Rinshō shinkeigaku = Clinical neurology
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Cortical spreading depression (CSD) is a slowly propagated wave of depolarization of neurons and glial cells, followed by a subsequent sustained suppression of spontaneous neuronal activity. Functional imaging studies of migraine patients have shown dramatic changes in blood flow and brain activity whose characteristics are similar to those of CSD, implicated in migraine visual aura. Although the trigeminal nerve innervates the meninges and participates in the genesis of migraine headaches, triggering mechanisms remain controversial and poorly understood. ⋯ Additional molecular insight into the pathophysiology of migraine may come from other monogenic syndromes such as CADASIL, RVCL. Several genetic associations with candidate migraine genes like ESR1, MTHFR, and INSR, have been convincingly replicated. The genome-wide association studies may be a successful strategy toward identification of migraine susceptibility genes.
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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.
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Epilepsy is a chronic neurological disorder characterized by recurrent seizures that are caused by abnormal and excessive cerebral neuronal discharges. The clinical symptoms are paroxysmal, and may include impaired consciousness and/or motor, sensory, autonomic, or psychic events. Diagnosis of epilepsy is not always straightforward and clear-cut. ⋯ In real situations, however, it is rare for physicians to actually witness the event of seizure. This lecture provides valuable opportunity to experience "real life" clinical diagnosis of epileptic seizures by showing the video of patient under seizure and EEG data. Representative visual examples of symptoms together with the detailed medical knowledge will greatly enhance the capability of diagnosis, the effectiveness of treatment, and help develop clinical strategies.
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Using clinical information, it was investigated whether lesions in sporadic amyotrophic lateral sclerosis (sALS) spread contiguously from an onset site to the another regions in domino-like manner as hypothesized by prion-like propagation of pathogenic proteins. First, the data from medical records of 53 sALS patients with bulbar or lower limb onset showed that the symptom has noncontiguously spread from the bulbar region to the lower limbs or vice versa, skipping the upper limbs, in 18.9% of the patients. ⋯ The two parameters should be positively correlated, if the lesion propagates contiguously from an initially affected motoneuron to the neighbouring ones within the same motoneuron pool (local progression) and then propagates to the another motoneuron pools (regional spread). However, the statistically significant correlation was not found, suggesting that there may be the different mechanisms between local progression and regional spread of ALS lesions.