[Amyotrophic lateral sclerosis with muscle weakness and dropped head during the course of Parkinson's disease: an autopsy case].

A 64-year-old female developed Parkinson's disease at the age of 52 years. She experienced muscle weakness in the upper right extremities and dropped head at 62 and 63 years, respectively; both symptoms were considered to be associated with Parkinson's disease (PD). The dosage of L-DOPA was increased from 200 mg/day to 900 mg/day; however, her neurological symptoms did not improve. Eventually, she was diagnosed with amyotrophic lateral sclerosis (ALS) at 64 years. She was placed under palliative care, and died of respiratory failure and malnutrition. Neuropathologic findings were consistent with the coexistence of PD and ALS. In fact, there were α-synuclein immunoreactive Lewy bodies (Braak stage 4) as well as TDP-43 immunoreactive deposits in the motor nuclei at the level of brainstem and spinal cord. Therefore, coexisting pathologies must be taken into account in a patient showing multi-system symptoms.

Dementia complicated with Takotsubo cardiomyopathy associated with unconsciousness induced by Wernicke's encephalopathy.

An 85-year-old woman who had been living alone and eating an unbalanced diet suddenly entered a neighbour's house. Her house was hot and humid due to lack of air conditioning caused by a loss of electrical power. After arrival, the patient exhibited disorientation, paresis of the right upper extremity, a tendency towards right conjugated deviation and perseveration. Electrocardiogram showed ST segment elevation and prolongation of the QT interval. Echocardiography suggested Takotsubo cardiomyopathy. The cardiac wall motion and neurological abnormalities improved after admission. The serum thiamine level was found to be low, which was compatible with a diagnosis of Wernicke's encephalopathy. Hasegawa dementia score was 10 points and the patient was suspected to have frontotemporal dementia. She was transferred to a nursing home with continuing dementia. In this case, psychological stress trigged by poor living circumstances induced by dementia and Wernicke's encephalopathy may result in the occurrence of Takotsubo cardiomyopathy.