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Shima T, Yamashita K, Furuta K, Tsujino K, Nagai S, Torimura D, Ohtsuka H, Tomita Y, Hirayama T, Yoshimura S, Miyazaki T, Tateishi Y, Tsujino A. Right-sided Herpes Zoster Ophthalmicus Complicated by Bilateral Third, Fourth, and Sixth Cranial Nerve Palsies and Syndrome of Inappropriate Antidiuretic Hormone Secretion: A Case Report. Intern Med 2024:2878-23. [PMID: 38403774 DOI: 10.2169/internalmedicine.2878-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
Cases of herpes zoster ophthalmicus (HZO) complicated by bilateral ophthalmoplegia are rare, and no cases of bilateral third, fourth, or sixth cranial nerve palsies have been reported. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a rare complication of HZO. We herein report an 80-year-old Japanese woman with right-sided HZO complicated by meningoencephalitis and discuss the pathogenesis of this condition. She developed bilateral third, fourth, and sixth cranial nerve palsies and SIADH almost simultaneously during treatment for HZO. The bilateral cranial palsy spontaneously resolved within a few months.
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Affiliation(s)
- Tomoaki Shima
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Kairi Yamashita
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Kanako Furuta
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Kohei Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Saeko Nagai
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Daiji Torimura
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Hiroaki Ohtsuka
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Yuki Tomita
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Takuro Hirayama
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Shunsuke Yoshimura
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Teiichiro Miyazaki
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
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Yamasaki Y, Horie I, Shigeno R, Nishikido S, Ikeoka T, Hirayama T, Tateishi Y, Tsujino A, Kawakami A. New onset of isolated adrenocorticotropin deficiency associated with encephalopathy following coronavirus disease 2019 in a healthy elderly man. Endocr J 2024:EJ23-0550. [PMID: 38246654 DOI: 10.1507/endocrj.ej23-0550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) due to a severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection can include various systemic organ disorders including endocrinopathies and neurological manifestations. We report the case of a 65-year-old Japanese man who developed isolated adrenocorticotropic hormone (ACTH) deficiency and encephalopathy following SARS-CoV-2 infection. Two weeks after his COVID-19 diagnosis, he was emergently admitted to our hospital because of subacute-onset delirium. On admission, he presented hyponatremia (128 mEq/L) and secondary adrenal insufficiency (ACTH <1.5 pg/mL, cortisol 0.53 μg/dL). Brain imaging and laboratory examinations including SARS-CoV-2 polymerase chain reaction testing in the cerebrospinal fluid revealed no abnormalities. His consciousness level worsened despite the amelioration of hyponatremia by intravenous hydrocortisone (100 mg/day), but his neurological presentations completely resolved after three consecutive days of high-dose (400 mg/day) hydrocortisone. His encephalopathy did not deteriorate during hydrocortisone tapering. He continued 15 mg/day hydrocortisone after discharge. His encephalopathy might have developed via a disturbance of the autoimmune system, or a metabolic effect associated with adrenal insufficiency, although the time lag between the hyponatremia's improvement and the patient's neurological response to the steroid was incompatible with common cases of delirium concurrent with adrenal insufficiency. At 13 months after his hospitalization, the patient's neurological symptoms have not recurred and he has no endocrinological dysfunctions other than the remaining ACTH deficiency. A thorough consideration of the immunological and metabolic characteristics of SARS-CoV-2 is advisable when clinicians treat patients during and even after their COVID-19 disease period.
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Affiliation(s)
- Yusuke Yamasaki
- Department of Endocrinology and Metabolism, Nagasaki University Hospital, Nagasaki 852-8501, Japan
| | - Ichiro Horie
- Department of Endocrinology and Metabolism, Nagasaki University Hospital, Nagasaki 852-8501, Japan
| | - Riyoko Shigeno
- Department of Endocrinology and Metabolism, Nagasaki University Hospital, Nagasaki 852-8501, Japan
| | - Shinpei Nishikido
- Department of Endocrinology and Metabolism, Nagasaki University Hospital, Nagasaki 852-8501, Japan
| | - Toshiyuki Ikeoka
- Department of Endocrinology and Metabolism, Nagasaki University Hospital, Nagasaki 852-8501, Japan
| | - Takuro Hirayama
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki 852-8501, Japan
| | - Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki 852-8501, Japan
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki 852-8501, Japan
| | - Atsushi Kawakami
- Department of Endocrinology and Metabolism, Nagasaki University Hospital, Nagasaki 852-8501, Japan
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Tateishi Y, Yamashita K, Furuta K, Nagai S, Tsujino K, Torimura D, Otsuka H, Tomita Y, Hirayama T, Shima T, Yoshimura S, Miyazaki T, Morofuji Y, Izumo T, Tsujino A. Streamlined workflow including nurse recognition of conjugate gaze deviation for reduced door-to-puncture time in endovascular thrombectomy: A retrospective study. Clin Neurol Neurosurg 2024; 236:108115. [PMID: 38246030 DOI: 10.1016/j.clineuro.2024.108115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Endovascular thrombectomy is recognized as a pivotal treatment for acute ischemic stroke due to large vessel occlusion. Prolonged door-to-puncture time correlates with decreased patient independence after acute ischemic stroke. This study aimed to assess whether a streamlined workflow, including nurse recognition of conjugate gaze deviation, could reduce door-to-puncture time in endovascular thrombectomy. METHODS This study retrospectively reviewed patients with acute ischemic stroke who underwent endovascular thrombectomy between March 2017 and March 2022 and compared a previous workflow with a streamlined workflow implemented in April 2019. In the streamlined workflow, nurses recognized conjugate gaze deviation to identify patients with large vessel occlusions and played a more active role in reducing the door-to-puncture time. We compared time metrics and outcomes, including recanalization status, parenchymal hemorrhage type 2, and favorable outcomes (modified Rankin Scale score 0-2) at three months between the previous and streamlined workflow groups. RESULTS After the application of the streamlined workflow, the door-to-puncture time was reduced from 76 min to 68 min (p = 0.014), and the number of patients with a door-to-puncture time of less than 60 min increased (15% vs. 36%, p = 0.002). Outcomes including modified thrombolysis in cerebral infarction ≥ 2b (73% vs. 71%, p = 1.000), parenchymal hemorrhage type 2 (7% vs. 2%, p = 0.281), and favorable outcome (33% vs. 34%, p = 1.000) were comparable between the two groups. CONCLUSION Nurse recognition of conjugate gaze deviation contributed to an 8-minute reduction in the door-to-puncture time, demonstrating the potential benefits of an organized workflow in acute ischemic stroke.
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Affiliation(s)
- Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan; Department of Clinical Neuroscience, Unit of Clinical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Kairi Yamashita
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
| | - Kanako Furuta
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
| | - Saeko Nagai
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
| | - Kohei Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
| | - Daiji Torimura
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiroaki Otsuka
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
| | - Yuki Tomita
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
| | - Takuro Hirayama
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
| | - Tomoaki Shima
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan; Department of Clinical Neuroscience, Unit of Clinical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shunsuke Yoshimura
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan; Department of Clinical Neuroscience, Unit of Clinical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Teiichiro Miyazaki
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan; Department of Clinical Neuroscience, Unit of Clinical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoichi Morofuji
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Tsuyoshi Izumo
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan; Department of Clinical Neuroscience, Unit of Clinical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Kanemaru K, Ueno Y, Kikuno M, Tateishi Y, Shimizu T, Kuriki A, Doijiri R, Takekawa H, Shimada Y, Yamaguchi E, Koga M, Kamiya Y, Ihara M, Tsujino A, Hirata K, Hasegawa Y, Aizawa H, Hattori N, Urabe T. High-risk patent foramen ovale and elderly in cryptogenic stroke. J Stroke Cerebrovasc Dis 2023; 32:107344. [PMID: 37722223 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND High-risk patent foramen ovale (PFO) could be pathological in cryptogenic stroke (CS), but its clinical characteristics have not been fully studied, especially in elderly patients. METHODS Patients with CS were enrolled in the CHALLENGE ESUS/CS registry, a multicenter registry of CS patients undergoing transesophageal echocardiography. Clinical characteristics were compared among three groups: high-risk PFO group, large shunt PFO (≥25 microbubbles) or PFO with atrial septal aneurysm (ASA); right-to-left shunt (RLS) group, RLS including PFO with <25 microbubbles or without ASA; and no-RLS group. RESULTS In total, 654 patients were analyzed: 91, 221, and 342 in the high-risk PFO, RLS, and no-RLS groups, respectively. In multinomial logistic regression analysis, the male sex (odds ratio [OR] 1.825 [1.067-3.122]) was independently associated with high-risk PFO, but hypertension (OR, 0.562 [0.327-0.967]), multiple infarctions (OR, 0.601 [0.435-0.830]), and other cardioaortic embologenic risks (OR, 0.514 [0.294-0.897]) were inversely associated with high-risk PFO compared with non-RLS. In 517 patients aged ≥60 years, multiple infarctions (OR, 0.549 [0.382-0.788]) and other cardioaortic embologenic risks (OR, 0.523 [0.286-0.959]) were inversely associated with high-risk PFO. CONCLUSIONS High-risk PFO had specific clinical characteristics and possible mechanistic associations, and this trend was consistent among CS patients aged ≥60 years. CLINICAL TRIAL REGISTRATION INFORMATION http://www.umin.ac.jp/ctr/ (UMIN000032957).
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Affiliation(s)
- Kodai Kanemaru
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Neurology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yuji Ueno
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan.
| | - Muneaki Kikuno
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Neurology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
| | - Takahiro Shimizu
- Department of Neurology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Ayako Kuriki
- Department of Neurology, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Ryosuke Doijiri
- Department of Neurology, Iwate Prefectural Central Hospital, Iwate, Japan
| | | | - Yoshiaki Shimada
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Eriko Yamaguchi
- Department of Neurology, Iwate Prefectural Central Hospital, Iwate, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yuki Kamiya
- Department of Neurology, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
| | - Koichi Hirata
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Yasuhiro Hasegawa
- Department of Neurology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Hitoshi Aizawa
- Department of Neurology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Takao Urabe
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
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Shima T, Furuta K, Yamashita K, Tateishi Y, Tsujino A. [Spontaneous Remission of Encephalitis that Developed 17 Weeks After the Last Dose of Pembrolizumab: A Case Report]. Brain Nerve 2023; 75:1163-1167. [PMID: 37849368 DOI: 10.11477/mf.1416202494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
We present a 73-year-old man with a history of lung adenocarcinoma and multiple metastases. He was treated with chemotherapy, including pembrolizumab, but treatment was interrupted due to concurrent drug-induced lung injury. Seventeen weeks after the last dose of pembrolizumab, he developed encephalitis, presenting with a disturbance of consciousness and right hemiplegia. However, his symptoms gradually improved spontaneously and disappeared three weeks after their onset. Late-onset encephalitis after the administration of immune checkpoint inhibitors is rare. In addition, this is the first report of a case in which severe encephalitis recovered spontaneously without leaving sequelae. (Received April 7, 2023; Accepted July 4, 2023; Published October 1, 2023).
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Affiliation(s)
- Tomoaki Shima
- Department of Neurology and Strokology, Nagasaki University Hospital
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Morofuji Y, Tateishi Y, Izumo T, Matsuo T. Stent retriever angioplasty for acute atherosclerotic occlusion of vertebral artery. Clin Neurol Neurosurg 2023; 232:107842. [PMID: 37453284 DOI: 10.1016/j.clineuro.2023.107842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 06/17/2023] [Indexed: 07/18/2023]
Abstract
The established effectiveness of mechanical thrombectomy using a stent retriever or aspiration catheter for emergent large-vessel occlusion caused by cardiogenic embolic stroke is widely recognized. However, in cases of acute artery occlusion resulting from atherosclerotic disease, mechanical thrombectomy often encounters challenges in achieving consistent recanalization, and aggressive percutaneous transluminal angioplasty (PTA) with a balloon and/or stenting can potentially lead to arterial dissection or additional perforator infarction. We present the case of an 88-year-old man who experienced sudden unconsciousness and tetra-paresis, diagnosed with cerebral infarction resulting from right vertebral artery occlusion. During the mechanical thrombectomy procedure, we identified atheromatous disease. Considering the circumstances, we made the decision to maintain the stent placement for 30 min following the loading of dual antiplatelet drugs. As a result, the right vertebral artery was successfully recanalized, although severe stenosis persisted. Two weeks after the initial procedure, we performed wingspan stent placement with a favorable outcome. Stent retriever angioplasty, using the deploy and re-sheath method, appears to be a viable option for managing acute atherosclerotic occlusion. This case highlights the challenges encountered in mechanical thrombectomy for atherosclerotic occlusion and demonstrates a potential approach to address this issue. By keeping the stent in place for a specific duration, combined with appropriate pharmacological intervention, recanalization was achieved, offering a promising therapeutic strategy for similar cases. Stent retriever angioplasty utilizing the deploy and re-sheath method emerges as a potential option for addressing acute atherosclerotic occlusion.
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Affiliation(s)
- Yoichi Morofuji
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
| | - Yohei Tateishi
- Department of Neurology and Strokology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Tsuyoshi Izumo
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Takayuki Matsuo
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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Kanamoto T, Tateishi Y, Yamashita K, Furuta K, Torimura D, Tomita Y, Hirayama T, Shima T, Nagaoka A, Yoshimura S, Miyazaki T, Ideguchi R, Morikawa M, Morofuji Y, Horie N, Izumo T, Tsujino A. Corrigendum to "Impact of width of susceptibility vessel sign on recanalization following endovascular therapy" [Journal of the Neurological Sciences 446 (2023) 120583]. J Neurol Sci 2023; 449:120662. [PMID: 37148774 DOI: 10.1016/j.jns.2023.120662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- Tadashi Kanamoto
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan; Department of Clinical Neuroscience, Unit of Clinical Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan; Department of Clinical Neuroscience, Unit of Clinical Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Japan.
| | - Kairi Yamashita
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Kanako Furuta
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Daishi Torimura
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Yuki Tomita
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Takuro Hirayama
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Tomoaki Shima
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Atsushi Nagaoka
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Shunsuke Yoshimura
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Teiichiro Miyazaki
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Reiko Ideguchi
- Department of Radiology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Minoru Morikawa
- Department of Radiology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Yoichi Morofuji
- Department of Neurosurgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan; Department of Neurosurgery, Hiroshima University, Kasumi 1-2-3 Minami-ku, Hiroshima 734-8551, Japan
| | - Tsuyoshi Izumo
- Department of Neurosurgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan; Department of Clinical Neuroscience, Unit of Clinical Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Japan
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Kanamoto T, Tateishi Y, Yamashita K, Furuta K, Torimura D, Tomita Y, Hirayama T, Shima T, Nagaoka A, Yoshimura S, Miyazaki T, Ideguchi R, Morikawa M, Morofuji Y, Horie N, Izumo T, Tsujino A. Impact of width of susceptibility vessel sign on recanalization following endovascular therapy. J Neurol Sci 2023; 446:120583. [PMID: 36827810 DOI: 10.1016/j.jns.2023.120583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/05/2023] [Accepted: 02/09/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND AND PURPOSE We aimed to investigate the relationship between arterial recanalization following endovascular therapy and the susceptibility vessel sign (SVS) length and width on susceptibility-weighted imaging. METHODS We retrospectively evaluated consecutive patients with anterior circulation ischemic stroke who underwent magnetic resonance imaging preceded endovascular therapy, and measured the SVS length and width. Successful recanalization was defined as expanded thrombolysis in cerebral infarction grade of 2b to 3. Logistic regression analysis was executed to determine the independent predictors of successful recanalization and first-pass reperfusion (FPR) after endovascular therapy. RESULTS Among 100 patients, successful recanalization and FPR were observed in 77 and 34 patients, respectively. The median SVS length and width were 10.3 mm (interquartile range, 6.8-14.1 mm) and 4.2 mm (interquartile range, 3.1-5.2 mm), respectively. In multivariate logistic regression analysis, SVS width was associated with successful recanalization (odds ratio, 1.88; 95% confidence interval, 1.14-3.07; p = 0.005) and FPR (odds ratio, 1.38; 95% confidence interval, 1.01-1.89; p = 0.039). The optimal cutoff value for the SVS width to predict successful recanalization and FPR were 4.2 mm and 4.0 mm, respectively. CONCLUSIONS Larger SVS width may predict successful recanalization and FPR following endovascular therapy.
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Affiliation(s)
- Tadashi Kanamoto
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Kairi Yamashita
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Kanako Furuta
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Daishi Torimura
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Yuki Tomita
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Takuro Hirayama
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Tomoaki Shima
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Atsushi Nagaoka
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Shunsuke Yoshimura
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Teiichiro Miyazaki
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Reiko Ideguchi
- Department of Radiology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Minoru Morikawa
- Department of Radiology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Yoichi Morofuji
- Department of Neurosurgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan; Department of Neurosurgery, Hiroshima University, Kasumi 1-2-3 Minami-ku, Hiroshima 734-8551, Japan
| | - Tsuyoshi Izumo
- Department of Neurosurgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
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Ishimaru H, Ikebe Y, Morikawa M, Ideguchi R, Tateishi Y, Tsujino A, Uetani M. Significance of Low Signal in Intracranial Vertebral Artery Wall Observed on Susceptibility-Weighted Angiography. Cerebrovasc Dis 2023; 52:89-96. [PMID: 35793613 DOI: 10.1159/000524840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/05/2022] [Indexed: 02/01/2023] Open
Abstract
PURPOSE We aimed to investigate the clinical significance of the low signal in the intracranial vertebral artery wall observed on susceptibility-weighted angiography. MATERIALS AND METHODS We retrospectively reviewed susceptibility-weighted angiographies from 200 consecutive patients with acute ischemic stroke in the posterior circulation territory. The presence of eccentric or concentric low signals in the vertebral artery wall was examined and evaluated. The etiology of the low signal was also investigated as much as possible by referring to computed tomography and T1-weighted imaging (T1WI). We also compared its frequency in each stroke subtype. RESULTS A low signal was observed in 128/200 patients (64%). The low signals (58%) corresponded to vessel wall calcification in 74 of 128 patients and to vessel wall thickening showing intermediate to low (n = 8) or high (n = 16) signals on T1WI in 24 (19%) patients. The low signal did not have vessel wall thickening or calcification in 1 patient, and the cause of the low signal could not be verified in 29 patients. According to stroke subtypes, a low signal was observed in 14/14 (100%) vertebral artery dissections, all of which corresponded to intramural hematoma. A low signal was observed in 51/65 (78%) atherothromboses, which were significantly more frequent than cardioembolism (34/66; 52%) and small-artery disease (18/39; 46%) (p < 0.01). In atherothrombosis, calcification was the most common cause of low signal (n = 32; 63%). CONCLUSION Low signals on susceptibility-weighted angiography were frequently observed in vertebral artery dissection and atherothrombosis, reflecting intramural hematoma in all of the former and predominantly calcification in the latter.
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Affiliation(s)
- Hideki Ishimaru
- Department of Radiology, Nagasaki University Hospital, Nagasaki, Japan
| | - Yohei Ikebe
- Department of Radiology, Nagasaki University Hospital, Nagasaki, Japan
| | - Minoru Morikawa
- Department of Radiology, Nagasaki University Hospital, Nagasaki, Japan
| | - Reiko Ideguchi
- Department of Radiology, Nagasaki University Hospital, Nagasaki, Japan
| | - Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
| | - Masataka Uetani
- Department of Radiology, Nagasaki University Hospital, Nagasaki, Japan
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10
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Nagaoka A, Tsujino A, Shiraishi H, Kanamoto T, Shima T, Yoshimura S, Miyazaki T, Tateishi Y, Tsujihata M, Motomura M, Maxwell S, Higuchi O, Beeson D, Vincent A. Motor end-plate analysis to diagnose immune-mediated myasthenia gravis in seronegative patients. J Neurol Sci 2022; 443:120494. [PMID: 36403297 DOI: 10.1016/j.jns.2022.120494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
This study aimed to evaluate the diagnostic usefulness of motor end-plate (MEP) analysis along with clustered acetylcholine receptor (AChR) antibody (Ab) assays in patients with myasthenia-like symptoms but negative routine AChR and muscle-specific kinase (MuSK) Ab tests. MEP analysis of muscle biopsies of the biceps brachii was performed in 20 patients to try to differentiate between those with or without immune-mediated myasthenia gravis (MG). Using a quantitative method, complement C3 deposition and AChR densities in MEPs were examined. Independently, cell-based assays were used to detect serum clustered-AChR Abs. Only five of 20 patients had complement deposition at MEPs; four of these patients had reduced AChR densities similar to those in patients with typical AChR Ab positive MG, and distinct from those in the remaining 15 patients. Two of the four serum samples from these patients had clustered-AChR Abs. All complement-positive patients were considered as having immune-mediated MG and improved with appropriate treatments; although one patient presented with MG 3 years later, the remaining patients had other diagnoses during over 10 years of follow-up. These results suggest the usefulness of MEP analysis of muscle biopsies in diagnosing immune-mediated MG in seronegative patients with myasthenia-like symptoms but, due to the invasiveness of the muscle biopsy procedure, clustered AChR Abs should, if possible, be tested first.
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Affiliation(s)
- Atsushi Nagaoka
- Department of Clinical Neuroscience, Unit of Clinical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki City, Japan.
| | - Akira Tsujino
- Department of Clinical Neuroscience, Unit of Clinical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki City, Japan.
| | - Hirokazu Shiraishi
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki City, Japan
| | - Tadashi Kanamoto
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki City, Japan
| | - Tomoaki Shima
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki City, Japan.
| | - Shunsuke Yoshimura
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki City, Japan.
| | - Teiichiro Miyazaki
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki City, Japan.
| | - Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki City, Japan.
| | | | - Masakatsu Motomura
- Medical Electronic Course, Nagasaki Institute of Applied Science, Nagasaki City, Japan.
| | - Susan Maxwell
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
| | - Osamu Higuchi
- Department of Neurology, Nagasaki Kawatana Medical Center, Nagasaki, Japan.
| | - David Beeson
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
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11
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Yamashita K, Tateishi Y, Kanamoto T, Ueda M, Nakamura Y, Tsujino A. [Two cases of ischemic stroke due to low protein C caused by severe hyperthyroidism]. Rinsho Shinkeigaku 2022; 62:839-843. [PMID: 36288963 DOI: 10.5692/clinicalneurol.cn-001754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
We reported two patients with acute ischemic stroke who had presented with symptoms of thyroid storm. Case1: A 43-year-old man abruptly developed left hemiparesis caused by the right middle cerebral artery occlusion. Cardiac evaluations revealed atrial fibrillation and left atrial enlargement. He had successful recanalization after reperfusion therapies. Case 2: A 66-year-old woman with severe bilateral middle cerebral artery stenosis presented with right hemiparesis and dysarthria. MRI revealed the acute infarction in the left frontal and parietal lobe. In both cases, protein C activity was decreased which could be related to severe hyperthyroidism. They concomitantly had arterial lesions where blood stasis could occur. Severe hyperthyroidism which could evoke the decreasing of protein C activity could be responsible to develop acute ischemic stroke.
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Affiliation(s)
- Kairi Yamashita
- Department of Neurology and Strokology, Nagasaki University Hospital
| | - Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Hospital
| | - Tadashi Kanamoto
- Department of Neurology and Strokology, Nagasaki University Hospital
| | - Mayu Ueda
- Department of Endocrinology and Metabolism, Nagasaki University Hospital
| | - Yuta Nakamura
- Department of Endocrinology and Metabolism, Nagasaki University Hospital
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital
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12
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Shimizu T, Ueno Y, Tateishi Y, Doijiri R, Kuriki A, Kikuno M, Takekawa H, Shimada Y, Kanemaru K, Kamiya Y, Yamaguchi E, Koga M, Ihara M, Tsujino A, Hirata K, Hasegawa Y, Hattori N, Urabe T. Evaluating the Potential Pathology and Short-Term Outcomes of Cryptogenic Stroke Using the Etiological Classification System. J Atheroscler Thromb 2022; 30:377-389. [PMID: 35691846 PMCID: PMC10067338 DOI: 10.5551/jat.63267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Various embolic sources and pathogenetic mechanisms underlie cryptogenic stroke (CS). We investigated the association of etiological diversity with short-term outcomes in patients with CS using a modified atherosclerosis (A), small-vessel disease (S), cardiac pathology (C), other causes (O), and dissection (D) (ASCOD) system. METHODS Patients with CS who underwent transesophageal echocardiography were registered in this multicenter, observational study. In the modified classification system, O and D were inapplicable and thus excluded. Instead, atherosclerosis, small-vessel disease, cardiac pathology-CS classification was specifically constructed for the etiological diagnosis of CS. We utilized this system to explore the mechanism of CS by grading each pathology and evaluated its association with poorer modified Rankin Scale scores of 3-6 at hospital discharge. RESULTS A total of 672 patients (68.7±12.8 years, 220 females) were analyzed. In the multiple logistic regression model, female sex (odds ratio [OR], 1.87 [1.15-3.04]; P=0.012), body mass index (OR, 0.93 [0.88-0.99]; P=0.025), National Institute of Health Stroke Scale score (OR, 1.16 [1.12-1.21]; P<0.001), CHADS2 score (OR, 1.56 [1.30-1.86]; P<0.001), D-dimer (OR, 1.04 [1.01-1.08]; P=0.015), diffusion-weighted image (DWI) lesion size (OR, 1.44 [1.10-1.89]; P=0.009), and S+C score (OR, 1.26 [1.03-1.56]; P=0.029) were associated with poor functional outcome at discharge whereas the S+C score was marginally associated with poor functional outcome after excluding 137 patients with a premorbid modified Rankin Scale score of ≥ 3. CONCLUSIONS The coexistence of small-vessel disease and cardiac pathology might be associated with poor in-hospital functional outcome in CS.
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Affiliation(s)
- Takahiro Shimizu
- Department of Neurology, St. Marianna University School of Medicine
| | - Yuji Ueno
- Department of Neurology, Juntendo University Faculty of Medicine
| | - Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Hospital
| | | | - Ayako Kuriki
- Department of Neurology, Showa University Koto Toyosu Hospital
| | - Muneaki Kikuno
- Department of Neurology, Tokyo Medical University.,Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | | | | | - Kodai Kanemaru
- Department of Neurology, Tokyo Medical University.,Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yuki Kamiya
- Department of Neurology, Showa University Koto Toyosu Hospital
| | | | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital
| | | | | | - Nobutaka Hattori
- Department of Neurology, Juntendo University Faculty of Medicine
| | - Takao Urabe
- Department of Neurology, Juntendo University Urayasu Hospital
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13
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Yamashita A, Kitamura M, Tateishi Y, Torigoe K, Muta K, Mochizuki Y, Izumo T, Matsuo T, Tsujino A, Sakai H, Mukae H, Nishino T. Correlation between a Bedridden Status and the Long-term Outcome in Hemodialysis Patients after Intracerebral Hemorrhaging. Intern Med 2022; 61:1133-1138. [PMID: 34565774 PMCID: PMC9107990 DOI: 10.2169/internalmedicine.8006-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective The quality of life and activities of daily living (ADL) are generally poor among dialysis patients after intracerebral hemorrhaging, and their precise clinical course remains unclear. In addition, the association between the severity of cerebral hemorrhaging and the long-term prognosis in these patients has not been fully elucidated. This study aimed to evaluate the subsequent prognosis of hemodialysis patients who survived the acute phase of intracerebral hemorrhaging. Methods We included hemodialysis patients who were admitted to Nagasaki University Hospital between 2007 and 2015 for intracerebral hemorrhaging treatment. After excluding cases of in-hospital death, survivors were classified using the 5-point modified Rankin Scale (mRS), which specifically measures the ADL in patients with cerebrovascular diseases. The patients were followed up at the medical facilities to which they were transferred in the same medical zone until 2017. Results Out of 91 patients with cerebral hemorrhaging (65±11 years old, 66% men, hemodialysis duration 108±91 months), 62 survived until discharge. Twenty-one patients died during observation, largely due to infectious diseases, such as sepsis and pneumonia (n=16, 76%). Compared to patients with mRS 0-4 (n=31), those with mRS 5 (n=31) showed a significantly poorer prognosis. The hazard ratio adjusted for age and antiplatelets was 13.7 (95% confidence interval: 3.88-63.7, p<0.001). Conclusion Hemodialysis patients with intracerebral hemorrhaging who were bedridden showed poor outcomes. The major causes of death were infections. Therefore, these patients should be carefully monitored for infections in order to improve their prognosis.
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Affiliation(s)
- Ayuko Yamashita
- Division of Blood Purification, Nagasaki University Hospital, Japan
- Department of Nephrology, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Japan
| | - Mineaki Kitamura
- Department of Nephrology, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Japan
| | - Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Kenta Torigoe
- Department of Nephrology, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Japan
| | - Kumiko Muta
- Department of Nephrology, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Japan
| | - Yasushi Mochizuki
- Division of Blood Purification, Nagasaki University Hospital, Japan
- Deparment of Urology, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Japan
| | - Tsuyoshi Izumo
- Department of Neurosurgery, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Japan
| | - Takayuki Matsuo
- Department of Neurosurgery, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Japan
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Hideki Sakai
- Deparment of Urology, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Japan
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14
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Kutsuna F, Tateishi Y, Yamashita K, Kanamoto T, Hirayama T, Shima T, Nagaoka A, Yoshimura S, Miyazaki T, Sone J, Izumo T, Tsujino A. Perfusion abnormality in neuronal intranuclear inclusion disease with stroke-like episode: A case report. Cerebral Circulation - Cognition and Behavior 2022; 3:100127. [PMID: 36324394 PMCID: PMC9616236 DOI: 10.1016/j.cccb.2022.100127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/02/2022] [Accepted: 02/19/2022] [Indexed: 11/28/2022]
Abstract
A patient with NIID developed stroke-like symptoms. The perfusion abnormality may be one of the causes of acute episodes in NIID. NIID should be considered as a stroke mimic.
Neuronal intranuclear inclusion disease (NIID) is a slowly progressive neurodegenerative disease. Some patients with NIID occasionally present with acute symptoms. However, its mechanism remains unclear. We report a patient with NIID who presented with a stroke-like episode. Arterial spin labeling magnetic resonance imaging revealed hypoperfusion in the focal cerebral region at the onset while no apparent arterial occlusion was observed. The abnormal perfusion area was normalized 6 days after admission. Therefore, the perfusion abnormality was likely the main cause of acute neurologic deficits in NIID. NIID should be considered in the differential diagnosis of stroke mimics.
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Affiliation(s)
- Fumiya Kutsuna
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
- Department of Neurology, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubara, Omura, Nagasaki, 856-0835, Japan
| | - Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
- Corresponding author at: 1-7-1 Sakamoto, Nagasaki City, Nagasaki 852-8501, Japan.
| | - Kairi Yamashita
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Tadashi Kanamoto
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Takuro Hirayama
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Tomoaki Shima
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Atsushi Nagaoka
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Shunsuke Yoshimura
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Teiichiro Miyazaki
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Jun Sone
- Department of Neurology, National Hospital Organization Suzuka National Hospital, 3-2-1 Kasado, Suzuka, 513-8501, Mie, Japan
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Tsuyoshi Izumo
- Department of Neurosurgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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15
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Kikuno M, Ueno Y, Takekawa H, Kanemaru K, Shimizu T, Kuriki A, Tateishi Y, Doijiri R, Shimada Y, Yamaguchi E, Koga M, Kamiya Y, Ihara M, Tsujino A, Hirata K, Hasegawa Y, Aizawa H, Hattori N, Urabe T. Distinction in Prevalence of Atherosclerotic Embolic Sources in Cryptogenic Stroke With Cancer Status. J Am Heart Assoc 2021; 10:e021375. [PMID: 34689573 PMCID: PMC8751843 DOI: 10.1161/jaha.120.021375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Cerebrovascular diseases are common comorbidities in patients with cancer. Although active cancer causes ischemic stroke by multiple pathological conditions, including thromboembolism attributable to Trousseau syndrome, the relationship between stroke and inactive cancer is poorly known. The aim of this study was to elucidate the different underlying pathogeneses of cryptogenic stroke in active and inactive patients with cancer, with detailed investigation by transesophageal echocardiography. Methods and Results CHALLENGE ESUS/CS (Mechanisms of Embolic Stroke Clarified by Transesophageal Echocardiography for Embolic Stroke of Undetermined Source/Cryptogenic Stroke) registry is a multicenter registry including data of patients initially diagnosed as having cryptogenic stroke and undergoing transesophageal echocardiography. Patients were divided into active cancer, inactive cancer, and noncancer groups, and their clinical features were compared. Of the total 667 enrolled patients (age, 68.7±12.8 years; 455 men), 41 (6.1%) had active cancer, and 51 (7.5%) had a history of inactive cancer. On multinomial logistic regression analysis, infarctions in multiple vascular territories (odds ratio [OR], 2.73; 95% CI, 1.39–5.40) and CRP (C‐reactive protein) (OR, 1.10; 95% CI, 1.01–1.19) were independently associated with active cancer, whereas age (OR, 1.05; 95% CI, 1.01–1.08), contralateral carotid stenosis from the index stroke lesion (OR, 4.05; 95% CI, 1.60–10.27), calcification of the aortic valve (OR, 2.10; 95% CI, 1.09–4.05), and complicated lesion of the aortic arch (OR, 2.13; 95% CI, 1.11–4.10) were significantly associated with inactive cancer. Conclusions Patients with cancer were not rare in cryptogenic stroke. Although patients with active cancer had more multiple infarctions, patients with inactive cancer had more atherosclerotic embolic sources potentially causing arteriogenic strokes. Registration URL: https://www.umin.ac.jp/ctr/; Unique identifier: UMIN000032957.
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Affiliation(s)
- Muneaki Kikuno
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,Department of Neurology Tokyo Medical University Hospital Tokyo Japan
| | - Yuji Ueno
- Department of Neurology Juntendo University Faculty of Medicine Tokyo Japan
| | | | - Kodai Kanemaru
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,Department of Neurology Tokyo Medical University Hospital Tokyo Japan
| | - Takahiro Shimizu
- Department of Neurology St. Marianna University School of Medicine Kanagawa Japan
| | - Ayako Kuriki
- Department of Neurology Showa University Koto Toyosu Hospital Tokyo Japan
| | - Yohei Tateishi
- Department of Neurology and Strokology Nagasaki University Hospital Nagasaki Japan
| | - Ryosuke Doijiri
- Department of Neurology Iwate Prefectural Central Hospital Iwate Japan
| | - Yoshiaki Shimada
- Department of Neurology Juntendo University Urayasu Hospital Chiba Japan
| | - Eriko Yamaguchi
- Department of Neurology Iwate Prefectural Central Hospital Iwate Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan
| | - Yuki Kamiya
- Department of Neurology Showa University Koto Toyosu Hospital Tokyo Japan
| | - Masafumi Ihara
- Department of Neurology National Cerebral and Cardiovascular Center Osaka Japan
| | - Akira Tsujino
- Department of Neurology and Strokology Nagasaki University Hospital Nagasaki Japan
| | - Koichi Hirata
- Department of Neurology Dokkyo Medical University Tochigi Japan
| | - Yasuhiro Hasegawa
- Department of Neurology St. Marianna University School of Medicine Kanagawa Japan
| | - Hitoshi Aizawa
- Department of Neurology Tokyo Medical University Hospital Tokyo Japan
| | - Nobutaka Hattori
- Department of Neurology Juntendo University Faculty of Medicine Tokyo Japan
| | - Takao Urabe
- Department of Neurology Juntendo University Urayasu Hospital Chiba Japan
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16
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Kutsuna F, Yamashita K, Kanamoto T, Kurohama H, Tateishi Y, Tsujino A. [Nonrecanalization after mechanical thrombectomy in acute ischemic stroke due to infective endocarditis: an autopsy case]. Rinsho Shinkeigaku 2021; 61:671-675. [PMID: 34565752 DOI: 10.5692/clinicalneurol.cn-001616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
An 86-year-old man was admitted for the abrupt onset of right hemiparesis and aphasia. DWI revealed the high intensity legion in the left insular cortex, and MRA demonstrated the left middle cerebral artery occlusion. Recanalization of the artery was not achieved after mechanical thrombectomy. The diagnosis of infective endocarditis was made as Enterococcus faecalis was cultured from the blood, and mobile vegetation was detected at the aortic valve by transthoracic echocardiography. The patient died from multiple organ failure at 19 days. Autopsy findings revealed fibrin-rich thrombus in the left middle cerebral artery containing neutrophils and bacteria. At the occluded site, neutrophils had intensively infiltrated into the vessel wall, and endothelial cells had partially disappeared. Moreover, disrupted internal elastic lamina was discovered. These findings could indicate that the thrombus had adhered to the vessel wall. The adhesion of the thrombus and vessel wall could be associated with unsuccessful recanalization after endovascular thrombectomy in patients with ischemic stroke due to infective endocarditis.
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Affiliation(s)
- Fumiya Kutsuna
- Department of Neurology and Strokology, Nagasaki University Graduate School of Biomedical Sciences
| | - Kairi Yamashita
- Department of Neurology and Strokology, Nagasaki University Graduate School of Biomedical Sciences
| | - Tadashi Kanamoto
- Department of Neurology and Strokology, Nagasaki University Graduate School of Biomedical Sciences
| | - Hirokazu Kurohama
- Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences
| | - Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Graduate School of Biomedical Sciences
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Graduate School of Biomedical Sciences
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17
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Izumo T, Fujimoto T, Morofuji Y, Tateishi Y, Matsuo T. Partial Clipping Occlusion Including Rupture Point Is an Effective Strategy for Ruptured Giant Fusiform Basilar Artery Aneurysm: A Technical Case Report. Front Neurol 2021; 12:743654. [PMID: 34659100 PMCID: PMC8516352 DOI: 10.3389/fneur.2021.743654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Treatment of fusiform basilar artery aneurysms is still challenging today. The authors present a case of a patient with a ruptured giant fusiform basilar artery aneurysm successfully treated by clipping occlusion of the rupture point. A 62-year-old man suddenly fell into a coma due to subarachnoid hemorrhage (SAH) with a ruptured giant fusiform basilar artery aneurysm with a bleb on the right shoulder. We considered treating the lesion with stent-assisted coil embolization because of the aneurysm's shape, but we had to give up because stents were off-label in the acute phase SAH in our country. Instead, we successfully performed clipping surgery to partially occlude the aneurysm, including the rupture point via the anterior transpetrosal approach. His postoperative course was uneventful, without rerupture of the aneurysm, and his conscious level tended to improve. The postoperative imaging studies showed no complications and disappearance of the rupture point of the aneurysm. Although direct surgery for the giant fusiform basilar artery aneurysms is one of the challenging operations, it is an essential and highly effective treatment as a last resort for complex aneurysms if other treatments are not available.
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Affiliation(s)
- Tsuyoshi Izumo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takashi Fujimoto
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoichi Morofuji
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yohei Tateishi
- Department of Clinical Neuroscience and Neurology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takayuki Matsuo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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18
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Tateishi Y, Ueno Y, Tsujino A, Kuriki A, Kamiya Y, Shimizu T, Doijiri R, Yamaguchi E, Kikuno M, Shimada Y, Takekawa H, Koga M, Ihara M, Hirata K, Hasegawa Y, Toyoda K, Hattori N, Urabe T. Cardiac and Echocardiographic Markers in Cryptogenic Stroke with Incidental Patent Foramen Ovale. J Stroke Cerebrovasc Dis 2021; 30:105892. [PMID: 34107415 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/02/2021] [Accepted: 05/08/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE Some cardiac abnormalities could be a substrate for potential embolic source in cryptogenic stroke (CS). We evaluated whether cardiac and echocardiographic markers were associated with CS in patients with incidental patent foramen ovale (PFO) as defined using the Risk of Paradoxical Embolism (RoPE) score. MATERIALS AND METHODS Among 677 patients enrolled in a multicenter observational CS registry, 300 patients (44%) had PFOs detected by transesophageal echocardiography. They were classified into probable PFO-related stroke (RoPE score>6, n = 32) and stroke with incidental PFO (RoPE score≤6, n = 268) groups, and clinical characteristics, laboratory findings, cardiac and echocardiographic markers (i.e. brain natriuretic peptide, left atrial [LA] diameter, ejection fraction, early transmitral flow velocity/early diastolic tissue Doppler imaging velocity [E/e'], LA appendage flow velocity, spontaneous echo contrast, atrial septal aneurysm, substantial PFO, and aortic arch plaques), stroke recurrence, and excellent outcome (modified Rankin scale score <2) at discharge were compared. Risk factors for low RoPE scores were determined using multiple logistic regression analysis. RESULTS Higher brain natriuretic peptide levels (p = 0.032), LA enlargement (p < 0.001), higher E/e' (p = 0.001), lower LA appendage flow velocity (p < 0.001), non-substantial PFO (p = 0.021), and aortic arch plaques (p = 0.002) were associated with the low RoPE score group. Patients with high RoPE scores had excellent outcomes (58% versus 78%, p = 0.035). LA enlargement (age- and sex-adjusted odds ratio, 1.15; 95 % confidence interval, 1.00-1.32; p = 0.039) was an independent predictor of low RoPE scores. CONCLUSIONS Abnormal cardiac substrate could be associated with CS occurrence in a subset of patients with PFO. Patients with CS who had incidental PFO may be at risk of cardioembolism.
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Affiliation(s)
- Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan.
| | - Yuji Ueno
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan.
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan.
| | - Ayako Kuriki
- Department of Neurology, Showa University Koto Toyosu Hospital, Tokyo, Japan.
| | - Yuki Kamiya
- Department of Neurology, Showa University Koto Toyosu Hospital, Tokyo, Japan.
| | - Takahiro Shimizu
- Department of Neurology, St. Marianna University School of Medicine, Kanagawa, Japan.
| | - Ryosuke Doijiri
- Department of Neurology, Iwate Prefectural Central Hospital, Iwate, Japan.
| | - Eriko Yamaguchi
- Department of Neurology, Iwate Prefectural Central Hospital, Iwate, Japan.
| | - Muneaki Kikuno
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Neurology, Tokyo Medical University, Tokyo, Japan.
| | - Yoshiaki Shimada
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan.
| | | | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Koichi Hirata
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan.
| | - Yasuhiro Hasegawa
- Department of Neurology, St. Marianna University School of Medicine, Kanagawa, Japan; Stroke Center, Department of Neurology, Shin-yurigaoka General Hospital, Kanagawa, Japan.
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan.
| | - Takao Urabe
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan.
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19
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Hiu T, Morimoto S, Matsuo A, Satoh K, Otsuka H, Kutsuna F, Ozono K, Hirayama K, Nakamichi C, Yamasaki K, Ogawa Y, Shiozaki E, Morofuji Y, Kawahara I, Horie N, Tateishi Y, Ono T, Haraguchi W, Izumo T, Tsujino A, Matsuo T, Tsutsumi K. Current status of a helicopter transportation system on remote islands for patients undergoing mechanical thrombectomy. PLoS One 2021; 16:e0245082. [PMID: 33465116 PMCID: PMC7815141 DOI: 10.1371/journal.pone.0245082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/21/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mechanical thrombectomy (MT) is standard treatment for acute ischemic stroke (AIS) with large-vessel occlusion within 6 h of symptom onset to treatment initiation (OTP). Recent trials have extended the therapeutic time window for MT to within 24 h. However, MT treatment remains low in remote areas. Nagasaki Prefecture, Japan has many inhabited islands with no neurointerventionalists. Our hospital on the mainland is a regional hub for eight island hospitals. We evaluated clinical outcomes of MT for patients with AIS on these islands versus on the mainland. METHODS During 2014-2019, we reviewed consecutive patients with AIS who received MT at our hospital. Patients comprised the Islands group and Mainland group. Patient characteristics and clinical outcomes were compared between groups. RESULTS We included 91 patients (Islands group: 15 patients, Mainland group: 76 patients). Seven patients (46.7%) in the Islands group versus 43 (56.6%) in the Mainland group achieved favorable outcomes. Successful recanalization was obtained in 11 patients (73.3%) on the islands and 67 (88.2%) on the mainland. The median OTP time in the Islands was 365 min. In both the Islands and Mainland groups, the OTP time and successful recanalization were associated with functional outcome. The modified Rankin Scale (mRS) score at 90 days ≤2 was obtained in two patients and mRS = 3 in four patients among eight patients with OTP time >6 h. CONCLUSIONS Few patients with AIS on remote islands have received MT. Although patients who underwent MT on the islands had longer OTP, the clinical outcomes were acceptable. OTP time on remote islands must be shortened, as this is related to functional outcome. In some cases with successful recanalization, a favorable outcome can still be obtained even after 6 h. Even if OTP exceeds 6 h, it is desirable to appropriately select patients and actively perform MT.
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Affiliation(s)
- Takeshi Hiu
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- * E-mail:
| | - Shimpei Morimoto
- Innovation Platform & Office for Precision Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Ayaka Matsuo
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Kei Satoh
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Hiroaki Otsuka
- Department of Neurology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Fumiya Kutsuna
- Department of Neurology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Keisuke Ozono
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Kosuke Hirayama
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Chikaaki Nakamichi
- Department of Emergency, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Kazumi Yamasaki
- Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Yuka Ogawa
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Eri Shiozaki
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Yoichi Morofuji
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Ichiro Kawahara
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yohei Tateishi
- Department of Neurology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomonori Ono
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Wataru Haraguchi
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Tsuyoshi Izumo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Akira Tsujino
- Department of Neurology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takayuki Matsuo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Keisuke Tsutsumi
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
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20
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Shima T, Tsujino S, Yamashita K, Hirayama T, Fukushima K, Kanamoto T, Ohta R, Nagaoka A, Yoshimura S, Miyazaki T, Tateishi Y, Shiraishi H, Tsujino A. Neuromyelitis Optica Spectrum Disorder Complicated by Posterior Reversible Encephalopathy Syndrome as an Initial Manifestation. Intern Med 2020; 59:1887-1890. [PMID: 32321890 PMCID: PMC7474992 DOI: 10.2169/internalmedicine.4226-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A 25-year-old woman was admitted to our hospital due to tonic convulsion with severe headache after having experienced symptoms of nausea and vomiting for a month. Brain magnetic resonance imaging showed extensive symmetrical lesions in the cortical and subcortical areas of parieto-occipital lobes and basal ganglia, consistent with typical characteristics of posterior reversible encephalopathy syndrome (PRES). Furthermore, some residual lesions in the left side of dorsal medulla oblongata and central area of the cervical spinal cord along with the presence of serum anti-aquaporin-4 antibody yielded the diagnosis of neuromyelitis optica spectrum disorder (NMOSD). We herein discuss the mechanism by which PRES may occur together with NMOSD.
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Affiliation(s)
- Tomoaki Shima
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Shuhei Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Kairi Yamashita
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Takuro Hirayama
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Kaori Fukushima
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Tadashi Kanamoto
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Rie Ohta
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Atsushi Nagaoka
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Shunsuke Yoshimura
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Teiichiro Miyazaki
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Hirokazu Shiraishi
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital, Japan
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21
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Kuriki A, Ueno Y, Kamiya Y, Shimizu T, Doijiri R, Tateishi Y, Kikuno M, Shimada Y, Takekawa H, Yamaguchi E, Koga M, Ihara M, Ono K, Tsujino A, Hirata K, Toyoda K, Hasegawa Y, Hattori N, Urabe T. Atrial Septal Aneurysm may Cause In-Hospital Recurrence of Cryptogenic Stroke. J Atheroscler Thromb 2020; 28:514-523. [PMID: 32684557 PMCID: PMC8193779 DOI: 10.5551/jat.56440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Aims:
Awareness of potentially embologenic diseases is critical to determining the prognosis of cryptogenic stroke. The clinical significance of atrial septal aneurysm (ASA) in cryptogenic stroke has not been fully studied. Therefore, we explored clinical characteristics and in-hospital recurrence in patients with ASA in cryptogenic stroke.
Methods:
A multicenter observational registry of cryptogenic stroke patients was conducted. We obtained baseline characteristics, radiological and laboratory findings, and echocardiographic findings, especially of embolic sources on transesophageal echocardiography. The CHALLENGE ESUS/CS (Mechanisms of Embolic Stroke Clarified by Transesophageal Echocardiography for embolic stroke of undetermined source/cryptogenic stroke) registry was recorded at http://www.umin.ac.jp/ctr/ (UMIN000032957). Patients’ clinical characteristics were compared according to the presence of ASA, and factors associated with in-hospital stroke recurrence were assessed.
Results:
The study included 671 patients (age, 68.7±12.7 years; 450 males; median National Institutes of Health Stroke Scale score, 2). ASA was detected in 92 patients (14%), displaying higher age (72.4±11.0 vs. 68.1 ±12.9 years,
p
=0.004), reduced frequency of diabetes mellitus (16% vs. 27%,
p
=0.030), higher frequency of right-to-left shunt (66% vs. 45%,
p
<0.001), and in-hospital stroke recurrence (8% vs. 3%,
p
=0.034). ASA was relatively associated with in-hospital recurrence (odds ratio 2.497, 95% confidence interval 0.959–6.500,
p
= 0.061).
Conclusions:
The CHALLENGE ESUS/CS registry indicated that ASA was not rare in cryptogenic stroke, and ASA’s clinical characteristics included higher age, reduced frequency of diabetes mellitus, and increased frequency of concomitant right-to-left shunt. ASA may be related to in-hospital stroke recurrence in cryptogenic stroke.
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Affiliation(s)
- Ayako Kuriki
- Department of Neurology, Showa University Koto Toyosu Hospital
| | - Yuji Ueno
- Department of Neurology, Juntendo University Faculty of Medicine
| | - Yuki Kamiya
- Department of Neurology, Showa University Koto Toyosu Hospital
| | - Takahiro Shimizu
- Department of Neurology, St.Marianna University School of Medicine
| | | | - Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Hospital
| | - Muneaki Kikuno
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | | | | | | | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center
| | - Kenjiro Ono
- Division of Neurology, Department of Medicine, Showa University School of Medicine
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital
| | | | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Nobutaka Hattori
- Department of Neurology, Juntendo University Faculty of Medicine
| | - Takao Urabe
- Department of Neurology, Juntendo University Urayasu Hospital
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22
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Kikuno M, Ueno Y, Shimizu T, Kuriki A, Tateishi Y, Doijiri R, Shimada Y, Takekawa H, Yamaguchi E, Koga M, Kamiya Y, Ihara M, Tsujino A, Hirata K, Toyoda K, Hasegawa Y, Aizawa H, Hattori N, Urabe T. Underlying embolic and pathologic differentiation by cerebral microbleeds in cryptogenic stroke. J Neurol 2020; 267:1482-1490. [PMID: 32016623 DOI: 10.1007/s00415-020-09732-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/24/2020] [Accepted: 01/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cryptogenic stroke encompasses diverse emboligenic mechanisms and pathogeneses. Cerebral microbleeds (CMBs) occur differently among stroke subtypes. The association of CMBs with cryptogenic stroke is essentially unknown. METHODS CHALLENGE ESUS/CS (Mechanisms of Embolic Stroke Clarified by Transesophageal Echocardiography for ESUS/CS) is a multicenter registry with comprehensive data including gradient-echo T2*-weighted magnetic resonance imaging of cryptogenic stroke patients who underwent transesophageal echocardiography. Patients' clinical characteristics were compared according to the presence and location of CMBs. RESULTS A total of 661 patients (68.7 ± 12.7 years; 445 males) were enrolled, and 209 (32%) had CMBs. Age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.00-1.04, p = 0.020), male sex (OR 1.85, 95% CI 1.18-2.91, p = 0.007), hypertension (OR 1.71, 95% CI 1.03-2.86, p = 0.039), chronic kidney disease (OR 1.64, 95% CI 1.11-2.43, p = 0.013), deep and subcortical white matter hyperintensity (OR 1.82, 95% CI 1.16-2.85, p = 0.009), and periventricular hyperintensity (OR 2.18, 95% CI 1.37-3.46, p = 0.001) were independently associated with the presence of CMBs. Aortic complicated lesions (OR 1.78, 95% CI 1.12-2.84, p = 0.015) were associated with deep and diffuse CMBs, whereas prior anticoagulant therapy (OR 7.88, 95% CI, 1.83-33.9, p = 0.006) was related to lobar CMBs. CONCLUSIONS CMBs were common, and age, male sex, hypertension, chronic kidney disease, and cerebral white matter diseases were related to CMBs in cryptogenic stroke. Aortic complicated lesions were associated with deep and diffuse CMBs, while prior anticoagulant therapy was related to lobar CMBs.
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Affiliation(s)
- Muneaki Kikuno
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
- Department of Neurology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yuji Ueno
- Department of Neurology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Takahiro Shimizu
- Department of Neurology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Ayako Kuriki
- Department of Neurology, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
| | - Ryosuke Doijiri
- Department of Neurology, Iwate Prefectural Central Hospital, Iwate, Japan
| | - Yoshiaki Shimada
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | | | - Eriko Yamaguchi
- Department of Neurology, Iwate Prefectural Central Hospital, Iwate, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yuki Kamiya
- Department of Neurology, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
| | - Koichi Hirata
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yasuhiro Hasegawa
- Department of Neurology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Hitoshi Aizawa
- Department of Neurology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takao Urabe
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
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23
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Tateishi Y, Kanamoto T, Yamashita K, Hirayama T, Yoshimura S, Miyazaki T, Tsuneto A, Maemura K, Morofuji Y, Horie N, Izumo T, Shiraishi H, Tsujino A. Biomarkers of Cardiac Dysfunction as Risk Factors in Cryptogenic Stroke. Cerebrovasc Dis 2019; 48:132-139. [PMID: 31694016 DOI: 10.1159/000504014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/09/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is unclear whether biomarkers of cardiac dysfunction are associated with cryptogenic stroke (CS). METHODS We retrospectively evaluated consecutive ischemic stroke patients. Patients underwent transthoracic echocardiography to evaluate left atrial diameter and the peak transmitral filling velocity/mean mitral annular velocity during early diastole (E/e'). Patent foramen ovale (PFO) and left atrial appendage flow velocity were evaluated by transesophageal echocardiography. We compared clinical characteristics and biomarkers of cardiac dysfunction (brain natriuretic peptide [BNP], left atrial diameter, E/e', and left atrial appendage flow velocity) between CS or CS without large PFO and other causative stroke subtypes. RESULTS Among 1,514 patients with ischemic stroke, 264 patients were classified as having CS. Of these, transesophageal echocardiography revealed 27/158 (17%) large PFOs. In comparison, for the noncardioembolic stroke group, which consisted of large artery and small vessel subtypes, patients with CS without large PFO had higher log10 BNP (adjusted OR 2.70; 95% CI 1.92-3.78; p < 0.001), higher log10 E/e' (3.41; 1.21-13.15; p = 0.019), and lower left atrial appendage flow velocity (0.98; 0.97-1.00; p = 0.031). Left atrial diameter was similar for noncardioembolic stroke and CS without large PFO (p = 0.380). Cutoff values of BNP, E/e', and left atrial appendage flow velocity capable of distinguishing CS without large PFO from noncardioembolic stroke were 65.0 pg/mL (sensitivity 55.3%; specificity 70.9%), 13.0 (45.5%; 68.0%), and 46.0 cm/s (37.1%; 87.5%), respectively. CONCLUSION Patients with CS without large PFO could have biomarkers of cardiac dysfunction.
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Affiliation(s)
- Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan,
| | - Tadashi Kanamoto
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
| | - Kairi Yamashita
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
| | - Takuro Hirayama
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
| | - Shunsuke Yoshimura
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
| | - Teiichiro Miyazaki
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
| | - Akira Tsuneto
- Department of Cardiology, Nagasaki University Hospital, Nagasaki, Japan
| | - Koji Maemura
- Department of Cardiology, Nagasaki University Hospital, Nagasaki, Japan
| | - Yoichi Morofuji
- Department of Neurosurgery, Nagasaki University Hospital, Nagasaki, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Nagasaki University Hospital, Nagasaki, Japan
| | - Tsuyoshi Izumo
- Department of Neurosurgery, Nagasaki University Hospital, Nagasaki, Japan
| | - Hirokazu Shiraishi
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
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24
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Morofuji Y, Horie N, Tateishi Y, Morikawa M, Yamaguchi S, Izumo T, Anda T, Tsujino A, Matsuo T. Arterial Spin Labeling Magnetic Resonance Imaging Can Identify the Occlusion Site and Collateral Perfusion in Patients with Acute Ischemic Stroke: Comparison with Digital Subtraction Angiography. Cerebrovasc Dis 2019; 48:70-76. [DOI: 10.1159/000503090] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 09/03/2019] [Indexed: 11/19/2022] Open
Abstract
Background and Objectives: Determining the occlusion site and collateral blood flow is important in acute ischemic stroke. The purpose of the current study was to test whether arterial spin labeling (ASL) magnetic resonance imaging (MRI) could be used to identify the occlusion site and collateral perfusion, using digital subtraction angiography (DSA) as a gold standard. Method: Data from 521 consecutive patients who presented with acute ischemic stroke at our institution from January 2012 to September 2014 were retrospectively reviewed. Image data were included in this study if: (1) the patient presented symptoms of acute ischemic stroke; (2) MRI was performed within 24 h of symptom onset; and (3) DSA following MRI was performed (n = 32 patients). We defined proximal intra-arterial sign (IAS) on ASL as enlarged circular or linear bright hyperintense signal within the occluded artery and distal IAS as enlarged circular or linear bright hyperintense signals within arteries inside or surrounding the affected region. The presence or absence of the proximal IAS and distal IAS were assessed, along with their inter-rater agreement and consistency with the presence of occlusion site and collateral flow on DSA images. Results: The sensitivity and specificity for identifying occlusion site with ASL were 82.8 and 100%, respectively. Those for identifying collateral flow with ASL were 96.7 and 50%, respectively. The inter-rater reliability was excellent for proximal IAS (κ = 0.92; 95% CI 0.76–1.00) and substantial for distal IAS detection (κ = 0.78; 95% CI 0.38–1.00). Conclusions: Proximal IAS and distal IAS on ASL imaging can provide important diagnostic clues for the detection of arterial occlusion sites and collateral perfusion in patients with acute ischemic stroke.
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25
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Horie N, Shobayashi K, Morofuji Y, Sadakata E, Iki Y, Matsunaga Y, Kanamoto T, Tateishi Y, Izumo T, Anda T, Morikawa M, Tsujino A, Matsuo T. Impact of Mechanical Thrombectomy Device on Thrombus Histology in Acute Embolic Stroke. World Neurosurg 2019; 132:e418-e422. [PMID: 31470156 DOI: 10.1016/j.wneu.2019.08.130] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/16/2019] [Accepted: 08/17/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although many studies have evaluated the retrieved thrombus to assess the cause of stroke after mechanical thrombectomy for acute large vessel occlusion, the results remain controversial. We investigated the hypothesis that histology of the retrieved thrombus is enhanced by mechanical thrombectomy devices. METHODS Thrombi were collected from consecutive patients who had undergone endovascular mechanical recanalization for large intracranial vessel occlusion. The mechanical thrombectomy device used was either an aspiration catheter or a stent retriever. The hematoxylin and eosin-stained specimens were quantitatively analyzed with respect to the relative fractions of the main constituents (erythrocytes and fibrin). Clinical and radiologic findings were also evaluated. RESULTS Of 65 patients, an aspiration catheter was used in 27, and a stent retriever was used in 38. The presence of a preoperative susceptibility vessel sign on magnetic resonance imaging was not correlated with the percentage of erythrocytes. Thrombus cross-sectional area was larger in the aspiration group than in the stent group (P < 0.01). Conversely, the percentage of the fibrin component was higher in the stent group (P < 0.001). Preoperative intravenous administration of recombinant tissue plasminogen activator reduced thrombus cross-sectional area with a trend of increased percentage of fibrin and reduced percentage of erythrocyte in the stent group. CONCLUSIONS Histologic differences in retrieved thrombi are enhanced by mechanical thrombectomy devices. Stent retrievers may crush the thrombus, which may have a synergistic effect with recombinant tissue plasminogen activator. Histology of the retrieved thrombi might be different from histology of the original thrombi.
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Affiliation(s)
- Nobutaka Horie
- Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki, Japan.
| | | | - Yoichi Morofuji
- Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Eisaku Sadakata
- Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Yusuke Iki
- Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Yuki Matsunaga
- Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Tadashi Kanamoto
- Department of Neurology, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Yohei Tateishi
- Department of Neurology, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Tsuyoshi Izumo
- Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Takeo Anda
- Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Minoru Morikawa
- Department of Radiology, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Akira Tsujino
- Department of Neurology, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Takayuki Matsuo
- Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki, Japan
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Kitamura M, Tateishi Y, Sato S, Obata Y, Mochizuki Y, Funakoshi S, Matsuo T, Tsujino A, Nishino T. MON-144 ASSOCIATION BETWEEN SERUM CALCIUM LEVELS AND THE PROGNOSIS, HEMATOMA VOLUME, AND THE ONSET OF CEREBRAL HEMORRHAGE IN PATIENTS UNDERGOING HEMODIALYSIS. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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27
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Yamashita A, Tokuda M, Matsuo M, Irie J, Tateishi Y, Mutsukura K. [A case of secondary central nervous system lymphoma presenting marked hypoglycorrhachia]. Rinsho Shinkeigaku 2019; 59:365-370. [PMID: 31142712 DOI: 10.5692/clinicalneurol.cn-001284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 67-year-old male was transferred to our hospital with diplopia, decreased deep tendon reflex and ataxia. He had been suspected Fisher syndrome because of previous upper respiratory tract infection. A cerebrospinal fluid examination showed marked hypoglycorrhachia, pleocytosis and elevated protein, and cytological examination suggested malignant lymphoma. Abdominal computed tomography revealed a left adrenal mass. A biopsy of the left adrenal mass revealed diffuse large B-cell lymphoma. He was treated with a combination of R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, oncovin and prednisolone) and intrathecal administration of methotrexate, cytarabine and prednisolone. Neurological symptoms were gradually improved. Malignancy should be considered in addition to bacterial, fungal or tuberculous meningitis in a case with marked hypoglycorrhachia.
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Affiliation(s)
- Aya Yamashita
- Department of Neurology, Nagasaki Harbor Medical Center
| | | | | | - Junji Irie
- Department of Pathology, Nagasaki Harbor Medical Center
| | - Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Hospital
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28
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Kitamura M, Tateishi Y, Sato S, Kitamura S, Ota Y, Muta K, Yamashita H, Uramatsu T, Obata Y, Mochizuki Y, Nishikido M, Izumo T, Harada T, Funakoshi S, Matsuo T, Tsujino A, Sakai H, Mukae H, Nishino T. Association between serum calcium levels and prognosis, hematoma volume, and onset of cerebral hemorrhage in patients undergoing hemodialysis. BMC Nephrol 2019; 20:210. [PMID: 31174486 PMCID: PMC6555959 DOI: 10.1186/s12882-019-1400-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 05/28/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND High serum calcium levels should be avoided in patients on hemodialysis (HD) because they can induce cardiovascular diseases and worsen the patient's prognosis. In contrast, low serum calcium levels worsen the prognosis of patients with cerebral hemorrhage in the general population. So far, whether serum calcium levels in patients on HD are associated with cerebral hemorrhage remains unknown. This study aimed to reveal the association between serum calcium and cerebral hemorrhage in patients on HD, including in-hospital death, volume of hematoma, and onset of cerebral hemorrhage. METHODS This cross-sectional case-control study included 99 patients on HD with cerebral hemorrhage at a single center between July 1, 2007 and December 31, 2017. Controls included 339 patients on HD at a single HD center between July 1, 2011 and June 30, 2012. Data on serum calcium level, patient demographics, and comorbid conditions were collected, and associations between cerebral hemorrhage and subsequent death were evaluated by multivariate logistic regression analysis. Further, the association of these backgrounds and hematoma volume was evaluated by multiple regression analysis. RESULTS Of the 99 patients, 32 (32%) died from cerebral hemorrhage. The corrected serum calcium level (odds ratio [OR], 2.49; 95% confidence interval [CI], 1.43-4.35; P < 0.001) and antiplatelet drug use (OR, 3.95; 95% CI, 1.50-10.4; P = 0.005) had significant effects on the prognosis. Moreover, the corrected serum calcium (P = 0.003) and antiplatelet drug use (P = 0.01) were significantly correlated with hematoma volume. In the patients, the corrected serum calcium level (OR, 1.54; 95% CI, 1.07-2.22; P = 0.02) was associated with the onset of cerebral hemorrhage, as was pre-hemodialysis systolic blood pressure (per 10 mmHg) (OR, 1.40; 95% CI, 1.23-1.59; P < 0.001). CONCLUSIONS Although the precise mechanisms remain unknown, a high serum calcium level is associated with cerebral hemorrhage in patients on HD. Thus, we should pay attentions to a patient's calcium level.
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Affiliation(s)
- Mineaki Kitamura
- Division of Blood Purification, Nagasaki University Hospital, Nagasaki, Japan
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
| | - Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
| | - Shuntaro Sato
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Satoko Kitamura
- Division of Blood Purification, Nagasaki University Hospital, Nagasaki, Japan
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
| | - Yuki Ota
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
| | - Kumiko Muta
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiroshi Yamashita
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
| | - Tadashi Uramatsu
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
| | - Yoko Obata
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
| | - Yasushi Mochizuki
- Division of Blood Purification, Nagasaki University Hospital, Nagasaki, Japan
| | | | - Tsuyoshi Izumo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takashi Harada
- Department of Nephrology, Nagasaki Renal Center, Nagasaki, Japan
| | | | - Takayuki Matsuo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
| | - Hideki Sakai
- Division of Blood Purification, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Unit of Basic Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
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Horie N, Morofuji Y, Iki Y, Sadakata E, Kanamoto T, Tateishi Y, Izumo T, Anda T, Morikawa M, Tsujino A, Matsuo T. Impact of basal ganglia damage after successful endovascular recanalization for acute ischemic stroke involving lenticulostriate arteries. J Neurosurg 2019; 132:1880-1888. [PMID: 31151109 DOI: 10.3171/2019.3.jns182909] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 03/08/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Regional ischemic vulnerability of the brain reportedly differs between the cortex and basal ganglia and has been poorly assessed in the setting of endovascular mechanical thrombectomy. This study was conducted to determine the fate of an ischemic basal ganglia and its contribution to the clinical outcome after successful endovascular recanalization for acute ischemic stroke with large vessel occlusion involving the lenticulostriate arteries. METHODS Clinical and radiological findings were retrospectively analyzed in consecutive patients with acute ischemic stroke characterized by large vessel occlusion involving the lenticulostriate arteries. Mechanical thrombectomy was performed in all patients using a stent retriever. The fate of ischemic basal ganglia based on location (lentiform nucleus, caudate nucleus, and internal capsule) and insular cortex was assessed according to the Alberta Stroke Programme Early CT Score (ASPECTS). RESULTS Of 170 patients with large intracranial vessel occlusion who achieved successful endovascular recanalization, defined as a thrombolysis in cerebral infarction grade of ≥ 2B, involvement of the lenticulostriate arteries was seen in 55 patients (internal carotid artery, n = 35; proximal middle cerebral artery, n = 20). Preoperative infarction was detected in the lentiform nucleus (66.7%), internal capsule (11.1%), and caudate nucleus (33.3%), all of which showed secondary advancement despite successful recanalization (85.4%, 27.3%, and 54.5%, respectively; p < 0.05). Lenticulostriate arteries with a lateral proximal and/or medial proximal origin significantly affected the development of mature infarction in the lentiform nucleus. Postoperative hemorrhagic transformation was detected in 25 of 55 patients, mostly in the lentiform nucleus. Involvement of insular ribbon infarction was significantly high in patients with hemorrhagic transformation in the basal ganglia. Age, initial National Institutes of Health Stroke Scale (NIHSS) score, initial ASPECTS, postoperative ASPECTS, postoperative infarction in the insular ribbon, and lesions in the middle cerebral artery area (M1-M6) were significantly different between patients with good and poor modified Rankin Scale scores. Interestingly, no differences were detected in postoperative infarction or hemorrhagic transformation in the basal ganglia. Multivariate analysis showed that only age (p = 0.02, OR 0.88) and the initial NIHSS score (p = 0.01, OR 0.86) independently affected favorable clinical outcomes. CONCLUSIONS The basal ganglia are vulnerable and readily develop secondary infarction and hemorrhagic transformation despite successful recanalization. However, this does not have a significant impact on the clinical outcome of acute ischemic stroke with large vessel occlusion involving the lenticulostriate arteries.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Minoru Morikawa
- 3Radiology, Nagasaki University School of Medicine, Nagasaki, Japan
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30
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Tateishi Y, Kanamoto T, Nakaoka K, Yoshimura S, Miyazaki T, Shiraishi H, Morimoto S, Tsuneto A, Maemura K, Morofuji Y, Horie N, Izumo T, Tsujino A. A score using left ventricular diastolic dysfunction to predict 90-day mortality in acute ischemic stroke: The DONE score. J Neurol Sci 2019; 398:157-162. [DOI: 10.1016/j.jns.2019.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
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31
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Tateishi Y, Kanamoto T, Nakaoka K, Fukushima K, Kitanosono H, Shima T, Ota R, Nagaoka A, Yoshimura S, Miyazaki T, Shiraishi H, Morofuji Y, Horie N, Izumo T, Tsujino A. Abstract WP273: Transesophageal and Transthoracic Echocardiography for Detecting Risk and Prognostic Factors in Embolic Stroke of Undetermined Source. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wp273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
It is unclear whether biomarkers of cardiac dysfunction are associated with embolic stroke of undetermined source (ESUS), while large patent foramen ovale (PFO) could relate to it.
Method:
We retrospectively review patients with ischemic stroke who underwent transesophageal echocardiography (TEE) from April 2012, to April 2018. The peak transmitral filling velocity/early diastolic mitral annular tissue velocity (E/e’) on transthoracic echocardiography was used to estimate diastolic dysfunction. PFO and left atrial appendage (LAA) flow velocity were evaluated by TEE. We compared risk factors, clinical characteristics and biomarkers of cardiac dysfunction (brain natriuretic peptide [BNP], left atrial diameter, E/e’, the presence of systolic dysfunction [EF<40%], and LAA flow velocity) adjusted for age and sex between ESUS with and without large PFO. We evaluated outcome at 90 days of ESUS patients who had biomarkers of cardiac dysfunction compared to that of ESUS patients with large PFO.
Results:
Among 294 patients with ESUS, 163 patients underwent TEE (55%). Of these, 24 patients (15%) had large PFO. Compared with ESUS patients with large PFO, those without large PFO had higher BNP (adjusted odds ratio 1.02, 95% confidence interval; 1.00-1.03, p=0.002) and higher E/e’ (1.25, 1.06-1.48; p=0.003). Left atrial diameter, EF<40% and LAA flow velocity were similar between ESUS with and without large PFO groups. (p=0.165, p=0.622 and p=0.859). ESUS patients without large PFO with both BNP level > 50 pg/ml and E/e’ > 12, which were median values, had worse clinical outcome compared to patients who have less cardiac biomarkers and patients with large PFO. (p=0.005)
Conclusion:
ESUS Patients without large PFO often have biomarkers of cardiac dysfunction. The clinic outcome of ESUS patients without large PFO who have biomarkers of cardiac dysfunction could be worse than that of ESUS patients with large PFO.
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Affiliation(s)
- Yohei Tateishi
- Dept of Neurology and Strokology, Nagasaki Univ Hosp, Nagasaki, Japan
| | - Tadashi Kanamoto
- Dept of Neurology and Strokology, Nagasaki Univ Hosp, Nagasaki, Japan
| | - Kenjiro Nakaoka
- Dept of Neurology and Strokology, Nagasaki Univ Hosp, Nagasaki, Japan
| | - Kaori Fukushima
- Dept of Neurology and Strokology, Nagasaki Univ Hosp, Nagasaki, Japan
| | - Hiroko Kitanosono
- Dept of Neurology and Strokology, Nagasaki Univ Hosp, Nagasaki, Japan
| | - Tomoaki Shima
- Dept of Neurology and Strokology, Nagasaki Univ Hosp, Nagasaki, Japan
| | - Rie Ota
- Dept of Neurology and Strokology, Nagasaki Univ Hosp, Nagasaki, Japan
| | - Atsushi Nagaoka
- Dept of Neurology and Strokology, Nagasaki Univ Hosp, Nagasaki, Japan
| | | | | | | | - Yoichi Morofuji
- Dept of Neurology and Strokology, Nagasaki Univ Hosp, Nagasaki, Japan
| | - Nobutaka Horie
- Dept of Neurosurgery, Nagasaki Univ Hosp, Nagasaki, Japan
| | - Tsuyoshi Izumo
- Dept of Neurosurgery, Nagasaki Univ Hosp, Nagasaki, Japan
| | - Akira Tsujino
- Dept of Neurology and Strokology, Nagasaki Univ Hosp, Nagasaki, Japan
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Yamaguchi S, Horie N, Morikawa M, Tateishi Y, Hiu T, Morofuji Y, Izumo T, Hayashi K, Matsuo T. Assessment of veins in T2*-weighted MR angiography predicts infarct growth in hyperacute ischemic stroke. PLoS One 2018; 13:e0195554. [PMID: 29617449 PMCID: PMC5884555 DOI: 10.1371/journal.pone.0195554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/23/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE T2*-weighted magnetic resonance angiography (SWAN) detects hemodynamic insufficiency as hypointense areas in medullary or cortical veins. We therefore investigated whether SWAN can help predict ischemic penumbra-like lesions in patients with acute ischemic stroke (AIS). MATERIALS AND METHODS Magnetic resonance imaging (MRI) records-including SWAN, diffusion-weighted imaging (DWI), and magnetic resonance angiography (MRA)-of consecutive patients with major vessel occlusion within 6 h from AIS onset were analyzed. Acute recanalization was defined as an arterial occlusive lesion score of 2-3. A modified Alberta Stroke Program Early CT Score (mASPECTS) was used to evaluate ischemic areas revealed by SWAN and DWI. SWAN- and DWI-based mASPECTSs were calculated, and correlations between DWI-SWAN mismatches with final infarct lesions or clinical outcomes were evaluated. RESULTS Among the 35 patients included in this study, we confirmed cardioembolic stroke in 26, atherothrombotic stroke in 4, and unknown stroke etiology in 5. Overall, recanalization was achieved in 23 patients, who showed a higher follow-up DWI-based mASPECTS and lower modified Rankin Scale (mRS) score at 90 days than patients without recanalization. Initial SWAN- and follow-up DWI-based mASPECTSs were significantly higher for atherothrombotic stroke than for cardioembolic stroke. Of 12 patients without recanalization, DWI-SWAN mismatch was significantly correlated with infarct growth. Patients with recanalization showed no such correlation. In the assessment of clinical outcome, follow-up DWI-based mASPECTS and patient's age were significantly correlated with mRS at 90 days after stroke. A multivariate logistic regression analysis revealed that the follow-up DWI-based mASPECTS was independently associated with a favorable outcome 90 days after stroke. CONCLUSIONS For patients with AIS, DWI-SWAN mismatch might show penumbra-like lesions that would predict infarct growth without acute recanalization. Assessment of ischemic lesions from the venous side appears to be useful for considering the etiology and revascularization therapy.
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Affiliation(s)
- Susumu Yamaguchi
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
- * E-mail:
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Minoru Morikawa
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yohei Tateishi
- Department of Neurology and Strokology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Takeshi Hiu
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yoichi Morofuji
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Tsuyoshi Izumo
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Kentaro Hayashi
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Takayuki Matsuo
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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Fujimoto T, Morofuji Y, Matsunaga Y, Horie N, Izumo T, Tateishi Y, Morikawa M, Miura T, Eishi K, Matsuo T. Early Diagnosis of Infective Endocarditis by Brain T2*-Weighted Magnetic Resonance Imaging. Circ J 2018; 82:464-468. [PMID: 28943531 DOI: 10.1253/circj.cj-17-0212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Because infective endocarditis (IE) carries a high risk of morbidity and mortality, rapid diagnosis and effective treatment are essential to achieving a good patient outcome. However, the diagnosis of IE is often difficult in patients presenting with nonspecific clinical manifestations. An association between IE and hypointense signal spots on brain T2*-weighted magnetic resonance imaging (MRI) has been reported, but the clinical significance remains unclear.Methods and Results:To assess the clinical importance of silent lesions in the brains of IE patients, hypointense signal spots detected on their brain T2*-weighted MRI scans were investigated in a retrospective review of 44 consecutive patients with definite or suspected IE evaluated by MRI between June 2006 and January 2014. Hypointense signal spots on T2*-weighted MRI were detected in 37 (84%) patients; of these, 21 (46%) had ischemic lesions, 10 (22%) had subarachnoid hemorrhage, 4 (9%) had intraparenchymal hemorrhage, and 4 (9%) had infectious aneurysm. The hypointense signal spots on T2*-weighted images were preferentially distributed in cortical areas. CONCLUSIONS T2*-weighted hypointense signal spots are highly frequent in patients with IE and their presence may be informative in the monitoring of IE-associated brain lesions, even those that are neurologically asymptomatic. The strong association between IE and T2*-weighted hypointense signal spots supports the need to consider additional criteria in the diagnosis of IE.
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Affiliation(s)
- Takashi Fujimoto
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Yoichi Morofuji
- Department of Neurosurgery, Nagasaki University School of Medicine
| | - Yuki Matsunaga
- Department of Neurosurgery, Nagasaki University School of Medicine
| | - Nobutaka Horie
- Department of Neurosurgery, Nagasaki University School of Medicine
| | - Tsuyoshi Izumo
- Department of Neurosurgery, Nagasaki University School of Medicine
| | - Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University School of Medicine
| | - Minoru Morikawa
- Department of Radiology, Nagasaki University School of Medicine
| | - Takashi Miura
- Department of Cardiovascular Surgery, Nagasaki University School of Medicine
| | - Kiyoyuki Eishi
- Department of Cardiovascular Surgery, Nagasaki University School of Medicine
| | - Takayuki Matsuo
- Department of Neurosurgery, Nagasaki University School of Medicine
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Tateishi Y, Kanamoto T, Nakaoka K, Fukushima K, Kitanosono H, Ota R, Nonaka T, Nagaoka A, Yoshimura S, Miyazaki T, Shiraishi H, Morofuji Y, Horie N, Izumo T, Tsujino A. Neurological symptoms on arrival to predict large vessel occlusion or surgical treatment of intracerebral hemorrhage. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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35
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Nagaoka A, Shiraishi H, Yoshimura S, Fukushima K, Ueno M, Ohta R, Nonaka T, Nakaoka K, Kanamoto T, Tateishi Y, Motomura M, Tsujino A. Motor end-plate biopsies in myasthenia gravis. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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36
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Fukushima K, Yoshimura S, Shiraishi H, Miyazaki T, Nagaoka A, Nonaka T, Ueno M, Ota R, Tateishi Y, Kanamoto T, Nakaoka K, Tsujino A. Effectiveness of selective plasma exchange therapy (SePE) in patients with myasthenia gravis. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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37
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Morofuji Y, Tateishi Y, Horie N, Sadakata E, Morikawa M, Izumo T, Tsujino A, Matsuo T. Collateral flow detected by arterial spin labelling MR imaging can predict outcome in endovascular recanalization for acute ischemic stroke. J Stroke Cerebrovasc Dis 2017. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.11.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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38
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Aoki J, Kimura K, Morita N, Harada M, Metoki N, Tateishi Y, Todo K, Yamagami H, Hayashi K, Terasawa Y, Fujita K, Yamamoto N, Deguchi I, Tanahashi N, Inoue T, Iwanaga T, Kaneko N, Mitsumura H, Iguchi Y, Ueno Y, Kuramoto Y, Ogata T, Fujimoto S, Yokoyama M, Nagahiro S. YAMATO Study (Tissue-Type Plasminogen Activator and Edaravone Combination Therapy). Stroke 2017; 48:712-719. [DOI: 10.1161/strokeaha.116.015042] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/05/2016] [Accepted: 12/07/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
We investigated whether administration of edaravone, a free radical scavenger, before or during tissue-type plasminogen activator (tPA) can enhance early recanalization in a major arterial occlusion.
Methods—
The YAMATO study (Tissue-Type Plasminogen Activator and Edaravone Combination Therapy) is an investigator-initiated, multicenter (17 hospitals in Japan), prospective, randomized, and open-label study. Patients with stroke secondary to occlusion of the M1 or M2 portion of the middle cerebral artery and within 4.5 hours of the onset were studied. The subjects were randomly allocated to the early group (intravenous edaravone [30 mg] was started before or during tPA) and the late group (edaravone was started after tPA and the assessment of early recanalization).
Results—
One-hundred sixty-five patients (96 men; median age [interquartile range], of 78 [69–85] years) were randomized 1:1 to either the early group (82 patients) or the late group (83 patients). Primary outcome, defined as an early recanalization 1.5 hour after tPA, was observed in 53% of the early group and in 53% of the late group (
P
=1.000). About secondary outcomes, the rate of significant recanalization of ≥50% was not different between the 2 groups (28% versus 34%;
P
=0.393). The symptomatic intracerebral hemorrhage has occurred in 4 patients (5%) in the early group and in 2 patients (2%) in the late group (
P
=0.443). The favorable outcome (modified Rankin Scale score of 0–2) at 3 months was also similar between the groups (53% versus 57%;
P
=0.738).
Conclusions—
The timing of edaravone infusion does not affect the rate of early recanalization, symptomatic intracerebral hemorrhage, or favorable outcome after tPA therapy.
Clinical Trial Registration—
URL:
http://www.umin.ac.jp/ctr/index-j.htm
. Unique identifier: UMIN000006330.
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Affiliation(s)
- Junya Aoki
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Kazumi Kimura
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Naomi Morita
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Masafumi Harada
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Norifumi Metoki
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Yohei Tateishi
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Kenichi Todo
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Hiroshi Yamagami
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Kouji Hayashi
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Yuka Terasawa
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Koji Fujita
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Nobuaki Yamamoto
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Ichiro Deguchi
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Norio Tanahashi
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Takeshi Inoue
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Takeshi Iwanaga
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Nobuyuki Kaneko
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Hidetaka Mitsumura
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Yasuyuki Iguchi
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Yasushi Ueno
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Yoji Kuramoto
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Toshiyasu Ogata
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Shigeru Fujimoto
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Mutsumi Yokoyama
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Shinji Nagahiro
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
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39
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Tateishi Y, Kanamoto T, Nakaoka K, Morofuji Y, Horie N, Izumo T, Tsujino A. Abstract 82: Diastolic Dysfunction Revealed by Transesophageal Echocardiography Predicts New Atrial Fibrillation During Hospitalization for Acute Ischemic Stroke. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Transesophageal echocardiography (TEE) is often performed to explore an embolic source in ischemic stroke patients without atrial fibrillation (AF). The aim of this study was to elucidate the relationship between the ratio of transmitral flow velocity (E) and mitral annular velocity (e’) measured by using TEE (E/e’ TEE) and prediction of new AF during hospitalization.
Method:
We prospectively enrolled 170 patients with acute ischemic stroke without known atrial fibrillation at admission. Transthoracic echocardiography was performed to assess left atrial diameter, ejection fraction, and E/e’. A subset of patients underwent TEE to explore an embolic source. We obtained the e’ at the lateral wall located near the left atrial appendage by using TEE. Baseline characteristics, stroke features, initial National Institutes of Health Stroke Scale (NIHSS) score, plasma and serum biomarkers included brain natriuretic protein (BNP), and imaging findings were recorded. We investigated factors to predict new documented AF by multivariate logistic regression analysis. To elucidate the cut off value of factors for predicting new AF, the area under the curve of the receiver operating characteristic curve was evaluated.
Results:
AF was detected in 14 patients (8%). In univariate analysis, older age (median, 75 years vs. 71 years; p=0.022), higher initial NIHSS score (median, 8 vs. 3; p=0.017), elevated plasma BNP level (median, 183 pg/mL vs. 36 pg/mL; p<0.001), larger left atrial diameter (median, 38 mm vs. 35 mm; p=0.024) and higher E/e’ TEE (median, 22.4 vs. 14.4; p=0.004) were positively associated with new documented AF. In multivariate analysis, E/e’ TEE was an independent predictor of newly diagnosed AF during hospitalization (Odds ratio, 1.680; 95% confidence interval, 1.174 to 3.420; p<0.001). The cut off value of E/e’ TEE for predicting new AF was 21.5 with the sensitivity of 80 % and the specificity of 98 %.
Conclusions:
Diastolic dysfunction evaluated by TEE may be a good predictor of newly diagnosed AF.
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Affiliation(s)
- Yohei Tateishi
- Dept of Neurology and Strokology, Nagasaki Univ Hosp, Nagasaki, Japan
| | - Tadashi Kanamoto
- Dept of Neurology and Strokology, Nagasaki Univ Hosp, Nagasaki, Japan
| | - Kenjiro Nakaoka
- Dept of Neurology and Strokology, Nagasaki Univ Hosp, Nagasaki, Japan
| | | | - Nobutaka Horie
- Dept of Neurosurgery, Nagasaki Univ Hosp, Nagasaki, Japan
| | - Tsuyoshi Izumo
- Dept of Neurosurgery, Nagasaki Univ Hosp, Nagasaki, Japan
| | - Akira Tsujino
- Dept of Neurology and Strokology, Nagasaki Univ Hosp, Nagasaki, Japan
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40
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Horie N, Morofuji Y, Sadakata E, Tateishi Y, Izumo T, Morikawa M, Tsujino A, Matsuo T. Abstract TP27: Impact of Mechanical Thrombectomy Device on the Thrombus Histology in Acute Embolic Stroke. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.tp27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
Thrombus composition has been suggested to have a decisive impact on the outcome of patients treated by mechanical thrombectomy because of embolic stroke. The aim of this prospective study was to assess the impact of a mechanical thrombectomy device (Penumbra aspiration catheter vs. Stent retriever) on thrombus composition, which could affect flow impairment after reperfusion.
Methods:
Thrombi of consecutive stroke patients with large vessel occlusion were collected during intracranial mechanical recanalization. Mechanical thrombectomy device was used either Penumbra aspiration catheter or Stent retriever. The hematoxylin and eosin-stained specimens were quantitatively analyzed in terms of the relative fractions of the main constituents (red blood cells and fibrin/platelets).
Results:
Of 65 cardio-embolic patients, Penumbra aspiration catheter was used in 27 patients, and Stent retriever was used in 38 patients. There was no significance in age, sex, occlusion vessel, NIH stroke scale, and onset to reperfusion time. The volume of thrombi was significantly larger in Penumbra group compared with that in Stent group (3.68 cm3 vs. 0.95 cm3, P<0.01). On the other hand, The percentage of fibrin component was significantly higher in Stent group (36.2% vs. 62.4%, P<0.01). Preoperative IV-tPA reduced the size of thrombi in Stent group, which was not seen in Penumbra group (0.46 cm3 vs. 1.26 cm3, P<0.01). Interestingly, preoperative susceptibility vessel sign on MR imaging correlated with the percentage of red blood cells in not Stent group but Penumbra group. Finally, new infarction on MR imaging was not different between two groups 24 hours after the treatment.
Conclusions:
Stent retriever could crush thrombus and reduce its size, which induce distal migration of the red blood cell component. However, it did not affect the final infarct lesion and outcome.
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41
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Aoki J, Kimura K, Morita N, Harada M, Metoki N, Tateishi Y, Todo K, Yamagami H, Hayashi K, Terasawa Y, Fujita K, Yamamoto N, Deguchi I, Tanahashi N, Inoue T, Iwanaga T, Kaneko N, Mitsumura H, Iguchi Y, Ueno Y, Kuramoto Y, Ogata T, Fujimoto S, Mitomi M, Nagahiro S. Abstract TMP36: Diabetes Mellitus Prevents The Complete Recanalization In Patients With Middle Cerebral Artery Occlusion. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.tmp36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
The mechanism of the unfavorable outcome in diabetic patients treated with intravenous thrombolysis (tPA therapy) is still uncertain. We investigated the relationship of diabetes mellitus with early and delayed recanalization after tPA therapy.
Methods:
Data on 165 patients from the prospective randomized control study, evaluated the efficacy of combined tPA and Edaravone therapy, were retrospectively analyzed. All patients had the middle cerebral occlusion before t-PA therapy. Based on a history of diabetes mellitus or hemoglobin A1c level of ≥6.5% on admission, all patients were classified into diabetes (D) or non-diabetes (ND) groups. The presence of arterial recanalization was assessed at 2 points: 1) early recanalization, defined as at least partial recanalization <50% within 2 h after tPA therapy; and 2) delayed complete recanalization at 24 h.
Results:
Among the 165 (96 men; median age, 78 [69-85] years) patients, 33 (20%) patients were classified into the D group. Age, initial NIHSS score, DWI-ASPECTS, proximal occlusion, and the onset to needle time were not different between the 2 groups (p=0.118, 0.607, 0.586, 0.258, 0.238). Early recanalization was similarly observed in the D and ND groups (61% vs. 51%, p=0.435). However, complete recanalization at 24 h was significantly infrequent in the D group (13% vs. 44%, p=0.002). This tendency was consistent in patients with as well as without early recanalization. Regarding patients with early recanalization, 4 (22%) of the 18 patients in the D group and 34 (58%) of the 59 patients in the ND group had complete recanalization at 24 h (p=0.014). Among those without early recanalization, none (0%) of the 13 patients with the D group had complete recanalization at 24 h, while 18 (30%) of the 60 patients achieved it (p=0.029). By the multivariate regression analysis, diabetes mellitus was the independent negative factor for complete recanalization at 24 h (OR 0.17, 95%CI: 0.05-0.54, p=0.002). At 3 months, there is an increased mortality rate in the D group (19% vs. 6%, p=0.038).
Conclusion:
Diabetes mellitus was an indicator of no complete recanalization at 24 h regardless of the early recanalization. This may explain the mechanism of the unfavorable outcome in patients with diabetes mellitus.
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Affiliation(s)
| | | | - Naomi Morita
- National Cerebral and Cardiovascular Cntr, Osaka, Japan
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42
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Yamaguchi S, Horie N, Tateishi Y, Morikawa MI, Suyama K, Matsuo T. Abstract WP43: Diffusion and T2 Star Weighted MR Angiography Mismatch Predicts Ischemic Penumbra in the Acute Stage. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.wp43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and purpose:
T2 star weighted MR angiography (SWAN) can detect hemodynamic insufficiency as hypointensity areas in the medullary or cortical veins. In this study, we investigate whether SWAN in 1.5T MRI can help to detect ischemic penumbra-like lesions in acute ischemic stroke (AIS) patients.
Materials and methods:
Patients showing acute major vessel occlusion (ICA and MCA) within 4.5 hours from onset were consecutively analyzed with MRI including SWAN, DWI, and MRA. To evaluate ischemic area in SWAN and DWI, modified ASPECT (mASPECTS) were used. SWAN- and DWI- based mASPECTS was calculated, and correlation between DWI-SWAN mismatch and final infarct lesion or outcome was evaluated.
Results:
Thirty-five patients were included in this study. Of the 35 patients (mean age: 73.5
±
13.5 years), cardioembolic stroke was confirmed in 26 patients, atherothrombotic stroke was in 4 patients, and the others had unknown etiology. Overall, recanalization was achieved in 23 patients (65%), showing higher mASPECTS in follow up DWI and lower mRS at 90 days than patients with no recanalization (
P
=0.037 and
P
<0.001). Initial SWAN-based mASPECTS and follow-up DWI-based mASPECTS were both significantly higher in atherothrombotic stroke than in cardiogenic stroke (
P
=0.016 and
P
=0.042). Of 12 patients showing no recanalization, DWI-SWAN mismatch was significantly correlated with infarct growth (R
2
=0.6160,
P
=0.0025). On the other hand, there was no such correlation for patients showing recanalization. Interestingly, initial SWAN-based mASPECTS was significantly correlated with mRS at 90 days (R=-0.38,
P
=0.037) regardless of recanalization.
Conclusions:
DWI-SWAN mismatch in 1.5T MRI could show penumbra-like lesions in AIS patients with major vessel occlusion. Low mASPECTS in initial SWAN might predict unfavorable outcome. Assessment of ischemic penumbra from venous side using SWAN can visualize a lesion’s viable tissue and is quite useful without contrast media.
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Affiliation(s)
- Susumu Yamaguchi
- Neurosurgery, Nagasaki Harbor Med Cntr City Hosp, Nagasaki, Japan
| | | | - Yohei Tateishi
- Neurology and strokology, Nagasaki Univ, Nagasaki, Japan
| | | | - Kazuhiko Suyama
- Neurosurgery, Nagasaki Harbor Med Cntr City Hosp, Nagasaki, Japan
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43
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Sadakata E, Horie N, Morofuji Y, Tateishi Y, Izumo T, Morikawa M, Tsujino A, Matsuo T. Abstract TMP2: Postoperative Luxury Perfusion on Arterial Spin Labeling MRI Indicates Reperfusion Injury and Hemorrhagic Complication After Endovascular Mechanical Thrombectomy. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.tmp2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
Endovascular thrombectomy is of benefit to most patients with acute ischemic stroke caused by major intracranial vessel occlusion. Reperfusion injury is, however, one of the critical complications after successful recanalization, which has not been fully evaluated. The aim of this prospective study was to assess the impact of hyper-intensity signal on postoperative arterial spin labeling (ASL) MR imaging on hemorrhagic complications and clinical outcome after endovascular treatment.
Methods:
Consecutive patients showing acute stroke with major intracranial vessel occlusion were prospectively analyzed. All the patients underwent endovascular thrombectomy, and MR imaging including ASL was performed at pre-, postoperative day 1 and day 7. Clinical and radiological outcomes were evaluated especially focusing on arterial spin labeling findings.
Results:
Of 81 patients, 21/81 (25.9%) showed hyper-intensity signal on ASL (ASL+) at postoperative day 1. There were no significant differences in baseline characteristics between the groups with and without ASL+, including preoperative NIH stroke scale, door to puncture time, occlusion vessel and TICI score. Interestingly, 15/21 (71.4%) patients developed minor bleeding or hemorrhagic changes in ASL+ group, which was detected only in 3/60 (5.0%) in ASL- group. Modified Rankin Scale was not different between the groups at postoperative day 90 under strict control of blood pressure. Multivariate regression analysis showed that ASL+ is significantly related to postoperative hemorrhagic complications (Adjusted OR: 21.68, P=0.004).
Conclusions:
Postoperative hyper-intensity signal on ASL MRI indicates vasoparalysis and luxury perfusion even successful recanalization after endovascular thrombectomy, which has a risk for hemorrhagic complications.
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Affiliation(s)
- Eisaku Sadakata
- Neurosurgery, Nagasaki Univ Sch of Medicine, Nagasaki, Japan
| | - Nobutaka Horie
- Neurosurgery, Nagasaki Univ Sch of Medicine, Nagasaki, Japan
| | - Yoichi Morofuji
- Neurosurgery, Nagasaki Univ Sch of Medicine, Nagasaki, Japan
| | - Yohei Tateishi
- Neurology, Nagasaki Univ Sch of Medicine, Nagasaki, Japan
| | - Tsuyoshi Izumo
- Neurosurgery, Nagasaki Univ Sch of Medicine, Nagasaki, Japan
| | - Minoru Morikawa
- Neurosurgery, Nagasaki Univ Sch of Medicine, Nagasaki, Japan
| | - Akira Tsujino
- Neurosurgery, Nagasaki Univ Sch of Medicine, Nagasaki, Japan
| | - Takayuki Matsuo
- Neurosurgery, Nagasaki Univ Sch of Medicine, Nagasaki, Japan
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44
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Tateishi Y, Hamabe J, Kanamoto T, Nakaoka K, Morofuji Y, Horie N, Izumo T, Morikawa M, Tsujino A. Subacute lesion volume as a potential prognostic biomarker for acute ischemic stroke after intravenous thrombolysis. J Neurol Sci 2016; 369:77-81. [DOI: 10.1016/j.jns.2016.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/30/2016] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
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45
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Tateishi Y, Kanamoto T, Nakaoka K, Hamabe J, Morofuji Y, Horie N, Izumo T, Matsuo T, Tsujino A. Abstract WMP78: Follow-up High-Sensitivity C-reactive Protein is Associated With Early Recurrent Ischemic lesions in Acute Ischemic Stroke. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.wmp78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Early recurrent ischemic lesions (ERILs) on diffusion-weighted imaging (DWI) after acute ischemic stroke have been considered as a potential marker of early recurrent symptomatic stroke. The aim of this study to explore the impact of High-sensitivity C-reactive protein (hsCRP) levels at different time points on ERILs.
Method:
We prospectively enrolled 484 patients with acute ischemic stroke who underwent DWI and whose plasma and serum biomarkers (hsCRP, D-dimer, and brain natriuretic protein [BNP]) within 24 hours of onset and subsequently at 7 days after onset. Baseline characteristics, stroke features, initial National Institutes of Health Stroke Scale (NIHSS) score, and DWI lesion volume were recorded. ERILs were defined as new ischemic lesions on 7-day DWI, which were outside the vascular territory of index stroke with arterial occlusion and the same or outside the vascular territory of index stroke with arterial stenosis.
Results:
ERILs were observed in 146 patients (30.2%). In univariate analysis, atrial fibrillation (p=0.040), higher initial NIHSS score (p<0.001), larger DWI infarct volume (p<0.001), stroke subtype (p<0.001), elevated initial and follow-up BNP (p=0.014 and p=0.003) and D-dimer (p=0.009 and p=0.011), and elevated follow-up hsCRP (p<0.001) were positively associated and combination of anticoagulation and antiplatelet therapy after admission (p=0.002) was negatively associated with ERILs. In multivariate analysis, combination of anticoagulation and antiplatelet therapy after admission (Odds ratio [OR], 0.462; 95% confident interval [CI], 0.272 to 0.785; p=0.004) and follow-up log hsCRP (OR, 1.389; 95% CI, 1.054 to 1.830; p=0.020) were independent predictors of ERILs.
Conclusions:
Underlying inflammation after acute ischemic stroke may be associated with ERILs.
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Affiliation(s)
- Yohei Tateishi
- Dept of Neurology and Strokology, Nagasaki Univ Hosp, Nagasaki, Japan
| | - Tadashi Kanamoto
- Dept of Neurology and Strokology, Nagasaki Univ Hosp, Nagasaki, Japan
| | - Kenjiro Nakaoka
- Dept of Neurology and Strokology, Nagasaki Univ Hosp, Nagasaki, Japan
| | - Jumpei Hamabe
- Dept of Neurology and Strokology, Nagasaki Univ Hosp, Nagasaki, Japan
| | | | - Nobutaka Horie
- Dept of Neurosurgery, Nagasaki Univ Hosp, Nagasaki, Japan
| | - Tsuyoshi Izumo
- Dept of Neurosurgery, Nagasaki Univ Hosp, Nagasaki, Japan
| | | | - Akira Tsujino
- Dept of Neurology and Strokology, Nagasaki Univ Hosp, Nagasaki, Japan
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Aoki J, Kimura K, Metoki N, Tateishi Y, Todo K, Morita N, Harada M, Hayashi K, Yamamoto N, Tanahashi N, Inoue T, Iwanaga T, Kaneko N, Iguchi Y, Ueno Y, Ogata T, Fujimoto S, Yokoyama M, Nagahiro S. Abstract WP68: Tissue Type Plasminogen Activator (t-PA) and Edaravone Combination Therapy Study (YAMATO Study). Stroke 2016. [DOI: 10.1161/str.47.suppl_1.wp68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction&Hypothesis:
The aim of the present study was to investigate whether administration of edaravone, a free radical scavenger, before or during t-PA administration can increase the rate of early recanalization and improve the clinical outcome in stroke patients with major arterial occlusion.
Methods:
YAMATO study is an investigator initiated, multicenter (17 hospitals in Japan), prospective, randomized, open labeled study. Acute stroke patients with horizontal (M1) or vertical (M2) portion of the middle cerebral artery occlusion within 4.5 h of onset were studied. The subjects were randomly allocated to the early edaravone (early-E) group (intravenous edaravone [30 mg] was started before or during t-PA administration) and the late edaravone (late-E) group (edaravone was started after t-PA administration). Primary outcome, defined as any early recanalization 1h after t-PA therapy. Secondary outcomes included the rate of the significant recanalization, defined as ≥50% of the territory of the occluded artery on magnetic resonance angiography, or the thrombolysis in cerebral infarction score ≥2b on digital subtraction angiography as well as the incidence of symptomatic intracerebral hemorrhage (sICH), and the favorable clinical outcome (modified Rankin scale [mRS] of 0-2) at 3 months after onset.
Results:
One-hundred and sixty-six patients (96 men; median age [interquartile range], 78 [69-85] years) were randomized 1:1 to either the early-E group or the late-E group. Twenty-three (13.9%) had proximal M1 occlusion; 60 (36.1%), distal M1 occlusion; 83 (50%), M2 occlusion. Early recanalization was similarly observed in the early-E group and in the late-E group (53.1% vs. 53.0%, P=1.000). The rate of significant recanalization was also similar between the 2 groups (27.2% vs. 33.7%, p=0.399). sICH was occurred in 4 (4.8%) patients in the early-E group and in 2 (2.4%) in the late-E group (p=0.682). Among the 144 patients who were pre-morbid mRS of 0-2 and eligible for 3 months assessment, favorable outcome was seen in 53.9% in the early-E group and 57.4% in the late-E group (p=0.738)
Conclusions:
The timing of the edaravone infusion should not affect the rate of early recanalization, sICH, or favorable outcome after t-PA therapy.
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Affiliation(s)
| | | | | | | | | | - Naomi Morita
- National Cerebral and Cardiovascular Cntr, Suita, Japan
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47
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Yamanashi H, Shimizu Y, Nagaoki K, Murase K, Koyamatsu J, Nobuyoshi M, Nagayoshi M, Kadota K, Tamai M, Tateishi Y, Tsujino A, Maeda T. Association between adult short stature and cerebral microbleeds. Int J Stroke 2016; 11:NP27-9. [PMID: 26783321 DOI: 10.1177/1747493015620810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Hirotomo Yamanashi
- Department of Island and Community Medicine, Nagasaki University Graduate School of Biomedical Science, Goto, JapanDepartment of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Sakamoto, Japan
| | - Yuji Shimizu
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Sakamoto, Japan
| | - Kenji Nagaoki
- Nagasaki Goto Central Hospital, Yoshikugi, Goto, Nagasaki, Japan
| | - Kunihiko Murase
- Nagasaki Goto Central Hospital, Yoshikugi, Goto, Nagasaki, Japan
| | - Jun Koyamatsu
- Department of Island and Community Medicine, Nagasaki University Graduate School of Biomedical Science, Goto, Japan
| | - Masaharu Nobuyoshi
- Department of Island and Community Medicine, Nagasaki University Graduate School of Biomedical Science, Goto, Japan
| | - Mako Nagayoshi
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Sakamoto, Japan
| | - Koichiro Kadota
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Sakamoto, Japan
| | - Mami Tamai
- Department of Rheumatology, Nagasaki University Hospital, Sakamoto, Japan
| | - Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Hospital, Sakamoto, Japan
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital, Sakamoto, Japan
| | - Takahiro Maeda
- Department of Island and Community Medicine, Nagasaki University Graduate School of Biomedical Science, Goto, JapanDepartment of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Sakamoto, Japan
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48
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Horie N, Morofuji Y, Morikawa M, Tateishi Y, Izumo T, Hayashi K, Tsujino A, Nagata I. Communication of inwardly projecting neovessels with the lumen contributes to symptomatic intraplaque hemorrhage in carotid artery stenosis. J Neurosurg 2015; 123:1125-32. [PMID: 26090834 DOI: 10.3171/2014.12.jns142371] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Recent studies have demonstrated that plaque morphology can contribute to identification of patients at high risk of carotid artery atherosclerosis as well as the degree of stenosis in those with carotid atherosclerosis. Neovascularization of carotid plaques is associated with plaque vulnerability. However, the mechanism of neovascularization in intraplaque hemorrhage (IPH) and its clinical contribution remain undetermined. In this study, the authors aimed to clarify the characteristics of neovessel appearance with a focus on inwardly projecting neovessels, which are reportedly important in plaque advancement. METHODS Consecutive patients with moderate to severe carotid atherosclerosis who underwent carotid endarterectomy were prospectively analyzed from 2010 to 2014. The neovessel appearance was categorized into 3 groups based on intraoperative indocyanine green (ICG) videoangiography: early appearance of neovessels from the endothelium (NVe), late appearance of neovessels from the vasa vasorum (NVv), and no appearance of vessels. Each neovessel pattern was evaluated with respect to clinical, radiological, and pathological findings including IPH, neovascularization, hemosiderin spots, and inflammation. RESULTS Of 57 patients, 13 exhibited NVe, 33 exhibited NVv, and 11 exhibited no neovessels. Overall, the interobserver and intraobserver reproducibilities of neovessel appearance were substantial for ICG videoangiography (κ=0.76) and at 7 days postoperatively (κ=0.76). There were no significant differences in baseline characteristics among the 3 groups, with the exception of a higher percentage of symptomatic presentations in patients with NVe (artery-to-artery embolic infarction in 61.5% and transient ischemic attack in 23.1%). Moreover, patients with NVe exhibited larger infarctions than did those with NVv (9675.0±5601.9 mm3 vs 2306.6±856.9 mm3, respectively; p=0.04). Pathologically, patients with NVe had more severe IPH (47.2±8.3 mm2 vs 19.8±5.2 mm2, respectively; p<0.01), hemosiderin spots (0.5±0.2 mm2 vs 0.2±0.1 mm2, respectively; p=0.04), neovessels (0.4±0.7 mm2 vs 0.1±0.4 mm2, respectively; p=0.11), and inflammation (1.0±1.1 mm2 vs 0.6±0.9 mm2, respectively; p=0.26) around the endothelium than did patients with NVv, and all of these parameters were correlated with hyperintensity on time-of-flight MRI. However, the neovessel and inflammation differences were nonsignificant. Interestingly, inflammation was significantly correlated with neovessel formation (r=0.43, p=0.0008), hemosiderin spots (r=0.62, p<0.0001), and IPH (r=0.349, p=0.0097), suggesting that inflammation may be a key factor in plaque vulnerability. CONCLUSIONS Communication of inwardly projecting neovessels with the lumen and inflammation synergistically contribute to IPH and symptomatic presentations in patients with carotid stenosis and are more specific than the vasa vasorum. This condition could be a new therapeutic target, and regression of luminal neovessel sprouting and inflammation may help to prevent IPH development and a symptomatic presentation.
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Affiliation(s)
| | | | | | - Yohei Tateishi
- Neurology and Strokology, Nagasaki University School of Medicine, Nagasaki, Japan
| | | | | | - Akira Tsujino
- Neurology and Strokology, Nagasaki University School of Medicine, Nagasaki, Japan
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49
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Tateishi Y, Wisco D, Aoki J, George P, Katzan I, Toth G, Hui F, Hussain MS, Uchino K. Large deep white matter lesions may predict futile recanalization in endovascular therapy for acute ischemic stroke. Interv Neurol 2015; 3:48-55. [PMID: 25999992 DOI: 10.1159/000369835] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This study investigated whether large ischemic lesions in the deep white matter (DWM) on pretreatment diffusion-weighted MRI (DWI) predict futile recanalization. METHODS Consecutive acute stroke patients with anterior circulation ischemia who underwent successful arterial recanalization with thrombolysis in cerebral infarction grade 2b or 3 were enrolled. A large DWI-DWM lesion was defined as a hyperintense lesion in the DWM on initial DWI, located mainly between the anterior and posterior horns of the lateral ventricle. The Alberta Stroke Program Early CT score on CT and DWI and stroke volume on initial DWI were recorded. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) score. Futile recanalization was defined as a 30-day modified Rankin scale score of 3-6 despite successful recanalization. Univariate and multivariate regression analyses were performed to identify predictors of futile recanalization. RESULTS In 35 of 46 patients (76%) with successful recanalization, futile recanalization was observed in 20 patients (57%). Patients with futile recanalization were older (median age 74 vs. 58 years; p = 0.053), had higher initial NIHSS scores (median 17 vs. 9; p = 0.042), and a higher prevalence of large DWI-DWM lesions (45 vs. 9%; p = 0.022). Logistic regression analysis showed that a large DWI-DWM lesion was an independent predictor of futile recanalization (OR 13.97; 95% CI 1.32-147.73; p = 0.028). CONCLUSION Patients with large preintervention DWI-DWM lesions may be poor candidates for endovascular therapy.
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Affiliation(s)
- Yohei Tateishi
- Cerebrovascular Center, Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki City, Tokyo, Japan ; Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Dolora Wisco
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Junya Aoki
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Pravin George
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Irene Katzan
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gabor Toth
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ferdinand Hui
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Ken Uchino
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
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50
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Cheng-Ching E, Frontera JA, Man S, Aoki J, Tateishi Y, Hui FK, Wisco D, Ruggieri P, Hussain MS, Uchino K. Degree of Collaterals and Not Time Is the Determining Factor of Core Infarct Volume within 6 Hours of Stroke Onset. AJNR Am J Neuroradiol 2015; 36:1272-6. [PMID: 25836727 DOI: 10.3174/ajnr.a4274] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 01/06/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Growth of the core infarct during the first hours of ischemia onset is not well-understood. We hypothesized that factors other than time from onset of ischemia contribute to core infarct volume as measured by MR imaging. MATERIALS AND METHODS Prospectively collected clinical and imaging data of consecutive patients with stroke presenting between March 2008 and April 2013 with anterior circulation large-vessel occlusion and MR imaging performed within 6 hours from the time of onset were reviewed. The association of time from onset, clinical, and radiographic features with DWI volume was assessed by using χ(2) and Mann-Whitney U tests. RESULTS Of 91 patients, 21 (23%) underwent MR imaging within 0-3 hours from onset, and 70 (76%), within 3-6 hours. Median MR imaging infarct volume was similar in both timeframes, (24.7 versus 29.4 mL, P = .906), and there was no difference in the proportion of patients with large infarct volumes (≥70 mL, 23.8% versus 22.8%, P = .928). Using receiver operating characteristic analysis, we detected no association between the time from onset and MR imaging infarct volume (area under the curve = 0.509). In multivariate analysis, CTA collaterals (>50% of the territory) (adjusted OR, 0.192; 95% CI, 0.04-0.9; P = .046), CTA ASPECTS (adjusted OR, 0.464; 95% CI, 0.3-0.8; P = .003), and a history of hyperlipidemia (adjusted OR, 11.0; 95% CI, 1.4-88.0; P = .023) (but not time from stroke onset to imaging) were independent predictors of MR imaging infarct volume. CONCLUSIONS Collateral status but not time from stroke onset to imaging was a predictor of the size of core infarct in patients with anterior circulation large-vessel occlusion presenting within 6 hours from onset.
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Affiliation(s)
- E Cheng-Ching
- From the Cerebrovascular Center (E.C.-C., J.A.F., S.M., F.K.H., D.W., M.S.H., K.U.)
| | - J A Frontera
- From the Cerebrovascular Center (E.C.-C., J.A.F., S.M., F.K.H., D.W., M.S.H., K.U.)
| | - S Man
- From the Cerebrovascular Center (E.C.-C., J.A.F., S.M., F.K.H., D.W., M.S.H., K.U.)
| | - J Aoki
- Department of Neurology and Cerebrovascular Disease (J.A.), Nippon Medical School, Tokyo, Japan
| | - Y Tateishi
- Cerebrovascular Center (Y.T.), Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
| | - F K Hui
- From the Cerebrovascular Center (E.C.-C., J.A.F., S.M., F.K.H., D.W., M.S.H., K.U.)
| | - D Wisco
- From the Cerebrovascular Center (E.C.-C., J.A.F., S.M., F.K.H., D.W., M.S.H., K.U.)
| | - P Ruggieri
- Department of Neuroradiology (P.R.), Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - M S Hussain
- From the Cerebrovascular Center (E.C.-C., J.A.F., S.M., F.K.H., D.W., M.S.H., K.U.)
| | - K Uchino
- From the Cerebrovascular Center (E.C.-C., J.A.F., S.M., F.K.H., D.W., M.S.H., K.U.)
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