Diagnostic Challenge of Diffusion Tensor Imaging in a Patient With Hemiplegia After Traumatic Brain Injury

A 51-year-old man showed hemiplegia on his right side after a traumatic brain injury (TBI). On initial brain computed tomography (CT) scan, an acute subdural hemorrhage in the right cerebral convexity and severe degrees of midline shifting and subfalcine herniation to the left side were evident. On follow-up brain magnetic resonance imaging (MRI), there were multiple microhemorrhages in the left parietal and occipital subcortical regions. To explain the occurrence of right hemiplegia after brain damage which dominantly on the right side of brain, we used diffusion tensor imaging (DTI) to reconstruct the corticospinal tract (CST), which showed nearly complete injury on the left CST. We also performed motor-evoked potentials, and stimulation of left motor cortex evoked no response on both sides of upper extremity. We report a case of patient with hemiplegia after TBI and elucidation of the case by DTI rather than CT and MRI.

Relationship Between Grip and Pinch Strength and Activities of Daily Living in Stroke Patients

OBJECTIVE: To investigate the relationship between grip and pinch strength and independence in activities of daily living (ADL) in stroke patients. METHODS: Medical records of 577 stroke patients from January 2010 to February 2013 were retrospectively reviewed. Patients' grip and pinch strength of both hemiplegic and non-hemiplegic hands and the Korean version of Modified Barthel Index (K-MBI) score were collected. These patients were divided into three groups: group A (onset duration: 3 months and or =2 years). The correlation between grip and pinch strength and the K-MBI score was analyzed. RESULTS: In group A (95 patients), the K-MBI score was significantly (p<0.05) correlated with the grip and pinch strength of both hands in patients with right hemiplegia. Significant (p<0.05) correlation between the K-MBI score and the grip and pinch strength of the hemiplegic hand was shown in patients with left hemiplegia. In group B (69 patients) and group C (73 patients), the K-MBI score was significantly (p<0.05) correlated with the grip and pinch strength of the hemiplegic hand. CONCLUSION: Stroke patients in subacute stage mainly performed activities of daily living using their dominant hand. However, independence in ADL was associated with the strength of the affected dominant hand. For stroke patients in chronic and late chronic stages, their hand power of the affected hand was associated with independence in ADL regardless whether the dominant hand was affected.

Ceftazidime-Induced Nonconvulsive Status Epilepticus

Ceftazidime is a widely used third-generation cephalosporin. We report a case of ceftazidime-induced nonconvulsive status epilepticus in a patient with renal failure. A 56-year-old man experienced the gradual development of altered mentation after a diabetic foot ulcer was treated with ceftazidime. Rhythmic sharply contoured triphasic waves were evident in all electroencephalography leads. The clinical and electrographical seizures ceased after introducing antiepileptic drugs and discontinuing ceftazidime. This case demonstrates that altered mentality and nonconvulsive status epilepticus can be caused by ceftazidime in patients with renal dysfunction.

Ceftazidime-Induced Nonconvulsive Status Epilepticus

Ceftazidime is a widely used third-generation cephalosporin. We report a case of ceftazidime-induced nonconvulsive status epilepticus in a patient with renal failure. A 56-year-old man experienced the gradual development of altered mentation after a diabetic foot ulcer was treated with ceftazidime. Rhythmic sharply contoured triphasic waves were evident in all electroencephalography leads. The clinical and electrographical seizures ceased after introducing antiepileptic drugs and discontinuing ceftazidime. This case demonstrates that altered mentality and nonconvulsive status epilepticus can be caused by ceftazidime in patients with renal dysfunction.

Multiple Cerebral Infarctions after Intravenous Vitamin K Injection in a Patient with Trauma / 대한뇌졸중학회지

Vitamin K, a cofactor of coagulation cascade, is used for hemostasis in patients with abnormal coagulation status. However, it is uncertain whether administration of vitamin K elevates the risk of thrombotic events. We present a patient with trauma who developed acute multiple cerebral infarctions after receiving intravenous vitamin K for several days. We presume that vitamin K can be a contributing factor for embolism in a patient with trauma.

Clinical Factors Correlated to Delirium Tremens during Acute Alcohol Withdrawal of Inpatients with Alcohol Dependence / 신경정신의학

OBJECTIVES: The aim of this study was to explore clinical factors or high-risk factors associated with occurrence of delirium tremens (DT) during acute alcohol withdrawal in inpatients with alcohol dependence. METHODS: This study included 164 inpatients seeking treatment for acute alcohol withdrawal in the detoxification unit. All subjects were evaluated prospectively for known risk factors for DT and their occurrence of DT. Correlations were determined between risk factors obtained at admission and development of DT. RESULTS: Among all subjects, 42 patients (25.6%) suffered from delirium tremens within seven days after admission. DT patients had more severe alcohol withdrawal symptoms, the presence of past DT, and higher levels of aspartate aminotransferas, alanine aminotransferase, gamma-glutamyl-transpeptidase, and homocysteine, compared with patients who did not suffer DTs. According to results of a multiple regression, occurrence of DT showed correlation with the following factors at admission: tremor, a past history of DT, higher homocysteine level, and nausea and vomiting. CONCLUSION: Development of DT showed correlation with symptoms of severe alcohol withdrawal, past history of DT, and higher homocysteine level. Among these, a severity of alcohol withdrawal symptoms and a history of DT are factors that can be easily evaluated on the day of admission in order to predict the potential for occurrence of DT.

Monitoring Platelet Inhibition by Clopidogrel Using Rapid Platelet Function Assay in Patients With Ischemic Stroke

BACKGROUND: Clopidogrel inhibits platelet P2Y12 adenosine diphosphate (ADP) receptors and has been widely used in patients with ischemic stroke. However, a considerable number of patients suffer from cerebrovascular events despite the use of clopidogrel. The rapid platelet function assay (RPFA) has been used for monitoring the antiplatelet effects on the P2Y12 ADP receptor. This study was performed to measure the platelet response to clopidogrel using RPFA in patients with ischemic stroke, and to identify the clinical factor related with clopidogrel resistance. METHODS: A total of 86 patients taking clopidogrel (75 mg/day) were enrolled. Demographic data, vascular risk factors, the presence of obesity and metabolic syndrome, drug history, hemoglobin, platelet counts, and stroke subtypes were recorded. RPFA presented the results as P2Y12 Reaction Units (PRU), base PRU (BASE), and Inhibition (%). Inhibition was calculated as (1-PRU/BASE)x100. The patients showing ineffective aggregation- inhibition (percentage of Inhibition < 20) on RPFA were defined as non-responders to clopidogrel. RESULTS: The response of platelet aggregation-inhibition to clopidogrel showed a variable distribution with mean and standard deviation of 32.2+/-22.3%. Twenty four (27.9%) patients showed the inhibition below 20%. There was no difference between responders and non-responders regarding the clinical factors above. We found no influence of co-medication with the statins on platelet response to clopidogrel. CONCLUSIONS: There is a patient variability in response to clopidogrel and a considerable portion of stroke patients have clopidogrel resistance on the platelet function test. The clinical usefulness of routine platelet function test requires further validation.

Perioperative Stroke in the Brain and Spinal Cord Following an Induced Hypotension

A 49-year-old woman presented with stupor and paraplegia following an induced hypotension. The temporal relationship to the induced hypotension and the absence of a clear embolic source on diagnostic tests support a causal association between the hypotensive episode and the ischemic infarct. However, despite the association, a cause-and-effect relationship could not be automatically inferred.