In patients presenting with brain metastases, the evaluation for extracranial metastases is important to determine the therapeutic strategies and predict the patients outcome. We investigated the findings of whole-body FDG-PET/CT in 30 patients with metastatic brain tumors. The patients were divided into two groups consisting of 16 patients with precocious or synchronous metastases (PS group), or 14 patients with metachronous metastases (M group), according to the brain metastatic patterns. In all patients of the PS group, the primary site was the lung. In one patient of the PS group, the primary lesion was detected neither by FDG-PET/ CT nor by contrast-enhanced CT or MRI in one patient of the PS group. The primary site of another patient in the PS group was confirmed only by FDG-PET/CT. The sensitivity of FDG-PET/CT in search of primary site was 93.3%, while that of conventional modalities was 87.5%. Maximum standardized uptake value (SUV) of the primary lesions did not show statistically significant difference between groups with single and multiple metastatic brain lesions. SUV also failed to show a statistically significant difference between groups with and without extracranial metastatic lesions. In patients comprising the M group, breast cancer was the most frequent primary site. 3 patients in the M group showed no definite hypermetabolic lesions including the primary sites. Two of them have been clinically independent for more than 20 months. 22 (73.3%) of all patients presented extracranial metastases when brain lesions were found. FDG-PET/CT is a useful modality in detecting the primary cancer and evaluating extracranial systemic metastases. It is important to establish a refined clinical staging system and predict the patient's prognosis based upon the findings of FDG-PET/CT in patients with brain metastasis.
要旨:症例は41歳の女性で,10年前に左中大脳動脈閉塞症を発症し,その後も複数回にわたり右上下肢の脱力や構音障害を自覚していた.今回,再度左中大脳動脈閉塞症を発症し,血栓回収療法中に carotid web を発見した.その後,再発予防を目的に頸動脈ステント留置術を行った.特に若年における危険因子のない脳梗塞において,carotid web は鑑別すべき重要な疾患と考えられた.
Rationale Thromboembolism is a serious complication of endovascular treatment for ruptured cerebral aneurysms. The administration of antiplatelet agents before endovascular treatment for ruptured cerebral aneurysms may reduce the risk of thromboembolic complications. Aim This study aimed to assess the safety and efficacy of preoperative aspirin administration in endovascular treatment for ruptured cerebral aneurysms. Sample size estimates Assuming a 15% incidence rate of both intraoperative thromboembolic morbidity and symptomatic ischemic lesions on magnetic resonance imaging diffusion-weighted imaging scans assessed by an Independent Review Committee, a sample size of 484 will be required to detect a 10% improvement with aspirin administration with 90% power using the Pearson’s chi-square test at a two-sided significance level of 2.5% for each primary outcome, after accounting for a 5% dropout rate. Methods and design ASTOP is a multicenter, randomized, double-blind, placebo-controlled clinical trial. A total of 484 patients with ruptured cerebral aneurysms receiving coil embolization within 72 h of onset will be randomly assigned 1:1 to receive 200 mg of aspirin or placebo before the procedure. Study outcomes The primary outcomes will be the incidence rates of intraoperative thromboembolic complications and symptomatic ischemic lesions on magnetic resonance imaging diffusion-weighted imaging scans evaluated by the Independent Review Committee. The secondary outcomes will be the incidence rate of cerebral ischemic events and all bleeding events within 14 days of enrollment and functional outcomes defined by the modified Rankin Scale score at 90 days. Discussion This trial will provide valuable data on the role of antiplatelet agents during endovascular treatment for ruptured cerebral aneurysms. Trial registration Registration : Japan Registry of Clinical Trials, Identifier: jRCTs031210421 .
Intraoperative view of aneurysmal pupilsparing third nerve palsyAneurysmal pupil-sparing third nerve palsy is a rare condition.We demonstrate three cases of pupil-sparing third nerve palsy by an unruptured posterior communication artery (PCoA) aneurysm.In all cases, the entire nerve was compressed on its ventromedial side by the aneurysm and stretched toward dorsolateral (Fig. 1).According to "the rule of the pupil in third nerve palsy," the iris sphincter is impaired by direct compression of PCoA aneurysms. 1The pupillary fiber runs around the superior dorsomedial surface of the third nerve, and PCoA aneurysms usually compress the dorsal side of the nerve. 2 However, when the internal carotid artery runs very close to the skull base, the aneurysm can compress the ventral side of the nerve, and the pupillary fiber can be spared.This report reminds us that an unruptured PCoA aneurysm cannot be excluded simply because the pupil appears normal.
The present study was to investigate the effects of 6 FK506 binding protein 51 (FKBP5) single nucleotide polymorphisms (SNPs) on brain structure using voxel-based morphometry (VBM) and the psychological tests to psychological stress. We genotyped 112 healthy controls with respect to 6 SNPs (rs) of FKBP5. We examined the Beck Depression Inventory and the State (STAI-S) and Trait (STAI-T) versions of the Spielberger Anxiety Inventory and the Profile of Mood States (POMS) to evaluate mood. The right amygdala was larger in subjects with the minor allele (C) of rs3800373 and rs992105 and the minor allele (T) of rs1360780. The right middle orbitofrontal region in those with the minor allele (C) of rs3800373 and the right inferior orbitofrontal region in those with the minor allele (T) of rs9470080 was larger. Both the amygdala volumes were associated significantly with FKBP5 SNPs. We found significant relationships between factors in POMS and the right and left amygdala and left insula. Our results suggest that FKBP5 SNPs are associated with the alternations of volumes in right amygdala and the right middle and inferior orbitofrontal region. Genetic variants of FKBP5 may be associated with depressive and anxiety state via differential effects on amygdala and orbitofrontal region.
