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1.
J Phys Ther Sci ; 35(3): 230-236, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36866016

RESUMO

[Purpose] The purpose of this study was to identify the optimal visual cues for gait disturbance in patients with Parkinson's disease based on the luminous duration and the individual patient preferences for a wearable visual cue device. [Participants and Methods] Twenty-four patients with Parkinson's disease walked while wearing only a visual cue device in the control condition. They then walked while the device was set to two stimulus conditions: the luminous duration at 10% and 50% of the individual gait cycle. After walking under the two stimulus conditions, the patients were asked for their preferred visual cue condition. The walking results were compared between the two stimulus conditions and the control condition. Gait parameters were compared among the three conditions. The comparisons with preference, non-preference, and control conditions were also made for the same gait parameter. [Results] When compared to the control condition, walking with visual cues in the stimulus conditions reduced stride duration and increased cadence. The preference and non-preference conditions had shorter stride durations than the control condition. Furthermore, the preference condition also resulted in a faster gait speed than the non-preference condition. [Conclusion] This study suggests that a wearable visual cue device with the patient's preferred luminous duration may help manage gait disturbance in patients with Parkinson's disease.

4.
Case Rep Gastroenterol ; 16(2): 278-283, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35702329

RESUMO

The inability to pass stool for a prolonged period can lead to the formation of fecaliths, which occurs most often in the colon or rectum. Although large fecaliths can lead to serious or life-threatening complications, the detailed process of their formation is unknown. This report describes a 65-year-old woman who presented with melena due to ischemic proctitis caused by a large fecalith. On computed tomography, the fecalith showed a unique multilayered calcification sign. We successfully dismantled and removed the fecalith transanally, assisted by a traction method using a balloon catheter. A review of imaging studies from 6 years ago revealed the growth of the fecalith over the previous year and provided an insight into the mechanism underlying the development of large fecaliths.

5.
BMC Neurol ; 21(1): 479, 2021 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-34893035

RESUMO

BACKGROUND: The diagnosis and therapy of reversible cerebral vasoconstriction syndrome (RCVS) tends to focus on neurological symptoms, but less attention has been paid the occurrence of extracerebral lesion such as the myocardium. CASE PRESENTATION: A 40-year-old woman taking iron supplements for iron deficiency anemia due to menorrhagia had suffered from a thunderclap headache and seizure. Brain magnetic resonance imaging revealed high-intensity lesions bilaterally in the cerebellar and cerebral hemispheres. Her symptoms once subsided with steroids and anticonvulsant therapy; however, she experienced a severe headache again while bathing and was transferred to our hospital. Based on the clinical course and imaging data, she was diagnosed as having RCVS triggered by a rapid improvement of anemia. At the same time, she had cardiac involvement revealed by electro and echocardiographs despite without chest symptoms. After the administration of a calcium channel blocker and nitrite, her cerebral and cardiac involvements were rapidly improved. CONCLUSIONS: The case presented RCVS with transient myocardial damage. With RCVS, we should always pay attention to the complication of extracerebral lesions.


Assuntos
Anemia , Transtornos Cerebrovasculares , Transtornos da Cefaleia Primários , Adulto , Feminino , Humanos , Deficiências de Ferro , Vasoconstrição
6.
Case Rep Neurol ; 13(3): 613-619, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34703451

RESUMO

An 81-year-old woman presented with a 2-year history of progressive dysarthria and gait disturbance. Subsequently, she developed orthostatic hypotension, obstructive sleep apnea, right-sided resting tremor, and rigidity. Together with characteristic findings of imaging studies, she was diagnosed with multiple system atrophy (MSA). Despite progressive dysphagia and repeated choking episodes, the patient elected not to use artificial feeding or tracheostomy. She died suddenly at age 91 after 12 years of illness. The autopsy revealed neuropathological features of both MSA and of Parkinson's disease. The peripheral autonomic ganglia revealed both pre- and postganglionic involvement by synucleinopathy, which may have underscored the sudden death of the patient. The patient survived 10 years after onset, despite the presence of multiple poor prognostic factors in MSA including the onset of old age and early appearance of orthostatic hypotension and falls, in addition to the complication of PD pathology found by autopsy. Multidisciplinary team approach and her preserved cognitive function may have been contributory to the long-term survival.

7.
BMC Neurol ; 19(1): 351, 2019 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-31888527

RESUMO

BACKGROUND: Occurrence of basal ganglia involvement in neuromyelitis optica spectrum disorders (NMOSD) has rarely been reported and none documented pathologically. CASE PRESENTATION: A 73-year-old female was clinically diagnosed with a NMOSD based on the clinical and radiological features and positive serum autoantibodies to AQP4. One month before her death, she became acutely ill with disturbed consciousness and right hemiparesis, and was diagnosed and treated as having basal ganglia infarction based on the brain CT. She made a partial recovery but later died from heart failure. At autopsy, the corresponding basal ganglia process revealed a large fresh area of necrosis. Histologically, several pathological signatures of NMOSD could be recognized in the lesion, including inflammatory cell infiltrations by B and T lymphocytes, perivascular complement and fibrinogen deposition, and the appearance of numerous phagocytosed corpora amylacea within the infiltrating macrophages. CONCLUSIONS: The present case illustrates that basal ganglia may be directly involved in the pathological processes of NMOSD, although the possibility of modification of the lesions by superimposed regional ischemia could not be excluded.


Assuntos
Gânglios da Base/patologia , Infarto Cerebral/diagnóstico por imagem , Neuromielite Óptica/diagnóstico por imagem , Adulto , Idoso , Aquaporina 4/imunologia , Autoanticorpos/sangue , Gânglios da Base/diagnóstico por imagem , Infarto Cerebral/patologia , Feminino , Humanos , Neuroimagem , Neuromielite Óptica/imunologia
8.
Intern Med ; 56(11): 1425-1430, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28566610

RESUMO

We herein report the clinical and autopsy findings of a 48-year-old right-handed man with athetoid cerebral palsy who suffered from cervical myelopathy due to abnormal neck movement, and who died of respiratory failure. Pathologically, the external appearance of the ventral surface of the cervical spinal cord revealed a linear indentation running obliquely at the level between the C4 and C5 segments. In the most severely compressed lesion, the gray matter was predominantly affected and severely atrophic. Microscopically, clusters of oligodendrocytes associated with thinly myelinated axons were also observed in the lateral funiculus. The latter findings are unique, and could be interpreted as regenerative and/or restorative phenomena of the central nervous system following chronic repetitive spinal cord compression.


Assuntos
Paralisia Cerebral/complicações , Vértebras Cervicais/patologia , Discinesias/complicações , Insuficiência Respiratória/etiologia , Compressão da Medula Espinal/complicações , Autopsia , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço
9.
J Clin Exp Hematop ; 54(3): 211-7, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25501112

RESUMO

We report here a case of a 37-year-old man with human immunodeficiency virus (HIV) infection followed by JC virus (JCV) infection and primary central nervous system lymphoma (PCNSL). The patient had been infected with HIV type 1 due to blood products for hemophilia A during infancy. He had progression of nervous symptoms and was diagnosed with progressive multifocal leukoencephalopathy (PML) clinically at the age of 36, when his CD4-positive lymphocyte counts ranged between 350 and 450/µl. Oral mefloquine, intravenous methylprednisolone pulse therapy, and intravenous immunoglobulin were not effective for the PML, and the patient entered a vegetative state. Brain biopsy revealed JCV infection without pathological findings of PML. Eight months after the clinical diagnosis of PML, he developed respiratory failure and brain magnetic resonance imaging revealed a mass lesion in the brain stem. The patient died 19 months after the diagnosis of PML. Autopsy findings were compatible with PCNSL. EBV-encoded small RNA-1-positive cells were not detected. We present a case of JCV-positive PCNSL with HIV infection complicated with clinical PML.


Assuntos
Doenças do Sistema Nervoso Central/virologia , Infecções por HIV/patologia , Infecções por HIV/virologia , Vírus JC/isolamento & purificação , Leucoencefalopatia Multifocal Progressiva/patologia , Leucoencefalopatia Multifocal Progressiva/virologia , Linfoma/virologia , Adulto , Doenças do Sistema Nervoso Central/patologia , Humanos , Linfoma/patologia , Masculino
10.
J Neurol Sci ; 346(1-2): 323-7, 2014 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-25216555

RESUMO

Acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) are both CNS inflammatory demyelinating diseases with overlapping clinical features. A case is reported of a 51-year-old female who presented with headache, progressive aphasia and hemiparesis without preceding infection or vaccination. Brain MRI revealed multiple, often confluent, subcortical white matter lesions without enhancement, affecting predominantly the left cerebral hemisphere. CSF examination failed to reveal oligoclonal bands. Brain biopsy revealed both pathological features of ADEM and findings are consistent with the early stage of MS, including meningeal B and T lymphocytic infiltration, perivenular demyelination, subpial demyelination and discrete confluent plaque-like foci of demyelination. Steroid treatment resulted in remarkable clinical and radiological improvement and there has been no recurrence in six years of follow-up. This case highlights the difficulties in differentiating between ADEM and the first attack of MS and further suggests that ADEM and the early stage of MS, and its tumefactive variant, may have a common underlying pathologic mechanism, which may have a therapeutic implication in treating these diseases.


Assuntos
Encéfalo/patologia , Doenças Desmielinizantes/patologia , Encefalomielite Aguda Disseminada/patologia , Inflamação/patologia , Meninges/patologia , Anti-Inflamatórios/uso terapêutico , Doenças Desmielinizantes/tratamento farmacológico , Encefalomielite Aguda Disseminada/tratamento farmacológico , Feminino , Humanos , Inflamação/tratamento farmacológico , Imageamento por Ressonância Magnética , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Resultado do Tratamento
11.
Hum Pathol ; 44(6): 1171-6, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23352207

RESUMO

Immunohistochemical studies were performed on postmortem brain and spinal cord from a patient with familial amyotrophic lateral sclerosis characterized by a C111Y mutation in the Cu/Zn superoxide dismutase gene. Clinically, the patient presented with classical amyotrophic lateral sclerosis and died of respiratory failure at age 53 years without ventilator dependence, 4 years after the onset. Pathologically, loss of motor neurons was more extensive than upper motor neurons. Lower motor neurons developed massive intracellular cytoplasmic neuronal inclusions, which were immunoreactive for Cu/Zn superoxide dismutase and phosphorylated α-synuclein, often colocalized. The inclusions were TAR DNA-binding protein 43 negative. The clinicopathologic significance of coaggregation of α-synuclein and Cu/Zn superoxide dismutase protein, a novel finding in neurodegenerative disorders, needs further investigation.


Assuntos
Esclerose Lateral Amiotrófica/patologia , Neurônios Motores/patologia , Mutação , Superóxido Dismutase/genética , alfa-Sinucleína/metabolismo , Esclerose Lateral Amiotrófica/genética , Esclerose Lateral Amiotrófica/metabolismo , Humanos , Imuno-Histoquímica , Corpos de Inclusão/metabolismo , Corpos de Inclusão/patologia , Pessoa de Meia-Idade , Neurônios Motores/metabolismo , Superóxido Dismutase-1
12.
Amyloid ; 13(2): 99-107, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16911964

RESUMO

Liver transplantation for familial amyloid polyneuropathy (FAP) patients has been carried out worldwide and the outcomes seem to be promising. To clarify the severity of amyloid deposits on visceral organs, we evaluated the histopathological findings of biopsied renal and sural nerve specimens in 13 FAP patients with ATTR Val30Met by quantitative analysis, and compared them with the outcome of transplantation. Renal dysfunction with proteinuria seemed to correlate with the degree of amyloid deposits in glomeruli, not with that in medullary tissues. The severity of renal amyloid deposition did not consistently parallel that of myelinated nerve fiber loss in sural nerve. Three patients with proteinuria and severe amyloid deposits in glomeruli were considered to be unsuitable for transplantation. Ten patients underwent living donor liver transplantation and three resulted in unfavorable outcomes. These three had heavy amyloid deposits on renal tissues, especially in glomerular areas, but the severity of myelinated nerve fiber loss in their sural nerves was very similar to that in patients who made a good recovery. The prognosis after operation might be closely related to the severity of amyloid deposits in renal glomeruli. Renal biopsy is, therefore, recommended when determining the indications and contraindications for liver transplantation in FAP patients, although this biopsy is not routinely required.


Assuntos
Neuropatias Amiloides Familiares/patologia , Nefropatias/patologia , Glomérulos Renais/patologia , Transplante de Fígado , Proteinúria/patologia , Adulto , Substituição de Aminoácidos , Amiloide/genética , Amiloide/metabolismo , Neuropatias Amiloides Familiares/complicações , Neuropatias Amiloides Familiares/genética , Neuropatias Amiloides Familiares/metabolismo , Neuropatias Amiloides Familiares/cirurgia , Biópsia , Feminino , Humanos , Nefropatias/genética , Nefropatias/metabolismo , Testes de Função Renal/métodos , Glomérulos Renais/metabolismo , Transplante de Fígado/efeitos adversos , Transplante de Fígado/patologia , Masculino , Pessoa de Meia-Idade , Mutação de Sentido Incorreto , Pré-Albumina/genética , Pré-Albumina/metabolismo , Valor Preditivo dos Testes , Proteinúria/etiologia , Proteinúria/genética , Proteinúria/metabolismo , Estudos Retrospectivos , Nervo Sural/metabolismo , Nervo Sural/patologia
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