Rinshō shinkeigaku = Clinical neurology
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We report a 61-year-old man with Parkinson's disease, who had a 3-year history of severe chronic pain with allodynia in the lower extremities prior to motor symptoms. He always had tingling pain around the ankles, and tactile sensation induced severe burning pain expanding to the toes and thighs, so his pain was considered to be allodynia. ⋯ To our knowledge, allodynia, which is usually recognized in causalgia or reflex sympathetic dystrophy, has never been reported in Parkinson's disease. Patients with Parkinson's disease may complain severe causalgia-like pain as an initial symptom.
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In this paper, results of the recent clinical trials were reviewed, and problems in treating patients with thrombolysis were discussed. Data generated from randomized controlled trials over the past few years have shown that acute intervention can improve neurological outcome in patients with ischemic stroke. Intravenous recombinant tissue plasminogen activator has become established as an acute treatment for stroke. ⋯ A difference between settings of a clinical trial and of general practice should be also noted. Early recognition of stroke symptoms and immediate transfer to a suitable treatment facility should bring thrombolysis to a larger number of stroke victims. Finally, successful treatment is due in part to selecting patients who are not at increased risk for intracranial hemorrhage based on clinical and imaging features, and therefore rapid in-hospital triage protocols are mandatory.
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Review
[Recent progress in intravascular neurosurgery for the treatment of cerebrovascular disease].
With the recent advances in the devices and techniques in intravascular neurosurgery such as microcatheters or a digital subtraction angiography, intravascular neurosurgery plays an important role for the treatment of cerebrovascular disease. We describe here, a recent progress in intravascular neurosurgery for the treatment of cerebrovascular disease. ⋯ So, recently it becomes one of standard methods of the treatment of cerebral aneurysm. Thrombolytic therapy, PTA and stenting also become an important treatment for the ischemic cerebrovascular disease.
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In this report, I have summarized the current situation surrounding diagnosis, treatment and related needs in the department of neurology in relation to postgraduate neurology training considered from the standpoint of a specialized department within a general hospital. This summary is based on the responses to a questionnaire that was sent to the persons in charge of education and training at 180 institutions affiliated with the Japanese Society of Neurology and 478 education and training institutions among Japanese city hospitals, excluding university hospitals and special research institutions. Replies were received from 305 hospitals, amounting to a response rate of 63.8%. ⋯ There should be a clear-cut clarification of the responsible roles of university and city general hospitals in the postgraduate education and training of neurologists. Furthermore, the professional staff and facilities of general hospitals that are affiliated with universities should be upgraded and expanded to enable them to serve more effectively as sites of clinical education and training. The position and status of neurologists at city general hospitals should be raised to the same level as that of university professors and institutions affiliated with the Japanese Society of Neurology.
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Development of portable ventilators has enabled patients suffering from respiratory failure to live outside hospitals. The number of patients with neuromuscular disorders receiving home mechanical ventilation (HMV) has been increasing year by year. However, Japanese social support services are not sufficient for these patients. ⋯ So it is important to decrease the risk related to HMV. We verified that the combination of monitoring system and multimedia can produce effective support system. It is important to improve these systems and cut down the cost for popularization.