Micturitional disturbance in patients with frontal lobe lesions

Micturitional disturbance in patients with frontal lobe lesions

264 during weightlessness simulated by head-out water immersion. Muscle sympathetic nerve activity, which plays an important role in controlling blood...

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264 during weightlessness simulated by head-out water immersion. Muscle sympathetic nerve activity, which plays an important role in controlling blood pressure in man, was recorded microneurographicaily from the tibial nerve in 16 healthy male volunteers aged 19 to 67. Muscle sympathetic nerve activity was significantly suppressed during head-out water immersion with higher water level. The water immersion-induced suppression of muscle sympathetic nerve activity was age dependent, and the effect was less marked in the elderly. A significant negative correlation was found between the age of the subject and the immersion-induced suppression rate of muscle sympathetic nerve activity ( Y = 80.7-0.68X, 3' = -0.64, P < 0.001). We conclude that the muscle sympathetic nerve activity suppression rate decreases with advancing age due to: (1) decreased body fluid shift by head-out water immersion; (2) decreased sensitivity of baroreceptors; (3) decreased sensitivity of parasympathetic nerve activity; and (4) decreased changes in fluctuation of blood pressure waves during water immersion.

(The Autonomic Nervous System, 30 (1993) 16-23)

Micturitional Disturbance in Patients with Frontal Lobe Lesions Ryuji Sakakibara, Takamichi Hattori, Masaki Tojo *, Tomonori Yamanishi *, Kosaku Yasuda * and Keizo Hirayama

Department of Neurology and * Department of Urology, School of Medicine, Chiba University, Chiba 260, Japan We collected detailed micturitional histories and performed urodynamic studies on 6 patients with frontal lobe lesions. Patients 1 to 3 had a lesion of the upper medial frontal lobe due to post-operative parasagittal meningioma or anterior cerebral artery occlusion, while patients 4 to 6 had a lesion of the lower medial frontal lobe due to a ruptured aneurysm of the anterior communicating artery or post-operative astrocytoma. Patients 1 to 3 had obstructive micturitional symptoms, and the urodynamie study revealed that all had increased bladder volumes of over 600 ml as well as atonic cystometrograms; one also had detrusorsphincter dyssynergia. Patients 4 to 6 had irritative as well as obstructive symptoms, and were shown to have decreased bladder volumes of under 200 ml and detrusor hyperreflexia. The above results suggest that there are two types of micturitional disturbance in frontal

lobe lesions: one in which there is a disturbed evacuation function, and another in which there is a combination of disturbed storage and disturbed evacuation function. The site of the lesions responsible for the former seem to be the upper medial frontal lobe, and for the latter the lower medial frontal Iobc.

(The Autonomic Nervous System, 30 (1993) 24-32)

Sweat Responses of Palmo-Plantar Hyperhydrotic Subjects Studied with an Apparatus for Continuous Recording of Local Parspiration Volume Tetsuaki Inamitsu, Yoshio Kitamura and Yusuke Fukui

Department of Psychosomatic Medicine, Faculty of Medicine, Kyushu University, Fukuoka 812, Japan We investigated palmar sweating in 13 subjects with palmo-plantar hyperhydrosis, using an apparatus for continuous recording of local perspiration volume (Kenz-Perspiro). Three types of sweating pattern were recognized from sweat responses at rest (with eyes open), while relaxing with eye closed and during a mental task (reversing the order of 4 figures given, eyes open). Type I (normal-respondent type): perspiration was reduced during relaxation with eye closed and enhanced by performing a mental task (7 cases). Type II (non-respondent type): perspiration was not affected by relaxation with eye closed or a mental task (5 cases). Type III (inhibited-respondent type): perspiration was suppressed during relaxation with eye closed and while performing a mental task (one case). In some Type II and Type lII cases a small amount of sweating not affected by relaxation with eye closed or a mental task was observed at the beginning of the examination, while painful or emotional stimulation triggered intense sweating. Periodic perspiration was observed at rest in Type I and Type III cases, and their sweating variability was larger than that in Type II. Taking the psychopathological aspects into consideration, 4 subjects were diagnosed as having adolescence paranoia, such as anthropophobia, and all exhibited a Type I sweating pattern. Hereditary hyperhydrosis was found in 3 of the Type II cases. These observations suggest that various mechanisms related to the different sweating centers affect the perspiration in palmo-plantar hyperhydrosis.

(The Autonomic Nervous System. 30 (1993) 33-41)