[Takotsubo Cardiomyopathy and Neurogenic Pulmonary Edema Following Fibrinolytic Therapy for Embolic Stroke:A Case Report].

A 79-year-old man presented with left hemiparesis and disturbance of consciousness. Brain magnetic resonance(MR)imaging revealed an infarction in the right insular cortex. MR angiography showed a defect in the inferior trunk of the right middle cerebral artery. The patient was treated with alteplase about 2.5 h after onset. Immediately after the intravenous alteplase administration, the hemiparesis improved. However, his respiratory condition unexpectedly worsened 10 h after onset. Chest radiography demonstrated an infiltrative shadow in both lung fields. Transthoracic echocardiogram showed a dysfunction in the left ventricle and no contraction at the apex of the heart, consistent with a type of cardiomyopathy, known as takotsubo cardiomyopathy(TCM). Gradually, the patient's respiratory and cardiac function improved. Here, we describe a very rare case of TCM and neurogenic pulmonary edema(NPE)following an acute cerebral infarction, which was treated with alteplase intravenous administration. TCM and NPE have a poor prognosis, therefore diagnosis, management, and treatment in the acute phase is required.

Cilostazol reduces periprocedural hemodynamic depression in carotid artery stenting.

The clinical effects of two different types of antiplatelet drugs, cilostazol and thienopyridine drugs, were compared in patients treated by carotid artery stenting (CAS). Two hundred patients scheduled for CAS were randomized to either cilostazol or a thienopyridine drug (ticlopidine or clopidogrel). The study was conducted in open-label design. Aspirin was also given to all patients. All episodes of periprocedural hemodynamic instability (bradycardia, hypotension) were recorded together with all instances of stroke, cardiac morbidity, and death within 30 days of the procedure. Angiographic follow-up studies were conducted about 6 months after CAS. Finally, 197 patients were enrolled in this study; 97 were treated with cilostazol (cilostazol group) and 100 with a thienopyridine drug (thienopyridine group). In the 30-day follow-up period, the incidence of stroke, cardiac adverse effects, and death was not significantly different between the 2 groups (cilostazol group 7.2%, thienopyridine group 11.0%; p = 0.85). The incidence of intra- and postprocedural bradycardia was significantly lower in the cilostazol group (cilostazol group 18.6% and 2.1%, thienopyridine group 40.0% and 18.0%, respectively; p < 0.01). Although the incidence of intraprocedural hypotension did not significantly differ between the 2 groups, postprocedural hypotension was significantly lower in the cilostazol group (16.5% vs. 34.0%, p < 0.01). In-stent restenosis on follow-up angiograms was lower in the cilostazol group but not significantly (0% vs. 4.4%, p = 0.12). This small open-label study shows that cilostazol may reduce periprocedural bradycardia and hypotension compared with thienopyridine drugs in patients treated by CAS.

[Microvascular decompression for glossopharyngeal neuralgia: case report].

We report the case of a glossopharyngeal neuralgia that was successfully treated using microvascular decompression (MVD). A 61-year-old female reported intermittent piercing pain from tongue to pinna on the left side. Although she had been prescribed carbamazepine and has undergone attempted nerve block on several occasions, no pain relief has been achieved. MVD was thus attempted using a lateral suboccipital approach. The offending vessel, which was PICA, had adhered to the glossopharyngeal nerve and was repositioned laterally away from the nerve by interposition of a felt cushion. Pain disappeared immediately after surgery and has not recurred. In the literature, MVD for glossopharyngeal neuralgia has been performed using a transcondylar approach to achieve minimally invasive surgery. However, the sensory distributions for the floor of the oral cavity and tongue involve 4 overlapping nerves: the trigeminal nerve, sensory components of the facial and vagal nerves, and the glossopharyngeal nerve. In typical cases, it seems that the transcondylar fossa approach is appropriate for glossopharyngeal neuralgia. If the pain occurs in the place involving an overlapping nerve, the lateral suboccipital approach might be necessary.

[A case of atypical meningioma with Lhermitte-Duclos disease].

Lhermitte-Duclos disease is known as an uncommon disease that characterized by a slowly progressive tumor of the cerebellar hemisphere. We present a case of atypical meningioma with Lhermitte-Duclos disease. A 57-year-old female was admitted to our hospital after presenting with general convulsion. CT scan on arrival showed a large mass of the left frontal region and slightly high-density linear lesion in the right cerebellar hemisphere. MRI also revealed well-enhanced mass in the left frontal region and parallel linear striation in the right cerebellar hemisphere. But, the patient had neither cerebellar dysfunction nor signs of increased intracranial pressure. The patient had angioma of the left breast and bilateral benign struma, no typical manifestation of Cowden syndrome. Removal of the frontal tumor caused the convulsion was subsequently performed. The pathological examination was atypical meningioma. After the operation, radiation therapy was not done because of the total removal of tumor and intension on patient side. Fortunately, the patient had no further adverse neurological events postoperatively. However, we should continuously take account to not only the recurrence of meningioma but also the enlargement of the cerebellar lesion and the complication of malignant tumors in whole body.