Intravascular Large B-cell Lymphoma Presenting as Rapidly Progressive Encephalopathy

Intravascular large B-cell lymphoma (IVLBCL) is a rare form of non-Hodgkin’s lymphoma that selectively involves the lumina of vessels, and may present as ischemic stroke. A 62-year-old man presented with progressive aphasia, dementia, seizure and stroke-like symptom. Brain magnetic resonance imaging revealed dynamic progressive fluid attenuated inversion recovery lesions and multiple punctate microbleeds in the bilateral subcortical region. A kidney biopsy revealed IVLBCL. We report a patient with IVLBCL presenting as rapidly progressive encephalopathy.

Multiple Cerebral Cavernous Malformations

No abstract available.

Reversible Splenial Lesion associated with Cellulitis in a Patient with Lymphedema

No abstract available.

D-dimer Predicts Short-Term Functional Outcome in Acute Ischemic Stroke

BACKGROUND: The objective of the study was to evaluate the predictive value of plasma D-dimer at admission after acute ischemic stroke, and to assess its effect on short-term functional outcome. METHODS: Fasting plasma D-dimer was measured in 290 consecutive patients (61.7% men, mean age 67.0±12.3 years) within 3 days after the onset of acute ischemic stroke. The outcomes were measured at 3-months after stroke onset, by the modified Rankin Scale (mRS). RESULTS: Atrial fibrillation, hypertension, diabetes and involvement of the insular cortex, the levels of serum high sensitive C-reactive protein and D-dimer, as well as incidence of women and age, were all significantly higher in the poor outcome group (P<0.05). After the adjustment of National Institutes of Health Stroke Scale (NIHSS) scores on admission, the plasma D-dimer levels positively correlated with mRS (Spearman partial rho=0.247, P<0.001). The cut-off value of D-dimer level for prediction of poor outcomes was 0.35 mg/L (sensitivity 0.70, specificity 0.63, area under the curve 0.71). Furthermore, two multivariated logistic regression analysis models were performed. One model excluded the NIHSS score as an independent variable, and demonstrated that D-dimer (odds ratio, 1.24 for every 1.0 mg/L, P<0.05) was independently associated with poor functional outcome. Conversely, the other model which included the NIHSS score, did not show any such association. CONCLUSIONS: Plasma D-dimer level is a useful marker for short-term outcomes in acute ischemic stroke, and may have a role in risk stratification for predicting a poor outcome.

Vertical One-and-a-Half Syndrome Accompanying Contralateral Abduction and Incomplete Depression Palsy Due to Thalamo-Mesencephalic Infarction / 대한평형의학회지

Vertical gaze palsy is usually associated with lesions of the rostral midbrain and thalamo-mesencephalic junction. The rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF), the interstitial nucleus of Cajal, and the posterior commissure located in the midbrain are the critical area in supranuclear control of vertical eye movements. We describe a case of vertical one-and-a-half syndrome accompanying contralateral abduction and incomplete depression palsy due to thalamo-mesencephalic infarction. These vertical eye movement abnormalities are presumed to be caused by damage to the ipsilateral riMLF, interstitial nucleus of Cajal, and oculomotor fascicles.

Acute Myeloradiculitis Associated with Herpes Simplex Virus Type 2 Presenting with Acute Flaccid Paralysis

We describe two patients with acute myeloradiculitis associated with herpes simplex virus type 2 (HSV-2). They were previously healthy and immunocompetent and had no history of herpes infection or rash. Myeloradiculitis manifested as an acute flaccid paralysis that primarily involved the conus medullaris and cauda equina. laccid paralysis can be caused by HSV-2 myeloradiculitis, and so early antiviral treatment should be considered.

Meningoencephalitis associated with Parvovirus B19 Infection in an Immunocompetent Patient / 고신대학교의과대학학술지

Parvovirus B19 (PVB19) infection is a rare cause of meningoencephalitis. A 53-year-old previously healthy woman presented with fever, headache, and multiple erythema on the both legs. Cerebrospinal fluid study revealed pleocytosis and elevated opening pressure and protein level. Brain MRI showed multiple, asymmetric, hyperintensity in the brain stem, basal ganglia, white matter, and gray matter. Anti-B19 IgM antibody and PCR for PVB19 were positive in serum. Clinician should consider PVB19 infection in any case of acute febrile illness with erythema and meningoencephalitis.

Serial MRI of Hypoxic Brain Damage after Hydrogen Sulfide Exposure

Hydrogen sulfide is a colorless gas and frequently lethal occupational hazard that causes tissue hypoxia with prominent neurological signs. Depending on the amount of exposure, many neurotoxic effects such as headache, disequilibrium, and loss of consciousness have been reported. However, a few address the brain MRI findings in hydrogen sulfide poisoning. We report serial brain MRI findings in a patient with hydrogen sulfide intoxication.

Trigeminal Neuralgia Presenting as Transient Ischemic Attack in a Patient with Lateral Medullary Infarction

No abstract available.

Paradoxical Cerebral Embolism Associated With Isolated Pulmonary Arteriovenous Fistula

No abstract available.

Molar Tooth Sign in Joubert Syndrome

No abstract available.

Cough-Induced Syncope in a Patient with Bronchial Asthma

Cough-induced syncope is belongs to the heterogeneous group of situational syncope. It is characterized by the loss of consciousness occurring after excessive coughing. A 63-year-old man complained of cough syncope for 15 days. During vigorous coughing, he lost consciousness for a few seconds. He had past medical history of bronchial asthma and diabetes mellitus. Various tests for syncope including electroencephalogram, electrocardiogram, 24-hours Holter monitoring, echocardiogram, carotid sinus massage, tilt table test, carotid duplex, and brain MRI were normal. He was treated successfully with anti-tussives and bronchodilators. We report a case of cough-induced syncope in a patient with bronchial asthma.

Atypical Sturge-Weber Syndrome Presenting with Stroke-Like Episode

Sturge-Weber syndrome (SWS) is a rare sporadic neurocutaneous syndrome, characterized by port-wine nevus of face, ocular vascular abnormalities and leptomeningeal angioma. A 63-year-old man developed sudden onset of right hemiparesis and global aphasia. He had a past history of epilepsy. Physical examination showed no skin lesions. Brain CT demonstrated gyriform calcification in the left frontal area. Brain MRI revealed cortical atrophy in the left hemisphere with no diffusion restrictions. Fourteen hours later, he was completely recovered from aphasia and motor weakness. We report a case of atypical SWS with episode of acute hemiparesis which highlight the difficulty in distinguishing seizure from ischemic symptoms.

Parenchymal Hemorrhage, Subdural Hematoma, and Subarachnoid Hemorrhage in a Patient with Cerebral Venous Sinus Thrombosis / 대한뇌졸중학회지

Cerebral venous sinus thrombosis (CVST) may be complicated with various intracranial hemorrhage such as petechial hemorrhage, hemorrhagic infarction, parenchymal hemorrhage, subarachnoid hemorrhage (SAH), and subdural hematoma (SDH). However, combination of these types of intracranial hemorrhages supervening on CVST is seldom reported. A 55-year-old female with rectal cancer presented with severe headache, nausea, vomiting and diplopia. She was diagnosed as having CVST in the superior sagittal sinus with left frontal parenchymal hemorrhage and was treated with anticoagulants. The CVST were extended to inferior sagittal and straight sinuses. Moreover, SDH along the left cerebral convexity and SAH in the left sylvian fissure were simultaneously observed. Our present case shows that combination of various types of hemorrhages is rare but may occur in advanced CVST.

Weakness of Index, Middle and Ring Fingers Due to Precentral Gyrus Infarction

No abstract available.

Cough-Induced Syncope in a Patient with Bronchial Asthma / 대한간질학회지

Cough-induced syncope is belongs to the heterogeneous group of situational syncope. It is characterized by the loss of consciousness occurring after excessive coughing. A 63-year-old man complained of cough syncope for 15 days. During vigorous coughing, he lost consciousness for a few seconds. He had past medical history of bronchial asthma and diabetes mellitus. Various tests for syncope including electroencephalogram, electrocardiogram, 24-hours Holter monitoring, echocardiogram, carotid sinus massage, tilt table test, carotid duplex, and brain MRI were normal. He was treated successfully with anti-tussives and bronchodilators. We report a case of cough-induced syncope in a patient with bronchial asthma.

Atypical Sturge-Weber Syndrome Presenting with Stroke-Like Episode / 대한간질학회지

Sturge-Weber syndrome (SWS) is a rare sporadic neurocutaneous syndrome, characterized by port-wine nevus of face, ocular vascular abnormalities and leptomeningeal angioma. A 63-year-old man developed sudden onset of right hemiparesis and global aphasia. He had a past history of epilepsy. Physical examination showed no skin lesions. Brain CT demonstrated gyriform calcification in the left frontal area. Brain MRI revealed cortical atrophy in the left hemisphere with no diffusion restrictions. Fourteen hours later, he was completely recovered from aphasia and motor weakness. We report a case of atypical SWS with episode of acute hemiparesis which highlight the difficulty in distinguishing seizure from ischemic symptoms.

Extensive Hemispheric Involvement on Diffusion-Weighted Image in a Patient with Status Epilepticus

Epileptic seizures have been shown to cause increased signal intensities on diffusion-weighted images (DWI). Extensive hemispheric involvement on MRI after status epilepticus was very rare. A 56-year-old man transferred to our hospital due to status epileticus. The status epilepticus lasted nearly 7 hours. Neurological examination showed confusional consciousness, left hemiplegia and hemineglect of left side. Brain DWI demonstrated extensive high signal intensities in the right posterior frontal, parietal, temporal and occipital lobes resembling acute cerebral infarction. EEG revealed periodic lateralized epileptiform discharges over the right hemisphere. Follow-up DWI showed more decreased signal intensity in right hemispheric lesions. This case demonstrates the importance of recognizing the characteristics that help differentiate status epilepticus from other disorders.

Hypertensive Brainstem Encephalopathy With Acute Pontine Hemorrhage

No abstract available.

A Case of Cerebellar Infarction with Pulmonary Arteriovenous Malformation / 대한뇌졸중학회지

Pulmonary arteriovenous malformation (PAVM) is a rare vascular anomaly. The vascular anomaly usually occurs congenitally, and enlarges progressively with aging. Although PAVM has many pulmonary manifestations, its most common symptom is known to be dyspnea on exertion. Non pulmonary complications, such as ischemic stroke, have rarely been reported. In this paper, we report a case of a patient with both cerebellar infarction and an isolated PAVM. The PAVM was diagnosed with transesophageal echocardiography, transcranial Doppler and pulmonary angiography, and treated with embolization.