Clinical Practice Guideline for Dementia (Diagnosis and Evaluation):2021 Revised Edition

no abstract available.

Added Value of Chemical Exchange-Dependent Saturation Transfer MRI for the Diagnosis of Dementia

Objective@#Chemical exchange-dependent saturation transfer (CEST) MRI is sensitive for detecting solid-like proteins and may detect changes in the levels of mobile proteins and peptides in tissues. The objective of this study was to evaluate the characteristics of chemical exchange proton pools using the CEST MRI technique in patients with dementia. @*Materials and Methods@#Our institutional review board approved this cross-sectional prospective study and informed consent was obtained from all participants. This study included 41 subjects (19 with dementia and 22 without dementia). Complete CEST data of the brain were obtained using a three-dimensional gradient and spin-echo sequence to map CEST indices, such as amide, amine, hydroxyl, and magnetization transfer ratio asymmetry (MTR asym) values, using six-pool Lorentzian fitting. Statistical analyses of CEST indices were performed to evaluate group comparisons, their correlations with gray matter volume (GMV) and Mini-Mental State Examination (MMSE) scores, and receiver operating characteristic (ROC) curves. @*Results@#Amine signals (0.029 for non-dementia, 0.046 for dementia, p = 0.011 at hippocampus) and MTR asym values at 3 ppm (0.748 for non-dementia, 1.138 for dementia, p = 0.022 at hippocampus), and 3.5 ppm (0.463 for non-dementia, 0.875 for dementia, p = 0.029 at hippocampus) were significantly higher in the dementia group than in the non-dementia group. Most CEST indices were not significantly correlated with GMV; however, except amide, most indices were significantly correlated with the MMSE scores. The classification power of most CEST indices was lower than that of GMV but adding one of the CEST indices in GMV improved the classification between the subject groups. The largest improvement was seen in the MTR asym values at 2 ppm in the anterior cingulate (area under the ROC curve = 0.981), with a sensitivity of 100 and a specificity of 90.91. @*Conclusion@#CEST MRI potentially allows noninvasive image alterations in the Alzheimer’s disease brain without injecting isotopes for monitoring different disease states and may provide a new imaging biomarker in the future.

Added Value of Chemical Exchange-Dependent Saturation Transfer MRI for the Diagnosis of Dementia

Objective@#Chemical exchange-dependent saturation transfer (CEST) MRI is sensitive for detecting solid-like proteins and may detect changes in the levels of mobile proteins and peptides in tissues. The objective of this study was to evaluate the characteristics of chemical exchange proton pools using the CEST MRI technique in patients with dementia. @*Materials and Methods@#Our institutional review board approved this cross-sectional prospective study and informed consent was obtained from all participants. This study included 41 subjects (19 with dementia and 22 without dementia). Complete CEST data of the brain were obtained using a three-dimensional gradient and spin-echo sequence to map CEST indices, such as amide, amine, hydroxyl, and magnetization transfer ratio asymmetry (MTR asym) values, using six-pool Lorentzian fitting. Statistical analyses of CEST indices were performed to evaluate group comparisons, their correlations with gray matter volume (GMV) and Mini-Mental State Examination (MMSE) scores, and receiver operating characteristic (ROC) curves. @*Results@#Amine signals (0.029 for non-dementia, 0.046 for dementia, p = 0.011 at hippocampus) and MTR asym values at 3 ppm (0.748 for non-dementia, 1.138 for dementia, p = 0.022 at hippocampus), and 3.5 ppm (0.463 for non-dementia, 0.875 for dementia, p = 0.029 at hippocampus) were significantly higher in the dementia group than in the non-dementia group. Most CEST indices were not significantly correlated with GMV; however, except amide, most indices were significantly correlated with the MMSE scores. The classification power of most CEST indices was lower than that of GMV but adding one of the CEST indices in GMV improved the classification between the subject groups. The largest improvement was seen in the MTR asym values at 2 ppm in the anterior cingulate (area under the ROC curve = 0.981), with a sensitivity of 100 and a specificity of 90.91. @*Conclusion@#CEST MRI potentially allows noninvasive image alterations in the Alzheimer’s disease brain without injecting isotopes for monitoring different disease states and may provide a new imaging biomarker in the future.

Vertebral Artery Dissection Presenting with Acute Infarction in Cervical Spinal Cord and Cerebellum

We describe a case of vertebral artery dissection (VAD) presenting with acute infarctions in cervical spinal cord and cerebellum in a 78-year-old man. Diffusion-weighted magnetic resonance (MR) imaging of the brain demonstrated diffusion-restricted lesions in the right cerebellum and sagittal T2-weighted MR imaging of spinal cord showed a hyperintense lesion of the cervical spinal cord at C2-C4 level. Right VAD was identified by transfemoral cerebral angiography and computed tomography angiography which showed segmental occlusion in the right vertebral artery.

Treatment of Propriospinal Myoclonus at Sleep Onset

No abstract available.

Characteristics of Emotion and Personality in Obstructive Sleep Apnea Patients with Insomnia Symptoms: Analysis of Minnesota Multiphasic Personality Inventory

OBJECTIVES: Obstructive sleep apnea-hypopnea syndrome (OSAHS) and insomnia are two of the most common sleep disorders in the general population. Because OSAHS patients with insomnia may have difficulty in adapting to the sleep breathing medical equipment, it is necessary to pay special attention to the diagnosis and treatment of comorbid insomnia. This study is to investigate the emotion and personality in OSAHS patients with insomnia complaints by using Minnesota Multiphasic Personality Inventory-2 (MMPI-2). METHODS: We reviewed the results of the standardized questionnaires assessing sleep-related variables, MMPI, and polysomnographic findings of the patients diagnosed as OSAHS. RESULTS: 145 subjects were 49.05+/-11.83 years of age. The mean Respiratory Disturbance Index was 33.57+/-19.91 and the mean score of Insomnia Severity Index (ISI) was 11.52+/-6.49. The mean scores of the Beck Depression Inventory (BDI) and MMPI-2 were within normal ranges. We divided the patients into two groups based on the scores of the ISI, OSAHS with insomnia (n=109) and OSAHS without insomnia (n=36). OSAHS patients with insomnia symptoms had significantly higher scores of hypochondriasis, hysteria, psychasthenia, schizophrenia, paranoia and psychopathic deviate scales and BDI than those without insomnia. CONCLUSIONS: Our results suggest that insomnia complaints are very common in OSAHS patients and the psychological problems are more frequently found in OSAHS patients with insomnia symptom than those without it.

Regrowth of Internal Carotid Artery Aneurysm after Neck Clipping Surgery Presenting with Compressive Optic Neuropathy / 대한임상신경생리학회지

No abstract available.

Sleep Disturbances and Predictive Factors in Caregivers of Patients with Mild Cognitive Impairment and Dementia

BACKGROUND AND PURPOSE: We examined the characteristics of sleep disturbances and sleep patterns in the caregivers of patients with amnestic mild cognitive impairment (aMCI) and dementia. METHODS: We prospectively studied 132 patients (60 with aMCI and 72 with dementia) and their caregivers, and 52 noncaregiver controls. All caregivers and controls completed several sleep questionnaires, including the Pittsburgh Sleep Quality Index (PSQI). The patients were administered neuropsychological tests and the neuropsychiatric inventory to evaluate their behavioral and neuropsychiatric symptoms of dementia (BPSD). RESULTS: The PSQI global score was 6.25+/-3.88 (mean+/-SD) for the dementia caregivers and 5.47+/-3.53 for the aMCI caregivers. The Insomnia Severity Index (ISI) and short form of the Geriatric Depression Scale (GDS-S) predicted higher PSQI global scores in aMCI caregivers, and higher scores for the ISI, Epworth Sleepiness Scale (ESS), and GDS-S in dementia caregivers. BPSD, including not only agitation, depression, and appetite change in dementia patients, but also depression, apathy, and disinhibition in aMCI patients, was related to impaired sleep quality of caregivers, but nighttime behavior was not. Age and gender were not risk factors for disturbed sleep quality. CONCLUSIONS: Dementia and aMCI caregivers exhibit impaired quality of sleep versus non-caregivers. ISI, GDS-S, and ESS scores are strong indicators of poor sleep in dementia caregivers. In addition, some BPSD and parts of the neuropsychological tests may be predictive factors of sleep disturbance in dementia caregivers.

Investigation of the Correlation between Seoul Neuropsychological Screening Battery Scores and the Gray Matter Volume after Correction of Covariates of the Age, Gender, and Genotypes in Patients with AD and MCI

PURPOSE: To investigate the correlations between Seoul Neuropsychological Screening Battery (SNSB) scores and the gray matter volumes (GMV) in patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) and cognitively normal (CN) elderly subjects with correcting the genotypes. MATERIALS AND METHODS: Total 75 subjects were enrolled with 25 subjects for each group. The apolipoprotein E (APOE) epsilon genotypes, SNSB scores, and the 3D T1-weighted images were obtained from all subjects. Correlations between SNSB scores and GMV were investigated with the multiple regression method for each subject group using both voxel-based and region-of-interest-based analyses with covariates of age, gender, and the genotype. RESULTS: In the AD group, Rey Complex Figure Test (RCFT) delayed recall scores were positively correlated with GMV. In the MCI group, Seoul Verbal Learning Test (SVLT) scores were positively correlated with GMV. In the CN group, GMV negatively correlated with Boston Naming Test (K-BNT) scores and Mini-Mental State Examimation (K-MMSE) scores, but positively correlated with RCFT scores. CONCLUSION: When we used covariates of age, gender, and the genotype, we found statistically significant correlations between some SNSB scores and GMV at some brain regions. It may be necessary to further investigate a longitudinal study to understand the correlation.

Acute Cerebral Infarction Related to Stenosis of Accessory Middle Cerebral Artery / 대한뇌졸중학회지

The accessory middle cerebral artery (MCA) is an anomalous vessel which arises from the anterior cerebral artery (ACA) and runs through the Sylvian fissure along with the normal MCA. Here we present a case of acute cerebral infarction in a patient with stenosis of the accessory MCA. The accessory MCA, which originated from the proximal A1 segment of the ACA, had severe focal stenosis in its proximal part and the ischemic lesions were in the frontal subcortical white matter. This case illustrates the anomalous vessel and its territory, the atheromatous vascular change, and the related ischemic insults.

Isolated Inferior Rectus Palsy from Midbrain Infarction / 대한뇌졸중학회지

We describe a patient with isolated inferior rectus palsy due to midbrain infarction. A 68-year-old-man developed vertical diplopia of sudden onset which was maximal with a right lower side gaze. Neurological examination revealed weakness of the right inferior rectus muscle. Magnetic resonance imaging of the brain showed a focal infarction in the dorsomedial portion of the right midbrain tegmentum. The sole involvement of fascicular fibers of the inferior rectus muscle in the midbrain was accountable as the cause of this isolated inferior rectus palsy. We think that this is a case supporting the three-dimensional model of somatotopic fascicular arrangement of oculomotor nerve in the midbrain.

Acute Ischemic Stroke Associated with Essential Thrombocythemia and Suspected Platelet Aggregation in Intracranial Artery / 대한뇌졸중학회지

Acute ischemic stroke is often the first manifestation of essential thrombocythemia (ET). We report two cases of acute ischemic stroke in patients with ET who suffered acute thrombus formation in a large cerebral artery with related cortical infarction. We suggest that platelet aggregation and its distal embolization may occur in large intracranial arteries in patients with ET.

Acute Hepatic Failure Associated with Stevens-Johnson Syndrome Induced by Carbamazepine Treatment in a Patient with Transverse Myelitis

Carbamazepine-induced liver injury is less common, but the consequences of the side effects can be very serious leading to death or a need for liver transplantation. We report a case of a 60-year-old female transverse myelitis patient with fulminant hepatic failure and Stevens-Johnson syndrome induced by carbamazepine who successfully underwent deceased donor liver transplantation. The patient, a 60-year-old female, was admitted to our service due to acute liver insufficiency and a drowsy mental state attributable to carbamazepine. She had been treated with carbamazepine to control transverse myelitis. Fifty days after the use of carbamazepine, she developed jaundice, erythematous papules and bullae, and decreased consciousness. The diagnosis of Stevens-Johnson syndrome was considered. She underwent deceased donor liver transplantation. She was discharged with normal graft functions 5 months after transplantation. Thus, liver transplantation can be a feasible therapy for patients with carbamazepine-induced hepatic failure associated with Stevens-Johnson syndrome.

A Case of Herpes Zoster Ophthalmicus with Isolated Trochlear Nerve Involvement

BACKGROUND: Herpes zoster ophthalmicus (HZO) can involve the oculomotor nerve; however, isolated trochlear nerve palsy has rarely been reported. CASE REPORT: An 83-year-old man who suffered from HZO in the right frontal area and scalp subsequently developed vertical diplopia and severe pain. Cerebrospinal fluid examination and brain MRI revealed no abnormalities. Isolated right trochlear nerve palsy was diagnosed based on the findings of neuro-ophthalmological tests. CONCLUSIONS: Isolated trochlear nerve involvement associated with HZO is very rare and may be easily overlooked. Physicians should carefully examine oculomotor involvement in HZO.

Clinical Assessment in Stroke Patients: Introduction of Neurologic Stroke Scales / 신경중재치료의학

Neurologic stroke scales have been developed for quantification of neurologic deficits, functional outcomes, and global outcomes in stroke patients. Neurologic deficit scales are scoring systems for severities of specific neurologic symptoms or signs. These scales are used to assess initial severity and deterioration in acute stroke phase, and to follow-up. National Institutes of Health Stroke Scale is widely used neurologic deficit scale. Functional outcome scales are evaluation tools used to measure stroke related disability. Modified Rankin scale, and Barthel index are most frequently used outcome scales. Because there is no scale that appears to satisfy all of the requirements of an ideal neurologic scale, it is helpful to use a neurologic deficit scale along with a functional outcome scale.

Headache Associated With Airplane Descent

Headache may develop in flight passengers without underlying pathology even though this type of headache is not included in "The International Classification of Headache Disorders". We report on a case of headache which had developed during airplane landing. A rapid change in the ambient pressure may give rise to headache.

A Case of Occipital Condyle Syndrome Associated with Hepatocellular Carcinoma

Occipital condyle syndrome, which consists of unilateral occipital region pain associated with ipsilateral 12th cranial nerve paresis, is a rare, but stereotypic syndrome. Herein, we report a patient with occipital condyle syndrome associated with metastasis at the skull base from the hepatocellular carcinoma.

Compressive Myelopathy due to Ossification of Ligamentum Flavum in a Patient with Primary Hypoparathyroidism

No abstract available.

A Case of Mercury Intoxication Presenting Cerebellar Ataxia

Mercury poisoning affects various organs including peripheral and central nervous systems, especially cerebellum. We report a case of mercury intoxication presenting cerebellar ataxia. From several days after exposure to mercury vapor, scanning speech, head titubation, bilateral limb and truncal ataxia developed and progressed slowly. On admission, brain MRI did not show remarkable change. However, nine months later, atrophic changes in both cerebellar hemispheres on follow-up brain MRI and perfusion defects in same areas on brain SPECT were found.

Two Cases of Partial Oculomotor Nerve Palsy due to Midbrain Infarction

Traditionally, monocular parital oculomotor pareses are localized to the cavernous sinus or retro-orbital region and are usually caused by diabetes mellitus, aneurysms of the internal carotid artery, inflammation by vrial infection or autoimmune diseases, neuropathy or neuromuscular disesases. Although rare, the monocular partial oculomotor paresis also can be caused by lesions of ventral midbrain because of their particular topographic arrangement. We present 2 cases with fascicular oculomotor nerve involvement from midbrain lesion, who presented with monocular partial ocu-lomotor nerve palsy. One patient showed partial ptosis and slow saccadic movement of the right eye. The other patient showed parital ptosis and limitation of adduction and elevation in the left eye. They had normal pupil size and light reflexes. Brain magnetic resonance images showed focal infarction in the fascicular portion of the oculomotor nerve.