Rinshō shinkeigaku = Clinical neurology
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Comparative Study
[Japanese guidelines for the management of herpes simplex encephalitis; comparison with those from the International Management Herpes Forum].
Herpes simplex encephalitis (HSE) is still recognized as a severe sporadic encephalitis, although the mortality and morbidity rates have been decreased to 10% and 30%, respectively. This disease is diagnosed using clinical symptoms, CSF, EEG, CT, MRI, and virologic tests such as polymerase chain reaction (PCR) or enzyme immunosorbent assay (EIA). Early diagnosis and treatment are essential for HSE. ⋯ However, antiviral therapy may be discontinued if a negative CSF HSV PCR is obtained at > 72 hours after onset. A recent Japanese study shows the efficacy of a combination therapy of aciclovir and corticosteroid for this disease. Further prospective investigation is expected.
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Review Case Reports
[Blunt traumatic dissection in common carotid artery with serial morphological changes detected by carotid ultrasonography in the acute phase].
A 68-year-old man was admitted to our hospital with left hemiparesis, unilateral spatial neglect, and anosognosia at nine hours after blunt neck trauma. Carotid ultrasonography and angiography revealed occlusion of the right common carotid artery. A second ultrasonographic examination detected a double lumen, intimal flap, and a movable thrombus at the occlusion site, with reversed flow in the external cerebral artery and antegrade flow in the internal cerebral artery. ⋯ The finding of carotid dissection on ultrasonography varied during the acute phase. We observed a mural thrombus in the true lumen and vessel recanalization. Treated only by anticoagulants without surgical therapy, the patient had a good outcome without reattack or hyperperfusion syndrome.
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In this study, the clinical features and MRI findings of 21 patients admitted for acute lateral medullary syndrome, including 10 patients with dysphagia, were examined. According to Cytoarchitecture of the Human Brain Stem (Olszewski, J & Baxter, D), MRI-identified lesions were classified into four groups based on their location (upper, middle-upper, middle-lower, and lower parts of the medulla oblongata). We also examined whether each lesion involved the ambiguous nucleus (AN). ⋯ Patients who had lesions involving the AN in the rostral part of the medulla oblongata were more likely to have dysphagia than the other patients. On the other hand, half of the patients with lesions involving the AN in the middle-lower part of the medulla oblongata did not have dysphagia. This might suggest that the caudal part of the AN has little involvement in the mechanisms of dysphagia.
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A 57-year-old woman had undergone surgery for meningioma. After the surgery, she suffered from repeated fever and headache. One year after surgery, she was admitted to our hospital for further examination. ⋯ Several English literatures on M. fortuitum meningitis after traumatic injury and surgery have been published. Its CSF findings distinctly resemble those of bacterial meningitis, but are resistant to the usual antituberculosis drugs. We reported a case of M. fortuitum meningitis associated with surgery for meningioma.
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Comparative Study
[Clinical characteristics of elderly Japanese patients with amyotrophic lateral sclerosis; with special reference to the development of respiratory failure].
To clarify the characteristics of elderly-onset amyotrophic lateral sclerosis (ALS). ⋯ In regard to the progression of respiratory function deterioration, early % VC was lower in E-ALS than in Y-ALS patients, and the period until VC fell below 1 L was shorter. The period until death was particularly short in elderly BP and RF patients, suggesting the possibility that the duration until death from respiratory failure is shorter in E-ALS, because of a decrease in respiratory reverse capacity that accompanies age.