Background and Purpose: The effectiveness of thrombectomy in acute ischemic stroke has been demonstrated, and the recanalization rate has improved with advances in equipment. The time from onset to recanalization greatly affects the prognosis. This paper describes the strengthening of efforts to shorten the time from patient presentation to the start of treatment in our hospital. Methods: Of 86 patients treated between January 2015 and December 2017, 30 patients were treated between January 2015 and December 2015 (the former group), and 56 patients were treated between January 2016 and December 2017 (the latter group). The time from presentation to the start of surgery and treatment prognosis were compared retrospectively. Results: The time from presentation to the start of surgery was significantly shortened in the latter group. The rates of thrombolysis in cerebral infarction grade 2B/3 recanalization and modified Rankin Scale score 0–2 at discharge in patients with recanalization were not significantly different between the two groups. Conclusion: The time from patient presentation to the start of surgery was significantly shortened by strengthening the system. Further shortening of the time and strengthening of the system are necessary to improve the treatment outcome.
Background and Purpose: Asymptomatic carotid artery stenosis (ACAS) is associated with not only ipsilateral stroke but also other vascular diseases or vascular death. Also, Japanese REduction of Atherothrombosis for Continued Health registry presented that both ACAS ≥ 70% and ankle-brachial index (ABI) <0.9 were predisposing factors for stroke excluding transient ischemic attack (TIA). Although, the reported prevalence rate of ACAS (≥70%) was 0.5–3%. We aimed to develop a sensitive screening method for detecting ACAS (≥70%). Methods: We analyzed 1096 patients who underwent both ultrasonography study (US) and ABI measurements during the period of 2014–2017. Extracranial Internal carotid artery stenosis (≥70%) was screened by US and confirmed by MRA. We retrospectively analyzed 39 (ACAS group) and 1057 patients (non-ACAS group). We also compared ABI values between two groups. Results: A total of 39 patients was presented with ACAS (≥70%). Binominal logistic regression analysis revealed that past history of ischemic vascular disease was the only predictive factor for ACAS (≥70%) (p < 0.001). Also, the number of patients presenting ABI <1.0 in the ACAS group was significantly higher than that in the non-ACAS group (p < 0.001). The detection rate of ACAS(≥70%) was 3.6% among 1096 patients. When screened by ABI (<1.0) and by having a history of ischemic vascular disease, detection rate of ACAS (≥70%) was increased up to 9.2%. Conclusion: We developed a simple two-step screening method for detecting ACAS (≥70%).
We report the rare case of a 44-year-old female with acute spontaneous subdural hematoma probably associated with fibromuscular dysplasia (FMD). She was suddenly presented with headache and consciousness disturbance. The head CT revealed thin acute subdural hematoma in bilateral convexity and craniovertebral junction. Angiography revealed stenosis of bilateral extra-cranial internal carotid arteries and unruptured saccular aneurysm of bifurcation of internal carotid artery and ophthalmic artery. She suffered from persistent severe hypertension. We confirmed the existence of renovascular stenosis by abdominal ultrasonic examination and reached the clinical diagnosis FMD. After 7 months, percutaneous transluminal angioplasty was performed and her blood pressure came under control.
A 60-year-old woman developed sudden onset of disturbance of consciousness, and was transferred to another hospital where she was diagnosed with subarachnoid hemorrhage, then transferred to our hospital. Cerebral angiography revealed left vertebral artery dissecting aneurysm (VADA) and right vertebral artery dissection with near occlusion. Balloon test occlusion (BTO) of the left vertebral artery (VA) was performed, and the right carotid angiography demonstrated retrograde filling of the right posterior inferior cerebellar artery (PICA) through the posterior communicating artery (Pcom). We performed internal trapping of the left VA to preserve left PICA flow. The postoperative course was favorable, and the final modified Rankin scale score was 0. Internal trapping of a symptomatic VADA may be worth considering even when the contralateral VA is occluded. BTO appears useful for evaluating collateral blood flow.
However ascending aortic thrombus is rare, has a potential of embolic strokes of undetermined source (ESUS). Prompt diagnosis and definitive treatment are imperative to decrease morbidity and mortality. We report a case of ascending aortic thrombus early diagnosed with computed tomography angiography (CTA). A 61-year-old man on post-operative chemotherapy for rectal cancer presented with sudden headache and vertigo. Magnetic resonance imaging depicted right cerebellar infarction, and CTA depicted a 20-mm mass at the ascending aorta. Emergency ascending aorta replacement was performed. Histological analysis demonstrated a fresh, mixed thrombus and early atherosclerotic changes at the aortic wall. CTA is useful in the early diagnosis of ascending aortic thrombus. Imaging of the aortic arch through CTA should be considered in ESUS patients.
Functional electrical stimulation (FES) is a technique used to produce contractions in paralyzed muscles by the application of small pulses of electrical stimulation to nerves that supply the paralyzed muscle. FES applied to the peroneal nerve during the swing phase of ambulation provides active dorsiflexion and can reduce foot drop by facilitating voluntary muscle activity, and improving gait quality and symmetry. The WalkAide FES system's unique control system, with tilt sensors to trigger electrical stimulation during the swing phase, can help normalize gait and thus optimize safety, cosmesis and energy efficiency in people with stroke, multiple sclerosis, cerebral palsy and a wide range of other CNS disorders. The feature of WalkAide are cuff, programming options, personalized solution, single battery operation, patented accelerometer, and freedom in footwear option. The results of previous studies showed the WalkAide to be equivalent to the ankle-foot orthoses for improvements in balance, gait ability, and muscle architecture of tibialis anterior of stroke survivors. We can expect further development of new applications of electrical stimulation in combination with other therapeutic exercises. Further studies should examine whether WalkAide enables better performance in tasks involving functional mobility, and activities of daily living.
The return to work (RTW) rate of the stroke patient in our country is 30–50% and is not parallel with the predicted functional convalescent degree. The following thing is important for successful RTW that right assessment about patient's severity of disability and job description, patient's self-understanding, implementation of the rehabilitation which considered the work contents, co-operation of a medical person to restoration, information sharing with a workplace. Japan Organization of Occupational Health and Safety has begun to train the dual support coordinator compatible who does necessary evaluation and dissemination of information appropriate time while nestling close to a patient from fiscal year 2014. After I intervened in the stroke patient who agreed to intervention from the acute stage, about 70% of RTW rate is obtained. Understanding of a workplace and appropriate consideration are necessary for success of restoration. It is more important that the medical stuff who does stroke treatment concerns from the acute stage to stop leaving the job early.