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AHN, Jun Hyong,JEON, Jin Pyeong,KIM, Jeong Eun,HA, Eun Jin,CHO, Won-Sang,PARK, Young Joo,CHO, Nam Han,CHOI, Hoon Sung,KANG, Hyun-Seung,SON, Young-Je,BANG, Jae Seung,OH, Chang Wan The Japan Neurosurgical Society 2018 Neurologia medico-chirurgica Vol.58 No.3
<P>The aim of this study was to investigate the specific thyroid condition and thyroid autoantibodies in adult moyamoya disease (MMD) according to clinical presentation (ischemia vs. hemorrhage stroke). In addition, a meta-analysis was performed to reveal the association between adult MMD and elevated thyroid function, or autoantibodies. Prospectively collected data on 169 consecutive patients with MMD at a single institution were analyzed. Community-based controls matched for age and sex were selected for comparison. Penalized multinomial logistic regression analysis was used for factors affecting stroke. For meta-analysis, heterogeneity was evaluated by using the <I>I</I><SUP>2</SUP> test. If <I>I</I><SUP>2</SUP> < 50%, a fixed effect model was used. Fifty-four cases (32.0%) presented with ischemic stroke and 37 cases (21.9%) with hemorrhage stroke. Hyperthyroidism had a marginally increased risk of MMD with ischemic stroke with reference value of MMD without stroke [odds ratio (OR), 2.53; <I>P</I> = 0.055]. Anti-thyroperoxidase antibody (TPOAb) increased the risk of MMD presenting with ischemic stroke significantly (OR, 2.99; <I>P</I> = 0.020). A meta-analysis revealed that adult MMD was significantly associated with elevated autoantibodies (OR, 7.663; <I>P</I> = 0.002) and hyperthyroidism (OR, 10.936; <I>P</I> < 0.001). Elevated TPOAb and hyperthyroidism may play important roles in adult MMD with ischemic stroke. Studies focusing on targeted hyperthyroidism and thyroid autoantibodies are necessary in treating adult MMD patients in the future.</P>
Brain Stem Hemorrhage Following Burr Hole Drainage for Chronic Subdural Hematoma
PARK, Kyung-Jae,KANG, Shin-Hyuk,LEE, Hoon-Kap,CHUNG, Yong-Gu The Japan Neurosurgical Society 2009 Neurologia medico-chirurgica Vol.49 No.12
<P>A 76-year-old man presented with brain stem hemorrhage after burr-hole drainage for bilateral chronic subdural hematomas. Neuroimaging demonstrated resolution of the transtentorial herniation but also detected new brain stem hemorrhage, manifesting as gait disturbance. He recovered after conservative treatment. Asymmetrical and rapid decompression, which leads to vascular disruption and/or sudden increase in cerebral blood flow, was probably responsible for the secondary brain stem hemorrhage. Therefore, simultaneous and bilateral decompression with a slow rate of evacuation of massive bilateral chronic subdural hematomas is recommended to prevent serious complications such as secondary intracranial hematoma.</P>