[Objective] The purpose of this study was to determine the optimal scale for predicting gait independence in patients with acute cerebellar infarction. [Method] Twenty–five patients with cerebellar infarction who presented with ataxia and independent gait and were admitted to our hospital between January 2019 to December 2020 were included in the study. We compared results of motor function assessments (Scale for the Assessment and Rating of Ataxia : SARA，Postural Assessment Scale for Stroke Patients : PASS，and Functional Ambulation Categories : FAC), results of cognitive function assessments (Mini–Mental State Examination : MMSE, and Frontal Assessment Battery : FAB), and background information at the time of admission between two groups : independent group (14 patients) and non–independent group (11 patients), based on walking function on day 14 of illness. ROC curve analysis was used to predict gait independence objectively for the parameters that showed significant differences. [Results] Significant differences were found in SARA, PASS, FAC, and FAB between the two groups. Among these assessments, SARA was the most effective in predicting gait independence, with a cut–off value of 9/10 points, sensitivity of 100%, specificity of 91%, and Area Under the Curve (AUC) of 0.977 (95% CI : 0.926–1.000).

[Conclusion] The results suggest that SARA at the time of admission can predict gait independence in patients with acute cerebellar infarction more accurately than other assessments.

An 90–year–old man with 10–year history of dementia due to Alzheimer disease admitted to our hospital because of severe hear failure. He had been prescribed donepezil hydrochloride for about ten years. He once was a member of domestic chorus group for his pleasure. After his admission he underwent non–invasive positive pressure ventilation management along with multidisciplinary treatment in the intensive care unit where he developed delirium. Dexmedetomidine hydrochloride, risperidone and eszopiclone relief his symptom only partially, thereafter he refused eating and his circadian rhythm deteriorated. Daily session of singing songs that he used sing previously was added to the standard rehabilitation program three times a week. After one week active and initiative attitude were recovered and after one month his ABC–Dementia Scale indicated improvement from 50 point to 60 point, then he discharged to his home. The efficacy of music therapy, one of non–drug therapies, is not yet proven. However it might be an effective intervention against behavioral and psychological symptom of dementia. Further investigation is warranted to gain scientific evidence of musictherapy.

A 65–year–old man suddenly developed dysarthria and right upper limb weakness during hemodialysis. His medical history included hypertension, diabetes mellitus, dyslipidemia, and maintenance hemodialysis for end–stage renal disease due to nephrosclerosis. Non–contrast brain computed tomography (CT) revealed a calcified embolus in the left middle cerebral artery branch. New cerebral infarcts were detected in the left frontal lobe on diffusion–weighted magnetic resonance imaging. After excluding other potential causes of cardiogenic cerebral or paradoxical embolism, a diagnosis of calcified cerebral emboli (CCE) was made based on the findings of multiple calcified lesions in the aortic valve, aortic arch, and base of the bilateral internal carotid artery on non–contrast chest CT, transthoracic echocardiography, and carotid echocardiography. In patients on dialysis with severe arterial wall calcification, non–contrast brain CT should be carefully reviewed, and CCE should be considered as a possible cause of cerebral infarction.

In November 2019, eculizumab (ECZ) became available in Japan for the prevention of recurrence of anti–aquaporin (AQP)–4 antibody–positive neuromyelitis optica spectrum disorder (NMOSD). However, a complement is involved in its acute pathological condition, and the drug is expected to be effective in the acute phase. Here, we report two cases of anti–AQP4 antibody–positive NMOSD wherein anti–complement therapy was initiated immediately after the end of acute treatment, with the expectation of improvement of acute pathology and prevention of recurrence. The clinical improvement trend continued after the initiation of ECZ, which was a useful treatment strategy. Since the effect of the single agent has not been evaluated, caution is required while interpreting the results. However, to start anti–complement therapy early after relapse may be useful treatment strategy in anti–AQP4 antibody–positive NMOSD. A verification study is expected in the future.