Hypoglycemic Encephalopathy with Reversible Unilateral Hippocampal Lesion on Brain MRI / 계명의대학술지

There have been few reports of hypoglycemic encephalopathy (HE) with unilateral brain lesion. A 66-year-old male with hypoglycemia, who had history of diabetes and recent poor oral intake, presented with amnesia and confusion. Diffusionweighted imaging (DWI) showed high signal intensity in left hippocampus, which was low on apparent diffusion coefficient (ADC) map. By intravenous glucose, the symptoms improved besides amnesia for hypoglycemic period. Follow-up DWI revealed no lesion and single photon emission computed tomography (SPECT) showed decreased perfusion in left temporo-parieto-frontal area. We experienced a case of HE with a reversible unilateral hippocampal lesion.

Factors Affecting Caregiver Burden in Family Caregivers of Patients with Dementia

BACKGROUND: This study aimed to know the state of caregiver burden of family caregivers of patients with dementia and also to know factors associated with the severity of caregiver burden. METHODS: Family caregivers of dementia patients were enrolled from five general hospitals in Daegu Metropolitan city, Korea. The participants analyzed in the present study were 199 subjects who were 24 to 86 years old, living in Daegu or Kyungsang Bukdo province. Demographic features, general characteristics, characteristics of caring patients were collected and Burden Interview was done by a psychologist. Factors affecting caregiver burden were assessed using statistical analyses. RESULTS: The average severity of caregiver burden of family caregivers were between mild and moderate. Factors affecting the severity of caregiver burden were caregiving days per week among caregiver's characteristics and Neuropsychiatric Inventory and Geriatric Depression Scale among patient characteristics by multiple regression linear analysis. Caregiving cost shows marginal significance. Interestingly, cognitive scales like Mini-Mental State Examination, Clinical Dementia Rating, Physical and Instrumental Activities of Daily Living did not affect caregiver burden of family caregivers. CONCLUSIONS: This study showed that caregiving days per week of caregivers and neuropsychiatric symptoms including depressive mood of patients are closely related with caregiver burden of family caregivers of patients with dementia in Korea.

Transverse Myelitis in Patient with Behcet's Disease

Behcet's disease (BD) is a multisystem disorder presenting recurrent oral and genital ulcerations as well as ocular lesions, involving the nervous system in a subgroup of patients. BD develops at a young age and is frequently presented with an acute or subacute brainstem syndrome or hemiparesis, as well as with other various neurological manifestations, the syndrome is often included in the differential diagnosis of multiple sclerosis, stroke of the young adult, and other neurological disorders. Transverse myelitis (TM) is a clinical syndrome in which an immune-mediated process causes neural injury to the spinal cord, resulting in varying degrees of weakness, sensory alterations and autonomic dysfunction. Spinal Neuro-behcet's disease is rare case. We reported a 33-year old man who had been treated for BD for 3 years.

Retrograde Amnesia as a Predominant Symptom of Transient Global Amnesia

Transient global amnesia (TGA) causes retrograde amnesia, but there have been few reports of retrograde amnesia as a presenting symptom in TGA. A 52-year-old male who had acute amnesia for the past 4 years presented with TGA and recovered within 1 day. Brain magnetic resonance imaging revealed a lesion in the left hippocampus, and brain single-photon emission computed tomography revealed decreased blood flow in the left temporal and frontal areas. We speculated that hippocampal lesion with a frontal perfusion defect can be a cause of TGA.

Moyamoya Syndrome Following Tuberculous Meningitis

While it is generally considered that tuberculous meningitis (TBM) causes various vascular complications, there have been few reports of moyamoya syndrome following TBM. A 23-year-old female was diagnosed as TBM. Preliminary brain MRA yielded normal findings. Follow-up MRA and cerebral angiography conducted 1.5 years later yielded findings that were consistent with moyamoya disease. They showed no interval change after 2 years, and the patient had no neurological deficits. This patient with TBM subsequently developed moyamoya syndrome during the course of antituberculosis medication.

Meningitis Associated Dengue Fever Imported from Vietnam

Dengue fever is an acute febrile disease caused by the dengue virus, which belongs to the family Flaviviridae. The increasing number of people traveling abroad has increased the number of cases of imported dengue fever in Korea. The most common symptoms in patients with dengue fever are malaise, fever, musculoskeletal pain, headache, nausea, vomiting, and abdominal pain. Neurological manifestations such as myelitis, encephalitis, and cranial nerve palsies have been recognized as clinical consequences of dengue infection, but meningitis is a rare complication. We report the case of a 38-year-old man who presented with fever, headache, and nuchal rigidity while traveling in Vietnam. The etiology of meningitis was confirmed by the presence of dengue IgM antibody in his serum. This case report highlights the potential of dengue infection as a cause of meningitis.

Cognitive Dysfunction Following High Mountain Climbing

Few studies have investigated cognitive impairment associated with globus pallidal lesion after acute mountain sickness (AMS). A 54-year-old mountaineer presented with a slowed response, social withdrawal, and apathy after exposure to high altitude. Neuropsychological evaluation revealed impairment in memory and frontal function. MRI revealed bilateral globus pallidal lesions and SPECT revealed decreased blood flow in the left temporal cortex. Symptoms and imaging findings were still impaired after 3 years. We speculate that globus pallidal lesions can cause cognitive dysfunction in AMS.

A Case of Viral Encephalitis as a Presenting Symptom of Histiocytic Necrotizing Lymphadenitis: Kikuchi's Disease

No abstract available.

Otologic Causes of Drop Attacks in Elderly Patients

BACKGROUND AND OBJECTIVES: Many neurologists are unaware of the drop attack that may occur from an inner ear dysfunction especially in elderly. We performed this study to investigate the clinical features and results of quantitative audiovestibular tests in six elderly patients (> or =65 years of age) who presented with drop attacks attributable to an inner ear pathology. MATERIALS AND METHOD:Group was divided into Meniere's syndrome (4) or non-Meniere peripheral vestibulopathy (2). Standard dizziness questionnaire and quantitative audiovestibular function testing were performed. RESULTS:Episodes were described as a sudden push to the ground in four or a violent illusionary movement of environment leading to a fall in two. All cases gave a history of prior vertiginous episodes and vestibular testing revealed unilateral caloric paresis. Ipsilateral hearing loss was documented in four cases. CONCLUSIONS:Our results suggest that otologic causes should be considered in the differential diagnosis of the drop attack in elderly, even if the symptoms and signs were not consistent with Meniere's syndrome.

A Case of Viral Encephalitis with Disproportionate Retrograde Amnesia

A 44-year-old man showed recurrent paroxysmal amnesic attacks following viral encephalitis which, despite antiepileptic treatment, developed into status epilepticus. Interestingly, the amnesic attacks mainly consisted of amnesia for retrograde events. After recovery from status, he showed a persistent amnesia which was characterized as disproportionate retrograde amnesia for the past 20 years. We attribute the amnesic attacks in the acute stage to a transient epileptic amnesia and the profound retrograde amnesia in the chronic stage to status- or infection-related focal brain damage.

A Familial Outbreak of Food-borne Botulism

We experienced 3 cases of food-borne botulism within a family. They presented with progressive ptosis, dysphonia, dysarthria and limb weakness, which had started about 12 hours after ingestion of vacuum-packed sausage. Two cases progressed to respiratory failure. Botulinum toxin A was detected from the stool sample of one case. Conservative treatment with mechanical ventilation was done and they recovered from respiratory failure over a 30-70 days period. This is the first case report of food-borne botulism in Korea.

Neuropsychological and Neuroimaging Findings of Frontal Variant of Alzheimer's Disease

BACKGROUND: Patients with Alzheimer's disease (AD) at an early stage present with memory decline and impairments of language and visuospatial functions. However, some AD patients occasionally show frontal lobe dysfunctions in the early stage those are known to emerge only at the advanced stage. This subtype of AD is called a frontal variant of AD (frontal AD). We report neuropsychological and FDG-PET findings of three cases of frontal AD. METHODS: Three patients met the diagnostic criteria of probable AD proposed by the NINCDS-ADRDA. However, they unusually showed clinical symptoms associated with frontal lobe dysfunctions even if they were relatively in the early stage of dementia. All the patients underwent neuropsychological tests and brain FDG-PET scans. Distribution of glucose hypometabolism was analyzed using statistical parametric mappings (SPM). RESULTS: Results of neuropsychological tests were consistent with findings of AD except that frontal lobe dysfunctions were prominent. FDG-PET scans and SPM analysis of these images showed hypometabolism in the frontal as well as temporo-parietal regions. Unlike the hypometabolism pattern found in frontotemporal dementia, frontal hypometabolism in our patients was not as severe as parietal hypometablism and hypometabolic regions within the temporal lobe were in the middle or posterior part of the middle and inferior temporal gyri rather than in the anterior part. CONCLUSIONS: Detailed neuropsycholgical tests and FDG-PET may help differentiate AD with frontal involvement in its early stage (frontal AD) from frontotemporal dementia. Future studies with FDG-PET in a larger series of frontal AD cases, especially with histologically proven cases, may be needed.

Apolipoprotein E Polymorphism in Ischemic and Hemorrhagic Stroke / 대한해부학회지

There is an evidence for a role of apolipoprotein E (APOE) in atherosclerosis, coronary heart disease and carotid artery stenosis. Morbidity of carotid artery atherosclerosis is higher in persons carrying an epsilon4 allele, but the association of cerebrovascular disease and apoE genotype is controversial. We studied the association between APOE genotype and allele (epsilon2, epsilon3, epsilon4) frequency and stroke. We evaluated APOE genotype in 133 first -ever stroke patients and 111 healthy controls. We also estimated the risk factors of stroke such as hypertension, diabetes and lipid profiles in both groups. APOE genotypes were analyzed by polymerase chain reaction. APOE genotypes and allele distributions were not different in patients and controls. There is also no difference of APOE allele frequencies between ischemic small artery occlusive disease and hypertensive subcortical intracerebral hemorrhage. We concluded that the APOE -epsilon4 allele is not associated with stoke including ischemic and hemorrhagic stroke.

A Case of Sudden Deafness with Simultaneous Ipsilateral Positional Vertigo

Although some cases of benign positional vertigo are associated with a chronic ipsilateral sensorineural hearing loss, an association with simultaneous ipsilateral sudden deafness is rare. We report a 53-year old woman with sudden deaf-ness with simultaneous positional vertigo in the same ear characterized by benign paroxysmal positional vertigo of pos-terior semicircular canal type. After a modified Epley particle-repositioning maneuver, the patient's vertigo was resolved. Clinical and neuro-otologic evaluations suggested that the lesion responsible for this patient was probably located within inner ear rather than within the vestibulocochlear nerve. (J Korean Neurol Assoc 19(4):410~412, 2001)