Even though symptoms are important in the diagnosis of hemiplegic migraine, myelin oligodendrocyte glycoprotein antibody‐positive benign unilateral cortical encephalitis shows unique progress and findings on magnetic resonance imaging. We encountered a case of hemiplegic migraine showing cortical hyperintensity on magnetic resonance imaging, and positive results for myelin oligodendrocyte glycoprotein antibody. A certain proportion of patients diagnosed with hemiplegic migraine appear to show myelin oligodendrocyte glycoprotein antibody‐positive benign unilateral cortical encephalitis.
The social and professional isolation of physicians remains an important issue in rural areas. However, few studies have investigated the involvement of geographic factors in the isolation. This study investigates rural public clinics in inland and remote island locations and attempts to objectively compare the isolation of these physicians. A mailed questionnaire was sent to rural clinics where graduate physicians from Jichi Medical School were working in 1994 and 1995. Among the 198 clinics with one or more full-time physicians, 185 (93 percent) responded to the inquiry. Geographic and demographic factors of the communities were compared between 43 clinics located in remote islands and the other 142 rural inland clinics. Rural clinics in remote islands have smaller subject populations, fewer part-time physicians, a longer journey to the nearest city, and a longer distance and travel time to the base hospital than rural inland clinics. Physicians in remote island clinics had less medical training and are more isolated than other physicians. More than half of the clinic physicians in remote islands have no regular training schedule, in contrast to less than a quarter of the inland clinic physicians. Almost all clinics (97.7%) in remote islands do not have a part-time physician, whereas about 20 percent of the rural inland clinics do. Physicians in remote island clinics are more socially and professionally isolated than those in inland clinics. Strategies to reduce these problems should be given priority in rural health policy and measures tailored to rural clinics in remote islands.
We report a 46‐year‐old man who presented repetitive jerky extension movements of the neck in lying position over a period of 10 years. His coexisting diseases included alcoholism and depression. Neurologically, there were repetitive, shock‐like, neck extension movements in the supine or recumbent position, which disappeared in the prone or sitting position. The jerks were not seen during sleep. There was a clear effect of distraction on the jerks, suggesting a psychogenic disorder.
A 79-year-old woman presented 3 years' history of hand shaking while drinking a cup of tea. The tremor was seen bilaterally, more predominantly on the left, and it also appeared when reading a book or writing. It was also induced by flexing the elbow to about 90 degrees or more without any specific task. Although there was no family history, the tremor in the present case was clinically diagnosed as essential tremor, because there were no other movement abnormalities, and other causes of tremor were excluded by laboratory tests. The tremor was dependent on the position of the involved extremity regardless of the kind of tasks. Position-specific tremor is discussed in relation to postural tremor.
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