{"title":"[A case of diagnosed pernicious anemia and subacute combined degeneration of the spinal cord with abnormally elevated serum vitamin B12].","authors":"Kazuaki Hirakata, Yoshito Ishii, Tamaki Yoshida, Fumiaki Tanaka, Yoshiharu Nakae","doi":"10.5692/clinicalneurol.cn-002023","DOIUrl":"https://doi.org/10.5692/clinicalneurol.cn-002023","url":null,"abstract":"<p><p>An 86-year-old male patient developed paresthesia in both hands, and six months later, pancytopenia was noted. He was diagnosed with myelodysplastic syndrome following bone marrow aspiration. Despite high serum vitamin B12 level, elevated level of serum homocysteine, positive anti-intrinsic factor antibody, and T<sub>2</sub>-weighted hyperintense lesions on spinal cord MRI led to a diagnosis of subacute combined degeneration of the spinal cord. Treatment with intramuscular mecobalamin injections improved the pancytopenia and resolved the MRI lesions. The pancytopenia in this patient was considered to be caused by pernicious anemia. The presence of anti-intrinsic factor antibody can cause falsely normal or elevated serum vitamin B12 levels. When patients with pancytopenia report numbness, even without a decrease in serum vitamin B12 levels, pernicious anemia and subacute combined degeneration of the spinal cord should be suspected, and measurements of serum homocysteine and anti-intrinsic factor antibodies should be considered.</p>","PeriodicalId":39292,"journal":{"name":"Clinical Neurology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068562","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":"[Detection of brain MRI abnormalities before symptom onset in case of Creutzfeldt-Jakob disease with compound heterozygous PRNP mutation (V180I/M232R)].","authors":"Kyotaro Miura, Yoshitsugu Nakamura, Shoji Ogawa, Katsuya Satoh, Tetsuyuki Kitamoto, Shigeki Arawaka","doi":"10.5692/clinicalneurol.cn-002025","DOIUrl":"https://doi.org/10.5692/clinicalneurol.cn-002025","url":null,"abstract":"<p><p>In an 81-year-old man, brain diffusion-weighted MRI revealed punctate high-intensity lesions in the bilateral frontal cortex. Three months later, these lesions had extended into the cerebral cortices. Six months after the original MRI, the patient developed cognitive decline. Clinically, he appeared to have Creutzfeldt-Jakob disease (CJD) based on brain MRI and cerebrospinal fluid examination findings. We identified a compound heterozygous mutation (V180I/M232R) in PRNP and diagnosed him with genetic CJD. This case of CJD with a compound heterozygous PRNP mutation had a relatively old onset, slowly progressive course, and low frequency of periodic synchronous discharges. Additionally, we detected CJD-associated brain MRI abnormalities before symptom onset. Reports of presymptomatic CJD such as the present case are important for the development of new therapeutic agents for CJD.</p>","PeriodicalId":39292,"journal":{"name":"Clinical Neurology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068565","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":"[Case of ictal aphasia and post-ictal aphasia due to focal epilepsy associated with cerebral hemorrhage].","authors":"Arisa Yamamoto, Kosuke Yoshida, Yasuhiro Suzuki, Kenji Kuroda, Takashi Kimura, Yoko Aburakawa","doi":"10.5692/clinicalneurol.cn-001954","DOIUrl":"10.5692/clinicalneurol.cn-001954","url":null,"abstract":"<p><p>The patient was a 69-year-old right-handed woman. She had sensory aphasia, and the brain MRI revealed a subacute phase hemorrhage in the left subcortical temporal lobe. We speculated that the patient had post-ictal aphasia due to symptomatic epileptic seizures associated with cerebral hemorrhage. Seven months later, she was readmitted to the hospital with sensory aphasia; however, this time, the brain MRI FLAIR demonstrated high signal in the left medial temporal lobe and thalamic pillow. Furthermore, the electroencephalogram showed periodic discharges focused on the left temporal region. <sup>123</sup>I-IMP SPECT of cerebral blood flow indicated a cluster within the medial left temporal lobe. Aphasia associated with nonconvulsive seizures was considered. Sudden onset sensory aphasia should be differentiated from ictal and post-ictal aphasias.</p>","PeriodicalId":39292,"journal":{"name":"Clinical Neurology","volume":" ","pages":"22-26"},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855979","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":"[Rheumatoid meningitis without arthritis presenting as widespread symmetrical high-intensity lesions along cerebral sulci on diffusion-weighted MRI: a case report].","authors":"Takanobu Kita, Hiroaki Okada, Seiji Takenouchi, Yoshiyuki Nakai, Masahiro Kanai, Keiji Yamaguchi","doi":"10.5692/clinicalneurol.cn-002022","DOIUrl":"10.5692/clinicalneurol.cn-002022","url":null,"abstract":"<p><p>A 52-year-old woman presented with the subacute onset of pantalgia, fever and consciousness disturbance. MRI revealed widespread symmetrical high-intensity areas along the sulci in both cerebral hemispheres on diffusion-weighted imaging (DWI). Rheumatoid meningitis was suspected based on elevated levels of anti-cyclic citrullinated peptide antibodies (ACPA) in both serum and cerebrospinal fluid (CSF), as well as an elevated ACPA index. Brain biopsy revealed marked infiltration of inflammatory cells in the subarachnoid space, confirming the diagnosis of rheumatoid meningitis. The patient fully recovered after receiving six courses of steroid pulse therapy, followed by postremission therapy. Diagnosing cases without arthritis can be challenging, but testing for ACPA and evaluating the ACPA index can be useful for both diagnosis and assessing therapeutic efficacy in cases of suspected rheumatoid meningitis.</p>","PeriodicalId":39292,"journal":{"name":"Clinical Neurology","volume":" ","pages":"39-44"},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855980","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":"[SELENON-related myopathy with scoliosis and respiratory failure since early childhood diagnosed through reassessment during pediatric-to-adult healthcare transition: a case report].","authors":"Yusuke Baba, Meiko Maeda, Kyosuke Muramatsu, Kenta Tominaga, Nunihiro Ueda, Shogo Komaki, Yoshihiko Saito, Masashi Hamada, Wataru Satake, Ichizo Nishino, Tatsushi Toda","doi":"10.5692/clinicalneurol.cn-002046","DOIUrl":"https://doi.org/10.5692/clinicalneurol.cn-002046","url":null,"abstract":"<p><p>The patient was a 33-year-old woman with no family history of a similar disorder. At one year of age, she exhibited scoliosis and respiratory failure, necessitating a tracheostomy performed at 5 years of age (1990s). During that time, the patient was provisionally diagnosed with \"non-Fukuyama congenital muscular dystrophy\" via muscle biopsy. Difficulties in independent walking and standing emerged by 14 years of age, progressing to significant mobility challenges by 21 years of age. The patient was referred to our department at 33 years of age for the transition to adult care. The examination revealed predominant trunk muscle weakness, persistent scoliosis, restricted neck and trunk mobility, significant restrictive ventilatory impairment, and mild intellectual developmental delay. Reanalysis of the muscle biopsy pathology was conducted, and genetic testing identified a known homozygous mutation, c.1574T>G (p.M525R), in the SELENON (SEPN1) gene, leading to a diagnosis of SELENON-related myopathy. The pediatric-to-adult healthcare transition can provide a valuable opportunity for the reassessment of diagnoses and disabilities.</p>","PeriodicalId":39292,"journal":{"name":"Clinical Neurology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048367","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":"[Two cases of Perry disease (Perry syndrome) in the same family with normal <sup>123</sup>I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy].","authors":"Yoshito Take, Ryuji Saigo, Hitoshi Arata, Yusuke Sakiyama, Kimiyoshi Arimura, Hideki Ohkatsu","doi":"10.5692/clinicalneurol.cn-001995","DOIUrl":"https://doi.org/10.5692/clinicalneurol.cn-001995","url":null,"abstract":"<p><p>This study investigated two cases. Case 1 involves a 53-year-old man who suffered from sleep apnea syndrome at age 48. Moreover, he was involved in a rear-end collision while driving and was admitted to the hospital at age. He exhibited impaired consciousness, postural tremors, and bradykinesia in the upper extremities. Subsequently, he was managed on a ventilator due to unexplained alveolar hypoventilation. Case 2 is his younger sister, a 46-year-old woman, who was being treated for depression and began to show signs of parkinsonism around age 43. The metaiodobenzylguanidine (MIBG) myocardial scintigraphy results were normal in both cases. Given that their father was also managed on a ventilator due to unexplained alveolar hypoventilation, exome analyses were performed. Both were found to have a previously reported heterozygous mutation (p.Y78C) in the DCTN1 gene and were diagnosed with Perry disease. Although MIBG myocardial scintigraphy is a useful test for diagnosing Perry disease, it is important to note that there are cases where it may yield normal results.</p>","PeriodicalId":39292,"journal":{"name":"Clinical Neurology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048373","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":"[Guidelines for presymptomatic genetic testing for adult-onset hereditary neuromuscular diseases in Japan].","authors":"Yuka Shibata, Hyangri Chang, Katsuya Nakamura, Shinichiro Yamada, Masaaki Matsushima, Kazumasa Saigoh, Hiroyuki Ishiura, Yoshiki Sekijima, Hirofumi Maruyama, Takeshi Ikeuchi, Kazuko Hasegawa, Masashi Aoki, Masahisa Katsuno, Tatsushi Toda, Ichiro Yabe","doi":"10.5692/clinicalneurol.cn-002049","DOIUrl":"https://doi.org/10.5692/clinicalneurol.cn-002049","url":null,"abstract":"<p><p>In Japan, there are no nationwide guidelines for presymptomatic testing for hereditary neuromuscular diseases. Although each institution has been dealing with this situation by using their own procedures to date, it is necessary to develop a standardized guidelines based on the Japanese medical system, because the development of disease-modifying therapies has progressed, and we are entering an era in which early diagnosis and early treatment are necessary. The guidelines presented here were devised by the Committee on Medical Genetics of the Japan Neurological Society. During their development, Delphi surveys were conducted among individuals with extensive experience in presymptomatic testing throughout Japan, with 42 experts participating in all three surveys, and a consensus-building process was undertaken. Finally, the guidelines consist of 45 recommendations for performing presymptomatic testing for adult-onset inherited neurological and muscular diseases.</p>","PeriodicalId":39292,"journal":{"name":"Clinical Neurology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048359","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}
Clinical NeurologyPub Date : 2025-01-24DOI: 10.5692/clinicalneurol.cn-002000
Shinji Itamura, Kasumi Sasaki, Rika Okano
{"title":"[An adult case of Dravet syndrome in which seizures worsened after discontinuation of lamotrigine and administration of stiripentol].","authors":"Shinji Itamura, Kasumi Sasaki, Rika Okano","doi":"10.5692/clinicalneurol.cn-002000","DOIUrl":"https://doi.org/10.5692/clinicalneurol.cn-002000","url":null,"abstract":"<p><p>The patient was a 21-year-old female. She had frequently had status seizures when she had a fever or while taking a bath since she was 6 months old. At 1 year and 8 months old, she developed epilepsy. She was treated with multiple antiepileptic drugs, but her condition was intractable. At the age of 3, the patient suffered from acute encephalopathy, which was complicated by severe psychomotor developmental retardation. Tonic seizures continued to occur on a daily basis even after school age, but they did not worsen even during periods of fever, and the patient was not hospitalized until the age of 8. At the age of 19, the diagnosis was revised and Dravet syndrome was diagnosed. Lamotrigine, which had been taken at the time of diagnosis, was discontinued and stiripentol was administered, but the seizure frequency worsened. Because of the pathology of Dravet syndrome in adults may differ from that in children, care must be taken when selecting antiepileptic drugs.</p>","PeriodicalId":39292,"journal":{"name":"Clinical Neurology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048348","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}
引用次数: 0
Clinical NeurologyPub Date : 2025-01-01DOI: 10.5692/clinicalneurol.65_1_facilities1
Clinical NeurologyPub Date : 2025-01-01DOI: 10.5692/clinicalneurol.65_1_proceedings3
{"title":"[The Proceedings of the 170th Tokai-Hokuriku Regional Meeting of the Japanese Society of Neurology].","authors":"","doi":"10.5692/clinicalneurol.65_1_proceedings3","DOIUrl":"https://doi.org/10.5692/clinicalneurol.65_1_proceedings3","url":null,"abstract":"","PeriodicalId":39292,"journal":{"name":"Clinical Neurology","volume":"65 1","pages":"78-89"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068573","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}