Neck rigidity and Kernig’s sign were also present. There were no striking abnormalities in the eye grounds. On June BGB324 order 5, 1957, she suffered her first seizure of convulsions, followed by similar attacks about 10 times a day. She occasionally assumed a posture with her four limbs stretched or with the knee and hip joints flexed at right angles. She also occasionally kicked and struggled with her lower limbs. Her dementia advanced. The tonicity and spasticity of her four extremities became aggravated, and the motor and mental

functions were entirely lost. On July 29, 1959, she was transferred to the Minamata City Hospital. When she received food and liquid directly into her mouth, she was able to swallow. When an excessive amount of food was given, she refused it by closing her mouth. She occasionally had general convulsions. On May 22, 1974, tracheotomy was performed against aspiration. Oral LY294002 nmr alimentation became impossible, and she was placed on a naso-gastric tube for alimentation of synthetic formula. She showed apallic syndrome. Infections of the urethra and respiratory disturbances occurred repeatedly until she died on August 25, 1974. The brain weighed 775 g and the atrophy degree was 37% compared to a control (brain weight, 1234 ± 17.9 g). The lesions involved a wide area of the cerebral hemisphere, and the calcarine cortex, pre-and postcentral gyri were severely damaged (Fig. 6). The white matter

of the cerebrum displayed secondary degeneration in accordance with the intense damage of the cerebral DNA ligase cortex. The pyramidal tracts from the precentral gyri and internal sagittal strata, consisting of corticofugal fibers passing from the occipital lobe to the superior colliculi and the lateral geniculate bodies, were involved. They showed little or no myelin staining. The fibers of the corpus callosum designated as the tapetum were less strikingly involved. The lesion of the cerebellum was severe. The neurons in the dentate nucleus were relatively well preserved compared to those in the cerebellar

cortex. In this case, changes in the dendrites of Purkinje cells and torpedoes were prominent. Stellate cells were found in the molecular layer as the report of a Hunter-Russell’s case.8 No loss of neurons was identified in the nuclei of the basal ganglion or brain stem, but the cell bodies of the neurons were frequently atrophic. Systemic damage of both the Goll’s tracts and pyramidal tracts occurred secondarily and predominantly in the lateral column. There were no remarkable changes in the neurons of the anterior and posterior horns, apart from occasional atrophy. In the spinal ganglia, there was relatively slight satellitosis following loss of ganglion cells, compared with the situation in the brain cortex. The dorsal roots were predominantly damaged with regeneration. The patient was a 29-year-old woman, born in 1957, who died in 1987 in Minamata.