[Case of severe motor and intellectual disabilities presenting with partial central diabetes insipidus triggered by infection].

We report a 42-year-old woman with severe motor and intellectual disabilities (SMID) who showed partial central diabetes insipidus during severe pneumonia. Serum sodium levels were previously within the upper normal range from 140 to 147 mEq/L. During pneumonia, however, serum sodium rose rapidly to reach 185 mEq/L. The daily urinary volume exceeded the daily intake of water. Nasal administration of 1-desamino-8-D-arginine vasopressin (DDAVP) reduced the daily urinary volume and the serum sodium level to normal ranges. Consequently, we diagnosed her as having central diabetes insipidus (DI). She required a smaller dose of DDAVP (2.5 microg/day) than usual DI (5-15 microg/day) to maintain normal urinary volume and the serum sodium level for seven months. After the nasal administration of DDAVP was discontinued, the serum sodium levels again returned to within the upper normal range. A water deprivation study demonstrated poor elevation of both plasma antidiuretic hormone (ADH) level (range, 0.5-2.0 pg/ml) and urine osmolarity (peak level, 552 mOsm/kgH2O) despite the elevation of plasma osomolarity, suggesting latent partial central DI. Water balance and serum electrolyte levels should be closely monitored in cases of SMID.

[The evaluation of lateralized frontal lobe function in the patients with autistic or attention deficit/hyperactivity disorder].

The prefrontal lobes are involved in two functionally distinct cognitive selection mechanisms: processing based on internal representation, such as planning (context-dependent reasoning) and exploratory processing of novel cognitive situations (context-independent reasoning). On the basis of this working hypothesis, a cognitive bias task (CBT; Goldberg, 1994), designed as an activation procedure representing contextual reasoning, was used to explore developmental disorders of lateralization in the frontal lobes in autistic disorder and attention deficit/hyperactivity disorder (ADHD). The subjects included 3 patients with autistic disorder, 4 with ADHD. Ten normal right-handed males served as controls. In CBT, a high score indicated consistency of choice: a context dependent selection bias, and a low score showed independent selection bias. The autistic group showed a score significant lower than those in controls (p < 0.01). The ADHD group had also a lower score. These findings implicate a deficit in the development of hemispheric specialization in the symptoms of these developmental disorders.