NMC case report journal最新文献

{"title":"Complete Liberation from Mechanical Ventilation Using Diaphragm Pacing in a Patient with Traumatic Spinal Cord Injury Despite Persistent Unilateral Diaphragmatic Paralysis.","authors":"Shinya Tokunaga, Akinori Miyakoshi, Shinsuke Sato, Yoshihito Hirata, Hiromasa Adachi, Daisuke Arai, Tsukasa Sato, Yoshifumi Kawanabe","doi":"10.2176/jns-nmc.2025-0231","DOIUrl":"10.2176/jns-nmc.2025-0231","url":null,"abstract":"<p><p>We report a case of successful diaphragm pacing in a patient with severe traumatic spinal cord injury resulting in complete ventilator dependence. A 29-year-old man sustained a traumatic cervical spinal injury at the C3 level. On admission, he exhibited tetraplegia, complete sensory loss below the C6 dermatome, and acute respiratory failure. Emergency spinal decompression surgery was performed; however, neurological deficits showed no improvement. Despite intensive respiratory rehabilitation, the patient remained fully dependent on mechanical ventilation. Diaphragm pacing implantation was planned approximately 17 weeks post-injury. Intraoperative electrical stimulation revealed no responsiveness in the left diaphragm, whereas the right diaphragm demonstrated sufficient contractility. After estimating that adequate tidal volumes could be achieved through unilateral right diaphragmatic stimulation, bilateral diaphragmatic electrodes were laparoscopically implanted. Diaphragm pacing was initiated on postoperative day one, gradually increasing pacing duration daily while maintaining exertion levels below the Borg scale 4. By day 46 post-implantation, the patient achieved complete independence from mechanical ventilation despite persistent left diaphragmatic paralysis. Enhanced right diaphragmatic function was confirmed by increased diaphragmatic thickness and thickening fraction. Additionally, improved sputum clearance allowed withdrawal from cough-assist therapy and subsequent closure of tracheostomy. At 1-year follow-up, the patient maintained independent respiration without device-related complications. This case highlights the potential efficacy of early diaphragm pacing implantation in patients with high cervical spinal cord injury, demonstrating favorable respiratory outcomes even in the presence of unilateral diaphragmatic dysfunction.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"13 ","pages":"55-61"},"PeriodicalIF":0.0,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12995512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Crystal Violet Staining Facilitates Boundary Recognition in the Removal of Spinal Arachnoid Pathology.","authors":"Aya Endo, Hime Suzuki, Sho Matsunaga, Yoshifumi Horita, Masayoshi Takigami, Takahiro Tsuji, Nobuhiro Mikuni, Takeshi Mikami","doi":"10.2176/jns-nmc.2025-0200","DOIUrl":"10.2176/jns-nmc.2025-0200","url":null,"abstract":"<p><p>Spinal arachnoid cysts are relatively uncommon lesions, broadly classified as either congenital or acquired. Acquired cysts may develop following trauma, hemorrhage, or post-infectious inflammation. Depending on their location, these cysts can cause a range of symptoms, including quadriplegia, pain, sensory disturbances, and gait impairment. Surgical resection may be indicated in cases with significant neurological symptoms. We report the case of a 77-year-old woman who presented with persistent bilateral leg numbness and pain. Magnetic resonance imaging revealed a suspected intradural spinal arachnoid cyst or arachnoid web at the Th7-8 level, and surgery was planned to relieve the symptoms. A laminectomy was performed, revealing a cystic, membrane-like structure in the subdural space. By injecting a crystal violet staining solution into the cyst, we enhanced the visibility of the boundary between the normal arachnoid membrane and the cyst, allowing for complete resection. Postoperatively, the patient experienced improvement in leg pain and numbness. This case demonstrates that crystal violet staining can facilitate clear boundary recognition during arachnoid cyst resection, enabling more precise cyst removal.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"13 ","pages":"49-54"},"PeriodicalIF":0.0,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12995513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct Carotid Artery Exposure for Mechanical Thrombectomy in a Patient with Marfan Syndrome and Prior Total Arch Replacement.","authors":"Kengo Kishida, Hideki Oka, Keisuke Fuji, Shigeomi Yokoya, Hitoshi Kawano, Hidesato Takezawa","doi":"10.2176/jns-nmc.2025-0276","DOIUrl":"10.2176/jns-nmc.2025-0276","url":null,"abstract":"<p><p>Marfan syndrome presents unique challenges for mechanical thrombectomy in acute ischemic stroke due to vascular fragility and complex aortic anatomy, often from prior surgeries. We describe the case of a man in his 50s with Marfan syndrome, total aortic arch replacement, mechanical valve replacement, and extensive chronic dissections, who presented with acute ischemic stroke due to right internal carotid artery occlusion. Conventional transfemoral access failed due to anomalous prosthetic brachiocephalic artery graft anatomy. Consequently, mechanical thrombectomy was performed via direct surgical exposure and puncture of the right common carotid artery. Despite initial avoidance of a stent retriever due to Marfan syndrome-related vessel fragility, an stent retriever was ultimately used in a combined technique with aspiration in the third pass, achieving partial recanalization (thrombolysis in cerebral infarction 2a) and retrieval of a fibrin-rich thrombus. This case highlights direct carotid access as a feasible alternative in Marfan syndrome patients with prohibitive conventional access and suggests stent retrievers can be used cautiously.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"13 ","pages":"63-68"},"PeriodicalIF":0.0,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12995514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to the Editor: \"Coil Embolization of a Ruptured Traumatic Pseudoaneurysm of the Middle Meningeal Artery: A Case Report\".","authors":"Naoki Nishizawa, Tomoki Kidani, Shin Nakajima, Yonehiro Kanemura, Katsunori Asai, Nobuyuki Izutsu, Saki Kawamoto, Koji Kobayashi, Mikako Nomoto, Yosuke Fujimi, Masayoshi Kida, Toshiyuki Fujinaka","doi":"10.2176/jns-nmc.2025-0349","DOIUrl":"10.2176/jns-nmc.2025-0349","url":null,"abstract":"","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"13 ","pages":"39-40"},"PeriodicalIF":0.0,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147380265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Myxoid Glioneuronal Tumor in the Lateral Ventricle.","authors":"Wataru Ueki, Terushige Toyooka, Keisuke Kuboshima, Tetsuya Yamamoto, Kazuya Fujii, Satoru Takeuchi, Arata Tomiyama, Fumihisa Kumazawa, Kimiya Sato, Hideaki Yokoo, Kojiro Wada","doi":"10.2176/jns-nmc.2025-0220","DOIUrl":"10.2176/jns-nmc.2025-0220","url":null,"abstract":"<p><p>Myxoid glioneuronal tumor is a newly included entity in the 2021 World Health Organization classification of central nervous system tumors, based on both pathological and molecular evidence, characterized by platelet-derived growth factor receptor alpha mutations. A 23-year-old female presented with intermittent visual field abnormalities and dizziness. Magnetic resonance imaging revealed a 2-cm mass occupying both foramens of Monro, leading to non-communicating hydrocephalus. Endoscopic surgery via the transcortical approach achieved gross total resection of the tumor. Postoperatively, she developed cognitive dysfunction involving recent memory disturbance and progressive ventricular dilation, necessitating a ventriculoperitoneal shunt, which led to significant cognitive recovery. Histopathological analysis confirmed myxoid glioneuronal tumor with a platelet-derived growth factor receptor alpha p.K385L mutation. A review of 23 cases, including ours, indicates that surgical resection is the preferred treatment and is generally associated with a favorable prognosis. However, recurrence and meningeal dissemination have been reported in some cases, emphasizing the need for long-term follow-up. Myxoid glioneuronal tumor is frequently located close to critical structures like the fornix, so careful surgical planning is essential to balance maximal resection with functional preservation. Endoscopic techniques offer advantages for deep-seated lesions by minimizing cortical damage while allowing adequate tumor resection. Further studies are needed to establish the optimal treatment strategies and clarify the long-term prognosis of myxoid glioneuronal tumor.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"13 ","pages":"41-47"},"PeriodicalIF":0.0,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147380230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adult Medullary Diffuse Midline Glioma Presenting with Orthostatic Hypotension: A Case Report.","authors":"Mizuho Inoue, Kentaro Mori, Shinichi Numazawa, Sadayoshi Watanabe","doi":"10.2176/jns-nmc.2025-0286","DOIUrl":"10.2176/jns-nmc.2025-0286","url":null,"abstract":"<p><p>Diffuse midline glioma, H3K27-altered, is a rare and aggressive central nervous system tumor that typically affects children, whereas adult cases are uncommon and less well characterized. We report a 43-year-old woman who experienced progressive lightheadedness for 10 months and was diagnosed with orthostatic hypotension on the basis of a positive tilt-table test result. Despite treatment with midodrine, her symptoms worsened, and dysarthria, dysphagia, sensory disturbance, and gait instability later developed. Magnetic resonance imaging confirmed an intra-axial mass in the dorsal medulla oblongata. Partial resection was performed, and histopathological examination with immunohistochemistry confirmed the diagnosis of H3K27-altered diffuse midline glioma. The patient subsequently received adjuvant chemoradiotherapy. Although her motor function improved postoperatively, severe orthostatic hypotension persisted, leading to recurrent syncopal episodes that significantly hindered rehabilitation. The solitary nucleus in the dorsal medulla plays a central role in the baroreflex by relaying sympathetic and parasympathetic signals within the central autonomic network. Disruption of this network by medullary tumors can impair blood pressure regulation, causing orthostatic hypotension. Although orthostatic hypotension has been reported in association with various medullary tumors, gliomas are rarely implicated. To our knowledge, this is the first reported case of medullary diffuse midline glioma presenting with orthostatic hypotension under the current World Health Organization molecular classification. This case highlights the importance of considering brain magnetic resonance imaging in patients with newly developed or severe orthostatic hypotension, particularly when accompanied by neurological symptoms, to enable timely diagnosis and management.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"13 ","pages":"33-36"},"PeriodicalIF":0.0,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147380271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Coil Embolization of a Ruptured Traumatic Pseudoaneurysm of the Middle Meningeal Artery: A Case Report\".","authors":"Myoung Soo Kim","doi":"10.2176/jns-nmc.2025-0127","DOIUrl":"10.2176/jns-nmc.2025-0127","url":null,"abstract":"","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"13 ","pages":"37-38"},"PeriodicalIF":0.0,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147380193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Thrombectomy in a Patient with Acute Ischemic Stroke due to Tumor Emboli Associated with Cardiac Metastasis of Extraskeletal Myxoid Chondrosarcoma: A Case Report.","authors":"Yasuhiro Kawabata, Osamu Kawakami, Kimihiko Tamura, Koichi Fujimoto, Yuki Tamura, Motohiro Kajiwara, Tomoya Myojin, Emi Date, Norishige Iizuka, Ayumi Iwamuro, Masahiro Kawashima","doi":"10.2176/jns-nmc.2025-0216","DOIUrl":"10.2176/jns-nmc.2025-0216","url":null,"abstract":"<p><p>Cardioembolic stroke caused by tumor emboli is a rare form of cancer-associated stroke. We report a case of a patient with cardiac metastasis of extraskeletal chondrosarcoma who developed left internal carotid artery occlusion due to embolic stroke. Extraskeletal chondrosarcoma is an extremely rare subtype of soft tissue sarcoma characterized by a tendency for local recurrence and metastasis. Endovascular thrombectomy was performed using a combined technique, achieving complete revascularization. Histopathological analysis of the retrieved cell mass confirmed that the embolic source was the preexisting extraskeletal chondrosarcoma.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"13 ","pages":"27-32"},"PeriodicalIF":0.0,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147380269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral Contraceptive Use and Acute Ischemic Stroke Risk in Patients with Moyamoya Disease.","authors":"Shoko Hara, Shota Takahashi, Ayako Fudono, Kotoi Tsurane, Bongguk Kim, Motoki Inaji, Yoji Tanaka, Tadashi Nariai, Naoyuki Miyasaka, Taketoshi Maehara","doi":"10.2176/jns-nmc.2025-0140","DOIUrl":"10.2176/jns-nmc.2025-0140","url":null,"abstract":"<p><p>To investigate whether oral contraceptives induce acute ischemic stroke in patients with moyamoya disease. We retrospectively reviewed female patients with moyamoya disease who were taking oral contraceptives during their reproductive years (12-49 years of age) at the time of diagnosis or during follow-up. The patients' detailed clinical history, including the time course of oral contraceptive usage and acute ischemic stroke occurrence, was evaluated. For patients with radiological evidence of acute ischemic stroke, the imaging pattern of stroke was assessed to investigate the underlying mechanisms. Among 589 female patients, 12 patients took oral contraceptives at some point during the period from 2012 to 2023; 5 patients were taking oral contraceptives at the time of diagnosis, and 4 of them were diagnosed with moyamoya disease after acute ischemic stroke. Among the 7 patients who started oral contraceptives during follow-up, 2 patients developed acute ischemic stroke several months after starting oral contraceptives. Notably, none of the hemispheres that developed acute ischemic stroke previously underwent revascularization, and none of the 5 hemispheres with prior revascularization developed acute ischemic stroke. The imaging pattern of acute ischemic stroke in 7 patients suggested the contribution of a thromboembolic mechanism. Oral contraceptives may increase the risk of acute ischemic stroke via thromboembolic mechanisms in patients with moyamoya disease, but its risk might be manageable in hemispheres with prior revascularization and stable disease conditions for years. Active education of patients regarding the possible risk of oral contraceptives and close communication with gynecologists seem necessary to provide the best treatment strategies for female patients with moyamoya disease who require contraception or treatment of menstrual disorders.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"13 ","pages":"21-26"},"PeriodicalIF":0.0,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12906944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Screw Extrusion through the Skin after Cervical Laminoplasty.","authors":"Yutaka Ito, Kunio Yokoyama, Naokado Ikeda, Hidekazu Tanaka, Daiji Ichihashi, Makoto Yamada, Akira Sugie, Masahiro Kawanishi","doi":"10.2176/jns-nmc.2025-0271","DOIUrl":"10.2176/jns-nmc.2025-0271","url":null,"abstract":"<p><p>Cervical laminoplasty is a well-established surgical approach for managing various cervical spine pathologies, including cervical spondylotic myelopathy, spinal canal stenosis, and ossification of the posterior longitudinal ligament. Among the available laminoplasty techniques, the use of Hydroxyapatite spacers secured with screws is common for maintaining the expanded interlaminar space. However, one potential complication is screw back-out, which, although recognized, has rarely been documented in the literature. We present a rare case of delayed screw migration culminating in skin perforation in a 76-year-old woman who underwent cervical laminoplasty for cervical spondylotic myelopathy. During the index procedure, Hydroxyapatite spacers were placed and secured with screws into the lamina. Seven years postoperatively, gradual subcutaneous migration of the screw from the lamina of the fourth cervical vertebra was observed, ultimately resulting in complete skin penetration 9 years after the initial surgery. The patient underwent surgical removal of the protruding screw along with surrounding granulation tissue. The surgical site was thoroughly irrigated with copious saline, and the wound was closed primarily with sutures. Postoperative recovery was uneventful. Stitches were removed on day 11 after confirming complete wound healing. This case underscores an exceptionally rare but clinically significant late complication of cervical laminoplasty with Hydroxyapatite spacers -complete screw extrusion through the skin. To our knowledge, this is the first documented case of its kind. The prolonged asymptomatic nature of screw migration in this patient highlights the importance of long-term surveillance following laminoplasty, even in the absence of clinical symptoms, to detect hardware-related complications at an early stage.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"13 ","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12906941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146207132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}