Recurrent Myelopathy in a Patient with Klippel-Trenaunay Syndrome / 대한임상신경생리학회지

Klippel-Trenaunay syndrome (KTS) is a rare congenital malformation syndrome involving blood and lymph vessels, which is characterized by triad of cutaneous hemangioma, venous varicosities, and overgrowth of the affected limbs. Because vascular malformation in KTS can be located anywhere except the face and brain, the clinical presentation could be extremely variable. But there are only rare case reports that KTS is associated with spinal cord lesion. We report a case of recurrent myelopathy in a patient with KTS.

Eagle's Syndrome Presenting With Transient Ischemic Attack

Eagle's syndrome is a condition due to elongation of styloid process or calcification of the stylohyoid ligament. The styloid process can cause compression of the cervical carotid arteries leading to flow reduction in these arteries. We report a 49 year-old man who experienced transient right-sided weakness and monocular blindness within 10 seconds of turning his head to the left. Three-dimensional computed tomography revealed compression of left carotid artery by elongated styloid process during symptom provocation.

Risk Factors for Peripheral Artery Disease in Patients With Ischemic Stroke or Transient Ischemic Attack

BACKGROUND: Co-morbid vascular disease, such as coronary artery disease or peripheral artery disease (PAD) is frequently combined in patients with ischemic stroke (IS) or transient ischemic attack (TIA). However, PAD has been underestimated and underevaluated in these patients. The aims of this study were to know the prevalence of PAD and to assess the risk factors for PAD in patients with IS or TIA. METHODS: Between February in 2006 and March in 2011, ankle-brachial index (ABI) was measured in 724 patients with acute IS or TIA. We compared the demographics and baseline characteristics, including risk factors and stroke subtypes between patients combined with and without PAD. RESULTS: PAD was found in 13.3% (96/724) and more frequent in patients with large artery disease. Patients with PAD were older (mean age 74.5+/-10.4 vs. 65.5+/-12.5, p<0.001),and had higher body mass index (BMI) (23.15+/-3.46 vs. 24.03+/-3.25; p=0.019), higher serum level of hemoglobin (12.99+/-2.12 vs. 13.68+/-1.87; p=0.001) and severe initial neurological deficit measured by National Institute of Health Stroke Scale (NIHSS) (median 4, IQR:2,7 vs. 2, IQR:1,5; p=0.001) on admission than those without PAD; patients with PAD were more likely to have hypertension (79.2% vs. 61.6%; p=0.001), diabetes (44.8% vs. 29.5%; p=0.004), and previous stroke or TIA (35.4% vs. 23.9%; p=0.022). In multivariable logistic regression analysis, age (OR, 1.069; 95% CI, 1.042-1.096; p<0.001) and diabetes (OR, 1.904; 95% CI, 1.134-3.196; p=0.015) were independently associated with PAD in IS or TIA. CONCLUSIONS: Age and diabetes were independent risk factors for PAD in IS or TIA.

Exofocal Anterograde Transsynaptic Neuronal Death in the Globus Pallidus: Two Case Reports

BACKGROUND: Exofocal neuronal death in the substantia nigra (SN) is a well-known form of anterograde transsynaptic cell death. Exofocal neuronal death could theoretically also occur in the globus pallidus (GP) after striatal injury. CASE REPORT: Case 1. A 70-year-old woman visited the emergency room because of decreased mentality. On admission, blood-gas analysis indicated that her oxygen tension was 69.1 mm Hg. The caudate nucleus, putamen, and temporooccipital cortex on both sides of the brain exhibited high-intensity diffusion-weighted magnetic resonance imaging (MRI) signals. At 10 days after admission, new high-intensity signals had developed in the SN and GP on both sides. Case 2. A 48-year-old man visited the emergency room because of right-sided weakness. Lesions were noted in the left caudate nucleus and putamen. At 4 days after admission, newly developed high-intensity MRI signals were observed in the left SN and GP. CONCLUSIONS: Exofocal neuronal death can occur in the GP as well as in the SN; these findings need to be clearly distinguished from those of recurrent ischemic injuries, such as recurrent stroke.