Rinshō shinkeigaku = Clinical neurology
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Randomized Controlled Trial
[Branch atheromatous disease: prognosis and management. The SPS3 experience].
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Randomized Controlled Trial Comparative Study
[Expectation to and problems of thrombin inhibitor].
Dabigatran is a direct thrombin inhibitor, does not require blood coagulation monitoring and limitation of vitamin K intake as well as very few drug interactions, and thus expected to be an oral anticoagulant alternative to warfarin. Randomized Evaluation of Long Term Anticoagulant Therapy (RE-LY) was conducted to determine non-inferiority of dabigatran against warfarin as an international multicenter-cooperative randomized trial in patients with non-valvular atrial fibrillation (NVAF). ⋯ In a sub-analysis of RE-LY in Japanese patients with NVAF, the results showed a consistency of the efficacy and safety profiles of dabigatran with the results of the global RE-LY trial. Use of dabigatran should be contraindicated in NVAF patients with renal insufficiency because some cases with fatal bleeding have been reported in a post marketing survey.
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Polyneuropathy associated with antibodies directed against myelin-associated glycoprotein (MAG) is a chronic symmetric sensorimotor demyelinating neuropathy caused by monoclonal IgM against MAG (anti-MAG neuropathy). Intravenous immunoglobulin therapy (IVIg) has been partially successful in patients with anti-MAG neuropathy. A placebo-controlled trial of rituximab in patients with anti-MAG neuropathy has been reported. ⋯ Anti-SGPG antibody titers reduced from 0.554 before rituximab administration to 0.307 (OD) at 1,600 dilution, 4 months after administration. We concluded that rituximab was effective for the treatment of anti-MAG neuropathy. We suggested that rapid and long-term improvement in our patient might be caused not only by preventing the formation of new antibody-secreting cells and antibody-titer reduction but also affecting the balance of proinflammatory cytokines and regulatory cytokines production.
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We report a case of tumefactive demyelinating lesion (TDL) diagnosed using (1)H-magnetic resonance spectroscopy (¹H-MRS) and conventional magnetic resonance imaging (MRI). A 7-year-old girl was admitted to our hospital with complaints of sleepiness and clumsiness of the right limbs. Neurological examination showed somnolence, right-sided apraxia, and hemiparesis with enhanced tendon reflexes and Babinski sign. ⋯ Based on this diagnosis, we treated the patient with three sets of methylprednisolone pulse therapy, which resulted in the reduction of TDL and neurological improvement. A follow-up study using MRI also demonstrated two more lesions in the corona radiata and internal capsule of the left hemisphere, supporting a diagnosis of multiple sclerosis based on the revised McDonald's criteria (2010). We concluded that ¹H-MRS may be beneficial in the differential diagnosis of TDL.
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Charles Bonnet syndrome refers to visual hallucinations in patients with visual acuity loss or visual field loss without dementia. We report a case of Charles Bonnet syndrome following syphilitic optic neuritis. A 62-year-old man was admitted to our hospital suffering acute bilateral visual loss in a few months. ⋯ Administration of olanzapine resulted in a partial remission of visual hallucinations. Charles Bonnet syndrome following syphilitic optic neuritis is rare. In the present case, visual loss and dysfunction of bilateral medial occipital lobes may have triggered the visual hallucinations, which were alleviated by olanzapine.