Rinshō shinkeigaku = Clinical neurology
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West Nile virus is a mosquito-borne flavivirus, and maintained in mosquito-bird cycle in nature. Humans are a dead-end host in West Nile virus infection. Symptoms are developed in approximately 20% of West Nile virus-infected humans. ⋯ Thus, West Nile virus causes various types of illness in humans. West Nile virus has not entered Japan yet. However, West Nile virus should be considered to be one of the causative agents for patient with a febrile illness, meningitis, encephalitis or acute flaccid paralysis who came back from West Nile endemic or epidemic areas of the world.
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Clinical characteristics of mobile thrombus in the cervical carotid artery were investigated. In the 1,528 patients with acute ischemic stroke, mobile thrombi were detected by carotid echography in 14 patients (0.9%; mean 77 years-old; 8 women). Mean National Institutes of Health Stroke Scale was 19 on admission, and 24 on day 10. ⋯ Followed echography showed occlusion of the internal carotid artery in 4 of 7 patients. Floating thrombus disappeared in one of 5 patients without clinical recurrence. Although surgical treatment including carotid endarterectomy was not performed in all of the present cases, clinical recurrence during admission was seen in only one patient with embolic stroke in the contralateral internal carotid artery of the mobile thrombus.
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Comparative Study
[The prevalence and character of primary headache in Japanese high school students].
We investigated prevalence and character of primary headache for 2,462 examples of high school student. An overall headache prevalence was 41.0 in boys, 55.3% in girls, and average of the headache onset was 12.7 in boys, 12.9 in girls years old. A prevalence of migraine is 5.5 in boys, 6.1% in girls according to ICHD-I and 13.7 in boys, 17.5% in girls according to modified ICHD-II diagnosis criteria. ⋯ High school students with primary headache tend take painkillers easily, but are much less likely visit physicians (only 15.0%). Our data showed that the prevalence of headache especially migraine in Japanese high school student was almost similar to past world wide findings, and suggest that its impact on the quality of life can not be ignored. Therefore, headache education must be important and necessary in a high school.
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Case Reports
[A case of spontaneous intracranial hypotension with multiple CSF leaks in the thoracic region].
A case of spontaneous intracranial hypotension (SIH) with multiple cerebrospinal fluid (CSF) leaks is reported. A 54-year-old man experienced a severe generalized headache associated with nausea and decreased hearing. The headache appeared when he was sitting or standing but was completely relieved by lying down. ⋯ After receiving EBP four times repeatedly, his symptoms entirely disappeared. SIH patients with multiple CSF leaks are rare in the literature. Although no consensus exists on the treatment strategy for such cases, our case suggests that at least 2 EBPs should be performed for each leak site before considering surgical treatment.
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A 68-year-old healthy woman without any evidence of recent wound, developed nuchal pain, difficulty in swallowing and trisumus in 10 days. Because of respiratory failure due to generalized muscle spasm, she was intubated and required mechanical ventilation. ⋯ Thereafter, her muscle spasm and hypertensive response were well controlled. The authors suggested that a combined use of midazolam and propofol was an optional antispastic therapy in patients with severe tetanus.