Atypical presentation of complex regional pain syndrome: neuropathic itching - A case report -

Background@#In some patients with neuropathic pain (NP), such as complex regional pain syndrome (CRPS), itching rather than pain is the main symptom making diagnosis and treatment difficult.Case: We report a case of a 23-year-old man with a history of hypoxic brain damage who presented with pruritus of the left foot and ankle. His left foot was fractured, and he underwent surgery 6 months previously. After the operation and cast application, he developed uncontrolled pruritus, swelling, sweating, and flushing of the left foot skin with limping. On examination, he showed well-known features of CRPS without pain. He was diagnosed with an atypical CRPS with neuropathic itching (NI). With treatment modalities used for NP and CRPS, his pruritus subsided gradually, and the his ankle mobility improved. @*Conclusions@#Unexplained itching can be the main symptom in some CRPS patients. Treatment according to NP can improve symptoms of NI in CRPS patients.

Imaging Characteristics of Brain SPECT, PET, and MRI in Neurosyphilis / 대한핵의학회잡지

The incidence of neurosyphilis has declined since effective penicillin therapy against Treponema pallidum was introduced. However, the diagnosis of neurosyphilis early in the disease course is very important in order to select appropriate antibiotic therapy. We report brain MRI, SPECT with Tc-99m ECD, and PET with F-18 FDG findings before antibiotic therapy in a neurosyphilis patient with neurological symptoms. The cerebral cortices showed hypoperfusion with a patchy distribution on SPECT and foci with high signal intensity on MRI, suggesting ischemia. Brain PET showed areas with hypometabolism in the temporoparietal lobes bilaterally.

Can Silent Ischemic Cerebral Lesions Affect Cognition of Parkinson's Disease Dementia?

BACKGROUND: Several studies have shown that the presence of cerebrovascular lesions may play an important role for determining the severity of the clinical symptoms of dementia. But no study to date has explored the clinical effect of cerebrovascular disease in Parkinson's disease with dementia (PDD), although cerebrovascular disease is common causes of dementia in elderly population. Therefore we conducted this study to evaluate the relationship between silent cerebrovascular lesions and cognitive decline in PDD. METHODS: Only 27 patients with PDD were chosen; 17 patients had PDD with silent cerebral ischemic lesions (PDDI) and 10 patients had PDD without silent cerebral ischemic lesions (pure PDD). These subjects received the global cognitive function testing and were all evaluated with detailed neuropsychological tests including attention, memory, language, and also the visuospatial and frontal function. RESULTS: There were no significant differences between pure PDD and PDDI group on general cognitive functions tests. Regard to mean time duration of suffering from Parkinson motor symptoms and motor function scale, pure PDD group showed more long duration than PDDI group but there was no significant difference between two groups. Furthermore, there were not any significant differences between the two groups on detailed neuropsychological tests. CONCLUSIONS: We concluded that silent cerebrovascular lesions do not contribute to neuropsychological severity of PDD, although vascular disease is a common cause of cognitive impairment in the elderly. Thus the results of the present study suggest that factors other than cerebrovascular disease contribute to severity of PDD.

Papillary Meningioma Presenting as Rapidly Progressive Dementia and Parkinsonism

There are a variety of different causes of parkinsonism including PD, secondary parkinsonism, and the parkinsonism plus syndromes. Secondary parkinsonism is caused by structural, toxic, metabolic, or infectious mechanisms. Among structural causes, intracranial neoplasms are a rare cause of secondary parkinsonism. Moreover, there are almost never case reports with intracranial space-occupying lesions resulting in parkinsonism associated with rapid cognitive impairment. Therefore, we report herein a 37-year-old woman diagnosed with papillary meningioma who presented with parkinsonism associated with rapidly progressive cognitive impairment mimicking diffuse Lewy body disease.

Erratum: Leukoencephalopathy and Akinetic Mutism in a Married Couple: A Probable Association with Oriental Medicine

No abstract available.

A Clinical Significance of High-Sensitivity C-reactive Protein Level in Alzheimer's Disease and Vascular Dementia

BACKGROUND: There is increasing evidence about inflammatory processes in the development of dementia. Therefore, inflammation has been believed to play a pivot role in cognitive decline, Alzheimer's disease (AD), and vascular dementia. High-sensitivity C-reactive protein (hs-CRP) is a sensitive systemic marker of inflammation, and increased levels of hs-CRP are associated with inflammatory reactions. It is important to identify modifiable risk factors, which could be used in preventing or delaying the onset of dementia. Therefore, we studied to clarify a clinical role of hs-CRP in AD and VaD. METHODS: This study population consisted of a sample of 102 patients with dementia (54 patients of AD and 48 patients of VaD) and 91 controls. We have investigated hs-CRP levels and cognitive function of each group. Cognitive function was evaluated with Mini-Mental State Examination (MMSE), Global Deterioration Scale (GDS), Clinical Dementia Rating (CDR) with Sum of Box and Activities of Daily Living (ADL). RESULTS: All subjects with dementia showed higher hs-CRP levels than subjects without dementia. But, there was no significant difference of hs-CRP levels between patients with AD and those with VaD. The odds ratio of patients with AD and VaD by hs-CRP is 2.250 (95% Cl 1.670-3.032) for Alzheimer's disease and 4.0 (95% Cl 2.451-6.529) for vascular dementia. CONCLUSIONS: The result of our study suggests the presence of inflammatory activity is related with dementia, not only AD known to degenerative disease but also VaD associated with cerebrovascular disease. However, we could suggest that dementia with cerebrovascular lesions is more related with inflammatory activity than AD.

Is There the Preventive Effect of COMT-inhibitor on Parkinson's Disease Associated with Dementia?

BACKGROUND: Elevated homocysteine (hcy) levels are associated with dementia, which is a frequent non-motor symptom of Parkinson's disease (PD). High levels of hcy in PD patients treated with levodopa are thought to result from increased synthesis during the metabolism of levodopa by COMT, and that use of a COMT-inhibitor may reduce hcy levels. In this study, we sought to clarify the effects of COMT-inhibitors on dementia in PD patients. METHODS: Thirty-eight PD patients without dementia (PDwoD), 35 PD patients with dementia (PDD), and 48 controls were enrolled in this study. All subjects underwent neuropsychological testing and a neurological examination. The hcy levels were measured in all subjects, and the relationship between hcy levels and dementia was evaluated in two PD groups (those that underwent treatment with levodopa-alone versus treatment with levodopa plus a COMT-inhibitor). RESULTS: Patients in the PDD group showed higher hcy levels than patients in the PDwoD group, though there was no significant difference in the hcy level between PDwoD patients and healthy controls. Regarding the effects of a COMT-inhibitor, there was no correlation between hcy levels in the 2 PD subgroups, indicating that there were no significant effects of the COMT-inhibitor on PDD. In addition, the odds ratio for PDD with the use of a COMT-inhibitor was 0.864 (95% CI=0.342-2.180). CONCLUSIONS: These results are in agreement with previous studies in that levodopa treatment in PD patients leads to elevated hcy concentrations. COMT-inhibitors, on the other hand, had no preventive effect on cognitive impairment in PD patients.

Differences of Regional Cerebral Blood Flow between Early Alzheimer's Disease and Parkinson's Disease Associated with Dementia on 99mTc-Hexamethyl Propylene Amine Oxime Perfusion Single Photon Emission Computed Tomography

BACKGROUND: Alzheimer's disease (AD) and Parkinson's disease associated with dementia (PDD) are considered to be frequent types of cortical and subcortical dementia. Definitive diagnosis of neurodegenerative diseases is impossible without biopsy. Single photon emission computed tomography (SPECT) of the brain has long been used for years with cognitive disorders. Nevertheless, differential brain perfusion of patients with PDD and AD who exhibit mild dementia has not been reported. Therefore, we investigated the differences in the cerebral perfusional pattern using perfusion SPECT between mild AD and mild PDD to help clarify the diagnosis in the early stage of these dementias, since accurate diagnosis is crucial in decision regarding treatment, appropriate advice, management and prognosis. METHODS: Thirty-one patients with mild PDD and 32 patients with mild probable AD were enrolled in this study. All subjects underwent 99mTc-hexamethyl propylene amine oxime perfusion SPECT and general neuropsychological tests, and these data including perfusion images were analyzed. RESULTS: Perfusion SPECT showed hypoperfusion in frontal, parietal and temporal regions in both PDD and AD patients with mild dementia. Hypoperfusion in the occipital and cerebellar regions was significantly apparent in only PDD patients. CONCLUSION: Comparison of mild PDD with mild AD showed a significantly decreased perfusion in the occipital and cerebellar region in patients with mild PDD. Cerebral perfusion in the occipital region and the cerebellum could be a crucial differential diagnostic method of these diseases in the early phase. Further studies are needed for a definitive conclusion.

Leukoencephalopathy and Akinetic Mutism in a Married Couple: A Probable Association with Oriental Medicine

BACKGROUND: Oriental medicines have been associated with severe psychiatric, neurological, and other adverse medical events. These medicines occasionally cause a typical reversible toxic encephalopathy, but most such cases are not recognized because these adverse events are complex and are associated with other systemic signs and symptoms. CASE REPORT: We describe a married couple with rapid progressive cognitive impairment and akinetic mutism after taking the same oriental medicines on the same day. Brain magnetic resonance images of the couple showed typical leukoencephalopathy in the periventricular white matter and basal ganglia regions, bilaterally. CONCLUSIONS: The development of neurobehavioral symptoms and toxic leukoencephalopathy in both patients following the ingestion of oriental medicines is suggestive of a cause-and-effect association, although such a relationship needs to be verified.

Posterior Cerebral Artery Infarct Complicated by Bacterial Meningitis

No abstract available.

Cardiac 123I-Metaiodobenzylguanidine Scintigraphy in Patients with Parkinson's Disease and Parkinson's Disease with Dementia

BACKGROUND: Because patients with idiopathic Parkinson's disease (PD) may exhibit patterns of cognitive impairment, it is difficult to distinguish from patients with Parkinson's disease dementia (PDD). Recently, cardiac 123I-metaiodobenzylguanidine (MIBG) scinti-graphy has been used to help distinguish PD from atypical Parkinsonism. This study investigated the relations between cardiac 123I-MIBG scintigraphy and these diseases. METHODS: Cardiac 123I-MIBG scintigraphy was conducted on 18 patients with PD, 18 patients with PDD and 13 normal controls matched for age, disease duration and severity of symptoms. The heart to mediastinum (H/M) ratio was calculated. RESULTS: The mean values of H/M ratio were significantly lower for PDD and PD than for normal controls but there was no difference between the disease groups. CONCLUSION: Unfortunately, cardiac 123I-MIBG scintigraphy did not distinguish PDD from PD in our study. We suggest further research with larger study populations be done to clarify the use of cardiac 123I-MIBG scintigraphy in differentiating other Lewy body diseases from dementia with PD features.

A Patient of Thyroid Storm with Neurological Manifestations and MRI Abnormalities

Thyrotoxicosis autoimmune encephalopathy (TAE) and Hashimoto's encephalopathy (HE) are steroid responsive disorders of persistent or relapsing neurological or neuropsychological deficits associated with elevated serum concentrations of an antithyroid antibody. Most patients with TAE or HE are reported to have normal brain imaging findings at the time of presentation. We report here a rare case of TAE in whom brain MRI abnormalities were associated with clinical manifestations of thyroid storm.

Alice in Wonderland Syndrome in a Case with Infarct in the Right Medial Temporal Lobe

We describe a patient who suffered an infarct of the right medial temporal lobe, and developed visual illusions for body images, referred to as Alice in wonderland syndrome (AIWS). Although, these phenomena are usually seen in settings of migraine with aura or epilepsy, an association with strokes has not previously been described. The occurrence of AIWS in our patient, following an infarct of the right medial temporal lobe, provides support for this symptom having a biological and anatomical substrate.

A clinical analysis for surgical treatment of osmidrosis bysubcutaneous shaving method / 대한피부과학회지

Though many effort,s have been made to develop a safe and effective treatment to control osmidrosis, no such goal has been achieved yet. A subcutaneous shaving method, developed by Inaba, appeared to be a favorable choice because of minimal postoperative scar formation. The authors, with this method operated on 112 cases of osmidrosis and compared the results with those of conventianal surgical therapy performed earlier in our department. The results were as follows : 1. The. average age at the time of the operation was 22.0 years old, and the sex ratio between male and female was 37 to 75. 2. The age onset ranged from 11 to 36 years with average of 15.5 years. 3. Family history for osmidrosis was found in 84.8%. 4. General anesthesia were used in 13 cases, while 99 cases were operated under local anesthesia. 5. The mean duration for operation were 75 minutes. 6. Flematoma were observed in 4.5%, wound disruption in 1.3%, and skin necrosis in 3.1%. 7. The results of analysis in 72 follow up cases for more than 6 months showed: 1). Rate for successful reduction of the malodor was 91.7%. 2) The rate of suppression of sweating was 88.9%. 3) The rate of skin tensian with motion was 2.8%. 4 ) The, pstoperative scars were mild or invisible in 95.1%

A case of lichenoid contact dermatitis caused by a color film developer / 대한피부과학회지

Color developers(CD) have been noted to produce lichen planus like eruption as well as eczematous contact dermatitis. The chemicals involved are derivatives of paraphenylenediamine or aniline, i. e., Kodak CD 2, Kodak CD 3, Agfa TSS. We report a 28-year-old male who showed a feature of lichenoid contact dermatitis after exposure to color developer. Patch test revealed positive reactions to CD2, CD3 and CD4. Skin biopsy from a patch site showed lichen planus-like tissue reaction.

A Case of Midline Malignant Reticulosis Associated with Distant Skin Metastases / 대한피부과학회지

Midline malignant reticulosis is a relentlessly progressive, localized, destructive inflammatory process of upper respiratory tract including the nose, nasopharynx, palate, paranasal sinuses, and midface. Histologically, it is characterized by a dense aceumulation of pleomorphic mononuclear cells with an admixture of inflammatory cells. We report a case of midline malignant reticulosis developed in a 64-year-old man, who showed a serosanguineous nasal discharge, perforation of nasal septum, persistent ulceration of hard palate, and disseminated lesions on the abdominal skin, which was confirmed by histopathalogical examination. In addition we studied infiltrated cells with atypical nuclei by immunohistochemical staining with a pannel of monoclonal antibodies. The results revealed that the atypical cells expressed the T-cell marker, but not the macrophage and B-cell marker.

A Case of Eosinophilic Pustular Folliculitis Associated with Plantar Lesion / 대한피부과학회지

We report a case of eosinophilic pustular folliculitis (EPF) with associated plantar lesions in a 45-year-old man. Exarnination of the skin disclosed an erythematous patch, approximstely 3 x 5cm, on the left cheek, which contained discrete and confluent pspulopustules and scaly circinated vesicular patch on the right foot. Histologic examination of a biopsy specirnen from the left cheek revealed the hair follicles and the sebaceous glands are infiltrated mainly by eosinophils and by some mononuclear and neutrophils. Histologic examination of a biopsy specimen from the right foot revealed a vesicle extending from the subcorneal portion to the lower epidermis, which was filled with neutrophils and a small number of eosinophils.