Background and Purpose: We designed an ICT-based transport system with stroke patients, and conducted a prospective clinical study at multiple facilities to see if the system can rapidly transport patients to appropriate facilities. Methods: As ICT, we used JUST-7, a stroke type prediction tool, and Join, a communication application between medical professionals. For patients with suspected stroke in the field, JUST-7 data entered by the EMS team were attached to Join and shared among the EMS team, the communication command center, the PSC and the PSC core facility, and the patient’s destination was determined according to the flow. Results: In stroke patients, the direct transport rate to the PSC core facility was 82.5% for the 40 patients who met the PSC core facility transport criteria. There was a trend toward an 18-minute reduction in the time from 119 call to core facility for LVO patients after using ICT compared to before using ICT. Conclusion: ICT-based transport systems such as JUST-7 and Join have the potential to rapidly transport stroke patients to the appropriate facility and may serve as a DX for regional stroke care coordination.

Background and Purpose: Continuous rehabilitation of patients with acute stroke is important for improving functional outcomes and preventing complications. In this study, we aimed to evaluate the effectiveness of holiday rehabilitation on the functional outcomes and complication rates of stroke survivors at the time of discharge. Methods: This retrospective cohort study included 402 patients with acute stroke admitted between April 2021 and March 2024. Patients were categorized into two groups: (1) a control group that received hospitalization and rehabilitation for 5–6 days per week and (2) an intervention group that received the same therapy, supplemented with rehabilitation during holidays. The primary outcomes included the modified Rankin Scale (mRS) score and complication rates. Propensity score matching was used to adjust for confounding factors. Results: The intervention group demonstrated a significantly higher rate of favorable functional outcomes (mRS≤2) at discharge compared to the control group (72.1% vs. 57.8%, p=0.012). Complication rates were significantly lower in the intervention group than in the control group (4.5% vs. 14.9%, p=0.003). Conclusion: This study suggests that holiday rehabilitation is associated with improved functional recovery and lower complication rates in stroke survivors.

Background and Purpose: In January 2019, radiologic technologists began providing assistance for mechanical thrombectomy (MT) in our hospital. The purpose of this study is to verify the effectiveness of task shifting/sharing by radiologic technologists in MT performed on holidays and at night. Methods: The subjects were 70 patients who underwent MT for occlusion of the internal carotid artery and middle cerebral artery M1 segment on holidays and at night (weekdays 17:15–8:30 the next day) at our hospital between January 2016 and December 2023. Cases were divided into two groups before and after providing assistant services, and backgrounds, number of staff participating in MT, clinical results, and prognosis were compared between the two groups. Results: There were 20 cases (29.0%) before providing assistant services and 50 cases (71.0%) after providing assistant services. Although assistant services were performed in 39 of the 50 cases (78.0%), there were no differences in backgrounds, clinical results, and prognosis between the two groups. Meanwhile, overtime work hours for neurosurgeons have decreased since 2018. Conclusion: Further improvements were considered necessary to promote task shifting/sharing by establishing in-hospital education systems.

Background and Purpose: It is often challenging to determine whether to resume driving after an acute stroke. Many studies have reported predicting whether someone can resume driving based on neuropsychological tests; however, no studies have examined the presence or absence of frailty before its onset. In this study, we analyzed factors related to whether patients who received support to resume driving after an acute stroke were able to do so. Methods: The participants were 68 patients with acute stroke. Binary logistic regression analysis was used to analyze factors associated with clinical assessment and neuropsychological test results, with covariates and cut-off values calculated. Additionally, the sensitivity and specificity of resuming driving were calculated based on related factors. Results: Factors associated with the ability to resume driving included attentional disorder, frontal lobe dysfunction, visuospatial cognitive disorder, and frailty prior to onset. Additionally, when predicting whether driving could resume by considering frailty before onset, the sensitivity was 100%, and the specificity was 88%. Conclusion: In addition to neuropsychological tests, it is important to assess frailty before the onset of acute stroke to support the return to driving.

Background and Purpose: N-terminal pro-brain natriuretic peptide (NT-proBNP) and brain natriuretic peptide (BNP) are established biomarkers for detecting paroxysmal atrial fibrillation (PAF) in stroke patients. However, because NT-proBNP is excreted through the kidneys, its accuracy may be affected by impaired renal function. This study aimed to evaluate the PAF detection ability of these biomarkers and compare their predictive performance stratified by chronic kidney disease (CKD) status. Methods: We retrospectively analyzed 438 patients with acute ischemic stroke, divided into two groups: those with chronic kidney disease (CKD, n=179) and those without (non-CKD, n=259). ROC curve analyses were performed for NT-proBNP and BNP measured at admission, and the biomarkers were dichotomized using optimal cutoff values. Multivariable logistic regression analyses were conducted separately for each group, adjusting for age, sex, congestive heart failure, and estimated glomerular filtration rate. Results: No significant difference in area under the curve (AUC) was observed between NT-proBNP and BNP. NT-proBNP above the cutoff was independently associated with PAF in both groups (CKD: odds ratio [OR] 20.34; non-CKD: 5.49). Similarly, BNP above the cutoff was independently associated with PAF (CKD: OR 5.86; non-CKD: OR 9.89). Conclusion: NT-proBNP and BNP independently predicted PAF regardless of CKD status, with no significant difference in AUC-based predictive performance between the two markers.

Our case is an 83-year-old man. He had a tooth extracted 8 months prior to admission and suffered a cerebral infarction 6 months prior to admission. He was admitted to the hospital for left submandibular adenitis. He had a left external carotid artery aneurysm on contrast-enhanced CT and underwent coil embolization. Post-operative MRI showed subacute infarctions and microbleeds in both cerebral hemispheres. Transthoracic echocardiography revealed a vegetation on the mitral valve. We diagnosed infective endocarditis with image and clinical findings. He was treated with antimicrobials and transferred for surgery. Our case was a case of infectious aneurysm due to infective endocarditis or submandibular adenitis. Infectious aneurysms of external carotid artery were extremely rare cases. Endovascular therapy is an effective treatment for infectious carotid aneurysms.

The patient was a 71-year-old woman who had previously been diagnosed with neurofibromatosis type 1 (NF-1). She developed dysphagia and hoarseness while under outpatient observation for an asymptomatic extracranial carotid artery aneurysm, with further examinations revealing dilation of the internal carotid artery, for which therapeutic intervention was planned. To determine the optimal treatment, a balloon occlusion test (BOT) was performed, confirming adequate ischemic tolerance. Endovascular trapping of the aneurysm was performed, resulting in a favorable outcome. However, following the treatment, a new dissection of the internal carotid artery occurred at the BOT site, underscoring the vascular vulnerability associated with NF-1. Vascular lesions in NF-1 are thought to arise due to vascular vulnerability resulting from the thinning of the tunica media and the rupture of the elastic lamina. This vulnerability must be considered when selecting approaches for treatment. In this case, coil embolization, both proximal and distal to the aneurysm, prompted thrombosis within the aneurysm and led to early symptomatic improvements.

A 69-year-old male patient with a history of paroxysmal atrial fibrillation, treated with rivaroxaban, visited the emergency room with complaints of dizziness. A cranial MRI revealed an acute ischemic stroke with hemorrhagic transformation in the region of the right cerebellar hemisphere and vermis. Blood tests were positive for lupus anticoagulant, leading to a diagnosis of antiphospholipid syndrome (APS). Transesophageal echocardiography showed valvular vegetation on the mitral valve, suggesting non-bacterial thrombotic endocarditis (NBTE) associated with APS. Thus, the diagnosis of cardiogenetic embolic cerebellar infarction due to NBTE was made. Due to the patient’s refusal to take warfarin, edoxaban and aspirin, instead of rivaroxaban, were prescribed for secondary stroke prevention. The patient experienced no recurrence of stroke, and follow-up transesophageal echocardiography performed at 130 days after the onset of the stroke showed a shrink in the valvular vegetation. This case suggests that combination therapy with edoxaban and aspirin can be a viable agent for patients with NBTE secondary to APS. Careful monitoring with transesophageal echocardiography is recommended for such cases.

We present 2 cases of ruptured cerebral aneurysms without subarachnoid hemorrhage and acute subdural hematoma surrounding the tentorium. Case 1: A 57-year-old man’s MRI revealed hematomas around the interhemispheric fissure, posterior cranial fossa, and cerebellar tentorium. Angiography revealed an aneurysm at the junction of the right internal carotid and anterior choroidal arteries, which was clipped on the third day after onset. Case 2: A 62-year-old man has a hematoma around his cerebellar tentorium. Angiography revealed an aneurysm at the junction of the right internal carotid artery and the posterior communicating artery, which was clipped on the fourth day after onset. In both cases, the dome of the internal carotid artery aneurysm came into contact with the dura of the posterior clinoid process beyond the tentorial incisura, and a subdural hematoma was found around the aneurysm, which was confirmed to be the origin of the bleeding. Even in cases of only acute subdural hematoma, the location of the aneurysm and the dome projection can be used to diagnose a ruptured aneurysm.

We report a case of thrombotic thrombocytopenic purpura (TTP), which was diagnosed following an asymptomatic cerebral infarction and progressed rapidly to a fatal outcome. The patient was an 82-year-old woman with no significant medical history, who visited her previous doctor due to discomfort in her neck for the past three days. She was diagnosed with multiple scattered cerebral infarctions and transfer our hospital by herself. Although she has no obvious neurological deficits, head MRI in our hospital revealed embolic acute infarctions, and she was admitted for treatment. Upon hospitalization, blood tests showed thrombocytopenia, acute renal failure, and hemolytic anemia. The patient also became agitated, and it was determined that specialized treatment was necessary, leading to her transfer to another hospital. Subsequently, a decrease in ADAMTS13 activity was observed, leading to the diagnosis of TTP. Plasma exchange was performed as soon as possible, but the patient passed away the day after admission. The asymptomatic cerebral infarction was presumed to have been caused by microembolisms. TTP can present with only nonspecific symptoms and progress rapidly. Delayed treatment can lead to a fatal outcome, and therefore, careful attention is required.