A Case of Isolated Aspergillus Sphenoid Sinusitis

Isolated Aspergillus infection originating within the sphenoid sinus is most often associated with the immunocompromised patient. A 53-year-old healthy woman presented with a 3-week history of headache and subsequent left 6th nerve palsy. Brain MRI demonstrated a space-occupying lesion within sphenoid sinus. Histological analysis through transnasal-transsphenoidal approach revealed numerous Aspergillus hyphae. Postoperatively, all symptoms resolved completely without anti-fungal treatment. Isolated Aspergillus sphenoid sinusitis should be routinely included in the differential diagnosis of patients with acute or subacute headache, even in nonimmunosuppressed patients.

Early Diagnosis of Acute Ischemic Stroke by Using 16 row Multi-slice Computed Tomography

PURPOSE: Conventional spiral computed tomography (CT) has a limitation in the diagnosis of the early phase of cerebral ischemia because ischemic signs may be subtle or even not detectable. The authors carried out this study in order to determine the value of 16 row multi-slice CT (MSCT) in the clinical study of patients with acute stroke. METHODS: Between June 2002 and May 2003, we performed MSCT on 18 consecutive patients who presented within 6 hours of onset of signs and symptoms suggesting stroke. We used an imaging protocol with 3 components, noncontrast CT, perfusion CT, and CT angiography, to evaluate hyperacute stroke patients. In order to evaluate it' s validity, we compared MSCT with MRI. RESULTS: Perfusion parameter maps such as cerebral blood flow, cerebral blood volume, and time to peak showed perfusion deficits in 14 of 18 patients. Perfusion deficits in two patients with brain stem infarcts and in one patient with a lacunar infarct were missed. Hemispheric territorial infarcts were diagnosed with a sensitivity of 93% (14 of 15 patients). MSCT has a significantly shorter interval between the patient's arrival and taking an image (23.1+/-13.3 vs 52.7+/-21.8 minutes, p=0.0001) and a significantly shorter scanning time (13.7+/-2.5 vs 26.8+/-11.2 minutes, p=0.0003) than MRI does. CONCLUSION: In hyperacute stroke, MSCT not only allows early detection of cerebral ischemia but also yields valuable information about the extent of perfusion disturbances. Compared with MRI, MSCT is a more readily available, less time consuming procedure. MSCT may help in therapeutic decision-making if perfusion and diffusion-weighted MRI are not available or cannot be performed on specific patients.

A Case of Postpartum Cerebral Angiopathy Following Ergot Alkaloid Medication

We report a 32-year-old woman who developed an altered consciousness and quadriparesis three days after ingesting an ergot alkaloid derivative to suppress lactation. Brain MRI showed extensive cerebral infarction in the posterior circulation territory with multifocal vasoconstriction in the intracranial vessels including both the middle cerebral arteries. Extensive studies for stroke etiology are negative. Follow-up MRA and serial TCD studies revealed that reVersible vasospasm was the mechanism. This case is additional evidence that ergot derivatives may lead to postpartum cerebral angiopathy.

Diffusion Weighted Magnetic Resonance Imaging in a Patient with Acute Wernicke Encephalopathy

We report a case of acute Wernicke encephalopathy in which diffusion-weighted imagings (DWI) revealed symmetrical high signal intensities in the medial thalamus, bilateral hemispheres of the cerebellum and periaqueductal gray matter. Calculation of the apparent diffusion coefficient demonstrated a mildly decreased diffusion on the affected regions. The high signal lesions were slowly resolved on the acute phase follow-up images with the administration of thimaine. We propose DWI should be included in the imaging protocols of patients suspected to suffer from Wernicke encephalopathy.

Relationship of Biological Indices of Manganese with Pallidal Index on MRI in Liver Cirrhotics / 대한산업의학회지

OBJECTIVES: The objectives of this study were to clarify which biological manganese exposure indices reflect the pallidal signal intensities in magnetic resonance imaging (MRI) in liver cirrhotics. METHODS: We examined whole blood, plasma, RBC and urinary manganese concentrations, as well as, brain MRI in 22 cirrhotic patients and 10 healthy controls. From MRI scans we calculated the signal intensity of the globus pallidus using the pallidal index (PI), the ratio of the globus pallidus to subcortical frontal white-matter signal intensity in axial T1-weighted MRI planes multiplied by 100. In addition, we studied the relationships between PI and other measurements. RESULTS: The high signal intensity in the globus pallidus on T1-weighted MRI was observed in 18 (81.8%) patients. There was a significant correlation between whole blood and RBC manganese concentration, and PI on MRI. According to multiple linear regression, whole blood and RBC manganese concentration reflected PI on MRI better the other indices did. CONCLUSIONS: Whole blood and RBC manganese concentrations could be useful as biological manganese exposure indices that reflect PI on MRI.

Purification and characterization of a 33 kDa serine protease from Acanthamoeba lugdunensis KA/E2 isolated from a Korean keratitis patient

In order to evaluate the possible roles of secretory proteases in the pathogenesis of amoebic keratitis, we purified and characterized a serine protease secreted by Acanthamoeba lugdunensis KA/E2, isolated from a Korean keratitis patient. The ammonium sulfate-precipitated culture supernatant of the isolate was purified by sequential chromatography on CM-Sepharose, Sephacryl S-200, and mono Q-anion exchange column. The purified 33 kDa protease had a pH optimum of 8.5 and a temperature optimum of 55 degrees C. Phenylmethylsulfonylfluoride and 4- (2- Aminoethyl) -benzenesulfonyl-fluoride, both serine protease specific inhibitors, inhibited almost completely the activity of the 33 kDa protease whereas other classes of inhibitors did not affect its activity. The 33 kDa enzyme degraded various extracellular matrix proteins and serum proteins. Our results strongly suggest that the 33 kDa serine protease secreted from this keratopathogenic Acanthamoeba play important roles in the pathogenesis of amoebic keratitis, such as in corneal tissue invasion, immune evasion and nutrient uptake.

A Case of Guillain-Barre Syndrome with Early Relapse

No abstract available.

A Case of Cerebral Venous Sinus Thrombosis Treated with Local Thrombolysis

We present a case of extensive thrombosis in the jugular vein and sigmoid, transverse, superior sagittal sinuses with partial deep venous thrombosis. The patient had acute severe headache but had neither focal neurological deficit nor consciousness change. Emergency endovascular thrombolysis through transfemoral approach was performed with successful restoration of venous drainage. There was no hemorrhagic complication. Several days later, the patient had a focal seizure attack due to focal venous infarction despite of continuous systemic anticoagulation therapy.

Expressed sequence tags (ESTs) analysis of Acanthamoeba healyi

Randomly selected 435 clones from Acanthamoeba healyi cDNA library were sequenced and a total of 387 expressed sequence tags (ESTs) had been generated. Based on the results of BLAST search, 130 clones (34.4%) were identified as the genes encoding surface proteins, enzymes for DNA, energy production or other metabolism, kinases and phosphatases, protease, proteins for signal transduction, structural and cytoskeletal proteins, cell cycle related proteins, transcription factors, transcription and translational machineries, and transporter proteins. Most of the genes (88.5%) are newly identified in the genus Acanthamoeba. Although 15 clones matched the genes of Acanthamoeba located in the public databases, twelve clones were actin gene which was the most frequently expressed gene in this study. These ESTs of Acanthamoeba would give valuable information to study the organism as a model system for biological investigations such as cytoskeleton or cell movement, signal transduction, transcriptional and translational regulations. These results would also provide clues to elucidate factors for pathogenesis in human granulomatous amoebic encephalitis or keratitis by Acanthamoeba.

Genetic analyses of Acanthamoeba isolates from contact lens storage cases of students in Seoul, Korea

We conducted both the small subunit ribosomal DNA (SSU rDNA) polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and mitochondrial (mt) DNA RFLP analyses for a genetic characterization of Acanthamoeba isolates from contact lens storage cases of students in Seoul, Korea. Twenty-three strains of Acanthamoeba from the American Type Culture Collection and twelve clinical isolates from Korean patients were used as reference strains. Thirty-nine isolates from contact lens storage cases were classified into seven types (KA/LS1, KA/LS2, KA/LS4, KA/LS5, KA/LS7, KA/LS18, KA/LS31). Four types (KA/LS1, KA/LS2, KA/LS5, KA/LS18) including 33 isolates were regarded as A. castellanii complex by riboprints. KA/LS1 type was the most predominant (51.3%) in the present survey area, followed by KA/LS2 (20.9%), and KA/LS5 (7.7%) types. Amoebae of KA/LS1 type had the same mtDNA RFLP and riboprint patterns as KA/E2 and KA/E12 strains, clinical isolates from Korean keratitis patients. Amoebae of KA/LS2 type had the identical mtDNA RFLP patterns with A. castellanii Ma strain, a corneal isolate from an American patient as amoebae of KA/LS5 type, with KA/E3 and KA/E8 strains from other Korean keratitis patients. Amoebae of KA/LS18 type had identical patterns with JAC/E1, an ocular isolate from a Japanese patient. Three types, which remain unidentified at species level, were not corresponded with any clinical isolate in their mtDNA RFLP and riboprint patterns. Out of 39 isolates analyzed in this study, mtDNA RFLP and riboprint patterns of 33 isolates (84.6%) were identical to already known clinical isolates, and therefore, they may be regarded as potentially keratopathogenic. These results suggest that contact lens wearers in Seoul should pay more attention to hygienic maintenance of contact lens storage cases for the prevention of Acanthamoeba keratitis.

Astasia and Asterixis after Acute Unilateral Thalamic Infarction

Organic causes of astasia or asterixis have been described in the literature. However, concurrent unilateral manifestation of the two symptoms is extremely rare. We report two cases presenting with astasia and asterixis due to infarcts involving the ventrolateral nucleus of the left thalamus. Acute onset of astasia or asterixis in patients without significant metabolic disorder should alert the clinician on the possibility of acute stroke involving the thalamus.

Moyamoya Disease Associated with Neurofibromatosis: A Case Report

Cerebrovascular lesions in neurofibromatosis are uncommon. Cerebral arterial occlusive diseases associated with neurofibromatosis have been documented in less than 40 patients in world literature. We report a 28-year-old male patient with moyarnoya disease associated witb neurofibromatosis. Neurofibromatosis manifestation consisted of multiple cafe-au-lait spots, depigmentation, neurofibromas, iris Lisch nodule, axillary freckling and mental retardation. On admission with acute ischemic syndrome, focal neurologic deficits were decreased left sided pinprick sensation and bilaterally brisk knee jerks. Magnetic resonance imaging showed multifocal ischemic lesions in deep cerebral white matter and multifocal signal voids at the basal ganglia. Angiogram showed bilateral occlusion of distal internal carotid artery associated with moyamoya vessels. To our knowledge. This is a first case report of moyarnoya disease with neurofibromatosis in Korean literature.