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Biomedical subjects

A Nezu

Publications and source records attributed to A Nezu.

67 records · Page 4Linked to original sources
PubMed1990

Efficacy of long-term fluoxetine treatment of obsessive-compulsive disorder.

Ten outpatients meeting DSM-III-R criteria for obsessive-compulsive disorder completed a 32-week, open-label study with fluoxetine, a selective serotonin reuptake blocker. The patients were evaluated every four weeks for obsessive-compulsive symptomatology, anxiety, and depression. Significant improvement of obsessive-compulsive and anxiety measures were observed after four weeks, with maximal improvement at eight weeks. Depressed and nondepressed patients showed similar rates of improvement in obsessive-compulsive symptomatology. Overall, fluoxetine was tolerated well by all patients, and no serious side effects were observed. This study suggests that fluoxetine is an effective and safe treatment for obsessive-compulsive disorder, both for short-term alleviation and for long-term maintenance.

Body Weight↗
PubMed1989

Peripheral nerve involvement in myasthenia gravis.

The dermal and muscular nerves in a 13-year-old female patient affected by myasthenia gravis (MG) were subjected to ultrastructural observation. The dermal nerves mainly examined were located around the sweat glands, which were thought to be autonomic cholinergic nerves. Axonal and Schwann cell pathologies, of various degrees, such as proliferation and/or disorganized axonal microorganelles, accumulation of Reich granules and lipopigments in the Schwann cell cytoplasm, and expansion of the intraperiod line of the outer myelin loop, were observed in both types of nerves. Although this patient showed no clinical signs of peripheral neuropathy, including dysautonomia, this study indicates that there is generalized cholinergic nerve involvement in MG.

Adolescent↗
PubMed1987

Pathophysiology of involuntary movements in Parkinson's disease.

Tremor and drug-induced dyskinesia are major involuntary movements in Parkinson's disease. The rhythm of resting tremor is 4-6 cycles/s, driven by generators in the brain, and stabilized by reflex arcs involving the spinal cord, nerves and muscles. Its frequency is fixed: it is the same in proximal and distal muscles in each case and does not change in the course of amplitude reduction of tremor by levodopa injection. An approximate doubling of frequency occurs in action tremor which suggests a central mechanism liable to produce harmonics. In postural tremor as observed in the lower limbs while on standing, the frequency of grouped discharges falls into ranges of rhythm with either resting or action tremor. Levodopa-induced dyskinesia has a similar nature to chorea in both clinical observation and EMG. With EMG choreic discharges may appear concomitant with regular parkinsonian tremors in the same muscle, suggesting that the two are not opposites as expressions of dysfunction of the dopaminergic system.

Humans↗
PubMedDate not supplied

Chronic subdural hematoma, as an initial manifestation of glutaric aciduria type-1.

A 10-month-old male with glutaric aciduria type-1 (GA-1) is reported. This patient showed frequent partial motor seizures, irritability, and involuntary movements, including oral dyskinesia at the age of 3 months. On admission, magnetic resonance (MR) scanning revealed a chronic subdural hematoma and widening of the bilateral insular cisterns. Urine organic acid analysis showed marked excretion of glutaric acid, 3-hydroxy glutaric acid and glutaconic acid, suggesting GA-1. Removal of the subdural hematoma was effective for the irritability but not for the extrapyramidal signs. This is the first report of a subdural hematoma as an initial symptom in a patient with GA-1. However, the complication of subdural fluid collection in GA-1 is not rare. To our knowledge, of 29 patients with GA-1 who underwent computed tomographic or MR scans, 5 had subdural fluid collection. Disproportional hypoplasia of the temporal lobes may be a suggestive etiology of subdural fluid collection/chronic subdural hematoma.

Amino Acid Metabolism, Inborn Errors↗
PubMedDate not supplied

Neurophysiological study in Pelizaeus-Merzbacher disease.

The Neurophysiological characteristics of Pelizaeus-Marzbacher disease (PMD) were studied in four Japanese patients aged between 5 and 13 years. Pendular spontaneous nystagmus was always recorded with a frequency between 2.5 and 4 Hz, and abnormal saccades with an almost twofold prolongation in onset time and 50% decrease in velocity were noted. Brainstem auditory evoked potentials consistently demonstrated severely altered waves II to V, following a normal wave I, despite normal hearing acuity. Somatosensory evoked potentials (SEPs) were always absent between brainstem components and early cortical responses. Late cortical components of SEPs and visual evoked potentials with significantly prolonged latencies were recorded in the three younger cases having normal sensory and visual acuity (N35 of SEP, 73.1 +/- 2.1 ms; N75 of VEP, 129.0 +/- 12.7 ms; mean +/- S.D.), while these peaks were absent in the oldest case having the most severe handicap. In motor evoked potentials (MEPs), R1 of blink reflex with significantly prolonged latency (14.9 +/- 1.48ms) was always obtained, and no subsequent R2 was elicited. Magnetic transcortical stimulation elicited no MEPs of the thenar even in the facilitating condition on voluntary contraction despite mild weakness of the thenar, while normal MEPs were always elicited on cervical stimulation. These electrophysiological findings were consistent with extensive conduction slowing involving the brainstem to the cerebrum, which seemed to be accompanied by conduction block in motor systems rather than sensory systems. Although each of the results was not specific, in combination they suggested the characteristics of diffuse brain dysmyelination in PMD.

Adolescent↗
PubMedDate not supplied

Tolosa-Hunt syndrome with pseudotumor cerebri. Report of an unusual case.

An 12-old-year girl with Tolosa-Hunt syndrome (THS) complicated with pseudotumor cerebri is presented. She suffered from alternating, recurrent and painful ophthalmoplegia at the age of 8, and bilateral papilledema which did not affect visual acuity was also recognized. THS subsided readily on steroid therapy, and the remission lasted more than 3 years after discontinuing steroid. However, papilledema did not change despite remission of THS, and resulted in optic atrophy with a mildly enlarged scotoma and 10% decrease in visual acuity 6 months after the onset. MRI disclosed slightly contrasted masses in the bilateral enlarged cavernous sinuses and narrowing of the left carotid siphon. Another small mass with partial gadolinium enhancement was revealed adjacent to the left narrowing of the carotid siphon in the optochiasmatic cistern; however, there was no lesion causing intracranial hypertension. The intracavernous MRI findings were considered characteristic of THS, and papilledema seemed to be due to pseudotumor cerebri by exclusion. Since subsequent MRI confirmed no progression of the above findings, the intracavernous and intracisternal masses were suspected to be non-specific inflammatory granulomas associated with THS.

Child↗
PubMedDate not supplied

Pelizaeus-Merzbacher-like disease: female case report.

We experienced a 15-year-old female, whose healthy parents were second cousins, who was suspected of having dysmyelinating disease involving only the central nervous system (CNS). She was noticed to have congenital pendula nystagmus, and spastic gait disturbance developed at the age of 10 years. Mild athetosis of the upper limbs and ataxia were recognized at age 13 years, and dysarthria presented at age 15. MRI and electrophysiological findings showed the characteristics of Pelizaeus-Merzbacher disease (PMD), although the extensive nerve conduction slowing of the CNS was less severe than that in male patients with PMD. No promoter or exonic mutations of proteolipid protein (PLP) gene were detected. Although this patient might be heterozygous for a mutation of the extraexonic PLP gene sequences or of other unknown X-linked PLP associated genes, we speculate that this case had a dysmyelinating disease with an autosomal recessive trait characterized by the same phenotype as that of PMD.

Adolescent↗
PubMedDate not supplied

Transcranial magnetic stimulation in an adrenoleukodystrophy patient.

We experienced an 11-year-old boy diagnosed as having adrenoleukodystrophy (ALD), and studied his motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS). He had intellectual and visual impairment, and MRI revealed high intensity of the parieto-occipital white matter. On evaluation of the long tracts, slight spasticity with equivocal Babinski signs was noted: however, the long tracts appeared intact on MRI, and short latency somatosensory evoked potentials (SSEPs) were completely normal. On TMS delivered through a circular coil, MEPs recorded from the relaxed first dorsal interosseous muscle showed that only the duration was significantly prolonged, which may be due to temporal dispersion of descending volleys in the pyramidal tracts, while the latency was not prolonged. TMS in ALD was considered sensitive and useful for detecting subtle involvement of the long tracts.

Adrenoleukodystrophy↗
PubMedDate not supplied

Serial magnetic resonance imaging in children with postinfectious encephalitis.

We analyzed follow-up magnetic resonance images (MRI) in eight children with clinical postinfectious encephalitis (PIE), and discussed their pathogeneses. Three categories of MRI findings were apparent: (1) multifocal lesions in the white matter with/without basal ganglia involvement consistent with acute disseminated encephalomyelitis (ADEM) (three patients); (2) single or multifocal lesions localized only in the gray matter (two patients); and (3) localized lesions in the brain stem, basal ganglia or cerebellum. Some lesions in the patients in Categories 1 and 2 migrated or were resolved quickly, sometimes within 10 days. Gadolinium caused linear or spotty enhancement in the patients in Category 2. These findings suggest that Categories 1 and 2 are a self-limiting allergic angiopathy without demyelination. In contrast, the lesions in the patients in Category 3 were fixed, and not resolved within 6 months (three patients). The pathogenesis of Category 3 is not known. All except one patient had no prednisolone (PSL) therapy, however; all lesions were resolved completely or markedly reduced in size, which indicates PSL therapy is not always necessary in patients with PIE.

Adolescent↗
PubMedDate not supplied

Coefficient of variation of R-R intervals in severe brain damage.

The coefficient of variation of R-R intervals (CVRR) was studied in 18 children having severe brain damage with a mean +/- standard deviation (s.d.) age of 8.4 +/- 5.9 years, who were divided into ten patients complicated with respiratory insufficiency (RI group) and eight patients with severe athetotic cerebral palsy (SA group). CVRR was obtained in the resting supine position, and was compared with that in 22 neurologically normal controls. CVRR in the RI group (mean +/- S.D., 2.19 +/- 1.28%) was significantly lower than that in controls (5.56 +/- 1.53%), while CVRR in the SA group (11.30 +/- 3.91%) was significantly higher than that in controls (both P < 0.01, ANOVA). In particular, the four patients with brain death showed extremely low CVRR of 1.00-1.29%. Since CVRR was 4.09% in the patient aged 4 years with birth injury of the upper cervical spinal cord causing absence of spontaneous respiration, the extremely low CVRR in patients with brain death may be directly related to brainstem dysfunction. The cause of the high CVRR in the SA group was not determined. Thus, CVRR may be useful for quantitative evaluation of severe neurological disorder.

Adolescent↗