Department of Neurology
Cranial nerve department is medical department for linking to treatment by diagnosing what kind of disorders are occurred in which part of the cranial nervous system that branches off from the brain and spinal cord and is widely distributed throughout the body.
As a characteristic of brain and nerve diseases, it is rather only a part that can be diagnosed by performing image examinations such as CT and MRI. Many diseases are diagnosed based on thorough examination by asking you for detailed symptoms and using special diagnostic equipment.
Stroke
It is a disease in which blood vessels in the brain are torn or clogged, preventing blood from reaching the brain and damaging brain neurons. Depending on the cause, this disease are classified to four: 1) cerebral infarction (clogged blood vessels in the brain), 2) cerebral hemorrhage (blood vessel ruptured), 3) subarachnoid hemorrhage (ruptured aneurysm), 4) transient ischemic attack (TIA) (brain Infarct symptoms disappear in a short time). Among these, cerebral infarction may reduce the sequelae if treatment (thrombolysis) that dissolves blood clots (thrombosis) is performed earlier (within 4.5 hours of onset), and even after 4.5 hours, because there may be a treatment that sucks and collects thrombus with a catheter (intravascular thrombus recovery therapy), it is important to see a stroke treatment specialist immediately.
Symptoms of stroke
It is the type that accounts for the majority of strokes. Brain cells are damaged because the blood vessels in the brain become thin or clots are clogged and oxygen and nutrients cannot be sent to the brain.
As a result, the following symptoms occur.
- Numbness or numbness in one limb, half face
(In some cases, only limbs or face) - I can't speak inarticulately, I can't say any words, I can't understand what others say
- I can't stand or walk even if I have power to do that, and I tend to totter.
- One eye is invisible, two things are visible, half of the field of view is missing
- Suddenly temporarily disappeared as if a curtain on one eye
- I have a severe headache I have never experienced
Classification of stroke
1. Cerebral infarction
It is the type that accounts for the majority of strokes. Brain cells are damaged because the blood vessels in the brain become thin or clots are clogged and oxygen and nutrients cannot be sent to the brain.
Cerebral infarction is divided into three types, “lacuna infarction”, “atherothrombotic cerebral infarction” and “cardiogenic cerebral embolism”, depending on the size of the clogged blood vessel and how it is clogged. Symptoms and extent vary depending on the location and extent of the damaged brain.
- Lacunar infarction
Thick blood vessels that enter the brain gradually branch into thin blood vessels. It is a lacunar infarction that narrows and clogs these fine blood vessels. This is the most common type of cerebral infarction in Japanese people, mainly caused by high blood pressure. - Atherothrombotic cerebral infarction
This is a type of cerebral infarction in which a blood clot is formed in a thick blood vessel narrowed by arteriosclerosis (atherosclerosis) and the blood vessel is clogged. Mainly due to lifestyle-related diseases such as hypertension, dyslipidemia (hyperlipidemia), and diabetes that emerge and develop arteriosclerosis. - Cardiogenic cerebral embolism
Blood clots in the heart are carried to the brain through the bloodstream and clog the thick blood vessels in the brain. The most common cause is atrial fibrillation, one of the arrhythmias. Among the three types, symptoms appear most rapidly and are often severe.
2. Cerebral hemorrhage
This is a disease in which nerve cells are damaged by the blood vessels in the brain are ruptured and the surrounding brain cells are pressed by overflowing blood, or by the pressure inside the brain (cerebral pressure) increases and blood in the part away from the bleeding site also affects blood flow, etc. This disease occurs when fine blood vessels (small arteries) are painful and ruptured mainly due to arteriosclerosis derived from high blood pressure.
3. Subarachnoid hemorrhage
When a cerebral aneurysm is formed in the main cerebral artery that runs on the surface of the brain, and a part of the blood vessel is swollen in a lumped shape, it ruptures and bleeds inside a thin membrane called the arachnoid membrane that covers the surface of the brain. Therefore, unlike other strokes, severe headaches that have never been experienced before occurred. Subarachnoid hemorrhage is a serious condition with a high mortality rate among strokes.
4. Transient ischemic attack
This is a condition in which neurological symptoms that occur with the same mechanism as cerebral infarction disappear within 24 hours. In most cases, symptoms disappear within an hour, and sometimes the symptom is just a few minutes of seizures. A transient cerebral ischemic attack is important as a harbinger of a cerebral infarction, but if left untreated, it is likely to cause a cerebral infarction. Initiating appropriate treatment before cerebral infarction increases the chance of preventing cerebral infarction.
Stroke prevention
The five major risk factors for stroke are hypertension, diabetes, arrhythmia (atrial fibrillation), smoking, and dyslipidemia (hyperlipidemia). Other risk factors for stroke include men, the elderly, obesity, excessive drinking, and lack of exercise. It is important the full control of risk factors on a daily basis.
Ten stroke prevention (Japan Stroke Association)
- Let's get rid of high blood pressure
- If you let go of diabetes, you will regret it
- Immediate visit as soon as arrhythmia is found
- With the will to stop smoking for prevention
- Alcohol Low-key is too much medicine
- Don't miss too high cholesterol
- Meal salt and fat sparingly
- Let's keep exercising according to physical strength
- Overweight to trigger a universal illness
- As soon as you get a stroke, go to the hospital
Epilepsy
Epilepsy is chronic brain disease of a nerve cell in the brain that causes seizures and convulsions with excessive electrical excitement. This illness has been known since BC and was once believed to be obsessed with gifts, so there are still many misunderstandings and prejudices. Excessive excitement occurs in various parts of the brain, so the symptoms vary depending on the place.
The symptoms are extremely varied, for example, the so-called “convulsions”, a clonic seizure in which the limbs are bent and stretched at a constant rhythm, a tonic seizure in which the limbs stiffen the body, an absence seizure in which a very brief loss of consciousness occurs suddenly, myoclonic seizures that cause the limbs and limbs to snap for a moment, changes in sensations and emotions, and complex partial seizures that exhibit special symptoms such as special behaviors. However, the symptoms of seizures are almost constant from patient to patient, and repeated attacks is one of the features of epilepsy.
In addition, since the current in the brain is disturbed during the seizure, abnormal waves (spine waves, etc.) appear when the brain waves are measured and are used to diagnose epilepsy. There are idiopathic (primary) epilepsy in which the causative disorder is not found, and symptomatic (secondary) epilepsy caused by brain lesions such as cerebral infarction / brain hemorrhage, brain tumor, encephalitis, etc. In the case of symptomatic (secondary) epilepsy, an abnormality is found by MRI. However, there are many cases where no obvious abnormalities are found by EEG or MRI, and it is often difficult to diagnose. For that reason, Knowing seizures is the most important thing in diagnosing epilepsy. It is necessary to obtain information not only from the patient but also from the person who witnessed the seizure, such as seizure symptoms, time zone / situation where seizures are likely to occur, and seizure frequency.
In addition, since mobile phones and smartphones with cameras are prevalent, we ask that you take a picture of the seizure when you have a seizure. A video of the state of the seizure can be very helpful in making a diagnosis. Epilepsy may be diagnosed based on information about seizures heard from patients and their families, even if the basis of diagnosis is not obtained by EEG or MRI.
Loss of consciousness due to seizures is a symptom that is the biggest obstacle to social life for patients, and it can be a major handicap when working, attending school, or driving a car, as well as risk of an accident. Therefore, how much seizures can be eliminated or how much the number of seizures that involve loss of consciousness can be reduced is the main goal for epilepsy treatment. As a specific treatment method, adjustment of antiepileptic drugs is the main, but it is important to prevent seizures without interrupting the drug by self-judgment. In addition, there are cases which complete cure can be expected by surgical treatment, and it is important to make an appropriate diagnosis early.
Parkinson's disease
Parkinson's disease is a diseases that by decreasing in substantia nigra dopamine neurons in the midbrain, make it difficult to move or tremble. The four signs of Parkinson's disease include resting tremor, stiff muscles, immobility or peristalsis that slows down movement, and posture maintenance disorders that make it easier to fall. In addition to these motor symptoms, constipation, frequent urination, sweating, easy fatigue (facilitating fatigue), decreased olfactory sensation, orthostatic hypotension (dizziness), feeling unwell (depressed), fading Symptoms such as decreased motivation (apathy) may also occur.
- Stationary tremor
- Hands, feet, chin, etc. shake. This tremor trembles when it is stationary, and it stops when you move your hand to do something.
- Tendon contraction
- Muscles become stiff. Bending the limbs of patients with Parkinson's disease makes you feel resistance.
- No movement
- The movement of the whole body becomes dull. It takes time to start moving and can only move slowly.
- Posture maintenance disorder
- Posture retention obstacles become unbalanced and more likely to fall over. It becomes difficult to sit, stand and maintain posture.
Most are sporadic with no genetic history. While aging is an important risk factor, there are hereditary Parkinson's disease that occurs in 5-10%, some of which develop before younger than 20 years. People tend to think that they develop in middle-aged and older, but younger-onset Parkinson's disease also exists. It is around 100-150 people per 100,000 people, but the incidence increases when they are over 60 years old.
If Parkinson's disease is suspected based on symptoms and progress, diagnoses will be made by nuclear medicine such as MIBG myocardial scintigraphy and Dat scan, and head MRI. If testing is not possible, sometimes you may be checked to see if symptoms improve by dopamine replacement therapy.
Treatment method
The basis of treatment is drug therapy. Because dopamine neurons decrease, it compensates for the decreased dopamine. Taking dopamine itself does not move into the brain, so dopamine precursor L-dopa (levodopa) is taken. There are other dopamine agonists, MAO-B inhibitors, anticholinergic agents, adenosine A2a receptor antagonists, COMT inhibitors, zonisamide, amantadine hydrochloride, and droxidopa. Early response is relatively good and can be well controlled, but at the advanced stage, wear-off (L-dopa is a phenomenon that shortens the time during which the symptoms get better and worse during the day) and the dyskinesia (which is a phenomenon where the drug is too effective and the limbs move freely) becomes a problem. In addition, surgery (deep brain stimulation) may be performed if it is difficult to control symptoms with internal use or if the required amount cannot be taken due to side effects.
In daily life, exercise therapy, especially stretching, helps maintain posture. Parkinson's disease tends to lean forward and lean sideways. The posture that you feel straight is often slanted, so look at the mirror as much as possible to improve your posture. Even if you think that it is okay, you can easily fall down. So you should clean up stuff disturbing your walk and set up a handrail.
Parkinson's disease is that there are data that the prognosis is better if an expert follows than a general doctor, so if you suspect a diagnosis, see a neurosurgeon as early as possible.
Cognitive disorder
Dementia is a condition in which various mental functions that have been normally developed after birth are chronically diminished or lost, preventing daily life and social life. In other words, it differs from intellectual disability (mental retardation) in that it is an intellectual disability caused by an acquired cause. Alzheimer's disease is the most common cause of dementia, accounting for over 60% of dementia. The second most common is dementia with Lewy bodies and vascular dementia.
Alzheimer's disease
In Alzheimer's disease, a protein called amyloid β protein accumulates in the brain, and a protein called tau accumulates, resulting in a decrease in nerve cells and atrophy of the brain. In particular, brain atrophy begins and spreads from the center of memory called the hippocampus. For that reason, symptoms begin with memory impairment (forgetfulness) and gradually decline in overall cognitive function. At first, forgetfulness (“I can't remember a little before”) is conspicuous, but there is almost no hindrance in daily life (mild cognitive impairment due to Alzheimer's disease). Gradually, it becomes difficult to live and becomes dementia (dementia due to Alzheimer's disease or Alzheimer-type dementia), and dementia progresses gradually from mild to moderate to advanced. In mild dementia, in addition to forgetting things, you will not know the date, and if you are moderate, you will not know where you are. Symptoms such as delusions and hemorrhoids can be problematic. At higher altitude (severity), you will not be able to understand the faces of close family members and will eventually be bedridden.
In the diagnosis of Alzheimer's disease, the process of the disease and the characteristics of the symptoms are important. As an auxiliary test, examination of brain images (MRI, CT, SPECT, PET) and cerebrospinal fluid makes it possible to diagnose Alzheimer's disease with a high degree of certainty.
There are two types of treatment for Alzheimer's disease: drug therapy and non-drug therapy. Drug therapy improves the symptoms of dementia and slows the progression of the disease by improving the communication between nerve cells in the brain, but it cannot stop the progression of the disease itself. For that reason, combined with rehabilitation such as brain training and games, life rehabilitation such as cooking and washing, horticultural therapy, music therapy, and non-drug therapy such as reminiscence is expected to improve the quality of life.
Dementia with Lewy bodies
Lewy body dementia is a disease in which a structure called Lewy bodies accumulates in nerve cells and exhibits various symptoms such as dementia. As to dementia, unlike Alzheimer's, forgetfulness may not stand out. Core features include: (1) cognitive function fluctuations (symptoms may improve or worsen depending on the date and time), (2) visual hallucinations (repeated specific visual hallucinations), and (3) Parkinson's symptoms (movement is getting slow), (4) abnormal behaviors during sleep (because of nightmares and rampage). In addition, symptoms of autonomic nerves (such as dizziness) and mental symptoms such as depression are also seen.
In the diagnosis of Lewy body dementia, the process of the disease and the characteristics of the symptoms are important. Auxiliary tests such as brain images (MRI, CT, SPECT, PET), Dat scan, MIBG myocardial scintigraphy, and brain waves during sleep can be used for highly reliable diagnosis.
At present, there is no fundamental cure, and treatment is performed by appropriately combining treatments that reduce each symptom, such as dementia symptoms, Parkinson's symptoms, and sleep disorders. As a drug for dementia symptoms, we use a drug called donepezil, which is also used in Alzheimer's disease.
Vascular cognitive disorder
Vascular dementia refers to a condition that results in dementia as a result of cerebrovascular disorders such as cerebral infarction or cerebral hemorrhage. In a typical case, cognitive function declines in a staircase fashion as cerebrovascular disorders occur. Symptoms may vary depending on the location and spread of cerebrovascular disorders, in addition to dementia, various symptoms such as paralysis of the limbs, language impairment, swallowing (swallowing) disorder, and incontinence are seen.
When cerebral infarction or cerebral hemorrhage is detected by head imaging (CT, MRI, cerebral blood flow SPECT, etc.) and cerebrovascular disorder is determined to be the cause of dementia, vascular dementia is diagnosed. Because cerebrovascular disorders are the cause, the treatment is to control lifestyle-related diseases such as hypertension, and for cerebral infarction, antiplatelet agents (drugs that make blood smooth) are used and prevent to recur the cerebrovascular disease.
Headache, dizziness, numbness
Headache
Headache is a general term for pain in a part or the whole of the head. Pain in the back of the head and neck (back neck) and behind the eyes is also treated as a headache. Many people are worried about brain disease when a headache occurs, but the brain itself does not have painful nerves (pain sensory nerves). So if you have no symptoms other than a headache, it is probably thought that your brain does not have bad disease. However, since the membrane (meninges) covering the brain and intracranial blood vessels have pain sensory nerves, sudden headaches, severe headaches that have never been experienced, suddenly peaked in a short time headaches, fever, and numbness or numbness in the limbs may cause headaches that appear as symptoms of brain disease such as meningitis, encephalitis, cerebral artery dissection, strokes such as subarachnoid hemorrhage. Therefore, it is better to go to the clinic immediately and receive an accurate diagnosis.
If you have had similar headaches for a long time, most of them are chronic headaches that are not life-threatening. Migraine and tension headache are typical. Recently, there are good treatments, so it is a good idea to see a neurology department, neurosurgery, headache outpatient clinic, etc. Even with chronic headaches, headaches that worsen over time may be brain tumors or chronic subdural hematomas.
Some chronic headaches are refractory. There is not necessarily a cure that can completely eliminate all headaches. It is necessary for the attending physician and the patient to collaborate in an effort to minimize the negative effects on daily life, work, housework, schoolwork, etc. due to headaches by using available treatments and treatments.
Dizzy
Vertigo is a collective term for the sensation that makes the eyes look round. In fact, it includes a wide range of symptoms, including the sensation that you and your surroundings turn around, feeling distracted, darkness in front of you, and things appearing double.
The most common cause of dizziness is inner ear vertigo (vertigo due to a semicircular canal failure, vestibular dysfunction), but some of them can be life-threatening due to stroke or heart disease. Also, these can also cause dizziness such as drug, hypertension, dehydration, arrhythmia, orthostatic hypotension, heat stroke, various neurological diseases, hypoglycemia, anemia, posttraumatic cervical syndrome, cervical dizziness, nasal dizziness, mental and physical stress, fatigue. In general, dizziness is often caused by inner ear vertigo, but there is a possibility of a stroke when you have these symptoms like blood pressure is higher than usual, suddenly no force is applied to one limb, one side of the face has become worse, Lu If you have symptoms such as losing rotation, things appear doubled, your face or limbs are dull, your ears are hard to hear, or you are unable to walk straight, so in that case let's visit a hospital and see a doctor.
Numbness
Numbness appears when there is a disorder in one of the sensory pathways (the sensory pathway from sensory receptors to the peripheral nerves, spinal cord, and cerebrum). However, the word numbness is used in many ways in everyday life. For example, it may mean dull sensation (decreased sensation), such as “feeling cold when touched”, “difficult to feel cold or heat”, “difficult to feel pain”, It may also mean an abnormal sensation such as “Jinging, Biri-biri”, “A feeling of being touched by a needle”, “A feeling of tingling”. Also, numbness may be expressed as movement paralysis (weakness), such as “It is difficult to apply force to the limbs” or “Movement is poor”.
One of the illnesses that many patients who visit the hospital for numbness are concerned with cerebrovascular disorders such as cerebral infarction and cerebral hemorrhage. Usually, numbness due to cerebrovascular disorder is a unilateral symptom that suddenly appears. Sensory disorders often involve muscle weakness, but sensory impairment may be the only symptom. Cerebrovascular disorders may also occur when the hands around one mouth and one side are numb. Also, Limb pain and weakness are occurred for the reason that there is numbness of the limbs due to abnormalities in the spine and intervertebral discs that protrude from bone spines (bone spines) or spinal canals formed by deformed bones are compressing and stimulating the nerve roots branched from the spinal cord. Peripheral neuropathy of limbs is single neuropathy when only one peripheral nerve is damaged, multiple single neuropathy when multiple peripheral nerves are asymmetrically asymmetric, and when the disorder is observed symmetricaly like as the shape of glove or socks , it is called polyneuropathy. Even if just thinking peripheral nerve disorders, there can be various causes of numbness, such as those associated with strangulation such as carpal tunnel syndrome and radial nerve palsy, those associated with inflammation such as vasculitis and collagen disease, those associated with immunity such as Guillain-Barre syndrome, metabolic diseases such as diabetes and vitamin deficiency.
Numbness can be occurred by a variety of causes. Medical treatment may be sufficient, but depending on the cause, surgery such as orthopedic surgery or neurosurgery may be required. Identifying the cause is considered to be the most important for proper treatment. In addition, since numbness may hide a serious illness, do not leave it easily, and first visit the Department of Neurology.
Neuroimmune disease
Immunity is a system to protect yourself against extraneous pathogens. But for some reason, this system can attack itself and is called “autoimmunity”. Diseases caused by autoimmunity to the brain, spinal cord, and peripheral nerves(including neuromuscular junctions)is an immune neurological disease. Just Representative diseases include multiple sclerosis (MS), neuromyelitis optica (NMO), myasthenia gravis (MG), Guillain-Barre syndrome (GBS), Fisher syndrome (MFS), chronic inflammatory demyelinating, polyneuritis (CIDP), multifocal motor neuropathy (MMN), neurosarcoidosis, and neuro-Behcet's disease and it is characterized by many diseases. Some of these diseases are severe but the prognosis is good if you survive the acute phase, while others are chronically progressive and gradually deprive you of your physical freedom. Therefore, it is important to perform appropriate diagnosis and treatment at an early stage.
Treatment method
Regarding treatment, large-scale treatment such as steroid pulse therapy, high-dose immunoglobulin therapy, and blood purification therapy is administered as needed for acute disease control. Oral steroids and other immunosuppressants such as oral steroids are used to control disease in the chronic phase and prevent recurrence in the remission phase. In MS, interferon β (1b: Betaferon®, 1a: Avonex®) and glatiramer acetate (Copaxone®) are used as self-injection drugs, natalizumab (Tysaburi®) is used as a monthly infusion, and fingolimod is used as an internal drug. (Imusella® / Gillenia®), dimethyl fumarate (Techfidella®), MG for tacrolimus and cyclosporine, eculizumab (Solilith®) for infusion once every two weeks, and CIDP / MMN once every three weeks Γ globulin as a drip infusion (blood donation globenin® I / blood donation venoglobulin® IH), and γ globulin (hyzentra®) as a self-injection once a week, like those, prevention of recurrence and maintenance therapy have been established, and it is possible to control the state of the disease with instillation drugs that can be done in the outpatient department of neurology without hospitalization.