Six cases of apparent and four cases of histopathologically confirmed vasculitis of the central nervous system (CNS), including one case of histopathologically documented vasculitis with encephalitis associated with coccidioidal meningitis (CM), are presented. Vasculitic complications included changes in mental status as well as stroke-like findings of aphasia, hemianopsia, and hemiparesis. Seven patients died. Vasculitic complications were unanticipated and often abrupt in onset, and delayed therapeutic intervention was characteristic. The diagnosis of vasculitis/encephalitis due to Coccidioides immitis infection must be based on clinical judgment, since serum antibody titers, cerebrospinal fluid findings, and initial radiological studies are not always helpful. Institution of both intravenous and intracisternal administration of amphotericin B and possibly concomitant intravenous administration of dexamethasone may be warranted in situations in which the association of C. immitis with CNS vasculitis or encephalitis appears likely before serologic or cultural confirmation of C. immitis infection involving the CNS is available.

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要旨：脳卒中患者の麻痺側上肢訓練の一つとして電気刺激療法があり，運動麻痺改善や痙 縮抑制効果などが報告されている．われわれは電気刺激療法の一種である随意運動介助型電 気刺激 （IVES） を回復期脳卒中患者の麻痺側上肢に行い，治療同日の持続効果について検討し た．IVES による訓練は 1 週間継続し，開始時と 1 週間後の治療前，治療直後，治療後から 30 分毎に 120 分後までの手関節背屈自動運動角度の経時変化を評価した．手関節背屈自動運 動角度は，開始時に比べ，有意な改善がみられた．SIAS，MAS は開始時と比べ，改善を認 めたが有意差はみられなかった．また，治療直後の角度が有意に低下するのが開始時は治療 後 60 分，1 週間後は治療後 90 分であり，継続した使用により効果が持続されやすいと考え られた． Key words: cerebrovascular disorders, electrical stimulation, upper limb functional training, carry-over effect （脳卒中 35: 174-180, 2013） はじめに 脳卒中患者の麻痺側上肢訓練の一つとして，治療的 電 気 刺 激 （therapeutic electrical stimulation; TES） が 行 わ 脳卒中 35 巻 3 号（2013：5） 35：180 Abstract Carry-over effect in integrated volitional control electrical stimulation of wrist extensor Purpose: Electrical stimulation therapy is used for training of the upper limbs in hemiplegic patients. It has been reported that this therapy can improve the functions of the paralyzed upper limb while suppressing spasticity. In this study, we applied integrated volitional control electrical stimulation (IVES) therapy for rehabilitation of the paralyzed upper limbs of sub-acute hemiplegic patients. Methods: Our objective was to investigate the carry-over effect of this method during stroke rehabilitation in patients. IVES therapy was conducted for 20 minutes per day for one week. To investigate the carry-over effect, we measured the active wrist dorsiflexion angles at 0, 30, 60, 90, and 120 minutes after daily rehabilitation sessions. Compared to the resulted obtained before the start of rehabilitation, the active wrist dorsiflexion angles had improved. Results: The SIAS and MAS also showed improvement. However, the differences were not significant. While active wrist dorsiflexion angles at 30, 60, 90, and 120 minutes after the daily sessions were decreased compared to those before rehabilitation, the active dorsiflexion angles were only significantly different for 60, 90, and 120 minutes. The dorsiflexion angle at one week after the start of rehabilitation was significantly improved at 90 and 120 minutes after daily sessions, compared with the angle at the start of rehabilitation. Conclusions: Our findings revealed the long-term therapeutic effects of IVES.