A case of acute cervical epidural hematoma mimicking medial medullary infarction complicated by arterial dissection]

A 67-year woman with hypertension rapidly noted weakness of the right upper and lower extremities with posterior cervical pain. At admission to our hospital, she showed right hemiparesis without facial palsy, and bilateral pathological reflex. Chest X-ray demonstrated enlargement of the mediastinal shadow. We suspected that she developed aortic arch dissection extending into the vertebral arteries and subsequent medial medullary infarction. However, enhanced thoracic CT, brain MRI-DWI and MRA examinations were negative. Her symptoms rapidly recovered three hours after the onset. A cervical MRI study revealed cervical epidural hematoma locating between the C3 and C6, which suppressed right side of the spinal cord. In conclusion, cervical epidural hematoma as well as medial medullary infarction complicated by the vertebral arterial dissection should be urgently explored when a patient had a sudden onset of cervical pain and hemiparesis without facial palsy.     

Changes in arousal level by differential exercise intensity

OBJECTIVE: The purpose of the present study was to investigate the influence of exercise intensity on arousal level. METHODS: Twelve subjects (22-33 years) performed a S1-S2 reaction time task consisting of warning stimulus (S1) and imperative stimulus (S2) in a control condition, and again after low, medium, and high intensity pedaling exercises. During this task, contingent negative variation (CNV) and spontaneous electroencephalogram before S1 were measured as indicators for arousal level. RESULTS: CNV amplitude after high intensity pedaling exercise was significantly smaller than after medium pedaling exercise. Compared to the control condition, relative power value of alpha waves increased after the high intensity exercise. CONCLUSIONS: These results suggested that arousal level was reduced after high intensity exercise and reached a state near optimal level after medium intensity exercise. The findings also suggested that changes in CNV amplitude by differences in exercise intensity followed an inverted-U shaped dose response curve. SIGNIFICANCE: The present study supported the view that CNV amplitude and arousal level followed an inverted-U relationship. It is concluded that differences in exercise intensity influenced arousal level.     

Motor denervation of tumors of the head and neck: changes in MR appearance.

PURPOSE: We reviewed the MR appearance of motor denervation of the third (mandibular) division of the trigeminal nerve (V3) and of the hypoglossal nerve. METHOD: Six cases of tumor of the head and neck with motor denervation were retrospectively evaluated. These comprised two patients with V3 denervation, three patients with hypoglossal nerve denervation, and one patient with both V3 and hypoglossal denervation. The observation was conducted for 6 to 44 months after onset. In denervated muscles, changes in signal intensity in T(1)- and T(2)-weighted images, degree of contrast enhancement, and volume of muscle were estimated during the follow-up period. RESULTS: In all cases of V3 denervation, the muscles showed no change in signal intensity in the T(1)-weighted images up to three months after onset. In two cases of hypoglossal denervation, the tongues appeared ipsilaterally hyperintense in the T(1)-weighted images within the first three months. In one case with V3 denervation and two cases with hypoglossal denervation, denervated muscles appeared hyperintense in the T(2)-weighted images up to three months after onset. At three months after denervation, the signal intensities of all motor-denervated areas increased in both T(1)- and T(2)-weighted images. Postcontrast T(1)-weighted images obtained within the first three months displayed contrast enhancement of all denervated muscles. In three cases of V3 denervation, the volumes of the affected muscles were reduced after the first three months. In three cases of hypoglossal denervation, the ipsilateral volume of the tongue decreased at three months after onset. CONCLUSION: Up to three months after onset, the denervated muscles appeared hyperintense in the T(2)-weighted images and contrast enhancement in postcontrast T(1)-weighted images before fatty infiltration and volume loss were apparent. Familiarity with the MR appearance of denervated muscles accompanying tumors of the head and neck is important to avoid confusion with inflammatory or neoplastic processes.     

Effects of alpha adrenoceptor blockade on renal nerve stimulation-induced norepinephrine release and vasoconstriction in the dog kidney

Effects of alpha-antagonists on renal norepinephrine (NE) release and vasoconstriction induced by renal nerve stimulation (RNS) were examined in pentobarbital-anesthetized dogs. RNS at 1,2 and 3 Hz (1 msec duration, 10-20 V) for 1 min decreased renal blood flow (RBF) and increased both the renal venous NE concentration (NEC) and calculated renal NE efflux (NEE). The RBF responses to 2 and 3 Hz RNS and NEC responses to 1, 2 and 3 Hz RNS during intrarenal arterial infusion of yohimbine (1.0 micrograms/kg/min) were greater than those observed during the control period. The NEE responses to 1 and 2 Hz RNS, but not to 3 Hz RNS, were also potentiated by the yohimbine infusion. Prazosin treatment (0.2 mg/kg i.v.) attenuated the RBF responses. Subsequent infusion of yohimbine potentiated both the NEC and NEE responses to 1, 2 and 3 Hz RNS in this alpha-1 adrenoceptor-blocked state. These results suggest that an alpha-2 adrenoceptor-mediated inhibitory mechanism of neural NE release exists in the dog kidney, which can be activated by endogenously released catecholamines to modulate the neural control of renal hemodynamics. Alpha-1 adrenoceptor-mediated renal vasoconstriction may affect the evaluation of neural NE release by NEE when high-frequency RNS is applied during inhibition of the alpha-2 adrenoceptor-mediated mechanism.     

Platelet adenine nucleotides in patients with primary glomerular disease

Total platelet adenosine diphosphate (ADP) and adenosine triphosphate (ATP) contents and amounts of ADP and ATP released from platelets by 3 micrograms/ml of collagen were studied in 20 patients with primary glomerular disease (PGD) to examine the metabolism of these platelet substances in the disease. ADP and ATP were measured by Holmsen's firefly luciferase method. The patients had significantly lower total platelet ATP compared with controls and total platelet ATP was significantly lower in nephrotic patients than in patients whose serum albumin levels were normal. Releasable platelet ADP and ATP were both significantly decreased in patients. Releasable ADP: total ADP ratio and releasable ATP: total ATP ratio were both significantly lower in patients' platelets than in normal platelets. There was no significant difference in platelet counts between patients and controls. Platelet aggregation induced by ADP and adrenaline were significantly higher in patients compared with controls. We conclude that total ATP content and the amount of ADP and ATP released by collagen are decreased in PGD patients' platelets.