Efficacy of mental practice on paralyzed upper extremity function in the acute phase of stroke: a case study.

[Purpose] Mental practice (MP) is a method of rehabilitating upper extremity function on the affected side of the body post-stroke, with the aim of improving motor task performance through the sustained repetition of motor imagery (MI). However, most studies thus far have investigated MP for post-stroke paralytic upper limb function in patients in the chronic phase. Therefore, it is necessary to obtain evidence regarding whether MP is an effective intervention modality in the acute phase of stroke. In the present study, we examined the effects of an intervention combining mirror therapy and MP initiated during the acute phase of cerebral infarction. [Participant and Methods] A female patient >80 years of age with a cerebral infarction was studied. Prior to cerebral infarction, the patient was independent in her activities of daily living. [Results] As a result of MP, sufficient improvement was observed in the upper extremity function on the paralyzed side, as assessed using the Fugl-Meyer Assessment (FMA) and Motor Activity Log (MAL). [Conclusion] In patients with MP initiated during the acute stroke phase, a combination of mirror therapy and action observation to enable vivid MI may elicit a more significant intervention effect.

Survival Rate and Shunt Infection Incidence Following Gastrostomy in Adult Patients with an Existing Ventriculoperitoneal Shunt.

Ventriculoperitoneal shunts (VPS) and gastrostomies are frequently provided in daily practice. This study investigated the incidence of VPS infection and the survival rate among adult patients who underwent gastrostomy at least 1 month after VPS placement. This single-center retrospective cohort study was conducted among patients with a VPS, who underwent a gastrostomy. This procedure was performed on a standby basis after a period of at least 1 month had elapsed since VPS placement. Subsequent VPS infection and survival rates were assessed over a period of at least 6 months. We reviewed 31 patients who had a VPS at the time of gastrostomy. Gastrostomy was performed endoscopically in 29 cases and via open surgery in 2 cases. The average interval between VPS insertion and gastrostomy was 1135.5 ± 1717.1 days. A single case of VPS infection (3.2%) was diagnosed during the study. This infection rate was not significantly different than that among 230 patients who underwent their first VPS placement (without gastrostomy) at our institution during the same time period (P = .57); there was also no significant difference in the survival rate, compared to 38 age-matched patients (with cerebrovascular disease, but without a VPS) who underwent gastrostomy (P = .73). Gastrostomy performed after an interval of at least 1 month after VPS placement was extremely safe in adult patients, and their prognosis was excellent. Additional studies are required to develop appropriate nutritional interventions for patients with a VPS.

Surgical Treatment of Ruptured Anterior Circulation Aneurysms: Comparative Analysis of Modified Mini-Pterional and Standard Pterional Craniotomies.

BACKGROUND: Minimally invasive surgical techniques for cerebral aneurysms have been developed. AIMS: To compare the efficacy and safety of modified mini-pterional (mMPT) and standard pterional (PT) craniotomies for ruptured anterior circulation aneurysms. MATERIALS AND METHODS: A total of 45 patients with ruptured anterior circulation aneurysms underwent surgical clipping; for 21 patients PT was used and for 24 patients mMPT was used. Initial clinical demographics and outcomes were retrospectively compared. A systemic inflammatory response syndrome (SIRS) score was derived by summing the number of variables meeting standard criteria for SIRS. RESULTS: The two groups were comparable with initial clinical demographics. Total operative time was significantly shorter in the mMPT (166.6 minutes, P = 0.001) compared with the PT (235 minutes). The rate of permanent operative morbidity were similar in both groups (P = 0.92). The mean SIRS score at 24 hours after the completion of the operation was significantly lower for patients in the mMPT group (0.96, P = 0.01) as compared to the patients in the PT group (1.81). The rate of postoperative symptomatic vasospasm was significantly lower in patients operated through the mMPT (8.3%, P = 0.03) than the PT (38.1%). Good outcome at discharge was more frequently seen in the mMPT (91.7%) than in the PT (70%), but this difference was not statistically significant (P = 0.11). CONCLUSION: The mMPT craniotomy is a safe and less invasive approach for ruptured anterior circulation aneurysms, leading to a significant lower rate of postoperative symptomatic vasospasm and a marginally significant improvement in clinical outcomes.

Prediction of prognosis of upper-extremity function following stroke-related paralysis using brain imaging.

[Purpose] Diffusion tensor imaging (DTI) has attracted attention as a method for determining prognosis following paralysis after stroke. However, DTI can assess the degree of damage to the corticospinal tract but cannot evaluate other brain regions. In this study, we examined in detail the prognosis of upper-limb function of the paralyzed side following stroke, using DTI and voxel-based morphometry (VBM). [Subjects and Methods] We studied 17 consecutive patients diagnosed with stroke, including hemorrhagic and ischemic types, who exhibited hemiparesis and were treated in our hospital. DTI and VBM were performed 14 days after admission. Outcome measurements that assessed upper limb function were Fugl-Meyer Assessment (FMA) and Motor Activity Log (MAL), which were applied after 3 months. [Results] The fractional anisotropy ratio of the bilateral cerebral peduncles (rFA) was significantly correlated with FMA, amount of use, and quality of movement 3 months after stroke. The precentral gyrus significantly degenerated as compared with the control group for a case with notable motor paralysis, for which rFA was high. [Conclusion] We suggest it may be possible to predict recovery of upper limb function following stroke by combining DTI and VBM visualization methods.

Dramatic recovery after severe descending transtentorial herniation-induced Duret haemorrhage: a case report and review of literature.

BACKGROUND: Although Duret haemorrhage of the brainstem caused by descending transtentorial herniation is considered fatal, a few cases have been reported to have good outcome. Moreover, most patients with Duret haemorrhage have severe primary brain injury and the potential outcome of those with mild primary brain injury remains unknown. CASE REPORT: This study reports the case of a patient presenting with Duret haemorrhage caused by an idiopathic subdural haematoma who demonstrated dramatic recovery. The patient presented with a low Glasgow Coma Scale score and bilateral oculomotor palsy on admission. Pre-operative CT revealed a large subdural haematoma and Duret haemorrhage of the mid-brain. The subdural haematoma was immediately evacuated under local anaesthesia and the patient demonstrated dramatic post-operative recovery, with no residual quadriparesis and minimal cognitive dysfunction. Interestingly, only bilateral oculomotor palsy persisted. This indicates that Duret haemorrhage restricted to the central portion of the mid-brain without severe primary brain injury has good prognosis. CONCLUSION: Therefore, patients with Duret haemorrhage of the mid-brain caused by simple subdural haematoma presenting with bilateral oculomotor palsy, including bilateral pupillary dilation, may not always have a poor prognosis.