Delayed Up-regulation of Vascular Endothelial Growth Factor and flk-1 after Global Cerebral Ischemia in Mongolian Gerbil: Possible roles in neuroangiogenesis?

BACKGROUND: Vascular endothelial growth factor (VEGF) is an endothelial cell-specific mitogen and a potent mediator of vascular permeability. Flk-1, one of the receptors for VEGF, is important in vascular development. Increased expression of VEGF is related with reactive astrogliosis, which stimulates the proliferation of neural progenitor cells. VEGF expression increases in the acute phase of cerebral ischemia, however the expression of VEGF together with flk-1 in subacute stage is still unknown. This study is done to demonstrate the spatial/cellular patterns of expression for VEGF/flk-1 up to subacute stages and to find out the role of VEGF in ischemia. METHODS: Transient global ischemia was induced by a 10 min-occlusion/reperfusion of the bilateral carotid arteries in the Mongolian gerbil. Immunohistochemistry and western blot were performed to ensure the expression of VEGF and flk-1 on the day 1, 3, 7, 14, and 28. RESULTS: Both VEGF and flk-1 initially increased at day1, and decreased at day 3. Thereafter, VEGF gradually increased again to the initial level at day 7 and to the peak level after day 14. Flk-1 showed a peak expression at day 14, and then decreased at day 28. Immunohistochemical staining for VEGF showed immunoreactivity mainly on the cytoplasm of neurons and endothelium in cortex and hippocampus at day 1, and neuron, endothelium, and glial cell from day 14 to 28. The distribution and chronological patterns of flk-1 expression were similar to that of VEGF expression. CONCLUSIONS: We suggest that global cerebral ischemia can induce a delayed up-regulation of VEGF and flk-1, which may be associated with neuroangiogenesis and repair process.

The Validity of the Korean Version of Global Deterioration Scale

BACKGROUND: Clinicians broadly accept the Global Deterioration Scale (GDS) as a staging measure for dementia. The aim of this study is to test the inter-rater reliability and concurrent validity of the Korean version of GDS. METHODS: Participants included 34 subjects without dementia and 41 patients with Alzheimer's disease, in addition to 37 patients with vascular dementia. A rater, using a semi-structured clinical interview, interviewed the participants and their informed collateral sources. To obtain the concurrent validity, all participants received the Korean Mini-Mental State Examination (K-MMSE), the Korean version of Syndrome Kurz Test (K-SKT) and a 15-items abbreviated Korean-Boston Naming Test (K-BNT) on the same day. We also tested the inter-rater reliability among the four raters using a videotape design. RESULTS: The agreements of the overall GDS ratings by the four raters were high (kappa, 0.93-1.0). GDS correlated significantly with K-MMSE, K-SKT, and the abbreviated K-BNT and Clinical Dementia Rating scale. CONCLUSION: The Korean version of GDS may be a reliable and valid tool to be used as a staging measure for Korean patients with Alzheimer's disease as well as vascular dementia.

A case of Pick's disease presenting with progressive nonfluent speech

BACKGROUND AND SIGNIFICANCE: Frontotemporal dementia is a behavioral disorder arising from nonAlzheimer's disease atrophy of frontal and anterior temporal lobe. Clinical manifestations include frontal lobe dysfunction. Kluver-Bucy syndrome or progressive language impairments. Two types of histological change underline, the atrophy. The commoner pathology is nerve cell loss and spongiform change with astrocytic gliosis. The second one is typical Pick-type histology characterized by intraneuronal inclusion body and astrocytic gliosis. We report a case with biopsy proved Pick's disease presenting with progressive nonfluent speech. CASE: A 41-years, old right-handed woman developed progressive language impairment over a period of 6 months. Brain MRI revealed asymmetric frontotemporal cortical atrophy more severe on the left side and 18F-FDG-brain, PET showed hypometabolism in the same area. Neuropsychological test including Korean version-Western Aphasia Battery revealed non-fluent speech as well as frontal lobe, dysfunction. A biopsy from left frontal lobe, demonstrate neuronal loss and diffuse astrogliosis. In the cytoplasm of remaining neurons are eosinophilic inclusion bodies which are neurofilament-positive with immunostaining. Senile plaque, neurofibrillary tangle and cortical Lewy body were absent. COMMENT: We report a case presenting with progressive nonfluent speech whose imaging and pathological findings are compatible with Pick's disease, which may be the first biopsy proven case in Korea.

A case of ataxia telangiectasia

Ataxia telangiectasia is an autosomal recessive disorder characterized by progressive cerebellar degeneration, cancer predisposition, immune defects, radiosensitivity and genetic instability. Ataxia telangiectasia is rare and has not been reported in Korea. We present a 9-year-old girl with early onset progressive cerebellar ataxia. Neurologic examination showed gaze apraxia, bulbar dysfunction, retained tendon reflexes and conjunctival telangiectasia. Alpha-feto protein was elevated and serum IgA was decreased. Brain MRI showed prominent cerebellar atrophy. Literatures were reviewed.