Jun Teramoto

Oculomotor Nerve Palsy due to Intraneural Hemorrhage in Idiopathic Thrombocytopenic Purpura: A Case Report

We report a 52-year-old man with idiopathic thrombocytopenic purpura accompanying acute oculomotor nerve palsy. At autopsy, intraneural hemorrhage was found in the cavernous portion of the oculomotor nerve. Intraneural bleeding as well as extraneural compression by hematoma formation should be considered as a cause of neuropathies occurring in patients with aggravated thrombocytopenia.

Inflammatory alterations in muscle contraction headache.

SYNOPSIS

Radiological Analysis of the Cervical Spines in Japanese Patients with Muscle Contraction Headache

The pa thogenes i s and mechanism o f muscle c o n t r a c t i o n headache (MCH) are s t i l l n o t known w i t h any c e r t a i n t y . I n o r d e r t o e v a l u a t e s t r a i g h t neck and droopy shou lde r as a p a t h o g e n e t i c f a c t o r o f MCH, w e undertook a r a d i o l o g i c a l s t u d y of t h e c e r v i c a l s p i n e i n 309 cases of MCH. They comprised 118 m a l e s and 1 9 1 females, and t h e ages a t examinat ion ranged f r o m 1 5 t o 80 yea r s . The d u r a t i o n of i l l n e s s w a s 2 weeks t o 45 yea r s . Grading and i n c i d e n c e of droopy shou lde r (DS) w e r e as fo l lows: A , 1 2 9 cases w i t h o u t D S ( 4 1 . 7 % ) ; B, 152 cases i n whom upper 1 / 3 of t h e T 1 v e r t e b r a ( 4 9 . 2 % ) w a s v i s i b l e on l a t e r a l view on p l a i n X-ray f i l m ; and C, 28 cases i n whom upper 1/3 of t h e T2 v e r t e b r a w a s v i s i b l e ( 9 . 1 % ) . A s t o s t r a i g h t neck (SN), D , 92 cases had no SN ( 2 9 . 8 % ) , E , 36 cases showed s l i g h t SN ( 1 1 . 7 % ) and F , 1 8 1 cases d i s p l a y e d d e f i n i t e S N (58 .6%) . The inc idence of D S w a s 4 4 . 9 % i n m a l e s and 66.5% i n females . SN w a s f r e q u e n t l y observed i n an i l l n e s s of less t h a n 3 months d u r a t i o n . The i n c i d e n c e of D S and SN decreased w i t h advancing age. There w a s no s i g n i f i c a n t r e l a t i o n w i t h o t h e r c l i n i c a l symptoms. Some 103 cases had b o t h D S and S N (33 .3%) . I n t h i s r e s e a r c h , w e i n v e s t i g a t e d abou t S N and D S , b u t t he importance of d i f f e r e n t i a t i n g t h e droopy shou lde r syndrome (DSS) from MCH w a s a lso p o i n t e d o u t earl ier. DSS i n d i c a t e d S N and DS ( T 1 o r T2 w a s v i s i b l e ) , and so MCH w a s s imi l a r t o DSS on r a d i o l o g i c a l f i n d i n g s . I n t h i s po in t S N and DS w e r e t h e i n t e r e s t i n g f a c t o r i n MCH. A l s o , SN w a s a ve ry impor t an t factor i n less t h a n 3 months d u r a t i o n . A s s t a t e d above, s i n c e b o t h DS and SN a r e commonly seen i n MCH, it is sugges t ed t h a t t h e abnormality of t h e c u r v a t u r e and droop p l a y a n important ro l e i n t h e pa thogenes i s and mechanism of MCH i n Japanese cases.