Search

We have been developing energy-resolved X-ray computed tomography (ER-CT) using a novel detector system called a transXend detector, which measures X-rays as electric current and gives the energy distribution of X-rays by unfolding analysis. This paper presents the results of the sugar content measurements of kiwifruit samples by ER-CT. Because the change of linear attenuation coefficients as a function of sugar content was small, we used a material decomposition method instead of the unfolding method to deduce the linear attenuation coefficient from the measured electric current. The obtained sugar contents showed good agreement with those measured by a refractometer.

Endovascular treatment has become a major tool for managing large vessel occlusion, and its applications in cancer associated thrombosis (CAT) is increasing. Histopathological diagnosis of the collected clots aids in understanding the pathology of cerebral infarction, and enables investigation of the relationship between the primary cancer and cerebral infarction if the primary cancer cells are present. We report one lung cancer patient who achieved effective recanalization by mechanical thrombectomy (MT) for acute internal carotid artery (ICA) occlusion. We diagnosed the cause of occlusion as cardiac metastasis from lung cancer based on transthoracic echocardiography and histopathological diagnosis of collected clots. In MT for large vessel occlusion induced by CAT, histopathological diagnosis of the collected clots is useful for understanding the pathology of cerebral infarction.

OBJECTIVEThe presence of disproportionately enlarged subarachnoid space hydrocephalus (DESH) on brain imaging is a recognized finding of idiopathic normal pressure hydrocephalus (iNPH), but the features of DESH can vary across patients. The aim of this study was to evaluate the utility of MRI-based DESH scoring for predicting prognosis after surgery.METHODSIn this single-center, retrospective cohort study, the DESH score was determined by consensus between a group of neurosurgeons, neurologists, and a neuroradiologist based on the preoperative MRI findings of the patients with suspected iNPH. The DESH score was composed of the following 5 items, each scored from 0 to 2 (maximum score 10 points): ventriculomegaly, dilated sylvian fissures, tight high convexity, acute callosal angle, and focal sulcal dilation. The association between the DESH score and improvement of the scores on the modified Rankin Scale (mRS), iNPH Grading Scale (iNPHGS), Mini–Mental State Examination (MMSE), Trail Making Test-A (TMT-A), and Timed 3-Meter Up and Go Test (TUG-t) was examined. The primary end point was improvement in the mRS score at 1 year after surgery, and the secondary outcome measures were the iNPHGS, MMSE, TMT-A, and TUG-t scores at 1 year after surgery. Improvement was determined as improvement of 1 or more levels on mRS, ≥ 1 point on iNPHGS, ≥ 3 points on MMSE, a decrease of > 30% on TMT-A, and a decrease of > 10% on TUG-t.RESULTSThe mean DESH score for the 50 patients (mean age 77.6 ± 5.9 years) reviewed in this study was 5.58 ± 2.01. The mean rate of change in the mRS score was −0.50 ± 0.93, indicating an inverse correlation between the DESH score and rate of change in the mRS score (r = −0.749). Patients who showed no improvement in mRS score tended to have a low DESH score as well as low preoperative MMSE and TMT-A scores. There were no differences in the areas of deep white matter hyperintensity and periventricular hyperintensity on the images between patients with and without an improved mRS score (15.6% vs 16.7%, respectively; p = 1.000). The DESH score did differ significantly between patients with and without improved scores on the iNPHGS (6.39 ± 1.76 vs 4.26 ± 1.69, respectively; p < 0.001), MMSE (6.63 ± 1.82 vs 5.09 ± 1.93; p = 0.010), TMT-A (6.32 ± 1.97 seconds vs 5.13 ± 1.93 seconds; p = 0.042), and TUG-t (6.48 ± 1.81 seconds vs 4.33 ± 1.59 seconds; p < 0.001).CONCLUSIONSMRI-based DESH scoring is useful for the prediction of neurological improvement and prognosis after surgery for iNPH.

The relative apparent diffusion coefficient (ADC) ratio can be used to evaluate the extent of ischemia. We investigated the risk factors for, and correlation between, relative ADC ratio and hemorrhagic transformation (HT) after thrombolysis.This single-center, retrospective study involved 105 patients with acute occlusion of the anterior circulation. Relative ADC ratio was calculated as the ratio of ADC pixel values, within the affected territory to ADC pixel values in the contralateral normal region. HT was determined by computed tomography and T2* weighted magnetic resonance imaging after endovascular revascularization.Data for 80 of the 105 patients were analyzed. Comparing the number of patients between the HT group (n=25) and the non-HT group (n=55), a significant difference was noted in tissue plasminogen activator (tPA) use (P=0.028), time from onset to reperfusion ≥380min (P0.001), fluid-attenuated inversion recovery (FLAIR) hyperintensity (P=0.009), and relative ADC ratio0.650 (P0.001). Multivariable logistic regression analysis identified relative ADC ratio0.650 as the only independent predictor of HT (odds ratio 7.79; 95% confidence interval 2.22-27.3; P=0.001). Twenty-nine patients (including 20 in the HT group) had a relative ADC ratio0.650. Multivariable logistic regression analysis identified use of tPA as the only independent predictor of HT (odds ratio 13.8; 95% confidence interval 1.35-125.5; P=0.010).Relative ADC ratio0.650 with use of tPA may be important for predicting HT.

Introduction: Dihomo-gamma-linolenic acid (DHLA) is an omega-6 essential fatty acid related to thrombotic diseases. There are many reports about the ratio of eicosapentaenoic acid to arachidonic acid which associates with coronary and brain ischemia. But there is no report focusing on DHLA and acute ischemic stroke (AIS). We report a new correlation between DHLA and hemorrhagic complications (HC). Method: We conducted a retrospective single center case-controlled study in Japan. Among all cases of AIS from January 2015 to May 2019, we selected those who had intravenous infusion of tissue plasminogen activator (tpa) with or without endovascular treatment (EVT). Tpa was administered at 0.6mg / kg according to guidelines in Japan. Intracranial hemorrhage confirmed by imaging within 24 hours after tpa was defined as HC. We considered the patient background including lipids and outcomes: mRS0-2 after 90 days, recurrence within 30 days, any complications. We also divided all cases into two groups; the presence (A) or absence (B) of HC, and examined factors that contribute to HC. Lipid fractions (DHLA, AA, EPA, docosahexaenoic acid) were measured before tpa. Result: In the eligible 111 patients, 59 were male, and the median age was 77.4±11.5 years old. There were 30 cases of HC (A); HC within infarction (14), beyond or other than infarction (7), SAH associated with EVT (9), traumatic (0). There were significant differences between two groups: age(median, A:85.0, B:75.0[p Conclusion: DHLA, age, D dimer, and renal function were significantly associated with HC in resuscitation therapy for AIS. The prognosis was poor in cases of HC. We emphasize DHLA as a new finding. DHLA may be related to vascular vulnerability. There is a possibility that early improvement of DHLA can reduce HC, lead to good prognosis, and decrease the cost.

In cerebral venous sinus thrombosis (CVST), venous sinus occlusion increases venous pressure and disrupts venous return, resulting in progression to venous infarction and venous hemorrhage, with poor neurologic outcome. Therefore, early recanalization of the major venous sinus is critical. Anticoagulant therapy with continuous intravenous infusion of heparin and subsequent oral anticoagulant administration is the recommended first line of treatment for CVST. Some large clinical trials for venous thromboembolism (VTE) have shown that direct oral anticoagulant (DOAC) is non-inferior to the standard therapy with heparin or warfarin and causes less bleeding. In contrast, there are only a few reports on CVST treatment with DOAC such as Dabigatran, Rivaroxaban and Edoxaban describing good efficacy and safety. And there is one randomized clinical trial on DOAC treatment for CVST after acute phase. We report a successfully treated case of CVST in acute phase with progressive neurologic symptoms that achieved early recanalization of the obstructed sinus by an early switch from continuous intravenous infusion of heparin to oral Edoxaban.

Pineal parenchymal tumor of intermediate differentiation (PPTID) is rare. The WHO first classified PPTID in 2000 as a pineal parenchymal tumor (PPT) with an intermediate prognosis between pineocytoma (PC) and pineoblastoma (PB). It is considered an intermediate-grade tumor and divided into WHO grade II or III.The number of available reports about PPTID is presently limited, and the appropriate management for this tumor has not yet been determined.The authors report a rare case of PC in a 63-year-old woman who presented with lower-extremity weakness and gait disturbance. A pineal mass lesion was detected on MRI. A diagnosis of PC was established after microsurgical gross-total tumor resection, and the patient received no adjuvant therapy after surgery. Two years after surgery, a partial recurrence was recognized and Gamma Knife radiosurgery was performed. Fours years later, the patient developed diffuse leptomeningeal dissemination. She was successfully treated with craniospinal irradiation. Leptomeningeal dissemination may develop 6 years after the initial diagnosis of PC. A histopathological study of the recurrent tumor revealed a malignant change from PC to PPTID.The present case shows the importance of long-term follow-up of patients with PPTs following resection and the efficacy of craniospinal irradiation in the treatment of leptomeningeal dissemination.

The initial treatment of cerebral venous sinus thrombosis (CVST) is intravenous heparin, however, a novel endovascular technique combining a stent retriever and an aspiration catheter has achieved rapid, safe, and effective revascularization. A 21-year-old man was transferred to our emergency department and diagnosed with CVST. Because of venous congestion due to massive thrombosis and clinical deterioration, endovascular intervention was opted for. A combination technique using a stent device (Solitaire) and a direct aspiration catheter (Penumbra) was used, which achieved recanalization with good anterograde venous flow. The combination therapy is safe and effective for CVST because of the favourable prognosis and low risk of complications reported in all 4 patients to date. Pathological examination of clots suggested that venous vasculitis is implicated in thrombus formation, fever, and raised white blood cell and C-reactive protein counts seen in CVST.

The relative apparent diffusion coefficient (ADC) ratio on magnetic resonance imaging (MRI) can be used to evaluate the degree of ischemia. Here, we assessed the predictability of ischemic reversibility and the risk of hemorrhagic transformation using the relative ADC ratio.This single-center retrospective study analyzed 56 patients with acute occlusion of the internal carotid artery (ICA) or the middle cerebral artery (M1) with endovascular revascularization. Diffusion-weighted imaging (DWI) lesions were classified as reversible lesions, final infarct lesions, and hemorrhagic or non-hemorrhagic regions. The relative ADC ratio was calculated in each DWI lesion and was defined as the ratio of ADC pixel values within affected territory to ADC pixel values in contralateral normal brain regions.The average relative ADC ratio was 0.890±0.045 in reversible DWI lesion and 0.640±0.041 in final infarct DWI lesion (P0.001). In 4 cases with hemorrhagic transformation, hemorrhagic transformation regions were 0.557±0.049 and non-hemorrhagic transformation regions were 0.762±0.042 (P0.001). In addition, percentage DWI improvement was inversely correlated with DWI lesion volume at the time of hospitalization (r=-0.840) and onset-to-reperfusion time (r=-0.765), but no correlation was noted with patient age (r=-0.043) or the first NIHSS score (r=-0.277).The relative ADC ratio may be useful for predicting DWI reversibility and post-reperfusion hemorrhagic transformation, even in patients with an unknown time of onset.

Background Segmental arterial mediolysis (SAM) is not yet well known in the neurosurgical field, even though it has become an increasingly recognized pathology in arterial dissection. Case Description A case of SAM presented as subarachnoid hemorrhage (SAH) due to a dissecting aneurysm of the left intracranial vertebral artery (VA), which extended from the proximal VA union to the distal portion of the left posterior inferior cerebellar artery. The lesion was successfully embolized by an endovascular technique. However, subsequent intraperitoneal hemorrhage due to rupture of a fusiform aneurysm of the middle colic artery prompted surgical treatments. The features of the extirpated visceral vascular lesion were compatible with the diagnosis of SAM based on histopathologic examinations. Conclusions It is very important that SAM is recognized as a systemic disease that affects the central nervous system, visceral arteries, and coronary arteries. The possibility of SAM should always be considered, particularly in patients with ruptured VA dissection—which is nowadays treated by endovascular techniques—since concomitantly involved visceral arteries may cause unexpected hemorrhagic complications other than SAH.