Shin Ueda

Peripheral hypoglossal nerve palsy caused by lateral position of the external carotid artery and an abnormally high position of bifurcation of the external and internal carotid arteries--a case report.

An unusual case of peripheral hypoglossal nerve palsy, caused by lateral position of the external carotid artery and an abnormally high carotid bifurcation is reported. Improvement followed ligation and cutting of the external carotid artery at its origin. Stroke Vol 15, No 4, 1984

Cortical blindness caused by acute general cerebral swelling

A 7-year-old girl who suffered from acute general cerebral swelling as a result of a traffic accident showed cortical blindness. Computed tomography (CT) scan on admission revealed marked slitlike ventricles and narrowing of the perimesencephalic cisterns, which indicated general cerebral swelling. While hospitalized, the patient developed transtentorial herniation twice on day 3, and CT scans at herniation episodes showed disappearance of the perimesencephalic cisterns. After recovery of consciousness, the patient showed cortical blindness, and during gradual recovery she showed pure alexia without agraphia. The visual evoked potentials at 8 weeks, 16 weeks, and 3 years 4 months after trauma showed normalization of the pattern, but revealed left occipital inactivity.

Indications for and perioperative management of emergency carotid endarterectomy—report on six cases

Abstract Emergency carotid endarterectomy (CEA) can be indicated to restore neurological functions or help prevent further stroke in impending stroke patients. We report on our experience of emergency CEA and perioperative patient management in six patients who underwent emergency CEA. We operated on 32 patients with carotid artery stenosis in the last 4 years, 6 of whom were classified as “emergency” patients. Two patients had a crescendo TIA, two had stroke in evolution, and the remaining two had acute severe stroke. In all cases, CEA was performed within 48 h of the last ischemic attack. Postoperatively two patients, each with crescendo TIA and stroke in evolution, and one acute severe stroke patient made a full recovery. One patient with acute stroke died from hypovolemic shock caused by gastrointestinal bleeding. The final postoperative neurological status, as graded by the modified Rankin scale, was Grade 0, of which we had four patients and Grade 2, which described one of our patients. No patient suffered further stroke after CEA in long-term follow-up. Transient postoperative complications occurred in two patients, and angina pectoris in the other. Emergency CEA is beneficial for patients with Crescendo TIA and stroke in evolution in perioperative and long-term follow-up. Postoperatively, however, blood pressure, coronary artery disease, and hemorrhagic complications such as gastrointestinal bleeding must be carefully managed.

Synthetic patch angioplasty proves useful in carotid endarterectomy

Abstract Patch angioplasty is performed to prevent recurrent stenosis after carotid endarterectomy (CEA). Controversy surrounds the selection of the patch material, with supporters for both autogenous tissue and synthetic patches. We reported on the efficacy of synthetic patch angioplasty. Thirty-four carotid endarterectomies with synthetic patch angioplasty, Hemashield Finesse® and Gore-Tex®, were performed on 32 patients. Twenty-eight of the thirty-four cases were classified as elective CEA and six were emergency CEA. The clinical outcome, perioperative complications, and incidence of recurrent stenosis (> or =50%), as detected by MRA and ultrasonography, were examined. Postoperatively, one severe acute stroke patient who underwent emergency CEA died from gastrointestinal bleeding. The perioperative permanent neurologic morbidity was 0% in elective CEA, and five of the six emergency CEA patients recovered. The total permanent morbidity and mortality rate in all CEA with synthetic patch angioplasty was 2.9%. No recurrent stenosis or further stroke occurred in the postoperative long-term follow-up period. Synthetic patch angioplasty in CEA is considered useful to prevent recurrent stenosis, and to avoid vein harvest site complications and patch rupture as previously described with vein patch angioplasty. Finally, there have been no thrombotic complications using synthetic patch angioplasty in emergency CEA.

Lupus anticoagulant and abnormal cerebral hemodynamics in a case of systemic lupus erythematosus with cerebral bleeding.

症例は41歳のSLEの女性で, 1985年1月2日に脳卒中発作あり, 頭部CTで右脳内血腫と脳室穿破が認められ, 脳血管撮影でmoyamoya病類似の右側中大脳動脈の狭窄, 異常血管網と豊富な側副血行路の形成が認められた.また, kaolin clotting time, tissue thromboplastininhibition testなどからlupus anticoagulant (LA) が患者血漿中に証明された.本患者におけるMoyamoya現象ともいいうる異常脳血行動態の発生にLAの関与したことが文献などから推定された.

Effects of Blood Flow on Development of Atheromatous Plaques at an Experimental Inter-Carotid Anastomosis (Model Carotid Bifurcation)

Atherosclerosis often develops at the carotid bifurcation. In order to analyse blood flow in this region in vivo, we constructed a bifurcation by microsurgical anastomosis of the carotid arteries in the rabbit. In animals with hypercholesterolemia, fully developed atheromatous plaques developed in three months. The stages involved in their development were first, changes in the endothelial cells aligned in the direction of blood flow, second, adhesion of leucocytes, mainly macrophages, at the lateral wall of the bifurcation, and then formation of thick atheromatous plaques. The proximal side of the plaques was smooth and rich in collagen fibers, while the distal side was rough and contained many foam cells.