田中 亮太

AIM: A reduction in low-density lipoprotein cholesterol (LDL-C) is beneficial for vascular diseases; however, lower LDL-C levels may be associated with an increased risk of spontaneous intracerebral hemorrhage (sICH). The present study investigated the relationship between the LDL-C levels and in-hospital mortality after sICH using data from the Juntendo Registry of Spontaneous Intra-Cerebral Hemorrhage (J-ICH registry). METHODS: Patients aged ≥ 20 years with non-traumatic sICH admitted to five Juntendo-affiliated hospitals between September 2016 and December 2019 were enrolled in this study. The relationships between the LDL-C levels and in-hospital mortality, statin therapy, and antithrombotic therapy were analyzed. RESULTS: Among the 1,017 patients with sICH, lower LDL-C levels were associated with older age, a lower BMI, a larger hematoma volume, more severe neurological deficits, and a higher in-hospital mortality. A logistic regression analysis confirmed that LDL-C ＜100 mg/dL independently increased the risk of in-hospital death, along with age, the NIHSS score, hematoma volume, and intraventricular hemorrhage. Subgroup analyses showed that the association between low LDL-C levels and mortality was particularly evident in patients with deep/infratentorial intracerebral hemorrhage, those managed without surgery, and those without prior statin use. Prior statin use was associated with a potential protective effect against in-hospital mortality and hematoma volume. CONCLUSION: This study demonstrated that lower LDL-C levels were associated with a higher in-hospital mortality after sICH, whereas prior statin use was not associated with poorer outcomes and may instead offer a protective effect.

BACKGROUND: This case reports aimed to clarify the characteristic MRI findings in GABAA receptor encephalitis. CASE PRESENTATION: We report the cases of two encephalitis patients who had a history of thymoma surgery and in whom anti-GABAAR antibodies and characteristic MRI findings were observed. These patients were clinically diagnosed as having thymoma-associated paraneoplastic encephalitis (TAPE) before the antibodies were identified. TAPE is often associated with antibodies to various neuronal surface antigens, including GABAAR, AMPAR, CASPR2, LGI1, and GlyR. MRI findings of autoimmune encephalitis are extremely variable, but when multiple homogenous high-signal-intensity lesions are observed on FLAIR images, as in these cases, anti-GABAAR antibodies are likely to be involved. We have named here this MRI finding the "cotton-wool-like appearance". CONCLUSION: In cases of encephalitis with such characteristic radiological findings, neurologists should first investigate the presence or a history of thymoma surgery, and then promptly consider testing for anti-GABAAR antibodies.

Background <p lang="en">Mucosal‐associated invariant T (MAIT) cells are involved in acute ischemic stroke in mice models. This study aimed to clarify the dynamics and role of circulating MAIT cells in patients with acute ischemic stroke. </p> Methods <p lang="en">Patients with acute ischemic stroke were classified according to the National Institutes of Health Stroke Scale into severe (score ≥ 10) and mild (score &lt; 10) groups; outpatients with matched sex and age were selected as controls. Circulating MAIT cells, activation (CD69+), and cytokine production (IFN‐γ [interferon‐gamma] + and IL‐17 [interleukin‐17]+) on days 3, 10, and 17 after stroke, along with invariant natural killer T cells, gamma delta T cells, CD4+, and CD8+ T‐cell populations, were analyzed by flow cytometry. The relationship between MAIT cell dynamics and clinical outcomes was examined. </p> Results <p lang="en"> One hundred participants (30 severe, 40 mild, 30 controls) were included. On day 3, patients with severe stroke had a significantly lower proportion of MAIT cells than the mild group and controls (severe, mild, control [median]: 0.09%, 0.33%, 0.38%, respectively; P  &lt; 0.001), which gradually recovered on day 17. Severe stroke MAIT cells showed higher frequencies of CD69 expression and IL‐17 production. Multivariate analysis showed patients in the lowest MAIT cell population quartile on day 3 had a significantly higher probability of poor outcomes at 3 months than those in the highest quartile (odds ratio, 21.64 [95% CI, 1.41–331.58]; P  = 0.027). </p> Conclusions <p lang="en">An early decrease in MAIT cells with higher activity and proinflammatory cytokine production correlated with stroke severity and poor outcomes, suggesting a significant role of MAIT cells in acute cerebral infarction and unfavorable outcomes. </p>