ABSTRACT
Current stroke guidelines recommend the administration of non-vitamin-K-antagonist oral anticoagulant (NOAC) for the prevention of cardioembolic stroke induced by nonvalvular atrial fibrillation. We report a patient who suffered from recurrent posterior circulation strokes-occurring eight times in 4 months-even under adequate antiplatelet medication. Changing the medication from antiplatelet agents to NOAC stopped the stroke recurrence. We suggest that NOAC has a role in the prevention of recurrent stroke of undetermined etiology in the posterior circulation.
Subject(s)
Humans , Atrial Fibrillation , Platelet Aggregation Inhibitors , Recurrence , StrokeABSTRACT
No abstract available.
Subject(s)
Arthritis, Rheumatoid , Headache , Post-Traumatic HeadacheABSTRACT
BACKGROUND: Metamorphopsia includes a broad spectrum of visual perceptual distortions, such as alteration of perceived object size or, rarely, altered perception of faces, termed prosopometamorphopsia. CASE REPORT: This report describes a patient who complained of metamorphopsia restricted to the center of the face, particularly the lower part of the face (nose and mouth), following infarction of the right medial temporooccipital lobe that included the fusiform face area. CONCLUSIONS: The fusiform face area is commonly believed to be a face-selective cortical region dedicated to the visual analysis of face stimuli. We speculate that any injury to this brain area could bring about prosopometamorphopsia involving whole or unilateral face perception, or very rarely, as in our case, distortion restricted to the central area of the face. Furthermore, there could be topographical correspondences between facial structures and the fusiform face area.
Subject(s)
Humans , Brain , Infarction , Mouth , Nose , Perceptual Distortion , Vision DisordersABSTRACT
No abstract available.
Subject(s)
Humans , Diplopia , Isaacs Syndrome , Neoplasm Metastasis , OrbitABSTRACT
Spontaneous remission in untreated primary central nervous system lymphoma is rare. A 66-year-old man was admitted with dizziness and gait disturbance. Initial fluid-attenuated inversion-recovery images revealed hyperintensities in the upper brainstem, left temporal lobe, and right occipital lobe. The patient's symptoms and lesions disappeared spontaneously after 1 month. However, he was readmitted after 4 months with right hemiparesis. Magnetic resonance imaging revealed a homogenous enhanced lesion in the left basal ganglia with a vasogenic pattern. This disease warranted biopsy, which revealed large B-cell lymphoma.
Subject(s)
Aged , Humans , Basal Ganglia , Biopsy , Brain Stem , Central Nervous System , Dizziness , Gait , Lymphoma , Lymphoma, B-Cell , Magnetic Resonance Imaging , Occipital Lobe , Paresis , Remission, Spontaneous , Temporal LobeABSTRACT
Behcet's disease is a systemic vasculitis that is characterized mainly by recurrent oral and genital aphthous ulcers, uveitis, and skin findings. Its neurological manifestations are well recognized. Recurrent meningitis in Behcet's disease is exceptional. We describe herein the case of a 31-year-old man who presented with recurrent aseptic meningitis without any specific cause. A few years later he developed oral and genital ulcers, and uveitis. Behcet's disease should always be considered in a differential diagnosis of recurrent aseptic meningitis without viral infection, particularly in the context of multisystem manifestations.
Subject(s)
Adult , Humans , Diagnosis, Differential , Meningitis , Meningitis, Aseptic , Neurologic Manifestations , Skin , Stomatitis, Aphthous , Systemic Vasculitis , Ulcer , UveitisABSTRACT
No abstract available.
Subject(s)
Immunization, Passive , Immunoglobulins , Lambert-Eaton Myasthenic SyndromeABSTRACT
OBJECTIVE: To compare gait parameters of patients with idiopathic Parkinson's disease (IPD) during obstacle crossing with those of healthy control subjects. METHOD: Conventional physical examinations and three- dimensional gait analysis were performed on 16 patients of IPD with stage 2~3 of the Hoehn and Yahr disease rating scale, and 11 healthy control subjects during stepping over the obstacle. Temporospatial, kinematic and kinetic parameters of patients were compared with those of the control group. RESULTS: In patients with IPD, walking velocity was slower and stride length were shorter than control group. Decreased post-obstacle distance of the lead limb and increased pre-swing time of the lead and trail limbs were noted in IPD patients compared to control group. Many significant modifications of kinematic and kinetic parameters were detected in IPD patients compared to control group during obstacle crossing. CONCLUSION: Using three-dimensional gait analysis, we could identify specific modifications of gait parameters in IPD patients during obstacle crossing. These modifications may reduce or increase the risk of a falling in IPD patients.
Subject(s)
Humans , Extremities , Gait , Parkinson Disease , Physical Examination , WalkingABSTRACT
High signal intensity on diffusion-weighted image (DWI) at the site of venous occlusion has previously been reported in cerebral venous thrombosis (CVT). The frequency and diagnostic value of these signal changes in CVT were unknown. Some authors suggest that the presence of high signal intensity on DWI in occluded veins might help diagnose CVT and suggest low rate of recanalization. We experienced two cases of CVT with high signal intensity at the site of intravascular clot on DWI.
Subject(s)
Diffusion , Veins , Venous ThrombosisABSTRACT
A 59-year-old man visited an emergency room due to the sudden onset of severe dysarthria with a drowsy mental status. MRI demonstrated T2 prolongation and restricted diffusion involving the splenium of the corpus callosum and bilateral frontal white matter neurological signs and symptoms were mild, and the recovery was complete within a week. Follow-up MRI performed one month later revealed complete resolution of the lesions. The clinical and radiological courses were consistent with previously reported reversible isolated splenial lesions in mild encephalitis/encephalopathy except for the presence of frontal lesions. This case suggests that such reversible lesions can occur outside the splenium.
Subject(s)
Humans , Middle Aged , Corpus Callosum , Diffusion , Dysarthria , Emergency Service, Hospital , Follow-Up Studies , Magnetic Resonance ImagingABSTRACT
Small cortical strokes can produce predominant isolated weakness in a particular group of fingers: radial or ulnar. The traditional views are of point-to-point representations of each finger to neurons located in the precentral gyrus of the motor cortex such that the neurons of the radial fingers are located laterally and those of the ulnar fingers are located medially. We present a case of isolated weakness of middle, ring, and little fingers due to a small cortical infarction in the medial precentral gyrus.
Subject(s)
Fingers , Infarction , Motor Cortex , Neurons , StrokeABSTRACT
Peripheral neuropathy has been uncommon reported as one of neurologic adverse effects associated with phenytoin. A 53 year-old man presented with clinical and electrophysiologic signs of peripheral neuropathy after 13 years of phenytoin administration. Despite a modest dose of phenytoin (300 mg/day), blood level was 40 microg/ml. After discontinuing phenytoin about eight months, the peripheral neuropathy was improved. We present a case of reversible peripheral neuropathy caused by chronic phenytoin intoxication.
Subject(s)
Humans , Middle Aged , Peripheral Nervous System Diseases , PhenytoinABSTRACT
Nonaka myopathy (NM) or distal myopathy with rimmed vacuoles (DMRV) is an autosomal recessively inherited neuromuscular disorder characterized by early adult-onset weakness of distal muscles, rimmed vacuoles in muscle biopsy, and mutations in the UDP-N-acetylglucosamine 2-epimerase/N-acetylmannosamine kinase (GNE) gene. The authors describe a patient with typical clinical features of NM confirmed by GNE mutation. Mutation analysis of the GNE gene revealed that the patient was a compound heterozygous for V572L and C13S mutations.
Subject(s)
Humans , Biopsy , Distal Myopathies , Muscles , Muscular Diseases , Phosphotransferases , VacuolesABSTRACT
BACKGROUND: The purpose of this study was to assess the efficacy and safety of entacapone, a catechol-O-methyltransferase (COMT) inhibitor in Parkinson's disease (PD) patients with wearing-off phenomenon. METHODS: A total of 197 PD patients were included in this 2-month multi-center, randomized, placebo-controlled, double blind, parallel-group study. After a 2-week screening period, each patient was randomly allocated to receive either entacapone (n=98) or placebo (n=99) as an adjunct to levodopa. The efficacy was evaluated with the changes of "on" and "off" time percentage while awake, the reduction of the levodopa dose, Unified Parkinson's Disease Rating Scale (UPDRS), and the clinical global impression (CGI) by the examiner. RESULTS: The percentage of "on" time increased by 9.4 +/- 18.0% in the entacapone group, 7.4 +/- 15.6% in the placebo group. The percentage of "off" time was reduced by 8.6 +/- 16.9% in the entacapone group, 6.6 +/- 18.2% in the placebo group. These parameters did not show a statistical significance between the two groups. However, the levodopa dose was significantly reduced in the entacapone group (51.6 +/- 154.5 mg/day) compared with the placebo group (0.7 +/- 130.0 mg/day) (p=0.009). The total and motor scores of the UPDRS were significantly decreased in the entacapone group (p=0.039, p=0.017, respectively). The most common adverse drug reactions in the entacapone group were urine discoloration (22%), dyskinesia (13%), dizziness (7%). CONCLUSIONS: Entacapone was a safe and well-tolerated drug. Although the changes of "on" and "off" time were not significant, entacapone showed an overall significant beneficial effect in the PD patients with wearing-off phenomenon.
Subject(s)
Humans , Catechol O-Methyltransferase , Dizziness , Double-Blind Method , Drug-Related Side Effects and Adverse Reactions , Dyskinesias , Levodopa , Mass Screening , Parkinson DiseaseABSTRACT
Migraine without aura was significantly frequent in Beh et's disease patients. While, the relationship of TAC(trigeminal autonomic cephalalgia) and Beh et's disease was not known. And, it is thought that pathogenesis of proxysmal headache with autonomic features in neuroBehcet's disease as our case may be different from those of clust headache and TAC. A 45-year-old male admitted with left sided periobital poxysmal headache accompained by ipsilateral conjunctival injection and lacrimination with autonomic features. T2WMR image showed about 1.5x2.6x2.6 cm sized mass with high signal intensity surrounded by a rim of low signal intensity in pons. Enhanced MR image showed enhancing mass-like lesion inside the T2 high signal intensity. CSF study revealed neutrophilic pleocytosis with normal pressure, protein and glucose concentration. No malignant cell were seen. Antiphospholipid antibody and cryoglobuline was significantly increased. 3 days after hospitalvisit, oral ulcerations appeared in the patient. He was treated with high-dose steroid for a week and his headache and abnormal findings of CSF study became fully recovered. Two weeks later, the mass was nearly reduced in the pons on follow-up MR image. We suggest to include a careful interviewfor 2ndary TAC as the first neurologic symptom in the diagnostic work-up of Behet's disease.
Subject(s)
Humans , Male , Middle Aged , Antibodies, Antiphospholipid , Brain Stem , Brain , Follow-Up Studies , Glucose , Headache , Leukocytosis , Migraine without Aura , Neurologic Manifestations , Neutrophils , Oral Ulcer , Pons , Trigeminal Autonomic CephalalgiasABSTRACT
Abnormalities in the number and function of platelets may contribute to thromboembolic complications in patients with essential thrombocythemia(ET). Physicians often use hydroxyurea which reduces the platelet count for the initial treatment of ET. A 74-year-old man with ET was presented with headache, dysarthria, and right hemiparesis 10 months after discontinuation of hydroxyurea. Initial platelet count was 450x103/microliter and we gave him heparin. However, his platelet count rised upto 1,019x103/microliter within 4 days. He was on hydroxyurea 1.5 g/day and his symptoms improved with decrease of platelet count. We report a case of left MCA(middle cerebral artery) multifocal infarction in ET after discontinuation of hydroxyurea.
Subject(s)
Aged , Humans , Cerebral Infarction , Dysarthria , Headache , Heparin , Hydroxyurea , Infarction , Paresis , Platelet Count , Thrombocythemia, EssentialABSTRACT
BACKGROUND: The term 'young-onset Parkinson's disease (YOPD)' refers to patients who have developed parkison-ian symptoms or signs between the ages of 21 and 40, and the term 'old onset Parkinson's disease (OOPD)' refers to those with onset after the age of 65. Patients with YOPD may show clinical features different from those with OOPD. METHODS: We compared the clinical features and courses of Parkinson's disease between 27 patients with YOPD and 31 patients with OOPD. RESULTS: YOPD more frequently affected male patients. Patients with YOPD more frequently had family members also affected by Parkinson's disease. Rest tremor was the most frequent initial symptom in both YOPD and OOPD. Other initial symptoms included akinesia-rigidity and dystonia, but occurred more frequently in patients with YOPD than OOPD. Patients with YOPD developed levodopa induced motor complications more frequent-ly but had much less hallucinations and delusions. The disease progression of YOPD was slower than the progression of OOPD. CONCLUSIONS: Patients with YOPD may develop clinical features and courses different from those of OOPD because they have neuronal degeneration relatively confined to the substantia nigra with changes in the central pharma-cokinetics and pharmacodynamics.