Magnetic resonance imaging features of syringobulbia in small breed dogs

Syringobulbia is a rare neurological disorder characterized by a fluid-filled cavity in the brainstem. In this study, clinical signs, features on magnetic resonance imaging (MRI), and the diseases present concurrently with syringobulbia were investigated in 33 small breed dogs. Most dogs (97%) had concurrent syringomyelia, and some dogs (24%) presented with vestibular or cranial nerve symptoms associated with the medulla oblongata. MRIs revealed slit-like, bulbous, and vertical linear shapes of the cavities on T2-weighted hyperintense and T1-weighted hypointense signals similar to the cerebrospinal fluid. Chiari-like malformations were identified in all dogs. This study highlights the association of syringobulbia with syringomyelia and Chiari-like malformations in small breed dogs with or without brainstem-associated clinical signs.

Multiple Cerebral infarction Associated with Heat Stroke

Heat stroke is a condition of severe heat injury characterized by hyperthermia, multiorgan failure and central nervous system dysfunction. A 79-year-old woman was brought to our hospital in a semicomatose state. She was found lying unconscious on her house yard at a hot summer day. Her body temperature was 40.3°C. Laboratory findings were consistent with multiorgan failure and rhabdomyolysis. Brain magnetic resonance imaging showed multifocal infarctions in the bilateral basal ganglia, cerebellum, and occipital lobe. Despite cooling therapy and supportive treatment, her mentality was not recovered. This case suggests that multiple cerebral infarction may occur as a complication of heat stroke and prompt treatment is crucial.

Migrainous Infarction with Adjacent Cortical Enhancement

A 26-year old woman developed left homonymous superior quadrantanopia followed by severe pulsating headache with vomiting. Thereafter, she experienced recurrent left hemiparesis and paresthesia with or without headache. Brain magnetic resonance imaging showed diffusion restriction in the territory of the right posterior cerebral artery and contrast enhancement in the right lingual gyrus adjacent to the diffusion-restricted region. This case suggests an occurrence of cerebral infarction and blood-brain barrier disruption associated with migraine with aura.

Migrainous Infarction with Adjacent Cortical Enhancement

A 26-year old woman developed left homonymous superior quadrantanopia followed by severe pulsating headache with vomiting. Thereafter, she experienced recurrent left hemiparesis and paresthesia with or without headache. Brain magnetic resonance imaging showed diffusion restriction in the territory of the right posterior cerebral artery and contrast enhancement in the right lingual gyrus adjacent to the diffusion-restricted region. This case suggests an occurrence of cerebral infarction and blood-brain barrier disruption associated with migraine with aura.

Ventriculitis Associated with Liver Abscess Caused by Klebsiella Pneumoniae

Klebsiella pneumoniae has been recognized to cause an invasive syndrome characterized by liver abscess and its metastatic infection. The characteristics of metastatic infection involving the central nervous system in this invasive syndrome are poorly understood. The authors report an 84-year-old woman with diabetes mellitus who developed liver abscess caused by K. pneumoniae, complicated with ventriculitis. The patient died despite the antibiotic treatment. Ventriculitis is a rare CNS complication of K. pneumoniae invasive syndrome and requires prompt diagnosis for the appropriate treatment.

Posterior Reversible Encephalopathy Syndrome in a Patient with Systemic Lupus Erythematosus and Systemic Sclerosis Overlap Syndrome

Posterior reversible encephalopathy syndrome (PRES) is characterized by neurotoxic symptoms and neuroimaging finding of reversible cerebral edema in association with various conditions including hypertension, eclampsia, and autoimmune diseases. The author experienced a 47-year-old woman with systemic lupus erythematosus and systemic sclerosis overlap syndrome who developed PRES. The patient presented with alteration of consciousness in association with hypertension and increased autoimmune activity. Magnetic resonance imaging revealed vasogenic edema in the bilateral cerebral cortex, subcortical white matter, basal ganglia, brainstem, and cerebellum.

Strategic Infarct Dementia Caused by Anterior Corona Radiata Infarction

A 79-year-old woman experienced the sudden onset of cognitive impairment that interfered with her activities of daily living. A neurological examination revealed no focal neurological deficits. Brain magnetic resonance imaging showed an acute infarction in the left anterior corona radiata, and neuropsychological tests revealed attention deficit, verbal memory impairment, and frontal executive dysfunction. This case suggests that a focal infarction affecting the anterior portion of the corona radiata can cause a strategic infarct dementia that predominantly manifests as frontal lobe dysfunction.

Cerebral Infarction Followed by Hemorrhagic Transformation Accompanied by Carbon Monoxide Poisoning

Carbon monoxide poisoning causes hypoxic brain damage with various neurological complications. Cerebral hemorrhagic infarction has rarely been reported as a complication of carbon monoxide poisoning. The author experienced a patient who developed cerebral infarction in the striatocapsular area extending to the corona radiata after carbon monoxide poisoning, which was followed by hemorrhagic transformation associated with neurological deterioration.

Predictors for Early Neurological Deterioration in Lacunar Infarction

BACKGROUND: Patients with lacunar infarction often show neurological deterioration during the acute period of stroke. The aim of this study was to identify the predictors for early neurological deterioration (END) in patients with lacunar infarction using clinical variables and the findings of diffusion-weighted imaging (DWI). METHODS: This study involved 104 consecutive patients with acute lacunar infarction in the lenticulostriate artery territory who were admitted within 24 hours after onset between January 2010 and October 2014. END was defined as a decrease of > or =1 point in the National Institutes of Health Stroke Scale (NIHSS) motor score or > or =2 points in the total NIHSS score during the first 7 days after stroke onset. Clinical characteristics including initial NIHSS score, vascular risk factors, laboratory parameters, and DWI findings including the size, location, and shape of the lacunar infarction were evaluated to identify predictors for END. RESULTS: END occurred in 25 (24%) patients with lacunar infarction. The initial NIHSS score (odds ratio, 1.47; p=0.01), number of infarct slices (odds ratio, 1.95; p<0.01), and infarction with an irregular shape (odds ratio, 2.87; p=0.048) were independently associated with END in multivariable logistic regression analysis. In receiver operating characteristic curve analysis, the best threshold for predicting END was an NIHSS score of 4 points (sensitivity, 72%; specificity, 68%) and an infarct slice number of 3 (sensitivity, 84%; specificity, 62%). CONCLUSIONS: This study suggests that the initial NIHSS score, number of infarct slices, and an irregular lesion shape are independent predictors for END.

Oromandibualr Dystonia Associated with Diabetic Hyperglycemia

Oromandibular dystonia (OMD) is a focal dystonia that is characterized by repetitive or sustained spasms of the masticatory, facial, or lingual muscles. The etiology is idiopathic in most cases. A patient presenting with OMD associated with diabetic hyperglycemia is reported herein. A 74-year-old woman with a history of diabetes developed OMD. Brain MRI revealed a high signal intensity in the bilateral putamen on T1-weighted imaging. Nonketotic hyperglycemia was detected. The OMD gradually subsided with normalization of the hyperglycemia and medication with haloperidol over 10 days.

Sick Sinus Syndrome Mimicking Complex Partial Seizure

No abstract available.

Selective Gray Matter Infarction in the Basal Ganglia Associated With Transient Ischemic Attack

Selective gray-matter involvement has been recognized in global cerebral ischemia, but is not readily acknowledged to occur in focal ischemic stroke. The author reports two patients with acute infarcts that selectively affected the gray matter of the basal ganglia among the striatocapsular areas, but spared the white matter of the internal capsule. The clinical manifestation was transient ischemic attack in both patients. The observations indicate that selective gray-matter injury can occur following focal ischemia under a certain condition of transient ischemic attack.

Cefepime-Induced Reversible Encephalopathy with Triphasic Waves in Patients with Impaired Renal Function / 대한간질학회지

Cefepime is a widely used beta-lactam antibiotic. We first report two cases of cefepime-induced reversible encephalpathy in Korea. Two patients with renal impairment presented stupor while being treated with cefepime for pneumonia, one of whom also developed myoclonus and asterixis. Their electroencephalogram showed triphasic waves despite of normal liver function. After discontinuation of cefepime, they completely recovered with normalization of electroencephalogram. Early recognition of cefepime-induced encephalopathy and immediate withdrawal of cefepime would be important for the prognosis of the patients.

Isolated Trigeminal Neuropathy Caused by Pontine Infarction

No abstract available.

Comparison of the Clinical Course of Ischemic Stroke Depending on the Stroke Subtypes

BACKGROUND: There is still scarce information on the clinical course and prognosis in acute stroke patients with different etiologies. METHODS: We studied 464 patients with acute ischemic stroke within 24 hours of onset. Patients were assigned to 5 stroke subtypes based on the TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria with slight modification: small vessel occlusion (SVO, 30%), large artery atherosclerosis (LAA, 29%), cardioembolism (CE, 23%), stroke of two or more etiologies (STM, 12%), and stroke of undetermined etiology (SUD, 7%). The NIH Stroke Scale was used to assess the neurological status at day 0, 1, 3, 7, 14, and 28 after admission. The neurological deterioration and improvement at the examination period and the extent of recovery at one month were evaluated in different stroke subtypes. RESULTS: Most of the neurological deterioration occurred within 7 days after stroke, most frequently in LAA (30%), followed by STM (24%) and SVO (17%), and least frequently in CE (13%) and SUD (10%). In contrast, the temporal profile of neurological improvement was not different between subtypes. Patients with good recovery were most common in SVO (64%), whereas those with no recovery were most common in LAA (22%) and STM (28%). CONCLUSIONS: The clinical course was different according to stroke etiologies. Patients with LAA and STM experienced more frequent neurological deterioration and poorer recovery. SVO was associated with milder stroke and better recovery. CE and SUD caused severe neurological deficit, but lead to less frequent neurological deterioration and favorable recovery.

Episodic Ataxia Type 2 with Downbeating Nystagmus Caused by Mutation in the CACNA1A: A Case Report

Episodic ataxia type 2 (EA 2) is a rare disorder characterized by intermittent episodes of ataxia with interictal nystagmus. The authors report a patient with EA 2, who presented with recurrent episodes of vertigo, gait ataxia and interictal downbeat nystagmus, which had developed about 16 years before. The chromosomal analysis revealed a translocation between chromosome 7 and chromosome 19 (t(7;19)). The break point in chromosome 19 was the P13 locus of the CACNA1A gene.

Argatroban Treatment in Acute Ischemic Stroke: Multicenter, Randomized, Aspirin-Controlled Study

BACKGROUND: Argatroban, a direct thrombin inhibitor, has been suggested to be beneficial in acute ischemic stroke by preventing microthrombi formation. The aim of this multicenter, aspirin-controlled, randomized trial is to determine the safety and the efficacy of argatroban compared with aspirin in acute ischemic stroke. METHODS: The patients within 48 hours of noncardioembolic ischemic stroke were recruited from 8 centers. Argatroban was infused continuously at 2.5 mg/hr for the first 48 h, and then 10mg of argatroban was infused over 3 h twice a day on days 3-7. Control group received aspirin 300 mg/day for 7 days. The primary outcome was the NIHSS at 30 days and the secondary outcome was Barthel index (BI) and modified Rankin scale (mRS) at 90 days. The safety was evaluated by the incidence of bleeding complication. RESULTS: A total of 236 patients (123 for argatroban and 113 for aspirin) were included. NIHSS at 30 days, BI at 90 days and mRS at 90 days did not show significant difference between the argatroban and the aspirin group (3.1 +/- 3.1 vs 3.5 +/- 3.0, 88.9 +/- 22.5 vs 86.2 +/- 23.8, 1.4 +/- 1.1 vs 1.6 +/- 1.3, p>0.3, respectively). Post hoc analysis revealed that as for the patients who were treated within 24 hours after onset, numbers of patients with NIHSS=1 at 30 days were larger in the argatroban group (23 of 49) than in the aspirin group (10 of 40) (p=0.03). Bleeding complication was not different between the two groups (2 of 123 vs 0 of 113: p>0.4). CONCLUSIONS: Argatroban treatment is relatively safe in acute ischemic stroke. The efficacy of argatroban is not superior to aspirin. However, argatroban may be more beneficial in some subgroup of stroke patients than aspirin.

Forntal Lobe Epilepsy Presenting with Blinking and Leg Jerking

Eye blinking is a rare semiology in frontal lobe epilepsy. However, eye blinking with leg jerking as a manifestation of simple partial seizure has not been reported. We report a patient with frontal oligodendroglioma who showed simple partial seizure presenting with eye blinking and leg jerking.

Change of the Balance Function with Aging: Computerized Dynamic Posturography Study

BACKGROUND: The purpose of this study is to evaluate balance functions as one ages using the values of the sensory organization test (SOT) and the motor control test (MCT) of computerized dynamic posturography (CDP) in healthy Korean adults. METHODS: We studied the equilibrium scores of the SOT and weight symmetries, latencies, and adaptation scores of the MCT in 72 healthy Korean adults. Subjects were divided into three age groups, the 30's (young group), 50's (middle-aged group), and 70's (elderly group). RESULTS: In the SOT, the range of mean equilibrium scores was from 69.8 to 94.2 in the 3rd decade group, 62.6 to 93.8 in the 5th decade group, 59.2 to 91.2 in the 7th decade group. In the MCT, during sudden anterior and posterior perturbations, the weight symmetries were 101.1 +/- 7.5 in the 3rd decade group, 103.6 +/- 6.9 in the 5th decade group, and 106.4 +/- 9.4 in the 7th decade group. The mean latencies were 123.6-132.8 msec in the 3rd decade group, 130.5-138.5 msec in the 5th decade group, 132.7-141.8 msec in the 7th decade group. CONCLUSIONS: Almost all measures of balance were significantly worse in the elderly group compared with the young group and some changes of balance were observed in the middle-aged group as well. These significant age-associated declines of balance function suggested the decreased capacity to process sensory inputs in aged persons. This occurs most likely as a result of biomechanical or central processing changes.

Hyperventilation Induced Nystagmus in Patient with Vestibular Schwannoma : A Case Report

When doctors evaluate the complaints of dizziness, they often perform a series of clinical tests to look for the evidence of a vestibular dysfunction. A useful procedure is to ask the patient to take deep breaths and observe the gaze behind Frenzel goggles. If hyperventilation-induced nystagmus(HIN) is detected, it is the evidence for an underlying vestibular imbalance. The authors evaluated nystagmus with electronystagmography after hyperventilation for 50 seconds. Brain imaging was performed to search the responsible lesion for dizziness. Brain MRI revealed a brain tumor suggesting vestibular schwannoma in the left cerebellopontine angle. After hyperventilation, dizziness and the right beating horizontal nystagmus with Alexander law could be detected. By precisely measuring the HIN, we determined that inputs arising from the horizontal semicircular canal were mainly responsible. The contralaterality of the direction of the horizontal component of the nystagmus was detected. We suggest that clinicians should routinely check the nystagmus after hyperventilation, when they evaluate patients complaining of dizziness.