Usefulness of Seoul Verbal Learning Test in Differential Diagnosis of Alzheimer's Disease and Subcortical Vascular Dementia

BACKGROUND: The Seoul Verbal Learning Test (SVLT) is a relatively brief test of verbal learning and memory, which is used to examine dementia patients when a more comprehensive memory assessment is not feasible or when serial testing is desired. The aim of this study was to investigate the pattern of the SVLT performance and its usefulness in making a differential diagnosis between Alzheimer's disease (AD) and subcortical vascular dementia (SVD). METHODS: The SVLT was administered to 15 younger controls, 12 elderly controls, 84 probable AD and 53 SVD patients who met the DSM-IV criteria for dementia. In order to determine the difference of the SVLT parameters between AD and SVD according to the disease severity, the subjects were first grouped into mild dementia (CDR 1 or less) and advanced dementia (CDR2), then the parameters were compared. RESULTS: Pattern analysis of the SVLT performance in subjects with AD and SVD revealed that the mild AD subjects recalled fewer words in trial 2, had a lower discrimination index, a lower combination memory score and more recognition of semantically-unrelated distracter items. In advanced cases, with the exception of combination memory score, there were no differences between the groups in terms of the overall learning or the discrimination index. CONCLUSIONS: Although SVLT has limited differential diagnostic value in advanced cases, in mild cases, pattern analysis of the SVLT performance is a useful tool for discriminating mild AD from SVD. Therefore, a further clinical study should be promising.

Malignant Proliferating Trichilemmal Tumor Showing Invasion into the Brain Parenchyme

A 32-year-old man was admitted to our hospital due to a headache. A brain CT and MRI showed a parenchymal mass in the right temporoparietooccipital lobe and histopathological specimens demonstrated a proliferating trichilemmal tumor (PTT). Two years prior to experiencing headache, the man had a round mass localized in the right suboccipital scalp which recurred after wide excisions and was found to be PTT. There was no evidence of tumor recurrence at the scalp during the period the man first began experiencing headache. Although PTT usually occurrs at the scalp, direct invasion into the brain is very rare. We report a patient with malignant PTT who developed brain parenchymal inva-sion, which was supported by neuroradiological and histopathological findings.

The Cervical Herniated Intervertebral Disc Presenting with False Localizing Thoracic Sensory Levels

Symptoms of compressive cervical myelopathy classically include spasticity and weakness, predominantly involving the lower extremities. Sensory abnormalities are reportedly common in the upper extremities, but are often vague or misleading. The sensory findings are usually localized 2-3 spinal segments below the actual spinal cord compression. In our current series, 3 patients presented with progressive symptoms of weakness and hyperreflexia involving the lower extremities without upper extremity symptoms and with a distant thoracic sensory level ranging from T10 to T12. All 3 patients were eventually found to have a cervical herniated intervertebral disc. The direct physical effects of compression and vascular compromise in the central cervical cord compression may be responsible for the reported abnormality at a distinct thoracic sensory level. Failure to diagnose cervical myelopathy because of the presence of a thoracic sensory level can delay appropriate treatment or lead to incorrect therapy.