A Case of Voltage Gated Potassium Channel Antibodies-associated Nonparaneoplastic Limbic Encephalitis

Limbic encephalitis has been reported usually as an autoimmune complication related to onconeuronal antigen of underlying cancer with poor prognosis. Antibodies reactive with neuronal voltage-gated potassium channels (VGKCs) are recently recognized as a pathogenic cause in nonparaneoplastic limbic encephalitis, which is responsive to immunotherapy. We report a patient who had subacute encephalopathy with clinical and radiographic evidences of limbic encephalitis. The patient was seropositive for VGKC antibodies and resulted in a good prognosis with steroids. This has not yet been reported in Korea.

Neurologic Complications of Herpes Zoster

Herpes zoster is an acute, self-limited disease of infectious origin. It is characterized by grouped vesicular lesions on an erythematous base distributed over several dermatomes as well as single. In some cases the patients can be found to have an identifiable risk factor such as old age, malignancy, irradiation, chemotherapy, immunosuppresive therapy and trauma. The majority of cases are self-limited and resolved completely. However it may have serious complication. We reviewed 369 cases of herpes zoster to determine the distribution of lesions, incidence of postherpetic neuralgia, associated disorders, and the age. 134 cases (36.1%) of 369 cases with herpes zoster were associated with chronic disorders. The complications of herpes zoster were developed in 71 cases (19.2%) and postherpetic neuralgia (PHN) was the most commom complication. The frequency and severity of postherpetic neuralgia were proportional to age. There was a predilection of the involvement in thoracic dermatomes, lumbar dermatomes and ophthalmic division of trigeminal nerve in decreasing order of frequency. The incidence and duration of postherpetic neuralgia are significantly related to age.

Monitoring of Heparin Treatment in Acute Cerebral Infarction

Althought there are controversies regarding the appropriate dosage and the best monitoring method, heparin is the most widely used anticoagulant. Recent reports indicate that continuous infusion appears safer and is as effective as interrnittent intravenous infusion in. thromboembolic diseases. The therapeutic arnount has been determinated on the assumption of lowest of thrombosis and bleeding. However, several studies indicate that standardized doses of heparin can induce unpredictable anticoagulation in some patients. Recently, a new method for measuring the plamsma heparin concentratiOn using a chromogenic substrate is available. We designed this study to evaluate the accuracy of aPTT in the monitoring of heparin therapy and define the appropriate dosage and rnethods for infusion in patients with acute cerebral infarction. Among the patients with acute cerebral infarction and admitted to neurology department from June 1989 to December 1989. 13 patients were enrolled. They were divided into two groups according to the heparin dosage and using bolus infusion or not. Group 1 included 6 patients(4 men, 2 women) treated with 5,000 unit bolus IV followed by contionus infusion of 15.000 unit./day. Group 2 included 7 pa tients(5 men. 2 women) treated with contionus infusion of 10.000 unit/day. Their mean age were 55.2 and 60.1 years oId respectivelv. We measured the baseline plasma heparin level. aPTT, antithrombin-III and platelet and 1 24 48 96 and 120 hours after starting therapy. The mean of the aPTT and heparin concentration of 1, 24 hour after infusion of the group 1 increased markedly near to the 3 times of control value. But the all value of the group 2 remained constratly in therapeutic range during the study. The best method of heparin administration to maintain an effective therapeutic range is continous intravenous infusion. The results of this study indicate that treatment of acute cerebral infarction with continous intravenous infusion of 10000 unit/day of heparin is more effective and safer than bol.

Technetium-99m HM-PAO SPECT in patients with delayed neurologic sequelae after carbon monoxide poisoning

We used single photon emission computed tomography (SPECT) with technetium-99m hexamethylpropylene amine oxime (99mTc-HM-PAO) in 14 studies on 6 patients with delayed neurologic sequelae from carbon monoxide (CO) poisoning to determine whether any changes in cerebral blood flow could be correlated with clinical or computed tomographic evidence of delayed deficits. Among the six initial CT brain scans, two showed low density of both basal ganglia and two showed decreased density of the cerebral white matter. There was no correlation between the clinical outcome and the findings of the follow-up CT brain scans. Of the two SPECTS with 99mTc-HM-PAO performed during acute anoxic insult, one showed focal hypoperfusion which appeared 20 days prior to the onset of delayed neurologic sequelae after CO poisoning. Seven SPECTs in the six patients performing the delayed phase showed diffuse patched patterns of hypoperfusion which improved on follow-up images. There was good correlation between the clinical outcome and the findings of the 99mTc-HM-PAO SPECT. In preliminary conclusion, 9Tc-HM-PAO brain SPECT can be used for predicting or evaluating the outcome of delayed neurologic sequelae after CO poisoning. Cerebral vascular changes may be the possible cause of hypoperfusion in patients with CO poisoning.