Intrarenal Epidermal Cyst / 대한비뇨기과학회지

Epidermal cysts are benign cysts, which rarely localize in solid organs, but have an unclear pathogenesis. Herein, a case of an intrarenal epidermal cyst, in a 60-year-old woman with right flank pain, is reported. Multiple renal stones in the right kidney were identified by an intravenous pyelogram. A percutaneous nephrolithotomy (PCNL) was performed under the assumption of renal stones. Amorphorous cysts, containing calcification, were identified during the PCNL, which were histologically identical in appearance to an epidermal cyst within the skin. We suspected the pathogenetic mechanism of this lesion was a metaplasia of traumatic origin, due to the patient's history of renal stones, which had been previously treated with an open nephrolithotomy. According to the literature, an intrarenal epidermal cyst was usually treated by nephrectomy, under the assumption of a renal mass. Although the intrarenal epidermal cyst was incidentally found during the PCNL, an additional nephrectomy was not performed as it had almost been removed.

Intrarenal Epidermal Cyst / 대한비뇨기과학회지

Epidermal cysts are benign cysts, which rarely localize in solid organs, but have an unclear pathogenesis. Herein, a case of an intrarenal epidermal cyst, in a 60-year-old woman with right flank pain, is reported. Multiple renal stones in the right kidney were identified by an intravenous pyelogram. A percutaneous nephrolithotomy (PCNL) was performed under the assumption of renal stones. Amorphorous cysts, containing calcification, were identified during the PCNL, which were histologically identical in appearance to an epidermal cyst within the skin. We suspected the pathogenetic mechanism of this lesion was a metaplasia of traumatic origin, due to the patient's history of renal stones, which had been previously treated with an open nephrolithotomy. According to the literature, an intrarenal epidermal cyst was usually treated by nephrectomy, under the assumption of a renal mass. Although the intrarenal epidermal cyst was incidentally found during the PCNL, an additional nephrectomy was not performed as it had almost been removed.

The Influence of Acute Cerebral Infarction on the Circadian Rhythm of Melatonin Secretion

BACKGROUND: The circadian rhythm of circulating melatonin is regulated by the endogenous oscillators, the suprachi-asmatic nuclei, and entrained by the light-dark cycle of the environment, but it seems that the rhythm can be affected by variable lesions outside the retina-pineal pathway. We intended to know how acute cerebral infarction affects on the cir-cadian rhythm of plasma melatonin secretion. METHODS: Plasma melatonin level was measured from 64 patients with acute cerebral infarction. On admission, blood samples were collected by venipuncture at 2AM, 4AM, 10AM, and 2PM and melatonin level was measured by radioimmunoassay. The state of consciousness of each patient was assessed clini-cally and the infarction site and size were evaluated clinically and radiographically. RESULTS: Among 64 patients with acute cerebral infarction, dramatic blunting or obliteration of nocturnal melatonin surge in the blood was found in 29 patients. The circadian rhythm of melatonin secretion was absent in 12 of 35 alert patients, in 10 of 20 drowsy patients, and in 5 of 7 stuporous patients. Melatonin secretion into plasma was markedly decreased in all 2 comatose patients. Of 14 patients with brainstem lesions, 8 patients showed decreased melatonin levels with the absence of a nocturnal rise, although most of them were alert. CONCLUSIONS: This study suggests that brainstem and the initial mental state might contribute to the regulation of the circadian rhythm of plasma melatonin even though the lesion does not involve the retina-pineal pathway, but further extensive study is required to elucidate it. (J Korean Neurol Assoc 19(4):359~363, 2001)

Spontaneous Resolution of Pituitary Apoplexy: Report of 4 Cases

Pituitary apoplexy refers to a clinical syndrome characterized by sudden headache, visual impairmentm and ophthalmoplegia, which are caused by infarction or hemorrhage of the pituitary tumor. There is disagreement regarding the role of early surgery. All the patients may not require surgical decompression because spontaneous recovery is possible. We report 4 cases of pituitary tumor showing spontaneous resolution after pituitary apoplexy treated only by hormonalreplacement therapy.

A Case of Cerebral Infarction and Chronic Subdural Hematoma in Essential Thrombocythemia

Essential thrombocythemia is one type of the related chronic myeloproliferative disorders that also include poly-cythemia vera, chronic myelogenous leukemia, and idiopathic myelofibrosis. It is a rare disorder of unknown origin characterized by thrombocytosis, excessive megakaryocytes, hemorrhage, and thrombotic complication. Several cases of ischemic stroke in essential thrombocythemia have been reported, but cerebral infarction combined with cerebral hemorrhage has been very rare and has not been reported in Korea. We report a case of cerebral infarction and chronic subdural hematoma in a pateint with essential thrombocythemia. A 59-year-old woman with essential thrombocythemia was admitted with mild left hemiparesis that developed 3 days prior. She had a history of minor trauma 15 days prior. A brain MRI showed an infarction in the right temporal lobe and a chronic subdural hematoma in the right frontoparietal area. A cerebral angiography revealed an occlusion of the M2 portion of the right middle cerebral artery.

Two Cases of Histiocytic Necrotizing Lymphadenitis Accompanied by Aseptic Meningitis

Histiocytic necrotizing lymphadenitis is a benign disorder of the lymph node which should be differentiated from other types of lymphadenitis or malignant lymphoma. The most common presentation includes fever and cervical lym-phadenopathy .The course is invariably benign and spontaneous resolution usually occurs within 4 to 6 months. The diagnosis is confirmed by characteristic pathological findings of the involved lymph node. The involvement of the ner-vous system is known to be rare. We report two patients with histiocytic necrotizing lymphadenitis accompanied by aseptic meningitis. In one patient, both diseases developed simultaneously and in the other patient, histiocytic necrotiz-ing lymphadenitis was followed by aseptic meningitis 2 months later.

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.

A Case of Tuberculous Epidural Abscess Developed During the Treatment of Disseminated Intracranial Tuberculosis

A 29-year-old man has been presented with disseminated pulmonary tuberculosis and brain parenchymal tuberculous nodule. The CSF examination showed the features of subacute meningitis consistent with tuberculosis, and chronic granulomatous inflammation with acid-fast bacilli was found on pleural biopsy. He was treated with anti-tuberculous chemotherapy and showed subjective improvement of the symptoms. But rather rapidly progressive weakness of lower extremities and voiding difficulty were newly developed, and the thoracic spinal MRI showed diffuse epidural abscess along the entire thoracic segment. He showed excellent clinical improvement with additive steroid therapy.