Using a new method to measure the hardness of pericranial muscles, the role of muscle factors in tension-type headache was evaluated. In 223 normal healthy subjects, the hardness of trapezius muscles was 82 +/- 15 kPa/cm (mean +/- SD). The muscle hardness in women, 92 +/- 17 kPa/cm, was significantly greater than that in men, 74 +/- 14 kPa/cm (P < 0.01). Trapezius muscles were significantly harder than paraspinal posterior neck muscles measured at the level of the fifth cervical vertebra (71 +/- 13 kPa/cm; n = 26) but a significant correlation in muscle hardness did exist between these two muscle groups (r = 0.89, P < 0.001). Muscle hardness did not show a significant correlation with advancing age, blood pressure or subjective feeling of stiffness in the shoulder. A significant correlation was noted between the muscle hardness measured by the present method and the stiffness scores evaluated by manual palpation. In patients with tension-type headache (n = 60), the hardness of trapezius muscles, 114 +/- 24 kPa/cm (mean +/- SD), was significantly greater than that in normal subjects (P < 0.01). Twenty-six patients (43% of the total) showed significantly high values which exceeded the mean +/- 2 SD (113 kPa/cm) of the normal value, while the remaining patients (57%) constituted a high normal group. The hardness of posterior neck muscles measured in 27 patients (99 +/- 21 kPa/cm) was also significantly greater than that in normal subjects (P < 0.01). There was no significant difference in muscle hardness between episodic tension-type headache and chronic tension-type headache.(ABSTRACT TRUNCATED AT 250 WORDS)
A 52-year-old woman is described, whose clinical features were typical of Creutzfeldt-Jakob disease except for the presence of optic atrophy. Serial CT scans showed rapid development of brain atrophy early in the course. Postmortem examination revealed extensive degeneration of the cerebral and cerebellar white matter and of the optic nerves in addition to the classic findings of Creutzfeldt-Jakob disease. It is suggested that both the grey and white matter may undergo a severe destructive process early in the course of the disease, and the possibility is discussed that the white matter involvement is not a result of neuronal loss.
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