RESUMEN
Objective: The most important function required for the stroke center is prompt treatment for acute stroke. We report the initial results of stroke care under the new medical care system of stroke center in a new hospital that merges three hospitals with different management bases to verify the effect of stroke center on mechanical thrombectomy. Methods: We investigated changes in the number of inpatients and surgical treatments compared with the past 3 years (Stages I, II, and III) with stage IV one year after the new hospital was opened, and examined the effect of establishing a stroke center on mechanical thrombectomy for acute main cerebral artery occlusion. Results: From stage I to stage IV, the number of hospitalized patients increased from 396, 485, 482 to 630, respectively, and the proportion of patients with cerebrovascular disease increased from 57.6%, 55.7%, 60.4% to 68.3%, respectively. Total surgical treatment increased from 137, 195, 224 to 297, respectively, especially endovascular therapy increased markedly from 22, 36, 68 to 118, respectively. The main treatment contents of endovascular treatment in stage IV were ruptured cerebral aneurysm embolization 22 cases, unruptured cerebral aneurysm embolization 13 cases, carotid artery stenting 23 cases, other intracranial or extracranial artery angioplasty/stenting 9 cases, and mechanical thrombectomy 34 cases. In particular, mechanical thrombectomy was significantly increased to 34 in stage IV, compared to 4 in stage I, 4 in stage II, and 17 in stage III (degree of contribution [DC] 25.0%, contribution ratio [CR] 34.0%). Conclusion: With the establishment of the stroke center, the number of cases of acute cerebral infarction within the adaptation time who received mechanical thrombectomy remarkably increased. It is considered that the effect and validity of function aggregation by establishing stroke center are shown.
RESUMEN
New-onset refractory status epilepticus (NORSE) is a rare neurological emergency condition with poor prognosis. A 30-year-old male suddenly had tonic-clonic convulsions seven days after a preceding fever and diarrhea. MRI showed a reversible splenial lesion, and he developed refractory multifocal and generalized seizures in spite of anticonvulsant medication. He was diagnosed with NORSE and received a combination treatment with immunotherapy and targeted temperature management (TTM), which effectively decreased his seizures. This case suggests that even for patients with reversible splenial lesions, NORSE should be considered, and that treatment with immunotherapy and TTM may be effective.