Forty-five cases with aquaporin-4 antibody-positive neuromyelitis optica spectrum disorders (NMOSD) who underwent convalescent rehabilitation were studied. After excluding three cases with recurrence during rehabilitation treatment, the Expanded Disability Status Scale of Kurtzke improved a median of 1 point. Corticosteroids were the most used disease-modifying drugs (DMDs). Three cases relapsed during rehabilitation treatment. Six cases developed febrile infections. Thirty-four cases were discharged home, but half of the cases in their 80s were transferred to a medical care hospital. In the rehabilitation treatment of NMOSD, reducing the risk of recurrence by appropriate DMDs and preventing infections are important. Information sharing using a regional collaborative medical care plan is useful.

Figures are essential components of case reports, often conveying information more effectively than the text. Common figure types include images, pathology slides, photographs, schematic drawings, and clinical courses. Each figure type should follow four design principles: alignment, repetition, proximity, and contrast. Precise "alignment" of elements and "repetition" with font usage are crucial for improving clarity. Employing "contrast," such as arrows to highlight specific areas, can also significantly improve visual impact. Additionally, enlarged views or detailed schematics can be beneficial in certain cases. Creating figures early in the process can boost your motivation to write case reports. The enjoyment of writing case reports lies in discovering the key learning points of the case and summarising them. Additionally, creating figures for your case can be enjoyable.

The patient was a 69-year-old right-handed woman. She had sensory aphasia, and the brain MRI revealed a subacute phase hemorrhage in the left subcortical temporal lobe. We speculated that the patient had post-ictal aphasia due to symptomatic epileptic seizures associated with cerebral hemorrhage. Seven months later, she was readmitted to the hospital with sensory aphasia; however, this time, the brain MRI FLAIR demonstrated high signal in the left medial temporal lobe and thalamic pillow. Furthermore, the electroencephalogram showed periodic discharges focused on the left temporal region. 123I-IMP SPECT of cerebral blood flow indicated a cluster within the medial left temporal lobe. Aphasia associated with nonconvulsive seizures was considered. Sudden onset sensory aphasia should be differentiated from ictal and post-ictal aphasias.

Autoimmune cerebellar ataxia is a disease entity that affects the cerebellum and is induced by autoimmune mechanisms. The disease is classified into several etiologies, including gluten ataxia, anti-glutamate decarboxylase (GAD) ataxia, paraneoplastic cerebellar degeneration, primary autoimmune cerebellar ataxia and postinfectious cerebellar ataxia. The autoimmune response in the periphery cross-reacts with similar antigens in the cerebellum due to molecular mimicry. Breakdown of the blood‒brain barrier (BBB) could potentially explain the vulnerability of the cerebellum during the development of autoimmune cerebellar ataxia, as it gives rise to the entry of pathogenic autoantibodies or lymphocytes into the cerebellum. In this review, the maintenance of the BBB under normal conditions and the molecular basis of BBB disruption under pathological conditions are highlighted. Next, the pathomechanism of BBB breakdown in each subtype of autoimmune cerebellar ataxia is discussed. We recently identified glucose-regulated protein (GRP) 78 antibodies in paraneoplastic cerebellar degeneration and Lambert-Eaton myasthenic syndrome, and GRP78 antibodies induced by cross-reactivity with tumors can disrupt the BBB and penetrate anti-P/Q type voltage-gated calcium channel (VGCC) antibodies into the cerebellum, thus leading to cerebellar ataxia in this disease.

This study aims to quantify the economic burden of Parkinson's disease (PD) in Japan. We conducted a targeted literature review and extracted data on the direct medical costs and long-term care costs of PD patients based on their severity, as categorized by the Hoehn and Yahr (HY) disease severity scale. These costs were estimated using information from literature sources and governmental statistics. The mean annual long-term care costs for HY1 to 5 were estimated: JPY 333 433, 527 194, 982 578, 2 023 735, and 3 080 743, respectively. These estimates were based on a cross table of HY severity and designated grade of long-term care, which was extracted from a survey of PD patients in Tokyo conducted in 2017 and national statistics on long-term care expenditure per person in June 2023. Assuming that the number of PD patients in Japan is 200,000, the annual costs for direct medical, long-term care, and the total are estimated approximately JPY 380, 270, and 650 billion, respectively. These results suggest that PD requires a significant amount of long-term care resources.

Here we present the case of a 23-year-old female with a history of onychomycosis and oral thrush since childhood. She presented with a gradual onset of headache, and cerebrospinal fluid (CSF) analysis on admission revealed an elevated mononuclear cell count. Hydrocephalus was observed on brain MRI. Candida albicans (C. albicans) was detected in the CSF, and antifungal treatment was initiated to diagnose of Candida meningitis. Due to an insufficient therapeutic response, intraventricular administration of liposomal amphotericin B initiated; however, the lesions persisted. Subsequently, the patient experienced repeated occlusions of the ventriculoperitoneal shunt tube, ultimately dying from a bacterial shunt infection. Autopsy findings revealed diffuse fungal proliferation on the surface of the brainstem and ventricular walls. Genetic testing confirmed a diagnosis of CARD9 deficiency. Although CARD9 deficiency is a rare disease, genetic testing should be considered when primary immunodeficiency is suspected.