Kenji Kamogawa

Primitive reflexes distinguish vascular parkinsonism from Parkinson's disease.

OBJECTIVES Although vascular parkinsonism (VP) occurs frequently in the elderly, its clinical features have not been investigated in detail, particularly in comparison with Parkinsons disease (PD). The goal of this study is to clarify the diagnostic value of pathological reflexes in differentiating between VP and PD. PATIENTS AND METHODS In 132 patients with PD and 55 with VP, pathological reflexes, including snout reflex (SR), palmomental reflex (PMR), corneomandibular reflex (CMR), jaw reflex (JR), Hoffmann reflex (HR), and extensor plantar response (EPR), were evaluated. RESULTS The percentage of each pathological reflex elicited in two groups (VP:PD) was as follows: SR (78:30), PMR (53:26), CMR (9:6), JR (33:12), HR (29:11), and EPR (25:8). The prevalence of pathological reflexes, except for CMR, was significantly higher in the VP patients than in the PD patients. In particular, SR and PMR were more frequent than upper motor neuron signs in the VP patients. The sensitivity and specificity of either SR or PMR for VP were 84% and 82%. CONCLUSION Snout and palmomental reflexes are useful tools in the differentiation between VP and PD.

Usefulness of cervical computed tomography and magnetic resonance imaging for rapid diagnosis of crowned dens syndrome: A case report and review of the literature

Highlights • We report a patient with crowned dens syndrome dramatically improved following treatment with nonsteroidal anti-inflammatory medication.• This condition should be considered in the differential diagnosis of a possible etiology for fever, headache and cervical pain of unknown origin.• The rapid diagnosis of crowned dense syndrome using CT and MRI can prevent invasive, expensive and useless investigations.• It was very interesting that the soft tissue surrounding the odontoid process was hyperintense on MR T2-weighted imaging with fat suppression.• This is the first report of making reference to MRI findings of crowned dens syndrome.

Importance of perioperative management for emergency carotid artery stenting within 24 h after intravenous thrombolysis for acute ischemic stroke: Case report

Highlights • We report a patient treated successfully via endovascular surgery within 24 h after intravenous thrombolysis using recombinant tissue plasminogen activator for acute cervical internal carotid artery occlusion.• Emergency carotid artery stenting for the acute internal carotid artery occlusion may be considered a safe procedure in preventing early stroke recurrence in selected patients.• When trying to perform emergency carotid artery stenting within 24 h after intravenous recombinant tissue plasminogen activator administration, several issues require attention, such as the decisions regarding the type of stent and embolic protection device, the selection of antiplatelet therapy and the methods of preventing hyper perfusion syndrome.• We administered aspirin and clopidogrel for the prevention of subacute thrombosis, and we used dexmedetomidine for preventing hyperperfusion syndrome, so that we also obtained a good result.

Efficacy of Early Superficial Temporal Artery–Middle Cerebral Artery Double Anastomoses for Atherosclerotic Occlusion in Patients with Progressing Stroke

BACKGROUND We investigated the efficacy of early superficial temporal artery-middle cerebral artery (STA-MCA) double anastomoses for patients with progressing stroke due to atherosclerotic occlusion. MATERIALS AND METHODS Nine consecutive patients who underwent early STA-MCA double anastomoses were enrolled. All patients presented with progressing stroke despite maximal medical treatment. Cerebral blood flow in 7 patients was analyzed by single-photon emission tomography. Clinical outcomes were investigated postoperatively, and we evaluated the utility of early STA-MCA double anastomoses. RESULTS Nine patients in the present study included those with middle cerebral artery occlusion (n = 6) and internal carotid artery occlusion (n = 3). The mean age was 58.4 years. Subjects comprised 1 female (11.1%) and 8 males (88.9%). The cause was low perfusion ischemia due to atherosclerotic occlusion with a small infarct. The mean regional cerebral blood flow (rCBF) ratio in the middle cerebral artery territory compared to the normal side was 69.6 ± 5.3%. The duration from onset to surgery was 1-8 days (median, 3.11 days). All patients underwent early STA-MCA double anastomoses, and no reperfusion-induced hemorrhage occurred. All of them slowly achieved obvious remission compared to symptoms on admission and achieved a good functional outcome. CONCLUSIONS Early STA-MCA double anastomoses were safe and effective, and early revascularization resulted in rapid neurological improvement. We recommend this procedure for patients with progressive ischemia due to main trunk artery occlusion, when the rCBF flow ratio with the normal side was 70 ± 10%, even at the subacute stage.

Useless hand syndrome with astereognosis in multiple sclerosis

We report on a patient with multiple sclerosis (MS) who developed bilateral useless hand syndrome (UHS) and astereognosis. Clinical features of UHS in our patient are similar to limb-kinetic apraxia with astereognosis. Cervical T1-weighted magnetic resonance imaging revealed a gadolinium-enhanced lesion at the level of C3-C4, mainly involving the posterior cord. This patient suggests that posterior cord lesions at high cervical levels cause UHS and astereognosis in MS, involving the sensorimotor integration needed to execute complex finger movements.