Decision-making is choice of actions based on values. The striatum, orbitofrontal cortex, anterior cingulate cortex, in the brain are thought to play important roles in processing of decision-making. Autonomic activity is also critical for decision-making. It has been shown that autonomic activity is dynamically modulated by contingency between choice and outcome, and that body's arousal states reflected in adrenaline secretion, facilitates the tendency of exploration in decision-making mediated by activity of the insula cortex. The theory of predictive processing, which has become dominant in cognitive neuroscience in recent years, has the potential to provide a unified account of the brain and autonomic functions underlying such processes of decision-making. This mini review introduces empirical findings on this issue and a computational model that describes the brain and body functions therein.

The International Classification of Headache Disorders has indicated low cerebrospinal fluid pressure headache since the 1st edition (1988). The 3rd edition was stated that in patients with typical orthostatic headache and no an apparent cause, and after exclusion of postural orthostatic tachycardia syndrome, it is reasonable in clinical practice to provide autologous lumbar epidural blood patch. In 2007, the Guidelines for Cerebrospinal Fluid Leakage 2007, Cerebral Spinal Fluid Leakage Diagnostic Imaging Criteria and Diagnostic Imaging Criteria in 2011, and the Cerebral Spinal Fluid Leakage Clinical Guidelines in 2019 were issued. The item ``how to diagnose and treat headache due to low cerebrospinal fluid pressure'' was taken up in the Clinical Practice Guidelines for Headache 2021. Cerebrospinal fluid hypovolemia and cerebrospinal fluid leak are described in the guidelines as headache due to low cerebrospinal fluid pressure and a clinical condition characterized by orthostatic headache secondary to low cerebrospinal fluid pressure and/or cerebrospinal fluid leak. By defining it as such, a path was shown for advancing diagnosis and treatment.

Cerebrospinal fluid hypovolemia is diagnostic challenge, partly owing to its diverse presentation on imaging findings. The development of magnetic resonance imaging (MRI) has led to the production of detailed images and significantly advanced our understanding of this entity. However, the complexity of imaging manifestations makes interpretations of the findings difficult. This review paper attempts to summarize the conventional and novel MRI findings of this disease in two main categories, spinal and head MRI findings. Spinal MRI primarily evaluates cerebrospinal fluid leakage, while head MRI can assess secondary changes caused by the leakage. The characteristic signs of spinal cerebrospinal fluid leakage include the floating dural sac sign and Narwhal sign. Emerging MRI sequences such as 3D and FLAIR can be applied to evaluate the two categories. Appropriate selection of MRI sequences is essential to produce appropriate images for interpretation. In fact, however, some patients may receive inappropriate MRI in unsuspected cerebrospinal fluid hypovolemia. This review aims to explain principles behind diagnostic procedures used to make an accurate diagnosis under difficult circumstances.

Circumventricular organs (CVOs) are rich in blood vessels, but lack a blood-brain barrier, and are important regulators of life homeostasis. CVOs include sensory CVOs and secretory CVOs. The sensory CVOs include the subfornical organ, the organum vasculosum of the lamina terminalis, and the area postrema. Environmental stress signals such as angiotensin II and sodium ion concentrations sensed by these organs are neurotransmitted to the hypothalamic paraventricular nucleus. The secretory CVOs include the neurohypophysis, the pineal gland, the subcommissural organ, and the median eminence. They are responsible for the regulation of body fluid and osmolarity, sleep and sex hormones, immune and energy metabolism, and feeding behavior via hormone secretion functions. Although the choroid plexus is not strictly included in CVOs, it secretes cerebrospinal fluid under the control of the autonomic nervous system and is also important as a disordered organ of COVID-19. Kuroiwa et al. proposed the term "circumventricular organs dysregulation syndrome" or "hypothalamic syndrome" for conditions caused by dysregulation of CVOs and the hypothalamus.

Patients with myasthenia gravis (MG) rarely complain lower urinary tract (LUT) dysfunction, even though they may have, since blephaloptosis, extraocular muscle weakness and limb weakness are the major problems for the patients. MG is a relatively common neuromuscular junction disorder. We recently found that 30% of patients with generalized MG had LUT dysfunction, which was more common than that in control population, and it affected the quality of life of the patients. In female patients stress urinary incontinence due to sphincter and pelvic floor weakness was the most common, whereas male patients might have overactive bladder due to bladder irritation by anti-cholinesterase treatment, and polyuria due to corticosteroids. In conclusion, patients with MG may have LUT dysfunction mainly of sphincter etiology. Amelioration of LUT dysfunction, particularly of stress urinary incontinence that affects the quality of life, therefore should be a primary target in the treatment of patients with MG.

While some reports indicate that baroreceptor reflex and sympathetic output are centrally suppressed during anaphylactic hypotension, other reports that baroreflex function is enhanced, thus there is no clear consensus. This study examined the cardiovascular and sympathoexcitatory responses during an anaphylactic reaction in anesthetized rats. Anaphylactic hypotension induced by re-sensitization with Ovalbumin (OVA) significantly suppressed responses to the heart rate and sympathetic nerve activity in the early phase during the baroreceptor reflex. In addition, we investigated the medullary neuronal excitability related to the cardiovascular response during the anaphylactic reaction in conscious rats. In the OVA-sensitized group, heart rate was increased accompanying a marked decrease in blood pressure after re-sensitizing the administration of OVA in the conscious animals and this tachycardic response was significantly suppressed compared to the control group. And also, the excitability of neurons in the rostroventral medulla (RVM), the center of the baroreceptor reflex, was suppressed compared to the control group. Our results suggest that baroreceptor reflex function may be centrally suppressed during anaphylaxis-induced hypotension.