Cardiogenic embolism caused hypoglycemia

The direct relationship between a hypoglycemic attack and cerebral infarction remains unknown. It has been reported that a hypoglycemic attack can result in takotsubo syndrome, leading to cerebral infarction. We report a case of a cardiogenic cerebral embolism caused by a hypoglycemic attack, with additional literature review. A 71-year-old woman was admitted to our hospital in a semi-comatose state due to a severe hypoglycemic attack ; she developed hemiplegia one day after admission. Magnetic resonance imaging revealed cerebral infarction in the area supplied by the left middle cerebral artery. Takotsubo syndrome was suspected based on echocardiography. We diagnosed cerebral embolism due to takotsubo syndrome, caused by the hypoglycemic attack

A novel COL4A1 variant associated with recurrent epistaxis and glioblastoma

COL4A1-related disorders are characterized by a higher incidence of cerebral hemorrhage than other hereditary cerebral small vessel diseases. Accumulating data have shown broad phenotypic variations, and extracerebral hemorrhages have been linked to these disorders. Moreover, the coexistence of neural tumors has been described. Here, we report a Japanese family with a novel COL4A1 variant, including a patient with recurrent epistaxis and glioblastoma

膠芽腫においてAd-DKK3の抗腫瘍効果はWnt蛋白と受容体の相互作用の阻害によりもたらされる

Field log book of Mike Gagner, labeled WM-7, 4/14/04, WM-7, 06/26/04, and WM-7, 8/20/04 of project 1418.01 PHABSIM site

髄膜癌腫症による頭蓋内圧亢進症に対する脳室腹腔短絡術の有用性

　髄膜癌腫症は，がんの集学的治療の進歩による生存期間の延長に伴い，診断される機会も増加している．髄膜癌腫症は患者のQuality of life(QOL) を著しく低下させ，生命予後に直結することが多い．神経症状の軽減によるQOL の改善を考えると，髄膜癌腫症に対する外科治療の介入を検討し直す必要があると思われる．　我々は，髄膜癌腫症に対し外科治療を施行した３症例経験した．外科治療の適応に関し，過去の症例も交え，文献的考察を加え報告する．　【症例１】56歳男性．肺癌を原発とする多発脳転移を伴う髄膜癌腫症と診断された．全脳照射後に全身化学療法を行うも，意識障害をきたし，全身化学療法の継続が困難となった．髄液排除によりPerformance Status（PS）が改善したため，脳室腹腔短絡術を施行した．術後，意識障害は改善し，治療を再開した．PS は改善し，比較的良好な日常生活を送れQOL は改善したと考えられたが，Nivolumab の副作用により，全身状態は悪化し，術後３か月で死亡した．　【症例２】55歳女性．肺腺癌と診断され，頭痛が出現し，髄膜癌腫症と診断された．EGFR-TKIを含む全身化学療法を行い，症状は改善傾向であった．その後，頭痛，嘔気が増悪しPS は低下した．脳室ドレナージ術により，PS は改善し，嘔気・疼痛のコントロールが可能となったため，脳室腹腔短絡術を施行した．術後，緩和医療に移行し，残された時間を有意義に過ごすことができ，QOL は改善したと考えられたが，全身状態の悪化により術後４か月で死亡した．　【症例３】66歳女性．頭痛が出現し，肺癌に伴う，髄膜癌腫症と診断された．疼痛コントロールが困難であり，PS も低下していたため，脳室ドレナージ術を施行したところ，疼痛コントロールが可能となった．PS の改善に伴い，Erlotinib による治療を開始することができた．しかし，間質性肺炎による全身状態の悪化により，脳室腹腔短絡術は施行できず，脳室ドレナージ術から44日で死亡した．　The incidence of leptomeningeal carcinomatosis is increasing with the extension of the survival because of the advances in cancer treatment. This condition significantly deteriorates the patients\u27 quality of life (QOL) and worsens the prognosis. Because the reduction of neurological symptoms can be expected to improve the QOL, it is necessary to reexamine the indications for surgical treatment of leptomeningeal carcinomatosis. We report three cases of surgically treated leptomeningeal carcinomatosis, and we review the literature, including past cases, with regard to the indications for surgical treatment.　Case 1: A 56-year-old man was diagnosed with leptomeningeal carcinomatosis with multiple brain metastases from lung cancer. Whole-brain irradiation was performed, followed by systemic chemotherapy, which was discontinued because of the development of a consciousness disorder. As the patient’s performance status (PS) improved after ventricular drainage, ventriculoperitoneal (VP) shunt was performed. Postoperatively, the consciousness disorder improved, and treatment was restarted. The patient’s PS and QOL improved; he was able to live a relatively good daily life. However, he died 3 months after the surgery because of deterioration of his general condition resulting from the side effects of nivolumab.　Case 2: A 55-year-old woman diagnosed with lung adenocarcinoma complained of headaches. She was diagnosed with leptomeningeal carcinomatosis and underwent systemic chemotherapy, including epidermal growth factor receptor tyrosine kinase inhibitors. Her symptoms initially improved; however, after a while, the headaches and nausea worsened and her PS deteriorated. The ventricular drainage improved her PS; therefore, VP shunt was performed. Postoperatively, her PS and QOL improved and she was switched to palliative care as the nausea and pain became controllable. However, she died because of deterioration of her general condition 4 months after the surgery.　Case 3: A 66-year-old woman complaining of headaches was diagnosed with leptomeningeal carcinomatosis associated with lung cancer. Because pain control was difficult and her PS was reduced, ventricular drainage was performed. Postoperatively, pain control became possible and her PS improved. Although treatment with erlotinib was started, the patient could not undergo VP shunt because of deterioration of her general condition resulting from an interstitial pneumonia, and she died 44 days after the ventricular drainage

破裂脳動脈瘤の発症12日目に別の未破裂脳動脈瘤が破裂した1例

　67歳女性．以前より左中大脳動脈・脳底動脈本幹・左海綿静脈洞部内頚動脈に未破裂脳動脈瘤を指摘されていた．突然に激しい頭痛・嘔気が出現し，その5日後に他院でsubarachnoid hemorrhage（SAH）を指摘されたため，当院紹介となった．CT で左シルビウス裂・左大脳半球脳溝を中心にSAH を認めるも，脳幹周囲には認めなかった．緊急DSA では，左中大脳動脈瘤は4.9mm でbleb を伴っていたが，脳底動脈瘤は6.5mm，左内頚動脈瘤は2.9mm で，いずれもblebはなかった．左中大脳動脈瘤の破裂と考え，緊急で同部位にコイル塞栓術を施行し，ほぼ完全閉塞された．しかし，第12病日に突然昏睡状態となり，CT で橋腹側を中心に新たなSAH を認めた．脳底動脈瘤の破裂と診断し，緊急コイル塞栓術を行った．術後意識状態は改善し，NPH に対しVP シャントを追加し，mRS1で自宅退院となった．短期間で2個の動脈瘤が破裂した比較的稀な症例と考えられ，報告する．　We report a rare case of recurrent bleeding caused by another cerebral aneurysm during the subacute phase of aneurymal subarachnoid hemorrhage (SAH). A 67-yearold woman developed severe headache and visited our hospital on the 5th day from the onset. Her computed tomography (CT) confirmed SAH, and her angiography revealed three intracranial aneurysms: a 4.9-mm left middle cerebral artery aneurysm (MCA An) with bleb formation, a 6.5-mm basilar trunk aneurysm (BA trunk An) without bleb, and a 2.9-mm internal carotid cavernous sinus aneurysm without bleb. As the SAH was present mostly in the left cerebral hemisphere and left Sylvian fissure without the involvement of the basal cistern. MCA An was thought to bleed. Subsequently, she underwent coil embolization and recovered well. However, she suddenly became comatose on the 12th day from the onset. Her CT showed diffuse SAH localized around the prepontine cistern. Second angiography demonstrated the expanded BA trunk An. Coil embolization was then successfully performed. VP shunt insertion was added for hydrocephalus secondary to SAH, and left our hospital with favorable outcome