A 42-year-old man with aphasia and right hemiparesis thought to be caused by a middle cerebral artery branch occlusion and consistent with an embolic stroke was referred to our hospital for further evaluation and treatment. Imaging studies failed to identify the embolic source of the stroke, although a lesion protruding into the proximal portion of the left internal artery lumen was demonstrated on carotid ultrasonography. Specifically, the protruding lesion was a crescent-shaped membranous structure however, we did not initially regard the protruding lesion as the embolic source. Therefore, he was treated with warfarin and followed in the outpatient clinic. Serial carotid ultrasonographic examinations performed at each outpatient clinic visit revealed no structural changes in the crescent-shaped membranous structure, but a thrombus distal to the membranous structure was detected 6 months after the stroke onset in spite of warfarin therapy. At that time, we determined that the protruding lesion was a carotid web and the embolic source of the stroke. He underwent a carotid endarterectomy, the warfarin was discontinued, and he has had no recurrent strokes. A carotid web is an important embolic source of an ischemic stroke, but has not been widely reported. It is essential to recognize a carotid web as a potential embolic source to prevent stroke recurrence.
{"title":"A case of juvenile cerebral infarction in which thrombus at carotid web was detected by carotid ultrasound","authors":"Tami YAMAMOTO, Masaki NAGANUMA, Yuichiro INATOMI, Masatomo KAJI, Takihiro KAMIO, Toshiro YONEHARA, Yoichiro HASHIMOTO","doi":"10.2301/neurosonology.36.52","DOIUrl":"https://doi.org/10.2301/neurosonology.36.52","url":null,"abstract":"A 42-year-old man with aphasia and right hemiparesis thought to be caused by a middle cerebral artery branch occlusion and consistent with an embolic stroke was referred to our hospital for further evaluation and treatment. Imaging studies failed to identify the embolic source of the stroke, although a lesion protruding into the proximal portion of the left internal artery lumen was demonstrated on carotid ultrasonography. Specifically, the protruding lesion was a crescent-shaped membranous structure however, we did not initially regard the protruding lesion as the embolic source. Therefore, he was treated with warfarin and followed in the outpatient clinic. Serial carotid ultrasonographic examinations performed at each outpatient clinic visit revealed no structural changes in the crescent-shaped membranous structure, but a thrombus distal to the membranous structure was detected 6 months after the stroke onset in spite of warfarin therapy. At that time, we determined that the protruding lesion was a carotid web and the embolic source of the stroke. He underwent a carotid endarterectomy, the warfarin was discontinued, and he has had no recurrent strokes. A carotid web is an important embolic source of an ischemic stroke, but has not been widely reported. It is essential to recognize a carotid web as a potential embolic source to prevent stroke recurrence.","PeriodicalId":40206,"journal":{"name":"Neurosonology and Cerebral Hemodynamics","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135443099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.2301/neurosonology.36.3
Y. Ueno
{"title":"Pathophysiology of cryptogenic stroke identified by transesophageal echocardiography multicenter study : CHALLENGE ESUS/CS registry","authors":"Y. Ueno","doi":"10.2301/neurosonology.36.3","DOIUrl":"https://doi.org/10.2301/neurosonology.36.3","url":null,"abstract":"","PeriodicalId":40206,"journal":{"name":"Neurosonology and Cerebral Hemodynamics","volume":"52 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73908708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.2301/neurosonology.36.1
Kotaro Noda, S. Yoshimura, M. Koga
{"title":"Sonographic findings in flip-flop phenomenon (FFP)","authors":"Kotaro Noda, S. Yoshimura, M. Koga","doi":"10.2301/neurosonology.36.1","DOIUrl":"https://doi.org/10.2301/neurosonology.36.1","url":null,"abstract":"","PeriodicalId":40206,"journal":{"name":"Neurosonology and Cerebral Hemodynamics","volume":"7 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74813487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.2301/neurosonology.36.48
Kie OHYAMA, Jun FUJISAKI, Makiko KANEKO, Arisa SASAKI, Masashi KISHINO, Keita TAKAHASHI, Michihiro SAITO, Hidehiko HARA, Iruru MAETANI, Satoshi IWABUCHI
We report a suspected case of fungal mass in the right internal jugular vein. A 70-year-old man was admitted to our hospital with heart failure. He had a persistent fever and the inflammatory response increased. Serum β-D-glucan level was elevated, and Candida albicans was identified from blood culture. He was diagnosed with a fungal infection. A central venous catheter had been inserted into the right internal jugular vein for 3weeks. The ultrasonography showed a full mass image of 6 × 5mm which was attached to a string-like organizing thrombus of approximately 25mm long in the right internal jugular vein. The echogram presented a spherical and smooth outline, and slightly heterogeneous inside of the mass with scattered vesicular structures. We attempted to retrieve a foreign body using a catheter under ultrasound guidance. However, it cannot be detached from the vessel wall. Next, surgical resection was planned under intraoperative ultrasound examination, however, the surgical procedure was not performed because his general condition deteriorated. Fortunately, the level of β-D-glucan decreased after administration of amphotericin B and the foreign body, suspected fungal mass, became smaller on ultrasonography. We experienced a suspected patient with a fungal mass in the right internal jugular vein. Ultrasonography was useful in diagnosis, treatment or follow-up.
我们报告一例怀疑真菌肿块在右颈内静脉。一位70岁的老人因心力衰竭住进我院。他持续发烧，炎症反应增强。血清β- d -葡聚糖水平升高，血培养检出白色念珠菌。他被诊断患有真菌感染。中心静脉导管插入右颈内静脉3周。超声示右侧颈内静脉6 × 5mm的全肿块，附着约25mm长的串状组织血栓。超声显示肿块轮廓呈球形，光滑，肿块内部微不均质，散在泡状结构。我们试图在超声引导下用导管取出异物。然而，它不能与血管壁分离。随后，在术中超声检查下计划手术切除，但因患者一般情况恶化，未行手术。幸运的是，在给予两性霉素B后，β- d -葡聚糖水平下降，超声检查显示疑似真菌肿块的异物变小。我们遇到了一个疑似病人真菌肿块在右颈内静脉。超声检查对诊断、治疗和随访均有一定的价值。
{"title":"A case of suspected fungal mass in the right internal jugular vein detected by ultrasonography","authors":"Kie OHYAMA, Jun FUJISAKI, Makiko KANEKO, Arisa SASAKI, Masashi KISHINO, Keita TAKAHASHI, Michihiro SAITO, Hidehiko HARA, Iruru MAETANI, Satoshi IWABUCHI","doi":"10.2301/neurosonology.36.48","DOIUrl":"https://doi.org/10.2301/neurosonology.36.48","url":null,"abstract":"We report a suspected case of fungal mass in the right internal jugular vein. A 70-year-old man was admitted to our hospital with heart failure. He had a persistent fever and the inflammatory response increased. Serum β-D-glucan level was elevated, and Candida albicans was identified from blood culture. He was diagnosed with a fungal infection. A central venous catheter had been inserted into the right internal jugular vein for 3weeks. The ultrasonography showed a full mass image of 6 × 5mm which was attached to a string-like organizing thrombus of approximately 25mm long in the right internal jugular vein. The echogram presented a spherical and smooth outline, and slightly heterogeneous inside of the mass with scattered vesicular structures. We attempted to retrieve a foreign body using a catheter under ultrasound guidance. However, it cannot be detached from the vessel wall. Next, surgical resection was planned under intraoperative ultrasound examination, however, the surgical procedure was not performed because his general condition deteriorated. Fortunately, the level of β-D-glucan decreased after administration of amphotericin B and the foreign body, suspected fungal mass, became smaller on ultrasonography. We experienced a suspected patient with a fungal mass in the right internal jugular vein. Ultrasonography was useful in diagnosis, treatment or follow-up.","PeriodicalId":40206,"journal":{"name":"Neurosonology and Cerebral Hemodynamics","volume":"116 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135442741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: Patent foramen ovale (PFO), migraine, and ischemic stroke are interrelated. Although PFO closure has proven to be effective for secondary prevention of ischemic stroke in patients with cryptogenic stroke, the efficacy of PFO closure for migraine has not been established. This study aimed to evaluate the prevalence and changes in migraine before and after PFO closure in patients who underwent this procedure as a secondary prevention measure for cryptogenic stroke. Methods: Between November 2018 and March 2020, 11 consecutive patients with cryptogenic stroke who underwent transcatheter percutaneous PFO closure were enrolled and followed-up for more than six months. The diagnosis was made by a stroke neurologist, and PFO closure was performed according to relavent guidelines. Results: Four of the 11 patients had migraine, and all showed improvement after PFO closure using the Amplatzer PFO occluder. Conclusion: Some patients, especially those with cryptogenic stroke with PFO, may benefit from PFO closure for migraine.
{"title":"卵円孔開存を有する潜因性脳梗塞患者における卵円孔閉鎖術前後の片頭痛の検討（in English）","authors":"Shota IGASAKI, Takahito YAGIHASHI, Takuya SAITO, Yuichi KAWABATA, Yukako YAZAWA","doi":"10.2301/neurosonology.36.44","DOIUrl":"https://doi.org/10.2301/neurosonology.36.44","url":null,"abstract":"Objectives: Patent foramen ovale (PFO), migraine, and ischemic stroke are interrelated. Although PFO closure has proven to be effective for secondary prevention of ischemic stroke in patients with cryptogenic stroke, the efficacy of PFO closure for migraine has not been established. This study aimed to evaluate the prevalence and changes in migraine before and after PFO closure in patients who underwent this procedure as a secondary prevention measure for cryptogenic stroke. Methods: Between November 2018 and March 2020, 11 consecutive patients with cryptogenic stroke who underwent transcatheter percutaneous PFO closure were enrolled and followed-up for more than six months. The diagnosis was made by a stroke neurologist, and PFO closure was performed according to relavent guidelines. Results: Four of the 11 patients had migraine, and all showed improvement after PFO closure using the Amplatzer PFO occluder. Conclusion: Some patients, especially those with cryptogenic stroke with PFO, may benefit from PFO closure for migraine.","PeriodicalId":40206,"journal":{"name":"Neurosonology and Cerebral Hemodynamics","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135442911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-30DOI: 10.2301/neurosonology.35.1
M. Kinoshita, H. Kishima
{"title":"Focused ultrasound-induced drug delivery to the brain","authors":"M. Kinoshita, H. Kishima","doi":"10.2301/neurosonology.35.1","DOIUrl":"https://doi.org/10.2301/neurosonology.35.1","url":null,"abstract":"","PeriodicalId":40206,"journal":{"name":"Neurosonology and Cerebral Hemodynamics","volume":"2018 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83585981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-30DOI: 10.2301/neurosonology.35.9
R. Shirasawa, H. Takekawa, Shu Inami, S. Toyoda, H. Fukuda, K. Ohikata, S. Konno
Cardiac papillary fibroelastoma (CPF) is often of valvular origin, but rarely forms in coumadin ridge (CR) and may cause cerebral embolism. We present an unusual 79-year-old man with cerebral embolism caused by CPF in CR. The patient presented with right upper limb paresis and was diagnosed with left centrum ovale infarction. Atrial fibrillation and severe stenosis of the cerebral and carotid artery were not found in various examinations. Although transthoracic echocardiography showed no abnormalities, transesophageal echocardiography (TEE) revealed a mobile string-like structure measuring approximately 11 mm at the tip of the CR. We suspected a thrombus attached to the CR, and anticoagulation therapy was administered, however the structure did not dis-appear. Therefore, the patient was diagnosed as cardiac tumor and underwent tumor excision and surgical clo-sure of the left atrial appendage. The tumor was confirmed to be CPF on histopathology. Warfarin therapy was continued, and there was no recurrence of tumor or cerebral embolism at 4 months after surgery. CPF should be considered in cryptogenic stroke, especially in embolic stroke of undetermined sources cerebral embolism.
{"title":"A case of cerebral embolism due to papillary fibroelastoma in the coumadin ridge","authors":"R. Shirasawa, H. Takekawa, Shu Inami, S. Toyoda, H. Fukuda, K. Ohikata, S. Konno","doi":"10.2301/neurosonology.35.9","DOIUrl":"https://doi.org/10.2301/neurosonology.35.9","url":null,"abstract":"Cardiac papillary fibroelastoma (CPF) is often of valvular origin, but rarely forms in coumadin ridge (CR) and may cause cerebral embolism. We present an unusual 79-year-old man with cerebral embolism caused by CPF in CR. The patient presented with right upper limb paresis and was diagnosed with left centrum ovale infarction. Atrial fibrillation and severe stenosis of the cerebral and carotid artery were not found in various examinations. Although transthoracic echocardiography showed no abnormalities, transesophageal echocardiography (TEE) revealed a mobile string-like structure measuring approximately 11 mm at the tip of the CR. We suspected a thrombus attached to the CR, and anticoagulation therapy was administered, however the structure did not dis-appear. Therefore, the patient was diagnosed as cardiac tumor and underwent tumor excision and surgical clo-sure of the left atrial appendage. The tumor was confirmed to be CPF on histopathology. Warfarin therapy was continued, and there was no recurrence of tumor or cerebral embolism at 4 months after surgery. CPF should be considered in cryptogenic stroke, especially in embolic stroke of undetermined sources cerebral embolism.","PeriodicalId":40206,"journal":{"name":"Neurosonology and Cerebral Hemodynamics","volume":"21 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89495433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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