廣瀬 雄一

Background Administration of andexanet alfa has shown to achieve hemostatic efficacy in factor Xa inhibitor (FXai)-associated intracranial hemorrhage (ICrH). Code stroke (CS), implemented through the visual task management application Task Calc. Stroke (TCS) facilitates timely reperfusion therapy for acute ischemic stroke. However, the association between TCS-based CS and in-hospital treatment time of andexanet for FXai-associated ICrH remains unknown. Methods In this single-center retrospective study, patients with FXai-associated ICrH who received andexanet were enrolled from May 2022 to May 2025. TCS was activated via prehospital notification when patients presented with at least one of the clinical symptoms including face dropping, arm weakness, or speech difficulty with a time from onset or last known well of <24 h. Multivariable linear regression was performed to investigate the association between TCS-based CS and door-to-andexanet administration time. Results Forty-two patients (22 men, median age 80 years) were included. The primary location of hemorrhage was intracerebral ( n  = 26), epidural/subdural ( n  = 8), or subarachnoid ( n  = 8). Among them, 17 (41.5%) were treated with TCS-based CS. The door-to-andexanet administration time was shorter in patients treated with TCS-based CS compared to those without (90 min vs. 132 min, p  < 0.01). Multivariable analysis showed that TCS-based CS was associated with door-to-andexanet administration time (Exp [ β ] 0.58, 95% confidence interval 0.43–0.77) after adjustment with arrival during regular hours and baseline hematoma volume. Conclusion TCS-based CS was associated with a shorter door-to-andexanet administration time for FXai-associated ICrH. The outcome benefit from improved treatment times warrants further investigation.

OBJECTIVE: Central nervous system (CNS) solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms with a high propensity for local recurrence and extracranial metastasis. Although surgery and radiotherapy are the mainstays of treatment, systemic therapeutic options for recurrent disease remain limited. Pazopanib, a multitargeted tyrosine kinase inhibitor, has demonstrated clinical activity in extracranial SFTs; however, evidence in CNS SFTs is scarce. METHODS: We conducted a retrospective, single-institution study of patients with recurrent CNS SFTs treated with pazopanib. Clinical data, including prior treatments, imaging responses, treatment duration, and adverse events, were collected from medical records. Exploratory next-generation sequencing-based cancer panel testing was performed in two patients. RESULTS: Four patients with recurrent CNS SFTs were included. All had undergone prior surgical resection and radiotherapy. Pazopanib achieved partial response in one patient and stable disease in three patients, with treatment durations ranging from 7 months to over 2 years. One patient experienced disease progression after an initial period of response. Adverse events, including fatigue, gastrointestinal symptoms, and hypertension, were observed in all patients but were generally manageable with supportive care or dose adjustment. Exploratory molecular profiling identified various genomic alterations in two patients. CONCLUSIONS: In this single-institution retrospective series, pazopanib provided durable disease control with acceptable tolerability in selected patients with recurrent CNS SFTs. These findings support considering pazopanib as a systemic treatment option when further local therapies are not feasible, while highlighting the need for larger multicenter studies.

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.

Compared to oligodendrogliomas, astrocytomas may have a relatively higher frequency of intracranial remote recurrence, despite generally favorable prognoses. Previous studies identified 8q gain, particularly in the terminal region, as a poor prognostic factor. This study evaluated MYC expression and its relationship with copy number gain at 8q24.21, in relation to recurrence patterns in astrocytomas, with a particular focus on intracranial remote recurrence. A retrospective analysis was conducted on 27 patients treated between 2006 and 2019. MYC expression was assessed by immunohistochemistry (IHC), and copy number status by metaphase comparative genomic hybridization and next-generation sequencing. Recurrence patterns were categorized as local or remote.Among 43 specimens analyzed by IHC, MYC expression was observed in 72%, with higher positivity in recurrent (80%) than initial (61%) specimens, though the difference was not statistically significant (p = 0.30). Copy number analysis showed a significant increase in 8q24.21 copy number in specimens from cases with remote recurrence compared to those with local recurrence (p = 0.033). However, no significant correlation was found between MYC copy number and protein expression (p = 0.055). These findings suggest that MYC is frequently expressed in astrocytomas, but its expression does not significantly reflect 8q gain or recurrence pattern.