Takeki Nagao

Weak detrusor contractility correlates with motor disorders in Parkinson's disease

Limited attention has been paid to the relationship between urinary symptoms or urodynamic findings and motor disorders in Parkinsons disease (PD). We aimed to correlate pressure‐flow urodynamic parameters with video‐gait analysis parameters in PD. We recruited 41 patients with PD (25 men and 16 women; age, 70.6 ± 8.5 years; H & Y motor grading: 2 [range, 1–3]; disease duration: 4 years [range, 1–7]; taking levodopa 300 mg/day [range, 100–400]). All patients underwent pressure‐flow urodynamics (parameters: first sensation, bladder capacity, detrusor overactivity [noted in 24 patients], and Watts factor [WF]) and video‐gait analysis (parameters: time and number of strides for 5‐m gait [simple task] and time for timed up and go [complex task]). Statistical analysis was made by Mann‐Whitneys U‐test for analyzing the relation between detrusor overactivity and gait as well as Spearmans rank‐correlation coefficient test for analyzing the relation between the remaining parameters and gait. We found no relation between filling‐phase urodynamics (detrusor overactivity, first sensation, and bladder capacity) and video‐gait analysis parameters. By contrast, we found a significant relation between voiding‐phase urodynamics (WF, reflecting detrusor power) and all three video‐gait analysis parameters (reflecting lower‐half bradykinesia and loss of postural reflex) in our PD patients (P < 0.01). The close relation between the WF and motor disorders in the present study suggests that, though clinically mild, a weak detrusor in PD might have a central origin. We should follow postvoid residual volume carefully in PD patients with advanced gait disorder, because postvoid residual volume might increase in such patients.

Thalamic infarction disrupts spinothalamocortical projection to the mid-cingulate cortex and supplementary motor area

Thalamic infarction presenting with heat anesthesia is rare. A 62-year-old man developed acute heat anesthesia and deep sensory disturbance in the right half of his body, but sensation for cold and pain was preserved. The resolution of these symptoms was accompanied by the gradual development of central dysesthesia. Magnetic resonance imaging (MRI) and computed tomography (CT) findings showed a small infarction in the left thalamic principal somatosensory nucleus (ventral caudal) and pulvinar. Single-photon emission CT showed hypoperfusion in the mid-cingulate cortex (mid-CC) and supplementary motor area (SMA), however, the primary and secondary somatosensory cortices were spared. Somatosensory-evoked potential findings were normal. The disruption of spinothalamocortical projection to the mid-CC and SMA is attributable to the development of central dysesthesia in the present case.

Isolated Hemiataxia and Cerebellar Diaschisis after a Small Dorsolateral Medullary Infarct

Isolated hemiataxia after a medullary infarct is rare. We describe a case of isolated hemiataxia after a small infarct localized at the ipsilateral dorsolateral medulla. An 83-year-old man developed acute onset of ataxia in the left arm and in both legs. Speech and extraocular movement were normal, and he did not have any other neurological manifestations. Brain MRI showed a small infarct localized at the left dorsolateral medulla, which involved the inferior cerebellar peduncle. 123ECD-SPECT showed hypoperfusion in the left cerebellar hemisphere without clear vascular territory. Neuroimaging findings for our patient suggested the involvement of the inferior cerebellar peduncle that projects to the cerebellum in our patient.

The study of systemic general circulation disturbance during the initiation of therapeutic hypothermia: Pit fall of hypothermia

Aims: Neurointensive care has reduced the mortality and improved the outcome of patients for severe brain damage, over recent decades, and made it possible to perform this therapy in safety. However, we have to understand the complications of this therapy well. The purpose of our study was to determine the systemic circulation disturbance during the initiation of therapeutic hypothermia by using this continuous neurointensive monitoring system. Materials and Methods: Ten severe brain damage patients treated with hypothermia were enrolled. All patients had Glasgow Coma Scale (GCS) less than or equal to 8, on admission. Results: We verified that heart rate, cardiac output, and oxygen delivery index (DO2I) decreased with decreasing core temperature. We recognized that depressed cardiac index (CI) was attributed to bradycardia, dehydration, and increased systemic vascular resistance index (SVRI) upon initiation of hypothermia. Conclusion: Although the hypothermia has a therapeutic role in severe brain damage patients, we have to carry out this therapy while maintaining their cardiac output using multimodality monitoring devices during hypothermia period.

Ruptured aneurysm of the PICA communicating artery: a case report.

A 47-year-old man presented with a rare aneurysm arising from the posterior inferior cerebellar artery communicating artery (PICA com A), manifesting as subarachnoid with intraventricular hemorrhage. Cerebral angiography showed a defect of the left PICA, and the left PICA region was supplied by a communicating artery formed by the fusion of branches from the right PICA and right vertebral artery. Aneurysms arose in the communicating artery, and a small, unruptured fusiform aneurysm was observed adjacent to a ruptured aneurysm. Trapping was performed for the 2 aneurysms with occipital artery (OA)-PICA bypass. Six cases of aneurysms occurring in this vessel including ours have been reported, and hemodynamic factors and congenital fragility of the arterial wall have been suggested as causative factors. Ours is the first case in which a ruptured aneurysm of this vessel was treated surgically with concurrent vascular reconstruction. If the aneurysm has a shape that is difficult to clip, the affected vessel is difficult to preserve, and collateral blood flow to the affected PICA region is considered insufficient, trapping with OA-PICA bypass is recommended.