Effects of white matter hyperintensities on isolated executive function assessed by the Trail Making Test.

Background: White matter hyperintensities (WMHs) on MRI are associated with cognitive dysfunction, particularly slow processing speed and executive dysfunction. However, it is not clear whether WMHs burden affects isolated executive function independent of aging when WMHs are assessed separately in periventricular hyperintensity (PVH) and deep and subcortical white matter hyperintensity (DSWMH).

Purpose: To assess the relationship between the degree of WMHs and the performance on the Trail Making Test (TMT), which can evaluate isolated ability of set-shifting and working memory.

Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Hospital Course, Confounders, and Medications.

The convergence of an interdisciplinary team of neurocritical care specialists to organize the Curing Coma Campaign is the first effort of its kind to coordinate national and international research efforts aimed at a deeper understanding of disorders of consciousness (DoC). This process of understanding includes translational research from bench to bedside, descriptions of systems of care delivery, diagnosis, treatment, rehabilitation, and ethical frameworks. The description and measurement of varying confounding factors related to hospital care was thought to be critical in furthering meaningful research in patients with DoC.

Development, implementation, and refinement of a comprehensive postcardiac arrest care training course in Japan.

Aim: In Japan, no training course is dedicated to postcardiac arrest care (PCAC), including venoarterial extracorporeal membrane oxygenation (VA-ECMO); thus, faculty members of the Japanese Circulation Society developed an original, comprehensive PCAC training course. This report reviews the development, implementation, and refinement of this PCAC training course.

Methods: We examined the preserved data from the Japanese Circulation Society PCAC training courses between 2014 and 2020.

Proposal of new diagnostic criteria for fatal familial insomnia.

Background: The understanding of fatal familial insomnia (FFI), a rare neurodegenerative autosomal dominant prion disease, has improved in recent years as more cases were reported. This work aimed to propose new diagnostic criteria for FFI with optimal sensitivity, specificity, and likelihood ratio.

Methods: An international group of experts was established and 128 genetically confirmed FFI cases and 281 non-FFI prion disease controls are enrolled in the validation process.

Stroke Care during the COVID-19 Pandemic: International Expert Panel Review.

Background: Coronavirus disease 2019 (COVID-19) has placed a tremendous strain on healthcare services. This study, prepared by a large international panel of stroke experts, assesses the rapidly growing research and personal experience with COVID-19 stroke and offers recommendations for stroke management in this challenging new setting: modifications needed for prehospital emergency rescue and hyperacute care; inpatient intensive or stroke units; posthospitalization rehabilitation; follow-up including at-risk family and community; and multispecialty departmental developments in the allied professions.

Summary: The severe acute respiratory syndrome coronavirus 2 uses spike proteins binding to tissue angiotensin-converting enzyme (ACE)-2 receptors, most often through the respiratory system by virus inhalation and thence to other susceptible organ systems, leading to COVID-19.

[Neurological Manifestations of COVID-19 and Work-up at the Emergency Room and the Intensive Care Unit].

The global pandemic due to the Coronavirus Disease 2019 (COVID-19) has placed tremendous strain on healthcare services. This review provides guidance to neurologists on the appropriate management of neurological and neurocritical conditions and diseases during the COVID-19 pandemic in the emergency room and the intensive care unit. The guidance is based on official recommendations and manuals that were urgently produced by the international and domestic societies with the contributions of an expert panel including this author.

Novel clinical features of nonconvulsive status epilepticus.

Nonconvulsive status epilepticus (NCSE) has rapidly expanded from classical features such as staring, repetitive blinking, chewing, swallowing, and automatism to include coma, prolonged apnea, cardiac arrest, dementia, and higher brain dysfunction, which were demonstrated mainly after the 2000s by us and other groups. This review details novel clinical features of NCSE as a manifestation of epilepsy, but one that is underdiagnosed, with the best available evidence. Also, we describe the new concept of epilepsy-related organ dysfunction (Epi-ROD) and a novel electrode and headset which enables prompt electroencephalography.

[Nonconvulsive status epilepticus; progress in clinical practice and research].

Mainly after 2000, we have reported novel manifestations of nonconvulsive status epilepticus (NCSE), such as reversible protracted coma, posthyperventilation apnea, and higher brain dysfunctions, including Klüver-Bucy syndrome. In this review, we discuss the progress in clinical practice and research of NCSE with best available evidence, especially the spectrum of electroencephalographic abnormalities in NCSE, clinical manifestations of malignant NCSE, relationship between sudden unexpected death in epilepsy (SUDEP) and NCSE, and a strategy for real-time neuromonitoring. In addition, we propose some new concepts, NCSE, such as the antiepileptic drug-responsive neurological deficit (ADND), critical NCSE, fosphenytoin challenge test, epilepsy-related organ dysfunction (Epi-ROD), and a Neurocritical Score (Integrated Scale) for the comprehensive and serial evaluation of neurocritical conditions.

Comparison of the European and Japanese guidelines for the acute management of intracerebral hemorrhage.

Background: Different aspects of acute stroke management and strategies for stroke prevention derive from two viewpoints: specific traditional and historical backgrounds and evidence-based medicine from modern randomized controlled trials (RCTs), meta-analysis and authorized clinical practice guidelines (GLs). Regarding intracerebral hemorrhage (ICH), Cerebrovascular Diseases published the 2006 European stroke initiative recommendations for the management of ICH. In 2009, the revised Japanese GLs for the management of stroke, including that of ICH, appeared in Japanese.

Comparison of the European and Japanese guidelines for the management of ischemic stroke.

Background: Different aspects of acute stroke management and strategies for stroke prevention derive from two viewpoints: specific traditional and historical backgrounds and evidence-based medicine from modern randomized controlled trials (RCTs), meta-analysis and authorized clinical practice guidelines (GLs). Regarding stroke, GLs have been published by national and international organizations in different languages, most frequently in English. Cerebrovascular Diseases published the European GLs for the management of ischemic stroke and transient ischemic attacks in 2003, with an update in 2008.

[Nonconvulsive status epilepticus: clinical practice and pathophysiology].

The clinical spectrum of nonconvulsive status epilepticus (NCSE) is rapidly expanding from classical manifestations, such as staring, repetitive blinking, chewing, swallowing, and automatism to novel manifestations, such as acute and protracted coma, apnea, cognitive impairment, higher brain dysfunction, and cardiac arrest. It is only in the last decade that these novel NCSE manifestations have been revealed, which is certainly reflective of modern advances in critical care neurology, such as the introduction and spread of continuous electroencephalography (cEEG) monitoring. Although NCSE is a relatively frequent, treatable condition but with a high mortality rate, physicians are still unfamiliar with its clinical manifestations, thus leading to underdiagnosis.

Postpublication external review of the Japanese guidelines for the management of stroke 2004.

Background And Purpose: Many guidelines for management of stroke have been published throughout the world, but no postpublication external review of any set of stroke guidelines by users, using standard checklists, has been reported. The purpose of this article is to present the results of an external review of the Japanese Guidelines for the Management of Stroke 2004, conducted several months postpublication.

Methods: Forty-one evaluators, who had not been involved in developing the guidelines, were selected from representative stroke centers and institutions in Japan.

[Stroke and the genetics of hyperhomocysteinemia].

The T allele of the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism has been shown to be a risk factor for stroke. Previous meta-analyses have shown that the individuals with the TT genotype have 1.26-1.

[The Japanese Guidelines for the Management of Stroke 2007 and medical professionalism].

In 2004, we published the first Japanese Guidelines for the Management of Stroke which were evidence-based and took into consideration of the differences in races and therapeutic agents between Japan and other countries, and also, employed the detailed, lots of evidences from Japan. For the renewal of this Guideline, the new Joint Committee on Guidelines for the Management of Stroke was established (Chairperson: Yukito Shinohara, Vice-Chairpersons: Akira Ogawa, Yasuo Katayama, Norihiro Suzuki, Akio Kimura, Clinical Epidemiology: Hideki Origasa, Secretariat-General: Masao Nagayama). Approximately 120 representative authorities were selected from five stroke-related societies in Japan.

Continuous venovenous hemodiafiltration for life-threatening mitochondrial myopathy with lactic acidosis and rhabdomyolysis.

We report here the clinical course of a 31-year-old male who recovered from a fulminant form of mitochondrial myopathy with lactic acidosis. The patient was transferred to our hospital with acute dyspnea and a convulsive seizure. On admission, he was in a state of shock, and presented with severe high-output heart failure, acute renal failure, and rhabdomyolysis.