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Volume 33 (2011)
- Issue 6 Pages 551-
- Issue 5 Pages 473-
- Issue 4 Pages 393-
- Issue 3 Pages 305-
- Issue 2 Pages 217-
- Issue 1 Pages 1-
Volume 33, Issue 6
Displaying 1-7 of 7 articles from this issue
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Originals
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The trend in antithrombotic therapy for cardioembolic stroke due to non-valvular atrial fibrillationYoshiharu Taguchi, Shutaro Takashima, Nobuhiro Dougu, Koji Hirano, Tak ...2011 Volume 33 Issue 6 Pages 551-558
Published: 2011
Released on J-STAGE: November 25, 2011
JOURNAL FREE ACCESSBackground and Purpose: We studied the trend in antithrombotic therapy for cardioembolic stroke (CE) due to non-valvular atrial fibrillation (NVAF).Methods: The trend in antithrombotic therapy for CE was evaluated in eighty-eight (88) patients with CE due to NVAF who had been hospitalized in our department between June 2005 and November 2010.Results: Among these 88 patients, 39 (44.3%) had paroxysmal atrial fibrillation (PAF), and 34 (38.6%) had a CHADS2 score of 0 or 1. 28 patients (31.8%) were on oral warfarin therapy, 20 (22.7%) were on oral antiplatelet therapy alone, and 40 (45.5%) were not receiving antithrombotic therapy. In addition, the mean PT-INR value on admission in patients on oral warfarin therapy was only 1.17, and only 2 patients showed PT-INR values within the optimal therapeutic range. The patients who were not receiving oral warfarin therapy had a significantly lower incidence of prior cerebral infarction, with PAF incidence and D-dimer values being significantly higher, than those on oral warfarin therapy.Conclusion: Antithrombotic therapy in the NVAF patients with CE was insufficient. Therefore, antithrombotic therapy complying with the guidelines can also be considered necessary in PAF and CHADS2 score of 1.View full abstractDownload PDF (854K) -
Hideharu Tomita, Ryo Shimoda, Yasuhiro Fujino, Tomoya Hashimoto, Akiko ...2011 Volume 33 Issue 6 Pages 559-563
Published: 2011
Released on J-STAGE: November 25, 2011
JOURNAL FREE ACCESSWe investigated whether renal function has an effect on risk factors for stroke and anticoagulation quality by warfarin therapy in patients with non-valvular atrial fibrillation (NVAF). Ninety-three (93) NVAF patients were enrolled and were separated into three groups according to Creatinine Clearance Rate (CCr), Group A (15 patients): <30 ml/min, Group B (23 patients): 30-50 ml/min, Group C (55 patients): >50 ml/min. We evaluated the differences in age, CHADS2 score, and time in therapeutic range (TTR) among the three groups. The averages of age, CHADS2 score, and TTR were 87.3, 3.33, and 56.9% in group A, 82.1, 3.13, and 73.5% in group B, 72.5, 2.35, and 76.8% in group C, respectively. NVAF patients with renal dysfunction had higher risks in age, higher CHADS2 score, and lower TTR. Anticoagulation therapy in NVAF patients with chronic renal dysfunction should be used carefully, taking into consideration the risk for stroke, the quality of anticoagulation, and the indication for new anticoagulants.View full abstractDownload PDF (817K) -
Kana Shimomura, Kanako Shimizu, Yoshiaki Tokuyama, Kenzo Sakurai, Kenj ...2011 Volume 33 Issue 6 Pages 564-571
Published: 2011
Released on J-STAGE: November 25, 2011
JOURNAL FREE ACCESSBackground and Purpose: The mechanism of inflammation plays a key role in the pathophysiology of atherothrombosis. We aimed to elucidate the relationships between ischemic stroke subtypes and serum levels of inflammatory biomarkers early after stroke onset.Methods: Serum levels of high-sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, IL-10, IL-18, matrix metalloproteinase (MMP)-2, and MMP-9 were measured in 142 ischemic stroke patients within 48 hours of stroke onset. Relationships between the biomarkers and ischemic stroke subtypes were investigated using logistic regression analysis.Results: Serum levels of MMP-2 [odds ratio (OR) 1.003 (95% confidence interval (CI), 1.000-1.005)] as well as initial infarct volume [OR 1.006, (95% CI, 1.001-1.010)] were significantly higher in cardioembolic stroke than with other stroke subtypes even after adjustment of possible confounders. In patients with severe intracranial artery stenosis, hs-CRP and IL-6 levels were significantly higher than those with mild stenosis (p = 0.034 and 0.029, respectively).Conclusions: MMP-2 levels were significantly higher in cardioembolic stroke than for any other stroke subtype. IL-6 and hs-CRP levels measured within 48 hours of stroke onset may represent an atherosclerotic burden in the cerebral arteries.View full abstractDownload PDF (988K)
Case Reports
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Shiro Chitoku, Michiyoshi Sato, Shinzo Ota, Katsuya Goto, Kosuke Ota2011 Volume 33 Issue 6 Pages 572-577
Published: 2011
Released on J-STAGE: November 25, 2011
JOURNAL FREE ACCESSThis is a report on a case with good recovery from the so-called "alpha coma state" caused by subarachnoid hemorrhage following coil embolization. A sixty-year-old male showed severe disturbance in consciousness. On arrival, he was in deep coma with respiratory insufficiency, mydriasis, and quadriparesis. CT scan showed severe subarachnoid hemorrhage. Plain chest film showed acute pulmonary edema. Cerebral angiography showed a small aneurysm at the anterior communicating artery. EEG demonstrated monotonous alpha rhythm in all leads. Endovascular treatment was performed on the same day. Coil embolization was successfully done with 19% embolization rate. His consciousness level and quadriparesis slowly recovered. His Hasegawa mental score was 26 points, and his modified Rankin scale was 3 at 6 months follow-up. Although previous reports about patients showing alpha coma resulted in bad outcome, recent reports showing good outcome are occasionally seen. Reflecting the current cerebral function, EEG is considered to be one of the useful methods in evaluating the outcome of patients with disturbance in consciousness. As it is becoming clear that alpha coma is not a definite sign of poor outcome, we should evaluate the preoperative results of other neurophysiological studies and response to first therapy to determine the surgical indication of these poor grade SAH patients.View full abstractDownload PDF (1643K) -
Yushin Takemoto, Hiroyuki Kawano, Yuichiro Inatomi, Toshiro Yonehara, ...2011 Volume 33 Issue 6 Pages 578-582
Published: 2011
Released on J-STAGE: November 25, 2011
JOURNAL FREE ACCESSA 77-year-old man was admitted with vertigo and headache. The following day, he developed dysarthria and left hemiplegia. Diffusion-weighted imaging demonstrated bilateral medial medullary infarcts which were separately located in the anterior and posterior portions. He gradually developed quadriplegia and dysphagia, and died due to aspiration pneumonia. Diffusion-weighted imaging findings of the present case revealed a unique configuration, which might predict poor outcome in patients with medial medullary infarction.View full abstractDownload PDF (875K) -
Masaki Mogi, Mutsuo Fujisawa, Shiro Yamashita, Masatsugu Horiuchi, Ryo ...2011 Volume 33 Issue 6 Pages 583-589
Published: 2011
Released on J-STAGE: November 25, 2011
JOURNAL FREE ACCESSA 64-year-old woman was admitted to our hospital for sudden slurred speech and right leg-predominant weakness. She experienced recurrent episodes of stroke during her 6 years of warfarinization. Magnetic resonance imaging (MRI) indicated anterior cerebral artery (A3) occlusion. Anticoagulation therapy with heparin was started because she was not suitable for t-PA treatment due to "wake-up stroke." After conversion from heparin to warfarin, ischemic stroke recurred twice in the posterior cerebral artery (P1) and the middle cerebral artery (M1) in one month. We speculated but were not able to diagnose cardioembolic stroke because there was no abnormality in her cardiac echo test, ambulatory blood pressure monitor, etc. Fibrin degradation products (FDP) and D-dimer levels were significantly elevated. Moreover, significant leukocytosis, especially monocytosis was observed. Abdominal computed tomography scan exhibited progressive pancreatic cancer which invaded into the spleen with multiple metastasis to the liver. There was a remarkable increase in CA-125 levels. After change of treatment from warfarin to low molecular weight heparin, stroke did not recur; however, she was in a serious systemic condition due to the large M1 occlusion and malignant tumor. Therefore, she received palliative care and died at 66 days after administration. We diagnosed this case as Trousseau syndrome. Monocytosis may be involved in this blood coagulation disorder.View full abstractDownload PDF (1840K)
Letter
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Makoto Nakajima, Teruyuki Hirano2011 Volume 33 Issue 6 Pages 590-591
Published: 2011
Released on J-STAGE: November 25, 2011
JOURNAL FREE ACCESSSome patients with hemilateral striatal infarction demonstrate increased intensity of ipsilateral substantia nigra on diffusion-weighted imaging, which is known as a pitfall of diagnostic imaging of acute stroke. Clinicians should be cautious of misdiagnosis and should avoid unnecessary investigation or treatment in such patients.View full abstractDownload PDF (379K)
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