Naotoshi Tamura

Effect of l-DOPA on nitric oxide production in striatum of freely mobile mice

In Parkinsons disease, nitric oxide (NO) and other free radicals are thought to be involved in neuronal degeneration. Furthermore, L-DOPA is suggested to have a cytotoxic action on dopaminergic neurons. We studied 24-h NO production and the effect of L-DOPA on this in freely mobile mice using in vivo microdialysis. A microdialysis probe was implanted into the right striatum 12 h before the experiment. This dialysis probe was perfused with Ringer solution for 100 min, then with 20, 50, or 100 nM L-DOPA for 20 min, and finally with Ringer solution. Dialysate fractions were collected every 20 min for 4 h. Production of nitrite and total NO were significantly higher during daytime than during nighttime. Nitrate production was increased significantly by L-DOPA. NO production in the striatum appears to exhibit a diurnal rhythm and to increase with exposure to L-DOPA.

Secondary SUNCT syndrome caused by viral meningitis

A 49-year-old male had been complaining of general fatigue since July 31, 2007. On August 3, he developed a headache in the forehead bilaterally, and he had a slight fever on the next day. At 3:00 a.m. on August 3, a stabbing pain lasting less than 3 seconds suddenly occurred on the right side of the forehead, cheek, and jaw. He felt pain while he was awake. The pain attacks occurred at least once every two or three minutes, and at most once every 10 seconds; attacks occurred with a frequency from 100 to 200 times per day. During the attacks, he showed dacryorrhea, swelling of the eyelids of the right eye, and rhinorrhea. The patient was not able to keep still because of his severe, stabbing headache. During the daytime of August 6, the pain moved to the right occipital and right upper auricular regions. The symptoms persisted, and he was admitted on August 7. His past history and family history were not contributory. The patient reported a stabbing headache in the right side of the forehead, cheek, and jaw, as well as in the upper auricular and occipital regions. On physical examination, Yasuo Ito Toshimasa Yamamoto Mikiko Ninomiya Yoshikazu Mizoi Kaori Itokawa Naotoshi Tamura Nobuo Araki Kunio Shimazu

A case of α-synuclein gene duplication presenting with head-shaking movements

PARK4 is a candidate locus for familial Parkinsons disease (PD), combined with multiplication of the α‐synuclein gene (SNCA). The eventual phenotype is dependent on the copy number of SNCA. Mutations in leucine‐rich repeat kinase 2 (LRRK2) are also causative of parkinsonism. This report describes a man who presented at our hospital complaining of a stagger after running and difficulty in handling the mouse of a personal computer, having suffered tremors since his twenties. Nine months after treatment and discharge, he developed titubation and began to drag his right foot.

Dural arteriovenous fistula as a possible cause of Tolosa-Hunt syndrome: a case report.

THS is a syndrome of painful ophthalmoplegia due to nonspecific inflammation in the cavernous sinus. THS and dAVF in the cavernous sinus may show similar symptoms, but the etiologies seem to differ. Sugano et al. [1] reported a case of dAVF developing from THS, and discussed a possible role of inflammation in the development of dAVF. We report herein an additional case of dAVF in the cavernous sinus due to THS.

An adult case of cyclic vomiting syndrome successfully responding to valproic acid

Sirs: The pathophysiology of cyclic vomiting syndrome (CVS) has not yet been established, and treatment for CVS remains unsatisfactory [1, 2]. We herein report an adult case of CVS associated with vascular headache and consciousness disturbance. Valproic acid had a completely protective effect against the vomiting attacks in this patient. The efficacy of an anticonvulsant for CVS thus supported the existence of a nosological link between CVS, migraine, and epilepsy. A 48-year-old woman, with several attacks of vomiting during one hour, was admitted to our hospital seeking treatment for this symptom on December 10, 2005. Nausea and vomiting developed suddenly on the evening of December 9. Her symptoms included fever, headache and palpitations, but no vertigo or abdominal pain. The attack did not subside until the next day, and she visited to her family doctor and then was transferred to our hospital. Her first attack had appeared in August LETTER TO THE EDITORS

QSART in idiopathic pure sudomotor failure

QSART (quantitative sudomotor axon reflex testing) was performed in a patient with idiopathic pure sudomotor failure. Generalized reduction in thermoregulatory sweating and complete absence of axon reflex sweating were observed, suggesting a deficit of sweat gland cholinergic synaptic transmission or receptors. QSART responded promptly to treatment. Putative pathophysiological mechanisms are discussed.

A case of sick sinus syndrome and autonomic failure with Parkinson's disease

Few case reports have described associations between autonomic failure and sick sinus syndrome.Only 1 report has presented the caseof a patient with pure autonomic failure accompanying sick sinus syndrome (Sakai et al., 1996), but electrophysiological studies (EPS) to evaluate sinus node function were not included. We therefore present herein thefirst case report of autonomic failure associated with Parkinsons disease and sick sinus syndrome, in which sinus node function was confirmed as normal by EPS.

A case of idiopathic pure sudomotor failure associated with prolonged high levels of serum carcinoembryonic antigen

We report a case of idiopathic pure sudomotor failure (IPSF) in which serum carcinoembryonic antigen (CEA) levels elevated at onset, and remained high while anhidrosis lasted. We considered that changes in serum levels of CEA were related to the disease activity of IPSF.

Daily morning hemifacial spasm in a patient with cluster headache

According to the classification of the International Headache Society, cluster headache is a severe unilateral orbital, supraorbital or temporal pain lasting 15–180 min if untreated. It is usually associated with symptoms of autonomic nervous system dysfunction, including conjunctival afflux, dacryorrhoea, and ipsilateral sensation of nasal obstruction (1). Recently, autonomic crisis occurring alone and without headache has been reported under the classification of ‘cluster headache sine headache’ (2, 3). We present a man with a history of typical cluster headache, who developed daily morning hemifacial spasm without headache. After several episodes of daily headache, he experienced daily occurrence of acephalgic hemifacial spasm every morning, lasting 120 min. We consider the pathophysiology of this daily morning hemifacial spasm to be similar to that of cluster headache.

Evaluation of the Differences in the Effects of Antihypertensive Drugs on Blood Pressure Variability by 24-Hour Ambulatory Blood Pressure Monitoring in Chronic Cerebrovascular Disease

BACKGROUND It has been suggested that antihypertensive drug therapy is attributable to the lower blood pressure variability, we investigated the effects of 4 classes of antihypertensives on the blood pressure variability; in addition, we also compared the effects among 4 calcium channel blockers. METHODS We measured the 24-hour blood pressure variability in 309 patients with a history of cerebrovascular disease treated with angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, β blocker, or calcium channel blocker. RESULTS The daytime blood pressure variability treated with β blockers (14.3 ± 3.1) was higher than that treated with an angiotensin receptor blockers (11.5 ± 3.1) or calcium channel blockers (12.6 ± 3.4) in patients with cerebrovascular disease (P < .05). In the analysis of the patient distribution of blood pressure variability, patients receiving β blockers occurred more frequently in the higher blood pressure variability (P = .0023). Treatment with angiotensin receptor blockers and cilnidipine, which blocks N-type calcium channels, was shown to be more frequently associated with the lower blood pressure variability (P = .0202 and .0467). The mean blood pressure of patients grouped by distribution of blood pressure variability was found to be independent to blood pressure variability, for any of the antihypertensive drugs or calcium channel blockers examined. CONCLUSIONS From the results, it is suggested that angiotensin receptor blocker and calcium channel blockers rather than β blockers may be more favorable for blood pressure management in patients with cerebrovascular disease. Among the calcium channel blockers, cilnidipine may be more favorable than other calcium channel blockers.