A case report on using biofeedback for psychological assessment.

A psychological assessment using biofeedback was performed for an adjustment disorder inpatient who showed less verbal and non-verbal expressions, and experienced difficulty in receiving favorable results from treatment. The assessment revealed hidden problems behind the symptoms. She was subsequently discharged, after which no clinical intervention was required, including medication.

Ammonium acid urate urolithiasis in anorexia nervosa: a case report and literature review.

Ammonium acid urate urolithiasis is a quite rare condition. Our literature review of ammonium acid urate urolithiasis suggests that ammonium acid urate urolithiasis should be regarded as a general medical complication related to anorexia nervosa, and purging by laxative abuse might be a crucially important risk.

Prefrontal oxygenation during verbal fluency and cognitive function in adolescents with bipolar disorder type II.

Evaluation of depressive states in children can be challenging. Most of the studies that have investigated cognitive function and cerebral blood volume changes using functional MRI (fMRI) in bipolar disorder (BD) have been confined to BDI or heterogeneous cohorts with attention-deficit/hyperactivity disorder (ADHD). This study investigated cognitive functions in adolescents with BDII and without ADHD using near-infrared spectroscopy (NIRS) and a Das-Naglieri Cognitive Assessment System (DN-CAS). Ten patients with BDII and without ADHD symptoms and 10 age- and gender-matched healthy controls were enrolled in the present study. NIRS was used to detect hemoglobin concentration changes during a verbal fluency test (VFT). In addition, the DN-CAS was used to evaluate cognitive function in four domains: planning, attention, simultaneous, and successive processing. Significant differences between the BDII and control groups in [oxy-Hb] changes during the early phase of VFT were observed in the lower prefrontal cortex but not in cognitive functioning. Furthermore, there was a significant correlation between planning and attention scores in BD subjects.

[Simultanagnosia and scene agnosia induced by right posterior cerebral artery infarction: a case report].

A 68-year-old man was admitted to our hospital for rehabilitation of topographical disorientation. Brain magnetic resonance imaging revealed infarction in the right medial side of the occipital lobe. On neuropsychological testing, he scored low for the visual information-processing task; however, his overall cognitive function was retained. He could identify parts of the picture while describing the context picture of the Visual Perception Test for Agnosia but could not explain the contents of the entire picture, representing so-called simultanagnosia. Further, he could morphologically perceive both familiar and new scenes, but could not identify them, representing so-called scene agnosia. We report this case because simultanagnosia associated with a right occipital lobe lesion is rare.

[A long-term follow up of right ophthalmoplegia and severe right middle cerebral artery stenosis with right herpes zoster ophthalmics: a case report].

Here we report a case of a 68-year-old man with severe stenosis of the right middle cerebral artery (MCA) following herpes zoster ophthalmicus. He presented with right-sided ptosis and ophthalmoplegia 2 months after herpes zoster ophthalmicus. Cerebrospinal fluid (CSF) analysis revealed monocytosis, increased protein levels, and positivity for herpes zoster virus immunoglobulin M (IgM). Brain magnetic resonance imaging (MRI) revealed a small asymptomatic infarct in the right basal ganglia and severe stenosis of the right MCA (M1 segment). One month later, he presented with muscle weakness of the fingers of the left hand. Repeat CSF analysis revealed similar abnormalities to the previous analysis, and MRI showed a new small infarct in the right-sided motor area corresponding to the left fingers. He was treated with acyclovir (750 mg/day), prednisolone (1 mg/kg/day), and aspirin (100 mg/day). O2-gas positron emission tomography (PET) revealed decreased cerebral blood flow (CBF) after acetazolamide injection and normal cerebral vascular reactivity (CVR). He was on continuous treatment with prednisolone and aspirin for 1 year. The muscle weakness of the fingers of the left hand and right-sided ophthalmoplegia improved, and magnetic resonance angiography revealed considerable decrease in the stenosis of the right middle cerebral artery. CBF before and after acetazolamide injection and CVR on O2-gas PET also normalized. These results suggested that long-term treatment may prevent subsequent infarcts following herpes zoster ophthalmics.

Pathophysiological decrease in the regional cerebral blood flow in Hashimoto's encephalopathy: a multiple-case SPECT study.

BACKGROUND: The aim of this study was to evaluate the changes in regional cerebral blood flow (rCBF) in multiple cases of Hashimoto's encephalopathy (HE). METHODS: Seven untreated patients with HE and 10 age-matched healthy controls underwent brain single photon emission computed tomography (SPECT) with N-isopropyl-p-[(123)I]iodoamphetamine. All patients had anti-NH2-terminal of α-enolase autoantibodies (Abs), which served as a useful diagnostic marker for HE, in addition to anti-thyroid Abs in their sera and responded to corticosteroid therapy. The obtained SPECT images were compared between the patients and the controls using 3D-SSP analysis. RESULTS: The rCBF of all patients with HE was significantly decreased in the bilateral anterior cingulate areas and left prefrontal cortex compared with the controls (p < 0.05). Focusing on the HE patients with acute neuropsychiatric symptoms (n = 5) such as consciousness disturbance and/or psychosis, the decreased rCBF in these areas was more significant, and the rCBF in the right frontal cortex was also decreased. CONCLUSION: Statistical analysis of these multiple-case SPECT images revealed the regions of decreased CBF associated with clinical symptoms, especially acute neuropsychiatric symptoms, in HE patients. This study shed light on the pathophysiological decrease in rCBF observed in HE.

Detection of preclinically latent hyperperfusion due to stroke-like episodes by arterial spin-labeling perfusion MRI in MELAS patients.

In stroke-like episodes (SEs) of patients with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS), the detection of preclinically latent lesions is a challenge. We report regional cerebral hyperperfusion observed on arterial spin labeling (ASL) perfusion magnetic resonance imaging (MRI) in the preclinical phase more than 3 months before the clinical onset of SEs in 3 MELAS patients. These hyperperfused areas were not detected by conventional MRI in the preclinical phase and developed into acute lesions at the clinical onset of SEs, suggesting that ASL imaging has the potential for predicting the emergence of SEs.

[Hashimoto's encephalopathy presenting periodic synchronous discharge, as a differential diagnosis for Creutzfeldt-Jakob disease].

Here, we report a case of Hashimoto's encephalopathy (HE) mimicking Creutzfeldt-Jakob disease (CJD). A 57-year-old man was admitted to our hospital for status epilepticus. He had gradually presented personality change over the last two years. On admission, he was in state of akinetic mutism. He exhibited seizures on the left side of his body, including the face, and intermittent myoclonic movement. Routine laboratory tests showed no abnormalities, including thyroid functions. An EEG study showed typical periodic synchronous discharge (PSD). Brain MRI showed high-intensity areas in the bilateral frontal cortex, thalamus, and right insula on diffusion-weighted imaging (DWI). So, initially, sporadic CJD was suspected. However, there were no abnormalities in the caudate or putamen on MRI. Anti-TG and anti-TPO antibodies, as well as anti-NAE antibody were all positive. He was administered methylpredonisolone pulse therapy. Subsequently, his consciousness levels and EEG and MRI findings markedly improved. So, he was finally diagnosed with HE. HE should be considered in patients with PSD on EEG, even if the patients have typical MRI abnormalities of CJD. Anti-thyroid antibodies should be examined in such patients.

Posterior reversible encephalopathy syndrome following measles vaccination.

Due to recent domestic measles outbreaks in Japan, the Japanese government has mandated measles vaccination at ages 14 and 17 since April 2008. Since then, the number of people receiving measles vaccination has increased in Japan. Measles vaccination may cause serious neurological complications including encephalopathy, although the incidence is very low. We report here an adult case of posterior reversible encephalopathy syndrome (PRES) and myeloradiculoneuropathy following measles vaccination. Brain MRI demonstrated typical findings of PRES, high intensity signals in the occipital lobes on FLAIR imaging, isointensity signals on diffusion weighted imaging, with an increase in the apparent diffusion coefficient (ADC). Vasoconstriction mainly in the posterior cerebral arteries was detected by MRA. Physicians should keep in mind the possible occurrence of PRES and myeloradiculoneuropathy following measles vaccination.

Early assessment of rapidly progressive interstitial pneumonia associated with amyopathic dermatomyositis.

Amyopathic dermatomyositis (ADM) is occasionally complicated by rapidly progressive interstitial pneumonia (RPIP), and in such cases, diffuse alveolar damage (DAD) is usually diagnosed at autopsy. Here, we present three patients with RPIP accompanied by ADM in whom lung disease was assessed at an early stage. High-resolution computed tomography (HRCT) carried out before the onset of dyspnoea revealed uniformly subpleural reticular opacity with faint ground-glass attenuation. At that stage, surgical lung biopsies from two patients showed histological patterns typical of cellular nonspecific interstitial pneumonia (NSIP). Despite pulse methylprednisolone and subsequent high-dose oral administration of prednisolone, lung disease progressed in all patients, with extensive areas of ground-glass opacity and consolidation observed in HRCT scans. DAD was confirmed histologically in one case. Additional administration of cyclosporine, pulse cyclophosphamide or high-dose intravenous administration of immunoglobulin rescued all patients. Our data suggest that ADM-associated interstitial pneumonia takes an aggressive course even when the radiological and histological features are consistent with NSIP. Aggressive combination therapy with high-dose steroids and immunosuppressive agents is required as early as possible for patients with this life-threatening disorder.