Calcified Neurocysticercosis that Invaded the Subarachnoid Space Presenting as Focal Status Epilepticus

Neurocysticercosis is the most common parasitic infection of the nervous system. However, the improvement in public health made the prevalence of neurocysticercosis low. Neurocysticercosis may have symptoms such as seizures, headache, and hydrocephalus, and calcified neurocysticercosis is generally known to be asymptomatic and inert. Also, status epilepticus associated with neurocysticercosis has been rarely reported. Therefore, we report a case of focal status epilepticus caused by calcified neurocysticercosis that invaded the subarachnoid space, which is uncommon pathophysiology of neurocysticercosis.

Imaging Features and Pathological Correlation in Mixed Microcystic and Angiomatous Meningioma:A Case Report

Meningiomas are the most common intracranial tumors. However, microcystic and angiomatous meningiomas are very rare subtypes that present unusual imaging findings. Hence, radiological diagnosis of these tumors can be challenging. We herein describe a case of mixed angiomatous and microcystic meningioma in an 81-year-old male. MRI revealed an extra-axial mass with high T2 signal intensity, measuring 1.5 cm in diameter, with multiple tiny intralesional cysts and entrapped peritumoral cyst formation. After tumor resection, a histopathological diagnosis of mixed angiomatous and microcystic meningioma was made.

Intracerebral Hemorrhage Caused by Thrombosis of a Developmental Venous Anomaly with an Unusual Structure: A Case Report

Developmental venous anomalies (DVAs) are common intracranial vascular malformations and they are generally do not cause clinical complications. In cases showing DVA and hemorrhage, the hemorrhage is usually associated with adjacent cavernous malformations. Very few cases of intracerebral hemorrhage (ICH) caused by thrombosis in DVA have been reported in the literature. In this case report, we present an interesting case of a large ICH caused by thrombosis within a DVA with an unusual structure that may have potentiated the thrombosis.

Is the Presence of Headache Indispensable in Diagnosing Reversible Cerebral Vasoconstriction Syndrome?

No abstract available.

Analysis of medical disputes regarding chronic pain management in the 2009–2016 period using the Korean Society of Anesthesiologists database / 대한마취과학회지

BACKGROUND: The active involvement of anesthesiologists in chronic pain management has been associated with an increase in the number of related medical dispute cases. METHODS: Using the Korean Society of Anesthesiologists Legislation Committee database covering case files from July 2009 to June 2016, we explored injuries and liability characteristics in a subset of cases involving chronic pain management. RESULTS: During the study period, 58 cases were eligible for final analysis. There were 27 cases related to complex regional pain syndrome (CRPS), many of them involving problems with financial compensation (24/27, 88.9%). The CRPS cases showed male dominance (22 males, 5 females). In a disproportionately large number of these cases, the causative injury occurred during military training (n = 5). Two cases were associated with noninvasive pain managements, and 29 cases with invasive procedures. Of the latter group, procedures involving the spine (both neuraxial and non-neuraxial procedures) resulted in more severe complications than other procedures (P = 0.007). Seven of the patients who underwent invasive procedures died. The most common type of invasive procedures were lumbosacral procedures (16/29, 55.2%). More specifically, the most common damaging events were inadvertent intravascular or intrathecal injection of local anesthetics (n = 6). CONCLUSIONS: Several characteristics of medical disputes related to chronic pain management were identified: the prevalence of injury benefit claims in CRPS patients, higher severity of complications in procedures performed at the spine or cervical region, and the preventability of inadvertent intravascular or intrathecal injection of local anesthetics.

Methanol-Induced Encephalopathy: a Case Report

A characteristic imaging finding in cases of methanol intoxication is putaminal necrosis, but its presence is usually not suspected due to its rarity. Methanol intoxication generally produces serious neurological symptoms that include visual disturbances and diminished consciousness, characteristically with metabolic acidosis. We reported the case of a 59-year-old man who was admitted to the hospital with diminished consciousness. Acute methanol intoxication was determined as the cause. Laboratory tests revealed high anion gap metabolic acidosis. Diffusion-weighted MRI indicated diffuse symmetric diffusion restriction lesions in the subcortical white matter of both cerebral hemispheres.

Green urine after general anesthesia with propofol: different responses in the same patient: A case report

Green discoloration of the urine after propofol administration is a rare clinical phenomenon. Although the exact incidence of propofol-induced green urine is not known, the reported incidence is thought to be less than 1%. In most reported cases of propofol-induced green urine, the clinical effects were benign and reversible. However, many clinicians are unfamiliar with this rare side effect of propofol. Here, we present the case of a patient who showed green urine following two-staged repair of a thoracoabdominal aortic aneurysm with propofol infusion. His urine had a normal yellowish color after the first operation, but appeared green immediately after the second surgery. Because propofol is a commonly used sedative agent, knowing that green urine can be attributed to propofol administration and that its clinical effect is mostly benign will help clinicians with patient management, as such knowledge will also reduce unnecessary concerns and laboratory tests.

Risperidone in a child with untractable emergency delirium: a case report / 대한마취과학회지

A 6-year-old boy was scheduled for thoracic magnetic resonance imaging under deep sedation with midazolam 1.8 mg and propofol 100 µg/kg/min via intravenous injection. He showed emergence delirium in the post-anesthesia care unit. The staff attempted to calm him by administering flumazenil as an antidote for midazolam, propofol for further sedation, and meperidine. However, this was not successful. A psychiatrist recommended the use of antipsychotics. Administration of risperidone led to immediate resolution of the boy's symptoms and relaxed him. The use of antipsychotic drugs is not common for anesthesiologists, but should be considered for treating uncontrolled emergence delirium after anesthesia.

A scientific treatment approach for acute mast cell leukemia: using a strategy based on next-generation sequencing data

BACKGROUND: Mast cell leukemia (MCL) is the most aggressive form of systemic mastocytosis disorders. Owing to its rarity, neither pathogenesis nor standard treatment is established for this orphan disease. Hence, we tried to treat a patient with MCL based on the exome and transcriptome sequencing results of the patient's own DNA and RNA. METHODS: First, tumor DNA and RNA were extracted from bone marrow at the time of diagnosis. Germline DNA was extracted from the patient's saliva 45 days after induction chemotherapy and used as a control. Then, we performed whole-exome sequencing (WES) using the DNA and whole transcriptome sequencing (WTS) using the RNA. Single nucleotide variants (SNVs) were called using MuTect and GATK. Samtools, FusionMap, and Gene Set Enrichment Analysis were utilized to analyze WTS results. RESULTS: WES and WTS results revealed mutation in KIT S476I. Fusion analysis was performed using WTS data, which suggested a possible RARα-B2M fusion. When RNA expression analysis was performed using WTS data, upregulation of PIK3/AKT pathway, downstream of KIT and mTOR, was observed. Based on our WES and WTS results, we first administered all-trans retinoic acid, then dasatinib, and finally, an mTOR inhibitor. CONCLUSION: We present a case of orphan disease where we used a targeted approach using WES and WTS data of the patient. Even though our treatment was not successful, use of our approach warrants further validation.

Recurrent Cardiac Arrest during a Nontransplant Operation Due to Variant Angina in a Liver Transplantation Patient / 대한이식학회지

We report a case of recurrent cardiac arrest during a nontransplant operation in a liver transplant recipient with prior cardiac arrest during liver transplantation. A 45-year-old man who experienced cardiac arrest for 17 minutes during the preanhepatic phase of liver transplantation–which was performed 34 months ago–did not survive the recurrent cardiac arrest during portal venoplasty. Variant angina was not suspected for the first cardiac arrest; however, myocardial infarction by coronary vasospasm was revealed to be the cause of the second cardiac arrest.

Microembolism after Endovascular Treatment of Unruptured Cerebral Aneurysms: Reduction of its Incidence by Microcatheter Lumen Aspiration / 신경중재치료의학

PURPOSE: Diffusion-weighted MR images (DWI) obtained after endovascular treatment of cerebral aneurysms frequently show multiple high-signal intensity (HSI) dots. The purpose of this study was to see whether we could reduce their incidence after embolization of unruptured cerebral aneurysms by modification of our coiling technique, which involves the deliberate aspiration of the microcatheter lumen right after delivery of each detachable coil into the aneurysm sac. MATERIALS AND METHODS: From January 2011 to June 2011, all 71 patients with unruptured cerebral aneurysms were treated using various endovascular methods. During the earlier period, 37 patients were treated using our conventional embolization technique (conventional period). Then 34 patients were treated with a modified coiling technique (modified period). DWI was obtained on the following day. We compared the occurrence of any DWI HSI lesions and the presence of the symptomatic lesions during the two time periods. RESULTS: The incidence of the DWI HSI lesions differed significantly at 89.2% (33/37) during the conventional period and 26.5% (9/34) during the modified period (p < 0.0001). The incidence of symptomatic lesions differed between the two periods (29.7% during the conventional period vs. 2.9% during the modified period, p < 0.003). CONCLUSION: Aspiration of the inner content of the microcatheter right after detachable coil delivery was helpful for the reduction of the incidence of microembolisms after endovascular coil embolization for the treatment of unruptured cerebral aneurysms.

A Case of Coarctation of the Aorta Diagnosed by Tardus-Parvus Renal Doppler Flow Patterns

No abstract available.

Intestinal malrotation detected by abdominal CT / 대한내과학회지

No abstract available.

The Impact of the Amount of Intracellular SPIO on MR Signal Intensity during In Vivo Tracking of Macrophage Homing

PURPOSE: To determine whether the amount of intracellular superparamagnetic iron oxide (SPIO) in macrophages influences MR signal intensity during in vivo celluar tracking. MATERIALS AND METHODS: Peritoneal macrophages harvested from thioglycolate-treated mice were labeled with SPIO using concentrations of 112, 56, and 28 microgramFe/ml, and different incubation times of 3h, 6h, 12h, 24h and 48 h, respectively. The iron concentration was quantified with the use of absorption spectrophotometry. Each group of macrophages labeled with different concentrations of SPIO was intravenously injected into 18 mice, after inoculation with S. aureus to the thigh. The relative signal intensity (SI) of the abscess wall (SI of the abscess wall/SI of muscle) was measured on MR and was analyzed by the use of the Kruskal-Wallis test. RESULTS: A higher concentration of SPIO in the labeling solution and a longer incubation time resulted in a higher concentration of SPIO in the macrophages. The relative SI of the abscess wall (0.63 for 112 microgramFe/mL; 0.67 for 56 microgramFe/ml; 0.89 for 28 microgramFe/mL) significantly decreased with an increase of SPIO concentration (k2=10.53, p < 0.005). CONCLUSION: The amount of intracellular SPIO influences the MR signal intensity by the susceptibility effect, and it is recommended to use sufficient iron-oxide label as long as it does not affect cellular function and viability.

Coil Embolization of Spontaneous Vertebral Arteriovenous Fistula Associated with Neurofibromatosis Type 1: A Case Report / 신경중재치료의학

We present a case of 44-year-old male with spontaneous right vertebral arteriovenous fistula associated with neurofibromatosis type 1. The symptom of this patient was myeloradiculopathy of which was due to compressed cervical spinal cord by enlarged epidural vein. Complete occlusion of the fistula using coils resulted in relief of the patient symptom and complete disappearance of enlarged epidural vein on follow-up MR image one month later.