Tadashi Umehara

Findings of segmental zoster paresis on MRI

A 72-year-old man developed herpes zoster rash involving the left C3-5 dermatomes. The patient was receiving treatment for myasthenia gravis, which was very well controlled with oral prednisolone (25 mg). There was no muscle weakness or other complications on examination in the outpatient clinic. Ten days before the onset of rash, he noticed weakness of the left arm. On admission, the left arm weakness was limited to muscles controlled by the C5 myelomere. He had no clinical symptoms of myelitis, but the T2-weighted magnetic …

Are hypersegmented neutrophils a characteristic of Boucher-Neuhäuser syndrome?

We report a family with Boucher-Neuhäuser syndrome (BNS). All 3 patients with BNS had hypersegmented neutrophils on peripheral-blood films. Our findings indicate that hypersegmented neutrophils are a characteristic of BNS. Blood films should therefore be examined in patients with a suspected diagnosis of BNS.

Body weight and dysautonomia in early Parkinson's disease

Patients with Parkinsons disease (PD) begin to lose weight several years before diagnosis, which suggests weight variation is associated with some factor(s) that precede the onset of motor symptoms. This study aimed to investigate the association of autonomic nervous system with body weight in patients with PD.

Pearls & Oy-sters: Trigeminal neuropathy associated with herpes labialis

A previously healthy 41-year-old woman with recurrent herpes labialis since her 20s noticed a herpes labialis lesion on the left side of the lower lip. After 2 days, she experienced the acute onset of tingling and a swollen sensation of the left side of the face, beginning at the V3 division of the trigeminal nerve and progressing to involve the V1 and V2 divisions over the course of 2 days. A dermatologist diagnosed herpes labialis and prescribed acyclovir 1,000 mg in 2 divided doses for 5 days. However, the symptoms did not improve after the lesion disappeared. The left side of the tongue perceived a bitter taste 8 days after the onset of symptoms. Examinations …

Rotigotine Improves Abnormal Circadian Rhythm of Blood Pressure in Parkinson’s Disease

Introduction: Cardiovascular autonomic failure is commonly associated with Parkinson’s disease (PD), affecting the daily lives of patients. Rotigotine was recently reported not to influence cardiovascular autonomic responses in contrast to other dopaminergic drugs. The effect of rotigotine on daily blood pressure (BP) fluctuations might reflect autonomic failure in patients with PD. Methods: Twenty-five PD patients who were receiving rotigotine and 12 patients not receiving rotigotine were recruited. Systolic BP during the daytime and nighttime was measured by 24-h BP monitoring at an interval of 2 years. The patients were divided into 3 groups according to the BP fluctuation type: dippers (nocturnal fall in BP ≥10%), non-dippers (0–10%), and risers (< 0%). The time course of BP was compared between the patients given rotigotine and those not given rotigotine. Results: Among the 25 patients who received rotigotine, the BP type worsened in 2 patients, was unchanged in 16 patients, and improved in 7 patients. Among the 12 patients who were not receiving rotigotine, the BP type worsened in 5 patients, was unchanged in 4 patients, and improved only in 3 patients (p = 0.042). Conclusion: Rotigotine improves the abnormal circadian rhythm of BP in patients with PD. Rotigotine was suggested to have favorable effects on cardiovascular autonomic responses and circadian rhythm in patients with PD.

Relative adrenal insufficiency in adult-onset cerebral X-linked adrenoleukodystrophy

A 48-year-old man with adrenoleukodystrophy was admitted because of heavy sweating, sputum, and high fever. Brain MRI showed extensive cerebral white matter demyelination (figure, A). The patient was previously diagnosed with adult-onset cerebral X-linked adrenoleukodystrophy (ACALD) with ABCD1 gene mutation at age 46 years. Laboratory findings on admission showed inflammatory changes (white blood cell count 12,400/μL, C-reactive protein 2.1 mg/dL), hypotonic hyponatremia (Na 118 mEq/L, Osm 255 mOsm), hyperkalemia (K 5.6 mEq/L), and hypoglycemia (75 mg/dL). The serum cortisol level was higher than normal (cortisol 35.2 μg/dL). Chest CT showed mild consolidation in the right lower lobe (figure, B).