[Juvenile parkinsonism with symmetrical hypoperfusion in the cerebellum--a case report].

We report a 24-year-old female presenting levodopa-responsive juvenile parkinsonism with symmetrical hypoperfusion in the cerebellum. At the age of 21, she noticed difficulty in brushing her teeth and writing with the right hand. She developed resting tremor in the right hand. These symptoms were dramatically relieved by levodopa. One year prior to the admission, she noticed dystonia and drug-induced motor fluctuations and her symptoms became worse. Neurological examinations disclosed resting and postural tremor in both hands and the right leg. Bradykinesia and cogwheel rigidity were noted on the right side. Deep tendon reflexes were slightly increased on the right side, while Babinski sign was negative. Slight lateropulsion was observed without retropulsion. Sensory, autonomic and cerebellar disturbances were not observed. No abnormalities were found in parkins gene or in the genes of spinocerebellar ataxia (SCA) 1,2,3,6,7,8 and alpha-synuclein. Cranial CT scan and brain MRI were normal, but technetium-99m ethyl cysteinate dimer (ECD) single photon emission computed tomography (SPECT) showed symmetrical hypoperfusion in the cerebellum. Other 5 patients presenting juvenile parkinsonism and 10 aged-matched normal controls in our hospital did not show hypoperfusion in the cerebellum on ECD SPECT. Cerebellar blood flow has not been measured in the previously reported cases of juvenile parkinsonism. These results suggested that etiopathogenesis in this patient was different from that in previously reported cases.

[Beneficial effect of eyelid make-up (natural rubber latex) to induce a new fold in the treatment of blepharoptosis in myotonic dystrophy].

Blepharoptosis is one of the troublesome ocular complications of myotonic dystrophy. To correct drooping eyelids for two men with myotonic dystrophy, we used Eye Putti, a cosmetic made of natural rubber latex, which induces a new fold in the upper eyelid. The cosmetic rubber latex dramatically improved the sight of a 59-year-old patient who previously had a great difficulty in looking forward and had to bend his head backward to see an object because of severe blepharoptosis. The other patient aged 54 with moderate ptosis also had satisfactory improvement. Appropriate use did not prevent eye blinking and induce corneal erosion or skin rash. The cosmetic rubber latex was effective to patients who had no residual function of the levator palpebrae and frontal muscles. This daily treatment is simple and safe, therefore may have an advantage over surgical correction of blepharoptosis for patients not only with myotonic dystrophy, but with other neuromuscular disorders including oculopharyngeal muscular dystrophy.

[A case of Lyme disease with the triad of neurologic manifestations (meningitis, radiculoneuritis, facial nerve palsy) and dermatitis of the nail roots].

A 23-year-old man experienced dysesthesia of the distal parts of four limbs and spilling of drinking water from the right corner of his mouth. He also experienced low grade fever, headache, and nausea. Neurological examination showed weakness of the right frontal, orbicularis oculi and orbicularis oris muscles, atrophy and weakness of the interosseous muscles in both upper limbs and dysesthesia in the distal parts of four limbs. Laségue's sign was also positive on the left side. Examination of CSF showed lymphocytic pleocytosis and an increase of total protein. Serum antibody against Borrelia garinii was positive as determined by ELISA. The patient was diagnosed as a case of Lyme disease. His symptoms were not alleviated by administration of ceftriaxone (2 g/day) for 15 days, and dermatitis of nail roots appeared. Following administration of penicillin G at a high dose (12 million units/day) for 20 days, both neurologic symptoms and dermatitis were alleviated. Since B. garinii was reported to move preferentially toward the sites of low temperature, dermatitis of nail roots may be one of the characteristic features of Lyme disease caused by B. garinii.