Degenerative cervical spondylosis (DCM) is an umbrella term used to describe myelopathy caused by various degenerative changes in the cervical spine. This article outlines the spectrum of DCM and ...reviews the epidemiology of each factor composing DCM. The uniform term of DCM is expected to elucidate the epidemiology of myelopathy caused by degenerative changes of the cervical spine."
There has been no precise guide for treatment management of aneurysmal subarachnoid hemorrhage (aSAH) based on the patient's age and treatment method. This study clarifies each risk management for ...aSAH according to age and treatment method listed in a nationwide database.
We compared 2 groups of patients (nonelderly, <65 years; elderly, ≥65 years) who underwent surgical clipping or endovascular coiling and were registered in a nationwide database in Japan from 2010 to 2015. The odds ratio (OR) and 95% confidence interval (CI) of each risk factor were calculated through multivariate logistic regression analysis for poor outcome according to a modified Rankin Scale score >2 at discharge for each group.
In all groups, the risk factors for poor outcome were older age, male sex, neurologic grade on admission, diabetes mellitus, and use of anticoagulation drugs. Inverse risk factors were a high-volume hospital, academic hospital, hypertension, and use of an antiplatelet drug (OR, 0.63–0.81; 95% CI, 0.56–0.88). Chronic heart disease was also a risk factor, but use of a statin drug (OR, 0.85–0.87; 95% CI, 0.76–0.97) and location other than on the anterior communicating artery (OR, 0.74–0.80; 95% CI, 0.67–0.91) were inverse risks in both the elderly and the endovascular coiling groups.
Management for patients with aneurysmal subarachnoid hemorrhage was recommended in high-volume and academic institutes with the administration of antiplatelet drugs and consideration of several risk factors. Elderly patients undergoing endovascular coiling might be better given a statin drug, and patients with chronic heart failure or an anterior communicating artery aneurysm should be treated more carefully.
Objective: Transvenous embolization (TVE) is an effective treatment for cavernous sinus dural arteriovenous fistulas (CS-DAVFs). The facial vein (FV) can be used as an access route for TVE when a ...trans-inferior petrosal sinus (IPS) approach is difficult. We evaluated the usefulness of combining ultrasonography (US) with computed tomography angiography (CTA) for confirming that the FV is a suitable access route for treating CS-DAVFs.Methods: Trans-FV TVE was planned for five CS-DAVF patients in whom the shunt point was located in the posterior compartment of the CS and anterior venous drainage predominantly occurred via the superior ophthalmic vein (SOV). The anterior drainage route was examined with CTA and US. We reviewed the relationships between preoperative CTA/US findings and the accessibility of CS-DAVFs via the FV.Results: The periorbital and perimandibular drainage pathways were clearly more visible on US than on CTA, and the cervical and thoracic drainage pathways were more visible on CTA than on digital subtraction angiography (DSA). CS-DAVFs were accessible via the FV when (1) the entire drainage pathway could be confirmed on CTA and US, (2) the periorbital and perimandibular pathways were unclear on CTA, but could be confirmed on US, or (3) the FV pathway drained into the internal jugular vein (IJV) or external jugular vein (EJV). On the other hand, TVE was challenging to perform via the FV when (1) the periorbital pathway was unclear on CTA and US, (2) the FV pathway drained into the brachiocephalic vein, or (3) the SOV thrombosed intraoperatively. In all five patients, TVE for CS-DAVFs performed via the FV or IPS was successful.Conclusion: CTA and US are useful for confirming the anterior access route for trans-FV TVE for CS-DAVFs and predicting the feasibility of such treatment. Our findings suggest that CS-DAVFs can be accessed via the FV if the periorbital drainage pathway can be confirmed on US, even if the pathway is unclear on CTA.
•A walking assistive device that targets ankle movements has been utilized.•Short-term intervention of the device decreased spinal cord reciprocal inhibition.•The device might be effective for ...regulating spinal cord excitability.
One of the major problems with walking encountered by patients with spastic hemiplegia is diminished toe clearance due to spasticity of their leg muscles. To improve their walking, a specialized robot assist for ankle movements (RE-Gait) has been utilized. The present study examined the neurophysiological effects whether spinal cord reciprocal Ia inhibition (RI) in the leg was altered by using RE-Gait. Sixteen patients with a clinical diagnosis of stroke were divided into the two groups, RE-Gait walking group (Group R) and normal (controlled) walking group (Group C). In each group, they walked on a flat floor for 15 min with or without RE-Gait. The depression of soleus (Sol) H-reflexes conditioned by common peroneal nerve stimuli with the conditioning-test (C-T) intervals of 1, 2, 3, and 4 ms were assessed before and immediately after each walking session. After the intervention, the LSM (SE) of Sol H-reflex amplitude with 1, 2 and 3 ms C-T interval conditions were significantly decreased in group R (1 ms: 88.15 (4.60), 2 ms: 86.37 (4.60), 3 ms: 89.68 (4.62)) compared to group C (1 ms: 105.57 (4.56), 2 ms: 100.89 (4.58), 3 ms: 107.72 (4.58)) 1 ms: p = 0.012, 2 ms: p = 0.035, 3 ms: p = 0.011. Walking assistive robot that targets ankle movements might be a new rehabilitation tool for regulating spinal cord excitability.
Use of angioscopy to directly observe the stent lumen in the chronic phase after carotid artery stenting (CAS) has not been reported to date. Here we report 3 patients in whom angioscopy helped ...confirm the stent lumen during retreatment after CAS.
Case 1 required retreatment for stent shortening that occurred 1 month after the first CAS. Preprocedure angioscopy showed the presence of neointima, which could not be revealed by intravascular ultrasound (IVUS). In case 2, which required repeat CAS for distal progressive stenosis of the internal carotid artery, the neointima was observed on the stent surface and was more pronounced on the distal side. In case 3, retreatment was necessary for recurrent ischemic stroke caused by stent restenosis; preprocedure angioscopy showed an unstable plaque, which was not detected as vulnerable by IVUS, protruding into the stent lumen, with partial ulceration and bleeding.
Compared with IVUS, angioscopy enables a more detailed observation of the stent lumen. Although angioscopy is relatively invasive, its use in evaluating changes in the stent lumen after CAS should be clarified by accumulation of reported cases.
Differentiating between germinoma and non-germinomatous germ cell tumor (NGGCT) is important because sensitivity to chemotherapy and/or radiotherapy is quite different between these two subgroups. In ...this study, we evaluated whether the arterial spin labeling (ASL) based perfusion-weighted imaging (PWI) could provide additional information for the differential diagnosis between germinoma and NGGCT.
Between 2011 and 2018, 20 patients with central nervous system (CNS) germ cell tumor (GCT) who underwent preoperative MR imaging including ASL-PWI were enrolled in this study. Relative tumor blood flow (rTBF) was evaluated on ASL-PWI by manually placing regions of interest at gadolinium enhanced part of the tumors and normal subcortical white matter. Presence of intratumoral T1 hyperintense foci and apparent diffusion coefficient (ADC) were also evaluated. The final diagnosis was made by the combination of tumor markers and the histological diagnosis.
Among 20 patients of CNS-GCT, 11 were diagnosed as germinoma and 9 were diagnosed as NGGCT. In the germinoma subgroup, the rTBF ranged from 0.90 to 1.71 (mean 1.21, median 1.09), while it ranged from 1.14 to 5.75 (mean 3.91, median 3.31) in NGGCT subgroup. The receiver operating characteristic (ROC) curve showed that calculating rTBF is useful for differentiating between germinoma and NGGCT (area under the curve (AUC) 0.929, P = 0.0012) compared to intratumoral T1 hyperintense foci (AUC 0.788, P = 0.0304) and ADC (AUC 0.919, P = 0.0016).
High rTBF obtained by ASL-PWI implied the presence of NGGCT component. This information might help in deciding the chemotherapy/radiotherapy intensity.
There has never been evidence for aneurysmal subarachnoid hemorrhage (aSAH) by endovascular coiling compared to surgical clipping with all grade. The present study and meta-analysis aimed to clarify ...the in-hospital mortality and poor outcome in the nationwide databases of patients with all grade aSAH between them. The outcome of modified Rankin scale (mRS) at discharge was investigated according to the comprehensive nationwide database in Japan. The propensity score-matched analysis was conducted among patients with aSAH in this database registered between 2010 and 2015. Meta-analysis of studies was conducted based on the nationwide databases published from 2007 to 2018. According to this propensity score-matched analysis, no significant association for poor outcome of mRS > 2 was shown between surgical clipping and endovascular coiling (47.7% vs 48.3%,
p
= 0.48). However, significantly lower in-hospital mortality was revealed after surgical clipping than endovascular coiling (7.1% vs 12.2%,
p
< 0.001). Meta-analysis of propensity score-matched analysis in the nationwide database showed no significant association for poor outcome at discharge between them (odds ratio OR, 1.08; 95% confidence interval CI, 0.93 to 1.26;
p
= 0.31). Meta-analysis of propensity score-matched analysis for in-hospital mortality was lower after surgical clipping than after endovascular coiling, however, without significant difference (OR, 0.74; 95% CI, 0.52 to 1.04;
p
= 0.08). Further prospective randomized controlled study with all grade aSAH should be necessary to validate the in-hospital mortality and poor outcome.
We herein report the case of a 60-year-old man with a "target sign" in the left frontal lobe on magnetic resonance imaging (MRI), which is thought to be a specific sign of cerebral toxoplasmosis. ...18F-fluorodeoxyglucose-positron emission tomography showed no increased uptake, and 201Tl-single photon emission computed tomography showed the focal uptake in the left frontal lesion. On a brain biopsy, the patient was given a definitive diagnosis of brain metastasis from diffuse large B-cell lymphoma, and cerebral toxoplasmosis was excluded. In the present case, multilayer intensities on MRI may reflect the fast-growing nature of this tumor.
Evaluation of plaque protrusion after carotid artery stenting (CAS) is important for predicting periprocedural ischemic complications. In contrast to intravascular ultrasound (IVUS), angioscopy ...allows direct visualization of the plaque. The aim of this study was to evaluate utility and safety of angioscopy during CAS and compare it with IVUS.
The study included 13 carotid artery stenosis lesions in 11 consecutive patients (mean age 70.5 years; 10 men) at a single center. During CAS procedure, poststenting plaque protrusion was evaluated with angioscopy and IVUS.
Mean level of internal carotid artery stenosis was 79.2%. Eight lesions were symptomatic, and 5 lesions were predicted to have vulnerable plaque by preprocedural magnetic resonance imaging. A carotid WALLSTENT was placed in all cases. After stenting, angioscopy provided good visualization in all cases. Plaque protrusions were observed in 1 case by IVUS and in 8 cases by angioscopy. Diffusion-weighted imaging showed positive lesions in 3 cases (23%). For 2 of these lesions, plaque protrusions were observed by angioscopy but not by IVUS. All lesions associated with positive diffusion-weighted imaging findings were observed to have yellow plaque on angioscopy.
Angioscopy provided direct visualization of stent lumens after CAS. Angioscopy detected more plaque protrusion than IVUS and allowed clearer observation of plaque characteristics. Angioscopy may be more useful than IVUS for examination of plaque protrusion and plaque evaluation after CAS, especially for plaque identified as potentially vulnerable by preprocedural examination.
Objectives
The objective of this study was to investigate the usefulness of model-based iterative reconstruction (IR) for detecting neointimal formations after carotid artery stenting.
Methods
In a ...cervical phantom harbouring carotid artery stents, we placed simulated neointimal formations measuring 0.40, 0.60, 0.80 and 1.00 mm along the stent wall. The thickness of in-stent neointimal formations was measured on images reconstructed with filtered-back projection (FBP), hybrid IR (AIDR 3D), and model-based IR (FIRST). The clinical study included 43 patients with carotid stents. Cervical computed tomography (CT) images obtained on a 320-slice scanner were reconstructed with AIDR 3D and FIRST. Five blinded observers visually graded the likelihood of neointimal formations on AIDR 3D and AIDR 3D plus FIRST images. Carotid ultrasound images were the reference standard. We analysed results of visual grading by using a Jack-knife type receiver observer characteristics analysis software.
Results
In the phantom study, the difference between the measured and the true diameter of the neointimal formations was smaller on FIRST than FBP or AIDR 3D images. In the clinical study, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of AIDR 3D were 58%, 88%, 83%, 67% and 73%, respectively. For AIDR 3D plus FIRST images they were 84%, 78%, 80%, 82% and 81%, respectively. The mean area under the curve was significantly higher on AIDR 3D plus FIRST than AIDR 3D images (0.82 vs 0.72;
p
< 0.01).
Conclusions
The model-based IR algorithm helped to improve diagnostic performance for the detection of neointimal formations after carotid artery stenting.
Key Points
• Neointimal formations can be visualised more accurately with model-based IR.
• Model-based IR improves the detection of neointimal formations after carotid artery stenting.
• Model-based IR is suitable for follow up after carotid artery stenting.
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