Takahito Nishihira

Recurrent juvenile ischemic stroke caused by bow hunter’s stroke revealed by carotid duplex ultrasonography

Bow hunter’s stroke (BHS) is a rare cause of vertebrobasilar insufficiency due to rotational vertebral artery (VA) occlusion associated with head turning. We report a juvenile patient presenting with recurrent ischemic stroke caused by BHS, which was revealed by carotid duplex ultrasonography. Carotid duplex ultrasonography performed in the neutral position showed normal findings. However, disappearance of end-diastolic blood flow of contralateral VAs was observed with head rotation. Digital subtraction angiography confirmed occlusion at C1/2 levels in the VA contralateral to the head rotation, bilaterally. Importantly, our patient did not recognize the association of head rotation and previous episodes of stroke. We suggest that BHS should be considered in patients with cryptogenic stroke occurring in the vertebrobasilar artery territory.

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

Post-irradiation Skin Changes Associated with Lumbosacral Radiculopathy

We herein describe the cases of two patients with post-irradiation lumbosacral radiculopathy. The patients underwent postoperative radiation therapy to the abdomen due to testicular neoplasms 20 and 25 years prior to the onset of weakness, respectively. On physical examinations, asymmetric lower limb weakness and areflexia without apparent sensory loss were observed in both patients. Interestingly, artificial and squared atrophy of the skin and subcutaneous tissue, thought to correspond to the radiation fields, were observed in the lower back, and electromyography revealed selective motor axon loss localized to the lower extremities. The detection of skin changes in the area being irradiated is a valuable clue for diagnosing post-irradiation lumbosacral radiculopathy.

Hemiballism-Hemichorea Following Subthalamic Nucleus Hemorrhage

A 67-year-old man with untreated hypertension was admitted due to sudden onset involuntary movements involving the left arm and leg. Examination disclosed irregular coarse and twisting movement involving both distal and proximal muscles in the left arm and leg (Figure 1A). Magnetic resonance imaging and computed tomography of the brain revealed an acute hemorrhage in the right subthalamic nucleus (STN) (Figure 1BD). His hemiballismus-hemichorea improved within a few days following administration of risperidone 1 mg/day. However, after admission, the patient became restless, agitated and delirious and these symptoms were resolved by administration of haloperidol 3mg/day and tiapride 50mg/day.