Rinshō shinkeigaku = Clinical neurology
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A 36-year-old man presented with cognitive impairment and disturbance of short-term memory functions with character change. Cerebrospinal fluid analysis revealed no abnormalities; however, brain MRI revealed high-signal intensity from bilateral hippocampus lesions on fluid attenuated inversion recovery (FLAIR) images and T(2) weighted images. The 18F-fluorodeoxyglucose PET demonstrated high glucose uptake in the bilateral hippocampus lesions. ⋯ The pathological findings were seminoma. We experienced a case of paraneoplastic limbic encephalitis associated with seminoma with short-term memory disturbance. The occurrence of paraneoplastic limbic encephalitis with antibodies against cell membrane (NMDA-receptor antibody and GluRε2 antibody) and intracellular (Ma2 antibody) is rare even in the literature.
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Review Case Reports
[Neurological decompression illness in a Japanese breath-held diver: a case report].
We report a Japanese breath-hold diver (Ama) who presented neurological disorders after diving. He repeated diving into 25-30 meters depth in the sea for 6 hours. After diving, he felt dizziness and unsteady gait. ⋯ He was diagnosed as having neurological decompression illness and therefore underwent hyperbaric oxygen therapy. The pathogenesis of this case was considered to be microbubbles induced by decompression. The present case suggests that repetitive rapid surfacing from the deep sea causes neurological decompression illness even in the breath-hold diver.
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The Antihypertensive Treatment for Acute Cerebral Hemorrhage (ATACH)-II Trial (ClinicalTrials.gov no. NCT01176565; (UMIN 000006526) is an international, multicenter, randomized, concurrently-controlled, parallel arm, Phase III trial to determine the therapeutic benefit of early intensive systolic blood pressure (SBP) lowering compared with standard SBP lowering for acute hypertension in patients with spontaneous intracerebral hemorrhage (ICH). The Trial is funded by the National Institutes of Health in the United States and led by Dr. ⋯ Subjects undergo a follow-up assessment for functional and quality of life assessment at 90 days post-randomization. The primary research hypothesis of the trial is that intensive SBP reduction (to ≤140mmHg) using intravenous nicardipine infusion for 24 hours post-randomization reduces the proportion of death and disability at 90 days by ≥10% (absolute) compared to the standard SBP reduction (to 140-180mmHg range) among subjects with ICH whose treatment is initiated within 4.5 hours of symptom onset. The ATACH-II Trial could be the seminal research project for stroke researchers in Japan to demonstrate themselves as effective contributing members of investigator-initiated international clinical trials.
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Comparative Study
[Associated tumors in patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis].
In 2007, Dalmau and colleagues described anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis associated with ovarian teratoma. As the numbers of patients with anti-NMDAR encephalitis increased, the frequency of paraneoplastic findings declined. The frequency of anti-NMDAR encephalitis with the tumor declined to 60% of a total of 100 patients in 2008, and 42% of a total of 400 patients in 2011. ⋯ These patients included breast cancer, neuroendocrine tumors, pancreatic carcinoma, sex cord stromal tumors, testicular germ-cell tumors and small-cell lung carcinoma. We encountered a 65-year-old female affected by anti-NMDAR encephalitis with carcinosarcoma with neuroendocrine differentiation of the uterus. The prognosis of anti-NMDAR encephalitis with malignant tumor could be dependent on the prognosis of the associated tumor.