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Background: A temporary increase in the occurrence of cerebrovascular diseases (CVDs) after the Great East Japan Earthquake and Tsunami of 2011 was reported; however, no studies have been conducted to investigate long-term effects. We assessed the long-term impact of the disaster on the incidence of CVDs. Methods: Incidence data for CVDs from 2008 to 2017 were acquired from the population-based Stroke Registry with an inventory survey of Iwate Prefecture, Japan. Part of the coastal area in Iwate Prefecture was mildly flooded and the other part was severely flooded. Age-adjusted incidence rates of CVDs (according to the Japanese standard population) were calculated for each area. The relative risk (RR) of incidence based on the years before the disaster (2008–2010), adjusted by stratified age groups, was calculated for the year of the disaster (2011), and the years after the disaster (2012–2017) in each area. Results: The age-adjusted incidence rates gradually decreased in all areas, with the exception of a temporary increase among men who lived on the coast the year the disaster occurred. The adjusted RR in the disaster year were not significant in any area and those of the postdisaster years were 0.91 (95% CI 0.87–0.96) for all inland men, 0.93 (0.89–0.97) for all inland women, 0.85 (0.78–0.93) for all coastal men, 0.87 (0.81–0.94) for all coastal women, 0.88 (0.80–0.98) for men at mildly flooded coast, 0.82 (0.75–0.89) for women at mildly flooded coast, 0.79 (0.68–0.91) for men at severely flooded coast, and 0.98 (0.86–1.11) for women at severely flooded coast. Conclusions: The occurrence of CVDs in the flooded coastal areas did not increase in the year of the Great East Japan Earthquake and Tsunami; furthermore, it decreased for men according to the severity of flood damage in the subsequent years; this can be attributed to supportive activities for the tsunami victims and the migration of the population.

Second impact syndrome occurrs when a patient who has sustained an initial head injury, most often a concussion, sustains a second head injury before the symptoms associated with the first have fully resolved, leading to rapid brain swelling and herniation. However, the underlying pathophysiology remains unclear. We report two cases in which acute subdural hematoma with rapid malignant brain swelling developed after repeated head traumas while snowboarding. One patient did not undergo craniotomy and died 21h after symptom onset. The other underwent urgent decompressive craniotomy and experienced prolonged disturbance of consciousness. Axial susceptibility-weighted magnetic resonance imaging performed 1 month after surgery in the second patient revealed multiple microbleeds in the subcortical white matter and parasagittal white matter in the bilateral hemispheres. These findings indicate that axonal injuries from angular acceleration may contribute to the rapid malignant brain swelling and poor outcomes.

We report the number of first aid stations established in tsunami-affected areas following the Great East Japan Earthquake of 2011 and the number of patient consultations, and discuss the demand and supply of medical services in a tsunami disaster. A total of 76,952 medical records from 188 first aid stations in coastal areas of Iwate Prefecture were analyzed and the numbers of daily consultations were calculated. There were only 25 consultations on the day of the disaster, the number rapidly increased to 1603 consultations seven days after the disaster, and reached a peak of 2090 consultations twelve days after the disaster. Request of prescribed drugs for daily use accounted for approximately 30–50% of all consultations during first four weeks after the disaster. We noted the number of first aid stations in each municipality and analyzed the number of consultations during the first four weeks after the disaster, calculated per 1000 residents in each municipality. In municipalities where hospitals and clinics were damaged, the number of first aid stations per 1000 residents and number of consultations during the first four weeks correlated well with the proportion of the resident population in the flooding area. The municipalities with extensive damage needed three first aid stations and 700 consultations per 1000 flooding population during the first four weeks after the disaster.

IntroductionIn 2015, the authors reported the results of a preliminary investigation of preventable disaster deaths (PDDs) at medical institutions in areas affected by the Great East Japan Earthquake (2011). This initial survey considered only disaster base hospitals (DBHs) and hospitals that had experienced at least 20 patient deaths in Miyagi Prefecture (Japan); therefore, hospitals that experienced fewer than 20 patient deaths were not investigated. This was an additional study to the previous survey to better reflect PDD at hospitals across the entire prefecture.MethodOf the 147 hospitals in Miyagi Prefecture, the 14 DBHs and 82 non-DBHs that agreed to participate were included in an on-site survey. A database was created based on the medical records of 1,243 patient deaths that occurred between March 11, 2011 and April 1, 2011, followed by determination of their status as PDDs.ResultsA total of 125 cases of PDD were identified among the patients surveyed. The rate of PDD was significantly higher at coastal hospitals than inland hospitals (17.3% versus 6.3%; PConclusion:Preventable disaster death at medical institutions in areas affected by the Great East Japan Earthquake occurred mainly at coastal hospitals with insufficient medical resources, disrupted lifelines, delayed medical intervention, and deteriorated environmental conditions in homes and emergency shelters constituting the main contributing factors. Preventing PDD, in addition to strengthening organizational support and functional enhancement of DBHs, calls for the development of business continuity plans (BCPs) for medical facilities in directly affected areas, including non-DBHs.YamanouchiS, SasakiH, KondoH, MaseT, OtomoY, KoidoY, KushimotoS. Survey of preventable disaster deaths at medical institutions in areas affected by the Great East Japan Earthquake: retrospective survey of medical institutions in Miyagi Prefecture. Prehosp Disaster Med. 2017;32(5):515–522.

Introduction:The Japanese Association for Disaster Medicine (JADM) Disaster Medical Coordination Support Team (DMCST) was formed in 2016 when Japan experienced Kumamoto earthquake to support other disaster medical assistance teams in terms of headquarter operation logistics.Aim:Introducing medical association-based disaster medical support team.Methods:JADM DMCST was formed by an association member who had experience in disaster medical headquarter operation and logistic support. Disaster medical headquarter tends to have a gap between acute phase and sub-acute phase due to an alternation of disaster medical assistance team. To keep disaster medical management at medical management headquarter, experienced manpower requires. JADM DMCST provided assistance to fill those gaps.Results:For 2016 Kumamoto Earthquake, 107 members responded as a JADM DMCST, 78 members responded for 2018 West Japan Torrential Rain Disaster. Most of the members responded to the medical headquarter of affected prefecture’s, city’s, and medical region’s headquarters. Members provided logistic support in headquarter operation, gathered medical needs information, helped medical team dispatch coordination, gathered evacuation shelter information, provided heat stroke support for evacuees, assisted deep vein thrombosis management, provided AED delivery operation, and helped statistical information analysis based on WHO standards.Discussion:JAMD DMCST could provide medical management support at each headquarters without time span restrictions which the most of disaster medical assistance team has. Since all members were experienced in disaster medical management, they could connect and keep providing medical assistance to the affected people. At the time of disaster, disaster medical management headquarter is always short handed due to a large amount of incoming information. All this information was managed by the support team. Although JADM DMCST contributed to support headquarter management, each member had to pay for his/her transportation, hotel, food and any devices required for headquarter operations. Therefore, improving member’s responding condition is next problem to solve.

Introduction:On March 11, 2011, the Great East Japan Earthquake struck the northeastern coast of Japan with the magnitude nine. Ishinomaki medical zone was affected most severely with 328 evacuation shelters and approximately 50,000 evacuees. The Ishinomaki Zone Joint Relief Team gathered information directly from all evacuation shelters using assessment sheets. Based on this assessment data, various measures were carried out for environmental improvement of the shelters. To prepare for the next major disaster, a software program called Rapid Assessment System of Evacuation Center Condition - Gonryo and Miyagi (RASECC-GM) was developed, which computerizes the whole process, including entering, tabulating, and managing of shelter assessment data.Aim:To verify the feasibility, usability, and accuracy of RASECC-GM, a verification test was performed using mock shelter data on October 23-26, 2018, to coincide with Logistics Training Course of Medical Logistics for Disasters held by Iwate Medical University.Methods:On October 22, 2018 at four simulated disaster relief and health care branches, participants at each branch were asked to enter two mock shelter data items, submit a closed shelter request, and register a new shelter using RASECC-GM, respectively. The next day participants were asked to enter two mock shelter data items per branch while offline and upload the data to the server when next online. The uploaded data was checked for accuracy and whether it could be viewed on the management screen. After the test, a questionnaire survey was given to participants to verify the feasibility and usability of RASECC-GM.Results:It was confirmed that RASECC-GM functioned almost correctly. All participants answered that input operation was easy to understand, and 90.9% of participants could input without a mistake and did not feel stress when inputting data.Discussion:RASECC-GM appeared to be useful to shelter assessment, but further improvements are needed for practical use.

A 65-year-old woman presented with subarachnoid hemorrhage (SAH). Angiography detected a small bulge in the A1 segment of the right anterior cerebral artery (ACA). The patient was managed conservatively. Ten days after the initial SAH, the patient suffered a second SAH. Cerebral angiography demonstrated a fusiform aneurysm in the right A1 segment and vasospasm in the left A1 segment. The aneurysm of the right A1 segment was trapped and the right superficial temporal artery (STA) was end-to-end anastomosed to the distal portion of the right A1 segment. The patient had no postoperative cerebral ischemic events. Postoperative cerebral angiography revealed that the bypass flow through the right STA perfused the right ACA territories. STA-A1 end-to-end anastomosis can prevent cerebral ischemic events following parent vessel occlusion or microsurgical trapping for fusiform cerebral aneurysms in the A1 segment without sufficient collateral flow to the ipsilateral ACA territory from the contralateral ACA.

Surgical indications in traumatic optic nerve injury are controversial. Many report that patient with no light perception or light reflex immediately after trauma had no surgical indication. We reported 2 cases in which optic nerve decompression was useful in ameliorating traumatic optic nerve injury. Both subjects had been injured in traffic accidents. Three-dimensional CT scan (3D-CT) was useful in diagnosing optic canal fracture. Case 1: 72-year-old man. 3D-CT showed right optic canal fracture. On hospital day 7, we conducted optic canal decompression. Preoperative visual acuity of 0.04 improved to 0.08 after operation. Case 2: 41-year-old man. 3D-CT showed right optic canal fracture and he was diagnosed as blind in the right eye. After 2.5 half months, visual acuity improved to enable light perception. After optic canal decompression, the subject's visual acuity improved to where he could count fingers. 3D-CT is thus useful in diagnosing optic canal fracture. Optic nerve decompression should be considered even in patients having no light perception or light reflex.

脳血管障害急性期の睡眠周期上の昼夜の逆転状態 (以下, 昼夜逆転) について検討した.方法 : 対象は発症当日入院の脳梗塞97例, 脳出血50例の計147例である.結果 : 昼夜逆転は43例で, (1) 70歳以上および入院時意識障害例に高率にみられた. (2) 入院時意識障害なし例では第2, 3病日以内に発症し, 意識障害あり例では92%が覚醒後3日以内に発症した. (3) 梗塞, 出血例の重症例に多い. (4) 可能な体位がpassive坐位以下の例で41例みられた. (5) 初発症状は, 日中の嗜眠傾向が15例, 夜間開眼が28例で, 精神症状は16例 (37.2%) でみられた. (6) 睡眠-覚醒リズムの異常が明らかになった時点では日中の睡眠が23例, 日中の睡眠, 夜間開眼が17例, 全日覚醒が3例である.精神症状は26例 (60.5%) でみられた. (7) 治療は日中の椅子での坐位管理とリハビリテーションを基礎とするtiapride hydrochloride投与が有用である.結論 : 昼夜逆転の早期発見と治療が重要である.

Background Carotid endarterectomy (CEA) might improve cognitive function. Fractional anisotropy (FA) values in the cerebral white matter derived from diffusion tensor magnetic resonance imaging (DTI) correlate with cognitive function in patients with various central nervous system diseases. Objective To use tract-based spatial statistics to determine whether postoperative changes of FA values in the cerebral white matter derived from DTI are associated with cognitive improvement after uncomplicated CEA. Methods In 80 patients undergoing CEA for ipsilateral internal carotid artery stenosis (≥70%), FA values in the cerebral white matter were derived from DTI before and 1 month after surgery and were analyzed by using tract-based spatial statistics. Neuropsychological testing, consisting of the Wechsler Adult Intelligence Scale Revised, the Wechsler Memory Scale and the Rey-Osterreith Complex Figure test, was also performed preoperatively and after the first postoperative month. Results Based on the neuropsychological assessments, 11 (14%) patients were defined as having postoperatively improved cognition. The difference between the 2 mean FA values (postoperative values minus preoperative values) in the cerebral hemisphere ipsilateral to surgery was significantly associated with postoperative cognitive improvement (95% confidence intervals, 2.632-9.877; P = .008). White matter FA values in patients with postoperative cognitive improvement were significantly increased after surgery in the whole ipsilateral cerebral hemisphere, in the contralateral anterior cerebral artery territory, and in the watershed zone between the contralateral anterior and middle cerebral arteries. Conclusion Postoperative increase in cerebral white matter FA on DTI is associated with cognitive improvement after uncomplicated CEA.

BACKGROUND: Rhabdoid meningioma exhibits high mitotic activity, anaplasia, and increased markers of cell proliferation. Here we describe a rhabdoid meningioma with a pattern of growth extending into the subarachnoid space and filled the cortical sulci. CASE DESCRIPTION: A 72-year-old woman presented with headache and was admitted to our hospital. Neurologic and physical examinations revealed no abnormalities. Contrast-enhanced axial T1-weighted images showed a well-enhanced, dural-based mass compressing the right temporal and frontal lobes, and extending into the sylvian cistern and filling the cortical sulci. The patient underwent partial resection and the histologic findings demonstrated rhabdoid meningioma. CONCLUSION: Although this type of tumor is known to be aggressive in its growth, extension into the adjacent cisternal space and the filling of the cortical sulci are rare. The combination of histologic anaplasia with the highest reported proliferation rate, loss of cohesion of neoplastic cells, and the location of the tumor led to the unique growth pattern.

A 4-month-old girl fell off a table onto the floor. Computed tomography performed 4 hours after the trauma showed a left parietal epidural hematoma (EDH) with an omega-shaped fracture line in the left parietal region. The EDH was enlarged after another 4 hours. However, the EDH showed drainage into the subgaleal space through the skull fracture 2 days after the trauma and was almost completely discharged into the subgaleal space by 5 days after trauma. Both the EDH and the subgaleal hematoma had resolved completely by 12 days after the trauma. No symptoms or signs were observed during the course. This case suggests that EDH can drain slowly and spontaneously into the subgaleal space through a skull fracture in an infant.

Posterior reversible encephalopathy syndrome (PRES) is rarely associated with subarachnoid haemorrhage (SAH). We present a case involving a patient who developed PRES, prior to induction of hypertensive therapy, 2 days after the onset of a SAH due to a ruptured intracranial aneurysm.

A 65-year-old woman presented with subarachnoid hemorrhage (SAH). Angiography detected a small bulge in the A1 segment of the right anterior cerebral artery (ACA). The patient was managed conservatively. Ten days after the initial SAH, the patient suffered a second SAH. Cerebral angiography demonstrated a fusiform aneurysm in the right A1 segment and vasospasm in the left A1 segment. The aneurysm of the right A1 segment was trapped and the right superficial temporal artery (STA) was end-to-end anastomosed to the distal portion of the right A1 segment. The patient had no postoperative cerebral ischemic events. Postoperative cerebral angiography revealed that the bypass flow through the right STA perfused the right ACA territories. STA-A1 end-to-end anastomosis can prevent cerebral ischemic events following parent vessel occlusion or microsurgical trapping for fusiform cerebral aneurysms in the A1 segment without sufficient collateral flow to the ipsilateral ACA territory from the contralateral ACA.

Excimer laser (KrF excimer laser, 248 nm wavelength) was used to damage cellular components in the dorsal funiculus at the lumbar level (L2) of the rat spinal cord. An open lesion was not found at the irradiation site on the spinal cord. However, the cytological examination revealed that cellular components were damaged to the depth of 200-500 microm from the pial surface. The characteristic feature was that at the border of the lesion, many axons remained naked but intact after their myelin sheaths had been completely disintegrated. Such naked axons were subsequently remyelinated by mature or immature glial cells. Mature oligodendrocytes, while retaining their cytoplasmic processes connected with the myelin sheaths of unaffected axons, extended new cytoplasmic processes on nearby naked axons and made new myelin sheaths around them. In contrast, 7 days after the irradiation, numerous immature glial cells appeared in association with naked axons, and some of them were differentiated into oligodendrocytes forming thin myelin sheaths on naked axons. These findings suggest that demyelinated axons can cause the proliferation and probably dedifferentiation of the oligodendrocyte lineage. The use of lasers provides a unique experimental model of demyelination and remyelination in the central nervous system of adult mammals.