Two Cases of Wernicke Encephalopathy with Focal Cerebral Cortical Involvement and Convulsive Seizure

We report two cases of Wernicke encephalopathy presenting with convulsive seizures. The first patient had been supplied with total parenteral nutrition due to acute pancreatitis and presented with partial seizure evolving to generalized seizure. The second patient had been malnourished due to alcoholism and recent dyspepsia after a gastrectomy, who presented with generalized seizure. Brain MRI revealed high-signal lesions in the focal cerebral cortex on T2-weighted, FLAIR, and diffusion-weighted images. After a thiamine injection, the patients recovered and abnormalities on the MRIs disappeared.

Meningioma Presenting as Frequent Transient Ischemic Attacks

A brain tumor is rarely considered as a differential diagnosis of a transient ischemic attack. However, a 76-year old man presented with frequent attacks of transient dysarthria, right hemiparesis and right hemiparesthesia. A brain MRI showed a carpet-like mass with homogeneous enhancement along the high convexity of the left dura, which was compatible with en plaque meningioma. In this case, the symptoms were thought to be the result of cerebral ischemia, attributed to the hemodynamical change in a tumorous condition.

Postoperative Ureteral Injury Treated by Percutaneous Nephrostomy and Ureteral Stent

PURPOSE: To evaluate percutaneous nephrostomy and ureteral stent placement in patients with postoperative ureteral injury. MATERIALS AND METHODS: Percutaneous nephrostomy and antegrade ureteral stent placement we reattempted in 12 patients with postoperative ureteral injuries. The previous operations which caused ureteral injuries included ureteroscopic extraction of ureteral stones(7), total abdominal hysterectomy due to uterinemyoma(2), ureteroscopic biopsy in a patient with ureteral tuberculosis(1), open ureteroplasty due to retroperitoneal fibrosis(1), and ureterocystostomy during renal transplantation(1). After percutaneousnephrostomy, a 7.0 F ureteral stent was inserted in each patient. The stent was removed under cystoscopic guidancefour to six weeks after this procedure. Urinalysis was performed to evaluate the presence of urinary tractinfection after ureteral stent placement. Ultrasonography and/or intravenous urography were performed three weeksafter stent placement, and every six months after the stent removal. RESULTS: Percutaneous nephrostomy andplacement of an antegrade ureteral stent were successfully performed in all 12 patients. In three patients, the diagnosis of ureteral injuries was made immediately and in nine was delayed for between two and nineteen days. Theureteral stents remained in position for 25-95 days (average, 51) ; no evidence of urine leakage or ureteralstricture was seen on the follow-up examinations carried out from six months to several years after removal of thestent and no case required reintervention. CONCLUSION: Percutaneous nephrostomy and antegrade ureteral stentingare easy to perform, provide for the drainage of urine, cause no significant complication and show a successful therapeutic effect, and are this effective non-operative interventional techniques for patients with postoperative ureteral injury.