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[Bilateral Medial Medullary Infarction with Meningovascular Neurosyphilis]. [双侧内侧髓质梗死伴脑膜血管性神经梅毒]。
Brain and Nerve Pub Date : 2026-09-01 DOI: 10.11477/mf.188160960780091041
Masahiko Kato, Nobuaki Yoshikura, Takayoshi Shimohata
{"title":"[Bilateral Medial Medullary Infarction with Meningovascular Neurosyphilis].","authors":"Masahiko Kato, Nobuaki Yoshikura, Takayoshi Shimohata","doi":"10.11477/mf.188160960780091041","DOIUrl":"https://doi.org/10.11477/mf.188160960780091041","url":null,"abstract":"<p><p>Case report A 31-year-old previously healthy man who had sex with men presented with a two-day history of acute-onset dizziness, nausea, and vomiting. On admission, he was afebrile with generalized lymphadenopathy and a truncal and lower-limb rash. Neurological examination revealed no motor weakness or hyperreflexia, but he could not walk unassisted due to dizziness. Brain MRI diffusion-weighted imaging (DWI) showed characteristic V-shaped hyperintense lesions in the bilateral medial medulla (Fig. 1A) and at the pontomedullary junction (Fig. 1B). MR angiography (MRA) showed no stenosis or dissection of the basilar or vertebral arteries (VA) (Fig. 1C).</p>","PeriodicalId":52507,"journal":{"name":"Brain and Nerve","volume":"78 9","pages":"1041-1042"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978811","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
[A Practical Diagnostic Approach to Patients Presenting with "Dizziness": Evaluation and Differential Diagnosis Based on the ATTEST/TiTrATE Framework]. [一种实用的“头晕”诊断方法：基于测试/滴定框架的评估和鉴别诊断]。
Brain and Nerve Pub Date : 2026-09-01 DOI: 10.11477/mf.188160960780090967
Ichiro Deguchi
{"title":"[A Practical Diagnostic Approach to Patients Presenting with \"Dizziness\": Evaluation and Differential Diagnosis Based on the ATTEST/TiTrATE Framework].","authors":"Ichiro Deguchi","doi":"10.11477/mf.188160960780090967","DOIUrl":"10.11477/mf.188160960780090967","url":null,"abstract":"<p><p>Dizziness is one of the most common complaints encountered in outpatient clinical practice, and is associated with a wide range of underlying conditions, ranging from peripheral vestibular disorders to cerebrovascular disease, cardiovascular abnormalities, and psychological factors. Traditional classifications based on the quality of dizziness symptoms have inherent limitations in diagnostic accuracy. In contrast, the ATTEST approach, which structures clinical reasoning according to temporal profiles and triggering factors, has been shown to be useful. In this article, we outline the practical strategies for evaluating patients with dizziness and emphasize the importance of a thorough basic assessment and the avoidance of premature diagnostic closure to ensure an appropriate differential diagnosis.</p>","PeriodicalId":52507,"journal":{"name":"Brain and Nerve","volume":"78 9","pages":"967-974"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978740","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
[Approach to Patients with Lack of Strength]. 【力量不足患者的治疗方法】。
Brain and Nerve Pub Date : 2026-09-01 DOI: 10.11477/mf.188160960780090995
Masaki Saitoh
{"title":"[Approach to Patients with Lack of Strength].","authors":"Masaki Saitoh","doi":"10.11477/mf.188160960780090995","DOIUrl":"https://doi.org/10.11477/mf.188160960780090995","url":null,"abstract":"<p><p>In the examination of patients with \"lack of strength\", abnormalities in motor units (α motor neurons, myelinated fibers, neuromuscular junctions, and muscle fibers), spinal cord-mediated neurons, projections that descend the spinal cord to control motor units (corticospinal tract, corticoreticular tract, and reticulospinal tract), and autonomic nerves, are considered, and physiological changes, diseases, and external factors are investigated. Appropriate assessment of muscle strength, investigations for pyramidal tract signs, appropriate expression of pathology, blood sampling, needle electromyography, and magnetic resonance imaging/magnetic resonance angiography of the head, are desirable.</p>","PeriodicalId":52507,"journal":{"name":"Brain and Nerve","volume":"78 9","pages":"995-1001"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978771","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
[Numbness and Pain in the Limbs: A Practical Approach to the Diagnosis and Treatment of Numbness and Pain]. 四肢麻木与疼痛：麻木与疼痛诊断与治疗的实用方法。
Brain and Nerve Pub Date : 2026-09-01 DOI: 10.11477/mf.188160960780090975
Takemori Yamawaki
{"title":"[Numbness and Pain in the Limbs: A Practical Approach to the Diagnosis and Treatment of Numbness and Pain].","authors":"Takemori Yamawaki","doi":"10.11477/mf.188160960780090975","DOIUrl":"https://doi.org/10.11477/mf.188160960780090975","url":null,"abstract":"<p><p>This review provides a practical approach to evaluating and managing patients presenting with numbness and pain in the extremities. It emphasizes that careful history-taking and neurological examination remain the foundation of anatomic localization before imaging or electrophysiological studies are considered. The review summarizes the epidemiology, differential diagnosis, appropriate laboratory testing and neurophysiological investigations, indications for specialist referral, and current treatment strategies. Particular attention is given to distinguishing among nociceptive pain, neuropathic pain, and the recently recognized category of nociplastic pain because each requires a different therapeutic approach. The review also discusses chronic sensory symptoms frequently encountered in older adults, including patients with idiopathic distal sensory polyneuropathy and small-fiber neuropathy, in whom conventional investigations may be inconclusive. The review places these conditions within the spectrum of age-related peripheral nerve dysfunction while acknowledging emerging evidence for previously unrecognized etiologies. The review concludes that neurologists should focus not only on identifying serious neurological disorders but also on recognizing and validating patients' subjective sensory symptoms. A systematic clinical approach, combined with appropriate referral and individualized management, can substantially improve diagnostic accuracy and patient care in routine neurological practice.</p>","PeriodicalId":52507,"journal":{"name":"Brain and Nerve","volume":"78 9","pages":"975-983"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978831","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
[Diagnosis and Management of Patients with Migraines and Other Headaches]. [偏头痛和其他头痛患者的诊断和处理]。
Brain and Nerve Pub Date : 2026-09-01 DOI: 10.11477/mf.188160960780090959
Takao Takeshima
{"title":"[Diagnosis and Management of Patients with Migraines and Other Headaches].","authors":"Takao Takeshima","doi":"10.11477/mf.188160960780090959","DOIUrl":"https://doi.org/10.11477/mf.188160960780090959","url":null,"abstract":"<p><p>Headache is one of the most common complaints encountered by neurologists. Therefore, it is important to rule out secondary headaches and correctly diagnose primary headaches, particularly migraines. The key features for the diagnosis of migraine are disturbances in daily life, aggravation due to physical movement, nausea, and light sensitivity. CGRP-related antibodies and CGRP-receptor antagonists have been introduced in Japan. These new medications have drastically improved migraine management outcomes. Appropriate diagnosis of migraine is essential to achieve optimal treatment. Cluster headache and related diseases are classified as trigeminal autonomic cephalalgias (TACs).</p>","PeriodicalId":52507,"journal":{"name":"Brain and Nerve","volume":"78 9","pages":"959-966"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978821","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
[Differential Diagnosis of Trembling]. [震颤的鉴别诊断]。
Brain and Nerve Pub Date : 2026-09-01 DOI: 10.11477/mf.188160960780090985
Shigeru Nogawa
{"title":"[Differential Diagnosis of Trembling].","authors":"Shigeru Nogawa","doi":"10.11477/mf.188160960780090985","DOIUrl":"https://doi.org/10.11477/mf.188160960780090985","url":null,"abstract":"<p><p>Trembling/shaking is among the most common complaints encountered in general or neurological clinics. The differential diagnosis of this symptom is important as it can be caused by various conditions and neurological diseases. Essential tremor (ET) is a dominantly inherited disorder that manifests as a bilateral fine (>8Hz) postural tremor. Physiological tremor can develop in patients with sympathetically activated conditions, such as hyperthyroidism, fever, anxiety, and muscle fatigue, in addition to being induced by many drugs. Patients with Parkinson's disease may demonstrate lateralized, moderately fast (4-6Hz) resting and postural tremors. Rubral (midbrain) tremors in the arms with low frequency (3Hz) oscillation or palatal myoclonus may suggest lesions within the Guillain-Mollaret's triangle, which comprises the contralateral midbrain rubral nucleus, contralateral medullary inferior olivary nucleus, and ipsilateral cerebellar dentate nucleus. Intension (terminal) tremor is defined as an action tremor showing an amplitude increases towards the end of the movement to touch a target, as in the finger-nose-finger test. Orthostatic tremor (also termed shaky legs syndrome) is a variant of ET involving the legs observed only in the standing still position. In conclusion, a precise diagnosis of symptoms allows the management of the condition according to its causal mechanism.</p>","PeriodicalId":52507,"journal":{"name":"Brain and Nerve","volume":"78 9","pages":"985-993"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978837","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
[A New Understanding of the Amyotrophic Lateral Sclerosis/Parkinsonism-Dementia Complex in the Kii Peninsula, Japan, 2026]. [A New Understanding of Amyotrophic Lateral Sclerosis/ parkinson - dementia Complex in Kii Peninsula, Japan, 2026]。
Brain and Nerve Pub Date : 2026-09-01 DOI: 10.11477/mf.188160960780091023
Yasumasa Kokubo
{"title":"[A New Understanding of the Amyotrophic Lateral Sclerosis/Parkinsonism-Dementia Complex in the Kii Peninsula, Japan, 2026].","authors":"Yasumasa Kokubo","doi":"10.11477/mf.188160960780091023","DOIUrl":"10.11477/mf.188160960780091023","url":null,"abstract":"<p><p>The distribution of amyotrophic lateral sclerosis/parkinsonism-dementia complex (ALS/PDC) in the Kii Peninsula of Japan exhibits regional variations, with ALS/PDC in the Hohara focus closely resembling that in Guam and ALS in the Kozagawa focus. Recent structural analysis using cryo-electron microscopy revealed that the tau filaments in patients with ALS/PDC in Kii have a chronic traumatic encephalopathy (CTE) fold, confirming the disease's distinct pathological identity and commonality with the Guam focus. While the exact causal genes remain unidentified, research utilizing patient-derived induced pluripotent stem cells and proteomic analysis has uncovered endogenous mitochondrial dysfunction, specifically involving decreased expression of CHCHD2 and SSBP1. The presence of migrant cases further suggests that ALS/PDC is a multifactorial disorder triggered by environmental factors that influence genetic vulnerability. Although the incidence of ALS in Kozagawa and Hohara districtst has declined, new cases with PDC continue to emerge in Hohara. Identifying these modifiable environmental triggers is crucial for preventing and eradicating neurological disorders.</p>","PeriodicalId":52507,"journal":{"name":"Brain and Nerve","volume":"78 9","pages":"1023-1029"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978787","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
[Pathology and Assessment of Peripheral Autonomic Neuropathy]. [周围自主神经病变的病理与评价]。
Brain and Nerve Pub Date : 2026-08-01 DOI: 10.11477/mf.188160960780080875
Ryota Sato
{"title":"[Pathology and Assessment of Peripheral Autonomic Neuropathy].","authors":"Ryota Sato","doi":"10.11477/mf.188160960780080875","DOIUrl":"10.11477/mf.188160960780080875","url":null,"abstract":"<p><p>The peripheral autonomic nervous system predominantly comprises unmyelinated fibers, which are difficult to evaluate using conventional light microscopy. Historically, morphological assessment of unmyelinated fibers relied on the electron microscopy of sural nerve biopsy specimens, which is a technically demanding approach with limited accessibility to autonomic structures. Skin biopsy with immunohistochemical staining for the pan-axonal marker PGP 9.5 has enabled minimally invasive and quantitative evaluation of somatic small (intraepidermal nerve fiber density) and autonomic fibers innervating sweat glands, arrector pili muscles, and dermal vasculature. An integrated analysis combining autopsy findings, sural nerve biopsy, and skin biopsy may clarify the pathophysiology of peripheral autonomic neuropathy.</p>","PeriodicalId":52507,"journal":{"name":"Brain and Nerve","volume":"78 8","pages":"875-882"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801322","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
[Autonomic Dysfunction in Guillain-Barré Syndrome]. 格林-巴罗综合征的自主神经功能障碍。
Brain and Nerve Pub Date : 2026-08-01 DOI: 10.11477/mf.188160960780080883
Norito Kokubun
{"title":"[Autonomic Dysfunction in Guillain-Barré Syndrome].","authors":"Norito Kokubun","doi":"10.11477/mf.188160960780080883","DOIUrl":"10.11477/mf.188160960780080883","url":null,"abstract":"<p><p>Guillain-Barré syndrome is an acute-onset, immune-mediated neuropathy characterized by humoral immune attacks on peripheral motor and sensory nerve fibers, with predominant motor involvement. Autonomic dysfunction, typically characterized by sympathetic hyperactivity, is common and varies in severity, occasionally affecting prognosis. This autonomic dysfunction is considered to result from conduction failure in autonomic nerve fibers, similar to the damage observed in motor and sensory fibers. It remains unclear whether this process results from an immune response against common antigens expressed on motor, sensory, and autonomic nerves or from an immune reaction against antigens specific to the autonomic nervous system that occurs concurrently with attacks on motor and sensory nerves. This paper summarizes the clinical semiology and pathological and physiological findings of autonomic dysfunction in Guillain-Barré syndrome and discusses its pathophysiology by comparing it with other immune-mediated autonomic neuropathies.</p>","PeriodicalId":52507,"journal":{"name":"Brain and Nerve","volume":"78 8","pages":"883-887"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801071","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
[Characteristics and Treatment of Peripheral Autonomic Neuropathy]. 【周围自主神经病变的特点及治疗】。
Brain and Nerve Pub Date : 2026-08-01 DOI: 10.11477/mf.188160960780080913
Masato Asahina
{"title":"[Characteristics and Treatment of Peripheral Autonomic Neuropathy].","authors":"Masato Asahina","doi":"10.11477/mf.188160960780080913","DOIUrl":"https://doi.org/10.11477/mf.188160960780080913","url":null,"abstract":"<p><p>Peripheral autonomic disorders, including autonomic neuropathies, lead to autonomic failure, a condition characterized by reduced autonomic function. The clinical manifestations involve multiple organ systems: in the cardiovascular system, orthostatic hypotension, postprandial hypotension, and supine/hypertension; in the gastrointestinal tract, gastroparesis, constipation, and diarrhea; and in the lower urinary tract, an underactive bladder. Peripheral autonomic disorders predominantly affect the postganglionic autonomic nerves, resulting in characteristic clinical features. The management of autonomic symptoms relies primarily on non-pharmacological interventions, with pharmacological therapy introduced when these measures are insufficient. This article reviews the clinical features, underlying pathophysiology, and treatment of symptoms associated with peripheral autonomic disorders.</p>","PeriodicalId":52507,"journal":{"name":"Brain and Nerve","volume":"78 8","pages":"913-920"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801073","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
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