A Case of Tonic Spasm Presenting as Sole Manifestation of Multiple Sclerosis

A young woman developed a hemilateral tonic spasm associated with multiple sclerosis. Her symptoms included brief recurrent episodes of abnormal, often painful, posturing of one or more extremities without alteration of consciousness. An area of demyelination in the contralateral cerebral peduncle was observed on a magnetic resonance imaging. The tonic attacks abated with carbamazepine therapy. The pathophysiology may involve ephaptic transmission between demyelinated fibers in acute plaques within the corticospinal tract secondary to axonal irritation by lymphokines. (J Korean Neurol Assoc 19(2):167~169, 2001)

A Case of Tonic Spasm Presenting as Sole Manifestation of Multiple Sclerosis

A young woman developed a hemilateral tonic spasm associated with multiple sclerosis. Her symptoms included brief recurrent episodes of abnormal, often painful, posturing of one or more extremities without alteration of consciousness. An area of demyelination in the contralateral cerebral peduncle was observed on a magnetic resonance imaging. The tonic attacks abated with carbamazepine therapy. The pathophysiology may involve ephaptic transmission between demyelinated fibers in acute plaques within the corticospinal tract secondary to axonal irritation by lymphokines. (J Korean Neurol Assoc 19(2):167~169, 2001)

Mortality Rate and Early Prognostic Factors In Patients With Severe

BACKGROUND & OBJECTIVES: Severe hemispheric infarction(SHI) reportedly has various range of high mortality. Recently it has been reported that more aggressive therapeutic intervention, such as decompressive hemicraniectomy or mild hypothermia might has potential benefits in the management of SHI. However, the mortality and the prognosis of Sill under the conservative treatment were rarely studied yet in Korea. METHODS: Sixty-six patients with CT proven SHI were subjected among 1649 acute stroke patients registered at the Hallym Stroke Data Bank since Jan. 1993. We analyzed the computerized databases for the mortality and compared inclusively demographic features, clinical characteristics, etiology, therapy modalities and CT findings of fatal group with those of survivors. RESULTS: Twenty-five patients were expired among 66 SI-il patients(mean age: 64.9+/-11.5, male to female ratio;37:29). The mean time to expire was 160.4 hours. The fatal group had a significantly higher incidence of cardioembolism. uncontrolled BP during the acute stage, and extensive infarction territory(MCA+ACA). Risk factors for ischemic stroke such as hypertension, hyperlipidemia. smoking, previous stroke history, diabetes mellitus. and old age were not related to mortality low densities and hyperdense MCA signs on brain imaging were not different between two groups. CONCLUSIONS: The early mortality rate of Sill under the conservative care was 38% in a referral hospital of Korea. intractable hypertension in the acute stage, cardioembolism and extent of infarct area may have predictable values of early mortality of SHI.

Consecutive Reversible Changes of Peripheral Nerve Conduction in Tetrodotoxification

Tetrodotoxin (TTX) cause neurologic dysfunction by blocking the voltage-gated sodium channels located in all of the peripheral nerves and muscles. We experienced two patients presenting with generalized motor weakness after ingestion of pufferfish. The nerve conduction study showed diffuse slowing of motor and sensory nerve conduction velocity, prolonged motor terminal latency and decreased sensory nerve action potentials without temporal dispersion or conduction block. Abnormal findings of nerve conduction study improved rapidly without any deterioration. Clinical symptoms and signs ameliorated in accordance with findings of nerve conduction study without any neurologic sequelae. These imply that tetrodotoxication is reversible and functional neurologic disorder. We suggest that nerve conduction studies can be available in serial monitoring of tetrodotoxication as an objective means.