記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) has been used to estimate infarct core volume in acute stroke. However, the same and indiscriminate score deduction for punctate or confluent DWI high-intensity lesion might lead to variation in performance. AIMS: To develop and evaluate a differential detailed DWI-ASPECTS method in comparison with the conventional DWI-ASPECTS in core infarct volume measurement and clinical outcome prediction. METHODS: We retrospectively recruited patients with acute ischemic stroke (AIS) treated with endovascular treatment between April 2013 and October 2019. In differential detailed DWI-ASPECTS, restricted diffusion lesion that was punctate or less than half of a cortical region (M1-M6) would not lead to subtraction of point. A favorable outcome was modified Rankin Scale score ⩽2 at 90 days after stroke onset. RESULTS: Among 298 AIS patients, mean age was 75 years (interquartile range (IQR) 67-82), and 194 patients (65%) were males. Mean infarct core volume was 11 mL (IQR 3-37). Overall, the score by detailed DWI-ASPECTS was significantly higher than conventional DWI-ASPECTS (8 (7-9) vs. 7 (5-9); P < 0.01). The detailed DWI-ASPECTS resulted in a higher correlation coefficient (r) for core infarct volume estimation than the conventional DWI-ASPECTS (r = 0.832 vs. 0.773; P < 0.01). Upon re-classification of those scored ⩽6 in conventional DWI-ASPECTS (n = 134) by detailed DWI-ASPECTS, the rate of favorable outcome in patients with detailed DWI-ASPECTS >6 was significantly higher than those with ⩽6 (29 (48%) vs. 14 (19%); P < 0.01). CONCLUSIONS: Detailed DWI-ASPECTS appeared to provide a more accurate infarct core volume measurement and clinical outcome correlation than conventional DWI-ASPECTS among AIS patients treated with endovascular therapy.

DOI： 10.1177/17474930231185468

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.omtm.2023.07.005

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Early control of elevated blood pressure is the most promising treatment for acute intracerebral haemorrhage. We aimed to establish whether implementing a goal-directed care bundle incorporating protocols for early intensive blood pressure lowering and management algorithms for hyperglycaemia, pyrexia, and abnormal anticoagulation, implemented in a hospital setting, could improve outcomes for patients with acute spontaneous intracerebral haemorrhage. METHODS: We performed a pragmatic, international, multicentre, blinded endpoint, stepped wedge cluster randomised controlled trial at hospitals in nine low-income and middle-income countries (Brazil, China, India, Mexico, Nigeria, Pakistan, Peru, Sri Lanka, and Viet Nam) and one high-income country (Chile). Hospitals were eligible if they had no or inconsistent relevant, disease-specific protocols, and were willing to implement the care bundle to consecutive patients (aged ≥18 years) with imaging-confirmed spontaneous intracerebral haemorrhage presenting within 6 h of the onset of symptoms, had a local champion, and could provide the required study data. Hospitals were centrally randomly allocated using permuted blocks to three sequences of implementation, stratified by country and the projected number of patients to be recruited over the 12 months of the study period. These sequences had four periods that dictated the order in which the hospitals were to switch from the control usual care procedure to the intervention implementation of the care bundle procedure to different clusters of patients in a stepped manner. To avoid contamination, details of the intervention, sequence, and allocation periods were concealed from sites until they had completed the usual care control periods. The care bundle protocol included the early intensive lowering of systolic blood pressure (target <140 mm Hg), strict glucose control (target 6·1-7·8 mmol/L in those without diabetes and 7·8-10·0 mmol/L in those with diabetes), antipyrexia treatment (target body temperature ≤37·5°C), and rapid reversal of warfarin-related anticoagulation (target international normalised ratio <1·5) within 1 h of treatment, in patients where these variables were abnormal. Analyses were performed according to a modified intention-to-treat population with available outcome data (ie, excluding sites that withdrew during the study). The primary outcome was functional recovery, measured with the modified Rankin scale (mRS; range 0 [no symptoms] to 6 [death]) at 6 months by masked research staff, analysed using proportional ordinal logistic regression to assess the distribution in scores on the mRS, with adjustments for cluster (hospital site), group assignment of cluster per period, and time (6-month periods from Dec 12, 2017). This trial is registered at Clinicaltrials.gov (NCT03209258) and the Chinese Clinical Trial Registry (ChiCTR-IOC-17011787) and is completed. FINDINGS: Between May 27, 2017, and July 8, 2021, 206 hospitals were assessed for eligibility, of which 144 hospitals in ten countries agreed to join and were randomly assigned in the trial, but 22 hospitals withdrew before starting to enrol patients and another hospital was withdrawn and their data on enrolled patients was deleted because regulatory approval was not obtained. Between Dec 12, 2017, and Dec 31, 2021, 10 857 patients were screened but 3821 were excluded. Overall, the modified intention-to-treat population included 7036 patients enrolled at 121 hospitals, with 3221 assigned to the care bundle group and 3815 to the usual care group, with primary outcome data available in 2892 patients in the care bundle group and 3363 patients in the usual care group. The likelihood of a poor functional outcome was lower in the care bundle group (common odds ratio 0·86; 95% CI 0·76-0·97; p=0·015). The favourable shift in mRS scores in the care bundle group was generally consistent across a range of sensitivity analyses that included additional adjustments for country and patient variables (0·84; 0·73-0·97; p=0·017), and with different approaches to the use of multiple imputations for missing data. Patients in the care bundle group had fewer serious adverse events than those in the usual care group (16·0% vs 20·1%; p=0·0098). INTERPRETATION: Implementation of a care bundle protocol for intensive blood pressure lowering and other management algorithms for physiological control within several hours of the onset of symptoms resulted in improved functional outcome for patients with acute intracerebral haemorrhage. Hospitals should incorporate this approach into clinical practice as part of active management for this serious condition. FUNDING: Joint Global Health Trials scheme from the Department of Health and Social Care, the Foreign, Commonwealth & Development Office, and the Medical Research Council and Wellcome Trust; West China Hospital; the National Health and Medical Research Council of Australia; Sichuan Credit Pharmaceutic and Takeda China.

DOI： 10.1016/S0140-6736(23)00806-1

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記述言語：日本語   出版者・発行元：(一社)日本脳循環代謝学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The pathophysiology of unilateral cortical fluid-attenuated inversion recovery (FLAIR)-hyperintense lesions in anti-myelin oligodendrocyte glycoprotein (MOG)-associated encephalitis with seizures (FLAMES) is unclear. A 26-year-old man was referred because of a seizure. FLAIR showed an increased signal intensity and swelling of the right frontal cortex. His symptoms and imaging abnormalities were improved after intravenous methylprednisolone therapy. MOG antibody was detected both in serum and cerebrospinal fluid (CSF). Therefore, the patient was diagnosed with FLAMES. Myelin basic protein (MBP) was elevated in CSF. The high MBP value in the CSF in the present case suggested that demyelination as well as inflammation can occur in some FLAMES patients.

DOI： 10.2169/internalmedicine.9439-22

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND PURPOSE: We investigated whether the signal change on fluid-attenuated inversion recovery (FLAIR) can serve as a tissue clock that predicts the clinical outcome after endovascular thrombectomy (EVT), independently of the onset-to-admission time. METHODS: Consecutive patients with acute stroke treated with EVT between September 2014 and December 2018 were enrolled. Based on the parenchymal signal change on FLAIR, patients were classified into FLAIR-negative and FLAIR-positive groups. The clinical characteristics, imaging findings, EVT parameters, and the intracranial hemorrhage defined as Heidelberg Bleeding Classification ≥1c hemorrhage (parenchymal hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage, and/or subdural hemorrhage) were compared between the 2 groups. A modified Rankin Scale score 0 to 1 at 3 months was considered to represent a good outcome. RESULTS: Of the 227 patients with EVT during the study period, 140 patients (62%) were classified into the FLAIR-negative group and 87 (38%) were classified into the FLAIR-positive group. In the FLAIR-negative group, the patients were older (P=0.011), the onset-to-image time was shorter (P<0.001), the frequency of cardioembolic stroke was higher (P=0.006), and the rate of intravenous thrombolysis was higher (P<0.001) in comparison to the FLAIR-positive group. Although the rate of complete recanalization after EVT did not differ between the 2 groups (P=0.173), the frequency of both any-intracranial hemorrhage and Heidelberg Bleeding Classification ≥1c hemorrhage were higher in the FLAIR-positive group (P=0.004 and 0.011). At 3 months, the percentage of patients with a good outcome (FLAIR-negative, 41%; FLAIR-positive, 27%) was significantly related to the FLAIR signal change (P=0.047), while the onset-to-image time was not significant (P=0.271). A multivariate regression analysis showed that a FLAIR-negative status was independently associated with a good outcome (odds ratio, 2.10 [95% CI, 1.02-4.31], P=0.044). CONCLUSIONS: A FLAIR-negative status may predict the clinical outcome more accurately than the onset-to-admission time, which may support the role of FLAIR as a tissue clock.

DOI： 10.1161/STROKEAHA.120.033374

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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

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Several studies have investigated the predictors of functional outcome in patients with ischemic stroke after mechanical thrombectomy (MT). However, it is not clear whether pre-stroke cognitive (PSC) impairment is associated with the functional outcome of patients treated with MT. METHODS: We enrolled 113 patients treated with MT from December 2016 to November 2018. PSC was evaluated using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Poor outcome was defined as a modified Rankin Scale score of 3-6. We compared the clinical characteristics between the groups with poor outcome (n = 61) and good outcome (n = 52) to determine if PSC could be a predictor of poor outcome. RESULTS: IQCODE was significantly higher in the group with poor outcome than good outcome (3.34 vs. 3.13, P = 0.017). Moreover, the following metrics differed between those two groups: age (75.9 vs. 71.6 years old, P = 0.010), the percentage of females (39.9% vs. 17.3%, P = 0.009), the percentage with hypertension (72.1% vs. 44.2%, P = 0.003), National Institutes of Health Stroke Scale (NIHSS) score on admission (20 vs. 11, P < 0.001), and no successful recanalization (24.5% vs. 7.7%; P = 0.025). Multivariable logistic regression analysis demonstrated that PSC (OR: 5.59; 95% CI: 1.55-23.47), history of hypertension (OR: 3.33; 95% CI: 1.29-9.11), no successful recanalization (OR: 5.51; 95% CI: 1.49-25.03), and NIHSS score on admission (OR: 1.14; 95% CI: 1.07-1.22) were associated with poor outcome 3 months after stroke onset. CONCLUSIONS: PSC was significantly and independently associated with poor functional outcome in patients treated with MT.

DOI： 10.1007/s10072-021-05158-6

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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  

症例は、79歳、女性。意識障害、全失語、左共同偏倚、右片麻痺で発症し、胸部X線とCTで肺水腫、低酸素血症を認めた。頭部MRAで左内頸動脈から中大脳動脈は描出されず、MRIでは島皮質を含む左中大脳動脈全域に梗塞を認めた。左内頸動脈閉塞症に対して経皮的血栓回収療法を施行しTICI3の再開通を得た。呼吸状態が悪化し経皮的血栓回収療法直後に気管内挿管行い、人工呼吸器管理を行った。肺水腫は第2病日には著明に改善、第3病日には消失し呼吸状態も改善した。経胸壁心臓超音波、心電図では、心疾患はなく脳梗塞に伴い二次性に生じた神経原性肺水腫と診断した。本症例は左島皮質梗塞が神経原性肺水腫の引き金になったと考えられた。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J01550&link_issn=&doc_id=20210120270006&doc_link_id=1390286981379460480&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390286981379460480&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective Computed tomography (CT) can be used for visualizing acute intracerebral hemorrhages (ICHs) as distinct hyperdense areas and cerebral edema as perihematomal low-density areas (LDAs). We observed a perihematomal LDA on CT, which appeared to be part of a hemorrhage on magnetic resonance imaging (MRI) in acute ICH. We named this "CT perihematomal rim" and evaluated its characteristics and clinical significance. Methods We stratified patients with acute ICH according to the presence or absence of a CT perihematomal rim and then compared their radiologic findings. Logistic regression analyses were performed to assess whether the CT findings can predict the presence of a CT perihematomal rim. Patients Patients within 24 hours of ICH onset who were admitted between September 1, 2014, and October 31, 2018, were registered. Results Overall, 139 patients (91 men; mean age, 66 years) were investigated. CT perihematomal rims were observed in 40 patients (29%). ICH volumes on CT were 30% smaller than those on MRI in patients with CT perihematomal rims. On a multivariate analysis, the presence of a CT perihematomal rim was independently associated with the maximum diameter of the perihematomal LDA. According to a receiver operating characteristic analysis, the maximum LDA diameter threshold was 7.5 mm (sensitivity, 85%; specificity, 83%). Conclusion CT perihematomal rims were observed in 29% of the patients with acute ICH. A perihematomal LDA (>7.5 mm) in acute ICH cases should be considered a CT perihematomal rim. Clinicians should be aware that the ICH volume on CT may be underestimated by 30%.

DOI： 10.2169/internalmedicine.6653-20

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記述言語：日本語   出版者・発行元：(一社)日本神経治療学会  

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記述言語：英語  

Aortogenic embolic stroke (AES) is an important stroke mechanism. However, as many stroke patients have aortic atheromatous lesions, it is unclear whether these lesions are the cause of these strokes. Cholesterol crystals are the solid, crystalline form of cholesterol that is found in atherosclerosis, but not in cardiac diseases such as atrial fibrillation, valvular diseases, and cardiomyopathy. Therefore, if a cholesterol crystal is found in a thrombus removed by mechanical thrombectomy (MT), this makes it possible to diagnose a patient as having an atheromatous lesion. Here, we report an AES case with a cholesterol crystal found in a thrombus removed by MT. A 67-year-old man was admitted due to consciousness disturbance, aphasia, and right hemiplegia. Diffusion-weighted imaging (DWI) showed a hyperintense area in the left frontal lobe, and magnetic resonance angiography demonstrated a branch occlusion of the left middle cerebral artery (MCA). MT was performed 1.5 h after stroke onset, with the thrombus removed and a left occluded MCA completely recanalized. Carotid duplex ultrasonography did not reveal any plaque in the carotid artery. Echocardiography did not show any abnormal function or findings, including thrombus. Transesophageal echocardiography showed a 4.9 mm atheromatous lesion at the aortic arch. Therefore, we suspected this patient as having an AES due to the embolic source of atheromatous lesion at the aortic arch. Pathological examination of the embolus revealed a cholesterol crystal cleft in the thrombus. Therefore, we diagnosed this patient as having AES caused by an atheromatous lesion at the aortic arch.

DOI： 10.1016/j.jstrokecerebrovasdis.2020.105178

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Stroke is the most prevalent cardiovascular disease worldwide, and is still one of the leading causes of death and disability. Stem cell-based therapy is actively being investigated as a new potential treatment for certain neurological disorders, including stroke. Various types of cells, including bone marrow mononuclear cells, bone marrow mesenchymal stem cells, dental pulp stem cells, neural stem cells, inducible pluripotent stem cells, and genetically modified stem cells have been found to improve neurological outcomes in animal models of stroke, and there are some ongoing clinical trials assessing their efficacy in humans. In this review, we aim to summarize the recent advances in cell-based therapies to treat stroke.

DOI： 10.3390/ijms21186718

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Urinary liver-type fatty-acid binding protein (L-FABP), which is a biomarker of kidney tubule injury, has been studied extensively and established as a risk marker of acute kidney injury (AKI). However, no evidence has indicated whether kidney tubule injury is associated with the development of AKI and mortality in patients with acute ischemic stroke. METHODS: Acute ischemic stroke patients hospitalized in the stroke care unit (SCU) within 24 hours after symptom onset were prospectively investigated. AKI was defined on the basis of Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Baseline urinary L-FABP was measured upon admission. We evaluated the association among urinary L-FABP, the incidence of AKI, and 90-day mortality adjusted for renal function, albuminuria, and other potentially predictive variables using the multivariable analysis. RESULTS: In total, 527 acute ischemic stroke patients (342 males; median age 74 years) were enrolled to the study. Twenty-seven patients (5.1%) occurred AKI within 7 days after admission. In the univariate analysis, high urinary L-FABP level had positive associations with AKI (53.8 μg/g Cr vs. 3.9 μg/g Cr, P<0.001) and 90-day mortality (15.5 μg/g Cr vs. 4.0 μg/g Cr, P<0.001). In the multivariate analysis, elevated urinary L-FABP level (per 10 μg/g Cr increase) was independently associated with AKI (Odds ratio 1.225; 95% confidence interval (CI), 1.083-1.454, P=0.003) and 90-day mortality (Hazard ratio 1.091; 95% CI, 1.045-1.138, P<0.001). CONCLUSION: Urinary biomarker of kidney tubule injury is independently associated with the development of AKI and 90-day mortality in patients with acute ischemic stroke treated at the SCU.

DOI： 10.1111/ene.14448

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The long-term outcome in acute stroke patients with large vessel occlusion (LVO) treated with endovascular therapy (EVT) are unclear. We investigated functional outcomes one year after EVT in acute stroke patients with LVO. METHODS: We retrospectively enrolled 149 stroke patients with LVO who underwent EVT from our prospective stroke registry. We assessed modified Rankin Scale (mRS) scores at one year from onset. The degree of recanalization was evaluated using modified thrombolysis in cerebral infarction (mTICI) grades. Good recanalization and a favorable outcome were defined as an mTICI grade ≥ 2b and mRS score ≤ 2, respectively. RESULTS: Favorable outcomes were observed in 76 (51.0%) patients. The favorable outcome group was younger (median age: 72 [interquartile range, 63-79] years vs. 79 [70-84] years, P < .001) and had more male patients (79% vs. 60%, P = .013), lower National Institutes of Health Stroke Scale scores at admission (median 14 [7-18]) vs. 19 [15-25], P < .001), higher DWI-ASPECTS upon admission (median [6-9] vs. 6 [4-8], P = .022), more patients with mTICI ≥ 2b (93% vs. 64%, P < .001) and fewer post-therapy intracranial cerebral hemorrhages (13% vs. 29%, P = .019) than the poor outcome group. In our multivariate analysis, mTICI ≥ 2b were independently associated with favorable outcomes at one year from onset (odds ratio, 10.282; 95% confidence interval, 1.587-66.604; P = .015). CONCLUSIONS: Good recanalization was associated with favorable functional outcomes one year after EVT in acute stroke patients with LVO.

DOI： 10.1016/j.jns.2020.117009

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Myeloproliferative neoplasms (MPNs) including polycythemia vera (PV) and essential thrombocythemia (ET) have an increased risk of ischemic stroke. However, little is known about brain morphological changes and the cerebral vasculature in MPNs. The aim of the present study is to clarify the prevalence rates of brain infarcts (BIs) on magnetic resonance imaging (MRI) and to assess the detailed clinical and MRI characteristics in those patients. METHODS: We prospectively enrolled patients with MPNs who underwent brain MRI between September 2017 and June 2019. BI patterns were characterized by the numbers and locations of BIs on MRI. RESULTS: A total of 101 patients were included in the present study. BIs were observed in 23 patients (23%). Multiple logistic regression analysis showed that age > 60 years (odds ratio (OR) 7.34, 95% confidence interval (CI) 1.08-49.7, p = .041) and history of thrombosis (OR 40.6, 95% CI 7.97-207, p < .0001) were independently associated with BIs, but not the JAK2V617F mutation. Of the 23 patients with BIs, eight patients (35%) had multiple territorial infarcts, and large vessel involvement was identified in five patients (22%). Two patients had thrombus formation in large vessels. CONCLUSIONS: Among patients with MPNs who underwent MRI, BIs were observed in 23% of patients followed up in our center. Older age and thrombosis history were independently associated with BIs. Some patients with MPNs may present with distinctive MRI findings including multiple territorial infarcts and thrombus formation in large vessels.

DOI： 10.1016/j.jns.2020.116990

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Some hyperacute stroke patients have unfavorable outcomes after endovascular thrombectomy (EVT) despite successful recanalization. We hypothesized that a cardiac parameter, moderate-to-severe mitral regurgitation (MR), might decrease the rate of favorable clinical outcome after EVT in patients with atrial fibrillation (AF). METHOD: From our prospective EVT registry, AF patients who underwent transthoracic echocardiography (TTE) were retrospectively analyzed. Based on the presence of moderate-to-severe MR, patients were assigned to either significant MR or nonsignificant MR group. The severity of MR was determined by the ratio of the color Doppler jet area to the left atrial area in mid-systole. Moderate-to-severe MR was estimated to be at a ratio of >20%. Favorable outcome was defined as having a modified Rankin Scale score of 0-1 at 3 months. RESULT: 127 patients with AF who underwent TTE were included in the study. TTE results found that 25 (20%) patients had significant MR. Patients with significant MR were older (p = 0.051) and had enlarged left (p = 0.015) and right (p = 0.002) atria. Tricuspid and aortic regurgitation (p = 0.007 and 0.043, respectively) were more severe in significant MR group. At 3 months, favorable outcomes were 11% in the significant MR group and 26% in the non-significant MR group (p = 0.031). Multivariate regression analysis reported that moderate-to-severe MR was a negative predictor of favorable outcome (odds ratio = 0.14; 95% confidence interval = 0.02, 0.84; p = 0.031). CONCLUSIONS: Significant MR might prevent the clinical recovery of AF patients.

DOI： 10.1080/01616412.2020.1773611

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 88-year-old man suddenly presented with aphasia and right hemiparesis. The diffusion-weighted image of MRI showed ischemic lesions on the left middle cerebral artery area, and MRA showed the left intracranial artery (ICA) occlusion. Therefore, we diagnosed him as having acute ischemic stroke and treated with mechanical thrombectomy (MT). The DWI of MRI showed ischemic lesions on the left middle cerebral artery area, and MRA showed the left ICA occlusion. Therefore, we performed MT and continued best medical treatment, but ICA was reoccluded. Six day later, aspergillus was found in the thrombus from ICA. Then, we considered that ICA occlusion was caused by aspergillus. We experienced a patient specified the cause by thrombus pathology. The pathological diagnosis of the thrombus getting by MT is usefulness for stroke etiology.

DOI： 10.5692/clinicalneurol.cn-001400

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND PURPOSE: We investigated the impact of complete recanalization beyond partial recanalization in distal (M2) middle cerebral artery (MCA) occlusion. METHODS: Data regarding M2 occlusion patients treated with endovascular thrombectomy (EVT) and/or intravenous thrombolysis (tPA) were reviewed from our prospective EVT registry and multicenter tPA (YAMATO study) data bank. Complete recanalization was modified thrombolysis with cerebral infarction score (TICI) of 3 at the end of EVT or similar appearances of both MCAs on magnetic resonance angiography (MRA) within 1.5 h after tPA. Partial recanalization was defined as TICI ≥2b or > 50% recanalization on MRA. At 3 months, favorable outcome was defined as a modified Rankin Scale score ≤ 2. RESULT: Data on 121 patients were analyzed. EVT-alone was in 38 patients; combined EVT and tPA in 28; and tPA-alone in 55. Complete recanalization was achieved in 27 (22%), partial recanalization in 48 (40%), and no-to-limited recanalization in 46 (38%). At 3 months, 51% of patients had favorable outcomes, and this rate was significantly higher in the complete recanalization group than in the partial and no-to-limited recanalization groups (75% vs. 41% vs. 49%, p = .043). Multivariate regression analysis showed that complete recanalization was an independent parameter related to favorable outcomes (odds ratio 4.78, 95% CI: 1.16-19.73, p = .030). However, combined complete and partial recanalization was not associated with favorable outcomes (odds ratio 1.49, 95% CI 0.53-4.22, p = .449). CONCLUSION: Complete recanalization, but not partial recanalization, at the end of EVT and tPA therapy is associated with favorable outcomes in patients with M2 occlusion.

DOI： 10.1016/j.jns.2020.116873

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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  

症例は88歳の男性である。右麻痺、失語を認め救急搬送された。来院時の頭部MRI/Aにて左中大脳動脈領域に新規梗塞巣と左内頸動脈の閉塞を認めたため、機械的脳血栓回収療法を施行した。その後内科的治療を行うも、左内頸動脈は再閉塞した。血栓病理でアスペルギルス真菌塊を認めた。副鼻腔炎と骨破壊を認めており、アスペルギルスが内頸動脈に直接浸潤し、血栓を形成し、閉塞したことが考えられた。血栓病理によって原因の特定に至った症例を経験した。原因不明の脳梗塞は、機械的血栓回収療法によって回収された血栓を確認することで、原因が判明する可能性がある。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J01550&link_issn=&doc_id=20200602480005&doc_link_id=1390285300159919360&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390285300159919360&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: Evaluation of cognitive status is not performed routinely in the acute stroke setting. This study aimed to evaluate the frequency of early cognitive impairment in patients with minor ischemic stroke, analyze the factors associated with early cognitive impairment, and assess functional outcomes. METHODS: In this prospective study, 112 consecutive patients with acute minor ischemic stroke were enrolled. Neuroimages were assessed for semiquantitative evaluation of brain atrophy and small vessel disease (SVD) markers. Cognitive performance was measured within 5 days of onset using Montreal Cognitive Assessment (MoCA) scores. Functional outcome analyses were adjusted for demographic variables, premorbid cognitive status, education level, vascular risk factors, neuroimaging characteristics, stroke severity, and MoCA scores. RESULTS: The median MoCA score was 22, and 63% of patients had cognitive impairment. Factors independently associated with cognitive impairment were education (odds ratios [OR], .79; confidence intervals [CI], .63-.99), smoking (OR, .26; 95%CI, .073-.89), and temporal horn atrophy (OR, 4.73; 95% CI, 1.66-13.49). Factors independently associated with poor functional outcome were total MoCA score (OR, .78; 95%CI, .62-.95) and the sum of 4 MoCA subscores (visuospatial/executive, attention, language, and orientation; OR, .72; 95%CI, .53-.92). The cutoff value of the sum of 4 MoCA subscores for predicting poor outcome was 13 points with 76.5% sensitivity and 81.1% specificity. CONCLUSIONS: Early cognitive impairment was common after minor ischemic stroke and was associated with preexisting temporal horn atrophy but not SVD markers. The sum of 4 MoCA subscores was useful in predicting the functional outcome.

DOI： 10.1016/j.jstrokecerebrovasdis.2020.104749

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: Cognitive assessment is not performed routinely in the acute stroke setting. We investigated factors associated with cognitive impairment and the differences between the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores in patients with acute stroke. METHODS: In this prospective study, 881 consecutive patients (median age, 73 years) with acute stroke were enrolled. Clinical characteristics, such as education, vascular risk factors, premorbid cognitive status using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), and stroke severity, were assessed. Cognitive performance was measured using MMSE and MoCA within 5 days of stroke onset. RESULTS: Both MMSE and MoCA were feasible in 621 (70.5%) patients. Factors independently associated with nonfeasibility were age (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 1.02-1.08), IQCODE score (OR: 1.02; 95%CI: 1.00-1.04), and National Institutes of Health Stroke Scale (NIHSS) score (OR, 1.16; 95%CI, 1.12-1.20). Impaired MoCA (with a cut-off <26/30) performance was observed in 544 of 621 (87.6%) patients. Factors independently associated with cognitive impairment were age (OR: 1.06; 95%CI: 1.03-1.10) and NIHSS score (OR: 1.34; 95%CI: 1.14-1.57). Eighty percent of patients with normal MMSE scores had an impaired MoCA score (MMSE-MoCA mismatch). The differences were highest in the visuospatial (94.8% versus 65.3%; P < .0001), recall (76.6% versus 35.6%; P < .0001), abstraction (82.5% versus 49.8%; P < .0001), and language (72.3% versus 65.9%; P < .0001) domains between the normal MMSE and MoCA group and MMSE-MoCA mismatch group. CONCLUSIONS: The MoCA can be particularly useful in patients with cognitive deficits undetectable on the MMSE in the acute stroke phase.

DOI： 10.1016/j.jstrokecerebrovasdis.2020.104688

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The feasibility of performing MRI first for patients with suspected hyperacute stroke in real-world practice has not been fully examined. Moreover, most past studies of reducing door-to-reperfusion time (DRT) in endovascular treatment (EVT) were conducted using CT. The aim of this study was to evaluate the feasibility of an MRI-first policy and to examine the effects of a quality improvement (QI) process for reducing DRT using MRI. METHODS: From January 2013 to December 2018, consecutive patients with acute stroke who came to hospital directly and were treated with emergent EVT were prospectively enrolled into the present study. In principle, MRI was performed first for patients with suspected acute stroke. A step-by-step QI process for decreasing DRT was adopted during this period. Time metrics for EVT were compared between specific time periods. RESULTS: A total of 180 patients (71 women; median age 76 years (range 69-64); National Institutes of Health Stroke Scale score 17 (range 10-23)) were included in the present study. More patients in the late phase were managed with the MRI-first policy (p<0.001). DRT (199 min in Phase 1, 135 min in Phase 2, 129 min in Phase 3, and 121 min in Phase 4, p<0.001) was significantly reduced across the phases. The percentage of patients with DRT <120 min increased significantly across time periods (p<0.001). Symptomatic intracerebral hemorrhage did not increase across phases (p=0.575). CONCLUSION: An MRI-first policy was feasible, and DRT decreased considerably with a step-by-step QI process. This process may be applicable to other hospitals.

DOI： 10.1136/neurintsurg-2019-015625

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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：(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)日本頭痛学会  

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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）  

OBJECTIVE: Dopamine transporter (DAT) imaging such as 123I-ioflupane (123I-FP-CIT) SPECT is a useful tool for the diagnosis of parkinsonism and dementia. The Southampton method is the quantitative method for evaluating 123I-FP-CIT SPECT and is less affected by the partial volume effect of the striatum. The method may be vulnerable to contamination by low-uptake areas of cerebrospinal fluid in whole brain, and the threshold of voxel value (threshold method, TM) was developed to correct the contamination. The purpose of this study is to evaluate the TM in the patients with neurological disease. METHODS: We studied 99 subjects, including 39 patients with Alzheimer's disease (AD), 15 patients with Parkinson's disease (PD) and 10 patients with dementia with Lewy bodies (DLB). Each subject had undergone 123I-FP-CIT SPECT. We calculated the SBR with and without the TM. The SBR laterality was assessed using the asymmetry index (AI). We investigated the relationship between the SBR change with TM and brain atrophy, which were assessed using Evans index (EI), sylvian index (SI) and cerebral atrophy index (CAI). Cutoff value for EI was 0.3, and cutoff values for SI and CAI were the first quartile, respectively. RESULTS: The SBR with TM was 0.53 percentage points lower than the SBR without TM overall (p < 0.01). Positive and negative reversal of AI increased with age. The rate of the SBR change with TM was tended to be lower in groups with brain atrophy. The number of voxels excluded by TM in striatal volumes of interest (VOIs) was larger with high groups for EI, SI and CAI than in low groups. The number of voxels excluded using TM in reference VOIs was related to SI. CONCLUSIONS: The SBR was decreased using TM. The effect of TM on the SBR tended to be small in the subjects with severe brain atrophy. The effect of brain atrophy in the TM is larger in the striatal VOIs than in the reference VOIs. Even if quantitative analyses are available, visual assessment of 123I-FP-CIT SPECT is essential for diagnosis.

DOI： 10.1007/s12149-019-01367-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jjcc.2019.06.002

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Atrial fibrillation (AF) is the leading cause of cardioembolic stroke (CES), and patients with stroke and AF are frequently assumed to have CES. However, strokes presumably due to atherosclerotic pathophysiologies in large or small vessels can also occur in patients with AF. The aims of the present study were to clarify the prevalence of and factors related to a non-cardioembolic etiology in acute stroke patients with AF. METHODS: From March 2011 through May 2017, consecutive acute ischemic stroke patients with AF were retrospectively recruited. The concomitant presence of non-cardioembolic features (small vessel occlusion [SVO] or large artery atherosclerosis [LAA]) on imaging was evaluated. The frequency of and factors associated with co-existing SVO/LAA features were assessed. RESULTS: A total of 560 consecutive patients with AF and acute stroke (237 women; median age 78 [IQR 71-85] years; NIHSS score 9 [3-20]) were enrolled. Of these, 42 (7.5%) had co-existing SVO/LAA features. Multivariable logistic regression analysis showed that the brain natriuretic peptide level (BNP, OR 0.78, p = .030 per 100 pg/mL increase) was independently and negatively associated with co-existing SVO/LAA features and receiver operating characteristic curve analysis revealed the practical cut-off BNP value was 130 pg/mL (sensitivity 54% and specificity 68%). CONCLUSION: SVO/LAA features were found in 7.5% of acute stroke patients with AF. A relatively low BNP level on admission was independently associated with co-existing SVO/LAA features. Thorough examination for a more appropriate etiology may be particularly necessary in acute stroke patients with AF and a relatively low BNP level.

DOI： 10.1016/j.jns.2019.03.031

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Anticoagulant therapy often requires temporary interruption. Nevertheless, the frequency and clinical characteristics of stroke patients who develop stroke during anticoagulant interruption are not fully known. METHODS: From March 2011 through May 2017, consecutive acute ischemic stroke patients with AF who were admitted to our stroke unit were retrospectively recruited. Patients who developed ischemic stroke during anticoagulant interruption were defined as those who developed ischemic stroke within 30 days from anticoagulant interruption. The frequency and clinical characteristics of patients during anticoagulant interruption were analyzed. RESULTS: A total of 561 patients with AF and acute ischemic stroke (237 women; median age 78 [IQR 71-85] years) were admitted during the study period. Of these, 21 (3.7%, 12 patients discontinued vitamin K antagonist [VKA] and 9 discontinued direct oral anticoagulants [DOACs]) patients were admitted during the period of anticoagulant interruption. Severity and functional outcomes in stroke patients during anticoagulant interruption were not different from those without anticoagulant treatment. The number of days between anticoagulant interruption and stroke onset was shorter in patients who discontinued DOACs (3 [3-5] days) than in those who discontinuedVKAs (10 [7-20] days, p = .004). The major reason for interruption was planning of invasive procedures (52%). Guideline deviations were suspected in 82% of such cases. CONCLUSION: Patients developing stroke during anticoagulant interruption accounted for 3.7% of stroke patients with AF. Strokes occurred relatively early after interruption, especially in patients who discontinued DOACs. Guideline deviations was frequent.

DOI： 10.1016/j.jns.2019.03.018

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: We investigated the precise clinical and radiologic characteristics of intracerebral hemorrhage associated with direct oral anticoagulant use. METHODS: Patients with acute spontaneous intracerebral hemorrhage admitted to our department from September 2014 to November 2017 were retrospectively analyzed. Clinical and neuroradiological characteristics of patients with direct oral anticoagulant-related intracerebral hemorrhage, and effects of prior treatment on the severity at admission and on outcome at discharge were assessed. RESULTS: Of the 301 enrolled patients (103 women; median age 68 years), 261 received no oral anticoagulants (86.8%), 20 received warfarin (6.6%), and 20 received direct oral anticoagulants (DOACs) (6.6%). Median initial National Institutes of Health Stroke Scale scores differed significantly among the groups (P = .0283). Systolic blood pressure (P = .0031) and estimated glomerular filtration rate (P = .0019) were significantly lower in the oral anticoagulant-related intracerebral hemorrhage group than in other groups. Total small vessel disease scores were significantly higher in the oral anticoagulant-related intracerebral hemorrhage group than in the warfarin group (P = .0413). Multivariate analysis revealed that prior oral anticoagulant treatment (odds ratio: 0.21, 95% confidence interval: 0.05-0.96, P = .0445) was independently negatively associated with moderate-to-severe neurological severity (stroke scale score ≥10) after adjusting for intracerebral hemorrhage location and various risk factors. There were significant differences in hematoma volume in the basal ganglia (P = .0366). CONCLUSIONS: DOAC-related intracerebral hemorrhage may occur particularly in patients with a high risk of bleeding; however, they had a milder initial neurological severity than those with warfarin-related intracerebral hemorrhage, possibly due to relatively smaller hematoma volume, especially in the basal ganglia.

DOI： 10.1016/j.jstrokecerebrovasdis.2018.12.013

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Because the efficacy and safety of anticoagulant therapy in patients with acute intracerebral hemorrhage (ICH) are not fully known, present study aimed to elucidate the current status and the safety of anticoagulant therapy, mainly direct oral anticoagulants (DOACs), for acute ICH and anticoagulant-indicated patients. Methods and Results: From September 2014 through March 2017, consecutive patients with acute (<7 days from onset), spontaneous ICH were retrospectively enrolled from a prospective registry. Whether to start anticoagulation was at the attending physicians' discretion, and thromboembolic or hemorrhagic events during hospitalization were analyzed. A total of 236 patients (80 women [34%]; median age 69 [interquartile range 61-79] years; National Institutes of Health stroke scale score 7 [3-16]) were enrolled. Of them, 47 patients (20%) had an indication for anticoagulant therapy (33 had atrial fibrillation, 14 developed deep vein thrombosis), and 41 of 47 patients (87%) were actually treated with anticoagulant therapy (DOACs were used in 34 patients) after a median of 7 days from ICH onset. There was neither hematoma expansion nor excessive hemorrhagic complications during hospitalization after starting anticoagulant therapy. CONCLUSIONS: Anticoagulant therapy was conducted for approximately 90% of anticoagulation-indicated patients after a median of 7 days from ICH onset. The predominant anticoagulant medications were DOACs. Anticoagulant therapy started from the acute phase of ICH should be safe.

DOI： 10.1253/circj.CJ-18-0938

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIMS: Numerous experimental studies have shown that cellular therapy, including human dental pulp stem cells (DPSCs), is an attractive strategy for ischemic brain injury. Herein, we examined the effects of intravenous DPSC administration after transient middle cerebral artery occlusion in rats. METHODS: Male Sprague-Dawley rats received a transient 90 min middle cerebral artery occlusion. DPSCs (1 × 106 cells) or vehicle were administered via the femoral vein at 0 h or 3 h after ischemia-reperfusion. PKH26, a red fluorescent cell linker, was used to track the transplanted cells in the brain. Infarct volume, neurological deficits, and immunological analyses were performed at 24 h and 72 h after reperfusion. RESULTS: PKH26-positive cells were observed more frequently in the ipsilateral than the contralateral hemisphere. DPSCs transplanted at 0 h after reperfusion significantly reduced infarct volume and reversed motor deficits at 24 h and 72 h recovery. DPSCs transplanted at 3 h after reperfusion also significantly reduced infarct volume and improved motor function compared with vehicle groups at 24 h and 72 h recovery. Further, DPSC transplantation significantly inhibited microglial activation and pro-inflammatory cytokine expression compared with controls at 72 h after reperfusion. Moreover, DPSCs attenuated neuronal degeneration in the cortical ischemic boundary area. CONCLUSIONS: Systemic delivery of human DPSCs after reperfusion reduced ischemic damage and improved functional recovery in a rodent ischemia model, with a clinically relevant therapeutic window. The neuroprotective action of DPSCs may relate to the modulation of neuroinflammation during the acute phase of stroke.

DOI： 10.1016/j.biopha.2018.09.084

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND PURPOSE: The association between thyroid hormone levels and long-term clinical outcome in patients with acute stroke has not yet been thoroughly studied. The purpose of the present study was to test the hypothesis that thyroid hormone levels are associated with 3-month functional outcome and mortality after acute stroke. METHODS: We retrospectively analyzed 702 consecutive patients with acute stroke (251 women; median age, 73 years) who were admitted to our department. General blood tests, including thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4), were performed on admission. Neurological severity was evaluated using National Institutes of Health Stroke Scale (NIHSS) scores on admission and modified Rankin Scale (mRS) scores at 3 months after stroke onset. Poor outcome was defined as an mRS score of 3-5 or death. The impact of thyroid function on 3-month outcome was evaluated using multiple logistic regression analysis. RESULTS: Poor functional outcome was observed in 295 patients (42.0%). Age (P < .0001), female sex (P < .0001), admission NIHSS score (P < .0001), smoking (P = .0026), arterial fibrillation (P = .0002), preadmission mRS (P < .0001), estimated glomerular filtration rate (P = .0307), and ischemic heart disease (P = .0285) were significantly associated with poor functional outcome, but no relationship between FT4, TSH, and poor functional outcome was found. A multivariate logistic regression analysis showed that low FT3 values (<2.00 pg/mL) were independently associated with poor functional outcome (odds ratio [OR], 3.16; 95% confidence interval [CI], 1.60-6.24) and mortality (OR, 2.55; 95% CI, 1.33-4.91) at 3 months after stroke onset. CONCLUSIONS: Our data suggest that a low FT3 value upon admission is associated with a poor 3-month functional outcome and mortality in patients with acute stroke.

DOI： 10.1016/j.jstrokecerebrovasdis.2018.06.009

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.2169/internalmedicine.0704-17

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: This study investigated changes in anticoagulant use, treatment, and functional outcomes in acute ischemic stroke (AIS) patients with non-valvular atrial fibrillation (NVAF) over a 6-year period. Methods and Results: Patients with AIS and NVAF admitted to our department from April 2011 to March 2017 were analyzed retrospectively. Patients were divided into 3 groups based on the time of the initial visit (Periods 1-3, corresponding to April 2011-March 2013, April 2013-March 2015, and April 2015-March 2017, respectively). Associations between prescribed medication prior to event and stroke severity, reperfusion therapy, and outcomes were assessed. There was no significant change in the rate of insufficient warfarin and inappropriately lowered doses of direct oral anticoagulant (DOAC) treatment over time. The number of patients receiving prior DOAC treatment increased, but neurological severity on admission was milder than in the other 2 groups. The rate of reperfusion therapy increased from 19.9% (Period 1) to 42.7% (Period 3) for moderate-to-severe stroke patients. Multivariate logistic regression analysis revealed that reperfusion therapy was independently positively associated with good functional outcomes, but negatively associated with mortality (odds ratios [95% confidence intervals] 7.14 [3.34-15.29] and 0.13 [0.008-0.69], respectively). CONCLUSIONS: Inappropriate anticoagulant use for stroke patients with NVAF did not decrease over time. An increase in reperfusion therapy was a strong factor in improved functional outcomes and mortality.

DOI： 10.1253/circj.CJ-18-0561

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Hepatocyte growth factor (HGF) has neuroprotective effects against ischemia-induced injuries. Dental pulp stem cell (DPSC) transplantation attenuates tissue injury in the brain of rats with post-transient middle cerebral artery occlusion. We sought to determine whether DPSCs that overexpress HGF can enhance their therapeutic effects on brain damage post-ischemia/reperfusion injury. Treatment with DPSCs overexpressing HGF reduced infarct volumes compared to unmodified DPSC treatment at 3 and 7 days post-transient middle cerebral artery occlusion. The use of unmodified DPSCs and DPSCs overexpressing HGF was associated with improved motor function compared to that with administration of vehicle at 7 days post-transient middle cerebral artery occlusion. DPSCs overexpressing HGF significantly inhibited microglial activation and pro-inflammatory cytokine production along with suppression of neuronal degeneration. Post-reperfusion, DPSCs overexpressing HGF attenuated the decreases in tight junction proteins, maintained blood-brain barrier integrity, and increased microvessel density in peri-infarct areas. The administration of DPSCs overexpressing HGF during the acute phase of stroke increased their neuroprotective effects by modulating inflammation and blood-brain barrier permeability, thereby promoting improvements in post-ischemia/reperfusion brain injury.

DOI： 10.1016/j.omtm.2018.07.009

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background The aims of the present study were to investigate the relationships between prior direct oral anticoagulant ( DOAC ) therapy and infarct volume and the site of arterial occlusion in patients with acute ischemic stroke and non-valvular atrial fibrillation. Methods and Results From March 2011 through November 2016, consecutive patients with acute ischemic stroke in the middle cerebral artery territory and non-valvular atrial fibrillation were recruited. The infarct volume was assessed semi-automatically using initial diffusion-weighted imaging, and the arterial occlusion site was evaluated on magnetic resonance angiography. The effect of prior DOAC treatment on the site of arterial occlusion was assessed by multivariate ordinal logistic regression analysis. A total of 330 patients (149 women; median age 79 [quartiles 71-86] years; median National Institutes of Health Stroke Scale score 11 [4-21]) were enrolled. Of these, 239 were on no anticoagulant, 40 were undertreated with a vitamin K antagonist ( VKA ), 22 were sufficiently treated with VKA ( PT - INR ≥1.6), and 29 were on a DOAC before the acute ischemic stroke. The infarct volume on admission differed among the groups (median 14.5 [2.0-59.8] cm3 in patients with no anticoagulation, 24.8 [2.1-63.0] in undertreated VKA , 1.3 [0.3-13.5] in sufficient VKA , and 2.3 [0.5-21.0] in DOAC , P=0.001). Multivariate analysis showed that prior DOAC treatment was independently and negatively associated with more proximal artery occlusion (odds ratio [OR] 0.34, P=0.015), compared with no anticoagulant. Conclusions DOAC treatment before the event was associated with smaller infarct volume and decreased risk of greater proximal artery occlusion in acute ischemic stroke patients with non-valvular atrial fibrillation, compared with no anticoagulation.

DOI： 10.1161/JAHA.118.009507

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and Purpose- The strong evidence of endovascular therapy in acute ischemic stroke patients with large vessel occlusion (LVO) is revealed. Such patients are required to direct transport to the hospital capable of endovascular therapy. There are several prehospital scales available for paramedics to predict LVO. However, they are time consuming, and several of them include factors caused by other types than LVO. Therefore, we need a fast, simple, and reliable prehospital scale for LVO. Methods- We developed a new prehospital stroke scale, emergent large vessel occlusion (ELVO) screen, for paramedics to predict LVO. The study was prospectively performed by multistroke centers. When paramedics referred to stroke center to accept suspected stroke patients, we obtain the following information over the telephone. ELVO screen was designed focusing on cortical symptoms: 1 observation; presence of eye deviation and 2 questions; paramedics show glasses, what is this? and paramedics show 4 fingers, how many fingers are there? If the presence of eye deviation or ≥1 of the 2 items were incorrect, ELVO screen was identified as positive. We evaluated between results of ELVO screen and presence of LVO on magnetic resonance angiography at hospital arrival. Results- A total of 413 patients (age, 74±13 years; men, 234 [57%]) were enrolled. Diagnosis was ischemic stroke, 271 (66%); brain hemorrhage 73 (18%); subarachnoid hemorrhage, 7 (2%); and not stroke, 62 (15%). One hundred fourteen patients had LVO (internal carotid artery, 33 [29%]; M1, 52 [46%]; M2, 21 [18%]; basilar artery, 5 [4%]; P1, 3 [3%]). Sensitively, specificity, positive predictive value, negative predictive value, and accuracy for ELVO screen to predict LVO were 85%, 72%, 54%, 93% and 76%, respectively. Among 233 patients with negative ELVO screen, only 17 (7%) had LVO, which indicated to be an ideal scale to avoid missing endovascular therapy. Conclusions- The ELVO screen is a simple, fast, and reliable prehospital scale for paramedics to identify stroke patients with LVO for whom endovascular therapy is an effective treatment.

DOI： 10.1161/STROKEAHA.118.022107

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Perampanel (PER), a noncompetitive α-amino-3-hydroxy-5-methyl-4-isoxazole propionate receptor antagonist, clinically used for seizure control, has been reported to exert neuroprotective effects in experimental models of neurodegenerative diseases. However, few studies have investigated the therapeutic effects of PER in brain injury including stroke. Our aim was to investigate the neuroprotective potential of PER using a rat transient middle cerebral artery occlusion (MCAO) model. Sprague-Dawley rats underwent 90-min MCAO followed by intraperitoneal PER administration at a dose of 1.5 mg/kg. Infarct volumes, neurological deficits, and immunological analyses were performed at 7 days after MCAO. PER significantly reduced infarct volumes (p < 0.05) and improved motor function (p < 0.05) compared with vehicle. Immunological analysis showed that PER significantly inhibited microglial activation, pro-inflammatory cytokine expression, and oxidative stress compared with vehicle. Moreover, PER suppressed neurodegeneration in the cortical ischemic boundary zone, via downregulation of Bcl-2-associated x and upregulation of Bcl-extra-large with Akt activation. In addition, post-stroke secondary neuronal damage and cognitive impairments, using the Y-maze test, were assessed 30 days after MCAO. PER significantly improved spatial working memory, which was accompanied by hippocampal CA1 neuronal loss and cortical thinning, compared with vehicle. These results indicate that PER attenuates infarct volumes and motor function deficits possibly through its anti-inflammatory, antioxidant, and anti-apoptotic activities, mediated via activation of phosphatidylinositol 3-kinase (PI3K)/Akt pathways in the acute ischemic phase, and further ameliorates post-stroke cognitive impairments via the suppression of secondary neuronal damage in the chronic ischemic phase.

DOI： 10.1016/j.neuroscience.2018.06.043

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND PURPOSE: Urgent diagnosis of acute Stanford type A aortic dissection (AAD) in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) is sometimes challenging. We assessed predictive values for markers of AAD in patients with AIS or TIA. METHODS: Consecutive patients with AIS or TIA with AAD who presented to our emergency room within 4.5 hours of symptom onset between 2007 and 2014 were compared with patients without AAD seen between 2012 and 2014. RESULTS: Data were obtained for 24 patients with AIS or TIA with AAD (15 women; mean age, 75 ± 12 years) and 812 patients without AAD (305 women; mean age, 73 ± 12 years). Compared with patients without AAD, patients with AAD displayed significantly higher systolic blood pressure (SBP) laterality (30 ± 20 mm Hg versus 12 ± 11 mm Hg), initial D-dimer concentration (median 38.1 µg/mL versus 1.3 µg/mL), and mediastinal width-to-chest width (M/C) ratio on x-ray (.35 ± .05 versus .29 ± .05), and more frequently showed common carotid artery (CCA) dissection on carotid ultrasonography (84% versus 1%) and pericardial effusion on echocardiography (43% versus 0%). Sensitivity and specificity to identify AAD were 80% and 75% for SBP laterality 17 mm Hg or greater; 100% and 86% for D-dimer concentration 4.1 µg/mL or greater; 75% and 76% for M/C ratio .32 or greater; 84% and 99% for CCA dissection; and 43% and 100% for pericardial effusion, respectively. CONCLUSIONS: High D-dimer level may provide the most reliable screening test for AAD in patients with AIS or TIA. CCA dissection on ultrasonography appears to represent the most disease-specific finding and shows acceptable sensitivity.

DOI： 10.1016/j.jstrokecerebrovasdis.2018.03.010

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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：W.B. Saunders  

Background and Purpose: Anemia upon hospital admission is a known predictor of poor functional outcomes in patients with acute cerebral infarction. However, it remains unclear whether reductions in hemoglobin levels during hospitalization influence stroke outcomes. We investigated the association between in-hospital decline in hemoglobin and poor outcomes. Materials and Methods: We retrospectively analyzed data from 480 consecutive patients who had experienced acute cerebral infarction and presented without anemia between January 2012 and March 2015. Decline in hemoglobin was taken as the difference between hemoglobin levels upon admission and nadir hemoglobin. Poor outcome was defined as a modified Rankin Scale score 3-6. A multivariate analysis of the relationship between decline in hemoglobin and poor outcome at discharge was conducted for various patient characteristics. Results: The mean hemoglobin level at admission was 14.3 ± 1.3 g/dL, whereas the mean nadir hemoglobin value was 13.1 ± 1.9 g/dL, with a mean decline in hemoglobin of 1.3 ± 1.5 g/dL. In patients with poor outcomes, mean decline in hemoglobin was significantly reduced to 3.1 g/dL (P &lt
.001). The optimal cutoff decline in hemoglobin required to distinguish a poor outcome was 1.5 g/dL whereas the sensitivity and specificity were 62% and 82.3%, respectively, with an area under the curve of .77 (P &lt
.0001). A decline in hemoglobin below 1.5 g/dL was found to be an independent predictor of poor outcome (odds ratio: 2.10
confidence interval: 1.10-3.99
P = .023). Conclusion: Decline in hemoglobin in patients hospitalized with acute stroke may be associated with poor outcome.

DOI： 10.1016/j.jstrokecerebrovasdis.2018.01.026

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND PURPOSE: Stanford type A aortic dissection (AAD) sometimes causes acute ischemic stroke (AIS) or transient ischemic attack (TIA). There is little understanding of cerebrovascular imaging of AIS or TIA in patients with AAD. METHODS: Consecutive AIS/TIA patients with AAD who were admitted within 4.5 h of onset were reviewed. We compared findings of MRI/MRA between these and consecutive AIS/TIA patients without AAD within 4.5 h of onset. RESULTS: Seventeen AAD and 249 non-AAD patients were identified. Compared to non-AAD patients, AAD patients had infarcts more frequently in the right anterior cerebral artery (ACA) territory (18% vs. 2%, P = 0.007) and the right middle cerebral artery (MCA) territory (71% vs. 29%, P < 0.001). There was no difference between the groups regarding whether it was perforator or cortical infarct, single or multiple infarcts, unilateral or bilateral infarcts, or ischemic change extension. On the MRA imaging, the AAD patients more frequently had poor visualization of the right internal carotid artery (ICA) (47% vs. 6%, P < 0.001). After adjustment for sex, age and confounding factors, the right ACA territory infarct [odds ratio (OR), 12.2; 95% confidence interval (CI), 1.4-119.4], the MCA territory infarct (OR, 4.9; 95% CI, 1.0-25.0) and poor visualization of the right ICA (OR, 18.1; 95% CI, 4.0-101.9) were independently associated with AAD. CONCLUSION: In emergency AIS/TIA patients, right anterior circulation infarct and poor visualization of the right ICA on cerebrovascular imaging are potential imaging markers of AAD.

DOI： 10.1016/j.jns.2018.02.044

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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-Verlag Italia s.r.l.  

DOI： 10.1007/s10072-018-3434-y

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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 B.V.  

Introduction: Magnetic resonance imaging (MRI) has recently emerged as a first-line tool for investigating acute stroke. However, MRI requires long scan times, which could be detrimental for severe stroke patients with a large intracerebral hemorrhage (ICH). MRI scout images, which are taken prior to a study to determine the range of subsequent images, can be used to rapidly screen the whole brain. We examined whether MRI scout imaging can detect ICHs observed by computed tomography (CT). Methods: Between September 2014 and March 2016, consecutive acute ICH patients who underwent both MRI scout and CT imaging in the acute setting were studied. ICHs on MRI scout images were defined as space-occupying lesions. Two neurologists independently assessed the scout images. We investigated whether ICHs on CT scans can be detected on MRI scout images and the characteristics of ICHs not detected by MRI scout images. Results: One hundred and forty-eight ICH patients (median age, 68 [interquartile range, 59–77] years
99 [67%] males
median National Institutes of Health Stroke Scale score, 11 [4–17]) were enrolled. Among these, 138 (93%) patients were diagnosed as having ICH by MRI scout imaging (positive group), and 10 (7%) patients were not (negative group). The bleeding volume was 9.3 [4.5–22.4] ml in the positive group and 1.0 [0.4–2.0] ml in the negative group (p &lt
.001). The cut-off value of bleeding volume calculated from the receiver operating characteristic curve was 2.0 ml. Regarding ICH lesions, 4 (44%) of the 9 pontine hemorrhages were detected on MRI scout images, whereas 134 (96%) of the 139 other hemorrhages were diagnosed (p &lt
.001). Conclusions: We diagnosed &gt
90% of ICHs using MRI scout images. Low levels of ICH and pontine hemorrhaging might be difficult to detect using MRI scout imaging.

DOI： 10.1016/j.jns.2018.01.041

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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：Dr. Dietrich Steinkopff Verlag GmbH and Co. KG  

Stroke-associated infection (SAI) is a common and serious complication of stroke. This study aimed to assess the effects of SAI on patient mortality and functional outcome at 3 months after stroke onset. We retrospectively analyzed 809 consecutive patients with acute stroke (517 men and 292 women
median age, 72 years) who were admitted to our department between September 2014 and June 2016. SAI was defined as an infection diagnosed during the hospitalization period. Poor outcome was defined as a modified Rankin Scale (mRS) score of 3–5 or death (mRS score of 6). The effect of SAI on functional outcome was evaluated using a multivariate logistic regression analysis. SAI occurred in 169 patients (20.9%)
of these, 106 (62.7%) had pneumonia, 23 (13.6%) had a urinary-tract infection, and 40 (23.7%) had other types of infection. Patients with SAI were older, more likely to be female, had lower body mass indices, had higher stroke severity, and were more likely to have atrial fibrillation and a history of ischemic heart disease than patients without SAI. Poor functional outcome and mortality were more common in patients with SAI than in patients without SAI (poor functional outcome 41.8 vs. 4.8%, mortality 24.3 vs. 3.9%, respectively). After adjusting for age, sex, stroke severity, and various comorbidities, SAI was independently associated with poor functional outcome [odds ratio (OR) 6.88
95% confidence interval (CI) 3.72–12.73] and mortality (OR 4.45, 95% CI 2.27–8.72) at 3 months after stroke onset. Our results suggest that SAI during the hospitalization period is independently associated with 3-month poor functional outcome and mortality.

DOI： 10.1007/s00415-017-8714-6

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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：W.B. Saunders  

Background: Poststroke infection (PSI) is common and is usually associated with a severe prognosis. We investigated the association between PSI and thyroid hormones, which are critical to immune regulation, in patients with acute stroke. Methods: We retrospectively enrolled 520 consecutive patients with acute ischemic stroke (326 men
age, 71.9 ± 13.2 years) admitted to our department between September 2014 and June 2016. The impact of serum thyroid hormone levels measured at admission (thyroid-stimulating hormone [TSH], free triiodothyronine [FT3], and free thyroxine [FT4]) on the PSI was evaluated using multivariate logistic regression analysis. Results: We diagnosed 107 patients (20.6%
pneumonia, 65
urinary tract infection, 19
others, 23) with PSIs. While age (P &lt
.001), body mass index (P =.0012), preadmission modified Rankin scale score (P =.0001), National Institutes of Health Stroke Scale score on admission (P &lt
.001), admission FT3 level (P &lt
.001), atrial fibrillation (P &lt
.001), and ischemic heart disease (P =.0451) were significantly associated with PSI, we found no relationship among TSH levels, FT4 levels, and PSI occurrence. After multivariate adjustment, patients with PSIs were more frequently in the Q1 quartile (≤2.25 pg/mL) than in the Q2 (2.26-2.55 pg/mL
P =.0251), Q3 (2.56-2.89 pg/mL
P =.0007), or Q4 (≥2.90 pg/mL
P =.0010) quartiles of FT3 levels. Moreover, low FT3 levels (&lt
2.29 pg/mL) were independently associated with PSI occurrence (P =.0013). Conclusions: Low FT3 levels at admission are independently associated with PSI occurrence.

DOI： 10.1016/j.jstrokecerebrovasdis.2017.09.012

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記述言語：英語  

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記述言語：英語  

DOI： 10.1016/j.jns.2016.06.063

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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 Association of Nippon Medical School  

Background and Purpose: It is clinically important to evaluate time course changes in symptomatic middle cerebral artery (MCA) stenotic plaques because of likely recurrence. The objective of this study is to determine whether contrast-enhanced high-resolution magnetic resonance imaging (MRI) is a feasible method for this purpose. Methods: Contrast-enhanced, high-resolution, 3D turbo spin-echo images with low refocusing flip angle control (3D LOWRAT) applied to 7 patients with symptomatic MCA stenosis were evaluated at the initial (1 month after stroke onset) and follow-up (7 months after stroke onset) stages, and statistical variables, including plaque-to-thalamus signal intensity ratio, degree of stenosis, and stroke recurrence obtained at the 2 stages, were compared. Stenotic change at the initial stage was compared to that at the follow-up stage using MR angiography. Results: In 4 of the 7 patients, the signal intensity ratio measured at the follow-up stage was lower than that measured at the initial stage and in 1 patient, the stenosis subsequently improved. We used a Chi-Square Test. In the other 3 patients, the signal intensity ratios did not differ between the 2 stages, and ischemic stroke occurred in 2 of these 3 patients. Conclusion: Gadolinium contrast enhancement was found to be useful for effective evaluation of time course changes in the stability of symptomatic MCA stenotic plaques.

DOI： 10.1272/jnms.2018_85-4

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DOI： 10.1159/000490461

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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：Japanese Circulation Society  

Background: Insufficient anticoagulant intensity on admission is common in stroke patients with atrial fibrillation (AF) on vitamin K antagonist (VKA) therapy. Nevertheless, the effects of VKA under-treatment on stroke severity or arterial occlusion are not well known. The aim of the present study was to investigate the relationship between insufficient VKA therapy and stroke severity, or the site of arterial occlusion in patients with acute ischemic stroke (AIS) and AF. Methods and Results: From March 2011 through July 2016, 446 consecutive patients with AF and AIS were recruited. Of the 446 patients, 364 (167 women
median age, 79 years
IQR, 71–86 years) with anterior-circulation stroke were assessed to investigate the effects of insufficient VKA. Of these, 281 were on no anticoagulant, 53 were undertreated with a VKA, and 30 were sufficiently treated with VKA on admission (PT-INR ≥2.0 for patients &lt
70 years and PT-INR ≥1.6 for ≥70 years old). On multivariate analysis, insufficient VKA was independently associated with severe stroke (i.e., initial NIHSS score ≥10
OR, 2.70, P=0.022) and higher prevalence of proximal artery occlusion (OR, 1.91
P=0.039) compared with no anticoagulant therapy. Conclusions: Insufficient VKA therapy on admission was associated with higher severity of stroke and higher prevalence of proximal artery occlusion in patients with AF and acute anterior-circulation stroke compared with no anticoagulant medication.

DOI： 10.1253/circj.CJ-17-1110

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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 HEIDELBERG  

Cortical superficial siderosis (cSS) is a pathologic and radiologic diagnosis of hemosiderin deposition in subpial brain layers. However, cSS has not been fully studied in patients with acute stroke. Here, we investigated the prevalence of cSS in patients with acute stroke and analyzed the relationship between cSS and different clinical and neuroimaging characteristics. From September 2014 through June 2016, consecutive patients with acute stroke who were admitted to our department were retrospectively investigated. We analyzed the prevalence of cSS and the associations between cSS and risk factors, the topographic distribution of cerebral microbleeds (CMBs), and the severity of white matter lesions (WMLs). In total, 739 patients (589 patients with ischemic stroke/transient ischemic stroke [IS/TIA] and 150 with intracerebral hemorrhage [ICH]; mean age, 71.4 years) were enrolled. We identified cSS in six (1.0%) patients with IS/TIA and seven (4.7%) patients with ICH. The presence of cSS was associated with ICH (P &lt; 0.0001), WMLs (P = 0.0105), and lobar and non-lobar CMBs (both P &lt; 0.0001); no associations between cSS and age, sex, cardiovascular risk factors, IS subtype classification, or antiplatelet and anticoagulant therapy were found. In a multivariable logistic regression analysis, high numbers of lobar CMBs (ae&lt;yen&gt; 2; odds ratio, 11.03; 95% confidence interval, 2.03-205.40; P = 0.0029) were independently associated with cSS. Furthermore, cSS was often located near lobar CMBs. Our results suggest that cSS is prevalent in ICH and is independently associated with lobar CMBs; however, no associations between cSS and other risk factors or comorbidities were observed.

DOI： 10.1007/s00415-017-8646-1

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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-VERLAG ITALIA SRL  

Previous case reports and studies have shown that anti-myelin-associated glycoprotein (MAG) antibody can be detected in patients with polyneuropathy without any detectable M-protein. Nevertheless, the frequency of and related factors have not yet been adequately investigated. The objectives of this study are to examine the prevalence of anti-MAG antibody in patients with demyelinating neuropathy without M-protein and to determine their clinical characteristics. From January, 2004, to September, 2016, consecutive patients with chronic demyelinating neuropathy were recruited. Anti-MAG antibody presence was tested at the first evaluation. We determined the prevalence of anti-MAG antibody without M-protein among included patients and evaluated the clinical characteristics. A total of 44 patients were included in the present study (12 women; median age at first visit 60 years [interquartile range 47-67 years]; median duration between onset and first visit 9 months [3-26 months]). M-protein was found in eight patients (18%) at the first evaluation. Anti-MAG antibody was present in 2 of remaining 36 (5.6 [95% confidence interval 0-13.0] %) patients without M-protein. Patients with anti-MAG antibody exhibited slowly progressive and distal dominant neuropathy with elevated serum IgM levels and refractory to immunotherapy. There were no differences in clinical features between patients having anti-MAG antibody without M-protein, and those with M-protein. One patient with the anti-MAG antibody showed a delayed appearance of M-protein during a 4-year follow-up after diagnosis. The prevalence of the anti-MAG antibody in chronic demyelinating neuropathy without any detectable M-protein was 5.6%. Anti-MAG antibody may be detectable earlier than M-protein.

DOI： 10.1007/s10072-017-3133-0

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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 SCIENCE BV  

Background and Purpose: Recent studies using magnetic resonance imaging (MRI) have reported that wake-up stroke (WUS) patients may be able to be treated using tissue-plasminogen activator (tPA) when showing no ischemia on fluid-attenuated inversion recovery (Negative-FLAIR). We investigated the frequency of WUS and calculated what percentage of WUS patients with Negative-FLAIR meets most of the conventional tPA criteria. We did not include a time parameter in this study.
Methods: Consecutive patients with acute stroke affecting the anterior circulation who presented within 12 h of onset were enrolled. All patients were examined using diffusion-weighted imaging (DWI) and FLAIR. As large infarctions are excluded from tPA therapy, an Alberta Stroke Program Early Computed Tomography Score (DWI ASPECTS) of 3 was used as the upper limit for exclusion.
Results: A total of 816 consecutive patients were included in the study and were separated into two groups; 163 (20%) WUS patients as the WUS group, and 653 (80%) non-WUS patients as the non-WUS group. The median National Institutes of Health Stroke Scale (NIHSS) score on admission was 7 (interquartile range, 3-17) in the WUS group and 8 (3-16) in the non-WUS group (p = 0.313). MRI study revealed Negative-FLAIR in 67 (41%) of 163 patients in the WUS group. Of the 67 patients with Negative-FLAIR, 19 patients were excluded from tPA therapy. Therefore, 48 (29%) of the 163 wake-up stroke patients met the tPA criteria.
Conclusions: About 30% of WUS patients may be candidates for tPA therapy based upon Negative-FLAIR findings.

DOI： 10.1016/j.jns.2017.09.042

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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  

Background and purposeAnticoagulant treatment with a vitamin K antagonist (VKA) has been reported to reduce stroke severity when patients with atrial fibrillation (AF) suffer acute ischaemic stroke (AIS). Direct oral anticoagulant (DOAC) therapy also has the potential to reduce the initial severity of AIS. However, the effect of DOAC therapy on the severity of AIS is not well known. The aim of the present study was to investigate the effect of DOACs on initial stroke severity in patients with AIS and non-valvular AF.
MethodsFrom March 2011 to July 2016, consecutive patients with AIS having non-valvular AF were recruited. The effects of prior DOAC treatment on severity were assessed by multivariate logistic regression analyses.
ResultsA total of 484 patients [208 women; median age 79 (interquartile range, 71-85) years; National Institutes of Health Stroke Scale (NIHSS) score 9 (interquartile range, 3-20)] were enrolled. Of these, 352 (73%) were on no anticoagulant medication, 54 (11%) were undertreated with a VKA, 35 (7%) were sufficiently treated (admission prothrombin time-international normalized ratio: 2.0 for patients &lt;70 years old and 1.6 for 70 years old) with a VKA and 43 (9%) were on a DOAC. The initial NIHSS score (median 10 in patients with no anticoagulation, 13 in undertreated VKA, 7 in sufficient VKA and 6 in DOAC, P = 0.018) was different among the groups. Multivariate analysis showed that DOAC was independently and negatively associated with severe (initial NIHSS score 10) stroke (odds ratio, 0.39; P = 0.041), compared with no anticoagulant therapy.
ConclusionsDirect oral anticoagulant treatment prior to the event should reduce initial stroke severity in patients with AIS and non-valvular AF.

DOI： 10.1111/ene.13405

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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 SCIENCE BV  

Background: The safety of intravenous thrombolysis (IVT) and endovascular therapy (EVT) in patients treated with DOAC is unclear. We investigated whether recanalization therapy in patients treated with DOAC is safe.
Methods: A nationwide, multicenter, retrospective cohort questionnaire survey was conducted to investigate the: (1) frequency of intracerebral hemorrhage (ICH) after recanalization therapy in patients treated with DOAC; (2) independent factors related to ICH; (3) relationship between last intake time of DOAC and ICH; and (4) comparison of ICH frequency between patients treated with DOAC, vitamin K antagonist (VKA), and no-anticoagulation (no-ACT) (control).
Results: One hundred eighteen stroke centers returned the questionnaire and 100 patients (56 IVT alone, 29 EVT alone, and 15 both IVT and EVT) on DOAC were registered. The frequency of asymptomatic and symptomatic (&gt;=. 4-point NIHSS score increase) ICH within 24 h in DOAC patients were 18% and 2%, and were not different compared with the VKA and no-ACT groups (p = 0.728; and p = 0.626). On multivariate analysis, systolic blood pressure (OR, 1.04; p&lt;0.001) and blood glucose (OR, 1.02; p = 0.019) were independent factors for ICH. Among the 52 patients with a known last intake time of DOAC, the rate of ICH was higher in patients 54 h from last intake than those &gt;4 h (38% vs. 10%, p = 0.033).
Conclusions: Risk of ICH after reperfusion therapy in patients treated with DOAC should be low. Systolic blood pressure, glucose level, and DOAC intake time appear to be factors for ICH. (C) 2017 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jns.2017.06.004

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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-VERLAG ITALIA SRL  

Although typical corticobasal syndrome (CBS) presents with asymmetric upper limb symptoms, the prevalence and clinical characteristics of patients with symptoms beginning in other sites are unknown. From January 1997 through April 2016, consecutive patients with CBS who fulfilled the modified Cambridge criteria were recruited. Their medical records were reviewed to determine the body part, where the initial symptoms developed and the clinical characteristics. A total of 24 patients [13 female participants, median age at onset: 64 (IQR 60-74) years, and median duration between onset and evaluation: 38 (17-53) months] met the criteria. The initial symptom involved the unilateral upper limb in 14 cases (58%), unilateral lower limb in five (21%), gait in four (17%), and visual field in one (4%). Over a median of 59 (IQR 40-68) months of follow-up, the duration between the onset and the time for need of assistance in walking was significantly shorter in the patients with lower limb (p = 0.018 with log-rank test) or gait (p = 0.025) onset than in those with upper limb onset. About a half of the CBS patients initially complained of symptoms other than the upper limb. The most common area of origin of the initial symptom after the upper limb was the lower limb followed by gait. Such patients need assistance in walking earlier than those with upper limb-onset CBS. Patients with lower limb- or gait-onset CBS are not rare and may have unfavorable outcome.

DOI： 10.1007/s10072-017-2846-4

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記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

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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 SOC INTERNAL MEDICINE  

Ataxic hemiparesis (AH) is a classic lacunar syndrome associated with localized damage to the pons, internal capsule, thalamus, or corona radiata. A depression of metabolic activity known as crossed cerebellar diaschisis (CCD) is frequently observed in the cerebellar hemisphere contralateral to the site of the lesion in patients with AH. Though small cortical or subcortical lesions may result in AH, such occurrences are rare. The current report details the case of a patient with AH resulting from acute infarction associated with localized lesions of the postcentral gyrus who presented without CCD.

DOI： 10.2169/internalmedicine.8806-17

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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：KARGER  

Background: Thrombus visualization in patients with acute ischemic stroke has been detected and reported using various imaging modalities. T1-weighted imaging (T1-WI) can depict thrombi as hyperintense signals within vessels. Moreover, in addition to thrombi, T1-WI hyperintensities in arteries may suggest arterial dissection. However, the frequency of and factors related to the T1-hyperintense vessel sign (T1-HVS) are not fully known. The aim of this study was to clarify the prevalence of and related factors for the T1-HVS in patients with acute ischemic stroke.
Methods: From September 2014 through December 2015, consecutive acute ischemic stroke patients who were admitted to our stroke unit within 7 days from symptom onset were retrospectively recruited from the prospective registry. A T1-HVS was defined as the presence of a hyperintense signal, with intensity higher than surrounding brain, within the vessel lumen. Moreover, T1-HVSs were separated into filled T1-HVSs (hyperintensity fills whole vessel lumen) and non-filled T1-HVSs. The frequency of the T1-HVS and the timing of emersion and the relationship between the presence of the T1-HVS and arterial occlusion were assessed. Results: A total of 399 patients (139 women; median age 73 years; National Institutes of Health Stroke Scale score 3) were enrolled in the present study. Of these, 327 (82%) patients had T1-WI on admission. Two hundred and sixty-seven (67%) subjects had at least one follow-up T1-WI (median 6 days after admission), and 134 (34%) cases had &gt;= 2 follow-up T1-WI examinations. The T1-HVS was observed in 18 patients during admission; therefore, the frequency of the T1-HVS in acute ischemic stroke patients was 4.5% (95% CI 2.5-6.5%). All but one (94%) of the T1-HVSs were first observed on follow-up imaging, and the median number of days from onset to T1-HVS appearance was 9. For patients having initial major artery occlusion and follow-up MRI (n = 95), sensitivity and specificity of the T1-HVS for persistent arterial occlusion on follow-up MR angiography were 22 and 100%, respectively. T1-HVS persisted for a few months and then normalized. Although there were no significant differences between filled and non-filled T1-HVS, more patients with non-filled T1-HVS had arterial dissection (43%) than those with filled T1-HVS (9%, p = 0.245). Conclusion: The T1-HVS was observed in 4.5% of acute ischemic stroke patients. T1-HVSs appeared in the subacute phase in arteries with persistent occlusion and remained for a few months. (C) 2017 S. Karger AG, Basel.

DOI： 10.1159/000479593

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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 SCIENCE BV  

Objective: This study was performed to investigate whether the Penumbra 5MAX ACE is superior to other Penumbra systems. Materials and Methods: We performed a retrospective, single center analysis of patients with acute ischemic stroke with occlusion of the internal carotid artery or middle cerebral artery (M1 segment) who underwent endovascular therapy using a Penumbra system. The reperfusion success rate, puncture-to-revascularization time, and number of passes were assessed. Multivariate regression analysis was conducted to evaluate independent factors related to revascularization within 60 minutes. Successful revascularization was defined by a thrombolysis in cerebral infarction score &gt;= 2b. Results: The Penumbra 5MAX ACE was used in 24 of the 40 patients (60%). Although the revascularization success rate was similar between patient groups (P = .229), the number of passes was significantly lower (1.5 +/- .8 versus 2.6 +/- 1.3, P = .006) and the puncture-to-revascularization time was shorter (50 +/- 26 minutes versus 116 +/- 69 minutes, P = .002) in patients treated with the Penumbra 5MAX ACE. The Penumbra 5MAX ACE was identified as an independent factor for early revascularization (odds ratio, 5.80; P = .041). Among patients with a premorbid modified Rankin Scale score of 0-1, a modified Rankin Scale score of 0-2 at 3 months was observed in 15 of the 19 patients (79%) treated with the Penumbra 5MAX ACE and in 8 of the 16 (50%) who were not (P = .072). Conclusion: Acute revascularization therapy using the Penumbra 5MAX ACE can achieve rapid successful recanalization and tend to improve clinical outcomes.

DOI： 10.1016/j.jstrokecerebrovasdis.2016.08.016

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記述言語：英語   出版者・発行元：ELSEVIER SCIENCE BV  

DOI： 10.1016/j.jns.2016.07.050

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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 SCIENCE BV  

A 59-year-old woman was admitted to our hospital because of repeated episodes of bilateral hand weakness. She had a 10-year history of combined estrogenprogestin therapy for menopausal symptoms. Magnetic resonance imaging on admission showed multiple hyperintense lesions in bilateral cerebral and cerebellar cortices on diffusion-weighted imaging. Transesophageal echocardiography showed thrombus formation on the aortic valve and moderate aortic insufficiency. Laboratory test demonstrated elevated CA125 (334.8 U/mL) and D-dimer (7.0 mu g/mL) levels. Trousseau's syndrome (cancer-related hypercoagulation) was considered, but various examinations showed only uterine adenomyosis and no evidence of cancer. Multiple cerebral infarctions were considered to be caused by Trousseau's syndromelike condition associated with uterine adenomyosis. CA125 and coagulation markers should be measured in adenomyosis patients treated with hormone replacement therapy, because a mucinous tumor and coagulation markers may be good markers for the risk of thromboembolism in such patients.

DOI： 10.1016/j.jstrokecerebrovasdis.2016.07.024

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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 SCIENCE BV  

Background and purpose: The aim of this study was to investigate the association of admission serum thyroid hormone concentration with clinical characteristics and functional outcomes in patients after acute ischemic stroke.
Methods: We retrospectively enrolled 398 consecutive patients admitted to our stroke center between July 2010 and April 2012. Serum thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were evaluated upon admission. Neurological severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) upon admission and the modified Rankin Scale (mRS) upon discharge. Poor outcome was defined as a mRS score of 3-5 or death (mRS score 6). Separate analyses were conducted according to outcome and quartile serum FT3 concentration.
Results: In total, 164 patients (41.2%) demonstrated a poor outcome. Age, male gender, blood glucose level, arterial fibrillation, dyslipidemia, smoking, NIHSS score, cardioembolic stroke type, and periventricular hyperintensities, but not FT4 or TSH, were significantly associated with poor functional outcome. Furthermore, poor functional outcome was independently associated with low FT3 (&lt;2.29 pg/mL). In comparisons between FT3 quartiles (Q1 [&lt;= 2.11 pg/mL], Q2 [2.12-2.45 pg/mL], Q3 [2.46-2.77 pg/mL], Q4 [&gt;= 2.78 pg/mL]), patients with poor outcomes were more frequent in Q1 than in Q4 after multivariate adjustment. Death was more frequent in Q1 than in Q4 after adjustment for risk factors and comorbidities, but this difference was non-significant after additional adjustment for age and NIHSS score.
Conclusions: Our data suggest that a lower FT3 value upon admission may predict a poor functional outcome in patients with acute ischemic stroke. Further large-scale prospective studies are required to clarify the role of thyroid hormone in the acute phase of ischemic stroke. (C) 2016 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jns.2016.06.063

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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 SCIENCE BV  

Background: Feasibility of performing MRI first for suspected hyperacute stroke patients in real-world practice has not been fully examined. Moreover, most past studies of reducing door-to-needle time (DNT) in intravenous thrombolysis were conducted using CT. The aim of this study was to evaluate the feasibility of an MRI-first policy and examine the effects of a quality improvement (QI) process for reducing DNT using MRI.
Methods: From January 2014 to August 2015, consecutive acute stroke patients who were treated with thrombolysis were prospectively enrolled into the present study. In principle, multimodal 1.5T-MRI was performed first for patients with suspected acute stroke. A step-by-step QI process for decreasing DNT, including prenotification by the emergency medical service, limiting the MRI sequence, and introduction of a rapid examination tool, was also implemented during this period. Time metrics for thrombolysis were compared between specific time periods.
Results: A total of 73 patients (27 women; median age 74 years) were included in the present study. More than 80% of the patients were screened with MRI. More patients were managed with the MRI-first policy in the late phase (p = 0.018). DNT (83 min in the early phase, 68 min in the middle phase, and 54 min in the late phase, p &lt; 0.001) was significantly reduced across phases. The percentage of patients with DNT &lt; 60 min increased significantly across time periods (p &lt; 0.001).
Conclusion: An MRI-first policy was feasible, and DNT was substantially reduced with a QI process. This process may be applicable to other hospitals. (C) 2016 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jns.2016.07.011

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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 SCIENCE BV  

Objective: Isolated deep subcortical infarcts develop as a result of occlusion of the penetrating arteries from the internal carotid artery (ICA) and the proximal (M1) and distal middle cerebral artery (MCA). However, the clinical and neuroimaging characteristics of infarcts due to the occlusion of the distal MCA penetrating artery are unclear.
Methods: Consecutive patients with ischemic stroke or transient ischemic attack with magnetic resonance imaging (MRI) performed within 2 days of onset were studied retrospectively. Using coronal MRI data, isolated deep subcortical infarcts were classified into two groups: 1) proximal group, described as being longer than they are wide, which were expected to be related to the occlusion of the ICA or M1 penetrating artery; and 2) distal group, described as oblong, which were expected to be associated with the occlusion of penetrating arteries from the distal MCA (M2/M3/M4).
Results: A total of 653 consecutive acute ischemic stroke patients (proximal group, 50 [7.7%]; distal group, 14 [2.1%]) were enrolled. Baseline clinical characteristics were not different between the 2 groups. Modified Rankin Scale scores were lower in the distal group than in the proximal group 3 months after stroke onset (1.43 +/- 0.36 vs. 226 +/- 1.35, p = 0.023). We measured the lengths of the infarcts in the X and Y directions using axial MRI. The X/Y ratio was larger in tile distal group than in the proximal group (1.3 +/- 0.6 vs. 0.7 +/- 02, p &lt; 0.01), which indicated that distal MCA penetrating artery infarcts appear more oblong on axial MRI.
Conclusions: One cause for deep subcortical infarction is the occlusion of the distal MCA penetrating arteries, which occurs in 22% of patients with deep subcortical infarctions. These patients had better clinical outcomes than those with ICA and M1 penetrating artery infarctions. Distal MCA penetrating artery infarctions appear oblong on axial MRI. (C) 2016 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jns.2016.07.005

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記述言語：英語   出版者・発行元：ELSEVIER SCIENCE BV  

DOI： 10.1016/j.jns.2016.05.044

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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 SCIENCE BV  

Spontaneous cervical artery dissection (sCAD) is a major cause of ischemic stroke in young adults. Frequently, sCAD involves multiple neck arteries, accounting for 13%-28% of the total sCAD cases. However, little is known about factors related to multiple sCAD. In this case, a 52-year-old man was admitted due to headache without aura. There was a personal history of migraine with aura and a family history of similar symptoms. The patient's younger brother had a left vertebral artery (VA) dissecting aneurysm and underwent endovascular occlusion of his parent artery at the age of 48. Magnetic resonance imaging of our admitted patient showed hyperintensities in the right internal carotid artery (ICA) without acute infarction, and magnetic resonance angiography revealed a narrowing of the right ICA. Angiography was then performed, which showed a trace of dissection of the left ICA and both VAs as well as the right ICA. The patient did not fulfill any major criteria of collagen vascular disease such as Ehlers-Danlos syndrome type IV or Loeys-Dietz syndrome. The data in our patient are quite similar to those reported in patients with single-nucleotide polymorphism (SNP) of PHACTR1. Obtaining the patient's informed consent, we analyzed a common SNP variation in the rs9349379[G] allele (PHACTR1), which has been reported to be associated with a lower risk of sCAD.

DOI： 10.1016/j.jstrokecerebrovasdis.2016.04.027

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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-BLACKWELL  

BACKGROUND AND PURPOSE: The safety and feasibility of intravenous thrombolysis using recombinant tissue plasminogen activator (IV-tPA) were retrospectively compared between patients with unknown onset time and no ischemia on fluid-attenuated inversion recovery (negative FLAIR) and patients receiving standard therapy.
METHODS: Acute stroke patients with unknown onset times were treated using IV-tPA if they had: negative FLAIR; internal carotid artery and/or middle cerebral artery occlusion; and a diffusion-weighted imaging (DWI)-Alberta Stroke Programme Early CT Score &gt;= 5. All patients had abnormal DWI scans indicating an acute stroke. IV-tPA therapy was performed within 3-4.5 h of first found abnormal time (FAT). Patients who were admitted within 3-4.5 h of FAT and did not receive IV-tPA therapy despite the same imaging findings were extracted from our registry as controls.
RESULTS: There were 24 patients in the IV-tPA group and 28 in the control group. None of the IV-tPA group and 1 (4%) of the control group patients experienced symptomatic intracerebral hemorrhage (P = 1.000). The rate of dramatic recovery at day 7 (&gt;= 10-point reduction in the total National Institutes of Health Stroke Scale [NIHSS] score or NIHSS score of 0-1) was 46% in the IV-tPA group and 18% in the control group (P = .038). Multivariate regression analysis revealed that IV-tPA was an independent predictor of dramatic recovery at day 7 (odds ratio 13.74; 95% confidence interval, 1.95-96.92; P = .009).
CONCLUSIONS: IV-tPA may safely increase the rate of dramatic recovery in acute stroke patients with unknown onset times and negative FLAIR.

DOI： 10.1111/jon.12323

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記述言語：英語   出版者・発行元：ELSEVIER SCIENCE BV  

DOI： 10.1016/j.jns.2016.04.014

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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 SCIENCE BV  

Background: Peak systolic velocity (PSV) is measured with pulse-wave (PW) Doppler with angle correction in patients with internal carotid artery stenosis (ICAS). However, the correlation between conventional angiography and PSV shows considerable scattering. We hypothesized that measuring PSV without angle correction would lead to better inter-rater reliability. This hypothesis was tested using a sector probe and continuous-wave (CW) Doppler without angle correction. Methods: Consecutive patients with more than 50% ICAS were enrolled from a prospective database. PSV was measured with PW Doppler with angle correction (PW PSV) and CW Doppler without angle correction (CW PSV) by 2 examiners. The inter-rater reliabilities of PW PSV and CW PSV were analyzed by Spearman's rank correlation test. Results: A total of 37 ICAS sites (median 67 [interquartile range 57-78] % stenosis) were enrolled. Measuring PSV using a sector probe insonating nearly parallel to the flow was feasible in all cases. Inter-rater reproducibility of CW PSV (Spearman's rho = .810) was similar to that of PW PSV (Spearman's rho = .796). When limited to patients with a PSV greater than 200 cm/s with both PW Doppler examinations (25 ICAS sites), inter-rater reliability was relatively higher for CW PSV (Spearman's rho = .674) than for PW PSV (Spearman's rho = .423). Conclusions: Measuring PSV with CW Doppler using a sector probe was feasible. Inter-rater reliability was similar between PW Doppler with angle correction and CW Doppler without angle correction in evaluating PSV in patients with ICAS. CW Doppler appears to have better inter-rater reproducibility than PW Doppler in assessing high PSV. (C) 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

DOI： 10.1016/j.jstrokecerebrovasdis.2015.12.009

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記述言語：英語   出版者・発行元：WILEY-BLACKWELL  

DOI： 10.1111/ene.12977

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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 SCIENCE BV  

Background and purpose: Data on long-term outcomes after tissue-plasminogen activator (tPA) therapy are limited. We evaluated the rate of favorable outcomes and mortality at 5 years after tPA therapy and investigated factors related to long-term clinical outcomes.
Methods: Telephone interviews or interview letters were used to assess the modified Rankin Scale (mRS) scores at 3 months, 6 months, 1 year, 2 years, 3 years, 4 years, and 5 years after tPA therapy. Favorable outcome was defined as mRS 0-2. Multivariate logistic regression analysis was conducted to investigate factors associated with favorable outcomes and mortality at 5 years after tPA therapy.
Results: From 2005 to 2013, 256 (median age, 77 [interquartile range, 68-84] years; 157 [61%] males; median National Institutes of Health Stroke Scale score, 11 [5-18]) patients were enrolled. Kaplan-Meier curve showed that favorable outcomes after 5 years after tPA therapy occurred in 45% of the patients and that the mortality rate was 40%. Univariate analysis showed that onset-to-treatment time (OTT) was 121 (107-172) minutes in patients with favorable outcomes and 156 (126-171) minutes in patients with unfavorable outcomes (p = 0.016). In addition, OTT was 157 (133-172) minutes in the death group and 123 (106-169) minutes in the survival group (p = 0.001). Multivariate regression analysis indicated that OTT was an independent factor related to favorable outcomes (odds ratio 0.96, 95% confidence interval 0.93-0.99, p = 0.004) and mortality (odds ratio 1.04, 95% confidence interval 1.02-1.06, p = 0.001).
Conclusion: Early tPA administration can improve long-term clinical outcomes. (C) 2016 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jns.2016.01.018

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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）   出版者・発行元：Lippincott Williams and Wilkins  

DOI： 10.1212/WNL.0000000000002293

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記述言語：英語   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Limb-shaking associated with steno-occlusion of the internal carotid artery (ICA) was first reported by Miller Fisher(1) in 1962, and is characterized by brief, jerky, coarse, involuntary movements involving an arm or leg. Limb-shaking TIA is an under-recognized manifestation of an intracranial and extracranial carotid occlusion or severe stenosis. Although hemodynamic compromise has been suggested to be associated with shaking movements, the pathogenic nature of this symptom remains unclear. Neurophysiologic evaluation of this movement disorder would be useful, but the attack is rare and typically lasts less than 5 minutes.(2) Thus, few reports have investigated this hyperkinetic phenomenon under neurophysiologic assessment.(3&lt;/SUP)

DOI： 10.1212/WNL.0000000000002293

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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 SCIENCE BV  

A 59-year old man was admitted to our stroke care unit 1.8 hours after onset of cardioembolic stroke. Administration of issue-plasminogen activator achieved complete recanalization, and his lesion on diffusion-weighted imaging (DWI) disappeared and single photon emission computed tomography showed luxury perfusion. DWI reversal and luxury perfusion were sometimes observed in hyperacute stroke patients, especially timely reperfusion was achieved. However, the relationships between DWI reversal and luxury perfusion were not well known. Transient DWI reversal may be associated with luxury perfusion in patients treated with t-PA, via early complete recanalization achieved by thrombolysis.

DOI： 10.1016/j.jstrokecerebrovasdis.2015.09.017

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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：KARGER  

Background and Purpose: Hyperintense vessels (HV) detected on fluid-attenuated inversion recovery (FLAIR) in patients with acute ischemic stroke (AIS) indicate cerebral hypoperfusion. However, the clinical meaning of changes in HV is yet to be clarified. Here, we investigated serial changes to HV in patients with AIS who received tissue plasminogen activator (t-PA) therapy. Methods: We studied t-PA patients presenting with HV on FLAIR in the middle cerebral artery territory. Patients underwent brain MRI 1 h before and after t-PA infusion. HV scores (range 1-7) were evaluated according to Alberta Stroke Program Early Computed Tomography Score territories, and then by subtracting HV scores at 1 h after t-PA infusion from those on admission, with a result of &gt; 1 defined as decrease in HV score (DHV). Patients were divided into 2 groups based on the presence or absence of DHV. Multivariate logistic regression analysis was conducted to identify variables independently associated with good outcome (modified Rankin Scale score at 90 days after stroke onset of 0-1). Results: A total of 118 consecutive patients were enrolled (73 men; mean age 76 +/- 9.7; median initial National Institutes of Health Stroke Scale (NIHSS) 13; median initial HV score 5), of whom 52 (44%) had DHV. Patients with DHV showed a significantly lower NIHSS time course (p &lt; 0.001) and significantly smaller infarct volume time course (p &lt; 0.001) compared to those without DHV. Multivariate analysis showed that DHV was independently associated with good outcome (OR 3.89; 95% CI 1.55-9.77; p &lt; 0.01). The sensitivity and specificity of DHV for good outcome were 70 and 68%, respectively. Conclusion: A DHV on FLAIR predicts good outcome in patients receiving t-PA. (C) 2016 S. Karger AG, Basel

DOI： 10.1159/000443533

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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：KARGER  

Background and Purpose: Acute Stanford type A aortic dissection (AAD) is a devastating aortic disease, and prompt diagnosis is sometimes difficult to make. Identification of AAD in suspected acute stroke patients is especially challenging. Nevertheless, the frequencies and predictive factors of AAD in suspected acute stroke patients have not been well investigated. The aim of this study was to elucidate the prevalence of and predictors for AAD in patients with suspected acute stroke. Methods: From January 2012 through January 2013, consecutive patients who visited our emergency department (ED) due to suspected acute (&lt;24 h from onset) stroke were retrospectively enrolled. Clinical parameters including systolic blood pressure (SBP) and laboratory data were collected. Frequency of AAD in suspected acute stroke patients and acute ischemic stroke (AIS) subjects were assessed, and factors associated with AAD among AIS patients were investigated. Results: A total of 1,637 patients were included in this study. Five patients (0.31%, 95% CI 0.04-0.57) were diagnosed as having AAD. The prevalence of AAD in all AIS individuals during the study period was 1.09% (95% CI 0.142.05), and AAD accounted for 1.70% (95% CI 0.05-3.36) of AIS patients who appeared at the hospital within 4 h from onset. Most AAD patients presented with disturbed consciousness, and none of the AAD patients complained of chest pain. Neck ultrasonography detected an intimal flap in AAD patients. Two AAD cases died soon after ED arrival. The remaining 3 were promptly diagnosed as having AAD in the ED and underwent emergency surgery; all were discharged with only mild neurological symptoms. Low SBP in the right arm (cut-off value &lt;= 110 mm Hg, sensitivity 100%, specificity 94.4%) and high D-dimer level (cut-off value &gt;= 5.0 mu g/ml, sensitivity 100%, specificity 91.7%) had high predictive values for detecting AAD in patients with AIS presenting within 4 h from onset. Conclusions: AAD was seen in 0.31% of suspected acute stroke patients and 1.70% of AIS patients presenting within 4 h from onset. AAD patients who were initially suspected as having acute stroke had severe neurological symptoms, including disturbance of consciousness, did not complain of typical chest pain, and when emergency surgery was performed, favorable neurological and survival outcomes were achieved. Low SBP in the right arm and high D-dimer level could predict AAD. (C) 2016 S. Karger AG, Basel

DOI： 10.1159/000445528

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記述言語：英語   出版者・発行元：KARGER  

DOI： 10.1159/000445528

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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 SCIENCE BV  

Background: Youth stroke education is promising for the spread of stroke awareness. The aim of this study was to examine whether our stroke awareness teaching materials without teacher's participation can increase student awareness to act fast on suspected stroke signs. Methods: We used the face, arm, speech, and time (FAST) mnemonic derived from the Cincinnati Prehospital Stroke Scale. Seventy-three students of the second grade and 72 students of the third grade (age range, 13-15 years) in a junior high school were enrolled in the study. The students were divided into 2 groups: students who received a teacher's lesson (group I) and those who did not receive a teacher's lesson (group II). Students in group II watched an animated cartoon and read a Manga comic in class. All students took the educational aids home, including the Manga comic and magnetic posters printed with the FAST message. Questionnaires on stroke knowledge were examined at baseline and immediately and 3 months after receiving the intervention. Results: At 3 months after the intervention, a significant improvement in understanding the FAST message was confirmed in both the groups (group I, 85%; group II, 94%). Significant increases in the knowledge of risk factors were not observed in each group. Conclusions: Our education materials include a Manga comic, an animated cartoon, and a magnetic poster, without an accompanying teacher's lesson can increase stroke awareness, including the FAST message, in junior high school students.

DOI： 10.1016/j.jstrokecerebrovasdis.2015.07.001

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記述言語：英語   出版者・発行元：SPRINGER-VERLAG ITALIA SRL  

DOI： 10.1007/s10072-015-2128-y

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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-BLACKWELL  

Background and purposeThe CHA(2)DS(2)-VASc score is associated with severity and outcome of ischaemic stroke in patients with atrial fibrillation (AF). It was hypothesized that a high CHA(2)DS(2)-VASc score was related to severity and outcome because of its association with proximal artery occlusion (PAO). This study aimed to elucidate the relationship between the CHA(2)DS(2)-VASc score and PAO and to determine whether the effect of the CHA(2)DS(2)-VASc score on severity or outcome is independent of PAO.
MethodsAcute stroke patients with AF were retrospectively enrolled. PAO was defined as occlusion at the internal carotid artery or proximal middle cerebral artery on admission magnetic resonance angiography. Multivariable analyses were performed to identify independent factors associated with PAO and determine the associations of the CHA(2)DS(2)-VASc score with the initial National Institutes of Health Stroke Scale (NIHSS) score and poor functional outcome (discharge modified Rankin scale score 4-6).
ResultsIn all, 213 patients [102 women; median age 80 (interquartile range 71-86)years; NIHSS score 16 (9-22)] were enrolled. On multivariable analysis, the CHA(2)DS(2)-VASc score (odds ratio 1.40, 95% confidence interval 1.12-1.76 per 1 point) was independently associated with PAO and correlated with the initial NIHSS score (standardized coefficient 0.198, P=0.017). This association was not significant after further adjustment for PAO (0.080, P=0.241). The CHA(2)DS(2)-VASc score was independently related to poor outcome even adjusted for PAO (odds ratio 1.39, 95% confidence interval 1.03-1.88).
ConclusionThe CHA(2)DS(2)-VASc score was associated with PAO in acute ischaemic stroke patients with AF. The CHA(2)DS(2)-VASc score may be correlated with the NIHSS score through the presence of PAO and with poor functional outcome independently of PAO.

DOI： 10.1111/ene.12711

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記述言語：英語   出版者・発行元：SPRINGER-VERLAG ITALIA SRL  

DOI： 10.1007/s10072-015-2138-9

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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：JAPANESE CIRCULATION SOC  

Background: We conducted a multicenter retrospective cohort study to elucidate the characteristics of intracranial hemorrhage (ICH) in patients with atrial fibrillation treated with non-vitamin K antagonist oral anticoagulants (NOACs).
Methods and Results: We sent a questionnaire to the directors of 241 stroke centers in Japan to establish the clinical characteristics of NOAC-associated cerebral hemorrhage (CH), including hematoma size, hematoma enlargement (HE) and in-hospital mortality of patients treated in their institutions. We undertook a literature review to establish the clinical characteristics of warfarin-associated CH and compared these with our data. We received 174 responses (72.2%), of which 67 (38.5%) gave anonymous details of 130 eligible patients (male, 67.7%; mean age, 77.3 +/- 8.3 years, in-hospital mortality rate, 11.5%). We judged that 87 of the 130 patients had presented with CH: one-fifth had taken antiplatelet drugs. We found that the incidences of HE and mortality in the 87 patients presenting with NOAC-associated CH were lower than would have been expected in those with warfarin-associated CH (17% vs. 26%, and 16% vs. 35%, respectively).
Conclusions: More than half the stroke center directors who responded to our questionnaire had not experienced cases of NOAC-associated ICH. Compared with warfarin, NOACs appear to present a lower risk of HE and death in patients with atrial fibrillation who develop CH.

DOI： 10.1253/circj.CJ-14-1209

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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：LIPPINCOTT WILLIAMS & WILKINS  

Background and purpose: Blood pressure lowering is often performed as a part of general acute management in acute intracerebral hemorrhage (ICH) patients. The relationship between relative blood pressure reduction and clinical outcomes is not fully known.
Methods: Hyperacute (&lt;3 h from onset) ICH patients with initial SBP more than 180 mmHg were included in the observational study. All patients received intravenous antihypertensive treatment based on a predefined protocol to lower and maintain SBP between 120 and 160 mmHg. The relative SBP reduction was defined as the ratio of SBP reduction to the admission SBP in the first 24 h, and associations between the relative SBP reduction and neurological deterioration (&gt;= 2 points decrease in the Glasgow Coma Scale score or &gt;= 4 increase in the National Institutes of Health Stroke Scale score), hematoma expansion (&gt;33% increase), and unfavorable outcome (modified Rankin scale score 4-6 at 3 months) were assessed with multivariate logistic regression analyses.
Results: Of the 211 patients [81 women, median age 65 (interquartile range 58-74) years, and median initial National Institutes of Health Stroke Scale score 13 (8-17)] enrolled, 17 (8%) showed neurological deterioration, 36 (17%) showed hematoma expansion, and 87 (41%) had an unfavorable outcome. On multivariate regression analyses, relative SBP reduction was independently and inversely associated with neurological deterioration (odds ratio 0.053, 95% confidence interval 0.011-0.254 per 10% increment), hematoma expansion (0.289, 0.099-0.841), and unfavorable outcome (0.254, 0.095-0.680) after adjusting for known predictive factors.
Conclusion: Insufficient relative SBP reduction after standardized antihypertensive therapy in hyperacute ICH was independently associated with poor clinical outcomes. Aggressive antihypertensive treatment may improve clinical outcomes.

DOI： 10.1097/HJH.0000000000000512

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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 SCIENCE BV  

Valproic acid (VPA) is widely used for the clinical treatment of epilepsy. Previous studies have demonstrated that VPA ameliorates brain injury following experimental stroke. However, the effect of VPA in stroke models featuring comorbid conditions has not been fully explored. In this study, we investigate the effects of VPA on permanent ischemic stroke with hyperglycemia. Hyperglycemia Was induced by streptozotocin (STZ) injection 3 days before. Test animals received a single injection of VPA immediately after induction of ischemia. Control animals received occlusion and physiological saline injection, or STZ, occlusion, and saline. Magnetic resonance imaging of cerebral blood flow (CBF) and apparent diffusion coefficient (ADC) was performed 60 min after ischemia. Infarct volume, neurological deficits, rotarod test performance, and immunohistological markers were assessed 3 days after ischemia. Hyperglycemia significantly expanded the area of decreased of CBF and ADC, and increased the number of myeloperoxidase-positive cells, ionized calcium binding adapter molecule 1-positive cells, inducible nitric oxide synthase-positive cells, von Willebrand factor-positive cells, and Fluoro-Jade C-positive cells in the ischemic boundary zone, which was accompanied by increased infarct volume and deteriorated neurological deficit and rotarod test compared with normoglycemia (P &lt;0.05). VPA significantly alleviated the aggravation of functional outcome accompanied by suppressing these inflammation, endothelial injury, and neuronal degeneration compared with saline-treated group (P&lt;0.05). A single injection of VPA following permanent ischemia in STZ-induced hyperglycemic rats ameliorates neurological deficits and reduces neuronal degeneration by inhibiting inflammation and endovascular injury. VPA may be promising as a candidate therapy for human stroke. (C) 2015 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.brainres.2015.02.013

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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 SCIENCE BV  

Background: Half of acute stroke patients have poor outcomes at 3 months even when treated with intravenous thrombolysis using tissue-plasminogen activator (t-PA) therapy. The aim of the present study was to evaluate the impact of the susceptibility vessel sign (SVS) on magnetic resonance imaging (MRI) T2* at the proximal portion of the middle cerebral artery (M1 proximal SVS) on clinical outcome in anterior circulation stroke patients treated with t-PA.
Methods: The presence of the M1 proximal SVS was assessed before t-PA therapy. Good outcome and poor outcome at 3 months were defined as a modified Rankin Scale score of 0 to 2 and 4 to 6, respectively. The predictive values of the M1 proximal SVS for a good and poor outcome were calculated.
Results: 161 patients (median age [interquartile], 76 [67-83] years; male, 91 [57%]) were enrolled. At 3 months after stroke, 68 (42%) patients achieved a good outcome, and 75 (47%) had a poor outcome. The M1 proximal SVS was found in 17 (11%) patients, of whom none (0%) achieved a good outcome, and 16 (94%) had a poor outcome. The sensitivity and positive predictive value of the M1 proximal SVS for good outcome were very low (0.000 and 0.000, respectively). Furthermore, the specificity and positive predictive value of the M1 proximal SVS for poor outcome were very high (0.988 and 0.941, respectively).
Conclusion: The M1 proximal SVS appears to be a strong predictor for poor outcome after t-PA therapy. (C) 2014 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jns.2014.12.002

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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 SCIENCE BV  

Background: The goal of this study was to investigate the relationship between white matter lesions on magnetic resonance imaging and flow parameters in the middle cerebral artery (MCA) measured by transcranial color flow imaging. Methods: Patients with acute ischemic stroke or transient ischemic attack were included. The relationship between severities of periventricular hyperintensity (PVH) and ultrasonographic parameters in the MCA was investigated. The frequency of PVH was calculated for different categories according to the presence or absence of 2 considerable parameters according to the value of area under the receiver operating characteristic curve. Results: MCA flow was successfully measured in 203 temporal windows among 124 patients. After determining the cutoff value of end-diastolic velocity (EDV) and pulsatility index (PI) for the presence of PVH, 4 different categories were established: Category A, EDV more than 40 cm/second and PI less than.7; Category B, EDV more than 40 cm/second and PI more than.7; Category C, EDV less than 40 cm/second and PI less than.7; and Category D, EDV less than 40 cm/second and PI more than.7. The prevalence of PVH gradually increased along with category (P &lt; . 01). Conclusions: The evaluation of MCA parameters using the combination of PI and EDV may be useful for the prediction of PVH.

DOI： 10.1016/j.jstrokecerebrovasdis.2014.07.027

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記述言語：英語   出版者・発行元：The Japanese Circulation Society  

DOI： 10.1253/circj.CJ-66-0111

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その他リンク： https://jlc.jst.go.jp/DN/JLC/20011202002?from=CiNii

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：(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：(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：(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：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KARGER  

Background: Intravenous thrombolysis using the tissue-type plasminogen activator (t-PA) is contraindicated for patients with a history of intracerebral hemorrhage (ICH). T2*-weighted magnetic resonance imaging (MRI) is able to detect asymptomatic ICH. If there is an association between asymptomatic ICH on T2* before t-PA therapy and ICH after t-PA therapy, we may be able to take preventive measures before starting t-PA therapy in patients with MRI-proven hemorrhage. The aim of the present study was to investigate whether asymptomatic ICH seen on T2* increases the risk of new ICH after t-PA therapy. Methods: Patients who had consecutive stroke treated with t-PA between October 2005 and November 2013 were enrolled. A hypointense T2* signal with a diameter &gt;5 mm was defined as asymptomatic ICH before t-PA therapy. The presence of new ICH at 24 h after t-PA therapy was assessed using T2*. Symptomatic ICH (sICH) was defined as new ICH combined with an increase in the National Institutes of Health Stroke Scale score &gt;= 4. At 3 months after onset, good and poor outcomes were defined as modified Rankin Scale (mRS) scores of 0-1 and 4-6, respectively. Results: Of 300 patients (age 77 [68-83] years; 173 [58%] males), 25 (8%) had an asymptomatic ICH on T2* before t-PA therapy. Eleven (45%) patients showed an isolated asymptomatic ICH. Three (12%) patients had a round hypointense lesion similar to microbleeds. Nine (36%) patients had a hemorrhagic transformation within a prior infarcted area. Multiple asymptomatic ICHs were seen in 2 (8%) patients. The rates of good and poor outcomes at 3 months were 24 and 59% of patients with asymptomatic ICH and 38 and 41% of patients without asymptomatic ICH (p = 0.300 and 0.202, respectively). At 24 h after t-PA therapy, 11 (44%) of the 25 patients with asymptomatic ICH before t-PA therapy and 87 (32%) of 275 without asymptomatic ICH had new ICH (p = 0.265). Only 1 (4%) of 25 patients with asymptomatic ICH before t-PA therapy and 6 (2%) of 275 without asymptomatic ICH had sICH within 24 h (p = 0.460). On multivariate logistic regression analysis, neither new ICH (odds, 1.19; 95% CI, 0.40-3.54, p = 0.753) nor sICH (odds, 0.95; 95% CI, 0.08-11.90, p = 0.970) was related to asymptomatic ICH on T2* before t-PA therapy. Conclusion: The presence of T2* hypointensity as a marker of asymptomatic ICH may not be associated with new ICH and sICH after t-PA therapy. (C) 2014 S. Karger AG, Basel

DOI： 10.1159/000365207

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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 SCIENCE BV  

Background: Stroke education for the youth is expected to reduce prehospital delay by informing the bystander of appropriate action to take and providing knowledge to prevent onset of stroke in future. Previously, we developed effective teaching materials consisting of an animated cartoon and a Manga for junior high school students. The aim of this study was to evaluate the feasibility and effectiveness of our educational materials for stroke education taught by schoolteachers to elementary school children. Methods: Using our teaching materials, a 30-minute lesson was given by trained general schoolteachers. Questionnaires on stroke knowledge (symptoms and risk factors) and action to take on identification of suspected stroke symptoms were filled out by school children before, immediately after, and at 3 months after completion of the lesson. Results: A total of 219 children (aged 10 or 11 years) received the stroke lesson. Stroke knowledge significantly increased immediately after the lesson compared with before (symptoms, P &lt; .001; risk factors, P &lt; .001); however, correct answer rates decreased at 3 months immediately after completion of the lesson (symptoms, P = .002; risk factors, P = .045). The proportion of the number of children calling emergency medical service on identifying stroke symptoms was higher immediately after the lesson than baseline (P = .007) but returned to the baseline at 3 months after the lesson. Conclusions: Stroke lesson by schoolteachers using our teaching materials consisting of an animated cartoon and a Manga that was previously used for junior high school students was feasible for elementary school children. However, revision of the materials is required for better retention of stroke knowledge for children.

DOI： 10.1016/j.jstrokecerebrovasdis.2014.02.015

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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 SCIENCE BV  

Background: The purpose of this study was to determine whether our stroke education system can help junior high school students acquire stroke knowledge when performed by a schoolteacher. Methods: A stroke neurologist gave a stroke lesson to 25 students (S group) and a schoolteacher through our stroke education system. After instruction, the schoolteacher performed the same lesson using the same education system to another 75 students (T group). Questionnaires on stroke knowledge were examined at baseline, immediately after the lesson (IL), and at 3 months after the lesson (3M). We analyzed the results of stroke knowledge assessment by linear mixed effects models adjusted for gender and class difference using the student number. Results: We assessed 24 students in the S group and 72 students in the T group. There were no significant differences in the changes of predicted scores of symptoms and risk factors adjusted for gender, class difference, and each student knowledge level until 3M between the 2 groups. Correct answer rates for the meaning of the FAST (facial droop, arm weakness, speech disturbance, time to call 119) at IL were 92% in the S group and 72% in the T group, respectively. At 3M, they were 83% in the S group and 84% in the T group. The correct answer rates of FAST at 3M were not significantly different adjusted for group, gender, class difference, and correct answer rate at IL. Conclusions: A schoolteacher can conduct the FAST message lesson to junior high school students with a similar outcome as a stroke neurologist using our stroke education system.

DOI： 10.1016/j.jstrokecerebrovasdis.2013.11.016

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記述言語：日本語   出版者・発行元：(一社)日本脳神経超音波学会  

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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 SCIENCE BV  

Background: Patients with atrial fibrillation (AF) are more likely to exhibit proximal carotid axis occlusion than those without AF. However, clinical characteristics associated with proximal arterial occlusion (PAO) in acute stroke patients with AF are not fully known. This study was aimed to elucidate the factors correlated with PAO. Methods: Consecutive patients with acute ischemic stroke developed in the middle cerebral artery (MCA) territory and AF who underwent magnetic resonance angiography (MRA) within 24 h from onset were retrospectively enrolled. Prior users of warfarin were excluded. Patients were divided into 3 groups based on the site of arterial occlusion: occlusion at the internal carotid artery (ICA), at the horizontal segment of the MCA (M1), and at the MCA branch or no identifiable occlusion. Clinical characteristics were compared between the 3 groups, and the factors associated with proximal vessel occlusion were evaluated with ordinal logistic regression analysis. All variables identified on univariable analyses with P values less than .1 were entered into the model. Results: A total of 244 patients (124 women, median 80 years old [interquartile range 72-87], median National Institutes of Health Stroke Scale [NIHSS] score 16 [7-22]) were studied. MRA was performed median 2.7 h (1.5-8.9) after stroke onset. Occlusion site was the ICA in 34 patients, M1 in 78, and MCA branch or no occlusion in the remaining 132. As the occlusion site was more proximal, patients were older and more female, the initial NIHSS score was higher, levels of D-dimer and brain natriuretic peptide (BNP) were higher, and histories of heart failure and systemic embolism were more common. On multivariable ordinal logistic regression analysis, female sex (odds ratio [OR] 1.83, 95% confidence interval [CI] 1.03-3.26), advanced age (OR 1.37, 95% CI 1.02-1.84 for every 10 years), history of systemic embolism (OR 14.9, 95% CI 1.41-157.75), and higher BNP level (OR 1.03, 95% CI 1.01-1.07 for every 100 pg/mL) were independent factors associated with the risk of occlusion at more proximal arteries. The risk was 2.68-fold higher (95% CI 1.28-5.61) in patients having 2 of the following factors: female sex, age more than 80 years, systemic embolism, and BNP greater than 250 pg/mL; and 4.50-fold (2.11-9.59) higher in those having 3 or 4 of the 4 factors compared with those without any of these factors. Conclusions: Female sex, advanced age, history of systemic embolism, and higher BNP level were independently associated with more proximal carotid axis occlusion. Patients with AF having these factors may be prone to have relatively large thrombi in the heart.

DOI： 10.1016/j.jstrokecerebrovasdis.2013.07.002

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記述言語：英語   出版者・発行元：ELSEVIER IRELAND LTD  

DOI： 10.1016/j.ijcard.2014.03.048

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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）   出版者・発行元：ELSEVIER SCIENCE BV  

Background: We produced a stroke education program using the FAST (facial droop, arm weakness, speech disturbance, time to call an ambulance) mnemonic. Aims: The aim of this study is to examine efficacy of our education program for junior high school students and their parents. Methods: One hundred ninety students of 3 junior high schools (aged 12-13 years) and their parents were enrolled. Students received a 45-minute lesson of stroke enlightenment using the FAST mnemonic. Enlightenment items, such as a magnet poster, were distributed. Parents were educated indirectly from their child. Surveys of stroke knowledge were examined at baseline, immediately after the lesson, and at 3 months after the lesson. Results: For the students, correct answers at 3 months were significantly higher than those at baseline in questions of facial palsy (98% versus 33%), speech disturbance (98% versus 54%), numbness on one side (64% versus 42%), weakness on one side (80% versus 51%), calling an ambulance (88% versus 60%), alcohol drinking (85% versus 65%), smoking (70% versus 43%), dyslipidemia (58% versus 46%), hyperglycemia (59% versus 48%), and obesity (47% versus 23%). At 3 months, the parents answered more correctly questions of facial palsy (93% versus 66%), calling an ambulance (95% versus 88%), and alcohol drinking (65% versus 51%) than at baseline. At 3 months, 96% of students and 78% of parents answered the FAST mnemonic correctly. Conclusions: Our stroke education program improved stroke knowledge, especially the FAST message, for junior high school students and their parents.

DOI： 10.1016/j.jstrokecerebrovasdis.2013.08.021

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記述言語：英語   出版者・発行元：W B SAUNDERS CO LTD  

DOI： 10.1016/j.seizure.2013.11.001

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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-BLACKWELL  

Background and purposeThe characteristics of reverse magnetic resonance angiography and diffusion-weighted imaging (MRA-DWI) mismatch (RMM), defined as a large DWI lesion in the absence of major artery occlusion (MAO), remain unknown, especially in patients treated with intravenous recombinant tissue plasminogen activator (rt-PA).
MethodsPatients with stroke in the middle cerebral artery territory were included. Early ischaemic changes (EIC) were assessed with the Alberta Stroke Program Early CT Score on DWI (DWI-ASPECTS). All patients were divided into four groups based on the presence of MAO and a DWI-ASPECTS cut-off value of &lt;7. RMM was defined as DWI-ASPECTS &lt;7 without MAO. Clinical characteristics, symptomatic intracerebral hemorrhage (sICH) and favorable functional outcome (modified Rankin Scale score 0-2) at 90days were compared amongst the four groups.
ResultsOf the 486 patients enrolled (167 women, median age 74years, median initial National Institutes of Health Stroke Scale score 13), reverse MRA-DWI mismatch was observed in 24 (5%). Of the clinical characteristics, cardioembolism was the only factor that was independently associated with RMM [odds ratio (OR) 5.49, 95% confidence interval (CI) 1.25-24.1]. Multivariable analyses revealed that patients with RMM more commonly had sICH than those with DWI-ASPECTS7 irrespective of the presence (OR 5.44, 95% CI 1.13-26.1) or absence (13.1, 2.07-83.3) of MAO, and they had a more favorable functional outcome than those with DWI-ASPECTS&lt;7 plus MAO (7.45, 2.39-23.2).
ConclusionRMM was observed in 5% of patients treated with rt-PA and associated with cardioembolism. Patients with RMM may benefit from thrombolysis compared with those with EIC with MAO, although increment in the rate of sICH is a concern.

DOI： 10.1111/ene.12308

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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 SCI LTD  

Previous reports have shown that plasma brain natriuretic peptide (BNP) levels are increased in patients with subarachnoid hemorrhage and ischemic stroke. We examined BNP in patients with intracerebral hemorrhage (ICH). Between June 2006 and February 2010, we prospectively enrolled consecutive patients with acute ICH within 24 hours of onset. The plasma BNP level was measured twice, on admission and 4 weeks after onset or at discharge. We investigated whether plasma BNP was elevated in the acute phase of ICH and associated factors. The mean standard deviation (SD) plasma BNP level of all patients was 71.1 +/- 104.1 pg/mL. The log BNP level positively correlated with the cardio-thoracic ratio (r = 0.240, p = 0.0001). Moreover, BNP was significantly associated with intraventricular extension (p = 0.0039) and hydrocephalus (p = 0.0046). The mean SD BNP level of patients with cerebellar hemorrhage was the highest (130.2 +/- 152.0 pg/mL), followed by brainstem (84.5 +/- 170.6 pg/mL), lobar (72.4 +/- 148.1 pg/mL), thalamus (64.8 +/- 72.1 pg/mL), and putamen (59.9 +/- 62.6 pg/mL) hemorrhages. In 185 patients, BNP was measured in the subacute phase of ICH. The BNP level in the acute phase of ICH was significantly higher than that in the subacute phase of ICH (69.3 +/- 108.1 versus 21.7 +/- 23.5 pg/mL, p &lt; 0.0001). In conclusion, plasma BNP appears to be elevated in the acute phase of ICH, particularly in those with cerebellar lesions. (C) 2013 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jocn.2013.02.035

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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 SCIENCE BV  

Background: The purpose of this study was to examine the frequency and characteristics of re-exacerbation of stroke symptoms within 24 hours after tissue plasminogen activator (t-PA) infusion. Methods: We studied consecutive stroke patients treated with t-PA within 3 hours of onset of symptoms admitted between October 2005 and March 2010. We divided patients into 4 groups: improvement (IM; improvement in National Institutes of Health Stroke Scale [NIHSS] &gt;= 4 points), unchanged (UN; no change or decline in NIHSS &lt;4 points), exacerbation (EX; decline in NIHSS &gt;= 4 points), and re-exacerbation (RE-EX; decline of NIHSS &gt;= 4 points accompanied by re-exacerbation of neurologic symptoms in NIHSS &gt;= 4 points). We compared clinical characteristics among the 4 groups. Results: Two hundred twenty-two patients (135 men; median age 76 years) were enrolled. Sixteen of the 222 (7%) were in the RE-EX group. Small vessel disease (SVD), hemorrhagic cerebral infarction, and reocclusion were significantly more common among patients in the RE-EX group. SVD, hemorrhagic cerebral infarction, and reocclusion occurred in 44%, 25%, and 13% of patients in the RE-EX group, in 9%, 22%, and 0% of patients in the EX group, in 5%, 6%, and 0% of patients in the IM group, and in 17%, 14%, and 1% of patients in the UN group, respectively (P &lt; .001, P = .041, and P &lt; .001). Multivariate logistic regression analysis revealed that SVD was the only independent factor associated with re-exacerbation within 24 hours after t-PA infusion (odds ratio 3.52; 95% confidence interval [CI] 1.19-10.40; P = .023). Conclusions: Seven percent of patients re-exacerbated within 24 hours after intravenous infusion of t-PA. Re-exacerbation within 24 hours after t-PA infusion was strongly associated with SVD.

DOI： 10.1016/j.jstrokecerebrovasdis.2012.09.009

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記述言語：英語   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1161/STROKEAHA.113.002903

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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：LIPPINCOTT WILLIAMS & WILKINS  

Background and Purpose It is unknown whether new-extraischemic microbleeds (new-EMBs) develop rapidly after tissue-type plasminogen activator (tPA) infusion. We hypothesized that new-EMBs may develop rapidly after tPA infusion using T2*-weighted MRI (T2*) and investigated the frequency and clinical factors associated with new-EMBs.
Methods Patients with acute stroke within 3 hours of onset who were treated with tissue-type plasminogen activator (tPA) were studied prospectively. T2* was performed before and 24 hours after tPA therapy. Independent clinical factors associated with new-EMBs development were examined using multivariate logistic regression analysis.
Results A total of 224 patients (121 men; mean age, 76.210.6 years) were enrolled in the present study. MBs before tPA infusion were observed in 72 (32.1%) patients. Within 24 hours after tPA infusion, 6 (2.7%) patients had symptomatic intracranial hemorrhage (extraischemic [n=4], and hemorrhagic transformation [n=2]). Follow-up T2* revealed asymptomatic new-EMBs in 11 (4.9%) patients and hemorrhagic transformation in the infarcted area in 65 (29.0%). The total and mean number of new-EMBs were 23 and 1.6 +/- 1.3, respectively. Patients with new-EMBs more frequently had symptomatic extraischemic hemorrhage than those without new-EMBs (27.3% [3/11] versus 0.5% [1/213]; P=0.0003). However, the frequency of hemorrhagic transformation was not different between patients with and without new-EMBs (27.3% versus 29.1%; P=0.9999). Multivariate logistic regression demonstrated that the presence of MBs before tPA infusion was the only independent factor associated with new-EMBs (odds ratio, 10.6; 95% confidence interval, 20.68-54.279; P=0.0046).
Conclusions New-EMBs occurred rapidly after tPA infusion in 4.9% of patients. The presence of MBs before tPA therapy was associated with new-EMBs. Patients with new-EMBs are likely to have symptomatic extraischemic hemorrhage.

DOI： 10.1161/STROKEAHA.113.001778

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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：LIPPINCOTT WILLIAMS & WILKINS  

Background and Purpose-Blood pressure (BP) lowering is often conducted as part of general acute management in patients with acute intracerebral hemorrhage. However, the relationship between BP after antihypertensive therapy and clinical outcomes is not fully known.
Methods-Hyperacute (&lt;3 hours from onset) intracerebral hemorrhage patients with initial systolic BP (SBP) &gt;180 mm Hg were included. All patients received intravenous antihypertensive treatment, based on predefined protocol to lower and maintain SBP between 120 and 160 mm Hg. BPs were measured every 15 minutes during the initial 2 hours and every 60 minutes in the next 22 hours (a total of 30 measurements). The mean achieved SBP was defined as the mean of 30 SBPs, and associations between the mean achieved SBP and neurological deterioration (&gt;= 2 points' decrease in Glasgow Coma Score or &gt;= 4 points' increase in National Institutes of Health Stroke Scale score), hematoma expansion (&gt;33% increase), and unfavorable outcome (modified Rankin Scale score 4-6 at 3 months) were assessed with multivariate logistic regression analyses.
Results-Of the 211 patients (81 women, median age 65 [interquartile range, 58-74] years, and median initial National Institutes of Health Stroke Scale score 13 [8-17]) enrolled, 17 (8%) showed neurological deterioration, 36 (17%) showed hematoma expansion, and 87 (41%) had an unfavorable outcome. On multivariate regression analyses, mean achieved SBP was independently associated with neurological deterioration (odds ratio, 4.45; 95% confidence interval, 2.03-9.74 per 10 mm Hg increment), hematoma expansion (1.86; 1.09-3.16), and unfavorable outcome (2.03; 1.24-3.33) after adjusting for known predictive factors.
Conclusions-High achieved SBP after standardized antihypertensive therapy in hyperacute intracerebral hemorrhage was independently associated with poor clinical outcomes. Aggressive antihypertensive treatment may ameliorate clinical outcomes.

DOI： 10.1161/STROKEAHA.113.001212

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND PURPOSE: Recent studies have shown that thrombolysis could decrease or eliminate ischaemic diffusion-weighted imaging lesions. However, the features of such diffusion-weighted imaging lesion reduction are not well known. AIMS: To clarify, the frequency of and factors associated with lesion reduction were investigated. METHODS: Patients given intravenous tissue plasminogen activator therapy within three-hours of onset were prospectively enrolled. Magnetic resonance imaging including diffusion-weighted imaging and magnetic resonance angiography was performed four times: on admission, just after intravenous tissue plasminogen activator, 24 h from intravenous tissue plasminogen activator, and seven-days after intravenous tissue plasminogen activator. The diffusion-weighted imaging lesion volume was measured by manual trace using National Institutes of Health imaging software. All patients were divided into three groups according to the early diffusion-weighted imaging lesion volume change from admission to just after intravenous tissue plasminogen activator: the lesion reduction group (>20% decrease); the lesion growth group (>20% increase); and the lesion unchanged group. RESULTS: In total, 105 patients [56 males, median age 77 (interquartile range 70-83) years, and National Institutes of Health Stroke Scale score 16 (10-22)] were enrolled. Early diffusion-weighted imaging lesion reduction was observed in seven (7%) patients. The decreased lesion increased subsequently. On multivariate analysis, the glucose level on admission (odds ratio 0·95, 95% confidence interval 0·91 to 0·99, P = 0·045) and early recanalization (odds ratio 15·7, 95% confidence interval 1·61 to 153, P = 0·018) were independently related to early lesion reduction. CONCLUSION: Early diffusion-weighted imaging lesion reduction was observed in 7% of patients treated with intravenous tissue plasminogen activator. The decreased lesion increased subsequently. Initial glucose level and early recanalization were independently associated with early diffusion-weighted imaging lesion reduction.

DOI： 10.1111/j.1747-4949.2012.00902.x

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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-BLACKWELL  

BACKGROUND We investigated how many contrast-transcranial Doppler (c-TCD) examinations should be performed on different days in patients with acute stroke. METHODS Consecutive acute stroke patients within 24 hours of onset were enrolled. Presence of RLS was examined using c-TCD examinations on days 1, 7, and 14. Each c-TCD examination used one test without Valsalva maneuver (VM) and three tests with VM. Patients were diagnosed with RLS when TCD detected 1 microembolic signal on 1 c-TCD examination on any of the days 1, 7, or 14. RESULTS One hundred seventy patients (105 men [62%]; median age, 74 [IQR, 6681] years) were enrolled. RLS was diagnosed in 45 patients (26%). RLS was identified on day 1 in 30 patients (18%), on day 7 in 28 patients (16%), and on day 14 in 23 patients (14%; P= .143). Detection rate of RLS by combining day 1 and 7 examinations was significantly higher than that of day 1 alone (25% vs 18%, P &lt; .001). However, the rate did not increase when results of day 14 were added (25% vs 26%, P= .250). CONCLUSIONS c-TCD examinations should be performed on at least two different days to assess the prevalence of RLS.

DOI： 10.1111/j.1552-6569.2011.00660.x

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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 SCIENCE BV  

Background: We aimed to devise a scale comprising a simple multiplication of initial National Institutes of Health Stroke Scale (NIHSS) score and onset-to-treatment time (OTT) as a scale for predicting outcomes after recombinant tissue plasminogen activator (rt-PA) therapy.
Methods: Data from rt-PA patients in 10 stroke centers in Japan were investigated. NIHSS-time score was calculated as initial NIHSS score x OTT.
Results: Subjects comprised 526 patients. Median NIHSS score was 12 (7-18), and median OTT was 2.42 h (2.00-2.75 h). Median NIHSS-time score was 27.7 (16.9-41.7). Good (modified Rankin Scale [mRS] 0-1) and poor (mRS 4-6) outcome rates at 3 months for patients with NIHSS-time scores &lt;= 10 were 71.1% and 7.8%, compared to 54.7% and 16.5% for scores &gt;10 and &lt;= 20, 38.9% and 31.9% for scores &gt;20 and &lt;= 30, 25.0% and 44.6% for scores &gt;30 and and &lt;= 40, and 17.4% and 61.8% for scores &gt;40, respectively. Cut-off NIHSS-time scores to predict good and poor outcomes with 50% probability were defined as 20 and 40, respectively. Multivariate logistic regression analysis revealed NIHSS-time score as an independent predictor of good (odds ratio [OR], 0.587; 95% confidence interval [CI], 0.422-0.818, p = 0.002) and poor (OR, 1.756; 95%CI, 1.227-2.514, p = 0.002) outcomes after adjusting for age, sex, NIHSS score, OTT, Alberta Stroke Program Early CT Score, internal carotid artery occlusion, and glucose level.
Conclusions: NIHSS-time score predicts clinical outcomes in rt-PA patients. (c) 2013 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jns.2013.01.029

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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-BLACKWELL  

A diffusion-weighted imaging (DWI) lesion changed dramatically in a hyperacute stroke case treated with intravenous tissue-plasminogen activator (IV t-PA). The initial hyperintense lesion on DWI disappeared completely immediately after IV t-PA treatment without improvement of neurological symptoms. However, the lesion reappeared 24 hours later. Successful thrombolysis can resolve DWI lesions but does not always improve the neurological symptoms.

DOI： 10.1111/j.1552-6569.2011.00635.x

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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-BLACKWELL  

Background and purpose: Sleep-disordered breathing (SDB) is a risk factor for cerebrovascular disease. We investigated the frequency of SDB in Japanese patients with acute ischaemic stroke and transient ischaemic attack (TIA), as well as factors associated with SDB severity.
Methods: Between April 2010 and March 2011, we prospectively enrolled patients with ischaemic stroke and TIA within 24 h of onset to participate in a sleep study within 7 days of admission. We defined SDB as a respiratory disturbance index (RDI) (number of apnoeas or hypopnoeas per hour) of &gt;= 5. Patients were assigned to groups based on RDI values of &gt;= 30 (severe) and &lt;30 (absent or not severe). The frequency of SDB and factors associated with severity were investigated using multivariate regression analysis.
Results: We enrolled 150 patients amongst whom 126 (84%) had SDB. The frequencies of SDB were 21 (75%) patients with TIA, 105 (86%) with ischaemic stroke, 8/10 (80%) with large artery atherosclerosis, 14/14 (100%) with small vessel occlusion, 37/41 (90%) with cardioembolism and 46/57 (81%) with other causes of stroke/undetermined. Severe SDB was evident in 44 (29%) patients. The frequency of males (75% vs. 56%, P = 0.027), atrial fibrillation (AF) (39% vs. 23%, P = 0.045), higher body mass index (23.8 +/- 3.8 vs. 22.3 +/- 3.8, P = 0.043) and a larger neck circumference (37.8 +/- 4.3 vs. 35.8 +/- 4.2, P = 0.012) was significantly higher in the group with severe SDB. Multivariate regression analysis found that AF (OR 2.4; 95% CI 1.079-5.836, P = 0.0359) was independently associated with severe SDB.
Conclusion: Most Japanese patients with acute ischaemic stroke and TIA had SDB, and AF was associated with SDB.

DOI： 10.1111/j.1468-1331.2012.03837.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND PURPOSE - : In patients with middle cerebral artery trunk occlusion we investigated whether the diffusion-weighted imaging- the Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) predicts short-term neurological recovery after intravenous recombinant tissue plasminogen activator administration, and investigated how DWI-ASPECTS relates to clinical outcome. METHODS - : Dramatic recovery was defined as a ≥10-point reduction or a total National Institutes of Health Stroke Scale score of 0 to 1 at 24 hours and 7 days. Early recanalization was defined as recanalization within 1 hours after intravenous recombinant tissue plasminogen activator. Favorable outcome at 3 months was defined as a modified Rankin Scale score of 0 to 2. RESULTS - : Sixty-six patients (median age [interquartile], 79 [70-85] years, male
34 [52%]) were enrolled. DWI-ASPECTS was 6 (5-9). Dramatic recovery was seen in 16 (24%) and 26 (39%) patients at 24 hours and on day 7, respectively. Early recanalization occurred in 22 (33%) patients. DWI-ASPECTS ≥7 was an independent predictor of dramatic recovery at 24 hours (odds ratio, 100.85
95% confidence interval, 4.29-2371.40
P=0.004) and 7 days (odds ratio, 14.15
95% confidence interval, 2.21-90.48
P=0.005). Although the favorable outcome rate was not significantly different between patients with DWI-ASPECTS ≥7 with and without early recanalization (60% versus 31%
P=0.228), it was statistically more frequent in patients with DWI-ASPECTS &lt
7 with early recanalization than those without early recanalization (38% versus 0%
P=0.017). CONCLUSIONS - : DWI-ASPECTS predicted short-term recovery in patients with middle cerebral artery trunk occlusion receiving intravenous recombinant tissue plasminogen activator. In patients with lower DWI-ASPECTS, there may still be benefit from early recanalization. © 2013 American Heart Association, Inc.

DOI： 10.1161/STROKEAHA.112.675470

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記述言語：英語   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

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記述言語：英語   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

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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）   出版者・発行元：IEEE  

To prevent stroke, it is necessary to identify the symptoms of a transient ischemic attack (TIA) quickly and to be treated at special medical facilities. A stroke neurologist has been conducting stroke education lessons for teens. However, efficiently conveying the information is difficult because the lesson has some limitations, including a shortage of physicians who can present the information. In this study, we have developed an online support system that enables schoolteachers to provide stroke education. This is a new approach. By using our system, schoolteachers can lecture to students on stroke signs, risk factors, symptoms and the FAST message (Facial droop, Arm weakness, Speech disturbance and Time of emergency call) for identifying typical symptoms of TIA. Additionally, we provide a web-based questionnaire survey for checking students' knowledge level. As a trial run of the system, we conducted a test lesson involving 78 students and a schoolteacher in a public junior high school. It was confirmed that the lesson could be conducted without trouble. On average, 70% of all students answered a question about the FAST message correctly. It was suggested that the function of the management side needs to be improved to increase the accuracy of the answer data. Our system could be used as a support tool for stroke education.

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DOI： 10.1159/000348552

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DOI： 10.1159/000354848

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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 SCIENCE BV  

Background and purpose: For optimal acute stroke management and secondary prevention, discrimination of stroke etiology is crucial. We hypothesized that a low Alberta Stroke Program Early CT Score (ASPECTS) on diffusion-weighted imaging (DWI) immediately after stroke onset was associated with the presence of atrial fibrillation (AF).
Methods: Consecutive patients admitted within 24 h from stroke onset with an occlusion at the horizontal segment of the middle cerebral artery (M1) on initial MRA were retrospectively enrolled. AF was diagnosed based on continuous electrocardiogram monitoring during acute hospitalization or its confirmed history.
Results: Of the 206 patients (95 women, median age 77 [IQR 69-85] years, NIHSS score 18[13-23]) enrolled, AF was identified in 138 patients (AF group): chronic AF in 89, known paroxysmal AF (pAF) in 13, and masked pAF on admission in 36. The ASPECTS score on the initial DWI, performed a median of 2.5 h after onset, was lower in the AF group than in the others (4 [2-6] vs. 7 [4-8], p&lt;0.001). With the optimal cut-off value of &lt;= 6(sensitivity, 78%; specificity, 57%; area under the ROC curve, 0.682), DWI-ASPECTS was independently associated with the presence of any AF (OR 5.05, 95%CI 2.36 to 10.8), as well as the presence of any pAF (OR 8.64, 95%CI 3.00 to 24.9) and that of masked pAF on admission (OR 10.0, 95%CI 3.06 to 32.9).
Conclusion: Extensive early ischemic change assessed by DWI-ASPECTS predicts the presence of AF, even initially masked pAF, in acute stroke patients with M1 occlusion. (C) 2012 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jns.2012.08.021

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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 SCIENCE BV  

Background and purpose: The symptoms of about 30% of acute ischemic stroke patients progress, but the mechanism and predictors of the deterioration are not well known. The augmentation index (AIx), estimated with the arterial pulse waveform, is known to be pathophysiologically relevant to the pathogenesis of cardiovascular diseases. The aim of the present study was to investigate the prognostic value of the AIx for early symptom progression (ESP) in patients with acute ischemic stroke.
Methods: Acute ischemic stroke patients admitted to our stroke center within 24 h from onset were prospectively enrolled. The AIx was measured within 48 h from admission. ESP was defined as increase in the NIHSS score during 7 days from admission. All patients were divided into &gt;= 2 groups according to the ESP (the ESP group and the non-ESP group).
Results: A total of 147 patients (79 males, median age 74 [IQR 64-82] years, and NIHSS score 3 [1-7]) were enrolled. ESP was observed in 23 (16%) patients. There were no differences in clinical characteristics including the AIx between the two groups. However, when only cases with lacunar and atherothrombotic strokes were evaluated, the AIx was higher in the ESP group (37.0 [32.0-38.0]%) than in the non-ESP group (29.5 [21.8-33.3]%, p = 0.003). With the optimal cut-off value of &gt;36%, the AIx was independently associated with ESP (OR 37.3, 95% CI 1.71-811, p = 0.021).
Conclusion: The AIx level was independently related to ESP in patients with acute lacunar and atherothrombotic strokes. The AIx may have a potential to predict ESP in these patients. (C) 2012 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jns.2012.07.049

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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-BLACKWELL  

BACKGROUND We investigated whether combined transcranial Doppler (TCD) and magnetic resonance angiography (MRA) can diagnose significant stenosis (s-stenosis) of the siphon portion of the internal carotid artery (S-ICA) on digital subtraction angiography (DSA).
METHODS TCD criteria cut-off peak systolic blood-flow velocity of 75 cm/s or mean blood-flow velocity of 50 cm/s, with both values more than 30% higher than in the contralateral SICA. MRA criterion was defined as a = 50% signal reduction of the column width. Combined TCD and MRA criteria were fulfillment of both TCD and MRA criteria.
RESULTS Among 295 vessels, seven (2%) had s-stenosis on DSA. Using TCD criteria, 16 vessels (5%) were identified to have s-stenosis, of which six (38%) had s-stenosis on DSA (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV] were.86,.97,.38, and.99). Using MRA criteria, 17 (6%) vessels were s-stenosis, of which seven (41%) had s-stenosis on DSA. Sensitivity, specificity, and NPV were 1.00,.97, and 1.00; however, PPV was low (. 41). Combined TCD and MRA criteria identified six (2%) vessels as having s-stenosis, all were s-stenosis on DSA (PPV was 1.00).
CONCLUSION Combined TCD and MRA examinations have similar diagnostic power to DSA.

DOI： 10.1111/j.1552-6569.2010.00567.x

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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 IRELAND LTD  

Background: The aim of the present study was to investigate whether the prevalence of atrial fibrillation (AF) is associated with the level of glycated hemoglobin (HbA1c) in Japanese adults in Kurashiki-city.
Methods: Adult residents (&gt;= 40 years old) were examined twice, in 2006 and 2007. Electrocardiography was conducted to determine the presence of AF. After categorizing all participants into two groups (HbA1c &lt; 6.5% as low group and &gt;= 6.5% as high group), factors independently associated with the prevalence of AF were investigated in total cohort, low and high groups using multivariate logistic regression analysis.
Results: Of the total 52,448 participants (median age, 72 years; range, 65-78 years; 17,980 men), AF prevalence was 2.2% (1161/52,448). After classifying all participants by HbA1c level, the proportion of participants with AF was 2.2% (1073/49,498) in the low group and 3.0% (88/2950) in high group (p=0.005). AF was significantly associated with cardiac disease (OR, 5.78; 95% CI, 5.07-6.58; p&lt;0.001), elevating HbA1c (OR, 1.57; 95% CI, 1.33-1.84; p&lt;0.001), increasing age (OR, 1.40; 95% CI, 1.30-1.51; p&lt;0.001), and male sex (OR, 1.27; 95% CI, 1.10-1.47; p=0.001) in low group and was related to cardiac disease (OR, 4.85; 95% CI, 3.08-7.62; p&lt;0.001) and age (OR, 1.45; 95% CI, 1.09-1.93; p=0.010) in high group. After adjusted age, gender, vascular risk factors, cardiac disease, and eGFR, elevating HbA1c (OR, 1.18; 95% CI, 1.09-1.28; p&lt;0.001) was the factor in association with AF.
Conclusions: The presence of AF appears to be associated with the level of HbA1c, especially in patients with HbA1c &lt;6.5%. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.ijcard.2010.10.039

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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 SCIENCE BV  

Background and purpose: The aim of the present study was to investigate whether administration of edaravone during t-PA infusion can enhance early recanalization in acute stroke patients.
Methods: This trial was undertaken as a multicenter, single blind, randomized, open-labeled study. Acute stroke patients with M1 or M2 occlusion within 3 h of onset were studied prospectively. The subjects were randomly allocated to edaravone (Edaravone group: when t-PA was intravenously infused, intravenous edaravone (30 mg) was started at the same time) and no edaravone (Non-Edaravone group). Early recanalization within 1 h after t-PA infusion and neurological recovery 24 h after t-PA infusion were compared between the two groups.
Results: 40 patients (23 men. 17 women; mean age, 76.4 +/- 8.2 years, median 79 years) were enrolled; 23 patients were assigned to the Edaravone group and 17 to the Non-Edaravone group. Early recanalization was more frequently observed in the Edaravone group than in the Non-Edaravone group (56.5% vs. 11.8%, P=0.0072). Eight patients who underwent endovascular therapy immediately after t-PA infusion were excluded, and neurological recovery was analyzed. Remarkable and good recoveries were more frequently observed in the Edaravone group than in the Non-Edaravone group (80.1% vs. 45.5%, P=0.0396).
Conclusion: Early recanalization and good neurological recovery were more frequently observed in the Edaravone group than in the Non-Edaravone group. These results demonstrate that administration of edaravone during t-PA infusion should enhance early recanalization in acute stroke patients. (C) 2011 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jns.2011.09.006

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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  

A 64-year-old man presented with alternating exotropia and bilateral medial longitudinal fasciculus (MLF) syndrome known as wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) syndrome. Diffusion-weighted imaging showed a small localized lesion in the median dorsal pons, and high-resolution T2-weighted imaging revealed slight left deviation of the lesion. A small penetrating artery was assumed to be occluded at the level of the MLF decussation. The median dorsal pons appears to be a location for the lesions causing WEBINO syndrome.

DOI： 10.1007/s10072-011-0647-8

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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：KARGER  

Background and Purpose: Vessel signs, such as the susceptibility vessel sign (SVS) on T2*-gradient echo imaging (T2*) and the hyperdense middle cerebral artery sign (HMCAS) on CT, are well-known markers of arterial occlusion. However, the relationship between the signs is not fully known. Methods: Patients suspected of having hyperacute (&lt;3 h from symptom onset) stroke were prospectively enrolled. MRI including T2* and MR angiography, and thin-section CT were performed on admission. The consistency between SVS and HMCAS were evaluated. Results: A total of 67 patients [38 males, median age: 76 (interquartile range: 67-82) years, median NIHSS score: 12 (4-21)] were enrolled. SVS was observed in 6 patients (9%), and HMCAS was present in 8 (12%). Sixteen patients (24%) had middle cerebral artery proximal (M1) occlusion on MR angiography. The presence or absence of SVS was highly consistent with that of HMCAS when all cases were evaluated (kappa = 0.841), as well as when only patients with M1 occlusion were assessed (kappa = 0.750). Conclusion: SVS and HMCAS were highly consistent with each other in suspected hyperacute stroke patients. SVS and HMCAS may represent the same thrombus. Copyright (C) 2012 S. Karger AG, Basel

DOI： 10.1159/000338308

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記述言語：英語   出版者・発行元：KARGER  

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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：MANEY PUBLISHING  

Background and purpose: The frequency of good outcome at 3 months after tissue plasminogen activator (t-PA) therapy is y35%. The present study aimed to devise a simple scale to predict good outcome using clinical factors and magnetic resonance imaging (MRI) findings before and immediately after t-PA infusion.
Methods: Consecutive patients with acute ischemic stroke treated with t-PA within 3 hours of stroke onset were studied prospectively. We assessed clinical factors independently associated with good outcome [ modified Rankin scale (mRS): 0-1] at 3 months after t-PA therapy. We created a simple scale to predict good outcome in t-PA patients using factors selected by multivariate logistic regression analysis.
Results: Subjects comprised 105 patients (69 men; median age, 74 years). Multivariate logistic regression analysis revealed the following independent factors associated with good outcome: baseline National Institutes of Health Stroke Scale (NIHSS) &lt;11 [ odds ratio (OR), 13.64; 95% confidence interval (CI), 3.588-51.822; P=0.0001], glucose &lt;150 mg/dl (OR, 3.76; 95% CI, 1.014-13.963; P=0.0475), and early recanalization within 1 hour after t-PA infusion (OR, 5.28; 95% CI, 1.179-23.656; P=0.0296). Those three variables were selected for use in the good outcome scale, with NIHSS &lt;11 as 2 points, glucose &lt;150 mg/dl as 1 point, and early recanalization as 1 point. Frequencies of patients with good outcome for each score were as follows: score 0, 0.0%; score 1, 7.1%; score 2, 43.5%; score 3, 65.4%; and score 4, 71.4%. The C statistic for the score was 0.849 (95% CI, 0.776-0.922).
Conclusion: A simple clinical and MRI scale can predict good outcome in t-PA patients.

DOI： 10.1179/1743132811Y.0000000031

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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：LIPPINCOTT WILLIAMS & WILKINS  

Background and Purpose-The aim of the present study was to investigate independent clinical and MRI factors associated with no early recanalization within 1 hour after tissue-type plasminogen activator (tPA) administration.
Methods-Patients with acute stroke within 3 hours of onset who were treated with tPA were studied prospectively. Patients with internal carotid artery, M1, and M2 occlusion were enrolled, and independent clinical and MRI factors associated with no early recanalization within 1 hour after tPA administration were examined using multivariate logistic regression analysis.
Results-One hundred thirty-two patients (63 men; mean age, 76.4 +/- 10.2 years; internal carotid artery occlusion in 37 patients, M1 occlusion in 58, and M2 occlusion in 37) were enrolled. Follow-up MR angiography within 60 minutes after tPA infusion revealed early recanalization in 49 (37.1%) patients (complete in 16 patients, partial in 33) and no recanalization in 83 (62.9%). Using 8 variables (atrial fibrillation, time from stroke onset to treatment &gt;= 140 minutes, use of warfarin, glucose &gt;= 135 mg/dL, large artery diseases, internal carotid artery occlusion, M1 occlusion, and M1 susceptibility vessel sign on T2*) identified on univariate analysis at P&lt;0.2, multivariate logistic regression analysis revealed that M1 susceptibility vessel sign was the only independent factor associated with no early recanalization (OR, 7.157; 95% CI, 1.756 to 29.172; P=0.006). The sensitivity, specificity, positive predictive value, and negative predictive value of M1 susceptibility vessel sign for predicting no early recanalization were 31.3%, 93.9%, 89.7%, and 44.7%, respectively.
Conclusions-Of clinical and MRI factors before tPA infusion, M1 susceptibility vessel sign on T* is the only independent factor associated with no early recanalization within 1 hour after tPA administration. (Stroke. 2011;42:3150-3155.)

DOI： 10.1161/STROKEAHA.111.623207

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記述言語：英語   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1212/WNL.0b013e31823152f9

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掲載種別：研究論文（学術雑誌）  

DOI： 10.3995/jstroke.33.488

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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 SCIENCE BV  

Background and purpose: The present study examined the effects of admission hyperglycemia and early recanalization (ER) after t-PA administration on infarct volume and patient outcome.
Methods: Acute ischemic stroke patients with major artery occlusion treated with t-PA within 3 h of onset were studied prospectively. Hyperglycemia was identified as admitting blood glucose value &gt;= 130 mg/dl. We compared serial infarct volume and patient outcome between normoglycemic and hyperglycemic groups, and assessed correlation between admitting blood glucose value and Delta infarct volume (7 days baseline) between patients with and without ER.
Results: 97 patients (ICA occlusion in 30, M1 in 44, and M2 in 23 patients) were enrolled in the present study; 52 had hyperglycemia, and 40 had ER. The initial infarct volume did not differ between the normoglycemic and hyperglycemic groups. However, infarct volume at 7 days was larger in the hyperglycemic group than in the normoglycemic group (156.2 +/- 157.1 cm(3), vs. 85.4 +/- 140.7 cm(3), P = 0.0061) and the baseline admitting blood glucose value was correlated with Delta infarct volume (7 days baseline) (r=0.340, P = 0.0014). Regarding ER, Delta infarct volume (7 days baseline) in patients without ER was correlated with admitting blood glucose value(r = 0.372, P = 0.0078). However, in patients with ER, Delta infarct volume was not associated with admitting blood glucose value (r = 0.225, P = 0.1173). Good outcome (mRS 0-2) at 3 months was more frequent in normoglycemic patients than hyperglycemic patients (43.2% vs. 22.2%, P=0.0418).
Conclusion: Admission hyperglycemia was associated with infarct volume expansion and patient outcome in t-PA patients. However, if ER occurs, hyperglycemia should not adversely affect infarct volume. (C) 2011 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jns.2011.05.017

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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 SCIENCE BV  

Background and purpose: Spontaneous intra-cranial arterial dissection (SICAD) without history of head and neck injury is now recognized as an important cause of stroke. However, the frequency of SICAD involving the anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) territories remains unclear. This study therefore investigated the distribution of SICAD.
Methods: Subjects comprised 194 patients (126 men, 68 women; median age, 68.0 years) with infarct isolated to the ACA, MCA or PCA territories who underwent conventional angiography. Diagnosis of SICAD was based on clinical and neuroradiological findings. Frequency of SICAD was compared among ACA. MCA, and PCA infarcts. All patients were divided into SICAD and non-SICAD groups, and clinical characteristics were compared between groups.
Results: Infarcts involved the ACA in 14 cases (7.2%), MCA in 165 cases (85.1%), and PCA in 15 cases (7.7%). SICAD was diagnosed in 17 of 194 cases (8.8%), with cerebral angiography showing main findings of the string sign in 11 patients (64.7%), the pearl and string sign in 6 patients (353%), and pseudoaneurysm formation in 2 patients (11.7%). SICAD most frequently involved the ACA (ACA, 643%; MCA, 42%; PCA, 6.7%; P&lt;0.001).
Conclusion: SICAD was seen in 643% of patients with ACA infarct The mechanisms of ACA infarction may thus differ from those of MCA and KA infarction. (C) 2011 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jns.2011.02.021

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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 SCIENCE BV  

Background and purpose: Detection rate of right-to-left shunt (RLS) may be lower in stroke patients with atrial fibrillation (AF) than in those without AF. This may be due to the mechanism of embolic stroke in AF patients that involves cardiac embolus rather than paradoxical embolism due to RLS. Patients with AF frequently have subclinical heart failure, resulting in elevated left atrial (LA) pressure, which may prevent opening of a patent foramen ovale (PFO). We aimed to investigate whether the detection rate of RLS in stroke patients with AF was affected by elevated LA pressure.
Method: We enrolled consecutive acute stroke patients with AF and, as controls, consecutive acute stroke patients without AF. RLS was diagnosed using contrast transcranial Doppler. To assess LA pressure, the ratio of early mitral inflow velocity to diastolic mitral annular velocity (E/E') was measured using transthoracic echocardiography.
Result: We enrolled 171 patients with AF (AF group, age, 78 years [IQR, 70-83]) and 171 patients without AF (control group, age, 73 years [IQR, 64-81]). RLS was observed less frequently in AF patients than in the control group (9% vs. 18%, p = 0.024). E/E' ratio was higher in AF patients (13.1 [9.4-17.4] vs. 10.9 [8.2-13.7], p&lt;0.001). Among controls, E/E' ratio did not differ between patients with and without RLS (11.8 [8.5-12.9] vs. 10.8 [8.0-13.9], p = 0.884). Conversely, in AF patients, E/E' ratio was lower in patients with RLS than in those without RLS (9.0 [8.3-12.6] vs. 13.6 [10.2-18.1], p = 0.008). Multivariate regression analysis demonstrated that E/E' ratio of &lt;11.0 was an independently associated with RLS (OR 4.61, 95%Cl 1.21-17.62, p = 0.025).
Result: RLS was detected less frequently in AF patients than in controls. Elevated LA pressure was associated with the absence of RLS in AF stroke patients and may prevent opening of a PFO. (C) 2011 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jns.2011.01.026

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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 SCIENCE BV  

Background and purpose: The present study investigated the relationship between serial changes in ischemic lesion volume (ILV) and neurological recovery after t-PA therapy.
Methods: A total of 110 consecutive patients with ICA and MCA occlusion on MRA treated with t-PA within 3 h of onset were prospectively studied. MRI including MRA, DWI, and FLAIR, was performed before, 1 h, 24 h, and 7 days after t-PA infusion to measure serial changes in ILV.
Results: The mean (SD) values of ILV at baseline, 1 h, 24 h, and 7 days after t-PA infusion were 30.2 (61.0), 48.1 (76.3), 98.3 (1253), and 125.9 (149.8) cm(3), respectively. Recovery at 7 days was remarkable in 46 patients and good in 21 patients. Change in NIHSS score (baseline NIHSS minus NIHSS at 7 days) correlated with Delta ILV (ILV at 7 days minus baseline ILV) (r = 0.611, P&lt;0.0001). Sensitivity and specificity curve analysis demonstrated that a cutoff value for Delta ILV of 40 cm(3) (sensitivity, 80.0%; specificity, 79.3%) indicated remarkable recovery, and that 80 cm(3) (78.8% and 76.3%) indicated good recovery.
Conclusion: The thresholds of Delta ILV enlargement for remarkable and good recovery after t-PA therapy were 40 and 80 cm(3), respectively. (C) 2011 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jns.2011.02.024

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DOI： 10.1159/000327154

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記述言語：日本語   掲載種別：研究論文（国際会議プロシーディングス）  

In Japan, time window of IV-t-PA therapy for acute stroke is within 3 hours of stroke onset. Recently, ECASS III study revealed that time window of 3-4.5 hours of stroke onset is effective for acute stroke. Thus, now US, Australia and many countries in Europe and Asia are available for time window of 4.5 hours. The extension of time window until 4.5 hours is expected in Japan. The target of treatment in acute stroke is penumbra. MRI can estimate the area of penumbra using perfusion MRI and diffusion MRI. IV-t-PA study using MRI was conducted in acute stroke patients with over 3-4.5 hours of onset, but did not reach satisfied results. We reported that M1 susceptibility vessel sign (SVS) on T 2*can predict no early recanalization after t-PA infusion. Next, FLAIR can estimate the onset time of stroke in acute stroke patients within 24h of onset. Our study demonstrated that acute stroke patients with unknown onset time may be able to safely receive intravenous thrombolysis using FLAIR. Extension of time window and development of t-PA therapy using the MRI is expected in future.

DOI： 10.5692/clinicalneurol.51.1174

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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：KARGER  

Background and Purpose: Patients with unknown onset time would be able to receive intravenous thrombolysis when showing diffusion-weighted imaging (DWI)/fluid-attenuated inversion recovery (FLAIR) mismatch. Methods: Consecutive acute stroke patients with unknown onset time were prospectively enrolled. We defined patients as having unknown onset time when the last known normal time (LNT) was not consistent with the first found abnormal time (FAT). Only patients with anterior-circulation stroke and presence of arterial lesion were enrolled. Intravenous thrombolysis was conducted within 3 h from FAT if the patient showed DWI/FLAIR mismatch. Results: From June 2009 to May 2010, 10 patients [median age, 84 years (interquartile range, IQR, 64-90); National Institutes of Health Stroke Scale (NIHSS) score, 14 (IQR, 9-19)] were enrolled. Subjects included 4 patients who developed stroke during sleep, 5 with disturbance of consciousness, and 1 with aphasia. Median interval between LNT and thrombolysis was 5.6 h (IQR, 4.5-9.8) and median interval between FAT and thrombolysis was 2.5 h (IQR, 2.1-2.8). Three patients had internal carotid artery occlusion, 5 had M1 occlusion, and 2 had M2 occlusion. Early recanalization within 24 h was seen in 7 patients (complete recanalization, n = 4; partial recanalization, n = 3). No patients experienced symptomatic cerebral hemorrhage within 48 h. At day 7, 5 patients showed dramatic recovery (defined as &gt;= 10-point reduction in total NIHSS score or score of 0 or 1). At 3 months, favorable outcome (modified Rankin scale score, 0-2) was seen in 4 patients. Conclusion: Acute stroke patients with DWI/FLAIR mismatch may be able to safely receive intravenous thrombolysis. Copyright (C) 2011 S. Karger AG, Basel

DOI： 10.1159/000323850

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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：KARGER  

Background/Aims: The main predictors of intracerebral hemorrhage (ICH) are clinical stroke severity and large ischemic lesions. Therefore, ICA occlusion as severe stroke is thought to frequently have ICH after tissue plasminogen activator (t-PA) therapy. The aim of this study was to investigate whether ICA occlusion more frequently had ICH after t-PA therapy compared with other occluded arteries. Subjects and Methods: We prospectively studied consecutive stroke patients treated with t-PA within 3 h of onset. We investigated the frequency of ICH after t-PA therapy for each occluded artery. Results: 165 patients were enrolled. Initial MRA demonstrated ICA occlusion in 38 patients, M1 in 48, M2 in 28, and BA and PCA in 12. At 24 h after t-PA infusion, 113 (68.5%) patients (non-HT group) did not have hemorrhagic transformation, 37 (22.4%; HI group) had hemorrhagic cerebral infarction and 15 (9.1%; ICH group) had ICH. The ICH group most frequently had M2 occlusion, NIHSS &gt;= 15, and &gt;= 1/3 of the MCA territory among the three groups. The frequency of ICH was 2.6% in no occlusion, 10.5% in ICA occlusion, 6.3% in M1, 21.4% in M2, and 8.3% in PCA and BA (p = 0.1016). Conclusion: Patients with ICA occlusion did not have ICH more frequently after t-PA therapy in comparison to other occluded arteries. Copyright (C) 2011 S. Karger AG, Basel

DOI： 10.1159/000326338

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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：KARGER  

Background and Purpose: The present study aimed to devise a simple scale to predict very poor outcome after tissue plasminogen activator (t-PA) therapy using clinical and MRI factors. Methods: Consecutive stroke patients treated with t-PA within 3 h of onset were studied prospectively. Clinical factors and MRI findings independently associated with very poor outcome (modified Rankin Scale score 4-6) at 3 months after t-PA therapy were assessed. Results: The subjects were 117 patients. Multivariate logistic regression analysis revealed the following independent factors associated with very poor outcome: time from stroke onset to treatment &gt;= 140 min (OR 2.790, 95% CI 1.082-7.193; p = 0.0337), baseline National Institutes of Health Stroke Scale score &gt;= 20 (OR 3.794, 95% CI 1.199-12.009; p = 0.0233), glucose &gt;= 180 mg/dl (OR 3.288, 95% CI 1.126-9.600; p = 0.0295), internal carotid artery occlusion (OR 6.187, 95% CI 5.090-18.354; p = 0.0129) and M1 susceptibility vessel sign (OR 6.379, 95% CI 1.194-34.074; p = 0.030). Those 5 variables were selected in the scale, with each factor as 1 point. Frequencies of patients with a very poor outcome for each score were as follows: score 0, 26.3%; score 1, 30.6%; score 2, 70.0%, and score 3-5, 100%. Conclusion: A clinical scale using clinical and MRI factors can predict very poor outcome in t-PA patients. Copyright (C) 2011 S. Karger AG, Basel

DOI： 10.1159/000327690

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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：KARGER  

Background: Hemorrhagic transformation (HT) is a well-known consequence of acute ischemic stroke, but little is known about HT in cerebellar infarction. Methods: Patients with acute cerebellar infarction within 48 h of onset were retrospectively recruited. MRI, including diffusion-weighted imaging (DWI) and T(2)*-gradient echo imaging (T(2)*), was performed twice (upon admission and 2 weeks after stroke onset). Infarct diameter and volume were measured by manual tracing on initial DWI. HT was evaluated with follow-up T(2)*, and all patients were divided into two groups according to the presence of HT (HT group and non-HT group). The frequency of HT and the factors associated with HT were investigated. Results: Ninety-six patients (64 males, median age 74 years, IQR 65-81 years, and National Institute of Health Stroke Scale score 5, IQR 1-14) were enrolled. Forty-two patients (43%) showed HT on follow-up T(2)* (HT group). Infarct diameter and volume were larger in the HT group than in the non-HT group (3.2 vs. 1.6 cm, respectively, p &lt; 0.001, for infarct diameter and 8.0 vs. 1.7 cm(3), respectively, p &lt; 0.001 for infarct volume). Multivariate logistic regression analysis revealed that both infarct diameter &gt; 2.7 cm (OR 7.58, 95% CI 2.82-20.4, p &lt; 0.001) and volume &gt; 4.5 cm(3) (OR 11.5, 95% CI 3.80-34.8, p &lt; 0.001) were independent factors associated with HT. Conclusions: Half of the patients with acute cerebellar infarcts had HT on follow-up T(2)*. Initial infarct diameter and volume on DWI were independent factors associated with HT. Copyright (C) 2011 S. Karger AG, Basel

DOI： 10.1159/000329259

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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：EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC  

The aim of this study was to investigate the annual incidence of atrial fibrillation (AF) and related factors from health surveys in 2006 and 2007. Participants (aged &gt;= 40 years) were examined from annual health surveys provided by the Kurashiki Public Health Center twice, in 2006 and 2007. Participants were classified into 2 groups: a control group without AF in 2006 and 2007, and an AF group with documented AF in 2007 but not in 2006. Annual AF incidence (per 1,000 patient-years) was calculated, and baseline characteristics were compared between groups. Independent factors for new documented AF were analyzed using multivariate logistic regression modeling. Health surveys were performed for 30,449 participants in 2006 and 2007. Excluding 439 participants with AF in 2006, newly documented AF was observed in 278 participants (0.9%), while the control group comprised 29,732 participants. The overall incidence of newly documented AF was 9.3/1,000 patient-years. Newly documented AF was significantly associated with age &gt;= 80 years (odds ratio [OR] 1.57, 95% confidence interval [CI] 1.20 to 2.06, p = 0.001), history of cardiac disease (OR 7.47, 95% CI 5.79 to 9.63, p &lt;0.001), increasing estimated glomerular filtration rate of 10 ml/min/1.73 m(2) (OR 0.93, 95% CI 0.87 to 0.99, p = 0.025), and hypercholesterolemia (OR 0.75, 95% CI 0.58 to 0.96, p = 0.023). (C) 2010 Elsevier Inc. All rights reserved. (Am J Cardiol 2010;106:1129-1133)

DOI： 10.1016/j.amjcard.2010.06.030

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Our aim is to investigate the utility of transcranial Doppler (TCD) monitoring during intravenous administration of 0.6 mg/kg recombinant tissue plasminogen activator (IV rt-PA) which is governmental approved in Japan. Acute ischemic stroke patients with M1 portion of the middle cerebral artery (M1) occlusion treated with IV rt-PA were prospectively enrolled. M1 occlusion was diagnosed before IV rt-PA using magnetic resonance angiography (MRA). Patients without sufficient temporal window of TCD were excluded. TCD monitoring was conducted for 1 hour (h) during IV rt-PA. Recanalization on TCD was defined using thrombolysis in brain ischemia (TIBI) flow grades. After all patients were classified into two groups according to the presence of TCD recanalization (TCD recanalization and TCD non-recanalization group), three-month patients outcome, recanalization rate on MRA 1 h of IV rt-PA, and symptomatic cerebral hemorrhage within 24 h were compared between two groups. We enrolled 16 patients. Eight patients (50%, 7 men [88%]; age, 70 years [interquartile range. 55-81]; NIHSS score, 18 [12-22]) were in the TCD recanalization group and 8 (50%, 6 men [75%]; age, 72 years [62-79]; NIHSS score 19 [15-23] were in the TCD non-recanalization group. Symptomatic cerebral hemorrhage was not seen in both groups at all. MRA 1 h of IV rt-PA revealed recanalization in all 8 (100%) patients with TCD recanalization group and 2 (25%) with TCD non-recanalization group (agreement, 88%; and kappa value, 0.75, P = 0.002). At three months, 5 (63%) of 8 patients in the TCD recanalization group had favorable outcome, and 0 (0%) of 8 in the TCD non-recanalization group (P = 0.026). TCD monitoring for 1 h during IV rt-PA can diagnose the recanalization based on MRA. TCD monitoring should predict good clinical outcome at three months.

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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 SCIENCE BV  

Background and purpose: in acute stroke patients treated with intravenous tissue plasminogen activator (t-PA), early recanalization can improve patient outcome. Heart failure may result in reduction of brain perfusion, which limits the ability of the blood stream to wash out emboli. Brain natriuretic peptide (BNP) is used as a biological marker of heart failure. Most stroke patients with atrial fibrillation (AF) have elevated BNP levels. We investigated the relationships of plasma BNP levels before t-PA infusion and AF with early recanalization after t-PA infusion.
Methods: Patients with a major brain artery occlusion were studied prospectively. MRAs were performed before and within 60 min after t-PA infusion. The relationship between BNP levels before t-PA infusion and the presence of AF with early recanalization was examined.
Results: Seventy-nine patients (49 men; mean age, 75.5 +/- 10.4 years; ICA occlusion in 25 patients, M1 in 32, M2 in 13, PCA in 3, and BA in 6) were enrolled. Follow-up MRA within 60 min after t-PA infusion revealed recanalization in 35 (44.3%) patients and no recanalization in 44 (55.7%). Patients with AF (57.1% vs. 75.0%, P=0.0294) and BNP &lt;= 150 pg/dl (39.0% vs. 73.7%, P=0.0019) less frequently had early recanalization than those without AF and with BNP 150 pg/dl. The combination of AF and BNP&gt; 150 pg/ml was a useful predictor for no early recanalization (positive predictive value, 79.4%: negative predictive value, 622%; sensitivity, 61.4%; specificity, 80.0%).
Conclusion: The presence of AF and elevated BINP was associated with no early recanalization after IV-t-PA therapy. We should need further study to ascertain its predictive ability. (C) 2009 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jns.2009.11.014

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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：KARGER  

Background It is not clear whether tissue plasminogen activator (t-PA) thrombolysis in patients without major arterial occlusion is effective or safe Methods Consecutive anterior circulation stroke patients treated with t-PA within 3 h of onset were studied The patients were divided into three groups according to magnetic resonance angiography findings before t-PA infusion ICA group, ICA occlusion, MCA group, M1 and M2 occlusion, and no occlusion group Clinical characteristics, the presence of hemorrhagic transformation on T(2)* at 24 h after t-PA thrombolysis, and outcome at 3 months were compared among the three groups Results 112 patients were enrolled The no occlusion group had 21 (18 8%) patients, the ICA group had 29 (25 9%), and the MCA group had 62 (55 4%) The frequency of hemorrhagic transformation was only 4 8% in the no occlusion group (31 0% for the ICA group, and 48 4% for the MCA group, p = 0 0012) At 3 months after t-PA therapy, 61 5% of the no occlusion group had a favorable outcome (modified Rankin score 0-1), which was the highest among the three groups (15 0% for the ICA group, and 41 5% for the MCA group, p = 0 0203) Conclusion Intravenous t-PA therapy in acute stroke patients without major artery occlusion seems to be safe and effective Copyright (C) 2010 S Karger AG Basel

DOI： 10.1159/000320950

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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：KARGER  

Background/Aim: Early recanalization after tissue plasminogen activator (t-PA) infusion greatly improves outcome in stroke patients. However, the time threshold of early recanalization for a favorable outcome remains unclear. The aim of this study was to assess patient outcome 3 months after t-PA therapy among patients with early, delayed and without recanalization. Methods: Consecutive patients with major brain artery occlusion on magnetic resonance angiography (MRA) before t-PA infusion were enrolled. We divided the patients into 3 groups according to the findings of follow-up MRA 1 and 24 h after t-PA: the early group who had recanalization within 1 h after t-PA; the delayed group who had recanalization between 1 and 24 h, and the no recanalization group. We then assessed the outcomes (modified Rankin score 0-1) 3 months after t-PA therapy among the 3 groups. Results: A total of 92 patients (53 men, mean age 75.8 +/- 10.3 years) were enrolled. A favorable outcome was most frequently observed in the early group (n = 39, 40.6%), followed by the delayed group (n = 25, 18.2%), and the no recanalization group (n = 28, 10.5%; p = 0.037). After adjusting for age, atrial fibrillation and NIHSS score, the adjusted OR for early recanalization when compared with no recanalization was 7.11 (95% CI 1.177-43.063; p = 0.032) for a favorable outcome, while the adjusted OR for delayed recanalization was 1.75 (95% CI 0.104-29.356; p = 0.698). Conclusion: Early recanalization within 1 h after intravenous t-PA is associated with a favorable outcome in stroke patients. Copyright (C) 2010 S. Karger AG, Basel

DOI： 10.1159/000311736

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記述言語：日本語   出版者・発行元：(一社)日本神経治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経治療学会  

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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：日本脳循環代謝学会  

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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：LIPPINCOTT WILLIAMS & WILKINS  

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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：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：(NPO)日本脳神経血管内治療学会  

【目的】2015年に脳梗塞の機械的血栓回収療法の有用性が示されたが,一方で頭蓋内/外の主幹動脈狭窄を有する脳梗塞例に対する血管形成術の有用性はいまだ明らかになっていない.われわれは急性期脳梗塞に対し血栓溶解療法,機械的血栓回収療法およびステントを用いた血管形成術を施行し奏功した症例を経験した.文献的考察と合わせて報告する.【症例】62歳の男性が前医で右内頸動脈閉塞に伴う脳梗塞と診断され,発症158分で当院に搬送された.Tissue plasminogen activator(tPA)静注療法後に血管内治療を行い,撮影で内頸動脈破裂孔部から海綿静脈洞部にかけて閉塞を認めた.内頸動脈に誘導した9Fr Optimoから用手吸引術を行うと内頸動脈破裂孔部に狭窄を確認できた.同部位にPercutaneous Transluminal Angioplasty(PTA)施行後,Penumbra 5MAX ACEを用いて右M1閉塞に対し機械的血栓回収療法を行い完全再開通が得られた.内頸動脈破裂孔部の残存狭窄に対し冠動脈ステントを留置し手技を終了した.翌日の頭部MRA検査では前方循環の描出は改善しており,臨床所見も著明な改善を認めた.【結語】頭蓋内内頸動脈内での用手吸引術,頭蓋内PTA,右M1での機械的血栓除去術,頭蓋内内頸動脈の残存狭窄に対する冠動脈ステント留置術によって良好な経過が得られた1例を報告した.(著者抄録)

DOI： 10.20626/nkc.cr.2016-0082

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記述言語：日本語   出版者・発行元：一般社団法人 日本脳卒中学会  

&lt;p&gt;Stanford A 型急性大動脈解離は緊急手術を要する疾患である．脳梗塞を合併すると意識障害や失語症などのために胸痛・背部痛の訴えがない場合が多く「不適切なrt-PA 静注療法による致死的経過」と「適切な外科的治療の遅れ」が問題となる．脳卒中疑い対応時に救急隊と初療医は常に大動脈解離の疑いをもつ必要がある．初療医は胸痛・背部痛の訴えがない場合でも血圧左右差やXp 上の上縦隔拡大から大動脈解離を疑う場合にはすぐに造影CT 検査で評価する．意識障害や失語症などにより胸痛・背部痛を確認できない場合や，緊急時に神経症候変動がある場合など大動脈解離を否定できない場合には必ず総頸動脈の評価を行う．頭頸部動脈を含めた頭部画像評価が望ましい．可能な施設はD-dimer を測定する．これらの結果から大動脈解離を疑う場合にもすぐに造影CT 検査を行う．大動脈解離が判明したらすぐに専門診療科に相談して治療方針を決定する．&lt;/p&gt;

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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：(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：日本脳循環代謝学会  

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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：LIPPINCOTT WILLIAMS & WILKINS  

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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：LIPPINCOTT WILLIAMS & WILKINS  

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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：LIPPINCOTT WILLIAMS & WILKINS  

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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：(一社)日本脳卒中学会  

2013年に筆者らの施設から論文報告された。急性期脳梗塞への静注血栓溶解療法の治療成績、とくに血管閉塞部位や治療後早期再開通に関する研究成果を概説する。Kogaらは治療開始後8時間以内(大半がrt-PA投与終了前後)のMRAでの再開通を阻害する要因としての、近位部主幹動脈閉塞と高感度C反応性蛋白高値の意義を報告した。Osakiらは、rt-PA静注の終了までの短時間に、NIH Stroke Scale値を用いて臨床転帰を予測する方法を報告した。またSakamotoらは、治療前の拡散強調画像とMRAの所見からreverse MRA-DWIミスマッチに該当する症例を割り出し、その臨床像やrt-PA静注療法の治療成績を報告した。(著者抄録)

DOI： 10.3995/jstroke.36.197

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記述言語：日本語   出版者・発行元：(一社)日本脳神経超音波学会  

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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：LIPPINCOTT WILLIAMS & WILKINS  

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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：LIPPINCOTT WILLIAMS & WILKINS  

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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)日本脳神経超音波学会  

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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：(一社)日本脳神経超音波学会  

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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：LIPPINCOTT WILLIAMS & WILKINS  

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：日本神経治療学会  

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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：LIPPINCOTT WILLIAMS & WILKINS  

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：LIPPINCOTT WILLIAMS & WILKINS  

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：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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記述言語：日本語   出版者・発行元：メディカ出版  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2010092585

記述言語：日本語   出版者・発行元：メディカ出版  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2010300930

記述言語：英語   会議種別：ポスター発表  

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記述言語：日本語   会議種別：口頭発表（一般）  

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会議種別：口頭発表（招待・特別）  

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