Crossed cheiro-oral syndrome.

OBJECTIVES: Cheiro-oral syndrome is characterized by sensory impairment confined to perioral area and ipsilateral fingers/hand. It results from an involvement of the ascending sensory tracts above the pons. However, a crossed pattern of perioral and acral paresthesia was rarely reported before. PATIENTS AND METHODS: This study reports the neuroanatomic relationship, course and clinical significance of perioral and contralateral acral paresthesia in four patients. We term it the crossed cheiro-oral syndrome. RESULTS: All patients had lateral or dorsolateral medullary infarctions that were ipsilateral to their perioral paresthesia. The contributory origin is considered a diagonal lesion involving the par oralis fibers within the descending trigeminal sensory tract and acral portion of the lateral spinothalamic tract at the lateral portion of medulla oblongata. Despite of a restricted sensory disturbance at initial, progressive neurological disability terminated to Wallenberg's syndrome ensued in three patients and disabling deficits persisted in two of them. CONCLUSION: The crossed cheiro-oral syndrome seems a mild form of Wallenberg's syndrome. Therefore, it predicts medullary involvement and is also a warning sign for progression.

Cheirobuccal sensory syndrome.

Two patients presented with sensory impairments confined to their right intraoral cheek and right first three fingers. An objective decrease of pinprick pain was detected at these sites. Neuroimaging illustrated recent infarcts in the contralateral ventral thalamus of both patients. The intraoral and cheiral sensory impairments resolved within two months after onset. We coined the term "cheirobuccal sensory syndrome" to describe these cases. The clinical significance and pathogenesis of this peculiar syndrome are discussed.

Uncoupling of protein C and antithrombin III activity in cerebral ischemia patients associated with cutis marmorata.

PURPOSE: Cutis marmorata is a cutaneous livedoid disorder which can be differentiated from livedo reticularis in both clinical and pathological presentations. Unlike Sneddon syndrome, a detailed immunocoagulation profile has not yet been delineated for cutis marmorata in patients with cerebral ischemia. METHODS: To analyze the immunocoagulation profile in cutis marmorata patients associated with cerebral ischemia (CMCI) in a series of 135 cerebral ischemia patients. RESULTS: A total of 32 patients were found to have cutis marmorata. The blood protein C activity, protein S activity, antithrombin III activity, platelet count, fibrinogen and frequency of abnormal antiphospholipid antibody level were similar among 32 CMCI patients, 103 cerebral ischemia patients without cutis marmorata, and 35 healthy subjects. However, uncoupling of protein C and anti-thrombin III was observed in CMCI patients. Serum antinuclear antibody and Venereal Disease Research Laboratory were not detected in these patients. CONCLUSION: Cutis marmorata is not uncommon in our ischemic stroke patient population, and is characterized by uncoupling of protein C and antithrombin III with altered thrombin hemostasis. Our findings raise the need for a careful cutaneous examination in patients with ischemic stroke. Abnormal immunocoagulating profile should alert physicians to the risk for cerebral ischemia even in the absence of other cardiovascular risk factors.

Inhibition of endogenous thyroid hormone receptor-beta and peroxisome proliferator-activated receptor-alpha activities by humic acid in a human-derived liver cell line.

Humic acid (HA), know to be ubiquitous in the natural environment, is present in almost all soil, surface water, and plants. Earlier studies indicate that HA can affect thyroid economy via binding with iodide, inhibiting both thyroid peroxidase and hepatic 5'-deiodinase in rodents. However, the effect of HA, a peroxisome proliferator in rodents, on thyroid hormone receptor (TR) and peroxisome proliferator-activated receptor (PPAR) in human cells has not yet been examined. In this study, we demonstrate that the malic enzyme activity and the transcriptional activities of endogenous TR and PPAR were inhibited after treatment with HA in human hepatocyte Chang liver cell line. Although the protein expression levels of TR-beta, PPAR-alpha and retinoid X receptor-alpha (RXRalpha) were not changed significantly by HA treatment, both the binding abilities of endogenous TR-beta on thyroid hormone response element (TRE) and PPAR-alpha on the PPAR response element (PPRE) were inhibited by HA treatment. The study of the subcellular distribution of HA, relying on the inherent HA fluorescence, showed that HA distributed in the intracellular compartments including cytoplasm and nucleus. The 50% binding inhibition values (CI(50)) of HA on ME-TRE (malic enzyme gene-TRE) and ACOX-PPRE (acylCoA oxidase gene-PPRE) were 19.31 and 19.94 microg/mL, respectively. These results suggest that HA-induced endemic goiter may link in part to the disruption of TRbeta and PPARalpha function in human Chang liver cells. This model may be useful in the investigation of environmental goitrogens.