We studied senile plaques (SP) in the cerebella of six autopsied subjects with Alzheimer-type dementia (ATD) and ten non-ATD autopsied subjects between the ages of 78 and 90. Neither SP nor amyloid angiopathy (AA) was observed in any of the non-ATD subjects. In the four of the six ATD subjects, diffuse plaques in the molecular layer were seen as ill-defined areas of fine fibrillar materials by beta protein immunostaining with formic acid pretreatment, the modified Bielschowsky stain, and periodic acid-methenamine silver (PAM) stain. The plaques were not visible with Bodian, Congo red, or periodic acid-Schiff stains. Compact plaques in the Purkinje cell or in the granular cell layers were found in three of the six subjects. Their amyloid core was often surrounded by areolar amyloid deposits. AA was observed in three of the six subjects. The argyrophilia of the diffuse and compact plaques, demonstrated by the modified Bielschowsky and PAM stains, became undetectable when the sections were first treated with formic acid. Such treatment made the plaques immunoreactive with beta protein antiserum. The findings suggested that cerebellar diffuse plaques and compact plaques consist mainly of an amyloid component, and are characteristic of ATD.

We studied cerebral amyloid deposits in the hippocampal area immunohistochemically, using antiserum to synthetic beta peptide (1-28) in 66 patients with or without dementia and aged 17 to 91 years old. Senile plaques (SP) and amyloid angiopathy (AA) were detected in 36 (55%) and 19 (29%) patients, respectively. Also, cerebral amyloid deposits from the brains of seven patients with dementia and five patients without were studied in serial sections stained with Bodian, modified Bielschowsky, Congo red, and beta protein immunostain. In the patients with Alzheimer-type dementia (ATD) diffuse plaques, typical of this group, were stained with beta protein antiserum but not with Bodian stain, because the plaques were devoid of abnormally swollen neuritic processes. The diffuse plaques often contained one or more neuronal cell bodies. As well as primitive and classic plaques and AA, the beta protein immunostain demonstrated small deposits among the SP, small stellate deposits of layer 1, subpial fibrillar deposits, and focal cribriform deposits of parasubiculum, which may be new types of amyloid deposits. Amyloid plaques within the subcortical white matter were only found in ATD brains. In the non-demented patients various kinds of SP, including diffuse and compact ones, were immunostained. They tended to be small and few. beta protein immunostain with formic acid pretreatment is a useful method for the identification of a variety of senile cerebral amyloid deposits.

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Isokinetic strength of knee extension and flexion was measured at two speeds of movement in 23 patients with Parkinson’s disease, to clarify whether muscle weakness is inherent to the disease. To counteract normal variation among subjects, we selected patients with symptoms completely or largely confined to one side and compared sides for each patient. The affected side was weaker than the other in both slow and fast movements early in the disease. In more advanced disease, the difference between sides diminished at the slow speed but remained significant at the faster speed. These observations suggest that weakness is inherent to Parkinson’s disease and influenced by movement speed.

We describe three cases of women with hot bath-related headache who reported that their severe paroxysmal headache could be provoked by pouring hot water over themselves or by soaking in a hot bath. In one patient, the headache was also brought on by exposure to cold wind. Another patient had headaches after she dived into a pool and started swimming. Neurological examination, routine laboratory tests, electroencephalography, and brain imaging showed no abnormality in any of the patients. Hot bath-related headache is a benign headache unassociated with a structural lesion.Key words: hot bath, headache, cold stimulus headache ( Headache 2000;40:173-175) We describe three cases of women with hot bathrelated headache who reported that their severe paroxysmal headaches were provoked by pouring hot water over themselves or by soaking in a hot bath. CASE HISTORIESPatient 1.-A 54-year-old woman developed a paroxysmal splitting headache with floating sensation in the bathroom for the first time on April 22, 1992. The headache lasted 5 to 10 minutes. She had suffered from tension-type headaches previously. The next day, she had the same severe headache with floating sensation when she undressed and poured hot water over herself just before soaking in a hot bath. The headache was not throbbing and lasted 10 minutes without photophobia, phonophobia, nausea, vomiting, and vertigo. Whenever she tried to take a hot bath daily for a week, this headache was brought on after pouring hot water over herself, but before soaking in the hot bath. She could not take a hot bath for 10 days because of this headache. On two occasions, she took a tablet containing ergotamine tartate, 1 mg, caffeine, 50 mg, and isopropylantipyrine, 300 mg, 30 minutes before she had a hot bath, however, she still had severe headaches. When she washed only her hair without undressing, she did not have a headache. The results of her neurological examination were normal. She was normotensive. The findings of a routine blood examination, a CT scan of the brain, MRI and angiography (MRA) of the brain, electroencephalography, and an HM-PAO SPECT scan of the brain were all negative. By avoiding taking a hot bath, she did not experience this severe headache at all. One month later, when she tried to pour hot water over herself in a hot bath, she did not develop a headache. Since that time, she has not experienced this severe headache.Patient 2.-A 49-year-old woman developed a severe bursting headache in the right occipital area for a few seconds when she went out of the house into the cold on the evening of January 22, 1991. The next day, she poured hot water over herself before taking a bath and developed a severe bursting headache in the right frontal to occipital area. She took an analgesic and diazepam, 5 mg. Her headache lasted 3 hours. Within a week, she had the headache whenever she poured hot water over herself before soaking in a hot bath. Twice she soaked in the hot bath despite the headache, but on other occasions she could not bathe and took an analg...