'Raisin bread sign' feature of pontine autosomal dominant microangiopathy and leukoencephalopathy

Pontine autosomal dominant microangiopathy and leukoencephalopathy is one of hereditary cerebral small vessel diseases caused by pathogenic variants in COL4A1 3'UTR and characterized by multiple small infarctions in the pons. We attempted to establish radiological features of this disease. We performed whole exome sequencing and Sanger sequencing in one family with undetermined familial small vessel disease, followed by clinicoradiological assessment and a postmortem examination. We subsequently investigated clinicoradiological features of patients in a juvenile cerebral vessel disease cohort and searched for radiological features similar to those found in the aforementioned family. Sanger sequencing was performed in selected cohort patients in order to detect variants in the same gene. An identical variant in the COL4A1 3'UTR was observed in two patients with familial small vessel disease and the two selected patients, thereby confirming the pontine autosomal dominant microangiopathy and leukoencephalopathy diagnosis. Furthermore, postmortem examination showed that the distribution of thickened media tunica and hyalinized vessels was different from that in lacunar infarctions. The appearance of characteristic multiple oval small infarctions in the pons, which resemble raisin bread, enable us to make a diagnosis of pontine autosomal dominant microangiopathy and leukoencephalopathy. This feature, for which we coined the name 'raisin bread sign', was also correlated to the pathological changes.

[A case of atypical progressive supranuclear palsy with degeneration of the fronto-pontine tracts, and without grumose degeneration of the dentate nucleus]

An autopsy case of progressive supranuclear palsy (PSP) with degeneration of the fronto-pontine tracts of the midbrain and pons, and without grumose degeneration of the dentate nucleus is reported. A 72-year-old woman was suffering from dysarthria and gait disturbance. Moderate dementia was noted and gradually worsened. Pyramidal and extrapyramidal signs and cerebellar ataxia were not observed. Eye movements were fully preserved. Brain CT showed cerebellar atrophy. Three years later, she was unable to stand or move, and became mutistic. At the age of 75, she died suddenly. The duration of her illness was approximately 4 years. Clinical diagnosis was LCCA (late cortical cerebellar atrophy). Neuropathological examination revealed gliosis of the deep layers of the cerebral cortex around the precentral gyrus, fronto-pontine tracts degeneration (posterior part of the anterior crus, genu and anterior part of the posterior crus of the internal capsule, cerebral peduncles of the midbrain, pontine base and pyramis of the medulla oblongata). Also, atrophy of the pons and marked degeneration of the superior colliculi and substantia nigra were observed. Neurofibrillary tangles (NFTs) and glial fibrillary tangles (GFTs) were found in the subcortical nuclei. These findings were almost consistent with PSP. However, the following differed from those of previously reported typical PSP cases: firstly, mild gliosis in the reticular formation of the midbrain; secondly, few NFTs in the pontine nuclei and superior colliculi and; thirdly, no grumose degeneration in the dentate nucleus. In addition, clinical symptoms of the present case are not consistent with PSP. Therefore, we concluded this case to be an atypical PSP both clinically and neuropathologically.

[Rapid diagnosis and therapeutic evaluation of herpes simplex encephalitis using polymerase chain reaction from cerebrospinal fluids]

We made a diagnosis and therapeutic evaluation of herpes simplex encephalitis using polymerase chain reaction (PCR). Cerebrospinal fluids (CSF) of 24 patients suspected of meningoencephalitis were examined by PCR. HSV (herpes simplex virus) DNA was demonstrated in 3 patients, in which CSF anti-HSV antibody raised, and moreover in another patient, lacking the raise of the HSV antibody. Since this patient was considered to suffer from HSV encephalitis by clinical symptoms and findings on brain CT, this result suggests authenticity of the PCR for detection of HSV infection. HSV-DNA in the 4 patients were semi-quantitated. The amount of the DNA reduced and disappeared corresponding to their improvement of clinical symptoms and laboratory data. Thus, the present method is considered to be useful for rapid diagnosis of HSV encephalitis, and also for evaluation of effects of therapy to decide whether administration of anti-herpes drugs should be stopped.

[Studies on lithium potentiation of antidepressant treatment]

The effects of chronic administration of clomipramine or citalopram (CMI or CIT, 20 mg/kg i.p. daily for 19 days) with/without short-term administration of lithium (Li, 2 mEq/kg i.p. daily for 5 days) on the concentration of monoamines and their metabolites and serotonergic receptors were studied in the rat cerebral cortex. Li or CMI by itself had no effects on the concentration of monoamines and their metabolites, but a combination of CMI and Li increased that of 5-HIAA. CIT alone increased that of 5-HIAA, and a combination of CIT and Li increased that of 5-HIAA more than CIT alone. There were no changes in 5-HT or 5-HIAA after acute administration of CMI or CIT with/without Li. For the serotonergic receptors, [3H] 8-OH-DPAT and [3H] paroxetine binding did not change in any of the treatments. CMI alone or a combination of CMI and Li reduced [3H] ketanserin binding, but Li did not potentiate this effect. It is speculated that the therapeutic action of Li when added to tricyclic antidepressants in the treatment of refractory depression may partly have its basis in potentiation of effects on the activation of presynaptic serotonergic system.

[Effects of risperidone on catalepsy and cerebral dopamine, serotonin and GABA metabolism in the rat: comparison with haloperidol]

Effects of risperidone (RIS, 1 mg/kg) and haloperidol (HPD, 1 mg/kg) on catalepsy, and monoamine and GABA metabolism were examined in the rats. Catalepsy was evaluated by means of a horizontal bar method. The rats were sacrificed 3 h after orally administered HPD or RIS. Levels of monoamines and their metabolites determined by HPLC-ECD, and GABA levels were determined by a radioreceptor assay. The score of catalepsy was significantly low 120 min after administration of RIS as compared to HPD. In comparison to control, HPD treatment significantly increased DOPAC in the frontal cortex, thalamus + hypothalamus, and striatum, and HVA in the striatum. In RIS-treated rats, DOPAC and HVA were significantly increased in the striatum. Moreover, RIS increased 5-HIAA in the frontal cortex, hippocampus, thalamus + hypothalamus, mid brain, pons and striatum. The concentration of GABA was unchanged in all areas of the brain after treatment with HPD, but was significantly decreased in the pons in RIS-treated rats. The present results suggested that the effects of RIS on serotonin and GABA metabolism may be related to the cause of the low potency of RIS to induce catalepsy.

[A manifesting carrier of Duchenne muscular dystrophy presenting mosaic distribution of dystrophin negative and positive muscle fibers]

A 25-year-old female patient with an approximate 10-year-history of slowly progressive muscle weakness was diagnosed as a manifesting carrier of Duchenne muscular dystrophy (DMD) because her muscle biopsy showed scattered fibers with no dystrophin on immunohistochemical staining. She had no family history of neuromuscular disorders. She was in good health until about 14 years of age, when she developed muscle weakness and atrophy of the extremities with slow aggravation. On admission at the age of 25 years, she had asymmetrical muscle atrophy in the lower extremities; the left femur, right femur, left crus, and right crus measured 36.0, 40.5, 31.5, and 35.5 cm in circumference, respectively. However, the muscle weakness of the extremities was symmetrical with no laterality, and the proximal muscles in the lower extremities were predominantly affected to 3+/5 MMT test. She walked with a mild wadding manner and stood up with Gower' maneuver. Deep tendon reflexes of the extremities were almost normoactive with no pathologic reflexes. As to laboratory findings, serum enzymes of muscular origin were elevated; GOT was 44 IU/l, GPT 60 IU/l, LDH 829 IU/l, CK 4238 IU/l, and aldolase 31 SL units. The electromyogram showed myopathic changes mixed with some neurogenic components. Peripheral nerve conduction velocity was normal. A computed tomography of the skeletal muscles showed more marked atrophy and lower density in the left lower extremity than in the right. The biopsied left gastrocnemius muscle demonstrated a marked variation in fiber size with some necrotic and regenerating fibers. On immunohistochemical stain with anti-dystrophin antibody, the dystrophin negative fibers were scattered among positive fibers in a mosaic distribution.