ABSTRACT
Acute vestibular syndrome (AVS) is characterized by the rapid onset of dizziness/vertigo accompanied by nausea/vomiting, gait unsteadiness, and nystagmus lasting a day or more. Some patients with AVS have potentially dangerous central etiologies. AVS caused by central etiologies without significant other neurologic deficit, so called pseudo-vestibular neuritis (pseudo-VN), could be difficult to be differentiated from acute vestibular neuritis. In addition to imaging studies, bedside oculomotor examination-head impulse test, nystagmus and test of skew)-is essential to identify patients with pseudo-VN. Among several central causes of AVS, brain tumor is extremely rare. We report a case of vascular tumor involving the anterior inferior cerebellum with AVS presentations.
Subject(s)
Humans , Brain Neoplasms , Cerebellum , Gait , Neuritis , Neurologic Manifestations , Nystagmus, Pathologic , Vertigo , Vestibular NeuronitisABSTRACT
BACKGROUND: Discontinuation of antiepileptic drug (AED) is valuable in patients of epilepsy who have been seizure free for a considerable time. However, there are few established methods to successfully stop AED. The purpose of study was to find the prognostic factors and the method of desirable AED withdrawal. METHODS: Seventy-eight patients who were seizure free for more than 18 months were enrolled in this retrospective study. The patients were followed for more than 2 years after starting withdrawal, or until seizure recurrence within 2 years. To clarify the prognostic factors affecting the seizure recurrence related to the withdrawal, statistical analyses were done about AED types, EEG before withdrawal, sex, age, onset age of seizure, febrile convulsion, family history, brain CT/MRI, trauma history, loss of consciousness history, seizure nature, and duration of seizure free. Furthermore, survival analysis between groups over the duration of withdrawal period and AED decrement rate was done to elucidate the most successful methods of AED withdrawal. RESULTS: Fifty-seven patients (73%) experienced seizure recurrence after starting withdrawal within 2 years. Over 12 months of withdrawal duration (p=0.037) and under 20 percent per month of the decrement rate of carbamazepine (p=0.019) were related to reduce the seizure recurrence. These were also confirmed via survival curve analysis. CONCLUSIONS: This study is a new attempt to apply reduction rate in withdrawal. AED withdrawal duration and decrement rate are important factor to prognostic factors of desirable AED withdrawal and minimize the recurrence after withdrawal.
Subject(s)
Humans , Age of Onset , Anticonvulsants , Brain , Carbamazepine , Electroencephalography , Epilepsy , Recurrence , Retrospective Studies , Seizures , Seizures, Febrile , UnconsciousnessABSTRACT
Primary angiitis of the central nervous system (PACNS) is a rare disorder of unknown etiology and a serious form of vasculitis that is limited to the brain and spinal cord. We report a case of PACNS presenting with multifocal enhancing tumefactive lesions on brain magnetic resonance imaging, and numerous small arteriolar ectasias on conventional angiography, with relapsing-remitting clinical features.
Subject(s)
Angiography , Brain , Central Nervous System , Dilatation, Pathologic , Magnetic Resonance Imaging , Spinal Cord , Vasculitis , Vasculitis, Central Nervous SystemABSTRACT
A 62-year-old man with a neurogenic tumor in the neck was admitted to our hospital for recurrent ischemic stroke due to carotid occlusion. The magnetic resonance (MR) angiograms revealed the occlusion of the right internal carotid artery (ICA). Arterial compression by the tumor could be considered as the cause of ICA occlusion. Since neurogenic tumors of the neck have significant surgical risks, the patient underwent extracranial-intracranial arterial bypass (EC-IC bypass) surgery. We report a case with recurrent ischemic stroke due to carotid compression by a neurogenic tumor of the neck.