Ocular Flutter associated with Merkel Cell Carcinoma

Ocular flutter is a relatively rare eye movement disorder that refers to occasional bursts of involuntary horizontal oscillation around the point of fixation, characterized by rapid, repetitive, horizontal, symmetrical and sinusoidal oscillation without inter- saccadic interval. It is known to be associated with disorders of the cerebellum and brainstem resulting from various pathological conditions, but it's anatomical and pathophysiological basis remains unclear. Here, we present the case of a patient who had severe ocular flutter associated with Merkel cell carcinoma.

Effect of Carotid Artery Stenting on Cognitive Function in Patients with Carotid Artery Stenosis: A Prospective, 3-Month-Follow-Up Study

BACKGROUND AND PURPOSE: Carotid artery stenting (CAS) is emerging as an alternative to carotid endarterectomy for the treatment of carotid artery stenosis (CS), but the effect of CAS on the cognitive function of patients with severe CS has not been fully investigated. The aim of this study was to use comprehensive neuropsychological tests to determine the effect of CAS on cognitive function from baseline to 3 months postprocedure in patients with severe CS. METHODS: Thirty-one patients due to undergo CAS due to high-grade CS (> or =70%) and 11 control subjects who were diagnosed with CS, but who did not undergo CAS, and who visited the clinic or emergency room between February 2009 and February 2012 were recruited consecutively at baseline (i.e., pre-CAS). Follow-up neuropsychological evaluations after 3 months were completed by 23 of the 31 patients who underwent CAS, and by 10 of the 11 control subjects. The primary cognitive outcome was assessed using a neuropsychological test containing subcategories designed to test general cognitive function, attention, visuospatial function, language and related functions, memory, and frontal lobe/executive function. RESULTS: Of the 23 patients undergoing CAS who completed the 3-month follow-up tests, 12 had asymptomatic CS. During the 3-month follow-up period, the patients who underwent CAS and those with asymptomatic CS achieved similar results to the control group on all cognitive tests. However, symptomatic CS patients (n=11) who underwent CAS exhibited improvements in visuospatial function (p=0.046) and total Seoul Neuropsychological Screening Battery-Dementia Version scores (p=0.010) in comparison with both the asymptomatic CS patients and the control group. CONCLUSIONS: The findings of this study suggest that CAS has a positive effect on cognitive function in patients with symptomatic CS over a 3-month follow-up period. A long-term, multicenter, prospective case-control study would be helpful to predict quality of life and prognoses for patients undergoing CAS.

A Case of Insulinoma Presenting as Repetitive Abnormal Behavior with Amnesia

Insulinomas are very rare tumors. Diagnosis of insulinoma is often delayed or misdiagnosed because of its various symptoms. We report a patient with hypoglycemic encephalopathy who had repetitive behavior changes, diagnosed as a pancreatic insulinoma. A 52 years old man was referred to a memory and dementia clinic for evaluation of his repetitive abnormal behavior changes. He has threatened his wife with violent acts and showed aggressive behaviors, but he couldn't remember when he was recovered to normal state. During the hospitalization, we noticed that his repetitive abnormal behaviors were correlated to severe hypoglycemia. After we corrected glucose level, his symptoms were disappeared. We performed an abdomen-pelvis CT scan, revealing pancreatic head tumor. After he took surgical treatment, His symptoms were fully recovered. Our case demonstrates that various neurological symptoms, such as abnormal behavior, rarely occur due to recurrent hypoglycemia in patient with insulinoma.