小嶋 大二朗

Some patients with cerebral amyloid angiopathy (CAA), which is characterized by amyloid β fibril deposition in cortical and leptomeningeal vessels, develop an inflammatory response, leading to CAA-related inflammation (CAA-RI). In such cases, histopathologically confirmed vasculitis is defined as amyloid β-related angiitis (ABRA). Here, we report the rare case of an 80-year-old woman who presented with anomic aphasia and mild right upper limb weakness. Magnetic resonance imaging revealed restricted diffusion in the subarachnoid space along the cerebral sulci and dura mater, mainly within the left parietal lobe. Additional imaging findings included lobar microbleeds, edematous white matter changes, and leptomeningeal and dural enhancement. Brain biopsy revealed vasculitis with amyloid β deposition, consistent with ABRA. Marked lymphoplasmacytic infiltration, which was present in the leptomeninges and the dural surface, was considered the cause of the subarachnoid diffusion restriction. Immunosuppressive treatment led to clinical and radiological improvement. As illustrated in this case, CAA-RI may present with atypical findings of subarachnoid diffusion restriction and dural involvement, and the recognition of these features, which can mimic rheumatoid meningitis and other inflammatory conditions, is important for differential diagnosis.

Abstract The lateralized efficacy of vagus nerve stimulation (VNS) remains insufficiently explored. We report a case of drug-resistant epilepsy with bilateral frontal lobe seizure onset, treated with left cervical VNS. Preoperative video- electroencephalogram revealed predominant interictal discharges in the right hemisphere and frequent seizures from both hemispheres. Following VNS, overall seizure frequency decreased. Notably, stereo-electroencephalography performed 15 months postoperatively showed a marked reduction in right-sided seizures, while left-sided seizures remained frequent. This case highlights the potential lateralized effect of VNS in a single patient with bilateral frontal lobe epilepsy, suggesting that VNS may preferentially suppress seizures originating from the right hemisphere.

Karnofsky Performance Status (KPS) is a widely used scale to assess performance status. KPS ≥ 50% implies that patients can live at home. Therefore, maintaining KPS ≥ 50% is important to improve the quality of life of patients with glioblastoma, whose median survival is less than 2 years. This study aimed to identify the factors associated with survival time with maintenance of KPS ≥ 50% (survival with KPS ≥ 50%) in patients with glioblastoma, IDH-wildtype. Ninety-eight patients with glioblastomas, IDH-wildtype, who were treated with concomitant radiotherapy (RT) and temozolomide (TMZ) followed by maintenance TMZ therapy, and whose KPS at the start of RT was ≥ 50%, were included. The median survival with KPS ≥ 50% was 13.3 months. In univariate analysis, preoperative KPS (≥ 80%), KPS at the start of RT (≥ 80%), residual tumor size (< 2 cm3), methylated MGMT promotor, and implantation of BCNU wafer were associated with survival with KPS ≥ 50%. In multivariate analysis, KPS at the start of RT (≥ 80%), methylated MGMT promotor, and residual tumor size (< 2 cm3) were significantly associated with increased survival with KPS ≥ 50%. A strategy of maximum possible tumor resection without compromising KPS is desirable to prolong the survival time with KPS ≥ 50%.