Japanese Journal of Stroke
Online ISSN : 1883-1923
Print ISSN : 0912-0726
ISSN-L : 0912-0726
Volume 35, Issue 3
Displaying 1-13 of 13 articles from this issue
Originals
  • Tomoyuki Ohara, Yasumasa Yamamoto, Eijiro Tanaka, Jun Fujinami, Fukiko ...
    2013 Volume 35 Issue 3 Pages 167-173
    Published: May 20, 2013
    Released on J-STAGE: May 24, 2013
    JOURNAL FREE ACCESS
    Background and Purpose: Cerebral venous thrombosis is more common than previously thought now that the use of neuroimaging is more widespread. The purpose of our study was to elucidate clinical and radiological features of patients with CVT admitted in our hospital.
    Methods: We reviewed consecutive 10 CVT cases (5 females and 5 males with a mean age of 49 years) admitted to our hospital from April 2008 to March 2011.
    Results: On admission, 7 patients had focal neurological deficits (mild motor paresis in 5) and the other 3 patients had isolated headache. Four patients presented with seizures on admission. CT/MRI on admission showed intracranial hemorrhages in 4 patients, venous infarct in 3 and no parenchymal lesion in 3. Initial MRI T2 weighted images in 9 cases revealed hypointense signals and enlargement of thrombosed vessels. All patients received anticoagulant therapy and 8 patients among them showed good functional outcome (modified Rankin Scale 0–1) at discharge.
    Conclusion: Most CVT cases in our series presented with mild symptoms and had good functional outcome at discharge. Applying neuroimaging, especially using T2 sequences, may help early diagnosis of CVT.
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  • Chieko Usami, Hiroyuki Miyasaka, Hitomi Uematsu, Izumi Kondo, Yutaka T ...
    2013 Volume 35 Issue 3 Pages 174-180
    Published: May 20, 2013
    Released on J-STAGE: May 24, 2013
    JOURNAL FREE ACCESS
    Purpose: Electrical stimulation therapy is used for training of the upper limbs in hemiplegic patients. It has been reported that this therapy can improve the functions of the paralyzed upper limb while suppressing spasticity. In this study, we applied integrated volitional control electrical stimulation (IVES) therapy for rehabilitation of the paralyzed upper limbs of sub-acute hemiplegic patients.
    Methods: Our objective was to investigate the carry-over effect of this method during stroke rehabilitation in patients. IVES therapy was conducted for 20 minutes per day for one week. To investigate the carry-over effect, we measured the active wrist dorsiflexion angles at 0, 30, 60, 90, and 120 minutes after daily rehabilitation sessions. Compared to the resulted obtained before the start of rehabilitation, the active wrist dorsiflexion angles had improved.
    Results: The SIAS and MAS also showed improvement. However, the differences were not significant. While active wrist dorsiflexion angles at 30, 60, 90, and 120 minutes after the daily sessions were decreased compared to those before rehabilitation, the active dorsiflexion angles were only significantly different for 60, 90, and 120 minutes. The dorsiflexion angle at one week after the start of rehabilitation was significantly improved at 90 and 120 minutes after daily sessions, compared with the angle at the start of rehabilitation.
    Conclusions: Our findings revealed the long-term therapeutic effects of IVES.
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  • Shinji Nogoshi, Toshihiro Ueda, Makoto Takagi, Takashi Hata, Noriko Ha ...
    2013 Volume 35 Issue 3 Pages 181-186
    Published: May 20, 2013
    Released on J-STAGE: May 24, 2013
    JOURNAL FREE ACCESS
    Objectives: The aim of the present study was to examine the degree of changes in cognitive performance after carotid artery stenting (CAS).
    Methods: Carotid artery stenting (CAS) was performed in 107 patients with high grade carotid artery stenosis from January 2005 to September 2007, of whom thirty four patients were finally included in the present study. Preoperative neuropsychological testing was conducted around five days before CAS and about 6 months after stenting. The following neuropsychological tests were selected: MMSE,WAIS-R,WMS-R, Trail making test, Word fluency test, and Self-rating depression test (SDS).
    Result: The preoperative mean MMSE score in 34 patients was 25.3±3.3 and the postoperative score improved significantly to 26.2±3.3 points (p=0.04). The postoperative scores improved in the following items; MMSE (total score), picture completion subtest of WAIS-R, general memory, visual memory and delayed recall subtest of WMS-R. In the univariate analysis, the low score of MMSE (<24) was the factor contributed to the improvement of MMSE after CAS.
    Conclusion: CAS has the potential for some improvement in cognitive and memory performance.
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  • Shinichiro Maeshima, Aiko Osawa, Takeshi Hayashi, Norio Tanahashi
    2013 Volume 35 Issue 3 Pages 187-194
    Published: May 20, 2013
    Released on J-STAGE: May 24, 2013
    JOURNAL FREE ACCESS
    Objectives: Dysphagia after stroke is common, and its detection is an important part of stroke management. The purpose of this study was to investigate the clinical utility of water swallowing test using 5 ml and 60 ml for detection of dysphagia.
    Subjects and Methods: The subjects were 183 patients with strokes, aged between 20–98 years including 107 males and 76 females, who underwent videofluorography (VF) for suspected swallowing difficulty. Stroke etiology included cerebral infarction in 98 patients, cerebral hemorrhage in 49, subarachnoid hemorrhage in 23, and other cerebral strokes in 23. Before VF, a two-step water swallowing test using 5 ml and 60 ml liquid water was evaluated as bedside clinical assessment. The results of the water swallowing test and VF were compared.
    Results: Forty-six of 183 patients were discontinued at the first step (5 ml) because of clinical condition. There are significant correlations between the results of the water swallowing test and aspiration on VF. The sensitivity and specificity of two-step water swallowing test for aspiration were 85.2% and 41.8%, respectively. Foodstuffs and intake methods were related to aspiration detected by VF but they were not related to result of the water swallowing tests.
    Conclusion: We concluded that the two-step water swallowing tests are a useful assessment to detect aspiration risk for stroke patients, however, we recommend performing VF before patients begin to eat.
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Case Reports
  • Masazumi Matsuda, Sachiko Kamada, Satoshi Okawa, Masashiro Sugawara, H ...
    2013 Volume 35 Issue 3 Pages 195-199
    Published: May 20, 2013
    Released on J-STAGE: May 24, 2013
    JOURNAL FREE ACCESS
    Body lateropulsion is the compelling sensation of being pulled toward one side. We report five cases presenting body lateropulsion as a chief complaint. All of them were admitted to our hospital with an ataxia of unknown origin. Some cases were accompanied with Horner’s syndrome (2/5), sensory loss in face or lower limbs (2/5), and limb ataxia (1/5). Corresponding lesion of the lateropulsion appeared on MRI 2 to 11 days after onset. The ipsilateral ventral spinocerebellar tract causes body lateropulsion. The contralateral ascending graviceptive pathway may also cause body lateropulsion. In cases presenting acute onset lateropulsion, we should perform a detailed neurological examination to not overlook the signs accompanied by Wallenberg syndrome and keep a possibility of medullary infarction in mind even if we cannot detect the lesion on early diffusion weighted MRI.
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  • Fumihiro Sakakibara, Naoki Otani, Satoru Takeuchi, Kentaro Mori
    2013 Volume 35 Issue 3 Pages 200-202
    Published: May 20, 2013
    Released on J-STAGE: May 24, 2013
    JOURNAL FREE ACCESS
    A 48-year-old woman presented with putaminal petechial hemorrhage manifesting as transient hemiparesis. She suddenly developed dysarthria and left hemiparesis, and was transferred to our hospital. On admission, her symptoms had almost completely resolved. However, 10 hours after the onset, left hemiparesis recurred without hematoma growth. She recovered completely within 3 days. The transient neurological dysfunctions were probably caused by mass effects and secondary ischemia rather than direct tissue damage. Putaminal petechial hemorrhage may manifest as transient symptoms like ischemic attack. Therefore, petechial hemorrhage should be considered even if the patient suffers only transient neurological dysfunctions.
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  • Naosuke Kanenaka, Hiroaki Sato, Hajime Abe, Takahide Nejo, Atsushi Fuk ...
    2013 Volume 35 Issue 3 Pages 203-208
    Published: May 20, 2013
    Released on J-STAGE: May 24, 2013
    JOURNAL FREE ACCESS
    We report the case of a 68-year-old man with thalamic dementia due to a dural arteriovenous fistula (DAVF). Intracranial DAVF represent approximately 10% to 15% of all intracranial arteriovenous malformations. He had been treated for DAVF of transverse sinus-Sigmoid sinus for the past three years. Obstruction of the right sigmoid sinus that provided the main drainage caused venous hypertension of deep venous around the thalamic lesion. Computed tomography (CT) of the brain revealed a symmetric hypodense lesion, T2 weighted MRI and FLAIR sequence of the brain revealed a symmetric hyperintense lesion of bilateral thalamus. Bilateral lesions of the thalamus characteristically present with specific neurological and neuropsychological patterns. After treatment of DAVF, his cognitive disorder was improved obviously. In addition, the low density area on the CT, and the high intensity area on T2 weighted MRI and FLAIR sequence had gradually disappeared. It was suspected that venous congestion as vasogenic edema is a reversible lesion. Thus, we concluded that early diagnosis and treatment must be important.
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  • Keisuke Enoki, Katsumi Matsumoto, Koichiro Tsuruzono, Manabu Sasaki, Y ...
    2013 Volume 35 Issue 3 Pages 209-212
    Published: May 20, 2013
    Released on J-STAGE: May 24, 2013
    JOURNAL FREE ACCESS
    The authors report a rare case of ruptured dissecting aneurysm of duplicated superior cerebella artery (SCA). A 72-year-old female presented with symptoms of sudden dysarthria, right abducens paralysis, left horizontal nystagmus and left hemiparesis. CT revealed the subarachnoid hemorrhage extending from the cerebellopontine angle to the right sylvian fissure. An angiogram showed a fusiform dilatation in one of the cerebellar mesencephalic segment of the duplicated right SCA. Endovascular embolization of the aneurysm was performed with no major complications. Treatment of ruptured dissecting aneurysm of SCA was not well determined. Coil embolization proved to be a safe and effective treatment of ruptured dissecting aneurysm of the duplicated SCA.
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  • Hiromasa Tsuda, Sara Koh, Kozue Tanaka
    2013 Volume 35 Issue 3 Pages 213-215
    Published: May 20, 2013
    Released on J-STAGE: May 24, 2013
    JOURNAL FREE ACCESS
    An 84-year-old woman with essential hypertension abruptly developed leftward body lateropulsion, hypalgesia and thermohypoesthesia in all divisions of the left trigeminal nerve, and concomitant skew deviation. Diffusion-weighted cranial magnetic resonance imaging demonstrated a small infarction in the right rostral pontine tegmentum. Although the ascending graviceptive pathway (GP) from the vestibular nuclei to the Cajal interstitial nucleus crosses the midline in the caudal pons, its precise location remains uncertain. In our patient, GP and the ventral trigeminothalamic tract might be simultaneously involved. Consequently, in the rostral pons, we speculated that GP might run in the vicinity of the ventral trigeminothalamic tract.
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  • Daisuke Wajima,, Yuki Ida, Hiroshi Yokota, Hiroyuki Nakase
    2013 Volume 35 Issue 3 Pages 216-220
    Published: May 20, 2013
    Released on J-STAGE: May 24, 2013
    JOURNAL FREE ACCESS
    Several reports have been published that state that homonymous hemianopsia or quadrantanopia is observed when the lateral geniculate body of the opposite side is disturbed. We experienced 2 cases of intracranial hemorrhage near the lateral geniculate body, one of which caused congruent and the other caused incongruent quadrantanopia. We show these cases and then discuss the relationship between intracranial hemorrhage near the lateral geniculate body, and visual disturbance caused by them.
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  • Hironori Fujisawa, Naoki Muramatsu, Yasuo Tohma, Shinya Kida
    2013 Volume 35 Issue 3 Pages 221-226
    Published: May 20, 2013
    Released on J-STAGE: May 24, 2013
    JOURNAL FREE ACCESS
    We report three rare cases of cerebral sinus thrombosis (CST) associated with iron deficiency anemia (IDA) in adults. Case 1: A 34-year-old female presented with unconsciousness and status epileptics because of thrombosis of the superior sagittal sinus. After administration of unfractionated heparin in the acute phase followed by warfarin, she was discharged uneventfully. She had IDA due to untreated myoma uteri. After resection of the myoma and discontinuation of warfarin, no recurrence of CST was reported for four years. Case 2: A 38-year-old female was admitted because of headache and unconsciousness due to hemorrhagic infarction of the right temporal lobe and ipsilateral thrombosis of the transverse-sigmoid sinus. Hypermenorrhea was found to be the cause of IDA. After heparin and warfarin therapy, she was discharged with left hemianopsia. Case 3: A 51-year-old female presented with headache and unconsciousness because of hemorrhagic infarction of the left temporal lobe and ipsilateral thrombosis of the transverse-sigmoid sinus. The thrombosis was ascribed to the simultaneous use of estrogen derivatives and IDA due to myoma uteri. After heparin and warfarin therapy, she was discharged with mild cognitive impairment and sensory aphasia. We should be aware that CST is occasionally associated with IDA.
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  • Wataru Shiraishi, Ryu Matsuo, Shuji Arakawa, Masahiro Kamouchi, Takana ...
    2013 Volume 35 Issue 3 Pages 227-231
    Published: May 20, 2013
    Released on J-STAGE: May 24, 2013
    JOURNAL FREE ACCESS
    We herein report a case of an 89-year-old woman who developed secondary brain stem hemorrhage due to broad brain infarction. She suddenly presented with loss of consciousness and right hemiplegia. Head CT and MRI showed fresh broad brain infarction in the left cerebral hemisphere. On MRA, her left internal carotid artery was occluded. She had atrial fibrillation and was diagnosed with cardioembolic stroke. Glycerol was used to treat her cerebral edema. However, her congestive heart failure worsened on day 4 after stroke onset, and the dose of glycerol was reduced. On day 7 after admission, she was in a deep coma and showed decerebrate posturing and bilateral pathological reflexes. Head CT revealed brain stem hemorrhage and transtentorial herniation. Secondary brain stem hemorrhage due to progressive descending transtentorial herniation, so-called Duret hemorrhage, subsequently occurred. In general, Duret hemorrhage is known to be caused by elevated intracranial pressure, as occurs in rapid progressive herniation with head injury or in brain hemorrhage. The present case shows that Duret hemorrhage can occur in supratentorial broad brain infarction.
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Short Report
  • Makoto Nomura, Hirotsugu Mikami, Takeshi Watanabe, Megumi Suzuki, Seii ...
    2013 Volume 35 Issue 3 Pages 232-234
    Published: May 20, 2013
    Released on J-STAGE: May 24, 2013
    JOURNAL FREE ACCESS
    A 78-year-old man acutely developed diplopia and left hemiplegia. Neurological examinations revealed limited abduction of the right eye with intermittent spontaneous abducting jerks. The left eye was slightly hyperabducted at the primary position and upward gaze was also slightly limited. When the left eye was covered, the right eye could abduct almost normally. An ischemic lesion was detected in the right paramedian thalamic region but not in the pons on magnetic resonance imaging. Therefore, this failure of ocular abduction is regarded as ‘pseudoabducens palsy.’ Within 7 days, the neurological findings resolved completely. Pseudoabducens palsy can occur by thalamic lesion and might easily be overlooked because of its transient duration.
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