ABSTRACT
Intravascular large B-cell lymphoma (IVLBCL) is a rare form of non-Hodgkin’s lymphoma that selectively involves the lumina of vessels, and may present as ischemic stroke. A 62-year-old man presented with progressive aphasia, dementia, seizure and stroke-like symptom. Brain magnetic resonance imaging revealed dynamic progressive fluid attenuated inversion recovery lesions and multiple punctate microbleeds in the bilateral subcortical region. A kidney biopsy revealed IVLBCL. We report a patient with IVLBCL presenting as rapidly progressive encephalopathy.
ABSTRACT
BACKGROUND: The objective of the study was to evaluate the predictive value of plasma D-dimer at admission after acute ischemic stroke, and to assess its effect on short-term functional outcome. METHODS: Fasting plasma D-dimer was measured in 290 consecutive patients (61.7% men, mean age 67.0±12.3 years) within 3 days after the onset of acute ischemic stroke. The outcomes were measured at 3-months after stroke onset, by the modified Rankin Scale (mRS). RESULTS: Atrial fibrillation, hypertension, diabetes and involvement of the insular cortex, the levels of serum high sensitive C-reactive protein and D-dimer, as well as incidence of women and age, were all significantly higher in the poor outcome group (P<0.05). After the adjustment of National Institutes of Health Stroke Scale (NIHSS) scores on admission, the plasma D-dimer levels positively correlated with mRS (Spearman partial rho=0.247, P<0.001). The cut-off value of D-dimer level for prediction of poor outcomes was 0.35 mg/L (sensitivity 0.70, specificity 0.63, area under the curve 0.71). Furthermore, two multivariated logistic regression analysis models were performed. One model excluded the NIHSS score as an independent variable, and demonstrated that D-dimer (odds ratio, 1.24 for every 1.0 mg/L, P<0.05) was independently associated with poor functional outcome. Conversely, the other model which included the NIHSS score, did not show any such association. CONCLUSIONS: Plasma D-dimer level is a useful marker for short-term outcomes in acute ischemic stroke, and may have a role in risk stratification for predicting a poor outcome.
Subject(s)
Female , Humans , Male , Atrial Fibrillation , C-Reactive Protein , Cerebral Cortex , Cerebral Infarction , Fasting , Hypertension , Incidence , Logistic Models , Plasma , Prognosis , Sensitivity and Specificity , StrokeABSTRACT
Vertical gaze palsy is usually associated with lesions of the rostral midbrain and thalamo-mesencephalic junction. The rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF), the interstitial nucleus of Cajal, and the posterior commissure located in the midbrain are the critical area in supranuclear control of vertical eye movements. We describe a case of vertical one-and-a-half syndrome accompanying contralateral abduction and incomplete depression palsy due to thalamo-mesencephalic infarction. These vertical eye movement abnormalities are presumed to be caused by damage to the ipsilateral riMLF, interstitial nucleus of Cajal, and oculomotor fascicles.
Subject(s)
Cerebral Infarction , Depression , Eye Movements , Infarction , Mesencephalon , Paralysis , Tegmentum MesencephaliABSTRACT
We describe two patients with acute myeloradiculitis associated with herpes simplex virus type 2 (HSV-2). They were previously healthy and immunocompetent and had no history of herpes infection or rash. Myeloradiculitis manifested as an acute flaccid paralysis that primarily involved the conus medullaris and cauda equina. laccid paralysis can be caused by HSV-2 myeloradiculitis, and so early antiviral treatment should be considered.
Subject(s)
Humans , Cauda Equina , Exanthema , Herpes Simplex , Herpesvirus 2, Human , Myelitis , Paralysis , Radiculopathy , Simplexvirus , Spinal CordABSTRACT
Hydrogen sulfide is a colorless gas and frequently lethal occupational hazard that causes tissue hypoxia with prominent neurological signs. Depending on the amount of exposure, many neurotoxic effects such as headache, disequilibrium, and loss of consciousness have been reported. However, a few address the brain MRI findings in hydrogen sulfide poisoning. We report serial brain MRI findings in a patient with hydrogen sulfide intoxication.
Subject(s)
Humans , Hypoxia , Brain , Headache , Hydrogen Sulfide , Hydrogen , Hypoxia, Brain , Magnetic Resonance Imaging , Poisoning , UnconsciousnessABSTRACT
Parvovirus B19 (PVB19) infection is a rare cause of meningoencephalitis. A 53-year-old previously healthy woman presented with fever, headache, and multiple erythema on the both legs. Cerebrospinal fluid study revealed pleocytosis and elevated opening pressure and protein level. Brain MRI showed multiple, asymmetric, hyperintensity in the brain stem, basal ganglia, white matter, and gray matter. Anti-B19 IgM antibody and PCR for PVB19 were positive in serum. Clinician should consider PVB19 infection in any case of acute febrile illness with erythema and meningoencephalitis.
Subject(s)
Female , Humans , Middle Aged , Basal Ganglia , Brain , Brain Stem , Cerebrospinal Fluid , Erythema , Fever , Headache , Immunoglobulin M , Leg , Leukocytosis , Magnetic Resonance Imaging , Meningoencephalitis , Parvovirus , Polymerase Chain ReactionABSTRACT
No abstract available.
Subject(s)
Humans , Infarction , Ischemic Attack, Transient , Lateral Medullary Syndrome , Trigeminal NeuralgiaABSTRACT
No abstract available.
Subject(s)
Arteriovenous Fistula , Cerebral Infarction , Intracranial Embolism , Ultrasonography, Doppler, TranscranialABSTRACT
Cough-induced syncope is belongs to the heterogeneous group of situational syncope. It is characterized by the loss of consciousness occurring after excessive coughing. A 63-year-old man complained of cough syncope for 15 days. During vigorous coughing, he lost consciousness for a few seconds. He had past medical history of bronchial asthma and diabetes mellitus. Various tests for syncope including electroencephalogram, electrocardiogram, 24-hours Holter monitoring, echocardiogram, carotid sinus massage, tilt table test, carotid duplex, and brain MRI were normal. He was treated successfully with anti-tussives and bronchodilators. We report a case of cough-induced syncope in a patient with bronchial asthma.
Subject(s)
Humans , Asthma , Brain , Bronchodilator Agents , Carotid Sinus , Consciousness , Cough , Diabetes Mellitus , Electrocardiography , Electrocardiography, Ambulatory , Electroencephalography , Massage , Syncope , Tilt-Table Test , UnconsciousnessABSTRACT
Sturge-Weber syndrome (SWS) is a rare sporadic neurocutaneous syndrome, characterized by port-wine nevus of face, ocular vascular abnormalities and leptomeningeal angioma. A 63-year-old man developed sudden onset of right hemiparesis and global aphasia. He had a past history of epilepsy. Physical examination showed no skin lesions. Brain CT demonstrated gyriform calcification in the left frontal area. Brain MRI revealed cortical atrophy in the left hemisphere with no diffusion restrictions. Fourteen hours later, he was completely recovered from aphasia and motor weakness. We report a case of atypical SWS with episode of acute hemiparesis which highlight the difficulty in distinguishing seizure from ischemic symptoms.
Subject(s)
Aphasia , Atrophy , Brain , Diffusion , Epilepsy , Hemangioma , Neurocutaneous Syndromes , Nevus , Paresis , Physical Examination , Seizures , Skin , Stroke , Sturge-Weber SyndromeABSTRACT
No abstract available.
Subject(s)
Cerebral Infarction , Fingers , Infarction , Muscle WeaknessABSTRACT
Cough-induced syncope is belongs to the heterogeneous group of situational syncope. It is characterized by the loss of consciousness occurring after excessive coughing. A 63-year-old man complained of cough syncope for 15 days. During vigorous coughing, he lost consciousness for a few seconds. He had past medical history of bronchial asthma and diabetes mellitus. Various tests for syncope including electroencephalogram, electrocardiogram, 24-hours Holter monitoring, echocardiogram, carotid sinus massage, tilt table test, carotid duplex, and brain MRI were normal. He was treated successfully with anti-tussives and bronchodilators. We report a case of cough-induced syncope in a patient with bronchial asthma.
Subject(s)
Humans , Asthma , Brain , Bronchodilator Agents , Carotid Sinus , Consciousness , Cough , Diabetes Mellitus , Electrocardiography , Electrocardiography, Ambulatory , Electroencephalography , Massage , Syncope , Tilt-Table Test , UnconsciousnessABSTRACT
Sturge-Weber syndrome (SWS) is a rare sporadic neurocutaneous syndrome, characterized by port-wine nevus of face, ocular vascular abnormalities and leptomeningeal angioma. A 63-year-old man developed sudden onset of right hemiparesis and global aphasia. He had a past history of epilepsy. Physical examination showed no skin lesions. Brain CT demonstrated gyriform calcification in the left frontal area. Brain MRI revealed cortical atrophy in the left hemisphere with no diffusion restrictions. Fourteen hours later, he was completely recovered from aphasia and motor weakness. We report a case of atypical SWS with episode of acute hemiparesis which highlight the difficulty in distinguishing seizure from ischemic symptoms.
Subject(s)
Aphasia , Atrophy , Brain , Diffusion , Epilepsy , Hemangioma , Neurocutaneous Syndromes , Nevus , Paresis , Physical Examination , Seizures , Skin , Stroke , Sturge-Weber SyndromeABSTRACT
Cerebral venous sinus thrombosis (CVST) may be complicated with various intracranial hemorrhage such as petechial hemorrhage, hemorrhagic infarction, parenchymal hemorrhage, subarachnoid hemorrhage (SAH), and subdural hematoma (SDH). However, combination of these types of intracranial hemorrhages supervening on CVST is seldom reported. A 55-year-old female with rectal cancer presented with severe headache, nausea, vomiting and diplopia. She was diagnosed as having CVST in the superior sagittal sinus with left frontal parenchymal hemorrhage and was treated with anticoagulants. The CVST were extended to inferior sagittal and straight sinuses. Moreover, SDH along the left cerebral convexity and SAH in the left sylvian fissure were simultaneously observed. Our present case shows that combination of various types of hemorrhages is rare but may occur in advanced CVST.
Subject(s)
Female , Humans , Anticoagulants , Diplopia , Headache , Hematoma , Hematoma, Subdural , Hemorrhage , Infarction , Intracranial Hemorrhages , Nausea , Rectal Neoplasms , Sinus Thrombosis, Intracranial , Subarachnoid Hemorrhage , Superior Sagittal Sinus , VomitingABSTRACT
Epileptic seizures have been shown to cause increased signal intensities on diffusion-weighted images (DWI). Extensive hemispheric involvement on MRI after status epilepticus was very rare. A 56-year-old man transferred to our hospital due to status epileticus. The status epilepticus lasted nearly 7 hours. Neurological examination showed confusional consciousness, left hemiplegia and hemineglect of left side. Brain DWI demonstrated extensive high signal intensities in the right posterior frontal, parietal, temporal and occipital lobes resembling acute cerebral infarction. EEG revealed periodic lateralized epileptiform discharges over the right hemisphere. Follow-up DWI showed more decreased signal intensity in right hemispheric lesions. This case demonstrates the importance of recognizing the characteristics that help differentiate status epilepticus from other disorders.
Subject(s)
Humans , Middle Aged , Brain , Cerebral Infarction , Consciousness , Diffusion Magnetic Resonance Imaging , Electroencephalography , Epilepsy , Follow-Up Studies , Hemiplegia , Neurologic Examination , Occipital Lobe , Status EpilepticusABSTRACT
Epileptic seizures have been shown to cause increased signal intensities on diffusion-weighted images (DWI). Extensive hemispheric involvement on MRI after status epilepticus was very rare. A 56-year-old man transferred to our hospital due to status epileticus. The status epilepticus lasted nearly 7 hours. Neurological examination showed confusional consciousness, left hemiplegia and hemineglect of left side. Brain DWI demonstrated extensive high signal intensities in the right posterior frontal, parietal, temporal and occipital lobes resembling acute cerebral infarction. EEG revealed periodic lateralized epileptiform discharges over the right hemisphere. Follow-up DWI showed more decreased signal intensity in right hemispheric lesions. This case demonstrates the importance of recognizing the characteristics that help differentiate status epilepticus from other disorders.