ABSTRACT
Higher brain dysfunctions commonly interfere with functional reconstruction during rehabilitation. Most culprit lesions causing higher brain dysfunctions are observed in the cerebral cortex. However, recently, higher brain dysfunction caused by cerebellar lesions, termed cerebellar cognitive affective syndrome (CCAS), has attracted attention. Here, we report a case of CCAS in a patient with cerebellar infarction exhibiting aphasia, where arterial spin labeling (ASL) method of magnetic resonance imaging (MRI) was used to confirm decreased blood flow due to crossed cerebello-cerebral diaschisis (CCCD). The patient was a 5x years old, left-handed female. She was initially admitted to a neurosurgical hospital for dizziness. MRI demonstrated cerebellar infarction in the left posterior inferior cerebellar artery area. The next day, she was admitted to our hospital for surgery after the diagnosis of hemorrhagic cerebellar infarction due to progressive loss of consciousness. Craniotomy was performed to remove the hematoma. Neurological examination revealed fluent aphasia and ataxia in the left upper and lower extremities and trunk. ASL demonstrated decreased cerebral blood flow in the left cerebellar hemisphere and right front-temporal lobe. Therefore, we detected that CCCD resulted in higher brain dysfunction. After 3 months of inpatient rehabilitation, the patient's auditory comprehension, word conversion, and word recall improved. The patient was discharged unaided. This study used ASL to confirm the diagnosis and rehabilitation of the CCAS incidence effectively.
ABSTRACT
Higher brain dysfunctions commonly interfere with functional reconstruction during rehabilitation. Most culprit lesions causing higher brain dysfunctions are observed in the cerebral cortex. However, recently, higher brain dysfunction caused by cerebellar lesions, termed cerebellar cognitive affective syndrome (CCAS), has attracted attention. Here, we report a case of CCAS in a patient with cerebellar infarction exhibiting aphasia, where arterial spin labeling (ASL) method of magnetic resonance imaging (MRI) was used to confirm decreased blood flow due to crossed cerebello-cerebral diaschisis (CCCD). The patient was a 5x years old, left-handed female. She was initially admitted to a neurosurgical hospital for dizziness. MRI demonstrated cerebellar infarction in the left posterior inferior cerebellar artery area. The next day, she was admitted to our hospital for surgery after the diagnosis of hemorrhagic cerebellar infarction due to progressive loss of consciousness. Craniotomy was performed to remove the hematoma. Neurological examination revealed fluent aphasia and ataxia in the left upper and lower extremities and trunk. ASL demonstrated decreased cerebral blood flow in the left cerebellar hemisphere and right front-temporal lobe. Therefore, we detected that CCCD resulted in higher brain dysfunction. After 3 months of inpatient rehabilitation, the patient's auditory comprehension, word conversion, and word recall improved. The patient was discharged unaided. This study used ASL to confirm the diagnosis and rehabilitation of the CCAS incidence effectively.
ABSTRACT
Papillary thyroid carcinoma (PTC) is the most representative carcinoma among thyroid malignancies. The treatment strategy, especially surgery, in Japan traditionally differs from that in other countries, including Korea. Total thyroidectomy has been less frequently adopted, but lymph node dissection has been more actively performed in Japan than in other countries. Based on our data, total thyroidectomy is not necessary for low-risk patients, while it is, of course, mandatory for patients with high-risk features. Prophylactic central node dissection may not prolong patients' survival, but we routinely perform it because reoperation for recurrence to this compartment is troublesome. In the past, Japanese endocrine surgeons actively performed prophylactic lateral node dissection, but indications are narrowing. However, it may be better to perform prophylactic modified radical neck dissection for patients exhibiting certain characteristics to reduce the rate of lymph node recurrence. I hope that surgical strategies in Japan and other countries will fuse with each other in order to identify the best treatments for PTC patients throughout the world.
Subject(s)
Humans , Asian People , Carcinoma , Factor IX , Japan , Korea , Lymph Node Excision , Lymph Nodes , Neck Dissection , Prognosis , Recurrence , Reoperation , Thyroid Gland , Thyroid Neoplasms , ThyroidectomyABSTRACT
Before, and at various time intervals after a marathon race, we examined the changes in serum β -enolase concentration in 6 healthy, non-athlete volunteers and compared then with changes in serum creatine kinase (CK) and creative kinase MB isozyme (CK-MB) activities. The enzyme β-enolase (a β and ββ) exists in skeletal and heart muscle, where it catalyzes the step in the glycolytic pathway between 2-phosphoglycerate and phosphoenolpyruvate. For determination of β-enolase concentration, serum was analyzed by the sandwich enzyme immunoassay method. The β-enolase concentration was significantly increased from the pre-race value. At 6 h after the race, the β-enolase concentration became maximal in all subjects, while CK and CK-MB activities did so in one and two subjects, respectively. CK and CK-MB activities peaked at 24 h in five and four subjects, respectively. The rise and fall of β-enolase concentration was faster than those of CK and CK-MB activities. Therefore, assay of β-enolase concentration has considerable advantage for early detection of skeletal muscle damage and is highly specific and sensitive. The mean β-enolase concentration±S. D. before and immediately after, and 6, 24, 48 h and 1 week after the race was 7.7±5.96, 204±87.6, 400±292.0, 214±166.3, 41.1±30.89, and 6.5±2.20 ng/ml, respectively. There was a significant correlation between the peak β-enolase concentration and peak CK activity (r=0.981, p<0.05) and peak CK-MB activity (r=0.926, p<0.05) . However, there was no significant correlation between β-enolase concentration and Vo<SUB>2</SUB>max.<BR>These results suggest that serum β-enolase concentration may be a more effective marker of skeletal muscle damage after prolonged exercise, as well as for determination of CK activity.