Atypical Symptoms in Migraine-Related Alice in Wonderland Syndrome: Expansion of the Phenotype and Reflection on the Pathomechanism

We report an 8-year-old girl who experienced daily episodes of visual and somesthetic distortion and was diagnosed with Alice in wonderland syndrome (AIWS). Ophthalmologic assessment revealed best-corrected visual acuity of 0.2 in both eyes, and bilateral constricted tubular or spiral visual fields. Augmented amplitude of visually evoked potentials was revealed, and treatment with lomerizine and valproate showed favorable effect on the visual/somesthetic distortion as well as the visual field and acuity. Psychogenic visual problems can co-exist with the typical sensory distortion in AIWS, similarly to the case of psychogenic pseudo-seizures in subjects with epilepsy. Otherwise, an ambiguous borderline between psychological and physical pathomechanisms in migraine may also be characteristic of the migraine-related AIWS

Decreased Wave V Amplitude in Auditory Brainstem Responses of Children with Cerebellar Lesions

【Background】 This study aims to elucidate the effect of isolated cerebellar lesions sparing the brainstem on the auditory brainstem responses in children. 【Methods】 We enrolled 10 children (aged 1?16 years) with cerebellar lesions on neuroimaging but lacking clinical brainstem involvement signs and with normal brainstem volumes on magnetic resonance imaging. 【Results】 The interpeak latency of waves I and V was normal in 9 patients and was marginally prolonged in 1 patient. While amplitudes of waves I and III were normal, we noted a decreased amplitude of wave V and/or an increased I/V amplitude ratio in 6 patients; these included 5 of 8 patients with cerebellar hypoplasia/atrophy and 1 patient with acute cerebellar ataxia. 【Conclusion】 Our results support the hypothesis of an inhibitory input from the cerebellar fastigial nucleus on the inferior colliculus, which might be disinhibited because of Purkinje cells dysfunction due to cerebellar cortex lesions, especially within the cerebellar vermis

筋突起切離術により治療した下顎骨筋突起過形成による開口障害の一例

This report describes a case of hyperplasia of the mandibular coronoid process treated by coronoidotomy. A 26-year-old man visited our clinic complaining of restricted mouth opening. Panoramic radiography revealed marked hyperplasia of the right mandibular coronoid process. Three-dimensional CT showed that the coronoid process touched the temporal surface of the zygomatic bone at the maximal mouth opening position. His maximum mouth opening range was 27mm. The coronoid process was amputated about 8mm in width, and mouth opening training was done for a year after the surgery. Although the coronoid process and mandibular ramus reunited, the maximum mouth opening range was maintained at 40mm 13 months after the surgery

Refinement of Austenite Grain in Carbon Steel by Addition of Titanium and Boron

The effects of the addition of titanium and boron on the austenite grain refinement in as-cast S45C carbon steel have been investigated and the results have been discussed based on an Fe–TiB2 pseudo-binary phase diagram. The molar ratio of the added titanium and boron was fixed at 1 : 2 and the estimated molar percent of the added TiB2 was varied from 0 to 0.5. The average austenite grain diameter decreased from 1900 to 250 μm as the TiB2 addition increased from 0 to 0.2 mol%, when the cooling rate was 0.02 K/s. The austenite grain diameter, however, did not exhibit further decrease when the TiB2 addition increased from 0.2 to 0.5 mol%. The lower limit grain diameter of 250 μm was very close to the secondary dendrite arm spacing, which was not affected by the addition of titanium and boron. When the cooling rate of the molten steel increased, the grain size and the dendrite arm spacing decreased. For all cooling rates, the lower limit grain size was very close to the secondary dendrite arm spacing. Metallographic observations revealed that one austenite grain included many dendrite arms when titanium and boron was not added, while with the addition of these elements one dendrite arm included several austenite grains having the dimension of the dendrite arm diameter. It was suggested that TiB2 particles and other inclusions such as TiC and Fe2B were formed in the inter-dendritic positions during and after solidification and they controlled the grain boundary migration in the inter-dendritic positions

Refinement of As-cast Austenite Grain in Carbon Steel by Addition of Titanium

Effects of Ti addition on as-cast austenite structure of S45C steel have been investigated by means of furnace cooling experiment at a cooling rate of 0.03°C/s, focusing on the Ti addition ranging from 0 to 0.5 mol%. The Ti addition reduces average austenite grain diameter down to a size comparable to secondary dendrite arm spacing. In samples with the Ti addition, the austenite grain boundary is located at inter-dendritic position where Ti(C,N) particles exist and the refinement of austenite grain structure is ascribable to pinning effect of the Ti(C,N) particle formed in L+γ-Fe+Ti(C,N) phase field. The increment of Ti addition does not substantially change the size of Ti(C,N) particle but increases the number of the Ti(C,N) particles, leading to further refinement of the austenite grains

Effects of Addition of Titanium and Boron on Columnar Austenite Grain in Carbon Steel

Effects of titanium and boron addition on columnar austenite grain structure of S45C steel have been investigated in casting experiments with different cooling rates of 4.50 and 16.67°C/s. Without addition of these elements, the columnar austenite grains develop over the whole sample under the present casting conditions. The addition of titanium and boron induces formation of equiaxed austenite grains and, importantly, fully equiaxed austenite structure was observed in the sample with 0.2 mol% Ti and 0.4 mol% B. The microstructural observations indicated that this behavior of austenite structure stems from the columnar-to-equiaxed transition of ferrite dendrite structure. The addition of these elements, furthermore, leads to refinement of the columnar austenite grains, which is ascribable to pinning effect of boron nitride and titanium carbonitride