NMC Case Report Journal最新文献

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Two Cases of Mechanical Thrombectomy in Patients with Fenestration of the M1 Segment of the Middle Cerebral Artery 两例大脑中动脉 M1 段瘘患者的机械血栓切除术

NMC Case Report Journal

Pub Date : 2024-04-05 DOI: 10.2176/jns-nmc.2023-0258

Masashi Nakadate, Ryushi Kondo, Shoichiro Ishihara, Nahoko Uemiya, Yoshiaki Kakehi, Yukihiro Hidaka, Kenzo Minamimura, Kazuo Tokushige, Nobusuke Tsuzuki

M1 fenestration of the middle cerebral artery is rare. We present two patterns of acute thromboembolic conditions in M1 fenestrations treated with mechanical thrombectomy. Case 1 was a male in his 60s presenting with right hemiparesis and aphasia. Angiography showed acute left M1 proximal occlusion; the first direct aspiration revealed two parallel routes, and the second aspiration achieved complete recanalization of the left M1 fenestration. Case 2 was a male in his 70s presenting right hemiparesis and aphasia. Angiography revealed a sudden stair-like narrowing of the left M1 in the intermediate part, and a retrograde blood flow cavity was observed on the upper side of the distal part. Mechanical thrombectomy was performed to diagnose the upper limb occlusion of the left M1 fenestration, and successful recanalization was achieved through direct aspiration. Anatomical variations, such as fenestration, should be considered to reduce complication risks.

大脑中动脉 M1 管腔狭窄非常罕见。我们介绍了两种通过机械性血栓切除术治疗 M1 开孔急性血栓栓塞的病例。病例 1 是一名 60 多岁的男性，出现右侧偏瘫和失语。血管造影显示左侧 M1 近端急性闭塞；第一次直接抽吸发现两条平行的路径，第二次抽吸实现了左侧 M1 管腔的完全再通畅。病例 2 是一名 70 多岁的男性，表现为右侧偏瘫和失语。血管造影显示左侧 M1 中间部分突然出现阶梯状狭窄，远端上侧出现逆行血流腔。为诊断左侧 M1 狭窄处的上肢闭塞，患者接受了机械性血栓切除术，并通过直接抽吸成功实现了再通。为降低并发症风险，应考虑到解剖上的变化，如瘘管。

引用次数: 0

A Case of Multiple Brain Tuberculomas in the Subarachnoid Cisterns: Recognition of Radiological Characteristics Regarding the Development of Paradoxical Response during Antituberculosis Treatment 蛛网膜下腔多发性脑结核瘤病例：认识抗结核治疗期间出现反常反应的放射学特征

NMC Case Report Journal

Pub Date : 2024-04-05 DOI: 10.2176/jns-nmc.2023-0270

Kazuma Sahara, Kiyohito Shinno, Kenta Sato, Yuya Watari, Tetsuya Tamura, Eiji Kudo

Brain tuberculoma and its occurrence within the subarachnoid cisterns is rare in Japan. Serological and cerebrospinal fluid (CSF) examinations and imaging findings lack specificity; thus, preoperative diagnosis is often challenging. This report presents the case of a 70-year-old woman admitted to our hospital with a one-month history of low-grade fever and altered mental status. Based on the CSF analysis and her history of latent tuberculosis infection seven years ago, she was strongly suspected of suffering from tuberculous meningitis (TBM). Consequently, the patient was enrolled in a clinical trial for antituberculosis treatment (ATT). CSF soluble interleukin-2 receptor level decreased from 2,926 U/mL on day 1 to 225 U/mL 42 days after initiating ATT. Her condition improved after five weeks; however, contrast-enhanced T1-weighted magnetic resonance imaging (MRI) revealed multiple enhanced lesions within the basal subarachnoid cisterns 25 days after admission. As the number and size of these lesions increased, a biopsy confirmed brain tuberculoma diagnosis, and the treatment was continued. In conclusion, when intracisternal scattered mass lesions are identified during TBM treatment, we should consider the possibility of tuberculoma developments arising from a paradoxical response (PR) during the treatment. Serial MRIs are crucial in monitoring PR development in cisternal tuberculomas, an extension of severe TBM. Finally, a PR can be effectively managed by continuing ATT with adjunctive corticosteroids.

在日本，脑结核瘤及其在蛛网膜下腔内的发生非常罕见。血清学和脑脊液（CSF）检查以及影像学检查结果缺乏特异性，因此术前诊断往往具有挑战性。本报告介绍了一名 70 岁女性的病例，她因一个月的低烧和精神状态改变入院。根据脑脊液分析和七年前的潜伏结核感染史，她被强烈怀疑患有结核性脑膜炎（TBM）。因此，患者被纳入了抗结核治疗（ATT）的临床试验。CSF 可溶性白细胞介素-2 受体水平从开始 ATT 第 1 天的 2,926 U/mL降至 42 天后的 225 U/mL。五周后，她的病情有所好转；然而，对比增强 T1 加权磁共振成像（MRI）显示，入院 25 天后，基底蛛网膜下腔内出现多个强化病灶。随着病灶数量和大小的增加，活检证实了脑结核瘤的诊断，治疗得以继续。总之，在 TBM 治疗过程中发现胸内散在肿块病变时，我们应考虑治疗过程中的矛盾反应（PR）导致结核瘤发展的可能性。连续磁共振成像对于监测严重 TBM 扩展的胸骨睫状体结核瘤的 PR 发展至关重要。最后，继续进行 ATT 并辅助皮质类固醇治疗可有效控制 PR。

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引用次数: 0

Parent Artery Occlusion for a Dissecting Posterior Cerebral Artery Aneurysm in the P4 Segment Presenting with Ischemic Stroke and Rapid Growth: A Case Report 以缺血性中风和快速增长为表现的 P4 节段解剖性大脑后动脉动脉瘤的母动脉闭塞术：病例报告

NMC Case Report Journal

Pub Date : 2024-04-05 DOI: 10.2176/jns-nmc.2023-0267

Kotaro Ishimoto, Jo Matsuzaki, R. Iwata, Naoki Yamamoto, Toru Yamagata, H. Ikuno, Misao Nishikawa, Takeo Goto

A dissecting aneurysm in the P4 segment of the posterior cerebral artery (PCA) is extremely rare, and its treatment is sometimes challenging. Endovascular parent artery occlusion (PAO) was performed for an unruptured P4 segment dissecting PCA aneurysm presenting with ischemic stroke and rapid growth. A 70-year-old man was rushed to our emergency department due to a right-sided headache and a visual field defect. Head magnetic resonance imaging showed a right occipital lobe ischemic stroke, with right PCA occlusion and aneurysm formation in the P4 segment. The diagnosis was PCA dissection in the calcarine artery, and oral aspirin was started. Within a week, the dissecting aneurysm had enlarged progressively to 6.2 mm in diameter. Thus, PAO with coils was performed as a preventive measure against aneurysm rupture, assuming that complication risks were low because the tributary area of the dissecting PCA had already infarcted. A 6-Fr guiding sheath was introduced from the right brachial artery to the right vertebral artery, and a microcatheter/microguidewire was placed into the true lumen of the calcarine artery distal to the aneurysm. PAO with coils was performed, and the blood flow to the aneurysm was completely obliterated. After the treatment, the known infarction in the right occipital lobe was enlarged, but no new neurological symptoms developed. The patient was discharged independently on postoperative day 3. Treatment for a distal PCA dissecting aneurysm is challenging. PAO with coils is one of the reasonable choices, especially when a visual field defect has already developed.

大脑后动脉（PCA）P4段的剥脱性动脉瘤极为罕见，其治疗有时也极具挑战性。我们对一个伴有缺血性中风和快速增长的未破裂的P4段剥离性PCA动脉瘤实施了血管内母动脉闭塞术（PAO）。一名 70 岁的男子因右侧头痛和视野缺损被紧急送往我院急诊科。头部磁共振成像显示患者右枕叶缺血性卒中，右侧PCA闭塞，P4段动脉瘤形成。诊断为钙动脉 PCA 夹层，开始口服阿司匹林。一周内，夹层动脉瘤逐渐扩大到直径 6.2 毫米。由于剥离的 PCA 支流区域已经发生梗塞，假设并发症风险较低，因此作为动脉瘤破裂的预防措施，进行了带线圈的 PAO。从右肱动脉到右椎动脉导入一根 6 英尺长的导引鞘，然后将微导管/微导丝放入动脉瘤远端钙动脉的真腔中。使用线圈进行了 PAO，动脉瘤的血流被完全阻断。治疗后，已知的右枕叶梗塞扩大，但没有出现新的神经症状。患者于术后第 3 天独立出院。远端 PCA 夹层动脉瘤的治疗具有挑战性。使用线圈的 PAO 是合理的选择之一，尤其是在已经出现视野缺损的情况下。

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引用次数: 0

Thoracic Intra and Extramedullary Capillary Hemangioma with Subacute Clinical Course: A Case Report and Literature Review 胸腔髓内和髓外毛细血管瘤，临床过程呈亚急性：病例报告和文献综述

NMC Case Report Journal

Pub Date : 2024-04-05 DOI: 10.2176/jns-nmc.2023-0205

Yumeki Yamamoto, Hiroya Shimauchi-Ohtaki, Fumiaki Honda, Takahiro Shirakura, Keigo Aramaki, Ryosuke Shintoku, T. Miyagishima, Masanori Aihara, Hideaki Yokoo, Y. Yoshimoto

Capillary hemangiomas are benign tumors comprising a lobulated proliferation of capillary vessels frequently located in the soft tissues of the neck and head. Spinal intradural capillary hemangiomas are rare, particularly intramedullary lesions. To our knowledge, only 31 cases of spinal intramedullary capillary hemangiomas have been reported. Here, we describe a rare case of a thoracic capillary hemangioma comprising extramedullary and intramedullary components. A 51-year-old male patient presented with bilateral lower extremity numbness and subsequent paraparesis, sensory disturbance, and bladder-bowel dysfunction with a subacute clinical course. Magnetic resonance imaging revealed a mass lesion with intramedullary and intradural extramedullary components at the Th9-10 vertebrae level and widespread spinal cord edema. Contrast-enhanced computed tomography revealed abnormal vessels on the dorsal spinal cord surface. Spinal angiography revealed a light-stained mass lesion fed by the radiculopial artery from the right Th11 intercostal artery. The tumor was resected en bloc, and the histological diagnosis was a capillary hemangioma. Postoperatively, the spinal cord edema diminished, and the patient was discharged from the convalescent rehabilitation ward. Although intramedullary capillary hemangioma is a rare spinal tumor and its preoperative diagnosis is difficult, it should be considered in the differential diagnosis of spinal intramedullary tumors.

毛细血管瘤是一种良性肿瘤，由经常位于颈部和头部软组织的毛细血管分叶状增生组成。脊髓硬膜内毛细血管瘤非常罕见，尤其是髓内病变。据我们所知，目前仅有31例脊髓髓内毛细血管瘤的报道。在此，我们描述了一例罕见的胸腔毛细血管瘤病例，该病例包含髓外和髓内成分。一名 51 岁的男性患者出现双下肢麻木，随后出现截瘫、感觉障碍和膀胱-肠道功能障碍，临床过程呈亚急性。磁共振成像显示，Th9-10椎体水平存在髓内和髓外肿块病变，脊髓广泛水肿。对比增强计算机断层扫描显示脊髓背侧表面血管异常。脊髓血管造影显示，右侧Th11肋间动脉的桡动脉供应了一个光染肿块病灶。肿瘤被整体切除，组织学诊断为毛细血管瘤。术后，脊髓水肿减轻，患者从康复疗养病房出院。虽然髓内毛细血管瘤是一种罕见的脊柱肿瘤，术前诊断也很困难，但在脊柱髓内肿瘤的鉴别诊断中应将其考虑在内。

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引用次数: 0

Probable Sporadic Creutzfeldt-Jakob Disease Presenting as Refractory Status Epilepticus in a Poststroke Epilepsy Patient: A Case Report 中风后癫痫患者出现难治性癫痫状态的疑似散发性克雅氏病：病例报告

NMC Case Report Journal

Pub Date : 2023-12-31 DOI: 10.2176/jns-nmc.2023-0166

Junki Sogano, Kenzo Kosugi, Atsushi Okano, Yoshihiro Nihei, Narumi Watanabe, Jin Nakahara, Masahiro Toda

引用次数: 0

Successful Treatment of a CNS Tumor with BCOR Internal Tandem Duplication: A Case Report 用 BCOR 内部串联复制成功治疗中枢神经系统肿瘤：病例报告

NMC Case Report Journal

Pub Date : 2023-12-31 DOI: 10.2176/jns-nmc.2023-0091

Reina Mizuno, Atsushi Sasaki, Tomonari Suzuki, junihci adachi, M. Shirahata, Ryo Nishikawa, K. Mishima

引用次数: 0

Internal Trapping of a Growing Ruptured Dissecting Aneurysm of the A1 Segment: A Case Report and Literature Review. A1 节段生长型破裂剥离动脉瘤的内陷：病例报告与文献综述

NMC Case Report Journal

Pub Date : 2023-08-03 eCollection Date: 2023-01-01 DOI: 10.2176/jns-nmc.2023-0060

Tomoki Kimura, Yoshikazu Arai, Shintaro Yamada, Tetsuya Hosoda

A 47-year-old man presented with sudden-onset headache and Fisher group 3 subarachnoid hemorrhage. The World Federation of Neurological Surgeons grade was II. Digital subtraction angiography (DSA) only showed a vessel wall irregularity in the A1 segment of the right anterior cerebral artery (ACA), but an obvious bleeding source was not detected. Repeat angiography showed a tiny aneurysmal dilatation in the A1 segment with an intimal flap. The aneurysm enlarged on subsequent angiograms. Dissecting aneurysm was diagnosed, and the patient underwent internal trapping of the A1 segment to prevent rerupture. Postoperative DSA showed complete obliteration of the dissected segment. Magnetic resonance imaging showed a clinically silent cerebral infarction in the territory of the A1 segment perforators. Parent vessel occlusion for a dissected A1 segment can be effective, provided that sufficient collateral blood flow from the contralateral ACA is observed. We recommend endovascular trapping in this setting and hope that fellow clinicians select this approach for this rare pathology.

一名 47 岁的男子因突发头痛和费舍尔第 3 组蛛网膜下腔出血而就诊。世界神经外科医师联合会分级为 II 级。数字减影血管造影（DSA）仅显示右侧大脑前动脉（ACA）A1段血管壁不规则，但未发现明显的出血源。复查血管造影显示，A1 段有一个微小的动脉瘤扩张，内膜瓣。随后的血管造影显示动脉瘤扩大。诊断为剥脱性动脉瘤，患者接受了 A1 段动脉瘤内陷术，以防止动脉瘤再次破裂。术后 DSA 显示夹层动脉瘤完全闭塞。磁共振成像显示，A1段穿孔器区域出现了临床上无症状的脑梗塞。只要能观察到来自对侧 ACA 的足够侧支血流，对 A1 节段断裂的母血管进行闭塞是有效的。在这种情况下，我们建议采用血管内阻断术，并希望临床医生选择这种方法来治疗这种罕见的病症。

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引用次数: 0

Spontaneous Middle Meningeal Arteriovenous Fistula Caused by Aneurysm Rupture: A Case Report. 动脉瘤破裂引起的自发性中脑膜动静脉瘘：病例报告。

NMC Case Report Journal

Pub Date : 2023-03-24 eCollection Date: 2023-01-01 DOI: 10.2176/jns-nmc.2022-0376

Satoshi Miyamoto, Hisayuki Hosoo, Eiichi Ishikawa, Yuji Matsumaru

Middle meningeal arteriovenous fistula (MMAVF) is a shunt between the middle meningeal artery and the vein surrounding the artery. We report an extremely rare case of spontaneous MMAVF; then, we evaluated the effectiveness of trans-arterial embolization for spontaneous MMAVF and the possible cause of spontaneous MMAVF. A 42-year-old man with tinnitus, a left temporal headache, and pain surrounding the left mandibular joint was diagnosed with MMAVF on digital subtraction angiography. Trans-arterial embolization with detachable coils was conducted, which resulted in a fistula closure and symptoms' diminishment. The cause of MMAVF was thought to be the rupture of the middle meningeal artery aneurysm. A middle meningeal artery aneurysm can be a cause of spontaneous MMAVF, and trans-arterial embolization might be an optimal treatment.

中脑膜动静脉瘘（MMAVF）是中脑膜动脉与动脉周围静脉之间的分流。我们报告了一例极为罕见的自发性中脑膜动静脉瘘病例，然后评估了经动脉栓塞治疗自发性中脑膜动静脉瘘的效果以及自发性中脑膜动静脉瘘的可能病因。一名 42 岁的男子患有耳鸣、左颞部头痛和左下颌关节周围疼痛，经数字减影血管造影确诊为 MMAVF。使用可拆卸线圈进行经动脉栓塞治疗后，瘘管闭合，症状减轻。MMAVF 的病因被认为是脑膜中动脉瘤破裂。脑膜中动脉瘤可能是自发性 MMAVF 的病因，经动脉栓塞可能是最佳治疗方法。

引用次数: 0

Advantages of Extradural Anterior Clinoidectomy and Extradural Approach with Dural Incision for Blood Blister Aneurysm or Pseudoaneurysm in the Internal Carotid Artery: Two Case Reports. 硬膜外前斜突切除术及硬膜外入路硬膜切口治疗颈内动脉血疱性动脉瘤或假性动脉瘤2例

NMC Case Report Journal

Pub Date : 2023-01-01 DOI: 10.2176/jns-nmc.2022-0272

Hideki Nakajima, Shigetoshi Shimizu, Takuro Tsuchiya, Hidenori Suzuki

Blood blister aneurysms (BBAs) or pseudoaneurysms (PAs) in the internal carotid artery (ICA) have fragile necks; therefore, conventional neck clipping is difficult. The standard treatment for BBAs or PAs is trapping with high or low flow bypass. However, there is no consensus on whether or not anterior clinoidectomy should be performed together. Two patients with ruptured ICA PA (anterior protrusion) or BBA (posterior protrusion) were presented to our hospital. Complete trapping was safely performed for both types of aneurysms via extradural anterior clinoidectomy and the extradural approach with dural incision. The advantages of the procedure are 1) safe proximal clipping, 2) early identification of the ICA C3 portion, 3) minimized frontal lobe retraction, 4) optic canal opening to allow mobility of the optic nerve, and 5) dural ring incision to allow mobility of the ICA.

颈内动脉(ICA)的血泡动脉瘤(BBAs)或假性动脉瘤(PAs)颈部脆弱;因此，传统的颈部修剪是困难的。bba或pa的标准处理方法是采用高流量或低流量旁路捕集。然而，对于是否应同时行前突切除术尚无共识。我们收治了2例ICA前突(PA)或后突(BBA)破裂的患者。通过硬膜外前斜突切除术和硬膜外入路硬膜切口对两种类型的动脉瘤均进行了完全捕获。该手术的优点是1)安全的近端夹闭，2)早期识别ICA C3部分，3)最小化额叶缩回，4)打开视神经管以允许视神经活动，5)硬膜环切口以允许ICA活动。

引用次数: 0

Speech-language Pathology Rehabilitation in a Case of Jefferson Fracture Complicated with Lower Cranial Nerve Palsies. 杰弗逊骨折合并下颅神经麻痹1例言语病理康复。

NMC Case Report Journal

Pub Date : 2023-01-01 DOI: 10.2176/jns-nmc.2022-0060

Shota Horiike, Yasuhiro Nakajima, Mamoru Matsuo, Akinori Kageyama, Ayako Motomura, Takashi Tsujiuchi, Ryuta Saito

A 68-year-old man presented with a Jefferson fracture leading to lower cranial nerve palsies affecting the ninth, tenth, and twelfth cranial nerves with a traumatic basilar impression. On the X day, the patient underwent occipitocervical posterior fixation surgery; the surgery was uneventful. However, just after the surgery, epipharyngeal palsy and airway obstruction occurred. Consequently, tracheostomy was needed. On the X+8 day, speech-language pathology (SLP) therapy was initiated for decannulation. On the X+21 day, the patient could clear all the checkpoints and was decannulated. On the X+36 day, the patient was discharged home and SLP therapy was continued. On the X+171 day, his SLP therapy was halted. However, the patient continued to complain that he could not speak as fast as before, and his quality of life remained compromised. Some studies reported that lower cranial nerve palsies affecting the ninth to the twelfth cranial nerve occur in conjunction with Jefferson fractures. Thus, SLP therapy is crucial for Jefferson fracture cases.

一名68岁男性患者因杰弗逊骨折导致下颅神经麻痹，影响第9、第10和第12颅神经，并伴有颅底外伤。第X天，患者行枕颈后路固定手术;手术很顺利。然而，手术后不久，出现了咽上麻痹和气道阻塞。因此，需要气管切开术。在X+8天，开始言语语言病理(SLP)治疗去管。在X+21天，患者可以清除所有检查点并去空。X+36天，患者出院，继续SLP治疗。在X+171天，他的SLP治疗停止。然而，病人继续抱怨说他不能像以前那样说话快，他的生活质量仍然受到影响。一些研究报道，影响第9至第12脑神经的下脑神经麻痹与杰弗逊骨折同时发生。因此，SLP治疗对杰弗逊骨折病例至关重要。

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