A case of strategic-infarct mild cognitive impairment.

INTRODUCTION: Although poststroke dementia has been investigated, patients with mild cognitive impairment (MCI) after stroke have received less attention, especially if there is cognitive decline in the absence of focal stroke symptoms. CASE REPORT: We report an 80-year-old female referred to our memory clinic with a 6-month history of amnestic symptoms. Neuropsychological evaluation demonstrated a marked decline in short-term memory, without anosognosia, aphasia, motor deficit, or sensory disturbance. A brain magnetic resonance imaging performed 2 months after the onset of her symptoms revealed a lacunar infarction in the genu of the right internal capsule extended to the anterior thalamus. This lesion had not been present in a previous magnetic resonance imaging obtained 2 months before her amnestic symptoms appeared. CONCLUSIONS: The patient reported here demonstrated the evolution of MCI in the setting of a newly emergent lacunar infarction in the genu of the right internal capsule extended to the anterior thalamus. One possible mechanism for amnestic symptoms from a lacunar infarct in this location might be thalamocortical disconnection leading to "strategic-infarct MCI."

Monitoring cortical hemodynamic changes after sumatriptan injection during migraine attack by near-infrared spectroscopy.

The aim of the present study is to provide effective tools for monitoring hemodynamic changes in the cortical and scalp surface during migraine attack and treatment. Using near-infrared spectroscopy system (NIRS) and laser Doppler skin blood flow (SkBF) devices in combination, we monitored changes in extra- and intra-cranial vasculature states upon sumatriptan injection during spontaneous migraine attack. We examined 4 control subjects and 4 migraine patients. Multi-channel NIRS probes were placed over the temporoparietal area bilaterally and oxygenated hemoglobin (oxy-Hb) was analyzed. Laser Doppler SkBF was simultaneously recorded to measure scalp surface blood flow changes. All patients were treated with a sumatriptan injection (3 mg), and all control subjects received a saline injection as a control for oxy-Hb/SkBF signals caused by injection pain over the monitoring period. There was a marked reduction of oxy-Hb/SkBF in all patients after sumatriptan injection, consistent with pain relief. Moreover, the changes in oxy-Hb/SkBF were significantly correlated. By contrast, saline injection did not cause any significant changes. These data suggest that sumatriptan induces blood vessel contraction at both cortical and scalp surfaces. Simultaneous oxy-Hb/SkBF recording enables real-time continuous monitoring of the effects of sumatriptan treatment in clinical situations.

Continuous urinary incontinence presenting as the initial symptoms demonstrating acontractile detrusor and intrinsic sphincter deficiency in multiple system atrophy.

Severe stress incontinence due to intrinsic sphincter deficiency may be common in aged women. However stress urinary incontinence could be the initial symptom of severe neurogenic bladder even if no neurological signs have previously been recognized. Urodynamic study is necessary in such a case. Tension-free vaginal tape surgery and intermittent self-catheterization may be one option, but self catheterization might become difficult when the neurological disorders develop. In this case report, we highlight the need for caution in identifying the presence of an occult neurogenic bladder when intending to carry out surgery for patients with severe stress incontinence.