Characteristics of drawing deficits in people with aphasia: Differences between symbolic and realistic drawn objects.

BACKGROUND: Pictures drawn by people with aphasia (PWA) are often more challenging to understand than those drawn by healthy people. There are two types of objects: those that tend to be drawn symbolically (symbolically drawn objects-SOs) and those that are likely to be drawn realistically (realistically drawn objects-ROs). AIMS: To compare the identification rate and number of misunderstanding types between SOs and ROs drawn by PWA and healthy controls (HCs). To reveal trends in the misunderstandings of drawings by PWA, and to identify the language or cognitive abilities related to the identification rate of pictures drawn by PWA. METHODS & PROCEDURES: We designed a drawing task involving SOs and ROs. A total of 18 PWA and 30 HCs completed the task, and respondents identified the drawings. The identification rate and number of misunderstandings were analysed with two-way analysis of variance (ANOVA) including group (PWA and HCs) and object type (SOs and ROs). The misunderstandings were divided into four categories varying in semantic and morphological similarity; these ratios were examined with a chi-square test. The relationships of language and cognitive abilities with the identification rate were investigated with multiple regression analyses. OUTCOMES & RESULTS: There was a significant effect of the interaction between group and object type on the identification rate (F(1.1387) = 3.90, Mean Squared Error (MSE) = 4139.67, p = 0.04): the identification rates for ROs were lower in the PWA than in the HCs. For the number of misunderstanding types, an interaction was observed between group and object type (F(1.56) = 8.26, MSE = 26.93, p < 0.01): the number of misunderstanding types for ROs in the PWA was greater than that in the HCs. The misunderstanding patterns differed between ROs and SOs (χ2(3) = 694.30, p < 0.001, V = 0.37). ROs were semantically related, whereas SOs were morphologically related. The identification rates of ROs and SOs were correlated only with Kanji writing scores (ROs: ß = 3.66, p = 0.01; SOs: ß = 6.57, p < 0.01). CONCLUSIONS & IMPLICATIONS: In drawings by the PWA, SOs had a higher identification rate, while ROs had a lower identification rate and a greater variety of misunderstandings. SOs may increase drawing motivation. Interventions to improve the identifiability of SOs and ROs should reflect each character. Identification rates were correlated only with Kanji writing scores. The PWA, whose native language was Japanese and had preserved Kanji writing abilities, and their communication abilities may be increased through drawing. WHAT THIS PAPER ADDS: What is already known on the subject PWA often have impaired drawing abilities and draw pictures that third parties misinterpret. Some objects tend to be drawn symbolically, and some are drawn realistically. However, it is not clear whether there is a difference between these types of drawings depicted by PWA in identifiability and the tendency to be misunderstood by ordinary people. In addition, the relationships between language or cognitive abilities and the identification rate of drawn pictures are not clear. What this paper adds to the existing knowledge The identification rate differed between SOs and ROs. In drawings by PWA, SOs had a higher identification rate, while ROs had a lower identification rate and the greatest variety of misunderstandings. Approximately half of the misunderstandings were related to the target object. SOs tended to be confused with morphologically related objects, while ROs tended to be confused with semantically related objects. Identification rates were correlated only with Kanji writing scores. What are the potential or actual clinical implications of this work? To motivate PWA's drawing, it is suitable to begin with SOs. Examining drawing ability from the perspective of SOs and ROs increases the chance of identifying drawing ability. PWA whose native language is Japanese and have preserved Kanji writing abilities may be able to increase their communication abilities through drawing.

Clinical features, pathogenesis, and management of stroke-like episodes due to MELAS.

Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) is a disease that should be considered as a differential diagnosis to acute ischemic stroke taking into account its onset pattern and neurological symptoms, which are similar to those of an ischemic stroke. Technological advancements in neuroimaging modalities have greatly facilitated differential diagnosis between stroke and MELAS on diagnostic imaging. Stroke-like episodes in MELAS have the following features: (1) symptoms are neurolocalized according to lesion site; (2) epileptic seizures are often present; (3) lesion distribution is inconsistent with vascular territory; (4) lesions are common in the posterior brain regions; (5) lesions continuously develop in adjacent sites over several weeks or months; (6) neurological symptoms and stroke-like lesions tend to be reversible, as presented on magnetic resonance imaging; (7) the rate of recurrence is high; and; (8) brain dysfunction and atrophy are slowly progressive. The m.3243ANG mutation in the MT-TL1 gene encoding the mitochondrial tRNALeu(UUR) is most commonly associated with MELAS. Although the precise pathophysiology is still unclear, one possible hypothesis for these episodes is a neuronal hyperexcitability theory, including neuron-astrocyte uncoupling. Supplementation, such as with L-arginine or taurine, has been proposed as preventive treatments for stroke-like episodes. As this disease is still untreatable and devastating, numerous drugs are being tested, and new gene therapies hold great promise for the future. This article contributes to the understanding of MELAS and its implications for clinical practice, by deepening their insight into the latest pathophysiological hypotheses and therapeutic developments.

Egocentric and Allocentric Spatial Cognition in Amnestic Mild Cognitive Impairment and Early Alzheimer's Disease.

BACKGROUND: Topographical disorientation is one of the early symptoms of Alzheimer's disease (AD). The nature of this symptom, however, remains unclear. OBJECTIVE: The aim of the study was to investigate egocentric and allocentric spatial cognition in patients with amnestic mild cognitive impairment (aMCI) and early AD. PARTICIPANTS AND METHODS: The participants consisted of normal healthy volunteers (n = 23), patients with aMCI (n = 26), and patients with early AD (n = 22). We administered the card placing test (CPT), in which a subject was required to recreate an array of 3 cards, each of which was randomly placed on 8 grids around the individual, before (part A) and after (part B) the individual's rotation. With this design, the CPT can reveal an individual's ability to represent spatial information either egocentrically (CPT-A) or allocentrically (CPT-B). A qualitative analysis of errors in performing the CPT was also conducted. RESULTS: Compared with the controls, the aMCI patients showed significantly poorer CPT-B performance, while there was no significant difference in CPT-A performance between these 2 groups. In contrast, the AD patients demonstrated significantly poorer performance on both the CPT-A and CPT-B than the controls and aMCI patients. There was no significant difference in the profile of errors on the CPT-B between the controls and aMCI patients, whereas there was a notable difference in those on the CPT-A between the controls and AD patients and the aMCI and AD patients. CONCLUSION: Allocentric spatial cognition is selectively impaired in aMCI patients, while an egocentric spatial cognition is additionally impaired in AD patients.

The Card Placing Test: a new test for evaluating the function of the retrosplenial and posterior cingulate cortices.

BACKGROUND/AIM: We developed a test named the Card Placing Test (CPT), which is potentially useful for evaluating a function of the retrosplenial and posterior cingulate cortices (RSC/PCC). Part A of the test assesses the ability of a subject to retain information on spatial locations of cards placed on the floor around the subject. Part B examines the subject's ability to integrate information on the spatial locations of similarly arranged cards and information on changes in body direction. The aim of this study is to identify brain regions involved in the CPT performance. SUBJECTS AND METHODS: Twenty-five subjects were recruited from our memory clinic. We analyzed the correlation between the CPT scores and resting state regional cerebral blood flow (rCBF) determined by single-photon emission tomography. RESULTS: The scores for part A correlated with rCBF in the right inferior parietal lobule. The scores for part B were associated with rCBF in the RSC/PCC. CONCLUSIONS: The right inferior parietal lobule seems to play a pivotal role in performing part A of the CPT, whereas the RSC/PCC appears to be involved in accomplishing part B of the CPT.

Herpes simplex encephalomyeloradiculitis initially presents with urinary retention.

Herpes simplex virus (HSV) infections necessitate careful management of urinary dysfunction and retention, which are underestimated conditions. Here, we present a rare case of HSV encephalomyeloradiculitis in a 76-year-old man, whose initial symptoms included urinary dysfunction and retention that alone lasted for approximately 1 week. Unlike in meningoencephalitis, high fever and headache were absent; however, the patient subsequently developed cauda equina syndrome and consciousness disturbance. Gadolinium-enhanced spinal MRI suggested enhanced cauda equina at the L2/3 level. Upon admission, he was treated for meningoencephalitis with acyclovir and steroid pulse therapy. Subsequent cerebrospinal fluid analysis result was positive for HSV DNA. A |brain MRI conducted 1 week after admission displayed high-intensity lesions in the white matter of the right temporal lobe, confirming HSV encephalomyeloradiculitis. These treatments were highly effective and gradually improved the patient's condition. He was discharged 1 month after hospitalization, and the urinary catheter was removed 2 weeks later. HSV infections can cause life-threatening encephalomyeloradiculitis. Therefore, both neurologists and urologists must pay attention to their occurrence and characteristics in clinical settings.

An Autopsy Case of Renal-Limited Granulomatosis With Polyangiitis Presenting With Acute Renal Failure and Initial Delirium.

Granulomatosis with polyangiitis (GPA) has three clinicopathological features, namely, necrotizing granulomatosis of the upper respiratory tract and lungs, focal segmental necrotizing glomerulonephritis of the kidney, and necrotizing vasculitis of small vessels throughout the body. A 92-year-old man with clinically diagnosed probable Alzheimer's disease (AD) exhibited subacute deterioration in cognitive function. On admission, he was diagnosed with acute renal failure with an elevated creatinine level (5.48 mg/dL) as well as severe disturbance of consciousness. Antineutrophil cytoplasmic antibodies (ANCAs) directed against proteinase 3 (PR3-ANCA) were highly positive with ≥ 350 U/mL. The patient was diagnosed with GPA and was managed with steroid pulse therapy. However, he died without any improvement in renal function. As a result of the autopsy, the patient was diagnosed with definite AD, and his impaired consciousness was found not to be caused by central nervous system involvement due to GPA. As necrotizing crescentic glomerulonephritis was observed, the cause of the acute progressive renal failure was found to be PR3-ANCA-positive GPA. The autopsy revealed no GPA-related lesions in other parts of the body aside from the kidneys. It is rare to encounter cases of PR3-ANCA-positive GPA with renal-limited vasculitis and acute renal failure as the initial manifestation, as in the present case. Making an accurate clinical diagnosis of older patients suffering from various diseases in multiple organs is challenging. Although autopsy has the limitation of a terminal image, it is extremely useful in elucidating the pathophysiology of the older patient in this case.

Diabetic Uremic Syndrome Presenting Reversible Parkinsonism with Bilateral Basal Ganglia Lesions: A Case Report.

The patient was a 57-year-old man with a 15-year history of diabetes mellitus and a 3-year history of dialysis. He developed a subacute onset of Parkinsonism, including gait disturbance, bradykinesia, cogwheel rigidity, and myoclonus attacks. Magnetic resonance imaging (MRI) of the brain revealed swollen bilateral basal ganglia lesions, which appeared hyperintense with the lentiform fork sign on fluid-attenuated inversion recovery images, indicating vasogenic edematous lesions. He was diagnosed with diabetic uremic syndrome. Dopamine transporter single-photon emission computed tomography revealed no decrease in dopamine transporters. After approximately 4 weeks of continuous hemodialysis, rehabilitation, and supportive therapy, his neurological symptoms and MRI findings markedly improved. Although this disease has been reported in a few cases, its etiology and treatment remain unclear. In this case of diabetic uremic syndrome, dopamine secretion capacity was normal even though the patient had parkinsonian symptoms. This finding might contribute to further elucidation of the pathological mechanism of diabetic uremic syndrome.

Repeated unconsciousness due to chronic carbon monoxide poisoning in an older patient: a case report.

Objective: Although much is known about acute carbon monoxide (CO) poisoning, little is known about chronic CO poisoning. Chronic CO poisoning is often diagnosed based on the patient's living environment and medical history. Herein, we report the case of an older patient who presented with repeated unconsciousness due to chronic CO poisoning. Case presentation: A 90-year-old man was brought to the emergency department after being found at home with a disturbance of consciousness. Arterial blood gas measurements in room air revealed a carboxyhemoglobin level of 18.0%. Impaired consciousness was caused by chronic CO poisoning. The patient received high-flow oxygen therapy, which promptly improved his condition. According to his family, briquette kotatsu was the cause of chronic CO poisoning. Conclusion: Although high-flow oxygen therapy has been said to be less effective than hyperbaric oxygen therapy in CO poisoning treatment, recent studies have demonstrated that high-flow oxygen has similar effects and benefits. Thus, in institutions that do not have hyperbaric oxygen, high-flow oxygen may be sufficient to treat patients with CO poisoning, as seen in the present case. It should be noted that briquette kotatsu can lead to CO poisoning. This case highlights the need for clinicians to consider patients' living conditions.

Anti-Ro/SSA Antibodies May Be Responsible for Cerebellar Degeneration in Sjogren's Syndrome.

BACKGROUND: Neurological disorders have been identified to be a common extraglandular manifestation of Sjogren's syndrome (SjS). Central nervous system (CNS) symptoms appear in about 5% of patients with SjS. However, so far, only a few incidences of cerebellar degeneration have been reported, and the clinical features and pathological mechanisms associated with SjS remain to be unclear. Intramedullary production of anti-Ro/anti-SjS-related antigen A (SSA) has been observed in some patients with SjS patients who have CNS involvement, suggesting the involvement of anti- Ro/SSA antibodies as antineuronal antibodies in previous studies. METHODS: We recently treated cerebellar degeneration in a patient with SjS. We analyzed the serum and cerebrospinal fluid (CSF) in order to detect anti-Ro/SSA and anti-La/anti-SjS-related antigen B (SSB) antibodies. We also searched the literature for previous case reports to evaluate the characteristics of cerebellar degeneration in patients with SjS. First, we have studied in mouse brain tissue and examined whether the Ro/SSA (Ro52/tripartite motif protein (TRIM)21) protein was expressed in the cerebellum of mice using immunohistochemistry. RESULTS: Although all patients that we found in the literature review and our patient 1 were positive for anti-Ro/SSA antibodies, some patients were also negative for anti-La/SSB antibodies. Anti-Ro/SSA antibodies were observed in both serum and CSF; however, anti-Ro/SSA antibodies were negative in the CSF of patients with SjS without CNS involvement. Cerebellar atrophy was observed, and sequelae remained in the majority of patients. Autopsy findings indicated a selective loss of Purkinje cells. Ro52/TRIM21 expression was also detected throughout murine brains, including the hippocampus, cerebral cortex and cerebellum. High Ro52/TRIM21 expression was observed in the Purkinje cells. CONCLUSIONS: We described the characteristics of cerebellar degeneration in patients with SjS and Ro52/TRIM21 expression in the Purkinje cells of murine cerebellar tissue sections. These outcomes indicate that anti-Ro/SSA antibodies were likely responsible for cerebellar degeneration in patients suffering from SjS.

Encephalopathy Associated with Severe Cytomegalovirus Infection in an Immunocompetent Young Woman.

Primary cytomegalovirus (CMV) infection in healthy young adults is usually an asymptomatic or mononucleosis-like syndrome, whereas in immunocompromised patients, CMV can cause significant disease. In this study, we report an unusual case of primary CMV infection wherein the patient, an immunocompetent 21-year-old woman, presented severe encephalopathy, acute hepatitis, retinitis, and reactivation of latent Epstein-Barr virus. She developed confusion, high fever, headache, and tonic-clonic seizures. Brain magnetic resonance imaging showed high-intensity lesions in the medial temporal lobe and basal ganglia. Liver dysfunction was observed, and abdominal computed tomography revealed splenohepatomegaly. After fundus findings, the patient was diagnosed with CMV retinitis. Upon admission, she was treated with intravenous acyclovir and steroid pulse therapy. Considering both her serious clinical condition and elevated serum levels of interleukin-6, we speculated that her condition was similar to cytokine-storm-induced encephalopathy. On day 2 after admission, she showed prompt recovery from these clinical manifestations. Since blood CMV pp65 antigenemia was found to be positive, we administered ganciclovir for 2 weeks. On the basis of her clinical manifestations and the presence of blood CMV DNA and CMV pp65 antigenemia along with IgM kinetics, we finally diagnosed this patient with severe primary CMV infection. She left our hospital without sequelae 20 days after admission. The incidence of severe CMV disease in immunocompetent young adults might be higher than previously recognized. Noninvasive testing for CMV (such as CMV pp65 antigenemia and CMV DNAemia) is widely available and can help early diagnosis. Short-term glucocorticoid therapy might be beneficial in the treatment of encephalopathy in the early stages of primary CMV infection. Considering such a background, clinicians should keep severe primary CMV infection in mind as a differential diagnosis in the clinical setting.

Heading disorientation: a new test and a possible underlying mechanism.

BACKGROUND/AIMS: Heading disorientation (HD) is a type of pure topographical disorientation. Reported cases showing HD have been very few so far, and its underlying mechanism remains unclear. The aim of this study is to find the anatomic substrates of HD and to demonstrate a possible underlying mechanism for the symptom. METHODS: We investigated 3 patients with HD by a new test, the card-placing test (CPT). Part A of the test assesses the ability of a subject to retain information on spatial locations of cards placed on the floor around the subject. Part B examines the subject's ability to integrate information on the spatial locations of similarly arranged cards and that on changes of the body directions. RESULTS: The patients had a lesion that commonly involved the right retrosplenial cortex and showed good record results for part A but very poor ones for part B. CONCLUSIONS: The results of the CPT suggest that HD patients cannot integrate information on the spatial locations of objects derived from an egocentric reference frame with that on changes of the body directions. The retrosplenial cortex may be the place where these different types of information necessary for navigation converge.

[A case of recurrent hypersomnia with excellent response to lithium carbonate].

We report a 38-year-old woman with recurrent hypersomnia, in whom lithium carbonate was effective in preventing hypersomnia attacks. After onset at 26 years, she complained of frequent and severe episodes of hypersomnia accompanied by anorexia and urinary incontinence. Electroencephalogram showed mild slowing during a hypersomnic period, but not during an asymptomatic period. The CSF orexin level was normal during a hypersomnic period. The effectiveness of lithium was confirmed because the symptoms recurred after its withdrawal and disappeared after its reintroduction. The treatment of recurrent hypersomnia has not been established although the effectiveness of lithium has been described in some cases. This report supports the importance of maintaining effective serum lithium levels in the treatment of recurrent hypersomnia.

Reversible lesion in the splenium of the corpus callosum in a patient with chronic alcoholism.

Marchiafava-Bignami disease (MBD) is often diagnosed in chronic alcoholics. The disease processes typically involve the corpus callosum and clinically presents with various manifestations on the basis of clinical condition, extent of the splenium of the corpus callosum involvement at brain magnetic resonance imaging (MRI), and prognosis. We report a patient affected by MBD, who presented an isolated reversible splenial lesion at brain MRI and achieved a favorable recovery.

Central nervous system tuberculoma with miliary tuberculosis in the elderly.

The aging phenomenon of tuberculosis (TB) patients is recognized all over the world, but no country is as prominent as Japan. Central nervous system (CNS) TB includes clinical entities: tuberculous meningitis, intracranial tuberculoma, and clinical features of CNS TB in the elderly may be atypical, non-specific, and confused with concomitant age-related diseases. Atypical clinical manifestations of TB in older persons can result in delay in diagnosis and initiation of treatment. A 91-year-old woman was brought to our emergency department after her family noted her altered mental status. Chest computed tomography confirmed miliary opacities. The cerebrospinal fluid (CSF) analysis showed elevated protein level, low glucose level, and a lymphocytic pleocytosis. Brain magnetic resonance imaging (MRI) showed multiple well­defined enhancing lesions in the cerebral and cerebellar hemispheres and the pons, suggestive of tuberculomas. Smear, culture, and polymerase chain reaction (PCR) tests confirmed Mycobacterium tuberculosis in the sputum and aspirate. Based on the CSF and brain MRI findings and the sputum microbiology results indicating the presence of M. tuberculosis in the sputum and gastric aspirate, the patient was diagnosed with CNS tuberculoma. The onset of TB is mainly associated with decreased immunity; however, several other factors such as comorbidities, decreased activity, dysphagia, and malnutrition, which influence one another, also influence the development of TB in the elderly. Because the mortality rate of TB increases rapidly with age, reaching approximately 30 % among the elderly, early diagnosis is critical.

Spinal Epidural Abscess: A Review Highlighting Early Diagnosis and Management.

Spinal epidural abscess (SEA) is still an uncommon but devastating infection of the spine. In recent years, a number of reported cases have risen. The most important prognostic factor for a favorable outcome is early diagnosis and appropriate treatment. However, a diagnosis of SEA is often delayed, particularly in the early stages of the disease before patients present with neurological symptoms. With enough knowledge of risk factors, clinical features, and appropriate diagnostic procedures, it may be possible to reduce diagnostic delay in the early stages of the disease. This review focuses on early diagnosis of SEA based on risk factors, presenting symptoms, and characteristic findings on magnetic resonance imaging (MRI), and also discusses the timing of surgical interventions. Traditionally, the symptoms of SEA are characterized by fever, back pain, and neurological symptoms, which are described as a classical triad of symptoms for this type of infection; but this collection of symptoms is seen in only about 10% of cases. However, most patients complain of severe localized lower back pain. Gadolinium-enhanced MRI is the most sensitive, specific, and beneficial imaging modality for establishing a diagnosis of SEA. Patients diagnosed prior to neurological deficits with a known causative microbial organism can be safely treated with antimicrobial therapy alone. However, about 30%-40% of the patients fail in conservative management without surgery. The best management and timing for surgical decompression in patients with or without mild neurological deficits should be established in the near future. Early diagnosis and management, before the occurrence of serious neurological symptoms, are the most important prognostic factors for good outcomes in patients with SEA. We proposed a simple algorithm for early diagnosis of SEA by selecting patients with severe back pain, leading to emergent MRI.

An Autopsy Case of Varicella Zoster Virus Encephalitis with Multiple Brain Lesions.

Varicella-zoster virus (VZV) encephalitis in the absence of vasculopathy may rarely occur in association with herpes zoster. We herein report the case of a 67-year-old woman with non-Hodgkin's lymphoma undergoing chemotherapy who presented with an acute alteration in consciousness. Magnetic resonance imaging of the brain revealed multiple and nonspecific lesions of hyperintensity with mild edema in the cortex and subcortex. She was treated with intravenous acyclovir. However, two days after admission, the patient died and was diagnosed with VZV encephalitis. This case highlights the risk of VZV reactivation with severe neurological complications in patients undergoing immunosuppressive therapy.

[Successive application of percutaneous endoscopic gastrostomy with jejunal extension and percutaneous endoscopic jejunostomy in a case of multiple system atrophy].

A 75-year-old man with multiple system atrophy received percutaneous endoscopic gastrostomy (PEG) because of dysphagia. But recurrent aspiration pneumonia occurred after PEG nutrition, which was due to gastroesophageal reflux. As he had floppy epiglottis, orally inserted endoscopic procedure caused upper airway obstruction, which required transient non-invasive positive-pressure ventilator (NIPPV) treatment. He underwent transgastrostomal jejunal tube (PEG-J) replacement under the nasal endoscopic guidance successfully, but tube was patent only for 5-months. Thereafter, endoscopic jejunostomy (PEJ) via gastric stoma was performed on NIPPV safely, and the patient is now stable. For the management of nutrition in the advanced stage of neurodegenerative disease patients, PEJ is one of useful choice.

Slightly Symptomatic Cerebral Amyloid Angiopathy-Related Inflammation with Spontaneous Remission in Four Months.

Cerebral amyloid angiopathy-related inflammation (CAA-ri) is a rare variant of CAA with autoimmune inflammation. A 77-year-old female experienced light-headedness during walking and mild ataxic gait without any other objective neuropsychological deficits. Brain magnetic resonance imaging (MRI) revealed an area of abnormal signal and mild parenchymal swelling in the right parietal lobe, indicating vasogenic edema. T2⁎-weighted gradient echo imaging revealed some subcortical microbleeds in the same lesion. Based on the proposed criteria for CAA-ri, she was diagnosed with probable CAA-ri. After 4 months, the spontaneous improvement was noted in the patient's clinical and radiological findings. This report presents a rare and atypical case of CAA-ri in which the diagnosis was established after the patient underwent neuroimaging for only mild neurological symptoms, and the patient's clinical and radiological findings displayed spontaneous improvement. Despite typical and striking MRI findings of CAA-ri, this patient only presented a minimal symptom; this dissociation could highlight the significance of not misinterpreting any new neurological symptoms. Thus, increased availability of MRI and growing awareness of CAA-ri might result in more incidentally diagnosed cases in the future. Furthermore, this case suggests that it would be better to strictly monitor the clinical-radiological findings of patients with probable CAA-ri who only present with minimal symptoms without the initiation of immunosuppressive therapy.

Transient Dyschromatopsia, Static Form Agnosia, and Prosopagnosia Observed in a Patient with Anti-NMDA Receptor Encephalitis.

We presented a case of a 19-year-old woman who suffered from anti-N-methyl-D-aspartate (NMDA) receptor encephalitis associated with ovarian teratoma. The patient showed a variety of higher visual symptoms which changed over the recovery phase of the disease. In chronological order, she experienced cortical blindness, amblyopia, dyschromatopsia, static form agnosia, and prosopagnosia. Among these symptoms, the most intriguing was the static form agnosia. Although she could recognize the forms of moving objects, she could not make out those of stationary ones. All of these visual symptoms were transient, implying that she might have incidentally regained the function of the distinct cortical visual areas in the time course of follow-up. This case further suggests that visual functions concerned with the perceptions of static form and form-from-motion could be dissociable and may rely on distinct brain regions.

Corticobasal Syndrome Associated with Antiphospholipid Syndrome Secondary to Systemic Lupus Erythematosus.

We report the case of a 53-year-old woman diagnosed with corticobasal syndrome (CBS) due to antiphospholipid syndrome (APS) secondary to systemic lupus erythematosus. Brain MRI showed marked cortical atrophy, several small infarctions in the deep white matter, and mild white matter changes, all of which were probably due to thrombosis manifestations of APS and could also be related to the CBS. To the best of our knowledge, this is the fourth reported case of CBS due to APS. It is noteworthy that although the common underlying pathologies of the CBS are neurodegenerative diseases, either primary or secondary APS can manifest itself as the CBS.