Rhombencephalitis Caused by Primary Varicella-Zoster Virus Infection

No abstract available.

Comparison of Families with and without a Suicide Prevention Plan Following a Suicidal Attempt by a Family Member

The frequency and extent of the existence of a familial suicide prevention plan may differ across cultures. The aim of this work was, therefore, to determine how common it was for families to develop a suicide prevention plan and to compare the main measures used by families with and without such a plan, after an attempt to commit suicide was made by a member of a family living in a rural area of Korea. On the basis of the presence or absence of a familial suicide prevention plan, we compared 50 recruited families that were divided into 2 groups, with Group A (31 families) employing a familial suicide prevention plan after a suicide attempt by a family member, and Group B (19 families) not doing so. The strategy that was employed most frequently to prevent a reoccurrence among both populations was promoting communication among family members, followed by seeking psychological counseling and/or psychiatric treatment. Contrary to our expectation, the economic burden from medical treatment after a suicide attempt did not influence the establishment of a familial suicide prevention plan. It is a pressing social issue that 38% (19 of 50) of families in this study did not employ a familial suicide prevention plan, even after a family member had attempted suicide. Regional suicide prevention centers and/or health authorities should pay particular attention to these patients and their families.

Delayed parkinsonism following high mountain climbing: A case report

Acute mountain sickness is an illness caused by climbing to a high altitude without prior acclimatization. Neurological consequences, like parkinsonism following acute mountain sickness without lesion of brain MRI have been reported rarely. A healthy 56-year-old man presented with dysarthria and gait disturbance. Neurological examination revealed tremor of hands, limb rigidity, and bradykinesia. The symptoms developed approximately 30 days following a 3,500 m climb of the Annapurna in the Himalayas. Brain MRI did not reveal any abnormalities including globus pallidus. The parkinsonism symptoms persisted for about 3 months before a complete recovered was made. We suggest that parkinsonism can develop after climbing to a high altitude but that the symptoms can be transient if a brain MRI detects no abnormalities.

Tactile Stimulation and Mastication Induced Contralateral Trigeminal Neuralgia after Bell's Palsy

We report a 43-year old woman patient presented with contralateral trigeminal neuralgia induced by tactile stimulation and mastication after Bell's palsy. Trigeminal neuralgia is characterized by recurrent episodes of intense lancinating pain affecting the face localized to the sensory supply areas of the trigeminal nerve. Increased excitability of facial motor neurons and bainstem interneurons which mediate trigemio-facial reflex are thought to be the cause of contralateral trigeminal neuralgia after Bell's palsy.

A Case of Idiopathic Granulomatous Hypophysitis

Granulomatous hypophysitis is a rare pituitary condition that commonly presents with enlargement of the pituitary gland. A 31-year-old woman was admitted to the hospital with a severe headache and bitemporal hemianopsia. Magnetic resonance imaging (MRI) showed an 18 x 10-mm sellar mass with suprasellar extension and compression of the optic chiasm. Interestingly, brain MRI had shown no abnormal finding 4 months previously. On hormonal examination, hypopituitarism with mild hyperprolactinemia was noted. The biopsy revealed granulomatous changes with multinucleated giant cells. We herein report this rare case and discuss the relevant literature.

Relationship Between Clinical Features and Recurrence in Benign Paroxysmal Positional Vertigo of Posterior Semicircular Canal / 대한평형의학회지

BACKGROUND AND OBJECTIVES: The aim of this study is to evaluate the relationship between the recurrence and clinical features of posterior canal benign paroxysmal positional vertigo (p-BPPV). MATERIALS AND METHODS: Eighty one consecutive patients with p-BPPV in 1 year period were selected and traced for 2 years by telephone interview and chart review. We reviewed the clinical chart to confirm the lesional side of semicircular canals when 13 patients of the recurrent groups had readmitted. We compared clinical characters between the recurrent group and the nonrecurrent group. RESULTS: The recurrence rate after the successful treatment in the p-BPPV is 28% (23/81) patients. There was no difference in the age, sex, and days prior to visit between the recurrent group and the nonrecurrent group (72%, 58/81). The interval to recurrences were ranged from 8 days to 24 months. In the patients we could confirm the side of recurrences (13/23), there was a tendency of recurring on the same side in the early recurrences (within 14 days) (4/13). CONCLUSION: In considering the causes, the fact that early recurrences tend to be on the same side may be related to unilateral otolith dysfunction as the cause of recurrences in p-BPPV. But the late recurrence may be related to systemic condition because recurrent BPPV developed equally on both sides.

Association of the Superoxide Dismutase (V16A) and Catalase (C262T) Genetic Polymorphisms with the Clinical Outcome of Patients with Acute Paraquat Intoxication

BACKGROUND/AIMS: Many patients with acute paraquat (PQ) intoxication die even at low PQ concentrations, whereas others with similar concentrations recover. Therefore, it is possible that individual differences in antioxidant capacity are responsible for the variable clinical outcome in patients with acute PQ intoxication. METHODS: We investigated whether there was a relationship between the genetic polymorphisms of SOD (V16A), catalase (C262T), and GPX1 (C593T) in 62 patients with acute PQ intoxication and the clinical outcomes of these patients. RESULTS: The frequency of the Mn-SOD V/V, V/A, and A/A genotypes were 56.3, 43.5, and 0% in survivors and 86.9, 13.1, and 0% in non-survivors (p > 0.05). The GPX1 C/C, C/T, and T/T genotypes were present in 100, 0, and 0% of all subjects. The catalase C/C, C/T, and T/T genotypes were present in 100, 0, and 0% of survivors, and in 82.6, 17.4, and 0% of non-survivors. Neither erythrocyte SOD activity nor catalase activity were significantly different between survivors and non-survivors. CONCLUSIONS: No association was found between clinical outcome of acute PQ intoxication and the genetic polymorphism of GPX1 (C593T) or the genetic polymorphisms or enzyme activity of superoxide dismutase (V16A) or catalase (C262T).

Clinical Features, Disability and Socioeconomic Status of Patients With Muscular Dystrophy in Korea

BACKGROUND: Since 2001, the Ministry of Health and Welfare in Korea has designated muscular dystrophy (MD) to be a rare and intractable disease, and has ensured that patients with this condition obtain support from the National Health Insurance Corporation for their medical expenditure. However, the health-related and socioeconomic status of Korean patients with MD has yet to be established. METHODS: We selected 441 patients with MD who received medical services at 17 neuromuscular centers during 2005. The medical records of selected patients were analyzed, and the subtype of MD was classified by its clinical course and diagnostic tests. A total of 95 patients or their family members participated in this health-related and socioeconomic status survey. RESULTS: Medical record analysis showed similar clinical and diagnostic characteristic data to those published previously in other countries: male predominance, being young at onset, and muscular weakness of the extremities as a predominant symptom in most patients. The diagnostic tests for MD were based on laboratory and electrophysiological studies. The most frequent form of MD among our cohort was Duchenne/Becker muscular dystrophy (42%). Our survey revealed the effect of the patients' profound disability on their activities of daily living. One-half of the patients were dissatisfied with the medical expenditure support service that was made available to them, and most patients suffered from a financial burden. The most important medical services to be developed in the future are expansion of the public health service or development of a rehabilitation hospital. CONCLUSIONS: This is the first multicenter-based epidemiologic study on the health-related and socioeconomic status of patients with MD in Korea. The findings indicate that medical coverage and public health service are currently inadequate and hence should be expanded in the future.

Paraquat Intoxication in Subjects Who Attempt Suicide: Why They Chose Paraquat

BACKGROUND/AIMS: Paraquat (PQ) has been used in suicide attempts; an estimated 2,000 toxic ingestions occur annually, with 60-70% mortality. We sought to determine why PQ is such a common agent for suicide attempts in Korea. METHODS: We analyzed 250 cases (143 males, 107 females) of attempted suicide by PQ ingestion from January to December 2007. The procurement of the PQ was divided into two categories: purchased and preexisting. RESULTS: Men were more likely to have purchased PQ than women (66% vs. 22%, p=0.042). Additionally, men were more likely to be unmarried (n=34, 23.9% vs. n=10, 9.3%) or divorced or separated (n=16, 11.3% vs. n=5, 4.6%) than the women (p<0.001). The group who intentionally selected PQ (38.4%) consisted of 96 cases (54 males, 42 females) and the group who did not intentionally select PQ (61.6%) included 154 cases (89 males, 65 females). The incidence of PQ purchase was higher in the intentional selection PQ group (46.9% vs. 18.2%, p<0.01). CONCLUSIONS: Only 38% of patients who attempted suicide with PQ intentionally selected PQ. Thus, greater control of PQ availability is needed, especially in patients at risk.

3-D Model of The Oculomotor Fascicular Arrangement Within The Midbrain Using Brain MRI

BACKGROUND AND PURPOSE: The oculomotor nerve fascicles arise along its entire length and sweep ventrally to exit the midbrain at the medial edge of the crus cerebri. A rostro-caudal topography among the fascicular fibers is relatively well established. There are, however, some controversies whether medio-lateral topography also exists. METHODS: We retrospectively reviewed the clinical records and MRI of the 8 patients showing isolated oculomotor nerve palsy due to midbrain infarction. Brain MRI was performed using a 1.5-T magnet with 2mm thickness and 0.1 mm slice interval. The anterior-posterior axis(X) was defined as the midline crossing the center of the cerebral aqueduct and the medio-lateral axis(Y) as the line crossing the same point. For rostro-caudal measurement, the intercommissural line was used as base line of the Z axis. The location of the lesions was defined by measuring actual distance of the margins of the lesions in millimeter from each axis; anterior, right, and caudal direction was defined as positive values in X, Y and Z coordinates, respectively. RESULTS: The mean values and range of the X, Y and Z are as follows: X=7.56+/-4.34, 1< or =X< or =15; Y=3.43+/-1.37, 0< or =Y< or =6; Z=6.51+/-3.91, 0< or =Z< or =12.5. CONCLUSIONS: The distribution of all the MRI lesions was 0< or =|Y|< or =6 (mm), 0< or =|Z|< or =12.5 (mm) in mediolateral and rostrocaudal direction respectively, which is almost the same as the previously reported divergent range of the oculomotor fascicles in midbrain tegmentum. We suggest that our method of three dimensional measurements of the MRI lesion in midbrain tegmentum could be a useful tool for the study of oculomotor fascicular arrangement.

Which Factors Influence the Detection of an Inflamed Appendix: Comparative Assessment of Ultrasonography and CT

PURPOSE: To compare and assess factors influencing the detection of an inflamed appendix by both ultrasonography (US) and CT. MATERIALS AND METHODS: We retrospectively analyzed US and CT findings of 58 patients with confirmed acute appendicitis (42 patients with perforation and 16 patients without perforation), in which both preoperative US and CT scans were performed. We compared the use of US and CT for the diagnostic accuracy of acute appendicitis, and determined the detection rate for an inflamed appendix. According to the location of the appendix, the amount of mesenteric fat content in lower abdominal cavity, the presence of cecal wall thickening, and the presence of pericecal fluid or an abscess, the use of US and CT were compared for the determination of the detection rate of an inflamed appendix. RESULTS: The diagnostic accuracies for US and CT for acute appendicitis in our study group were both 93.1%, and there was no difference between the use of the two modalities. Although the detection rate of an inflamed appendix was slightly higher for US (93.1%) than for CT (84.5%), the difference between the use of the two modalities was not significant (p > 0.05). There was no significant difference in the detection rate of an inflamed appendix between the use of US and CT according to location of appendix, the amount of mesenteric fat content and the presence of cecal wall thickening. A pelvic location of the inflamed appendix and the presence of pericecal fluid or an abscess, were factors that significantly increased the detection rate for US than for CT (p < 0.05). CONCLUSION: The use of US for diagnosis of acute appendicitis is as useful as the use of CT. US is especially useful to detect an inflamed appendix more effectively than CT in cases where the appendix is in a pelvic location and presents with pericecal fluid or an abscess.

A Case of Suspicious Focal Atonic Seizure Characterized by Drop Attack

Atonic seizures exhibits loss of postural tone, resulting in head drops or falling. When this event is extremely brief, It has been known as a drop attack. Atonic seizure are firmly placed under the category of generalized seizures. However, a various phenomena satisfying the above description has been recognized in patients with partial seizures. A 13-year-old girl had brief episodes of drop attacks. She complained of weakness of both legs in the absence of consciousness loss. These episodes occurred at a frequency of 4 or 5 time per day for 1 year. Her developmental and physical examinations were normal. Also, the brain MRI was normal. However, her Interictal EEG showed the repetitive spike and wave complexes on C(z) electrode. She was controlled completedly by antiepileptic drungs. We report a patient who suffered from focal atonic seizures characterized by drop attack.

Two Patients with Hemiparesis as Manifestation of Status Epilepticus

Inhibitory motor seizure or ictal hemiparesis is very infrequent seizure type and sometimes difficult to differentiate from acute cerebrovascular disease. We report two patients with hemiparesis as manifestation of status epilepticus. One patient showed epileptic discharge on midline frontocentral region by EEG-Video monitoring, another patient showed continuous slowing wave associated with hyperperfusion findings of brain SPECT on left fronto-temporo-parietal region. Both patients showed normal brain imaging.

A Case of Tetramine Intoxication from the Neptunea

Seafood is a vehicle for the transmission of intoxication. The Neptunea are sublittoral species of the marine prosobranch mollusk. Tetramine toxin is found in the salivary gland of Neuptunea. A woman developed blurred vision, dizziness, headache, diarrhea, numbness and gait disturbance one hour after ingesting conchs. Neurological examination showed dysesthesia, and motor weakness. Laboratory and electrophysiological studies were normal. The next day, she recovered from her symptoms. We report a patient with dysesthesia and motor weakness due to Neuptunea species' tetramine toxin.

A Patient of Border-zone Infarction Caused by Defecation Syncope

A severe or prolonged drop in blood pressure caused by syncope can lead to border-zone infarction in the absence of coexisting large artery disease. Syncope due to defecation represent special cases of reflex syncope for which the mechanisms are poorly understood and probably multifactorial. We experienced a 56-year-old woman was recurrent loss of consciousness duration defecation. Brain MRI revealed multifocal high signals in T2WI and FLAIR image on both end-artery border zone, but brain MRA revealed normal finding. Thus, We report a rare case of an old woman patient with end-artery border zone infarction due to prolonged hypoperfusion that was caused by defecation syncope.

The Usefulness of the Transabdominal Ultrasonography as a Screening Examination in the Evaluation of the Patient with Suspicious Gastric Disease

PURPOSE: To evaluate the usefulness of transabdominal ultrasonography as a screening examination in patients with suspicious gastric disease. MATERIALS AND METHODS: We selected 141 patients with epigastric pain and who were found to have antral gastric wall thickening of more than 5 mm in transabdominal ultrasonography, and who underwent gastroscopy immediately following the ultrasonography examination, because we suspected that these patients had gastric disease. We measured the full thickness of the five layers of the gastric wall and evaluated the preservation of this fivelayered structure. We respectively compared the gastric wall thickness and the preservation of gastric layers in 26 normal, 91 gastritis, 12 gastric ulcer, and 12 gastric cancer patients, who were classified based on the gastroscopy results. RESULTS: The mean thicknesses of the gastric wall in the normal, gastritis, gastric ulcer and gastric cancer patients were 5.13+/-0.14 mm, 6.71+/-1.33 mm, 8.08+/-2.80 mm, and 12.45+/-3.70 mm, respectively. The gastric walls in the gastritis, gastric ulcer and gastric cancer patients were significantly thicker than that in the normal patients (p 0.01). Except for two patients with gastritis and three patients with gastric ulcer, the stratification of the gastric wall was preserved in all of the normal, gastritis and gastric ulcer patients, whereas it was disrupted in all of the patients with gastric cancer. CONCLUSION: Transabdominal ultrasonography in the fasting state may be a helpful and convenient modality, which can serve as a screening examination in the evaluation of gastric disease. Therefore, careful attention and effort are needed to evaluate the gastric wall during transabdominal ultrasonography.

A Patient of Sweet Syndrome Associated with Encephalitis

No abstract available.

A Case of Cerebral Infarction Associated with Giant Cell Arteritis

Giant cell arteritis (GCA) is an autoimmune vasculitic disorder of unknown origin. Systemic GCA causing cerebral infarction due to intracranial arteritis is rare. Early diagnosis and anti-inflammatory treatment of the GCA are necessary to prevent systemic involvement. A 66-year-old woman presented with dysarthria and left hemiparesis. A brain MRI showed ischemic lesions in the right temporoparietal area. We report a pathological case of GCA with clinical and neuroradiological evidence of cerebral infarction.

A Case of Thyrotoxic Paraplegia / 대한내분비학회지

Hyperthyroidism may be associated or present with a variety of neuromuscular disorders, including thyrotoxic myopathy, exophthalmic ophthalmoplegia, periodic paralysis and myasthenia gravis. In contrast to muscle, peripheral nerve involvement in hyperthyroidism is exceedingly rare, and has received little attention. Paraplegia-like weakness during severe hyperthyroidism was first described by Charcot in 1889, and called Basedow's paraplegia' by Joffory in 1894. However, there has been no reported case in Korea. A 38-year-old woman was admitted for evaluation of progressive weakness and a gait disturbance. Her endocrinological results were compatible with hyperthyroidism. The polyneuropathy was also confirmed with sequential electrophysiological studies of the nerves and muscles. Drug therapy for hyperthyroidism resulted in resolution of the clinical neurological symptoms and progressive improvement of electrophysiological findings. Hyperthyroidisms are common medical disorders, which are often accompanied by diverse types of neurological and neuromuscular dysfunctions. All of these neurological manifestations are important, as they can serve as important clues to the diagnosis of a thyroid disorder. Furthermore, they are often related to the patient's presenting complaint. Therefore, the physician must be alert to the diverse manifestations of thyroid dysfunction, as they can lead to the diagnosis of potentially serious but treatable disorders. Herein is reported a case of myopathy and neuropathy associated with hyperthyroidism (Basedow's paraplegia), with a review of the literature

A Case of Thyrotoxic Paraplegia / 대한내분비학회지

Hyperthyroidism may be associated or present with a variety of neuromuscular disorders, including thyrotoxic myopathy, exophthalmic ophthalmoplegia, periodic paralysis and myasthenia gravis. In contrast to muscle, peripheral nerve involvement in hyperthyroidism is exceedingly rare, and has received little attention. Paraplegia-like weakness during severe hyperthyroidism was first described by Charcot in 1889, and called Basedow's paraplegia' by Joffory in 1894. However, there has been no reported case in Korea. A 38-year-old woman was admitted for evaluation of progressive weakness and a gait disturbance. Her endocrinological results were compatible with hyperthyroidism. The polyneuropathy was also confirmed with sequential electrophysiological studies of the nerves and muscles. Drug therapy for hyperthyroidism resulted in resolution of the clinical neurological symptoms and progressive improvement of electrophysiological findings. Hyperthyroidisms are common medical disorders, which are often accompanied by diverse types of neurological and neuromuscular dysfunctions. All of these neurological manifestations are important, as they can serve as important clues to the diagnosis of a thyroid disorder. Furthermore, they are often related to the patient's presenting complaint. Therefore, the physician must be alert to the diverse manifestations of thyroid dysfunction, as they can lead to the diagnosis of potentially serious but treatable disorders. Herein is reported a case of myopathy and neuropathy associated with hyperthyroidism (Basedow's paraplegia), with a review of the literature