[Three-dimensional surface display with 123I-IMP in corticobasal degeneration]

A 65-year-old right-handed woman was admitted due to gait disturbance. She had suffered from progressive motor clumsiness in the left-sided limbs for four years. On admission, she was mildly demented, but not aphasic. Neurological examination disclosed constructional disability, limb-kinetic apraxia on the left side, and parkinsonism. Brain CT and MRI showed no responsible lesion. Three-dimensional surface display with 123I-IMP demonstrated decreased cerebral blood flow mainly in the right angular gyrus, and mildly in the right central region. She was clinically diagnosed as having corticobasal degeneration. Hypoperfusion in the angular gyrus and central region may account for constructional disability and limb-kinetic apraxia, respectively. Three-dimensional surface display with 123I-IMP appears to be useful for detecting the cortical region.

[Correlation of visual evoked potentials with dementia in Parkinson's disease]

There has been some debate regarding abnormalities in visual evoked potentials (VEP) in Parkinson's disease (PD). To elucidate the mechanism causing abnormal VEP, we investigated the relationship between VEP and mental function in PD patients. Pattern reversal VEP was recorded in PD patients (n = 27) and age-matched control subjects (n = 14). PD patients consisted of two subgroups; PD without dementia (nD-PD; n = 17) and PD with dementia (D-PD; n = 10). Dementia was evaluated according to the criteria for dementia assigned in DSM III-R, and mental faculties were estimated by using the mini-mental state examination (MMSE). In pattern VEP recordings, P100 latency and amplitude were measured for each eye stimulated. No patient or control subject had impairment of corrected visual acuity or ophthalmological disease. There was no significant difference in age among the three groups (D-PD, nD-PD and control subjects). D-PD patients showed significantly prolonged P100 latency compared to nD-PD patients and control subjects (p less than 0.05). With respect to P100 amplitude, no significant difference was shown among the three groups. In PD patients, there was a rough correlation between P100 latency and MMSE score. No correlation was found between P100 amplitude and MMSE score. In control subjects, P100 latency did not correlate with advancing age. In PD patients, nD-PD patients showed a significant correlation between P100 latency and age, whereas D-PD patients presented no correlation. Abnormal VEP in PD has been mostly ascribed to dopaminergic deficiency in the retina.(ABSTRACT TRUNCATED AT 250 WORDS)

Motor neuron disease with slow eye movements and vertical gaze palsy

Two middle-aged patients with motor neuron disease showed common eye movement disorders and intellectual impairment in the later stage of the illness. Eye movement disorders were characterized by slow saccades and vertical glaze palsy, which seemed to be supranuclear ophthalmoplegia. Neuropathological examination of one patient revealed degeneration of the substantia nigra without pathological changes in the ocular motor nuclei, in addition to findings compatible with motor neuron disease. These cases appear to raise a possibility of a distinct group of multiple system degenerations.

[A case of posttraumatic parkinsonism]

We report a case of a 52-year-old man with posttraumatic parkinsonism. He was admitted to our department because of right-sided hand tremor and gait disturbance. He had suffered from a severe head injury incurred in a traffic accident with brief unconsciousness 6 months before admission. Three weeks after his injury, tremor and rigidity in the right upper limb developed, and he walked dragging his right leg. Five months after his injury, he received 1-dopa therapy, exhibiting a moderate improvement in parkinsonian symptoms. On admission, he was demented to a mild degree with masked face and monotonous speech. He presented with resting-postural-kinetic tremor and muscle rigidity on the right side. Cranial CT and MRI showed no abnormality. Inter-peak latencies of waves III to V of BAEP were significantly longer in this patient than in normal subjects. This BAEP findings suggested an upper brainstem lesion. 123I-IMP SPECT disclosed decreased cerebral blood flow in the left thalamus, bilateral frontal and parietal cortices. We diagnosed this case as having posttraumatic parkinsonism. Parkinsonism in the present case may be due to the involvement of multiple neuronal circuits of the extrapyramidal system at the level of the midbrain to the thalamus.

Spinocerebellar degeneration with slow eye movements and abducens nerve palsy

A 51-year-old woman with spinocerebellar degeneration manifested an unusual disorder of eye movements. She presented with bilateral abducens palsy and slow eye movements in the horizontal plane. Slow eye movements typically are seen with supranuclear lesions, whereas abducens palsies are of nuclear or infranuclear origin. This unique combination of eye movement disorders is discussed, as well as other features of ophthalmoplegias associated with spinocerebellar degeneration.

[A case of persistent proatlantal intersegmental artery with status epilepticus]

A 48-year-old woman with status epilepticus was admitted to our hospital. On admission, she was comatose with horizontal conjugate deviation of eye balls to the left side. Convulsive seizure of Jacksonian type involved initially the left mouth angle and sequentially the left arm and leg, developing into general convulsion. Routine laboratory examinations revealed no significant abnormality. CT scan was normal but carotid angiogram showed a persistent proatlantal intersegmental artery on the left side. Convulsive seizure lasted five days, followed by left hemiparesis. She recovered completely two weeks later. The origin of her illness remained unclear but the causal relationship between neurological symptoms and the persistent primitive artery was presumed.

Changes in the cerebello-cerebral response in the parietal cortex following ablation of the motor cortex in the cat: early occurrence and persistence

To elucidate the compensatory mechanism which begins to work soon after damage to the brain, changes in the cerebellar-induced cerebral cortical response in the parietal association cortex after ablation of the frontal motor cortex were studied in the cat. Stimulation of the interpositus or the lateral nucleus of the cerebellum before decortication, as reported in intact animals, induced two distinct types of response in the frontal motor and parietal association cortices respectively. The response in the frontal cortex was a sequential occurrence of a surface positive-depth negative (sP-dN) wave and a surface negative-depth positive (sN-dP) wave, and the response in the parietal cortex was mainly an sN-dP wave. In a small proportion of animals, the latter wave was preceded by a small sP-dN wave or a small dN wave without an sP wave. Ablation of the frontal motor cortex induced in the majority of animals a marked change in the cerebello-parietal cortical response, i.e. the occurrence of a new sP-dN wave preceding the sN-dP wave or enhancement of the pre-existing small dN wave, resulting in the parietal cortical response similar to the frontal cortical response of intact animals. The earliest post-lesion time observed for the occurrence of change was less than 1 hour, whereas its persistence was confirmed up to 213 days post-lesion.

A sensory level on the trunk in lower lateral brainstem lesions

We report nine cases of vascular lesions in the lateral aspect of the lower brainstem. Five patients showed a sensory defect involving one side of the face and the contralateral leg, trunk, or both (crossed pattern). This contralateral defect involved the foot and extended upwards to end in a sensory level. Three other patients had a continuous hemisensory defect of the face, arm, and trunk (unilateral pattern), with the lower border demarcated at a sensory level. One patient had a combined pattern of both crossed and unilateral defects with sensory loss of the bilateral face and the unilateral limbs and trunk. Magnetic resonance imaging revealed lesions in the lateral pons and medulla in six cases. Far-lateral lesions were responsible for the crossed sensory defects, and mediolateral lesions resulted in the unilateral sensory defects.

CT findings of cerebral paragonimiasis in the chronic state

The CT findings in 5 patients with cerebral paragonimiasis in the chronic state are presented. The findings were: 1) multiple, densely calcified areas with a variety of round or nodular shapes in the brain, 2) a large low density area surrounding or connecting with the calcified areas, and 3) cortical atrophy and ventricular dilatation. The relation between the CT findings and the previously reported plain skull X-ray findings or neuropathological findings are discussed.