A 54-year-old male presented with bilateral simultaneous thalamic hemorrhages manifesting as semicoma, tetraplegia, and skew deviation. Magnetic resonance imaging and angiography demonstrated no lesions responsible for the bleeding. Coagulant factors were within normal ranges. The cause of these hemorrhages was considered to be hypertension. Conservative treatment was performed. He was discharged with serious neurological deficits.
An 83-year-old female presented with signs of intracranial herniation due to subdural hematoma (SDH) which resolved rapidly and spontaneously. This patient showed bilateral decerebrate postures due to left SDH on admission. Since she had serious neurological symptoms and critical systemic conditions caused by an asthma attack, conservative treatment including osmotherapy and mechanical ventilation was performed instead of surgical intervention. Her signs of intracranial herniation resolved only 6 hours after admission. Although the SDH did not diminish rapidly, she showed excellent neurological improvement even with conservative treatment only. Characteristic serial changes on computed tomography corresponding to the neurological improvements were seen. She was discharged with slight right hemiparesis and slight dementia that were present prior to this admission. The rapid resolution of signs of intracranial herniation was attributable to the spontaneous diminution of SDH. The diminution or disappearance of hematomas probably depended on the redistribution of cerebrospinal fluid into the hematoma in the present case.
Objective: It is suggested that thalami, basal ganglia, putamina and caudate heads play a crucial role in strong emotion such as the fear of serious earthquake. The aim of this study was to elucidate the radiographic findings (mainly the lacunae) in these regions, mental abilities and the extent of the activities of daily livings (ADL) of moderately demented patients who could recognize the Niigata Ken (prefecture) Chuetsu earthquake 2004 Japan. Methods: In patients with moderate dementia, mainly Alzheimer's disease, who could recognize the Niigata Ken (prefecture) Chuetsu earthquake 2004 in Niigata prefecture in Japan, their radiographic findings regarding thalami, basal ganglia, putamina and caudate heads were investigated by counting the numbers of lacunae using magnetic resonance imaging. In addition, their mental abilities were examined by Mini-Mental Examination Score and Hasegawa Dementia Scale-Revised. Their activities of daily living were also assessed.
Results:The patients who could recognize the earthquake have statistically fewer lacunae in the thalami, basal ganglia, putamina and caudate heads, than those who could not (P < 0.01 by Student's t-test). This analysis revealed that the patients who could recognize the earthquake have statistically significant higher scores in both Mini-Mental Examination Score, Hasegawa Dementia Scale-Revised (P < 0.05 by Student's t-test) and activities of daily living (P < 0.01 by Student's t-test). However, statistical significance was not obtained regarding education between two groups. Conclusion: Thalami and the structures around them such as basal ganglia, putamina and caudate heads play an important role in emotion and cognition. Therefore, we concluded that numbers of lacunae might be a valuable marker in evaluating the cognitive abilities of the demented patients.
219 duced 10Fr long sheath type guiding catheter into the right femoral artery and navigated it proximal to the right CCA aneurysm. After systemic anticoagulation with heparin, we measured carefully the diameter of the aneurysm by IVUS (intra-vascular ultrasonography). Then, we navigated a microcatheter (RapidTransit, Cordis) inside the right CCA aneurysm through the left femoral artery for possible coil embolization. We successfully deployed a self-expandable stent-graft (PASSAGER 10 mm _ 40 mm, Boston Scientific) through the 10-Fr guiding sheath and dilated it sufficiently with an 8-mm balloon catheter. Immediately after post dilatation, the stent-graft was expanded enough to contact the CCA wall, and the aneurysm disappeared on angiograms. Therefore, we didn't perform coil embolization. Post-procedure carotid arteriography showed no visualization of the aneurysm. Three-month and twelve-month carotid ultrasonography and arteriography demonstrated complete obliteration and no recurrence of the right CCA aneurysm.
DiscussionSpontaneous common carotid artery aneurysms are rare, and treatment strategy has not yet been established. In general, asymptomatic aneurysms should not necessarily be treated surgically.
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