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We hypothesized that a single-leg version of the Hybrid Assistive Limb (HAL) system could improve the gait and physical function of patients with hemiparesis following a stroke. In this pilot study, we therefore compared the efficacy of HAL-based gait training with that of conventional gait training (CGT) in patients with acute stroke. Patients admitted to the participating university hospital were assigned to the HAL group, whereas those admitted to outside teaching hospitals under the same rehabilitation program who did not use the HAL were assigned to the control group. Over 3 weeks, all participants completed nine 20 min sessions of gait training, using either HAL (i.e., the single-leg version of HAL on the paretic side) or conventional methods (i.e., walking aids and gait orthoses). Outcome measures were evaluated before and after the nine training sessions. The Functional Ambulation Category (FAC) was the primary outcome measure, but the following secondary outcome measures were also assessed: National Institutes of Health Stroke Scale, Fugl–Meyer Assessment (Lower Extremity), comfortable walking speed, step length, cadence, 6-min walk distance, Barthel Index, and Functional Independence Measure. In total, 22 post-stroke participants completed the clinical trial: 12 in the HAL group and 10 in the CGT group. No serious adverse events occurred in either group. The HAL group showed significant improvement in FAC after nine sessions when compared with the CGT group (P = 0.014). However, secondary outcomes did not differ significantly between the groups. Our results demonstrate that HAL-based gait therapy may improve independent walking in patients with acute stroke hemiplegia who are dependent on ambulatory assistance. A larger-scale randomized controlled trial is needed to clarify the effectiveness of single-leg HAL therapy. Clinical Trial Registration: UMIN Clinical Trials Registry, identifier UMIN000022410.

A 32-year-old man developed an extremely rare subdural hematoma after syringosubarachnoid shunting for syringomyelia. He presented with a 4-year history of neck pain and spastic paraparesis resulting from T-7 and T-8 vertebral body fracture suffered in a traffic accident at age 22 years. Magnetic resonance imaging revealed syringomyelia between the craniocervical junction and the T-10 level. The symptoms were slowly progressive, and a syringosubarachnoid shunting was performed. His spasticity improved after surgery, but he developed orthostatic headache 7 days after surgery. Magnetic resonance imaging of the brain demonstrated a thin subdural hematoma over the right cerebral convexity. The subdural hematoma resolved spontaneously within a week with conservative treatment. Vigorous cerebrospinal. fluid outflow observed during surgery presumably lowered the pressure in the syrinx cavity, leading to significant but transient intracranial hypotension and consequently the formation of subdural hematoma.

OBJECTIVE: A variety of factors may affect the surgical outcome in patients with cervical spondylotic myelopathy. The aim of this study is to analyze the prognostic factors by comparing younger and elderly patient groups on the basis of preoperative radiological and clinical data. METHODS: To assess the prognostic factors after surgery had been performed, the clinical and radiological data of 64 patients who underwent expansive laminoplasty were reviewed. Patients were classified into two groups, a younger patient group (

Aneurysms can produce large defects in the parent vessel if the aneurysm tears at the neck of the vessel. We present techniques used to repair a tear at the base of an aneurysm encountered during microsurgical clipping of a ruptured aneurysm. The repair technique involved suturing and covering the aneurysm with an encircling aneurysm clip. A large tear had destroyed the vessel's tubular structure and therefore an encircling clip alone was insufficient for repair. Two microsuture stitches were placed on the tear, so that a split artery reformed a tubular structure. The temporary clip on the distal internal carotid artery was removed for a moment, allowing the retrograde blood flow to provide the counterforce necessary to maintain the vessel's tubular structure. An encircling clip was then applied to cover the entire circumference of the lesion. Another technique involved placing needles over a tear and applying clips while avoiding parent artery stenosis. Placing a clip to cover an entire tear resulted in an arterial stenosis but just applying a clip was insufficient for repair. With this guiding needle method, a clip can adequately be placed without parent artery stenosis. These methods required only a short occlusion time for arterial repair, thus helping avoid ischemic complications. These techniques are useful for repairing an aneurysmal tear at its base, especially if the tear is large.

A 34-year-old male presented with intrasyringal hemorrhage associated with Chiari type I malformation manifesting as a history of repetitive severe pain around his neck and back and progressive sensory disturbance. Magnetic resonance imaging clearly demonstrated syringomyelia at the cervical region associated with Chiari type I malformation and hemorrhage in the syrinx which was strongly suggestive of bleeding into pre-existing syringomyelia or Gowers'' syringal hemorrhage. Irrigation of the syrinx and syringosubarachnoid shunting were performed, but rebleeding occurred causing shunt malfunction. Shunt revision was performed, but a new cavity developed above the original syrinx. Foramen magnum decompression resulted in successful reduction of the new syrinx and subsequent neurological improvement. Simultaneous foramen magnum decompression and syrinx irrigation may be a better approach to treat this disease.

Principles of echo shifting with a train of observations was used to perform magnetic susceptibility-weighted magnetic resonance imaging with bolus-tracking in 14 patients with spondylotic myelopathy to assess changes in perfusion parameters of the spinal cord before and after decompression surgery for cervical spondylotic myelopathy. The mean transit time (MTT), bolus arrival time (T0), and time to peak (TTP) were obtained from regions of interest (ROIs) and assessed as the ratio between the spinal cord and the pons (MTT index = MTT(ROI)/MTT(pons), T0 index = T0(ROI)/T0(pons), TTP index = TTP(ROI)/TTP(pons)). The patients were divided into two groups according to percentage improvement on the Neurosurgical Cervical Spine Scale. The MTT index in patients with good recovery (> or =50%) was significantly reduced. The T0 index and TTP index showed no significant change in both groups. Reduction of MTT index may indicate improved perfusion of the spinal cord following surgery for cervical spondylotic myelopathy.

A rare case of a radiolucent osteoma of the skull is reported. The radiological and pathological findings of this lesion, including magnetic resonance imaging findings, are presented, and the efficacy of magnetic resonance imaging for the diagnosis of this skull tumor is evaluated. The differential diagnosis of radiolucent bone tumors is discussed.

A 42-year-old male was brought to the hospital within 20 minutes of sudden onset of headache followed by loss of consciousness. No spontaneous respiration or cardiac activity was observed, and the patient was regarded as dead on arrival. However, vigorous resuscitative measures restored his sinus rhythm and spontaneous breathing and he eventually regained consciousness. Computed tomography revealed severe subarachnoid hemorrhage, and cerebral angiography showed a dissecting aneurysm of the vertebral artery. Proximal clipping of the vertebral artery was carried out 20 days after admission, and the postoperative course was uneventful. The literature contains reports of 29 cases of a dissecting aneurysm of the vertebrobasilar system presenting with subarachnoid hemorrhage. One of the main clinical features in these patients was transient but severe suppression of respiration and impairment of consciousness. It should be emphasized that aggressive resuscitation is often rewarding even in patients considered dead on arrival. Also, this case confirmed that ligation of the vertebral artery proximal to a dissecting aneurysm is safe and effective, and is the treatment of choice in most cases.