Rinshō shinkeigaku = Clinical neurology
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Case Reports
[Prolonged headache six weeks before ischemic symptoms due to vertebral artery dissection--a case report].
A 43-year-old woman presented with weakness in her left arm and leg. She had noticed headache persisting for 2 weeks in her right occipital area 6 weeks prior to the onset of the weakness. Cranial diffusion-weighted MR image demonstrated acute infarction in the right medial part of medulla oblongata. ⋯ Generally, in patients with cervicocephalic artery dissection with ischemic onset, the occurrence of headache is either simultaneous with the ischemic symptoms, or several days prior to the ischemic symptoms. The present case showed that headache due to arterial dissection can occur several weeks prior the ischemic symptoms. Precise history of headache should be taken in patients with cervicocephalic artery dissection.
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Case Reports
[A case of methanol intoxication with optic neuropathy visualized on STIR sequence of MR images].
We report a 24-year-old man with severe methanol intoxication, who showed cerebral and optic nerve damages on MRI. He was admitted to our hospital with an acute onset of unconsciousness and severe metabolic acidosis, and was immediately treated by hemodialysis. His serum methanol concentration was 261.5 mg/dl. ⋯ Diffusion weighted images showed abnormal hyperintensities in bilateral putamina, subcortical white matter and cerebellar hemispheres. STIR sequence revealed bilateral optic nerve swelling with irregular hyperintense rims. These MRI features might reflect the optic nerve damages, mainly demyelination of the optic nerves caused by a myelinoclastic effect of formic acid, a metabolite of methanol.
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We report a 47-year-old woman with progressive multifocal leukoencephalopathy (PML). She was a carrier of HTLV-I virus, and developed subacute right hemiparesis and marked motor aphasia. She had a malignant lymphoma in the left neck and basal cell carcinoma in the right inguinal region. ⋯ Since it has been reported that HTLV-I, as well as HIV, activates the JC virus promoter and its proliferation, the latent infection of HTLV-I in the central nervous system (CNS) in this case might have stimulated the JC virus proliferation, promoting lesion extension over the cerebral cortex. There have been only a few reports of broad decreases in CBF by SPECT in PML patients. Further MRI and SPECT studies on PML patients are therefore necessary to evaluate the significance of HTLV-I in promoting the JC virus infiltration into the CNS.
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The purpose of this study was to determine factors that extend the length of hospital stay in patients with ischemic stroke in acute hospital. Clinical data of 462 consecutive patients with acute ischemic stroke were retrospectively researched. ⋯ Independent and significant factors associated with prolonged hospital stay were National Institutes of Health Stroke Scale score on admission (OR, 1.072: 95% CI, 1.021 to 1.125), transient ischemic attack (OR, 0.142: 95% CI, 0.021 to 0.966), any complications during hospital stay (OR, 7.975: 95% CI, 3.539 to 17.971) and interval between offer to discharge (OR, 1.441: 95% CI, 1.294 to 1.605). It was suggested that control of complication could decrease length of hospital stay in patients with ischemic stroke in acute hospitals.
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Case Reports
[MRI and SPECT findings in a case of metronidazole-induced reversible acute cerebellar ataxia].
A 69-year-old man was referred to our department because of acute onset nausea, vomiting, dysphagia, dysarthria and gait disturbance. He had a 50-day-history of amebic dysentery and had been treated with 1,500 mg metronidazole per day. Neurological examination revealed dysphagia, ataxic speech, ataxia of the left extremities and the trunk, and hyperactive deep tendon reflexes in all extremities. ⋯ In spite of the presence of the MRI lesion in the right dentate nucleus, the patient had no ataxia of the right extremities and there was no hypoperfusion in the right cerebellar hemisphere. Thus, metronidazole does not appear to have a direct neurotoxic effect on the central nervous system. On the other hand, nerve conduction studies showed axonal polyneuropathy, which was not improved one month after cessation of the drug; thus metronidazole seems to exert more damage on peripheral nerves.