Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY  

A 30-year-old woman presented with paresthesia in her left lower limb and blurred vision. She had bilateral horizontal gaze palsy with the absence of cranial nerve symptoms such as horizontal saccades, pursuit, and facial nerve palsy. Considering her convalescence, we speculated that her pure bilateral horizontal gaze palsy was mainly caused by disturbance in paramedian pontine reticular formation (PPRF). Pure horizontal gaze palsy may also be a characteristic feature of multiple sclerosis.

DOI： 10.1111/ncn3.12395

Web of Science

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J-GLOBAL

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: Dopamine transporter (DAT) imaging such as 123I-ioflupane (123I-FP-CIT) SPECT is a useful tool for the diagnosis of parkinsonism and dementia. The Southampton method is the quantitative method for evaluating 123I-FP-CIT SPECT and is less affected by the partial volume effect of the striatum. The method may be vulnerable to contamination by low-uptake areas of cerebrospinal fluid in whole brain, and the threshold of voxel value (threshold method, TM) was developed to correct the contamination. The purpose of this study is to evaluate the TM in the patients with neurological disease. METHODS: We studied 99 subjects, including 39 patients with Alzheimer's disease (AD), 15 patients with Parkinson's disease (PD) and 10 patients with dementia with Lewy bodies (DLB). Each subject had undergone 123I-FP-CIT SPECT. We calculated the SBR with and without the TM. The SBR laterality was assessed using the asymmetry index (AI). We investigated the relationship between the SBR change with TM and brain atrophy, which were assessed using Evans index (EI), sylvian index (SI) and cerebral atrophy index (CAI). Cutoff value for EI was 0.3, and cutoff values for SI and CAI were the first quartile, respectively. RESULTS: The SBR with TM was 0.53 percentage points lower than the SBR without TM overall (p < 0.01). Positive and negative reversal of AI increased with age. The rate of the SBR change with TM was tended to be lower in groups with brain atrophy. The number of voxels excluded by TM in striatal volumes of interest (VOIs) was larger with high groups for EI, SI and CAI than in low groups. The number of voxels excluded using TM in reference VOIs was related to SI. CONCLUSIONS: The SBR was decreased using TM. The effect of TM on the SBR tended to be small in the subjects with severe brain atrophy. The effect of brain atrophy in the TM is larger in the striatal VOIs than in the reference VOIs. Even if quantitative analyses are available, visual assessment of 123I-FP-CIT SPECT is essential for diagnosis.

DOI： 10.1007/s12149-019-01367-4

PubMed

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Language：Japanese   Publisher：(一社)日本頭痛学会  

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Language：Japanese   Publisher：(一社)日本血液学会-東京事務局  

成人T細胞性白血病・リンパ腫(ATL)はHTLV-1ウイルスによって引き起こされる予後不良のT細胞性造血器腫瘍である。再発難治性ATLでは抗CCR4抗体であるmogamulizumabの有用性が認められている。Mogamulizumabの代表的な有害事象として,インフュージョン・リアクション,皮膚障害などが知られているが,心不全合併例の報告は少ない。一方,HTLV-1感染者の比較的稀な合併症の一つにHTLV-1関連脊髄症(HTLV-1 associated myelopathy,HAM)があるが,ATLとの合併例の報告は極めて稀である。今回我々は,再発性のATLに対するmogamulizumab投与後に,たこつぼ型心筋症を合併し,その回復後にHTLV-1関連脊髄症(HAM)を発症したと考えられた症例を経験したので報告する。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2017&ichushi_jid=J01540&link_issn=&doc_id=20170512190008&doc_link_id=1390001205035455104&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390001205035455104&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

Language：Japanese   Publishing type：Research paper (scientific journal)  

Adult T-cell leukemia-lymphoma (ATL) caused by human T-lymphotropic virus type 1 (HTLV-1) is generally associated with poor prognosis. The anti-CCR4 antibody mogamulizumab is one of the options for refractory or relapsed ATL. Mogamulizumab is intravenously administered as a single agent at a dose of 1.0 mg/kg once a week for 8 weeks. The overall response rate is reported to be 50%. Reported common adverse events after administration of mogamulizumab are leukocytopenia, infusion reaction, and skin rash. Although rare, mogamulizumab-associated cardiomyopathy has also been reported. HTLV-1 is also associated with a number of diseases, such as HTLV-1-associated myelopathy (HAM). Approximately 0.25% of infected individuals are estimated to develop HAM. HAM is an inflammatory disease of the central nervous system, which is characterized by slowly progressive spastic paresis of bilateral lower limbs and bladder-rectal disorder. Coexistence of ATL and HAM has rarely been reported. Here we present the case of a patient with ATL in whom Takotsubo cardiomyopathy and HAM developed after mogamulizumab administration.

DOI： 10.11406/rinketsu.58.309

PubMed

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Language：Japanese   Publisher：(一社)日本頭痛学会  

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Language：Japanese   Publisher：(一社)日本血液学会-東京事務局  

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Language：English   Publishing type：Research paper (scientific journal)  

Central alveolar hypoventilation syndrome (CAHS) is a rare and potentially fatal condition. However, respiratory care for patients with CAHS caused by lateral medullary infarction (CAHS-LMI) remains an important unsolved problem. We describe 2 patients with CAHS-LMI and review the case reports for 17 previously described patients. Patient 1 was a 78-year-old man who was referred to our hospital because of dizziness. After admission, Wallenberg syndrome developed. Magnetic resonance imaging showed left LMI. He had hypercapnia and respiratory acidosis the next afternoon and temporarily received mechanical ventilation. A tracheotomy was performed on the 12th hospital day, and the patient was weaned from the ventilator on the 18th hospital day. Patient 2 was 72-year-old man who was referred to our hospital because of dizziness and gait disturbance. Wallenberg syndrome was diagnosed after admission, and magnetic resonance imaging showed right LMI. His consciousness deteriorated, and hypercapnia developed on the ninth hospital day. The patient received ventilatory support, and a tracheotomy was performed on the 12th hospital day. He was weaned from the ventilator by the 16th hospital day. Consistent with our findings, most previously reported cases of CAHS-LMI were initially associated with mild symptoms, which subsequently worsened. Five of the 19 patients (26.3%) died within 1 month after onset, and 7 patients (36.8%) died within 1 year. Tracheotomy was performed in 12 patients, 2 of whom died 1 month after onset (16.7%); another patient died of chronic renal failure after 2 years. Tracheotomy seemed to be an effective procedure in patients with CAHS-LMI. We speculate that tracheotomy assists alveolar ventilation by reducing dead space ventilation. Closure of the tracheotomy should, therefore, be avoided in patients with CAHS-LMI, even if respiratory status is good.

PubMed

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：English   Publisher：KARGER  

Web of Science

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Fabry disease is an X-linked lysosomal storage disease resulting from deficient activity of the enzyme alpha-galactosidase (alpha-Gal) A. It has been postulated that the accumulation of globotriaosylceramide in the endothelial cells of blood vessels may lead to thrombosis of the brain and other tissues. Recently, enzyme replacement therapy (ERT) for Fabry disease is available. A high incidence of thrombotic accidents in Fabry disease has been postulated. However, a systemic study on thrombosis in cases of Fabry disease has not been undertaken. To clarify the incidence of thrombosis in Fabry disease, we screened 65 patients with Fabry disease (49 hemizygotes and 16 heterozygotes) from 39 unrelated Japanese families. We found that ten patients with Fabry disease (7 hemizygous males and 3 heterozygous females) had experienced thrombotic accidents, under 45-years-old in 8 cases. These 10 patients showed the gene mutations of classical Fabry disease. Nine of these thrombotic patients developed brain infarctions, one man who had the complication of recurrent thrombophlebitis, and the remaining woman showed central retinal artery occlusion and thrombophlebitis. We demonstrated a high incidence of thrombosis in Fabry disease (15%). ERT should be performed in patients not only in hemizygous males but also in heterozygous females and started at their early ages.

DOI： 10.1016/j.jns.2009.02.319

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

Otitis media chronica cholesteatomatica with cerebral sigmoid sinus thrombosis is an important differential diagnosis in the evaluation of headache. We describe a 31-year-old Filipino man with chief complaints of headache, otalgia, vomiting, and vertigo, and no significant past medical history. Two years before admission he stuffed tissues into the right external auditory canal because of a noise in the street on the night of the New Years festival and sometimes had right ear discharge. One month before admission he had a right occipital headache with right otalgia and fever. One day before admission he vomited. Vertigo developed on the day of admission. On physical examination at admission, the patient was somnolent and had a body temperature of 36.9 degrees C, and meningeal signs were obvious. Magnetic resonance of the brain revealed right otitis media chronica cholesteatomatica and right cerebral sigmoid sinus thrombosis. Computed tomography of the skull base revealed that the tympanic cavity and mastoid air cells were filled with a mass of soft-tissue density invading toward the sigmoid sinus. Cerebrospinal fluid examination showed a cell count of 32/3 mm3. The patients level of consciousness and symptoms improved after administration of ampicillin and ceftriaxone sodium. A diagnosis of "headache attributed to disorder of ears," with The International Classification of Headache Disorders, 2nd edition (ICHD-II) code 11.4, was made on the basis of symptoms and imaging findings. Otitis media chronica cholesteatomatica had invaded toward the sigmoid sinus and was thought to be the cause of cerebral sigmoid sinus thrombosis and meningitis. Six weeks after admission the patient underwent mastoidectomy and tympanoplasty to cure the cholesteatoma and prevent recurrence of inflammation. The postoperative progress was satisfactory. In cases of headache with otalgia, "headache attributed to disorder of ears" should be considered.

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

rt-PA improves neurological outcome if it is administered at early time of stroke, and intracerebral hemorrhage is the main complication of thrombolytic therapy and it proves sometimes fatal. The aims of this study are to clarify the correlation between the efficacy of rt-PA, the severity of hemorrhage and treatment delay, using the developed embolic infarction model. Fibrin-rich clots were used to occlude MCA on Sprague–Dawley rats. Alteplase of 10 mg/kg was administrated via femoral vein at 30 (n=7), 60 (n=10), 90 (n=6) and 120 (n=6) min after clot embolization and vehicle group (n=10) received saline. Twenty four hours after embolization, brains were perfused with PBS and TTC stain was utilized to measure the infarct volume. Hemorrhage volume was quantified with spectrophotometric assay of extraction from ischemic hemisphere. Infarction was significantly smaller in the groups administrated altepalse at 30, 60 and 90 min and hemorrhage was significantly less in the group of 30 min than vehicle group. However, administration of alteplase at 120 min did not ameliorate infarction and more significantly increased hemorrhage than vehicle group. In these results, we clearly showed that vascular therapeutic time window of this model can be within 120 min and treatment delay of thrombolysis enhanced the severity of hemorrhagic transformation. © 2003, Elsevier B.V. All rights reserved.

DOI： 10.1016/S0531-5131(03)00066-9

Scopus

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Language：English   Publishing type：Research paper (scientific journal)  

The aim of this study is to assess the anticerebral edema effect of glycerol on a large cerebral infarction with magnetic resonance imaging (MRI). Glycerol, which is widely used as an osmotic agent against cerebral edema, could exacerbate brain tissue shift, since it has been suggested that glycerol might shrink a noninfarcted hemisphere and worsen the mass effect after a large hemispheric cerebral infarction. To investigate these issues, changes in a large hemispheric infarction with cerebral edema were studied using MRI before and after glycerol administration. Infarct volumes, normal brain tissue volumes and lateral ventricle volumes, in addition to signal intensities of T(2)-weighted images, were measured in six patients before and after administration of 300 ml of glycerol. Ventricle volumes were significantly increased (p=0.0015) and the T(2) signal intensity of the post-treatment ischemic region decreased after glycerol administration. In contrast, no significant differences in either cerebral volume or T(2) signal intensity were seen in the noninfarcted hemisphere before and after administration. Our data suggest that glycerol does not exacerbate the mass effect on a large hemispheric infarction.

PubMed

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Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：SPRINGER-VERLAG WIEN  

Background and purpose. To evaluate the feasibility of utilizing cerebral blood flow (CBF) index images, we attempted to investigate 1) whether CBF index images can reveal the resulting infracted area, 2) whether the CBF index can correlate other modality (SPECT).
Methods. DWI and DPI were obtained in 17 patients within 12 hours of stroke onset and follow up MRI. On three DPI delivered images, namely relative regional cerebral blood volume (rrCBV), uncorrected mean transit time (MTTu) and CBF index images, correlations between initial lesion volume of and follow up infarction volume of three images and rCBF images delivered with singular value decomposition (SVD) methods were assessed. Then Tc-99m-ECD SPECT was taken immediately after MRI to correlate to MRI data.
Results. Among the three images, lesion volume of CBF index images against follow up infarct volume had the highest correlation (r = 0.995) to a linear fit and the slope was closest to 1.0 (0.91) and had identical accuracy to the regression coefficient of rCBF images. CBF index well correlated to SPECT delivered CBF.
Conclusion. CBF index images can accurately predict final infarct volume. Evaluating CBF index images together with DWI can guide the initial assessment in the acute stage of cerebral ischemia.

Web of Science

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：English   Publisher：(一社)日本核医学会  

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Language：Japanese   Publisher：日本神経治療学会  

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：日本神経免疫学会  

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Language：Japanese   Publisher：日本内科学会-関東地方会  

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：日本神経治療学会  

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Language：Japanese   Publisher：日本神経治療学会  

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Language：Japanese   Publisher：日本神経治療学会  

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Language：Japanese   Publisher：日本神経治療学会  

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Language：Japanese   Publisher：日本神経治療学会  

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：Japanese   Publisher：(一社)日本内科学会  

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Language：Japanese   Publisher：(一社)日本内科学会  

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：(一社)日本頭痛学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本神経治療学会  

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Language：Japanese   Publisher：日本神経治療学会  

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Language：Japanese   Publisher：The Medical Association of Nippon Medical School  

Vertigo and nausea suddenly developed in a 33-year-old man without a relevant medical history. He reported that he had had throbbing headaches for 1 month. On admission, neurological examination revealed dysarthria, right Horner syndrome, and hypoesthesia of the left side of the face and of the left side of the body below the neck. Initial magnetic resonance imaging of the brain showed no areas of abnormal intensity on diffusion-weighted imaging, but magnetic resonance angiography showed a stringlike structure of the right vertebral artery. Acute infarction due to right vertebral artery dissection was diagnosed. Heparin sodium was immediately administered intravenously. Three days after symptom onset, magnetic resonance imaging-diffusion-weighted imaging of the brain clearly showed a high-intensity area in the right lateral medulla oblongata, a finding that confirmed the clinical diagnosis. This case emphasizes that vertebral artery dissection should be considered in patients with vertigo, especially young patients without risk factors for cerebrovascular disorders. The clinical history and neurological examination remain fundamental aspects of patient assessment in the era of advanced neuroimaging.<br>

DOI： 10.1272/manms.7.175

CiNii Books

CiNii Research

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Other Link： https://search.jamas.or.jp/link/ui/2012126755

Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：日本神経治療学会  

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：日本脳循環代謝学会  

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Language：Japanese   Publisher：日本内科学会-関東地方会  

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：日本内科学会-関東地方会  

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Language：Japanese   Publisher：(一社)日本頭痛学会  

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：日本脳循環代謝学会  

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Language：English   Publisher：日本脳循環代謝学会  

発症から24時間以内の脳梗塞患者16例を対象に,脳梗塞急性期に施行したdynamic perfusion MRI(DPI)のデータを用い,singular value decomposition(SVD)法とnon-deconvolution法という二種類の計算方法により導き出された脳血流量を,SPECTから求めたregional cerebral blood flow(rCBF)と比較した.その結果, 1)SVD法のrCBFとCBF indexはそれぞれSPECTのrCBFと有意に相関した(r=0.919,0.817,slope=1.007,0.757). 2)SVD法のrCBFとCBF indexの相関には有意差を認めなかった(p=0.784).以上,これらのことからも,CBF index mapは習熟者による処理が不要であり短時間で計算できるため,時間の限られた脳梗塞急性期における初回の脳血流評価に使用可能であると示唆された

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Language：Japanese   Publisher：日本内科学会-関東地方会  

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：日本脳循環代謝学会  

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Language：Japanese   Publisher：日本脳循環代謝学会  

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Language：Japanese   Publisher：(一社)日本神経治療学会  

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Language：Japanese   Publisher：脳浮腫・頭蓋内圧フォーラム  

ラット局所脳梗塞モデルを用いて,glycerol投与前後における脳浮腫の組成,水の状態の変化を各種MRパラメータmapより検討した.その結果,T1に反映される脳全体の含水量はglycerol投与後,全脳で有意に短縮し,結合水の割合を反映するMTRも全脳で増加を認めた.一方,自由水の割合を反映するT2は,glycerol投与後,梗塞部位でのみ有意な短縮を示した.以上より,glycerolは正常脳および梗塞領域にわたり脳含水量を低下させる効果がみられるが,その効果は自由水を血管外に引くことによるものであると考えられた.また,虚血性脳浮腫の領域では自由水が増加しているために,その効果が著明になることが示唆された

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Language：Japanese   Publisher：(一社)日本脳卒中学会  

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Language：Japanese   Publisher：(一社)日本脳卒中学会  

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Language：Japanese   Publisher：(一社)日本内科学会  

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：(株)にゅーろん社  

超急性期に得られたDPIデータより種々のマップを作成し,follow up MRIとの比較を行うことにより,急性期の治療法決定に最も適したマップを決定した.DPIより計算される各種灌流mapにおいてはCBFを反映したmapがdeconvolutionの有無に関わらず,視覚上最も最終梗塞を予測するのに優れていた.non-deconvolution法によるCBF index mapは,定量性ではSVD法によるrCBF mapに及ばないものの,計算が簡単で自動処理が可能であり,かつ最終梗塞に類似した灌流異常所見を示すことより急性期の治療法決定には有用であると考えられた.rCBFの定量においてはSVD法によるrCBF mapが優れるが,脳梗塞急性期のat risk領域の評価には計算の簡単なnon-deconvolution法によるCBF index mapでも十分可能であり,急性期において可及的に治療法決定を要する場合には短時間で複雑な操作が必要ないnon-deconvolution法をmap作成,評価に用いることが可能であると考えられた

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Language：Japanese   Publisher：脳浮腫・頭蓋内圧フォーラム  

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Language：Japanese   Publisher：(一社)日本神経治療学会  

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Language：Japanese   Publisher：(一社)日本脳卒中学会  

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Language：Japanese   Publisher：(一社)日本脳卒中学会  

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Language：Japanese   Publisher：(一社)日本脳卒中学会  

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Language：Japanese   Publisher：(一社)日本内科学会  

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：脳浮腫・頭蓋内圧フォーラム  

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Language：Japanese   Publisher：日本脳循環代謝学会  

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Language：Japanese   Publisher：日本脳循環代謝学会  

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Language：Japanese   Publisher：(一社)日本老年医学会  

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：(一社)日本脳卒中学会  

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Language：Japanese   Publisher：(一社)日本脳卒中学会  

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Language：Japanese   Publisher：(一社)日本脳卒中学会  

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Language：Japanese   Publisher：(一社)日本内科学会  

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Language：Japanese   Publisher：日本脳循環代謝学会  

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：(株)にゅーろん社  

脳梗塞急性期のDWI,perfusion MRI(DPI)所見から最終的に梗塞に陥る領域の血流閾値を決定できるか,もしできるならどの計算画像が評価に最も適するか検討した.脳梗塞急性期発症12時間以内にDWI,DPIを施行し,ADC imageを算出,亜急性期のT2強調画像と比較した.DWI,DPIを併用することにより脳梗塞急性期において梗塞進展の予測が可能であり,その場合DPI計算画像中ではCBF index画像が最も優れていた.又,このことよりD-P mismatchを論じる場合にはCBFを反映したPI計算画像を用いるべきであり,その場合,日常臨床においては計算が簡便なCBF indexがその評価に有用であると考えられた

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Language：Japanese   Publisher：(一社)日本老年医学会  

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Language：Japanese   Publisher：(一社)日本脳卒中学会  

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Language：Japanese   Publisher：脳浮腫・頭蓋内圧フォーラム  

臨床例における大梗塞病変での,glycerolによるmass effect悪化の可能性を検討した.また,その実際の抗浮腫作用を,MRIを用いる事により評価する事が出来るかを検討した.MRIを用いた多数例の検討では,glycerolにより健常側半球の体積や緩和時間に有意の変化は見られず,mass effectの悪化は見られなかった.glycerol投与により,脳室の拡大などのmass effectの軽減を示す所見及び梗塞側半球の緩和時間の短縮が見られた.これは,glycerolの抗浮腫効果を反映する物と考えられ,MRIを用いる事により,実際の脳梗塞急性期の臨床例に対する抗浮腫効果を非侵襲的に評価する事が出来た

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Language：Japanese   Publisher：(一社)日本内科学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Event date： 2018.11

Language：Japanese  

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