Brain and nerve = Shinkei kenkyū no shinpo
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Although the roles of the thalamocortical pathways in somatic movements are well documented, their roles in eye movements have only recently been examined. The oculomotor-related areas in the frontal cortex receive inputs from the basal ganglia and the cerebellum via the thalamus. Consistent with this, neurons in the paralaminar part of the ventrolateral (VL), ventroanterior (VA), and mediodorsal (MD) nuclei and those in the intralaminar nuclei exhibit a variety of eye movement-related responses. ⋯ Moreover the VL thalamus has been reported to play a role in monitoring smooth pursuit. While the functional analysis of thalamocortical pathways in eye movements is just a beginning, the anatomical data suggest their important roles. Analysis of eye movement control may shed light on the functions of the thalamocortical pathways in general, and may reveal the neural mechanisms of cerebro-cerebellar, cerebro-basal ganglia, and cerebro-thalamic interactions.
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Review Case Reports
[A tentorial dural arteriovenous fistula presenting progressive myelopathy: a case report].
Abstract We report a case of a dural arteriovenous fistula (DAVF) at the tentorium cerebelli, which presented progressive myelopathy. A 68-year-old man with neurological deterioration of the cervical myelopathy visited our hospital. T2 weighted magnetic resonance (MR) imaging showed high signal area and edema from the medulla to the upper thoracic spinal cord with flow voids on the dorsal surface of the cord. ⋯ His daily functioning gradually improved up to 6 months after the surgery. Tentorial DAVFs with clinical manifestation of myelopathy are rare. Considering its aggressive nature, early surgical treatment could be necessary. (Received: November 17, 2010, Accepted: December 18, 2010).
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Intravascular large B-cell lymphoma (IVLBCL) is an important cause of fever of unknown origin (FUO) and multiple organ failure (MOF). Earlier, most IVLBCL cases were diagnosed only postmortem; however, now, it is possible to diagnose and treat these cases antemortem. Although hematogeneous dissemination of malignant tumor cells except lymphoma is beyond the scope of present treatment regimens, IVLBCL (hematogeneous dissemination of lymphoma) can be treated by chemotherapy so correct diagnosis is important. ⋯ Delayed administration of rituximab and reduced dose of chemotherapy on the first course may be initially indicated in elderly, poor performance status or cases with high tumor burden. High-dose chemotherapy with autologous hematopoietic stem cell rescue should be considered, if possible. Aggressive combination therapy with high dose methotrexate is a recent idea because of central nervous system involvement, or relapse is common and there is poor prognosis.
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We report a case of malignant catatonia initially diagnosed as neuroleptic malignant syndrome (NMS) that responded successfully to diazepam administration. A 29-year-old man with mental retardation was admitted to our hospital because of high fever, muscle pain, and consciousness disturbance. Fifteen days before admission, he had developed muscle pain and weakness in his legs. ⋯ The clinical presentation of malignant catatonia is similar to that of NMS. Indeed, some authors have described NMS as a variant of malignant catatonia. If treatment is refractory in cases of NMS, malignant catatonia may be suspected, and changing treatment to diazepam administration may be useful.
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Review
[Treatment strategy for central nervous system involvement in intravascular large B-cell lymphoma].
Intravascular large B-cell lymphoma (IVLBCL) is a distinct disease entity of non-Hodgkin lymphoma which is characterized in the current WHO classification by the selective growth of tumour cells in the lumina of small vessels of various organs. This rare disease entity has a high incidence of central nervous system (CNS) involvement at diagnosis. Although several retrospective analyses indicate that the treatment of this lymphoma has improved in the post-rituximab era, risk of CNS recurrence at 3 years still reaches ~25%. ⋯ Considering that almost all IVLBCL patients have similar risk factors, CNS prophylaxis could also be effective, and thereby give rise to better clinical outcomes, in the treatment of IVLBCL, especially for patients without CNS involvement at initial diagnosis. Intensity regimens for CNS and systemic chemotherapy could be useful for patients with CNS involvement at initial diagnosis. This review describes the current understanding of clinical outcome and CNS involvement in IVLBCL, and discusses the optimal treatment strategy and future perspectives for CNS involvement of this rare lymphoma.