We investigated the relationship between the duration from onset of stroke to initial administration of sodium ozagrel (thromboxane A₂ synthetase inhibitor) and functional recovery in patients with acute ischemic stroke. The subjects includcd 118 patients with lacunar infarction (71 males and 47 females; mean age, 68 years) and 80 with atherothrombotic infarction (53 males and 27 females; mean age, 69 years), who were admitted to Tokai University Hachioji Hospital or Oiso Hospital from 2002 to 2004 and treated using sodium ozagrel. We evaluated the severity and functional outcome in each patient at admission, on day 7, and on day 28 or at discharge, using 3 scales; the Japan Stroke Scale (JSS), NIH Stroke Scale (NIHSS) and modified Rankin Scale (m-RS). As regards the duration from onset of stroke to the initial administration of sodium ozagrel, the patients were divided into 3 groups. In Group 1, treatment was started within 6 hours after the onset. In Groups 2 and 3, the start times were from 6 to 24 hours and more than 24 hours after the onset, respectively. In lacunar infarction and atherosclerotic infarction, patients with moderate severity (JSS equal to or more than 3.0) who started sodium ozagrel within 6 hours after the onset revealed a statistically significant improvement in severity and functional outcome, while those who started later did not. In conclusion, early administration of sodium ozagrel can improve severity and functional recovery in acute ischemic thrombosis.

View full abstract

Purpose:We investigated the perioperative and long-term outcome in both CAS and CEA cases separating acute and chronic phase operations for each procedure.
Methods:In total, 103 consecutive patients who underwent some revascularization procedure from January 1998 to October 2006 at our deparment were enrolled. The CAS cases amaunted to 52 (chronic cases, 48; acute cases, 4) and the CEA cases to 51 (chronic cases: 47; acute cases: 4).
Results:The perioperative outcome of chronic operations for both procedures was favorable; the morbidity rate was 2.1% and the mortality rate was 0% in both procedures. On the other hand, the perioperative outcome of acute operations appesred to be worse than the chronic one; that is, the morbidity rate was 25%, while the mortality rate was 0% in both procedures. Over the long-term follow-up period, both procedures revealed no infarction at both timings of the operation. Occurrence of other disorders that impaired the ADL was observed in 7.9% of chronic CAS cases and in 14% of chronic CEA cases. In contrast, acute operation cases revealed no other complications in both CAS and CEA. There were few cases that had ADL impairment due to cardiac diseases among our patients, This may have been attributable the fact that in our protocol, all patients underwent cardiological consultation before the operation and were managed even after leaving hospital. Conclusion: Our data suggest that CAS could be performed securely, and revealed good results on long-term follow-up. It could also be expected to represent an alternative for high-risk patients of CEA.

View full abstract

Background and purpose:Subarachnoid hemorrhage (SAH) patients with ruptured aneurysms smaller than 5 mm in diameter are sometimes encountoied at our hospital. However, the operative indication for unruptured aneurysm is over 5 mm according to the JAPANESE SOCIETY FOR DETECTION OF ASYMPTOMATIC BRAIN DISEASES. We therefore analyzed the characteristics of ruptured aneurysms smaller than 5 mm in diameter. Methods:A retrospective review of all SAH patients using digital subtraction angiography (DSA) between April 1999 and March 2004 was conducted. We compared 201 SAH patients with DSA (group A) and 61 with aneurysms smaller than 5 mm (group B). Age, gender, familial history, hypertension, and location of the ruptured aneurysm were examined. Results:In males younger than 40 years old, anterior communicating artery/distal anterior cerebral artery (Acom/DACA) aneurysms were significantly correlated with group B rather than group A. Familial history and hypertension were not found to be characteristic in group B in this study. Conclusion:Small unruptured aneurysms may have a risk of rupture especially in young males with Acom/DACA aneurysms. Further investigations on small aneurysms are needed.

View full abstract

The goal of activity (PGA) and length of stay (PLS) of 116 inpatients with stroke in the post acute rehabilitation unit were prearranged simultaneously with the first evaluation. The first FIM and SIAS (Stroke Impairment Assessment Set) were measured at 57.4±15.7 days after the onset and the last FIM was scaled just before the discharge. The PGA was also scored by FIM. The predicted FIM gain (PGA-first FIM) was correlated to the real FIM gain (R²=0.408) and the PLS was correlated to the real length of stay (RLS: 79.5±20.3 days) (R²=0.598). For further examination, patients were divided into four groups according to the goal error (GE: PGA-last FIM) and the length error (LE: RLS-PLS), as follows: Group AI, GE≤7 and LE≤13, 39 cases;Group AII, GE≤7 and LE≥14, 32 cases;Group BI, GE≥8 and LE≤13, 23 cases; and Group BII, GE≥8 and LE≥14, 22 cases. To investigate the factors affecting the errors, several clinical indicators were analyzed among the groups. Group AII had lower scores for the sum of the first FIM and SIAS but conserved cognitive function. Group BI had disturbed cognitive function in the first FIM and body function of SIAS. Group BII had extremely low scores for the first FIM and SIAS. The home return rates were significantly low in Groups BI and BII. In order to establish the PGA and PLS with accuracy, multiple factors affecting efficacy of rehabilitation should be considered in each patient.

View full abstract

Since 3D-CTA can demonstrate occlusion or stenosis of the arteries, it has been employed for the diagnosis of patients with cerebral infarction. However, it does not provide information on the blood-flow dynamics. We therefore developed a new technique, d3D-CTA (dynamic 3D-CTA), that yields 3D images of the vessels and hemodynamics. We assessed whether or not our technique could be applied to patients with cerebral infarction. We subjected 41 patients with cerebral infarction to d3D-CTA (17 lacunar infarctions, 14 cardioembolisms and 10 atherosclerotic infarctions). d3D-CTA was performed using a multi-detector row CT scanner with 64 detectors. Contrast medium was injected at a speed of 6 ml/s (a total volume of 30 ml). The scanning was performed for 30 sec with a scan delay of 5 sec. In all cases, we successfully developed d3D-CTA. The d3D-CTA provided us with information on the vascular structures, hemodynamics and cerebral perfusion. Although our technique, d3D-CTA, has some disadvantages such as a limited scan range (32 mm) and relatively high radiation dose, it does facilitate the acquisition of information on the vascular anatomy, flow dynamics on 3D images and cerebral perfusion. We conclude that d3D-CTA can be applied for the diagnosis and treatment of patients with cerebral infarction.

View full abstract

Background and Purpose:Abnormal secretion of adipocytokines from visceral fat tissue may be associated with the onset of stroke as well as development of atherosclerosis. The aim of this study was to examine the plasma adiponectin (ADPN) concentrations in each clinical subtype of stroke. Methods:From March 1, 2005 to February 28, 2006, 173 patients (111 men, 62 women; mean age, 71 years) with completed stroke who were admitted to our Stroke Care Unit within 7 days of the onset were enrolled. Fasting blood samples were obtained at 19 days on average after the onset of stroke. We measured the plasma ADPN concentrations with a sandwich ELISA system (adiponectin ELISA kit, Otsuka Pharmaceutical Co. Ltd.). Metabolic syndrome was diagnosed according to the criteria of the Japanese Society of Internal Medicine. Results:The ADPN concentrations were as follows:atherothrombotic brain infarction (ABI), 8.5±4.2; lacunar infarction (LI), 7.8±3.4; cardioembolic stroke (CES), 13.2±9.5; other types of infarction (OTI), 11.4±7.1; and intracerebral hemorrhage, 12.6±8.1 μg/ml. There was no significant difference in plasma ADPN concentration between brain infarction and hemorrhage. However, the plasma ADPN concentration in the thrombotic infarction group (ABI and LI) was significantly lower than that in the non-thrombotic infarction group (CES and OTI) (8.3±4.1 and 12.2±8.4 μg/ml, respectively;p=0.01).
Conclusion:Hypoadiponectinemia may be associated with thrombotic brain infarction

View full abstract

Purpose:To identify prognostic factors in patients with brainstem hemorrhage, we analyzed their clinical symptoms and laboratory data on admission to our hospital. Methods:In 70 patients with brainstem hemorrhage (51 men and 19 women aged 29-93, with a mean of 59 gears) who had been admitted to our hospital from 1995 to 2000, we statistically evaluated the association of the outcome with their age and clinical symptoms on admission, blood glucose levels and white blood counts within 6 hours of admission, and the volume and extent of hematoma, concomitant hydrocephalus, and intraventricular perforation on admission CT scans.Results and Conclusion:The mortality tended to be higher, but not significantly (P=0.07), in patients aged 70 years or older (83%) than in those aged less than 70 years (55%). Quadriplegia or decerebrate rigidity (P<0.01) and loss of the light reflex (P<0.05) were associated with a significantly poorer outcome. Blood glucose levels of 200 mg/dl or higher (P<0.05) and white blood counts of 10,000 /mm² or higher (P<0.01) on admission were significantly correlated with the prognosis. Hematoma volumes of 6 ml or larger on CT scans were most strongly correlated with the prognosis (P<0.001). Central hematoma and hematoma with extension to the midbrain, thalamus, or medulla oblongata (P<0.05), as well as hemorrhage complicated by hydrocephalus or intraventricular perforation (P<0.01), were correlated with the prognosis.

View full abstract

It has been reported that hyperglycemia associated with neurological deterioration in patients with acute ischemic stroke. We evaluated the effectiveness of edaravone in minor stroke patients with hyperglycemia. We retrospectively analyzed 32 consecutive acute stroke patients with hyperglycemia of over 200 mg/dl and neurological symptoms of between 1 and 4 on the National Institutes of Health Stroke Scale (NIHSS) score. We investigated which factors were associated with a good outcome of 0 or 1 on the modified Rankin Scale at hospital discharge. A good outcome was significantly related to a lower score on the NIHSS at admission, the administration of edaravone, and abnormality of serum creatinine. Multiple logistic regression analysis demonstrated a significant association of both a low score on the NIHSS and the administration of edaravone with a good outcome. The results obtained indicated that edaravone might improve the neurological symptoms in minor stroke patients with hyperglycemia.

View full abstract

Neurological progression in acute ischemic stroke is associated with an increased risk of a poor outcome. We evaluated the role of platelet activation, coagulation system marker and clinical background in acute small vessel infarction. Sixty-one patients with non-cardioembolic small vessel infarction, admitted within 3 days after onset, were evaluated. The progressive group was defined by a more than 2 points increase on the NIH Stroke Scale score within 2 days after admission. Clinical, radiological, and biochemical parameters including platelet activation and coagulation system marker were compared between the progressive (n=16) and non-progressive (n=45) groups. Patients with hyperlipidemia and a lesion size of over 15 mm were significantly associated with the progressive group. The value for D-dimer was significantly higher in the progressive group, and was considered as a significant predictor of early neurological progression by logistic regression analysis. These findings suggest that the coagulation system may play an important role in early neurological progression of acute small vessel infarction.

View full abstract

A 61-year-old man was admittied to our hospital with sudden onset of headache and vomiting. Computerized tomography demonstrated perimesencephalic nonaneurysmal subarachnoid hemorrhage (PSH). Left carotid artery angiography revealed a persistent primitive proatlantal intersegmentl artery (PPPIA) originating from the left internal carotid artery. No aneurysm was found. To our knowledge, this is the first report of a PPPIA (typeI) with a PSH. Primitive persistent artery combined with intracranial aneurysms is not rare, and since there are reports of delayed de novo aneurysm, we will pay particular attention to that possible outcome.

View full abstract

A 74-year-old woman suddenly developed left hemiplegia with no facial involvement. However, her symptoms rapidly improved, when the indication for intravenous recombinant tissue-type plasminogen activator was under careful consideration on admission. On the day following admission, she displayed left Horner syndrome, although the left hemiplegia was remarkably improved. Based on the precise neurological findings, we performed emergent magnetic resonance imaging and diagnosed the patient as having a spinal epidural hematoma.
In this case, we should have discriminated the cervical lesion from the intracranial lesion. Horner syndrome could be an important sign for the anatomical diagnosis and the possibility of spontaneous spinal epidural hematoma in some cases.

View full abstract

We recently experienced two cases of supratentorial intracranial hemorrhage which manifested as symptomatic epilepsy following lumbar spinal surgery. Case 1: An 80-year-old male, who had undergone posterior lumbar interbody fixation (PLIF) at L3/4 and L4/5 for lumbar spinal canal stenosis, later developed generalized seizures and consciousness disturbance postoperatively. Head computed tomography (CT) revealed a mild supratentorial subarachnoidal and subdural hemorrhage. He recovered completely without any neurological deficits by 24 hours after onset. Case 2: An 83-year-old male, who suffered pyogenic spondylitis and had undergone a corpectomy and PLIF at L3/4 and L4/5, showed stupor even after weaning from artificial ventilation. Head CT revealed a small supratentorial subarachnoidal hemorrhage. He became alert by 12 hours after the operation. The occurrence of perioperative intracranial hemorrhage is of relatively rare, late onset, and infratentorial complications after spinal surgery are speculated to be due to leakage of spinal fluid as a result of an unintended durotomy. Our cases are unique in several respects: 1) the supratentorial hemorrhage, 2) early onset, 3) lack of signs of cerebrospinal hypotension, and 4) they occurred as consciousness disturbance.

View full abstract

Subarachnoid hemorrhage (SAH) is one of the notorious categories in which it is difficul to predict functional outcome. We report here the results of our investigation of 46 SAH cases, aiming at predicting their functional outcome on discharge. FIM was chosen as an outcome indicator, and we then evaluated several acute stage parameters, as follows: patient's age at onset, CT classification by Fisher, presence or absence of intraventricular hematomas, level of consciousness on admission, and duration of disturbed consciousness. The most susceptible factor for predicting disability level was age, followed by CT classification, and then duration of disturbance of consciousness.

View full abstract

The presence of intracranial tumors, arteriovenous malformations or intracranial aneurysms is listed on the drug information sheet as a contraindication for using intravenous thrombolysis with rt-PA for acute cerebral infarction. In this study, a search was undertaken to collect scientific evidence for excluding unruptured intracranial aneurysms from such thrombolysis. As a result, no such evidence was found in studies that presented a theoretical basis for the therapy, and there was no case of intracranial aneurysmal rupture related to the use of intravenous thrombolysis with rt-PA for acute cerebral infarction.

View full abstract