Brain and NervePub Date : 2026-05-01DOI: 10.11477/mf.188160960780050567
Takayoshi Shimohata
{"title":"[COVID-19-Associated Encephalitis and Encephalopathy: Current Status].","authors":"Takayoshi Shimohata","doi":"10.11477/mf.188160960780050567","DOIUrl":"10.11477/mf.188160960780050567","url":null,"abstract":"<p><p>In recent years, the incidence of COVID-19-associated encephalitis and encephalopathy has decreased due to viral mutations and the acquisition of population immunity. The underlying mechanisms are now thought to involve immune-mediated pathology and cerebral microvascular injury, rather than direct viral invasion. In adults, encephalitis and encephalopathy are independent predictors of disease severity and mortality. In children, acute necrotizing encephalopathy is associated with high mortality rates and long-term neurological sequelae. Regarding treatment, correction of reversible factors and timely immunotherapy are essential, and favorable responses to high-dose corticosteroids and interleukin-6 receptor blockade have been reported.</p>","PeriodicalId":52507,"journal":{"name":"Brain and Nerve","volume":"78 5","pages":"567-572"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977197","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}
Brain and NervePub Date : 2026-05-01DOI: 10.11477/mf.188160960780050549
Ryota Sato
{"title":"[Epstein-Barr Virus Infection].","authors":"Ryota Sato","doi":"10.11477/mf.188160960780050549","DOIUrl":"10.11477/mf.188160960780050549","url":null,"abstract":"<p><p>The Epstein-Barr virus (EBV) infects over 90% of adults. Although rare, it can cause central nervous system disorders, the primary forms of which are meningitis, encephalitis, and myelitis. Diagnosis relies on the detection of EBV DNA in the cerebrospinal fluid and serum antibody titer patterns, which exclude other diseases. Empiric treatment with acyclovir and corticosteroids is often administered; however, its definitive efficacy has not been proven. The prognosis for meningitis is generally favorable but encephalitis requires caution, as it can lead to severe sequelae or death.</p>","PeriodicalId":52507,"journal":{"name":"Brain and Nerve","volume":"78 5","pages":"549-552"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977239","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}
Brain and NervePub Date : 2026-05-01DOI: 10.11477/mf.188160960780050523
Motohiro Yukitake
{"title":"[Rabies].","authors":"Motohiro Yukitake","doi":"10.11477/mf.188160960780050523","DOIUrl":"10.11477/mf.188160960780050523","url":null,"abstract":"<p><p>Rabies is a fatal encephalitis caused by the rabies virus. Japan is currently free of endemic rabies; the last domestically acquired human case of rabies infection was reported in 1956. Four rabies cases have been reported in Japan since then, all of which were imported infections. The clinical forms of rabies include furious and paralytic rabies, with the former being more common. No effective antiviral drugs are available against the rabies virus, and management is limited to symptomatic treatment. Post-exposure prophylaxis is critical in cases of suspected rabies virus infection. Vaccination is recommended for travelers in rabies-endemic areas.</p>","PeriodicalId":52507,"journal":{"name":"Brain and Nerve","volume":"78 5","pages":"523-526"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977335","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}
Brain and NervePub Date : 2026-05-01DOI: 10.11477/mf.188160960780050541
Ryutaro Kira
{"title":"[Acute Flaccid Myelitis].","authors":"Ryutaro Kira","doi":"10.11477/mf.188160960780050541","DOIUrl":"10.11477/mf.188160960780050541","url":null,"abstract":"<p><p>Acute flaccid myelitis (AFM) is a clinical syndrome characterized by acute flaccid paralysis that predominantly affects the spinal gray matter. It occurs mainly in children and is strongly associated with enterovirus D68. Magnetic resonance imaging typically demonstrates longitudinal lesions predominantly involving the gray matter, and the cerebrospinal fluid shows mild pleocytosis. The differential diagnosis from demyelinating transverse myelitis and Guillain-Barré syndrome is crucial for appropriate clinical management. AFM is included in acute flaccid paralysis (AFP) surveillance. Prompt notification and appropriate specimen collection are essential for the early detection of poliovirus reemergence. This article reviews the current understanding of the clinical features, diagnosis, and public health significance of AFM.</p>","PeriodicalId":52507,"journal":{"name":"Brain and Nerve","volume":"78 5","pages":"541-548"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977011","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}
Brain and NervePub Date : 2026-05-01DOI: 10.11477/mf.188160960780050484
Katsuro Shindo
{"title":"[Tetanus].","authors":"Katsuro Shindo","doi":"10.11477/mf.188160960780050484","DOIUrl":"10.11477/mf.188160960780050484","url":null,"abstract":"<p><p>Tetanus is a severe, potentially fatal disease caused by infection with Clostridium tetani, an anaerobic, spore-forming, Gram-positive bacillus. This organism produces tetanospasmin, a potent neurotoxin that enters nerve terminals and retrogradely travels to the central nervous system, where it blocks inhibitory neurotransmission. This blockage leads to uncontrolled motor neuron activity, resulting in muscle rigidity, painful spasms, and autonomic hyperactivity. The binding of the toxin is essentially irreversible, necessitating the regeneration of nerve terminals for recovery. The incubation period ranges from 1 to 21 days, with the generalized form accounting for approximately 80% of cases. The disease progresses through prodromal symptoms, trismus, and generalized spasms before recovery. Treatment strategies include thorough wound care, bacterial eradication, and toxin neutralization prior to the onset of symptoms. Once clinical signs appear, management focuses on controlling spasms and autonomic instability, often requiring sedation, muscle relaxants, and intensive care. Human tetanus immunoglobulin is critical for early toxin neutralization. Recovery may take weeks to months, and rehabilitation is essential for functional restoration. Prevention through vaccination remains the most effective measure, with most cases occurring in individuals who lack adequate immunization. Early recognition and prompt administration of immunoglobulin significantly improve outcomes and reduce mortality.</p>","PeriodicalId":52507,"journal":{"name":"Brain and Nerve","volume":"78 5","pages":"484-486"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977315","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}
Brain and NervePub Date : 2026-05-01DOI: 10.11477/mf.188160960780050475
Yu Shiozaki, Mai Kimura, Norihisa Ishii
{"title":"[Hansen's Disease].","authors":"Yu Shiozaki, Mai Kimura, Norihisa Ishii","doi":"10.11477/mf.188160960780050475","DOIUrl":"10.11477/mf.188160960780050475","url":null,"abstract":"<p><p>Hansen's disease is a chronic infection of the skin and peripheral nerves caused by Mycobacterium leprae and Mycobacterium lepromatosis. Recently, only a few new cases have been reported in Japan. Diagnosis is based on the demonstration of the bacillus through skin smears, histopathology, or polymerase chain reaction, as well as other clinical and laboratory findings. Nerve conduction studies can detect subclinical neuropathy. Clinical classification is determined by variations in the host's cell-mediated immunity. The World Health Organization divides leprosy into paucibacillary (PB) and multibacillary (MB) forms. Ridley and Jopling classified the disease along a continuous spectrum from tuberculoid to lepromatous. Leprosy reactions, both type 1 and type 2, can lead to rapid nerve deterioration, necessitating immediate anti-inflammatory treatment and the continuation of multidrug therapy. The standard multidrug therapy regimen includes dapsone, rifampicin, and clofazimine, with typical durations of 6 months for PB and 12 months for MB. Peripheral nerve damage is irreversible once it occurs, making prevention the most effective strategy. Neuropathic pain is treated with agents such as pregabalin and amitriptyline. Rehabilitation is provided for muscle atrophy, and orthoses and prostheses are used to address deformities of the fingers and toes as well as limb deficiencies. Collaboration between dermatologists and physiatrists is essential.</p>","PeriodicalId":52507,"journal":{"name":"Brain and Nerve","volume":"78 5","pages":"475-478"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977207","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}
Brain and NervePub Date : 2026-05-01DOI: 10.11477/mf.188160960780050469
Ikuko Takahashi-Iwata
{"title":"[Tuberculosis of the Central Nervous System].","authors":"Ikuko Takahashi-Iwata","doi":"10.11477/mf.188160960780050469","DOIUrl":"10.11477/mf.188160960780050469","url":null,"abstract":"<p><p>Tuberculous meningitis is a condition in which Mycobacterium tuberculosis affects the central nervous system. Although it does not present particularly distinctive symptoms, it often diverges from the classic signs seen in other forms of meningitis. Careful history-taking is essential for suspecting the diagnosis. Genetic testing has become increasingly important in diagnostic methods. Regarding treatment, not all recommendations from international guidelines can be applied domestically. Moving forward, there is a need to establish guidelines for tuberculous meningitis that leverage Japan's strengths.</p>","PeriodicalId":52507,"journal":{"name":"Brain and Nerve","volume":"78 5","pages":"469-474"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977338","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}
Brain and NervePub Date : 2026-05-01DOI: 10.11477/mf.188160960780050532
Hiroya Kuwahara
{"title":"[Acute Measles Encephalitis].","authors":"Hiroya Kuwahara","doi":"10.11477/mf.188160960780050532","DOIUrl":"10.11477/mf.188160960780050532","url":null,"abstract":"<p><p>Measles is acute and highly infectious. Febrile rash may be complicated by severe pneumonia or encephalitis. Acute measles encephalitis is a rare condition that develops within a few days of the appearance of a rash and presents with high fever, altered consciousness, seizures, and focal neurological signs. It frequently results in death, and survivors often experience residual neurological sequelae. No specific antiviral therapy is available. Management is primarily supportive. In Japan, the incidence is low owing to high vaccination coverage; however, maintaining a two-dose vaccination schedule and addressing unvaccinated adults are crucial for prevention.</p>","PeriodicalId":52507,"journal":{"name":"Brain and Nerve","volume":"78 5","pages":"532-536"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977019","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}
Brain and NervePub Date : 2026-05-01DOI: 10.11477/mf.188160960780050457
Yoshihisa Kawano, Taketoshi Maehara
{"title":"[Brain Abscess].","authors":"Yoshihisa Kawano, Taketoshi Maehara","doi":"10.11477/mf.188160960780050457","DOIUrl":"10.11477/mf.188160960780050457","url":null,"abstract":"<p><p>Brain abscess is a potentially life-threatening intracranial infection progressing from localized cerebritis to an encapsulated cavity. Infection routes are classified into contiguous spread from adjacent infectious foci, hematogenous dissemination, and cryptogenic origin. Because the classic clinical triad is often absent, diagnosis based solely on clinical symptoms is challenging. Diffusion-weighted magnetic resonance imaging is crucial in early diagnosis and differential assessment. Treatment comprises antimicrobial therapy combined with surgical intervention, selected according to abscess size, location, disease stage, neurological status, and the patient's general condition. An integrated, stage-based treatment strategy is essential for improving clinical outcomes and minimizing neurological sequelae.</p>","PeriodicalId":52507,"journal":{"name":"Brain and Nerve","volume":"78 5","pages":"457-461"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977144","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}
Brain and NervePub Date : 2026-05-01DOI: 10.11477/mf.188160960780050503
Masao Ogata
{"title":"[Human Herpesvirus-6B Encephalitis].","authors":"Masao Ogata","doi":"10.11477/mf.188160960780050503","DOIUrl":"10.11477/mf.188160960780050503","url":null,"abstract":"<p><p>Human herpesvirus 6B (HHV-6B) is a β-herpesvirus that establishes latency following primary infection during early childhood. In immunocompromised individuals, particularly those who have undergone allogeneic hematopoietic stem cell transplantation, HHV-6B reactivation occurs in 30-80% of cases, with notably high rates observed after cord blood or HLA-mismatched transplants. HHV-6B encephalitis poses a serious and often life-threatening neurological complication for these transplant recipients. The mortality rate associated with this condition remains approximately 30-50%, and many survivors endure long-term neurocognitive sequelae. Clinical manifestations include altered consciousness, memory impairment, and seizures, which are often preceded by hyponatremia resulting from the syndrome of inappropriate antidiuretic hormone secretion. A definitive diagnosis requires the detection of HHV-6B DNA in cerebrospinal fluid by polymerase chain reaction, the exclusion of inherited chromosomally integrated HHV-6, and the ruling out of other potential etiologies. Due to the rapid progression and poor prognosis associated with delayed treatment, empirical antiviral therapy should be initiated promptly whenever HHV-6B encephalitis is suspected. In Japan, foscarnet is recommended as the first-line treatment due to its superior clinical outcomes and antiviral potency, whereas ganciclovir serves as a second-line alternative. Recent advancements in early diagnosis and timely treatment have contributed to improved survival outcomes.</p>","PeriodicalId":52507,"journal":{"name":"Brain and Nerve","volume":"78 5","pages":"503-507"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977293","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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