Attack Interval Is the Key to the Likely Pathogenesis of Multiple Transient Ischemic Attacks

<b><i>Introduction:</i></b> The aim of this study was to test the hypothesis that the attack interval of multiple transient ischemic attacks (TIAs) is correlated with the underlying pathogenesis of ischemia. <b><i>Methods:</i></b> Patients with multiple TIAs, defined as 2 or more motor deficits within 7 days, were studied. The attack interval between the last 2 episodes was classified into 3 groups: 2 episodes within an hour (Hour group), over hours within a day (Day group), and over days within a week (Week group). Patients with a lacunar syndrome, no cortical lesions, and no embolic sources were recognized as having a small vessel disease (SVD) etiology for their multiple events. <b><i>Results:</i></b> Of 312 TIA patients admitted over a 9-year period, 50 (37 males, 13 females, mean 67.6 years) had multiple TIAs. Twelve patients were classified as being within the Hour group, 23 within the Day group, and 15 within the Week group. Lacunar syndromes were observed in 30 (75%, 35%, and 67%), embolic sources were detected in 28 (25%, 65%, and 67%), and a high signal lesion on diffusion-weighted imaging was depicted in 30 (75%, 48%, and 67%) patients (18 cortical, 11 subcortical, and one cerebellar). Patients in the Hour group had a significantly higher prevalence of SVD etiology (75%) than those in the Day and Week groups (30%, <i>p</i> = 0.0165; 27%, <i>p</i> = 0.0213, respectively). Four patients had a subsequent stroke within 7 days. <b><i>Conclusion:</i></b> Attack intervals of multiple TIAs may be correlated with the underlying pathogenesis of ischemia. Two motor deficits within an hour are more likely to suggest a SVD etiology.

NI-17 Evaluation of preoperative apparent diffusion coefficient (ADC) of peritumoral FLAIR high lesion and histopathological features in patients with glioblastoma

Objective: In removal of the glioblastoma, maximum and safe removal is desired for recurrence prevention with functional preservation. In recent years, the setting of the removal range has also been studied not only the contrast enhanced lesions, but also the surrounding FLAIR high signal lesion. We are studying the prediction of the site that is likely to occur recurrence in the FLAIR high signal lesion of glioblastoma, and we are focusing on the ADC of pre-operative MRI as an index. The purpose of this study is to evaluate the ADC and the actual pathological tissue image in the FAIR high signal lesion around the contrast enhanced lesion of glioblastoma. Method: We examined the case of removal of the glioblastoma treated in our department. Analysis was performed using a pathological tissue specimen of excised tumors and their surrounding tissues in each case, and the ADC value of pre-operative MRI. Pathological tissue image and ADC values of FAIR high signal lesion were compared. Results: 19 tissue samples which were taken from the FLAIR high signal lesion around the contrast enhanced tumor from 10 cases. For a total of 19 locations, it was compared with the histopathological features of the site. As a result, in the low part of the ADC value in the preoperative MRI relatively had high cell density of atypical cells, it was often exhibited findings that infiltration of tumor cells is suspected. Conclusion: In general, ADC is said to suggest an increase in cell density and thus infiltration of tumor cells. However, the same findings were obtained in the pre-operative MRI examined this time. Since ADC also suggests cell density and tumor infiltration in pre-operative MRI, ADC of pre-operative MRI was considered useful for examination of the removal range and radiation therapy planning in surgery for glioblastoma.

Lymphoplasmacyte-Rich Meningioma With Atypical Angiomatous Feature and an Increased Deposition of IgG4-Positive Plasma Cells: An Unusual Case Report

Lymphoplasmacyte-rich meningioma (LPRM) is an extremely rare variant of meningioma, and a small percentage of LPRM may be associated with IgG4-related disease. To date, the coexistence of 2 rare meningioma variants consisting of LPRM and angiomatous meningioma within one neoplasm has not been reported in the literature. A 56-year-old woman presented with episodes of frequent and severe epistaxis that began 4 months ago. Initial magnetic resonance imaging showed localized, heterogeneous, and intermediate to high signal lesion at the odontoid process and clivus. In subsequent magnetic resonance images, the mass grew to the posterior nasopharyngeal wall, and compression to the medulla, and a suspicious enhancement of both distal vertebral arteries became evident even though there was 3 times of partial resection over 17 years. The tumor showed regional and temporal heterogeneity, and atypical features such as mitoses and a high proliferative index were also identified in the area of angiomatous meningioma in addition to LPRM with an increased deposition of IgG4-positive plasma cells within the neoplasm.