Keiko Ohta

Herpetic Lumbosacral Radiculoneuropathy in Patients with Human Immunodeficiency Virus Infection

We report 4 cases of human immunodeficiency virus infection associated with lumbosacral radicular dysfunction and urinary retention. Three of these cases had the so-called Elsberg syndrome in that their symptoms were associated with genital herpes. In 1 case, different herpes simplex virus types were isolated from the cerebrospinal fluid and genital swabs. Lumbosacral radiculoneuropathy with urinary retention caused by herpes viruses can develop not only with an initial genital herpes infection, but also due to reactivation of a latent herpes virus.

Facial myokymia associated with an isolated lesion of the facial nucleus

We report on a patient with transient facial myokymia. He had an isolated lesion of the right facial nucleus in the pontine tegmentum. Facial myokymia is a rare symptom and its pathogenesis is not known. Our case had a very localized lesion and we attempted to determine the case of the facial myokymia.

Single Photon Emission Computed Tomography of an Acute Focal Demyelinating Disease Mimicking a Brain Tumor

Introduction Large, focal, cerebral demyelinating lesions with a single clinical course were thought to represent an intermediate entity between classic multiple sclerosis and post-infectious and post-vaccination encephalopathy [1, 2]. Neurologists and neurosurgeons often find it difficult to distinguish between such lesions and malignant tumors. In our analyses, three patients with irregularly enhanced large plaques visible on images were also diagnosed pathologically. In an earlier analysis, 201Tl SPECT imaging was employed to identify brain tumors accurately and to determine optimal therapy [3]. Lorberboym [4] reported that the retention index (delay/early) could distinguish nonmalignant lesions from lymphoma. We performed a SPECT study on such large lesions, and these lesions showed impressive uptakes. Case Report Case 1. A 44-year-old man was admitted to our hospital due to continued visual disturbance for two months. At the time of admission, he displayed decreased visual acuity, facial palsy, bulbar palsy and pyramidal signs. CSF cells and IgG index were not increased, and levels of CSF proteins, IgG and glucose were normal. No oligoclonal bands were detected, and the myelin-basic protein level was not elevated. Brain MRI scans showed large gadolinium-enhanced bilateral frontal lobe lesions, as if glioblastoma spread through the corpus callosum (fig. 1A). The early 201Tl SPECT image showed a 2.75and 2.28-fold uptake (right and left frontal lobe, respectively) in the lesion area (compared with intact parietal lobes), while the delayed image revealed a 3.1and 2.2-fold increase (right and left frontal lobe, respectively) in uptake (fig. 1B). The retention index values were 1.66 and 1.58 in the right and left frontal lobes, respectively. A 67Ga-citrate SPECT scan confirmed increased uptake (3.87 fold) in the left frontal lobe, while TcO4 SPECT analysis showed a 1.89and 7.12-fold (right and left frontal lobe, respectively) uptake. These neuroradiological findings indicated a malignant tumor. An open biopsy, performed for histological examination on the left frontal lobe, revealed extensive, sharply demarcated demyelinated areas with hypertrophic astrocytes and numerous macrophages filled with Sudan black stain (fig. 1C). Perivascular infiltration of T lymphocytes was also observed. Four weeks after the first scan, a 201Tl SPECT scan revealed that the accumulations of the lesions had disappeared. Following biopsy, the severity of the symptoms gradually decreased without the need for therapy.