Muneshige Tobita

Intractable hiccup and nausea in neuromyelitis optica with anti-aquaporin-4 antibody: a herald of acute exacerbations

Background: Intractable hiccup and nausea (IHN) are unique symptoms in neuromyelitis optica (NMO). Recent studies have strongly suggested that the pathogenesis of NMO is closely associated with anti-aquaporin-4 (AQP4) antibody. However, clinical implications of IHN and the relationship with anti-AQP4 antibody remain unknown. Methods: The past medical records of 35 patients with seropositivity for anti-AQP4 antibody were reviewed. We also followed the titres of anti-AQP4 antibody in a patient with NMO, who had newly developed IHN. Results: Of the 35 patients, 15 patients (43%) had episodes of IHN. There was a total of 35 episodes of IHN in these 15 patients and, of the 35 episodes, hiccup was seen in 23 episodes (66%) and nausea was seen in 28 episodes (80%). The IHN frequently preceded (54%) or accompanied (29%) myelitis or optic neuritis. The IHN was often preceded by an episode of viral infection. The titres of anti-AQP4 antibody were remarkably increased when the intractable hiccup appeared in a case. Conclusions: IHN could be a clinical marker for the early phase of an exacerbation. Careful observation may be needed when INH is seen in patients with NMO, and the early initiation of the treatment could prevent subsequent neurological damage.

Characterization of Experimental Ischemic Brain Edema Utilizing Proton Nuclear Magnetic Resonance Imaging

Correlations between T1 and T2 relaxation times and water and electrolyte content in the normal and ischemic rat and gerbil brains were studied by means of both nuclear magnetic resonance (NMR) spectroscopic and imaging methods. In the spectroscopic experiment on excised rat brains, T1 was linearly dependent on tissue water content and T2 was prolonged in edematous tissue to a greater extent than expected by an increase in water content, showing that T2 possesses a greater sensitivity for edema identification and localization. Changes in Na+ and K+ content of the tissue mattered little in the prolongation of relaxation times. Serial NMR imaging of gerbil brains insulted with permanent hemispheric ischemia offered early lesion detection in T1- and especially T2-weighted images (detection as soon as 30 min after insult). The progressive nature of lesions was also imaged. Calculated T1 and T2 relaxation times in regions of interest correlated excellently with tissue water content (r = 0.892 and 0.744 for T1 and T2, respectively). As a result, detection of cerebral ischemia utilizing NMR imaging was strongly dependent on a change in tissue water content. The different nature of T1 and T2 relaxation times was also observed.

DNA single-strand breaks in postischemic gerbil brain detected by in situ nick translation procedure

Using an in situ nick translation procedure, DNA single-strand breaks (SSB) in postischemic gerbil hippocampus were investigated after 15-min forebrain ischemia followed by 0-4h of recirculation. In the control group, increased SSB were noticed in the ependymal cell layer and the dentate gyrus. After 15-min ischemia without recirculation, no remarkable changes in SSB were observed. However, after 1 h of recirculation, a marked increase in SSB was recognized throughout the hippocampus, especially in the cells in CA1 subfield and the dentate gyrus. After 4 h of recirculation, SSB decreased to a level near that of the control group. The results of the present study indicate that ischemic insults may injure intranuclear DNA during postischemic recirculation periods. Although many factors may be involved, activated endonuclease due to an intracellular Ca2+ rise, free radicals, and postischemic hyperthermia appear to be involved in this phenomenon.

MR imaging of multiple sclerosis simulating brain tumor

Multiple sclerosis may sometimes present as a mass lesion that is indistinguishable from brain tumor both clinically and radiologically. We describe two cases of multiple sclerosis simulating brain tumor on computed tomography (CT) scans and magnetic resonance (MR) images, one of which was proved and another was suggestive to be demyelinating disease by biopsy. Steroid therapy produced regression of the lesions of MR images and CT scans. Our cases and others in the literature suggest strategies for detecting multiple sclerosis presenting as a mass lesion.

Correlations between proton nuclear magnetic resonance imaging and retrospective histochemical images in experimental cerebral infarction.

Evaluation of ischemic brain injury in experimental cerebral infarction in gerbils and rats was performed by means of both proton nuclear magnetic resonance imaging ([1H]NMR-CT) and various histochemical analyses. In vivo nuclear magnetic resonance (NMR) imaging was carried out employing saturation recovery, inversion recovery, and spin echo pulse sequences. Spatial resolution of the images was excellent. The ischemic lesions were detected with a remarkable contrast in inversion recovery and spin echo images within a few hours after insult. Those changes in NMR images consistently corresponded with the various retrospective histochemical observations, especially with methods related to brain edema (K+ staining) rather than structural (enzymatic) studies. Calculated T1 and T2 relaxation times indicated the evolution of the edema state in the brain in situ. They correlated excellently with the retrospective water content measurement. As a result, detailed characterization of the edema state induced by cerebral ischemia was possible in vivo using [1H]NMR imaging.

A Case of Hemiplegic Migraine Treated with Flunarizine

SYNOPSIS

Retrograde filling of the anterior choroidal artery: vertebral angiographic sign of obstruction in the carotid system

SummaryRetrograde filling of seven anterior choroidal arteries from the posterior circulation was observed on a vertebral angiogram in six patients with occlusion of the proximal anterior choroidal artery or of the internal carotid artery. In one patient with thrombotic occlusion of the internal carotid artery, the enlarged anterior choroidal artery functioned as a major collateral pathway from the posterior circulation to the territory of the middle cerebral artery. Retrograde filling of the anterior choroidal artery is a sign of obstruction changes in the ipsilateral carotid artery at or proximal to the origin of the anterior choroidal artery.

Traditional Chinese Medicine on Four Patients with Huntington's Disease

Four Huntingtons disease (HD) patients were treated with traditional Chinese medicines Yi‐Gan San (YGS) and Chaihu‐Jia‐Longgu‐Muli Tan (CLMT) in a cross‐over manner. Two patients took YGS for 8 weeks first, and after 4 weeks of washing out, they took CLMT for 8 weeks. Two other patients took these medicines in reverse order. All patients showed a decrease in the Unified Huntingtons Disease Rating Scale—motor assessment (from 106.3 ± 4.7 to 89.6 ± 5.8 as mean ± SD, P = 0.0004) by YGS treatment with no extrapiramidal symptoms or changes of cognition or ADL. Our study suggests a possibility of a new treatment for involuntary movements.

Immunocytochemical detection of tumor necrosis factor‐α in infiltrating tumor cells in the cerebrospinal fluid from five patients with leptomeningeal carcinomatosis

We studied the immunoreactivity for tumor necrosis factor‐α (TNF‐α) in cerebrospinal fluid (CSF) cell smears from five patients with leptomeningeal carcinomatosis (LC). Immunostained TNF‐α‐positive tumor cells had brownish deposits in the cytoplasm, but no deposits were observed in the nucleus. The intensity of the TNF‐α staining was greater in these tumor cells than in macrophages from patients with inflammatory diseases. Approximately 27–72% of the tumor cells were found to be TNF‐α immunoreactive in all five samples from the patient with LC. These results suggest that the large amount of TNF‐α produced by infiltrating tumor cells may play an important role in the development of the tumor.

The effect of transient ischemia on 2-[14C]deoxyglucose metabolism in the rat hippocampus pretreated with kainic acid

CA1 pyramidal neurons are selectively vulnerable to ischemia. 2-[14C]Deoxyglucose (2-DG) autoradiography was employed to measure local glucose utilization in the rat hippocampus after transient ischemia, under the condition of unilateral prevention of ischemic CA1 pyramidal cell necrosis by unilateral lesioning of Schaffer collaterals (left side). Columnar 2-DG uptake patterns in the CA1 region with intact Schaffer collaterals (right side) was observed 19-22 h after recirculation, though no laterality was noted 3 and 8 h after recirculation. In the right subiculum, higher 2-DG uptake was observed 19-22 h after recirculation in 5 out of 8 animals. These results suggest that Schaffer collaterals play a role in modulating glucose metabolism in the CA1 and subiculum during recirculation.