Encephalopathy Associated with Autoimmune Thyroid Disease Accompanied by Graves' Disease / 대한내과학회지

A patient with encephalopathy associated with autoimmune thyroid disease (EAATD), which is one of the most important differential diagnoses of treatable dementia, presents with various neurological symptoms, such as repetitive epileptic seizures, altered mental status, and cognitive dysfunction. Steroid treatment is effective for EAATD. The incidence of EAATD increases considerably with age, particularly in female patients. Most patients with EAATD have normal thyroid function test results or mild hypothyroidism. Patients with EAATD with Graves' disease are very rarely reported. Here, we report a case of a 63-year-old woman who complained of declining cognitive ability and ataxia. She was diagnosed with EAATD accompanied by Graves' disease. Her neurological symptoms improved after intravenous steroid administration.

Effect of Atorvastatin and Clopidogrel Co-Administration After Coronary Stenting in Korean Patients With Stable Angina

BACKGROUND AND OBJECTIVES: It was reported that atorvastatin co-administered with clopidogrel for 8 months did not affect the anti-platelet potency of clopidogrel in Korean patients with acute coronary syndrome, but not in patients with stable angina. We investigated whether co-administration of statins with clopidogrel affected the anti-platelet efficacy of clopidogrel in Korean patients with stable angina. SUBJECTS AND METHODS: This was a randomized, open-label and two-period crossover design study conducted at two centers. Two hundreds thirty three patients with stable angina scheduled for coronary stenting were randomized into two groups. In Group A, 119 patients first received atorvastatin (10 mg) followed by fluvastatin (80 mg) for 12 weeks per treatment. In Group B, 114 patients received the same treatments in reverse order. RESULTS: Baseline adenosine diphosphate (ADP, 10 micromol/L)-induced platelet aggregation was 54.4+/-9.1% in Group A and 53.8+/-9.0% in Group B (p=0.44), and significant differences were noted after each treatment period (p<0.001). Inhibition of platelet aggregation was similar between Group A and Group B at 24 hours following clopidogrel loading (29.2+/-11.0% vs. 30.4+/-12.7%; p=0.42). The two treatment least square means of 12-week ADP (10 mol/L)-induced platelet aggregation [29.50+/-0.79 {standard error (SE)}% on the atorvastatin treatment group vs. 28.16+/-0.70 (SE)% in the fluvastatin treatment group] in a 2x2 cross-over study were not significantly different (p=0.204). CONCLUSION: Statin and clopidogrel co-administration for 12 weeks is not associated with attenuated anti-platelet activity of clopidogrel in Korean patients with stable angina after coronary stenting, in support of the findings of similar studies conducted in Caucasian populations.

Preliminary Studies on the Clinical Features of Multiple Sclerosis in Korea

BACKGROUND AND PURPOSE: Multiple sclerosis (MS) in Asians is characterized by frequent involvement of the spinal cord and optic nerve and low prevalence rates, but even the most fundamental epidemiologic findings and unique clinical features of MS patients in Korea have not been studied extensively. We performed this study to establish the clinical spectrum of MS patients in Korea. METHODS: Sixty-two MS patients (25 men and 37 women) who satisfied the diagnostic criteria for definite MS were reviewed retrospectively using medical records from two university hospitals and one general hospital. The MS patients were classified into the three clinical subtypes according to the involved site (opticospinal, spinal, and conventional MS). RESULTS: The age at MS onset was 35.2+/-13.3 (mean+/-SD) years, and the predominant initial clinical manifestations were myelopathy (54.8%) and optic neuropathy (33.9%). The single most common involved lesion site was the spinal cord (35.5%). Spinal (35.5%) and opticospinal (25.8%) MS were the most common type, and they had a frequent relapsing-remitting course and long lesions extending over two vertebral segments (as assessed using spinal cord MRI). The interval between the first symptom and relapse was 35.6+/-71.1 months, and the number of relapses was 3.8+/-2.6. The spinal form of MS was associated with a higher age at onset and a higher male-to-female ratio than the other types. Positive rates of CSF oligoclonal bands and IgG index and the number of patients with characteristic brain MRI lesions were low. However, the abnormal rate of visual evoked potentials was relatively high (64.4%). CONCLUSION: The clinical features of MS patients in Korea are different from those in Western patients, but similar to those in Far East Asian patients. The value of the various diagnostic tools used for MS should therefore be reevaluated, at least for Korean patients.

Non-epileptic Events of Paroxysmal Dystonic Choreoathetosis in Two Patients with Cerebral Calcification Due to Hypoparathyroidism

There are diverse neurologic manifestations in patients with idiopathic or pseudohypoparathyroidism. Although one knows that hypocalcemia provokes symptoms of tetany, there is little knowldege about the paroxysmal dystonic choreoathetosis(PKC). We report two patients with paroxysmal symptoms resulting from hypocalcemia associated with idiopathic hypoparathyroidism and pseudohypoparathryoidism respectively, which were misdiagnosed and treated as epilepsy. They showed repetitive paroxysmal dystonic choreoathetotic movements that lasted for several seconds and typically induced by sudden voluntary movement. The ne-uroimaging showed bilateral symmetrical calcifications., mainly in the basal ganglia. In the clinical setting, these types of paroxysmal movements may be readily misdiagnosed as partial seizure or tetany. Therefore, not only the laboratory work up for hypocalcemia, but careful history taking and clinical observation is important in differential diagnosis of epilepsy and paroxysmal movements in the patient with hypocalcemia.

Vascular Risk Factors Related to Stroke Types in Hypertensive Subjects

Hypertension (HT) is a well-known risk factor for stroke, either hemorrhagic or ischernic like small artery disease (SAD) and large artkry territory infarction (LAI). And it sometunes causes both types of stroke in a single patient. We investigated the vascular nsk factors (controlling HT) that nught be related to their stroke types in 307 acute stroke patients with HT: 152 patients with intracerebral hemorrhage (ICH), 77 with SAD, and 78 with LAL These factors were compared between the groups using the univanate statistical methods. The most significant ICH-related factor was the lower serum level of triglyceride, compared to ischemic stroke. And ischemic stroke-rqlated profile included longer duration of HT, smoking, diabetes mellitus(DM), higher level of uric acid. And lower level of HDL-cholesteroL Increased hematocrit, DM and smoking were particularly related to LAI. These findings suggest that a well-balanced control of the above-mentioned risk factors is warranted to prevent future stroke, in addition to strict control of HT. And management of hypertensive stroke patients should be differentiated and individualized a6cording to the coexisting stroke type-related profiles.

A Clinical Study of Hemorrhagic Infarction

Hemorrhagic conversion (HC) of a cerebral infarct is a radiological sign of reperfusion to the infarcted tissue. Recently the concept on HC needs to be revised in relation to advanced therapeutic trials for acute ischeniic strokes. To investigate the clinical significance of HC of a bland cerebral infarct, we analyzed the clinical and neuroimaging files of 70 stroke patients showing HC on the brain CT and/or MRI scans. We also studied the best-possible stroke mechanisms on clinicolaboratory grounds, the factors that might have contributed to HC, and the prognostic impact of HC. Of 70 patients with HC, 51 had infarcts in the carotid artery system, 18 in the vertebrobasilar system, and 1 in cerebral venous system. Definite cardioembolic sources were identified in 21 patients (30%). HC was associated with antithrombotic therapy in 21 patients (30%). Other stroke mechanisms included migraine (23 cases), moyamoya disease (2, cases), thrombotic thrombocytopenic purpura (I case), postoperative vasospasm (1 case), and dural sinus thrombosis (I case). We identified a subset of 14 patients with HC of isolated subcortical infarcts but without definite embolic sources. Sixty-four of 70 patients (91.5%) remained clinically stable or improved after HC, suggesting a relative safety of HC in this retrospective study. In conclusion HC follows cerebral infarctions caused by various non-embolic mechanisms as well as by embolism. HC was not a bad prognostic sign in tl-iis small series.