Arterial Spin Labeling Perfusion MRI of Crossed Cerebellar Diaschisis in a Patient with Simple Partial Status Epilepticus

Crossed cerebellar diaschisis (CCD) is known to be due to a contralateral supratentorial lesion decreasing blood flow and the metabolism in a cerebellar hemisphere. Arterial spin labeling (ASL) is an imaging technique that utilizes arterial blood water as a tracer for quantifying the regional cerebral blood flow in magnetic resonance imaging (MRI). This case was a patient with simple partial status epilepticus (SPSE) and CCD confirmed by ASL-perfusion MRI. Controlling the SPSE resulted in improvement of CCD being observed in the follow-up ASL-perfusion MRI.

Toxocara canis-Associated Myelitis with Eosinophilic Pneumonia

The existence of Toxocara canis-specific antibodies has recently been reported in patients with atopic myelitis. Here, we report the case of a 35-year-old male patient admitted with a chief complaint of right lower limb hypoesthesia lasting for a month. The patient was diagnosed with eosinophilic pneumonia 3 months ago, and a spine MRI revealed the presence of myelitis in the cervicothoracic cord. After confirming the presence of hyper-IgE-emia and Toxocara canis antibodies, the patient was treated with steroids and albendazole treatment, which improved his symptoms. To our knowledge, this is the first case of Toxocara canis-associated myelitis with eosinophilic pneumonia.

Effects of age, sex, and body mass index on sudomotor and cardiovagal functions in a healthy Korean population

Background: Hypertension results from an impaired baroreceptor reflex and enhanced sympathetic activity. The prevalence of hypertension differs among ethnicities and is more frequent in South Asians than in Caucasians, suggesting that baseline autonomic nervous system functions and their regulation may also differ among ethnic groups. In most studies, the reference values for clinical autonomic function tests are obtained from heterogeneous ethnic populations, or ethnic factors are not considered in the study design. Obtaining reference data in a homogenous ethnic group and comparing them within various ethnic groups could be helpful to detect ethnic differences in autonomic functions. The aim of this study was to identify normative reference values for standard autonomic reflex measurements in a homogeneous Korean population. Methods: A total of 181 healthy Korean volunteers (age, 20–74 years) underwent standard autonomic function tests: heart rate difference during deep breathing, Valsalva maneuver, and the quantitative sudomotor axon-reflex test. Mean and 5th and 95th percentile values were obtained for each age group. We also analyzed factors (age, sex, and body mass index) that can influence autonomic functions. Results: The heart rate difference during deep breathing and expiratory-inspiratory ratio were higher in males than in females and were inversely related to age. The Valsalva ratio was inversely related to age. Males had higher sweat volumes at all body areas evaluated than those of females, and only forearm sweat volume was significantly different between the age groups. Conclusions: Cardiovagal function was affected by age and sex in Koreans. Sudomotor function was affected by sex, and only forearm sweat volume was affected by age and sex. These results represent preliminary normative clinical autonomic data in a Korean population comprised of a single ethnicity

Age, hypertension, and genetic polymorphisms and their relative associations with white matter hyperintensities in Korean patients with Alzheimer’s disease

Objectives: White matter hyperintensities are known to influence dementia in Alzheimer’s disease. Genetic components are suggested as putative risk factors for vascular pathology and cognitive decline. This study aimed to determine whether there is an association between candidate genetic polymorphisms and the severity of white matter hyperintensities in patients with Alzheimer’s disease. Methods: Seventy-five patients diagnosed with Alzheimer’s disease underwent genetic tests for specific alleles of apolipoprotein E, angiotensin-converting enzyme, and methylenetetrahydrofolate reductase. All patients underwent brain magnetic resonance imaging scans and neuropsychological tests. The severity of white matter hyperintensities was semiquantified using the CREDOS rating scale, and patients were divided into three groups according to their rating. Results:The severity of white matter hyperintensities was related to age and hypertension. However, none of the gene polymorphisms we tested was found to be associated with the severity of white matter hyperintensities. Conclusion:The genetic polymorphisms found in apolipoprotein E, angiotensin-converting enzyme and methylenetetrahydrofolate reductase did not contribute to white matter hyperintensities in Alzheimer’s disease.Only age and hypertension factors were found to be contributory to white matter hyperintensities.

Seizure Induction by Artemisia Annua in an Epilepsy Patient Taking Levetiracetam

Artemisia annua is a wormwood. Because it may induce Cytochrome P450 2C19 enzyme, Artemisia annua may have an influence on antiepileptic drugs which are substrates for the enzyme. This influence may negatively affect seizure control of epilepsy patient. We present a patient whose seizures were induced by Artemisia annua, despite he was taking levetiracetam which is not a substrate for the hepatic enzyme. Therefore there would be another mechanism of seizure induction of Artemisia annua besides hepatic metabolism.

Myeloma-associated Amyloidosis Presenting as Orthostatic Intolerance / 대한임상신경생리학회지

Amyloidosis is a systemic disorder associated with clonal plasma cell dyscrasia. Nephrotic syndrome, congestive heart failure, autonomic and peripheral neuropathy is often associated features in amyloidosis. Early diagnosis is most important because of different prognosis by stage. The diagnosis can be delayed since symptoms of amyloidosis may vary or nonspecific. We describe a patient of myeloma-associated amyloidosis, who showed orthostatic intolerance as the first symptom of the disease.

Asymptomatic Rheumatoid Meningoencephalitis Presented After Discontinuation of Methotrexate

Rheumatoid meningoencephalitis is a rare, but severe complication of rheumatoid arthritis (RA). A 64-year-old woman with the history of RA presented with abnormal behaviors and memory impairments since stopping methotrexate due to asymptomatic meningitis before 1 month. Brain MRI still demonstrated leptomeningeal enhancement in right fronto-temporal area, compared with the previous. Brain biopsy revealed multiple yellowish suppurative streaks in dura, and microscopically lymphoplasmic infiltrations and fibroid necrosis surrounded by granuloma. Soon after beginning treatment with corticosteroid and methotrexate, her symptoms improved.