Alcohol-Related Neurologic Disorders: Ten Years of Experiences

Alcohol-related disorders are among the most costly health problems worldwide. Ingested alcohol is mainly metabolized by an oxidative pathway in the liver. Alcohol and its metabolic products (e.g., acetaldehyde and reactive oxygen species) have toxic effects on multiple organs, especially the nervous system. The diverse mechanisms of alcohol-related neurologic disorders include the direct toxic effects of alcohol, the alcohol withdrawal effect, nutritional deficiency secondary to alcoholism, and abnormalities of serum electrolytes and osmolality. We analyzed 156 cases of alcoholrelated neurologic disorders among admitted patients that had been referred in Korea during the previous 10 years. The duration of alcohol consumption ranged from 0.5 to 47 years (mean=17.8 years) and the mean amount of alcohol intake per day was 245.5 g. The 156 patients had the following diseases: Wernicke's encephalopathy (n=81, 51.9%), peripheral neuropathy (n=68, 43.6%), delirium tremens (n=59, 37.8%), Rum fit (n=31, 19.9%), pellagra encephalopathy (n=29, 18.6%), Korsakoff's psychosis (n=22, 14.2%), cerebellar atrophy (n=11, 7.0%), and alcoholic myopathy (n=6, 3.8%). We report on these cases and review the literature on alcohol-related neurologic disorders.

Transient Global Amnesia With Unilateral Hippocampal Lesions and Contralateral Temporal Spikes

Recently, various diagnostic modalities revealed the characteristic abnormalities in transient global amnesia (TGA). We described two TGA patients with focal lesions in the right hippocampus. One patient showed bilateral temporal spike-and-wave on EEG and contralateral temporal hyperperfusion on SPECT. The other exhibited contralateral temporal sharp waves and ipsilateral temporal hypoperfusion. Our patients suggest that bilateral dysfunction of the medial temporal lobe is important for developing TGA. Multimodal diagnostic approach is required to clarify this phenomenon.

Guillain-Barre Syndrome With anti-GM1 and GD1b Antibodies Following Acute Hepatitis A

Guillain-Barre syndrome (GBS) rarely develops following acute viral hepatitis, and there has been no report on the association with anti-ganglioside antibodies. Herein, we report a 36-year-old man who presented with rapidly progressive areflexic quadriparesis following acute viral hepatitis A. The results of nerve conduction study were consistent with demyelinating motor polyneuropathy, and IgG anti-GM1 and anti-GD1b antibodies were positive. Immune responses towards gangliosides may also be important mediators in acute hepatitis A-associated GBS.

Idiopathic Spinal Cord Herniation as a Treatable Cause of Progressive Brown-Sequard Syndrome

Idiopathic spinal cord herniation is a rare spinal cord disorder caused by spinal cord prolapse through a adural defect. It is a curable disease, so early detection is of particular importance. We report a 38-year-old woman with Brown-Sequard syndrome which was caused by the thoracic spinal cord herniation. Her weakness was almost completely resolved after surgical management, which emphasizes the importance of early diagnosis and surgical management in this rare disease entity.

A Case of Acute Colchicine-induced Myopathy with Myotonia in Behcet Disease

Colchicine has been used in the treatment of autoimmune diseases such as Behcet disease. Long-term use of colchicine can cause vacuolar myopathy on rare occasions. We report colchicine-induced myopathy with myotonia in Behcet disease. A 34-year-old man with Behcet disease presented progressive proximal weakness, myalgia, and difficulty in relaxation of grip after increasing the dosage of colchicine. Electrophysiological findings showed myotonic myopathy. Muscle biopsy revealed vacuolar myopathy. His symptoms were resolved with the discontinuation of colchicine.

Comparison of Clinical and Neuroradiological Characteristics between Internal Carotid Artery and Middle Cerebral Artery Occlusive Diseases

BACKGROUND: The relative importance of embolic mechanisms as opposed to hemodynamic factor in the pathogenesis of ischemic strokes associated with atherosclerotic middle cerebral artery (MCA) or internal carotid artery (ICA) disease remains unresolved. We conducted the present study to identify the differences of clinicoradiological patterns between MCA or ICA diseases. METHODS: We defined atherosclerotic disease of MCA or ICA as > 50% stenotic lesions or ulcerative plaques. We divided the patients into groups of MCA and ICA diseases, and analyzed clinical, laboratory, and neuroradiological data. RESULTS: Among the 620 consecutive patients with acute ischemic strokes, 84 (12.9%) patients met the criteria for atherosclerotic MCA or ICA disease: 54 patients with MCA disease and 30 patients with ICA disease. The mean age was younger in patients with MCA than ICA disease (p=0.003). MCA disease clinically more frequently presented with lacunar syndrome (p=0.001). ICA disease more frequently presented with total anterior circulation infarct and had higher initial NIHSS scores than MCA disease (p=0.004 and 0.003, respectively). While whole MCA territorial infarcts were common in ICA disease, deep perforator infarcts were more significantly caused by MCA disease (p< 0.05). MR topographic patterns showed difference between MCA and ICA diseases according to the degree of stenosis (p< 0.05). Cortical dots were significantly accompanied by superficial perforator infarcts than internal borderzone infarcts (p=0.017). CONCLUSIONS: Our present study suggests that clinical and neuroradiological representations might be different between MCA and ICA diseases, which might reflect difference of underlying pathogenesis.

Comparison of Clinical and Neuroradiological Characteristics between Internal Carotid Artery and Middle Cerebral Artery Occlusive Diseases

BACKGROUND: The relative importance of embolic mechanisms as opposed to hemodynamic factor in the pathogenesis of ischemic strokes associated with atherosclerotic middle cerebral artery (MCA) or internal carotid artery (ICA) disease remains unresolved. We conducted the present study to identify the differences of clinicoradiological patterns between MCA or ICA diseases. METHODS: We defined atherosclerotic disease of MCA or ICA as > 50% stenotic lesions or ulcerative plaques. We divided the patients into groups of MCA and ICA diseases, and analyzed clinical, laboratory, and neuroradiological data. RESULTS: Among the 620 consecutive patients with acute ischemic strokes, 84 (12.9%) patients met the criteria for atherosclerotic MCA or ICA disease: 54 patients with MCA disease and 30 patients with ICA disease. The mean age was younger in patients with MCA than ICA disease (p=0.003). MCA disease clinically more frequently presented with lacunar syndrome (p=0.001). ICA disease more frequently presented with total anterior circulation infarct and had higher initial NIHSS scores than MCA disease (p=0.004 and 0.003, respectively). While whole MCA territorial infarcts were common in ICA disease, deep perforator infarcts were more significantly caused by MCA disease (p< 0.05). MR topographic patterns showed difference between MCA and ICA diseases according to the degree of stenosis (p< 0.05). Cortical dots were significantly accompanied by superficial perforator infarcts than internal borderzone infarcts (p=0.017). CONCLUSIONS: Our present study suggests that clinical and neuroradiological representations might be different between MCA and ICA diseases, which might reflect difference of underlying pathogenesis.

Prognostic Value of Parent Arterial Lesions in the Patients with Lacunar Syndrome

BACKGROUND: It is well known that a lacunar infarction has characteristic clinical features and a relatively good prognosis. However, the significance of lesions in the parent artery of patients with lacunar syndrome as regard to the prognosis remains unsettled. METHODS: Using the data of consecutive patients with their first ischemic stroke and were followed longer than 1 year, were divided the patients by their clinical features and the results of the work-up was as follows; (1) mismatching [MM] group; lacunar syndrome and the presence of parent arterial lesion, (2) large artery artherosclerosis [LAD]; non-lacunar syndrome and the presence of parent arterial lesion, (3) no determined etiology [NE]; non-lacunar syndrome without parent arterial lesion, and (4) small artery disease [SAD]; lacunar syndrome without parent arterial lesion. Patients with a potential source of embolism were excluded from this study. The prognosis and recurrence rate of patients with the MM group were compared with those of other groups. RESULTS: A total of 176 patients were included; 56 LAD, 62 SAD, 22 MM and 36 NE groups. An unstable hospital course was more frequently found in LAD than in the other groups. The recurrence rate of the MM group (23%) was significantly higher than that of SAD (2%), but was similar to that of patients with non-lacunar syndrome (LAD 16%, NE 28%). CONCLUSIONS: Among patients with lacunar syndrome, the prognosis of those with parent arterial lesions was different from those without lesions. Therefore, a systematic work up of the stroke mechanism may be important in patients with lacunar syndrome.

Two Cases of Postural Orthostatic Tachycardia Syndrome

No abstract available.

Influenza epidemic in the pediatric patients in Seoul, 1991

Influenza virus culture was performed in 149 patients with influenza-like illness who were admitted or visited to the Department of Pediatrics, Asan Medical Center from january, 1991 to March, 1991. The results were as follows; 1) Of the 149 patients, influenza virus were isolated in the 15 cases. 15 isolates were characterized by the WHO Collaborating Center for influenza: 7 cases were very similar to influenza A/Taiwan/1/86 (H1N1), 1 case was A/Beijing/353/89 (H3N2), 7 cases were B/Guangdon-g/55/89. 2) The age of 15 patients who were confirmed by viral isolation was between 11 months to 10 years. 3) The most common clinical symptoms were fever, vomiting, cough, nausea in deceasing order. 4) Of the total 149 patients, Reye syndrome occured in two patients and myositis occured in one: Influenza A/Taiwan/1/86 (H1N1) virus was isolated in one Reye syndrome patient.