Isolated Weakness of Middle, Ring, and Little Fingers due to a Small Cortical Infarction in the Medial Precentral Gyrus

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.

A Case of Reversible Peripheral Neuropathy Caused by Chronic Phenytoin Intoxication / 대한간질학회지

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.

Comparison of the Protective Effect of Indole beta-carbolines and R-(-)-deprenyl Against Nitrogen Species-Induced Cell Death in Experimental Culture Model of Parkinson's Disease

BACKGROUND: The membrane permeability transition of mitochondria has been suggested to be involved in toxic and oxidative forms of cell injury. Mitochondrial dysfunction is considered to play a critical role in neurodegeneration in Parkinson's disease. Despite the suggestion that indole beta-carbolines may be neurotoxic, these compounds provide a protective effect against cytotoxicity of other neurotoxins. In addition, the effect of indole beta-carbolines on change in the mitochondrial membrane permeability due to reactive nitrogen species (RNS), which may lead to cell death, has not been clarified. METHODS: Differentiated PC12 cells were used as the experimental culture model for the investigation of neuronal cell injury, which occurs in Parkinson's disease. The effect of indole beta-carbolines (harmalol and harmine) on differentiated PC12 cells against toxicity of S-nitroso-N-acetyl-DL-penicillamine (SNAP) was determined by measuring the effect on the change in transmembrane potential, cytochrome c release, formation of ROS, GSH contents, caspase-3 activity and cell viability, and was compared to that of R-(-)-deprenyl. RESULTS: Specific inhibitors of caspases (z-LEHD.fmk, z-DQMD.fmk) and antioxidants (N-acetylcysteine, dithiothreitol, melatonin, carboxy-PTIO and uric acid) depressed cell death in PC12 cells due to SNAP. beta-Carbolines and R-(-)-deprenyl attenuated the SNAP-induced cell death and GSH depletion concentration dependently with a maximal inhibitory effect at 25-50 microM. The compounds inhibited the nuclear damage, decrease in mitochondrial transmembrane potential, cytochrome c release and formation of reactive oxygen species caused by SNAP in PC12 cells. beta-Carbolines and R-(-)-deprenyl attenuated the H2O2-induced cell death and depletion of GSH. CONCLUSIONS: The results suggest that indole beta-carbolines attenuate the SNAP-induced viability loss in PC12 cells by inhibition of change in the mitochondrial membrane permeability, which may be caused by free radicals. Indole beta-carbolines appear to exert a protective effect against the nitrogen species-mediated neuronal cell injury in Parkinson's disease comparable to R-(-)-deprenyl.

A Case of Nonaka Myopathy Confirmed by GNE Mutation

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.

A Case of Brain Stem Neuro-Behcet's Disease Presenting as Paroxysmal Headache With Autonomic Features

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.

Gastric Emptying Time in Patients with Liver Cirrhosis / 대한소화관운동학회지

BACKGROUND/AIMS: Changes in gastric motility in patients with liver cirrhosis is not yet established in South Korea. In this study changes in gastric emptying time with attention to factors that effect this change in patients with liver cirrhosis were investigated. METHODS: Fifteen patients with liver cirrhosis (11 males and 4 females) and 15 healthy controls (11 males and 4 females) were enrolled in this study. Gastric emptying time was measured by gastric scintigraphy using a dual-head gamma camera after ingestion of the mixture of 99mTc-labeled egg and fried rice (754Kcal). Data acquisition was performed for 120 minutes with 15 minutes interval and geometric mean and decay correction were calculated for gastric emptying time. RESULTS: There were no differences in age and sex between the two groups. The half time of soild gastric emptying was 78.0+/-87.0 minutes and 70.2+/-2.8 minutes for liver cirrhosis and healthy control group, respectively (p>0.05). The level of serum cholesterol was statistically correlated with gastric emptying time (B=-0.165, p<0.01). CONCLUSIONS: There was no significant difference in gastric emptying time between liver cirrhosis and healthy control group.

Cerebral Infarction in Essential Thrombocythemia after Discontinuation of Hydroxyurea

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.

Interictal Motor Cortex Excitability in Migraine and Chronic Tension Type Headache using Transcranial Magnetic Stimulation

BACKGROUND: The pathophysiology of migraine is only partly understood. Transcranial magnetic stimulation has been developed to study cortical physiology noninvasively. Chronic tension-type headache has not been studied with transcranial magnetic stimulation. Among other hypotheses, it has been proposed that interictal hypoexcitability could be partly responsible for the migraine. METHODS: Patients were divided into three groups: normal subjects(n=30), migraine with(n=11) or without aura(n=19) and chronic tension-type headache(n=30) according to the International Headache Society criteria. We studied cortical excitability between normal subjects and patients with migraine with or without aura and between normal and patients with chronic tension-type headache. RESULTS: The mean amplitude of cortex and spinal cord for normal subjects was 3.76 +/-1.74 mV, 2.03 +/-1.54 mV(abductor digiti minimi muscles, respec-tively) and 2.99 +/-2.04 mV, 3.88 +/-3.89 mV(abductor hallucis muscles, respectively). The mean amplitude of cortex and spinal cord for migraine with aura or without aura was 2.16 +/-1.21 mV, 0.90+0.80 mV(abductor digiti minimi muscles, respectively) and 1.88 +/-1.23 mV, 2.31 +/-2.25 mV(abductor hallucis muscles, respectively). The mean amplitude of cor-tex and spinal cord for chronic tension-type headache was 1.61 +/-0.50 mV, 0.72 +/-0.32 mV(abductor digiti minimi mus-cles, respectively) and 1.54 +/-0.55 mV, 1.51 +/-0.59 mV(abductor hallucis muscles, respectively). The amplitude of motor evoked potentials of cortex and spinal cord in migraine and chronic tension-type headache showed significant decreases compared to normal subjects( p < 0.001). CONCLUSIONS: These results are explained by cortical and spinal hypoexcitability in migraine and chronic tension-type headache. We suggest that enhanced serotonergic activity could be some rule for cortical hypoexcitability.

The Effects of Catheter Revision and Mupirocin on Exit Site Infection/Peritonitis in CAPD Patients / 영남의대학술지

BACKGROUND: Exit site/tunnel infection causes cosiderable morbidity and technique failure in CAPD patients. We presently use a unique revision method for the treatment of refractory ESI/TI in CAPD patients and mupirocin prophylaxis for high risk patients. MATERIALS AND METHODS: We reviewed 139 CAPD patients about the ESI/TI from October 1993 to February 1999 at Yeungnam University Hospital. At the beginning of the ESI, we usually started medications with rifampicin and ciprofloxacin and then changed the antibiotics according to the sensitivity test. If the ESI had persisted and there were T1 symptoms(purulent discharge, abscess lesion around exit site), we performed catheter revision(external cuff shaving, disinfection around tunnel and new exit site on opposit direction) with a combination of proper antibiotics. We applied local mupirocin ointment at the exit site three times per week to the 34 patients who had the risk of ESI starting from October 1998. RESULTS: The total follow-up was 2401 patient months(pt. mon). ESI occurred on 105 occasions in 36 out of 139 patients, and peritonitis occurred on 112 occasions in 67 out of 139 patients. The total number of incidences of ESI and peritonitis was 1 per 23.0 pt.mon and 0 per 21.6 pt.mon. The most common organism responsible for ESI was Staphylococcus aureus(26 of 54 isolated cases, 48%), followed by the Methicillin resistant S. auresu(MRSA) (13 cases, 24%). Seven patients(5: MRSA, 2: Pseudomonas) had to be treated with a revision to control infection. Three patients experienced ESI relapse after revision. One of them improved with antibiotics, while another needed a second revision and the remaining required catheter removal due to persistent MRSA infection with re-insertion at the same time. But, there was no more ESI in these 3 patients who were received management to relapse (The mean duration: 14.0 months). The rates of ESI were significantly reduced after using mupirocin than before(1 per 12.7 vs 34.0 pt.mon, p<0.01). CONCLUSION: In summary, revision technique can be regarded as an effective method for refractory ESI/T1 before catheter removal. Also local mupirocin ointment can play a significant role in the prevention of ESI.