Clinicopathophysiological differences between dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) remain obscure. Our goals were to determine whether characteristic findings of electroencephalogram (EEG) power and coherence in DLB and a differential pathophysiological mechanism of quantitative EEG existed between DLB and AD. The group consisted of 15 patients with AD or DLB and 12 age-matched controls. Original EEG signals were recorded from 14 scalp electrodes positioned according to the International 10-20 System, using digitally linked earlobes as a reference. Although EEG power spectral analysis showed increasing EEG power density in patients with DLB in the delta and theta bands, such a difference did not exist in patients with AD. Compared with AD, the delta and theta band intrahemispheric coherence values in the fronto-temporo-central regions were higher in DLB. In the beta band, AD was lower than DLB in almost all temporo-centro-parieto-occipital regions. Comparing the mean power value between patients with/without donepezil treatment, there was a significantly lower EEG power density in the delta and theta bands in DLB subjects taking donepezil than in subjects not taking donepezil, whereas there was no significant difference in AD patients. These results suggest that cholinergic dysfunction is stronger in DLB than AD.
A 16-year-old woman with MELAS developed fever and myoclonic epilepsy which improved with conventional anti-epileptic drugs. Since seizures recurred one month after successful treatment, the doses of phenobarbital, clonazepan, and valproate were increased. However, there was no improvement and status epilepticus continued. The addition of lamotrigine resulted in a decreased frequency and good control of seizures. This case is important, showing satisfactory results from the addition of lamotrigine for treatment-resistant status epilepticus.
We report a case of anterior inferior cerebellar artery (AICA) syndrome due to vertebral artery dissection following a minimal neck injury. The patient was a 16-year-old male who developed a throbbing headache in the left occipital area during sumo sparring. He endured the headache and continued to practice sumo on successive days. Three days later, he developed vertigo, right hearing loss, and right tinnitus soon after impacting an opponent during sparring. The patient was admitted to our hospital with suspicion of sudden deafness. The following morning, he developed right peripheral facial paralysis, hypothermoesthesia and hypoalgesia of the right face, and cerebellar ataxia of the right upper limb and trunk. Diffusionweighted MRI showed high signal intensity in the territory of the right AICA and the right posterior inferior cerebellar artery (PICA). MRA showed left vertebral artery occlusion, basilar artery stenosis, and right AICA occlusion. An anticoagulant and edaravone were immediately administered. Twenty days later, cerebral angiography showed recanalization of the right AICA. Some symptoms gradually improved, but right hearing loss and truncal ataxia remained. This case suggests artery-to-artery embolism from vertebral artery dissection as a possible mechanism of AICA syndrome.
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