Cerebrovascular Diseases in Cancer Patients

BACKGROUND: The association of vascular thrombosis with cancer has been known since Trousseau's description of venous thrombophlebitis in patients with carcinoma. Previous studies, mainly autopsy-based, have suggested that the stroke spectrum in cancer patients differ from that of the general population. However, no studies that address this question in the adult oncological population from a clinical perspective are available in Korea. We therefore assessed the clinical features of cerebrovascular diseases in cancer patients. METHODS: We retrospectively analyzed 44 cases of symptomatic cerebrovascular disease in cancer patients who were admitted to the Wonju Christian Hospital from January 1993 to June 1998 by reviewing their charts and brain CT or MRI; primary cancer, the interval from a cancer diagnosis to the occurrence of stroke, the incidence of hypercoagulability as an infarction cause, the location and size of the infarction, the type of hemorrhage, and the prognosis. RESULTS: The mean age was 62.3 years. Twenty eight cases (63.6%) were ischemic stroke and sixteen cases (36.4%) were hemorrhagic stroke. The most common primary cancer of infarction and hemorrhage was stomach cancer. In ischemic patients, the most common cell type of cancer was ade-nocarcinoma and six cases (21.4%) were considered to have hypercoagulability as a cause. In hemorrhagic patients, seventy percent of patients with coagulopathy died in the hospital or were discharged moribundly. CONCLUSIONS: Although hypercoagulability is present to a greater extent in the patient population than in the general population, it appears that conventional stroke risk factors account for the majority of cerebral ischemic events in the adult cancer population. Cancer patients with intracranial hemorrhage owing to coagulopathy reveal poor prognosis.

Subclinical Ulnar Neuropathy in Carpal Tunnel Syndrome

BACKGROUND: When performing routine diagnostic nerve conduction studies in patients with carpal tunnel syndrome(CTS), we sometimes happen to be confronted with patients who have also ulnar nerve abnormality without any clinical symptoms or signs, although not so common. Anatomically, the borders of the carpal tunnel and the Guyon canal share common features, separated from each other by the pisiform bone, and the volar carpal ligament forming both the roof of the carpal tunnel and the floor of the Guyon canal. Therefore, if there is an entrapment syndrome at the carpal tunnel with subsequent electrophysiological changes for the median nerve, the same process could also affect the ulnar nerve in the Guyon canal. METHODS: We analyzed 283 patients who were diagnosed as CTS clinically and electrophysiologically for the past 5 years in this hospital. RESULTS: Of 283 patients(491 hands) with CTS, 15 patients(16 hands) had ulnar nerve involvement(5%). Of 75 patients with unilateral CTS, 2 patients(2%) had ulnar nerve involvement; whereas of 208 patients with bilateral CTS, 13 patients(6%) had ulnar nerve involvement. CONCLUSIONS: This study cannot conclusively explain why there is involvement of the ulnar nerve in CTS, but ulnar nerve may be involved at the level of the Guyon canal in some patients with CTS as an entrapment phenomenon and the patients with bilateral CTS may have a more tendency to have ulnar nerve lesion than those with unilateral CTS. In patients with CTS, it would be better to check up if there is also ulnar nerve involvement.

A Case of Moyamoya Disease Associated with Complete Duplication of the Basilar artery

Moyamoya disease is characterized by a bilateral progressive narrowing of the distal internal carotid and proximal portions of the anterior and middle cerebral arteries. The cerebral vessels of the 11 to 14 mm embryonic period are extremely similar to these moyamoya vessels. The vertebral arteries unite with a contralateral homologue to form the basilar artery during embryonic development and rarely, the failure of complete fusion results in duplication of these arteries. It is well known that moyamoya disease sometimes is accompanied by persistent primitive arteries, cerebral aneurysm, or rarely arteriovenous malformation. However, no case of the moyamoya disease with complete duplication of basilar artery has been previously reported. These two types of vascular abnormality are probably associated in certain developmental period, and moyamoya disease causes hemodynamic load in the basilar artery system as a collateral pathway and these effects are also involved in duplication of basilar artery. The relationship between these two varieties of vascular abnormality and possible pathogenesis of the moyamoya disease are discussed.