Kazumasa Sudo

Focal (segmental) dyshidrosis in syringomyelia

The features or mechanisms of dyshidrosis have not been sufficiently clarified. Neither has the difference between hyperhidrosis and hypohidrosis. To clarify the features and mechanisms of dyshidrosis (hyperhidrosis and hypohidrosis) in syringomyelia, the clinical features focusing on hidrosis of 30 patients with syringomyelia and Chiari malformation located from a syringomyelia database were prospectively analysed. The patients were classified into three groups: eight patients (26.7%) had segmental hypohidrosis, 10 (33.3%) had segmental hyperhidrosis, and 12 (40.0%) had normohidrosis. We found that the Karnofsky functional status for the hyperhydrosis and normohidrosis groups were significantly higher than for the hypohidrosis group (p=0.0012), with no significant differences between the hyperhidrosis and normohidrosis groups. The duration from the onset of syringomyelia to the current dyshidrosis was significantly longer in the hypohidrosis group than in the hyperhidrosis group (p=0.0027). A significant correlation was identified between the duration from the onset of syringomyelia to the time at study and the performance score (r=−0.599, p=0.0003). The results substantiate previous hypotheses that in its early stage syringomyelia causes segmental hyperactivity of the sympathetic preganglionic neurons, and hyperactivity of these gradually subsides as tissue damage progresses. Focal hyperhidrosis may be regarded as a hallmark of a relatively intact spinal cord, as well as normohidrosis.

Hot water epilepsy with pineal cyst and cavum septi pellucidi.

Abstract: A case of reflex epilepsy accompanied by pineal cyst and cavum septi pellucidi induced by hot water bathing is presented. The patient is a 25‐year‐old male who has had six episodes of convulsions during the last three years. The seizures were diagnosed as a complex partial epilepsy followed by generalized tonic seizures. We have succeeded in recording his electroencephalogram (EEG) during convulsions. Moreover, a magnetic resonance imaging (MRI) study revealed a pineal cyst and cavum septi pellucidi. This is quite a rare form of adult hot water epilepsy accompanied by intracranial malformations.

Syringomyelia as a cause of body hypertrophy

BACKGROUND Among 26 patients with communicating syringomyelia who came to our out-patient clinic from April, 1989, to March, 1995, three (11.5%) had hypertrophy in limbs, hands, or feet. One had crossed hypertrophy. We considered the possibility that syringomyelia caused body hypertrophy. METHODS We searched MEDLINE for articles which mention body asymmetry or hypertrophy, and examined the findings in our own patients. FINDINGS The site of hypertrophy in our three patients coincided with the site of the neurological and magnetic resonance imaging findings. In addition, the horizontal and vertical location of the syrinx corresponded with the site of all four hypertrophic limbs. We located ten articles in which a diagnosis of syringomyelia was made, and five in which other diagnoses were made. INTERPRETATION From studying our patients as well as those previously reported, we speculate that some types of body hypertrophy are due to damage, accompanied by stimulation, of the sympathetic neurons in the ipsilateral lateral horn of the spinal cord. Although there are many causes of hypertrophy, we suggest that the possibility of syringomyelia be investigated in patients with body hypertrophy, especially in those with any accompanying neurological abnormality.

Elbow flexion response as another primitive reflex

Abstract In daily clinical practice we noticed that patients with intellectual impairment spontaneously flex the elbow within a few seconds of the forearm being manipulated during routine examination of spasticity of the muscles in the upper extremities. We termed this phenomenon elbow flexion response (EFR), and prospectively studied it in 229 patients who underwent in‐hospital rehabilitation following brain damage. Evaluation of each patient included EFR, patient profile, ability to communicate, scores on three parameters from various intelligence tests, scores on seven parameters testing primitive reflexes, and scores on three parameters describing personality. We investigated for relationships among these parameters. Consequently, although EFR rarely have a statistical association with the varied profiles of patients, patients with bilateral lesion or bilateral paresis demonstrated significantly more marked EFR than those with unilateral lesion or unilateral paresis. Patients with involvement of the frontal lobe showed significantly more marked EFR than those without damage in this area. Elbow flexion responses occurred significantly more frequently in relation with lower scores on intelligence and occurred with significantly higher frequency in conjunction with the more marked appearance of conventional primitive reflexes. Therefore, we conclude that EFR have a strong association with intelligence and with the existence of frontal lobe lesion, and their mode of clinical presentation parallels that of primitive reflexes particularly that of the grasp reflex. We propose that EFR could be referred as a variation of the grasp reflex occurring in the more proximal or axial part of the body.

Psychogenic basilar migraine.

To the Editor: We read the article by Sanchez-Villasenor et al. [1] with interest because we sometimes have trouble making a differential diagnosis between true and pseudo- or psychogenic manifestations. In this article, the authors describe four patients who presented clinical manifestations identical to psychogenic basilar migraine (BM). We, however, believe it would have been better if the authors had investigated the patients further before making a diagnosis of psychogenic BM, …

Autonomic nervous system manifestations in epilepsy

Health Sciences, Osaka 590-0482, Japan Department of Acupuncture, Faculty of Health Sciences, Morinomiya University of Medical Sciences, Osaka 559-8611, Japan Department of Acupuncture, Faculty of Health Sciences, Takarazuka University of Medical and Health Care, Hyogo 665-0803, Japan Anesthesiology, Osaka Medical College Hospital, Osaka 569-8686, Japan Course of Acupuncture and Moxibustion, Department of Health, Faculty of Health Sciences, Tsukuba University of Technology, Ibaraki 305-8521, Japan

An episode of cerebrospinal fluid leak syndrome involving a marathon runner

A 57-year-old marathon runner presented with orthostatic dizziness and headache, which appeared just after running a few kilometres and had persisted for 7 days. No other neurological abnormalities were found. On lumbar puncture, the initial pressure was zero. A cranial MRI with gadolinium showed a marked enhancement of the dura mater (figure 1, arrows). MR …