ABSTRACT
Shigellosis is an acute inflammatory colitis by infection to one of the members of the genus Shigella. It is known that various CNS symptoms including headache and seizure can develop with shigellosis. Encephalopathy with severe brain edema in shigellosis were rarely reported even in children as well as in adults. We report a rare case of acute encephalopathy with shigellosis showing severe diffuse brain edema which resolved rapidly with administration of steroids in an adult.
Subject(s)
Adult , Child , Humans , Brain Edema , Brain , Colitis , Dysentery, Bacillary , Headache , Seizures , Shigella , SteroidsABSTRACT
The incidence of absence and occipital lobe epilepsy appearing in the same young individual is quite rare. A fourteen year-old girl has had two types of recurrent seizures: 1)simple partial seizure with secondary generalization probably originating in the left occipital lobe, and 2)absence seizure. Electroencephalogram demonstrated frequent spikes on the left occipital region with or without bilateral synchronization and generalized 3 Hz spike and wave complexes during hyperventilation procedure and photic stimulation.
Subject(s)
Adolescent , Female , Humans , Electroencephalography , Epilepsies, Partial , Epilepsy, Absence , Generalization, Psychological , Hyperventilation , Incidence , Occipital Lobe , Photic Stimulation , SeizuresABSTRACT
BACKGROUND: High blood pressure (BP) or BP reduction in acute ischemic stroke may be associated with poor outcomes. We investigated the factors associated with BP changes in acute ischemic stroke. METHODS: We examined consecutive ischemic stroke patients having symptom onset within 24 hours. We excluded patients with cardioembolism or stroke of other determined etiology. We assessed initial systolic/diastolic BP and the degree of BP reduction for 3 hospital days. We analyzed the following potential predictors: age, sex, stroke risk factors, severity of neurologic deficits, infarct size, occlusive lesions in the main cerebral arteries, and antihypertensive medication use. RESULTS: 112 patients were evaluated. The initial systolic/diastolic BP was 153/90 mmHg and systolic/diastolic BP reduction was 22/8 mmHg. In multivariate analyses, initial systolic BPs were significantly higher in patients with hypertension (p=0.007), and were negatively associated with prior regular antihypertensive medication use (p=0.018). Initial high systolic and diastolic BPs were strong predictors of systolic and diastolic BP reduction, respectively (p<0.001 and p<0.001). Diabetes mellitus was also an independent predictor of systolic BP reduction (p=0.011). CONCLUSIONS: Initial high BP was significantly associated with high degree of BP reduction in acute ischemic stroke. Acute ischemic stroke patients with diabetes mellitus may show significant systolic BP reduction, which requires further confirmation.
Subject(s)
Humans , Blood Pressure , Cerebral Arteries , Diabetes Mellitus , Hypertension , Multivariate Analysis , Neurologic Manifestations , Risk Factors , StrokeABSTRACT
Microcopic polyangiitis (MPA) is a systemic disorder affecting small vessels. In MPA, the central nervous system involvements have rarely been reported. We experienced a case of MPA with subdural effusion and pachymeningitis in a 50-year-old woman. The diagnosis of MPA was made by the presence of mononeuritis multiplex, hematuria, pachymeningitis, and p-ANCA seropositivity in this patient. Subdural effusion was of exudates and an active suppurative inflammation was observed on the dural biopsy.
Subject(s)
Female , Humans , Middle Aged , Antibodies, Antineutrophil Cytoplasmic , Biopsy , Central Nervous System , Diagnosis , Exudates and Transudates , Hematuria , Inflammation , Meningitis , Microscopic Polyangiitis , Mononeuropathies , Subdural EffusionABSTRACT
Sweet's syndrome, or acute febrile neutrophilic dermatosis, is an unusual disease characterized by fever, leukocytosis, and distinctive skin lesions. Common complications include arthralgia, arthritis, conjunctivitis, and iridocyclitis. However, the involvement of the central nervous system in this disease, termed `neuro-Sweet syndrome' is rarely reported. We present a patient with recurrent encephalitis for 15 years, accompanied with neutrophilic dermatosis, and characterized by HLA-B54 and Cw1, with good responsiveness to corticosteroid.
Subject(s)
Humans , Arthralgia , Arthritis , Central Nervous System , Conjunctivitis , Encephalitis , Fever , Iridocyclitis , Leukocytosis , Neutrophils , Skin , Skin Diseases , Sweet SyndromeABSTRACT
Osmotic myelinolysis syndrome in central nervous system is classified into central pontine myelinolysis(CPM) and extrapontine myelinolysis(EPM). The former can cause a spastic quadriplegia, pseudobulbar palsy, and varying degree of mental disorder, but the latter a movement disorder(tremor, dystonia, parkinsonism, and chorea, etc), behavior change(mood instability, personality change, agitated delirium, and disinhibition, etc), and cognitive dysfunction. Although a few cases of asymptomatic CPM have been reported, asymptomatic EPM were rare. A 67-year-old woman with diabetes mellitus and old cerebral infarction has suffered from the common bile duct stone. She had hyponatremia(Na=126mEq/L) on admission and was corrected rapidly. Incidental findings of her brain MRI showed EPM. We experienced a case of bilateral middle cerebellar peduncle myelinolysis incidentally without neurological presentations and report a rare case of asymptomatic EPM recoverd in diabetic woman after rapid correction of hyponatremia.
Subject(s)
Aged , Female , Humans , Brain , Central Nervous System , Cerebral Infarction , Chorea , Common Bile Duct , Delirium , Diabetes Mellitus , Dihydroergotamine , Dystonia , Hyponatremia , Incidental Findings , Magnetic Resonance Imaging , Mental Disorders , Myelinolysis, Central Pontine , Parkinsonian Disorders , Pseudobulbar Palsy , QuadriplegiaABSTRACT
BACKGROUND AND OBJECTIVES: Otitis media, with effusion has been known to require long term medical treatment. When medical treatment fails, myringotomy with or without ventilation tube insertion needs to be performed, but the duration of middle ear ventilation with myringotomy is very limited. The insertion of ventilation tubes may also cause some complications, and may require general anesthesia when performing at a young age. The purpose of this report is to see if myringotomy using CO laser can be used as an effective tool in the treatment of otitis media with effusion. MATERIALS AND METHODS: We retrospectively studied 66 ears of patients who went through myringotomy using CO laser between March, 1998 and May, 1999. We analyzed myringotomy size, patency time, recurrence and cost effectiveness. RESULTS: The average size of myringotorny was 2.1 mm in diameter. It remained patent for as long as 1.9 weeks in average. All myringotomy sites were healed without persistent perforations. Average recurrence rate and time were 27% and 3.2months, respectively. The medical treatment is expensive and needs more frequent follow-ups, but laser treatment is cheaper and requires less frequent follow-ups. CONCLUSIONS: CO laser myringotomy is a safe and cost effective procedure which can be done easily at the office in most of the cases.
Subject(s)
Humans , Anesthesia, General , Cost-Benefit Analysis , Ear , Follow-Up Studies , Middle Ear Ventilation , Otitis Media with Effusion , Otitis Media , Otitis , Recurrence , Retrospective Studies , VentilationABSTRACT
BACKGROUND: Chronic suppurative otitis media is one of the most common disease in the otolaryngologic field. It is important to choose of antibiotics in the management of chronic suppurative otitis media. OBJECTIVES: Bacteriologic studies can make it possible to use appropriate antibiotics. MATERIALS AND METHODS: The bacteriologic study was made on 98 cases of chronic suppurative otitis media who visited the department of otolaryngology, Dae Dong Hospital in Pusan from Nov. 1989 to Dec. 1995 and the following results were obtained. RESULTS: 1) In 90 cases in which pathogenic organism was isolated, single infection was 81 cases(90%) and mixed infection was 9 cases(10%). 2) The most frequent pathogenic organism was Staphylococcus(46.5%) and Proteus(16.1%), Pseudomonas(14.1%), Providencia(10.1%) were the next. 3) In the aspect of the sensitivity to antibiotics, Ciprofloxacin, Ceftriaxon and Amikacin were sensitive drug generally. 4) Staphylococcus was sensitive to Vancomycin and Ciprofloxacin. 5) Proteus was sensitive to Amikacin, Ciprofloxacin, and Ceftriaxon. 6) Pseudomonas was sensitive to Ciprofloxacin, Amikacin and Piperacin. 7) Providencia was sensitive to Ciprofloxacin, Ceftriaxon, Amikacin and Piperacin. 8) Methicillin Resistant Staphylococcus Aureus(MRSA) was 19 Strains(45.5%). CONCLUSION: Recently, pathologic strain and it's sensitivity to antibiotics has changed. So, we recommand that periodic bacteriologic study and sensitivity test should be done for effective management of chronic otitis media.
Subject(s)
Amikacin , Anti-Bacterial Agents , Bacteriology , Ceftriaxone , Ciprofloxacin , Coinfection , Methicillin Resistance , Otitis Media , Otitis Media, Suppurative , Otolaryngology , Proteus , Providencia , Pseudomonas , Staphylococcus , VancomycinABSTRACT
BACKGROUND: Herpes zoster oticus is a reactivation of latent varicella-zoster infection associated with otalgia, vesicle, facial nerve palsy, sensorineural hearing loss & vertigo. Facial paralysis is rapid in onset, usually severe in degree, and poor in prognosis. OBJECTIVES: To evaluate the treatment and prognosis of Herpes zoster oticus. MATERIALS AND METHODS: Retrospective study of 12 cases of Herpes zoster oticus from May 1992 to February 1996, which had been treated with acyclovir and steroid was done. RESULTS: All patients had otalgia, vesicle and facial palsy. All patients had been treated with adequate dosage of prednisolone & acyclovir. The complete recovery rate from facial palsy was 58%. CONCLUSION: Factors predicting good prognosis are as follows. 1) low degree of facial palsy on admission 2) delayed onset of facial palsy from initial symptom 3) early treatment for facial palsy 4) electrical test: Nerve excitability test(10%).