In order to clarify the relationship between the clinical phenotype and the human leucocyte antigen (HLA) in multiple sclerosis in Asians, 93 Japanese patients with clinically definite multiple sclerosis underwent clinical MRI and HLA-DPB1 gene typing studies. According to a neurological examination, 29 patients were classified as opticospinal multiple sclerosis, 17 as spinal multiple sclerosis and 47 as Western type multiple sclerosis showing the involvement of multiple sites in the CNS including either the cerebrum, cerebellum or brainstem. The opticospinal multiple sclerosis showed a significantly higher age of onset, higher expanded disability status scale scores and higher CSF cell counts and protein content than the Western type multiple sclerosis. On brain and spinal cord MRI, the opticospinal multiple sclerosis showed a significantly lower number of brain lesions, but a higher frequency of gadolinium-enhancement of the optic nerve and a higher frequency of spinal cord atrophy than in Western type multiple sclerosis. The frequency of the HLA-DPB1*0501 allele was found to be significantly greater in opticospinal multiple sclerosis (93%) than in healthy controls (63%, corrected P value = 0.0091 and relative risk = 7.9), but not in Western type multiple sclerosis (66%) or spinal multiple sclerosis (82%). The marked differences in the clinical and MRI findings as well as in the immunogenetic backgrounds between the opticospinal multiple sclerosis and Western-type multiple sclerosis together suggest that HLA-DPB1*0501-associated opticospinal multiple sclerosis is a distinct subtype of multiple sclerosis.
Background and Purpose-Hyponatremia after subarachnoid hemorrhage (SAH) is commonly associated with diuresis and natriuresis, but the causes are still controversial. We investigated whether brain natriuretic peptide (BNP) was related to such hyponatremia. Methods-Plasma BNP concentrations were measured by immunoradiometric assay in 18 patients at 0 to 2 days (period 1), 7 to 9 days (period 2), and Ͼ14 days (period 3) after SAH. Plasma concentrations of antidiuretic hormone (ADH), atrial natriuretic peptide (ANP), and noradrenaline were also measured during period 2. Results-The 11 patients with hyponatremia (serum sodium concentration of Ͻ135 mEq/L) had much higher plasma BNP concentrations during each period than did healthy controls (PϽ0.05), whereas the 7 patients with normonatremia did not show statistically higher values. In the patients with hyponatremia, the plasma BNP concentration during period 2 was statistically higher than that during periods 1 and 3 (PϽ0.05). The plasma noradrenaline concentration during period 2 was higher in patients with hyponatremia than in those with normonatremia (PϽ0.05), whereas the plasma concentrations of ADH and ANP during period 2 were not statistically different between the hyponatremic and normonatremic patients. Key Words: hyponatremia Ⅲ natriuretic peptide, brain Ⅲ subarachnoid hemorrhage H yponatremia after SAH has been reported to have an incidence of 30% to 40%. Recent studies have demonstrated that this phenomenon is frequently associated with hypovolemia, which is caused not by the syndrome of inappropriate secretion of ADH but by CSW. Conclusions-We1,2,3 However, the cause of CSW is still controversial. Some authors have reported that ANP 4,5 and digoxinlike peptides 6 may cause the hyponatremia, while others have suggested that these agents are not involved. 7,8 BNP, which was isolated from porcine brain in 1988, 9 causes natriuresis and diuresis. It has recently become possible to measure BNP accurately by immunoradiometric assay. We investigated whether BNP was related to hyponatremia after SAH by measuring plasma BNP concentrations with use of an immunoradiometric assay in patients with acute SAH. Subjects and Methods Patients and ManagementEighteen patients (4 men and 14 women without cardiac, renal, or endocrine diseases; meanϮSD age, 62.3Ϯ10.8 years) with SAH verified by CT scan were investigated from January 1995 through December 1996. All patients underwent cerebral angiography and aneurysm clipping within 48 hours of the onset, except for 1 patient in whom angiography failed to identify the source of hemorrhage. Each patient received intravenous fluid at approximately 2500 to 3000 mL/d to maintain a central venous pressure of 4 to 12 cm H 2 O. Sodium administration ranged from 280 to 320 mEq/d in patients without hyponatremia, while sodium loss was replaced according to urinary excretion when hyponatremia occurred. When symptomatic vasospasm occurred, ozagrel sodium (Xanbon, Kissei Pharmaceutical Co Ltd) was intravenously administered at 80 mg/d in pa...
An occurrence of acute localised myelitis was recently seen in four adult patients with atopic dermatitis who had hyperIgEaemia and mite antigen specific IgE. The total and mite antigen specific IgE was therefore studied in serum samples from 19 consecutive patients with acute localised myelitis of unknown aetiology, 56 patients with clinically definite multiple sclerosis, and 40 healthy controls. The total IgE concentration was significantly higher in acute localised myelitis (median=360 U/ml) than in multiple sclerosis (median=52 U/ml, p<0.0001) and the controls (median=85 U/ml, p=0.0002). The specific IgE to Dermatophagoides pteronyssinus was found more often in patients with acute localised myelitis (95%) than in patients with multiple sclerosis (34%, p<0.0001) and the controls (35%, p<0.0001) and the specific IgE to Dermatophagoides farinae was similar (acute localised myelitis 79%, multiple sclerosis 29% (p<0.0001), controls 30%, (p=0.0003). Atopic dermatitis coexisted more commonly in patients with acute localised myelitis (37%) than in patients with multiple sclerosis (0%, p<0.0001) and the controls (7.5%, p=0.0089). Therefore, acute localised myelitis with hyperIgEaemia, in which atopy to mite antigens seems to exist, may be a distinct subtype of allergic myelitis-that is, atopic myelitis. (J Neurol Neurosurg Psychiatry 1998;64:676-679)
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