Internal medicine
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A 63-year-old previously healthy man participated in a longitudinal epidemiologic study of dementia and aging. Although he initially showed no subjective symptoms and a normal motor function, verbal fluency test scores gradually declined, and progressive atrophy of the frontal lobes was observed on magnetic resonance imaging of the head. At 71 years old, progressive supranuclear palsy (PSP) was diagnosed after supranuclear gaze palsy, and gait disturbance developed. This longitudinal epidemiological study suggests that verbal symptoms and mild frontal lobe atrophy may be evident in the premotor phase of PSP.
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In hemodialysis-related portal-systemic encephalopathy (HRPSE), transient negative pressure in the inferior vena cava (IVC) during dialysis increases the blood flow through a portal-systemic shunt, leading to encephalopathy. We report the case of a 74-year-old man with a gastrorenal shunt who developed HRPSE for the first time following venous occlusion due to thrombosis around a right femoral tunneled-cuffed hemodialysis catheter. ⋯ Conversely, after the thrombosis was dissolved, the ammonia levels decreased after dialysis. We hypothesized that venous stasis in the right lower limb due to thrombosis intensified the negative pressure in the IVC during dialysis, triggering HRPSE.
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Migraine is a prevalent and highly disabling neurological disorder. Recent progress in neuroscientific research has contributed to the development of new therapies for migraine, including triptans, ditans, calcitonin gene-related peptide (CGRP) antagonists, and CGRP-related monoclonal antibodies. Noninvasive neuromodulation devices have also been developed. We herein review the recent advances in research and the current standard of management for migraine patients.