Japanese Journal of Stroke
Online ISSN : 1883-1923
Print ISSN : 0912-0726
ISSN-L : 0912-0726
Current issue
Displaying 1-10 of 10 articles from this issue
Original
  • Shoichi Fukuda, Yusuke Tomita, Yoshihiro Okada, Aiko Kobashi, Juntaro ...
    2025 Volume 47 Issue 1 Pages 1-6
    Published: 2025
    Released on J-STAGE: January 25, 2025
    Advance online publication: July 05, 2024
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    Background and Purpose: In patients with lateral medullary infarcts caused by posterior inferior cerebellar artery occlusion, central respiratory failure requiring intubation is a relatively rare condition without known risk factors. We found that the respiratory center is close to the straight line that connects the retro-olivary sulcus and the median sulcus, which we defined as the ROMS line. Herein, we examined the association of lateral medullary infarcts that cross the ROMS line with the requirement for intubation. Methods: We retrospectively studied 32 patients with lateral medullary infarction at our department from April 2006 to August 2023. Patients were divided into those without or with intubation. The background factors, neurological findings, imaging findings, and outcomes were compared between the two groups. Results: Six patients required intubation. Furthermore, these patients had lateral medullary infarcts that crossed the ROMS line. The intubated patients required more extended hospitalization periods and had poorer outcomes than those without intubation. Conclusion: Patients with lateral medullary infarcts that cross the ROMS line may require intubation. Clinicians should consider early tracheostomy for these patients to decrease in-hospital morbidity and mortality.

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  • Hidehiro Takekawa, Ikuko Miyawaki, Yoshihiro Fukumoto, Takafumi Mashik ...
    2025 Volume 47 Issue 1 Pages 7-16
    Published: 2025
    Released on J-STAGE: January 25, 2025
    Advance online publication: July 18, 2024
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    Background and Purpose: The implementation status of multiple types of rehabilitation for patients with stroke and comorbidities (combined rehabilitation) and its influence on hospital transfer are unknown. Methods: We conducted a questionnaire survey in primary stroke centers regarding facility information, rehabilitation systems, problems with combined rehabilitation, and transfer status. Results: The analysis included 414 hospitals. There were only a few speech-language pathologists and almost no full-time nurses in any hospital. There were a few nurses specializing in stroke rehabilitation (stroke nursing) and with other specialized qualifications. There was no support for dementia rehabilitation in the rehabilitation section. Additionally, many university hospitals require a prolonged period before transferring patients who require complex rehabilitation. Conclusion: Many PSCs in Japan may not be provided with enough complex rehabilitation. To provide complex rehabilitation, the number of speech-language pathologists and specialized nurses should be increased, dementia support should be improved, and medical reimbursement requirements should be revised.

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  • Shogo Watanabe, Nice Ren, Soshiro Ogata, Yuriko Nakaoku, Akihito Hagih ...
    2025 Volume 47 Issue 1 Pages 17-24
    Published: 2025
    Released on J-STAGE: January 25, 2025
    Advance online publication: July 31, 2024
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    Background and Purpose: We aimed to predict recurrent ischemic stroke after the first acute ischemic stroke within 1, 3, and 5 years. Methods: The subjects were patients admitted to participating J-ASPECT Study facilities with acute ischemic stroke from 2010 to 2019. A machine learning model was constructed using 117 clinical information variables to compare the predictive accuracy of the Stroke Prognosis Instrument II (SPI-II) and the Essen Stroke Risk Score (ESRS). Results: The mean area under the receiver operating characteristic curve (ROC AUC) for machine learning prediction of stroke recurrence within 1, 3, and 5 years was 0.62, 0.63, and 0.63, respectively. In contrast, the ROC AUCs for SPI-II were 0.54, 0.54, and 0.54, and ESRS were 0.55, 0.54, and 0.53 within 1, 3, and 5 years, respectively. Conclusion: The machine learning prediction model achieved better performance than classical risk scores for recurrent ischemic stroke prediction.

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Case Report
  • Taichiro Ashizaki, Masaya Togo, Miki Bando, Rei Hashimoto, Kento Matob ...
    2025 Volume 47 Issue 1 Pages 25-30
    Published: 2025
    Released on J-STAGE: January 25, 2025
    Advance online publication: July 18, 2024
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    The posterior spinal artery infarction is a rare occurrence among spinal infarctions and causes the infarction at the dorsal part of the inferior medulla oblongata to the upper cervical cord. Anatomically, in the inferior medulla oblongata, the trigeminal nerve spinal tract nucleus is close to the fasciculus cuneatus. We experienced a case with characteristic sensory impairment by the posterior spinal artery infarction. A 74-year-old man presented with sudden proprioceptive impairment in his left upper and lower limbs, along with sensory deficits on the left side of his face with an onion-skin pattern. MRI revealed the infarction extending from the inferior medulla oblongata to the upper cervical cord. The etiology of the infarction was presumed to be a dissection of the left vertebral artery based on findings from MRA and CT-Angiography. Somatosensory evoked potential demonstrated the disturbance of the left dorsal column tract. He started taking aspirin and underwent rehabilitation. Three months after the onset, the impairment of the proprioception of his left upper limb and the sensation of the left side of his face improved significantly. This case underscores the importance of considering the infarction spanning from the inferior medulla oblongata to the upper cervical cord in patients presenting with ipsilateral facial sensory and upper limb proprioception impairments. Careful investigation is warranted, as routine brain MRI scans may not always capture lesions in the superior cervical cord.

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  • Daiki Yokoyama, Hidetoshi Oigawa, Keijirou Yoshida, Yoshiki Mochizuki, ...
    2025 Volume 47 Issue 1 Pages 31-36
    Published: 2025
    Released on J-STAGE: January 25, 2025
    Advance online publication: July 17, 2024
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    We report a case of a fusiform aneurysm of the posterior cerebral artery that showed false positive results on MRI vessel wall imaging (VWI). The patient was a 55-year-old man who visited the emergency department with a chief complaint of persistent headache. CT and MRI revealed a small amount of subarachnoid hemorrhage around the midbrain and occipital lobe. Contrast-enhanced CT revealed an anterior communicating artery aneurysm and a posterior cerebral artery aneurysm. VWI showed a contrast effect in the posterior cerebral artery aneurysm, which, together with the hematoma distribution, was determined to be the source of bleeding. Surgery was performed to trap the lesion and create a superficial temporal artery-posterior cerebral artery bypass in the distal region, but intraoperative findings revealed an unruptured wide-neck aneurysm. Arterioplasty clipping was performed. Understanding the situations in which false positive VWI results are likely to occur and making decisions in multimodality are important for accurate diagnosis.

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  • Kohei Asano, Takashi Uematsu, Noriko Kato, Yasumasa Ohno, Keizo Yasui
    2025 Volume 47 Issue 1 Pages 37-41
    Published: 2025
    Released on J-STAGE: January 25, 2025
    Advance online publication: August 08, 2024
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    Supplementary material

    The patient was a 34-year-old pregnant woman who had two pregnancies and one parity. She had no complications or medical history. During her prenatal checkup at 35 weeks and 4 days of gestation, her blood pressure increased to 137/101 mmHg; she started taking nifedipine. The next day, her blood pressure remained high, and she complained of a slight headache; therefore, she was transferred to our hospital.

    No abnormalities were observed on neurological examination or initial brain MRI. Because her blood pressure was 158/106 mmHg, nicardipine and magnesium sulfate were started. Furthermore, cesarean section was performed on day 2 of hospitalization. On day 3, a brain MRI revealed cerebral vasospasms. On day 4, her headache disappeared. On day 13, a brain MRI performed at the outpatient care center revealed improvement of the spasms. She was diagnosed with reversible cerebral vasospasm syndrome (RCVS).

    Several studies have reported RCVS without spasms in the initial presentation or typical thunderclap headache; hence, RCVS at the perinatal period may be more common than previously thought.

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  • Yoshiki Mochizuki, Hidekazu Yamazaki, Hiroaki Satoh, Shinya Fukuta, Ya ...
    2025 Volume 47 Issue 1 Pages 42-46
    Published: 2025
    Released on J-STAGE: January 25, 2025
    Advance online publication: August 30, 2024
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    A 54-year-old man was presented to our hospital with left hemiplegia, dysarthria, and loss of sensation in the left upper and lower extremities. Although he had undergone carotid artery stenting for symptomatic right internal carotid artery stenosis, he did not take antiplatelet drugs for two months. The head MRI and DSA demonstrated tandem occlusion of in-stent occlusion of the right carotid artery and occlusion of the C1 segment of the right ICA. After percutaneous transluminal angioplasty of the former, mechanical thrombectomy was performed for the latter. They were recanalized, but a new secondary occlusion was found in the distal inferior trunk of the middle cerebral artery M2. The vessel diameter of the M2 was 1.08 mm as measured by DSA. Contact aspiration using a microcatheter was performed, and thrombolysis in cerebral ischemia 3 was achieved. Contact aspiration using a microcatheter for a narrow distal M2 occlusion has the potential to be a safe and effective treatment when it is difficult to use a mechanical thrombectomy device in this case.

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  • Keito Ishihara, Hiroyuki Naito, Takeshi Hara, Tomohisa Nezu, Shiro Aok ...
    2025 Volume 47 Issue 1 Pages 47-54
    Published: 2025
    Released on J-STAGE: January 25, 2025
    Advance online publication: August 02, 2024
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    We report the first case of Parkinsonism due to a dural arteriovenous fistula (DAVF) in a 74-year-old female with a confirmed diagnosis of Parkinson’s disease (PD). The patient had a 7-year history of PD and was admitted with drug-resistant gait disturbances and altered consciousness, which developed over a 2-month period. MRI and MRA/V suggested edema in the subcortical white matter and abnormal cerebral venous reflux. Detailed examination revealed a DAVF in the right transverse-sigmoid sinus. Endovascular treatment was performed on the 5th day of hospitalization, leading to improved hemodynamics. The patient’s level of consciousness improved 2 days post-surgery, and her Parkinsonism symptoms ameliorated 4 days post-surgery. Although the mechanism of DAVF-induced Parkinsonism remains unclear, it is hypothesized that blood flow abnormalities in the basal ganglia and frontal lobe are the underlying causes, manifesting primarily as gait disturbances similar to vascular Parkinsonism. Early and complete treatment of DAVF is essential for a favorable prognosis.

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Short Report
  • Hiroyuki Koketsu, Yoshihisa Otsuka, Yasuyuki Matsuno, Kana Onobuchi, J ...
    2025 Volume 47 Issue 1 Pages 55-57
    Published: 2025
    Released on J-STAGE: January 25, 2025
    Advance online publication: August 28, 2024
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    A 75-year-old man had been feeling light-headed when he woke up and visited our hospital 13 hours later. Neurological examination revealed left eight-and-a-half syndrome, a combination of left one-and-a-half syndrome and left peripheral facial nerve (VII) palsy. We diagnosed the lesion as being in the paramedian area of the left caudal pontine tegmentum. Although no infarction was detected on DWI at the time of admission, we diagnosed pontine infarction based on the clinical course and eight-and-a-half syndrome. DWI on the following day revealed an infarct in the paramedian area of the left caudal pontine tegmentum. Eight-and-a-half syndrome is caused by simultaneous damage to the paramedian pontine reticular formation (PPRF) or abducens nerve nucleus, medial longitudinal fasciculus (MLF), and nucleus or genu of the facial nerve. The localization of the lesion is a paramedian area of the caudal pontine tegmentum. Acute brain stem infarction is not uncommon with negative DWI on admission. Therefore, it is valuable to diagnose the eight-and-a-half syndrome in stroke management.

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  • Sayaka Matsumoto, Takehiro Ueda, Yukihiro Yoneda, Yasufumi Kageyama
    2025 Volume 47 Issue 1 Pages 58-61
    Published: 2025
    Released on J-STAGE: January 25, 2025
    Advance online publication: August 23, 2024
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    A 64-year-old man with a history of critical pulmonary embolism and leg venous thrombosis developed a large cerebral sinus thrombosis in the right hemisphere. The laboratory tests showed mild hyper-homocysteinemia associated with a low concentration of folic acid and vitamins B6 and B12. The genetic examination documented methylene tetrahydrofolate reductase (MTHFR) gene variant C677T, known as polymorphism associated with hyperhomocysteinemia. Treatments were anticoagulant medication and supplementation of folic acid and vitamins B6 and B12. Because the MTHFR gene polymorphism leads to a low enzyme activity, this genetic factor is important in the management of thrombosis.

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