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A 26-year-old womansuffered from acute myelitis at Th 6 level associated with systemic lupus erythematosus. Methyl-prednisolone pulse therapy, intravenous high-dose immunoglobulinadministration and plasmapheresis were not effective. Her neurological signs had persisted in spite of subsequent administration of oral prednisolone and azathiopurine. Magnetic resonance imaging (MRI) of spinal cord at the onset showed a marked swelling with intramedullary high intensity signals on T2WI along the whole thoracic cord. Three years later, MRIdemonstrated a severe longitudinal and segmental atrophy of the mid to low thoracic cord which resulted in transverse spinal signs. (Internal Medicine 40: 353-357, 2001)

A man with sensory neuropathy had evidence of autonomic failure: abnormal pupils, hypohidrosis, esophageal dilation, diarrhea, hypotension, orthostatic hypotension, sphincter disturbance, and impotence. Functional tests revealed abnormalities of both sympathetic and parasympathetic systems, mainly postganglionic. Autopsy revealed degeneration of posterior columns, posterior nerve roots, posterior root ganglia, and peripheral nerves. Degeneration was also observed in the sympathetic trunk, vagal nerve, and myenteric plexus. Neurons in the intermediolateral columns were preserved. Progressive sensory neuropathy with dysautonomia seems to be a new disease.

Cerebral processing for native and foreign languages differs.1 A 71-year-old, right-handed Japanese man with a 5-year history of Parkinson disease (PD) noticed that micrographia was more severe in his written Japanese than his written English. The severity of PD was Hoehn & Yahr III, and Menesit 300 mg and Domin 0.8 mg were given daily. The patient was a retired priest who had been a high school English teacher until age 65. He had never lived in an English-speaking country and was not bilingual. He educated himself by writing English every morning. Before drug therapy was initiated in the early morning, micrographia predominantly occurred in his written Japanese but less in his written English ( figure, A). After beginning drug therapy, micrographia improved in both languages ( figure, B).Micrographia is a common and well-known symptom of PD. However, to our knowledge, this discrepancy between native and foreign languages has not previously been described. These findings may reflect a type of paradoxical movement, a well-known symptom of PD.