The potential of transcranial direct current stimulation (tDCS) as a non-invasive brain stimulation technique for treating pain has been studied. However, its effectiveness in patients with central post-stroke pain (CPSP) and the impact of lesion location remain unclear. This study investigated tDCS’s pain reduction effects in patients with CPSP. Twenty-two patients with CPSP were randomized into the tDCS or sham groups. The tDCS group received stimulation of the primary motor cortex (M1) for 20 min, five times weekly, for two weeks, and underwent evaluations at baseline, immediately after the intervention, and one week after the intervention. The tDCS group had no significant improvement compared to the sham group in pain, depression, and quality of life. Nevertheless, significant changes were identified within the tDCS group, and the pain trends appeared to be influenced by the lesion location. These findings provide important insights into the use of tDCS in patients with CPSP, which could inform further research and development of pain treatment options.

Peripheral neuropathy in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis may present as mononeuritis multiplex, but early recognition can be difficult when focal foot drop is the dominant manifestation. We report the case of a 63-year-old man with fibrotic interstitial lung disease and prior atypical perinuclear ANCA positivity who developed painful, asymmetric lower-extremity sensory symptoms, followed by recurrent right foot drop. Nerve conduction studies and needle electromyography demonstrated an asymmetric, non–length-dependent, multifocal axonal neuropathy involving the right common peroneal distribution, bilateral tibial nerves, selected distal sensory nerves, and bilateral ulnar sensory nerves, consistent with mononeuritis multiplex. Five days later, he was hospitalized for a left lateral medullary infarction; brain magnetic resonance imaging showed diffusion restriction in the left lateral medulla, and noncontrast time-of-flight magnetic resonance angiography favored left posterior inferior cerebellar artery dissection rather than definite angiographic vasculitis. Repeat testing disclosed high-titer myeloperoxidase (MPO)-ANCA, elevated inflammatory markers, and worsening renal function. Sural nerve biopsy was nondiagnostic. The rheumatology team diagnosed MPO-ANCA–positive microscopic polyangiitis, and glucocorticoids, cyclophosphamide, and later rituximab were administered. This case illustrates that microscopic polyangiitis may evolve over years and may present with predominant peripheral neuropathy before overt systemic disease becomes apparent. Electrodiagnostic testing provided objective confirmation and localization of clinically suspected mononeuritis multiplex, supporting repeated diagnostic reassessment for systemic vasculitis.

Background: The prevalence of adhesive capsulitis (AC) is estimated to be 2–5% in the general population. However, the etiology of AC remains unclear. Among the various proposed factors, the precise role of cervical disease, and the severity of cervical degeneration, in the development of AC has not been fully elucidated. This study aimed to analyze the contribution of cervical disease to AC in patients with shoulder pain. Methods: A total of 409 patients who visited the Department of Rehabilitation Medicine for shoulder pain were retrospectively reviewed. The outcome variable was the presence of AC. In addition to cervical disease, other independent variables affecting AC, including sex, diabetes, obesity, dyslipidemia, thyroid disease, immobilization after surgery, rotator cuff tear, subacromial spur, and shoulder joint osteoarthritis were reviewed. To compare the two groups, an independent t-test or chi-square test was performed for continuous and categorical data. Multivariate regression analysis was used to assess the effects of independent factors on AC, adjusting for confounders. Results: Among the 409 patients, 176 (43.0%) were diagnosed with AC. Multivariate analysis demonstrated that diabetes (OR 3.03, 95% CI 1.55–5.91, p = 0.001) and cervical disease (OR 3.03, 95% CI 1.75–5.25, p < 0.001) were significantly associated with increased odds of AC. In contrast, increasing age (OR 0.95, 95% CI 0.92–0.98, p = 0.007), dyslipidemia (OR 0.55, 95% CI 0.31–0.98, p = 0.044), and postoperative immobilization (OR 0.64, 95% CI 0.41–0.99, p = 0.046) were associated with decreased odds of AC. The prevalence of AC increased with the severity of cervical degeneration. Conclusion: In patients with shoulder pain, diabetes and cervical disease were positively associated with AC, whereas age, dyslipidemia, and postoperative immobilization showed inverse associations. These findings suggest that both metabolic and cervical factors may contribute to the development of AC, highlighting the importance of considering cervical pathology in patients with shoulder pain.