Intrastriatal injection of 5,7-dihydroxytryptamine decreased 5-HT levels in the striatum and suppressed locomotor activity in C57BL/6 mice

Effects of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) and 5,7-dihydroxytryptamine (5,7-DHT) on striatal levels of dopamine (DA), 5-hydroxytryptamine (5-HT), and their metabolites, as well as on locomotor activity were investigated in C57BL/6 mice. The results showed that MPTP significantly increased locomotor activity and decreased striatal DA levels. However, injection of the serotonergic neurotoxin 5,7-DHT in the striatum, either alone or following high doses of MPTP, significantly decreased locomotor activity, and concomitantly decreased striatal levels of 5-HT and 5-HIAA. This study suggests that the increased locomotor activity may be due to increased striatal serotonergic activity which overcompensates for the DA deficiency. The locomotor hypoactivity, induced by 5,7-DHT, might be due to the decreased striatal levels of 5-HT and 5-HIAA.

Neurotoxic N-methyl-D-aspartate lesion of the ventral midbrain and mesopontine junction alters sleep-wake organization

The dorsal regions of the midbrain and pons have been found to participate in sleep regulation. However, the physiological role of the ventral brainstem in sleep regulation remains unclear. We used N-methyl-D-aspartate-induced lesions of the ventral midbrain and pons to address this question. Unlike dorsal mesencephalic reticular formation lesions, which produce somnolence and electroencephalogram synchronization, we found that ventral midbrain lesions produce insomnia and hyperactivity. Marked increases in waking and decreases in slow wave sleep stage 1 (S1), stage 2 (S2) and rapid eye movement sleep were found immediately after the lesion. Sleep gradually increased, but never returned to baseline levels (baseline/month 1 post-lesion: waking, 30.6 +/- 4.58%/62.3 +/- 10.1%; S1, 5.1 +/- 0.74/3.9 +/- 1.91%; S2, 46.2 +/- 4.74%/23.1 +/- 5.47%; rapid eye movement sleep, 14.1 +/- 3.15%/7.2 +/- 5.42%). These changes are comparable in magnitude to those seen after basal forebrain lesions. Neuronal degeneration was found in the ventral rostral pons and midbrain, including the substantia nigra, ventral tegmental area, retrorubral nucleus, and ventral mesencephalic and rostroventral pontine reticular formation. We conclude that nuclei within the ventral mesencephalon and rostroventral pons play an important role in sleep regulation.

Glial cell line-derived neurotrophic factor protects against 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced neurotoxicity in C57BL/6 mice

To mimic chronic exposure to neurotoxins in inducing dopaminergic cell damage, multiple doses of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) were injected in C57BL/6 mice. Effects of pre- and post-treatment with the glial cell line-derived neurotrophic factor (GDNF) by injections into the striatum were investigated. GDNF exerts protective and reverse effects on the dopaminergic damage, supporting the potential application of GDNF in prevention and treatment of Parkinson's disease.

Elevated 5-S-cysteinyldopamine/homovanillic acid ratio and reduced homovanillic acid in cerebrospinal fluid: possible markers for and potential insights into the pathoetiology of Parkinson's disease

High-performance liquid chromatography with electrochemical detection has been employed to analyze ultrafiltrates of cerebrospinal fluid of Parkinson's Disease (PD) patients and age-matched controls for the dopamine (DA) metabolites homovanillic acid (HVA) and 5-S-cysteinyldopamine (5-S-CyS-DA). The mean level of HVA in the CSF of PD patients, measured 5 days after withdrawal from L-DOPA therapy, was significantly lower than that measured in controls. By contrast, mean levels of 5-S-CyS-DA were not significantly different in the CSF of PD patients taking L-DOPA (PD-LT patients) the same patients 5 days after discontinuing this drug (PD-LW patients) or controls. However, the mean 5-S-CyS-DA/HVA concentration ratio was significantly (p < 0.05) higher in the CSF of PD-LW patients compared to controls. Although the PD patient population employed in this study had been diagnosed with the disease several years previously and had been treated with L-DOPA for prolonged periods of time the results of this study suggest that low CSF levels of HVA and a high 5-S-CyS-DA/HVA ratio together might represent useful markers for early diagnosis of PD. The high 5-S-CyS-DA/HVA ratio observed in the CSF of PD-LW patients also provides support for the hypothesis that the translocation of glutathione or L-cysteine into neuromelanin-pigmented dopaminergic cell bodies in the substantia nigra might represent an early event in the pathogenesis of PD.

Leptomeningeal malignant melanoma arising in neurocutaneous melanocytosis: a case report

A rare case of histology-proved giant congenital melanocytic nevus (GCMN) with symptomatic leptomeningeal melanocytosis is reported. A 26-year-old man had had a large patch of pigmented nevus over his back and left arm since birth. He had begun to have seizures as well as symptoms and signs of increased intracranial pressure about six months before admission. Serial computed tomography of brain showed hydrocephalus, diffuse leptomeningeal enhancement and multiple well-enhanced, rapid-growing nodules on the surface of the cerebellum and left parietal lobe. Magnetic resonance imaging (MRI) revealed T1 shortening of leptomeninges on precontrast T1 weighted imaging. Skin biopsy was done twice and showed intradermal nevus. Biopsy on one of the intracranial nodules revealed malignant melanoma arising in the melanocytosis. He died one year after the onset of neurologic symptoms. For early diagnosis of neurocutaneous melanocytosis, we suggest 1) MRI, and 2) leptomeningeal biopsy in patients with suspected leptomeningeal malignant melanoma.

Genetic analysis of regions involved in replication and cadmium resistance of the plasmid pND302 from Lactococcus lactis

The 8.8-kb Lactococcus lactis plasmid pND302 encodes resistance to cadmium (CdR). Regions of pND302 involved in replication and CdR were subcloned and sequenced. The replication region is localized on a 1.5-kb region and consists of an open reading frame (repB) preceded by a noncoding AT-rich sequence (ori) which is highly homologous to lactococcal theta-type replicons. The CdR determinant is localized on a 2.9-kb region and encodes putative proteins similar to the Cd(2+)-specific P-type efflux ATPase (CadA) and the transcriptional regulatory repressor (CadC) identified in Staphylococcus aureus, Bacillus firmus, and Listeria monocytogenes. Similar CdR determinants were also detected by PCR in other CdR plasmids isolated from different L. lactis strains.

Late blink reflex changes in lesions of thalamus and internal capsule

A 60-year-old man suddenly suffered from left hemiplegia with sensory loss on the left side of his face, trunk, and extremities. Brain CT disclosed hemorrhage in the right thalamus and internal capsule. Blink reflex with electrical stimulation on the left supraorbital nerve showed normal early response (R1) on the left side but absent late response (R2) on both sides, while stimulation of the right supraorbital nerve showed normal R1 on the right side and normal R2 on both sides. This observation suggests that the impulses of R2 from stimulation of the supraorbital nerve on the affected side may be blocked by contralateral lesions of the thalamus and internal capsule.

Effects of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine and 5,7-dihydroxytryptamine on the locomotor activity and striatal amines in C57BL/6 mice

The present study examined the effects of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) and 5,7-dihydroxytryptamine (5,7-DHT) on striatal levels of dopamine (DA), 5-hydroxytryptamine (5-HT), and their metabolites homovanillic acid (HVA) and 5-hydroxyindole-3-acetic acid (5-HIAA), respectively, as well as their influence on locomotor activity in conscious C57BL/6 mice. High doses (s.c., 35-45 mg/kg per day for 10 days) of MPTP resulted in a significant (P < 0.05) increase in locomotor activity and a marked decrease of striatal DA levels. Concomitantly, the ratios of HVA to DA and 5-HIAA to 5-HT increased significantly, the latter reflecting increased 5-HIAA levels. In contrast, i.c.v. administration of the serotonergic neurotoxin 5,7-DHT, either alone or following high doses (40 mg/kg per day for 10 days) of MPTP, decreased locomotor activity. Furthermore, striatal levels of 5-HT and 5-HIAA as well as the 5-HIAA/5-HT ratio decreased significantly. Thus, the increased locomotor activity induced by chronic high doses of MPTP might be due to increased striatal 5-HT levels which appear to compensate for the loss of DA. Furthermore, the locomotor hypoactivity induced by 5,7-DHT may be secondary to the striatal 5-HT deficiency.

Creutzfeldt-Jakob disease: clinical analysis of eight cases

BACKGROUND

Creutzfeldt-Jakob disease (CJD) or spongiform encephalopathy in humans, is a rare, rapidly progressive and fatal disorder of the central nervous system. Since clinical diagnosis is challenging, this retrospective investigation was performed.

METHODS

Eight cases who had been diagnosed as CJD from 1987 to 1995 were reviewed thoroughly, with a resulting clinical diagnosis of CJD. Two cases were proved by brain biopsy.

RESULTS

Four males and four females were included; their ages were 53 to 81 years with a mean of 66 years. The mean illness duration of the six patients who died was six and a half months. Clinical findings were variable and included dementia, aphasia, ataxic gait, pyramidal, extrapyramidal, myoclonus and visual problems.

CONCLUSIONS

For diagnosis of CJD, clinical suspicion is very important. Electroencephalogram (EEG) remains the most helpful laboratory diagnostic tool; serial recordings are necessary if the initial EEG finding is nonspecific. Single photon emission computed tomography (SPECT) may be helpful for premorten diagnosis of CJD, but sensitivity and specificity need further investigation. Brain biopsy seemed to be unnecessary if the clinical, EEG and SPECT findings are typical.

Studies of dementia, depression, electrophysiology and cerebrospinal fluid monoamine metabolites in patients with Parkinson's disease

Twenty-two patients with Parkinson's disease (PD) were studied by clinical evaluation, assessments of dementia and depression, as well as electrophysiologic examinations for blink reflex (BR), cortical somatosensory evoked potentials (CSEP), brain stem, and long-latency auditory evoked potentials (BAEP, and LAEP), and cerebrospinal fluid (CSF) assays for monoamine metabolites. Results show that PD patients have a significant decrease of Mini-Mental State Examination (MMSE) scores (p < 0.05) and an increase of Hamilton Depression Scale (HDS) scores (p < 0.01), as well as a longer latencies of R2 in BR, N19 and P22 in CSEP, W4 and W5 in BAEP and P300 in LAEP (p < 0.01), and lower CSF levels of HVA and MHPG (p < 0.05). The findings suggest a correlation between dementia/depression and mesocorticolimbic and mesostriatocortic dysfunction with dopaminergic and noradrenergic deficiencies in PD patients. Furthermore, parkinsonian dementia parallels the length of duration of the disease, but not the severity of motor disability. Parkinsonian depression parallels both the length of duration of the disease and the severity of motor disability.

Clinical distinction between acute hemorrhagic and acute ischemic stroke by Siriraj stroke score

BACKGROUND

The clinical distinction between hemorrhagic and ischemic stroke cannot be achieved by simple clinical evaluation, and it is impossible to submit all stroke patients to computed tomography. A simple, reliable, and safe diagnostic tool for acute stroke syndrome is needed. This study tested the Siriraj stroke score to verify its accuracy for distinguishing among the pathological subtypes of stroke.

METHODS

This study included the one hundred and seventy-one patients with acute supratentorial stroke syndromes consecutively admitted to the Emergency Room of the Taichung Veterans General Hospital from April 1 to September 30, 1993. The Siriraj stroke score was calculated, then compared with results of computed tomography. The Siriraj stroke score was calculated as (2.5 x level of consciousness) + (2 x vomiting) + (2 x headache) + (0.1 x diastolic blood pressure) - (3 x atheroma markers) - 12. A score above 1 indicates supratentorial intracranial hemorrhage, while a score below -1 indicates infarction. The score between 1 and -1 represents an equivocal result needing further evaluation to verify diagnosis.

RESULTS

The diagnostic sensitivities of the Siriraj stroke score for intracranial hemorrhage and infarction were 85% and 90% respectively, with an overall predictive accuracy of 88.5%. When three cases with subarachnoid hemorrhage whose scores were all above 1 were excluded, the sensitivities for cerebral hemorrhage and infarction were 83.8% and 90% respectively, with an overall predictive accuracy of 88.2%.

CONCLUSIONS

The Siriraj stroke score can be used as a reliable bedside method for diagnosing acute stroke and for deciding which patients should have priority for computed tomography, it is also a valuable tool for epidemiology studies of stroke incidence and outcome.

Central pontine myelinolysis in chronic hyponatremic patient: a case report

A 59-year-old woman had chronic hyponatremia from inappropriate secretion of antidiuretic hormone (SIADH) and malnutrition after recurrent cholecystitis for 2 months. She developed dysarthria, dysphagia, bilateral ptosis, clonic convulsions and delayed onset Parkinsonian features. Magnetic resonance imaging showed increased signal density in the central pons on T2-weighted images. She was also later diagnosed as having systemic lupus erythematosus (SLE). This case is reported because central pontine myelinolysis (CPM) developed in chronic hyponatremia without correction, and manifested with atypical, delayed-onset Parkinsonian features. The patient recovered well from her neurological illness, unlike the poor outcome in previously reported cases of CPM. In addition, the coincidence of CPM and SLE has not, to knowledge, been reported before.

Allen score in clinical diagnosis of intracranial hemorrhage

BACKGROUND

Allen score is a validated weighted linear score for clinical distinction between hemorrhagic and ischemic stroke. As the prevalence of hemorrhagic stroke differs between Caucasian and Chinese populations, and the predictive value of any diagnostic score depends greatly on the prevalence of disease being considered, we tried to verify prospectively this score among the Chinese living in Taiwan.

METHODS

From 1 April to 31 August 1993, all patients with acute stroke syndrome, who visited the emergency room at Veterans General Hospital-Taichung, were studied prospectively. Clinical features were recorded thoroughly to calculate the Allen score. The diagnosis was all confirmed by computed tomography (CT) of the head.

RESULTS

Totally 255 stroke cases were identified. The types of the stroke were cerebral infarction in 186 subjects (73%), cerebral hemorrhage in 64 subjects (25%), and subarachnoid hemorrhage in 5 subjects (2%). Seventy-five cases were excluded because of the lack of clinical details for calculation. Thus, 180 patients were included. When a cut-off of 4 or 24 was taken into account, the sensitivity of Allen score for diagnosing a hemorrhage was 67%, specificity 100%, accuracy 93%, positive predictive value 100%, and negative predictive value 91%.

CONCLUSIONS

Although Allen score can be used for epidemiological studies of incidence and outcome in stroke as well as for a first bedside screening to decide the priority of patients for CT, it is not safe enough as a guide for anticoagulant or thrombolytic therapy. Its validity should be verified before use in a given population other than the Caucasian.

Radionuclide esophageal transit test in the detection of esophageal dysmotility in Parkinson's disease

Thirty-three patients of idiopathic Parkinson's disease (PD) and 25 volunteers were admitted to the study for comparison. Esophageal motility including esophageal mean transit time (MTT), residual fraction (RF), and retrograde index (RI) of the two groups were evaluated and calculated by the radionuclide esophageal transit test. The results show that 12% (4/33) of the cases of PD were abnormal in proximal, 15% (5/33) in middle, 0% (0/33) in distal, and 12% (4/33) in total MTT, as well as 6% (2/33) in RF, and 24% (8/33) in RI. In addition, the patients with high H-Y scale scores had a higher incidence of abnormality in proximal MTT than those with low scale (P < 0.05 by a Fisher's exact test). We consider that the radionuclide esophageal transit test has potential as an effective, simple and noninvasive screening tool to detect abnormal esophageal motility in patients suffering from Parkinson's disease.

Dysphagia in Parkinson's disease. Assessment by solid phase radionuclide scintigraphy

Patients with Parkinson's disease often experience dysphagia, in which case food seems to be blocked in the throat. The patient must swallow over and over to get it down. A radionuclide solid phase esophageal motility study was conducted to evaluate esophageal function of patients with Parkinson's disease. Twenty-seven patients and 27 age-matched normal volunteers were studied. Each subject was placed in the supine position above a gamma camera linked to a computer and was given a 4 mL bolus of solid gelatin containing 75 MBq Tc-99m pertechnetate. Data were acquired in the list mode. A computer routine was used to calculate the total mean transit time, the residual fraction after the first swallow, and the retrograde index. The preliminary results suggest: 1) patients with Parkinson's disease display significantly slowed transit time when compared with normal age-matched controls, and 2) dysphagia of Parkinson's disease may improve with medication. A solid phase esophageal motility study may be used as a monitor of dysphagia in patients with Parkinson's disease in our future studies.

Rapid measurement of the monoamine content in small volumes of rat plasma

A method for the simultaneous measurement of serotonin, catecholamines, and their metabolites, 5-hydroxy-indoleacetic acid, homovanillic acid, and 3, 4-dihydroxyphenylacetic acid, by ultrafiltration and microbore high-performance liquid chromatography with dual electrochemical detection in small plasma volumes was established. Unlike the traditional assays which require at least 1-2 ml of plasma for each measurement, the present method uses only a 20-microliters sample volume. Since blood loss is minimal, repeated blood sampling from a single animal as a rat becomes practicable. The present microassay provides low detection limits (signal-to-noise ratio = 3) for all analytes (0.2-0.5 pg per 5-microliters injection or 50-120 pg/ml plasma). Isocratic separation of these analytes on a microbore column is achieved within 15 min. This rapid and sensitive method can be used as a routine research tool in various physiological or pharmacokinetic studies especially in small animals.

Bone mineral density in patients with Parkinson's disease measured by dual photon absorptiometry

Bone mineral density (BMD) in 22 patients (three females, 19 males, aged 58-76 years) with idiopathic Parkinson's disease (PD) was measured by dual photon absorptiometry (DPA) using a M&SE OsteoTech 300 scanner. The BMDs of the 2nd to 4th lumbar vertebrae were measured and the mean density was presented as g cm-2. The BMD of the PD patients was compared with normal BMD values within the same age groups, and the patients were interpreted as normal, suffering mild osteoporosis or severe osteoporosis. The patients were divided into two groups according to (a) the Hoehn and Yahr (H-Y) scale as high or low, or based on (b) the duration of the disease as long or short, for comparison. The prevalence of abnormal BMD in each subgroup of patients was calculated. The results show that the BMD of all the PD patients was lower than those of the normal controls. The PD patients with a high H-Y scale had a higher prevalence of severe osteoporosis. However, the difference between any two groups, separated by the two criteria, is not significant by Fisher's test. We find that PD patients have a higher incidence of severe osteoporosis.

Interactions among deprenyl, clorgyline and 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine on catecholamines in mice

The interactive effects of clorgyline, deprenyl and 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) on striatal dopamine (DA), serotonin (5HT) and hippocampal norepinephrine (NE) were examined in the present study. Results indicated that clorgyline did not have a preventive effect against MPTP's toxicity on DA and NE, but it had a partial therapeutic effect against subchronic MPTP-induced DA depletion when given with deprenyl together. However, this effect was not significantly different from the effect of deprenyl alone. Co-administration of clorgyline and deprenyl had a satisfactory effect in preventing MPTP-induced NE depletion. On the other hand, in all clorgyline-treated groups, there was a significant increase of 5HT in both the striatum and the hippocampus.

A clinical and MRI study of cerebellar infarctions

The frequency of cerebellar infarctions over two and a half years was 2.7% of the 1300 hospitalized patients over that period. Sixteen patients with cerebellar infarctions were studied by using clinical manifestations and magnetic resonance imaging (MRI). Ages ranged from 41-87 (mean 63.5) years; 13 were men and 3, women. Risk factors included: hypertension (50%), diabetes (44%), prior stroke (44%), cardiac disease (38%), and hyperlipidemia (19%). Common symptoms and signs were dizziness/vertigo (75%), unsteadiness (69%), dysarthria (69%), and nausea/vomiting (50%). Infarcts mainly involved the posterior inferior cerebellar artery (PICA) territory and tended to be associated with brainstem infarcts in 14 of the 16 patients. Most cerebellar infarctions had a benign course, especially the small ones. No mortality was noted in this series. The short-term outcome of the cerebellar infarctions seemed to depend on the size of the infarcts and the sites of the artery occlusion. It was concluded that diagnosis of cerebellar infarctions requires a high index of clinical suspicion, especially when patients present with a sudden onset of ataxia, dizziness/vertigo, nausea/vomiting and dysarthria; and that MRI is a useful tool for the detailed study of cerebellar infarctions and can elucidate associated brainstem infarcts.

The causes of ischemic stroke in patients under 45 years of age

From November 1982 to June 1991, a total of 81 cases of ischemic stroke in persons under 45 years of age were analyzed retrospectively. There were 44 males and 37 females, aged from 2 to 45 years (average 34.6 years). The modes of onset were immediately completed in 55 cases, progressed over a period of 1 hour to 5 days in 23 cases, and fluctuated over a period of 1 to 2 days in 3 cases. Fifty-six cases had one stroke episode; the others had transient ischemic attack or/and several episodes of cerebral infarction. Sixty-five cases had symptoms arising from the region of the carotid artery, more than 3.4 times those arising from the basilar artery territory. Probable causes of stroke were atherosclerosis (54.3%), embolism (28.5%), arteropathy (8.6%), hematological disease and coagulopathy (3.7%) and undetermined (4.9%).

Wallenberg's lateral medullary syndrome with loss of pain and temperature sensation on the contralateral face: clinical, MRI and electrophysiological studies

Thirteen patients with Wallenberg's lateral medullary syndrome (WLMS) were studied. Clinical and magnetic resonance imaging (MRI) evidence demonstrated infarction in the dorsolateral medulla which produced loss of pain and temperature sensation on one side of the face ipsilateral to the lesion in seven patients. However, in another six patients, the infarction in a similar location produced the same sensory loss on the contralateral face. This is the first report of an analysis comparing these two conditions in WLMS patients, confirmed by MRI. The finding of normal blink reflex and somatosensory evoked potentials (stimulation on median nerve) in the two groups of patients may indicate that the impulses travel along the central pathways of touch, vibration and joint position sensation instead of the pathways for pain and temperature, because the patients had normal sensation of touch, vibration and joint position but impairment of pain and temperature sensation. In addition, it is suggested that the pathways of late blink reflex (R2) pass through the medial lemniscus in the ventromedial medulla instead of the spinal trigeminal tract in the dorsolateral medulla. Further, the observation of the much longer lantencies (about 29 ms) of the normal R2 raises the possibility that the impulses may travel along the longer pathways through the opposite medial lemniscus and up to the thalamus or cortex where they project to bilateral motoneurons of the orbicularis oculi muscles. Although the alternative of R2 travelling only by the shorter pathways through the brain stem is not excluded, this is not supported by current data.

Simultaneous measurement of serotonin, catecholamines and their metabolites in mouse brain homogenates by high-performance liquid chromatography with a microbore column and dual electrochemical detection

A dual electrochemical detector with two working electrodes (anode and cathode) suitable for high-performance liquid chromatography with a microbore octadecylsilica column was applied for the simultaneous measurement of norepinephrine, epinephrine, dopamine, 3,4-dihydroxyphenylacetic acid, homovanillic acid, 5-hydroxyindoleacetic acid, 3-methoxytyramine and 5-hydroxytryptamine (serotonin) in mouse brain homogenates. Microbore high-performance liquid chromatography provides very good resolution of these analytes and offers selective detection of biogenic amines and their metabolites on the basis of their retention behaviour and electrochemical reversibility. The large early-eluting peak of brain homogenates was eliminated on cathodic detection, thereby providing reliable measurements of early eluates. The detection limit of this method was ca. 0.2-0.5 pg per injection for all components, at a signal-to-noise ratio of 3. Owing to the high sensitivity, the brain tissue samples could be kept very small (less than 10 mg). Isocratic separation of these analytes was achieved within 15 min; hence over 90 analyses could be performed in a single working day. This simple, efficient and sensitive method can be used as a basic research tool for the assaying of biogenic amines and their metabolites in brain homogenates.

Monoamines and their metabolites in plasma and lumbar cerebrospinal fluid of Chinese patients with Parkinson's disease

Ten free monoamines and their metabolites in plasma and cerebrospinal fluid (CSF) were simultaneous measured in 6 levodopa-untreated (LU), 18 levodopa-treated (LT) and 37 levodopa-withdrawn (LW) Chinese patients with Parkinson's disease (PD) and 26 controls. We found that the levels of these substances in LW patients were not significantly different from those in LU patients. In LU- and LW-PD patients, CSF epinephrine (EPI) was higher (P < 0.05) than that of the controls. 3-methoxy-DOPA (3-OMDOPA) might not inhibit the accumulation of 3,4-dihydroxyphenylalanine (DOPA) and dopamine metabolites in CSF. Levodopa treatment might change the dopaminergic and serotoninergic neuronal systems, but not the noradrenergic or adrenergic neuronal systems, in CNS of PD patients. Benserazide (a peripheral decarboxylase inhibitor) in Madopar might decrease the levels of serotonin (5-HT) and norepinephrine (NE), but not those of DOPA and homovanillic acid (HVA), in plasma. HVA, NE and EPI in plasma were not good indices for those in CSF. Otherwise, our results were consistent with some other studies by showing a significantly lower level (P < 0.01) of HVA in CSF of LU- and LW-PD patients than that of the controls, while no difference for NE, 3-methoxy-4-hydroxyphenylglycol (MHPG), 5-hydroxyindole acetic acid (5-HIAA) or 3-OMDOPA was noted. The severity of clinical disability was related to the deficiency of CSF HVA and DOPAC in LU- and LW-PD patients; however, there was no relationship between clinical symptoms of tremor, rigidity-bradykinesia, autonomic dysfunction, dementia, depression or levodopa-induced dyskinesia and CSF monoamines or their metabolites.

Generalized neuropathy in Taiwan: an etiologic survey

From July 1988 to June 1989, the etiology was registered of 520 patients with generalized neuropathy in 5 neurological centers in Taiwan. The neuropathy was diabetic in 256 cases (49.23%), alcoholic in 45 (8.65%), inflammatory in 34 (6.53%; including 21 with acute inflammatory demyelinating polyneuropathy, 12 with chronic inflammatory demyelinating polyneuropathy, and 1 with chronic relapsing polyneuropathy), 12 with associated malignancy (2.31%), 9 with dysproteinemia (1.73%), uremic in 22 (4.23%), hereditary motor and sensory in 22 (4.23%), toxic in 14 (2.69%), ischemic in 12 (2.31%), hypothyroidism in 10 (1.92%), nutritional deficiency and malabsorption in 6 (1.15%), chronic liver disease in 4 (0.77%), other diseases in 11 (2.12%) and unclassified in 63 (12.12%). This survey provided a crude etiological picture of generalized neuropathy on this island.

Simultaneous measurement of serotonin, catecholamines and their metabolites in cat and human plasma by in vitro microdialysis-microbore high-performance liquid chromatography with amperometric detection

A method for the simultaneous measurement of norepinephrine, epinephrine, dopamine, 3,4-dihydroxyphenylacetic acid, homovanillic acid, serotonin and 5-hydroxyindole-3-acetic acid in cat and human plasma by in vitro microdialysis-microbore high-performance liquid chromatography with electrochemical detection is described. The detection limit (signal-to-noise ratio = 3) is about 0.05-0.1 pg per injection. The volume of plasma samples required is very small (< 200 microliters), hence there is minimal blood loss in repeated blood sampling, especially in experiments using small animals. Within 15 min, a fast isocratic separation of these analytes by using a microbore reversed-phase ODS column is achieved, hence over 90 analyses can be performed in a single working day. As microdialysis per se is not destructive to plasma samples, the remaining plasma sample and perfusate can be repeatedly analysed for other substances. This simple, efficient and sensitive method can therefore be used as a routine clinical and basic research technique in the investigation of blood biogenic amines and their metabolites.

Differential effects of deprenyl and MPTP on catecholamines and activity in BALB/c mice

The present study examined the effects of deprenyl (1.5 mg kg-1) and 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) (30 mg kg-1) on dopamine (DA), norepinephrine (NE) and motor activity in BALB/c mice. Results indicate that pre-treatment with deprenyl injections protected against MPTP's toxicity on DA, NE and motor function. However, if deprenyl was given 3 or 7 days after the MPTP injection (for 3 days in succession), it could not reverse MPTP's toxicity. However, if deprenyl was given for an extended period of 7 days, it reversed MPTP's toxicity on NE, but not on DA and behaviour. If deprenyl was given soon after MPTP each day for 10 days, it protected against MPTP's toxicity on DA and NE, but not on locomotor activity. These results suggest that only prior and repeated deprenyl injection has a satisfactory protective effect against MPTP's neurotoxicity.

Bilateral putaminal necrosis caused by methanol poisoning: a case report

Bilateral putaminal necrosis is characteristic of methanol poisoning. A 31-year-old male alcoholic had headache, impaired consciousness, neck stiffness, roving eyes with dilated unreactive pupils, papilloedema, abdominal pain, vomiting, and severe metabolic acidosis after a binge. Abnormalities of the cerebrospinal fluid included an initial pressure of 240 mmH2 O, RBC 286/mm3, WBC 8/mm3, and protein 179 mg/dl. Peritoneal dialysis was performed on the 2nd day after drinking. A blood test for methanol was not performed until the 5th day, and its results was negative. However, computed tomography (CT) on the 3rd day showed necrosis and hemorrhage of bilateral putamina and the cerebral cortex, and post-contrast enhancement of meninges. On the 22nd day, a CT revealed further changes: necrosis of bilateral subcortical white matter, and post-contrast gyral enhancement at the otherwise normal-looking areas of the cerebral cortex. We suggest that, in certain situations, the characteristic CT findings are helpful in the diagnosis of methanol poisoning.

Parkinson's disease in Taiwan: an analysis of 215 patients

215 Chinese Parkinson's disease (PD) patients on levodopa therapy were followed up between 1982 and 1991. The ratio of males to females was 2.4 to 1. The mean durations from onset of the illness to stages I and II of Hoehn and Yahr (mild disability) were 4.0 and 6.5 years, to stage III (moderate) 7.9 years, and to stages IV and V (severe) 9.8 and 11.8 years. The mean duration of illness for living patients was 8.6 years. The mean duration of illness before death for the 46 patients who died was 8.9 years. The mean age at death was 68 years (4.4 years less than the normal life expectancy in Taiwan). The fate of this disease showed that patients with unilateral symptoms initially had a better prognosis than those with bilateral symptoms. The symptoms at onset were unilateral in 70% of the patients, of whom 91% had a spread of symptoms to the opposite side after a mean of 3.4 years. Familial PD occurred in 2.8% of our patients. The occurrence of blood ABO groups was not significantly different between the PD patients and the general population of Taiwan. Our findings differed from those in Western series by having a predominance of males, and a relatively shorter duration of unilateral symptoms before spread to the opposite side. In addition, the duration of illness and the survival time under levodopa treatment were shorter in Taiwanese and Japanese than in Western series.

Locations of cerebral infarctions in tuberculous meningitis

The locations of cerebral infarctions were studied in 14 patients with tuberculous meningitis (TBM) and 173 patients with noninflammatory ischemic stroke (IS). In patients with TBM, 75% of infarctions occurred in the "TB zone" supplied by medial striate and thalamoperforating arteries; only 11% occurred in the "IS zone" supplied by lateral striate, anterior choroidal and thalamogeniculate arteries. In patients with IS, 29% of infarctions occurred in the IS zone, 29% in the subcortical white matter, and 24% in (or involving) the cerebral cortex. Only 11% occurred in the TB zone. Bilaterally symmetrical infarctions of the TB zone were common with TBM (71%) but rare with IS (5%).

Ketoconazole and high-dose methylprednisolone predisposing to cyclosporine-induced seizures: report of 3 cases

Three consecutive cases of severe aplastic anemia undergoing immunosuppressive therapy with cyclosporin A (CyA) and high-dose methylprednisolone (HDMP) developed grand mal seizures after receiving ketoconazole treatment. All the seizures were reversed after transient discontinuation of those drugs. To our knowledge, it has not been reported as yet that the combination of ketoconazole and HDMP may considerably increase the risk of CyA-induced seizure. We would advise that ketoconazole and HDMP not be taken concomitantly with CyA treatment, and whenever ketoconazole therapy is needed, CyA be started with as small a dose as possible.

Internal carotid artery occlusion in painful ophthalmoplegia

Two patients with left painful ophthalmoplegia, caused by infiltrating lesion in left superior orbital fissure and/or cavernous sinus, subsequently developed left cerebral infarction associated with occlusion of the proximal portion of left internal carotid artery demonstrated by CT and angiogram. It thus is worthy to remind that painful ophthalmoplegia may have the possibility of resulting in cerebral infarction associated with carotid occlusion.

Locked-in syndrome with bilateral ventral midbrain infarcts

We report a patient who was quadriplegic and mute, but retained consciousness and communicated by eye movements and blinks. EEG and SEPs were normal. BAEPs showed slight prolongation of latencies for waves IV and V. MRI showed bilateral infarcts only in the middle and lateral portions of the cerebral peduncles.

[The effects of hypertension, diabetes mellitus, atrial fibrillation, transient ischemic attack and smoking on stroke in Chinese people]

Clinical findings and cranial CT scan identified stroke in 315 admitted patients at Taichung Veterans General Hospital from January 1, 1989 to December 31, 1989. Hemorrhage was found in 137 cases and infarction in 178 cases (thrombosis in 124 cases, embolism in 54 cases). Most cases with stroke (72.4%) were distributed in ages between 55 and 74 years. The mean age of patient with cerebral infarction was 64.8 years, which was about 3.3 years higher than those with cerebral hemorrhage (mean age 61.5 years). The control group consisted of 117 persons (matched in age and sex) who had no history of stroke. In comparison of the five risk factors (hypertension, diabetes mellitus, atrial fibrillation, transient ischemic attack, and smoking) between the patients and the controls, we found that cerebral thrombosis was significantly associated with hypertension, diabetes mellitus, and smoking; cerebral embolism with hypertension, atrial fibrillation, and transient ischemic attack; and cerebral hemorrhage with hypertension only.

[Blood viscosity and blood factors in non-embolic cerebral infarction]

We compared blood viscosity at a high and a low shear rate, hematocrit, as well as levels of fibrinogen, cholesterol, triglyceride and high density lipoprotein-cholesterol between 42 patients with nonembolic cerebral infarction and 39 normal subjects. Blood viscosity, levels of fibrinogen, cholesterol and triglyceride were significantly higher, and high density lipoprotein-cholesterol levels were significantly lower, in patients than in normal persons. Blood viscosity had a positive correlation with hematocrit and fibrinogen, and a negative correlation with high density lipoprotein-cholesterol, but no correlation with cholesterol and triglyceride.

Pure trigeminal motor neuropathy

Images

Mirror-writing and reversed repetition of digits in a right-handed patient with left basal ganglia haematoma

A 57 year old right-handed Chinese man sustained a left basal ganglia haemorrhage resulting in speech disorder and right hemiplegia. He mirror-wrote with his left hand and during speech recovery repeated digits in reverse sequence. The abnormal right to left directionality possibly reflected release of right basal ganglia from left-sided control.

Clinical and electrophysiological studies in a patient with keratitis, ichthyosis and deafness (KID) syndrome

Neurological studies were performed in a young boy with keratitis, ichthyosis and deafness syndrome. Skin biopsy showed features of ichthyosis. Clinically and electrophysiologically, he had normal motor and sensory systems, but there was an acoustic nerve lesion and absence of tendon reflexes. Audiometry and brainstem auditory evoked potentials showed bilateral neurosensory deafness. Poor vision may not be due to an optic nerve lesion as evidenced on visual evoked potential findings, but is probably due to pronounced vascularizing keratitis of the cornea. Computer tomography scan showed mild hypoplasia of the inferior vermis and left side of the cerebellum.

A clinical and electrophysiological study of patients with polychlorinated biphenyl poisoning

Neurological examination of 28 patients, 4 years after serious poisoning by polychlorinated biphenyl contaminated cooking oil, are compared with similar examinations of the same patients two years earlier (in 1980). Clinical peripheral sensory neuropathy was found in 54%, headache in 36% and dizziness in 46% of the patients; these findings did not differ (p greater than 0.1) from those in 1980. Although the mean blood polychlorinated biphenyl concentration (19.2 ppb) in the patients was lower (p less than 0.001) than that in 1980 (35.9 ppb), it was still higher than the normal value (less than 4 ppb). There was no difference in the blood polychlorinated biphenyl concentration of patients with neurological manifestation from those without. Although the mean motor and sensory nerve conduction velocities (MNCV and SNCV) were still slower (p less than 0.06) than the mean normal NCV, the mean MNCV of tibial nerve and SNCV of sural nerve were improved (p less than 0.06) as compared with those in 1980. EEGs were normal except in two cases showing nonspecific slow wave changes. In addition, evoked potentials (somatosensory, visual and brain-stem auditory) were measured in this study and found to be normal in all 12 cases examined.

Locked-in state with bilateral internal capsule infarcts

A posttraumatic patient was tetraplegic and mute (locked-in), but he retained consciousness and communicated by eye movements. CT showed bilateral internal capsule (IC) infarcts involving the posterior limb and caudal part of the genu, sparing the ventral brainstem. This is the first report of the locked-in state caused by infarcts in both IC.