Koujiro Sugita

Cognitive Functions in Subjects with Incidental Cerebral Hyperintensities

We investigated the association between incidental cerebral hyperintensities (CH) found by magnetic resonance imaging (MRI) and cognitive functions in neurologically normal, nondemented subjects. Semiquantitative scores for MRI lesions and those for brain atrophy were compared with the results of extensive cognitive examinations using multivariate analysis. There was no correlation between CH and cognition, except that periventricular hyperintensities, especially those in posterior locations, were associated with reduced performance in the Stroop test. Overall cognitive functions were associated with age, and age was a predominant factor in the prefrontal functions. Brain atrophy was associated more with decline of the posterior and dorsolateral frontal brain functions. We suggest that disturbances in attention and speed may initially result from incidental CH, while other cognitive functions remain unaffected.

Utilization Behavior and Concomitant Motor Neglect by Bilateral Frontal Lobe Damage

We reported on a patient who had bilateral mesial frontal lesions, presumably of a primary cerebral malignant lymphoma. The patient presented with a combination of unusual behavioral disorders of the upper extremities, which has not yet been documented in the literature: bilateral utilization and imitation behaviors and motor neglect of the left arm. Utilization behavior was closely associated with bilateral manual grasping behavior and was caused by the bifrontal lesions. Damage to the right supplementary motor area resulted most likely in concomitant motor neglect of the left hand. Discussion includes differentiation from other related behavioral disorders.

Human T Lymphotropic Virus Type I Associated Myelopathy and Myasthenia gravis: A Possible Association?

We report the first known patient with human T lymphotropic virus type I (HTLV-I) associated myelopathy (HAM) and myasthenia gravis (MG). A 50-year-old woman developed fluctuating muscle weakness with easy fatigability, transient bilateral blepharoptosis and double vision. Spastic paraparesis complicated these symptoms. Neurological assessments and specific laboratory findings revealed that the patient had definite HAM and MG. By inference from decreasing serum anti-HTLV-I antibody titers after thymectomy, the presence of antigenicity for HTLV-I in the thymic reticular cells, and a high incidence of various coexistent autoimmune diseases in HAM or MG, we suggested the possibility that these two diseases were associated with each other and with HTLV-I infection.

Acute Spinal Epidural Abscess and Spinal Leptomeningitis: Report of 2 Cases with Comparative Neuroradiological and Autopsy Study

A 21-year-old male developed back pain, fever, and rapidly progressive quadriparesis. Lumbar tap yielded frank pus which was confirmed on magnetic resonance imaging (MRI) to be located mainly in the cervical epidural space. Conservative antibiotic remedy was partially effective for restoration of the neurological deficits. A 82-year-old female noticed low-back pain which was rapidly accompanied with clouding of consciousness, paraplegia, and sphincter disturbances. Lumbar puncture revealed thick pus which was best depicted on MRI in the thoracolumbar subarachnoid space. At autopsy, spinal subarachnoid abscess or leptomeningitis was confirmed, and a spinal infarction previously unrecognized on MRI was found. Usefulness and shortcomings of MRI in the diagnosis of paraspinal infections are discussed.

Evaluation of Influential Factors of Cognitive Impairments in Idiopathic Parkinson’s Disease

Using multivariate analysis, we investigated the influence on cognitive functions of aging, brain atrophy, incidental cerebral hyperintensities (CHs), medication, and severity, duration and the initial symptoms of the disease in 53 patients with idiopathic Parkinsons disease (PD). We semiquantitatively assessed the degree of brain atrophy and CHs based on previously established methods. Cognitive functions were significantly and diffusely impaired in PD when compared with controls who were matched for age as well as for the degree and location of CHs. Patients with PD, however, had larger ventricles. Prefrontal dysfunctions were associated with a variety of predictors such as CHs, brain atrophy, severity of PD and medication whereas dorsolateral frontal functions were related simply to age and CHs in the periventricular region. Posterior brain functions had association with severity of illness, ventricular dilatation and total CH score. Clinically observed cognitive impairments in PD may consist of cognitive defects intrinsic to the disease which are variously modified by these factors. It is essential to consider all these predictors simultaneously in any discussion of cognitive functions in PD.

Differences in factors associated with silent and symptomatic MRI T2 hyperintensity lesions

Abstract The factors and symptomatology associated with different types of hyperintensity lesions on MRI were investigated. The study population consisted of 139 subjects who were recruited from 450 outpatients who had a neurological diagnosis in 1994. The subjects underwent brain magnetic resonance imaging between 1994 and 1995 and were divided into three groups (control, asymptomatic, and symptomatic) on the basis of T2 hyperintensity lesions, as well as a history of or neurological signs of stroke, or both. The demographic characteristics and risk factors were studied, and the T2 hyperintensity lesions were analysed semi-quantitatively. Results showed that: (1) the control and asymptomatic groups did not differ in terms of risk factors and demographic characteristics with the exception of age; (2) the symptomatic group was characterized by a significantly higher incidence of hypertension and electrocardiographic abnormalities, as well as significantly more numerous risk factors when compared with the other two groups; (3) the symptomatic patients also had higher proportion of men and higher levels of systolic blood pressure and blood glucose than the control patients, and more frequent hypertriglyceridaemia and higher triglyceride level than the asymptomatic patients; (4) the symptomatic group had a greater lesion distribution in the posterior basal ganglia-internal capsule and the infratentorial regions than did the asymptomatic group. We concluded that the asymptomatic and symptomatic groups should not be considered identical entities.