Argatroban Treatment in Acute Ischemic Stroke: Multicenter, Randomized, Aspirin-Controlled Study

BACKGROUND: Argatroban, a direct thrombin inhibitor, has been suggested to be beneficial in acute ischemic stroke by preventing microthrombi formation. The aim of this multicenter, aspirin-controlled, randomized trial is to determine the safety and the efficacy of argatroban compared with aspirin in acute ischemic stroke. METHODS: The patients within 48 hours of noncardioembolic ischemic stroke were recruited from 8 centers. Argatroban was infused continuously at 2.5 mg/hr for the first 48 h, and then 10mg of argatroban was infused over 3 h twice a day on days 3-7. Control group received aspirin 300 mg/day for 7 days. The primary outcome was the NIHSS at 30 days and the secondary outcome was Barthel index (BI) and modified Rankin scale (mRS) at 90 days. The safety was evaluated by the incidence of bleeding complication. RESULTS: A total of 236 patients (123 for argatroban and 113 for aspirin) were included. NIHSS at 30 days, BI at 90 days and mRS at 90 days did not show significant difference between the argatroban and the aspirin group (3.1 +/- 3.1 vs 3.5 +/- 3.0, 88.9 +/- 22.5 vs 86.2 +/- 23.8, 1.4 +/- 1.1 vs 1.6 +/- 1.3, p>0.3, respectively). Post hoc analysis revealed that as for the patients who were treated within 24 hours after onset, numbers of patients with NIHSS=1 at 30 days were larger in the argatroban group (23 of 49) than in the aspirin group (10 of 40) (p=0.03). Bleeding complication was not different between the two groups (2 of 123 vs 0 of 113: p>0.4). CONCLUSIONS: Argatroban treatment is relatively safe in acute ischemic stroke. The efficacy of argatroban is not superior to aspirin. However, argatroban may be more beneficial in some subgroup of stroke patients than aspirin.

Familial Idiopathic Striopallidodentate Calcifications

Familial idiopathic striopallidodentate calcification is a disorder radiologically characterized by bilateral calcifications of the brain without abnormalities in the serum calcium level and related endocrinological parameters. We report a 70-year-old woman presented with slowly progressive gait disturbance, dementia and Parkinsonism. She had bilateral and symmetric calcifications of the basal ganglia, thalamus, dentate nucleus, and subcortical white matter on the brain CT. One son and two granddaughters also showed calcifications of the basal ganglia, suggesting an autosomal dominant inheritance.

Effect of Antiepileptic Drugs on Cognitive Evoked Potentials in Epileptic Patients / 대한간질학회지

BACKGROUND: Epilepsy and antiepileptic drugs may be associated with cognitive dysfunction. P300 event-related potentials have been used to assess cognitive function. In this study we investigated the effect of antiepileptic drugs on P300 event-related potentials in epileptic patients. METHODS: P300 latency in event-related potentials was recorded during an auditory oddball paradigm in 29 patients, 10 with generalized epilepsy and 19 with partial epilepsy. The relationships between antiepileptic drugs and P300 latency prolongation were analyzed. RESULTS: P300 latency was prolonged in 31% (9/29) patients with epilepsy. There were no significant relationships between etiology of epilepsy, type of seizure, or type of antiepileptic drugs and P300 latency prolongation. The number or serum level of antiepileptic drugs and treatment duration were related to latency prolongation, but these relations were not significant. CONCLUSION: The prolongation of P300 latency in event-related potentials is not significantly related to antiepileptic drug. This finding suggests that P300 may not be a sensitive additional procedure to assess the cognitive status in epileptic patients.

Dislocation of the Bilateral Temporomandibular Joint due to Generalized Tonic-Clonic Seizures / 대한간질학회지

Dislocations or fractures of the limbs can arise from muscle contraction during epileptic seizures. Dislocation complication of the bilateral temporomandibular joint from seizures is reported very rarely. A 36-year-old woman, who had no history of epilepsy, presented recurrent dislocations of the bilateral temporomandibular joint and generalized tonic-clonic seizures. EEG showed intermittent generalized slow activity. We report a case of bilateral temporomandibular joint dislocation that occurred during generalized tonic-clonic seizures, which has not previously been reported in Korea.

Evaluation of Memory Impairment in Patients with Temporal Lobe Epilepsy Using the Wechsler Memory Scale / 대한간질학회지

PURPOSE: Memory complaints are common in patients with epilepsy, particularly temporal lobe epilepsy. Many factors may adversely affect memory function in epilepsy, including seizures themselves, pathology causing the epilepsy and antiepileptic medication. The Wechsler Memory Scale (WMS) is used widely for test of memory. The aim of this study is to evaluate memory in patients with temporal lobe epilepsy using the WMS and to analyze memory impairment with respect to various factors. METHODS: Twenty four epileptic patients with temporal lobe epilepsy were evaluated with the WMS. Memory impairment was analyzed with respect to age at seizure onset, epilepsy duration, and antiepileptic medication. RESULTS: Memory test using the WMS showed significant differences between epileptic patients and controls for general information, mental control, associate learning, digit span and logical memory subtests. There was no correlation between memory quotient and age at seizure onset, epilepsy duration, or antiepileptic medication. CONCLUSIONS: Patients with temporal lobe epilepsy have a memory impairment though none of the factors to impair memory function in epileptic patients could be identified.

Gelastic Seizures in a Patient with Tuberous Sclerosis / 대한간질학회지

BACKGROUND: Gelastic seizures are characterized by ictal inappropriate sudden laughter as the predominant seizure manifestation. they are very rare and may occur in patients with hypothalamic hamartomas, pituitary tumors, astrocytomas of the mamillary bodies, CNS infection, trauma, and dysraphic condition. CASE: A 21-year-old woman with tuberous sclerosis was admitted due to frequent sudden inappropriate laughter as a seizure manifestation. EEG showed paroxysmal brief generalized 4-5 Hz spike and wave complexes. Brain MRI revealed multiple tubers in the bilateral cerebral cortical areas, right caudate nucleus, and left anterior cingulate gyrus. We tried vigabatrin, but gelastic seizures were not controlled. COMMENT: We report a case of gelastic seizures associated with tuberous sclerosis, which has not previously been reported in Korea.

Asymmetric Asterixis Induced by Phenytoin in a Patient with Thalamic Infarction

Asterixis is an abrupt, brief, arrhythmic lapse of tonically contracting muscles. A 64-year old woman with a left thala-mic infarction showed asymmetric bilateral asterixis after taking phenytoin for the control of thalamic pain. Though thalamic lesion can cause asterixis, her asterixis may have been induced by phenytoin, because it was bilateral and sub-sided after stopping phenytoin. We report an unusual case of asymmetric asterixis induced by phenytoin in a patient with a left thalamic infarction.

Proatlantal Intersegmental Artery Type II Observed in a Patient with Locked-in Syndrome

No abstract available.

Development of Multiple Sclerosis in a Patient with Systemic Lupus Erythematosus

The coexistence of multiple sclerosis (MS) and systemic lupus erythematosus (SLE) is very rare. A 31-years old woman with SLE was admitted because of recurrent optic neuritis. She had positive antinuclear antibody and increased anti-Ro, anti-La and anti-RNP antibodies. T2 weighted MRI showed high signal intensity lesions in left anterior midbrain, internal capsule, and centrum semiovale and corpus callosum. We report a case of multiple sclerosis-like attacks in a patient with SLE.

Stroke Awareness in Korea : The Results of Survey in the Second Stroke Prevention Campaign

BACKGROUND: Assessing public knowledge concerning stroke and its risk factors is the starting point in developing the effective stroke prevention program. The aim of this study was to investigate the awareness of stroke risk factors and factors influencing it. METHODS: All who participated in the second stroke prevention campaign were encouraged to answer the survey. It was performed using a standard questionnaire designed to assess the awareness of stroke risk factors, its correlation with usual demographic characteristics, history of stroke, and self-assessment of stroke risk. The number of established risk factors on an open question estimated the awareness of stroke risk factors. RESULTS: Nationwide 4065 persons took part in the campaign and 43% of them (1749) responded the survey (age=65.4+/-12.2, male=34.2%). A total of 986 responders (56.4%) correctly listed at least one of the established stroke risk factors to open question. Age and schooling were the significant predictors for listing at least one of the established stroke risk factors on multivariate analysis. Number of classic risk factors of stroke in each subject was significantly correlated with self-assessment of stroke risk. Most of the individual risk factors of stroke were also correlated with self-assess-ment of stroke risk but smoking and old age (65 years or more) were not. CONCLUSIONS: This study suggests that the level of stroke risk awareness in Korea is not high, especially among the elderly and the lowly educated. The systematic public education program is warranted.

A Case of Subacute Onset Choreoathetosis as Sequelae of Central Pontine and Extrapontine Myelinolysis

Central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) are recognized complications of hypona-tremia and its overly rapid correction. A 42-year-old woman with uterine cervical cancer had a subacute onset of choreoathetosis on the thirteenth day after a rapid correction of severe hyponatermia. A follow-up brain magnetic reso-nance image (MRI) showed abnormal signal intensity changes in the central pons, putamen, and caudate nucleus. We report an unusual case of central pontine and extrapontine myelinolysis, that presented with choreoathetosis. (J Korean Neurol Assoc 19(4):393~395, 2001)

Changes of Electrocardiogram and Cardiac Enzymes in Acute Ischemic Stroke

BACKGROUND: Cardiac arrhythmias and other cardiac dysfunctions occur in relation with acute cerebral ischemia. This study was undertaken to evaluate the sequential changes of electrocardiogram and cardiac enzymes after acute ischemic stroke, and to evaluate the incidence of cardiac arrhythmias. METHODS: Forty-three patients with acute ischemic stroke were recruited for this study. Electrocardiogram and cardiac enzymes were checked at 1, 3, 5, 7, 15, and 30 days after onset. RESULTS: Heart rates were decreased acutely after ischemic stroke and showed maximal decrease at day 3 (p<0.05). Heart rates were more significantly decreased in the right-sided lesions than the left (p<0.05) and in the supratentorial lesions than the infratentorial (p<0.05). PR intervals and durations of QRS complex were prolonged at day 3 and 5 but were not significant. The prolongation of the QTc interval was found in 21 patients (48.8%) and sustained QTc prolongation at day 30 were seen in 16 patients. Compared with controls, patients showed significantly higher incidence of arrhythmias (p<0.01). Creatine phosphokinase-MB (CK-MB) was significantly increased at day 5 (p<0.01) and lactic dehydrogenase (LDH) was increased at day 7 (p<0.01). CONCLUSIONS: In our study, the incidence of neurogenic cardiac abnormalities in acute ischemic stroke was higher than that of previous studies. Abnormalities peaked at days 3 and 5 were nearly similar to control levels at day 30. These periods of peak abnormalities coincided with those of increasing brain edema. Therefore, we postulate that cardiac autonomic controls are also influenced by acute brain edema. (J Korean Neurol Assoc 19(3):207~212, 2001)

A Case of Reversible Posterior Leukoencephalopathy After Rhabdomyolysis

Reversible posterior leukoencephalopathy is commonly associated with malignant hypertension, toxemia of pregnancy, or treatment with immunosuppressive drugs. A 17-year-old man who was diagnosed with traumatic rhabdomyolysis presented with seizure, visual disturbance, and severe pain in both thighs. Brain MRI revealed multiple areas of cortical and subcortical high signal intensities on T2 weighted images in the bilateral parieto-occipital lobes. He was treated with antihypertensive and anticonvulsant drugs and steroids. Forty days later, a follow-up MRI showed almost complete resolution of the brain lesions. The reversible posterior leukoencephalopathy may be associated with acute hypertension due to rhabdomyolysis-related acute renal failure. (J Korean Neurol Assoc 19(2):163~166, 2001)

A Case of Reversible Posterior Leukoencephalopathy After Rhabdomyolysis

Reversible posterior leukoencephalopathy is commonly associated with malignant hypertension, toxemia of pregnancy, or treatment with immunosuppressive drugs. A 17-year-old man who was diagnosed with traumatic rhabdomyolysis presented with seizure, visual disturbance, and severe pain in both thighs. Brain MRI revealed multiple areas of cortical and subcortical high signal intensities on T2 weighted images in the bilateral parieto-occipital lobes. He was treated with antihypertensive and anticonvulsant drugs and steroids. Forty days later, a follow-up MRI showed almost complete resolution of the brain lesions. The reversible posterior leukoencephalopathy may be associated with acute hypertension due to rhabdomyolysis-related acute renal failure. (J Korean Neurol Assoc 19(2):163~166, 2001)

Subclinical Peripheral Neuropathy in Patients with Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: Symptomatic neuropathy is uncommon in rheumatoid arthritis (RA) but, compression neuropathy and vascular neuropathy were reported in longstanding RA. To investigate the occurrence of electrophysiologically evident peripheral nerve involvement in RA patients without a clinical manifestation of peripheral nerve involvement, we studied nerve conduction velocity study (NCV) in RA patients without symptomatic neuropathy. Twenty-five RA patients were evaluated neurological examination and by NCV. We compared clinical parameters between electrophysiologic positive group and negative group. There was no patient who had neurologic symptoms or signs of peripheral involvement. Eleven patients (44%) of all exhibited NCV findings consistent with distal symmetrical sensorimotor polyneuropathy, 5 patients (20%) had entrapment neuropathy, 2 patients (8%) showed distal symmetrical sensory polyneuropathy, 1 patient (4%) had digital neuropathy, and 6 patients (24%) had normal NCV. CONCLUSION: Patients with RA may have electrophysiologic peripheral nerve damage, even in the absence of clinical evidence of peripheral nerve involvement. There was no correlation with any clinical parameters. The inclusion of electrophysiologic examination of the RA patients is recommended in routine diagnostic procedures.

A Case of Ehlers-Danlos Syndrome Presenting with Neurological Symptoms

Ehlers-Danlos syndrome (EDS) is an inherited connective tissue disorder characterized by fragility of the skin, hyperelasticity of the skin, hyperextensible joints, vascular lesions, easy bruising, and excessive scarring after injuries. Some patients with EDS have neurological symptoms and signs, such as muscular hypotonia, muscular atrophy, spin-ocerebellar tract degeneration, cerebral atrophy, mental retardation, and epilepsy. We report a 16-year-old man who showed mental retardation, hyperelasticity of the skin, joint hypermobility, and muscular atrophy on the bilateral hand muscles. A skin biopsy revealed dermal thickening, a decrease in the density and number of collagen fibrils, distur-bances of the wickerwork pattern, and a disproportional increase in the number of elastic fibers.

Comparison of Fos Protein Expressions Rat Hippocampus Following Single and Repeated Intraperitoneal Administration of Kainic Acid / 대한간질학회지

BACKGROUND:Acute seizures that increase neuronal activity cause a rapid and transient induction of the immmediate early c-fos in specific brain regions. C-fos gene may mediate long-term changes in cell function, such as growth, differeniation, and development, in response to acute extracellular stimulation. This study is designed to compare the expression of Fos protein in hippocampus after single and repeated injections of kainic acid (KA). METHODS:In KA-single injection model, twelve adult male Sprague-Dawley rats were treated with single intraperitoneal injection of convulsive dose(20-30 mg/kg) of KA, and. in KA-multiple injections model, seven rats received KA by repeated daily intraperitoneal injections for 15 days. Eight control rats received normal saline. Expression of Fos protein was tested in hippocampus by immunohistochemical staining, and was scored by the degree of staining intensity and the ratio of stained cells to tested ones. RESULTS:The scores tended to increase in CA3 and dentate gyrus were significantly higher in KA-single injection model than in control (p<0.05). In comparison with scores in KA-model. CONCLUSION:These results show that repeated seizure produces some blockade of c-fos induction in CA2, CA3 and dentate gyrus. This may be a long-term adaptive response by the nervous system to repated neuronal activation