Impact of platelet transfusion on survival of patients with intracerebral hemorrhage after administration of anti-platelet agents at a tertiary emergency center.

This study examined the impact of platelet transfusion (PLT) on the survival of intracerebral hemorrhage (ICH) patients who had been administered anti-platelet agents (APA). This retrospective cohort analysis investigated 432 patients (259 men, 60%) who were newly diagnosed with ICH between January 2006 and June 2011 at the tertiary emergency center of Kitasato University Hospital. Median age on arrival was 67.

Yokukansan improves distress of medical staff, and cognitive function and motivation in patients with destructive and aggressive behaviors after traumatic brain injury.

Aim: Yokukansan (a Japanese Kampo medicine) has been reported to be safe and useful in treating behavioral and psychological symptoms in dementia patients. This study aimed to investigate the effects of yokukansan on destructive and aggressive behaviors in patients after traumatic brain injury.

Methods: From April 2008 to July 2010, 189 patients who suffered traumatic brain injury were admitted to our tertiary emergency center.

A case of HELLP syndrome with multiple complications.

Hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome is a rare complication of pregnancy. The mortality rate associated with HELLP syndrome increases when life-threatening complications occur. A 37-year-old woman at 37 weeks of gestation developed severe cerebral hemorrhage at the beginning of labor induction and was transferred to our hospital, where HELLP syndrome was diagnosed.

[Classification of heat illness].

In the type of heat illness, several medical terms such as heat syncope, heat cramp, heat exhaustion, heat stroke are included. But their Japanese medical terms are neither unified nor clearly defined. To eliminate this problem, the new classification for heat illness is proposed.

Efficacy of endovascular surgery for ruptured aneurysms with vasospasm of the parent artery.

Introduction: In the presence of vasospasm it is recommended that surgical clipping for a ruptured aneurysm should be delayed until it disappears, but this may be associated with re-rupture of the aneurysm resulting in a poor outcome. The indications for endovascular coil embolization in such cases are discussed.

Methods: Since November 2002, endovascular coil embolization has been used in 18 consecutive patients with ruptured aneurysm with vasospasm of the parent artery ranging from 2 to 28 days (mean 9 days) after the initial subarachnoid hemorrhage.

Linear fractures invisible on routine axial computed tomography: a pitfall at radiological screening for minor head injury.

Computed tomography (CT) is now widely used as the only screening method for fractures in patients with head injury. However, clear depiction of a fracture requires a discontinuity in the skull, so linear fractures parallel to the CT slice may not be visualized. We retrospectively evaluated 302 patients with minor head injuries aged from 0 to 91 years, who had undergone routine skull radiography (anteroposterior and lateral views) and head CT to study these types of fracture and discuss the risk of nondetection.

Linear fractures occult on skull radiographs: a pitfall at radiological screening for mild head injury.

Background: Skull radiography is widely used to screen for fractures in patients with mild head injury. However, the clear depiction of a fracture requires a gap in the skull separated by the fracture that is wide enough to allow the passage of x-rays. We studied atypical linear fractures that were not visualized clearly, because a specific anatomical configuration hampered the passage of x-rays.

Subarachnoid haemorrhage due to a lateral spinal artery aneurysm misdiagnosed as a posterior inferior cerebellar artery aneurysm: case report and literature review.

Clinical Description: A 61 year old man presenting with subarachnoid haemorrhage had a distal posterior inferior cerebellar artery (PICA) aneurysm diagnosed on the initial cerebral angiogram. However, a PICA aneurysm was not found during surgery. A follow-up, super-selective vertebral artery (VA) performed demonstrated a saccular aneurysm located on the lateral spinal artery (LSA).

[Infectious aneurysm rerupture caused by delayed diagnosis: an operative case report].

A 21-year-old febrile woman with sudden onset of headache and semicoma was transferred to our institute. CT and 3D-CT angiography showed subaracnoid hemorrhage and intracranial hemorrhage in the left hemisphere due to a saccular aneurysm at the occluded M2 portion of the middle cerebral artery (MCA). Her present illness started with a toothache and lumber pain 3 weeks earlier.

Unusual location of anterior communicating artery aneurysm located on the planum sphenoidale due to long A1 segments.

A 51-year-old woman presented with a rare variation in the location of the anterior communicating artery (AComA) complex associated with aneurysm manifesting as sudden onset of headache. Computed tomography (CT) revealed widespread subarachnoid hemorrhage with intracerebral hematoma and intraventricular hemorrhage. Three-dimensional (3D)-CT angiography revealed an aneurysm located at the AComA complex on the planum sphenoidale.

A randomized controlled trial of hydrocortisone against hyponatremia in patients with aneurysmal subarachnoid hemorrhage.

Background And Purpose: Hyponatremia is common after aneurysmal subarachnoid hemorrhage (SAH). It is caused by natriuresis, which induces osmotic diuresis and decreases blood volume, contributing to symptomatic cerebral vasospasm (SCV). Hypervolemic therapy to prevent SCV will not be efficient under this condition.

Efficacy of a direct puncture approach for anterior circulation aneurysms using a newly developed guiding catheter - especially for geriatric patients.

Background: Endovascular surgery is being increasingly used as an alternative to craniotomy clipping surgery, especially for aged patients and complicated cases. However, tortuous atherosclerotic arteries sometimes interfere with advancement of catheters so that direct puncture may be necessary. Short guiding catheters for use with this approach have been newly developed, as discussed in this article.

[Some problems on the organ transplantation in Japan from the viewpoint of the neurocritical care units].

The authors have referred to several issues encountered in the neuroemergency and critical care facilities in our country through the declaration of brain death to the successful removal of organs for donation. One of the most important is the fact that the legal validity of death in brain dead patients is only assured when the patient shows the advance directive for organ donation in Japan. So far as the selection of the recipient is not started until the brain death is declared legally, longer than 12 hours are to be spent in vain between the declaration of brain death and the beginning of the operation of removing the organs for donation.

Efficacy of endovascular surgery for the treatment of acute epidural hematomas.

Background And Purpose: Recent advances in the equipment and technology for endovascular surgery have led to an increasing number of patients undergoing this procedure to treat various lesions. The purpose of this study was to investigate the efficacy of early-stage endovascular surgery to treat growing acute epidural hematomas (AEDHs).

Methods: Over a period of 2.

Intracranial vertebral artery dissection with subarachnoid hemorrhage: clinical characteristics and outcomes in conservatively treated patients.

Object: Intracranial vertebral artery (VA) dissection with subarachnoid hemorrhage is notorious for frequent rebleeding and a poor prognosis. Nevertheless, some patients survive with a good final outcome. The factors associated with the prognosis of this disease are not fully understood and appropriate treatment strategies continue to be debated.