While physical therapy following the treatment with the Zuggurtung method enables the active flexion movement of the knee joint to enhance bone union at an early stage, the active extension movement may impose stress on the fractured segments toward their separation; thus due caution must be exercised. The treatment outcome of patella Fractures has been improved since the introduction of the Zuggurtung method;however, this method is not always applicable depending on the fracture type, and accordingly, risks of physical therapy would differ between cases treated with and without the Zuggurtung method. This paper reports on the cases of 2 patients with fractures of the distal patella who were not appropriate to the Zuggurtung method. Treatment outcomes similar to those of treatment with the Zuggurtung method were observed by clarifying accompanying risks and aggressively maintaining flexibility and smoothness of the supra-patella tissues during and after knee brace fixation. It was thought essential to proceed physical therapy after considering associated risks based on the details and characteristics of an open reduction and internal fixation (ORIF) performed for each patient’s patella fractures.

    A 76-year-old woman with dementia with Lewy bodies (DLB) was transferred to our Recovery Rehabilitation Unit because of systemic muscle weakness due to disuse. She had been bed-ridden for about 6 months because of treatment for deep venous thrombosis and urinary tract infection. Weakness and features of parkinsonism were severe and she could barely turn over in bed. On admission, she needed considerable assistance to sit up and have meals. Her Unified Parkinson's Disease Rating Scale (UPDRS) score was 129 and Functional In de pendence Measure (FIM) score was 27 at the first evaluation. The doctor organized the dose of the drugs for DLB, and physical rehabilitation therapists performed repeated arm stretching exercises using Red Cord, raising the body, and standing exercises. Recreational activities such as ball-throwing games and singing songs gradually made her feel positive. She returned home on day 84 after admission. On discharge, she could stand and transfer to a wheelchair by slight assistance. The final evaluation showed that her UPDRS and FIM scores were 105 and 43, respectively. The outcome in this case suggests that adequate interventions in recovery rehabilitation units can improve ADL in patients with advanced neurodegenerative disease.

Stroke is the most prevalent cardiovascular disease in Japan. This review introduces two epidemiologic studies and four registry studies of stroke in Japan. The Hisayama Study was begun as a population-based prospective cohort study of cerebrovascular and cardiovascular diseases in 1961 in the town of Hisayama. Most of the deceased subjects of the study underwent autopsy examinations from the beginning of the study. Changes in stroke trends in the last 50 years were clarified by comparison of data from different study cohorts registered every 13 to 14 years. The Suita Study was based on a random sampling of Japanese urban residents. Several reports from this study showed the significance of pre-hypertension, as well as hypertension, as a risk factor for stroke by itself and in combination with other underlying characteristics. In addition, the Japan Multicenter Stroke Investigators' Collaboration (J-MUSIC), the Japan Standard Stroke Registry Study, the Fukuoka Stroke Registry, and the Stroke Acute Management with Urgent Risk-factor Assessment and Improvement (SAMURAI) rt-PA Registry are explained as registry studies involving Japanese stroke patients.
Asian Continental Ancestry Group ; Autopsy ; Cardiovascular Diseases ; Cohort Studies ; Cooperative Behavior ; Epidemiologic Studies ; Humans ; Hypertension ; Incidence ; Japan ; Prehypertension ; Risk Factors ; Stroke

Chronic kidney disease, defined by a decreased glomerular filtration rate or albuminuria, is recognized as a major global health burden, mainly because it is an established risk factor for cardiovascular and cerebrovascular diseases. The magnitude of the effect of chronic kidney disease on incident stroke seems to be higher in persons of Asian ethnicity. Since the kidney and brain share unique susceptibilities to vascular injury due to similar anatomical and functional features of small artery diseases, kidney impairment can be predictive of the presence and severity of cerebral small vessel diseases. Chronic kidney disease has been reported to be associated with silent brain infarcts, cerebral white matter lesions, and cerebral microbleeds, independently of vascular risk factors. In addition, chronic kidney disease affects cognitive function, partly via the high prevalence of cerebral small vessel diseases. Retinal artery disease also has an independent relationship with chronic kidney disease and cognitive impairment. Stroke experts are no longer allowed to be ignorant of chronic kidney disease. Close liaison between neurologists and nephrologists can improve the management of cerebral small vessel diseases in kidney patients.
Albuminuria ; Arteries ; Asian Continental Ancestry Group ; Brain ; Cerebral Small Vessel Diseases* ; Dementia ; Glomerular Filtration Rate ; Humans ; Kidney ; Kidney Diseases ; Prevalence ; Renal Insufficiency, Chronic* ; Retinal Artery ; Risk Factors ; Stroke ; Stroke, Lacunar ; Vascular System Injuries

Development of direct oral anticoagulants and their antidotes has led to the need to reconsider the eligibility of acute stroke patients who have been taking oral anticoagulants for intravenous thrombolysis. Officially authorized Japanese guidelines on this issue were revised twice at the time of approval for clinical use of direct oral anticoagulants and idarucizumab, a specific reversal agent for dabigatran. A unique recommendation in the latest Japanese clinical guides was that thrombolysis can be recommended if the time of the last dose of direct oral anticoagulants exceeds 4 hours and if commonly available anticoagulation markers are normal or subnormal, i.e., international normalized ratio of prothrombin time < 1.7 and activated partial thromboplastin time < 1.5 times the baseline value (≤40 seconds only as a guide). These criteria are partly supported by the findings of domestic multicenter and single-center surveys that symptomatic or asymptomatic intracranial hemorrhage following thrombolysis was rare under the conditions of the criteria. Even for dabigatran users, stroke thrombolysis can be considered without pretreatment by idarucizumab if patients meet the above criteria. If not, direct mechanical thrombectomy can be considered without pretreatment by idarucizumab or thrombolysis, and use of idarucizumab, followed immediately by thrombolysis, can be considered only when thrombectomy cannot be quickly performed. These clinical guides are practical and to some extent economical, but they have some limitations, including lack of corroborating information from sufficient numbers of relevant cases. The guides will be further modified based on the results of future research.
Anticoagulants ; Antidotes ; Asian Continental Ancestry Group ; Atrial Fibrillation ; Consensus* ; Dabigatran ; Humans ; International Normalized Ratio ; Intracranial Hemorrhages ; Japan* ; Partial Thromboplastin Time ; Prothrombin Time ; Stroke* ; Thrombectomy

Intracranial large artery disease (ILAD) is the major cause of stroke worldwide. With the application of recently introduced diagnostic techniques, the prevalence of non-atherosclerotic ILAD is expected to increase. Herein, we reviewed recent reports and summarized progress in the diagnosis and clinical impact of differentiation between ILAD of atherosclerotic and non-atherosclerotic origin. Our review of the literature suggests that more careful consideration of non-atherosclerotic causes and the application of appropriate diagnostic techniques in patients with ILAD may not only provide better results in the treatment of patients, but it may also lead to more successful clinical trials for the treatment of intracranial atherosclerosis.
Arteries* ; Atherosclerosis ; Constriction, Pathologic ; Diagnosis ; Humans ; Intracranial Arteriosclerosis ; Magnetic Resonance Imaging ; Prevalence ; Stroke

BACKGROUND AND PURPOSE: Factors associated with early arrival may vary according to the characteristics of the hospital. We investigated the factors associated with early hospital arrival in two different stroke centers located in Korea and Japan. METHODS: Consecutive patients with ischemic stroke arrived hospital within 48 hours of onset between January 2011 and December 2012 were identified and the clinical and time variables were retrieved from the prospective stroke registries of Severance Hospital of Yonsei University Health System (YUHS; Seoul, Korea) and National Cerebral and Cardiovascular Center (NCVC; Osaka, Japan). Subjects were dichotomized into early (time from onset to arrival < or =4.5 hours) and late (>4.5 hours) arrival groups. Univariate and multivariate analyses were performed to evaluate factors associated with early hospital arrival. RESULTS: A total of 1,966 subjects (992 from YUHS; 974 from NCVC) were included in this study. The median time from onset to arrival was 6.1 hours [interquartile range, 1.7-17.8 hours]. In multivariate analysis, the factors associated with early arrival were atrial fibrillation (Odds ratio [OR], 1.505; 95% confidence interval [CI], [1.168-1.939]), higher initial National Institute of Health Stroke Scale scores (OR, 1.037; 95% CI [1.023-1.051]), onset during daytime (OR, 2.799; 95% CI [2.173-3.605]), and transport by an emergency medical service (OR, 2.127; 95% CI [1.700-2.661]). These factors were consistently associated with early arrival in both hospitals. CONCLUSIONS: Despite differences between the hospitals, there were common factors related to early arrival. Efforts to identify and modify these factors may promote early hospital arrival and improve stroke outcome.
Atrial Fibrillation ; Cerebral Infarction ; Emergency Medical Services ; Humans ; Japan ; Korea ; Multivariate Analysis ; Registries ; Seoul ; Stroke*

Adult ; Carotid Artery, Internal ; pathology ; physiopathology ; Headache ; pathology ; physiopathology ; Humans ; Male ; Migraine Disorders ; pathology ; physiopathology

A 60-year-old woman with Parkinson disease (PD) treated by Levodopa / carbidopa intestinal gel (LCIG) began physical therapy (PT). Before inducing LCIG therapy, she had six hours off time a day, and she have not walked outside for six years due to the fear of off time freezing. Scores for depression and anxiety on the Hospital Anxiety and Depression Scale (HADS) were 14 and 11, respectively. Symptoms of depression and anxiety as well as impaired endurance and balance were confirmed. While maintaining LCIG treatment, physical therapy (PT) was started with a focus on tasks to improve endurance and balance. Activity goals were decided with the patient. She stopped experiencing episodes of off time four months after PT was introduced and her HADS scores for depression and anxiety decreased to 6 and 3, respectively. She achieved the activity goals she had set, and outings became part of her daily routine. When introducing PT alongside LCIG treatment, patients and therapists should decide the activity goals together and work on activities that address the problems identified by the pre-PT assessment.