Rinshō shinkeigaku = Clinical neurology
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The blood-nerve barrier (BNB) is one of the functional barriers sheltering the nervous system from systemic blood. Although BNB is effective in controlling the endoneurial environment in normal condition, it may interfere the entrance of beneficial substances including various growth factors into the endoneurial space and inhibit the axonal regeneration in peripheral neuropathy. ⋯ We also obtained immortal endothelial and pericyte cell lines originating from human BNB. Analyses of physiological characteristics and protein profiles in these BNB-forming cells are underway in our laboratory.
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We report a 70-year-old man, who developed painful involuntary muscle contraction of the left leg after the lumbar discectomy, which exacerbated after a vertebral fracture of Th12. This involuntary movement was accompanied with the abnormal position of left leg simulating triple flexion response, and was induced by active or passive movement of his left knee and foot joints. Several drugs including benzodiazepines and dantrolene were ineffective, although treatment with baclofen or carbamazepine was effective. ⋯ The spinal root blocks from L3 to S1 were performed, after which the painful involuntary muscle spasm was resolved. The lumbar sympathetic ganglia block was also effective; suggesting that abnormal afferent neuronal input to spinal cord was caused by the nerve root trauma which triggered the formation of secondary abnormal network in the spine. Lumbar sympathetic ganglia block should be recommended to a therapeutic option for the refractory painful muscle spasm of the leg.
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A-58-year old man presented with fluctuating ptosis and dysphagia. When he was 53 years old, he developed oral candidiasis and serum human immunodeficiency virus (HIV) RNA was detected. After starting highly active antiretroviral therapy, serum HIV RNA became undetectable. ⋯ Most of those cases were benign in clinical course and required only anticholinesterase therapy. In our case, however, anti-MuSK antibodies were positive, and symptoms of myasthenia gravis remained despite prednisolone administration. Cyclosporin is directly active against HIV, and thus, cyclosporine therapy may be helpful in patients with concomitant myasthenia gravis and HIV infection.
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Case Reports
[Recurrent embolic strokes associated with persistent left superior vena cava draining into the left atrium].
We report a 36-year-old man who admitted due to brain infarctions of the pons and cerebellum. He had a history of brain infarction 4 years ago. Chest radiograph and enhanced CT showed an abnormal shadow in the superior mediastinum. ⋯ Abdominal CT showed surface irregularity of the bilateral kidney, suggesting that renal infarctions had occurred. There was no risk factor of systemic embolism except for PLSVC thrombosis. We thought that retention of blood flow caused the formation of thrombus in the PLSVC, and the thrombus flowed into directly the systemic circulation through the left atrium and caused multiple embolisms.