Rinshō shinkeigaku = Clinical neurology
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The Antihypertensive Treatment for Acute Cerebral Hemorrhage (ATACH)-II Trial (ClinicalTrials.gov no. NCT01176565; (UMIN 000006526) is an international, multicenter, randomized, concurrently-controlled, parallel arm, Phase III trial to determine the therapeutic benefit of early intensive systolic blood pressure (SBP) lowering compared with standard SBP lowering for acute hypertension in patients with spontaneous intracerebral hemorrhage (ICH). The Trial is funded by the National Institutes of Health in the United States and led by Dr. ⋯ Subjects undergo a follow-up assessment for functional and quality of life assessment at 90 days post-randomization. The primary research hypothesis of the trial is that intensive SBP reduction (to ≤140mmHg) using intravenous nicardipine infusion for 24 hours post-randomization reduces the proportion of death and disability at 90 days by ≥10% (absolute) compared to the standard SBP reduction (to 140-180mmHg range) among subjects with ICH whose treatment is initiated within 4.5 hours of symptom onset. The ATACH-II Trial could be the seminal research project for stroke researchers in Japan to demonstrate themselves as effective contributing members of investigator-initiated international clinical trials.
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Comparative Study
[Associated tumors in patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis].
In 2007, Dalmau and colleagues described anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis associated with ovarian teratoma. As the numbers of patients with anti-NMDAR encephalitis increased, the frequency of paraneoplastic findings declined. The frequency of anti-NMDAR encephalitis with the tumor declined to 60% of a total of 100 patients in 2008, and 42% of a total of 400 patients in 2011. ⋯ These patients included breast cancer, neuroendocrine tumors, pancreatic carcinoma, sex cord stromal tumors, testicular germ-cell tumors and small-cell lung carcinoma. We encountered a 65-year-old female affected by anti-NMDAR encephalitis with carcinosarcoma with neuroendocrine differentiation of the uterus. The prognosis of anti-NMDAR encephalitis with malignant tumor could be dependent on the prognosis of the associated tumor.
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We report the case of a 34-year-old woman with cerebral and pulmonary cryptococcosis. After surgery for uterine cervical cancer, chest CT scan indicated a solitary tumor. Cryptococcosis was detected by transbronchial lung biopsy, and brain MRI showed multiple tumors. ⋯ An intracranial C. gattii infection is associated with neurological complications and delayed therapeutic response. If cerebral cryptococcosis responds slowly and relatively poorly to antifungal therapy, C. gattii should be considered. Aggressive therapy, including intraventricular therapy and corticosteroids therapy for cryptococcoma, is required.
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We present a 39-year-old woman with transient global amnesia (TGA) who showed sudden onset amnesia immediately following sexual intercourse after taking a bath. Her amnesia resolved within 6 hours. Three-Tesla (3T) diffusion weighted magnetic resonance imaging (DWI) taken 80 hours after the onset revealed hyperintense spots in the CA1 subfields of the bilateral hippocampi. ⋯ Ultrasound sonographic studies revealed a prolonged retrograde flow component of the right internal jugular vein during a Valsalva maneuver. The vast majority of TGA attacks occur between the ages of 50 and 80, and very rarely under the age of 40 years, which is mostly not exposed to vascular risks. We therefore speculate that in conjunction with a decreased vascular beds from the brain, a Valsalva-like maneuver might have precipitated cerebral venous ischemia in the bilateral hippocampi, which are the most vulnerable to ischemic insults.
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A 55-year-old woman with a 3-year and 4-month history of liver metastasis from breast cancer underwent chemotherapy with capecitabine and cyclophosphamide for following 10-months. She did not have hypertension and was not pregnant. She showed dysarthria and mild somnolence, and her conscious level developed to semicoma after 6 days. ⋯ Combination of these drugs was considered for the possible cause to induce leukoencephalopathy like PRES. Usually leukoencephalopathy occurs in relatively early time after start of chemotherapy with capecitabine or cyclophosphamide, but we consider that late-onset leukoencephalopathy can be induced by long-term chemotherapy with these drugs. It is necessary to observe leukoencephalopathy by brain MRI regularly when these drugs are used.