We describe a rare case of neurovascular compression syndrome (NVCS) of the brain stem and opsoclonus-myoclonus syndrome (OMS) complicated with vestibular paroxysmia (VP) and autonomic symptoms. Moreover, we discuss the case with respect to the available information in medical literature. A 36-year-old man with vertigo and nausea had difficulty standing, and was transported by an ambulance to our hospital. He had VP, opsoclonus, cervical myoclonus, anxiety, and restless legs syndrome. Magnetic resonance imaging at hospitalization showed that the dolichoectatic vertebral artery was in contact with the postero-lateral side of the pontomedullary junction. He was diagnosed with NVCS of the brain stem (most likely of the input to the vestibular nucleus) associated with contact with the dolichoectatic vertebral artery. Combination therapy using multiple antiepileptic drugs, such as low-dose carbamazepine, clonazepam, and lacosamide, improved his clinical symptoms. He was finally able to walk and was discharged on day 42 after admission. He is being routinely followed-up since then. Further research is needed to confirm the validity of the combination therapy.
The rates of hemodynamic depression (HD) and thromboembolism were compared in 95 carotid artery stenting (CAS) procedures performed in 87 patients with severe carotid artery stenosis using self-expandable braided Elgiloy stents (Wallstent) in 52 and slotted-tube Nitinol stents (Precise) in 43 procedures. The blood pressure, pulse rate, and neurological signs were recorded at short intervals during and after CAS. All patients underwent diffusion-weighted magnetic resonance imaging within 5 days after the procedure. The incidences of hypotension, bradycardia, and both were 17.9%, 3.2%, and 11.6%, respectively. The rate of postprocedural HD was 23.1% with Wallstent and 44.2% with Precise; the difference was significant (p = 0.025). No patient manifested major cardiovascular disease after CAS. Diffusion-weighted magnetic resonance imaging revealed thromboembolism after 26.9% and 34.9% of Wallstent and Precise stent placement procedures, respectively; the difference was not significant. The type of self-expandable stent placed may affect the risk of procedural HD in patients undergoing CAS. Postprocedural HD was resolved successfully by the administration of vasopressors and by withholding antihypertensive agents.
Antiplatelet therapy is advised to prevent thrombotic complications during endovascular coil embolization of unruptured cerebral aneurysms. Due to multiple antithrombotic treatments, bleeding risk is a concern in patients using oral anticoagulants for existing comorbidities. We investigated the hemorrhagic and ischemic events following endovascular treatment (EVT) of unruptured cerebral aneurysms in patients taking anticoagulation and antiplatelet therapy.Between March 2013 and February 2019, 262 patients undergoing EVT for unruptured cerebral aneurysms and having at least 6 months of postoperative follow-up data were included in this retrospective study. Patients taking oral anticoagulants and antiplatelet drugs for cerebral vascular events following EVT were compared with those taking only antiplatelet agents.Of the 262 patients, 12 (4.6%) used anticoagulants before EVT for a preexisting condition. Cerebrovascular events after coil embolization were observed in 3 patients taking both anticoagulant and antiplatelet drugs and in 14 patients taking only antiplatelet drugs (25% vs. 5.6%, respectively, p = 0.035). Vitamin K antagonist (VKA) was administered in five patients and direct oral anticoagulants (DOACs) in seven patients. Patients taking VKA experienced cerebrovascular events, whereas those taking DOACs did not (p = 0.045).Our study showed that patients using oral anticoagulants and antiplatelet drugs experienced more cerebrovascular events after EVT for unruptured cerebral aneurysms. These results suggest that in patients requiring oral anticoagulants, DOACs may be more beneficial than VKA for preventing stroke occurrences after EVT.
The difference between coil-embolized ruptured and unruptured aneurysms with respect to intra-aneurysmal thrombus formation remains to be determined.We examined whether there was a difference between ruptured and unruptured coil-embolized aneurysms in the rate and timing of thrombus formation in the aneurysmal sac and discuss the effect of thrombus on the treatment outcome.We evaluated 209 aneurysms with an aneurysmal dome smaller than 10 mm and a neck size less than 4 mm. Of these, 91 (43.5%) were ruptured. We assessed intra-aneurysmal thrombus formation by the coil-packing ratio (CPR): the percentage of coil volume occupying the aneurysmal sac. The initial CPR was defined as the CPR at which contrast influx into the sac ceased and the final CPR as that at the end of the procedure. ΔCPR was calculated as the difference between initial and final CPRs. Embolized aneurysms were evaluated on follow-up angiograms.The initial CPR was significantly lower in ruptured aneurysms (P < .01), and there was not a significant difference in the final CPR between ruptured and unruptured aneurysms (P = .05). ΔCPR was significantly higher in ruptured aneurysms (P < .01). The rate of aneurysmal recanalization was significantly higher in ruptured aneurysms (P < .05). The incidence of recanalization was high in ruptured aneurysms with low initial CPR and ΔCPR values.In ruptured aneurysms, intra-aneurysmal thrombus formation tends to occur in the earlier stages of coil embolization. In some cases, thrombus formation may inhibit dense coil packing and result in recanalization.
Patients with both nonrheumatoid retro-odontoid pseudotumors (ROPTs) and congenital craniocervical junction (CCJ) abnormalities are rare. Here, a 73-year-old female presented with neck pain and myelopathy due to MR-documented ROPT with intramedullary hyperintensity at the CCJ warranting an occipital-cervical fusion.A 73-year-old female originally developed occipitalgia and became quadriparetic within the subsequent 7 months. The cervical MR showed a ROPT with intramedullary hyperintensity at the CCJ. Further, the CT demonstrated C1 occipitalization and a congenital C2-3 fusion without radiological instability. After she underwent an occipito-C2 fusion, her symptoms improved.For patients with C1 occipitalization and a Klippel-Feil syndrome, ROPT may occur due to loading of C1-2 complex. These patients typically favorably respond to occipito-C2 fusion.
We report a case of rapidly progressing primary high-grade B-cell lymphoma of the central nervous system with c-Myc translocation and Bcl-2 protein expression that resulted in the patient's death 45 days after the onset of convulsions. Further, we provide a literature review. CASE:A 74-year-old man was admitted to our hospital for convulsions. Magnetic resonance imaging on admission showed tumorous lesions at the left temporoparietal junction. An open biopsy was performed promptly. The patient was diagnosed with primary high-grade B-cell lymphoma of the central nervous system with c-Myc translocation and Bcl-2 protein expression(<50%). The tumor showed rapid progression postoperatively. The patient did not respond to steroids and died 45 days after the onset of convulsions. CONCLUSION:The c-Myc translocation, showing a strong c-Myc protein positivity, and co-expression of the Bcl-2 protein were poor prognostic factors for the tumor.
[Neurol Med Chir (Tokyo) 53, 259-262, 2013] Reference 20 on page 262 To the Readership: Reference 20 was incorrectly reported in the Reference section of the above-mentioned article. Incorrect: 20) Wada M, Harada N, Higuchi K, Misawa N, Nakatsubo N, Tsukamoto K, Hashimoto S: Journal of Health and Welfare Statistics 55: 137-141, 2008 (Japanese) Correct: 20) Health and Welfare Statistics Association: Journal of Health and Welfare Statistics 55: 137-141, 2008 (Japanese)
