Hiromi Tateno

Levodopa Does Not Worsen Gastric Emptying in Parkinson's Disease.

pneumonia severity on presentation to hospital: An international derivation and validation study. Thorax 2003;58:377–382. 5. Miyashita N, Matsushima T, Oka M et al. The JRS guidelines for the management of community-acquired pneumonia in adults: An update and new recommendations. Intern Med 2006;45:419–428. 6. Shigematsu K, Nakano H, Watanabe Y. The eye response test alone is sufficient to predict stroke outcome—reintroduction of Japan Coma Scale: A cohort study. BMJ Open 2013;e002736. doi: 10.1136/bmjopen-2013002736. 7. Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010;39:412–423. 8. Kuroda Y, Kuroda R. Relationship between thinness and swallowing function in Japanese older adults: Implications for sarcopenic dysphagia. J Am Geriatr Soc 2012;60:1785–1786. 9. Wakabayashi H. Presbyphagia and sarcopenic dysphagia: Association between aging, sarcopenia, and deglutition disorders. J Frailty Aging 2014;3:97–103. 10. Maeda K, Akagi J. Decreased tongue pressure is associated with sarcopenia and sarcopenic dysphagia in the elderly. Dysphagia 2015;30:80–87.

Myasthenia Gravis Manifesting As Head Drop in an Elderly Adult with Parkinson's Disease.

1. Heffernan C, Pachter HL, Megibow AJ et al. Stercoral colitis leading to fatal peritonitis: CT findings. AJR 2005;184:1189–1193. 2. Rozenblit AM, Cohen-Schwartz D, Wolf EL et al. Case reports: Stercoral perforation of the sigmoid colon—computed tomography findings. Clin Radiol 2000;55:727–729. 3. Hudson J, Abid Malik A. A fatal faecaloma stercoral colitis: A rare complication of chronic constipation. BMJ Case Rep 2015. doi: 10.1136/bcr2015-211732 4. Postuma RB, Berg D, Stern M et al. MDS clinical diagnostic criteria for Parkinson’s disease. Mov Disord 2015;30:1591–1601. 5. Sakakibara R, Odaka T, Lui Z et al. Dietary herb extract dai-kenchu-to ameliorates constipation in parkinsonian patients (Parkinson’s disease and multiple system atrophy). Mov Disord 2005;20:261–262. 6. Grinvalsky HT, Bowerman CI. Stercoraceous ulcers of the colon: Relatively neglected medical and surgical problem. JAMA 1959;171:1941–1946. 7. Sakakibara R, Kishi M, Ogawa E et al. Bladder, bowel, and sexual dysfunction in Parkinson’s disease. Parkinsons Dis 2011;2011:924605. 8. Sakakibara R, Tateno F, Kishi M et al. MIBG myocardial scintigraphy in pre-motor Parkinson’s disease: A review. Parkinsonism Relat Disord 2014;20:267–273. 9. Shiina S, Sakakibara R, Doi H et al. Levodopa does not worsen gastric emptying in Parkinson’s disease. J Am Geriatr Soc 2015;63:2185– 2186. 10. Sakakibara R, Doi H, Sato M et al. Nizatidine ameliorates slow transit constipation in Parkinson’s disease. J Am Geriatr Soc 2015;63:399– 401.

Transdermal Dopamine Agonist Ameliorates Gastric Emptying in Parkinson's Disease.

This research is supported by Grant T15LM007442 from the National Library of Medicine. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Chaudhuri: study design, recruitment, data collection, preparation of manuscript. Oudejans: data analysis and interpretation. Thompson, Demiris: study design, assisting primary author throughout the study, data interpretation, preparation of final manuscript. Sponsor’s Role: None.

Depth perception disorder after left ventral occipital lobe infarction.

Dear Sir,It is rare that patients with cerebral infarction report disorders of depth, shadow, and color perception. We recently reviewed such a patient.An 88-year-old, right-handed, amateur male ph...

Neuronal intranuclear inclusion disease with leukoencephalopathy and light motor-sensory and autonomic neuropathy diagnosed by skin biopsy.

Neuronal intranuclear inclusion disease (NIID) is a rare progressive neurodegenerative disorder characterized by eosinophilic hyaline inclusions which are widely observed in neuronal and somatic cells [1–3]. Familial and sporadic cases are reported. Clinically, the disease occurs in children and adult with any combination of progressive dementia, cerebellar ataxia and motorsensory and autonomic neuropathy. In 2011 skin biopsy proved helpful as antemortem diagnostic tool, showing intranuclear inclusions in the dermal cells [4]. Since then, several NIID cases have been reported by skin biopsy [5]. Here we add a case of NIID by skin biopsy, who presented with leukoencephalopathy [2–5] with high signal intensity linear lesion in the corticomedullary junction by diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI) scan [4,5], together with light motor-sensory and autonomic neuropathy [3,6]. A 58-year-old, previously healthyman began to have staggering gait onwalking stairways andmildmemory problem3 years ago. He did not drink alcohol nor have any history of medical illness. For the past one week, he was in poor nutrition because of his social problem. He was found to be unconscious, which brought him to our hospital and admitted as emergency. He had no family history. On admission, he regained consciousness completely, but suspected to have retrograde amnesia for half a day. His body temperature (36.8 degree Celsius), blood pressure (14/90 mmHg), heart rate (66/min) and oxygen saturation (99%, in room air) were normal. His general condition was normal except for gout in his left toes. He was alert and cooperative. However, the MiniMental State Examination (MMSE) Score was 21 (normal N24/30), the Frontal Assessment Battery score was 13 (normal N16/18), and total intelligent quotient in theWechsler Adult Intelligence Scale was 78 (normal N90). He had no apparent aphasia or apraxia. Cranial nerves were normal. He had no motor paresis. He had no tremor or rigidity. Deep tendon reflexes were normal except for a decrease in the lower extremities. His sensations were normal for pin prick, position and vibration. His coordination was normal in the four extremities, and he had no ataxia in speech. However, he had wide-based, staggering and shortstepped gait, and his Romberg test was positive. Blood chemistry, sugar and urinalysis were normal except for increased uric acid of 9.9 mg/dl (normal b7.0 mg/dl) and increased C-reactive protein of 6.27 mg/dl (normal b0.1 mg/dl). Although we did not perform the

Mild Cognitive Impairment as the Initial Manifestation of Progressive Supranuclear Palsy.

thoracic cavity (Figure 1B), providing a diagnosis of esophageal rupture. The patient underwent emergency surgery. The rupture was detected in the lower esophagus and was sutured successfully. He recovered gradually and was eventually discharged 2 months after the surgery. Elderly adults are reported to have a higher risk of complications during and after colonoscopy, but it is unknown whether esophageal perforation during colonoscopy preparation is associated with age. Esophageal perforation is a life-threatening condition, and mortality is high (11.9%) despite of surgical or medical treatment. Although there are several causes of esophageal perforation, only a few spontaneous esophageal perforation cases associated with PEG electrolyte solution for colonoscopy preparation have been reported. These previous reports and the present case suggested that esophageal rupture during colonoscopy preparation might be common in elderly adults (median 73, range 61–85). Therefore, clinicians should be aware of this potentially lethal complication of routine preparation for colonoscopy, especially in elderly adults.

Stercoral Ulcer and Colonic Perforation in an Individual with Parkinson's Disease with Constipation

GCA had previously been diagnosed in this woman in the context of isolated CISs in an elderly person who had neither clinical signs of GCA nor a high ESR, as described in the GCA diagnostic criteria, but the histopathological criteria confirmed GCA. The CISs could have been related to the GCA, which may also have been related to atherosclerosis, which was diffuse in the woman, especially in the carotid and vertebral arteries. Another possible cause of the CISs was the APS, for which the woman had the clinical criteria (confirmed arterial thrombosis (CISs) and early fetal loss), but the biological criteria were partial. Even though anticardiolipin antibodies and anti-beta-2-glycoprotein-1 antibodies were found at significant levels (>99th percentile), these antibodies were not measured a second time, as recommended (the woman had been discharged from hospital). In addition, she had been effectively treated with antivitamin K, and anticardiolipin antibodies are found in 32% to 50% of untreated GCA cases. The literature is contradictory regarding anti-beta-2glycoprotein-1. Some authors believe that these antibodies are not found in GCA, whereas others have reported cases of individuals with GCA with positive antibodies. Finally, atrial fibrillation (sick sinus syndrome) was not a plausible cause of the CISs because it causes embolic strokes; the woman described herein had diffuse atheromatous disease and was effectively treated with antivitamin K. In conclusion, GCA must be suspected in a context of stroke in elderly adults, even in the absence of the usual diagnostic criteria.

Hemiballism-Hemichorea Following Subthalamic Nucleus Hemorrhage

A 67-year-old man with untreated hypertension was admitted due to sudden onset involuntary movements involving the left arm and leg. Examination disclosed irregular coarse and twisting movement involving both distal and proximal muscles in the left arm and leg (Figure 1A). Magnetic resonance imaging and computed tomography of the brain revealed an acute hemorrhage in the right subthalamic nucleus (STN) (Figure 1BD). His hemiballismus-hemichorea improved within a few days following administration of risperidone 1 mg/day. However, after admission, the patient became restless, agitated and delirious and these symptoms were resolved by administration of haloperidol 3mg/day and tiapride 50mg/day.