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Volume 31 (2009)
- Issue 6 Pages 395-
- Issue 5 Pages 291-
- Issue 4 Pages 211-
- Issue 3 Pages 141-
- Issue 2 Pages 67-
- Issue 1 Pages 1-
Volume 31, Issue 2
Displaying 1-10 of 10 articles from this issue
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Originals
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Masatoshi Koga, Toshiyuki Uehara, Kazuyuki Nagatsuka, Nobuyuki Yasui, ...2009 Volume 31 Issue 2 Pages 67-73
Published: 2009
Released on J-STAGE: April 20, 2009
JOURNAL FREE ACCESSBackground and purpose: Emphasis is currently placed on the importance of the community-based care for stroke patients provided by acute hospitals (AH), convalescent rehabilitation wards (CRW), general practices (GP), long-term care facilities (LTCF) and in-home and commuting care services (IHCCS). We conducted a nationwide questionnaire survey to evaluate the role of AH in stroke care.
Subjects and Methods: In total, 12 representative prefectures were selected based on their population density. Questionnaires concerning the community-based referral system and long-term care insurance system were sent to all 2,185 AH.
Results: Forty-six percent of the hospitals answered. Fifty-two percent were engaged in medical practice for stroke patients. The major assessment scales for ADL were the Barthel Index (41%), the modified Rankin Scale (39%), and the simple ADL scale for long-term care insurance (41%). AH (69%) were expected to play a central role in the community-based care system. Good or fair relationships with other AH, CRW, GP, STW/LTCF/IHCCS, the overall community and the municipal corporation were found in 75%, 75%, 74%, 69%, 73% and 34%, respectively. Medical/care information sharing was achieved in 20%/14%, and planned in 51%/51%. Many problems were identified in the cooperation system with medical and long-term care insurances.
Conclusions: AH play a central role in the community-based referral system for stroke care. Although more than half of the AH have already planned information sharing, the situation remains inadequate at present.
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Yusuke Nanri, Yusuke Yakushiji, Hiroshi Takashima, Makoto Eriguchi, Ry ...2009 Volume 31 Issue 2 Pages 74-78
Published: 2009
Released on J-STAGE: April 20, 2009
JOURNAL FREE ACCESSBackground and purpose: Few acute ischemic stroke patients are treated with rt-PA. This is partly because of prehospital delays after symptom onset. We examined the factors related to such delays and investigated the limit area of rt-PA treatment in the central part of Saga Prefecture.
Methods: The subjects comprised 53 consecutive acute cerebral infarction patients (rt-PA treated group, 19 cases; non-treated group, 34 cases) admitted to our hospitals between December 2005 and February 2007. Their time from symptom onset to arrival was known, and they were transported directly to our hospitals by ambulance. Data for the distance components from the patients' location to our hospital and time components were obtained from clinical records. In the two groups, the limit area of rt-PA treatment was calculated according to the following components: time from onset to hospital arrival (<120 min) and average speed of ambulance (=0.32 km/min).
Results: In the rt-PA treated group, the time of telephone contact from onset to receipt of the emergency medical service was significantly shorter. The limit area of rt-PA treatment was within 38 km from our hospitals.
Conclusions: Our findings suggest that both enlightenment of the citizen and the construction of a stroke medical network are important in order to increase the number of ischemic stroke patients who receive rt-PA therapy.
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Yanosuke Kouzaki, Yuichiro Inatomi, Toshiro Yonehara, Yoichiro Hashimo ...2009 Volume 31 Issue 2 Pages 79-85
Published: 2009
Released on J-STAGE: April 20, 2009
JOURNAL FREE ACCESSBackground and purpose: It has been suggested that an increased risk of ischemic stroke may exist in the setting of cardioversion of atrial fibrillation to sinus rhythm. In the present study, we investigated the predictive factors associated with the occurrence of ischemic stroke in patients receiving cardioversion for defibrillation of paroxysmal atrial fibrillation.
Methods: We examined the frequency of ischemic stroke within 10 days after direct-current cardioversion between April 1995 and November 2003, and compared the clinical backgrounds of the atrial fibrillation patients with or without ischemic stroke.
Results: Ischemic stroke after cardioversion occurred in 9 (1.2%) of 768 patients. On comparison with 45 randomly selected, non-stroke controls, the time between onset of atrial fibrillation and cardioversion (in days; OR, 1.26; 95% CI, 1.03-1.53) was found to be a significant and independent predictive factor of ischemic stroke.
Conclusions: The present data suggest that early cardioversion for defibrillation might help to prevent ischemic stroke in patients with paroxysmal atrial fibrillation.
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Ichiro Deguchi, Hidetaka Takeda, Daisuke Furuya, Kimihiko Hattori, Har ...2009 Volume 31 Issue 2 Pages 86-95
Published: 2009
Released on J-STAGE: April 20, 2009
JOURNAL FREE ACCESSBackground: We investigated the usefulness of CT perfusion (CT-P) for assessing whether or not intravenous t-PA treatment is indicated for hyperacute cerebral infarction within 3 hours after onset.
Methods: Between April 2007 and March 2008, 40 cerebral infarction patients were brought to our hospital within 3 hours of occurrence (28 men, 12 women; average age, 71 years; average time from onset to hospital admission, 93 min). Among these 40 patients, 14 patients who underwent brain CT, brain MRI (DWI/MRA), and CT-P were investigated. The clinical types included 7 cardioembolic infarction (CE) cases, 6 atherothrombotic infarction (AT) cases, and 1 lacunar infarction (LC) case.
Results: Among the 14 patients who underwent CT-P, no perfusion abnormalities were noted in 6 of 8 patients with an NIHSS score of 11 points or less at the time of hospital arrival. Of these 6 patients, 1 had LC, 3 had CE, and 2 had AT. In 2 patients (CE: M2 occlusion; AT: M1 stenosis), an area of abnormal perfusion was recognized, but no difference was observed in the high signal area on DWI. In all patients with an NIHSS score of 15 points or more, diffusion-CT perfusion mismatch (DPM) was seen. In addition, main artery lesions were found on MRA in 5 of 6 patients with DPM. t-PA was given to 10 of the 14 patients.
Conclusions: In the hyperacute phase of cerebral infarction within 3 hours of occurrence, mild cases and those without main cerebral artery lesions have little need for CT-P. In moderate and severe cases, CT-P appears to be effective for evaluating DPM.
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Case Reports
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Masahito Kawabori, Satoshi Kuroda, Hiroshi Yasuda, Masaaki Hokari, Mot ...2009 Volume 31 Issue 2 Pages 96-99
Published: 2009
Released on J-STAGE: April 20, 2009
JOURNAL FREE ACCESSPersistent hypoglossal artery (PHA) is a relatively rare vascular anomaly of persistent carotid-basilar anastomosis and is usually asymptomatic. In this report, we describe a 73-year-old male patient who was admitted to our hospital due to sudden consciousness disturbance, right oculomotor palsy, left MLF syndrome, bilateral cortical blindness, and severe left hemiparesis. MRI/A at admission revealed acute cerebral infarction in both the carotid and vertebral artery territories, and moderate internal carotid artery stenosis associated with ipsilateral PHA. Artery-to-artery embolism from the internal carotid artery is thought to be the cause of this multiterritorial infarction. It should be borne in mind that persistent carotid-basilar anastomosis can cause multi-territorial cerebral infarction mimicking cardioembolism, and may be a candidate for aggressive prophylactic intervention when complicated by occlusive carotid artery diseases.
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Futoshi Kurimoto, Takao Kojima, Shuntaro Takasu, Norikazu Hatano, Taka ...2009 Volume 31 Issue 2 Pages 100-104
Published: 2009
Released on J-STAGE: April 20, 2009
JOURNAL FREE ACCESSIn adult patients with hemorrhagic moyamoya disease, in order to reduce hemodynamic stress on the fragile moyamoya vessels, direct or indirect revascularization is often performed. In Japan, its effectiveness is being examined in the Japan Adult Moyamoya Trial (JAMT). We report here a rare case of rebleeding from de novo aneurysm at an atypical location, at 4 years after revascularization surgery in a hemorrhagic moyamoya disease patient. Neuroendoscope surgery followed by endovascular surgery was very effective in this case.
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Yasuhiro Shimojima, Yoshio Shimojima, Takeshi Hattori, Takeomi Takizaw ...2009 Volume 31 Issue 2 Pages 105-110
Published: 2009
Released on J-STAGE: April 20, 2009
JOURNAL FREE ACCESSWe report a patient with convulsions which occurred in the acute phase of brainstem infarction. The patient was a 72-year-old man. He demonstrated consciousness disturbance and left-side hemiparesis when he was brought to our hospital emergency department. About 15 min later, we observed convulsions in his four extremities. Brief convulsions intermittently occurred over a period of a few days. A brain diffusion weighted MR image revealed a high signal lesion in the right ventral and bilateral dorsal pons. MR angiography disclosed a stenotic lesion in the basilar artery. The patient appeared to exhibit adduction impairment in his right eye. There were no significant pathogenic lesions attributable to convulsions in the cortico-subcortical areas on brain MRI and no significant decrease in cerebral blood flow on the 123I-IMP SPECT findings. We should therefore recognize the possibility of convulsions occurring that are ascribable to brainstem infarction.
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Shougo Kaku, Takuya Ishii, Yuzuru Hasegawa, Takahiro Fukuda, Toshiaki ...2009 Volume 31 Issue 2 Pages 111-116
Published: 2009
Released on J-STAGE: April 20, 2009
JOURNAL FREE ACCESSDural arteriovenous fistula (DAVF) is a relatively rare disease, accounting for about 10-15% of intracranial arteriovenous malformations. Multiple DAVF is very rare, accounting for about 7% of intracranial DAVF. In the present case, transarterial embolization (TAE) was performed in a 73-year-old female patient with a history of transarterial embolization (TAE) for carotid-cavernous fistula (CCF) 5 years previously. She had a contralateral transverse-sigmoid DAVF (T-S DAVF) that presented with intraventricular hemorrhage. Angiography revealed contralateral, transverse-sigmoid dural AVF. While multiple DAVF often occurs on the ipsilateral side, it can arise on the contralateral side in the presence of abnormal coagulation and fibrinolysis. The present histopathological analysis is very valuable and useful for investigating the etiology of multiple DAVF. In the future, long-term radiological follow-up will be necessary for patients with multiple DAVF.
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Shougo Kaku, Tetsuaki Iwamoto, Hideki Honma, Yasutaka Jimi, Suiei Kaku ...2009 Volume 31 Issue 2 Pages 117-121
Published: 2009
Released on J-STAGE: April 20, 2009
JOURNAL FREE ACCESSA 43-year-old woman with a 1.5-year history of ulcerative colitis was admitted to our hospital complaining of headache and left hemiparesis. Computed tomography revealed a low-density area in the right fronto-parietal lobe. Magnetic resonance imaging disclosed a high signal intensity area in the right fronto-parietal lobe on T2- and diffusion-weighted images. Primarily, we treated this patient as cerebral infarction, brain tumor, or inflammatory disease. However, her symptoms deteriorated rapidly, and urgent cerebral angiography revealed an obstruction of the superior sagittal sinus. Cerebral venous thrombosis occurring in patients with ulcerative colitis is very rare in Japan. Nevertheless, we should consider the possibility of cerebral venous thrombosis in ulcerative colitis patients who suffer from symptoms like strokes.
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Shiro Aoki, Toshiho Ohtsuki, Eiichi Nomura, Takeshi Nakamura, Tatsuo K ...2009 Volume 31 Issue 2 Pages 122-126
Published: 2009
Released on J-STAGE: April 20, 2009
JOURNAL FREE ACCESSWe report an elderly stroke patient with uncorrected tetralogy of Fallot (TOF). A 63-year-old man was admitted to our hospital due to disturbance of consciousness and right hemiparalysis. MRI demonstrated acute infarcts in the left medial thalamus and left cerebellar hemisphere, but no stenosis or occlusion of the basilar or posterior cerebral arteries. Echocardiography revealed right ventricular hypertrophy overridden by aorta and ventricular septal defect with right-to-left flow shunt. Organized thrombi were detected in the bilateral dilated peroneal veins. We diagnosed the case as paradoxical cerebral embolism with uncorrected TOF. TOF is a common cyanotic congenital heart disease of babies, whose prognosis is poor unless the condition is corrected during the infant years. There have been a few reports of elderly survivors of uncorrected TOF, and no reported cases of complication with paradoxical cerebral embolism. Anticoagulant therapy is requisite for the prevention of embolic stroke, because such hyperhematosis can cause deep vein thrombosis, with accompanying chronic cyanotic conditions.
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