Background and Purpose : Many cases of amnesia caused by thalamic hemorrhage involve anterior nucleus hemorrhage, dorsomedial nucleus hemorrhage, and intraventricular rupture. In the present study, intraventricular rupture was studied with a focus on cases with hematoma compression at the fornix. Methods : Of 116 patients with thalamic hemorrhage admitted to our hospital, 50 patients aged <70 years who had hemorrhage during their first stroke confined to the thalamus, internal capsule, and corona radiata, and who neither developed hydrocephalus nor showed dementia prior to onset were investigated. Thalamic hemorrhages were classified by CT findings and the extent of intraventricular rupture. Memory was studied by the FIM memory scores on admission and discharge. Results and Conclusion : Patients with dorsomedial nucleus hemorrhage showed no tendency toward amnesia and were equivalent to patients with posterolateral nucleus hemorrhage, which does not usually result in amnesia on its own. Of the 30 patients with posterolateral nucleus hemorrhage, a high degree of amnesia was observed in the 18 with intraventricular rupture. A high proportion of patients with dorsomedial nucleus hemorrhage experienced intraventricular rupture (5 of 6 patients). Equivalent degrees of amnesia were observed in patients with intraventricular rupture with dorsomedial nucleus hemorrhage and those with posterolateral nucleus hemorrhage. The present findings in conjunction with the fact that amnesia in thalamic hemorrhage involves episodic memory impairment suggest that amnesia in patients with dorsomedial or posterolateral nucleus hemorrhage or with intraventricular rupture does not stem from damage to the dorsomedial nucleus, which is part of the Yakovlev circuit involved in emotional memory. Instead, the primary cause appears to be the effects of intraventricular rupture on the Papez circuit surrounding the lateral ventricle and foramen of Monro.

A 51-­year-­old woman with a 10-­year history of diabetes visited our clinic for treatment of stiff shoulder and constipation. She was 156 cm tall and weighed 68 kg. The blood pressure was normal. Physical examination revealed no significant abnormalities. After she took the usual amount of tokakujokito for 3 days, hypertension and facial edema, legs edema, weight gain, and headache were observed. Pseudoaldosteronism inhibits 11 β-­hydroxysteroid dehydrogenase Type 2, which is an active glycyrrhizin (GL) and its metabolites glycyrrhizic acid, 3-­monoglucuronyl-­glycyrrhizic acid metabolize and inactivate cortisol to cortisone. As a result, excessive cortisol acts on the mineralocorticoid receptor and promotes sodium reabsorption and excretion of potassium (K+), resulting in water retention and hypokalemia in the body. Insulin also causes hypokalemia because it also takes K+ at the same time as it takes blood glucose in the cell. As a result of these two different processes, it was thought that pseudoaldosteronism developed in low dose licorice. Glycyrrhizin-­containing preparation should be careful used in patients receiving insulin.

Mokuboito is a Kampo formulation consisting of four flavors of Sinomeni Caulis Radix (防已), Gypsum Fi­brosum (石膏), Cinnamomi Cortex (桂皮) and Ginseng Radix (人参). From a modern medical interpretation of the source “Kinkiyoryaku” it can be indicated for pulmonary edema, and if administered early in the onset, respiratory management by tracheal intubation can be avoided, which may contribute to improving the pa­tient's QOL. We experienced 10 cases of pulmonary edema that occurred during the postpartum period and were able to avoid tracheal intubation with mokuboito already. All patients complained of dyspnea and moist rales were heard. Their chest X-­rays showed decreased permeability of the lung field and increased pulmonary vascular shadow, increased cardiothoracic ratio (CTR), costophrenic angle (CP angle) blunting, therefore, they were diagnosed as pulmonary edema. After X-­ray confirmation, mokuboito was administered, and in 6 cases,the subjective symptoms decreased from 7 to 4 in NRS (numerical rating scale), the CTR decreased from 60 to 40%, and CP angle, lung field findings, moist rales also improved. In 3 cases, mokuboito+choreito or mokuboito+choreito+choijokito were administered, and the X-­ray findings were similarly improved. Mokuboito was useful for respiratory management of pulmonary edema during puerperium.

Asthma attack difficulty breathing rapidly worsens the condition over time. Especially when the condition worsens before surgery, general anesthesia (GA) may be indicated depending on the type of surgery. In Japan, there is a tendency to avoid GA in cesarean section (C/S) due to the risk of difficult intubation, adverse effects on the fetus, and concerns about resuscitation of the newborn. This time, foreign body sensation in the throat (baikakuki) was found in a case of asthma-like attack accompanied by difficulty breathing caused by disturbance symptoms on the day of C/S and in a case of difficulty breathing due to preoperative antibiotic intravenous drip. After oral administration of hangekobokuto to the patients, dyspnea disappeared in either case, and I was able to avoid GA and perform C/S with combined spinal-epidural anesthesia. Considering asthma in Kampo medicine, it is thought that psychoactive predispositions such as anxiety and impatience are the triggers that cause qi counter flow and qi stagnation, which causes phlegm to condense, resulting in baikakuki and symptoms. Therefore, it was thought that hangekobokuto, which remove phlegm, was adapted.

After percutaneous coronary intervention (PCI), the patient developed symptoms of pain, sensory impairment, paralysis, pallor of the skin, and pain during passive extension, and was diagnosed with PCI-induced antebrachial compartment syndrome. Since it was considered to be blood stasis and water stasis in Oriental medicine, we administered jidabokuippo and keishibukuryogan to the patient. Then the subjective and objective symptoms improved promptly, and the symptoms disappeared by the 10th day after the operation. The patient was able to discontinue jidabokuippo 14 days after the operation. It was suggested that the symptomatic treatment with Kampo medicine is effective for compartment syndrome.