A Case of Anti-CRMP5 Paraneoplastic Neurological Syndrome Induced by Atezolizumab for Small Cell Lung Cancer.

We herein report a 76-year-old man who developed irritability and forgetfulness 5 months after the introduction of atezolizumab for the treatment of small cell lung cancer (SCLC). Brain magnetic resonance imaging showed lesions of the striatum, and an investigation of the serum revealed a high titer of anti-CRMP5 antibody. After stopping atezolizumab and starting steroid pulse therapy, these clinical features improved. Given these findings, it is considered that CRMP5-assciated striatal encephalitis was induced by atezolizumab in this case with SCLC.

CMOS-based opto-electronic neural interface devices for optogenetics.

CMOS-based opto-electronic neural interface devices are presented. The devices are designed with target application of in vitro and in vivo optogenetics. Two types of the opto-electronic neural interface devices are presented. One is single-chip type device for on-chip optogenetics, and the other is multi-chip type device with flexibility and wide-area coverage for in vivo optogenetics on brain. Design, packaging and functional evaluations are presented.

Carotid Wallstent placement difficulties encountered in carotid artery stenting.

PURPOSE: The present study aimed to identify the types of curved lesions that are difficult to place Carotid Wallstent (CWS). MATERIALS AND METHODS: The study targeted 31 consecutive carotid artery (CA) stenosis underwent carotid artery stenting using CWS. CWS placement success rate, stenosis location, lesion tortuosity, and relationship with stent placement failures were investigated. Lesion tortuosity was defined as the angle formed by 2 tangential lines between internal CA and common CA from the inflection point (IP) was defined as the center of lesion curvature. Stenosed lesions were classified into type A or B. Type A was defined as if the distal end of the stenosis was located proximal to the IP at a distance ≥0.5 of a vertebral body based on the posterior height of the 3rd vertebral body, otherwise was type B. RESULTS: The stent placement success rate was 93.5% (29/31). The 2 unsuccessfully stented lesions, both lesions were significantly different from other lesions by having a lesion tortuosity less than 90° and by belonging to type B. CONCLUSION: Since CWS placement is difficult in patients with CA stenosis located close to the IP at a lesion tortuosity ≤90°, open-cell stents should be considered as an alternative.

Obstacles encountered during transradial angiography from after Radial Artery puncture to the aortic arch.

OBJECTIVE: To elucidate the key points for safe performance of transradial angiography. CONCLUSIONS: Transradial angiography can be performed safely if attention is paid to the following points from after radial artery puncture to reaching the aortic arch: resistance during guide wire operation for sheath insertion after puncture; confirmation of the superficial brachial artery; guide wire resistance while guiding the catheter to the aortic arch; and aortic arch anomalies.

Changes of tumor size and tumor contrast enhancement during radiotherapy for non-small-cell lung cancer may be suggestive of treatment response.

We evaluated sequential dynamic contrast-enhanced CT (DCE-CT) scans to assess the possibility of early prediction of treatment responses by quantifying the tumor size reduction and the change in tumor enhancement during and after a course of radiotherapy (RT). Thirty-nine patients with non-small-cell lung cancer were treated with RT for initial treatment. DCE-CT scan was performed within one week before the beginning of treatment, after 17 or 18 fractions (34 or 36 Gy), and 1 week and 1 month after the end of RT. The correlation between the relative decrease in tumor diameter and that in the attenuation value was evaluated. Nineteen patients were evaluated in this study. The median tumor size was 39.5 mm at the start of treatment, 30.8 mm at 34-36 Gy, and 16.1 mm 1 month after the end of RT. The relative decrease in tumor diameter at 34-36 Gy well correlated with that 1 month after treatment (r = 0.85, r: Pearson's correlation coefficient, p < 0.001). Relative change in the attenuation value at the rim of the tumor at 34-36 Gy did not significantly correlate with the change in tumor diameter 1 month after the completion of RT, but in the center of the tumor, the change of the attenuation value in the delayed phase correlated with the change in tumor diameter. The decrease of tumor diameter during RT may be predictive of treatment response. The relative change of tumor enhancement in the center of the tumor in the delayed phase correlated with tumor shrinkage 1 month after the completion of RT.

Usefulness of contrast-enhanced magnetic resonance angiography for follow-up of coil embolization with the enterprise stent for cerebral aneurysms.

OBJECTIVE: The aim of this study was to determine the feasibility and usefulness of contrast-enhanced magnetic resonance angiography (CE-MRA) and 3-dimensional (3D) time-of-flight (TOF) MRA for follow-up of intracranial aneurysms treated using the Enterprise stent. METHODS: Five aneurysm cases using the Enterprise stent were prospectively analyzed and were followed up with CE-MRA, 3D TOF MRA, and digital subtraction angiography (DSA). Depictions of parent artery lumen and the aneurysm neck with 3D TOF MRA and CE-MRA were compared with those of DSA. RESULTS: In all cases, on 3D TOF MRA, it was difficult to evaluate the parent artery lumen and aneurysm neck owing to the significant artifacts from the stent. Contrast-enhanced MRA sufficiently demonstrated parent artery lumen and aneurysm neck distinctly and as clear as DSA did in all cases. CONCLUSIONS: For follow-up after coiling with an Enterprise stent, CE-MRA may be necessary to avoid susceptibility artifacts caused by the stent.

Initial experience of carotid artery stenting using the Carotid WALLSTENT and FilterWire EZ in Japan.

PURPOSE: The Carotid WALLSTENT (CWS) and Filter-Wire EZ (FWEZ) embolic protection devices for use in carotid arterial stenting (CAS) were newly approved for national health insurance coverage in Japan in April 2010. This article describes our initial experience of CAS using the CWS and FWEZ. MATERIAL AND METHODS: A group of 14 patients (12 men, 2 women; mean age 70.1 years, range 59-83 years) with 15 carotid artery stenoses at high risk for carotid endarterectomy were treated by CAS using the CWS and FWEZ. Of these stenoses, 5 were symptomatic with ≥50% stenosis of the common or internal carotid artery (ICA), and 10 were asymptomatic with ≥80% stenosis. The rates of technical success, ICA flow impairment during filter protection, periprocedural ischemic stroke, 30-day major adverse events (MAEs) (stroke, death, myocardial infarction), and development of new ischemic lesions on diffusion-weighted imaging (DWI) were assessed. RESULTS: CAS was successful in all cases. There was no ICA flow impairment, periprocedural ischemic stroke, or MAEs. DWI showed new ipsilateral ischemic lesions in only one patient (6.7%). CONCLUSION: Our initial clinical experience using the CWS and FEWZ for CAS was generally excellent, and the incidence of postprocedural ischemic lesions was low.

Anterior cerebral artery notching on anterior optic pathways in a child with craniopharyngioma and progressive blindness.

We report the clinical significance of anterior cerebral artery (ACA) notching on the optic nerve and chiasm in a 3.5-year-old girl with a craniopharyngioma and progressive blindness. She presented with a headache and vomiting, followed by binocular blindness. Magnetic resonance imaging (MRI) studies demonstrated severely distended A1 segments and ill-depicted ACAs. Surgical decompression via a right subfrontal approach was performed to reverse blindness. Postoperative MRI studies showed good ACA visualization. A second operation via a right pterional approach revealed ACA notching, which appeared as a transverse groove on the right optic nerve and chiasm. ACA notching should be considered as a possible cause of progressive visual disturbance and a potential risk of ACA infarction in a child with a craniopharyngioma.

Anatomical evaluation of the dural sinuses in the region of the torcular herophili using three dimensional CT venography.

RATIONALE AND OBJECTIVES: The torcular herophili, or "confluence of the sinuses," shows various configurations with other venous sinuses, as revealed by angiography. The aims of this study were to evaluate anatomic variations of this confluence and to assess their clinical relevance using three-dimensional (3D) computed tomographic (CT) venography. MATERIALS AND METHODS: The torcular herophili and its relevant venous sinuses were analyzed using 3D CT venography in 120 adults, consisting of 76 patients who were proven to have aneurysms and 44 patients who were proven to have no vascular malformations or aneurysms after the examinations. Three-dimensional CT venography was performed following the arterial phase of 3D CT angiography without any additional injection of contrast material. Three-dimensional volume-rendered venous images were reconstructed on a workstation and reviewed. RESULTS: The superior sagittal sinus (SSS) drained into the transverse sinus (TS) in four patterns: the SSS reached the centrally located confluence, where it divided into the bilateral TS (20.0%); the SSS was prematurely duplicated into the right and left limbs and drained into the same side TS (26.7%); the SSS drained exclusively into the right TS (44.2%); or the SSS drained exclusively into the left TS (9.2%). The draining pattern of the straight sinus was also classified into four types. The right TS was larger than the left TS. The right TS were higher compared to the left TS. Persistent occipital sinuses were recognized in 57.5% of the subjects. Finally, persistent falcial sinuses were seen in 2.5% of the subjects. A septum in the SSS and complicated venous channels in the confluence were each seen in only one case. CONCLUSION: Three-dimensional CT venography is useful as a noninvasive method to evaluate the confluence and its relevant dural sinuses and can provide useful information for surgical intervention.

Magnetic resonance plaque imaging to predict the occurrence of the slow-flow phenomenon in carotid artery stenting procedures.

INTRODUCTION: The purpose is to investigate the feasibility of magnetic resonance (MR) plaque imaging in predicting the arterial flow impairment (slow-flow phenomenon) during carotid artery stenting (CAS) using a filter-type protection device. METHODS: Thirty-one carotid artery stenotic lesions in 30 patients (28 men and two women; mean age, 71.8 years) were evaluated by MR plaque imaging with black blood T1- and T2-weighted and time-of-flight sequences before CAS. Main plaque components were classified as vulnerable (intraplaque hemorrhage and lipid-rich/necrotic core) or stable (fibrous tissue and dense calcification) from the signal pattern. The plaque classification was statistically compared with the occurrence of slow-flow phenomenon. RESULTS: The slow-flow phenomenon was observed in ten CAS procedures (five flow arrests and five flow reductions). Flow arrests consisted of four vulnerable and one stable plaque, and flow reductions consisted of four vulnerable and one stable plaque. The slow-flow phenomenon occurred significantly (P<0.01) more frequently in patients with vulnerable plaque. CONCLUSIONS: Vulnerable carotid plaques have a significantly higher risk of slow-flow phenomenon than stable plaques. The occurrence of the slow-flow phenomenon can be predicted by MR plaque imaging before CAS.

"Sukeroku sign" and "dent internal-capsule sign"--identification guide for targeting the subthalamic nucleus for placement of deep brain stimulation electrodes.

INTRODUCTION: The purpose of this study was to assess the usefulness of signs ("Sukeroku sign" and "dent internal-capsule sign") for the recognition of subthalamic nucleus (STN). MATERIALS AND METHODS: Five Parkinson's disease cases in which there was a successful placement of deep brain stimulation (DBS) electrodes at the STN were retrospectively reviewed. Five radiologists who were not engaged in localization of STNs in clinical practice were asked to locate the STNs before and after instructions on the signs. We evaluated the deviation between the reader-located points and the location of the DBS electrode for which there had been a successful installation. RESULTS: After instruction, there was a significant reduction in the deviation between the reader-located points and the DBS electrode. The time required for localization was also reduced after the instructions. CONCLUSION: Sukeroku sign and dent internal-capsule sign are feasible indicators of STN and seem to be useful in helping to identify the STN.

Initial experience of using the filter protection device during carotid artery stenting in Japan.

PURPOSE: No filter protection devices for carotid artery stenting (CAS) have been formally approved for use in Japan; however, as of April 2008, the Angioguard XP (AGXP) was approved. This article describes our initial results using the AGXP during CAS for the treatment of carotid artery stenosis. MATERIAL AND METHODS: A group of 15 patients (14 men) with a mean age of 72.3 years (range 53-81 years) were treated by CAS using the AGXP. Among them, 10 were symptomatic with >50% stenosis of the common or internal carotid artery (ICA), and 5 were asymptomatic with >70% stenosis. The rates of technical success, periprocedural stroke, ICA flow impairment, filter movement, and development of new ischemic lesions on diffusion-weighted imaging (DWI) were assessed. RESULTS: CAS using the AGXP was successful in all cases. There was one minor stroke, and flow impairment occurred in six patients. Filter movement averaged 1.9 vertebral bodies. DWI showed new ipsilateral ischemic lesions in eight of the patients. CONCLUSION: Initial clinical experience using the AGXP for CAS has been generally sufficient. However, attention must be paid to three problems when using the AGXP: the filter may move after placement; the filter may disturb blood flow in the ICA; and debris may pass around the filter.

Multiple cerebral aneurysms associated with Takayasu arteritis successfully treated with coil embolization.

The cerebrovascular complications of Takayasu arteritis are primarily related to the presence of occlusive lesions. Cerebral aneurysms rarely occur as complications; only 18 cases have been reported thus far. The use of coil embolization to treat cerebral aneurysms occurring as a complication of Takayasu arteritis has not been previously reported. We report a case of Takayasu arteritis with a basilar tip aneurysm and a P1 segment aneurysm of the left posterior cerebral artery that were successfully treated with coil embolization. Because coil embolization for cerebral aneurysms associated with Takayasu arteritis requires the use of limited access routes that have extremely curved and tortuous courses, catheter navigation was difficult. The guide catheter, microcatheter, and guidewire must be selected and navigated with greater care than is usually required for common aneurysm embolization.

Cerebral hemorrhage with angiographic extravasation immediately after carotid artery stenting.

Recognizing cerebral hyperperfusion syndrome with intracerebral hemorrhage following carotid artery stenting is critical because the mortality rate is high. This type of hemorrhage usually arises from within several hours to a few days after the procedure. Here we describe a putaminal hemorrhage with extravasation during angiography that developed immediately after carotid artery stenting. A search of the literature revealed only one other similar case report. The etiology of the intracerebral hemorrhage immediately after carotid stenting might be analogous to that of hypertensive hemorrhage.

Diffusivity and diffusion anisotropy of cerebellar peduncles in cases of spinocerebellar degenerative disease.

PURPOSE: This study accessed the feasibility of using tractography-based analysis to evaluate the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) of three cerebellar peduncles in subtypes of spinocerebellar degenerative disease. MATERIALS AND METHODS: We examined 7 cases of dentatorubro-pallidoluysian atrophy (DRPLA), 4 cases of multiple system atrophy, cerebellar type (MSA-C), 4 cases of late cerebellar cortical atrophy (LCCA) and 8 controls. Diffusion tensor images were obtained, and tractographies of cerebellar peduncles were generated. ADC and FA along the cerebellar peduncles and volume of cerebellar peduncle were measured, and analyses of variance were made among the control and each spinocerebellar degenerative disease groups. RESULTS: There were statistically significant decrease in FA and volume and increase in ADC values between DRPLA cases and controls in all three cerebellar peduncles. On the other hand, MSA-C cases mainly showed statistically significant decreased FA and volume and increased ADC values in the middle cerebellar peduncle. LCCA cases did not show prominent difference in the three cerebellar peduncles. CONCLUSION: The values of diffusivity and diffusion anisotropy of cerebellar peduncles evaluated by tractography based measurements seem to reflect characteristics of the different types of spinocerebellar degenerative diseases. Tractography-based measurements may be a feasible tool for differential diagnosis of spinocerebellar degenerative disease.