[A case of intravascular large B-cell lymphoma left undiagnosed even by two random skin biopsies].

We present a case of a 66-year-old man who initially presented with spinal cord lesions and was ultimately diagnosed with intravascular large B-cell lymphoma (IVLBCL) by autopsy after two inconclusive random skin biopsies (RSB). Prior steroid use may have contributed to the reduced diagnostic sensitivity of the skin biopsies. Given that brain and spinal cord biopsies are highly invasive, if IVLBCL of the central nervous system is strongly suspected for such reasons as elevated IL-10 in the cerebrospinal fluid, positron emission tomography (PET) may help identify non-neural or non-nervous organ lesions as the target of subsequent biopsies, potentially allowing the definite histological diagnosis when RSB are inconclusive.

Efficacy and safety of rimegepant for the preventive treatment of migraine in Japan: A double-blind, randomized controlled trial.

Objectives/background: This study was undertaken to compare the efficacy of the oral calcitonin gene-related peptide receptor antagonist rimegepant relative to placebo as a preventive treatment for migraine in Japan. This was the first randomized placebo-controlled trial of rimegepant for the preventive treatment of migraine to be conducted outside the United States and the second conducted globally.

Methods: In this phase 3, double-blind, randomized, multicenter trial, conducted August 9, 2022 through January 18, 2024, adults in Japan with a history of 4-18 migraine attacks/month of moderate or severe pain intensity completed a 28-day observation phase and then took rimegepant 75 mg or placebo every other day during the 12-week double-blind treatment phase.

Subregional analysis of the amygdala, thalamus, and hypothalamus at the pre-decline stage in Parkinson's disease with later cognitive impairment.

Cognitive decline in Parkinson's disease (PD) significantly impacts patients' quality of life, yet early detection remains challenging. While structural brain abnormalities in cortical regions have been widely documented using magnetic resonance imaging (MRI), subcortical regions have received less analytical attention despite their potential role as early biomarkers. This study investigated changes in specific subregions of the amygdala, thalamus, and hypothalamus in patients with PD before cognitive decline development.

Impact of istradefylline on motor and non-motor symptoms in patients with Parkinson's disease: Subanalysis of the ISTRA ADJUST PD.

Introduction: Parkinson's disease (PD) presents with diverse motor and non-motor symptoms, some of which do not fully respond to dopamine replacement therapy. To clarify the effects of the adenosine A receptor antagonist istradefylline (IST) on PD symptoms, we conducted a subanalysis of the 37-week ISTRA ADJUST PD randomized controlled trial.

Methods: Patients with PD experiencing wearing-off with levodopa at 300-400 mg/day were randomized 1:1 to receive IST or no IST (control).

Clinical and magnetic resonance imaging features in acute ischemic stroke with early wallerian degeneration: a case-control study.

Background: In advanced stages, Wallerian degeneration (WD) after cerebral infarction appears as an abnormality in the descending corticospinal tract on T2-weighted images. However, early WD in this region is detectable via diffusion-weighted imaging (DWI) within the first 14 days. We aimed to investigate the clinical and imaging characteristics of early WD using patient data.

A Case of Varicella Zoster Virus Meningoencephalitis With Generalized Chickenpox-Like Rash.

We report the case of a 91-year-old man with varicella zoster virus (VZV) meningoencephalitis who presented with acute progressive delirium. Brain MRI revealed multiple small vessel lesions, and cerebrospinal fluid testing came back positive for VZV DNA by polymerase chain reaction. We assume that VZV had reactivated since he was elderly and had lung cancer.

Infectious Endocarditis With Subarachnoid Hemorrhage and Cerebral Infarction in an Atopic Dermatitis Patient During Unsanitary Cupping Therapy.

A 23-year-old man with a history of untreated atopic dermatitis (AD) presented with a headache and fever. The patient history revealed that he purchased a medical cupping kit on the internet and performed cupping therapy at the flexion of the right elbow joint without disinfecting. Brain computed tomography revealed subarachnoid hemorrhage in the right frontal sulcus, and brain magnetic resonance imaging indicated a small cerebral infarction.

The effect of subjective postural vertical on forward flexed posture in Parkinson's disease.

Background: We developed a novel method to measure the angle of subjective postural vertical (SPV) and showed that the SPV may be related to the exacerbation of the forward flexed posture.

Objectives: The present study prospectively tested the effects of the subjective postural vertical on the exacerbation of the forward flexion of trunk (FFT) through long-term observation of Parkinson's disease patients.

Methods: Evaluation of the posture included measuring FFT, the angle of lateral flexion of trunk, and the angle at the position that the patient subjectively perceived as the vertical position at a stationary upright position immediately after standing up at the time of initial observation, 6 months later, and 1 year later.

Preliminary External Validation Results of the Artificial Intelligence-Based Headache Diagnostic Model: A Multicenter Prospective Observational Study.

The misdiagnosis of headache disorders is a serious issue, and AI-based headache model diagnoses with external validation are scarce. We previously developed an artificial intelligence (AI)-based headache diagnosis model using a database of 4000 patients' questionnaires in a headache-specializing clinic and herein performed external validation prospectively. The validation cohort of 59 headache patients was prospectively collected from August 2023 to February 2024 at our or collaborating multicenter institutions.

Comparing 2-dimensional versus 3-dimensional MR myelography for cerebrospinal fluid leak detection.

Purpose: We compared cerebrospinal fluid (CSF) leak conspicuity and image quality as visualized using 3D versus 2D magnetic resonance (MR) myelography in patients with spinal CSF leaks.

Methods: Eighteen patients underwent spinal MR imaging at 3 Tesla. Three board-certified radiologists independently evaluated CSF leak conspicuity and image quality on a 4-point scale; the latter assessed by scoring fat suppression, venous visualization, and severity of CSF flow artifacts.

Weekly Acupuncture for a Patient With Hemifacial Spasms: A Case Report.

The efficacy and optimal frequency of acupuncture for hemifacial spasms (HFSs) in patients unresponsive or averse to standard treatment methods remains unestablished. Here, we administered acupuncture to a patient with HFSs who was dissatisfied with the outcomes of botulinum toxin (BoNT) injections as symptomatic treatment. A man in his 60s, experiencing frequent spasms in his left facial muscles since 2015, had received several BoNT injections without receiving microvascular decompression or medication; however, the treatment results were not satisfactory.

The Effect of Aging on Nitric Oxide Production during Cerebral Ischemia and Reperfusion in Wistar Rats and Spontaneous Hypertensive Rats: An In Vivo Microdialysis Study.

Nitric oxide (NO) is involved in the pathogenesis of cerebral ischemic injury. Here, we investigated the effects of aging on NO production during cerebral ischemia-reperfusion (IR). Male Wister rats (WRs) were assigned to 12-month-old (older; = 5) and 3-month-old (younger; = 7) groups.

Early Effect of Calcitonin Gene-related Peptide Monoclonal Antibodies in Migraine with Medication Overuse: A Single-center Retrospective Study.

Objective Calcitonin gene-related peptide (CGRP)-(receptor) monoclonal antibody (mAb) has been reported to reduce the frequency of medication overuse in patients with migraine. The present study investigated whether or not CGRP-mAb treatment shows early effectiveness for medication overuse headache (MOH) in Japan. Methods We retrospectively reviewed 34 patients with MOH who received preventive treatment with CGRP-mAb from June 2021 to October 2022.

Cerebral cortical thinning in Parkinson's disease depends on the age of onset.

Patients with older-onset Parkinson's disease (PD) have more severe motor symptoms, faster progression, and a worse prognosis. The thinning of the cerebral cortex is one of the causes of these issues. Patients with older-onset PD manifest more extended neurodegeneration associated with α-synuclein deposition in the cerebral cortex; however, the cortical regions that undergo thinning are unclear.

Extracellular adenosine induces hypersecretion of IL-17A by T-helper 17 cells through the adenosine A2a receptor.

Extracellular adenosine, produced from ATP secreted by neuronal or immune cells, may play a role in endogenous regulation of inflammatory responses. Studies show that adenosine induces hypersecretion of IL-17A by CD4 T cells upon treatment with an A2aR agonist (PSB0777), and that adenosine-mediated IL-17A hypersecretion is suppressed by the A2aR antagonist (Istradefylline) in humans. However, it is unclear whether A2aR downstream signaling is involved in IL-17A hypersecretion.

Bacterial Meningitis Caused by Bacillus subtilis var. natto.

A 67-year-old woman with a 2-day history of a fever, headache and disturbed consciousness was admitted to our hospital. Bacillus subtilis was isolated from both the cerebrospinal fluid and blood. She was cured by the administration of vancomycin.

Relapsing Polychondritis and Aseptic Meningoencephalitis.

We herein report a 49-year-old Japanese man with relapsing polychondritis (RP) and aseptic meningoencephalitis. Four years ago, the patient was diagnosed with RP. Prednisolone (PSL) was started at 30 mg/day, and the symptoms promptly disappeared.

The Sudden Onset of Pure Parkinsonism Caused by Intracranial Dural Arteriovenous Fistulas.

We herein report a case of sudden-onset parkinsonism, with no other symptoms, caused by intracranial dural arteriovenous fistulas (DAVFs). Diffusion-weighted magnetic resonance imaging (MRI) revealed an increased signal intensity in the bilateral lenticular nucleus. Endovascular embolization improved the patient's parkinsonism and MRI findings.

[Morphology and Function of the Central Autonomic Network: Recent Findings].

Recent brain imaging studies show that the regions comprising the central autonomic network (CAN) receive strong fiber connections from the cerebral cortex to the spinal cord and that the CAN comprehensively controls autonomic functions. Several autonomic function tests are available to investigate CAN function. A thorough knowledge of CAN is important to understand the pathogenesis of not only acute cerebrovascular and degenerative diseases but also postural orthostatic tachycardia with mental vulnerability and some psychiatric disorders.

Evaluating the impact of adjunctive istradefylline on the cumulative dose of levodopa-containing medications in Parkinson's disease: study protocol for the ISTRA ADJUST PD randomized, controlled study.

Background: Levodopa remains the most effective symptomatic treatment for Parkinson's disease (PD) more than 50 years after its clinical introduction. However, the onset of motor complications can limit pharmacological intervention with levodopa, which can be a challenge when treating PD patients. Clinical data suggest using the lowest possible levodopa dose to balance the risk/benefit.

Cytology of progressive multifocal leukoencephalopathy revisited: A case report with special reference to JC polyomavirus-infected oligodendrocytes and astrocytes.

This article reports a case of progressive multifocal leukoencephalopathy in an immunocompromised female patient. The usefulness of cytology, as well as histology, is described, with special reference to JC polyomavirus‐infected oligodendrocytes and JC polyomavirus‐infected astrocytes.