[A case of hemichorea with hyperglycemia presenting with low signal intensity in the striatum on T2*-weighted gradient-echo magnetic resonance imaging].

A 76-year-old woman was admitted to our hospital with chorea in her left arm and leg. She also suffered from poorly controlled diabetes. Her arm and leg flexed and shook, and these movements were worsened by stress and disappeared during sleep. Neurological examinations were otherwise normal. The blood glucose level was 232 mg/dl and glycosylated hemoglobin A1c was 13.9%. Magnetic resonance (MR) showed high signal intensity on T1-weighted images (T1-WI) in the right striatum, and low signal intensity on T2-weighted images (T2-WI). T2*-weighted gradient-echo magnetic resonance imaging showed low signal intensity that gradually became even lower, suggesting petechial hemorrhage. SPECT showed normal blood flow in the right striatum under these conditions, and gradually decreased. The patient's diabetes was controlled with insulin, and the hemichorea improved on treatment with tiapride up to 75 mg per day, haloperidol up to 2.25 mg per day. Hemichorea with hyperglycemia is a disorder that is associated with poorly controlled diabetes, old age, and high signal intensity on T1-weighted MR imaging in the striatum contralateral to the hemichorea. The pathophysiology of the hemichorea is presumed to be ischemic changes in the striatum associated with hyperglycemia and hyperviscosity. The MR findings in our patient suggest petechial hemorrhage following ischemic change, although petechial hemorrhage has not been reported in similar cases in the recent literature. The striatal hyperactivity may be associated with the onset of hemichorea in our patient.

Population-based door-to-door survey of migraine in Japan: the Daisen study.

OBJECTIVES: To determine prevalence and characteristics of migraine in Japan, and to investigate use of medical care and whether food preference is associated with risk of migraine. METHODS: Structured questionnaires were given to all adult residents (N = 5758; 2681 men and 3077 women) in Daisen, a rural community in western Japan. Second questionnaires, specific to headache, were given to 1628 residents with headache. A telephone survey was also carried out. Statistical Packages for the Social Sciences analyzed the data. RESULTS: The 1-year prevalence of migraine was 2.3% (migraine with aura, 0.4% and without aura, 1.9%) in men and 9.1% (migraine with aura, 1.0% and migraine without aura, 8.1%) in women. Overall prevalence of migraine in Daisen was 6.0% (95% confidence interval [CI], 5.4% to 6.6%). Women observed a 5.9-fold higher risk of migraine than men (odds ratio, 5.9; 95% CI, 4.5 to 8.0; P <.0001, after age adjustment, by logistic analysis). Fatigue and loss of vigor were predominant premonitory symptoms of migraine. Fatigue, mental stress, and lack of sleep were the main headache triggers. Over a 3-month period, 20.3% of migraineurs experienced time or days off work due to headache. Only 7.3% of those with migraine with aura and 5.3% of those with migraine without aura had consulted a physician, and of those with migraine, 61.0% with aura and 71.8% without aura had never visited a medical doctor for their headache. Consumption of alcohol and cigarette smoking did not influence the risk for migraine or tension-type headache, after age and gender adjustment (logistic analysis). Migraineurs consume significantly more fatty/oily foods, coffee, and tea than nonheadache subjects of the same community. Migraineurs consume significantly fewer fish than nonheadache residents. CONCLUSIONS: Only a few Japanese migraineurs receive benefits of medical services and recent advances of headache medicine. Public education concerning headaches is one of the most urgent issues in Japan.

Double-blind crossover study of branched-chain amino acid therapy in patients with spinocerebellar degeneration.

To determine whether treatment with branched-chain amino acids (BCAA) can improve the condition of patients with ataxia, a double-blind crossover study of BCAA therapy was performed in 16 patients with spinocerebellar degeneration (SCD). The patients were treated with BCAA in oral doses of 1.5, 3.0, or 6.0 g or with placebo daily for 4 weeks in each study phase. The order of treatment phases (placebo or BCAA) was assigned randomly. An International Cooperative Ataxia Rating Scale (ICARS) was used to quantify the severity of symptoms of SCD. The mean ICARS score improved significantly with BCAA treatment compared with the mean pretreatment score (p<0.01). In addition, the improvement in the mean global ICARS score was significant in the middle-dose group compared with that in the placebo group (p<0.02). The estimated improvement in kinetic functions compared with pretreatment (p<0.01) was significant after treatment with BCAA, 1.5 and 3.0 g. All of the responders manifested predominantly cerebellar symptoms, especially those with spinocerebellar ataxia type 6 (SCA6). Thus, treatment with BCAA may be effective in patients with the cerebellar form of SCD.