Two Cases of Acute Esotropia in Contralateral Thalamic Hemorrhage

Monocular gaze palsies which result from a supranuclear cerebral lesion are rare clinical manifestations. The prefrontal cortico-oculomotor pathways travel across the thalamus and mesodiencephalic junction terminating directly in oculomotor complexes. These pathways exist bilaterally and the contralateral oculomotor bundle exerts an inhibitory influence upon the oculomotor neurons, particularly those related to the medial rectus muscle. The acute disinhibition of these neurons by a posterior thalamic lesion results in a sustained but transient discharge of the medial rectus and tonic activation. Impairment of monocular projections in the contralateral posterior thalamus could result in a tonic activation of the medial rectus, analogous to the conjugate gaze deviation observed with a frontal lobe lesion. We describe two patients with an acute onset of esotropia and contralateral supranuclear lesions - thalamic hemorrhages.

Spontaneous Dissecting Aneurysm in the Proximal Portion of the Posterior Inferior Cerebellar Artery

A spontaneous dissecting Aneurysm of the posterior inferior cerebellar artery(PICA) is a very rare cause of subarachnoid hemorrhage(SAH) or ischemic stroke. We report a 53-year-old male patient with left PICA territory infarction due to the spontaneous dissection of the PICA. A Brain MRI revealed an infarction of the left PICA territory and an angiography showed spindle-shaped dilatations of the left PICA followed by an irregular luminal narrowing. An angiography taken 3 months later showed spontaneous resolution of the left PICA dissecting aneurysm. The management of the intracranial dissecting aneurysm is still controversial. Some authors recommend surgical approaches for the prevention of SAH while others present medical management. Our case showed spontaneous regression of the PICA dissecting aneurysm.

Relationship of Leukoaraiosis with Cerebrovascular Disease

Non-specific periventricular white matter lucencies on computed tomography(leukoaraiosis) were found in 130(40%) of 324 patients with ischemic or hemorrhagic strokes. Patients with leukoaraiosis were significantly older than those without it and correlated with hypertension and lacunar infarction but not with cortical infarction. In patients with hemorrhage, leukoaraiosis occurred sinigificantly more often when aneurysm or arteriovenous malformation were not demonstrated. Our fiindings suggest that leukoaraiosis in cerebrovascular disease is associated with small vessel disease.

Urinary Dysfunction in Idiopathic Parkinson's Disease

The clinical and urodynarnic studies for urinary dysfunction were performed in 35 patients with idiopathic parkinson's disease who admitted at Hanyang University Hospital from January, 1988 to June, 1990. The results are as follows; 1. Urinary dysfunction was noted in 9 patients (25.7%) with idiopathic parkinson's disease Their cysto / uroflowmetry showed detrusor hyperreflexia in 6 patients, and detrusor hyporeflexia in 3 patients. The common urinary symptoms were frequency, incontinence, hesitency, decreased urinary force, and retention in that order. 2. The mean time-interval from the onset of initial parkinsonian symptoms to the development of urinary symptoms was 22.6 months (ranged from 3 to 48 months). Urinary dysfuncion showed no correlation with clinical severity of parkinson's disease. 3. The frequency of urinary dysfunction was greater in rigidity-predominant parkinsonian group than patients with tremor. Cysto / uroflowmetry in the former showed detrusor hyperreflexia more frequently than detrusor hyporeflexia. 4. It was suggested that urinary dysfunction in idiopathic parkinson's disease probably result from multifactorial causes such as the change of neuronal effect, dysautonomia, and skeletal rigidity.

A Clinical Study on Neglect Syndrome in Unilateral Hemispheric Lesion

We investigated 97 right-handed comprehensive patients with unilateral hemispheric lesion confirmed by computed tomogram, to evaluate the presence of neglect syndrome by using tests of visual neglect, auditory extinction, and somesthetic extinction. The results are as follows: 1.Neglect syndrome was noted in 38.8% of right hemispheric lesion and 25.6% of left hemispheric lesion, the frequency of neglect syndrome was higher in new lesion(less than 1 month) than old(over than 1 month) and the common locations of neglect syndrome were parieto-occipital, temporo-parietal, fronto-temporo-parietal, and parietal in that order. 2. The severity of neglect syndrome showed higher correlations with right hemispheric lesion and new lesion, but without any significant correlation with the location of lesion.

A Case of Multifocal Fibrosclerosis with CNS Involvement

Multifocal fibrosclerosis, a rare disorder, has no known etiology and is considered to be a systemic illness manifested by combinations of fibrosing process of multiple areas such as mediastinal fibrosis, retroperitoneal fibrosis, orbital pseudotumor, sclerosing cholangitis, and Reidel's thyroiditis. We have experienced a 49-year-old man with pseudotumor of the orbit, sclerosing cholangitis, and CNS involvements included unrecognized meningitis and suspicious CNS vasculitis. The patient showed clinical improvement with corticosteroid therapy.