Language：Japanese   Publisher：(一社)日本神経学会  

症例は44歳男性.左上肢の脱力発作で始まる2回の全身痙攣があり,MRIで右中心前回皮質直下白質に局所性T2延長領域を呈し,周囲の脳表に一部ガドリニウム増強効果を認めた.レベチラセタムで発作は消失し,他に神経学的異常はなかった.炎症性疾患を疑ったが,HLA-B54/Cw1を認めるものの発熱や皮膚病変はなく髄液の細胞数やIL-6値は正常であった.MRIで病変対側の脳表にわずかなflow voidsを,CT angiographyで皮質静脈の早期描出を認め,脳血管造影で右高位円蓋部を含む計4ヶ所に動静脈シャントを同定した.血管塞栓術を施行し病変は縮小し,以後痙攣の再発はない.(著者抄録)

Language：English   Publisher：(一社)日本神経学会  

Language：English  

Blood blister-like aneurysms (BBAs) are rare and challenging intracranial aneurysms. They pose significant diagnostic and surgical risks due to their delicate walls. Accounting for a small percentage of intracranial aneurysms, BBAs are pathologically pseudoaneurysms, often resulting from arterial dissection, with a high tendency to rupture. This report underscores the critical nature of BBAs by reviewing a case in which subarachnoid hemorrhage caused by a BBA rupture was difficult to diagnose with conventional imaging. We highlight the efficacy of three-dimensional (3D) high-resolution vessel wall imaging (VWI) in discerning the subtle vascular abnormality of BBAs. The integration of the black-blood imaging technique within VWI provides superior contrast between the aneurysm and surrounding tissues, facilitating clearer visualization of the aneurysmal wall. The use of 3D T1-weighted imaging provides intricate details of the vessel wall including its contrast enhancement, which is crucial for a comprehensive assessment of a ruptured aneurysm. This case is consistent with the existing literature, supporting the role of VWI in the identification of ruptured BBAs, an area with limited but growing information on its diagnostic value. VWI is precise and accurate in the preoperative diagnosis of BBAs, emphasizing its potential to improve patient management and outcomes, especially in conditions with high risks of morbidity and mortality.

DOI： 10.7759/cureus.58376

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OBJECTIVE: Intellectual function declines in about 30% of children with moyamoya disease (MMD). Memory function underpins higher order brain function, but the relationship between intellectual function and memory in pediatric MMD patients has not been well studied. This study aimed to investigate correlations between scores on the Wechsler Intelligence Scale for Children (WISC) and the Benton Visual Retention Test (BVRT), a visual memory test that can be administered to children, in children with MMD. Relationships between intellectual function or memory and regional cerebral blood flow (rCBF) have also not been well clarified in pediatric MMD patients. The authors also investigated associations between WISC or BVRT scores and rCBF in various brain regions. METHODS: WISC and BVRT scores and rCBF were assessed in 17 children with ischemic-onset MMD before revascularization. Single-photon emission CT with 123I-iodoamphetamine was used to measure rCBF. Relationships between WISC and BVRT scores were evaluated using Spearman's correlation coefficient and multivariate linear regression analysis. Cutoff values were identified for BVRT scores. Sensitivity and specificity were calculated to predict full-scale intelligence quotient (FSIQ) > 85 or ≤ 85. Associations between rCBF and WISC or BVRT scores were evaluated using linear regression analysis. RESULTS: BVRT scores were significantly correlated with FSIQ and scores on the Working Memory Index (WMI), Processing Speed Index, and Verbal Comprehension Index (VCI)/Verbal Intelligence Quotient (VIQ) of WISC. Multivariate linear regression revealed that number correct score and number of errors score of BVRT were associated with FSIQ. As cutoff values, a number correct score of 5 and a number of errors score of 8 offered the most reliable predictors of FSIQ > 85 and ≤ 85, respectively. FSIQ correlated positively with rCBF in the right and left hemispheres, right and left ganglia, right and left thalamus, right and left cerebellum, right middle cerebral artery (MCA) territory, pons, and vermis. WMI score was positively associated with rCBF in the right hemisphere, right anterior cerebral artery territory, right MCA territory, right basal ganglia, right and left thalamus, right and left cerebellum, pons, and vermis. CONCLUSIONS: BVRT score correlated well with WISC index scores, suggesting that BVRT may be helpful in screening for intellectual impairments in children with MMD. In the MCA territory, basal ganglia, thalamus, cerebellum, pons, and vermis, rCBF associated well with WISC index scores, suggesting that reduced rCBF in relevant brain regions may influence intellectual function.

DOI： 10.3171/2023.11.PEDS23317

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Moyamoya disease (MMD) is characterized by progressive arterial occlusion, causing chronic hemodynamic impairment, which can reduce brain volume. A novel quantitative technique, synthetic magnetic resonance imaging (SyMRI), can evaluate brain volume. This study aimed to investigate whether brain volume measured with SyMRI correlated with cerebral blood flow (CBF) and brain function in adult MMD. In this retrospective study, 18 adult patients with MMD were included. CBF was measured using iodine-123-N-isopropyl-p-iodoamphetamine single photon emission computed tomography. Cerebrovascular reactivity (CVR) to acetazolamide challenge was also evaluated. Brain function was measured using the Wechsler Adult Intelligence Scales (WAIS)-III/IV and the WAIS-R tests. Gray matter (GM), white matter, and myelin-correlated volumes were evaluated in six areas. Resting CBF was positively correlated with GM fractions in the right anterior cerebral arterial and right middle cerebral arterial (MCA) territories. CVR was positively correlated with GM fraction in the right posterior cerebral arterial (PCA) territory. Full-Scale Intelligence Quotient and Verbal Comprehension Index scores were marginally positively correlated with GM fractions in the left PCA territory. Processing Speed Index score was marginally positively correlated with GM fraction in the right MCA territory. The SyMRI-measured territorial GM fraction correlated with CBF and brain function in patients with MMD.

DOI： 10.1038/s41598-024-56210-2

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Language：Japanese   Publisher：(公社)日本医学放射線学会  

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Language：Others   Publishing type：Research paper (scientific journal)   Publisher：Wiley  

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Magnetic resonance imaging of spinal dural arteriovenous fistula (SDAVF) shows longitudinally extensive spinal cord lesions mimicking neoplastic or inflammatory myelopathy. On positron emission tomography/computed tomography (PET/CT), we report two patients who showed focal ¹⁸F‐fluorodeoxyglucose (FDG) uptake in longitudinally extensive spinal cord lesions. These lesions were indistinguishable from tumors or myelitis but were finally diagnosed as SDAVF. Although PET/CT availability may be limited, in cases of myelopathy with diagnostic challenges, it is important to recognize that focal FDG uptake can be observed in SDAVF.

DOI： 10.1111/ncn3.12794

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BACKGROUND: The systemic manifestations of coronavirus disease 2019 (COVID-19) include hyperinflammatory reactions in various organs. Recent studies showed evidence for the frequent involvement of central nervous system in affected patients; however, little is known about clinical features of cerebrovascular diseases in childhood-onset COVID-19. CASE PRESENTATION: A 10-year-old boy recovered from SARS-CoV-2 infection without complication. On 14 days after infection, he presented with loss of consciousness. A head computed tomography detected a ruptured cerebral aneurysm at the left posterior cerebral artery accompanying subarachnoid hemorrhage (SAH). Immediate surgical intervention did not rescue the patient, resulting in the demise 7 days after admission. Serological and genetic tests excluded the diagnosis of vasculitis and connective tissue disorders. Retrospective analysis showed markedly higher levels of interleukin (IL)-1β, IL-6 and IL-8 in the cerebrospinal fluid than the serum sample concurrently obtained. A review of literature indicated that adult patients with COVID-19 have a risk for the later development of SAH during the convalescent phase of COVID-19. CONCLUSIONS: SAH is a severe complication of COVID-19 in children and adults who have asymptomatic cerebrovascular aneurysms. The markedly high levels of cytokines detected in the cerebrospinal fluid suggested that intracranial hyperinflammatory condition might be one of the possible mechanisms involved in the rupture of a preexisting cerebrovascular aneurysms.

DOI： 10.1186/s12883-023-03493-z

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Language：Japanese   Publisher：Japan Society of Neurosurgical Emergency  

<p>  Carotid web is a fenestrated structure that develops on the posterior wall of the internal carotid artery origin and subtype of fibromuscular dysplasia. Blood stasis occurs in the carotid web, resulting to embolic material that can cause cerebral infarction, especially in young patients with no risk factors for stroke. For treatment, carotid revascularization is considered because of the high risk of recurrence with medical treatment alone. Although carotid endarterectomy has long been reported as a method of carotid revascularization, carotid artery stenting (CAS) has recently been increasingly reported. Here, we report three cases of CAS for symptomatic carotid web induced middle cerebral artery occlusion, which were successfully treated with CAS following mechanical thrombectomy.</p>

DOI： 10.24723/jsne.29.1_63

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Language：Japanese   Publisher：Societas Neurologica Japonica  

<p>We describe a 44-year-old man with a complaint of atonic seizures of the left upper limb, followed by generalized seizures. Brain MRI showed isolated juxtacortical white matter T₂ hyperintensity with gadolinium (Gd) enhancement of the adjacent cortical gray matter and subcortical white matter in the right frontal convexity. Treatment with levetiracetam was effective for seizure suppression, and he had no other neurological abnormalities. Human leukocyte antigen typing revealed B54 and Cw1, which indicated the possibility of neuro-Sweet disease. However, a general examination, which included vital signs and eye and skin findings, was normal. A cerebrospinal fluid test showed a mild elevation in protein levels without pleocytosis and a normal range of interleukin-6. Electroencephalography showed intermittent slow waves without epileptic discharge in the bilateral temporal lobes. We detected subtle flow voids in the pia mater of the left frontal lobe, which suggested cerebrovascular disease, and specifically, the possibility of dural arteriovenous fistulas. Computed tomography angiography showed abnormally dilated perimedullary veins in the left frontal lobe. Cerebral angiography confirmed the existence of four dural arteriovenous fistulas, which included two retrograde leptomeningeal venous drainages in the right frontal cortical veins supplied by the anterior branch of the right middle meningeal artery. The other dural arteriovenous fistulas were retrograde leptomeningeal venous drainages in the left frontal cortical veins supplied by the anterior and posterior convexity branches of the left middle meningeal artery. The patient underwent successful endovascular embolization of all dural arteriovenous fistulas with Onyx injection. A follow-up MRI showed gradual improvement of the T₂ hyperintensity and Gd enhancement. He remained seizure-free for 2 years following endovascular embolization.</p>

DOI： 10.5692/clinicalneurol.cn-001947

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OBJECTIVE: Cognitive function can decline in adults with moyamoya disease (MMD). Memory, which is an essential but complex and multifaceted function, underpins executive and intellectual functions. However, the relationship between memory and executive or intellectual functions in adults with MMD has not been well studied. The relationship between memory and cerebral blood flow has also not been elucidated. This study investigated correlations between memory, executive function, and intellectual function, and associations between cerebral blood flow and memory in adults with MMD. METHODS: Memory, executive function, and intellectual function were assessed using the Wechsler Memory Scale-Revised (WMS-R), Frontal Assessment Battery (FAB), and Wechsler Adult Intelligence Scale (WAIS) third or fourth edition, respectively, in 31 adults with MMD. Cerebral blood flow was measured with iodine 123I-iodoamphetamine single-photon emission computed tomography. RESULTS: WMS-R scores correlated significantly with total FAB and WAIS scores before and after revascularization. Cerebral blood flow in the left posterior cerebral artery territory correlated positively with WMS-R and WAIS scores pre- and postoperatively. Postoperative cerebrovascular reserves of the right cerebellum, pons, and vermis were positively associated with visual memory, and postoperative cerebrovascular reserve of the pons was also associated with general memory. CONCLUSIONS: Memory function correlates with executive and intellectual functions in adults with MMD. The FAB, which requires about 10 min to administer, might be useful to screen for memory dysfunction. Memory might be vulnerable to hypoperfusion in the posterior cerebral artery territory among adults with MMD. Postoperative cerebrovascular reserve might help predict memory dysfunction in adults with MMD.

DOI： 10.1016/j.wneu.2023.09.092

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Arterial spin labeling (ASL) is a noninvasive imaging technique that labels the proton spins in arterial blood and uses them as endogenous tracers. Brain perfusion imaging with ASL is becoming increasingly common in clinical practice, and clinical applications of ASL for intracranial magnetic resonance angiography (MRA) have also been demonstrated. Unlike computed tomography (CT) angiography and cerebral angiography, ASL-based MRA does not require contrast agents. ASL-based MRA overcomes most of the disadvantages of time-of-flight (TOF) MRA. Several schemes have been developed for ASL-based MRA; the most common method has been pulsed ASL, but more recently pseudo-continuous ASL, which provides a higher signal-to-noise ratio (SNR), has been used more frequently. New methods that have been developed include direct intracranial labeling methods such as velocity-selective ASL and acceleration-selective ASL. MRA using an extremely short echo time (eg, silent MRA) or ultrashort echo-time (TE) MRA can suppress metal susceptibility artifacts and is ideal for patients with a metallic device implanted in a cerebral vessel. Vessel-selective 4D ASL MRA can provide digital subtraction angiography (DSA)-like images. This review highlights the principles, clinical applications, and characteristics of various ASL-based MRA techniques. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 2.

DOI： 10.1002/jmri.29119

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BACKGROUND: The authors report a case of symptomatic cavernous sinus (CS) dural arteriovenous fistula (dAVF) that was successfully treated using direct puncture of the superior ophthalmic vein (SOV) with craniotomy. CS dAVF is commonly treated using transvenous embolization (TVE), with the most common access route via the inferior petrosal sinus (IPS). However, this route is sometimes unavailable because of an occluded, hypoplastic, aplastic, or tortuous IPS. The SOV is an alternative, albeit tortuous and long, route to the CS; therefore, direct SOV puncture is occasionally performed. Direct SOV puncture is mostly percutaneous; however, in this case, it was difficult because of subcutaneous SOV narrowing. OBSERVATIONS: As the patient experienced increased intraocular pressure, decreased vision, and eye movement disorders, CS embolization was performed via direct puncture with a craniotomy because of other access difficulties. LESSONS: Several reports have described CS dAVF in patients receiving endovascular treatment via direct SOV puncture using a transorbital approach. However, to the best of the authors' knowledge, this is the first reported case of a CS dAVF treated using TVE with craniotomy. This approach is useful when the SOV cannot be reached intravenously and its distance from the epidermis is long.

DOI： 10.3171/CASE23464

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BACKGROUND: We report a case of symptomatic, progressive stenosis of a persistent primitive hypoglossal artery (PPHA), which was successfully treated with percutaneous transluminal angioplasty (PTA) of the origin of the PPHA. The PPHA is a type of carotid-basilar anastomosis with an incidence of 0.02% to 0.10%. It originates from the internal carotid artery (ICA), passes through the hypoglossal canal, and merges with the basilar artery. In many cases, the ipsilateral vertebral artery is hypoplastic; therefore, PPHA stenosis causes cerebral infarction in the posterior circulation territory, as in this case. OBSERVATIONS: The patient's right PPHA had severe and progressive stenosis; therefore, he experienced cerebral infarction despite medical treatment. Therefore, PTA for the stenosis was performed, which ceased the recurrence of cerebral infarction and dizziness by improving blood flow in the posterior circulation. LESSONS: Several reports have described ICA stenosis accompanied by PPHA or PPHA stenosis in patients receiving endovascular treatments. Almost all cases were nonprogressive, and the treatment procedure was stenting. However, in our case, the PPHA stenosis was progressive, and we performed PTA because the patient experienced resistance to antiplatelet drugs and had poor collateral flow.

DOI： 10.3171/CASE23427

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Angiogenic factors associated with Moyamoya disease (MMD) are overexpressed in M2 polarized microglia in ischemic stroke, suggesting that microglia may be involved in the pathophysiology of MMD; however, existing approaches are not applicable to explore this hypothesis. Herein we applied blood induced microglial-like (iMG) cells. We recruited 25 adult patients with MMD and 24 healthy volunteers. Patients with MMD were subdivided into progressive (N = 7) or stable (N = 18) group whether novel symptoms or radiographic advancement of Suzuki stage within 1 year was observed or not. We produced 3 types of iMG cells; resting, M1-, and M2-induced cells from monocytes, then RNA sequencing followed by GO and KEGG pathway enrichment analysis and qPCR assay were performed. RNA sequencing of M2-induced iMG cells revealed that 600 genes were significantly upregulated (338) or downregulated (262) in patients with MMD. Inflammation and immune-related factors and angiogenesis-related factors were specifically associated with MMD in GO analysis. qPCR for MMP9, VEGFA, and TGFB1 expression validated these findings. This study is the first to demonstrate that M2 microglia may be involved in the angiogenic process of MMD. The iMG technique provides a promising approach to explore the bioactivity of microglia in cerebrovascular diseases.

DOI： 10.1038/s41598-023-41456-z

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Language：Japanese   Publisher：The Mt. Fuji Workshop on CVD事務局  

2013年1月～2020年12月に包括的脳卒中センター6施設における血栓回収術(MT)885例のうち、癌関連血栓症(CAT)に伴う脳主幹動脈閉塞症23例(女性74%:年齢中央値77歳)に対するMTの成績について後方視的検討を行った。非CAT群862例(女性49%:年齢中央値79歳)との比較では、女性の割合が有意に多く、発症前の抗凝固薬内服が高く、t-PA静注療法の施行例が少なく、院内発症率が有意に高かった。CAT群は90日後の機能予後および死亡率が不良であったが死因の多くが癌の増悪であり、再開通率や合併症率は非CAT群と有意差は認めなかった。

Language：Japanese  

Language：Japanese   Publisher：(一社)日本小児神経学会  

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OBJECTIVES: To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan. DESIGN: Retrospective study. SETTING: Six hundred and thirty-one primary care institutions in Japan. PARTICIPANTS: Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database. PRIMARY AND SECONDARY OUTCOME MEASURES: Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3-6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1-25 points). RESULTS: In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality. CONCLUSIONS: The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era.

DOI： 10.1136/bmjopen-2022-068642

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Language：Japanese  

Language：Japanese   Publisher：(一社)日本小児神経学会  

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Publishing type：Research paper (international conference proceedings)  

Intracerebral hematoma (ICH) is a blood clot that forms when a blood vessel in the brain ruptures for some reason and the spilled blood coagulates. ICH has a high morbidity and mortality rate, accounting for approximately 10% of all strokes. Manual segmentation of ICH in head CT images is very complicated, time consuming, and troublesome. When ICH perforates the ventricular wall and blood flows into the ventricle, there is little difference in CT value between ICH and intraventricular hemorrhage (IVH), and the boundary between them is unclear. Convolutional neural network (CNN) has proven to be a reliable method in the field of image recognition. In addition, quantification of ICH may aid in decision making in ICH treatment. In this study, we introduce CNN in a stepwise manner to differentiate ICH and IVH in the process and extract ICH regions. The results in 18 stroke patients show that our method is promising in the extraction of ICH regions with an accuracy of 75.2%.

DOI： 10.1117/12.2667011

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Language：Japanese   Publisher：Fukuoka Medical Association  

Purpose : We investigated the relationship between the arterial transit artifact (ATA) of the petrous portion of the internal carotid artery (pICA) on 1.5-T pulsed arterial spin labeling (ASL) perfusion images and hemodynamic changes on digital subtraction angiography (DSA) before and after carotid artery stenting (CAS) in patients with ICA stenosis. Method : ASL images were taken with postlabeling delay (PLD) of 1.5 s and 2.0 s before and after CAS, and these findings were compared with those of DSA in nine patients. Results : On pre-CAS ASL, ATA of the pICA was visualized both on PLD 1.5 s and 2.0 s in six cases, in which DSA demonstrated stagnation of contrast medium in the pICA and delayed visualization of the distal MCA. Immediately after CAS, DSA showed improvement in these findings : pICA was either visualized or not visualized on ASL images at 1.5 s, and disappeared at 2.0s. Conclusion : The presence of ATA of the pICA both on PLD 1.5 and 2.0 s suggests stagnation of blood flow within pICA with delayed visualization of the MCA and its disappearance after the CAS demonstrates improvement of these findings.

DOI： 10.15017/6788682

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BACKGROUND: Intracranial aneurysms (ICA) rarely occur in children under 3 years of age. Little is known for neuroimaging parameters that predict survival and clinical outcomes of patients with ICA in early childhood. CASE PRESENTATION: A 2-year-old girl showed intracranial hemorrhage due to a rupture of aneurysm at the middle cerebral artery. Quantitative measurements of ischemic damages on the head computed tomography (CT) marked an extremely low score of 2 points with modified Alberta Stroke Program Early CT Score (mASPECTS). She died 15 days after admission. In publications from 2021 to 2022, we found 21 children who were under 3 years of age at onset of ICA. None of them died, but two of three patients who had mASPECTS scores 0-8 showed developmental delay and/or epilepsy as neurological complications. CONCLUSION: Early CT findings are applicable for predicting survival and neurological outcomes of young children with intracranial hemorrhage.

DOI： 10.1186/s12883-022-03022-4

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Language：Japanese   Publisher：福岡医学会  

内頸動脈の椎体骨部(pICA)におけるarterial transit artifact(ATA)描出の臨床的意義について、頸動脈ステント留置(CAS)前後の一定時間後(PLD)1.5秒、2.0秒のarterial spin labeling(ASL)所見と造影剤注入後1.5秒、2.0秒のDSA所見を比較検討した。2021年4月～2022年3月の期間に同一術者により行われたCAS症例のうち、術前後にtime-of-flight法によるMRAおよびASLを含むMRIとECD-SPECTを行った9例(全例男性、平均71.3歳)を対象とした。CAS前のASLでは非手術側のpICAのATAはPLD 1.5、2.0秒ともに描出されないか、1.5秒で描出されても2.0秒では消失した。しかし、手術側のpICAは6例において1.5秒で強く描出され、2.0秒でも消失せずに残存した。ICA狭窄におけるpICAのATAがPLD 1.5、2.0秒ともに描出されることは頭蓋内arterial transit timeの遅延を伴うpICA内の血流停滞を意味し、CAS後の消失はこれらの改善を示唆しているものと考えられた。

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Accurate assessment of cerebral perfusion in moyamoya disease is necessary to determine the indication for treatment. We aimed to investigate the usefulness of dynamic PCASL using a variable TR scheme with optimized background suppression in the evaluation of cerebral perfusion in moyamoya disease. METHODS: We retrospectively analyzed the images of 24 patients (6 men and 18 women, mean age 31.4 ± 18.2 years) with moyamoya disease; each of whom was imaged with both dynamic PCASL using the variable-TR scheme and 123IMP SPECT with acetazolamide challenge. ASL dynamic data at 10 phases are acquired by changing the LD and PLD. The background suppression timing was optimized for each phase. CBF and ATT were measured with ASL, and CBF and CVR to an acetazolamide challenge were measured with SPECT. RESULTS: A significant moderate correlation was found between the CBF measured by dynamic PCASL and that by SPECT (r = 0.53, P < 0.001). The CBF measured by dynamic PCASL (52.5 ± 13.3 ml/100 mg/min) was significantly higher than that measured by SPECT (43.0 ± 12.6 ml/100 mg/min, P < 0.001). The ATT measured by dynamic PCASL showed a significant correlation with the CVR measured by SPECT (r = 0.44, P < 0.001). ATT was significantly longer in areas where the CVR was impaired (CVR < 18.4%, ATT = 1812 ± 353 ms) than in areas where it was preserved (CVR > 18.4%, ATT = 1301 ± 437 ms, P < 0.001). The ROC analysis showed a moderate accuracy (AUC = 0.807, sensitivity = 87.7%, specificity = 70.4%) when the cutoff value of ATT was set at 1518 ms. CONCLUSION: Dynamic PCASL using this scheme was found to be useful for assessing cerebral perfusion in moyamoya disease.

DOI： 10.1007/s00234-022-03095-5

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DOI： doi: 10.25259/SNI_422_2022.eCollection 2022.

Language：Japanese   Publisher：The Mt. Fuji Workshop on CVD事務局  

もやもや病に対するSTA-MCAバイパス術後の過灌流症候群(CHS)の発症を術前に予測することは現在困難である。以前、ハイパースペクトルカメラ(HSC)によって脳表血流を評価できることを報告した。HSCは、可視域にわたる脳皮質表面の連続スペクトルデータ(ハイパースペクトル画像データ)を撮影し、このデータを光学的固有信号に変換することで、脳表の酸素飽和度を算出することができる。今回、HSCを用いてSTA-MCAバイパス術前後の脳表皮質の酸素飽和度を算出し、脳血流を評価することでCHSを予測できるのではないかと考え、自験例で検証を行った。対象は2018～2020年にSTA-MCAバイパス術を行った患者29例とした。神経学的症状やSPECT所見からCHSと診断されたのは5例で、この5例(CHS群)と他の24例(非CHS群)とで脳表皮質の酸素飽和度を比較するとCHS群が有意に高かった(33±28% vs 8±14%)。酸素飽和度増加率のROC分析を行った結果、酸素飽和度の15%以上の増加があれば術後CHSを予測しうることが示された(感度85.0%、特異度81.3%)。

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BACKGROUND: Cerebrovascular events and infection are among the most common complications of left ventricular assist device (LVAD) therapy. The authors reported on a patient with an infectious intracranial aneurysm (IIA) associated with LVAD infection that was successfully occluded by endovascular therapy. OBSERVATIONS: A 37-year-old man with severe heart failure received an implantable LVAD. He was diagnosed with candidemia due to driveline infection 44 months after LVAD implantation, and empirical antibiotic therapy was started. After 4 days of antibiotic treatment, the patient experienced sudden dizziness. Computed tomography (CT) revealed subarachnoid hemorrhage in the right frontal lobe, and CT angiography revealed multiple aneurysms in the peripheral lesion of the anterior cerebral artery (ACA) and middle cerebral artery. Two weeks and 4 days after the first bleeding, aneurysms on the ACA reruptured. Each aneurysm was treated with endovascular embolization using n-butyl cyanoacrylate. Subsequently, the patient had no rebleeding of IIAs. The LVAD was replaced, and bloodstream infection was controlled. He received a heart transplant and was independent 2 years after the heart transplant. LESSONS: LVAD-associated IIAs have high mortality and an increased risk of surgical complications. However, endovascular obliteration may be safe and thus improve prognosis.

DOI： 10.3171/CASE21559

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Language：English   Publisher：American Journal of Neuroradiology  

BACKGROUND AND PURPOSE: An accurate assessment of the hemodynamics of an intracranial dural AVF is necessary for treatment planning. We aimed to investigate the utility of 4D-MRA based on superselective pseudocontinuous arterial spin-labeling with CENTRA-keyhole and view-sharing (4D-S-PACK) for the vessel-selective visualization of intracranial dural AVFs. MATERIALS AND METHODS: We retrospectively analyzed the images of 21 patients (12 men and 9 women; mean age, 62.2 [SD,19.2] years) with intracranial dural AVFs, each of whom was imaged with DSA, 4D-S-PACK, and nonselective 4D-MRA based on pseudocontinuous arterial spin-labeling combined with CENTRA-keyhole and view-sharing (4D-PACK). The shunt location, venous drainage patterns, feeding artery identification, and Borden classification were evaluated by 2 observers using both MRA methods on separate occasions. Vessel selectivity was evaluated on 4D-S-PACK. RESULTS: Shunt locations were correctly evaluated in all 21 patients by both observers on both MRA methods. With 4D-S-PACK, observers 1 and 2 detected 76 (80.0%, P, .001) and 73 (76.8%, P, .001) feeding arteries of the 95 feeding arteries identified on DSA but only 39 (41.1%) and 46 (48.4%) feeding arteries with nonselective 4D-PACK, respectively. Both observers correctly identified 10 of the 11 patients with cortical venous reflux confirmed by DSA with both 4D-S-PACK and 4D-PACK (sensitivity = 90.9%, specificity = 90.9% for each method), and they made accurate Borden classifications in 20 of the 21 patients (95.2%) on both MRA methods. Of the 84 vessel territories examined, vessel selectivity was graded 3 or 4 in 73 (91.2%) and 66 (88.0%) territories by observers 1 and 2, respectively. CONCLUSIONS: 4D-S-PACK is useful for the identification of feeding arteries and accurate classifications of intracranial dural AVFs and can be a useful noninvasive clinical tool.

DOI： 10.3174/ajnr.A7426

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PubMed

Language：Japanese   Publisher：(公財)大和証券ヘルス財団  

脳梗塞血栓回収療法を施行した763例の治療データベースを解析し、高齢者脳梗塞患者に対する血栓回収療法有効性予測スコアを作成した。内頸動脈・中大脳動脈閉塞かつ発症前の生活自立(mRS 0-2)患者は523例で、そのうち75歳以上の高齢者は316例(52%)、中大脳動脈M2以遠の末梢病変は61例(21%)であった。90日後mRS 0-2を予後良好とし、多変量解析を行ったところ、高齢者群は非高齢者群と比較し予後良好の割合が低かった。高齢者群のみで解析を行った場合は性別、NIH Stroke Scale(NIHSS)、mTICI2b以上の再開通が有意に予後良好と相関していた。年齢、女性、抗凝固薬内服、tPA非使用、末梢病変、NIHSS、ASPECTS、発症前mRS2、脂質異常症の有無計22点による予後予測スコアを作成した。本スコアにおいて、カットオフ値7点以下により比較的高い精度で予後良好を予測できると考えられた。

Language：English   Publishing type：Research paper (scientific journal)  

DOI： doi: 10.1136/neurintsurg-2021-017837.

Language：English   Publishing type：Research paper (scientific journal)  

DOI： doi: 10.25259/SNI_1077_2021.

DOI： 10.1161/str.53.suppl_1.TMP66

Web of Science

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publisher：(一社)日本脳卒中学会  

症例は42歳の男性.23年前に左総頸動脈と左鎖骨下動脈の閉塞を伴う高安動脈炎と診断されたが,内服加療により血管炎の活動性は落ち着いていた.経過中,腎性高血圧の指摘があり,降圧剤が処方された.今回,突然の頭痛を主訴に前交通動脈瘤破裂によるくも膜下出血を発症した.各種治療を施すも,再破裂や脳血管攣縮,脳梗塞を合併し死亡した.剖検にて前交通動脈に複数の嚢状動脈瘤を認めたが,組織学的に血管炎や粥状硬化および壁の解離を認めなかった.高安動脈炎により左総頸動脈は外頸動脈分岐部直前まで閉塞していたが,内頸動脈は開存していた.高安動脈炎では,脳梗塞,一過性脳虚血発作の合併頻度が高いが,動脈瘤形成やくも膜下出血に関する報告は少ない.抗血小板剤の使用も推奨される本疾患において,血行力学的機序によると考えられる脳動脈瘤破裂のリスクや寛解期における閉塞血管の血行再建術についても考慮する必要があると思われる.(著者抄録)

Language：Japanese   Publisher：Biomedical Fuzzy Systems Association  

Intracerebral hematoma (ICH) is a disease with high mortality and poor prognosis rate, accounting for approximately 10% of all cerebrovascular disease. Manual extraction of ICH regions lacks accuracy and speed, and a quantitative evaluation method is needed. In this study, we propose a method that divides the extraction of ICH regions into multiple stages and extracts the target using two-class classification based on convolutional neural network. The performance of the model is evaluated using 18 subjects with intraventricular hemorrhage, and it is shown that the proposed method is promising for the extraction of ICH regions in a region with high absorption rates.

DOI： 10.24466/pacbfsa.35.0_a-2

CiNii Research

Language：English  

BACKGROUND: Angiolipomas are benign mesenchymal tumors comprising mature adipocytes and abnormal blood vessels, commonly found in the subcutaneous tissue of the trunk and rarely in the skull. Furthermore, sporadic cases of angiolipoma with arteriovenous fistula (AVF) have been reported. CASE DESCRIPTION: We reported the case of a 72-year-old woman who presented with head swelling, seizures, and cognitive dysfunction. Computed tomography and magnetic resonance imaging revealed a right frontal bone tumor exceeding a sagittal suture of up to 10.7 cm. Angiography revealed AVF and varices formation. Endovascular embolization was performed to treat the AVF and reduce blood loss during surgical resection. Two days after the embolization, a craniotomy was performed; however, uncontrollable bleeding was observed at the time of tumor resection. Postoperatively, the patient was symptom-free and has been stable for 2 years without recurrence. CONCLUSION: Despite careful preoperative evaluation and treatment planning, the patient in this case report was difficult to treat. Such cases require adequate preparation.

DOI： 10.25259/SNI_422_2022

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Language：Japanese   Publisher：The Japan Stroke Society  

<p>We report an autopsy case of 42-year-old man with Takayasu arteritis and subarachnoid hemorrhage due to ruptured anterior communicating artery aneurysm. Radiological imaging study revealed total occlusion of left common carotid artery and left subclavian artery. Renal hypertension was also pointed out. The patient was treated with longterm therapy of corticosteroids, and vasculitis had been controlled. Autopsy findings revealed severe subarachnoid hemorrhage due to ruptured saccular aneurysms at the anterior communicating artery. No vasculitis, atherosclerosis, or dissection was observed at the intracranial arteries and the aneurysmal walls. The histological findings of the largesized arteries were compatible with Takayasu arteritis. Although left common carotid artery was almost completely occluded, left internal carotid artery was patent. There were 22 case reports of subarachnoid hemorrhage due to ruptured aneurysm complicated with Takayasu arteritis. These papers reported that the aneurysms were more common in the posterior circulation and that one or more of the cervical arteries showed stenosis or occlusion in most cases. Aneurysmal formation due to hemodynamic mechanism is generally considered, but spread of inflammatory changes to the intracranial blood vessels has also been reported. The antiplatelet therapy for Takayasu arteritis is recommended to prevent thrombosis, and the condition of patients is often complicated with hypertension. Since aneurysmal formation at the cerebral arteries is not a rare complication and fatal subarachnoid hemorrhage may occur, periodic head imaging tests may be recommended and reconstructive vascular operation may be considered in certain cases.</p>

DOI： 10.3995/jstroke.10922

CiNii Research

Language：English  

Background: Long-term outcomes after surgical treatment of arachnoid cysts (ACs) have not been reported adequately. Impaired visual acuity is not a common symptom of shunt dependency syndrome due to cyst-peritoneal (CP) shunt malfunction for ACs. We report a case of CP shunt malfunction, who presented only impaired visual acuity as a symptom, long after the initial surgical treatment. Case Description: A 16-year-old boy was surgically treated for the left frontal AC with CP shunting at 2 years of age. Extension of the peritoneal shunt catheter was performed at 15 years of age. A year later, he started experiencing impairment of visual acuity without headaches, which worsened to bilateral light perception. The presence of bilateral optic atrophy was confirmed. The AC in the left frontal lobe had enlarged very slightly, with shortening of the intracystic catheter, and the cerebrospinal fluid pressure was elevated to 30 cmH2O. He was treated with lumboperitoneal shunting. The visual acuity showed limited improvement. Conclusion: The possibility of CP shunt malfunction and shunt dependency syndrome should be considered, even if the patient presented only impaired visual acuity and no significant changes in the size of the ACs are observed.

DOI： 10.25259/SNI_1077_2021

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Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

DOI： doi: 10.1523/ENEURO.0098-21.2021.

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1136/neurintsurg-2021-017837

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Scopus

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

DOI： doi: 10.1159/000513289.

Language：Japanese   Publishing type：Research paper (scientific journal)  

DOI： doi: 10.1253/circj.CJ-20-0639.

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1253/circj.CJ-20-0639

Language：English  

DOI： 10.3171/CASE2037

Language：Japanese   Publishing type：Research paper (scientific journal)  

DOI： doi: 10.1007/s00330-020-07057-4. Epub 2020 Jul 21.

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1136/bmjopen-2019-033055

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00330-020-07057-4

Language：English   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

DOI： 10.1371/journal.pone.0230953. eCollection 2020.

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.3171/2019.12.JNS192584

Language：English   Publishing type：Research paper (other academic)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

DOI： 10.11477/mf.1436204116

Language：Japanese  

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: We aimed to develop quality indicators (QIs) related to primary and comprehensive stroke care and examine the feasibility of their measurement using the existing Diagnosis Procedure Combination (DPC) database. METHODS AND RESULTS: We conducted a systematic review of domestic and international studies using the modified Delphi method. Feasibility of measuring the QI adherence rates was examined using a DPC-based nationwide stroke database (396,350 patients admitted during 2013-2015 to 558 hospitals participating in the J-ASPECT study). Associations between adherence rates of these QIs and hospital characteristics were analyzed using hierarchical logistic regression analysis. We developed 17 and 12 measures as QIs for primary and comprehensive stroke care, respectively. We found that measurement of the adherence rates of the developed QIs using the existing DPC database was feasible for the 6 QIs (primary stroke care: early and discharge antithrombotic drugs, mean 54.6&#37; and 58.7&#37;; discharge anticoagulation for atrial fibrillation, 64.4&#37;; discharge antihypertensive agents, 51.7&#37;; comprehensive stroke care: fasudil hydrochloride or ozagrel sodium for vasospasm prevention, 86.9&#37;; death complications of diagnostic neuroangiography, 0.4&#37;). We found wide inter-hospital variation in QI adherence rates based on hospital characteristics. CONCLUSIONS: We developed QIs for primary and comprehensive stroke care. The DPC database may allow efficient data collection at low cost and decreased burden to evaluate the developed QIs.

DOI： 10.1253/circj.CJ-19-0089

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.wneu.2019.05.140

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1177/1747493019884526

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00234-019-02217-w

Language：Japanese  

Objective : With advent of an endovascular suite in the operating room (hybrid OR), it has been reported recently that combination therapy with surgical and endovascular procedures in hybrid OR for complex cerebrovascular diseases is feasible. / Materials and methods : We analyzed the 15 consecutive cases who underwent combination therapy with hybrid OR in our hospital from October 2014 to September 2017 (8 Aneurysms, 3 carotid artery stenosis, and 4 dural arteriovenous fistulas (DAVF)). / Results : All procedures were performed successfully. We performed bypass surgery and endovascular trapping with endovascular procedure for all aneurysm cases. In 3 cases of carotid artery stenosis, we performed carotid artery stenting (CAS) with direct puncture of common carotid artery for 2 cases and rescue stenting with carotid endarterectomy for 1 case. Perioperative antiplatelet therapy was performed in all cases of unruptured aneurysms and carotid artery stenosis. In the cases of DAVF, we performed transarterial or transvenous embolization combined with craniotomy, or shunt ligation with selective indocyanine green videoangiography using microcatheter. Systemic full heparinization was performed during all endovascular procedures. There was no symptomatic hemorrhagic and ischemic complication. There was no neurological deterioration of modified Rankin scale at discharge except for the case of symptomatic hyperperfusion after CAS. / Conclusion : Combination therapy with hybrid OR for complex cerebrovascular disease is safe and feasible.

DOI： 10.15017/2545089

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.2176/nmc.oa.2018-0325.

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.2176/nmc.oa.2018-0325

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.wneu.2019.04.177

Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00234-019-02217-w

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DOI： 10.1159/000499190

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.wneu.2019.04.177

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00330-018-5462-7

Language：Japanese  

Language：Japanese  

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.neurad.2018.02.009

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.neurad.2018.02.009

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1111/neup.12471

Language：Japanese  

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.2169/internalmedicine.9472-17

Language：English  

DOI： 10.1111/neup.12471

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1212/WNL.0000000000005207

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1212/WNL.0000000000005207

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1148/radiol.2017162279

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1148/radiol.2017162279

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.2169/internalmedicine.9472-17

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.wneu.2017.08.141

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.wneu.2017.08.141

Language：English  

Safety and Efficacy of Prasugrel with Endovascular Treatment for Unruptured Cerebral Aneurysm

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese   Publishing type：Research paper (scientific journal)  

DOI： 10.11477/mf.1436203635

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

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DOI： 10.1016/j.jocn.2016.11.009

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jocn.2016.11.009

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.7887/jcns.26.750

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.2176/nmc.ra.2015-0312

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1177/0271678X15606456

Language：English   Publishing type：Research paper (scientific journal)  

Language：Japanese  

Language：English   Publishing type：Research paper (scientific journal)  

Central nervous system (CNS) pericytes have been recognized as an indispensable component of the neurovascular unit. The expression of platelet-derived growth factor receptor β (PDGFRβ) is markedly increased in CNS pericytes after brain ischemia. It has been elucidated that PDGFRβ, expressed in pericytes and pericyte-derived fibroblast-like cells, plays important roles in the maintenance of the blood-brain barrier (BBB) and in the repair process in infarct areas. The aim of this study was to uncover how the PDGFRβ expression is regulated in pericytes after brain ischemia. We found that basic fibroblast growth factor (bFGF), but neither hypoxia at 1% O₂ nor acidification at pH 6.5, significantly upregulated the PDGFRβ expression in human cultured CNS pericytes. SU5402, an inhibitor of FGF receptor (FGFR), and inhibitors of its downstream effectors Akt and Erk abolished the bFGF-induced upregulation of PDGFRβ. On the other hand, acidification significantly upregulated the expression of bFGF, while hypoxia upregulated the expression of FGFR1 in the pericytes. The expression of bFGF and FGFR1 was markedly induced in the ischemic hemisphere after ischemic insult in a middle cerebral artery occlusion stroke model. Immunofluorescent double labeling demonstrated that the expression of bFGF and FGFR1 was co-localized with PDGFRβ-positive cells in peri-infarct areas. Moreover, treatment with bFGF enhanced cell growth and the PDGF-BB-induced migratory activity of cultured pericytes, which were significantly suppressed by SU5402 or Sunitinib, an inhibitor of PDGFR. These data suggested that increased bFGF upregulates the expression of PDGFRβ and may enhance PDGFRβ-mediated pericyte functions after brain ischemia.

DOI： 10.1016/j.brainres.2015.11.003

Language：English   Publishing type：Research paper (scientific journal)  

Central nervous system (CNS) pericytes have been recognized as an indispensable component of the neurovascular unit. The expression of platelet-derived growth factor receptor β (PDGFRβ) is markedly increased in CNS pericytes after brain ischemia. It has been elucidated that PDGFRβ, expressed in pericytes and pericyte-derived fibroblast-like cells, plays important roles in the maintenance of the blood-brain barrier (BBB) and in the repair process in infarct areas. The aim of this study was to uncover how the PDGFRβ expression is regulated in pericytes after brain ischemia. We found that basic fibroblast growth factor (bFGF), but neither hypoxia at 1&#37; O2 nor acidification at pH 6.5, significantly upregulated the PDGFRβ expression in human cultured CNS pericytes. SU5402, an inhibitor of FGF receptor (FGFR), and inhibitors of its downstream effectors Akt and Erk abolished the bFGF-induced upregulation of PDGFRβ. On the other hand, acidification significantly upregulated the expression of bFGF, while hypoxia upregulated the expression of FGFR1 in the pericytes. The expression of bFGF and FGFR1 was markedly induced in the ischemic hemisphere after ischemic insult in a middle cerebral artery occlusion stroke model. Immunofluorescent double labeling demonstrated that the expression of bFGF and FGFR1 was co-localized with PDGFRβ-positive cells in peri-infarct areas. Moreover, treatment with bFGF enhanced cell growth and the PDGF-BB-induced migratory activity of cultured pericytes, which were significantly suppressed by SU5402 or Sunitinib, an inhibitor of PDGFR. These data suggested that increased bFGF upregulates the expression of PDGFRβ and may enhance PDGFRβ-mediated pericyte functions after brain ischemia.

DOI： 10.1016/j.brainres.2015.11.003

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.2176/nmc.ra.2015-0312

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.7887/jcns.24.833

Language：English   Publishing type：Research paper (scientific journal)  

Fibrosis is concomitant with repair processes following injuries in the central nervous system (CNS). Pericytes are considered as an origin of fibrosis-forming cells in the CNS. Here, we examined whether platelet-derived growth factor receptor β (PDGFRβ), a well-known indispensable molecule for migration, proliferation, and survival of pericytes, was involved in the production of extracellular matrix proteins, fibronectin and collagen type I, which is crucial for fibrosis after ischemic stroke. Immunohistochemistry demonstrated induction of PDGFRβ expression in vascular cells of peri-infarct areas at 3-7days in a mouse stroke model. The PDGFRβ-expressing cells extended from peri-infarct areas toward the ischemic core after day 7 while expressing fibronectin and collagen type I in the infarct areas. In contrast, desmin and α-smooth muscle actin, markers of pericytes, were only expressed in vascular cells. In PDGFRβ heterozygous knockout mice, the expression of fibronectin and collagen type I was attenuated at both mRNA and protein levels with an enlargement of the infarct volume after ischemic stroke compared with that in wild-type littermates. In cultured brain pericytes, the expression of PDGF-B, PDGFRβ, fibronectin, and collagen type I, but not desmin, was significantly increased by serum depletion (SD). The SD-induced upregulation of fibronectin and collagen type I was suppressed by SU11652, an inhibitor of PDGFRβ, while PDGF-B further increased the SD-induced upregulation. In conclusion, the expression level of PDGFRβ may be a crucial determinant of fibrosis after ischemic stroke. Moreover, PDGFRβ signaling participates in the production of fibronectin and collagen type I after ischemic stroke.

DOI： 10.1016/j.expneurol.2014.12.007

Language：English   Publishing type：Research paper (scientific journal)  

Fibrosis is concomitant with repair processes following injuries in the central nervous system (CNS). Pericytes are considered as an origin of fibrosis-forming cells in the CNS. Here, we examined whether platelet-derived growth factor receptor β (PDGFRβ), a well-known indispensable molecule for migration, proliferation, and survival of pericytes, was involved in the production of extracellular matrix proteins, fibronectin and collagen type I, which is crucial for fibrosis after ischemic stroke. Immunohistochemistry demonstrated induction of PDGFRβ expression in vascular cells of peri-infarct areas at 3-7. days in a mouse stroke model. The PDGFRβ-expressing cells extended from peri-infarct areas toward the ischemic core after day 7 while expressing fibronectin and collagen type I in the infarct areas. In contrast, desmin and α-smooth muscle actin, markers of pericytes, were only expressed in vascular cells. In PDGFRβ heterozygous knockout mice, the expression of fibronectin and collagen type I was attenuated at both mRNA and protein levels with an enlargement of the infarct volume after ischemic stroke compared with that in wild-type littermates. In cultured brain pericytes, the expression of PDGF-B, PDGFRβ, fibronectin, and collagen type I, but not desmin, was significantly increased by serum depletion (SD). The SD-induced upregulation of fibronectin and collagen type I was suppressed by SU11652, an inhibitor of PDGFRβ, while PDGF-B further increased the SD-induced upregulation. In conclusion, the expression level of PDGFRβ may be a crucial determinant of fibrosis after ischemic stroke. Moreover, PDGFRβ signaling participates in the production of fibronectin and collagen type I after ischemic stroke.

DOI： 10.1016/j.expneurol.2014.12.007

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: We have previously shown that Na(+)/H(+) exchanger isoform 1 (NHE1) plays an important role in Ca(2+) signaling and cell proliferation in human central nervous system (CNS) pericytes. The aims of the present study were to elucidate how NHE1-induced Ca(2+) signaling during acidosis is transformed into cellular responses in CNS pericytes. METHODS AND RESULTS: Human CNS pericytes were cultured, and the activation of cAMP responsive element-binding protein (CREB) was evaluated by Western blotting analysis, immunofluorescence, and luciferase assays. In human CNS pericytes, low extracellular Na(+) or low pH generated Ca(2+) oscillation and subsequently phosphorylated Ca(2+)/calmodulin-dependent kinase II (CaMKII) and CREB in a time-dependent manner. Focal cerebral ischemia was applied using photothrombotic distal middle cerebral artery occlusion in mice, and the phosphorylation of CREB and the production of interleukin-6 were observed in pericytes migrating into the peri-infarct penumbra during the early phase after ischemic insult. CONCLUSIONS: Our results indicate that extracellular acidosis induces Ca(2+) oscillation via NHE1, leading to Ca(2+)/CaMKII-dependent CREB activation in human CNS pericytes. Acidosis may upregulate a variety of proteins, such as interleukin-6, through the NHE1-Ca2+/CaMKII-CREB pathway in brain pericytes and may thus modulate brain ischemic insult.

DOI： 10.1161/ATVBAHA.112.254946

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.mvr.2012.02.009

Language：English   Publishing type：Research paper (scientific journal)  

Platelet derived growth factor (PDGF)-B plays a neuroprotective role in brain damages, including ischemic stroke. It has been suggested recently that PDGF receptor β (PDGFRβ) expressed in brain pericytes as well as in neurons and astrocytes may mediate the neuroprotective role of PDGF-B. The aims of this study were to elucidate the roles of PDGFRβ signaling in brain pericytes after ischemic stroke. In a rat middle cerebral artery occlusion (MCAO) model, PDGFRβ expression was induced specifically in the pericytes in peri-infarct areas and its level was gradually increased. PDGF-B induced marked phosphorylation of Akt in cultured brain pericytes. Consistently, PDGF-B was upregulated in endothelial cells in per-infarct areas and Akt was strongly phosphorylated in the PDGFRβ-expressing pericytes in periinfarct areas after MCAO. In the cultured pericytes, PDGF-B induced cell growth and anti-apoptotic responses through Akt. Furthermore, PDGF-B significantly increased the expression of nerve growth factor (NGF) and neurotrophin-3 (NT-3) through Akt in the pericytes. Thus, the PDGFRβ-Akt signaling in brain pericytes may play various important roles leading to neuroprotection after ischemic stroke.

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：Japanese  

症例は45歳男性. 42歳時に噴門側部分胃切除を施行.術後,眼球運動障害と四肢脱力,体幹失調を2回繰り返した.頭部MRIで両側視床および中脳水道周囲に異常信号域を認め,血中ビタミンB1が著明に低下していた.入院当日よりビタミンB1を投与開始したところ2日目には眼球運動障害は消失, 2週間後には歩行可能となった.大酒家でなくても胃切除の既往を有する例では少量のアルコール摂取でも繰り返しWernicke脳症を起こす可能性が考えられた.

DOI： 10.2169/naika.94.1606

Language：Japanese  

症例は45歳男性. 42歳時に噴門側部分胃切除を施行.術後,眼球運動障害と四肢脱力,体幹失調を2回繰り返した.頭部MRIで両側視床および中脳水道周囲に異常信号域を認め,血中ビタミンB1が著明に低下していた.入院当日よりビタミンB1を投与開始したところ2日目には眼球運動障害は消失, 2週間後には歩行可能となった.大酒家でなくても胃切除の既往を有する例では少量のアルコール摂取でも繰り返しWernicke脳症を起こす可能性が考えられた.

DOI： 10.2169/naika.94.1606

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.2169/naika.94.1606

Language：Japanese  

Language：Japanese  

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Language：Japanese   Book type：Scholarly book

Ⅲ-12.カテーテル脳血管撮影

Language：Japanese  

Event date： 2024.11

Language：Japanese   Presentation type：Public lecture, seminar, tutorial, course, or other speech  

Venue：京都   Country：Japan  

Event date： 2024.11

Language：Japanese   Presentation type：Public lecture, seminar, tutorial, course, or other speech  

Venue：京都   Country：Japan  

Event date： 2024.11

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：京都   Country：Japan  

Event date： 2024.11

Language：Japanese  

Venue：京都   Country：Japan  

Event date： 2024.10

Language：Japanese  

Venue：横浜   Country：Japan  

Event date： 2024.10

Language：Japanese   Presentation type：Public lecture, seminar, tutorial, course, or other speech  

Venue：横浜   Country：Japan  

Event date： 2024.10

Language：Japanese   Presentation type：Public lecture, seminar, tutorial, course, or other speech  

Venue：横浜   Country：Japan  

Event date： 2024.5

Language：Japanese   Presentation type：Public lecture, seminar, tutorial, course, or other speech  

Venue：大阪   Country：Japan  

Event date： 2024.3

Language：Japanese   Presentation type：Oral presentation (invited, special)  

Venue：横浜   Country：Japan  

Event date： 2024.3

Language：English   Presentation type：Oral presentation (invited, special)  

Country：Japan  

Event date： 2023.6

Language：Japanese   Presentation type：Public lecture, seminar, tutorial, course, or other speech  

Venue：大阪   Country：Japan  

Event date： 2023.6

Language：English   Presentation type：Oral presentation (general)  

Country：Japan  

Event date： 2023.6

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Country：Japan  

Event date： 2023.6

Language：English  

Country：United States  

Event date： 2023.6

Language：Japanese  

Venue：WEB   Country：Japan  

Event date： 2023.6

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：福岡   Country：Japan  

Event date： 2023.6

Language：Japanese  

Country：Japan  

Event date： 2023.6

Language：English  

Country：Japan  

Event date： 2023.6

Language：English  

Country：Japan  

Event date： 2023.6

Language：Japanese  

Venue：東京   Country：Japan  

Event date： 2023.6

Language：Japanese  

Venue：大阪   Country：Japan  

Event date： 2023.3

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：WEB   Country：Japan  

Event date： 2021.11

Language：English  

Country：Japan  

Event date： 2021.10

Language：Japanese  

Venue：横浜   Country：Japan  

Event date： 2021.9

Language：English   Presentation type：Symposium, workshop panel (public)  

Country：Japan  

Event date： 2021.5

Language：Japanese   Presentation type：Public lecture, seminar, tutorial, course, or other speech  

Venue：web   Country：Japan  

Event date： 2021.3

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Country：Japan  

Event date： 2020.11

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Country：Japan  

Event date： 2020.11 - 2021.5

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Country：Japan  

Event date： 2020.8 - 2021.5

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Country：Japan  

Event date： 2019.11

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：福岡   Country：Japan  

Event date： 2019.6

Language：English  

Country：Japan  

Event date： 2018.1

Language：English  

Country：Japan  

Event date： 2017.11

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：東京   Country：Japan  

Event date： 2017.10 - 2018.10

Language：Japanese  

Venue：名古屋   Country：Japan  

Event date： 2017.10

Language：Japanese  

Country：Japan  

Event date： 2017.3

Language：Japanese  

Venue：大阪   Country：Japan  

Event date： 2017.2

Language：English  

Country：United States  

Event date： 2016.11

Language：Japanese  

Country：Japan  

Event date： 2016.11

Language：English  

Country：Japan  

Event date： 2016.11

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Country：Japan  

Event date： 2016.10

Language：Japanese  

Venue：福岡   Country：Japan  

Event date： 2016.4

Language：Japanese  

Venue：札幌   Country：Japan  

Event date： 2015.11

Language：Japanese  

Venue：岡山   Country：Japan  

Event date： 2015.11

Language：Japanese  

Venue：岡山   Country：Japan  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese   Publisher：(株)日本臨床社  

Language：Japanese   Publisher：(株)メディカ出版  

Language：English   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese