Transient Cortical Blindness after Removal of Subclavian Vein Catheter

A 42-year-old woman who had undergo a subtotal gastrectomy for stomach cancer, developed transient bilateral cortical blindness and hemiplegia after the removal of a subclavian vein catheter. A brain MRI, transcranial doppler sonogram and visual evoked potentials revealed no abnormalities. She returned to normal neurologic status 4 days after onset. There have been a few cases of transient cortical blindness after an insertion or removal of the subclavian vein catheter. However, caution should be taken for this possibility whenever the subclavian catheter is inserted or removed.

Two Cases of Sporadic Encephalitis Lethargica

We present two patients with clinical features suggestive of a hyperkinetic form of encephalitis lethargica described by von Economo. While undergoing treatment for viral meningoencephalitis, they both developed comatose mentality, oromandibular dyskinesia, chorea, myoclonic jerk, oculogyric crisis, opistotonus, respiratory failure, and autonomic dysfunction. One patient died of autonomic failure while the other improved several months later. In both patients, cerebrospinal fluid exmamination revealed only pleocytosis. A brain MRI and EEG showed no specific findings. In order to control severe hyperkinetism and autonomic failure, medical treatments including L-dopa, clonazepam, and steroid pulse therapy were administereed in both cases while electroconvulsive therapy was tried in one of the cases. However, they all failed. These cases and previous reports informed us of the presence of sporadic form of encephalis.

Metabolic Abnormalities in Patients with Mitochondrial Myopathy Evaluated by In Vivo 31P Magnetic Resonance Spectroscopy

PURPOSE: To investigate the phosphorus metabolic abnormalities in skeletal muscle of patients with mitochondrial myopathy using in vivo 31P magnetic resonance spectroscopy(MRS). MATERIAL AND METHODS: Patients with mitochondrial myopathy(N=10) and normal control subjects (N=10) participated. All in vivo 31P MRS examinations were performed on 1.5T whole-body MRI/MRS system by using an image selected in vivo spectroscopy (ISIS) pulse sequence that provided a 4 X 4 X 4 cm3 volume of interest (VOI) in the right thigh muscle tissue. Peak areas for each phophorus methabolite were measured using a Marquart algorithm. RESULTS: The specific features in patients with mitochondrial myopathy were a significant increase of Pi/PCr ratio (p=0.003) and a significant decrease of ATP/PCr ratio (p=0.004) as compared with normal controls. In particular, the beta-ATP/PCr ratio between controls and patients with mitochondrial myopathy was predominantly altered. CONCLUSIONS: In vivo 31P MRS may be a useful modality in the clinical evaluation of patients with mitochondrial myopathy based on ATP/PCr and Pi/PCr ratios in skeletal muscle tissue and provides a valuable information in further understanding disorders of muscle metabolism.

Metabolic Alterations of Acute Cerebral Infarction Evaluated by Localized, Water-Suppressed In Vivo'H MRS

Localized, water-suppressed in vivo 'H MRS was performed to evaluated the proton metabolic alterations in patients with acute cerebral infarction.Ten brain infarction patients(six males and four females; age range 53-77) participated in this study. GE Signa 1.5-T whole-body NMI/MRS system using STEAM pulse sequence was used. Voxels were selected from the cerebral infarcted region and contralateral normal region as control in the same patient. Proton metaboliteratiosrelativetocreatine (Cr) wereobtainedusingaMa-rquartalgorithm. The specific features in the cerebral infarcted regions demonstrated a significant decrease of N-acetyl aspartate (NAA)/creatine (Cr) ratio, compared with control regions. Markedly increased lactate (Lac) level was observed in areas of cerebral infarctioln in all patients. Our preliminary study showed that NAA/Cr ratio in the infarcted regions was substanially different from that in control regions.The signal intensity of Lac may be served as a metabolic criterion that can specify acuteness of infarction, and also evaluate the therapeutic effect. It is necessary to investigate the spectral alterations in various stages of cerebral infarction for further detail analysis.