Carotid Micromesh Stent for the Cervical Carotid Artery Dissecting Aneurysm in a Patient with Vascular Eagle Syndrome.

OBJECTIVES: An elongated styloid process may cause vascular Eagle syndrome that includes cervical carotid artery (CCA) dissection with stenosis and aneurysm formation. There are only four reported cases with vascular Eagle syndrome-related CCA dissecting aneurysm treated with carotid artery stenting (CAS). This is the first report of applying a dual-layer nitinol micromesh stent (CASPER) for vascular Eagle syndrome-related CCA dissecting aneurysm. CASE PRESENTATION: A 38-year-old man presented with a sudden onset of aphasia and right hemiplegia. Cerebral angiography demonstrated the left CCA dissecting aneurysm. The superior trunk of the left middle cerebral artery (MCA) was also occluded, and emergent thrombectomy was performed. Computed tomography with angiography (CTA) revealed that a 33 mm-long styloid process compressed the CCA at the aneurysm formation. Three weeks later, a CASPER stent was applied for the CCA aneurysm under the flow reversal system. Immediately after stent placement, blood flow in the aneurysm became stagnant, and postoperative CTA demonstrated regression of the aneurysm. The aneurysm did not recur for 6 months with no styloid process resection. CONCLUSIONS: The dual-layer nitinol micromesh stent (CASPER) was useful to treat vascular Eagle syndrome-related CCA dissecting aneurysm.

Coronavirus Disease 2019 Complicated by Multiple Simultaneous Intracerebral Hemorrhages.

The relationship between coronavirus disease 2019 (COVID-19) and intracerebral hemorrhage remains unclear. We herein report a case of severe COVID-19 pneumonia complicated by multiple simultaneous intracerebral hemorrhages (MSICH). The patient died eight days after the episode of MSICH. No apparent coagulopathy was observed; however, extracorporeal membrane oxygenation and anticoagulation might have caused the occurrence of MSICH. Laboratory findings showed hypercoagulability, suggesting that thrombotic etiologies, such as sinus thrombosis or cerebral infarction, might also have caused MSICH. MSICH can occur as a fatal complication of COVID-19, and this should be considered when providing treatment.

Hydrocephalus Resulting from Late-Onset Aqueductal Membranous Occlusion: A Case Report and Review of the Literature.

BACKGROUND: Late-onset aqueductal membranous occlusion (LAMO) is 1 of the few causes of noncommunicating hydrocephalus. Here, we report a case of LAMO and review the associated literature. CASE DESCRIPTION: A 36-year-old man had complained of headache and loss of consciousness. Conventional magnetic resonance imaging (MRI) showed dilatation of the lateral and third ventricles but not of the fourth ventricle. Phase-contrast cine MRI confirmed cessation of cerebrospinal fluid (CSF) flow in the aqueduct of Sylvius. Sagittal and coronal turbo spin echo T2-weighted imaging with 3-dimensional driven equilibrium pulse (3D-DRIVE) revealed a membranous occlusion at the aqueduct of Sylvius and LAMO was diagnosed. The patient underwent endoscopic third ventriculostomy. Occlusion of the aqueduct of Sylvius by a thin membrane was observed and endoscopic aqueductoplasty was also conducted. The patient's symptoms were ameliorated shortly after the operation. Postoperative phase-contrast cine and 3D-DRIVE MRI showed restored CSF flow in the aqueduct of Sylvius and at the bottom of the third ventricle. CONCLUSIONS: We treated a case of LAMO, which usually presents with headache as an initial symptom. 3D-DRIVE MRI is useful for detecting membranous occlusions and for evaluating pre- and postoperative CSF flow. LAMO can be cured by endoscopic third ventriculostomy and/or endoscopic aqueductoplasty.

Cerebral Venous Thrombosis after Red Blood Cell Transfusion for the Treatment of Iron Deficiency Anemia.

A 57-year-old male presented with generalized seizure who received red blood cell (RBC) transfusion for the treatment of iron deficiency anemia (IDA). Neuroradiological findings revealed cerebral venous thrombosis (CVT) on the left frontal vein. He received anticoagulants, anticonvulsants, and iron supplements. He discharged without any neurological deficit. It should be noted that RBC transfusion might increase the risk of CVT in patients with IDA.

Recurrence in 787 Patients with Chronic Subdural Hematoma: Retrospective Cohort Investigation of Associated Factors Including Direct Oral Anticoagulant Use.

OBJECTIVE: Chronic subdural hematoma (CSDH) is a highly recurrent disorder. Although some predictors including the use of antithrombotic agents such as aspirin and warfarin have been proposed, the pathogenic mechanism involved remains unclear. Moreover, the link between direct oral anticoagulant (DOAC) agent use and CSDH recurrence has not been reported. The aim of this study was to investigate factors including DOAC use that could potentially be associated with CSDH recurrence. METHODS: The authors analyzed 787 patients with CSDH who underwent surgery for CSDH with 1 burr-hole irrigation at Baba Memorial Hospital from January 2012 to November 2017. The patients were divided into recurrence and nonrecurrence groups and anticoagulant, antiplatelet, and control groups. Recurrence was defined as ipsilateral hemorrhage within 90 days from the original operation. Variables with P < 0.1 in the univariate analysis were included in a multivariate logistic regression model. RESULTS: CSDH recurrence was observed in 12.2% of patients, and significantly more men (80.2%) than women experienced recurrence. Age, sex, and warfarin use were entered in the multivariate analysis, and it was revealed that age and male sex were independently associated with CSDH recurrence. Antithrombotic agent use including use of DOACs was not associated with increased CSDH recurrence. CONCLUSIONS: The present study found that age and male sex were independently associated with CSDH recurrence, while the use of antithrombotic agents was not.

Basilar Artery Occlusion with "Seizures" as a Presenting Symptom: Three Cases Treated Using Mechanical Thrombectomy.

BACKGROUND: Basilar artery occlusion (BAO) is a rare, potentially fatal cause of ischemic stroke. It is often challenging to diagnose, especially when the presenting symptom is "seizures". We present 3 cases of patients with BAO presenting with seizures. CASE DESCRIPTION: The first patient was a 53-year-old man with clonic convulsions. On angiography, BAO was detected and mechanical thrombectomy (MT) was performed. The modified Rankin Scale score at 3 months after treatment was 1. The second patient was a 64-year-old man with generalized convulsions. He was diagnosed with BAO and vertebral artery dissection and was treated with MT, percutaneous transluminal angioplasty, and stenting. The modified Rankin Scale score at 3 months after treatment was 3. The third patient was a 77-year-old man with tonic convulsions. He was diagnosed with BAO and treated with MT. However, he did not survive. CONCLUSIONS: BAO is devastating; however, it is a treatable disease. Our report suggests that BAO should be suspected in patients presenting with initial convulsive seizures.

A case of delayed distal coil migration after coil embolization of an unruptured distal azygos anterior cerebral artery aneurysm: A case report and literature review.

Intraprocedural coil migration during endovascular treatment for an aneurysm that might carry serious ischemic complications is well known. On the other hand, delayed coil migration after endovascular treatment for an aneurysm is very rare. A 77-year-old woman was incidentally diagnosed with unruptured aneurysm associated with distal azygos anterior cerebral artery (ACA). The aneurysm was located at the distal bifurcation of the azygos ACA and was wide necked (approximately 7 mm in diameter). Endovascular coil embolization was selected and the aneurysm was occluded successfully, but 29 days after endovascular therapy, follow-up computed tomography (CT) and magnetic resonance (MR) angiography revealed distal coil migration in the peripheral portion of the ACA. In addition, CT on day 57 after therapy revealed the migrated coil had moved more distally. Fortunately, in the course of these events, the patient remained asymptomatic. To the best of our knowledge, this represents the first case of delayed distal coil migration associated with relatively rare azygos ACA aneurysm, and also the first report confirming more distal coil movement over time. In the future, a large number of patients could develop this complication as more aneurysms are aggressively treated with endovascular treatment. Knowledge regarding the possibility of delayed coil migration is thus important.

[Coil Embolization for Very Small Intracranial Aneurysms with Diameter Less than 3mm:A Case Series of 14 Patients and Literature Review].

INTRODUCTION: Many studies describe aneurysms measuring ≤3mm as "very small" or "tiny, " with a risk of intraoperative rupture higher than that of most cerebral aneurysms. We evaluated the results of endovascular coil embolization for very small aneurysms with diameter ≤3mm. MATERIAL AND METHODS: The same interventional neurosurgeon performed coil embolization for 14 tiny aneurysms in 14 patients(8male and 6 females)at our institution between May 2015 and June 2017. Patient age range was 42-88 years(average 65.6 years). Five aneurysms had ruptured and 9 were unruptured. Of the 9 unruptured aneurysms, 3 were associated with a previous ruptured aneurysm. We assessed the procedural complications, type of microcatheter and coils used, total number and length of coils, and angiographic results immediately after the procedure. RESULTS: In 14 aneurysm cases, 8 used only 1 pre-shaped microcatheter, 4 used 2, and 2 used 3;cases using multiple microcatheters added final shaping. Only one case used a helical first coil and the remaining 13 cases used a 3-dimensional coil. The number of coils used was 1 in 3 cases, 2 in 7 cases, 3 in 2 cases, and 4 in 2 cases. The total length of coils inserted was <5 cm in 5 cases, 5-10 cm in 5 cases, and >10 cm in 4 cases. The total length of coils used was <10cm in 70% of cases. Immediately after coil embolization, complete occlusion and a neck remnant were achieved in 11 and 3 cases, respectively. Ballooning was induced by intentionally introducing a balloon-assist technique during surgery in 7 cases, and the balloon was actually inflated in 4 cases. Complications were seen in 2 ruptured cases;1 had an intraoperative rupture, the other had parent artery occlusion, and both patients recovered. CONCLUSION: Coil embolization for tiny aneurysms can be performed comparatively safely by understanding the pitfalls and by using appropriate procedures and tools. Placing the catheter tip at the aneurysm neck is the first step and endovascular treatment is usually performed with ≤3 coils measuring ≤10 cm in total length. Complete embolization should be attempted, but even incomplete embolization is acceptable. More delicate coil embolization is required.

Goreisan Inhibits Upregulation of Aquaporin 4 and Formation of Cerebral Edema in the Rat Model of Juvenile Hypoxic-Ischemic Encephalopathy.

Secondary cerebral edema regulation is of prognostic significance in hypoxic-ischemic encephalopathy (HIE), and aquaporin 4 (AQP4) plays an important role in the pathogenesis of cerebral edema. The traditional Japanese herbal medicine Goreisan relieves brain edema in adults; however, its effect and pharmacological mechanism in children are unknown. We investigated the effects of Goreisan on HIE-associated brain edema and AQP4 expression in a juvenile rat model, established by combined occlusion of middle cerebral and common carotid arteries. Magnetic resonance imaging showed that the lesion areas were significantly smaller in the Goreisan- (2 g/kg) treated group than in the nontreated (saline) group at 24 and 48 h postoperatively. AQP4 mRNA levels in the lesion and nonlesion sides were significantly suppressed in the Goreisan group compared with the nontreated group 36 h postoperatively. Western blotting revealed that levels of AQP4 protein were significantly decreased in the Goreisan group compared with the nontreated group in the lesion side 72 h postoperatively, but not at 12 or 36 h. After 14 days, the Goreisan group had a significantly better survival rate. These findings suggest that Goreisan suppresses brain edema in HIE and improves survival in juvenile rats, possibly via regulation of AQP4 expression and function.

A case with coil embolization for ruptured aneurysm associated with fenestration of the posterior inferior cerebellar artery.

An 87-year-old man hospitalized for subarachnoid hemorrhage showed a ruptured aneurysm arising from fenestration of the posterior inferior cerebellar artery. Endovascular treatment was selected and the aneurysm and superior limb were embolized completely using three coils. Fenestration of the posterior cerebellar artery is exceedingly rare. In addition, we present a first case of aneurysm as fenestration of the posterior inferior cerebellar artery that was definitively identified as a cause of bleeding.

Postnatal interleukin-1ß administration after experimental prolonged febrile seizures enhances epileptogenesis in adulthood.

It remains unclear whether prolonged febrile seizures (pFS) in childhood facilitate mesial temporal lobe epilepsy (MTLE) in adulthood. Interleukin (IL)-1ß is associated with seizures in children and immature animal models. Here, we use a rat model of pFS to study the effects of IL-1ß on adult epileptogenesis, hippocampal damage, and cognition. We produced prolonged hyperthermia-induced seizures on postnatal days (P) 10-11 and administered IL-1ß or saline intranasally immediately after the seizures. Motor and cognitive functions were assessed at P85 using rotarod and passive avoidance tests. Electroencephalogram recordings were conducted at P90 and P120. Hippocampal CA1 and CA3 neurons and gliosis were quantified at the end of the experiment. Spontaneous seizure incidence was significantly greater in rats that had received IL-1ß than in those that had received saline or those without hyperthermia-induced seizures (p < 0.05). Seizure frequency did not differ significantly between the three groups and no motor deficits were observed. Passive avoidance learning was impaired in rats that received IL-1ß compared with controls (p < 0.05), but was not different from that in rats that received saline. Hippocampal cell numbers and gliosis did not differ between the three groups. These results indicate that neuronal loss and gliosis are not prerequisites for the epileptogenic process that follows pFS. Our results suggest that infantile pFS combined with IL-1ß overproduction can enhance adulthood epileptogenesis, and might contribute to the development of MTLE.

Collapse of homochirality of amino acids in proteins from various tissues during aging.

Prior to the emergence of life, it is believed that only L-amino acids were selected for formation of proteins, and that D-amino acids were eliminated on the primitive Earth. Whilst homochirality is essential for life, recently the occurrence of proteins containing D-beta-aspartyl (Asp) residues from various tissues of elderly subjects has been reported. Here, we discuss the presence of D-beta-Asp-containing proteins in the lens, ciliary body, drusen, and sclera of the eye, skin, cardiac muscle, blood vessels of the lung, chief cells of the stomach, longitudinal and circular muscles of the stomach, and small and large intestines. Since the D-beta-Asp residue occurs through a succinimide intermediate, this isomer may potentially be generated in proteins more easily than initially thought. UV Rays and oxidative stress can accelerate the formation of the D-beta-Asp residue in proteins.

Localization of D-ß-aspartyl residue-containing proteins in various tissues.

Prior to the emergence of life, it is believed that only l-amino acids were selected for formation of protein and that d-amino acids were eliminated on the primitive Earth. Whilst homochirality is essential for life, the occurrence of proteins containing d-beta-aspartyl (Asp) residues in various tissues from elderly subjects has been reported recently. Here, we demonstrate the presence of a d-beta-Asp-containing protein in the cardiac muscle of heart, blood vessels of the lung, chief cells of the stomach, longitudinal and circular muscle of the stomach, small intestine and large intestine. Since the d-beta-Asp residue occurs through a succinimide intermediate, this isomer may potentially be generated in proteins more easily than initially thought. Formation of the d-beta-Asp residue in proteins may be related to stress.