Hiroaki Nokura

Surgical indications for infantile subdural effusion

Thirty-four cases of infantile subdural effusion (ISE) were reviewed in relation to surgical treatment and its prognosis during an average of 4 years of extended follow-up. The surgical indications were determined mainly by the size of the ISE on computed tomography (CT) scan and by metrizamide CT cisternography (MCTC). Consequently, 18 cases were categorized as type A according to MCTC, including 11 cases (61.1%) of ISE CT grade 1. All type A cases were closely observed. This nontreatment regimen yielded excellent results in 15 cases (83.3%). For 10 cases categorized as type B according to MCTC, including 5 cases (50%) of ISE CT grade 3, surgical treatment was indicated and excellent results were obtained in 8 cases (80%). For 6 cases categorized as type C according to MCTC and as ISE CT grade 3, surgery yielded excellent results in 4 cases (66.7%). Antiepleptic drugs have been given to three (27.3%) of the 11 patients who had convulsive attacks. In conclusion, the surgical indications for ISE were based mainly on MCTC in addition to the clinical course, and it is emphasized that, in the early stages, surgery on ISE cases categorized as MCTC types B and C is necessary.

Prediction of Stroke Rehabilitation Outcome with Xenon-enhanced Computed Tomography Cerebral Blood Flow Study

BACKGROUND Cerebral blood flow (CBF) of stroke patients in the chronic stage is supposed to reflect brain functions. We examined the relation between rehabilitation outcome and CBF values. METHODS The study group comprised 101 consecutive patients (mean age, 69±12 years) including 61 patients with cerebral infarction, 32 patients with cerebral hemorrhage, and 8 patients with subarachnoid hemorrhage. Xenon-enhanced computed tomography was performed on 39 days on average after stroke onset. Regions of interest were in the cerebral cortices, putamen and thalamus, and CBF values were statistically compared with the functional independence measure (FIM). Furthermore, we performed a multivariate analysis for predictive factors. RESULTS 1. The right mean CBF (mCBF) tended to be more closely correlated with the FIM total scores at discharge (r=0.495, P<.001) than the left mCBF (r=0.351, P<.001), in case of significance level 0.1 and statistical power 0.65. 2. The FIM total and motor scores at discharge showed the highest correlations to regional CBF (rCBF) in the right frontal cortex, and the FIM cognitive scores at discharge showed the highest correlation to rCBF in the left frontal cortex. 3. Right cerebral infarct subgroup (n=30) showed significant correlations between FIM total scores at discharge and mCBF values of the right (r=0.582, P<.001) and the left (r=0.563, P<.005) brain, respectively. 4. Rehabilitation outcome evaluated with the FIM total scores could be led by the formulae with the factors of age, gender, NIHSS, right/left hemispheric lesions and the right mCBF values (r=0.837, P<.001). CONCLUSION The CBF of the right brain proved to be more influencing to rehabilitation results.

ASSOCIATION BETWEEN ADHERENCE OF ALZHEIMER'S DISEASE MEDICATION AND 3D-SSP DECREASE IMAGES

Parenchymal hyperintensity Native 0.630 0.60 0.66 0.611 0.56 0.56 Subtraction 0.592 0.56 0.62 0.580 0.52 0.65 Sulcal hyperintensity Native 0.800 0.78 0.82 0.780 0.75 0.81 Subtraction 0.745 0.72 0.77 0.721 0.66 0.77 Swelling Native 0.683 0.66 0.71 0.634 0.58 0.69 Subtraction 0.606 0.58 0.64 0.576 0.51 0.65 Highest score of subtypes Native 0.912 0.89 0.93 0.810 0.73 0.87 Subtraction 0.823 0.81 0.84 0.824 0.79 0.86 Sulcal hyperintensity and gyral swelling Native 0.836 0.82 0.85 0.811 0.78 0.84 Subtraction 0.815 0.80 0.83 0.805 0.76 0.84

DIAGNOSTIC STRATEGIES OF DEMENTIA AT AN OUTPATIENT NEUROSURGERY DEPARTMENT IN A CITY GENERAL HOSPITAL OF JAPAN

at age of 20-month-old were used. We simultaneously injected Shiga-Y5 and Shiga-X22 at a dose of 200 mg/kg into the tail vein of three mice. At 3-h after the injection, F chemical shift imaging was obtained using a 7-tesla MR scanner. Another three mice were killed by overdose of sodium pentobarbital and we removed the brain. Then, the concentrations of Ab oligomers were measured by enzyme-linked immunosorbent assay (ELISA). Results: The F MR signal of Shiga-Y5 appeared mainly in the olfactory bulb, the subcortical area, and the cerebellum. In contrast, the F MR signal of Shiga-X22 displayed predominantly in the olfactory bulb, the cortex, and the cerebellum. Then, we produced a subtracted image by subtracting F MR images of Shiga-X22 from that of Shiga-Y5. F MR signal in the subtracted image was located in the subcortical area. ELISA measurement showed that Ab oligomers uniformly distributed in the brain except for the brainstem, and there is no specific region showing the accumulation of Ab oligomers. In contrast, the level of insoluble Ab was significantly less in the subcortical area where the concentration of insoluble Ab was relatively low. The imbalance between relative high level of Ab oligomers and the less level of insoluble Ab in the subcortical area may contribute to intense F MR signal in the subtracted image. Conclusions:We simultaneously injected Shiga-Y5 and Shiga-X22 into the tail vein of APPswe/ PS1dE9 double transgenic mice, and then obtained an image in the brain by subtracting FMR images of Shiga-X22 from those of Shiga-Y5 to reflect the distribution of Ab oligomers.