A 50-year-old male presented with benign intracranial hypertension (BIH). He was admitted to our hospital for headache and papilledema. The diagnosis was BIH as continuous monitoring of lumbar cerebrospinal fluid pressure (CSFP) showed high basal pressure with intermittent plateau waves. Ten months after successful ventriculoperitoneal shunting, he presented with headache again due to shunt malfunction. CSFP monitoring showed the same findings as before. Regional cerebral blood flow (rCBF) was measured by positron emission tomography (PET) using the 15O-labeled water autoradiographic method with simultaneous recording of lumbar CSFP. The rCBF values of the cerebral cortex, white matter, thalamus, cerebellar cortex, and pons were evaluated during both the plateau waves and the intervals. In spite of severely reduced cerebral perfusion pressure, rCBF during the plateau waves was not reduced when compared with the rCBF of normal volunteers in all regions. This result might explain why patients with BIH show no impairment of consciousness or focal signs during the plateau waves.
In patients with suprasellar tumors, the tumor itself and also its surgical resection may produce hypothalamic dysfunction including thermoregulatory disturbances. We quantitatively evaluated skin sympathetic nerve activity (SSNA) using microneurography in eight patients with hypothalamic dysfunction following resection. SSNA, skin blood flow by laser Doppler, sweating, blood pressure, and pulse rate were monitored during changes of core (tympanic) temperature, in the patients and seven healthy controls. Core temperature was decreased by 0.3°C and increased by 0.5°C relative to baseline using a cooling/heating blanket. Argumentation of SSNA by cooling did not differ between patients and controls. An increase of SSNA upon heating was absent in patients but present in controls. Skin blood flow during heating increased significantly in controls but not in patients. Our results indicated that the patients had impaired heat loss during body temperature elevation. Microneurography is a sensitive measure of hypothalamic autonomic function.
Objective Neuroendovascular treatment (NET) is an effective and minimally invasive procedure used for patients with vascular disease of the central nervous system. The purpose of this study was to examine anxiety levels using standardized psychometric tools and an original questionnaire among patients before and after NET. Method A total of 40 patients who underwent NET were included. There were 18 patients with unruptured cerebral aneurysm, 18 with carotid stenosis, and 4 other cases. Patients were asked to complete a State-Trait Anxiety Inventory (STAI) and also to fill out a questionnaire about perioperative anxiety. It elicited the following information: (a) state-anxiety score and level before and after NET; (b) trait-anxiety score and level before and after NET; and (c) perioperative anxiety about NET. In all cases, the procedure was performed under local anesthesia. Results The preprocedural state-anxiety score was high in many patients (82%). The principal cause of the preprocedural anxiety was the procedure-related complications (92%). Patients with cerebral aneurysm experienced anxiety during the procedure because they could not know which stage of the procedure was involved. Their state-anxiety score was improved in the postprocedural examination (88%). However, patients were still anxious about postoperative complications and recurrence, particularly those with cerebral aneurysm. Patients with cerebral aneurysm generally tended to experience a higher level of anxiety than those with carotid stenosis. Conclusion Though NET is apt to be thought as a relatively easy procedure, patients actually felt much anxiety, especially those with cerebral aneurysm. Due care for perioperative anxiety in patients who undergo NET is important.
To evaluate the possible relationship between Helicobacter pylori infection and gastric carcinoma, and its precursor lesion, intestinal metaplasia, in a Japanese population.H. pylori infection was identified by the presence of anti-H. pylori immunoglobulin (Ig)G. The frequency of H. pylori infection was compared in 109 patients with gastric carcinoma, the same number of patients with atrophic gastritis and asymptomatic controls matched for age, sex and place of birth. To study the relation between H. pylori and intestinal metaplasia, sera and gastric antral and corpus mucosal biopsies were obtained from 58 asymptomatic controls, 92 patients with chronic gastritis and 80 patients with peptic ulcer.The presence of IgG antibody to H. pylori was significantly more frequent in those with gastric carcinoma than in asymptomatic controls (87.2 versus 74.3%; odds ratio 2.4; 95% confidence interval 1.2-4.8). The positive rates of H. pylori IgG antibody were 80.7% in patients with atrophic gastritis. Mean serum gastrin and pepsinogen II levels in H. pylori-positive patients were higher than those in H. pylori-negative patients. Serum gastrin and pepsinogen I levels were significantly higher in controls than gastric carcinoma patients (P < 0.01 and P < 0.05, respectively). Serum pepsinogen I:II ratios were significantly lower in controls than in gastric carcinoma patients (P < 0.01). Intestinal metaplasia was strongly associated with H. pylori infection, and was only found in patients with IgG antibodies to H. pylori.These results suggest that H. pylori infection is associated with the development of gastric cancer by providing a suitable environment for carcinogenesis of the gastric mucosa, such as gastric atrophy and intestinal metaplasia.
Objective: The purpose of the present exploratory study was to evaluate the effects of uncomplicated carotid endarterectomy (CEA) on cognitive function and brain perfusion in patients with unilateral asymptomatic severe stenosis of the internal carotid artery (ICA) by comparison with unoperated patients.Methods: Patients with age ≤75 years and unilateral asymptomatic severe stenosis (≥70%) of the cervical ICA underwent CEA with antiplatelet therapy (surgically treated group: 116 patients) or antiplatelet therapy alone or neither (medically treated group: 45 patients). For the surgically treated group, neuropsychological testing and brain perfusion measurement using single-photon emission computed tomography were performed within one month before surgery and one month after surgery. For the medically treated group, the same testing and measurement were performed twice at an interval of 1 to 2 months.Results: None of the operated patients developed new major ischemic events after surgery or intraoperative cerebral hyperperfusion. None of the patients in the medically treated group experienced neurological deficits including transient ischemic attacks during the study period. The incidence of patients with interval cognitive improvement was significantly greater in the surgically treated group (11 patients: 9%) than in the medically treated group (0%) (p = 0.0352). The incidence of patients with interval brain perfusion improvement in the ipsilateral cerebral hemisphere was significantly greater in the surgically treated group (24 patients: 21%) than in the medically treated group (0%) (p = 0.0003).Conclusions: Uncomplicated CEA may improve cognitive function and brain perfusion in patients with unilateral asymptomatic severe stenosis of the ICA when compared with unoperated patients.
BACKGROUND AND IMPORTANCE: A double-layer micromesh stent is designed for the treatment of carotid artery stenosis that has been reported to potentially provide a flow diversion effect. However, the actual flow diversion effect of stents remains unclear. Here, we present a case of a growing saphenous vein graft (SVG) aneurysm treated with the placement of the double-layer micromesh stent using its flow diversion effect. CLINICAL PRESENTATION: A 66-year-old woman, who underwent high-flow bypass using a SVG for a blister-like internal carotid artery aneurysm 13 years earlier at our institute, was referred to our hospital with a pulsatile cervical mass. Magnetic resonance angiography showed a 9-mm aneurysm on the left SVG, although the aneurysm was a small pouch 4 years earlier. Digital subtracted angiography demonstrated a 9.4 × 8.3-mm aneurysm from the SVG at the auricular level. Because the diameter of the graft was larger than that of the available flow diverter stents in Japan, we decided to place the double-layer micromesh stent (CASPER RX, 7 × 25 mm MicroVention) using its flow diversion effect. Computational fluid dynamics analysis before and after stent deployment showed a significant reduction in the average flow velocity and wall shear stress in the aneurysm, indicating actual flow diversion. An angiogram 2 months postoperatively showed complete obliteration of the aneurysm. CONCLUSION: Obliteration of the saphenous vein aneurysm was achieved because of the flow diversion effect of the double-layer micromesh stent. The stents might be a feasible alternative for treating cervical carotid aneurysms.
