Kidney Transplantation

Pseudotumor cerebri is a syndrome of increased intracranial pressure, and may be a rare complication of cyclosporine treatment. We report a 26-year-old woman with pseudotumor cerebri which developed after cyclosporine medication for kidney transplantation. Regular examinations of the fundi are required in patients taking oral cyclosporine, especially when they report headache or blurred vision.

Relationship between Serum Levels of Homocysteine and Folate and Seizure Severity in Patients with Idiopathic Epilepsy / 대한간질학회지

BACKGROUND AND PURPOSE: High serum homocysteine level is recognised as one of risk factors for epileptic seizure. Folate is involved in the homocysteine metabolism and low serum folate level increases the frequency of the seizure activity. The purpose of this study is to examine the changes of the serum levels of homocysteine and folate in epileptic patients and to evaluate the correlation between the severity of seizure and serum levels of homocysteine and folate. METHOD: Subjects were 17 patients who were diagnosed as idiopathic epilepsy and the control group was composed of age and sex matched 17 healthy adults. The serum homocysteine level was measured with the Chemiluminescent Immunoassay (CLIA), and folate level was measured with Radioimmuno assay (RIA). The severity of seizure was measured by using National Hospital Seizure Scale. RESULTS: The serum level of homocysteine was significantly higher in the patients group than in control group. However, the serum level of folate was not different between two group. The relationship between the seizure severity and the serum levels of homocysteine and folate showed positive correlations. CONCLUSIONS: There results reveal that the serum homocysteine may effect on the epileptic seizure severity.

Visual Disturbance following Autologous Fat Injection into Periorbital Area

PURPOSE: Autologous fat injection into the facial area is a frequently used technique in aesthetic plastic surgery for augmentation of the soft tissue. Fat injection is a very safe procedure because of the advantage of being autologous tissue. Minimal foreign body reaction or infections are noted after fat injection. However, there may be some complications including those as severe as blindness. There have been some case reports on visual disturbances after autologous fat injection reported in the literature. METHODS: A 21-year-old female patient underwent autologous fat injection into left eyebrow area to correct depression of soft tissue. Immediately after injection of autologous fat, she complained sudden visual loss on the left eye. She had come to our emergency room and ophthalmologic evaluation showed that the patient could only recognize hand motion. There was no abnormality of the optic nerve on magnetic resonance imaging. Suspecting an ischemic optic neuritis from fat embolism of the central retinal artery, the patient was treated conservatively with occular massage, antiglaucomatic agent, anti-inflammatory drugs and antibiotics. Visual field examination showed visual defect of half the lower hemisphere. RESULTS: While maintaining antiglaucomatic agents and non steroidal anti inflammatory drugs, fundoscopic examination showed no abnormalities on the second day of admission. Visual field examination showed an improvement on the fourth day along with decreased eyeball pain. Significant improvement of vision was noted and the patient was discharged on the fifth day of admission. The patient was followed-up 2 days afterwards with improved vision and visual field defect. CONCLUSION: We describe an unusual case of sudden unilateral visual disturbance following autologous fat injection into periorbital area.

Progressive Middle Cerebral Artery Infarction in a Patient with Thrombotic Thrombocytopenic Purpura

Thrombotic thrombocytopenic purpura (TTP) is frequently associated with small cortical and subcortical infarcts. However, major intracranial artery occlusion is rare. We report a case of progressive middle cerebral artery (MCA) infarction in a patient with TTP. A 76-year-old woman with hypertension was admitted due to right hemiparesis and transcortical motor aphasia. On laboratory findings, she had microangiopathic hemolytic anemia and thrombocytopenia. Brain MRI showed left subcortical multiple infarction, and MR angiogram revealed severe stenosis of left MCA main stem. She was treated with heparin and steroid but a few days later, there was neurologic deterioration attributed to progressive occlusive stroke in the left MCA territory. Follow-up brain CT demonstrated left malignant MCA infarction. TTP may be associated with progressive occlusion of large cerebral artery.

Large Intraorbital Cyst after Silicone Implant Insertion : A Case Report

PURPOSE: Alloplastic implants, such as methylmethacrylate, Teflon, silicone, Supramid are commonly used to cover the floor defect and to prevent reherniation of the displaced orbital tissue in orbital floor fracture. Silicone implant has been used for reconstruction of orbital wall defects because of pliability, advantage of carving and chemically inert nature. However, silicone implant also has complications including infection, extrusion, pain, dystopia and tissue reaction. Cyst formation around the silicone implant is a very rare complication. According to many reports, cysts around alloplastic implant in an orbital area are mostly hemorrhagic cysts consisted of blood breakdown product with fibrous capsule cell in histologic examination. METHODS: The authors report atypical case and successful treatment of intraorbital hemorrhagic cyst around silicone implant of a 37-year-old male patient. RESULTS: Preoperative symptoms of diplopia, exophthalmos, proptosis, vertical dystopia and ectropion of lower eyelid were resolved after surgical removal of implants with surrounding capsule. CONCLUSION: Clinical suspicion of plastic surgeon is important in diagnosis of intraorbital cyst of patients who have history of silicone implantation and computed tomography is the standard tool of diagnosis. During the operation, caution must be taken on delivering the whole capsule of intraorbital cyst along with silicone implant to prevent recurrence of the cyst.

Leber's Hereditary Optic Neuropathy with Mitochondrial DNA 11778 Mutation Presenting with Various Types of Seizures

Leber's hereditary optic neuropathy (LHON) is a mitochondrial genetic disease characterized by acute or subacute visual loss associated with other neurologic diseases. We report a man with LHON caused by a mitochondrial DNA point mutation at nucleotide position 11778, who presented various types of seizures, and hydrocephalus. EEG showed frequent brief generalized 2.5~3 Hz spike or polyspikes-and-wave activities. Brain MRI and cisternography showed communicating hydrocephalus. LHON plus associated with epilepsy and hydrocephalus in our patient widens the clinical presentation of LHON.