Spastic pure motor monoparesis

Pure motor hemiplegia (PMH) is, in most cases, caused by a lacunar infarction. However, pure motor monoparesis (PMM), i.e., isolated motor involvement with spasticity in one limb, has drawn little attention. We studied prospectively 5 patients with PMM and found that it was always due to a mass lesion in the contralateral superficial cerebral hemisphere. Our observation suggests that PMM should not be regarded as simply a variant of PMH.

Progressive multifocal leukoencephalopathy and magnetic resonance imaging

Progressive multifocal leukoencephalopathy developed in a homosexual man with underlying Hodgkin's disease. Computed tomography and magnetic resonance imaging of the brain demonstrated multiple lesions, more in gray than white matter. Brain biopsy established the diagnosis of progressive multifocal leukoencephalopathy. Magnetic resonance imaging was found useful for detecting brain lesions and for localizing an accessible lesion for biopsy.

Herpes simplex virus encephalitis. A case with dysplastic plasma cell infiltration

A case of herpes simplex virus (HSV) encephalitis was diagnosed by means of a brain biopsy specimen on the 31st day of the illness. The infiltrate showed dense plasma cells, with dysplastic features that mimicked plasma cell neoplasm. The diagnosis of HSV encephalitis was substantiated by the finding of intranuclear virus particles and by seroconversion with HSV-specific enzyme-linked immunosorbent assay tests in blood serum and cerebrospinal fluid. This histologic appearance correlated temporally with the time of peak seroconversion. Extensive plasma cell infiltrate may be an unrecognized variant of the histopathology of HSV encephalitis in its subacute phase, and only careful electron microscopic study will establish the diagnosis.

Complement-dependent lysis of cultured rat myotubes by myasthenic immunoglobulins

We used cultured myotubes to demonstrate complement-dependent lysis of muscle membranes by serum from patients with myasthenia gravis. Lysis was monitored by light microscopy and release of incorporated [86Rb]. In the presence of guinea pig complement (GPC), 18 of 37 heat-inactivated myasthenic sera (49%), but none of 16 controls, caused morphologically detectable myotube lysis. Ten of 19 myasthenic sera (53%) increased [86Rb]-release compared with 10 controls. Immunoglobulin fractions retained the complement-dependent lytic activity. Inactivation of GPC prevented the lysis. [86Rb]-release appeared to correlate with clinical severity. The complement-dependent lysis resulted in a decrease in the number of acetylcholine receptors (AChRs) in myotubes, and AChR-immunoglobulin complexes were found in the medium of lysed cultures. The data suggest that cultured myotubes can be used to document complement-dependent antibody reactions in the pathogenesis of myasthenia.

The hot bath test in multiple sclerosis: comparison with visual evoked responses and oligoclonal bands

We studied 50 patients with definite, probable, and possible multiple sclerosis (MS), prospectively (20 patients) and retrospectively (30 patients), to determine the value of the hot bath test for diagnosing MS and to compare it to visual evoked responses and oligoclonal bands. The hot bath test was abnormal in 8 of the 23 patients with definite MS (35%), and 4 of the 27 patients with probable or possible MS (15%). Only one patient with an abnormal hot bath test did not also have other evidence of definite multiple sclerosis. Our results suggest that the hot bath test seldom adds diagnostic information, especially when tests for evoked responses and oligoclonal bands are available.

Endogenous inhibitor of ligand binding to the muscarinic acetylcholine receptor

An endogenous inhibitor of L-[3H]quinuclinidinyl benzilate binding to the brain muscarinic acetylcholine receptor was identified. [3H]Quinuclinidinyl benzilate binding to rat brain synaptosomes was measured using a filtration assay. The inhibitor was prepared from several calf tissues and was found in highest specific activity in thymus. The loss of binding activity was slow, requiring a 30-40 min preincubation of the synaptosomes with the inhibitor, and reversed by removing the inhibitor by washing the membranes. Scatchard analysis of the binding data showed that the inhibition was noncompetitive resulting from both a decrease in affinity and a decrease in the number of binding sites. Zn2+ was required in low concentrations for this effect. Muscarinic acetylcholine receptor in synaptic membranes and in membranes free of most peripheral membrane proteins was still sensitive to inhibition. Preliminary characterization of the inhibitory molecule showed that it is of low molecular weight, moderately heat-stable, and acidic. The inhibitor was inactivated by reagents that are nonspecific for nucleophiles, but not by reagents specific for primary amine or thiol groups.

Anorexia nervosa precipitated by a prepubertal pyometra

A severe pyometra was found in a typical case of anorexia nervosa, with the latter illness apparently precipitated by the former. Compulsory alimentation before and after operation brought some weight gain as well as reversal of dilated cerebral sulci and hypothyroidism, though hypothalamo-pituitary dysfunction persisted.

Ligation and catheterization of the hepatic artery for palliative treatment of malignant hepatic tumors

Eleven unresectable hepatoma patients and three metastatic tumor patients with colonic cancer underwent ligation and/or catheterization of the hepatic artery of the main tumor-bearing zone. Mitomycin C (liquid or microcapsulated) or Adriamycin were administered via the catheter intermittently or continuously with a portable pump device. In follow-up study the tumor size was frequently visualized by arteriography via the cannula. Some tumors became smaller with calcification. The levels of alpha-Fetoprotein of CEA in some cases dropped remarkably and stayed low for a fairly long period. There was no immediate postoperative death. Six of 11 unresectable hepatoma patients survived longer than 8 months with a maximum survival of 17.5 months. Two of three metastatic patients have survived more than 11 months at this writing. This method seems effective for prolongation of patient survival.

A dominantly inherited syndrome with continuous motor neuron discharges

A distinct syndrome with continuous motor neuron discharges apparently developed in seven members of a single family, involving both sexes and spanning three generations. Persistent vermiform twitching and episodic stiffness predominantly in lower extremity muscles occurred in early childhood and tended to be less severe in adulthood. In 2 patients the clinical manifestations improved with oral phenytoin and carbamazepine but not with parenteral diazepam. Insertional activity was normal, and continuous, rhythmical, normal-appearing muscle discharges were observed on electromyography. The cerebrospinal fluid levels of homovanillic acid and 5-hydroxyindoleacetic acid were increased in the proband. The disappearance of continuous muscle discharges during spinal anesthesia and the lack of response to diazepam indicated generation of the discharges from the proximal portion of the motor unit.

Acetylcholine receptor turnover in myasthenia gravis

Humoral antibodies directed against the acetylcholine receptor are present in most patients with myasthenia gravis. These antibodies accelerate receptor degradation and thus cause a decrease in receptor level and impaired neuromuscular transmission. The stimulus that triggers and sustains the formation of the antibodies has not been identified, but it is possible that the primary antigen may be located on the cell surface of thymic lymphocytes. In some situations the clinical state in myasthenia gravis does not correlate with the antibody titer, suggesting that other factors also influence receptor amount and/or function of other potential regulators that have been investigated. Calcium and agents that increase cyclic AMP appear to increase the formation of the receptor and thus might serve to mitigate the effects of the circulating antibodies. In contrast, cholinergic agonists may cause a further decrease in receptor number, providing an explanation of why myasthenic patients may become resistant to therapy.

Interaction of myasthenic immunoglobulins and cholinergic agonists on acetylcholine receptors of rat myotubes

Acetylcholine receptor (AChR) antibodies from patients with myasthenia gravis (MG) impair neuromuscular transmission by altering the number of AChRs at the skeletal muscle motor endplate. Cholinergic agonists similarly impair transmission by altering the number and affinity of AChRs. The frequent clinical resistance ot anticholinesterase medication in patients with MG has raised the question of possible synergistic effects of these agents on regulation of AChRs and neuromuscular transmission. To investigate this question, rat myotube cultures were incubated with MG globulin and carbamylcholine (CMC) for 20 hours. The number of AChRs was assayed by 125I-alpha-bungarotoxin binding. Incubation of cultures with both MG globulins and CMC consistently produced greater reductions of AChRs than incubation with either substance alone. Cholinergic antagonists blocked the CMC effect but not the MG globulin effect. A muscarinic antagonist had no effect. The effects of short-term incubation with these substances on the affinity of AChR were assessed by the rate of 125I-alpha-bungarotoxin-AChR complex formation. CMC desensitized AChRs, but MG globulins did not alter the affinity of AChRs. Results with this in vitro model suggest that chronic anticholinesterase therapy in the presence of MG AChR antibodies may aggravate failure of neuromuscular transmission in MG.

Disruption of the purine nucleotide cycle. A potential explanation for muscle dysfunction in myoadenylate deaminase deficiency

A patient with symptoms of easy fatigability, postexercise myalgias, and delayed recovery of muscle strength after activity is described. Skeletal muscle from this patient had <1.0% normal myoadenylate deaminase activity and NH(3) was not released from muscle after ischemic exercise. In association with this enzyme deficiency, exercise led to a >90% reduction in muscle content of adenine nucleotides. No inosine monophosphate accumulated after exercise and total purine content of the muscle fell to 21% of control. Repletion of the adenine nucleotide pool in this patient was delayed compared to controls, and ATP content had only returned to 68% of control at 165 min after exercise. These studies demonstrate that disruption of the purine nucleotide cycle as a consequence of myoadenylate deaminase deficiency results in marked alterations in ATP content of muscle, and potentially, these changes in ATP content could account for muscle dysfunction in this patient.

Antitumor activity of 7-N-phenyl derivatives of mitomycin C in the leukemia P388 system

The antitumor activity of 7-N-phenyl derivatives of mitomycin C was tested in an ip-ip system of mouse leukemia P388 by single administration. The compounds tested were 7-N-phenyl-, 7-N-(p-aminophenyl)-, 7-N-(p-hydroxyphenyl)- and 7-N-(p-chlorophenyl)-mitomycin C. The maximum increases in life span (ILSmax) obtained were 124, 169, > 386 and 112%, respectively, that with mitomycin C being 104%. 7-N-(p-Hydroxyphenyl)-mitomycin C showed a higher ILS% than its ortho and meta isomers. Thus, 7-N-(p-hydroxyphenyl)-mitomycin C was the most effective of these compounds.

Meige's syndrome

We present two women with Meige's syndrome, a condition in which the clinical presentation differs from tardive dyskinesia by the lack of exposure to neuroleptic drgus, greater severity of blepharospasms, and more prolonged dystonic contractions of oromandibular muscles. In this condition we used triaxial accelerometry to detect dystonia, which may also appear in limb and respiratory muscles. Although psychologic factors may affect the symptoms, the basic pathogenesis of this syndrome does not seem to be psychogenic. We think that biochemical abnormalities in the basal ganglia are responsible for the dyskinesias and submit data suggesting a reduction of dopamine turnover in the central nervous system of one patient. Both patients have evidence of autoimmune diseases, and one patient's dystonic movements responded to immunosuppressive therapy, suggesting that autoimmune processes contribute to the pathogenic mechanism of Meige's syndrome in some instances.