Rinshō shinkeigaku = Clinical neurology
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A extremely rare case of unilateral retinocephalic vascular malformation (Wyburn-Mason syndrome) was reported. A 5 year-old girl was seen to a ophthalmologist complaining of exophthalmus of her left eye after trauma on her face for the past 2 months. On ophthalmologic examinations, retinal arteriovenous malformation was recognized in her left eye and she was referred to neurosurgical service for the evaluation on occurrence of traumatic carotid cavernous fistula. ⋯ The intraorbital part of the malformation was mainly fed from the external cerebral artery. She was diagnosed as Wyburn-Mason syndrome. We stressed in the paper that enhanced CT was useful for the diagnosis of the Wyburn-Mason syndrome.
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Review Case Reports
[A case of spinal artery aneurysm presenting transverse myelopathy associated with coarctation of the aorta].
We report a case of spinal artery aneurysm, secondary to the coarctation of aorta, who presented with initial signs of transverse myelopathy. A 45-year-old woman was admitted to the hospital because of quadriplegia. She had a history of subarachnoid hemorrhage traced to unknown origin. ⋯ The right retrograde brachial angiography showed an aneurysm of cervical spinal artery. Digital subtraction angiography demonstrated a coarctation of the aorta. Coarctation of the aorta was considered to have caused spinal artery aneurysm, and is the first reported case in Japan.
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A case of a survivor who showed alpha coma after an attempted suicide by hanging was reported. A 19 years old woman was admitted to the hospital because of respiratory arrest following a hanging attempt on October 10, 1987. She was found pendent completely. ⋯ On the 45th day the brain MRI revealed diffuse cerebral cortical atrophy, although no lesions were visualized in the brain stem. She showed gradual progress towards neurologic recovery. This is the first presentation of a survivor from alpha coma caused by anoxic encephalopathy following a hanging attempt.
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Somatosensory evoked potentials (SEPs) to posterior tibial nerve (PTN) and median nerve (MN) stimulations were recorded in 30 patients with cervical spondylotic myelopathy. Measurements performed include N20-P2 interpeak latency (IPL) for PTN-SEPs, EP-N13 IPL and EP-N20 IPL for MN-SEPs. Limits of normal IPL were defined by the mean + 3S. ⋯ PTN-SEPs was more sensitive (with 73.3% abnormal) than MN-SEPs (with 33.3% abnormal) and strongly correlated with the clinical signs of posterior column, but not with those of anterolateral column indicated by superficial sensory disturbances and spasticity of lower limbs. Severities of cord compression (sagital diameter/transverse diameter ratio) calculated from the picture of metrizamide CT were not correlated with SEPs findings and clinical signs. In patients with cervical myelopathy, SEPs, especially PTN-SEPs, were thought to be very useful examination.
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Case Reports
["My hand" sign associated with tactile extinction in two patients with callosal lesion].
Two patients with "my hand" sign in association with tactile extinction from callosal lesion, one due to left anterior cerebral artery occlusion, the other due to right anterior cerebral artery aneurysm rupture, were reported. The examination of "my hand" sign was performed with the methods proposed by Brion et al. Our patients correctly responded when they grasped their own or the examiner's thumb with their left hand. ⋯ However, they said "both" when their right index finger alone was touched (synchiria) during an extinction test using the following method: both index fingers of patients were approached by examiner to touch each other or for one of them to touch the examiner's finger. When they were asked whose finger they touched in this method (whose finger test), they made the same errors as seen in "my hand" sign test. These test results suggest that there is a common underlying mechanism in the "my hand" sign and extinction, because the sense of double stimulations felt when only one stimulation is given (synchiria), is a possible explanation for the "my hand" sign and the pathogenesis of synchiria appears to be related to extinction.(ABSTRACT TRUNCATED AT 250 WORDS)