Functional Outcomes of Decompressive Craniectomy in Patients with Malignant Middle Cerebral Artery Infarction and Their Association with Preoperative Thalamus Deformation: An Analysis of 12 Patients.

Objective Decompressive craniectomy (DC) in patients with malignant middle cerebral artery (MCA) infarction is known to decrease the mortality rate. However, the functional outcomes (communication and oral intake) of this procedure remain unclear. Most patients with malignant MCA infarction exhibit a loss of consciousness, which may be principally governed by the thalamus.

Duplicate origin of the anterior cerebral artery diagnosed by magnetic resonance angiography: a case report.

An anterior cerebral artery (ACA) of duplicate origin results from the fusion of two arteries that arise from the terminal segment of the internal carotid artery (ICA) to form a ring. This variation is extremely rare and differs from proximal ACA fenestration, supraclinoid fenestration of the ICA, and duplicate origin of the middle cerebral artery. We report a case diagnosed incidentally by magnetic resonance angiography.

Clinical Features of Ischemic Stroke during Treatment with Dabigatran: An Association between Decreased Severity and a Favorable Prognosis.

Objective: Anticoagulation therapy with warfarin is associated with a favorable prognosis in ischemic stroke. Dabigatran, a new oral anticoagulant, is widely used to prevent ischemic stroke in non-valvular atrial fibrillation (NVAF) patients. However, its association with decreased severity and a favorable prognosis once ischemic stroke has occurred remains unknown.

Antithrombotic Drugs Play a Significant Role in Intracerebral Hemorrhage in the Elderly Patients.

Background: Japan has the fastest aging society in the world. Compared with younger patients, older ones have a different stroke risk profile and different stroke features. The aim of this study was to examine the risk factor profiles, stroke severities, and functional outcomes of hypertensive intracerebral hemorrhage (ICH) in different age groups.

Human T lymphotropic virus type-1-associated myelopathy manifesting shortly after living-donor renal transplantation.

A 38-year-old woman experienced numbness in both lower extremities and spastic paralysis a few months after undergoing living-donor renal transplantation. The patient was negative for human T lymphotropic virus type-1 (HTLV-1) antibodies prior to the procedure; however, she was diagnosed with HTLV-1-associated myelopathy (HAM) based on positive serum and cerebrospinal fluid antibody titers after the surgery. Because the donor was also positive for HTLV-1 antibodies, the infection likely originated from the transplanted kidney.

Ischemic stroke with essential thrombocythemia: a case series.

Background: Essential thrombocythemia (ET) is considered a rare cause of stroke partly because it is not detected if the platelet count is not elevated. However, early detection of ET is important because thrombosis can recur frequently, unless adequately treated.

Methods: We retrospectively collected data from 10 stroke cases with ET.

Clinical outcomes of persistent and paroxysmal atrial fibrillation in patients with stroke.

Background: We compared the clinical outcomes of persistent atrial fibrillation (PeAF) and paroxysmal atrial fibrillation (PAF) in patients with cardioembolic stroke caused by nonvalvular atrial fibrillation (NVAF) because the nature of the fibrillation can cause persistent cerebral infarction.

Methods: We classified 619 of 964 patients hospitalized with cardioembolic stroke between April 2007 and December 2013 within 24 hours of onset as having PeAF (n = 447) and PAF (n = 172) according to a retrospective analysis of their clinical records, including National Institutes of Health Stroke Scale (NIHSS) scores on admission, clinical outcomes (modified Rankin Scale [mRS] scores) at 90 days after admission, and major cerebral artery occlusion.

Results: The PeAF group was significantly older (P < .

Research article: clinical characteristics of isolated anterior cerebral artery territory infarction due to arterial dissection.

Background: Isolated brain infarction in the anterior cerebral artery (ACA) territory is rare, and its etiology has not yet been fully elucidated. Thus, we aimed to determine the etiologic and clinical characteristics of patients with isolated ACA territory infarction due to arterial dissection.

Methods: Of 2315 patients with acute cerebral infarction admitted to our hospital between April 2007 and September 2013, 34 patients (1.

Contrast-induced encephalopathy after coil embolization of an unruptured internal carotid artery aneurysm.

A 58-year-old woman developed agraphia and mild right hemiparesis approximately one month after undergoing coil embolization of an unruptured left internal carotid artery aneurysm. MRI performed on day 39 post-coil embolization showed multiple lesions in the white matter with signal hyperintensity on T2-weighted and FLAIR images in the left middle cerebral artery territory. The patient's cerebrospinal fluid exhibited an elevated protein level at 46 mg/dL; however, no other findings suggested another underlying disease.

Clinical characteristics of cardioembolic transient ischemic attack: comparison with noncardioembolic transient ischemic attack.

Background: Previous studies show that 6%-31% of transient ischemic attacks (TIA) were caused by cardiogenic cerebral embolism (cardioembolic TIA). As prompt initiation of therapy is essential in TIA to prevent subsequent strokes, determining their cause is important. In this study, we aim to determine the features of cardioembolic TIA and to compare them with those of noncardioembolic etiology.

Effects of rosuvastatin on serum lipids and arteriosclerosis in dyslipidemic patients with cerebral infarction.

Background: We investigated the effect of rosuvastatin, 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor, on serum lipids and arteriosclerosis in dyslipidemic patients with cerebral infarction.

Methods: The subjects were 24 patients with noncardiogenic cerebral infarction complicated by dyslipidemia (low-density lipoprotein cholesterol [LDL-C] ≥ 140 mg/dL). Serum lipids and highly sensitive C-reactive protein (hs-CRP) were measured at the start of the study and at 3 and 12 months after the initiation of oral rosuvastatin (5 mg/day).

Clinical review of 24 patients with acute cholecystitis after acute cerebral infarction.

Objective: Acute cholecystitis (AC) after acute cerebral infarction is rare and has not been fully investigated. Because patients with acute cerebral infarction often cannot complain of abdominal pain due to loss of consciousness, hemiparesis and aphasia, delays in diagnosis may increase the severity of the condition. It is clearly important to identify symptoms, reach a diagnosis and provide treatment as soon as possible.

Primary central nervous system cytotoxic T-cell lymphoma mimicking demyelinating disease.

A 40-year-old man visited to our hospital due to progressive right hemiparesis. Magnetic resonance imaging demonstrated a heterogeneous contrast-enhanced lesion in the left basal ganglia with compression of the ventricles. A brain biopsy did not demonstrate central nervous system (CNS) lymphoma, although acute demyelination was observed.

Response to clopidogrel and its association with chronic kidney disease in noncardiogenic ischemic stroke patients.

Objective: Noncardiogenic ischemic stroke patients with chronic kidney disease (CKD) are known to have a greater rate of ischemic stroke recurrence than those without. Although clopidogrel is often used to prevent the recurrence of noncardiogenic ischemic stroke, the relationship between the response to clopidogrel and CKD is unclear. In the present study, the relationship between the response to clopidogrel and the presence of CKD was investigated in noncardiogenic ischemic stroke patients.

CHADS2 score/CHA2 DS2 -VASc score and major artery occlusion in cardioembolic stroke patients with nonvalvular atrial fibrillation.

Objective: The associations between the CHADS2 score/CHA2 DS2 -VASc score, and the presence of cerebral vessel occlusion on admission were examined in cardioembolic stroke patients with nonvalvular atrial fibrillation.

Methods: The subjects were 546 consecutive patients hospitalized between April 2007 and December 2012 with onset of cardioembolic stroke associated with nonvalvular atrial fibrillation within 24 h. The associations between the CHADS2 score/CHA2 DS2 -VASc score and the presence of occluded cerebral vessels on magnetic resonance angiography were evaluated retrospectively.