Hiroshi Nogaki

Muscle Weakness in Parkinson’s Disease: Isokinetic Study of the Lower Limbs

Isokinetic strength of knee extension and flexion was measured at two speeds of movement in 23 patients with Parkinson’s disease, to clarify whether muscle weakness is inherent to the disease. To counteract normal variation among subjects, we selected patients with symptoms completely or largely confined to one side and compared sides for each patient. The affected side was weaker than the other in both slow and fast movements early in the disease. In more advanced disease, the difference between sides diminished at the slow speed but remained significant at the faster speed. These observations suggest that weakness is inherent to Parkinson’s disease and influenced by movement speed.

Movement velocity dependent muscle strength in Parkinson's disease

We measured isokinetic muscle strength of knee extension and flexion in 18 patjents with Parkinsons disease who showed marked laterality in symptom severity and compared strength between the sides in the same patient. In all patient groups, the maximum peak torque of the more affected side was significantly less than for the less affected side at 15 revolutions per minute (r.p.m.) and 30 r.p.m. with the difference between the sides being larger at 30 r.p.m. than at 15 r.p.m., while at 5 r.p.m. there were no significant differences between sides. In the Yahr stage I group, the maximum peak torque in both extension and flexion at each velocity showed no significant difference between the sides. In contrast, in the stage II and III groups the maximum peak torque at 5 r.p.m. showed no significant difference between the sides, while at 15 r.p.m. and 30 r.p.m. these values showed a tendency and a significant difference between the sides, respectively, with the more affected side being weaker. These results suggest that muscle weakness in patients with Parkinsons disease increases with performance velocity, especially as the disease progresses.

Benign hot bath-related headache.

We describe three cases of women with hot bath‐related headache who reported that their severe paroxysmal headache could be provoked by pouring hot water over themselves or by soaking in a hot bath. In one patient, the headache was also brought on by exposure to cold wind. Another patient had headaches after she dived into a pool and started swimming. Neurological examination, routine laboratory tests, electroencephalography, and brain imaging showed no abnormality in any of the patients. Hot bath‐related headache is a benign headache unassociated with a structural lesion.

Muscle weakness in Parkinson's disease: a follow-up study.

We compared isokinetic muscle strength between initial and subsequent measurements in 10 patients who could repeat the same testing later among 23 previously described patients with Parkinsons disease. Patients were divided into two groups according to changes in clinical condition between the times of the first and the subsequent measurements. For patients who had improved, both extension and flexion on the more affected side showed significantly greater torque at 15 rpm in the later than the earlier measurement. For patients who had worsened, both extension and flexion on the more affected side showed significantly less torque at 5 and 15 rpm in the later than the earlier measurement. Although isokinetic muscle strength is likely to depend on movement velocity in the early stages of Parkinsons disease, it may be influenced by bradykinesia, as the disease progresses. Speed-force correlation seen in these patients may give clues to the understanding of the pathophysiology of bradykinesia.

Superficial punctate keratitis and corneal abrasion due to amantadine hydrochloride

Sirs: We encountered a case of possible amantadine hydrochloride-induced impaired visual acuity and corneal damage in a patient with parkinsonism due to cerebral infarction. The patient was a 64-year-old man who noticed around April 1991 that he had difficulty in walking and speaking and was no longer inclined to read newspapers and books. Because these difficulties gradually worsened, he visited our outpatient clinic on 1 October 1991. His medications included 3 mg warfarin potassium, 200 mg allopurinol, 20 mg famotidine, and 300 mg disopyramide daily. The first neurological examination revealed no apparent impairment in visual acuity. Paralytic impairment of speech and slight muscular rigidity in the neck were observed, but there were no involuntary movements or muscular rigidity in the extremities. The patient also displayed gait disturbance and impaired postural reflex. CT of the head showed small infarction foci in the cerebral white matter and diffuse cerebral atrophy. From these findings, a diagnosis of parkinsonism and depression due to cerebral infarction was made. Treatment with oral amantadine hydrochloride 100mg/day was immediately begun. The patients mood and difficulty in walking improved, although not satisfactorily. On the evening of 23 October, the patient had a foreign-body sensation in the right eye. On 24 October, he visited a local ophthalmologist. Snellen visual acuity was 20/30 (uncorrected) in the right and 20/30 (corrected to 20/20) in the left eye, and superficial punctate keratitis was found in the right eye. By 25 October the foreign-body sensation had intensified, and superficial punctate keratitis and corneal abrasion were observed in both eyes. On 11 November,

Simultaneous assay of activated platelet count and platelet-activating capacity by P-selectin detection using K2-EDTA-treated whole blood for antiplatelet agents

It is well recognized that examinations of activated platelets (aPLTs) and platelet‐activating capacity are very important to observe and prevent embolic diseases (events) such as ischemic stroke and myocardial infarction. Previously, we reported an appropriate measurement technique of aPLT for clinical assay. In this paper, we investigated stable conditions for measurement of activating capacity of platelets.

Influencing factors in quantitative measurement using activated platelet levels and platelet-activating capacity for the assessment of thrombosis in pre-metabolic syndrome and type 2 diabetes mellitus: Informative factors for thrombosis prevention

Activated platelet levels and platelet-activating capacity are well recognized as useful index parameters for the physiological and pharmacological prediction of thrombotic events. Recently, quantitative measurements for platelet functions using a flow cytometer have been increasing gradually. However, the relation of physiological factors, such as sex, aging, and laboratory tests, to platelet functions has not been well documented. We conducted a blood analysis of people with normal/pre-metabolic syndrome and patients with type 2 diabetes mellitus to clarify the pathological factors. The levels of basal (non-stimulated)-activated, platelet-expressed P-selectin and activated platelet stimulated by agonists were measured by a flow cytometer, and ratios of platelet-activating capacity were also calculated. Statistical analyses indicated significantly high basal-activated platelet in pre-metabolic syndrome, and basal-activated platelet was positively associated with hyperlipidemia and hepatic damage. Platelet-activating capacity was significantly low in aging and hyperlipidemia, but high in hyperglycemia, and was negatively associated with hyperlipidemia and hepatic damage. Aging and high nutrient condition impaired platelet functions. Quantitative measurements of basal-activated platelet and platelet-activating capacity are precise parameters for the prediction of thrombotic events.

Analysis of 5 cases of cerebral infarctions presenting acute onset global aphasia with slight hemiparesis.

急性発症で, 片麻痺が軽微で全失語を呈した脳梗塞5例の臨床所見・画像所見を検討した.対象は右利きの男2例, 女3例 (35～69歳).X線CT・MRIでは2例で一次運動領野を含まない前頭葉皮質を中心とする梗塞巣を認め, 3例で左側脳室体部外側から前頭葉白質, 基底核領域に散在性の梗塞巣を認めた.SPECTを施行した4例中2例で左大脳半球の全般的血流低下を認め, うち1例は脳血管撮影で左中大脳動脈閉塞を, 他の1例ではMRAで左中大脳動脈閉塞が疑われた.SPECTを施行した他の2例では左前頭葉の血流低下と左側頭後頭葉の軽度の血流低下を認め, うち1例の脳血管撮影では両側中大脳動脈閉塞・モヤモヤ血管が, 他の1例のMRAでは左内頸動脈閉塞が認められた.SPECT末施行の1例の脳血管撮影では左中大脳動脈閉塞を認めた.急性期に頭部CT・MRIで見られる病変よりも広汎な血流低下・機能低下領域が存在し, これが失語症発現に重要な役割を果しているものと考えられる.