Rinsho Shinkeigaku
Online ISSN : 1882-0654
Print ISSN : 0009-918X
ISSN-L : 0009-918X
Volume 63, Issue 7
Displaying 1-12 of 12 articles from this issue
  • Hiroyuki Tatekawa, Yukio Miki
    2023 Volume 63 Issue 7 Pages 425-432
    Published: 2023
    Released on J-STAGE: July 22, 2023
    Advance online publication: June 30, 2023
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    When demyelinating disease of the central nervous system is suspected, MR examination has mainly three roles: diagnosis, imaging biomarkers, and early detection of adverse effects from therapeutic agents. Because the location, size, shape, distribution, signal intensity, and contrast pattern of the brain lesions on MRI vary depending on the demyelinating diseases, careful attentions are required to assess the differential diagnosis and activity. It is necessary to be familiar with not only typical imaging findings but also atypical findings of demyelinating disease since minor neurological findings and nonspecific brain lesions may lead to misdiagnosis of demyelinating disease. This article reviewed the characteristics of MRI findings and showed recent topics of the demyelinating diseases.

Original Articles
Case Reports
  • Tomoko Tanaka, Masaya Togo, Kiminobu Okayama, Norio Chihara, Takehiro ...
    2023 Volume 63 Issue 7 Pages 441-449
    Published: 2023
    Released on J-STAGE: July 22, 2023
    Advance online publication: June 30, 2023
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    We report two male patients who had a sensory seizure, which evolved into a focal impaired awareness tonic seizure, and after that, focal to bilateral tonic-clonic seizure. The first case, a 20-year-old man had been treated with steroids for anti-myelin oligodendrocyte glycoprotein (MOG) antibody-positive optic neuritis. His seizure started with abnormal sensation in the little finger of the left hand, which spread to the left upper and then to the left lower limb. The seizure then evolved into tonic seizures of the upper and lower limbs and he finally lost awareness. The second case, a 19-year-old man experienced floating dizziness while walking, followed by numbness and a pain-like electrical shock in the right upper limb. The right arm somatosensory seizure evolved into a right upper and lower limb tonic seizure, which spread to the bilateral limbs, and finally he lost awareness. Symptoms of both patients improved after the treatment with steroids. Both patients shared a similar high-intensity FLAIR lesion in the posterior midcingulate cortex. Both patients were diagnosed with MOG antibody-positive cerebral cortical encephalitis because of a positive titer of anti-MOG antibody in the serum. Several reports showed involvement of the cingulate gyrus in MOG antibody-positive cerebral cortical encephalitis, but only a few reported seizure semiology in detail. The semiology reported here is consistent with that of cingulate epilepsy or the findings of electrical stimulation of the cingulate cortex, namely, somatosensory (electric shock or heat sensation), motor (tonic posture), and vestibular symptoms (dizziness). Cingulate seizures should be suspected when patients show somatosensory seizures or focal tonic seizures. MOG antibody-positive cerebral cortical encephalitis should be considered as one of the differential diagnoses when the young patient shows the unique symptoms of an acute symptomatic cingulate seizure.

  • Kenji Ishihara, Misa Kakurai, Keiko Endoh, Kazuhiko Kobayashi, Toshiom ...
    2023 Volume 63 Issue 7 Pages 450-455
    Published: 2023
    Released on J-STAGE: July 22, 2023
    Advance online publication: June 30, 2023
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    We report a patient presenting with crossed aphasia following infarction in the territory of the right anterior cerebral artery (ACA). A right-handed 68-year-old woman without a history of correction had acute disturbance of consciousness, left hemiparesis predominant in the lower extremity, speech disorder and left unilateral spatial neglect during the admission due to hypertensive emergency. No other family member was left-handed. MRI of the head revealed acute phase infarction in the territory of the right ACA: mesial frontal lobe including the supplementary motor area, anterior cingulate gyrus, and the corpus callosum. Language symptoms in the subacute phase included difficulty in initiation, slow speech rate, loss of intonation and phonetic paraphasia, and accompanying errors in comprehension, repetition, reading, and writing letters. These symptoms suggested “anomalous” type crossed aphasia. No limb apraxia, construction disorder or left unilateral spatial neglect was observed in this period. Only a few cases of crossed aphasia due to infarction in the territory of the ACA have been reported so far. However, language and concomitant symptoms differs, depending on each case, suggesting a difference in individual cerebral lateralization.

  • Takahiro Kawase, Yuko Takeuchi, Daiyu Honda, Naoki Mabuchi
    2023 Volume 63 Issue 7 Pages 456-460
    Published: 2023
    Released on J-STAGE: July 22, 2023
    Advance online publication: June 30, 2023
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    An 82-year-old woman had been suffering from progressive forgetfulness and abnormal speech and behavior for One month. Findings of the MRI of the head indicated scattered small cerebral infarcts in the cerebellum and in bilateral cerebral cortex/subcortical white matter. After admission, she experienced a subcortical hemorrhage, and the percentage of small cerebral infarcts increased over time. Based on the suspicion of central primary vasculitis or malignant lymphoma, we performed a brain biopsy targeting the right temporal lobe hemorrhage site, and the patient was diagnosed with cerebral amyloid angiopathy (CAA). We conclude that CAA can cause multiple small progressive cerebral infarcts.

  • Kenshiro Fuse, Amane Araki, Saori Morozumi, Keizo Yasui
    2023 Volume 63 Issue 7 Pages 461-466
    Published: 2023
    Released on J-STAGE: July 22, 2023
    Advance online publication: June 30, 2023
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    A 48-year-old male was admitted to our hospital because of chronic progressive demyelination of the peripheral nerves of the upper limbs, as well as acute myelitis presenting with sensory disturbance from the left chest to the left leg. We established a diagnosis of combined central and peripheral demyelination (CCPD). The patient was positive for serum anti-myelin oligodendrocyte glycoprotein (MOG), anti-galactocerebroside IgG, and anti-GM1 IgG antibodies. Intravenous methylprednisolone therapy and plasma exchange improved myelitis, and the subsequent administration of oral prednisolone yielded a gradual improvement of the peripheral nerve damage with a mostly negative result for the antibodies. However, the patient experienced a relapse of radiculitis eight months later. Relapses of anti-MOG antibody-associated disease can provoke new immune reactions, leading to CCPD.

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