[A case of left posterior inferior temporal infarction with right homonymous upper quadrantanopsia and alexia with agraphia for Kanji].

BACKGROUND: Alexia with agraphia usually represents damage in angular gyrus. We report an unusual case of alexia with agraphia caused by a posterior inferior temporal lesion. CASE REPORT: A 82-year-old, right-handed man was admitted because of reading disorder. Visual acuity was 0.7 OD and 0.7 OS. Goldmann perimetry revealed right homonymous upper quadrantanopsia. Standard Language Test of Aphasia revealed mild anomia and severe alexia with agraphia for kanji. Magnetic resonance imaging demonstrated left temporal and posterior infarction in the posterior cerebral artery region. Single photon emission computed tomography revealed decreased blood flow in the left inferior temporal, parahippocampal, fusiform, lingual and inferior occipital gyri. There were no significant lesions nor any decreased of blood flow in the angular gyrus. CONCLUSION: It is suggested that reading and writing of ideograms such as Kanji is related not only to the angular gyrus but also to the posterior inferior temporal lobe and medial posterior lobe of the visual cortex.

[A case of acute bromvalerylurea intoxication: clinical course and alteration in serum bromvalerylurea concentration].

Bromvalerylurea is one of the non-barbiturates products and has been used as analgesics and hypnotics in Japan. A 20-year-old woman was admitted to our hospital for loss of consciousness. She had a 6-month history of transient delirium and drunken gait. Physical examination revealed erythema less than thumb's head size at her face, shoulder and thigh. Neurologically, she had a state of coma and low muscle tonus. EEG showed the pattern of burst-suppression. The level of her serum chloride was not elevated. The erythema made us check up her state of acute bromvalerylurea intoxication. High blood concentration of bromvalerylurea led to diagnosis of the bromvalerylurea intoxication. The maximum value of her serum bromvalerylurea concentration was 107 microg/ml on the second hospital day, while the concentration in cerebrospinal fluid were also increased and remained for several days. She was treated with respiration control and drip infusions. She gradually improved and recovered to be alert. She was complicated severe liver dysfunction and disseminated intravascular coagulation resulting from bromvalerylurea intoxication, also treated with intensive care and gradually recovered. We should take notice to bromvalerylurea, easily available over the counter, as one of the drugs which may cause severe loss of consciousness or coma, and general complications. And if the bromvalerylurea intoxication is prospective, we should consider whether the option of gastric irrigation is available regardless of the elapsed time.

[Effects of personal controls on cortisol secretion during stress processes].

This study investigated effects of personal control on psychobiological stress responses. Salivary cortisol was used as an index of hypothalamic pituitary-adrenocortical axis response. Healthy males (N = 20) were exposed five times serially to a psychosocial stressor: mental arithmetic under time pressure. "Chance control", "other powerful controls" and "internality" were reported personality-dependent aspects of personal controls; "personal control as coping" under the psychosocial stress situation was also assessed with a questionnaire after the session ended. Cortisol response showed significant increase (F (16,304) = 6.69, p < 0.01). From the view point of personality, the high "chance control" score group showed higher levels of cortisol compared to the low score group before stressful tasks. On the other hand, the high "personal control as coping" score group showed higher levels of cortisol compared to the low score group after the stressful tasks. We inferred that the high "personal control as coping" score group conducted stressful tasks with high concentration and effort. The effects of such personal controls as personality and as ways of coping were demonstrated in this experiment through cortisol secretion in different stress-process phases.

Vertical ophthalmoplegia in a demented patient with striatopallidodentate calcification.

A case is presented here of a 73-year-old man who showed signs of dementia, supranuclear vertical ophthalmoplegia, pseudobulbar palsy, axial dystonia, mild rigidity, and parkinsonian gait. Computed tomography of the head revealed symmetrical calcification in the striatum, globus pallidus and dentate nucleus to an extraordinary degree. No metabolic conditions were observed that could explain the intracranial calcification. Oral administration of levodopa improved the patient's motor symptoms to some extent. Ophthalmoplegia, parkinsonism and dementia combined are typically seen in patients with progressive supranuclear palsy. However, the present case and a few others that have been reported would seem to indicate that these unique symptoms might also be found in patients with intracranial calcification.

Steroid-responsive limbic encephalitis.

A 71-year-old man presented with gradually progressing cognitive decline following acute febrile exanthematous disorder. The MRI showed an abnormality in the bilateral limbic systems. An elevation of cerebrospinal fluid (CSF) protein with lymphocyte pleocytosis was noted. Immunoblot of the CSF revealed the presence of anti-white matter antibodies that mainly recognized astrocytes. Intravenous steroid followed by oral steroid reduced the symptoms to a remarkable degree. The patient has now been successfully sustained with steroid for more than two years. We considered that this case is classified as non-paraneoplastic limbic encephalitis, and acquired autoimmunity played a major role in the pathogenesis of this case.