The Clinical Presentations and Prognosis of Non-Ketotic Hyperglycemia Induced Seizure

BACKGROUND: Seizure can be triggered by the non-ketotic hyperglycemia (NKH). Recently we analysed 18 cases of NKH induced seizure to identify the causes for NKH, seizure types, prognosis, and the differences of clinical presentation between the patient with chronic brain structural lesion (CBSL) and the patient without. METHODS: Eighteen patients with NKH induced seizure were selected from the database. Data regarding brain images, clinical symptoms, co-morbid illnesses, blood laboratories, and prognosis were collected. Patients were divided into two groups according to the presence of CBSL. RESULTS: The patients with CBSL showed more generalized tonic-clonic seizure (GTCS) than without. Focal seizures in this group appeared to be originated from the pre-existing lesion in many situations. The poor compliance to anti-diabetic treatment and physical stresses were most common causes for NKH. One year seizure remission without anti-epileptic drug treatment was achieved in 17 of 18 patients. CONCLUSIONS: The patients with CBSL might have more GTCS than without. The impairment of inhibitory mechanism surrounding the focal irritative zone might be one of plausible explanation for this phenomenon. The prognosis was favorable. Further large studies are required.

The Relationship between Hypertension and the Lesion Distribution of Posterior Reversible Encephalopathy Syndrome

BACKGROUND: The relationship between hypertension and the lesion distribution of posterior reversible encephalopathy syndrome (PRES) is in debate. METHODS: Twenty patients with PRES which developed during chemotherapy or immunosuppression treatment for the control of underlying malignancy or auto-immune disorders were selected from the database. Data regarding brain images, clinical symptoms, co-morbid illnesses, and mean arterial pressure (MAP) at the pre-symptomatic period (one day before the symptom onset) and at the symptom onset were collected. Patients were divided into two groups according to the presence of pre-symptomatic hypertension. The lesion distribution degree was calculated by numerical method (involvement score [IS]) and compared with MAP. RESULTS: No significant differences of clinical symptoms were found between two groups. IS and onset period MAP were higher in the hypertensive group. Pre-symptomatic MAP correlated with onset period MAP and IS in total patients. No significant correlation was found between IS and onset period MAP. CONCLUSIONS: The PRES patient with hypertension in the pre-symptomatic period would show more spatially distributed brain lesions than the patient with stable blood pressure.

Prognosis and Recovery of Motor Function with Lesion–Symptom Mapping in Patients with Stroke

Although studies have demonstrated that several specific brain lesions are related to the recovery and functional prognosis in patients with stroke, it still remained to be illusive. Modern imaging techniques make us possible to identify regions that are commonly related to specific deficit. Superimposing individual lesions to identify an area related to a particular function is based on the assumption that these functional modules are in the same location in different individuals. It is traditional to overlay plots using ‘lesion subtraction.’ Additionally, voxel-based lesion-symptom mapping (VLSM) can be used to determine relationships between behavioral measures and its neural correlates in the brain. VLSM estimates statistical parameters on a voxel-by-voxel basis by calculating the correlations between t-scores for tasks and treating voxels as subjects, allowing fairly high spatial precision. Understanding their relative merits with regard to specific brain lesions should be useful in planning rehabilitation strategies and will become an important part of neurorehabilitation.

Analysis of Visual Field Defect in Patient with Brain Lesion

PURPOSE: In this study we analyzed the results of visual field tests in patients diagnosed with a brain lesion in an ophthalmology clinic. METHODS: The medical records of 55 patients who underwent visual field examinations and diagnosed with brain pathology using magnetic resonance imaging (MRI) from January 1, 2005 to June 30, 2014 were retrospectively investigated. RESULTS: Of the 55 patients (M:F = 30:25), 31 displayed symmetrical hemianopsia, a typical visual field defect associated with brain lesions. Twenty-four patients showed atypical visual field defect (20 showed normal visual field despite the brain lesion, 3 had bilateral narrowing of the peripheral visual field in 2 cerebral infarctions and 1 multiple sclerosis, and 1 had horizontal inferior visual field defect in 1 eye from nasopharyngeal cancer). CONCLUSIONS: Patients having a brain lesion with the optic tract invasion may present with atypical visual field defects. The peripheral visual field constriction and horizontal inferior visual field defect in 1 eye could be the visual field defect in patients with a brain lesion.

Análisis neuropsicológico de un caso con alteración de la función ejecutiva / Neuropsychological analysis of a case with alteration of executive function

Producto de un traumatismo craneoencefálico un individuo puede perder capacidades mentales previamente adquiridas, una de ellas es la función ejecutiva. Ésta es conceptualizada como un grupo de habilidades mentales que permiten a un ser humano evidenciar un comportamiento eficaz dentro de parámetros socialmente aceptados. Estas habilidades han sido descritas como la inhibición, memoria operativa, flexibilidad mental, regulación emocional, monitorización; entre otras. En el presente artículo se revisa un caso clínico que producto de un traumatismo craneoencefálico frontal presenta un cuadro de alteración de su función ejecutiva. En el análisis del caso se toma en consideración teorías clásicas en la neuropsicología sobre el funcionamiento cerebral que permitirán comprender de forma clara qué sucede actualmente con el paciente...

Asymptomatic Brain Lesions on Cranial Magnetic Resonance Imaging in Inflammatory Bowel Disease

BACKGROUND/AIMS: This study aimed to examine the frequency and type of asymptomatic neurological involvement in inflammatory bowel disease (IBD) using cranial magnetic resonance imaging (MRI). METHODS: Fifty-one IBD patients with no known neurological diseases or symptoms and 30 controls with unspecified headaches without neurological origins were included. Patients and controls underwent cranial MRI assessments for white matter lesions, sinusitis, otitis-mastoiditis, and other brain parenchymal findings. RESULTS: The frequencies of white matter lesions, other brainstem parenchymal lesions, and otitis-mastoiditis were similar in IBD patients and controls (p>0.05), whereas sinusitis was significantly more frequent in IBD patients (56.9% vs 33.3%, p=0.041). However, among those subjects with white matter lesions, the number of such lesions was significantly higher in IBD patients compared to controls (12.75+/-9.78 vs 3.20+/-2.90, p0.05 for all). CONCLUSIONS: The incidence of white matter lesions seemed to be similar in IBD patients and normal healthy individuals, and the lesions detected did not pose any clinical significance. However, long-term clinical follow-up of the lesions is warranted.

Comparing the Effect of Botulinum Toxin Type B Injection at Different Dosages for Patient with Drooling due to Brain Lesion

OBJECTIVE: To investigate Botulinum toxin type B (BNT-B) injection's effect and duration depending on dose for patients with brain lesion. METHOD: Twenty one patients with brain lesion and severe drooling were included and divided into three groups. All patients received conventional dysphagia therapy. Group A patients (n=7) received an injection of 1,500 units and group B patients (n=7) received an injection of 2,500 units of BNT-B in submandibular gland under ultrasound guidance. Group C patients (n=7) received conventional dysphagia therapy. Saliva secretion was assessed quantitatively at baseline and at weeks 1, 2, 4, 8, and 12. The severity and frequency of drooling was assessed using the Drooling Quotient (DQ) by patients and/or caregivers. RESULTS: Group A and B reported a distinct improvement of the symptoms within 2 weeks after BNT-B injection. Compared to the baseline, the mean amount of saliva decreased significantly throughout the study. However, there was no meaningful difference between the two groups. The greatest reductions were achieved at 2 weeks and lasted up to 8 weeks after BNT-B injection. Group C did not show any differences. CONCLUSION: Local injection of 1,500 units of BNT-B into salivary glands under ultrasonic guidance proved to be a safe and effective dose for drooling in patient with brain lesion, as did 2,500 units.

Correlation between Patterns of Focal Epileptiform Discharges and Brain Lesions in Children with Focal Epilepsy / 대한소아신경학회지

PURPOSE: The objective of this study was to evaluate the correlation between patterns of focal epileptiform discharge (ED) and brain lesions diagnosed by MRI in children with focal epilepsy. METHODS: We retrospectively reviewed routine scalp EEGs, medical records, and results from brain MRIs in 149 children who had been diagnosed as epilepsy with focal epileptiform discharges in our hospital between 2008 and 2010. We classified the patterns of focal ED into spikes, sharp waves, and polyspikes. EEGs with homogenous patterns of ED were termed single-form ED and those with heterogenous patterns of ED were termed multi-form ED. We evaluated the relationship between the specific patterns of focal ED and brain lesions in pediatric epilepsy. RESULTS: Fifty-six of 149 (37.6%) patients had brain lesions on brain MRI. 67.8% (101/149) patients exhibited single-form ED and 32.2% (48/149) patients revealed multi-form ED. Thirty of 48 patients (62.5%) with multi-form ED showed brain lesions, which was higher than those for patients with single-form ED (25.7%, 26/101) (P <0.001). 27.5% (41/149) patients had and 25/41 (61.0%) also had brain lesion, which was higher than those for patients without polyspikes (28.7%, 31/108) (P <0.001). 19 of 82 patients (23.2%) with single-form ED with spikes only had brain lesion on brain MRI, which was significantly lower than those of remaining patients (55.2%, 37/67) (P <0.001). CONCLUSION: We suggest that a heterogenous pattern of ED or polyspikes lead to a higher incidence of brain lesions in children with focal epilepsy.

Urinary Difficulty in Brain Lesion: Impact on Quality of Life: Multicenter Prospective Epidemiologic Study

OBJECTIVE: To asses the prevalence of urinary difficulty and the relationship of urinary difficulty and type of brain lesion from multicenter prospective epidemiologic study. METHOD: 394 patients including outpatients and inpatients who visited from multicenter department of rehabilitation medicine from January 2008 to June 2008 were evaluated. Study based on international prostate symptom score (IPSS) and Quality of life (QoL) score were assessed, and the correlation between the two indexes was analyzed. RESULTS: 140 patients (35.5%) complained urinary difficulty as patient's main symptom, while IPSS score was 13.7 showing above moderate symptom at 77.5%. For patients complained urinary difficulty, the average of quality of life score was 3.1. Among stroke, 37% of infarction and 34% of hemorrhage complained urinary difficulty while 40% of traumatic brain injury did. Patients with ACA infarction reported urinary difficulty most frequently. Nocturia (71%), frequency (53.3%), incomplete emptying (30%) were the most frequent symptoms. Sixty-six patients (46%) complaining urinary difficulty were taking medications and anticholinergics were most widely used (75%). Scores of IPSS and QoL according to type and site of brain lesion didn't show meaningful difference while QoL score correlated significantly with IPSS score (p<0.05). CONCLUSION: Among all the brain lesion patients, 35.5% complained urinary difficulty while IPSS and QoL score according to type and site of brain lesion didn't show meaningful difference. Urinary difficulty affects the life quality of brain lesion patients.

Detection of Saliva Aspiration Using Salivagram in Bedridden Patients with Brain Lesion

OBJECTIVE: To investigate the aspiration of saliva itself in bedridden patients with brain lesion using the response of radionuclide salivagram, and its association with patient characteristics and clinical factors. METHOD: Thirty two patients (21 men and 11 women) in bedridden state with brain lesion were performed the radionuclide salivagram. (99m)Tc sulfur colloid (1.0 mCi in a drop of saline) was instilled into patients' tongue with supine position. The sequential images were obtained at first 5 minutes and 10 minutes interval for 1 hour, and evaluated the presence of saliva aspiration as the entrance of tracer into major airways or lung parenchyma. The characteristics of patients and the states of cooperation, drooling, tracheostomy, and method of feed were also assessed. RESULTS: Seven out of 32 subjects exhibited positive response of saliva aspiration by radionuclide salivagram. Men, uncooperative, and anterior drooling was significantly associated with positive finding of salivagram (p<0.05). CONCLUSION: In bedridden patients with brain lesion, it seems that radionuclide salivagram may be one of methods for detection of the aspiration of saliva itself.

Brain Lesions in Conduction Aphasia

OBJECTIVE: To investigate the neuroanatomical correlation of conduction aphasia by analyzing neuroimage data of patients who were diagnosed as conduction aphasia after stroke. METHOD: Nine patients with conduction aphasia after stroke were retrospectively reviewed with their medical records. Language functions of patients were assessed by Korean-version Western Aphasia Battery (K-WAB). Stroke lesions were assessed by brain computed tomography or magnetic resonance images taken within 1 month after onset of stroke. RESULTS: The stroke subtypes were cerebral infarction in 5 patients and intracranial hemorrhage in 4 patients. The lesions were located in left hemisphere in 8 subjects and right hemisphere in 1 subject. The left hemispheric lesion were located in the insula and superior temporal lobe in 3, the inferior parietal lobe in 2, the corona radiate in 1, the basal ganglia in 1 patient and both corona radiata and basal ganglia in 1. The right hemispheric lesion was located in the inferior parietal and superior temporal lobe. CONCLUSION: 6 of 9 patients with conduction aphasia had brain lesions in the path of arcuate fasciculus in the left hemisphere, however, 3 of 9 patients showed other brain lesions. These findings suggested that conduction aphasia could be caused by heterogeneous brain lesions. The characteristic features of conduction aphasia according to diverse brain lesions may need further investigation.

Study of Visual Cognition Antijamming Ability of Patients with Brain Lesions in Conjunction of Occipital and Parietal Lobes / 中国康复理论与实践

@#ObjectiveTo investigate the related functional orientation of the visual cognition antijamming ability in brain.MethodsThe number of recognizing errors of reaction to visual stimulations in 8 patients with brain lesions in conjunctions of occipital and parietal lobes was tested by three different kinds of noises from visual materials as stimulations, and error numbers as index, and result was compared with that of 10 normal persons.ResultsThe number of recognizing errors in the patients was higher than that in normal person ( P<0.01), and the signal-to-noise (SNR) lower, the number of recognizing errors was higher in the patients ( P<0.01).ConclusionThe conjunction of occipital and parietal lobes maybe play an important role in the visual cognition antijamming ability.

Low-Resolution Electromagnetic Tomography (LORETA) Source Imaging Compared with Structural Brain Imaging in Patients having Organic Brain Lesion / 신경정신의학

OBJECTIVES: Patients with organic brain lesion can produce unique slow waves (delta and theta) in the EEG. Basic assumption of this study was that the low resolution electro magnetic tomography (LORETA), an inverse source localization program, can provide functional images representing increased slow wave activity in these patients compared to normal subjects. METHODS: The current study was performed by 18 channels digital EEG for 10 patients whose organic deficit have been visually confirmed by CT or MRI. The source images of slow wave (1-7 Hz) frequency were produced by LORETA-key program. RESULTS: We found that in eight out of ten subjects, LORETA successfully found out the source regions which were very closely matched to their original brain lesions. However in two subjects whose organic brain lesions were too small (<1 cm) and located out of gray matter, we failed to find any increased slow wave activity compared with normal control. CONCLUSION: We can conclude that LORETA could be a useful method to provide functional imaging in patients with gray matter deficits in their brain. Its usefulness and limitations were discussed.

The Changes of Male Sexual Dysfunction after Stroke: Correlations of Brain Lesions and Sexual Function / 대한남성과학회지

PURPOSE: To identify the effects of the locations of brain lesion on sexual function in stroke patients. MATERIALS AND METHODS: A survey was conducted on 109 male stroke patients(mean age: 64.93+/-8.81 yr.) diagnosed by magnetic resonance imaging or computerized tomography at least 6 months before study(mean duration of disease: 24.4+/-16.7 mo.). A normal age-matched control group included 109 men(mean age: 64.7+/-8.9 yr.). Each subject completed the 5-item Version of the International Index of Erectile Function(IIEF-5) to measure the changes of sexual desire, ejaculation function, and sexual satisfaction. RESULTS: Statistically lower sexual function was found in the stroke patient group(IIEF-5; 5.9+/-7.0) compared with the normal control group(IIEF-5; 10.7+/-7.1)(p<0.01). In cases where brain lesions were seen in the right frontal lobe and the right pons after stroke, erectile function was significantly reduced. In cases of brain lesion in the right cerebellum, ejaculation disorder was frequently reported. In cases where the brain lesion was located in the right thalamus and the left basal ganglia, significantly lower sexual desire was found. CONCLUSIONS: Sexual function is significantly lower in stroke patients. Injury to the right frontal lobe and right pons is linked to reduce sexual function; lesions to the right cerebellum are associated with ejaculation disorder; and lesions located in the right thalamus and the left basal ganglia are significantly associated with reduced desire.

Comparison of the Latent Period of Symptomatic Epilepsy after the Onset of Etiologic Brain Lesions in Children / 대한소아신경학회지

PURPOSE: The common etiologies of most symptomatic epileptic children are congenital brain malformation, hypoxic injury, CNS infection and traumatic brain injury, etc. These brain lesions are often followed by a latent period of variable durations before the appearance of epilepsy. This research was designed to study the latent period of each etiology. METHODS: Subjects were 125 children with epilepsy who visited the Department of Pediatrics, Pusan National University Hospital between March 1993 and July 2002. We divided these patients into five groups according to etiologic brain lesions - congenital brain malformation(group 1), hypoxic brain injury(group 2), CNS infection(group 3), traumatic brain injury(group 4) and metabolic disorders or intoxication(group 5) - and compared the latent period of each patient group. RESULTS: The latent period of each patient group was as follows; 1.5 years(group 1), 1.7 years(group 2), 0.4 years(group 3), 2.9 years(group 4) and 0.4 years(group 5). There were significantly statistical differences in the latent periods among group 3, 4 and 5, between group 1 and 3, group 1 and 5, group 2 and 3, and group 2 and 5. CONCLUSION: The onset of epilepsy tends to appear relatively later after traumatic brain injury, while CNS infection and metabolic disorders cause the onset of epilepsy usually within 6 months.

Effects of Therapeutic Electrical Stimulation of Sensory Dermatome on Spasticity in Patients with Brain Lesion

OBJECTIVE: The purpose of this study was to investigate the immediate and delayed effects of electrical stimulation of sensory nerve pathway on spasticity in patients with brain lesions. METHOD: Sixteen stroke and traumatic brain injured subjects participated in this study. Electrical stimulation on the der matome of spastic muscles was applied for 30 minutes a day for 4 weeks. Spasticity was quantified through the use of a relaxation index obtained from pendulum test and a amplitude and latency from knee tendon reflex test. The measurements were performed 6 times in treatment period. The data were analyzed by repeated measures one way ANOVA. RESULTS: Relaxation index was significantly increased in treatment period (p<0.05). In each therapeutic stimulation session, relaxation index of post-stimulation was increased in comparison with that of pre-stimulation (p<0.01). The amplitude of post-stimulation was significantly decreased in comparison with pre-stimulation status in each measurement session (p<0.01). The latency of tendon reflex was not changed after stimulation. CONCLUSION: These results showed that the electrical stimulation was useful method to decrease spasticity in patients with brain lesions. Further studies are needed to explore the effects of functional improvement and the long-lasting carry over effects on spasticity in electrical stimulation.

Vascular Depression

This article reviews the recent literature of 'vascular depression' hypothesis. The 'vascular depression' hypothesis is supported by the evidence for associations between vascular disease and late-onset depression and between ischemic brain lesions and distinctive depressive symptoms. Patients with vascular depression is characterized by late-onset, absence of family history of mood disorders, evidence of vascular disease or vascular risk factors, cognitive impairment, psychomotor retardation, limited depressive ideation, poor insight, and disability. Vascular depression may be the entity suitable for studies of mechanism of depression. Depression in later life is often under-diagnosed and under-treated. Drugs used in the prevention and treatment of cerebrovascular disease may be shown to be beneficial influences for the prevention of vascular depression. Combined treatment with antidepressant and cognitive-behavioral rehabilitation will be more helpful. In the future, developments in structural and functional imaging, electrophysiology, chronobiology, and genetics will permit the knowledge of the association between mood disorders and brain lesions.

Preoperative Evaluation of Brain Lesion with 201Tl Brain SPECT: Is It Useful to Differentiate Benign and Malignant Lesions? / 대한핵의학회잡지

PURPOSE: Thallim-201 (201Tl) brain SPECT, which can represent cellular activity of brain lesions, may provide more useful information in differentiating between benign and malignant brain lesions more so than CT or MRI, that merely represents anatomic changes or breakdown of blood brain barrier. We used 201Tl brain SPECT prospectively to evaluate the utility of 201Tl-indices as an indicator of benign or malignant lesions. MATERIALS AND METHODS: We studied 28 patients. There were 13 cases of benign lesions (3: nonspecific benign lesion, 3: meningioma, 2: low grade glioma, 1: tuberculoma, central neurocytoma, hemangioblastoma, radiation necrosis, and choroid plexus papilloma) and 15 cases of malignant lesions (6: glioblastoma multiforme, 5: anaplastic glioma, 2: medulloblastoma, 1: metastasis and lymphoma). In all patients, CT and/or MRI were obtained and then 201Tl brain SPECT was obtained with measuring mean 201Tl index and peak 201Tl index. An unpaired t-test was performed to compare the 201Tl-indices and pathologic diagnoses to evaluate the utility of 201Tl-indices as an indicator of benign or malignant lesions. RESULTS: There were no statistically significant difference in 201Tl-indices between benign and malignant brain lesions (P>0.05). CONCLUSION: These results demonstrated that we could not use 201Tl indices on brain SPECT alone as an indicator of benign or malignant brain lesions.

Correlation between P300 Latency and Cognitive Capacity Screening Examination in Patients with Brain Lesion

OBJECTIVE: To verify the correlation between auditory event-related potential and Cognitive Capacity Screening Examination (CCSE) in patients with brain lesion. METHOD: P300 study using an auditory paradigm was performed in thirty patients with brain lesion, age ranged from thirteen to seventy-three years-old, and then was compared with the score of CCSE. RESULTS: The mean latency of P300 was 383.07+/-50.63 msec. The mean score of CCSE was 17.10+/-8.62. There was no significant difference in P300 latency and score of CCSE between male and female, and among the types of brain lesion. There was significant negative correlation between P300 latency and score of CCSE (p<0.05, r= 0.686), between score of CCSE and age (p<0.05, r= 0.364). There was significantly high intra-rater reliability in P300 latency study (alpha=0.9771). CONCLUSION: We conclude that P300 electrodiagnostic study is useful for reflection of cognitive function in patients with brain lesion.

Reactive Plasticity of Neuroglial Cells on Brain Lesion / 대한해부학회지

Neuroglial cells are actively participate in the pathogenesis or in the recovery procedures following brain lesions. The study was performed to evaluate the plasticity of glial cells following different degree of brain lesions. Neurosurgical operations were made on the rats fixed on the stereotaxic apparatus. Tissue column of 3 mm-diameter was isolated in the caudatoputamen with concomitant severe bleeding in the first group. In the second group, the sensorimotor cortex was suctioned out with moderate bleeding. In the third group, the mammillary body was electrically coagulated with minimal bleeding. Caudatoputamens, as a lesioned tissue or as a target tissue of lesioned area, were studied light and electron microscopically. Observations on reactivities and plasticities of neuroglial cells on the different situations, the following results were obtained : 1. Astrocytes were swollen within an hour following brain lesions. 2. In case of smaller lesion, astroglia alone remove altered structures. 3. Microglia are increased in number, if the lesion is large with severe bleeding. The microglia might come from blood monocyte via transformation to pericyte. 4. In large lesion, astroglia were greatly hypertropied, and microglia might be moving and functioning effeciently within the hypertropied cytoplasm of astroglia. 5. In the stabilizing stage, astroglia produce glial fibers and fix the exhausted microglia. Fixed microglia are proceed into apoptotic process in the cytoplasm of astroglia and removed by them. All these procedures might be controlled by various receptors and secretions of astroglia. It means that astroglia is not only the basic supporting element of nervous tissue, but also an actively functioning element for the most effective homeostatic functioning of the neuropil.