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

No abstract available.

Spontaneous Intracranial Hypotension Complicated by Cerebral Venous Thrombosis Relieved by Epidural Blood Patch

Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache, diffuse dural thickening, and enhancement in magnetic resonance imaging. Cerebral venous thrombosis (CVT) has been reported to be a rare complication of SIH. There is no consensus in anticoagulation treatment of CVT secondarily caused by SIH. We report a female patient with SIH complicated by CVT and spontaneously regressed CVT not by anticoagulation but by epidural blood patch.

Frontal Sinusitis Presenting as Cluster-Like Headache

No abstract available.

Acute Ischemic Stroke Associated With Essential Thrombocythemia and JAK2 Mutation

No abstract available.

Cerebral Infarction Caused by a Tortuous Subclavian Artery: a Case Report / 신경중재치료의학

Tortuous arteries are common clinical observation. Although mild tortuosity is asymptomatic, severe tortuosity can lead to ischemic attack in several organs. With advances in imaging technology, an increasing number of tortuous vessels have been detected. The purpose of this report is to describe a case of acute cerebral infarction due to tortuous subclavian artery and to review the literature.

A Case of Pathologic Crying, Delusion and Memory Impairment Due to Hemorrhage in the Right Basal Ganglia / 대한뇌졸중학회지

Gradual decline in cognitive function and behavioral changes are characteristic in degenerative dementia. Although acute to subacute subcortical lesion can affect behavior and cognition, few reports have described both cognitive and behavioral deficits in patients with right basal ganglia lesion. An 82-year-old man presented with memory impairment, pathological crying, delusion and other psychological symptoms that developed insidiously over the previous 2 months. Initially, the patient had been diagnosed with degenerative dementia, but brain MRI showed the hematoma in the right basal ganglia. Our case shows that cognitive dysfunction, behavioral and psychological symptoms including pathological laughing and delusion can be developed concurrently by the lesion of the right basal ganglia. Our case suggests that cerebrovascular disease should be considered in elderly patients presenting with subacute cognitive and behavioral deterioration, even when there were no other neurological signs.

Recurrent Vertigo Episodes due to Sick Sinus Syndrome / 대한평형의학회지

Vertigo due to primary cardiac disease, known as cardiogenic vertigo, has been rarely reported. We report one case showing recurrent vertigo episodes due to sick sinus syndrome. A 77-year-old female presented to our department because of long history of intermittent brief episodes of rotatory vertigo and non-vertiginous dizziness. She had no past medical history. There was no abnormal sign in neurological examination. Cardiac murmur, finally confirmed as grade 4 ejection systolic and grade 3 decrescendo diastolic murmurs, was found on physical examination. Brain magnetic resonance imaging and auditory evoked potential did not show any abnormal findings. She was consulted to a cardiologist for the evaluation of cardiac murmur. After the evaluation using electrocardiogram, echocardiography, and holter monitoring, she was diagnosed as sick sinus syndrome. After then, a ventricle ventricle inhibited (VVI) pacemaker was inserted. She did not complain of vertigo and dizziness for 3 months after the insertion of a VVI pacemaker. This case shows the need of auscultation for patients with recurrent vertigo episodes although there is rare cardiogenic vertigo.

A Case of Cervical Epidural Abscess Presenting Rapidly Progressing Quadriplegia without any other Symptom or Sign of CEA / 감염과화학요법

Cervical epidural abscess (CEA) is a very uncommon disease with diverse clinical presentations. Clinically, it is difficult to diagnose this disease, especially in early stage. We report an atypical case of CEA showing only progressive quadriparesis without any other symptoms or signs of CEA. From this experience, CEA must be considered when progressive quadriparesis without any specific cause is developed in immuno-compromised patients and diabetic patients with polyneuropathies.

A Case of Cervical Epidural Abscess Presenting Rapidly Progressing Quadriplegia without any other Symptom or Sign of CEA / 감염과화학요법

Cervical epidural abscess (CEA) is a very uncommon disease with diverse clinical presentations. Clinically, it is difficult to diagnose this disease, especially in early stage. We report an atypical case of CEA showing only progressive quadriparesis without any other symptoms or signs of CEA. From this experience, CEA must be considered when progressive quadriparesis without any specific cause is developed in immuno-compromised patients and diabetic patients with polyneuropathies.

A Case of MELAS with Maternally Transmitted Type II Diabetes Mellitus and Deafness

MELAS syndrome is typically a multisystemic disorder. We report one case of MELAS showing both maternally transmitted type II diabetes mellitus (DM) and deafness. A 41-year-old woman was admitted because of severe headache and vomiting. She developed type II DM at age 26 and was followed by bilateral sensorineural type hearing loss at age 37. Family history revealed that her mother and two sisters suffered from similar disorders. MELAS with A3243G point mutation was confirmed in the patient and her daughter.

A Case of Posthypoxic Myoclonus with Lamotrigine Add-On Therapy / 대한간질학회지

Posthypoxic myoclonus is poorly controlled with current treatments. Based on clinical experience, valproate and benzodiazepines have been used to treat myoclonic seizures. Rarely, some antiepileptic drugs may exacerbate myoclonic seizures. Although lamotrigine is controversial for treatment in myoclonic seizures, we experience a case of posthypoxic myoclonus improved with lamotrigine add-on therapy.

Role of Glycogen Synthase Kinase-3 in Motor Neuronal Cell Death Mechanism of in Vitro Familial ALS Model (G94A, A4V mutant motoneuron)

BACKGROUND: G93A or A4V mutations in the human Cu/Zn- superoxide dismutase gene (hSOD1) cause familial amyotrophic lateral sclerosis (fALS). However, it has not yet clearly understood how these bring about fALS. We investigated the effects of the G93A or A4V mutations in hSOD1 on the phosphatydilinositol-3-kinase (PI3K)/Akt and glycogen synthase kinase-3 (GSK-3) pathway, and effects of GSK-3 inhibitor on the G93A- or A4V-mutant cells. METHODS: To evaluate those effects, VSC4.1 motoneuron cells were transfected with G93A- or A4V-mutant types of hSOD1 (G93A and A4V cells, respectively) with/without GSK-3 inhibitor were compared with them transfected with wild type (wild cells) in cell viability and intracellular signals, including PI3K/Akt, GSK-3, and caspase-3, 24 hours after neuronal differentiation. RESULTS: Compared with wild cells, MTT assay revealed a greatly reduced viability in G93A and A4V cells without GSK-3 inhibitor. However, treatment with GSK-3 inhibitor increased the viability of G93A and A4V cells. Western blotting showed that PI3K and pAkt were decreased, and GSK-3 and caspase-3 were increased in G93A and A4V cells, and that GSK-3 inhibitor treatment reduced caspase-3 but did not affected PI3K, Akt and GSK-3. CONCLUSIONS: These results suggest that the G93A or A4V mutations induce inhibition of PI3K/Akt and activation of GSK-3 and caspase-3 resulting the vulnerability to oxidative stress, and that GSK-3 mediated cell death mechanism is important in G93A and A4V cell death.

A Case of Unilateral Hypothalamic Infarction with Polyphagia and Hypersomnolence

Brain infarction restricted to the unilateral hypothalamus is known to be very rare because of the abundant blood supply from the circle of Willis. We report a case of right hypothalamic infarction. A 63-year-old woman developed hyperphagia, hypersomnolence and hemihyperhidrosis limited to the left half of the face. Brain MRI revealed a high signal intensity at the right anteromedial hypothalamus.

Effect of Poly (ADP-ribose) Polymerase Inhibitor Against the Ischemia/Reperfusion Injury in Ischemic Stroke Model

BACKGROUND: Nuclear enzyme poly (ADP-ribose) polymerase (PARP) activated by DNA damage participates in DNA repair. However, overactivation of PARP could be an important pathogenic mechanism of ischemic cell death. We investigated the protective effect of an inhibitor of PARP, 3-aminobenzamide (3-AB), against ischemia/reperfusion injury in ischemic stroke model. METHODS: Occlusion of left middle cerebral artery (MCA) was done by intraluminal filament technique in 24 rats weighing from 315 g to 358 g, and reperfusion was done at 2 hours after occlusion. To evaluate the effect of PARP inhibitor in ischemic stroke, 3-AB was administered to 12 rats (3-AB group) 10 minutes before artificial occlusion of left MCA. Infarct area was confirmed by using 2, 3, 5-triphenyltetrazolium chloride stain. The immunoreactivities of poly (ADP-ribose) reflecting activity of enzyme PARP and activated caspase-3 were compared in infarct, peri-infarct and normal zones in 3-AB group and 12 controls. RESULTS: The volume of infarction was decreased about 34% in 3-AB group compared with controls. In 3-AB group, immunoreactivities of PAR were significantly reduced in ischemic regions, especially peri-infarct zone, but those of activated caspase-3 were significantly increased in same region. CONCLUSIONS: These results suggest that treatment of PARP inhibitor can reduce the infarct volume by converting necrotic cell death into apoptosis. PARP inhibition can be another potential neuroprotective strategy in ischemic stroke.

Epilepsy and Driving / 대한간질학회지

BACKGROUND: Although the law to restrict the automobile driving of epilepsy patients is existed in Korea, it is not clear. We investigated the opinions of doctors who treat the epilepsy patients on this matter. METHODS: 296 doctors, including neurologists, neurosurgeons, psychiatrists, and pediatricians, participated in this survey. The questionnaire was composed of 15 questions. RESULTS: Their opinions are as follows : the regulation should be legislated (95.3%), the decision on the patient's driving must be done by the doctor (79.1%), the patient's driving is reported obligatorily (34.1%), the seizure free interval for license should be more than 24 months (61.1%), the renewal of the driving license needs to be done every other year, the escaping rebuke for the reporter is also needed (89.5%), and the draft for the law should be composed by the Korean Epilepsy Society (77%). CONCLUSIONS: Many doctors who treat the epilepsy patients agree that the new law to restrict the epilepsy patient's automobile driving is needed. The new law including general and individual restrictions, considering several conditions and made by Korean Epilepsy Society must be accepted by the patients and other members of the society.