Clinical utility of evaluating intracranial artery stenosis and silent brain infarction to predict the presence of subclinical coronary artery disease in ischemic stroke patients.

OBJECTIVE: We have recently reported the prevalence of subclinical cardiovascular diseases and the association between the presence of subclinical coronary artery disease (CAD) and vascular risk factors in ischemic stroke patients. The relationship between the presence of subclinical CAD and elements of brain ischemia including intracranial artery stenosis, silent brain infarction (SBI), and white matter lesions remains unclear. We determined the usefulness of elements of brain ischemia to predict the presence of subclinical CAD in ischemic stroke patients. METHODS: The study group comprised 100 patients with first-ever ischemic stroke who had no history of CAD. Intracranial artery stenosis on magnetic resonance angiography and SBI and white matter lesions on magnetic resonance imaging were investigated in comparison with CAD defined as > or =50% stenosis on coronary computed tomographic angiography. RESULTS: Thirty-six patients had subclinical CAD. Intracranial artery stenosis (78.1% vs 35.1%, p<0.0001) and SBI (69.4% vs 46.9%, p=0.03) were more prevalent in patients with subclinical CAD. Of the patients with both intracranial artery stenosis and SBI, 61% had subclinical CAD. Multiple regression analyses showed that the presence of subclinical CAD was independently associated with intracranial artery stenosis; <50% stenosis (OR 8.01 95%CI 2.02 to 31.9; p<0.01), > or =50% stenosis (OR 19.5 95%CI 2.77 to 137.4; p<0.01), and multiple SBI (OR 3.85 95%CI 1.23 to 12.0; p<0.05). CONCLUSION: The evaluation of intracranial artery stenosis and SBI may be useful to identify ischemic stroke patients at high risk for subclinical CAD.

Prevalence of coronary artery disease in Japanese patients with cerebral infarction: impact of metabolic syndrome and intracranial large artery atherosclerosis.

BACKGROUND: Patients with cerebral infarction have a high prevalence of asymptomatic coronary artery disease (CAD) and other vascular diseases, but there is a lack of such data for Japanese patients, so the present study investigated the prevalence of cardiovascular disease (CVD) in Japanese patients and determined the predictors of CAD. METHODS AND RESULTS: The study group comprised 104 patients with cerebral infarction who had no history of CVD. All patients underwent coronary computed tomographic angiography, and systematic evaluation was done on the basis of the presence of other vascular diseases, CVD risk markers, and the degree of atherosclerosis. Of the total, 39 patients (37.5%) had CAD, 9 (8.7%) had carotid artery stenosis, 9 (8.7%) had peripheral artery disease of the lower limbs, and 3 (2.9%) had atherosclerotic renal artery stenosis. Multiple regression analysis showed that the presence of CAD was independently associated with metabolic syndrome (odds ratio (OR) 5.008, 95% confidence interval (CI) 1.538-16.309; p<0.01) and intracranial large artery atherosclerosis (OR 4.979, 95% CI 1.633-15.183; p<0.01). CONCLUSION: Japanese patients with cerebral infarction have a high prevalence of CVD, especially asymptomatic CAD. Both metabolic syndrome and intracranial large artery atherosclerosis may be potential predictors for identifying patients with cerebral infarction who are at the highest risk of asymptomatic CAD.

[Prognosis of patients with myasthenia gravis].

AIM: To study the correlation between therapy and outcome of patients with late adult onset and ocular type myasthenia gravis (MG). METHODS: The 58 MG patients admitted to our hospitals from 1991 to 2003 were classified into juvenile (younger than 20), early adult onset (20-64) and late adult onset (65 or older) groups, or also ocular and generalized types. We evaluated their therapeutic outcomes. RESULTS: The late adult onset group consisted of 11 patients, classified as 4 ocular and 7 generalized types. There were more women than men in both the late and early adult onset groups. Anti-acetylcholine receptor (anti-AchR) antibodies were positive in all patients. Four patients had thymus lesions. Ten patients received treatment as follows: steroid therapy in 6, thymectomy in 4 and only choline-esterase (ChE) inhibitor therapy in 4 patients. However 4 patients worsened after treatment because of inadequate steroid therapy, 2 of whom experienced myasthenic crisis. On the other hand 21 patients were ocular type, of whom anti-AchR antibodies were positive in 12. They received treatments of the 21, steroid therapy was given to 12, thymectomy was performed in 4 and only ChE inhibitor therapy was given to 8 patients. One ocular type patient progressed to the generalized type. Six of 16 improved patients showed distinct recovery. CONCLUSION: In the late adult onset group careful assessment concerning timings of administration and reduction of steroid are required to avoid side effects and complications. One ocular type patient progressed to the generalized type and most patients had a good outcome, which might be related to steroid therapy.

Idiopathic thrombocytopenic purpura and mononeuropathy multiplex.

Peripheral neuropathy is an uncommon complication of idiopathic thrombocytopenic purpura (ITP). We report a 61-year-old man with ITP who developed acute-onset mononeuropathy multiplex. An electrophysiologic study revealed active axonal degenerative alteration, and a sural nerve biopsy showed axonal degeneration. Intraneural hemorrhage was suggested to be the most likely cause.

Peripheral neuropathy in Japanese patients with hepatitis C virus infection.

OBJECTIVE: The aim of this study was to report a series of Japanese patients with neuropathic symptoms following HCV infection. PATIENTS AND METHODS: Fifteen patients with neuropathic symptoms and HCV infection were studied retrospectively (neuropathy group). We evaluated clinical and electrophysiologic findings. As a control group, we investigated prospectively 11 patients with chronic HCV hepatitis without neuropathic symptoms. RESULTS: In the neuropathy group, the peripheral neuropathy was a multiple mononeuropathy (MM) in 8 patients, a polyneuropathy in 4 patients, a single cranial neuropathy in 2 patients, and a cervical radiculopathy in one patient. Five patients with MM had relapsing symptoms. Two patients showed a progression of neurologic symptoms following varicella zoster virus infection. Mixed cryoglobulinemia was noted in 4 of 13 tested patients. Circulating immunocomplexes were detected in 3 of 10 tested patients, and low complement (C3, C4, or CH50) levels were noted in 10 of 13 tested patients. Nerve conduction study (NCS) showed abnormal findings in 10 of 13 investigated patients. In the control group, only the frequency of low CH50 was significantly lower than that in the neuropathy group. Abnormal findings of NCS were found in 3 of 11 patients. CONCLUSION: We showed the presence of various types of neuropathies in patients with HCV infection. Our results suggest that relapsing MM is common in HCV positive neuropathy with or without cryoglobulinemia, and that the virus may modulate neurologic manifestations of other viral infections. Subclinical neuropathy may be present in some patients with HCV infection without neurologic symptoms.