論文

Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare clinical entity, the common clinical symptoms of which are headache, disturbance of consciousness, altered mental status, seizures, and visual disturbance. Recently, some cases have been reported in association with the increased use of cytotoxic and immunosuppressive agents in cancer patients, and relevant reports have increased with advances in radiological examinations. We describe here the case of a 50-year-old man with advanced bladder cancer who suddenly experienced diminished spontaneity and speech, and finally became semicomatose. Two months previously, he had received gemcitabine and cisplatin chemotherapy. Computed tomography and magnetic resonance imaging revealed symmetrical edema of the posterior occipital lobe and thalamus. Based on these findings, we made a diagnosis of RPLS and treated him with supportive measures. His mental status gradually improved in 2 weeks, although slight neurological symptoms persisted. When the level of consciousness of a cancer patient worsens rapidly, this syndrome should be included in the differential diagnosis and recognized at an early stage. Early supportive management and discontinuation of the causative medication may reverse the clinical and radiological manifestations of the syndrome.

There have been few studies that investigated and clarified the relationships between progression of degenerative changes and sagittal alignment of the cervical spine. The objective of the study was to longitudinally evaluate the relationships among progression of degenerative changes of the cervical spine with age, the development of clinical symptoms and sagittal alignment of the cervical spine in healthy subjects. Out of 497 symptom-free volunteers who underwent MRI and plain radiography of the cervical spine between 1994 and 1996, 113 subjects (45 males and 68 females) who responded to our contacts were enrolled. All subjects underwent another MRI at an average of 11.3 years after the initial study. Their mean age at the time of the initial imaging was 36.6 +/- 14.5 years (11-65 years). The items evaluated on MRI were (1) decrease in signal intensity of the intervertebral disks, (2) posterior disk protrusion, and (3) disk space narrowing. Each item was evaluated using a numerical grading system. The subjects were divided into four groups according to the age and sagittal alignment of the cervical spine, i.e., subjects under or over the age of 40 years, and subjects with the lordosis or non-lordosis type of sagittal alignment of the cervical spine. During the 10-year period, progression of decrease in signal intensity of the disk, posterior disk protrusion, and disk space narrowing were recognized in 64.6, 65.5, and 28.3% of the subjects, respectively. Progression of posterior disk protrusion was significantly more frequent in subjects over 40 years of age with non-lordosis type of sagittal alignment. Logistic regression analysis revealed that stiff shoulder was closely correlated with females (P = 0.001), and that numbness of the upper extremity was closely correlated with age (P = 0.030) and male (P = 0.038). However, no significant correlation between the sagittal alignment of the cervical spine and clinical symptoms was detected. Sagittal alignment of the cervical spine had some impact on the progression of degenerative changes of the cervical spine with aging; however, it had no correlation with the occurrence of future clinical symptoms.

Prospective longitudinal study, mean follow-up period; 11.7 +/- 0.8 years was conducted from 1995 to 2007.

We conducted a prospective long-term follow-up study to assess associations between magnetic resonance imaging (MRI) findings and changes in clinical symptoms, as well as factors relating to the prognosis of symptoms.

高血圧性脳症は,悪性高血圧に伴い,頭痛,痙攣,意識障害等が引き起こされる病態として1928年にOppenheimerとFishbergにより初めて報告され,その画像所見が後頭部優位の可逆性の浮腫性変化であることは以前から知られていた.同様の臨床症状,画像所見が,妊娠子癇,免疫抑制剤の使用等でも認められ,Hanchyらはこれらの病態をまとめてreversible posterior leukoencephalopathy syndrome(RPLS)として報告した2).以来,同様の病態は多数報告され,posterior reversible encephalopathy syndrome(PRES)とも称せられる.高血圧性脳症とRPLS/PRESとは若干の異同もあるものの,病態生理,画像所見上は共通点が多く,本稿では古典的な高血圧性脳症のみならず,他の原因を含めたRPLS/PRES(以下PRES)の画像所見について概説する.(著者抄録)

PURPOSE: To evaluate the usefulness of selective computed tomography (CT) angiography in preventing severe complications, such as spinal cord injury and broncho- esophageal fistula, during the transcatheter arterial embolization or infusion chemotherapy for thoracic diseases.

血管性認知症を画像所見のみから診断することは難しい場合が多く、臨床経過、神経症状との対比が重要である。血管性認知症に認められる画像所見は、(1)Binswanger病(大脳白質の虚血性変化)、(2)ラクナ梗塞、(3)多発皮質梗塞、(4)特定の「戦略的部位」の梗塞、(5)出血性病変に大別できる。しかし、純粋な脳血管性認知症は比較的少なく、特に加齢とともにアルツハイマー病など変性認知症との合併が増加する。このほか鑑別すべきものとして、アミロイドアンギオパチー、正常圧水頭症などが重要である。(著者抄録)

PURPOSE: To investigate the frequency of tandem lumbar and cervical intervertebral disc degeneration in asymptomatic subjects. METHODS: We evaluated magnetic resonance imaging (MRI) results from 94 volunteers (48 men and 46 women; mean age 48 years) for age-related intervertebral disc degeneration in the lumbar and cervical spine. RESULTS: MRI indicated degenerative changes in the lumbar spine in 79 subjects (84 %), with decreased disc signal intensity in 74.5 %, posterior disc protrusion in 78.7 %, anterior compression of the dura in 81.9 %, disc space narrowing in 21.3 %, and spinal canal stenosis in 12.8 %. These findings were more common in older subjects at caudal levels. MRI showed degenerative changes in both the lumbar and cervical spine in 78.7 % of the volunteers. CONCLUSIONS: Degenerative findings in both the lumbar and cervical spine, suggesting tandem disc degeneration, was common in asymptomatic subjects. These results provide normative data for evaluating patients with degenerative lumbar and cervical disc diseases.