Solitary intraventricular hemorrhage without subarachnoid hemorrhage due to aneurysmal rupture: a case report

The presence of primary intraventricular hemorrhage (IVH) without vascular lesion is very rare. We experienced solitary IVH without subarachnoid hemorrhage due to aneurysmal rupture in a 58-year-old man treated with coil embolization, which contributed to his good prognosis. After 33 days of hospitalization, he had mild right hemiplegic symptoms remaining, and he was transferred to a rehabilitation institute for further treatment. In cases of primary IVH, computed tomography angiography seems worthwhile for making a differential diagnosis, although the possibility of IVH due to cerebral aneurysmal rupture is very low. Endovascular intervention is a good option for diagnosis and treatment.

Pipeline Embolization Device for Large/Giant or Fusiform Aneurysms: An Initial Multi-Center Experience in Korea / 신경중재치료의학

PURPOSE: The purpose of this study was to assess the safety and early outcomes of the Pipeline device for large/giant or fusiform aneurysms. MATERIALS AND METHODS: The Pipeline was implanted in a total of 45 patients (mean age, 58 years; M:F=10:35) with 47 large/giant or fusiform aneurysms. We retrospectively evaluated the characteristics of the treated aneurysms, the periprocedural events, morbidity and mortality, and the early outcomes after Pipeline implantation. RESULTS: The aneurysms were located in the internal carotid artery (ICA) cavernous segment (n=25), ICA intradural segment (n=11), vertebrobasilar trunk (n=8), and middle cerebral artery (n=3). Procedure-related events occurred in 18 cases, consisting of incomplete expansion (n=8), shortening-migration (n=5), transient occlusion of a jailed branch (n=3), and in-stent thrombosis (n=2). Treatment-related morbidity occurred in two patients, but without mortality. Both patients had modified Rankin scale (mRS) scores of 2, but had an improved mRS score of 0 at 1-month follow-up. Of the 19 patients presenting with mass effect, 16 improved but three showed no changes in their presenting symptoms. All patients had excellent outcomes (mRS, 0 or 1) during the follow-up period (median, 6 months; range, 2-30 months). Vascular imaging follow-up (n=31, 65.9%; median, 3 months, range, 1-25 months) showed complete or near occlusion of the aneurysm in 24 patients (77.4%) and decreased sac size in seven patients (22.6%). CONCLUSION: In this initial multicenter study in Korea, the Pipeline seemed to be safe and effective for large/giant or fusiform aneurysms. However, a learning period may be required to alleviate device-related events.

Association of Left Atrial Enlargement with Cortical Infarction in Subjects with Patent Foramen Ovale / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: Left atrial dysfunction has been reported in patients with patent foramen ovale (PFO). Here we investigated the role of left atrial dysfunction in the development of embolic stroke in patients with PFO. METHODS: We identified consecutive patients with embolic stroke of undetermined sources except for PFO (PFO+ESUS). Healthy subjects with PFO served as controls (PFO+control). A stratified analysis by 10-year age group and an age- and sex- matching analysis were performed to compare echocardiographic markers between groups. In the PFO+ESUS group, infarct patterns of PFO-related stroke were determined (cortical vs. cortico-subcortical) and analyzed in correlation with left atrial function parameters. RESULTS: A total of 118 patients and 231 controls were included. The left atrial volume indices (LAVIs) of the PFO+ESUS patients were higher than those of the PFO+controls in age groups of 40–49, 50–59, and 60–69 years (P28 mL/m2) LAVI was more associated with the cortical infarct pattern (P=0.043 for an acute infarction and P=0.024 for a chronic infarction, both adjusted for age and shunt amount). The degree of right-to-left shunting was not associated with infarct patterns, but with the posterior location of acute infarcts (P=0.028). CONCLUSIONS: Left atrial enlargement was associated with embolic stroke in subjects with PFO. Left atrial physiology might contribute to the development of PFO-related stroke and need to be taken into consideration for optimal prevention of PFO-related stroke.

MR Signal Change in a Patient with Partial Seizure and Nonketotic Hyperglycemia / 대한간질학회지

Seizures are a common presenting manifestation in patients in a nonketotic hyperglycemic(NKH) hyperosmolar state and the MR findings are typically hyperintense on T2 weighted (T2-W) and fluid attenuated inversion recovery (FLAIR) images. We recently experienced a case of the patient with partial seizure and nonketotic hyperglycemia who showed T2-W and FLAIR hypointensities with T1 weighted (T1-W) contrast enhancement.

Diagnostic Usefullness of Current Perception Threshold Test in Carpal Tunnel Syndrome

BACKGROUND: Carpal tunnel syndrome (CTS) is the most commonly reported nerve entrapment syndrome. When performing routine nerve conduction studies (NCS) in clinically diagnosed CTS, we sometimes confronted with patients who have no definite electrophysiological evidence of CTS. Current perception threshold (CPT) test can evaluate the functioning of all major subpopulations of sensory nerve. The purpose of this study is to determine clinically usefulness of the CPT test in idiopathic CTS. METHODS: We prospectively studied 60 patients (90 hands) who were clinically diagnosed as CTS. Involved hands were grouped into three clinical grades (mild, moderate and severe). NCS was done using a standard technique and equipment. CPT test was measured at the distal interphalangeal joint of second, third and fifth fingers with electrical current of 5 Hz, 250 Hz and 2,000 Hz in frequency. RESULTS: Of 60 patients (90 hands), 8 (13.1%) were men and 52 (86.9%) were women. Mean age at evaluation was 56.00+/-8.94 years old. Positive rate of NCS and CPT was 0.80 (0.72, 0.88) and 0.61 (0.51, 0.71), respectively. Sensitive and specificity of CPT test was 0.49 and 0.57. As the clinical severity of CTS deteriorate, CPT test showed abnormality in low frequency stimulation. CONCLUSIONS: CPT test is an effective and relatively simple procedure for measuring perception in CTS. But CTS test is difficulty and subjectively at interpretation. We suggested that the usefullness of CPT test is lower than NCS in diagnosis of CTS.

Association of Apolipoprotein E Gene Polymorphism With Cognitive Function of the Elderly Residents in a Rural Community

BACKGROUND: It is not clear whether polymorphism of the apolipoprotein E (ApoE) gene influences the cognition of community residents. The aim of this study was to establish the association between ApoE gene polymorphism and cognitive function in an elderly rural community in Korea. METHODS: A total of 388 subjects aged 65 and over were recruited. Demographic characteristics, past history of illness, and scores on the Korean version of the Mini Mental State Examination (K-MMSE), the Geriatric Depression Scale . Short Form (GDS-S), and the Korean version of Instrumental Activities of Daily Living (K-IADL) were evaluated. The lipid profile and ApoE genotype were sampled from 377 of the participants. RESULTS: Of the entire cohort, 75% had less than 6 years of education, and 30% were illiterate. The frequencies of the ApoE epsilon2, ApoE epsilon3, and ApoE epsilon4 alleles were 48 (6.6%), 372 (86.9%), and 49 (6.5%), respectively. The K-MMSE score was much lower in those with two ApoE epsilon3 alleles than in those with only one ( p=0.046). However, the numbers of ApoE epsilon2 alleles (p=0.976) and ApoE epsilon4 alleles (p=0.934) carried by the individual were not associated with K-MMSE score. Both K-IADL (p<0.001) and GDS-S (p<0.001) scores were significantly correlated with K-MMSE score. Grouping of the participants into three groups according to K-MMSE score (i.e., 0-17 , 18-24, and 25-30) also revealed that this score was correlated with K-IADL score (p<0001), GDS-S score (p<0.001), and the ApoE epsilon3 allele (p=0.035). CONCLUSIONS: These results suggest that the ApoE epsilon3 allele has a negative influence on cognitive function (K-MMSE) in this rural community. Surprisingly, we were unable to detect any relationship between the ApoE epsilon4 allele and cognitive function. There was a positive correlation between K-MMSE, K-IADL, and GDS-S scores.