Rinshō shinkeigaku = Clinical neurology
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Rehabilitation is essential for treatment of Parkinson's disease. New rehabilitation therapy is updated, in addition to evidence shown with "Parkinson's disease treatment guidelines 2011". Furthermore, a portable gait rhythmogram (acceleration sensor) is presented (not publication). ⋯ We also could examine consecutive changes of gait rhythm and detect freezing gait in patients. In this study, we could extract the characteristic of the parkinsonian gait and evaluate especially freeing events more objectively. This method may bring us to evaluate severity of parkinsonian gait not only in a consulting room but also daily profile even not to see directly, using the portable gait rhythmogram.
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Neuroendovascular therapy is a rapidly evolving clinical subspecialty because of its minimal invasiveness and novel device development. In Japan, neurosurgeons perform a substantial portion of neuroendovascular procedures, however, the number of neurologists who certified by the Japanese Society for Neuroendovascular Therapy (interventional neurologist) is gradually increasing. Neurologists tend to deal with medical treatment in the acute stage and prevention of ischemic stroke, in addition, neuroendovascular procedures for ischemic cerebrovascular diseases performed by neurologists themselves, such as acute revascularization therapy for acute intracranial major artery occlusion or carotid artery stenting, might provide various benefits to ischemic stroke patients because of the smooth, seamless and close management from admission, to intervention, to discharge and after discharge. Because of insufficient number of interventionists to perform emergent neurointerventional procedures in the clinical setting of acute ischemic stroke in Japan, we wish that more neurologists get interested in and receive training in the neuroendovascular therapy.
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Over the last few years, various autoantibodies against cell surface or intracellular antigens were identified in association with several forms of encephalitis, i.e. autoimmune encephalitis. Immunoprecipitaion and sequence analysis of the target protein (proteomics) provided the identification of the antigens corresponding to autoantibodies in autoimmune encephalitis. Appropriate preparation of antigens (synthesized peptides, or recombinant proteins prepared in E.coli or cultured mammalian cells) and assay systems (immunoblot, ELISA, immunoprecipitation or cell-based assay) should be selected for detection of each autoantibodies. ⋯ Cerebellar ataxia is a common form of autoimmune encephalitis (cerebellits). The autoimmune cerebellar ataxia consists of paraneoplastic ataxia (anti-Yo etc.), anti-GAD-autoantibodies associated ataxia, gluten ataxia (anti-gliadin) and ataxic form of Hashimoto's encephalitis (anti-NAE). The early and accurate diagnosis of autoimmune encephalitis is important because most patients show responses to immunotherapy.
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A case of a small left pontine tegmental hemorrhage that presented as cheiro-oral syndrome with a bilateral perioral sensory disturbance is described. An 83-year-old man suddenly developed numbness in his bilateral perioral area and right hand. Head CT and MRI (T(2)*-weighted image) revealed a small left pontine tegmental hemorrhage. ⋯ The hematoma located in the left pontine tegmentum impaired the sensory fibers from the contralateral medial lemniscus (from the right hand) and the ventral trigeminothalamic tract (from the right perioral region). In addition, the ipsilateral trigeminothalamic tract (from the left perioral region) was also impaired. It is important to know that a small unilateral lesion in the brainstem (especially the pons) can cause cheiro-oral syndrome with a bilateral perioral sensory disturbance, and a small brainstem hematoma is the most frequent etiology of this disease.
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We report a patient with cerebral air embolism in whom we could perform serial brain magnetic resonance images (MRIs). A 78-year-old man was admitted to our hospital because of recurrent empyema after surgery for esophageal cancer. He suddenly demonstrated left hemiparesis in the middle of pleural lavage. ⋯ He didn't receive hyperbaric oxygen therapy because he had status epilepticus. The hypointense spots on the T2*WI became smaller and spread after 7 hours from onset and almost disappeared after 53 days. It is important to recognize that cerebral arterial air embolism is similar to multiple microbleeds and cerebral arteriovenous fistula in hypointense spots on the T2*WI.