Rinshō shinkeigaku = Clinical neurology
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Randomized Controlled Trial
[Stimulation of primary motor cortex and reorganization of cortical function].
The use of electrical motor cortex stimulation (EMCS) for post-stroke pain was established in Japan and has spread globally. EMCS has been used for the treatment of neuropathic pain, Parkinson's syndrome, and recovery of motor paresis. Since 2000, repetitive transcranial magnetic stimulation (rTMS) has been developed for the treatment of various neurological disorders. rTMS is a non-invasive method with almost no adverse effects. ⋯ For 'Kaifukuki' rehabilitation, high-frequency rTMS of affected M1 seemed to be effective for recovery of hand function. And even after cessation of rTMS, the recovery would be better than usual rehabilitation for two weeks. New methods and devices for rTMS therapy are under development, and rTMS of the M1 is likely to be established as an effective therapy for some neurological disorders.
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Review Case Reports
[Neurological decompression illness in a Japanese breath-held diver: a case report].
We report a Japanese breath-hold diver (Ama) who presented neurological disorders after diving. He repeated diving into 25-30 meters depth in the sea for 6 hours. After diving, he felt dizziness and unsteady gait. ⋯ He was diagnosed as having neurological decompression illness and therefore underwent hyperbaric oxygen therapy. The pathogenesis of this case was considered to be microbubbles induced by decompression. The present case suggests that repetitive rapid surfacing from the deep sea causes neurological decompression illness even in the breath-hold diver.
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The Antihypertensive Treatment for Acute Cerebral Hemorrhage (ATACH)-II Trial (ClinicalTrials.gov no. NCT01176565; (UMIN 000006526) is an international, multicenter, randomized, concurrently-controlled, parallel arm, Phase III trial to determine the therapeutic benefit of early intensive systolic blood pressure (SBP) lowering compared with standard SBP lowering for acute hypertension in patients with spontaneous intracerebral hemorrhage (ICH). The Trial is funded by the National Institutes of Health in the United States and led by Dr. ⋯ Subjects undergo a follow-up assessment for functional and quality of life assessment at 90 days post-randomization. The primary research hypothesis of the trial is that intensive SBP reduction (to ≤140mmHg) using intravenous nicardipine infusion for 24 hours post-randomization reduces the proportion of death and disability at 90 days by ≥10% (absolute) compared to the standard SBP reduction (to 140-180mmHg range) among subjects with ICH whose treatment is initiated within 4.5 hours of symptom onset. The ATACH-II Trial could be the seminal research project for stroke researchers in Japan to demonstrate themselves as effective contributing members of investigator-initiated international clinical trials.
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Comparative Study
[Associated tumors in patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis].
In 2007, Dalmau and colleagues described anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis associated with ovarian teratoma. As the numbers of patients with anti-NMDAR encephalitis increased, the frequency of paraneoplastic findings declined. The frequency of anti-NMDAR encephalitis with the tumor declined to 60% of a total of 100 patients in 2008, and 42% of a total of 400 patients in 2011. ⋯ These patients included breast cancer, neuroendocrine tumors, pancreatic carcinoma, sex cord stromal tumors, testicular germ-cell tumors and small-cell lung carcinoma. We encountered a 65-year-old female affected by anti-NMDAR encephalitis with carcinosarcoma with neuroendocrine differentiation of the uterus. The prognosis of anti-NMDAR encephalitis with malignant tumor could be dependent on the prognosis of the associated tumor.
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We report the case of a 34-year-old woman with cerebral and pulmonary cryptococcosis. After surgery for uterine cervical cancer, chest CT scan indicated a solitary tumor. Cryptococcosis was detected by transbronchial lung biopsy, and brain MRI showed multiple tumors. ⋯ An intracranial C. gattii infection is associated with neurological complications and delayed therapeutic response. If cerebral cryptococcosis responds slowly and relatively poorly to antifungal therapy, C. gattii should be considered. Aggressive therapy, including intraventricular therapy and corticosteroids therapy for cryptococcoma, is required.