Stroke is a disease that requires not only acute treatment but also long-term continuous cooperation between medical care, nursing care, and welfare, including rehabilitation, life support, and support for returning to work and school. Therefore, it is necessary to build a one-stop information provision and consultation support system from acute care hospitals. At the stroke consultation desk, a stroke specialist is in charge, and each professional who is familiar with stroke, such as certified nurses, medical social workers, physical therapists, occupational therapists, speech therapists, pharmacists, registered dietitians, and clinical psychologists (certified public psychologists), collaborate as counselors for stroke care and support. Those team provide information and support to their families on medical care, welfare, nursing care, etc., and share information with collaborating medical institutions.

The 16-Item Informant Questionnaire on Cognitive Decline for the Elderly (IQCODE 16) has been frequently used to diagnose prestroke dementia, an important determinant of stroke prognosis. We developed the Japanese version of the IQCODE 16 (J-IQCODE 16) using standardized translation methods. We applied the J-IQCODE 16 to 102 patients with stroke (19 with prestroke dementia diagnosed with DSM-5) admitted to the stroke care unit in our hospital. The cohort was randomly divided into a derivation cohort and a validation cohort containing 51 patients each. In the derivation cohort, the median J-IQCODE 16 score was 3.06, and the area under the receiver operating characteristic curve for prestroke dementia was 0.96, with an optimal cutoff value of 3.25 determined using the Youden index. When applied this cut-point to the validation cohort, the sensitivity and specificity of the J-IQCODE 16 for prestroke dementia were 90% and 85%, respectively. The J-IQCODE 16 is considered useful for the diagnosis of prestroke dementia.

A 66-year-old Japanese man was referred to our hospital with myalgia and muscle weakness. He had a history of rectal cancer, which invaded into the urinary bladder and ileum and was treated with chemotherapy, radiotherapy, resection of the rectum, colostomy, and ileal conduit construction. He showed recurrent markedly elevated serum creatine kinase levels and concurrent hypocalcemia. Muscle magnetic resonance imaging demonstrated abnormal signals in the proximal limb muscles, and needle electromyography showed myopathic changes. Further examination revealed hypomagnesemia and hyposelenemia with underlying short bowel syndrome. Calcium, magnesium and selenium supplementation improved his symptoms and laboratory findings.

A man in his 50s presented with a 2-month history of paresthesia and hypoesthesia of the extremities and B symptoms including low-grade fever, weight loss, and night sweats. He also reported a 3-year history of skin discoloration in cold weather. Laboratory test results showed a high white blood cell count and elevated serum C-reactive protein and rheumatoid factor (RF) levels. Complement levels were low, and tests for cryoglobulin showed positive results. Computed tomography revealed generalized lymphadenopathy, and ¹⁸F-fluorodeoxyglucose-positron emission tomography showed increased uptake; therefore, we performed cervical lymph node and muscle biopsies. The patient was diagnosed with nodular marginal zone lymphoma and cryoglobulinemic vasculitis (CV) and received chemotherapy and steroid treatment with improvement in symptoms. CV is a rare immune complex small-vessel vasculitis. It is important to measure RF and complement levels and consider infections, collagen diseases, and hematological disorders in the differential diagnosis in patients with suspected vasculitis or CV.

A 67-year-old woman with a history of diabetes mellitus was admitted to our hospital with convulsions due to bilateral frontal subcortical hemorrhages. MR venography showed a defect in the superior sagittal sinus, and thrombi were demonstrated in the same lesion with head MRI three-dimensional turbo spin echo T₁-weighted imaging. She was diagnosed with cerebral venous sinus thrombosis. As precipitating factors, we found high levels of free T3 and T4, low levels of thyroid stimulating hormone, anti-thyroid stimulating hormone receptor antibody, and anti-glutamic acid decarboxylase antibody with her. We diagnosed her with autoimmune polyglandular syndrome type 3 with Graves’ disease and slowly progressive type 1 diabetes mellitus. Since she also had nonvalvular atrial fibrillation, she was treated with apixaban subsequently to intravenous unfractionated heparin in the acute phase, resulting in partial regression of the thrombi. Autoimmune polyglandular syndrome should be considered when multiple endocrine disorders are identified as precipitating factors for cerebral venous sinus thrombosis.

Case reports are designed for sharing a clinician’s personal experiences and providing readers with useful information on the insights and pitfalls of clinical practice. They require appropriate case selections, satisfactory literature searches, accurate case reporting, targeted journal submission, and effective responses to the reviewers. This sequential process provides a great learning experience for young physicians and can kickstart their academic/scientific careers. The first steps to writing a case report are that a clinician should always note the pathogenesis and anatomy of their patients. Consider the atypical character of their patient; make it a daily habit to research the relevant literature. Clinicians should remember that case reports should not focus only on the rarity of a disease. A reportable case needs to provide a clear “learning point.” A well-written case report should be clear, concise, coherent, and convey a crisp take-home message for the reader.