Rhino-orbito-cerebral Mucormycosis Complicated with Intracranial Hemorrhage

Rhino-orbito-cerebral mucormycosis is an uncommon fulminant fungal infection that occurs usually in debilitated or immune suppressed patients. Intracranial lesions such as cerebral ischemia mostly develop secondary to vascular injuries like thrombosis of cavernous sinus or internal carotid artery and also from arteritis. However, intracranial hemorrhage complicated by mucormycosis is very rare. We report a patient with a fatal complicaton of intracranial hemorrhage presumably due to arteritis by mucormycosis. A 66-year-old female patient with uncontrolled diabetes mellitus developed complete ophthalmoplegia in her left eye for two days. Rhinoscopic examination revealed black necrotic turbinate. Orbital CT scan and Brain MRI showed soft tissue material at the left orbital apex and mild deformities in the left lateral cavernous sinus. On the basis of radiological evidence and biopsy, a diagnosis of mucormycosis was established, and the patient underwent surgical debridement followed by an Amphotericin B infusion. On the following day, she suddenly developed a right hemiparesis and stupor. An immediate brain CT scan revealed a large intracranial hemorrhage in the left frontal head region. Removal of the hematoma and a biopsy was performed immediately. A pathological examination revealed a fungal invasion of the small arterial wall and an acute inflammatory reaction of the surounding tissues.

Incomplete AICA Syndrome Presented with Peripheral Facial Palsy; A Variant of Gasperini Syndrome

Acute infarcts of the anterior inferior cerebellar artery (AICA) territory are unusual. Furthermore incomplete AICA infarcts are perplexing because of its variations of vascular anatomy and inconsistent clinical features. We present a case with clinical features of AICA infarction, which consist of ipsilateral peripheral-type facial palsy, vertigo, and contralateral facial and upper limb sensory changes without motor weakness. The patient had hypertension and was a current smoker. The high signal intensity on inferior pontine tegmental area was found on MRI and the R2 interneuronal dysfunction was note on Blink reflex. The angiographic findings didn't show any focal vascular lesions, which is contrary to the pathogenesis of AICA infarction published previously. On the clinical ground, the present case reserves to attention in that patients with peripheral-type facial palsy should be properly evaluated and with thorough neurological examination and we could differentiate between the incomplete AICA infarcts such as Gasperini syndrome and Bell's palsy.

Status Epilepticus in Adult Hospitalizde Patients: Cause and Clinical Outcome / 대한간질학회지

Background AND PURPOSE: Status epilepticus (SE) is one of the major neurological emergency that requires immediate treatment to avoid significant morbidity and mortality. Thus, understanding the cause, features and prognosis of SE is important for the evaluation and treatment of this condition. We retrospectively reviewed the possible cause and clinical outcome of adult patients treated for SE at the Hallym Univrsity Hospital from 1994 to 1998. METHODS: For the identification of patients, we searched the data bank for patients meetinf criteria of SE who were 18 year or older, and their medical records were reviewed. We also investigated the relationships between cause, response to anticonvulsant therapy and short-term clinical outcome. RESULTS: The selected 127 patients wer 84 males and 43 females, aged 18 to 85 yeats (meen age: 49.5 years). The possible etiologies of SE were withdrawal of AED (n=27, 21.3%), anoxia (n=22, 17.3%), CNS infection (n=20, 15.7%), stroke (n=16, 12.6%), alcohol-related (n=15, 11.8%), metabolic (n=8, 6.3%), unknown (n=7, 5.5%), drug inroxicatio (n=5, 3.9%), trauma (n=4, 3.2%) and cerebral tumor (n=3, 2.4%). in 77 patients (n=77, 60.6%), SE was successfully aborted with first-line therapy, which usually included diazepam with or without phenytoin. The food responders to AEDs occurred in patients with AED withdrawal, alcohol-related, stroke, unknown, and trauma, The poor response related to anoxia, drug intoxication and CNS infection. Seventy nine patients (62.2%) had food outcome, but nineteen patients (14.9) were died. Anoxia, drug intoxication, CNS infection and metabolic abnormalities were associated with particularly poor outcome compared with other etiologies. CONCLUSION: This study indicates that the etiology of SE may help predict both the intial response to drug therapy and short-term clinical outcome.

Anterior Spinal Artery Syndrome Associated With Cervical Spinal Stenosis

BACKGROUND: The anterior spinal artery infarction constitutes a classical syndrome of vascular myelopathy. The causes of the anterior spinal artery syndrome are various, but most episode probably occur as the result of atherosclerosis or dissection of the aorta and its branches. However, few cases reported developed with spinal structural abnormalities. CASE: A 65-year-old man presented with sudden paraparesis. There was no evidence of hypertension, diabetes and smoking. Motor weakness was more prominent on the left side and progressed. Loss of pain and temperature senses were shown at the level of 71 with preservation of touch, joint perception and vibration senses. The DTR's of legs were depressed and extensor toe signs were presented. A C-spine MRI showed high signal intensity on 72 weighted image and low signal on 71 weighted image(C6-71) with cervical spinal stenosis at the C4-C7 spinal level and mild cervical disc protrusion (C6-C7, C7-T1). After three months later, follow up cervical MRI showed somewhat decreased size of high signal intensity on 72 weighted image and more prominent low signal on 71 image. DISCUSSION: In our case, we could not find any usual cause of anterior spinal artery infarction. However only cervical spinal stenosis associated with mild cervical disc protrusion was present. In stenotic cervical canal, the anterior spinal artery can be more vulnerable to extrinsic compression and the infarction may early develop with insignificant trigger event, such as disc protrusion. We concluded that the ischemic change of anterior two thirds of cervical spinal cord might develop due to the compression of the anterior spinal artery by cervical stenosis and mild cervical intervertebral disc protrusion.