Rinshō shinkeigaku = Clinical neurology
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Idiopathic normal pressure hydrocephalus (iNPH) is a syndrome characterized by gait disturbance, dementia, and/or urinary incontinence without causative disorders, and ventricular enlargement due to disturbed CSF circulation. The diagnosis of iNPH in the elderly remains a substantial issue, and the treatment is not always adequately provided. Many patients with possibly curable INPH often are misdiagnosed as having AD or vascular dementia. ⋯ Here, some key clinical and neuroimaging features distinctive from other dementia are discussed. Also reviewed are the results of the recently completed prospective cohort study of iNPH (Study of iNPH on Neurological Improvement: SINPHONI). In SINPHONI, the MRI-based diagnosis (dilated ventricles associated with narrow dorsal subarrachnoid space) and ventriculoperitoneal shunt with Codman Hakim programmable valve shunt system were validated against 1-year post-surgery outcome.
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Case Reports
[Probable amebic brain abscess in a homosexual man with an Entamoeba histolytica liver abscess].
A 51-year-old Japanese-Brazilian homosexual man was admitted to a hospital because of fever, headache and right epigastralgia. He had been homosexual for 20 years. An abdominal CT revealed a liver abscess and microscopic examination of the pus of the drainage revealed cystic forms of Entamoeba histolytica. ⋯ A diagnosis of amebic brain abscess was made on the basis of coexistent amebic liver abscess, MRI findings and a dramatic effectiveness to metronidazole. One should pay attention to E. Histolytica infection in the differential diagnosis of the abscess of the liver and brain since it has been increasing in Japan in recent years.
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Case Reports
[Late-onset hemorrhagic infarction in patients with patent foramen ovale: reports of two cases].
We presented here two patients with hemorrhagic infarction occurred during subacute phase of brain embolism. The patients were 71-year-old and 73-year-old men who suffered from brain infarction of the left posterior cerebral artery and right middle cerebral artery territory, respectively. Both of them were diagnosed as having cryptogenic stroke and patent foramen ovale. ⋯ Their blood pressure remained within normal range throughout acute and subacute phase. Although most of hemorrhagic infarction occurs within 24 hours of stroke onset, some patients develop symptomatic hemorrhagic infarction even after 10 days. We need to be careful about late-onset hemorrhagic infarction, because many patients are now transferred early to rehabilitation hospitals to facilitate dedicated systematic rehabilitation.
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A 61-year-old woman with diabetes mellitus was admitted to our hospital with right hemiparesis and dysarthria. Brain MRI showed bilateral cerebral peduncular infarctions. Three days after admission, she was unable to generate any voluntary movements, except for those of the eye, suggesting locked-in syndrome (LIS). ⋯ Eye movements were impossible in all directions on the 11th day and MRI showed new infarctions of the midbrain and the ventral portion of the pons. However, an EEG on the 20th day was almost normal. We speculated that low blood flow in the basilar artery from the PPTA caused bilateral cerebral peduncular infarctions, and that weakness of the PPTA caused SAH.
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A 71-year-old man had recurrent spells of transient diplopia for about four years. Vertical diplopia were induced by downward gaze, mostly to the lower-left, and lasted for about ten seconds. During the spells, limitation in elevation of the left eye was observed. ⋯ Furthermore, patients with ocular neuromyotonia often benefit from the use of carbamazepine, a membrane-stabilizing agent. We report a case of idiopathic ocular neuromyotonia without history of damage to the cranial nerves. It is the first report in Japan.