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We herein report a 49-year-old Japanese man with relapsing polychondritis (RP) and aseptic meningoencephalitis. Four years ago, the patient was diagnosed with RP. Prednisolone (PSL) was started at 30 mg/day, and the symptoms promptly disappeared. However, cognitive impairment gradually appeared from six months before hospitalization. Methylprednisolone pulse therapy was immediately initiated, followed by administration of PSL at 1 mg/kg/day. Intravenous cyclophosphamide was combined with PSL. After treatment, the patient's cognitive impairment clearly improved. In conclusion, RP rarely causes aseptic meningoencephalitis, highlighting the need for prompt and aggressive immunosuppressive therapy.

We conducted an internet survey to assess sociodemographic variables, lifestyle factors, sleep hygiene, and comorbidities for sleep apnea syndrome (SAS) in COVID-19 and influenza (FLU) infections. Data from 10,323 workers (50.0% male) were analyzed. COVID-19 was diagnosed in 144 subjects (COVID-19+), and 8,693 were classified as not suspected to be infected (COVID-19-). SAS had been diagnosed in 35.4% of the COVID-19+ subjects, but only 231 (2.7%) of the 8,693 COVID-19- subjects. COVID-19+ subjects were more susceptible to FLU (35.4%) compared to COVID-19- subjects (3.0%). A multivariate analysis revealed that higher risks of COVID-19+ were linked to the following factors: going out without a face mask (OR 7.05, 95% CI: 4.53-11.00), FLU+ (OR 6.33, 95% CI: 3.80-10.54), excessive exercise before going to sleep (OR 2.10, 95% CI: 1.63-2.70), SAS+ (OR 5.08, 95% CI: 2.88-8.94), younger age OR 1.05, 95% CI: 1.03-1.07), tendency for dozing off (OR 3.70, 95% CI: 2.30-5.95), and use of hypnotics (OR 2.28, 95% CI: 1.20-4.30). Since sleep impairment played a relatively small role in COVID-19+/SAS- subjects, we assume that SAS itself was a more significant risk factor for COVID-19 infection rather than sleep impairment. A better understanding of the mechanisms that result in increased susceptibility to COVID-19 in SAS is vital for helping prevent COVID-19.

We report a rare case of fatal familial insomnia in a 58-year-old man who initially developed parkinsonism, secondary dementia, and visual hallucinations that were suspected to be due to dementia with Lewy bodies. We evaluated the function of the striatum via dopamine transporter single-photon emission computed tomography (DAT SPECT) using 123I-ioflupane and found marked presynaptic dopamine dysfunction in the bilateral striatum. This is the first reported case in which the initial symptom of fatal familial insomnia was parkinsonism and in which the dopamine transporter function was evaluated by DAT SPECT.

Objective The purpose of this study was to clarify the clinical features of ischemic patients for whom cigarette smoking was the sole risk factor for ischemic stroke. Methods Among the 1,329 patients (male, n=833; female, n=496) with acute ischemic stroke who were admitted to our hospital between April 2005 and September 2016, 346 (26%) were smokers [male, n=308 (36.9%); female, 38 (7.6%)]. In 42 (3.1%; male, n=41; female, n=1) cases, cigarette smoking was considered to be the sole risk factor for ischemic stroke. Data regarding gender, age, the clinical type of ischemic stroke, the National Institutes of Health Stroke Scale (NIHSS) score at the admission, the modified Rankin scale (mRS) scores before the onset and at discharge, the progression of symptoms, and the recurrence of infarction were investigated. Results The mean age of the 42 patients was 63.2±12.4 years (range, 26-86 years). The clinical types of ischemic stroke included atherothrombosis (n=19), lacunar (n=17), other type (n=2) and undetermined type (n=4). The median NIHSS score at the time of admission for ischemic stroke was 2 (interquartile range: IQR 1-4.25). The median mRS scores before the onset and at the discharge were 0 (IQR 0-0) and 1 (IQR 0-2), respectively. One patient had symptoms of progression; no patients had recurrence of infarction. Conclusion Our findings suggest that cigarette smoking alone may induce ischemic stroke; moreover, patients for whom smoking was the sole risk factor for ischemic stroke showed milder symptoms in comparison to patients with other risk factors; however, ischemic stroke was induced from youth. Since cigarette smoking has detrimental effects on the central nervous system, we suggest that people be encouraged to quit smoking in order to maintain good health.

A 70-year-old man developed urinary retention in the early stages of herpes simplex virus (HSV) type-1 encephalitis. A nerve conduction study suggested latent myeloradiculitis. This is the first report of human herpes simplex virus-1 encephalitis followed by urinary retention at early stage from the onset like the Elsberg syndrome. Although relatively few similar cases have been reported, we consider that urinary retention is common in HSV-1 encephalitis, in which disturbances of consciousness usually require bladder catheterization from the onset. We further emphasize that urinary retention may occasionally occur in early stages of HSV-1 encephalitis, with a significant possibility of recovery.

s from the Japanese Journal: The autonomic nervous system #1 Adreno-medullary sympathetic nerves and ascending baroreceptor pathways are not affected in Parkinson's disease patients with orthostatic hypotension Toshimasa Yamamoto, Akifumi Miyake, Toshinori Kimura, Yasuko Ohe, Naotoshi Tamura, Nobuo Araki Department of Neurology, Faculty of Medicine, Saitama Medical University, Saitama 350-0495, Japan We investigated whether the activity in adreno-medullary nerves and in ascending baroreceptor pathways in Parkinson's disease with orthostatic hypotension differs from that in multiple system atrophy. We examined noradrenergic, adreno-medullary, and ascending baroreceptor pathway abnormalities, by measuring plasma noradrenaline, adrenaline and arginine-vasopressin in Parkinson's disease patients with and without orthostatic hypotension, in multiple system atrophy patients with orthostatic hypotension and in healthy controls, before and during a 70° passive head-up tilt lasting 10 min. We found that elevation of plasma noradrenaline to tilt was significantly smaller in both sets of patients with orthostatic hypotension (compared to controls), but there was no difference between the two groups of patients. Elevation of plasma adrenaline to tilt was significantly higher in Parkinson's disease patients with orthostatic hypotension compared to the other two groups of patients. Elevation of plasma vasopressin to tilt was significantly higher in Parkinson's disease patients with orthostatic hypotension than in the other three groups. We conclude that noraderenergic pathways are functionally disturbed in patientswith Parkinson's diseasewith orthostatic hypotension. The functions of adreno-medullary nerves and of the ascending baroreceptor pathways are well preserved in Parkinson's disease with orthostatic hypotension, but are adversely affected in patients with multiple system atrophy. (The Autonomic Nervous System, 48: 251-257, 2011) doi:10.1016/j.autneu.2012.08.006 #2 Chrono-medical impact on morning hypertension therapy and home blood pressure measurement: The Val-HOPE study Kuniaki Otsuka, Kim Gwang U., Tatsushi Sugiura, Yoshiaki Harada, Keiko Mochizuki, Hamyuki Nakagawa, Hideaki Sudo and Val-HOPE study group Department of Medicine, Tokyo Women's Medical University Medical Center East Department of Internal Medicine, Nishi-Arai Hospital Department of Internal Medicine, Seiwa Clinic, Nishi-Arai Hospital Department of Internal Medicine, Harada Clinic Department of Internal Medicine, Nishikawa Clinic Department of Internal Medicine, Nakagawa Clinic Department of Internal Medicine, Johoku Clinic, Tokyo 116-8567, Japan We evaluated chrono-medically the effect of valsartan's therapy on home-measured blood pressure (BP) in patients, whose blood pressure was inadequately controlled with or without anti-hypertensive agents. The subjects were 42 men and 63 women, of average age of 63.4 years. Administration of valsartan significantly reduced blood pressure both at the clinic and at home, i.e., from 158.6±13.7/90.9±11.6 to 139.3±12.9/82.5±10.2 mmHg, and from 150.0±11.6/89.4±10.9 to 136.6±11.9/82.5±10.2 mm Hg (pb0.001), respectively. Morning and evening blood pressure levels were both significantly decreased (pb0.001), and the difference morning/evening dropped from 9.9/5.6 (systolic/diastolic) mmHg to 6.6/4.0 mmHg (pb0.05). In 34 subjects who suffered from amorning blood pressure surge and had a morning/ evening difference of more than 15 mmHg, the morning/evening difference decreased from 24.2±7.6 to 14.3±10.2 mmHg (pb0.001) after the valsartan treatment. Among 81 subjects whose systolic blood pressure levels in both morning and evening exceeded 135 mm Hg, 62 subjects showed a reduction of the evening blood pressure of over 5 mm Hg after administration of valsartan. In these 62 subjects, the ratio of the fall in pressure in the morning over that in the evening (M/E ratio, index of continuousness of antihypertensive action) was 1.13+0.62 when calculated in the individual patients and was 1.02 when calculated from mean values of the patient group. Depression symptoms were significantly alleviated (pb0.05), and no adverse events were seen. In conclusion the chrono-medical assessment of this study has shown that valsartan is a potential, well-tolerated antihypertensive agent. (The Autonomic Nervous System, 48: 258-265, 2011) doi:10.1016/j.autneu.2012.08.007 #3 Evaluation of chilly constitution in young women with a postural change test Shunji Sakaguchi, Yoshihisa Kojima, Junji Miyazaki, Hiroshi Kuge, Hidetoshi Mori Autonomic Neuroscience: Basic and Clinical 171 (2012) 89–91