Neuro-Behcet's Disease Mimicking a Cerebral Tumor: A Case Report

We report a rare case of neuro-Behcet's disease (NBD) presenting as an inflammatory pseudotumor in the brain. A 52-yr-old woman was evaluated for subacute dizziness and headache. Brain magnetic resonance (MR) imaging showed a right cerebellar mass, which disappeared 2 weeks later. After a year, recurrent mucocutaneous manifestations of Beh et's disease were observed. Immunosuppressant and steroid maintenance treatment were started. She experienced two more neurologic attacks and brain MR imaging revealed an enhancing mass in the right temporal lobe. The second attack showed a good response to steroid pulse therapy, but the third attack did not respond to steroid and her neurologic signs suggested an impending transtentorial hernia. The right temporal lobectomy was performed for the purpose of life-saving. The pathologic finding of the mass was a chronic inflammatory vasculitis, compatible with NBD.

A Case of Hemiageusia Associated with Pontine Infarction

The generally accepted taste pathway in an animal projects ipsilaterally from the solitary nucleus. However, the path-way of gustatory fibers in the human brainstem has not been sufficiently clarified. A 57-year-old hypertensive man was admitted with sudden dizziness and hemiageusia. A neurological examination revealed also a diminution of taste on the left half of his tongue. A MRI showed a high signal intensity in the right lower pontine area. This case suggests that the unilateral lesion of the pons may lead to contralateral taste disturbances.

A Case of Hypoglycemic Hemiplegia: Reversible Change of Diffusion- and Perfusion-Weighted MRI

Hypoglycemic hemiplegia is an under-recognized manifestation of hypoglycemia and mimics cerebrovascular dis-ease, especially in elderly patients. We report a 70-year-old diabetic woman with hypoglycemic hemiplegia, whose dif-fusion- and perfusion- weighted images showed large cortical high signal intensities and hypoperfusion of the right hemisphere during the period of hypoglycemia. We suggest that the regional cerebral blood redistribution and selective vulnerability in hypoglycemia are responsible for the laterality of neurological deficits observed during hypoglycemic episodes.

Lack of Association between Angiotensinogen M235T Gene Polymorphism and Ischemic Stroke in Korean

BACKGROUND: The associations between angiotensinogen M235T polymorphism and essential hypertension or ischemic stroke are still controversial. The aims of this study were to observe the associations of the angiotensinogen M235T polymorphism with hypertension or ischemic stroke, and to elucidate whether angiotensinogen M235T polymorphism was related to ischemic stroke itself or to hypertension. METHODS: We analyzed a particular polymorphysm in exon 2 of the angiotensinogen gene, a threonine to methionine substitution at position 235 (M235T), by a polymerase chain reaction in sixty patients with symptomatic ischemic stroke, one hundred patients with hypertension, and one hundredcontrol subjects without cardiovascular risks. Cardioembolic stroke was excluded. RESULTS: The three groups differed with respect to age and sex, but not total cholesterol, low-density lipoprotein, triglyceride, or body mass index. However, the distribution of angiotensinogen M235T genotypes was not different among the ischemic stroke group, hypertensive group, and control subjects. The TT genotype of angiotensinogen M235T was not significantly associated with ischemic stroke or hypertension (adjusted odds ratio (OR) = 1.02, 95% confidence interval (CI), 0.44 to 2.41, adjusted OR = 0.74, 95% CI=0.41 to 1.33, respectively), adjusting for age and sex. CONCLUSIONS: We found no significant associations between the angiotensinogen 235T alleles and hypertension or ischemic stroke in the Korean population. (J Korean Neurol Assoc 19(1):24~28, 2001

Angiotensinogen M235T and Essential Hypertension in Korea / 대한신장학회잡지

BACKGROUND: Potential involvement of the angiotensinogen gene(M235T) in the pathogenesis of essential hypertension has been suggested by some investigators. However, an association between M235T gene polymorphism and essential hypertension has been reported by some, but not by others. Since genetic diversity exists among different ethnic population, we addressed the question of whether there is an association between M235T gene polymorphism and essential hypertension in the Korean. METHODS: 100 patients with essential hypertension and 100 control subjects were recruited from outpatients at the Department of Internal Medicine, Soon-chunhyang Hospital, Chunan City. The criteria for hypertension was defined as systolic blood pressure higher than 160mmHg and/or diastolic blood pressure higher than 95mmHg. For detection of the M235T polymorphism at the angiotensinogen locus, the primer sequences were: sense primer : 5'-TGAAGGAG- AAGGTGTCTGCGGGA-3' and antisense primer : 5'- AGGACGGTGCGGTGAGAGTG-3'. The PCR product mixture was exposed to restriction enzyme Tthlll I and then submitted to electrophoresis in polyacrylamide gel. Differences between the molecular variants of the gene in hypertensives and normotensives were compared by using the chi square test. p<0.05 was considered statistically significant. The odds ratio and 95% confidence interval were calculated using Woolf's method. RESULTS: Compared with the control subjects, hypertensives had higher values of three established risk factors for hypertension : age, BMI cholesterol (total and LDL). X analysis showed no difference in the distribution of genotype or allele frequency between the hypertensives and normotensives (chi square=1.14, p=0.29). The crude odds ratio was 0.73 for CC over CT (95% confidence interval 0.41-1.30). The adjusted odds ratio with age, sex, lipid profilcs and BMI was 0.68 for CC over CT (9596 confidence interval 037-1,23). CONCLUSION: The molecular varient M235T of the angiotensinogen gene is not associated with essential hypertension in Korean population.

A Case of Ischemic Stroke Following Bee Venom Acupuncture

The effects of bee venom on humans are variable from local to lethal reactions. However, ischemic stroke following bee venom acupuncture has rarely been reported. We report a case of a person who developed an ischemic stroke after bee venom acupuncture. The patient, who had a small cortical infarction one year ago, experienced anaphylatic symptoms several minutes after bee venom acupuncture. Shortly thereafter, he became confused and had aggravation of the left hemiparesis. A brain MR T2-weighted image showed a high signal intensity lesion on the right anterior border zone. A cerebral angiography revealed a right proximal internal carotid artery occlusion with collateral circulation via an anterior communicating artery. The presumed mechanism in this case was a hemodynamic infarction due to the bee venom induced anaphylactic shock. We alert the possibility for another disaster caused by inadvertent bee venom acupuncture for stroke patients.

Correlation between Clinicoradiological Findings and Prognosis in Paramedian Pontine Infarction

BACKGROUND: To clarify the clinicoradiological correlation and prognosis of acute ischemic stroke involving para-median territory of pons. METHODS: We studied 37 patients with first-ever ischemic stroke involving paramedian terri-tory of pons and divided them based on the shape and level of lesion shown in their MRI. The clinical features, MRI findings, and prognosis were assessed. RESULTS: The paramedian infarctions extending to the basal surface were found in 28 patients (76%), and small infarctions separated from the basal surface were found in 9 patients (24%). In patients with infarction extending to the basal surface, 23 patients (82%) had progressive or fluctuating onset, whereas all patients with small infarction separated from the basal surface had non-progressive onset. In the group with upper pon-tine lesion (14 patients), dysarthria-clumsy hand syndrome was found in 4 patients, ataxic hemiparesis (AH) in 3, pure motor hemiparesis (PMH) in 2, and pure sensory stroke in 1. In the group with middle and lower pontine lesion (22 patients), PMH was found in 9, AH in 3, and sensory motor stroke in 2. The mean Modified Rankin Disability Scale scores on admission and after follow-up (mean 29 months) of the group with upper pontine lesion were 2.36 +/-0.50 and 1 . 0 0 +/-0.55, those with mid-lower pontine lesions, 3.48 +/-0.51 and 1.17 +/-0.49 (P0.05 respectively). CONCLUSIONS: Paramedian pontine infarction extending to the basal surface usually presents with progressive onset. Paramedian pontine infarction most often produces classic lacune syndrome of which PMH is the most common. In our study, patients with mid-lower paramedian pontine infarction had more severe initial neurological deficits than those with upper paramedian pontine infarction. However, a late outcome was found to be favorable in both groups.

Silent Brain Infarcts in First-ever Ischemic Stroke Patients: MRI Findings and Stroke Risk Factors

BACKGROUND AND OBJECTS: It is common to find cerebral infarction without a history of stroke on neuroimaging. This study was to determine the frequency, MRI characteristics of these lesions, and the risk factors related with silent brain infarcts in patients with first-ever ischemic stroke. METHOD: Sixty seven patients with acute ischemic stroke, who hospitalized in our hospital from April 1992 to May 1994, were reviewed. Brain MRI was performed in all patients. We evaluated frequency, site, size, and anatomic location of silent infarcts and compared the risk factors of the patients with silent infarcts with that of the ones without silent infarcts. RESULTS AND CONCLUSIONS: The prevalence of silent infarct was 58.2% ( (39/67). The predilection sites were in the right hemisphere and subcortical area (basal ganglia, thalamus), and their sizes were less than 1 cm mostly. The significant risk factor of silent infarcts was hypertension(P<0.01), and the other risk factors, such as age, sex, DM, and EKG abnormality, were not remarkable.

Cerebral Thromboangiitis Obliterans: Report of 3 cases

Thromboangiitis obliterans (Buerger's disease) is an inflammatory, thromboccluisive vasclar disease that usually involves small and medium sized arteries and veins of the distal extremities of young male smokers. Involvement of cerebral blood vessels in Buerger's disease is rare, but clinical and Pathological demonstration has ionally been found. We describe three patients with cerebral infarction who had amputated their distal extremities due to thromboangiitis obliterans. - they had . No clinical, laboratory, a,ngiographic evidence of vasculitis, source of emboli, and atherosclerotic risk factors except heavy smoking.

Magnetic Resonance Angiography: Its Role in Early Thrombolytic Theraphy: Preliminary study

In early thrombolytic therapy for acute focal ischemic stroke, the start of treatment within therapeutic time window is one of the most important thing. Recently, new imaging modalities such as SPECT, transcranial doppler, diffusion/ perfusion-weighted MRI, and MR anglography have been implicated to avoid time consumption and delayed therapy. Of these, MR angiography is nomnvasi and rapid technique to visualize large and medium-sized arteries. We explored the usefulness of MR angiography in early thrombolytic therapy. Arterial occlusion of three patients with severe ischemic stroke were demonstrated on MR anglography and wluch were treated with Urokmase (10, 000-20, 000 units/kg) by intravenous infusion within 2-4 hours after symptom onset. Recanalization and brain lesion was assessed by repeated MR angiography and MRI or CT 24 hours later. Clinical improvement was observed in two patients 5-24 hours after initiation of treatment. In one patient hemorrhagic infarction without clinical deterioration was detected by follow-up computed tomography. Recanalization was documented on repeated MR angiography of three patients. MR angiography can document occlusion of stroke-related vasculature without delay of thrombolytic therapy and repeated MR anglography can reveal whether recanalization has occurred.

Seasonal Variation of Fibrinolytic Activity

BACKGROUND AND PURPOSE: Among the many factors having influence on seasonal incidence of thrombotic disease, we studied the seasonal variation of fibrinolytic activity, which might be thought to have influence on seasonal incidence of thrombotic disease. SUBJECT AND METHOD: Seasonal plasma tissue type plasminogen activator (t-PA) and euglobulin fibrinolytic activity (EFA) were measured in 18 male and 22 female normal volunteers during a year. RESULT: The level of t-PA was higher in winter than in spring (p<0.05), but was not significantly different in the other couples of four seasons. The level of EFA was higher in winter than in summer and in autumn (p<0.01), and was slightly higher in winter than in spring without significance. The level of EFA was higher in spring than in summer (p<0.05). There was no correlation between the level of t-PA and that of EFA in any of the seasons. CONCLUSION: The fibrinolytic activity is higher at lower temperature than at higher temperature. Thus, it seems that a rise in fibrinolytic activity in cold weather counters certain changes which make a thrombotic event.

An Experimental Investigation of the Lesions of the Globus Pallidus and Substantia Nigra in Acute Carbon Monoxide Posioning in Cats

Severe morphologic changes in the central nervous system(CNS) have been recognized in aucte carbon monoxide(CO) poisoning. These have been usually located in globus palIidus, hippocarnpus, substantia nigra, cerebral white matter, cortical gray mattr, and cerebellum. It is well known that lesions in the CNS are shown both in the globus pallidus and cerebral white matter on neuroradiologic studies using CT or MRI. However we recently experienced two patients of aucte CO poisoning with residual neurologic sequelae, showing the bilateral lesions in the globus pallidus and substantia nigra on MRI performed 10 to 11 days after acute CO poisoning. Experimental studies were performed to investigate the correlation between the physlological data, such as duratlon of CO exposure, change of blood pressure, and termmal carboxyhemoglobin (HbCO) concentration in the blood, and the severities of pallidal and nigral lesions in acute CO exposured cats. Twelve mature cats, weighing 2.7-3.8kg, were exposured to 0.3% CO gas for 95-215 min. using artificial ventilation. The systemic blood pressure and electrocardiograrn were monitored continuously during CO exposure. HbCO concentration in the blood was analyzed immediatelly when CO exposure was terrninated. One to 12 days after CO poisoning, animals were killed and the brain was examined morphologically. Then the correlation between the physiological data and the severities of ischemic change in the globus pallidus and substantia nigra was examined. The results were summerized as follows; 1. The duration of CO ex.posure was ranged from 95 to 215 minutes, and the degree of BP drop from 14 to 76%. There were various hnds of abnorrnalities, such as cardiac arrhythmia and ischemic pattem on EKG, and terrninal HbCO concentration in the blood was ranged from 36 to 79.3%. 2. Morphologically, there was focal necrosis with intense infiltration of macrophages in the globus pallidus of a cat. In the globus pallidus of the remaining 11 cats, the severity of ischemic change was 27.3 to 95.6%.

Herper Zoster Ophthalmicus and Delayed Contralateral Hemiparesis: A Case Report

Herpes zoster may be associated with a number of neurological complication. Herper zoster ophthalmicus and delayed contralateral hemiparesis is a well-described entity. We report a patient who had acute cerebral infarction 8 weeks after herpes zoster ophthalrnicus. Brain CT disclosed large cerebral infarction in the right middle cerebral artery territory. Decompressivecraniectomy was perforrned because of the impending uncal herniation on the 4th admission day. Pathological finding of resected brain parenchyrna and meninges showed the early cerebral infarction without evidence of vasculitis or er;cephalitis. Postoperatively the patient was improved.