To elucidate the mechanisms that mediate secondary amenorrhea following stroke, we studied functional alterations in hypothalamic-pituitary-ovarian axis in 7 patients having amenorrhea for at least 3 months after the onset of stroke, and 6 control patients with normal menstruation after stroke. All patients underwent evaluation of serum lutenizing hormone (LH), follicle stimulating hormone (FSH), thyroid-stimulating hormone (TSH), prolactin and estradiol. LH and FSH in response to LH-releasing hormone (LH-RH) were measured after intravenous administration of LH-RH. There was no difference in the baseline values for LH, FSH, TSH, and prolactin between the two groups. Baseline values of LH and FSH were normal in all except for one amennorhea patient in whom FSH was elevated. All amenorrhea patients demonstrated normal or good LH and FSH responses to LH-RH. In six amenorrhea patients, serum estradiol was decreased, whereas it was normal in all control patients. In 4 amenorrhea patients, menses spontaneously returned with normal estradiol. Accordingly, 6 amenorrhea patients showed normogonadotropic hypogonadism. The results suggest that, in secondary amenorrhea following stroke, the timely release of FSH and LH might be disturbed in the hypothalamus that has a positive feed-back mechanism sensitive to circulating estradiol. Another possible explanation is the influence of the primary hypogonadism due to aging. The majority of the amenorrhea patients are negative for treatment, because they regard menstruation as a burden for a disabled person.

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Reliability of the headphone sound localization test using the RSS-10 sound processor was examined in 15 healthy subjects without hearing difficulty. First, white noise and female voice were presented 3 times, respectively, in front of the subjects, and 30, 60, and 90 degrees toward the left or right. All sounds were clearly located extracranially in all subjects. Discrepancies between presented and answered angle of the sound direction were an average of 12 degrees per trial (SD=9, range 5-18 degrees) with white noise and an average of 11 degrees per trial (SD=8, range 1-19 degrees) for the female voice. Secondly, white noise was moved from one side to the other side within a period of 10sec, drawing an arc in front of the subject. The average angle at which the subject felt that the sound reached midline was actually 11.1 degrees toward left when the movement was initiated from the left and 3.4 degrees toward the right when the movement was initiated from the right. Sound localization test using RSS-10 is sufficiently reliable for clinical use.

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Psychogenic amnesia, classified as dissociative amnesia in DSM-IV, has been little studied in the literature. It is said that failure in early diagnosis makes this disorder resistant to treatment. 52y/o male showed anterograde and retrograde amnesia and short-term memory disturbance two months after the operation of esophageal carcinoma without a loss of personal identity and information. Since the patient's neuropsychological features were suggestive of organic amnesia and his procedural memory was preserved, “a memory note training” was administered. His behavioral responses to this training were indicative of psychogenic amnesia. Counseled by the physiatrist, the patient's wife accepted psychiatric treatment, and so did the patient. Confrontation with cancer would have been a precipitating stress. We emphasize the importance of behavioral responses to the memory training in differentiating psychogenic amnesia from organic amnesia. Physiatrists should play an importance role in diagnosis and introduction of treatment of psychiatric disorders.

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