients with atherosclerotic cerebral thrombosis. They were assigned to three equal groups based on the severity of carotid artery stenosis on ultrasonograms. Group 1 had no stenosis, group 2 manifested moderate stenosis (<60%), and group 3 presented with severe stenosis (≥60%). We compared the FMD and PWV among the three groups. The PWV was significantly lower in group 1 than the other two groups. The FMD was significantly lower in group 3; it was significantly lower in group 2 than group 1. There was an inverse correlation between the FMD and the severity of carotid artery stenosis. Our findings show that for assessing the severity of carotid artery stenosis, the FMD is more useful than the PWV.

DOI： 10.2176/nmc.oa.2019-0193

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: There have been reports on postoperative ischemic complications with vascular reconstructive surgery. However, various factors, such as lesions, operative technique, and perioperative treatment, prevent analyzing the causes of ischemic complications in vascular reconstruction surgeries. In the present study, we analyzed the cause of ischemic complications for vascular reconstruction surgeries with the same operator, surgical procedure, and perioperative treatment and without focusing on the lesions. PATIENTS AND METHODS: We retrospectively reviewed 66 patients, including 24 aneurysm cases and 42 ischemic disease cases, between 2008 and 2018. The patient group comprised 35 males and 31 females, and the patient mean age was 63.3 (23-87) years. We investigated the postoperative presence of symptomatic and asymptomatic cerebral ischemia on MRIDWI performed within 4 postoperative days. We conducted a statistical analysis of the ischemic complications and clinical and treatment factors. RESULTS: Symptomatic cerebral ischemia was detected in 3 cases, whereas asymptomatic ischemic findings were identified in 8 cases. All cases of symptomatic cerebral ischemia involved cerebral aneurysms. Results of a univariate analysis revealed an association between symptomatic cerebral ischemia and preoperative antithrombotic therapy (OR, 0.07; p =  0.049 (95 %CI; 0.007-0.8794)), clipping (OR, 4.8; p =  0.0501 (95 %CI; 1.641-342.9)), and aneurysm (OR, 14.16; p =  0.0423 (95 %CI; 0.6991-286.9)). Significant associations were found between asymptomatic cerebral ischemia and preoperative antithrombotic therapy [OR, 0.2941; p =  0.0514 (95 %CI; 0.08335-1.038)], aneurysms [OR, 7.8; p =  0.0146 (95 %CI; 1.414-43.04)] and radial artery grafts (RAGs) [OR, 6.8; p =  0.0192 (95 %CI; 1.410-32.98)]. Multivariate analysis identified clipping [OR, 5.462; p =  0.045 (95 %CI; 1.01-78.25] and preoperative antithrombotic therapy [OR, 0.187; p =  0.037 (95 %CI; 0.004-0.813)] as the risk factors for symptomatic cerebral ischemia. Further, a correlation was found between asymptomatic cerebral ischemia and RAGs [OR, 9.244; p =  0.00013 (95 %CI; 2.34-29.44)]. CONCLUSION: Ischemic complications associated with combined vascular reconstruction surgeries for cerebral aneurysms are possibly associated with procedures related to aneurysmal occlusions. Thus, vascular reconstruction surgeries can be performed relatively safely. Further, preoperative antithrombotic treatment should be considered, and caution is required for asymptomatic cerebral ischemia in RAG cases.

DOI： 10.1016/j.clineuro.2020.105768

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記述言語：英語  

BACKGROUND: Aplastic or twiglike middle cerebral artery (MCA), a congenital anomaly related to the abnormal development of the MCA, is rare. It is usually unilateral; bilateral lesions are extremely rare. An aplastic or twiglike MCA may lead to cerebral ischemic stroke, intracranial hemorrhage, and subarachnoid hemorrhage (SAH). In patients with ischemic stroke due to hemodynamic stress, extracranial-intracranial (EC-IC) bypass surgery is indicated. As hemodynamic stress may also elicit SAH, it is important to select the appropriate treatment. EC-IC bypass surgery was successful in a patient with bilateral aplastic or twiglike MCA who suffered SAH due to hemodynamic stress. CASE DESCRIPTION: A 64-year-old female with a history of surgery for tetralogy of Fallot experienced SAH in the left sylvian fissure. As angiography showed a bilateral aplastic or twiglike MCA and single photon emission computed tomography revealed a decrease in the cerebral blood flow in the left MCA territory, we attributed her SAH to hemodynamic stress due to the decreased blood flow in the MCA territory and to the vulnerability of abnormal vessels as are seen in moyamoya disease. We performed EC-IC bypass surgery to reduce hemodynamic stress. A cerebral angiogram obtained 2 weeks postoperatively revealed sufficient blood flow in the MCA territory from the superficial temporal artery used for bypass. In the course of 2-year follow-up she remained stroke free. CONCLUSIONS: The presence of aplastic or twiglike MCA may lead to stroke due to hemodynamic stress. EC-IC bypass surgery may help to prevent stroke recurrence and SAH.

DOI： 10.1016/j.wneu.2019.10.054

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DOI： 10.4103/ajns.AJNS_261_18

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DOI： 10.4103/ajns.AJNS_11_19

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記述言語：英語  

Persistent primitive hypoglossal artery is a rare anastomosis between the carotid and basilar arteries, and sometimes associated with cerebral aneurysms. However, association of persistent primitive hypoglossal artery with aneurysms located on arteries other than persistent primitive hypoglossal artery itself or posterior circulation is very rare. An 80-year-old woman suffered from subarachnoid hemorrhage, whose angiography demonstrated aneurysms on the left middle cerebral artery and anterior communicating artery, and the left persistent primitive hypoglossal artery. The middle cerebral artery aneurysm was the origin of hemorrhage. Although repeated craniotomy was necessary for the left middle cerebral artery aneurysm, both aneurysms were successfully clipped. In our case, neither aneurysm was located on an artery related to the persistent primitive hypoglossal artery. There is a possibility that cases of persistent primitive hypoglossal artery are accompanied by cerebral aneurysms on arteries other than the persistent primitive hypoglossal artery or in the posterior circulation.

DOI： 10.14740/jocmr3649

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記述言語：英語  

For a case of dissecting vertebral artery aneurysm (DVAA) in a dominant vertebral artery (VA) or posterior inferior cerebellar artery (PICA)-involving lesion, stent-assisted coil embolization (SACE) is an effective technique to preserve blood flow of the VA. A 41-year-old man presented with subarachnoid hemorrhage. Angiography demonstrated DVAA on the left VA just distal to the PICA, and the right VA was thinner than the left. For this case, SACE was performed to preserve the left VA and PICA. On the 10th day, angiography showed recurrence of the dissection. The dissected portion had thickened and extended to both distal and proximal sides involving the PICA origin and proximal portion to the PICA. A second endovascular embolization was performed and the recurrent dissecting aneurysm was embolized including the main VA cavity. In cases of DVAA, there is a possibility of recurrence after SACE, if a dissecting cavity remains unembolized. Therefore, total embolization is necessary under close observation from multiple angles, including the down-the-barrel view.

DOI： 10.14740/jocmr3397w

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley-VCH Verlag  

Various reports have been published regarding quantitative evaluations of intraoperative fluorescent intensity studies using indocyanine green (ICG) with videoangiography (VAG). The effects of scattering and point-spread functions (PSF) on quantitative ICG-VAG evaluations have not been investigated. Clinically, when ICG is administered through the peripheral vein, it reaches the tissue intra-arterially. To achieve more reliable intraoperative quantitative intensity evaluations, we examined the impact of high-intensity structures on close areas. The study was conducted using a phantom model and surgical fluorescent microscope. A region of interest (ROI) was created for the vessel model and another ROI was created within 3 cm of that. With an ROI of 6.8 mm in the vessel phantom model, 10% intensity was confirmed, even though there was no fluorescent structure. Intensity decreased gradually as the ROI moved further from the vessel model. Our study results suggest that the presence of a high-intensity structure and the size of the ROI may affect quantitative intensity evaluations using ICG-VAG. Results of linear regression analysis indicate that the relationship of intensity (Y) and distance (X) is as follows: Y(real/A) = 29 Exp(−0.062X) + 164.3 Exp(−1.81X). The optical effect should be considered when performing an intraoperative intensity study with a surgical microscope.

DOI： 10.1002/jbio.201700254

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SAGE Publications Inc.  

Background: In cases of subarachnoid hemorrhage due to aneurysm rupture, the administration of an anticoagulant or antiplatelet agent involves the risk of rebleeding from the aneurysm. There is a possibility of inducing thromboembolic events during the endovascular embolization of ruptured cerebral aneurysms. Patients and methods: From April 2006 to March 2017, we treated a total of 70 patients with ruptured cerebral aneurysms with an endovascular technique. Among them, five patients (7.1%) showed intra-arterial thrombus formation. The aneurysms were located at the anterior communicating artery and basilar artery in two patients each, and on the internal carotid artery at the bifurcation of the anterior choroidal artery (AChoA) in one. In these patients, the clinical course, radiological findings, and management were retrospectively reviewed. Results: Thrombus formation was observed in the posterior cerebral artery, anterior cerebral artery (A2), AChoA, and middle cerebral artery. The timing of thrombus formation was during coil delivery in four cases, and guiding catheter advancement in one. As for thrombus management, for all patients, administrations of heparin and antiplatelet agents were performed. For four patients, urokinase injection into the affected arteries was added after the completion of embolization. Cerebral infarction was postoperatively identified in two patients, but no hemorrhage was noted. Conclusion: Administrations of heparin and antiplatelet drugs should be performed appropriately during procedures, and close observation of the arterial condition on angiography is necessary. Once thromboembolism occurs during the endovascular embolization of ruptured cerebral aneurysms, adequate heparinization, and antiplatelet therapy should first be performed.

DOI： 10.1177/1591019917739448

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier Inc.  

Background Arachnoid cysts and intracranial aneurysms are not rare, but it is unusual for an aneurysm to be associated with an arachnoid cyst. The objective of this study was to reveal the association between arachnoid cysts and intracranial aneurysms. Methods Methods included to report 3 cases with these 2 pathologies and to perform a systematic review of the English and Japanese literature using PubMed, Scopus, and Ichushi Web. Results The first case was of a 46-year-old man with a subarachnoid hemorrhage on the basal cistern and bilateral arachnoid cysts in the middle fossa, the second was that of a 29-year-old woman with a subarachnoid hemorrhage at the basal cistern and an arachnoid cyst in the left middle fossa, and the third was that of a 60-year-old man with a right putaminal hemorrhage and contralateral unruptured aneurysm and arachnoid cyst. A literature search for similar cases found 27 patients. Conclusions It was difficult to diagnose a ruptured aneurysm in some cases with an arachnoid cyst because computed tomography scan showed atypical findings, such as no hemorrhage, intracystic localized hemorrhage, or subdural hematoma. This review revealed that aneurysms and arachnoid cysts were significantly located ipsilaterally and that they occurred together in relatively young patients.

DOI： 10.1016/j.wneu.2017.09.139

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記述言語：英語  

Background: An aneurysm of distal lenticulostriate artery is very rare. The natural course and management of this rare aneurysm are not clear. Case Description: An 81-year-old woman developed consciousness disturbance. Computed tomography revealed hemorrhage in the right caudate nucleus and lateral ventricles. Three-dimensional computed tomographic angiography demonstrated only an aneurysm at the basilar artery. On angiography, on the sixth day, an aneurysm at the right lenticulostriate artery was demonstrated. Then, the aneurysm disappeared on three-dimensional computed tomographic angiography on the 15th day. Subsequent radiological examinations revealed no vascular anomaly in the right lenticulostriate artery. Conclusion: An aneurysm at this location can show dynamic changes based on radiological findings. Close radiological observation is necessary.

DOI： 10.4103/sni.sni_126_18

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

In penetrating injuries, woods are known to be difficult to detect with radiological imaging studies, because the wood density are known to be extremely close to the value of air on CT. Adjustment of CT window and reconstruction of a 3D image from CT images allowed us to more accurately distinguish wood from air and to find the fragment of the wooden chopstick. It is particularly useful in transorbital penetrating injury.

DOI： 10.1007/s00381-017-3510-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：CAMBRIDGE UNIV PRESS  

We experienced two cases in which aneurysm clips sprang from the applier. In case 1, a subdural haematoma from a ruptured anterior cerebral artery aneurysm was detected. When the clip was opened for final positioning, it suddenly sprang from the applier and ruptured the aneurysm. In case 2, the clip suddenly sprang from the applier as the surgeon opened the applier to clip an unruptured anterior cerebral aneurysm. These accidental phenomena are rare but dangerous. We present these cases to help prevent similar occurrences in the future. Video recordings of actual procedures can point to potential mechanisms and help reduce the incidence of this complication.

DOI： 10.1017/cjn.2016.434

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記述言語：日本語  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

Background: Infundibular dilatation (ID) is a funnel-shaped enlargement of the origin of cerebral arteries. The coexistence of an aneurysm and ID is relatively rare. Patients with IDs are rarely followed up. However, some IDs have been reported to develop into aneurysms with subsequent rupture. Here we report on a case of an aneurysm that coexisted with ID of the posterior communicating artery.
Case Presentation: A 51-year-old woman underwent magnetic resonance imaging (MRI) to check for aneurysms and other problems. MRI revealed an unruptured aneurysm of the right internal carotid artery, for which the patient was admitted to our hospital. Three-dimensional computed tomographic angiography revealed an aneurysm, which protruded outward, and ID of the posterior communicating artery, which protruded inward. A right pterional craniotomy was performed with aneurysm clipping. The postoperative course was uneventful. In this report, we demonstrate operative views of the aneurysm and ID with the use of neuroendoscopy.
Conclusion: ID can develop into a true arterial aneurysm and potentially rupture. Therefore, we need to observe the patients with IDs carefully, particularly in young women.

DOI： 10.1272/jnms.83.268

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

The intraoperative confirmation of blood flow direction is necessary in cerebral vascular surgery. Using indocyanine green video angiography (ICG-VAG) with the FLOW 800 system, we examined the transit time of the blood vessel of interest and semiquantitatively evaluated the delay time (T1/2max) from indocyanine green (ICG) injection into the donor artery in reconstructive surgery and the middle cerebral artery (MCA) in aneurysmal surgery. The direction of cerebral blood flow (CBF), which can often be confirmed by ICG-VAG, may be more difficult to determine with faster blood flow. Here, we report our findings regarding the feasibility of detecting CBF direction using the FLOW 800 system. Twenty patients undergoing superficial temporal artery (STA) to MCA anastomosis for carotid occlusive disease and 13 patients with a small MCA aneurysm clipping were evaluated using the T1/2max, semiquantitative method with the FLOW 800 system. In STA-MCA anastomosis cases, the regions of interest (ROIs) included: the proximal donor STA and a region more than 10 mm on the distal side of the donor STA near the anastomosis site. In MCA aneurysms, the ROIs included the proximal M1 and distal M2 sides of the MCA aneurysm. T1/2max was significantly shorter for the proximal sites compared to the distal sites for all subjects (ps &lt; 0.01). T1/2max was shorter for all subjects in the proximal sites. The direction of CBF can be determined using the FLOW 800 system.

DOI： 10.1007/s10143-016-0726-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

A 79-year-old man experienced sudden-onset left hemiparesis and disturbance of consciousness. Diffusion-weighted magnetic resonance imaging showed an acute ischemic stroke in the territory of the right middle cerebral artery. He underwent systemic thrombolysis via the intravenous administration of tissue plasminogen activator (t-PA). Chest radiography and computed tomography performed the following day showed severe hemothorax with atelectasis of the left lung and multiple rib fractures; the initial chest radiogram had revealed rib fractures but we did not recognize them at the time. Conservative treatment with the placement of chest tubes was successful, and the patient recovered without further deterioration. Although systemic thrombolysis with t-PA is an accepted treatment for acute cerebral ischemic stroke, posttreatment intracranial hemorrhage has a negative effect on prognosis. Extracranial bleeding is a rare complication, and our search of the literature found no reports of hemothorax after treatment with t-PA in patients with cerebral ischemic stroke. We have reported a rare case of severe hemothorax after systemic thrombolysis with t-PA. This important complication indicates the need to rule out thoracic trauma with radiography and computed tomography of the chest.

DOI： 10.1272/jnms.81.43

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN NEUROSURGICAL SOC  

A 65-year-old woman presented a rare dissecting aneurysm of the anterior temporal artery (ATA) manifesting as headache. Computed tomography and magnetic resonance imaging revealed a mixed-density mass in the horizontal segment of the middle cerebral artery. Emergent angiography demonstrated aneurysmal dilatation and a thrombosed mass in the sylvian fissure. Infectious aneurysm was excluded. She underwent emergent surgery to reduce the risk of repeated infarction and hemorrhage. The distal side of the ATA manifested occlusive changes suggestive of arterial dissection. The proximal side of the ATA was ligated and the lesion was excised. Histological examination confirmed that the aneurysmal dilatation was attributable to arterial dissection due to disruption of the internal elastic lamina. Distal dissecting aneurysms may occur in the absence of infectious disease. We recommend that ruptured distal dissecting aneurysms be treated surgically in the acute stage immediately after detection.

DOI： 10.2176/nmc.51.777

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経外科救急学会  

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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：日本語   出版者・発行元：(一社)日本脳卒中の外科学会  

症例1(69歳女性)。左内頸動脈瘤に対する左前頭側頭開頭によるクリッピング術後5日頃より左側の聴力低下を自覚した。症例2(69歳女性)。左中大脳動脈瘤に対する左前頭側頭開頭によるクリッピング術後3日目より左聴力の低下を自覚した。いずれも耳鼻咽喉科を受診し、鼓室内血腫による伝音性難聴と診断され、カルボシステイン、アンブロキソール塩酸塩内服による保存的加療を行ったところ、20〜30日で自覚症状や聴力検査所見が改善した。

DOI： 10.2335/scs.44.229

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

J-GLOBAL

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語   出版者・発行元：日本救急医学会-関東地方会  

60代男。夏季に自宅の寝室で唸り声をあげて倒れているのを発見され、救急搬送された。来院時のGCSはE1V1M1、体温は40.5℃で、諸検査の結果から、脱水による腎前性腎不全と臥床による横紋筋融解症を伴うIII度熱中症と診断した。気管挿管し人工呼吸管理を行うとともに、体温管理として冷却マットと冷却急速輸液および冷却水での胃洗浄を行い、体温は来院後約1時間で36.8℃まで改善した。血液ガスや血液検査所見、意識レベルも改善傾向を示し、抜管を予定していたところ、第3病日に心室細動が出現し、蘇生処置により自己心拍再開が得られた。心電図と心エコーの所見から心室細動の原因は、たこつぼ型心筋症と判断した。自己心拍再開後はランジオロールの投与を行い、心室細動の再発は認めなかった。たこつぼ型心筋症の誘因となったのは熱中症による身体的ストレスではないかと考えられた。

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記述言語：日本語   出版者・発行元：日本救急医学会-関東地方会  

小学生男児。階段の2階踊り場から地下1階の中庭に転落し、救急要請となった。救急隊到着時は意識レベルJCS 100で両側瞳孔散大を認め、直近病院を経て頭部単独外傷の診断で受傷3時間後に当院へ搬送された。来院時、意識レベルは鎮静・挿管下でGCS E1VTM1、両側瞳孔散大は持続しており、頭部CTで中脳出血と瀰漫性脳浮腫を認めた。治療法の選択にあたり、瀰漫性脳浮腫を呈していることから両側減圧開頭術も考慮したが、両側瞳孔散大は中脳出血による両側動眼神経核損傷に起因すると判断し、頭蓋内圧管理下に平温療法を72時間施行した。その結果、意識レベルはGCS E4VTM6に改善し、頭部CT所見の改善もみられ、リハビリテーション病院を経て第82病日に自宅退院し、復学に至った。

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記述言語：日本語   出版者・発行元：日本救急医学会-関東地方会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：日本救急医学会-関東地方会  

J-GLOBAL

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経外科救急学会  

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

J-GLOBAL

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記述言語：日本語  

J-GLOBAL

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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  

J-GLOBAL

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語   出版者・発行元：(一社)日本脳卒中学会  

【目的】Merci Retriever適応基準を満たすwake-up ischemic stroke(WUIS)例について、急性期血栓回収術応用の可能性について検討した。【方法】2009年1月より2010年12月に入院した心原性脳塞栓症158例を対象としてWUISの発症比率、頭蓋内主要血管閉塞症例のDWI-ASPECTSを評価した。【結果】28症例(17.7%)がWUISであった。DWI-ASPECTSは発症2時間以内搬送群、2-8時間搬送群、WUIS群の3群間で有意差はなかった。WUIS群には血行再建術の適応となり得るDWI-ASPECTS高スコアで、当施設の使用適応基準を満たす例が5例存在した。実際にMerci Retrieverを使用したWUIS2例の予後は良好であった。【結論】WUIS患者においても適切な患者選択をすれば脳血管内治療の有効性が期待できることが示唆された。(著者抄録)

DOI： 10.3995/jstroke.34.228

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記述言語：日本語  

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記述言語：日本語  

DOI： 10.3995/jstroke.34.228

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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  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(株)へるす出版事業部  

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記述言語：日本語  

CiNii Books

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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：(一社)日本脳神経外傷学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

J-GLOBAL

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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記述言語：日本語  

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語  

J-GLOBAL

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