[A case of heat stroke showing abnormal diffuse high intensity of the cerebral and cerebellar cortices in diffusion weighted image].

Cerebellar ataxia is most neurological sequelae in heat stroke. Heat stroke with cerebral cortical lesions is very rare. A 39-year-old man was admitted to our hospital because of coma, shock status and hyperthermia on arrival and developed disseminated intravascular coagulation (DIC). Hypotension was transient and all vital signs were resumed to normal within a week. Though normal vital sign, his coma state continued throughout. A diffusion weighted image (DWI) on MRI disclosed abnormal diffuse high intensity in the cerebral and cerebellar cortex without decreased apparent diffusion coefficient (ADC). These cortical changes were supported to the vasogenic edema induced by heat stroke. Four months later after the onset, the abnormal signal intensity in the cerebral and cerebellar cortex disappeared and cortical atrophy with ventricular enlargement developed. Electroencephalogram (EEG) of several times showed no electrical activities. The brain SPECT ((123)I-IMP) disclosed all over decreased blood flow. His vegetative state continued.

[A case of acute disseminated encephalomyelitis (ADEM) with an anti-galactocerebroside antibody].

Acute disseminated encephalomyelitis (ADEM) with an anti-galactocerebroside antibody is very rare. We report a case of 82-year-old man with ADEM associated with anti-galactocerebroside antibody in serum. He was admitted to our hospital after developing disturbed consciousness and respiratory failure. A cerebrospinal fluid examination disclosed an albuminocytologic dissociation and elevation of myelin basic protein. Magnetic resonance images revealed lesions in the medulla oblongata, pons, midbrain, bilateral cerebellar hemisphere and thalami. Initially, he was treated with methylprednisolone (1 g/day) for three days. His clinical symptoms improved. We found on 15(th) hospital day that an anti-galactocerebroside antibody was positive in serum without serological evidence of Mycoplasma pneumoniae infection. This case can be diagnosed as ADEM associated with an anti-galactocerebroside antibody.