Brain and nerve = Shinkei kenkyū no shinpo
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The morbidity of hyperglycemic crises and acute hypoglycemic attacks in patients with diabetes mellitus has been increasing for the past several decades. One of the reasons for this is the increase in the number of patients with diabetes. The increased proportion of aging and isolation in society is another reason. ⋯ Sufficient amount of intravenous extracellular fluid and constant infusion of insulin are essential. The development of LA is not associated with the use of metformin, but with the severity of the pre-existing disease. Early recognition and aggressive treatment is vital to improving the prognosis of hyperglycemic emergencies and severe hypoglycemic episodes.
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Case Reports
[A case of primary erythromelalgia successfully treated with high-dose intravenous immunoglobulin therapy].
Erythromelalgia is a rare condition characterized by constant or paroxysmal burning pain, erythema, and the elevation of skin temperature in the extremities. Recently, the impairment of C-fiber function due to autoimmune system involvement is considered as the primary cause of erythromelalgia. However, a successful treatment has yet not been established. ⋯ She received various antiepileptic and anti-inflammatory drugs, but failed to improve. She finally underwent high-dose intravenous immunoglobulin therapy, which dramatically improved her symptoms and normalized cerebrospinal fluid protein concentration. This result demonstrates the effectiveness of high-dose intravenous immunoglobulin therapy for the treatment of primary erythromelalgia and the possibility of autoimmune system involvement.
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Critically ill patients in the intensive care unit (ICU) often develop ICU-acquired weakness, which is characterized by acute or subacute onset diffuse limb weakness, during the early course of their severe illness and is related to prolonged mechanical ventilation, ICU stay, hospital stay, and even increased mortality. The development of generalized weakness or paralysis may be because of critical illness polyneuropathy (CIP), critical illness myopathy (CIM), and a combination of both. The basic mechanisms underlying these disorders are complex and poorly understood. ⋯ In addition, muscle biopsy and direct muscle stimulation test can be used to distinguish CIP from CIM. To date, no therapeutic approach has been established for ICU-acquired weakness, and potential preventive measures should be implemented in the daily management of the critically ill patients. Further studies are required to clarify the pathogenesis of these disorders and to identify appropriate therapeutic options.
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Microtubules are key cytoskeletal elements found in all eukaryotic cells. Tau was identified as microtubule associated protein and was implicated in microtubule initiation as well as assembly. Its expression is increased expression in neurons and has a specific association with axonal microtubules. ⋯ In PSP NFTs, tufted astrocytes, coiled bodies and threads contain 4R-tau and in CBD, pretangles, astrocytic plaques, coiled bodies and threads also demonstrate 4R-tau. Argyrophilic grains are immunopositive for 4R-tau. Although PSP and CBD sometimes share certain pathological distribution, which makes clinical diagnosis difficult, cellular tau pathology and aggregation patterns in neurons and glia are different between the two diseases.
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Sjogren's syndrome is a systemic autoimmune disease characterized by xerophthalmia and xerostomia; it is associated with widespread systemic visceral involvement. A wide variety of neurological complications are characteristic features of Sjogren's syndrome, of which peripheral neuropathy is a major neurological manifestation. Based on the predominant neuropathic symptoms, patients can be considered to have several forms of neuropathies, including sensory ataxic neuropathy, painful sensory neuropathy without sensory ataxia, multiple mononeuropathy, multiple cranial neuropathy, trigeminal neuropathy, autonomic neuropathy, and radiculoneuropathy. ⋯ Differential therapeutic responses to corticosteroids and intravenous immunoglobulin can be seen among the various neuropathic forms. In conclusion, the clinicopathological features of neuropathies associated with Sjogren's syndrome are highly variable. The neuropathy classification is important from a therapeutic point of view.