Left Hand Mirror Writing Following a Left Temporo-Parietal Lobe Infarction

Mirror writing is the simultaneous process of reversing individual letters and composing word strings in the reverse direction. This phenomenon appears rarely only after brain damage. We present the case of a 65-year-old, right-handed man with mirror writing following a left temporo-parietal lobe infarction. He preferred to write in the mirror direction with his left hand, but he did not show any visual-spatial disturbance and allochria. We think that damage to the dominant writing program of the brain, releases the normally suppressed contralesional writing program and this uninhibited program induces the mirror writing.

The Psychological Characteristics of the Patients with Tension-Type Headache: Using MMPI

BACKGROUND: The investigations of personality traits have been the issue of many studies on patients with tension-type headache. However, there was few comparison study of personality traits between the patients with episodic tension-type headache (ETTH) and chronic tension-type headache (CTTH) using Minnesota Multiphasic Personality Inventory (MMPI). METHODS: The study was consecutively made of the personality profiles of two groups with ETTH (137 patients) and CTTH (115 patients) in accordance with the International Headache Society (IHS) criteria, employing the MMPI. RESULTS: The two groups could be classified into three clusters by a multivariate cluster analysis, which are relatively normal profile (cluster I), somatic profile (cluster II, elevated Hs-D-Hy scales), and psychosomatic profile (cluster III, elevated Pa-Pt-Sc-Si and Hs-D-Hy scales). The proportion of the patients with CTTH in the psychosomatic profile group was stastically more significant (59.6%) than that of the patients with ETTH (40.4%) by a chi-square test. CONCLUSIONS: This study shows that the psychosomatic profile might be more common in the CTTH patients than in the ETTH patients.

Plasma Levels of Soluble Adhesion Molecules in Patients with Acute Cerebral Ischemic Stroke

BACKGROUNDS: The inflammatory reaction after cerebral ischemia involving adhesion molecules aggravates neurologic deficit. This study aimed to study the change of plasma level of the adhesion molecules after acute cerebral ischemia. METHODS: Nineteen patients with acute cerebral infarction and ten control subjects without a history of cerebrovascular disease were included in this study. The patient groups were subgrouped into large artery atherosclerosis and small artery occlusion groups according to TOAST classification. Plasma levels of sP-selectin, sE-selectin, sICAM-1 and sVCAM-1 were measured within 24 hours and in 6 to 8 days after acute ischemic infarction. RESULTS: The plasma level of sP-selectin was elevated in acute stroke patients within 24 hours and in 6 to 8 days after stroke onset compared with control group(p<0.05). But plasma levels of sE-selectin, sICAM-1 and sVCAM-1 were not different from those of control group. The plasma level of sP-selectin was significantly elevated in large artery artherosclerosis group compared with control group. CONCLUSION: This study suggest that P-selectin actively involves in inflammatory process after acute ischemic stroke, especially associated with atherosclerosis.

The Effects of Dopamin D-1 Agonist (SKF-38393) on Expression of Substance-P & Enkephalin mRNA in the Striatum of Hemiparkinsonian Rat Model

BACKGROUND: The selective D1 dopamine agonist has been known to play a stimulatory role in substance-P synthesis in the striatum, but its effect on the enkephalin mRNA expression has not been well known in the striatum of unilateral 6-hydroxydopamine(OHDA)-lesioned rat. So we investigated the effect of selective D1 dopaminergic agonist on substance-P, enkephalin mRNA expression in the striatum with different time interval. METHODS: The lesioned rats were divided into two groups (treated and non-treated). Each group was subdivided according to time course after lesioning (2nd, 4th and 8th week). Dopamine 1 receptor agonist, SKF-38393 (5 mg/kg/ip) and the same volume of saline was injected to treated and nontreated group respectively. The levels of enkephalin and substance-P mRNA were determined by in situ-hydridization and the expression of mRNA levels were compared between the groups. RESULTS: The expression of striatal enkephalin mRNA was increased on lesioned side in all groups. Especially, SKF-38393 enhanced the striatal expression of enkephalin mRNA after lesioning 2nd week. After lesioning 4th week and 8th week, the effect of SKF-38393 was not significant. The striatal expression of substance-P mRNAs was significantly decreased on the lesioned side, especially at the 2nd weeks. This decrement of substance-P mRNA was reversed by SKF-38393 at the 2nd week. CONCLUSIONS: These data show that the selective D1 agonist SKF-38393 have an agonistic effect on direct pathway but antagonistic effect on indirect pathway in early course of Parkinsonian rat model.

The Effects of Dopamin D-1 Agonist (SKF-38393) on Expression of Substance-P & Enkephalin mRNA in the Striatum of Hemiparkinsonian Rat Model

BACKGROUND: The selective D1 dopamine agonist has been known to play a stimulatory role in substance-P synthesis in the striatum, but its effect on the enkephalin mRNA expression has not been well known in the striatum of unilateral 6-hydroxydopamine(OHDA)-lesioned rat. So we investigated the effect of selective D1 dopaminergic agonist on substance-P, enkephalin mRNA expression in the striatum with different time interval. METHODS: The lesioned rats were divided into two groups (treated and non-treated). Each group was subdivided according to time course after lesioning (2nd, 4th and 8th week). Dopamine 1 receptor agonist, SKF-38393 (5 mg/kg/ip) and the same volume of saline was injected to treated and nontreated group respectively. The levels of enkephalin and substance-P mRNA were determined by in situ-hydridization and the expression of mRNA levels were compared between the groups. RESULTS: The expression of striatal enkephalin mRNA was increased on lesioned side in all groups. Especially, SKF-38393 enhanced the striatal expression of enkephalin mRNA after lesioning 2nd week. After lesioning 4th week and 8th week, the effect of SKF-38393 was not significant. The striatal expression of substance-P mRNAs was significantly decreased on the lesioned side, especially at the 2nd weeks. This decrement of substance-P mRNA was reversed by SKF-38393 at the 2nd week. CONCLUSIONS: These data show that the selective D1 agonist SKF-38393 have an agonistic effect on direct pathway but antagonistic effect on indirect pathway in early course of Parkinsonian rat model.

A Case of Recurrent Bacterial Meningitis associated with Traumatic Cerebrospinal Fluid Fistula / 감염

Recurrent bacterial meningitis in adults is a rare disease mostly due to traumatic cerebrospinal fluid (CSF) fistula and usually occurs within 2 weeks after head trauma. Recurrent bacterial meningitis shows high mortality and requires prompt diagnosis and proper treatment. However, diagnostic problems often arise when there may be no recent history of head injury, no direct radiologic evidence, and no CSF rhinorrhea or otorrhea. A 43-year-old man who had head trauma 2 years ago was admitted two times during 3 months due to acute bacterial meningitis. Culture of CSF grew Streptococcus pneumoniae during the second admission. The temporal bone CT scan revealed the transverse fracture on the right temporal bone. CSF leakage through the fracture was corrected by the open cavity mastoidectomy with middle ear obliteration. After the operation further recurrence of bacterial meningitis has not occurred.

A Case of Occipital Dural Arteriovenous Malformation Presenting Visual Field Defect and Positive Visual Phenomena

Although dural arteriovenous malformations(DAVM) involving the occipital lobe can be the cause of variable posi-tive visual phenomena, the mechanism of these visual disturbances is not fully understood. We report a 42-year-old man with a left occipital DAVM presenting headache and positive visual phenomena in the right hemianopic field. Occipital DAVM was not accompanied by parenchymal lesions in a brain magnetic resonance imaging. The cerebral angiography demonstrated the retrograde flow into the dilated occipital cortical veins as well as the left occipital DAVM having multiple arterial feeders and the drainage into the left transverse sinus. All clinical symptoms disap-peared after a transarterial embolization. Brain 99mTc-ECD single photon emission computed tomography also showed the improvement of hypoperfusion on the left occipital area after the embolization. We believe that the venous hyper-tension by occipital DAVM impeding the perfusion to the occipital lobe plays an important role in producing positive visual phenomena on the hemianopic field.

A Case of Occipital Dural Arteriovenous Malformation Presenting Visual Field Defect and Positive Visual Phenomena

Although dural arteriovenous malformations(DAVM) involving the occipital lobe can be the cause of variable posi-tive visual phenomena, the mechanism of these visual disturbances is not fully understood. We report a 42-year-old man with a left occipital DAVM presenting headache and positive visual phenomena in the right hemianopic field. Occipital DAVM was not accompanied by parenchymal lesions in a brain magnetic resonance imaging. The cerebral angiography demonstrated the retrograde flow into the dilated occipital cortical veins as well as the left occipital DAVM having multiple arterial feeders and the drainage into the left transverse sinus. All clinical symptoms disap-peared after a transarterial embolization. Brain 99mTc-ECD single photon emission computed tomography also showed the improvement of hypoperfusion on the left occipital area after the embolization. We believe that the venous hyper-tension by occipital DAVM impeding the perfusion to the occipital lobe plays an important role in producing positive visual phenomena on the hemianopic field.

Three Cases of Chronic Acquired Hepatocerebral Degeneration

BACKGROUND: Chronic acquired hepatocerebral degeneration (CAHD), a slowly progressive neurologic disease characterized by chronic intermittent hepatic encephalopathy, is seen sporadically in patients with chronic hepatic disease. The spectrum of clinical presentations could include neuropsychiatric (apathy, lethargy, excessive somnolence), a movement disorder (ataxia, tremor, chorea, Parkinsonism, myoclonus, dystonia) or both. Unfortunately only a few reports are available concerning the neurological manifestations as well as the findings of brain Magnetic resonance image (MRI) in patients with CAHD in spite of high prevalence of chronic liver disease in Korea. METHODS: We reviewed clinical or laboratory data of 3 patients with CAHD. All patients had evaluations such as neurological examination, mini-mental status examination, liver function test and brain MRI. From sagittal image of their brain MRI, we calculated pallidal signal intensity. RESULTS: The most common neurological findings were cognitive dysfunction, dysarthria, and parkinsonism including tremor, rigidity and bradykinesia. The brain MRI of all three patients showed hyperintensity signal in globus pallidus on T1 weighted image. Some patients also showed similar signal intensity on their brainstem. CONCLUSIONS: We describe three cases of CAHD with clinical, radiological feature.