Clinical utility of paced finger tapping assessment in idiopathic normal pressure hydrocephalus.

Background: The Finger Tapping (F-T) test is useful for assessing motor function of the upper limbs in patients with idiopathic normal pressure hydrocephalus (iNPH). However, quantitative evaluation of F-T for iNPH has not yet been established. The purpose of this study was to investigate the usefulness of the quantitative F-T test and optimal measurement conditions as a motor evaluation and screening test for iNPH. Methods: Sixteen age-matched healthy controls (mean age 73 ± 5 years; 7/16 male) and fifteen participants with a diagnosis of definitive iNPH (mean age 76 ± 5 years; 8/15 male) completed the study (mean ± standard deviation). F-T performance of the index finger and thumb was quantified using a magnetic sensing device. The performance of repetitive F-T by participants was recorded in both not timing-regulated and timing-regulated conditions. The mean value of the maximum amplitude of F-T was defined as M-Amplitude, and the mean value of the maximum velocity of closure of F-T was defined as cl-Velocity. Results: Finger Tapping in the iNPH group, with or without timing control, showed a decrease in M-Amplitude and cl-Velocity compared to the control group. We found the only paced F-T with 2.0 Hz auditory stimuli was found to improve both M-Amplitude and cl-Velocity after shunt surgery. Conclusion: The quantitative assessment of F-T with auditory stimuli at the rate of 2.0 Hz may be a useful and potentially supplemental screening method for motor assessment in patients with iNPH.

Self-remitting Elevation of Adenosine Deaminase Levels in the Cerebrospinal Fluid with Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy: A Case Report and Review of the Literature.

A 29-year-old man presented with a high-grade fever, headache, and urinary retention, in addition to meningeal irritation and myoclonus in his upper extremities. A cerebrospinal fluid (CSF) examination showed pleocytosis and high adenosine deaminase (ADA) levels with no evidence of bacterial infection, including Mycobacterium tuberculosis. T2-weighted brain magnetic resonance imaging showed transient hyper-intensity lesions at the splenium of the corpus callosum (SCC), bilateral putamen, and pons during the course of the disease. The CSF was positive for anti-glial fibrillary acidic protein (GFAP) antibodies. He was diagnosed with autoimmune GFAP astrocytopathy. The present case shows that the combination of an elevated ADA level in the CSF and reversible T2-weighted hyper-intensity on the SCC supports the diagnosis of autoimmune GFAP encephalopathy.

Early treatment for IgG4-related disease may prevent cognitive impairment caused by cerebral vasculitis: A case report and review of the literature.

IgG4-related disease (IgG4-RD) is a recently recognized disease entity. A 74-year-old male presented with transient headache. He was diagnosed IgG4-RD by pancreatic biopsy at the age of 72. Magnetic Resonance Imaging (MRI) showed disseminated cerebral microbleeds and microinfarctions in time and space. It suggested cerebral vasculitis, however any causative factor were not confirmed. IgG4-RD rarely causes cerebral vasculitis. This might be a first case of an asymptomatic cerebral vasculitis due to IgG4-RD. Patient was started on oral prednisolone, and no neurological or neuropsychological symptom was clinically observed. The MRI findings improved after treatment, and revealed no indication of newly lesions at 6-months follow-up. Early treatment for IgG4-RD may be recommended to prevent irreversible cognitive dysfunction.

A longitudinal study of the effect of experimental osteoporosis on bone trabecular structure in the rat mandibular condyle.

The authors performed a longitudinal study of the microstructural changes occurring in the mandibular condyle during osteoporosis using the findings obtained from micro-CT. The subjects used in this study were eight Sprague-Dawley rats. Among them, five were administered the immunosuppressant drug FK506 by injection for five weeks, while the other three were administered saline solution in the same manner. Micro-CT images were taken of the bilateral mandibular condyle, hip, and knee joints in all animals on days 1, 8, 15, 22, 29, and 36 following injection. Six indices of morphometric analysis were compared between the two groups. Significant differences were observed in BV/TV, Tb.Th, Tb.N, and Tb.Sp in the mandibular condyle, while trabecular bone density appeared to decrease in the immunosuppressant group on three-dimensional (3D) imaging. And, in comparison with the mandibular condyle and femur, they were similar. These results suggested that osteoporosis affects not only the femur, but also the mandibular condyle.

Idiopathic trigeminal neuropathy with trigeminal mass lesion on MRI: Neoplasm or not?

The objective of the present study was to investigate clinical and magnetic resonance imaging (MRI) features of idiopathic trigeminal neuropathy with transient MR abnormalities mimicking a neoplasm (ITNmn). We retrospectively evaluated clinical and MRI features in two cases of ITNmn seen in our institution in comparison with those of previously reported five cases. The most common symptom was altered facial sensation and numbness limited to one or more trigeminal nerve divisions (100%). ITNmn commonly affected not only the second and third divisions (86% and 57%, respectively) but also the first division (71%). The most common findings on MRI were enlargement and gadolinium enhancement of the trigeminal nerve, which were similar to those seen in neoplasms (100%). The abnormalities spontaneously regressed in all five evaluable cases. ITNmn should be added in the differential diagnosis of non-specific mass-like lesions in trigeminal neuropathy and be observed carefully without surgical treatment.

[Case of paraneoplastic limbic encephalitis associated with malignant B cell lymphoma].

We report a case of a 62-year-old man with limbic encephalitis associated with diffuse large B cell lymphoma. He was hospitalized for the assessment of cognitive disturbance and changes in characteristics. Neurological examination revealed disturbance of recall and recent memory. Magnetic resonance (MR) imaging of the brain revealed bilateral atrophy of the medial temporal lobes. Cerebrospinal fluid (CSF) examination revealed mononuclear pleocytosis and elevated protein levels. Herpes simplex virus DNA was not detected in the CSF by the polymerase chain reaction. Immunological investigation of the patient's serum samples showed no evidence of acute infection with herpes simplex virus or cytomegalovirus. Chest computed tomography (CT) revealed a mass lesion on the right hilum of the lung. Therefore, tumor resection was performed. The pathological diagnosis was diffuse large B cell lymphoma. We diagnosed this patient with paraneoplastic limbic encephalitis. Chemotherapy was performed, but the patient's clinical symptoms failed to improve. We investigated 7 previously reported cases of paraneoplastic limbic encephalitis associated with malignant lymphoma in Japan. We suggest that an early diagnosis of paraneoplastic limbic encephalitis with progressive symptoms such as changes in characteristics is important. Early diagnosis and treatment of malignant tumors is desirable to facilitate clinical recovery and improve prognosis.

A comparison of a new limited cone beam computed tomography machine for dental use with a multidetector row helical CT machine.

OBJECTIVE: We sought to compare a new limited cone beam computed tomography (CT) machine for dental use (3DX) with the multidetector CT machine for image quality and skin doses. STUDY DESIGN: Images of the right maxillary central incisor and the left mandibular first molar of an anthropomorphic phantom were taken by both the 3DX and the multidetector CT. A 5-point method was used to evaluate the depiction of cortical and cancellous bone, enamel, dentin, pulp cavity, periodontal ligament space, lamina dura, and overall impressions. Furthermore, the skin doses for both modalities were compared. RESULTS: The image quality of the 3DX was better than the multidetector CT for all items (P < .01). Moreover, the mean skin doses with the multidetector CT were 458 mSv per examination, whereas the doses with the 3DX were 1.19 mSv per examination. CONCLUSIONS: These results clearly indicate the superiority of the 3DX in the display of hard tissues in the dental area while substantially decreasing the dose to the patient.