Rinshō shinkeigaku = Clinical neurology
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Case Reports
[The painful multiple mononeuropathy of acute onset in the left arm which was diagnosed as leprous neuropathy].
A 31-year-old man from Myanmar with leprous neuropathy was reported. The progress of the disease was subacute but the painful symptom at the time of the onset was acute. Multiple mononeuropathy was diagnosed by the biopsy findings of the left superficial radial nerve. ⋯ Leprous neuropathy is one of the commonest causes of infectious neuropathy in the world, especially in Southeast Asia. These days many foreign workers from that area are staying in Japan, and the chances to see the disease are increasing. We have to recognize leprous neuropathy as a candidate for the multiple mononeuropathy of acute onset with painful dysesthesia similar to vascular neuropathy.
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Historical Article
[The growing-up and background of clinical neurology in Japan].
Japan strictly closed the country to foreigners except for the Dutch and Chinese in the days of Tokugawa Regime for about 200 years (1639-1858). During this period, Japanese neurology made a start. In 1774, five Dutch scholars in Edo (Tokyo at present) translated the Dutch version of a German textbook "Anatomische Tabellen". ⋯ Kinnosuke MIURA founded the first neurological journal in Japan in 1902. These two pioneers in Japanese neurology had their medical education under Prof. Erwin Baelz at the University of Tokyo during the last-eighteenth century.
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An effectiveness of neurointensive care unit for the treatment of neurological diseases and an application of the information technology (IT) for this and a critical pathway were discussed. A critical pathway is useful to make a standardized treatment, to reduce the days in hospital and to obtain an informed consent. But the hospital information system should include the critical pathway in itself otherwise doctors have to make duplicated order to nurses and the hospital ordering system.
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The right-to-left shunt from pulmonary arteriovenous fistula (P-AVF) with Rendu-Osler-Weber (R-O-W) disease can cause paradoxical brain embolism. However, it has remains unclear whether the isolated P-AVF without Rendu-Osler-Weber (R-O-W) disease is associated with ischemic stroke, in particular, paradoxical brain embolism. Our group previously reported a case with paradoxical brain embolism associated with isolated P-AVF without R-O-W disease in 1996. Furthermore, in 1999, we reported that transcranial Doppler (TCD) with saline contrast medium was useful for identifying the presence of P-AVF as a right-to-left shunt. Therefore, when we have an embolic stroke patient with unknown source, we have performed TCD for detecting P-AVF since 1998. The aim of this study was to investigate the frequency of brain infarction associated with isolated P-AVF without R-O-W disease and to evaluate clinical characteristics including a previously reported case, and to elucidate the stroke mechanism. ⋯ The isolated P-AVF without R-O-W disease can cause paradoxical brain embolism. Catheter embolization of P-AVF may be effective in prevention for recurrent stroke. We should not overlooked isolated P-AVF as a right-to-left shunt in embolic stroke patients with unknown etiology.