Left-sided hemichorea developed suddenly in a 73-year-old male. Computed tomography revealed a left subdural hematoma (SDH) and infarction in the right corona radiata and temporo-occipital region. Hemichorea subsided completely after removal of the SDH. Postoperative single photon emis sion computed tomography with technetium-99m-hexamethyl-propyleneamine oxime revealed a global low-perfusion area in the right cerebral hemisphere. Right carotid angiography demonstrated severe stenosis of the trunk of the right middle cerebral artery. The cerebral blood flow in the right cerebral hemisphere had probably already decreased to nearly the critical level and was reduced further by the left SDH, inducing the left-sided hemichorea due to dysfunction of the right cerebral hemisphere. This case shows that when hemichorea ipsilateral to a SDH is present, it is important to ascertain whether there is a pre-existing ischemic lesion in the contralateral cerebral hemisphere, partic ularly in the basal ganglia, thalamus, or corona radiata.

anti-white matter antibodies that mainly recognized astrocytes. Intravenous steroid followed by oral steroid reduced the symptoms to a remarkable degree. The patient has now been successfully sustained with steroid for more than two years. Weconsidered that this case is classified as non-paraneoplastic limbic encephalitis, and acquired autoimmunity played a major role in the pathogenesis of this case. (Internal Medicine 42: 428-432, 2003)

The subjects here were patients (two males and a female) with the severe acute Guillain-Barre Syndrome admitted to our hospital between September 1987 and December 1988. One case was treated with a double filtration plasmapheresis and two cases were with a immunoadsorption. Of the two extracorponeal thrapeutical methods, the clinical efficacies seemed not to be different however biochemical and serological laboratory data showed prominent differences. For instance the large molecular substances in blood; immunoglobulins, coagulating factors and albumin were reduced in plasma levels by the double filtration plasmapheresis, but not or less by the immunoadsorption. Considering the expectable side effects of the two methods, it may say that the immunoadsorption should be applied as a beneficial extracorponeal method for the acute Guillain-Barre Syndrome.

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