Rinshō shinkeigaku = Clinical neurology
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Case Reports
[Beneficial effect of steroid pulse therapy on Wernicke-Korsakoff syndrome due to hyperemesis gravidarum].
A 25-year-old woman suffered from hyperemesis gravidarum when she was seven weeks pregnant. Since her vomiting continued, she received intravenous dextrose and electrolytes without thiamine in a hospital. One month later, she developed gait disturbance, followed by confusion and dysarthria. ⋯ Soon after, her psychosis began to improve gradually. She recovered remarkably from the psychosis, but she was left with persistent nystagmus, mild ataxic gait and polyneuropathy. The present case suggests that corticosteroid may have the beneficial effect on Wernicke-Korsakoff syndrome.
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We herein report a patient with the abnormal eye movement characterized by a conjugate slow-upward eye movement followed by a fast-downward movement to the primary position (slow-upward ocular bobbing). A 55-year-old man with a 12 years' history of striatonigral degeneration developed pneumonia and was admitted to our hospital. ⋯ This spontaneous eye movement was recognized throughout his stay in the hospital, irrespective of his consciousness level. Although other forms of ocular bobbing/dipping are usually associated with the loss of consciousness, all three reported patients with this slow-upward ocular bobbing were awake and responsive, therefore, suggesting a different kind of background pathophysiology in this unique eye sign.
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In order to evaluate diagnostic usefulness of MRI in vertebrobasilar insufficiency (VBI), we performed magnetic resonance imaging (MRI) and MR angiography (MRA) in 90 patients presenting vertigo and dizziness as an initial and cardinal complaint. High signals observed by T2-weighted imaging in the basal ganglia (44.4%) or pontine base (48.9%) were more frequently seen in the possible VBI group than in the controls (p < 0.001). ⋯ Vertebral artery asymmetry (45.6%) or basilar artery twisting (41.1%) as shown by MRA was also significantly more frequent in the patients than in the controls (p < 0.05). In conclusion, MRI and MRA were considered to be useful in making a clinical diagnosis of VBI in such patients.
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To clarify the temporal discrepancies between cerebral circulatory arrest and loss of brain functions in relation to neuroradiological differences of brain damage, we analyzed 100 cases of impending brain death evaluated by neurological findings and continuous, simultaneous neuromonitoring of somatosensory and brainstem auditory evoked potentials (SEP, BAEP), compressed spectral arrays (CSA), and transcranial Doppler sonography (TCD). A) Cases of supratentorial lesions: 1) Loss of brain functions after supratentorial circulatory arrest (TCD) were advanced rostrocaudally -(SEP N20 > CSA) > (BAEP III-V > SEP P13/14). 2) All patients demonstrated supratentorial circulatory arrest (TCD) after both neurological and cerebral (CSA) functions had been lost for more than 6 hours or after loss of neurological, cerebral (CSA), and brainstem (BAEP, SEP) functions. ⋯ Both intervals were less than 24 hours in almost all cases. In applying ancillary studies to the diagnosis of brain death, consideration should be given to the time lag between cerebral circulatory arrest and loss of brain functions caused by pathophysiological differences in brain damage.
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The subclavian steal syndrome (SSS) is often associated with occlusive disease involving the subclavian or innominate arteries, but an asymptomatic subclavian steal, called the "subclavian steal phenomenon" (SSP), is not uncommon. Though intracranial collaterals had been postulated as one of the etiologies for the SSP's being asymptomatic, little has been accomplished in the investigation of extracranial channels. To study the hemodynamic role of cervical collateral channels, an angiographical study was done in three cases with SSP. ⋯ On angiography, occlusions of the unilateral proximal subclavian artery, the left in case 1 and the right in case 2, or a tight stenosis of the innominate artery was found in case 3. In each case, the vertebral artery flow in the affected side was inverted, siphoning off from the opposite vertebral artery into the affected subclavian artery. In addition to the vertebral siphoning; muscular branches of ipsilateral external carotid origin in cases 1 and 2, or the thyrocervical trunk via the inferior thyroid artery in case 3 was also found to function as a collateral channel to the vertebral artery on the affected side.(ABSTRACT TRUNCATED AT 250 WORDS)