A Case of Status Epilepticus Amauroticus / 대한간질학회지

Ictal blindness is a deficient symptomatology of partial seizure arising from visual cortex and usually short lived. When the blindness is the initial semiology of seizures, epileptic discharge arising from the primary visual cortex is associated. Ictal blindness has been reported in many patients with occipital lobe epilepsy, but prolonged ictal blindness called status epilepticus amauroticus has been reported only in few patients. We report a 45-year-old woman who had suffered prolonged epileptic blindness. The epileptic blindness was accompanied with rapid eyelid blinking and upward turning of head and eyeballs. Motor seizure and mental changes were not occurred. Ictal EEG showed 11-13 Hz repetitive spikes on the right occipital area followed by propagation to ipsilateral temporal area and contralateral occipital area. On T2-weighted MRI, abnormal lesions with high signal intensity were noted within bilateral occipital areas. She had been improved dramatically by loading dose of intravenous phenytoin.

Correlation between Mirror Movements and Recovery of Motor Power in Stroke Patients

BACKGROUND: Mirror movement is common in young children, and it could be seen in normal adults. Several mechanisms including motor pathway reorganization involved in motor recovery after stroke. Motor pathway reorganization has been reported to be a mechanism in several studies of patients with mirror movement. However, the correlation of motor recovery and mirror movement has been debated. We studied the degree of mirror movement in stroke patients compared with a controlled group to look into their relationship. METHODS: Our controls were 50 adults without neurologic symptoms and signs. The hemiparetic group was comprised 94 patients who had incurred unilateral brain lesion: 36 patients were acute stroke patients, 58 patients were chronic stroke patients. Mirror movements were assessed by three different tasks: abduction of thumb, sequential finger tapping, and grasping. We analyzed mirror movements in controls and patients, and tried to find a correlation between the degree of mirror movement and the recovery of motor power in chronic stroke patients. RESULTS: In controls, male exhibited more frequent mirror movement than female at specific tasks, and there was no difference between tasks of right or left hand. In stroke patients, there was more mirror movement in the nonparetic hand than in the paretic one during the movement of contralateral hand. In acute stroke, the frequency of mirror movement had no variability according to the degree of motor power. The recovery of motor power at a late stage was not correlated with the degree of mirror movement. Consclusions: Motor pathway reorganization seems to be insignificant for motor recovery because the degree of mirror movement was not correlated with the recovery of motor power in this study.

A case of spinal epidural lipomatosis associated with phenytoin induced hypothyroidism and obesity

Spinal epidural lipomatosis(SEL) is characteristic by abnormal accumulation of unencapsulated fat in the epidural space, which usually occurred as a complication of longterm steroid therapy or Cushing's syndrome and occasionally in obese patients with no other known etiology. This condition, which may result in devastating neurologic complications has also been reported without exogenous steroid intake. Magnetic resonance imaging is the meet helpful diagnostic means and should be used initially. We describe a case of nonsteroid induced symptomatic SEL associated with phenytoin-induced hypothyroidism and obesity. A 27-year-old woman was hospitalized with inability to walk for 2 months ago. She has back pain in her legs associated with radiating pain. She had a history of myoclonic seizure and treated with phenytoin 300 mg for 8 years. On admission, she shows mild hypothyroidism on thyroid function test. Serum phenytoin level was elevated as to 22.1 ug/ml. On cross sectional MRI, the thecal sac has a striking stellate appearance with three rays emanating from a central core. It produces a trifid shape resembling the letter "Y". Correction of underlying endocrine abnormality with weight reduction instead of decompressive laminectomy can reverse the process. In a obese patient with radicular pain or progressive paralysis, SEL may be the etiologic factor involved.

A case of entrapped temporal horn of lateral ventricle caused by Pseudomonas stutzeri choroid plexitis

Focal ventricular dilatation of the temporal horn caused by an occlusion of the cerebrospinal fluid pathway at the atrium of the lateral ventricle is a form of non communicating hydrocephalus, and this condition is termed as "entrapment of the temporal horn". The choroid plexus is important central nervous system(CNS) structure, but it is often neglected in pathologic and clinical studies of intracranial diseases. Even though choroid plexitis is very rare, it may be occurred as the resultant of CNS infections and primary choroid plexitis can be associated with bacterial, viral, and parasitic etiologies. Some aspects of the neuroimaging findings of this infection mimick those of a intraventricular neoplasms. The most important neoplasms which should be differentiated, are choroid plexus papilloma and carcinoma. Wherem primary neoplasms of the choroid plexus are well known, but primary infections of the choroid plexus (such as choroid plexitis) are not commonly encountered. Pseudomonas stutzeri infections are especially rare as the causative organism of the choroid plexitis and often have serious underlying disease but generally respond well to treatment with antibiotics. We report a 65-year-old female patient with primary choroid plexitis due to Pseudomonas stutzeri and the findings of her brain computerized tomography and magnetic resonance imaging. In conclusion, our case revealed that choroid plexitis may result in ventricular entrapment and mimick intraventricular tumors. Although it is very rare, when a intraventricular mass was observed in imaging studies and combined with signs and symptoms suggesting CNS infection, choroid plexitis should be considered.

Post-Lumbar puncture headache: Does bed rest prevent the post-lumbar puncture headache?

BACKGROUND & OBJECTIVES: It is widely believed that the post-lumbar puncture headache(PLPH) is related to CSF leakage through the dural hole made by needle tract. So it is accepted that PLPH is prevented by at least 4 hour bed rest after lumbar puncture (LP). If bed rest was unneccessary, the administrative and nursing advantages would be obvious,, especially in neurologic units, whereLP has been done frequently. Therefore, we evaluate the incidence of PLPH in the ambulant and bed-rest patients prospectively and compared the incidence difference between two group. METHODS: Eighty-eight patients without preceding headache who were done lumbar puncture for diagnostic purpose were selected prospectively. We compared the incidence of PLPH between the ambulant (50 patients) and bed-rest group (38 patient,) at 6 hour and 24 hours. We also evaluated the effect of the CSF profile (count of RBC and WBC, protein level and opening pressure) on PLPH. RESULTS: The PLPH was found in 11 cases(12.5%) among bed-rest and ambulant groups. The frequency of each group was 8% (3/38) in bed-rest group and 16%(8/50) in ambulant group, but there is no significant difference between two groups (p-vaIue = 0.26). The frequency of PLPH is also not correlated to the CSF profiles; count of RBC and WBC, protein level, and opening pressure. CONCLUSIONS: There is no significant difference between the ambulant and bed rest group in the frequency of the PLPH. We conclude that the bed rest after LP is unnecessary for the prevention of the PLPH.

A case of apraxia of lid opening in Wilson's disease

Apraxia of lid opening is a nonparalytic motor abnormality characterized by difficulty in initiating the act of lid elevation. It has been reported in various extrapyramidal disorders(Parkinson's disease, Huntington's chorea, progressive supranuclear palsy), right middle cerebral infarction and Wilson's disease. We report a case of apraxia of opening in Wilson's disease, 34-year-old man was noted to have resting tremor and voluntary eye opening difficulty. Wilson's disease without Kayser-Fleisher ring was diagnosed by serum Cu, serum ceruloplasmin and liver biopsy. He was treated with D-penicillamine anticholinergics, amantadine, and levodopa.