Summary:We report a case of simultaneously treated extracranial carotid artery stenosis and concomitant ipsilateral intracranial unruptured aneurysm by endovascular approach. Bilateral cervical carotid artery stenosis and a left intracranial unruptured aneurysm were incidently revealed in a 68-year-old male. To minimize the risk of cerebral ischemia and rupture of aneurysm, we simultaneously treated both lesions in the same session.The patient was given general anesthesia, and left carotid artery stenting was performed with distal embolic protection. Then, a guiding catheter was passed through the stent-strut and endovascular embolization of the lt. IC-PC aneurysm was performed. The postoperative course was uneventful, and the patient underwent contralateral CAS 6 days after the first intervention. The patient discharged 6 days after the second intervention.Simultaneous treatment for such ipsilateral lesions could be an optimum treatment strategy.
A 43-year-old man was admitted to our hospital for rehabilitation of higher brain dysfunction caused by traumatic brain injury. He had undergone an emergency operation for acute epidural hematoma after a fall. He had impaired cognitive function with regard to memory, attention, and executive function. However, he also exhibited facial features such as frontal baldness and hatched face. Neurological examination showed mild distal muscle weakness in the extremities, gait disturbance, and grip and percussion myotonia. Needle electromyography showed myotonic discharges. Brain magnetic resonance imaging did not show any intra-axial abnormalities. Myotonic dystrophy DM was therefore diagnosed. Rehabilitation resulted in improved gait stability, but the patient s cognitive function did not improve. Severity of illness in DM patients varies from a floppy infant to a lack of awareness of the disease throughout one s lifetime. Therefore, DM patients might not be properly diagnosed because of the mildness of their clinical symptoms. It is important for non-neurologists to be aware of the possible occurrence of this disease. Jpn J Rehabil Med .
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