Transient global amnesia （TGA） is a sudden and severe anterograde memory disturbance accompanied by various degrees of retrograde amnesia, not fully oriented in space and time. Characteristic punctate high-signal intensity lesions in the hippocampus CA1 on diffusion-weighted imaging （DWI） have been reported. Otherwise the pathology is not clear. We investigated the influence of the timing of DWI and considered its pathology. Patients diagnosed with TGA underwent DWI. They were divided into three subgroups according to the time lapse after the symptom onset to the first DWI （0-24 h, 24-72 h, and ＞72 h）. Between January 2009 and July 2014, 33 patients with TGA were identified and 12 underwent MRI. Of these 12 patients, 8 showed hippocampas CA1 punctuate highintensities within 24 hours. Of these ten were within 24-72 h, and one at 72 h. Seven patients had reversible hippocampal punctuate high intensities. Most DWI lesions were detectable 24 h-72 h after the onset of symptoms. Selective vulnerability of CA1 neurons to Cortical Spreading Depression and metabolic stress may play a role in the pathophysiology of TGA.

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Very low birth weight infants （VLBW） have associated adverse neurodevelopmental sequelae. Our aim was to measure the cerebrum volumes by volumetric MRI for VLBW infants at term-equivalent age, and to compare with those of term normal birth weight infants. Twenty VLBW infants at term-equivalent age without perinatal brain damage and nine term normal birth weight infants without abnormal neurological and MRI findings were recruited. These infants were admitted at NICU in Showa University Hospital. Brain volumes were measured by voxel-based morphometry. With the exception of head circumference, body weight and body length were significantly reduced in VLBW infants as compared to term infants. No significant differences were observed in total cerebrum volumes, white matter volumes, percentages of grey and white matter volume to total cerebrum volume in the two groups using paired t test. Total cerebrum volumes were equal in the two groups, using analysis of covariance adjusted for growth status at term-equivalent age. Grey matter volumes were significantly reduced in VLBW infants compared to term infants. White matter volumes were significantly larger in VLBW infants compared to term infants, using analysis of covariance adjusted for body weight and body length at term-equivalent age, respectively. The percentages of grey matter volume to total cerebrum volume were significantly lower, and percentages of white matter volume to total cerebrum volume were significantly higher in VLBW infants compared to term infants, using analysis of covariance adjusted for growth status at term-equivalent age. In conclusion, our study suggested that postnatal growth patterns of grey and whiter matter volume in VLBW infants without perinatal brain damage at term-equivalent age were significantly different from term normal birth weight infants, even when total cerebrum volume was equal in the two groups.

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Hypoxemia occurs after walking in patients with chronic obstructive pulmonary disease （COPD）, but the recovery of blood oxygen saturation （SpO₂） after walking has not been studied, and its underlying mechanism remains unclear. This study evaluated changes over time in hypoxemia occurring after walking and examined SpO₂ recovery–related factors in patients with COPD after the incremental shuttle walking test （ISWT） and six-minute walking distance test （6MWT）. Forty-four patients with COPD were included. They underwent a pulmonary function test and performed the ISWT and 6MWT. SpO₂ was recorded every second and ⊿SpO₂ （extent of the change in this value of resting SpO₂ and during or after walking SpO₂） was used in Simpson’s formula for calculating decrease in SpO₂ （expressed in terms of area） every minute during and after walking. Decrease in SpO₂ after walking was inversely correlated with percent diffusing capacity for carbon monoxide （％DL_co） and peak expiratory flow （PEF, expressed as a percentage of the predicted peak flow: ％PEF）. Classification based on ％DL_co＝70％ showed that those with ％DL_co ＜70％ had significantly greater decrease in SpO₂ after walking than did those with ％DL_co≧70％. SpO₂ recovery was not noted 1 minute after walking but significantly improved at 2 minutes. These results suggest that SpO₂ recovery after walking is related to ％DL_co. Continuous walking led to exercise-induced dynamic lung hyperinflation in the 6MWT, indicating that SpO₂ recovery may be related to both ％DL_co and ％PEF. The results suggest that hypoxemia continues for up to 2 minutes after walking, indicating that patients with COPD need a 2-minute rest period （rough standard） after walking.

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The aim of this study was to investigate the effect and mechanism of transcutaneous electrical nerve stimulation （TENS） in rats with chronic inflammatory pain. 1） Investigation of the antinociceptive effect. Rats were divided into four groups: the Control group, the TENS-treated control rats （TENS） group, the Adjuvant Arthritis rats （AA） group, and the TENS-treated AA rats （AAT） group. The stimulus （4Hz, 30 min） was applied three times a week for two weeks, after which the paw volume and the pain threshold were detected. The paw volume in the rats with arthritis induced by a mycobacterial adjuvant was significantly increased and the swelling was not controlled by the TENS treatment. The threshold was significantly decreased in the AA group compared with the Control group, but on day 14 these decreases were inhibited in the AAT group. 2） Investigation of the involvement of the endogenous opioids system. The rats were divided into four groups: the Control group, the AA group, the AAT group and the naloxone-treated AAT rats （AAT＋N） group. In the ATT＋N group, 3 mg/kg of naloxone, an opioid antagonist, was subcutaneously administered before the TENS treatment. The pain threshold was detected on days 0, 7 and 14 and the μ-opioid receptor （MOR） level in the spinal cord was analyzed immunohistochemically on day 14. The antinociceptive effect of TENS was attenuated by the administration of naloxone. The expression of MOR in the dorsal horn was increased in the AA group compared with the Control group. This increase was inhibited by TENS treatment. These results suggest that low-frequency TENS treatment has an antinociceptive effect on chronic inflammatory pain in association with the endogenous opioid system.

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It is known that the number of patients with dementia is increasing in Japan. Stratified by age, the incidence of epilepsy rises among patients aged ≥60 years, demonstrating a high incidence among the elderly. Therefore, an increased incidence of epilepsy among patients with dementia would be expected. However, no study has addressed this question in detail in Japan; thus, we investigated the trends and characteristics of epilepsy among elderly Japanese patients. We surveyed 357 patients （who had epilepsy or complained of epileptic seizures） admitted to the Department of Neurology at our hospital during a 7-year period between January 1, 2007 and December 31, 2013. We found that the number of elderly patients with epilepsy increased every year, with the proportion rising with increasing age. A greater proportion of elderly patients suffered from non-convulsive seizures such as complex partial seizures, and most suffered from underlying dementia. With regard to the antiepileptic drugs used, a higher proportion of elderly patients received monotherapy, suggesting that they responded well to the treatment. In addition, a novel antiepileptic Levetiracetam is increasingly being used, suggesting its suitability for elderly patients. The incidence of epilepsy is high among the elderly, and there are many patients with dementia as an underlying disease. In Japan which is a super-aged society, it is important to elucidate the association between epilepsy and dementia, and to determine the tendencies and characteristics.

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We report a rare case of idiopathic diaphragmatic rupture with respiratory failure. A 73-year-old woman was admitted to another hospital because of sudden dyspnea after vomiting. Chest and abdominal CT scans revealed a prolapse of the fornix of the stomach in the left thoracic cavity. Her breathing state worsened and she was referred to our hospital. Based on the CT findings, we diagnosed incarcerated esophageal hiatal hernia. Emergency laparotomy was carried out at 20 after hours onset. There was a diaphragm laceration in the left side of esophageal hiatal hernia, from which a fornix of the stomach prolapsed to the left thoracic cavity. We diagnosed idiopathic diaphragmatic rupture intraoperatively. The stomach was reduced into the abdominal cavity, and the ruptured diaphragm was directly sutured. Her postoperative course was uneventful, and she was discharged from our hospital 18 days after surgery.
Since idiopathic diaphragmatic rupture is extremely rare, we report this case with a review of the literature.

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