Ayano Suzuki

The relationship between right-to-left shunt and brain white matter lesions in Japanese patients with migraine: a single center study

BackgroundThere may be a link between right-to-left shunt (RLs) and brain white matter lesions (WMLs) in patients with migraine. In this study, we assessed the relationship between WMLs and RLs in Japanese migraine patients.MethodsA total of 107 consecutive patients with migraine with (MA) and without aura (MWOA) were included in this study. Contrast transcranial Doppler ultrasound was used to detect RLs. WMLs were graded using brain magnetic resonance imaging based on well-established criteria.FindingsThe prevalence of RLs was significantly increased in the WMLs positive group (n = 24) compared with the WMLs negative group (n = 83) (75.0% vs. 47.0%, p = 0.015). In prevalence of WMLs between MA and MWOA patients, there were no statistical differences (p = 0.410). Logistic regression analysis adjusted by age and disease duration of migraine identified an RLs-positive status as the sole determinant for the presence of WMLs (OR = 6.15; 95% CI 1.82–20.8; p = 0.003)ConclusionOur study suggests a possible link between RLs and WMLs in Japanese patients with migraine.

Utility of chest X-ray in predicting left atrium dimension and brain natriuretic peptide

Objective: Detection of paroxysmal atrial fibrillation (PAF) in patients with acute stroke is often difficult. Dilatation of left atrium dimension (LAD) and increased levels of brain natriuretic peptide (BNP) are reported to indicate cerebral embolism due to PAF. We assessed the usefulness of chest X-ray in predicting LAD and BNP among patients with acute cerebral infarction. Methods: We included 141 consecutive patients with cerebral infarction [107 cerebral thromboses (cerebral thrombosis group)] and 34 cardiogenic cerebral embolisms due to PAF (PAF group). Transthoracic echocardiography (TTE) was used to evaluate LAD (TTE-LA). On chest X-ray, heart diameter at the third aortic arch (XPLA) and XP-LA divided by maximum intrathoracic diameter (XP-LA ratio) were measured. Results: TTE-LA, XP-LA, XP-LA ratio and BNP levels were significantly higher in PAF group compared with those in cerebral thrombosis group. XP-LA had a significant positive correlation with TTE-LA (r = 0.332, p < 0.0001) and BNP (r = 0.292, p < 0.001). XP-LA ratio also showed a significant correlation with TTE-LA (r = 0.210, p = 0.0126) and BNP (r = 0.515, p < 0.0001). Conclusion: We suggest chest X-ray is a simple and useful tool for predicting LAD and BNP.

Influence of pulsed wave doppler angle on diagnosis of internal carotid artery stenosis

WCN17-1276 SHIFT 3 STROKE Significance of hyperintense vessels in negative DWI area as a prognostic factor after thrombolysis M. Ichijo, S. Ishibashi, K. Miki, S. Itaya, T. Amino, T. Kamata, T. Yokota. Musashino Red Cross Hospital, Department of Neurology, Tokyo, Japan; Tokyo Medical and Dental University, Department of Neurology and Neurological Science, Tokyo, Japan; Tokyo Medical and Dental University, Department of Endovascular Surgery, Tokyo, Japan

Risk factors for deep venous thrombosis in patients with acute stroke

脳卒中の急性期では下肢麻痺や長期臥床,うっ血性心 不全の併発による静脈還流のうっ滞により,下肢深部静 脈血栓(deep venous thrombosis: DVT)を併発する例 が存在する .DVTは肺塞栓症の原因となり,予後不 良の転帰を示すことから,急性期からDVTの予防,早 期発見が重要となる. 脳卒中に対するDVT予防に明確なエビデンスはない ものの,弾性ストッキングの着用が勧められていた . しかし脳卒治療ガイドライン 2015では,脳出血に対し て弾性ストッキングの使用は推奨されておらず,脳梗塞 に対しても明らかな予防効果は示されていない .し たがって,現在では間欠的空気圧迫法による予防が主体 となるが,医療資源の問題からすべての脳卒中患者に対 して施行するのは困難と考えられる. そこでわれわれは脳卒中の急性期においてDVTを併 発する患者の危険因子を明らかにするため,急性期脳卒 28 Neurosonology 29(1):2016

Bilateral hippocampal hyperintensities on diffusion-weighted images in transient global amnesia

A 60-year-old woman with hypertension was referred to DokkyoMedical University Hospital, Tochigi, Japan, for a sudden onset of amnesia and repeating the same questions every few minutes after a quarrel with her mother. Her blood pressure was 138/108 mmHg. Neurological findings were unremarkable, except for anterograde amnesia and impaired orientation. Her symptoms disappeared 6 h after the symptom onset. Diffusion-weighted brain magnetic resonance images obtained 24 h after the symptom onset showed dot-like hyperintense lesions in the bilateral hippocampus (Fig. 1a,b), with the corresponding low signal intensity on the apparent diffusion coefficient maps (Fig. 1c,d). Based on these findings, a diagnosis of transient global amnesia (TGA) was made. Transient global amnesia is characterized by abrupt onset of anterograde amnesia and repetitive questioning, lasting less than 24 h. Diffusion-weighted brain magnetic resonance imaging abnormalities in the hippocampus in the acute phase are rarely detected, but can be observed in up to 80% of patients after 24 48 h of onset. Bilateral hippocampal abnormalities on diffusion-weighted images are also reported in approximately one-sixth to one-third of TGA patients. Brain diffusion-weighted brain magnetic resonance images of the present patient clearly detected characteristic imaging findings of TGA involving the bilateral hippocampus.