Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 56, Issue 1
Displaying 1-8 of 8 articles from this issue
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Review Article
  • Brain Death in Pediatric Patients in Japan: Diagnosis and Unresolved Issues
    Takashi ARAKI, Hiroyuki YOKOTA, Akira FUSE
    2016 Volume 56 Issue 1 Pages 1-8
    Published: 2016
    Released on J-STAGE: January 15, 2016
    Advance online publication: November 06, 2015
    DOIhttps://doi.org/10.2176/nmc.ra.2015-0231
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    Brain death (BD) is a physiological state defined as complete and irreversible loss of brain function. Organ transplantation from a patient with BD is controversial in Japan because there are two classifications of BD: legal BD in which the organs can be donated and general BD in which the organs cannot be donated. The significance of BD in the terminal phase remains in the realm of scientific debate. As indicated by the increasing number of organ transplants from brain-dead donors, certain clinical diagnosis for determining BD in adults is becoming established. However, regardless of whether or not organ transplantation is involved, there are many unresolved issues regarding BD in children. Here, we will discuss the historical background of BD determination in children, pediatric emergencies and BD, and unresolved issues related to pediatric BD.
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Original Articles
  • The Associated Venous Anomalies Variant and Adjacent Brain Function on Iron Sensitive Image Indicate Surgical Risk of Cavernous Malformation
    Li MA, Xiao-Lin CHEN, Jun MA, Yuan-Li ZHAO
    2016 Volume 56 Issue 1 Pages 9-20
    Published: 2016
    Released on J-STAGE: January 15, 2016
    Advance online publication: October 21, 2015
    DOIhttps://doi.org/10.2176/nmc.oa.2015-0057
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    The cavernous malformations (CMs) associated with venous anomalies (VAs) are now being described with increasing frequency. Assessment of the associated VAs is overlooked in surgical management of the CM. The clinical profiles of CMs with VAs were reviewed to investigate the value of T2* gradient echo (GRE)/susceptibility weighted imaging (SWI) in surgical risk evaluation. Twenty-six patients with symptomatic CMs associated with VAs between 2008 and 2013 were identified. Demographic, clinical, and radiological data were reviewed and functional outcomes were assessed using the modified Rankin Scale (mRS). The T2* GRE/SWI could allow more accurate evaluation of the boundary and drainage vicinity of VAs than contrast-enhanced images (6 vs. 2 patients with VAs on the eloquent region). Patients with VAs adjacent to eloquent brain showed poorer outcomes than those who had VAs in non-eloquent areas (P = 0.005), while the CMs adjacent to eloquent brain did not correlated with poor outcomes (P = 0.15). Type I and III variants of VAs were also significantly associated with poor outcomes, compared with type II variant (P = 0.002). Careful evaluation of VAs variant type and the association between VAs and eloquent brain is helpful for the management of CMs associated with VAs. We recommend T2* GRE/SWI in patients with CMs to assess the associated VAs. The evaluation of VA drainage vicinity on T2* GRE/SWI would be more useful for designing treatment strategies and risk stratification.
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  • Impact of Aneurysmal Neck Position in Endovascular Therapy for Anterior Communicating Artery Aneurysms
    Hidemichi ITO, Hidetaka ONODERA, Daisuke WAKUI, Masashi UCHIDA, Taigen ...
    2016 Volume 56 Issue 1 Pages 21-26
    Published: 2016
    Released on J-STAGE: January 15, 2016
    Advance online publication: October 09, 2015
    DOIhttps://doi.org/10.2176/nmc.oa.2015-0201
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    Anterior communicating artery (ACoA) aneurysms have a complex architecture and many variations, making endovascular therapy more difficult in some cases. The aim of this study was to investigate whether the neck position of an aneurysm was identifiable for determining the immediate angiographic success and procedural complications in the coiling of the ACoA aneurysms. We conducted a retrospective case review of 40 patients with ACoA aneurysms treated by endovascular therapy from 2008 to 2015. The mean age was 66.8 years. Thirty-five aneurysms were ruptured; five were unruptured. For the analysis, the patients were divided into two groups according to the neck position of aneurysms: the true ACoA group, 9 patients with the neck located on the ACoA itself; and the other ACoA group, 31 patients with the neck at the junction of the A1 and A2 portions of an anterior cerebral artery. Morphological characteristics (dome size, dome direction, rate of wide neck, and angulation of aneurysms in relation to the parent artery) were analyzed along with immediate angiographic results, volume embolization ratio (VER), and procedural complications. Small aneurysms with superior dome projection and acute angulation of the aneurysm direction occurred more often in the true ACoA group. The rates of complete obliteration, VER, and procedural complications were 33.3%, 32.3%, and 22.2% in the true ACoA group and 54.8%, 36.3%, and 6.5% in the other ACoA group, respectively. True ACoA aneurysms could present an anatomical difficulty in endovascular coiling. Aneurysmal neck position should be accurately assessed to achieve successful embolization of the ACoA aneurysms.
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  • Endovascular and Surgical Treatment of Spinal Dural Arteriovenous Fistulas: Assessment of Post-treatment Clinical Outcome
    Panagiotis ZOGOPOULOS, Hajime NAKAMURA, Tomohiko OZAKI, Katsunori ASAI ...
    2016 Volume 56 Issue 1 Pages 27-32
    Published: 2016
    Released on J-STAGE: January 15, 2016
    Advance online publication: October 15, 2015
    DOIhttps://doi.org/10.2176/nmc.oa.2015-0100
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    Spinal dural arteriovenous fistulas (DAVFs) are the most commonly encountered vascular malformation of the spinal cord and a treatable cause of progressive para- or tetraplegia. It is an elusive pathology that tends to be under-diagnosed, due to lack of awareness among clinicians, and affects males more commonly than females, typically between the fifth and eighth decades. Early diagnosis and treatment may significantly improve outcome and prevent permanent disability and even mortality. The purpose of our retrospective, single-center study was to determine the long-term clinical and radiographic outcome of patients who have received endovascular or surgical treatment of a spinal DAVF. In particular, during a 6-year period (2009–2014) 14 patients with a spinal DAVF were treated at our department either surgically (n = 4) or endovascularly (n = 10) with detachable coils and/or glue. There was no recurrence in the follow-up period (mean: 36 months, range 3–60 months) after complete occlusion with the endovascular treatment (n = 9; 90%), while only one patient (10%) had residual flow both post-treatment and at 3-month follow-up. All four surgically treated patients (100%) had no signs of residual DAVF on follow-up magnetic resonance angiography (MRA) and/or angiography (mean follow-up period of 9 months). Since improvement or stabilization of symptoms may be seen even in patients with delayed diagnosis and substantial neurological deficits, either endovascular or surgical treatment is always justified.
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  • Factors Predicting the Effects of Hybrid Assistive Limb Robot Suit during the Acute Phase of Central Nervous System Injury
    Hideo CHIHARA, Yasushi TAKAGI, Kazunari NISHINO, Kazumichi YOSHIDA, Yo ...
    2016 Volume 56 Issue 1 Pages 33-37
    Published: 2016
    Released on J-STAGE: January 15, 2016
    Advance online publication: November 05, 2015
    DOIhttps://doi.org/10.2176/nmc.oa.2015-0178
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    To improve the activities of daily living of patients with injury to the central nervous system, physical therapy starting from the acute phase of the injury is important. Recently, the efficacy of physical therapy using a hybrid assistive limb (HAL) robot suit was reported. However, individual differences exist in the effects of HAL. We investigated factors predicting the effects of HAL in 15 patients at our institution with central nervous system injury, primarily due to stroke, who underwent training using HAL during the acute phase. Patients were classified as either “with HAL suitability” or “without HAL suitability” based on scores from 10-m walking speed, gait, satisfaction, and pain. In both groups, Brunnstrom stage before HAL intervention, Fugl-Meyer assessment (FMA), stroke impairment assessment set (SIAS), and functional independence measure (FIM) were evaluated. Although motor function items did not differ significantly, FIM cognitive function items (P = 0.036), visuospatial perception items on SIAS (P = 0.0277), and pain items on SIAS (P = 0.0122) differed significantly between groups. These results indicated that training using HAL does not involve pain in patients with central nervous system injury during the acute phase, and exhibits positive effects in patients without pain and with high communication ability and visuospatial perception function. When conducting HAL intervention, incorporating functional assessment scores (FIM and SIAS), including peripheral items, may be useful to predict the suitability of HAL.
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Case Reports
  • Ruptured Pseudoaneurysm after Gamma Knife Surgery for Vestibular Schwannoma
    Mamoru MURAKAMI, Kentaro KAWARABUKI, Yasuo INOUE, Tsutomu OHTA
    2016 Volume 56 Issue 1 Pages 38-42
    Published: 2016
    Released on J-STAGE: January 15, 2016
    Advance online publication: December 11, 2015
    DOIhttps://doi.org/10.2176/nmc.cr.2015-0034
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    Ruptured aneurysms of anterior inferior cerebellar artery (AICA) after radiotherapy for vestibular schwannoma (VS) are rare, and no definite treatment has been established for distal AICA pseudoaneurysms. We describe a 61-year-old man who underwent Gamma Knife surgery (GKS) for left VS. Follow-up magnetic resonance imaging (MRI) revealed partial regression of the tumor. Twelve years after GKS, he suffered from subarachnoid hemorrhage. Initial angiogram showed no vascular lesions; second left vertebral angiogram, 10 days after admission, demonstrated a pseudoaneurysm in the lateral pontine segment of the left AICA. The proximal portion of the AICA was occluded by a coil. Postoperative MRI revealed an infarction on the left side of the pons and brachium pontis. Although the patient suffered from mild postoperative cerebellar ataxia and facial and abducens nerve palsy, he was discharged 1 month postoperatively requiring no assistance with activities of daily living. Twelve months later, he recovered satisfactorily with a modified Rankin Scale grade of 1, and no recanalization of the aneurysm was found on MR angiography. Endovascular parent artery occlusion for ruptured aneurysms at distal AICA carries the risk of brain stem infarction, but should be considered when no other option is available such as after radiotherapy for VS.
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  • Stent-assisted Coiling for Ruptured Basilar Artery Dissecting Aneurysms: An Initial Experience of Four Cases
    Satoshi KOIZUMI, Masaaki SHOJIMA, Akira IIJIMA, Soichi OYA, Toru MATSU ...
    2016 Volume 56 Issue 1 Pages 43-48
    Published: 2016
    Released on J-STAGE: January 15, 2016
    Advance online publication: December 11, 2015
    DOIhttps://doi.org/10.2176/nmc.cr.2015-0233
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    No treatment strategy has been established for subarachnoid hemorrhages due to basilar artery (BA) trunk dissecting aneurysms. Our aim was to report our initial experience performing stent-assisted coiling (SAC) for ruptured BA dissecting aneurysms to validate the effectiveness of this treatment. We experienced four consecutive cases of ruptured dissecting BA trunk aneurysm treated with SAC between 2008 and 2014 at three institutions. Aneurysm rebleeding was prevented without causing severe brainstem ischemia in all cases. In our opinion, both the blockage of the inflow to aneurysms and the preservation of the antegrade flow of the BA can be achieved by SAC, although controversies regarding long-term stability and appropriate antiplatelet therapy remain.
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Editorial Committee
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