多発脳造影病変を呈しトキソプラズマ脳症との鑑別に苦慮した多巣性膠芽腫の1例
症例は57歳男性．日常的に野良猫との接触歴があった．X年6月より左下肢脱力，7月より意識障害を呈し当院に入院した．髄液検査で細胞数増多，頭部造影MRIで脳内に多発造影域を認めた．トキソプラズマ脳症を疑い抗生剤を投与したが，反応に乏しかった．初回脳生検で診断に至らず，組織よりPropionibacterium acnesの検出があり，抗生剤を継続したが症状の悪化と病変の増大がみられた．再生検で膠芽腫と診断され，画像所見と合わせて多巣性膠芽腫と診断した．同病は膠芽腫の稀な病型で，予後不良である．診断に苦慮する多発脳病変では同病も鑑別に挙げ，早期の脳生検を考慮すべきである．...
Saved in:
| Published in | 臨床神経学 Vol. 65; no. 3; pp. 224 - 229 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本神経学会
2025
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0009-918X 1882-0654 |
| DOI | 10.5692/clinicalneurol.cn-002019 |
Cover
| Abstract | 症例は57歳男性．日常的に野良猫との接触歴があった．X年6月より左下肢脱力，7月より意識障害を呈し当院に入院した．髄液検査で細胞数増多，頭部造影MRIで脳内に多発造影域を認めた．トキソプラズマ脳症を疑い抗生剤を投与したが，反応に乏しかった．初回脳生検で診断に至らず，組織よりPropionibacterium acnesの検出があり，抗生剤を継続したが症状の悪化と病変の増大がみられた．再生検で膠芽腫と診断され，画像所見と合わせて多巣性膠芽腫と診断した．同病は膠芽腫の稀な病型で，予後不良である．診断に苦慮する多発脳病変では同病も鑑別に挙げ，早期の脳生検を考慮すべきである． |
|---|---|
| AbstractList | 症例は57歳男性．日常的に野良猫との接触歴があった．X年6月より左下肢脱力，7月より意識障害を呈し当院に入院した．髄液検査で細胞数増多，頭部造影MRIで脳内に多発造影域を認めた．トキソプラズマ脳症を疑い抗生剤を投与したが，反応に乏しかった．初回脳生検で診断に至らず，組織よりPropionibacterium acnesの検出があり，抗生剤を継続したが症状の悪化と病変の増大がみられた．再生検で膠芽腫と診断され，画像所見と合わせて多巣性膠芽腫と診断した．同病は膠芽腫の稀な病型で，予後不良である．診断に苦慮する多発脳病変では同病も鑑別に挙げ，早期の脳生検を考慮すべきである． |
| Author | 島谷, 佳光 毛利, 菜月 石原, 広之 岩本, 宗矩 山元, 一樹 今井, 幸弘 |
| Author_xml | – sequence: 1 fullname: 山元, 一樹 organization: 加古川中央市民病院脳神経外科 – sequence: 1 fullname: 島谷, 佳光 organization: 加古川中央市民病院脳神経内科 – sequence: 1 fullname: 岩本, 宗矩 organization: 加古川中央市民病院脳神経内科 – sequence: 1 fullname: 毛利, 菜月 organization: 加古川中央市民病院脳神経内科 – sequence: 1 fullname: 今井, 幸弘 organization: 加古川中央市民病院病理診断科 – sequence: 1 fullname: 石原, 広之 organization: 加古川中央市民病院脳神経内科 |
| BookMark | eNpVkM1Kw0AUhQdRsNa-gy-QOjP5naUU_6DoRsFdSCcTTUlTSerCXZNarXZVN0UXWrD-USyIC6FQX2ZMm76FKRXEzT33cr9zFmcJzLtllwGwgmBWVghepY7t2tRwXHbilZ0sdQUIMURkDqSQpmEBKrI0D1IQQiIQpB0sgozv24XpLRMNSSlQirq345tBfPYxqXai4fu4XY-6lzy8jloNHrR5rcHDNx4OeS3ZX3k44LW7BB63L3jwwoP-pNWKGo886MXNp1G9P7UE90lm9Pkwqj7H5534ahjXewmJvr-ay2DBMhyfZX41DfY31vdyW0J-d3M7t5YXilhRKgIhJiMqgRCpTC5YVCQqZpCaksWSl1mwRFOzLMxUWcZMsahCGEMUY4VpkoVUQ0yDnVlu0a8Yh0w_9uyS4Z3qhlexqcP0_73piqyL00FdfdbfH3hkeHrREH8Ap2eX8g |
| ContentType | Journal Article |
| Copyright | 2025 日本神経学会 |
| Copyright_xml | – notice: 2025 日本神経学会 |
| DOI | 10.5692/clinicalneurol.cn-002019 |
| DatabaseTitleList | |
| DeliveryMethod | fulltext_linktorsrc |
| Discipline | Medicine |
| EISSN | 1882-0654 |
| EndPage | 229 |
| ExternalDocumentID | article_clinicalneurol_65_3_65_cn_002019_article_char_ja |
| GroupedDBID | ALMA_UNASSIGNED_HOLDINGS JSF OK1 P2P RJT |
| ID | FETCH-LOGICAL-j266t-99de9790017e5bfc3972e0cd4fe99ddbf3d8ff2e7552e6fc69ee1c226e84f17a3 |
| ISSN | 0009-918X |
| IngestDate | Wed Sep 03 06:30:46 EDT 2025 |
| IsDoiOpenAccess | true |
| IsOpenAccess | true |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 3 |
| Language | Japanese |
| License | https://creativecommons.org/licenses/by-nc-nd/4.0/deed.ja |
| LinkModel | OpenURL |
| MergedId | FETCHMERGED-LOGICAL-j266t-99de9790017e5bfc3972e0cd4fe99ddbf3d8ff2e7552e6fc69ee1c226e84f17a3 |
| OpenAccessLink | https://www.jstage.jst.go.jp/article/clinicalneurol/65/3/65_cn-002019/_article/-char/ja |
| PageCount | 6 |
| ParticipantIDs | jstage_primary_article_clinicalneurol_65_3_65_cn_002019_article_char_ja |
| PublicationCentury | 2000 |
| PublicationDate | 2025 |
| PublicationDateYYYYMMDD | 2025-01-01 |
| PublicationDate_xml | – year: 2025 text: 2025 |
| PublicationDecade | 2020 |
| PublicationTitle | 臨床神経学 |
| PublicationTitleAlternate | 臨床神経学 |
| PublicationYear | 2025 |
| Publisher | 日本神経学会 |
| Publisher_xml | – name: 日本神経学会 |
| References | 33) Li M, Huang W, Chen H, et al. T2/FLAIR Abnormity Could be the Sign of Glioblastoma Dissemination. Front Neurol 2022;13:819216. 4) Otsuji R, Fujioka Y, Hata N, et al. Liquid Biopsy for Glioma Using Cell-Free DNA in Cerebrospinal Fluid. Cancers (Basel) 2024;16:1009. 28) Li Y, Zhang ZX, Huang GH, et al. A systematic review of multifocal and multicentric glioblastoma. J Clin Neurosci 2021;83:71-76. 12) Bansal S, Goyal M, Modi M, et al. Eccentric target sign of cerebral toxoplasmosis. QJM 2016;109:555. 23) Kyritsis AP, Levin VA, Yung WK, et al. Imaging patterns of multifocal gliomas. Eur J Radiol 1993;16:163-170. 11) Zawadzki R, Modzelewski S, Naumowicz M, et al. Evaluation of imaging methods in cerebral toxoplasmosis. Pol J Radiol 2023;88:e389-e398. 8) Khalid S, Memon SF, Jumani L, et al. Neurotoxoplasmosis in the immunocompetent: a rare occurrence. Cureus 2023;15:e36782. 18) Ueunten D, Tobias J, Sochat M, et al. An unusual cause of bacterial meningitis in the elderly. Propionibacterium acnes. Arch Neurol 1983;40:388-389. 1) Garg RK, Sinha MK. Multiple ring-enhancing lesions of the brain. J Postgrad Med 2010;56:307-316. 30) Lim DA, Cha S, Mayo MC, et al. Relationship of glioblastoma multiforme to neural stem cell regions predicts invasive and multifocal tumor phenotype. Neuro Oncol 2007;9:424-429. 25) Barnard RO, Geddes JF. The incidence of multifocal cerebral gliomas. A histologic study of large hemisphere sections. Cancer 1987;60:1519-1531. 15) Clinicalinfo.HIV.gov. [Internet]. Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV. Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV. National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and Infectious Diseases Society of America; 2024 Aug 15. [cited 2024 Sep 10]. Available from https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-opportunistic-infection. English. 3) Patel A, More B, Rege I, et al. Clinical diagnosis and management of multiple cerebral ring-enhancing lesions-study of 50 patients at a tertiary healthcare center. J Cancer Res Ther 2024;20:112-117. 6) Dian S, Ganiem AR, Ekawardhani S. Cerebral toxoplasmosis in HIV-infected patients: a review. Pathog Glob Health 2023;117:14-23. 7) Pekova L, Parusheva P, Mitev M, et al. A rare case of an HIV-seronegative patient with Toxoplasma gondii meningoencephalitis. IDCases 2021;26:e01271. 19) Burnham JP, Thomas BS, Trevino SE, et al. De Novo meningitis caused by Propionibacterium acnes in a patient with metastatic melanoma. J Clin Microbiol 2014;52:1290-1293. 16) Yakhkind A, Yacoub HA, Grove J, et al. Pathogenesis, clinical course and neuro-radiological signs of Proprionibacterium acnes cerebritis: case report and literature review. Hosp Pract 2015;43:128-136. 10) エイズ治療・研究開発センター．サーベイランスのためのHIV感染症/AIDS診断基準．[Internet]．東京：厚生労働省；2018 Aug 13. [cited 2024 Sep 10]. Available from: https://www.acc.ncgm.go.jp/information/mhlwinfo/surveillance.html. Japanese. 22) Schwartz KM, Erickson BJ, Lucchinetti C. Pattern of T2 hypointensity associated with ring-enhancing brain lesions can help to differentiate pathology. Neuroradiology 2006;48:143-149. 2) Fine HA, Mayer RJ, Fine MD, et al. Primary central nervous system lymphoma. Ann Intern Med 1993;119:1093-1104. 27) Farhat M, Fuller GN, Wintermark M, et al. Multifocal and multicentric glioblastoma: Imaging signature, molecular characterization, patterns of spread, and treatment. Neuroradiol J 2023;10:19714009231193162. 17) Schlesinger JJ, Ross AL. Propionibacterium acnes meningitis in a previously normal adult. Arch Intern Med 1977;137:921-923. 20) Dammers R, Schouten JW, Haitsma IK, et al. Towards improving the safety and diagnostic yield of stereotactic biopsy in a single centre. Acta Neurochir (Wien) 2010;152:1915-1921. 29) Ho ML, Moonis G, Ginat DT, et al. Lesions of the corpus callosum. AJR Am J Roentgenol 2013;200:W1-16. 26) Thomas RP, Xu LW, Lober RM, et al. The incidence and significance of multiple lesions in glioblastoma. J Neurooncol 2013;112:91-97. 5) Safarpour H, Cevik M, Zarean M, et al. Global status of Toxoplasma gondii infection and associated risk factors in people living with HIV. AIDS 2020;34:469-474. 24) Djalilian HR, Shah MV, Hall WA. Radiographic incidence of multicentric malignant gliomas. Surg Neurol 1999;51:554-558. 21) Kurdi M, Baeesa S, Maghrabi Y, et al. Diagnostic discrepancies between intraoperative frozen section and permanent histopathological diagnosis of brain tumors. Turk Patoloji Derg 2022;38:34-39. 31) Mistry AM, Hale AT, Chambless LB, et al. Influence of glioblastoma contact with the lateral ventricle on survival: a meta-analysis. J Neurooncol 2017;131:125-133. 32) Lasocki A, Gaillard F, Tacey MA, et al. The incidence and significance of multicentric noncontrast-enhancing lesions distant from a histologically-proven glioblastoma. J Neurooncol 2016;129:471-478. 13) Ueno H, Norose K, Kamimura T, et al. Metastatic malignant lymphoma mimicking cerebral toxoplasmosis with the “Target Sign”. Intern Med 2019;58:1157-1162. 14) León Ruiz M. A novel case of solitary cerebral toxoplasmosis mimicking glioblastoma as the first presentation of HIV. J Clin Neurol 2016;12:248-250. 9) Agrawal A, Bhake A, Sangole V, et al. Multiple-ring enhancing lesions in an immunocompetent adult. J Glob Infect Dis 2010;2:313-314. |
| References_xml | – reference: 31) Mistry AM, Hale AT, Chambless LB, et al. Influence of glioblastoma contact with the lateral ventricle on survival: a meta-analysis. J Neurooncol 2017;131:125-133. – reference: 28) Li Y, Zhang ZX, Huang GH, et al. A systematic review of multifocal and multicentric glioblastoma. J Clin Neurosci 2021;83:71-76. – reference: 13) Ueno H, Norose K, Kamimura T, et al. Metastatic malignant lymphoma mimicking cerebral toxoplasmosis with the “Target Sign”. Intern Med 2019;58:1157-1162. – reference: 17) Schlesinger JJ, Ross AL. Propionibacterium acnes meningitis in a previously normal adult. Arch Intern Med 1977;137:921-923. – reference: 33) Li M, Huang W, Chen H, et al. T2/FLAIR Abnormity Could be the Sign of Glioblastoma Dissemination. Front Neurol 2022;13:819216. – reference: 2) Fine HA, Mayer RJ, Fine MD, et al. Primary central nervous system lymphoma. Ann Intern Med 1993;119:1093-1104. – reference: 10) エイズ治療・研究開発センター．サーベイランスのためのHIV感染症/AIDS診断基準．[Internet]．東京：厚生労働省；2018 Aug 13. [cited 2024 Sep 10]. Available from: https://www.acc.ncgm.go.jp/information/mhlwinfo/surveillance.html. Japanese. – reference: 12) Bansal S, Goyal M, Modi M, et al. Eccentric target sign of cerebral toxoplasmosis. QJM 2016;109:555. – reference: 30) Lim DA, Cha S, Mayo MC, et al. Relationship of glioblastoma multiforme to neural stem cell regions predicts invasive and multifocal tumor phenotype. Neuro Oncol 2007;9:424-429. – reference: 18) Ueunten D, Tobias J, Sochat M, et al. An unusual cause of bacterial meningitis in the elderly. Propionibacterium acnes. Arch Neurol 1983;40:388-389. – reference: 8) Khalid S, Memon SF, Jumani L, et al. Neurotoxoplasmosis in the immunocompetent: a rare occurrence. Cureus 2023;15:e36782. – reference: 7) Pekova L, Parusheva P, Mitev M, et al. A rare case of an HIV-seronegative patient with Toxoplasma gondii meningoencephalitis. IDCases 2021;26:e01271. – reference: 21) Kurdi M, Baeesa S, Maghrabi Y, et al. Diagnostic discrepancies between intraoperative frozen section and permanent histopathological diagnosis of brain tumors. Turk Patoloji Derg 2022;38:34-39. – reference: 14) León Ruiz M. A novel case of solitary cerebral toxoplasmosis mimicking glioblastoma as the first presentation of HIV. J Clin Neurol 2016;12:248-250. – reference: 23) Kyritsis AP, Levin VA, Yung WK, et al. Imaging patterns of multifocal gliomas. Eur J Radiol 1993;16:163-170. – reference: 32) Lasocki A, Gaillard F, Tacey MA, et al. The incidence and significance of multicentric noncontrast-enhancing lesions distant from a histologically-proven glioblastoma. J Neurooncol 2016;129:471-478. – reference: 20) Dammers R, Schouten JW, Haitsma IK, et al. Towards improving the safety and diagnostic yield of stereotactic biopsy in a single centre. Acta Neurochir (Wien) 2010;152:1915-1921. – reference: 26) Thomas RP, Xu LW, Lober RM, et al. The incidence and significance of multiple lesions in glioblastoma. J Neurooncol 2013;112:91-97. – reference: 1) Garg RK, Sinha MK. Multiple ring-enhancing lesions of the brain. J Postgrad Med 2010;56:307-316. – reference: 3) Patel A, More B, Rege I, et al. Clinical diagnosis and management of multiple cerebral ring-enhancing lesions-study of 50 patients at a tertiary healthcare center. J Cancer Res Ther 2024;20:112-117. – reference: 5) Safarpour H, Cevik M, Zarean M, et al. Global status of Toxoplasma gondii infection and associated risk factors in people living with HIV. AIDS 2020;34:469-474. – reference: 15) Clinicalinfo.HIV.gov. [Internet]. Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV. Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV. National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and Infectious Diseases Society of America; 2024 Aug 15. [cited 2024 Sep 10]. Available from https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-opportunistic-infection. English. – reference: 22) Schwartz KM, Erickson BJ, Lucchinetti C. Pattern of T2 hypointensity associated with ring-enhancing brain lesions can help to differentiate pathology. Neuroradiology 2006;48:143-149. – reference: 6) Dian S, Ganiem AR, Ekawardhani S. Cerebral toxoplasmosis in HIV-infected patients: a review. Pathog Glob Health 2023;117:14-23. – reference: 16) Yakhkind A, Yacoub HA, Grove J, et al. Pathogenesis, clinical course and neuro-radiological signs of Proprionibacterium acnes cerebritis: case report and literature review. Hosp Pract 2015;43:128-136. – reference: 25) Barnard RO, Geddes JF. The incidence of multifocal cerebral gliomas. A histologic study of large hemisphere sections. Cancer 1987;60:1519-1531. – reference: 19) Burnham JP, Thomas BS, Trevino SE, et al. De Novo meningitis caused by Propionibacterium acnes in a patient with metastatic melanoma. J Clin Microbiol 2014;52:1290-1293. – reference: 27) Farhat M, Fuller GN, Wintermark M, et al. Multifocal and multicentric glioblastoma: Imaging signature, molecular characterization, patterns of spread, and treatment. Neuroradiol J 2023;10:19714009231193162. – reference: 24) Djalilian HR, Shah MV, Hall WA. Radiographic incidence of multicentric malignant gliomas. Surg Neurol 1999;51:554-558. – reference: 29) Ho ML, Moonis G, Ginat DT, et al. Lesions of the corpus callosum. AJR Am J Roentgenol 2013;200:W1-16. – reference: 4) Otsuji R, Fujioka Y, Hata N, et al. Liquid Biopsy for Glioma Using Cell-Free DNA in Cerebrospinal Fluid. Cancers (Basel) 2024;16:1009. – reference: 9) Agrawal A, Bhake A, Sangole V, et al. Multiple-ring enhancing lesions in an immunocompetent adult. J Glob Infect Dis 2010;2:313-314. – reference: 11) Zawadzki R, Modzelewski S, Naumowicz M, et al. Evaluation of imaging methods in cerebral toxoplasmosis. Pol J Radiol 2023;88:e389-e398. |
| SSID | ssib000959814 ssib058494234 ssib002821941 ssib000940416 ssib002484599 ssib005879791 ssj0060813 |
| Score | 2.4506342 |
| Snippet | 症例は57歳男性．日常的に野良猫との接触歴があった．X年6月より左下肢脱力，7月より意識障害を呈し当院に入院した．髄液検査で細胞数増多，頭部造影MRIで脳内に多発造影... |
| SourceID | jstage |
| SourceType | Publisher |
| StartPage | 224 |
| SubjectTerms | トキソプラズマ脳症 多巣性膠芽腫 多発性膠芽腫 検体サンプリング 膠芽腫 |
| Title | 多発脳造影病変を呈しトキソプラズマ脳症との鑑別に苦慮した多巣性膠芽腫の1例 |
| URI | https://www.jstage.jst.go.jp/article/clinicalneurol/65/3/65_cn-002019/_article/-char/ja |
| Volume | 65 |
| hasFullText | 1 |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| ispartofPNX | 臨床神経学, 2025, Vol.65(3), pp.224-229 |
| journalDatabaseRights | – providerCode: PRVAFT databaseName: Open Access Digital Library customDbUrl: eissn: 1882-0654 dateEnd: 99991231 omitProxy: true ssIdentifier: ssib000959814 issn: 0009-918X databaseCode: KQ8 dateStart: 20080101 isFulltext: true titleUrlDefault: http://grweb.coalliance.org/oadl/oadl.html providerName: Colorado Alliance of Research Libraries |
| link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwrV3La9RAGA-lgngRn_imB-eYuklmkpljspu1CBWEFnoL2TyQRVcp24un7tZqtad6KXrQgvVFsSAehEL9Z-K22__C75tJ1kQsaBFKGGZ-871mZuf7pvPQtOuCW4kThky3QoPqlCaW3opjij-GKWNpaEQtPCg8fduemqW35tjc2Dgr7Vpa6LYmo0d_PFdylFaFPGhXPCX7Dy07IgoZkIb2hS-0MHz_qo2Jz4hLiXCJ7xAhiAcJTjglnkV8gZsY3BpivAbxDIlxCGd5LS6IbxFuEmFijjAI5zLHQBgmrCLHJG4jT3iNvGiEcQs6yF0V-SUxFFMnp-wWLFwfJQSm8AfcgZHLiiJPVveIaxPfRoERXBYMEs2S7qCgQ1xLgkFlR1a3pe6QcKXMXNLxRtyBK8jnA5uyey5xjpSSoT5cWhYkQ5Uc4oGgdcm4AcIVfVViDWlhhlzAAtBvJX2OAoFYQNATFbxFPBu5eTUUvsA3pMkUlSrelHa2iagTt67w0i5oEQfN4ZbwwLBJhFcYVig8CNPE-oqKeuawWPBRx8Ll4JTlUukRu8NtIKWuQytUZj8Bk5t8yhnmfjXhYYSFB4zLM6J6vSMf-VZ5elPn3XNPyVRrVb9PwswWeKlvcbJX3st6bzLq6Bia5PNj9YrzfAAF1SqBzQILP1EnUFWDEfBuOB-0ISw6ZjrgYOJejDulqELQWuWf6YIJXtosYFJOmaisOhjl49yMO8L5dYUUuOgCgg5aOHg2eNGjBxrRnGqDIKp94zClwb9tQ7RX7BSVzuvMKe1kHnVOuEqx09pYOzyjHZ_O99Wc1e4PNl_tv9wZPv56sLgx2P2yv7482HyW9V8M1lay3nq2tJL1P2f93WwJ0p-y_k629BrA--tPs97HrLd9sLY2WHmX9baGq-_3lrexSu8N0Bx8e7u3-GH4ZGP4fHe4vAVI48f31XPabNOfqU_p-UMsehv8964uRJyARdCjTVgrjSCGMZNaFNM0gaK4lVoxT1MzcRgzEzuNbJEkRgSBXcJpajihdV4b7zzoJBe0CVxwonEtDsFcNLLQtlEtjcCBhsCMWeZF7aYyVPBQ3bYTHLVzXPpvlC5rJ3AcqoXXK9p4d34huQqhSLd1TXa8n0JvCaU |
| linkProvider | Colorado Alliance of Research Libraries |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=%E5%A4%9A%E7%99%BA%E8%84%B3%E9%80%A0%E5%BD%B1%E7%97%85%E5%A4%89%E3%82%92%E5%91%88%E3%81%97%E3%83%88%E3%82%AD%E3%82%BD%E3%83%97%E3%83%A9%E3%82%BA%E3%83%9E%E8%84%B3%E7%97%87%E3%81%A8%E3%81%AE%E9%91%91%E5%88%A5%E3%81%AB%E8%8B%A6%E6%85%AE%E3%81%97%E3%81%9F%E5%A4%9A%E5%B7%A3%E6%80%A7%E8%86%A0%E8%8A%BD%E8%85%AB%E3%81%AE1%E4%BE%8B&rft.jtitle=%E8%87%A8%E5%BA%8A%E7%A5%9E%E7%B5%8C%E5%AD%A6&rft.au=%E5%B1%B1%E5%85%83%2C+%E4%B8%80%E6%A8%B9&rft.au=%E5%B3%B6%E8%B0%B7%2C+%E4%BD%B3%E5%85%89&rft.au=%E5%B2%A9%E6%9C%AC%2C+%E5%AE%97%E7%9F%A9&rft.au=%E6%AF%9B%E5%88%A9%2C+%E8%8F%9C%E6%9C%88&rft.date=2025&rft.pub=%E6%97%A5%E6%9C%AC%E7%A5%9E%E7%B5%8C%E5%AD%A6%E4%BC%9A&rft.issn=0009-918X&rft.eissn=1882-0654&rft.volume=65&rft.issue=3&rft.spage=224&rft.epage=229&rft_id=info:doi/10.5692%2Fclinicalneurol.cn-002019&rft.externalDocID=article_clinicalneurol_65_3_65_cn_002019_article_char_ja |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0009-918X&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0009-918X&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0009-918X&client=summon |