RESUMEN
OBJECTIVES: To elucidate the pathophysiology of urinary dysfunction in idiopathic normal-pressure hydrocephalus (iNPH) by single-photon emission computed tomography (SPECT) and statistical brain mapping. METHODS: Urinary symptoms were observed and N-isopropyl-p-[(123)I]-iodoamphetamine (IMP)-SPECT imaging was performed in 97 patients with clinico-radiologically definite iNPH. The patients included 56 men and 41 women; mean age, 74 years. The statistical difference in normalized mean tracer counts was calculated and visualized between patients with urinary dysfunction of severer degrees (>grade 2/4) and milder degrees (Asunto(s)
Lóbulo Frontal/irrigación sanguínea
, Lóbulo Frontal/diagnóstico por imagen
, Hidrocéfalo Normotenso/complicaciones
, Flujo Sanguíneo Regional/fisiología
, Incontinencia Urinaria/epidemiología
, Trastornos Urinarios/epidemiología
, Anciano
, Anciano de 80 o más Años
, Mapeo Encefálico
, Trastornos del Conocimiento/fisiopatología
, Femenino
, Lóbulo Frontal/fisiopatología
, Trastornos Neurológicos de la Marcha/fisiopatología
, Humanos
, Hidrocéfalo Normotenso/fisiopatología
, Radioisótopos de Yodo
, Masculino
, Persona de Mediana Edad
, Estudios Retrospectivos
, Índice de Severidad de la Enfermedad
, Tomografía Computarizada de Emisión de Fotón Único
, Incontinencia Urinaria/fisiopatología
, Trastornos Urinarios/fisiopatología
RESUMEN
A 69-year-old, chronically constipated patient with Parkinson's disease developed fecal impaction and the malignant syndrome simultaneously, even while the patient was taking anti-parkinsonian drugs as prescribed. Administration of intravenous levodopa and oral Dai-kenchu-tou, an herbal medicine with serotonergic 5-HT3 receptor agonistic property successfully ameliorated his clinical symptoms. Constipation may trigger worsening of Parkinson's disease and occurrence of the malignant syndrome by affecting levodopa absorption. Further, improved bowel motility may prevent worsening of Parkinson's disease and occurrence of the malignant syndrome.
Asunto(s)
Antiparkinsonianos/efectos adversos , Estreñimiento/inducido químicamente , Estreñimiento/tratamiento farmacológico , Levodopa/efectos adversos , Extractos Vegetales/administración & dosificación , Receptores de Serotonina 5-HT3/administración & dosificación , Administración Oral , Anciano , Estreñimiento/diagnóstico por imagen , Humanos , Masculino , Panax , Enfermedad de Parkinson/diagnóstico , Enfermedad de Parkinson/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Zanthoxylum , ZingiberaceaeRESUMEN
A 73-year-old woman developed subacute meningitis-retention syndrome (MRS), dermatitis, and latent pneumonitis likely due to the herbal medicines Shinbu-Tou and Rikkunshi-Tou. The responsible site of lesions for urinary retention seemed to be the spinal micturition pathways and, to a lesser extent, the sacral spinal cord. All of her clinical manifestations were successfully ameliorated within three weeks of discontinuation of the herbal remedies.