Determinants of Central Nervous System Involvement in Herpes Zoster

BACKGROUND: Herpes zoster is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body, often in a stripe. Central nervous system(CNS) involvements are uncommon complications of herpes zoster. The exact mechanism and risk factors are still unknown. METHODS: We retrospectively reviewed the clinical data of patients who was admitted at our hospital due to herpes zoster from 2003 to 2013. The patients under age 15, herpes zoster infection without skin lesions, and cases not confirmed by a dermatologist were excluded. CNS involvements are defined as meningitis, encephalitis, single or multiple cranial neuropathies and all cases were evaluated with brain magnetic resonance imaging, spinal tapping, serological tests and confirmed by a neurologist. We compared the herpes zoster patients with CNS involvement to those without CNS involvement. Age, sex, body mass index, associated chronic medical illnesses, site and extent of skin lesion and development of post herpetic neuralgia were compared between two groups. RESULTS: Total 1,131 subjects (male 460, female 671) were recruited. A group with CNS involvement was 91(8.04%). Sex, body mass index, associated chronic medical illnesses, extent of skin lesion were not different between two groups. A group with CNS involvement showed younger age(p<0.01), more facial and cervical skin lesions(p<0.01), lesser development of post herpetic neuralgia(p=0.048). CONCLUSIONS: CNS involvement is not a rare complication of herpes zoster and more frequent in patients with younger age and faciocervical zoster.

Acute Ophthalmoplegia Without Ataxia Associated With Anti-GM1 IgG Antibody

No abstract available.

Atypical Posterior Reversible Encephalopathy Syndrome after Cervical Facet Joint Steroid Injection

Posterior reversible encephalopathy syndrome (PRES) is characterized by headache, altered mental function, seizures, and loss of vision predominantly affecting the bilateral parieto-occipital area. Most cases of PRES are associated with hypertension, or use of immunosuppressants or cytotoxic drugs; associated brainstem and cerebellar lesions are uncommon. We report herein a case of PRES that developed in a patient after injecting a steroid for cervical pain management. The presence of a territorial lesion along the vertebral artery on the same side as the pain-management procedure suggests an association between injectable steroid suspension and PRES.

Treatment of Anteroinferior Tibiofibular Ligament Avulsion Fracture Accompanied with Ankle Fracture / 대한족부족관절학회지

PURPOSE: To evaluate the clinical results of anteroinferior tibiofibular ligament avulsion fracture accompanied ankle fractures treated with anatomical reduction and internal fixation. MATERIALS AND METHODS: From January 2007 to April 2010, 30 cases with anteroinferior tibiofibular ligament avulsion fracture that treated with anatomical reduction and internal fixation were analyzed. The average follow-up period was 26 months (minimum 6 months). We have reviewed the bony union, complication and subjective satisfaction according to the fracture classification and method of internal fixation. RESULTS: Among 30 cases, 28 cases were occurred in Lauge-Hansen classification supination-external rotation type, one case was fracture-dislocation and one case was Maisonneuve fracture. We have performed internal fixation with Mini screw in 11 cases, K-wire in 10 cases, repair in six cases and Mini screw & K-wire in three cases. In all cases bony union was completed. two cases in Mini screw, one case in K-wire, two cases in repair and one case in Mini screw & K-wire revealed LOM of ankle joint. Skin irritation and superficial peroneal nerve irritation happened in one case each. Other cases show good subjective satisfaction. CONCLUSION: Anteroinferior tibiofibular ligament avulsion fracture accompanied with ankle fracture is a good clinical outcome with internal fixation. So we should not miss out the anteroinferior tibiofibular ligament avulsion fracture in radiologic evaluation or operation room.

Checkrein Deformity by Incarcerated Posterior Tibial Tendon and Displaced Flexor Hallucis Longus Tendon following Ankle Dislocation: A Case Report

We report a case of 20 year-old man who had unusual equinus and checkrein deformity following dislocation of his right ankle joint. He had been treated with distal tibiofibular screw fixation and external fixation. After removal of external fixator, he had suffered from progressive deformity of foot and ankle. Widening of distal tibiofibular joint and medial clear space was found on radiograph and it was revealed that posterior tibial tendon had been dislocated and incarcerated into the distal tibiofibular joint on MRI. We corrected the deformity with excision of incarcerated posterior tibial tendon, adhesiolysis and lengthening of flexor hallucis longus tendon, reconstruction of deltoid ligament and flexor digitorum longus tendon transfer.