Kazuhiro Tomiyasu

Stroke while driving: Frequency and association with automobile accidents:

Background Cardiovascular events while driving have occasionally been reported. In contrast, there have been few studies on stroke while driving. Aim The objectives of this study were to (1) report the frequency of stroke while driving and (2) evaluate its association with automobile accidents. Methods Clinical data prospectively acquired between January 2011 and December 2016 on 2145 stroke patients (1301 with ischemic stroke, 585 with intracerebral hemorrhage, and 259 with subarachnoid hemorrhage) were reviewed to identify patients who sustained a stroke while driving. The ratio of driving to performing other activities was evaluated for each stroke type. Furthermore, the drivers’ response to stroke was reviewed to understand how automobile accidents occurred. Results Among the 2145 patients, 85 (63 ischemic stroke, 20 intracerebral hemorrhage, and 2 subarachnoid hemorrhage) sustained a stroke while driving. The ratio of driving to performing other activities was significantly higher in ischemic stroke (4.8%) than in intracerebral hemorrhage (3.4%) or subarachnoid hemorrhage (0.8%). A majority of drivers either continued driving or pulled over to the roadside after suffering a stroke. However, 14 (16%) patients were involved in automobile accidents. In most patients, an altered mental status due to severe stroke was the presumed cause of the accident. Conclusion Stroke occurred while driving in 4.0% of all strokes and accidents occurred in 16% of these instances.

Clinical characteristics of stroke occurring in the toilet: Are older adults more vulnerable?: Stroke occurring in the toilet

While autonomic imbalance during defecation/micturition can cause hemodynamic instability, stroke occurring in the toilet has rarely been investigated. The objective of the present study was to clarify the frequency and clinical characteristics of toilet‐related stroke.

Lymphomatosis cerebri showing transient spontaneous regression

We describe the case of a 35‐year‐old man who presented with a seizure. Brain magnetic resonance imaging showed multiple white matter lesions in the cerebral hemispheres. His seizure was controllable with antiepileptics, and he remained asymptomatic for the next 4 months with follow‐up magnetic resonance imaging showing transient spontaneous regression. However, he developed progressive decline in cognitive functions approximately 1 year after symptom onset. Magnetic resonance imaging showed recurrence of the white matter lesions and progression of brain atrophy. A brain biopsy established the pathological diagnosis of diffuse large B‐cell lymphoma, and he was clinically diagnosed with lymphomatosis cerebri. Lymphomatosis cerebri is a rare variant of primary central nervous system lymphoma characterized by diffuse infiltration of lymphomatous cells into the brain without forming a cohesive tumor mass. Although the clinical and radiographic course is rapidly progressive in the great majority of patients with lymphomatosis cerebri, transient spontaneous regression can occur, posing diagnostic challenges for physicians.

Clinical Characteristics of Stroke Occurring while Bathing

BACKGROUND Stroke can occur during any human activity. Although cardiac arrests or drowning accidents while bathing have been studied extensively, there are few studies focusing on stroke occurring while bathing. The objectives of this study were to evaluate the clinical characteristics of stroke occurring while bathing and the association between stroke and drowning accidents. METHODS Clinical data prospectively acquired between January 2011 and December 2015 on 1939 patients with stroke (1224 cerebral infarctions [CIs], 505 intracerebral hemorrhages [ICHs], and 210 subarachnoid hemorrhages [SAHs]) were reviewed to identify patients who sustained a stroke while bathing. The ratio of bathing-related strokes to strokes occurring during other activities was evaluated. Moreover, the demographics of these 2 groups were compared in each stroke type. RESULTS Among the 1939 patients, 78 (CI, 32; ICH, 28; and SAH, 18) sustained a stroke while bathing. The ratio of bathing to other activities in the SAH group was the highest (8.6%), followed by the ICH group (5.5%), whereas that in the CI group was the lowest (2.6%). Regardless of stroke type, only a minority of patients were found to have collapsed inside the bathtub. CONCLUSIONS The higher ratio of bathing in hemorrhagic strokes may indicate that there is a small risk of hemorrhagic stroke while bathing in vulnerable subjects. This retrospective study did not establish a causal relationship between bathing and stroke nor identify risk factors, which means that future prospective studies are warranted. The finding that the great majority of bathing-related stroke patients were found to have collapsed outside the bathtub suggests that the involvement of stroke in drowning accidents in the bathtub may be small.