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A letter to the editor is presented on the medical case study of a patient with isolated hemifacial sensory impairment.

A 60-year-old male experienced an inappropriate shock from an implantable cardioverter-defibrillator (ICD) because of oversensing of pectoral myopotentials. Battery depletion was also observed, and a generator change was performed. A single-chamber ICD (VENTAK PRIZM II 1860) was changed to a new ICD (INCEPTA VR F161). The myopotentials were clearly eliminated by the difference in the band pass filter (PRIZM; 21-171 Hz, INCEPTA; 20-85 Hz), but unfortunately, new noise was documented 4 years later. The utility of the bandpass filter for preventing oversensing of myopotentials was observed, but the limitation of its use for long-term follow-up was also indicated.

Background: Repetitive interpolated ventricular bigeminy (RIVB) can introduce a doubling of the ventricular rate., Objective: To clarify the mechanism of RIVB, we hypothesized that it was introduced by a strong modulation of the ventricular automatic focus., Methods: RIVB, defined as more than 7 bigeminy events, was detected by instantaneous heart rate and bigeminy interval (BI) tachograms in 1450 successive patients with frequent ventricular premature contractions (≥3000 per day). Postextrasystolic interval bigeminy interval curves were plotted to determine the degree of modulation. Mean sinus cycle length bigeminy interval curves were plotted for selection. RIVB was simulated by using a computer-based parasystole model., Results: RIVB was observed in 7 patients (age 60 ± 16 years; 2 men and 5 women) with a heart rate of 58.2 ± 6.5 beats/min during a rest period both during the day and at night. The tachograms disclosed the onset of the RIVB with a doubled ventricular rate to 112.3 ± 8.5 beats/min. On the postextrasystolic interval bigeminy interval curves, compensatory bigeminy and interpolated bigeminy constituted overlapping regression lines with slopes close to 1.00 and RIVB was located in the lower left portion. RIVB lasting for up to 3 hours was quickly detected by mean sinus cycle length bigeminy interval curve. The PQ interval immediately after RIVB was prolonged in comparison with baseline (0.18 ± 0.02 to 0.21 ± 0.02 seconds; P < .001). The simulation was able to reproduce RIVB faithfully at a slow heart rate., Conclusions: Our findings support the hypothesis that RIVB was introduced by strongly modulated ventricular pacemaker accelerated by an intervening normal QRS., (© 2013 Heart Rhythm Society. All rights reserved.)

Introduction: Sjögren's syndrome (SS) is an autoimmune disorder involving the exocrine glands, which affects 1.9-3.0% of the elderly population. Approximately 20% of all patients with SS have CNS involvement, including dementia, as a result of angiitis., Aims: The aim of the study was to clarify the prevalence and impact of SS among patients in a memory clinic., Methods: This study prospectively recruited patients with cognitive dysfunction in a memory clinic from 2007 to 2010. In addition to the examinations for dementia, the patients' levels of anti-SSA and SSB antibodies were measured. Schirmer's test and/or a lip biopsy were added if required. SS was diagnosed based on the American European consensus criteria., Results: Out of 276 cases who completed the examinations, 265 (97/168 males/females, mean age: 77.9, median MMSE score: 23) did not demonstrated cognitive decline. Sixteen (6.3%) and seven (2.7%) patients were positive for anti-SS-A and SS-B antibodies, respectively. Twenty patients (7.5%) were diagnosed with primary SS (mean age: 77.2 years old, median MMSE: 21). Seven of these patients had previously been diagnosed with MCI (VCIND: 5, aMCI: 2), and 13 had been diagnosed with dementia. All had asymmetrical focal hypoperfusion on SPECT, and eighteen had subcortical lesions on MRI. Twelve were treated for dementia (median time: 2.1 years), and their MMSE significantly improved (median MMSE: 26, p=0.0019), while the non-SS subjects' MMSE declined (n=126, median: 22)., Conclusion: The patients with SS accounted for 7.5% of those with a cognitive decline as determined at a memory clinic, and are characterized by subcortical white matter lesions and asymmetric hypoperfusion., (Copyright © 2012 Elsevier B.V. All rights reserved.)

A 62-year-old man without structural heart disease underwent electrophysiological testing for ventricular tachycardia (VT). Hemodynamically unstable VT was induced after isoproterenol (ISP) provocation. Electroanatomical mapping using a multipolar catheter identified the earliest activation originating from the posterior papillary muscle (PPM) where prepotentials preceding the local ventricular electrogram were observed. Irrigated radiofrequency current guided by the shadow of a multipolar catheter eliminated the VT. This case suggested that multipolar catheters may be helpful for identifying tachycardia origins arising from the PPM.

Acute ischaemic stroke patients sometimes receive heparin for treatment and/or prophylaxis of thromboembolic complications. This study was designed to elucidate the incidence and clinical features of heparin-induced thrombocytopenia (HIT) in acute stroke patients treated with heparin. We conducted a prospective multicentre cohort study of 267 patients who were admitted to three stroke centres within 7 d after stroke onset. We examined clinical data until discharge and collected blood samples on days 1 and 14 of hospitalization to test anti-platelet factor 4/heparin antibodies (anti-PF4/H Abs) using an enzyme-linked immunosorbent assay (ELISA); platelet-activating antibodies were identified by serotonin-release assay (SRA). Patients with a 4Ts score ≥4 points, positive-ELISA, and positive-SRA were diagnosed as definite HIT. Heparin was administered to 172 patients (64·4%: heparin group). Anti-PF4/H Abs were detected by ELISA in 22 cases (12·8%) in the heparin group. Seven patients had 4Ts ≥ 4 points. Among them, three patients (1·7% overall) were also positive by both ELISA and SRA. National Institutes of Health Stroke Scale score on admission was high (range, 16-23) and in-hospital mortality was very high (66·7%) in definite HIT patients. In this study, the incidence of definite HIT in acute ischaemic stroke patients treated with heparin was 1·7% (95% confidence interval: 0·4-5·0). The clinical severity and outcome of definite HIT were unfavourable., (© 2011 Blackwell Publishing Ltd.)

Background: Stroke patients often develop deep-vein thrombosis (DVT), a potential cause of pulmonary thromboembolism. Little information is available on DVT in Asian patients with intracerebral hemorrhage (ICH)., Methods: We prospectively enrolled consecutive acute ICH patients. The main exclusion criteria were neurosurgical treatment, early death and coagulation disorders. DVT was evaluated using venous duplex ultrasonography on the day of admission, as well as 7 and 14 days later. Underlying characteristics, stroke features and laboratory data on admission were compared between patients who developed DVT by 14 days and those who did not., Results: A total of 81 (50 men, mean age 65 years, median NIH Stroke Scale, NIHSS, score 12) of 117 Japanese ICH patients were enrolled. DVT was detected in 4 patients on admission and was newly detected in 9 at 7 days. By 14 days, 17 patients (21%) were diagnosed as having DVT without thromboembolic complications, although 1 patient developed pulmonary thromboembolism. DVT was detected in the soleal veins of all 17 patients, followed by the peroneal veins (7 patients). After adjustment for age and related confounders, female sex was the only independent predictor for DVT (odds ratio 6.89, 95% confidence interval, CI, 1.56-36.34, p = 0.014). Female patients with an initial NIHSS score > or =12 had 19 times the risk for DVT compared to men with an NIHSS score <12 (95% CI 2.61-213.77, p = 0.007)., Conclusions: DVT formation was not rare in Japanese ICH patients. Contrary to previous findings reported from western countries, female sex was strongly associated with DVT formation., (Copyright 2009 S. Karger AG, Basel.)

On the basis of a hypothesis that proteins encoded by the mRNAs that are transported to and translated at the dendrites/synapses may play key roles in synaptic plasticity, this study reports on attempts to isolate mRNAs which are localizing at the dendrites/synapses from mouse cerebellar synaptosomal fractions. Among 100 pieces of dendritic mRNA candidates, 10 pieces of mRNAs were found to contain the cytoplasmic polyadenylation element (CPE)-like sequences which were contained in certain mRNAs translated in dendrites. We next examined the issue of whether the CPE-like sequence-containing mRNAs (CPERs) were localized in the synapses/dendrites by means of in situ hybridization. The findings indicate that CPER9 was actually localized at the apical dendrites of a portion of cerebral cortex layer V pyramidal cells, as well as at the proximal dendrites of some of the cerebellar Purkinje cells. CPER9 was found to encode a mouse homolog of MRG15, a nuclear protein which contains a chromodomain identified in several proteins that act as regulators of transcription. Immunohistochemistry with anti-MRG15 antibodies revealed that MRG15 was localized in dendrites as well as in the nuclei of Purkinje cells. These results suggest that MRG15 may serve as a link between synaptic activity and gene expression.