Rinshō shinkeigaku = Clinical neurology
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[Hemodynamics of the vertebral artery in subclavian steal syndrome and subclavian steal phenomenon].
To evaluate hemodynamics of the vertebral artery (VA) in subclavian steal syndrome (SSS) and subclavian steal phenomenon (SSP), blood flow velocities of the bilateral VAs were measured by duplex ultrasonography in four patients with SSS and eight patients with SSP. The reversal of flow in the VA was noted in both systolic and diastolic phases in all of the SSS group, and was recorded only in a systolic phase in all but one of the SSP group. ⋯ This indicates that collateral blood flow through the VA in the SSS group is still insufficient to compensate the blood requirement of the upper extremity on the affected side. In conclusion, hemodynamics of the VA in the SSS group could be distinguished from those in the SSP group by duplex ultrasonography.
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Review Case Reports
[Neuro-Behçet disease with bilateral cheiro-oral syndrome following simultaneous multiple brain hemorrhage].
A 34-year-old man with neuro-Behçet disease showed bilateral cheiro-oral syndrome following simultaneous multiple brain hemorrhage. The patient suddenly developed fever, headache, right-sided heminumbness, and gait disturbance after ciclosporin therapy was instituted. Bilateral uveitis, oral aphthous ulcers and follicular skin eruptions were observed. ⋯ As dysesthesia was attenuated, bilateral typical symptoms of cheiro-oral syndrome were found. These results suggest that the intracerebral hemorrhage was caused by angitis related to Behçet disease. MRI findings implicate that the involvement of bilateral paramedian areas including medial parts of both the medial leminiscus and the ventral secondary ascending tract of the trigeminal nerve is responsible for bilateral cheiro-oral syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)
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We reported two patients with neurocutaneous angiomatosis. Patient 1, a 36-year-old woman of Cobb syndrome had cutaneous portwine angiomas in the high back and spinal arteriovenous malformations at the level of Th4-11. ⋯ Neuroradiological examination revealed abnormal vessels in the spinal canal at the level of C5 and Th4. These syndromes may have no essential difference because of the presence of neural and cutaneous angiomas at the corresponding level, venous system disorders and trophic changes (hypertrophy/atrophy).
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A 25-year-old female with McArdle's disease was reported. She had no characteristic symptoms for McArdle's disease such as muscle cramp and brown urine, but had general fatiguability from childhood. On examination, she showed no neurological abnormalities including muscle atrophy and weakness. ⋯ The skinned fiber test of the muscle showed no enhanced Ca induced Ca release (CICR), and serum VLDL level was normal. Her 27-year-old elder brother had similar clinical symptoms and serological abnormalities and may also have McArdle's disease, although muscle biopsy was not performed. A possibility of McArdle's disease should be considered when we encounter a patient who has only general fatigue and high serum CK level.
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The purposes of this paper are to evaluate degree of dysphagia at the pharyngeal stage of swallowing in patients with myasthenia gravis (Osserman IIB). A catheter with three diode transducers 5 cm apart was swallowed through the nose into the upper esophagus. Firstly a patient was commanded to drink water of 1 ml at about five second intervals, and the swallowing pressures were recorded on condition that the speed of paper recording and catheter pull-through is the same 1 mm/sec. ⋯ Thirdly the resting pressure of upper esophageal sphincter was recorded on the same condition of the first recording. The results were as follows: (1) All seven patients showed extremely low swallowing pressure at the all level of the pharynx compared with healthy men. (2) At the edrophonium test all seven patients revealed increased percentage of swallowing pressure. (3) One patient showed poor relaxation of the upper esophageal sphincter. (4) The resting pressure of the upper esophageal sphincter was low compared with control. In myasthenia gravis manometric study of the pharynx and the pharyngoesophageal sphincter is a useful method for evaluating swallowing function.