ABSTRACT
No abstract available.
Subject(s)
Humans , Brain Diseases , Brain Stem , Hypertensive Encephalopathy , Stroke, LacunarABSTRACT
No abstract available.
Subject(s)
Cerebral Infarction , Stroke , Thrombocythemia, EssentialABSTRACT
Tortuous arteries are common clinical observation. Although mild tortuosity is asymptomatic, severe tortuosity can lead to ischemic attack in several organs. With advances in imaging technology, an increasing number of tortuous vessels have been detected. The purpose of this report is to describe a case of acute cerebral infarction due to tortuous subclavian artery and to review the literature.
Subject(s)
Arteries , Cerebral Infarction , Subclavian ArteryABSTRACT
We report on a 55-year-old man with alcoholic liver cirrhosis who presented with status epilepticus. Laboratory analysis showed markedly elevated blood ammonia. Brain magnetic resonance imaging (MRI) showed widespread cortical signal changes with restricted diffusion, involving both temporo-fronto-parietal cortex, while the perirolandic regions and occipital cortex were uniquely spared. A follow-up brain MRI demonstrated diffuse cortical atrophy with increased signals on T1-weighted images in both the basal ganglia and temporal lobe cortex, representing cortical laminar necrosis. We suggest that the brain lesions, in our case, represent a consequence of toxic effect of ammonia.
Subject(s)
Humans , Male , Middle Aged , Ammonia/blood , Atrophy/pathology , Brain Diseases/blood , Hepatic Encephalopathy/complications , Liver Cirrhosis, Alcoholic/complications , Magnetic Resonance Imaging/methods , Necrosis/pathology , Status Epilepticus/pathologyABSTRACT
Ramsay-Hunt syndrome (RHS) is a well known disease caused by varicella-zoster virus infection in the geniculate ganglion of the facial nerve. Although the otic vesicle and facial palsy are easily recognized clinical signs of RHS, cases of associated multiple cranial nerve palsies present a difficult diagnostic challenge and furthermore, the mechanisms is unclear. We report a case of an 86-year-old man with otic crusted vesicles and peripheral typed facial palsy preceded by severe headache and fever. Several days later, he developed diplopia, dysphagia, hiccup and abdominal myoclonus. On fluid attenuated inversion recovery image of brain, diffuse subdural inflammatory exudates, which disappeared after treatment of acyclovir and corticosteroid, and ipsilateral facial nerve enhancement were observed in follow-up imaging.
Subject(s)
Aged, 80 and over , Humans , Acyclovir , Brain , Cranial Nerve Diseases , Cranial Nerves , Deglutition Disorders , Diplopia , Exudates and Transudates , Facial Nerve , Facial Paralysis , Fever , Follow-Up Studies , Geniculate Ganglion , Headache , Herpesvirus 3, Human , Hiccup , MyoclonusABSTRACT
Gradual decline in cognitive function and behavioral changes are characteristic in degenerative dementia. Although acute to subacute subcortical lesion can affect behavior and cognition, few reports have described both cognitive and behavioral deficits in patients with right basal ganglia lesion. An 82-year-old man presented with memory impairment, pathological crying, delusion and other psychological symptoms that developed insidiously over the previous 2 months. Initially, the patient had been diagnosed with degenerative dementia, but brain MRI showed the hematoma in the right basal ganglia. Our case shows that cognitive dysfunction, behavioral and psychological symptoms including pathological laughing and delusion can be developed concurrently by the lesion of the right basal ganglia. Our case suggests that cerebrovascular disease should be considered in elderly patients presenting with subacute cognitive and behavioral deterioration, even when there were no other neurological signs.
Subject(s)
Aged , Aged, 80 and over , Humans , Basal Ganglia , Brain , Cognition , Crying , Delusions , Dementia , Hematoma , Hemorrhage , MemoryABSTRACT
Vertigo due to primary cardiac disease, known as cardiogenic vertigo, has been rarely reported. We report one case showing recurrent vertigo episodes due to sick sinus syndrome. A 77-year-old female presented to our department because of long history of intermittent brief episodes of rotatory vertigo and non-vertiginous dizziness. She had no past medical history. There was no abnormal sign in neurological examination. Cardiac murmur, finally confirmed as grade 4 ejection systolic and grade 3 decrescendo diastolic murmurs, was found on physical examination. Brain magnetic resonance imaging and auditory evoked potential did not show any abnormal findings. She was consulted to a cardiologist for the evaluation of cardiac murmur. After the evaluation using electrocardiogram, echocardiography, and holter monitoring, she was diagnosed as sick sinus syndrome. After then, a ventricle ventricle inhibited (VVI) pacemaker was inserted. She did not complain of vertigo and dizziness for 3 months after the insertion of a VVI pacemaker. This case shows the need of auscultation for patients with recurrent vertigo episodes although there is rare cardiogenic vertigo.
Subject(s)
Aged , Female , Humans , Auscultation , Brain , Dizziness , Echocardiography , Electrocardiography , Electrocardiography, Ambulatory , Evoked Potentials, Auditory , Heart Diseases , Heart Murmurs , Magnetic Resonance Imaging , Neurologic Examination , Physical Examination , Sick Sinus Syndrome , VertigoABSTRACT
Cervical epidural abscess (CEA) is a very uncommon disease with diverse clinical presentations. Clinically, it is difficult to diagnose this disease, especially in early stage. We report an atypical case of CEA showing only progressive quadriparesis without any other symptoms or signs of CEA. From this experience, CEA must be considered when progressive quadriparesis without any specific cause is developed in immuno-compromised patients and diabetic patients with polyneuropathies.
Subject(s)
Humans , Diabetes Mellitus , Epidural Abscess , Polyneuropathies , QuadriplegiaABSTRACT
Cervical epidural abscess (CEA) is a very uncommon disease with diverse clinical presentations. Clinically, it is difficult to diagnose this disease, especially in early stage. We report an atypical case of CEA showing only progressive quadriparesis without any other symptoms or signs of CEA. From this experience, CEA must be considered when progressive quadriparesis without any specific cause is developed in immuno-compromised patients and diabetic patients with polyneuropathies.
Subject(s)
Humans , Diabetes Mellitus , Epidural Abscess , Polyneuropathies , QuadriplegiaABSTRACT
Posthypoxic myoclonus is poorly controlled with current treatments. Based on clinical experience, valproate and benzodiazepines have been used to treat myoclonic seizures. Rarely, some antiepileptic drugs may exacerbate myoclonic seizures. Although lamotrigine is controversial for treatment in myoclonic seizures, we experience a case of posthypoxic myoclonus improved with lamotrigine add-on therapy.
Subject(s)
Anticonvulsants , Benzodiazepines , Myoclonus , Seizures , Valproic AcidABSTRACT
MELAS syndrome is typically a multisystemic disorder. We report one case of MELAS showing both maternally transmitted type II diabetes mellitus (DM) and deafness. A 41-year-old woman was admitted because of severe headache and vomiting. She developed type II DM at age 26 and was followed by bilateral sensorineural type hearing loss at age 37. Family history revealed that her mother and two sisters suffered from similar disorders. MELAS with A3243G point mutation was confirmed in the patient and her daughter.
Subject(s)
Adult , Female , Humans , Deafness , Diabetes Mellitus , Headache , Hearing Loss , MELAS Syndrome , Mothers , Nuclear Family , Point Mutation , Siblings , VomitingABSTRACT
BACKGROUND AND PURPOSE: Negative findings on diffusion-weighted imaging (DWI) does not exclude the possibility of brainstem infarction, particularly in the acute stage of medullary lesion. Our aim was to investigate the false-negative rate of DWI in patients with acute lateral medullary infarction. METHODS: We applied DWI to 26 patients with a clinical diagnosis of lateral medullary infarction within 72 h of the onset. We assessed relationships between initial DWI findings and time-to-MRI (the time between onset of symptoms and initial DWI), number of clinical symptoms and signs, and final lesion volume. RESULTS: There were 8 cases (31%) of false negatives in the initial DWI results. The occurrence of false-negative DWI findings decreased significantly as the time-to-MRI increased (P=0.014). However, the false-negative rate was not significantly correlated with the number of clinical symptoms and signs or the final lesion volume. CONCLUSIONS: The diagnosis of lateral medullary infarction should not be ruled out on the basis of early negative DWI. To confirm the lesion, follow-up DWI or further MRI should be performed in cases with early negative DWI results
Subject(s)
Humans , Brain Stem Infarctions , Diagnosis , Diffusion , Follow-Up Studies , Infarction , Magnetic Resonance ImagingABSTRACT
Hypereosinophilic syndrome is a rare disease, characterized by hypereosinophilia of the blood and by the presence of varying internal symptoms and neurological signs. We report a 70-year-old woman who was admitted with rapidly progressive cognitive dysfunction, which had begun 10 months earlier. On admission, she had hypereosinophilia with elevated IgE. Following steroid therapy, there was rapid improvement of dementia. Considering the possibility of irreversibility at delayed intervention, the early diagnosis and treatment of dementia due to hypereosinophilic syndrome cannot be overemphasized.
Subject(s)
Aged , Female , Humans , Dementia , Early Diagnosis , Hypereosinophilic Syndrome , Immunoglobulin E , Rare DiseasesABSTRACT
Brain infarction restricted to the unilateral hypothalamus is known to be very rare because of the abundant blood supply from the circle of Willis. We report a case of right hypothalamic infarction. A 63-year-old woman developed hyperphagia, hypersomnolence and hemihyperhidrosis limited to the left half of the face. Brain MRI revealed a high signal intensity at the right anteromedial hypothalamus.
Subject(s)
Female , Humans , Middle Aged , Brain , Brain Infarction , Circle of Willis , Disorders of Excessive Somnolence , Hyperphagia , Hypothalamus , Infarction , Magnetic Resonance ImagingABSTRACT
BACKGROUND: Nerve conduction study (NCS) is an objective and quantitative test in evaluating peripheral nerve disorders. Several physiological and technical factors are well known to influence the results of NCS, which can be controlled and regulated by standardization of environment and through the process to make range of normality. However, most electromyographers do not pay much attentions about inter- and intra-examiner variabilities, and there are only a few and incomplete reports on these topics. We examined the intra-examiner variability of NCS on the basis of periods of practice. METHODS: Twenty-eight electromyographers were divided into two groups: residents and neurologist-technicians. All, having variable NCS training periods, have performed NCS on one of other 27 electromyographers ten times within two weeks where each study was made once a day. RESULTS: Coefficient of variation and external quotient increased according to the following order - nerve conduction velocities (NCV), terminal latencies (TL), and amplitudes of compound action potentials (AMP). There were significant differences between the two groups in NCV and TL, but no statistical difference in AMP. CONCLUSIONS: Our results suggest that errors from intra-examiner variability should be considered when interpreting NCS and that those electromyographers who have enough training should perform NCS.
Subject(s)
Humans , Action Potentials , Attention , Neural Conduction , Peripheral NervesABSTRACT
Phospholipase D (PLD) catalyzes the hydrolysis of phosphatidylcholine to phosphatidic acid and choline. A variety of signal molecules such as hormones, neurotransmitters, extracellular matrix molecules, and growth factors are known to induce the activation of PLD in a wide range of cell types. Hence PLD is implicated in a broad spectrum of physio-logical processes and diseases, including mitogenesis, cell differentiation, metabolic regulation, secretion, neural and cardiac stimulation, inflammation, oncogenesis, and diabetes. The signal-dependent activation of PLD has been observed in a variety of brain and neural-derived cells. In this paper, human chromosomal locations and developmental neural expression patterns in rat of PLD1 and PLD2 were investigated with fluorescent in situ hybridization (FISH) and in situ hybridization histochemistry, respectively. The PLD1 was assigned to human chromosome 3q26 and expressed most strikingly in selected ventricular neural cells lining spinal cord and brain during neuronal differentiation and migration period. The PLD2 was assigned to human chromosome 17p13.1 and expressed in differentiating ventricular neural cells and multiple regions of the postnatal rat brain.
Subject(s)
Animals , Humans , Humans , Rats , Brain , Carcinogenesis , Cell Differentiation , Choline , Chromosomes, Human , Extracellular Matrix , Hydrolysis , In Situ Hybridization , In Situ Hybridization, Fluorescence , Inflammation , Intercellular Signaling Peptides and Proteins , Neurons , Neurotransmitter Agents , Phosphatidic Acids , Phosphatidylcholines , Phospholipase D , Phospholipases , Spinal CordABSTRACT
The Guglielmi Detachable Coil(GDC), a soft platinum alloy micro-coil, has been used to treat certain intracranial aneurysms for recent several years. This detachable platinum coil was soldered to a stainless steel delivery guidewire. Intra-aneurysmal thrombosis was then initiated by applying a low positive direct electric current to the guidewire. Thrombosis occurred because of the attraction of negatively charged platinum coil positioned within the aneurysm. The passage of electric current detached the platinum coil tithin the clotted aneurysm from the stainless steel guide wire by electrolysis in 4 to 12 minutes. A 24-year-old unmarried woman visited our hospital complaining of severe headache on the right occipital area. The MRI and angiography demonstrated an unruptured right posterior communicationg artery aneurysm, emasured 10 x 15 mm in diameter with a medium sized neck. We tried GDC therapy for the aneurysm not to subject the patient to craniectomy, and the angiograhy after two times of GDC trials revealed a successful occlusion of the aneurysm . Adicussion about the problems during and after the procedure was presented, along with a brief review of the literature including the theoretical basis, clinical results and comparison with surgical treatment.
Subject(s)
Female , Humans , Young Adult , Alloys , Aneurysm , Angiography , Arteries , Electrolysis , Headache , Intracranial Aneurysm , Magnetic Resonance Imaging , Neck , Platinum , Single Person , Stainless Steel , ThrombosisABSTRACT
To find out whether the commonly observed ictal behaviors in temporal lobe epilepsy (TLE) contribute to the lateralization of epileptogenic focus, 116 seizures in 19 unilateral TLE patients were reviewed and analyzed carefully by two epileptologists. Unilateral motor manifestations such as dystonia, tonic posturing, clonic jerking, head version, head turning, eye deviation, unilateral eye blinking and unilateral automatism were observed in ipsilateral or contralateral side of EEG seizure focus. Ictal language was classified as normal speech, speech arrest, dysphasia and nonidentifiable speech. They were evaluated for their significance in determining dominant (DHS) or nondominant hemisphere onset (NHS) based on the results of Wada test. Other categories of automatisms were analyzed to investigate whether they indicate right or left TLE. Dystonia(in 34 seizures), tonic posture(17), clonic jerking(24) and head version (14) were observed only in contralateral side of EEG seizure focus in 89 seizures. The direction of head turning was ipsilateral to seizure focus in 15 seizures (46.9%) and contralateral to seizure focus in 17 seizures (53.1%), Eye deviation direction inclined to suggest contralateral hemisphere seizure origin without statistical significance [contralateral in 13 seizures (65%) and ipsilateral in 7 seizures (35%)]. Unilateral eye blinking and unilateral automatism were seen in 35 seizures and occurred exclusively in ipsilateral side to ictal EEG onset (12,85.7% ;23,88.5%) compared with contralateral side(2,14.3% ;3,11.5%). Ictal normal speech was observed in 9 seizures of 2 patients who had NHS, wheares dysphasia occurred in 4 DHS of 3 patients. Deglutition, sexual automatism and sniffing were observed in both right and left TLE, and not valuable in seizure lateralization. These results show unilateral dystonia, tonic posture, clonic jerking and head version suggest strongly contralateral hemisphere seizure origin. Unilateral eye blinking and unilateral automatism indicate ipsilateral hemisphere seizure focus. Among ictal speech manifestations, ictal normal speech and dysphasia suggested NHS and DHS respectively.