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Biomedical subjects

Yuichiro Inatomi

Publications and source records attributed to Yuichiro Inatomi.

At least 19 recordsLinked to original sources
PubMed2006

Efficacy of edaravone in cardioembolic stroke.

OBJECTIVE: We investigated the efficacy of edaravone in patients with cardioembolic stroke. METHODS: Cardioembolic stroke patients were treated with drip intravenous infusion of edaravone (ED group, n=141) for 7 days, and were retrospectively compared with a historical-controlled cohort of similar patients (control group, n=114). RESULTS: Early improvement (between day 0 and day 10), defined as change in National Institutes of Health Stroke Scale (NIHSS), was seen more frequently in mild patients (NIHSS on admission < or = 7) among the ED group than in the control group (change in NIHSS +2 vs. -2, respectively, p=0.013). Similar efficacy was not seen in the moderate to severe (NIHSS >7) patients. Independent patients (modified Rankin Scale < or = 2) 6 months after the onset were likely to be less frequent in the ED than the control group (28% versus 41%; p=0.066). Other clinical outcomes in the ED group were not significantly different from those in the control group. CONCLUSION: The results suggest that edaravone may only be effective in mild patients with cardioembolic stroke.

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PubMed2006

Rotational vertigo associated with parietal cortical infarction.

A 65-year-old woman experienced sudden positional vertigo with rightward, horizontal nystagmus that resolved within days. MRI revealed a left parietal lobe infarction involving the supramarginal gyrus. The patient experienced a transient recurrence of vertigo after 7 days but MRI failed to reveal the presence of any new lesions; furthermore, the patient's EEG was normal. We suggest that this patient's vertigo was due to her parietal cortical infarction.

Aged↗
PubMed2006

[A case report of streptococcus oralis meningitis after dental manipulation].

A 75-year-old man was admitted to our hospital because of high fever and disturbance of consciousness 4 days after dental treatment including scaling, irrigation, and oral antibiotic for dental caries without gingivitis. A lumber puncture revealed cloudy cerebrospinal fluid (CSF): it contained 984 leukocytes/mm3, 680 mg/dl of protein, 5 mg/dl of glucose (blood sugar 233 mg/dl), and Streptococcus oralis, one of common microorganisms on the gingival, was isolated from the CSF. He was successfully treated with intravenous antibiotics. The authors believe this patient's meningitis developed as a result of bacteremia after the dental scaling in the present case.

Aged↗
PubMed2006

[Decompressive craniectomy for ischemic stroke].

We analysed retrospectively 15 consecutive patients with cerebral infarction undergoing decompressive craniectomy. Ninety-three percent of patients survived, and 53% of them were partially dependent (Barthel Index > 0). We defined the partially dependent patients as good outcome group, and totally dependent as poor outcome group. In good outcome group, compared with poor outcome group, there are more frequent left hemispheric lesion (50%: 0%, p = 0.029), and pre-operative JCS < or = II-30 (62.5%: 14.3%, p = 0.057). Although many patients were severely disabled, 79% of the patients and their family answered that having operation was correct choice. All the patients in good outcome group acquired the ability of oral feeding and communication skill. 87.5% of the patient in good outcome group was satisfied with the outcome. Based on these results, we emphasized that comprehensive evaluations, including satisfaction scale and QOL assessment necessary to decide the indication of decompressive craniectomy for ischemic stroke.

Activities of Daily Living↗
PubMed2006

[Early seizures after acute ischemic stroke].

In order to determine predictive factors of early seizures (ES) after acute stroke and to estimate prognosis, we retrospectively examined clinical data of 1,743 consecutive patients with acute ischemic stroke. The subjects were divided into two groups; an ES group (19 patients) and a non-ES group (1,724 patients). Multivariate statistical analysis revealed that the NIH-Stroke Scale score on admission (/10, OR, 1.1: 95% CI 1.04 to 1.13) and positive past history of cerebrovascular disease or brain injury (OR, 3.85: 95% CI 1.49 to 9.95) are significant factors to predict ES. There was no significant difference in the outcome between the two groups. A recurrence of seizures, after follow up for 4 to 40 months, was observed only in one patient with a history of ES.

Acute Disease↗
PubMed2006

[Two cases of cavernous sinus dural arteriovenous fistula presenting headache as the one and only initial symptom].

We report 2 cases with cavernous sinus dural arteriovenous fistula (C-dAVF) presenting with headache as an initial symptom. A 70-year-old woman complained of acute persistent headache in the right temporal region. Another 74-year-old woman suffered from sudden and severe headache, developing from right-sided temporal throbbing to bilateral headache. Her condition was also complicated with cranial nerve deficits. These two patients were finally diagnosed as having C-dAVF based on the results of magnetic resonance angiography and cerebral angiography. It was difficult to make rapid diagnosis of C-dAVF in our patients, because they presented with headache alone but no typical symptoms of C-dAVF, such as proptosis, conjunctival injection or orbital bruit. C-dAVF should be considered as an important differential diagnosis in patients with headache.

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PubMed2005

Presence of early ischemic changes on computed tomography depends on severity and the duration of hypoperfusion: a single photon emission-computed tomographic study.

BACKGROUND AND PURPOSE: To evaluate the clinical significance of early ischemic change (EIC) on computed tomography (CT), pertinent factors that contribute to the appearance of EIC. METHODS: Both CT and technetium-99m hexamethylpropylene amine oxime were performed on a total of 53 patients (34 men, 19 women, mean 69.7 years old) with acute embolic stroke within 6 hours of onset. Patients were excluded if they showed definite clinical recovery or were administered thrombolytic agents. EIC was evaluated using Alberta Stroke Program Early CT Score (ASPECTS). Residual cerebral blood flow (CBF) was determined on SPECT. Variables that were considered pertinent were patients' age, gender, neurological severity, symptom duration, and residual CBF. Using significant pertinent factors for EIC, separate analyses of brain swelling without hypoattenuation and parenchymal hypoattenuation were performed. RESULTS: Patients with EIC (n=37) showed severe neurological deficits, a longer duration and severe hypoperfusion. A positive correlation was observed between ASPECTS and residual CBF (P=0.002; Kruskal-Wallis test). A logistic-regression analysis revealed that both symptom duration (r=0.024, P=0.006) and severity of hypoperfusion (r= -12.167, P=0.006) are independent factors related to EIC. Symptom duration and residual CBF were significantly different among patients with parenchymal hypoattenuation (n=32), brain swelling without hypoattenuation (n=5), and no EIC (P=0.018 and P=0.001, respectively; one-way ANOVA). CONCLUSIONS: The presence of EIC is determined by the duration and the degree of hypoperfusion. This finding supports the hypothesis that tissue damage may be evaluated by a combination of onset time and the presence of EIC.

Adult↗
PubMed2005

Hyperacute diffusion-weighted imaging abnormalities in transient ischemic attack patients signify irreversible ischemic infarction.

BACKGROUND: To characterize the frequency and clinical features of diffusion-weighted imaging (DWI) abnormalities in the hyperacute phase of transient ischemic attacks (TIAs). METHODS: We performed DWI in 21 consecutive patients with TIA (mean age 64 years; 17 men and 4 women) during both the hyperacute phase (within 6 h after onset) and subacute phase (within 2-9 days after onset). RESULTS: DWI abnormalities were present in the hyperacute phase in 11 patients (positive group) and absent in the other 10 patients (negative group). These groups could not be differentiated based on the clinical characteristics. In the subacute phase, all 11 patients from the positive group had abnormalities on MRI including T2-weighted and fluid attenuation inversion recovery images as well as DWI, with lesions being located in regions similar to those observed in the hyperacute phase. Of the 10 patients in the negative group, new DWI abnormalities were noted in 2 during the subacute phase. CONCLUSIONS: Approximately half of TIA patients in whom MRI was performed in the hyperacute phase had DWI abnormalities, all of which persisted in the subacute phase. The findings suggest that essentially all hyperacute DWI abnormalities in TIA patients may indicate irreversibility and signify the presence of brain infarction.

Adult↗
PubMed2005

[A patient with Vibrio vulnificus meningoencephalitis].

A 76-year-old man with liver cirrhosis and diabetes mellitus was admitted to our hospital because of bacterial meningoencephalitis. He had eaten raw fish 2 days before onset. He also developed septic shock, disseminated intravascular coagulation, adult respiratory distress syndrome and panophthalmitis of the right eye. Vibrio vulnificus was isolated from the blood culture. Extensive therapy including antibiotics and nafamostat methylate, resulted in full recovery except for right blindness. The necrotizing fasciitis, which is common with Vibrio vulnificus infection, had not been complicated in this patient.

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PubMed2005

[A case of migraine with aura who showed no visual symptom].

A 22-year-old man experienced a severe migraine on left side of the head with an aura including aphasia and a numbness on the right hand. A migraine with an aura of sensory disturbance on the both hands recurred immediately after cerebral angiography. Further examinations including MRI and angiography did not reveal any evidence of cerebrovascular diseases. Aphasic migraine was diagnosed in this patient. At all attacks, this patient never experienced visual aura which was common in the previous reports of migraine.

Adult↗
PubMed2005

[Portal vein thrombosis associated with hepatic encephalopathy].

A 54-year-old man who had been administered chlormadinone acetate 3 months after prostatectomy for prostate cancer, acutely developed disorientation and memory disturbance. Six days later, he experienced high grade fever and epigastralgia. He was suspected to have hepatic encephalopathy, because the Fischer ratio was low although serum ammonia level remained normal. Further examinations including abdominal echography and CT scan disclosed a thrombus extending from the portal vein to the superior mesenteric vein together with abnormal collateral vessels originating from the portal vein. He was successfully treated with warfarin potassium, urokinase and heparin sodium. It was suggested that the patient developed hepatic encephalopathy due to portal-systemic circulation shunting secondary to portal vein thrombosis.

Drug Therapy, Combination↗
PubMed2005

[A case of unilateral ischemic stroke with ipsilateral limb-kinetic apraxia].

A 74-year-old man developed aphasia, weakness of the right upper extremity and left limb-kinetic apraxia. Brain MRI showed an infarct in the area supplied by the left middle cerebral artery. Cerebral angiography revealed high grade stenosis with plaques of bilateral proximal internal carotid arteries. The carotid endarterectomy of the left carotid artery was performed three months later. After this operation his left limb-kinetic apraxia improved. We considered transhemispheric diaschisis, callosal apraxia or diagonistic dyspraxia as a possible cause of this rare symptom.

Aged↗
PubMed2005

[Normalization of physical activity on acute ischemic stroke].

The purpose of present study is to clarify the association between early normalization, orthostatic hypotension (OH) and neurological deterioration in patients with acute ischemic stroke. The authors retrospectively performed scheduled ambulation in 162 consecutive patients who were diagnosed as having ischemic stroke without them being comatose. Blood pressure and neurological findings were examined during the orthostatic tolerance test. OH was occurred in 86 (53.1%) of all patients. Neurological worsening were found in 22 of them during all clinical course, although worsening closely associated with orthostatic tolerance was only two of them. Significant OH was occurred in the patients with cerebral arterial stenosis on head-tilt 60 degrees after 15 minutes (p = 0.001). And the patients who have atrial fibrillation also yield OH on sitting immediately after (p = 0.041) and 5 minutes after moving (p = 0.035). Because symptomatic OH were rarely observed in the patients with acute ischemic stroke without them being comatose, early ambulation could be achieved safely.

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PubMed2005

[Traumatic extracranial vertebral artery dissection treated with coil embolization--a case report].

We reported a 37-year-old man who developed vertigo, dysarthria and left hemiparesis following neck pain. Magnetic resonance imaging (MRI) demonstrated infarct in the right superior cerebellar artery (SCA) territory. Duplex color-flow imaging detected dissection (double lumen) in the right vertebral artery (VA) at the level of the C4-C6 vertebra (V2 segment). Cerebral angiography showed irregular narrowing in the right V2, and occlusion of the right SCA. These findings suggested that dissection in the right V2 caused artery-to-artery embolism in the right SCA. Despite administration of anti-thrombotic agents, he recurrently suffered from transient ischemic attacks. Serial duplex color-flow imaging echography revealed that the dissection of the right VA gradually became more stenotic and extended to the distal site. Coil-embolization of the right VA by endovascular therapy was performed, and thereafter the dissecting lesion of the right VA was completely occluded and ischemic attacks disappeared.

Adult↗
PubMed2005

[Paradoxical brain embolism with a floating deep venous thrombus detected by sonography of lower extremities].

A 68-year-old woman was admitted to our hospital due to brain embolism in the right middle cerebral artery. Patent foramen ovale was detected by transesophageal echocardiogram. The sonogram of the legs revealed a floating thrombus originating from the left posterior tibial vein and extended to the superficial femoral vein. Both right middle lobe and left upper lobe were defected in perfusion scans of lung. She was treated with administration of warfarin potassium and caval filters placed in the inferior vena cava and the azygos vein. Thereafter, she had never experienced brain embolism or pulmonary embolism. A floating deep venous thrombus, which is a high risk of pulmonary embolism, could be observed in patients with paradoxical brain embolism. It was suggested that sonography of veins in the legs is essential for detecting embolic sources of brain infarction, as well as evaluating the risk of pulmonary embolism.

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PubMed2005

[Prolonged factors of length of hospital stay in acute ischemic stroke].

The purpose of this study was to determine factors that extend the length of hospital stay in patients with ischemic stroke in acute hospital. Clinical data of 462 consecutive patients with acute ischemic stroke were retrospectively researched. These subjects were divided into two groups; short stay group (length of hospital stay < or = 14 days, 238 patients) and long stay group (length of hospital stay > 14 days, 224 patients). Using multivariate statistical methods, the independent factors associated with prolonged hospital stay were investigated. Independent and significant factors associated with prolonged hospital stay were National Institutes of Health Stroke Scale score on admission (OR, 1.072: 95% CI, 1.021 to 1.125), transient ischemic attack (OR, 0.142: 95% CI, 0.021 to 0.966), any complications during hospital stay (OR, 7.975: 95% CI, 3.539 to 17.971) and interval between offer to discharge (OR, 1.441: 95% CI, 1.294 to 1.605). It was suggested that control of complication could decrease length of hospital stay in patients with ischemic stroke in acute hospitals.

Aged↗
PubMed2005

[Urinary retention associated with unilateral medullary infarction].

A 59-year-old man without any history of urinary disturbance, admitted to our hospital because of dysarthria and left hemiparesis. Diffusion weighted MR image of the brain of the 2nd hospital day showed left lateral medullary infarction. He also suffered from urinary disturbance which revealed to be the atonic bladder after the urodynamic study. Although the autonomic disturbance, such as Horner syndrome, is a well-known symptom in patients with lateral medullary infarction, few reports mentioned about the prevalence and the extent of urinary disturbance. The obstructive urinary disturbance observed in the present patient was thought to be caused by the unilateral lateral medullary infarction.

Diffusion Magnetic Resonance Imaging↗