Tatsuo Amano

Stroke Education Program of Act FAST for Junior High School Students and Their Parents

BACKGROUNDnWe produced a stroke education program using the FAST (facial droop, arm weakness, speech disturbance, time to call an ambulance) mnemonic.nnnAIMSnThe aim of this study is to examine efficacy of our education program for junior high school students and their parents.nnnMETHODSnOne hundred ninety students of 3 junior high schools (aged 12-13xa0years) and their parents were enrolled. Students received a 45-minute lesson of stroke enlightenment using the FAST mnemonic. Enlightenment items, such as a magnet poster, were distributed. Parents were educated indirectly from their child. Surveys of stroke knowledge were examined at baseline, immediately after the lesson, and at 3xa0months after the lesson.nnnRESULTSnFor the students, correct answers at 3xa0months were significantly higher than those at baseline in questions of facial palsy (98% versus 33%), speech disturbance (98% versus 54%), numbness on one side (64% versus 42%), weakness on one side (80% versus 51%), calling an ambulance (88% versus 60%), alcohol drinking (85% versus 65%), smoking (70% versus 43%), dyslipidemia (58% versus 46%), hyperglycemia (59% versus 48%), and obesity (47% versus 23%). At 3xa0months, the parents answered more correctly questions of facial palsy (93% versus 66%), calling an ambulance (95% versus 88%), and alcohol drinking (65% versus 51%) than at baseline. At 3 months, 96% of students and 78% of parents answered the FAST mnemonic correctly.nnnCONCLUSIONSnOur stroke education program improved stroke knowledge, especially the FAST message, for junior high school students and their parents.

Stroke Education Using an Animated Cartoon and a Manga for Junior High School Students

BACKGROUNDnWe investigated whether junior high school students could be educated regarding stroke with an animated cartoon and a Manga that we produced for the purpose of dissemination of this knowledge.nnnMETHODSnWe produced a 10-minute animated cartoon and a Manga that provided information regarding stroke risk factors, stroke signs and symptoms, and awareness to immediately contact emergent medical service (EMS) on identification of stroke signs and symptoms. From December 2011 to March 2012, 493 students in 15 classes of the first grade (age 12-13xa0years) of 3 junior high schools were enrolled in the study. Each subject watched the animated cartoon and read the Manga; this was referred to as training. Lessons about stroke were not given. Questionnaires on stroke knowledge were evaluated at baseline, immediately after the training, and 3xa0months after the training.nnnRESULTSnThe proportion of correct answers given immediately after the training was higher for all questions, except those related to arrhythmia, compared with baseline. Percentage of correct answers given at 3xa0months was higher than that at baseline in questions related to facial palsy (75% versus 33%), speech disturbance (91% versus 60%), hemiplegia (79% versus 52%), numbness of 1 side (58% versus 51%), calling for EMS (90% versus 85%), alcohol intake (96% versus 72%), and smoking (69% versus 54%). At 3xa0months after the training, 56% of students answered the FAST (facial droop, arm weakness, speech disturbance, time to call for EMS) mnemonic correctly.nnnCONCLUSIONSnStroke education using these teaching aids of the animated cartoon and the Manga improved stroke knowledge in junior high school students.

The Effectiveness of a Stroke Educational Activity Performed by a Schoolteacher for Junior High School Students

BACKGROUNDnThe purpose of this study was to determine whether our stroke education system can help junior high school students acquire stroke knowledge when performed by a schoolteacher.nnnMETHODSnA stroke neurologist gave a stroke lesson to 25 students (S group) and a schoolteacher through our stroke education system. After instruction, the schoolteacher performed the same lesson using the same education system to another 75 students (T group). Questionnaires on stroke knowledge were examined at baseline, immediately after the lesson (IL), and at 3xa0months after the lesson (3M). We analyzed the results of stroke knowledge assessment by linear mixed effects models adjusted for gender and class difference using the student number.nnnRESULTSnWe assessed 24 students in the S group and 72 students in the T group. There were no significant differences in the changes of predicted scores of symptoms and risk factors adjusted for gender, class difference, and each student knowledge level until 3M between the 2 groups. Correct answer rates for the meaning of the FAST (facial droop, arm weakness, speech disturbance, time to call 119) at IL were 92% in the S group and 72% in the T group, respectively. At 3M, they were 83% in the S group and 84% in the T group. The correct answer rates of FAST at 3M were not significantly different adjusted for group, gender, class difference, and correct answer rate at IL.nnnCONCLUSIONSnA schoolteacher can conduct the FAST message lesson to junior high school students with a similar outcome as a stroke neurologist using our stroke education system.

Effects of Stroke Education Using an Animated Cartoon and a Manga on Elementary School Children

BACKGROUNDnStroke education for the youth is expected to reduce prehospital delay by informing the bystander of appropriate action to take and providing knowledge to prevent onset of stroke in future. Previously, we developed effective teaching materials consisting of an animated cartoon and a Manga for junior high school students. The aim of this study was to evaluate the feasibility and effectiveness of our educational materials for stroke education taught by schoolteachers to elementary school children.nnnMETHODSnUsing our teaching materials, a 30-minute lesson was given by trained general schoolteachers. Questionnaires on stroke knowledge (symptoms and risk factors) and action to take on identification of suspected stroke symptoms were filled out by school children before, immediately after, and at 3xa0months after completion of the lesson.nnnRESULTSnA total of 219 children (aged 10 or 11xa0years) received the stroke lesson. Stroke knowledge significantly increased immediately after the lesson compared with before (symptoms, Pxa0<xa0.001; risk factors, Pxa0<xa0.001); however, correct answer rates decreased at 3xa0months immediately after completion of the lesson (symptoms, Pxa0=xa0.002; risk factors, Pxa0=xa0.045). The proportion of the number of children calling emergency medical service on identifying stroke symptoms was higher immediately after the lesson than baseline (Pxa0=xa0.007) but returned to the baseline at 3xa0months after the lesson.nnnCONCLUSIONSnStroke lesson by schoolteachers using our teaching materials consisting of an animated cartoon and a Manga that was previously used for junior high school students was feasible for elementary school children. However, revision of the materials is required for better retention of stroke knowledge for children.

Effective Education Materials to Advance Stroke Awareness Without Teacher Participation in Junior High School Students.

BACKGROUNDnYouth stroke education is promising for the spread of stroke awareness. The aim of this study was to examine whether our stroke awareness teaching materials without teachers participation can increase student awareness to act fast on suspected stroke signs.nnnMETHODSnWe used the face, arm, speech, and time (FAST) mnemonic derived from the Cincinnati Prehospital Stroke Scale. Seventy-three students of the second grade and 72 students of the third grade (age range, 13-15 years) in a junior high school were enrolled in the study. The students were divided into 2 groups: students who received a teachers lesson (group I) and those who did not receive a teachers lesson (group II). Students in group II watched an animated cartoon and read a Manga comic in class. All students took the educational aids home, including the Manga comic and magnetic posters printed with the FAST message. Questionnaires on stroke knowledge were examined at baseline and immediately and 3 months after receiving the intervention.nnnRESULTSnAt 3 months after the intervention, a significant improvement in understanding the FAST message was confirmed in both the groups (group I, 85%; group II, 94%). Significant increases in the knowledge of risk factors were not observed in each group.nnnCONCLUSIONSnOur education materials include a Manga comic, an animated cartoon, and a magnetic poster, without an accompanying teachers lesson can increase stroke awareness, including the FAST message, in junior high school students.

The significant impact of framing coils on long-term outcomes in endovascular coiling for intracranial aneurysms: how to select an appropriate framing coil

OBJECTIVE The importance of a framing coil (FC)-the first coil inserted into an aneurysm during endovascular coiling, also called a lead coil or a first coil-is recognized, but its impact on long-term outcomes, including recanalization and retreatment, is not well established. The purposes of this study were to test the hypothesis that the FC is a significant factor for aneurysmal recurrence and to provide some insights on appropriate FC selection. METHODS The authors retrospectively reviewed endovascular coiling for 280 unruptured intracranial aneurysms and gathered data on age, sex, aneurysm location, aneurysm morphology, maximal size, neck width, adjunctive techniques, recanalization, retreatment, follow-up periods, total volume packing density (VPD), volume packing density of the FC, and framing coil percentage (FCP; the percentage of FC volume in total coil volume) to clarify the associated factors for aneurysmal recurrence. RESULTS Of 236 aneurysms included in this study, 33 (14.0%) had recanalization, and 18 (7.6%) needed retreatment during a mean follow-up period of 37.7 ± 16.1 months. In multivariate analysis, aneurysm size (odds ratio [OR] = 1.29, p < 0.001), FCP < 32% (OR 3.54, p = 0.009), and VPD < 25% (OR 2.96, p = 0.015) were significantly associated with recanalization, while aneurysm size (OR 1.25, p < 0.001) and FCP < 32% (OR 6.91, p = 0.017) were significant predictors of retreatment. VPD as a continuous value or VPD with any cutoff value could not predict retreatment with statistical significance in multivariate analysis. CONCLUSIONS FCP, which is equal to the FC volume as a percentage of the total coil volume and is unaffected by the morphology of the aneurysm or the measurement error in aneurysm length, width, or height, is a novel predictor of recanalization and retreatment and is more significantly predictive of retreatment than VPD. To select FCs large enough to meet the condition of FCP ≥ 32% is a potential relevant factor for better long-term outcomes. These findings support our hypothesis that the FC is a significant factor for aneurysmal recurrence.

Successful Intravenous rt-PA Thrombolysis for a Childhood Cardioembolic Stroke with Emery-Dreifuss Muscular Dystrophy

Case Report A right-handed 12-year-old boy had suffered from pathologically proven EDMD for 7 years and required a wheelchair in daily life due to limb weakness. He had been given warfarin for one year because of chronic atrial fibrillation and suddenly developed leftsided motor weakness and was admitted to our hospital. On admission, he was alert and had a conjugate gaze deviation to the right, dysarthria, and complete left hemiparesis including the face. His National Institute of Health Stroke Scale (NIHSS) score was 15. International Normalized Ratio (INR) was 1.49. Head CT showed indistinctness of the right lenticular nuclei and a right hyIntroduction Patients and carriers of Emery-Dreifuss muscular dystrophy (EDMD), a known inherited muscular disorder [1] , are at high risk of sudden death due to arrhythmias, heart failure, and embolism Published online: December 13, 2011

Common Carotid Artery Dissection Caused by a Frontal Thrust in Kendo (Japanese Swordsmanship)

A 66-year-old right-handed man suddenly developed left hemiplegia after an opponent thrust at his neck with a bamboo sword during a practice game of Kendo (Japanese swordsmanship; Figure 1). Fifty minutes later, he visited our emergency service. His blood pressure was 77/55 mm Hg in the left arm but could not be measured in the right arm; his right radial artery was initially pulseless but became palpable 1 hour later. He was somnolent and had left unilateral spatial neglect, left complete hemiplegia, and left-sided sensory disturbance. Enhanced computed tomography (CT) showed an occlusion 15 mm distal to the origin of the right common carotid artery (CCA) without any abnormal findings at the aorta and innominate and right subclavian arteries. On emergent carotid ultrasonography, an intraluminal filling defect occupied the right CCA and swung back and forth with pulsation. He was …

Reconstructive endovascular treatment of ruptured vertebral artery dissection involving the posterior inferior cerebellar artery

Two cases with ruptured vertebral artery (VA) dissection involving the origin of the posterior inferior cerebellar artery (PICA) are presented. Endovascular proximal occlusion of the dissected segment proximal to the PICA origin was performed, leaving the PICA patent in the acute stage. Stent placement from the PICA to the VA through the contralateral VA and coil embolization were added to the residual dissection in the chronic stage. Rebleedings were not observed. This is the first report of a staged, combined strategy for the treatment of a ruptured PICA involving VA dissection, which enabled preservation of the PICA without bypass surgery.

Regionwide Retrospective Survey of Acute Mechanical Thrombectomy in Tama, Suburban Tokyo: A Preliminary Report

BACKGROUND AND PURPOSEnTo improve results of acute thrombectomy, the time from stroke onset to efficient recanalization must be minimized. Studies have confirmed the importance of rapid treatment, workflow, and efficient team-based care for acute thrombectomy in large vessel occlusion. This study examined the challenges facing mechanical thrombectomy in the Tama area (population, 4.3 million), a densely populated urban area of Tokyo, Japan, and analyzed retrospective data from the Tama-REgistry of Acute endovascular Thrombectomy.nnnMETHODSnThis study was a retrospective observational study using data from Tama-REgistry of Acute endovascular Thrombectomy, a multicenter registry of mechanical thrombectomy for acute ischemic stroke in the Tama area of Tokyo. The survey covered 396 patients with large vessel occlusion who underwent acute thrombectomy between January 2015 and March 2017. Participating facilities are 12 of the 13 recanalization therapy-capable stroke centers.nnnRESULTSnWe analyzed 326 cases for which modified Rankin Scale score at 90days was available, of which 264 cases were directly admitted, and 62 cases were transferred from other stroke centers. Median time from stroke onset to hospital arrival was 111 minutes, and from arrival to efficient recanalization was 135 minutes. Efficient recanalization was achieved in 257 cases (78.8%), symptomatic hemorrhage developed in 19 cases (5.8%), and modified Rankin Scale 0-2 at 90days was seen in 129 cases (39.6%). The vast majority of patients (nu202f=u202f299, 94.3%) were transferred within 10km to the enrolling hospital.nnnCONCLUSIONSnThese results provide useful information about the emergent transfer system for patients with large vessel occlusion in a densely populated urban area.