Brain and nerve = Shinkei kenkyū no shinpo
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Cerebral salt wasting syndrome (CSWS) in patients with aneurysmal subarachnoid hemorrhage (SAH) is considered to correlate with delayed ischemic neurological deficits (DIND) induced by cerebral vasospasm; however, its exact mechanism is still not well-known. The purpose of the present study is to evaluate the relationship between hyponatremia caused by CSWS and the increase of the urinary sodium excretion in early phase following SAH. Fifty-four patients with SAH were divided into 2 groups, normonatremia group and hyponatremia group which suffered hyponatremia after SAH. ⋯ Further, excretion of sodium in the urine tended to increase 3 days after SAH and significantly increased 7 days after SAH. In conclusion, the increased urinary sodium excretion in the early phase of SAH would serve as a predictive factor for CSWS after SAH. We consider that it is important to start sodium and fluid supplementation and inhibit natriuresis by fludrocortisone acetate administration before hyponatremia occurs in order to prevention delayed ischemic neurological deficits in SAH patients.
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Review
[Magnetic resonance imaging in patients of amyotrophic lateral sclerosis with and without dementia].
Classic magnetic resonance imaging (MRI) findings in patients with amyotrophic lateral sclerosis (ALS) are subtle, but some findings have been reported such as signal changes in the primary motor cortex and the corticospinal tract (CST). Only a few reports have discussed MRI findings of ALS with dementia (ALS-D), in which frontotemporal atrophy and hyperintensity in subcortical white matter of bilateral temporal tips have been reported. Recent development of diffusion tensor imaging (DTI) techniques allows us to extract specific white matter tracts and to analyze them quantitatively, i.e. we can visualize the CST and can also measure its integrity using DTI parameters such as fractional anisotropy (FA) or apparent diffusion coefficient (ADC). ⋯ Voxel based morphometry or statistical analysis of imaging are the newly developed methods which enable to make objective and reliable imaging analysis based on automated procedure using standardized database. We also presented several researches using these techniques. In this article, we reviewed classic imaging findings and recent development of MRI including DTI and statistical imaging analysis in patients with ALS/ALS-D.
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Beta blockers (beta-adrenoceptor blockers) are known to be used for the prophylactic treatment of migraine. The improvement of migraine in the patients who recieved propranolol for angina pectoris revealed the effectiveness of propranolol in migraine prophylaxis. Many clinical trials have confirmed that propranolol is effective in the prophylactic treatment of migraine. ⋯ In contrast, several beta blockers with intrinsic sympathetic activity (ISA), such as alprenolol, oxprenolol, pindolol and acebutolol, have not been demonstrated to be effective in migraine prophylaxis. In this review, we have descrived the pharmacologic background and pharmacokinetics of the beta blockers that demonstrated a prophylactic effect for migraine will be described. We have also reviewed the results of clinical trials of beta-blocking drugs for migraine.
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Review Case Reports
[Case of ruptured middle cerebral artery bifurcation aneurysm presenting as putaminal hemorrhage without subarachnoid hemorrhage].
Ruptured aneurysms typically present as subarachnoid hemorrhage (SAH); however, they can also cause intracerebral hemorrhage (ICH) that can be mistaken for hypertensive hemorrhage. We report a rare case of a ruptured middle cerebral artery bifurcation aneurysm presenting as putaminal hemorrhage without subarachnoid hemorrhage (SAH). A 47-year-old man, with a past history of hypertension, presented with a decreased level of consciousness. ⋯ We performed aneurysmal clipping and hematoma evacuation. The postoperative course was uneventful. This case suggested that ruptured aneurysms situated on the middle cerebral artery can present as putaminal hemorrhage without SAH.
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Case Reports
[Rupture of a small aneurysm originating from an infundibular dilatation--case report].
Infundibular dilatations (IDs) are funnel-shaped enlargements of the origin of cerebral arteries. Usually IDs occur at the junction between posterior communicating artery and the internal carotid artery. Progression from an ID of the posterior communicating artery to an aneurysm has previously been described, but it is unclear whether an ID is a pre-aneurysmal state or a normal anatomical variant. ⋯ An ID of the posterior communicating artery can develop into an aneurysm and subsequently rupture. The development of an aneurysm from the ID may be influenced by hemodynamic stress and hypertension. Thus patients with the pre-aneurysmal ID should be carefully followed up for a long time.