RESUMO
BACKGROUND: The Immediate Stroke Life Support (ISLS) course run in Wakayama (Wakayama-ISLS course) is an off-the-job training course for understanding the initial treatment of acute stroke. A total of 22 Wakayama-ISLS courses have been held in Wakayama Prefecture since 2008. To begin with, the case presentation was performed using human-like, mechanical manikins for simulation training. However, as the course progressed, we found the students paying great attention to the display monitor, and less to the patients' neurological status. METHODS: From the fourth Wakayama-ISLS course onward, we conducted the group work with the facilitators pretending to be patients, i.e., without medical training manikins. RESULTS: When the facilitators acted as patients, the students gained a more realistic and expressive perception of neurological symptoms. As a result, they expressed a high level of satisfaction with the course in the questionnaire sent immediately afterwards, regardless of their profession or prior experience. Moreover, as we did not need to transfer medical training simulators, we were able to carry out three ISLS courses at locations some distance from Wakayama city on a low-cost basis. This also enabled the regional medical staff in rural hospitals to participate in the courses easily. CONCLUSION: The Wakayama-ISLS course without medical training manikins is an entirely feasible off-the-job training course, which provides training on fast and excellent treatment of acute stroke problems based on clinical practice. The course has the potential to spread not only across Japan but throughout the world, including to developing countries, given the cost perspective.
RESUMO
Posterior cerebral artery (PCA) aneurysms are rare, especially those at the P4 segment. We report such a case involving a 77-year-old man who suffered from a sudden-onset headache. Computed tomography showed intracerebral hemorrhage in the left occipital lobe, intraventricular hemorrhage, and subarachnoid hemorrhage at the left occipital sulcus. Magnetic resonance angiography failed to reveal any aneurysms or abnormal vessels. Because the patient had renal dysfunction, we refrained from conventional angiography. Five days after the initial onset, rebleeding occurred, and conventional angiography revealed a small(2-mm)PCA aneurysm in the left P4 segment. We performed endovascular treatment and occluded the parent artery with a liquid embolic material, n-butyl-2-cyanoacrylate. The etiology of the aneurysm was not determined. The patient did not suffer from any apparent visual field deficits and was transferred to a rehabilitation hospital. Reviewing previous reports of distal PCA aneurysms indicated that PCA aneurysms in the P4 segment have two characteristics that distinguish them from other PCA aneurysms:P4 segment aneurysms are relatively small and the resulting hematoma distribution tends to be manifest as a combination of intracerebral hemorrhage, intraventricular hemorrhage, and subarachnoid hemorrhage at the occipital sulcus. With respect to these characteristics, our case was a typical P4 segment aneurysm. In conclusion, although P4 segment aneurysms are rare, if the characteristic hematoma distribution is observed, conventional angiography should be performed to confirm a possible P4 segment aneurysm. Parent artery occlusion with a liquid embolic material may be a treatment option for selected cases.
