ABSTRACT
BACKGROUND: Symptomatic bilateral extracranial internal carotid artery (ICA) aneurysms at the subpetrosal portion are extremely rare, and their treatment strategy remains unknown. CLINICAL PRESENTATION: A 42-year-old man presented to our hospital with a 2-month history of sudden onset of hoarseness, dysarthria, and dysphagia. Magnetic resonance imaging, magnetic resonance angiography, and computed tomography angiography revealed extracranial bilateral ICA aneurysms at the subpetrosal portion. The left-sided aneurysm compressed the left-sided lower cranial nerves (IX, X, XI, and XII), whereas the right-sided aneurysm was asymptomatic. We prioritized the treatment of the right-sided aneurysm to prevent bilateral lower cranial nerve deficits. This strategy was used because aneurysm treatment is not guaranteed to cure the left-sided cranial nerve palsies that lasted for 2 months. The right-sided ICA aneurysm was treated with ICA ligation and high-flow extracranial-intracranial bypass using the radial artery as bypass graft. Stent-assisted coil embolization was performed to the left-sided ICA aneurysm after 17 days. The patient showed no right-sided symptoms, and his left-sided symptoms remarkably improved 1 year after surgery. CONCLUSION: Our unique surgical strategy of prioritizing the aneurysm on the "asymptomatic" side may be one of the best treatment approaches in an extremely rare bilateral aneurysm case.
Subject(s)
Cerebral Revascularization/methods , Cranial Nerve Diseases/complications , Cranial Nerve Diseases/surgery , Functional Laterality/physiology , Intracranial Aneurysm/complications , Intracranial Aneurysm/surgery , Adult , Cranial Nerve Diseases/diagnostic imaging , Humans , Image Processing, Computer-Assisted , Intracranial Aneurysm/diagnostic imaging , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Male , Neurosurgical ProceduresABSTRACT
Stroke is a major cause of mortality and disability worldwide. During the past three decades, major advances have occurred in secondary prevention, which have demonstrated the broader potential for the prevention of stroke. Risk factors for stroke include previous stroke or transient ischemic attack, hypertension, high blood cholesterol and diabetes. Proven secondary prevention strategies are anti-platelet agents, antihypertensive drugs, statins and glycemic control. In the present review, we evaluated the secondary prevention of stroke in light of clinical studies and discuss new pleiotropic effects beyond the original effects and emerging clinical evidence, with a focus on the effect of optimal oral pharmacotherapy.
ABSTRACT
Free radicals play major roles in the pathogenesis of tissue damage in many diseases and clinical conditions, and the removal of free radicals may offer a treatment option. Several modulators of free radical scavenger pathways have been developed and some have progressed to clinical trials. One such agent, edaravone, was approved in 2001 in Japan for the treatment of cerebral infarction. It has since been shown that edaravone can diffuse into many organs and, in addition to its effects on hydroxyl radical removal, edaravone modulates inflammatory processes, matrix metalloproteinase levels, nitric oxide production, apoptotic cell death, and necrotic cell death. Edaravone also exerts protective effects in a number of animal models of disease and tissue damage, including models of myocardial, lung, intestinal, liver, pancreatic and renal injury. Together with the proven safety of edaravone following 9 years of use as a modulator of free radical scavenging pathways in neurological disease, these additional effects of edaravone suggest that it may offer a novel treatment for several non-neurological diseases and clinical conditions in humans.
Subject(s)
Antipyrine/analogs & derivatives , Cardiovascular Diseases/drug therapy , Free Radical Scavengers/pharmacology , Free Radicals/antagonists & inhibitors , Wounds and Injuries/drug therapy , Animals , Antipyrine/pharmacology , Antipyrine/therapeutic use , Apoptosis/drug effects , Cardiovascular Diseases/metabolism , Cardiovascular Diseases/pathology , Edaravone , Free Radical Scavengers/therapeutic use , Free Radicals/metabolism , Heart/drug effects , Humans , Liver/drug effects , Liver/metabolism , Liver/pathology , Lung/drug effects , Lung/metabolism , Lung/pathology , Mice , Necrosis/drug therapy , Nitric Oxide/metabolism , Oxidative Stress/drug effects , Pancreas/drug effects , Pancreas/metabolism , Pancreas/pathology , Rats , Wounds and Injuries/metabolism , Wounds and Injuries/pathologyABSTRACT
Historically, clinical outcomes following spinal cord injury (SCI) have been dismal. Severe SCI leads to devastating neurological deficits, and there is no treatment available that restores the injury-induced loss of function to a degree that an independent life can be guaranteed. To address all the issues associated with SCI, a multidisciplinary approach is required, as it is unlikely that a single approach, such as surgical intervention, pharmacotherapy or cellular transplantation, will suffice. High mobility group box 1 (HMGB1) is an inflammatory cytokine. Various studies have shown that HMGB1 plays a critical role in SCI and that inhibition of HMGB1 release may be a novel therapeutic target for SCI and may support spinal cord repair. In addition, HMGB1 has been associated with graft rejection in the early phase. Therefore, HMGB1 may be a promising therapeutic target for SCI transplant patients. We hypothesize that inhibition of HMGB1 release rescues patients with SCI. Taken together, our findings suggest that anti-HMGB1 monoclonal antibodies or short hairpin RNA-mediated HMGB1 could be administered for spinal cord repair in SCI patients.
