Rinshō shinkeigaku = Clinical neurology
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A 63-year-old man was admitted because of sudden transient consciousness disturbance and left-side hemiparesis 110 minutes after the onset. Typical symptoms of aortic dissection, such as chest pain, back pain, neck pain, laterality of blood pressure or hypotension were not found. Brain magnetic resonance imaging (MRI) showed multiple acute brain infarction of the right middle cerebral artery territory. ⋯ Thus our patient showed thoracic aortic dissection with extension of the dissection toward the right internal carotid artery. And the patient complained of neither the pain in the chest, the back nor the neck. So we emphasize the necessity of carotid duplex ultrasonography examination before intravenous administration of rt-PA in the treatment of the cerebral infarction, regardless of having chest pain, back pain, neck pain or not.
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Case Reports
[A case of acute disseminated encephalomyelitis (ADEM) following treatment for pneumococcal meningoencephalitis].
A 58-year-old man was admitted to our hospital with fever, vomiting and disturbance of consciousness after common cold-like symptoms for 2 days. Physical examination showed high fever, moderate hypertension and tachycardia. There were no superficial lymph nodes swelling nor skin rashes. ⋯ Herpes simplex virus and herpes zoster virus DNA in the CSF were undetectable by PCR. After 6 days of treatment with corticosteroid pulse therapy, left facial palsy and paresis of the left arm gradually improved and MRI showed the disappearance of tumor-like hyperintense signals. Although ADEM usually develops as a complication after viral infection such as measles, rubella, mumps and herpes zoster, this case suggests that ADEM complication should be considered even after pneumococcal meningoencephalitis.