Rinshō shinkeigaku = Clinical neurology
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Case Reports
[A case of dissecting aneurysm of the basilar artery presented as superior pons type of Foville's syndrome].
Here we report a 47-year-old man with dissecting aneurysm of the basilar artery who developed Foville's syndrome due to upper pons involvement. At first he had an abrupt onset of dysarthria and weakness in his left upper and lower extremities during his work. Neurological examination on admission revealed mild disturbance of consciousness, absent light reaction on the left side, hypesthesia of the left face, absent gag reflex, dysarthria, and left hemiparesis with ataxia. ⋯ Computed tomography showed low density area in the right upper pons, and the basilar artery had marked lateral shift, dilatation, and calcification. Vertebral angiography demonstrated dissecting aneurysm of the basilar artery. Although it is very rare that dissecting aneurysm of the basilar artery causes the brain stem symptoms, its possibility should be considered when computed tomography shows marked lateral shift, dilatation, and/or calcification of the basilar artery.
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Warfarin potassium (warfarin) is one of anticoagulants. Its anticoagulant effect is induced by inhibiting vitamin K in a complex manner. It is used effectively and safely in preventing cerebral embolism of cardiac origin, provided that thrombotest (TT) values is maintained from 10 to 20%. ⋯ There was no evidence of discontinuing warfarin, or taking drugs containing vitamin K or Natto. Chlorella is one of vitamin K-rich foods. Thus, it may inhibit the anticoagulant effect of warfarin.
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This study was designed to elucidate if there is a potential hazard of developing neuropsychological deterioration after major cardiovascular surgery. Neuropsychological functions were studied in 49 patients before and after cardiac (coronary artery bypass, cardiac valve replacement, etc.) and thoracic aortic surgery (aortic aneurysm). Neuropsychological examinations using 5 batteries (Mini-Mental State Examination, Cross Cultural Cognitive Examination, Miyake's Verbal Memory Test, Benton Visual Retention Test and Wisconsin Card Sorting Test) were performed before surgery and subsequently at 3 weeks and 8 months after. ⋯ Cognitive function in five patients did not improve and remained at the decreased level. The other two patients whose function was normal at the first post-surgical examination, were found to have developed impairment of cognitive function at the follow up. Although the patients had some deficits on their neuropsychological function, they scarcely complained about any problems in their daily life.(ABSTRACT TRUNCATED AT 250 WORDS)
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We present a case of acute severe demyelination affecting both CNS and PNS with pathological evidence. A 62-year-old man presented with acute onset of coma preceded by common cold-like symptoms. He was diagnosed as acute disseminated encephalomyelopathy (ADEM), and died of brain herniation in two weeks. ⋯ So far the association of hypertrophic demyelinating neuropathy was reported in cases of multiple sclerosis. However, there have not been any papers in which substantial involvement of both CNS and PNS in cases of ADEM except for the clinical report by Amit. Antigenic cross-reactivity between CNS and PNS against myelin proteins or other antigens like glycolipid may elicit similar immune responses producing demyelination.
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Tapia's syndrome, first described in 1904 by A. G. Tapia, is considered to be a syndrome consisting of ipsilateral hemiplegia of larynx and tongue with spared movement of soft palate. ⋯ The patient's lower cranial polyneuropathy was considered to be caused by the aneurysm. A survey of the literature indicates that extracranial carotid aneurysm is an extremely rare cause of Tapia's syndrome. In this case, the location of the aneurysm, which was present considerably distant from the skull base, seems to be the reason for the sparing of the accessory nerve.