9. 脳幹, 小脳での
構音障害の部位.
橋底部∼中脳の腹側
主にSCA領域で多い.
region on the right side in four patients and the left side in and/or ataxic
one. In another patient, a left-sided superior cerebellar tive predictiv
artery infarction was combined with a left-sided posterior lacunar infarc
inferior cerebellar artery infarct. dysarthria, dy
Combined cerebellar and brainstem infarctions oc- facial paresis,
NEUROLOGY 2001;56:1021–1027 curred in eight patients (11.8%), affecting the superior cer- 15 of 17 (88.2
10. Table 2 Lesion localization of dysarthria in classic lacunar syndromes in 36 patients
MCA territory Corona radiata/ Cerebral
Finding with cortex internal capsule peduncle Basis pontis Cerebellum Total
Isolated D — 2 — — — 2
D–lingual paresis — 1 — — — 1
D–facial paresis 1 5 — — — 6
D–clumsy hand syndrome 2 2 1 1 2 8
D–PMH/AH 1 8 — 10 — 19
D ϭ dysarthria; PMH ϭ pure motor hemiparesis; AH ϭ ataxic hemiparesis; MCA ϭ middle cerebral artery.
1024 NEUROLOGY 56 April (2 of 2) 2001
• 構音障害のみ呈した脳 塞2例/68 (2.8%)は NEUROLOGY 2001;56:1021–1027
2例とも内包, 放線冠のラクナ 塞.
Table 3. Lesion localization of dysarthria
構音障害101例の解析でも
in lacunar syndromes Clinical feature ACA MCA territory Internal Thala- Mesen- Pons Cere- Total
capsule/ mus ceph- bel-
cortical subcortical putamen alon lum
(構音障害のみは15例)
Pure D – 5 4 3 1 – – 21 15
その15例は全例ラクナ. D-clumsy hand 2 1 1 – – 3 – 7
D-PMH 1 4 4 – 1 4 – 14
D-AH 1 3 2 – – 5 – 11
D-facial paresis 2 3 1 – 1 1 – 8
13例がテント上, D-PSS
D-lingual
–
–
–
–
–
2
2
–
–
–
1
–
–
–
3
2
2例が小脳+橋 ACA = Anterior cerebral artery; AH = ataxic hemiparesis; D = dysarthria; MCA =
middle cerebral artery; PMH = pure motor hemiparesis; PSS = pure sensorial stroke.
1 The 2 patients had a concomitant pontine lesion.
Cerebrovasc Dis 2007;23:331–338
12. 261名のSingle-center Retrospective cohort study
Severe Sepsis, Septic ShockでEGDTを開始した患者群を対象
トリアージ∼抗生剤開始までの時間と, 死亡率 Crit Care Med 2010;38:1045-53
Triage-appropriate Abx投与までの
時間と死亡率
Cutoff 死亡率 Difference OR
=<1hr vs >1hr 19.5% vs 33.2% 13.7% 0.30[0.11-0.83]
=<2hr vs >2hr 28.2% vs 33.6% 5.4% 0.54[0.29-1.03]
=<3hr vs >3hr 27.9% vs 37.1% 9.2% 0.53[0.27-1.01]
=<4hr vs >4hr 28.5% vs 39.3% 10.8% 0.62[0.31-1.24]
=<5hr vs >5hr 30.7% vs 32.6% 1.8% 0.82[0.37-1.79]
大事なのは早期の診断とAppropriateな抗生剤の投与!
(早くても見当違いなAbxではダメだし, 遅くてもダメ!)