Abstract A 57‐year‐old man presented with progressive muscle weakness in the lower limbs, with elevated anti‐P/Q‐type voltage‐gated calcium channel antibody levels. A repetitive stimulation test showed waxing with high‐frequency stimulation. He was diagnosed with Lambert–Eaton myasthenic syndrome (LEMS) and small‐cell lung cancer. After four courses of cisplatin and etoposide, computed tomography showed a decrease in tumor size and muscle weakness improved. After 3 months, the patient presented with progressive ataxic gait and dysarthria and was admitted to our hospital. Magnetic resonance imaging revealed slight cerebellar atrophy. We diagnosed the patient with paraneoplastic cerebellar degeneration (PCD)‐LEMS. The patient received intravenous immunoglobulin therapy, steroid pulse therapy, and plasmapheresis. The patient's cerebellar ataxia then improved. This represents a rare case of PCD‐LEMS after improvement of LEMS.
{"title":"Paraneoplastic cerebellar degeneration after improvement of <scp>Lambert–Eaton</scp> myasthenic syndrome","authors":"Hiroaki Hirosawa, Hiroki Maesaka, Noriyuki Matsuda, Takamasa Nukui, Shunya Nakane, Yuji Nakatsuji","doi":"10.1111/ncn3.12783","DOIUrl":"https://doi.org/10.1111/ncn3.12783","url":null,"abstract":"Abstract A 57‐year‐old man presented with progressive muscle weakness in the lower limbs, with elevated anti‐P/Q‐type voltage‐gated calcium channel antibody levels. A repetitive stimulation test showed waxing with high‐frequency stimulation. He was diagnosed with Lambert–Eaton myasthenic syndrome (LEMS) and small‐cell lung cancer. After four courses of cisplatin and etoposide, computed tomography showed a decrease in tumor size and muscle weakness improved. After 3 months, the patient presented with progressive ataxic gait and dysarthria and was admitted to our hospital. Magnetic resonance imaging revealed slight cerebellar atrophy. We diagnosed the patient with paraneoplastic cerebellar degeneration (PCD)‐LEMS. The patient received intravenous immunoglobulin therapy, steroid pulse therapy, and plasmapheresis. The patient's cerebellar ataxia then improved. This represents a rare case of PCD‐LEMS after improvement of LEMS.","PeriodicalId":19154,"journal":{"name":"Neurology and Clinical Neuroscience","volume":"13 21","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135043857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Neuroradiologic features associated with heat stroke","authors":"Yasutaka Tajima, Yasunori Mito","doi":"10.1111/ncn3.12784","DOIUrl":"https://doi.org/10.1111/ncn3.12784","url":null,"abstract":"","PeriodicalId":19154,"journal":{"name":"Neurology and Clinical Neuroscience","volume":" 10","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135241693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background The corticobulbar tract (CBT) exerts bilateral supply to the cerebral nuclei. The cerebellar motor circuit controls the coordination and regulation of voluntary movements including speech function, and consists of input and feedback pathways including the parietopontine fibers (PPFs) which descend along with the CBT. Aim The pathogenesis of dysarthria caused by ischemic extracerebellar lesions was studied. Methods Six patients with extracerebellar lesions comprising two patients with pure dysarthria, three patients with dysarthria—(central) facial nerve palsy, and one patient with isolated central facial paresis were enrolled. Results Lesions were located in the corona radiata in four patients and the posterior limb of the internal capsule (PLIC) in two patients. Lesions were lateralized on the right side in three patients and the left side in three patients. Lesions in the corona radiata and the PLIC included the middle parts where the CBT exists. Conclusions Based on the hypothesis of bilateral supply to the cerebral nuclei for speech function through the cerebellar motor circuit, it was explicable that unilateral involvement of the PPFs caused dysfunction of the bilateral CBT, which led to the incidence of dysarthria in our case series. Involvement of the PPFs might play a crucial role in the incidence of dysarthria caused by ischemic extracerebellar lesions.
{"title":"Clinical study of six patients with pure dysarthria and dysarthria—(Central) facial nerve palsy/isolated central facial nerve palsy caused by extracerebellar infarction","authors":"Katsuhiko Ogawa, Takayoshi Akimoto, Makoto Hara, Midori Fujishiro, Hideto Nakajima","doi":"10.1111/ncn3.12782","DOIUrl":"https://doi.org/10.1111/ncn3.12782","url":null,"abstract":"Abstract Background The corticobulbar tract (CBT) exerts bilateral supply to the cerebral nuclei. The cerebellar motor circuit controls the coordination and regulation of voluntary movements including speech function, and consists of input and feedback pathways including the parietopontine fibers (PPFs) which descend along with the CBT. Aim The pathogenesis of dysarthria caused by ischemic extracerebellar lesions was studied. Methods Six patients with extracerebellar lesions comprising two patients with pure dysarthria, three patients with dysarthria—(central) facial nerve palsy, and one patient with isolated central facial paresis were enrolled. Results Lesions were located in the corona radiata in four patients and the posterior limb of the internal capsule (PLIC) in two patients. Lesions were lateralized on the right side in three patients and the left side in three patients. Lesions in the corona radiata and the PLIC included the middle parts where the CBT exists. Conclusions Based on the hypothesis of bilateral supply to the cerebral nuclei for speech function through the cerebellar motor circuit, it was explicable that unilateral involvement of the PPFs caused dysfunction of the bilateral CBT, which led to the incidence of dysarthria in our case series. Involvement of the PPFs might play a crucial role in the incidence of dysarthria caused by ischemic extracerebellar lesions.","PeriodicalId":19154,"journal":{"name":"Neurology and Clinical Neuroscience","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135871060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Immune‐mediated necrotizing myopathy (IMNM) is an idiopathic inflammatory myopathy characterized by limb weakness, markedly elevated serum creatine kinase (CK), and muscle fiber necrosis without lymphocytic infiltration. Here, we present a case of IMNM that developed during pregnancy. The patient was treated immediately with systemic corticosteroids, and muscle weakness and serum CK levels were improved without adverse effects on the pregnancy. As there are only a few reports of IMNM during pregnancy, the clinical course and treatment of IMNM during pregnancy are discussed with a review of the literature.
{"title":"Successful treatment of seronegative immune‐mediated necrotizing myopathy developing during pregnancy: A case report and literature review","authors":"Yuto Hayashi, Tatsuhiko Ozono, Goichi Beck, Yuki Yonenobu, Rika Yamashita, Kensuke Ikenaka, Tatsusada Okuno, Shigeo Murayama, Hideki Mochizuki","doi":"10.1111/ncn3.12781","DOIUrl":"https://doi.org/10.1111/ncn3.12781","url":null,"abstract":"Abstract Immune‐mediated necrotizing myopathy (IMNM) is an idiopathic inflammatory myopathy characterized by limb weakness, markedly elevated serum creatine kinase (CK), and muscle fiber necrosis without lymphocytic infiltration. Here, we present a case of IMNM that developed during pregnancy. The patient was treated immediately with systemic corticosteroids, and muscle weakness and serum CK levels were improved without adverse effects on the pregnancy. As there are only a few reports of IMNM during pregnancy, the clinical course and treatment of IMNM during pregnancy are discussed with a review of the literature.","PeriodicalId":19154,"journal":{"name":"Neurology and Clinical Neuroscience","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136069182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Masaya Shimozato, Nobuaki Yoshikura, Akio Kimura, Mika Otsuki, Takayoshi Shimohata
Abstract A 53‐year‐old woman presented with repetitive involuntary elevation of the left upper limb beyond her shoulder joint. Initially, the symptom was suspected to be due to a functional neurological disorder. Based on the clinical and radiological findings, however, we diagnosed arm levitation associated with multiple system atrophy. The mechanism of her arm levitation was suggested to be a disturbance of the right frontal cortex with resultant impairment of the inhibitory mechanisms of the primary motor cortex.
{"title":"Arm levitation in multiple system atrophy","authors":"Masaya Shimozato, Nobuaki Yoshikura, Akio Kimura, Mika Otsuki, Takayoshi Shimohata","doi":"10.1111/ncn3.12780","DOIUrl":"https://doi.org/10.1111/ncn3.12780","url":null,"abstract":"Abstract A 53‐year‐old woman presented with repetitive involuntary elevation of the left upper limb beyond her shoulder joint. Initially, the symptom was suspected to be due to a functional neurological disorder. Based on the clinical and radiological findings, however, we diagnosed arm levitation associated with multiple system atrophy. The mechanism of her arm levitation was suggested to be a disturbance of the right frontal cortex with resultant impairment of the inhibitory mechanisms of the primary motor cortex.","PeriodicalId":19154,"journal":{"name":"Neurology and Clinical Neuroscience","volume":"150 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135900244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Iwona Mazurkiewicz, Zaneta Chatys‐Bogacka, Joanna Slowik, Joanna Szaleniec, Jacek Czepiel, Agnieszka Slowik, Leszek Drabik, Marcin Wnuk
Abstract Objective To evaluate course of quality of life (QoL) after hospitalization due to COVID‐19 and to assess whether symptoms of chronic fatigue syndrome (CFS) were its predictors at different time points. Methods Participants aged 18 or older retrospectively reported QoL at work with 4‐point Likert scale and presence of eight CFS symptoms before infection, within 0–4, 4–12, and > 12 weeks post‐COVID with online or paper version of validated neuropsychological questionnaire. Results Two hundred and eighty‐three patients (median age 59 [47–67] years, 37.45% women, 95.76% non‐ICU residents) were evaluated after median of 27.1 (24.9–31.6) weeks from first positive swab test for SARS‐CoV‐2. Any decrease in QoL at work was observed in 33.21%, 29.28%, and 25.54% of patients within 4, 4–12, and > 12 weeks after COVID‐19, respectively ( p < 0.001). Within 4 weeks after COVID‐19 onset, decrease in QoL at work was predicted by age (OR = 0.93, 95% CI:0.90–0.96, p < 0.001), persistent fatigue unrelated to effort (OR = 4.03, 95% CI:1.21–13.50, p < 0.001), sore throat (OR = 5.33, 95% CI:1.92–14.78, p = 0.001), and prolonged post‐exercise fatigue (OR = 8.12, 95% CI:2.17–30.56, p = 0.002). Predictors of deterioration in QoL at work 4–12 and > 12 weeks post‐infection were age (OR = 0.97, 95% CI:0.94–0.99, p = 0.015 and OR = 0.93, 95% CI:0.90–0.97, p = 0.001, respectively), non‐restorative sleep (OR = 2.75, 95% CI:1.25–6.05, p = 0.012 and OR = 3.62, 95% CI:1.40–9.38, p = 0.008, respectively), and headache (OR = 2.78, 95% CI:1.29–5.99, p = 0.009 and OR = 5.68, 95% CI:2.15–15.02, p < 0.001, respectively). Furthermore, decreased QoL at work was predicted by post‐exercise fatigue (OR = 5.99, 95% CI:2.18–16.20, p < 0.001) and fatigue not caused by effort (OR = 14.40, 95% CI:4.77–43.45, p < 0.001) within 4–12 and > 12 weeks post‐infection, respectively. Conclusions Different CFS symptoms are associated with decreased QoL at work at various time points since COVID‐19 onset.
目的评价新冠肺炎患者住院后的生活质量(QoL)，并评估慢性疲劳综合征(CFS)症状在不同时间点是否为其预测因素。方法18岁或以上的参与者用4点李克特量表回顾性报告工作时的生活质量，感染前存在8种CFS症状，在0 - 4,4 - 12和>之间;COVID - 19后12周，使用在线或纸质版本的有效神经心理学问卷。结果283例患者(中位年龄59[47-67]岁，37.45%为女性，95.76%为非ICU住院患者)在首次SARS - CoV - 2拭子检测阳性的中位时间为27.1(24.9-31.6)周后接受评估。在4、4 - 12和>期间，33.21%、29.28%和25.54%的患者工作时生活质量下降;分别在COVID - 19后12周(p <0.001)。在COVID - 19发病后4周内，年龄预测工作生活质量下降(OR = 0.93, 95% CI: 0.90-0.96, p <0.001)，与努力无关的持续性疲劳(OR = 4.03, 95% CI: 1.21-13.50, p <0.001)、喉咙痛(OR = 5.33, 95% CI: 1.92-14.78, p = 0.001)和运动后长时间疲劳(OR = 8.12, 95% CI: 2.17-30.56, p = 0.002)。工作中生活质量恶化的预测因素4-12和>感染后12周分别为年龄(OR = 0.97, 95% CI: 0.94-0.99, p = 0.015和OR = 0.93, 95% CI: 0.90-0.97, p = 0.001)、非恢复性睡眠(OR = 2.75, 95% CI: 1.25-6.05, p = 0.012和OR = 3.62, 95% CI: 1.40-9.38, p = 0.008)和头痛(OR = 2.78, 95% CI: 1.29-5.99, p = 0.009和OR = 5.68, 95% CI: 2.15-15.02, p <分别为0.001)。此外，运动后疲劳可以预测工作中生活质量的下降(OR = 5.99, 95% CI: 2.18-16.20, p <0.001)和非努力引起的疲劳(OR = 14.40, 95% CI: 4.77-43.45, p <0.001)在4-12和>之间;分别为感染后12周。结论自COVID - 19发病以来，不同时间点CFS症状与工作生活质量下降相关。
{"title":"Quality of life at work and fatigue after hospitalization due to COVID‐19","authors":"Iwona Mazurkiewicz, Zaneta Chatys‐Bogacka, Joanna Slowik, Joanna Szaleniec, Jacek Czepiel, Agnieszka Slowik, Leszek Drabik, Marcin Wnuk","doi":"10.1111/ncn3.12777","DOIUrl":"https://doi.org/10.1111/ncn3.12777","url":null,"abstract":"Abstract Objective To evaluate course of quality of life (QoL) after hospitalization due to COVID‐19 and to assess whether symptoms of chronic fatigue syndrome (CFS) were its predictors at different time points. Methods Participants aged 18 or older retrospectively reported QoL at work with 4‐point Likert scale and presence of eight CFS symptoms before infection, within 0–4, 4–12, and > 12 weeks post‐COVID with online or paper version of validated neuropsychological questionnaire. Results Two hundred and eighty‐three patients (median age 59 [47–67] years, 37.45% women, 95.76% non‐ICU residents) were evaluated after median of 27.1 (24.9–31.6) weeks from first positive swab test for SARS‐CoV‐2. Any decrease in QoL at work was observed in 33.21%, 29.28%, and 25.54% of patients within 4, 4–12, and > 12 weeks after COVID‐19, respectively ( p < 0.001). Within 4 weeks after COVID‐19 onset, decrease in QoL at work was predicted by age (OR = 0.93, 95% CI:0.90–0.96, p < 0.001), persistent fatigue unrelated to effort (OR = 4.03, 95% CI:1.21–13.50, p < 0.001), sore throat (OR = 5.33, 95% CI:1.92–14.78, p = 0.001), and prolonged post‐exercise fatigue (OR = 8.12, 95% CI:2.17–30.56, p = 0.002). Predictors of deterioration in QoL at work 4–12 and > 12 weeks post‐infection were age (OR = 0.97, 95% CI:0.94–0.99, p = 0.015 and OR = 0.93, 95% CI:0.90–0.97, p = 0.001, respectively), non‐restorative sleep (OR = 2.75, 95% CI:1.25–6.05, p = 0.012 and OR = 3.62, 95% CI:1.40–9.38, p = 0.008, respectively), and headache (OR = 2.78, 95% CI:1.29–5.99, p = 0.009 and OR = 5.68, 95% CI:2.15–15.02, p < 0.001, respectively). Furthermore, decreased QoL at work was predicted by post‐exercise fatigue (OR = 5.99, 95% CI:2.18–16.20, p < 0.001) and fatigue not caused by effort (OR = 14.40, 95% CI:4.77–43.45, p < 0.001) within 4–12 and > 12 weeks post‐infection, respectively. Conclusions Different CFS symptoms are associated with decreased QoL at work at various time points since COVID‐19 onset.","PeriodicalId":19154,"journal":{"name":"Neurology and Clinical Neuroscience","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135198973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background A shorter onset‐to recanalization (O2R) time in mechanical thrombectomy for acute ischemic stroke (AIS) results in better outcomes. Thus, we should reduce the door‐to‐puncture (D2P) time. Aim To evaluate the effectiveness of a triage system named “Code AIS.” We adopted the emergency large vessel occlusion (ELVO) screen as a screening test. Methods Using the ELVO screening test, Code AIS was invoked when ≥1 positive results were obtained without witnessed seizures. The Code AIS system requires the assembly of neurologists, neurosurgeons, and an endovascular team in the emergency department before a patient arrives at the hospital. In total, 104 consecutive patients who underwent thrombectomy after emergency transport from January 2015 to December 2022 were included. The Code AIS system was initiated on February 17, 2022, and patients were divided into the pre‐Code AIS and Code AIS era groups. D2P time, outcome, and other parameters were compared between the groups. Results Eighty‐eight and 16 cases were in the pre‐Code AIS and Code AIS era groups, respectively. Background factors, including age, sex, and etiology, did not differ between the groups. The median (interquartile range) time of D2P in the Code AIS era was 60 (41–102) min and significantly shortened compared to 135 (109–161) min in the pre‐Code AIS era ( p < 0.001). The proportion of patients with favorable outcomes (modified Rankin Scale score, 0–2) improved significantly from 33% (pre‐Code AIS era) to 63% (Code AIS era) ( p = 0.047). Conclusion Using Code AIS, we succeeded in shortening D2P time and improving patient outcomes.
{"title":"A systemized strategy to reduce door‐to‐puncture time using the <scp>ELVO</scp> screen: “Code <scp>AIS</scp>”","authors":"Hiroyasu Inoue, Yusuke Nishikawa, Masahiro Oomura, Tomonori Hattori, Yuki Hayashi, Tomoyasu Yamanaka, Mitsuru Uchida, Yoko Taniguchi, Kengo Suzuki, Yuta Madokoro, Toyohiro Sato, Teppei Fujioka, Masayuki Mizuno, Shoji Kawashima, Kenji Okita, Mitsuhito Mase, Noriyuki Matsukawa","doi":"10.1111/ncn3.12778","DOIUrl":"https://doi.org/10.1111/ncn3.12778","url":null,"abstract":"Abstract Background A shorter onset‐to recanalization (O2R) time in mechanical thrombectomy for acute ischemic stroke (AIS) results in better outcomes. Thus, we should reduce the door‐to‐puncture (D2P) time. Aim To evaluate the effectiveness of a triage system named “Code AIS.” We adopted the emergency large vessel occlusion (ELVO) screen as a screening test. Methods Using the ELVO screening test, Code AIS was invoked when ≥1 positive results were obtained without witnessed seizures. The Code AIS system requires the assembly of neurologists, neurosurgeons, and an endovascular team in the emergency department before a patient arrives at the hospital. In total, 104 consecutive patients who underwent thrombectomy after emergency transport from January 2015 to December 2022 were included. The Code AIS system was initiated on February 17, 2022, and patients were divided into the pre‐Code AIS and Code AIS era groups. D2P time, outcome, and other parameters were compared between the groups. Results Eighty‐eight and 16 cases were in the pre‐Code AIS and Code AIS era groups, respectively. Background factors, including age, sex, and etiology, did not differ between the groups. The median (interquartile range) time of D2P in the Code AIS era was 60 (41–102) min and significantly shortened compared to 135 (109–161) min in the pre‐Code AIS era ( p < 0.001). The proportion of patients with favorable outcomes (modified Rankin Scale score, 0–2) improved significantly from 33% (pre‐Code AIS era) to 63% (Code AIS era) ( p = 0.047). Conclusion Using Code AIS, we succeeded in shortening D2P time and improving patient outcomes.","PeriodicalId":19154,"journal":{"name":"Neurology and Clinical Neuroscience","volume":"129 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135344470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Parkinson's disease (PD) patients experience nocturnal movement linked to primary sleep disorders. We describe a patient with PD who presented with unusual nocturnal tremor. Frequent, violent tremor during sleep is unusual but can occur in PD, and treatment is likely to be difficult. Nocturnal tremor may result from the on–off phenomenon and can be successfully treated using a long‐acting ropinirole patch.
{"title":"Ropinirole patch treatment of nocturnal violent tremor in Parkinson's disease","authors":"Hiroshi Kataoka, Kazuma Sugie","doi":"10.1111/ncn3.12779","DOIUrl":"https://doi.org/10.1111/ncn3.12779","url":null,"abstract":"Abstract Parkinson's disease (PD) patients experience nocturnal movement linked to primary sleep disorders. We describe a patient with PD who presented with unusual nocturnal tremor. Frequent, violent tremor during sleep is unusual but can occur in PD, and treatment is likely to be difficult. Nocturnal tremor may result from the on–off phenomenon and can be successfully treated using a long‐acting ropinirole patch.","PeriodicalId":19154,"journal":{"name":"Neurology and Clinical Neuroscience","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135539140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background The pathophysiology of sensory impairment in thalamic infarction is unclear. Aim The association between extents of lesions in the ventroposterior nucleus (VP) and distributions of sensory impairments after thalamic infarction was studied. Methods Neurological symptoms and locations of lesions in 16 patients with thalamic infarction were analyzed. Locations of lesions were grouped into the four regions (region 1–4) in the front to back direction. Results The lateral part of the region3 within the intermediate to caudal levels where the VP exists was frequently involved. Subjective superficial sensory impairments were noted in eight patients. The other six patients showed objective sensory impairment alone. The most frequent type was the face/arm in 6 patients. In these six patients, sensory impairments were distributed to the distal part of the arm and the mouth surrounding in five patients each. Sensory impairments were distributed to the half of the body in four patients, the face/trunk/arm in one patient, the face/arm/leg in two patients, and the arm in one patient. Conclusions The principal inferolateral branch supplies the VP and has no anastomosis. In ischemic conditions, blood flow can be decreased in the inside part of the VP, which corresponds to the field of the hand and the mouth surrounding. The detection threshold of superficial sensations for hand and mouth is low. These phenomena were associated with frequent involvement limited to the face/arm. Distributions of sensory impairments were considered to depend on the detection threshold and the lower blood flow in the inside part.
{"title":"Clinical study of 16 patients with thalamic infarction","authors":"Katsuhiko Ogawa, Takayoshi Akimoto, Makoto Hara, Midori Fujishiro, Hideto Nakajima","doi":"10.1111/ncn3.12776","DOIUrl":"https://doi.org/10.1111/ncn3.12776","url":null,"abstract":"Abstract Background The pathophysiology of sensory impairment in thalamic infarction is unclear. Aim The association between extents of lesions in the ventroposterior nucleus (VP) and distributions of sensory impairments after thalamic infarction was studied. Methods Neurological symptoms and locations of lesions in 16 patients with thalamic infarction were analyzed. Locations of lesions were grouped into the four regions (region 1–4) in the front to back direction. Results The lateral part of the region3 within the intermediate to caudal levels where the VP exists was frequently involved. Subjective superficial sensory impairments were noted in eight patients. The other six patients showed objective sensory impairment alone. The most frequent type was the face/arm in 6 patients. In these six patients, sensory impairments were distributed to the distal part of the arm and the mouth surrounding in five patients each. Sensory impairments were distributed to the half of the body in four patients, the face/trunk/arm in one patient, the face/arm/leg in two patients, and the arm in one patient. Conclusions The principal inferolateral branch supplies the VP and has no anastomosis. In ischemic conditions, blood flow can be decreased in the inside part of the VP, which corresponds to the field of the hand and the mouth surrounding. The detection threshold of superficial sensations for hand and mouth is low. These phenomena were associated with frequent involvement limited to the face/arm. Distributions of sensory impairments were considered to depend on the detection threshold and the lower blood flow in the inside part.","PeriodicalId":19154,"journal":{"name":"Neurology and Clinical Neuroscience","volume":"334 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136060623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Omri Zveik, Tal Benoliel Berman, Tarek Keadan, Khalil Barhum, Ariel Rechtman, Adi Vaknin‐Dembinsky
Abstract Myelin oligodendrocyte glycoprotein antibody‐associated disease (MOGAD) commonly presents as optic neuritis or transverse myelitis. We report an atypical clinical presentation for MOGAD in a 28‐year‐old female experiencing right‐arm dystonic episodes. MRI scans demonstrated multifocal periventricular and subcortical lesions, including in the left centrum semiovale and corona radiata. Despite the atypical presentation, her clinical, serological, and radiographic features favor a MOGAD diagnosis. This report emphasizes the heterogeneity of MOGAD phenotypes and the need to consider MOGAD, even in a non‐typical presentation.
{"title":"Myelin oligodendrocyte glycoprotein antibody‐associated disease presenting with dystonia","authors":"Omri Zveik, Tal Benoliel Berman, Tarek Keadan, Khalil Barhum, Ariel Rechtman, Adi Vaknin‐Dembinsky","doi":"10.1111/ncn3.12775","DOIUrl":"https://doi.org/10.1111/ncn3.12775","url":null,"abstract":"Abstract Myelin oligodendrocyte glycoprotein antibody‐associated disease (MOGAD) commonly presents as optic neuritis or transverse myelitis. We report an atypical clinical presentation for MOGAD in a 28‐year‐old female experiencing right‐arm dystonic episodes. MRI scans demonstrated multifocal periventricular and subcortical lesions, including in the left centrum semiovale and corona radiata. Despite the atypical presentation, her clinical, serological, and radiographic features favor a MOGAD diagnosis. This report emphasizes the heterogeneity of MOGAD phenotypes and the need to consider MOGAD, even in a non‐typical presentation.","PeriodicalId":19154,"journal":{"name":"Neurology and Clinical Neuroscience","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136154154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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