Serial MRI Findings in a Clinically Diagnosed Adult Onset Leigh Syndrome

Adult onset Leigh syndrome is a very rare neurodegenerative disorder of unknown cause. We report the evolution of the lesions on serial MRIs in a 38-year-old man with clinically diagnosed Leigh syndrome. We emphasize that the mammillary bodies can be involved during the disease course and that premortem diagnosis of Leigh syndrome is pos-sible, if a characteristic distribution of lesions can be demonstrated on MRI.

The Relationship between Febrile Convulsion and Temporal Lobe Epilepsy: Is Febrile Convulsion a Preferential Association with Temporal Lobe Epilepsy?

BACKGROUND: Although a history of febrile convulsion (FC) is common in epilepsy patients, the preferential associa-tion of febrile convulsion with temporal lobe epilepsy (TLE) is not clear. METHODS:We obtained the FC data from "Paik and Bongsang hospital" epilepsy clinic. We classified epilepsy syndromes into generalized epilepsy (GE), temporal lobe epilepsy (TLE), extratemporal epilepsy (ETLE), unclassified partial and undetermined epilepsy by standardized criteria. The incidence of antecedent FC was evaluated in relation to the epilepsy classifications. We calculated kappa values for inter and intra observer reliability for the classifications of epilepsy syndromes. RESULTS: The agreement of epilepsy classifications were reliable (intra-observer kappa value=0.78, inter-observer kappa value=0.77). Thirteen percent of the studied patients (72/537) had a history of FC and 38% of FC (27/72) were complex types of FC. TLE was more likely to be preceded by FC 25% (42/166) than ETLE 6% (12/189), p<0.05 or GE 13% (12/93), p<0.05 and 85% of complex FC (23/27) preceded TLE. GE however, was more likely to have non-complex FC 100% (12/12) than partial epilepsy 55% (32/58), p<0.05. CONCLUSIONS We therefore conclude and agree that FC should be preferentially associated with TLE.

A Case of Lateral Sinus Thrombosis Presenting with Cranial Nerve Syndrome

Cerebral venous thrombosis (CVT) is a disease sometimes associated with a wide variety of clinical signs and symp-toms. Single or multiple cranial nerve palsies without evidence of any other signs and symptoms have not, so far, been considered as a relevant syndrome of CVT. A 49-year-old woman was admitted to our hospital because of diplopia, vertigo with tinnitus and ataxia which had begun approximately three weeks before. Neurological examination revealed a right 6th nerve palsy by a red glass test and an impaired tandem walking test. Laboratory tests including CSF exami-nation and brain MRI were normal but MR venography and following 4-vessel angiography showed thrombosis in the left transverse and sigmoid sinuses and suspicious thrombosis in the right lateral sinus. She was treated with heparin and proceeded to get well.

Reversible MRI Findings in Metronidazole-induced Cerebellar Dysfunction

Metronidazole is widely used for the treatment of trichomoniasis, giardiasis, amebiasis, and anaerobic infections. It pro-duces a number of neurological side effects including peripheral neuropathy, encephalopathy, cerebellar dysfunction, and seizures. A 66-year-old male patient was admitted to our department because of a tingling sensation in both toes as well as ataxia with dizziness which had developed five prior to admission. He had had been diagnosed with hepatoma and had an operation in 1993. One month before admission, he felt a febrile sensation and was diagnosed as having abdominal abscess by an ultrasonography, and took about 30g of metronidazole until visiting our emergency room. A nerve conduc-tion test revealed sensorimotor polyneuropathy in the four extremities. A brain MRI showed symmetrically increased signal intensities without enhancement in the supratentorial white matter and the dentate nucleus of the cerebellum. After stopping metronidazole, his neurological symptoms began to improve and on the following MRI taken seven weeks later, the symmetrically increased signal intensities in the dentate nucleus of the cerebellum were nearly disappeared.

Reversible MRI Findings in Metronidazole-induced Cerebellar Dysfunction

Metronidazole is widely used for the treatment of trichomoniasis, giardiasis, amebiasis, and anaerobic infections. It pro-duces a number of neurological side effects including peripheral neuropathy, encephalopathy, cerebellar dysfunction, and seizures. A 66-year-old male patient was admitted to our department because of a tingling sensation in both toes as well as ataxia with dizziness which had developed five prior to admission. He had had been diagnosed with hepatoma and had an operation in 1993. One month before admission, he felt a febrile sensation and was diagnosed as having abdominal abscess by an ultrasonography, and took about 30g of metronidazole until visiting our emergency room. A nerve conduc-tion test revealed sensorimotor polyneuropathy in the four extremities. A brain MRI showed symmetrically increased signal intensities without enhancement in the supratentorial white matter and the dentate nucleus of the cerebellum. After stopping metronidazole, his neurological symptoms began to improve and on the following MRI taken seven weeks later, the symmetrically increased signal intensities in the dentate nucleus of the cerebellum were nearly disappeared.