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Konomatsu K, Kakisaka Y, Sato S, Kubota T, Soga T, Ukishiro K, Jin K, Mugikura S, Aoki M, Nakasato N. "Caterpillar sign" in corpus callosum associated with curvilinear pericallosal lipoma in MRI: A case report. Radiol Case Rep 2024; 19:2058-2061. [PMID: 38523692 PMCID: PMC10958131 DOI: 10.1016/j.radcr.2024.02.058] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 03/26/2024] Open
Abstract
Lipoma of the corpus callosum, also known as pericallosal lipoma, is a rare congenital brain abnormality associated with corpus callosum dysgenesis or agenesis. Two morphological types are described: tubulonodular and curvilinear, with the latter being mostly asymptomatic. We present the case of a 30-year-old woman with epilepsy, whose magnetic resonance imaging revealed a "caterpillar sign" in the corpus callosum associated with a curvilinear pericallosal lipoma. The "caterpillar sign" in the corpus callosum showed low signal intensity on magnetization prepared rapid acquisition with gradient echo, high signal on fluid-attenuated inversion recovery, and low on susceptibility-weighted imaging, possibly indicating abnormal blood vessels penetrating from the ventricle to the posterior callosal vein. We need to be conscious of this unusual finding, particularly when considering surgical intervention in the corpus callosum in cases of pericallosal lipoma, to avoid vascular complications.
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Affiliation(s)
- Kazutoshi Konomatsu
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Departments of Neurology Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yosuke Kakisaka
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shiho Sato
- Departments of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takafumi Kubota
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Departments of Neurology Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Temma Soga
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Departments of Neurology Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazushi Ukishiro
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazutaka Jin
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shunji Mugikura
- Division of Image Statistics, Tohoku Medical Megabank Organization, Sendai, Miyagi, Japan
| | - Masashi Aoki
- Departments of Neurology Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nobukazu Nakasato
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Konomatsu K, Kakisaka Y, Jin K, Aiba T, Takahashi S, Ueda H, Kubota T, Soga T, Ukishiro K, Aoki M, Nakasato N. Genetic generalized epilepsy with catecholaminergic polymorphic ventricular tachycardia complicated by ryanodine receptor 2 variant: A case report. Seizure 2024; 117:284-287. [PMID: 38583245 DOI: 10.1016/j.seizure.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/09/2024] Open
Affiliation(s)
- Kazutoshi Konomatsu
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Departments of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Yosuke Kakisaka
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazutaka Jin
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Shin Takahashi
- Department of Cardiology, National Hospital Organization, Morioka Medical Center, Morioka, Iwate, Japan
| | - Hironobu Ueda
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University School of Medicine, Morioka, Iwate, Japan
| | - Takafumi Kubota
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Departments of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Temma Soga
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Departments of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazushi Ukishiro
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Masashi Aoki
- Departments of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nobukazu Nakasato
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Konomatsu K, Kakisaka Y, Jin K, Ukishiro K, Sakata A, Shimogawa T, Morioka T, Kubota T, Soga T, Aoki M, Nakasato N. Dynamic electro-clinical changes corresponding to immediate recovery after glucose administration from insulinoma-induced hypoglycemia: Report of two cases. Epileptic Disord 2023; 25:900-903. [PMID: 37632394 DOI: 10.1002/epd2.20155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/07/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Kazutoshi Konomatsu
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yosuke Kakisaka
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazushi Ukishiro
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Ayumi Sakata
- Department of Clinical Chemistry and Laboratory Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Takafumi Shimogawa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takato Morioka
- Department of Neurosurgery, Hachisuga Hospital, Munakata, Japan
| | - Takafumi Kubota
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Temma Soga
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Konomatsu K, Kakisaka Y, Ishida M, Soga T, Ukishiro K, Osawa SI, Jin K, Aoki M, Nakasato N. Referral odyssey plot to visualize causes of surgical delay in mesial temporal lobe epilepsy with hippocampal sclerosis. Epilepsy Behav 2023; 147:109434. [PMID: 37716330 DOI: 10.1016/j.yebeh.2023.109434] [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] [Received: 05/29/2023] [Revised: 08/26/2023] [Accepted: 08/31/2023] [Indexed: 09/18/2023]
Abstract
The "odyssey plot" was used to visualize referral delays in epilepsy surgery. Participants were 36 patients (19 males; 13-67 years, median 27 years) with mesial temporal lobe epilepsy with hippocampal sclerosis (HS) who underwent resection surgery. The "referral odyssey plot" included five clinical episodes: seizure onset (T1), first visits to a non-epileptologist (T2) and to an epileptologist (T3), first admission to our epilepsy monitoring unit (EMU) (T4), and resection surgery (T5). For each patient, we identified the first seizure type: the physician who first diagnosed focal aware seizure (FAS), focal impaired awareness seizure (FIAS), focal to bilateral tonic-clonic seizure (FBTCS), and radiologically suspected HS. Within the overall delay (T1-T5, median 18 years; interquartile range [IQR] 14), non-epileptologist's delay (T2-T3, 11.5 years; IQR 12.25) was far (p < 0.0001) longer than patient's (T1-T2, 0 year; IQR 2.25), epileptologist's (T3-T4, 1 year; IQR 4), or after-EMU delay (T4-T5, 1 year; IQR 1). FAS onset cases had significantly longer T1-T2 (N = 5, median 7 years; IQR 6) than FIAS (N = 22, 0 year; IQR 1, p < 0.005) or FBTCS onset cases (N = 9, 0 year; IQR 0, p < 0.001). FAS was correctly diagnosed first by non-epileptologists in 17.9%, by out-patient epileptologists in 35.7%, and at the EMU in 46.4%. FIAS was correctly diagnosed first by non-epileptologists in 94.4% and by out-patient epileptologists in 5.6%. Non-epileptologists diagnosed FBTCS in all cases. HS was diagnosed by non-epileptologists in 13.9%, by out-patient epileptologists in 47.2%, and at the EMU in 38.9%. Early referral to epileptologists is most critical for early surgery. Early utilization of the EMU is highly recommended because FAS is often overlooked by outpatient epileptologists. The odyssey plot will be useful to improve the healthcare system for other types of epilepsy.
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Affiliation(s)
- Kazutoshi Konomatsu
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Departments of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yosuke Kakisaka
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Makoto Ishida
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Temma Soga
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Departments of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazushi Ukishiro
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shin-Ichiro Osawa
- Departments of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazutaka Jin
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Masashi Aoki
- Departments of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nobukazu Nakasato
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Ohseto H, Soga T, Kakisaka Y, Jin K, Ukishiro K, Konomatsu K, Kubota T, Fujimori J, Nakasato N. Ictal chest discomfort in a patient with temporal lobe seizures and amygdala enlargement. Epilepsy Behav Rep 2022; 21:100578. [PMID: 36606273 PMCID: PMC9807991 DOI: 10.1016/j.ebr.2022.100578] [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: 10/04/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Chest discomfort is the representative symptom of dangerous coronary artery disease (CAD), but rarely occurs in patients with seizures. We treated a 74-year-old man with right mesial temporal lobe epilepsy and amygdala enlargement, who was initially suspected of CAD and underwent repeated cardiac angiography because of recurrent episodes of paroxysmal chest discomfort starting from 68 years old. He visited an epileptologist and underwent long-term video electroencephalography monitoring (LTVEM), which confirmed right temporal seizure onset during a habitual episodes of "chest discomfort," stereotyped movement of chest rubbing with the right hand, followed by impaired conscousness. Brain magnetic resonance imaging revealed right amygdala enlargement. The present case emphasizes the importance of the wide range of symptoms, such as chest discomfort, which may associated with epielpsy and result in a delayed diagnosis. LTVEM is useful for diagnosis of epilepsy with unusual seizure semiology by recording ictal EEG changes during chest discomfort.
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Key Words
- AMPAR, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor
- Amygdala enlargement
- CAD, coronary artery disease
- CAG, coronary angiography
- CASPAR2, contactin-associated-protein-receptor-2
- Chest discomfort
- EEG, electroencephalography
- GABABR, γ-aminobutyric acid-B receptor
- LGI-1, leucine-rich glioma-inactivated ptotein-1
- LTVEM, long-term video electroencephalography monitoring
- MRI, magnetic resonance imaging
- Mesial temporal lobe epilepsy
- NMDA, N-methyl-D-aspartate receptor
- TLE, temporal lobe epilepsy
- mTLE, mesial temporal lobe epilepsy
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Affiliation(s)
- Hisashi Ohseto
- Department of Graduate Medical Education Center, Tohoku University Hospital, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan
| | - Temma Soga
- Department of Epileptology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan,Department of Neurology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan,Corresponding author at: Department of Epileptology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan.
| | - Yosuke Kakisaka
- Department of Epileptology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan
| | - Kazushi Ukishiro
- Department of Epileptology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan
| | - Kazutoshi Konomatsu
- Department of Epileptology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan,Department of Neurology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan
| | - Takafumi Kubota
- Department of Neurology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan
| | - Juichi Fujimori
- Division of Neurology, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-ku, Sendai, Miyagi 983-8536, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan
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Konomatsu K, Izumi R, Suzuki N, Takai Y, Shirota Y, Saito R, Kuroda H, Aoki M. A rare case of sporadic inclusion body myositis and rheumatoid arthritis exhibiting ectopic lymphoid follicle-like structures: a case report and literature review. Neuromuscul Disord 2021; 31:870-876. [PMID: 34465502 DOI: 10.1016/j.nmd.2021.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/21/2021] [Revised: 06/17/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
Sporadic inclusion body myositis (sIBM) is a degenerative, intractable, inflammatory myopathy with an immune pathomechanism. We report on a case of a 44-year-old Japanese man who began developing progressive muscle weakness at age 40. Rheumatoid arthritis symptoms manifested at 43 with strongly positive anti-cyclic citrullinated peptide antibodies. Along with typical sIBM pathology, a muscle biopsy revealed dramatic inflammation with prominent perivascular B-cell infiltration forming ectopic lymphoid follicle-like structures (ELFLSs). Exome sequencing identified no causative variants of hereditary myopathy or immune disorders. A combination of immunotherapy slowed the progression of the muscular symptoms. This unusual form of sIBM, including earlier age at onset, a partial response to immunotherapy, and a histopathology presenting B-cell infiltrate with ectopic lymphoid follicle-like structures, indicates a possible association of rheumatoid arthritis and heterogeneity with the autoimmune involvement of sIBM. We review the clinical and pathological features of patients with rheumatoid arthritis associated sIBM in the literature.
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Affiliation(s)
- Kazutoshi Konomatsu
- Department of Neurology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan; Department of Neurology, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara-machi, Shibata-gun, Miyagi 989-1253, Japan
| | - Rumiko Izumi
- Department of Neurology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Naoki Suzuki
- Department of Neurology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Yoshiki Takai
- Department of Neurology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Yuko Shirota
- Department of Hematology and Rheumatology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan; Department of Hematology and Rheumatology, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-ku, Sendai, Miyagi 983-8536, Japan
| | - Ryoko Saito
- Department of Pathology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Hiroshi Kuroda
- Department of Neurology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan; Department of Neurology, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara-machi, Shibata-gun, Miyagi 989-1253, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.
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Konomatsu K, Kuwai T, Yamaguchi T, Imagawa H, Yamaguchi A, Kouno H, Kohno H. Endoscopic full-thickness resection for inverted Meckel's diverticulum using double-balloon enteroscopy. Endoscopy 2017; 49:E66-E67. [PMID: 28135732 DOI: 10.1055/s-0042-121008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Kazutoshi Konomatsu
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Toshio Kuwai
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Toshiki Yamaguchi
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Hiroki Imagawa
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Atsushi Yamaguchi
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Hirotaka Kouno
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Hiroshi Kohno
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
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