Risk Factors of Cerebral White Matter Change in Patients with Stroke

BACKGROUND: Cerebral white matter change (WMC) is usually seen in stroke patients. This study was aimed at determining whether there might be a relationship between the extent of WMC and whether to control hypertension or not and the frequency of previous stroke lesion. Stroke subtypes were also analyzed to elucidate WMC distribution. METHODS: We investigated demographic features, vascular risk factors, subtypes, and WMC in 339 ischemic stroke patients over forty years of age who had brain MRI from the Hallym Stroke Registry between January 1998 and December 2001. In hypertension, it was divided into with therapy and with no therapy. In frequency of previous stroke lesion, we subdivided the patients into three groups by number of frequency: 0, 1, and >or=2. Stroke subtypes were classified into large artery atherosclerosis (LAA), small artery occlusion (SAO), cardioembolism (CE), and stroke of undetermined etiology (SUE). WMC was quantitatively estimated by subdividing into 5 grades (0~IV). RESULTS: Age, female, hypertension, previous stroke lesion, and SAO correlated significantly with prevalence of WMC (p0.05). In previous stroke lesion, it showed significant difference between 0 and (1 and >or=2) (por=2 (p<0.001). In subtype, CE also correlated significantly with prevalence of WMC as well as SAO than LAA (p<0.001). CONCLUSIONS: WMC seen in patients with stroke is related with small-vessel disease and is mainly affected by age, female, hypertension, and previous stroke lesion.

Seizures in Chronic Alcoholics / 대한간질학회지

PURPOSE: Seizures constitute one of the most frequent medical complications in alcoholics. The purpose of this study is to elucidate clinical characteristics of seizures in chronic alcoholics. METHODS: Subjects were 50 alcoholics with seizure who were admitted to Kang-Dong Sacred Heart Hospital between Jan. 1999 to May. 2002. We classified them into alcohol withdrawal seizure (AWS) and alcohol related seizure (ARS). AWS was defined as 1) seizures occur within 72 hrs after the last alcohol intake and 2) occurring in the patients without focal abnormalities on brain CT and EEG. ARS was defined as 1) seizures occurring more than 72 hrs after the last alcohol intake, 2) occurring regardless of onset-time in the patients who had concomitant focal brain lesions or focal abnormalities on EEG, and 3) occurr in patients who had experienced seizure unrelated with alcohol. Their clinical, electrophysiologic and neuroradiologic features were analyzed. RESULTS: 45 patients (90%) were male. Mean age was 47 years. 48 patients (96%) were presented with generalized tonic-clonic seizure. 28 patients (56%) were classified into AWS and 22 (44%) into ARS. Mean age was 46 years in patients with AWS and 54.9 in ARS (p=0.04). Mean duration of alcohol intake was 17 years in AWS and 26.2 in ARS (p=0.002). Mean amount of alcohol intake (yrs x bottles/day) were 30.3 in AWS and 42.0 in ARS (p=0.061). EEG showed diffuse slowing in 5 of AWS, sharp waves in 4 of ARS, focal slowing in 3 of ARS and PLEDs in one of ARS. Among 28 patients with AWS, only one patient was treated with long term antiepileptic drugs (AED). Among 22 ARS, 14 (64%) patients were treated with long term AED. One patient of each group experienced recurrent seizure during follow up. Delirium tremens was developed in 17 patients (34%). Among them, 13 (76%) had alcoholic liver disease (p=0.036). CONCLUSIONS: Our study suggests that patients with ARS were older and drunk more for a longer period of time than patients with AWS. Long term AED administration may be required to prevent recurrent seizures in patients with ARS. On the other hand, delirium tremens may be significantly associated with alcoholic liver disease.

A Case of Recurrent Tolosa-Hunt Syndrome

Tolosa-Hunt syndrome (THS) is a clinical syndrome of painful ophthalmoplegia associated with an idiopathic inflammation in the superior orbital fissure or cavernous sinus. We report a 61-year-old woman with recurrent THS. She had been treated with steroids for the painful ophthalmoplegia. After a symptom-free period, she developed similar symptoms. The postcontrast brain MRI showed increased signal in the cavernous sinus, which was also seen in the previous MRI.

Diffuse Signal Changes in Corpus Callosum after Decompression Surgery of Hydrocephalus

Wide spread MR signal changes in the corpus callosum can occur after shunt operation in patients with hydrocephalus. Although the mechanism of these signal changes remains unclear, neural compression caused by active hydrocephalus and changes of conditions after shunt operation may contribute to the development of these changes. We present a patient who underwent successful ventriculo-peritoneal shunt operation for hydrocephalus and had diffuse signal changes in the corpus callosum in MR images taken 2 years after the surgery.

A Case of Kennedy Syndrome Mimicking Myasthenia Gravis

Patients with Kennedy syndrome, which progresses more slowly than amyotrophic lateral sclerosis show a mild degree of motor fluctuation but rarely show significant decremental responses to repetitive nerve stimulations. Even in a patient with decremental responses to repetitive nerve stimulations, there is usually no significant improvements in motor symptoms to anticholinesterases. We experienced a patient with Kennedy syndrome, who showed significant decremental responses to repetitive nerve stimulations and a marked degree of motor fluctuation. His motor fluctuation responded dramatically to anticholinesterase. (J Korean Neurol Assoc 19(5):544~546, 2001)