Brain and nerve = Shinkei kenkyū no shinpo
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Cerebral small vessel disease (SVD), including subcortical lacunar infarcts (lacunes) and white matter hyperintensities (WMH), is commonly observed on MRI of elderly individuals with and without dementia. SVD is frequently observed in patients with Alzheimer's disease (AD). ⋯ Our recent studies suggest that cerebral SVD observed on CT/MRI of patients with AD is associated with delusions and delirium as well as depression. Mechanisms underlying these psychiatric symptoms in patients with AD remain unclear.
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Several studies have demonstrated the serious impact of surgeries on patients with Parkinson's disease (PD). In addition, PD is a risk factor for postoperative complications and prolonged hospital stays. Discontinuation of anti-Parkinsonian drugs due to surgery causes an exacerbation of Parkinsonism and sometimes Parkinsonism-hyperpyrexia syndrome (PHS). ⋯ During the postoperative phase, postoperative pain, aspiration pneumonia, ileus, and psychotic symptoms should be managed, taking into consideration the interactions between anti-Parkinsonian drugs and therapeutic agents. Currently, new anti-Parkinsonian drugs, such as rotigotine and apomorphine are available for patients with PD requiring parenteral treatment. It is important that medical experts share awareness about perioperative problems and their management in patients with PD.
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Spontaneous anterior or posterior interosseous nerve palsy is usually treated as a part of neuralgic amyotrophy. However, recent studies have shown that many of these cases involved fascicular constriction in the affected nerves, and interfascicular neurolysis may be a better option than conservative treatment in cases that do not show spontaneous recovery within several months. Here, we review recent studies on these palsies.
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Review Case Reports
[Multiple cranial neuropathies in a patient with IgG4-related hypertrophic pachymeningitis: a case report].
We describe the case of a 75-year-old woman who presented with acute loss of vision. She experienced subacute headache, hearing loss on the left side, hoarseness, and dysphagia during the previous 10 months. On admission, she had bilateral loss of vision, without any ophthalmological abnormalities, and multiple cranial nerve palsies, including left hearing loss and right IX, X, and XI nerve palsies. ⋯ However, it should be recognized that these conditions might be underdiagnosed. The possibility of central nervous system involvement in IgG4-related disorders should be considered in patients with multiple cranial nerve neuropathies associated with hypertrophic pachymeningitis, even in the absence of systemic sclerosis symptoms. In our case, early treatment with corticosteroids showed immediate effectiveness in correcting the visual symptoms.
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Charcot-Marie-Tooth (CMT) disease is a clinically and genetically heterogeneous group of diseases with over 45 different causative gene mutations identified. Nerve conduction studies are important for the classification and diagnosis of CMT, whereas ultrasound (US) is increasingly used to assess the peripheral nerves of patients with CMT, as a complement to neurophysiological studies. Recent ultrasound assessment reports of peripheral nerves in CMT are summarized here. ⋯ Focal enlargement of nerves at entrapment sites is a characteristic US finding of hereditary neuropathy with liability to pressure palsy. US findings of CMT are thus subtype-specific. Therefore, the assessment of nerve US may become a useful supporting tool for the diagnosis of CMT subtypes.