Brain and nerve = Shinkei kenkyū no shinpo
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Recently, the introduction of 3 tesla (3T) magnetic resonance (MR) system for more sophisticated clinical applications has yielded in important benefits, especially in neuroradiology. The aim of this article is to illustrate the practical scientific applications of the 3T system in the neuroradiological filed. From the clinical point of view, we focused on the usefulness of 3T system for the diagnosis of several neurological disorders, such as brain tumors, vascular lesions, hemorrhagic lesions, acute cerebral infarcts and degenerative diseases. ⋯ This finding should not be mistaken for multiple system atrophy. 3T MR system indeed offers new potential because of a substantial increase in signal intensity provided by the higher magnetic field. Routine neuroradiologic imaging would benefit from higher magnetic field. However, It is required that extended knowledge of clinical data in comparison with 1.5T system to elucidate the efficacy of 3T system in the neuroradiology.
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X-linked adrenoluekodystrophy (X-ALD) is a clinically heterogenous disorder ranging from the rapidly progressive childhood cerebral form to the milder adrenomyeloneuropathy in adults, and some persons with ALD protein (ALDP) defects may remain asymptomatic for life. Hematopoietic cell transplantation (HCT) is currently the only effective therapy for cerebral X-ALD. Stem cell sources for transplantation are bone marrow, peripheral blood and cord blood. ⋯ More than 90% of early stage patients have survived with good quality of life for a long term, whereas patients with advanced disease had the higher mortality rate during transplant procedures and the neurological abnormalities progressed in most of them. Patients with a parietal-occipital lobe pattern of demyelination demonstrated a greater mean loss of performance IQ (PIQ) points than patients with a frontal lobe pattern of demyelination. Thus, boys with early-stage disease benefit from HCT, whereas boys with advanced disease may be candidates for experimental therapies.
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Vagus nerve stimulation (VNS) and stereotactic radiosurgery (SRS) represent novel and less invasive therapeutics for medically intractable epilepsy. VNS ushered in the recent advancement in clinical application of electrical stimulation therapy for epilepsy. Chronic stimulation of the left vagus nerve with implanted generator and electrodes inhibits seizure susceptibility of the cerebral cortices. ⋯ A randomized clinical trial using the dose of 20 or 24 Gy is ongoing in the United States. SRS for intractable epilepsy associated with hypothalamic hamartoma has been advocated because of a high surgical morbidity, but further study is needed for standardization of the treatment. Substitute use of SRS for other surgical technique like callosotomy or disconnection of epileptic focus seems to be another direction worth pursuing.
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Case Reports
[A case of neuralgic amyotrophy in the lower extremity (lumbosacral radiculoplexus neuropathy)].
We report a 76-year-old man who suddenly had pain in the right buttock that radiated down the back of the leg. He underwent nerve block therapy, but subsequently noted weakness of the right leg. On examination, there was moderate weakness of the right gastrocnemius, flexor digitorum longus and extensor hallcis longus, and mild weakness of the tibialis anterior, quadriceps and hamstrings muscles. ⋯ Treatment with corticosteroids was effective for alleviating his pain, and muscle strength improved gradually. One year later, he showed no neurological deficits. Neuralgic amyotrophy in the lower extremities is rare, but awareness of this disorder helps us avoid unnecessary surgical investigations and leads to possible treatment with immunomodulative therapy.
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Despite advances in radiation and chemotherapy along with surgical resectioning, the prognosis of patients with malignant glioma is poor. Therefore, the development of a new treatment modality is extremely important. There are increasing reports demonstrating that systemic immunotherapy using peptide is capable of inducing an antiglioma response. ⋯ Peptide-based immunotherapy strategies appear promising as an approach to successfully induce an antitumor immune response and increase survival in patients with glioma. Peptide-based therapy of glioma seems to be safe and without major side effects. Biotherapy for malignant glioma with peptide will open a novel reality now.