Rinshō shinkeigaku = Clinical neurology
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Case Reports
[A case of long thoracic nerve palsy, with winged scapula, as a result of prolonged exertion on practicing archery].
Reports of isolated long thoracic nerve palsy are rare in Japan. We reported a case of isolated long thoracic nerve palsy, resulted from recurrent injury to the nerve. Muscle CT and electrodiagnostic study were useful for confirming diagnosis of this cases. ⋯ Conduction time for left long thoracic nerve was prolonged, and amplitude of the evoked response was small and there were temporal dispersion. Muscle CT and electrodiagnostic studies were suggestive of neuroapraxia of left long thoracic nerve. Over stretching or compression during exercises may be responsible for the damage to the long thoracic nerve.
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We studied positron emission tomography in nine patients with unilateral internal carotid artery occlusion, selected as having good collateral circulation through the anterior portion of the circle of Willis. Analyses of regional cerebral blood flow, cerebral oxygen metabolic rate, oxygen extraction fraction, and cerebral blood volume allowed quantitative evaluation of the regional hemodynamic status, especially in relation to watershed area. The patient group has a significantly (p less than 0.01) decreased regional blood flow in the middle cerebral artery territory and the surrounding watershed areas of the occluded hemisphere, as compared with eight control subjects. ⋯ Oxygen extraction fraction gave information on the balance of energy supply and demand, serving as an index of the oxygen carriage reserve. A concomitant decrease in the ratio of cerebral blood flow to volume suggested reduction in mean flow velocity with possible development of "stagnation thrombus". These findings suggest 1) hemodynamic vulnerability of watershed areas after internal carotid artery occlusion and 2) importance of systemic hemodynamic factors such as blood pressure and circulating blood volume in the genesis of watershed infarctions.
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Review Case Reports
[Motor amusia following a right temporal lobe hemorrhage--a case report].
A 65-year-old female was admitted to our hospital because of left hemiparesis with sudden onset one week before. She was congenitally right-handed. She had been a teacher of Japanese string instrument (samisen) playing and been able to sing Japanese traditional songs well. ⋯ MRI was performed one year and a half after the brain hemorrhage. It displayed a thin linear of hematoma in the white matter of the right upper temporal and transverse gyrus. It was proved in our case that motor amusia with minimal musical receptive dysfunction could appear following a cerebral lesion and musical function might be independent of intelligence or verbal function.
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Idiopathic orthostatic hypotension (IOH) and primary sympathicotonic orthostatic hypotension (PSOH) are conspicuous orthostatic hypotension syndromes without overt somatic neurologic signs. IOH, also referred as pure autonomic failure, is a syndrome of chronic pandysautonomia, and its clinical features include supine hypertension, anhidrosis, impotence, neurogenic urinary and bowel disturbances. PSOH is different from IOH in which it is not accompanied with autonomic features outside of cardiovascular symptoms, and has been most commonly described in German-Scandinavian literatures. ⋯ By means of the method of maximum normed residual, statistically screened out were 7 cases with extremely great orthostatic fall in systolic blood pressure (OH-I). Another OH group (OH-II) consisted of 24 cases who showed orthostatic decrease in systolic blood pressure of 30 mmHg or more, but did no fall into the extreme observation. Assuming that the orthostatic regulation mechanism of blood pressure was well maintained in the remaining 256 cases, they were used as the control.(ABSTRACT TRUNCATED AT 250 WORDS)
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Review Case Reports
[Subacute myeloneuropathy after abuse of nitrous oxide: an electron microscopic study on the peripheral nerve].
We have experienced a case of myeloneuropathy following habitual abuse of nitrous oxide. We report clinical and pathological findings of this case with review of literatures. A 36-year-old dentist was first admitted to our hospital on August 17, 1983 because of numbness of both lower legs and unsteady gait. ⋯ Axon was almost normal at least in the early stage of degeneration. Later, axon disappeared with destruction of myelin sheath. These nerve changes largely demonstrated demyelination but it was occasionally accompanied with axonal degeneration.(ABSTRACT TRUNCATED AT 250 WORDS)