[A Case of Bacterial Meningitis in Which Occurrence of Ataxie Optique Led to Detection of a Small Subdural Abscess and Pialitis].

We report the case of a 69-year-old man with bacterial meningitis who presented with ataxie optique in the peripheral part of the left visual field in both hands. A detailed neurological examination with contrast-enhanced brain MRI in the early stage of the clinical course identified a small subdural abscess and pialitis in the right parietal area. A favorable outcome was obtained with antibiotic therapy alone. In a case with higher brain dysfunction of unknown cause in the clinical course of bacterial meningitis, a detailed neurological examination may be helpful to identify the causative site. (Received September 25, 2023; Accepted October 31, 2023; Published March 1, 2024).

[Allesthesia].

Allesthesia is a peculiar symptom in which sensory stimulation to one side of the body is perceived on the opposite side. This was first described by Obersteiner1) in patients with spinal cord lesions in 1881. Thereafter, it has occasionally been reported for brain lesions and was classified into higher cortical dysfunction as a right parietal lobe symptom. No detailed studies on this symptom have long been reported in association with lesions of either the brain or spinal cord, partly because of difficulties in its pathological evaluation. Being scarcely mentioned in recent books on neurology, allesthesia has virtually become a forgotten neural symptom. The author identified allesthesia in some patients with hypertensive intracerebral hemorrhage and three patients with spinal cord lesions, and studied its clinical signs and mechanism of pathogenesis2). The following sections discuss allesthesia in light of its definition, cases and responsible lesions, clinical signs, and mechanism of pathogenesis.

Symptomatology and Neuropathology of patients presenting with focal cortical signs.

Here, we describe two patients who presented with focal cortical signs and underwent neuropathological examination. Case 1 was a 73-year-old woman with progressive speech disorder and abnormal behavior. She showed agraphia of the frontal lobe type, featured by the omission of kana letters when writing, other than pyramidal tract signs, pseudobulbar palsy, and frontal lobe dementia. Neuropathological examination, including TAR DNA-binding protein 43 (TDP-43) immunohistochemistry, revealed bilateral frontal and anterior temporal lobe lesions accentuated in the precentral gyrus and posterior part of the middle frontal gyrus. Both upper and lower motor neurons showed pathological changes compatible with amyotrophic lateral sclerosis. Case 2 was a 62-year-old man with progressive speech disorder and hand clumsiness. He had a motor speech disorder, compatible with apraxia of speech, and limb apraxia of the limb-kinetic and ideomotor type. Neuropathological examination revealed degeneration in the left frontal lobe, including the precentral gyrus, anterior temporal, and parietal lobe cortices. Moreover, numerous argyrophilic neuronal intracytoplasmic inclusions (Pick body) and ballooned neurons were observed in these lesions and the limbic system. The pathological diagnosis was Pick disease involving the peri-Rolandic area and parietal lobe. In these two cases, the distribution of neuropathological changes in the cerebral cortices correlated with the clinical symptoms observed.

[Marcel Proust: Birth of Neurology of Memory and Time in "In Search of Lost Time"].

Marcel Proust had interactions with a lot of neurologists through treatments of his asthma. His great work, "In Search of Lost Time", is one of the highest masterpieces in French literature, about which numerous reviews have been published from various angles as well as literature. This work is also important for neurology, as the origin of Proust's idea of creations is related to the neurology of memory and time. Especially, this article focuses on and discusses the Proust and the beginning of neurology of memory and time.

The Eyes Are More Eloquent Than Words: Anticipatory Looking as an Index of Event Memory in Alzheimer's Disease.

Alzheimer's disease (AD) is a disorder in which individuals experience a difficulty in maintaining event memory for when, where, who, and what. However, verbal deficiency, one of the other symptoms of AD, may prevent a precise diagnosis of event memory because existing tests are based on verbal instructions by the tester and verbal response from patient. Therefore, non-verbal methods are essential to evaluate event memory in AD. The present study, using eye tracking, investigated whether AD patients deployed anticipatory looking to target acts related to future events based on previous experience when an identical video was presented to them twice. The results revealed the presence of anticipatory looking, although AD patients were unable to verbally report the content of the video. Our results illustrate that AD patients have a one-time event memory better than previously thought.

[What are the Association Areas?: A Discussion of Their History, Mapping and Number].

While the term 'association areas' is well established among those engaged in neurology and its related sciences, it is difficult to say precisely what it means. This review tries to better define it, and begins with a brief discussion of its history, how it came about and finally gained wide acceptance. I introduce the work of Theodor Meynert (1833-1892), and Paul Flechsig (1847-1929), both of whom played important roles in brain mapping. Furthermore, I review how the term is linked to the work of Joseph Jules Dejerine (1849-1917) on white matter, and to disconnection syndrome as proposed by Norman Geschwind (1926-1984). Lastly, I focus on brain maps, historically essential to the study of association areas, and discuss the numbering of brain areas.

Stopwatch training improves cognitive functions in patients with Parkinson's disease.

Parkinson's disease (PD) impairs various cognitive functions, including time perception. Dysfunctional time perception in PD is poorly understood, and no study has investigated the rehabilitation of time perception in patients with PD. We aimed to induce the recovery of time perception in PD patients and investigated the potential relationship between recovery and cognitive functions/domains other than time perception. Sixty patients with PD (27 females) and 20 healthy controls (10 females) were recruited. The participants underwent a feedback training protocol for 4 weeks to improve the accuracy of subjective spatial distance or time duration using a ruler or stopwatch, respectively. They participated in three tests at weekly intervals, each comprising 10 types of cognitive tasks and assessments. After duration feedback training for 1 month, performance on the Go/No-go task, Stroop task, and impulsivity assessment improved in patients with PD, while no effect was observed after distance feedback training. Additionally, the effect of training on duration production correlated with extended reaction time and improved accuracy in the Go/No-go and Stroop tasks. These findings suggest that time perception is functionally linked to inhibitory systems. If the feedback training protocol can modulate and maintain time perception, it may improve various cognitive/psychiatric functions in patients with PD. It may also be useful in the treatment of diseases other than PD that cause dysfunctions in temporal processing.

A case of prosopometamorphopsia caused by infarction of the splenium of the corpus callosum and major forceps.

An adult female complained of enlargement of right eyes in other people. Diffusion-weighted imaging detected an abnormal high-intensity area in the region from the splenium of the corpus callosum to the major forceps on the right side. The patient reported that right eyes appeared larger in size, which suggested prosopometamorphopsia. Adichotic listening test identified left-ear deficit. Acombination of prosopometamorphopsia and left-ear deficit was not identified in the reported patients. Prosopometamorphopsia in most of the reported patients included the eye as did that in our patient. This result suggested the importance of information on the eye in recognizing faces.

[Savant Syndrome and an "Oshikuramanju Hypothesis"].

Oshikuramanju is a simple Japanese, competitive game and we adapted the name to describe "competition" between different brain functions related to Savant syndrome. We also show that Savant-like ability exists in animals other than humans and describe three types of Savant syndrome: autistic, acquired, and transcranial magnetic stimulation.

Discriminating chorea-acanthocytosis from Huntington's disease with single-case voxel-based morphometry analysis.

BACKGROUND AND PURPOSE: Chorea-acanthocytosis is clinically difficult to distinguish from Huntington's disease because these disorders have similar symptoms and MR imaging findings. We evaluated the usefulness of single-case voxel-based morphometry (VBM) analysis for differentiating the two diseases as well as VBM analysis. MATERIALS AND METHODS: We examined five genetically proven chorea-acanthocytosis patients and 11 Huntington's disease patients to detect differences in the gray and white matter atrophic pattern by using single-case VBM analysis in each patient and their clinical findings. We also evaluated VBM analysis for a group comparison in both disease and control groups. RESULTS: The single-case VBM analysis results demonstrated a gray matter volume loss in caudate nucleus in all 16 patients. A characteristic symmetrical white matter volume loss was detected in globus pallidus, putamen, and thalamus on both sides in all the chorea-acanthocytosis patients, but this pattern of atrophy was not seen in any of the Huntington's disease patients. With the VBM analysis, a significant gray matter volume loss was noted in caudate nucleus on both sides in chorea-acanthocytosis patients compared with Huntington's disease patients, and a more extensive white matter volume loss around the basal ganglia and thalamus was observed in chorea-acanthocytosis patients compared to Huntington's disease patients, consistent with the single-case VBM analysis results. Genetic testing identified two novel pathogenic mutations, exon 1 c.16_22delGTGGTCG and exon 55 c.7736-7739delGAGA in a chorea-acanthocytosis patient. CONCLUSIONS: Single-case VBM analysis may be useful to differentiate chorea-acanthocytosis from Huntington's disease with a focus on white matter atrophy.

[From "Shaking Palsy" to "Parkinson's Disease": Was Charcot Correct?]

In light of contemporary knowledge, we review a classic case of "Parkinson's disease" presented by Charcot. The patient, Bachère, provided an opportunity to change the name of the disease from "Shaking palsy" to "Parkinson's disease". We also explore a total of 4 cases of "Parkinson's disease in extension", especially that of Rab. Léon, described in 2 articles (1889 and 1892) in Nouvelle Iconographie de la Salpêtrière. Although diagnosed by Charcot as a type of Parkinson's disease, and historically accepted as such, he may have been misled. English text is available

Contraction of distance and duration production in autism spectrum disorder.

Autism spectrum disorder (ASD) presents certain hallmark features associated with cognitive and social functions, however, the ability to estimate self-generated distance and duration in individuals with ASD are unclear. We compared the performance of 20 ASD individuals with 20 typical developments (TDs) with respect to two tasks: (1) the drawing of a line of a specified distance (10 or 20 cm) and (2) waiting for a specified time (10 or 20 s). We observed that both the line distances and waiting times were substantially shorter in the ASD group than in the TD group. Furthermore, a trait of "attention to detail," as measured by the Autism-Spectrum Quotient, correlated with some distance and duration productions observed in individuals with ASD. We suggest that attentional functions are related to the contraction of distance and duration in ASD.

History of Amusia.

We live in a world surrounded by sound. Throughout life, we are exposed to music: from lullabies and songs taught at school to instrumental music both heard and played for pleasure. Every nation, along with its own language, has unique forms of music and dance. "Music knows no boundaries," as the saying goes. Just as language impairment is known as "aphasia," impairment of the perception of music is called "amusia." In this article, we will first classify the types of amusia. This will be followed by an introduction to the classical research of Salomon Eberhard Henschen (1847-1930), and to a discussion of higher auditory functions in which we highlight cases of amusia encountered in a person and through the literature.

[An Autopsy Case of Amiotrophic Lateral Sclerosis Characterized by Upper Motor Neuron Degeneration and Progressive Pseudobulbar Palsy].

This is a case report of autopsy findings for a male Japanese patient who presented with progressive gait disturbance and dysarthria. Neurological examination at the age of 61 years revealed pseudobulbar palsy and upper motor neuron disorder. The patient appeared unaware of his illness. Electrophysiological examination showed lower neuron damage. The patient was diagnosed with amyotrophic lateral sclerosis characterized by lower motor neuron damage. He died of pneumonia 2 years and 3 months after diagnosis. Neuropathological examination demonstrated severe degeneration of the upper neurons and mild degeneration of the lower neurons. Immunohistological examination indicated transactivation-responsive DNA-binding protein-43-positive pathology in the frontal and temporal lobes, amygdala, corpus striatum, and spinal cord. We believe the neuropathological findings correlate well with the clinical features. Furthermore, we also discuss the lesions involved in the patient's dementia. (Received March 28, 2017; Accepted September 19, 2018; Published November 1, 2018).

Impaired cognitive modification for estimating time duration in Parkinson's disease.

Parkinson's disease (PD) is associated with various cognitive impairments. However, the nature of cognitive modification in patients with PD remains to be elucidated. In the present study, we examined whether patients with PD could correct and maintain subjective time duration and line length estimation. After training sessions, in which participants repeatedly memorized either a duration or a length, we compared a learning performance in 20 PD patients with 20 healthy controls. In the case of duration in the PD patients, the learned durations immediately returned to baseline of pre-training within a few minutes. However, the patients' ability to learn length estimation remained unimpaired. In contrast, healthy controls were able to retain the learned duration and length estimations. Time compression in PD's internal clock may become entrained to their altered duration estimation even after learning of accurate time duration. These deficits may be associated with disrupting cognitive modification in PD.

The subjective perception of past, present, and future time in patients with Alzheimer's disease: a qualitative study.

BACKGROUND: The relationship between dementia and time perception impairment is unknown. AIM: This study aims to explore subjective perception of the passage of time in patients with Alzheimer's disease (AD). METHODS: We conducted semi-structured interviews with 11 AD patients. Grounded theory, a qualitative research methodology, was used for data analysis. RESULTS: Based on interview transcripts, five categories were designated: {Live according to a private clock}, {The past comes up}, {Move back and forth between the present and the past}, {Cannot imagine the future}, and {Bid farewell to this world as early as tomorrow}. DISCUSSION: Our results suggest that AD patients alternate past and present without complete awareness and cannot imagine a future other than one ending in death.

[Musical Hallucinosis].

Musical hallucination is one of the most complex forms of auditory hallucinations, where subjects perceive complex sound in the form of music, in the absence of an acoustic stimulus. It has been reported in patients with diseases such as psychiatric disorders, organic brain diseases, and epilepsy. However, the most common of these are idiopathic musical hallucinations that occur alongside deafness in the elderly. In recent years, there have been many reports of musical hallucination occurring as a result of mild cognitive impairment and dementia. Musical hallucinations accompanying hearing loss may reflect deterioration of cerebral function. It has been suggested that auditory Charles Bonnet syndrome is a pathophysiological mechanism of musical hallucination. The decrease in auditory stimulation and activation of the auditory network may activate the cerebral network in relation to music. It is also thought that musical hallucination appears from disintegration of the complementary relationship between sensation and memory. Treatment is still the focus of extensive investigation. Some authors have reported that hearing aids, antiepileptic drugs, anticholinergics, and antipsychotics can relieve musical hallucination. It is possible that such treatment may lead to relief of musical hallucination in patients with various background diseases. Population aging in Japan has exceeded 20%, which is the highest in the world; therefore, there may be many undiagnosed patients throughout the country.

Diagonistic Apraxia: A Unique Case of Corpus Callosal Disconnection Syndrome and Neuromyelitis Optica Spectrum Disorder.

Diagonistic apraxia is a corpus callosal disconnection syndrome. Callosal lesions in Neuromyelitis optica spectrum disorder (NMOSD) have been reported, but callosal disconnection syndrome are rare. A 48-year-old woman was treated for fever and a cough before hospitalization. Her fever abated immediately, but she had balance problems in walking and standing. She also had slurred speech. On neurological examination, she had diagonistic apraxia. Her left hand moved in an uncoordinated way when she moved her right hand: changing her clothes for example or using a knife and fork. She had to instruct her left hand to stop. She had dysarthria and her gait was wide-based. She also had many callosal disconnection syndrome symptoms such as alexia of left visual field, left ear extinction, crossed optic ataxia. Using FLAIR and DWI MRI, a mixture of low and high signals, a so-called "marbled pattern," was seen in the corpus callosum. Since the patient was positive for anti-aquaporin-4 antibody, she was diagnosed with NMOSD. After two courses of steroid pulse therapy, the symptoms improved. Here we report diagonistic apraxia and other symptoms of callosal disconnection syndrome in anti-AQP4-positive NMOSD.