Unilateral Hypoglossal Neuropathy in Multifocal Acquired Demyelinating Sensory and Motor Neuropathy: Differential Diagnosis of Motor Neuron Disease

Multifocal acquired demyelinating sensory and motor neuropathy (MADSAM) is a peripheral neuropathy characterized by multifocal weakness and associated sensory impairment. MADSAM is associated with multifocal persistent conduction block and other signs of demyelination. The incidence of cranial nerve involvement in MADSAM was recently reported to be approximately 15%. However, reports of hypoglossal neuropathy occurring in MADSAM are rare. Unilateral hypoglossal neuropathy in MADSAM is usually misdiagnosed as motor neuron disease. We report a patient with MADSAM presenting with tongue hemiatrophy.

Simultaneous Occurrence of a Splenial Lesion and Downbeat Nystagmus Due to Lithium Neurotoxicity

No abstract available.

Bilateral Lesions in the Posterior Limb of Internal Capsule Attributed to Combination Therapy of Isoniazid and Rifampin

Transient isoniazid-induced brain lesions have rarely been reported. The lesions were in the dentate nucleus of cerebellum and thalamus. Meanwhile, the neurotoxicity of rifampin has not been reported evidently. We observed bilateral lesions in the internal capsule in a young woman after taking a combination of isoniazid and rifampin. She transiently suffered numbness in both hands, dysarthria, and left side motor weakness while taking the medication. Isoniazid may induce structural lesions in various brain areas including the internal capsule.

Recurrent Ischemic Strokes with Progression of Middle Cerebral Artery Stenosis during HIV Treatment

Human immunodeficiency virus (HIV) infection can result in ischemic stroke via several mechanisms, including opportunistic infection, vasculopathy, cardioembolism, and coagulopathy. HIV-vasculopathy is related to endothelial dysfunction, stenosis and aneurysm formation, infectious vasculitis, dissection and accelerated atherosclerosis during highly active antiretroviral therapy (HAART). We represent a case of HIV infection manifested as an acute ischemic stroke attack. After 4 months during HAART, our patient experienced a recurrent ischemic stroke with progression of middle cerebral artery stenosis.

A giant retroperitoneal lymphangioma in a patient with neurofibromatosis type 1 / 대한외과학회지

Neurofibromatosis type 1 (NF-1) is a genetically inherited disorder that may cause skin abnormalities and tumors that form on nerve tissues. These tumors can be small or large and can occur anywhere in the body, including the brain, spinal cord, or other peripheral nerves. Retroperitoneal lymphangiomas are very rare benign malformations of the lymphatic system. About 95% lymphangiomas occur in the skin and the subcutaneous tissues of the head, neck and axillary region and the remaining 5% appear in other parts of the body such as lungs, pleura, pericardium, liver, gallbladder, kidney, and the mesentery. Herein, we report the case of a giant retroperitoneal lymphangioma in a patient with NF-1 with a review of the literature.

Hyponatremia Induced Coma during Risperidone Treatment in 2 Cases of Schizophrenia / 대한정신약물학회지

Antipyschotics have been frequently reported being associated with hyponatremia. We have experienced two cases of severe hyponatremia with neurological symptoms in patients with acute schizophrenia who were treated with risperidone. Case 1 was a 33-year-old female who developed hyponatremia (Na+114 mEq/L) at 17 days after initiation of treatment with risperidone. Case 2 was a 41-year-old female who developed hyponatremia (Na+107 mEq/L) 5 months after treatment with risperidone. In both cases, polydipsia was not obvious. The exact cause of hyponatremia was uncertain, but we suggest that syndrome of inappropriate secretion of antidiuretic hormone due to risperidone may be the mechanism of hyponatremia in both cases. Although there have been many recent studies about the pathophysiology of hyponatremia among psychiatric patients, the exact mechanism remains unclear. There have been many case reports in the literature of hyponatremia associated with antipsychotics. We suggest that risperidone may be a potential drug that can cause hyponatremia and lead to life-threatening neurological symptoms in the early stage treatment, and that clinicians should monitor patients on a regular basis.

Cardiac tamponade in a patient with lupus nephritis / 대한내과학회지

Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that involves many different organ systems, and this illness exhibits a wide spectrum of clinical manifestations. The renal involvement in SLE is called lupus nephritis and 50~80% of patients with SLE suffer from lupus nephritis. Although pericarditis or pericardial effusion is a common cardiac manifestation of SLE, cardiac tamponade is rare. Cardiac tamponade may be fatal if it is not recognized quickly and treated promptly. We report a case of cardiac tamponade associated with lupus nephritis. Treatment consisted of pericardiocentesis and high-dose corticosteroid.

Continuous ambulatory peritoneal dialysis in a patient with diabetic chronic renal failure and hemophilia / 대한내과학회지

Long-term dialysis is undertaken infrequently in patients with hemophilia and chronic renal failure, and there are no definite guidelines for the treatment of end-stage renal disease in hemophiliacs. We report a case of peritoneal dialysis in a hemophiliac with diabetic chronic renal failure. A 46-year-old man with severe hemophilia was admitted to our hospital for decreased visual acuity and the management of uremia. After vitrectomy, he was started on hemodialysis to treat his uremic bleeding diathesis. To avoid bleeding through a vascular access site, peritoneal dialysis therapy for long-term treatment was proposed. A surgical peritoneal catheter was introduced with simultaneous factor VIII administration. In the seven subsequent months, no episodes of intraperitoneal or retroperitoneal hemorrhage have been observed. Continuous ambulatory peritoneal dialysis may be a relatively safe dialysis modality without danger of bleeding in hemophiliacs.

Constipation is Closely Associated with Depression in Patients with End-Stage Renal Disease Undergoing Hemodialysis or Peritoneal Dialysis / 대한신장학회지

PURPOSE: Constipation is a frequent complaint among dialysis patients. However, factors that contribute to constipation in these patients have not been evaluated rigorously. The aim of study was to assess the prevalence and factors that contribute to constipation in patients with End-Stage Renal Disease (ESRD) undergoing hemodialysis (HD) or peritoneal dialysis (PD). METHODS: Patients undergoing HD or PD for more than six months in the six dialysis centers were asked to complete a self-administered questionnaire that is designed to assess constipation by Rome- III criteria. Beck depression inventory (BDI) were assessed. A total of 146 patients (HD 91, PD 55) completed the study. RESULTS: The prevalence of constipation was 33% in 91 HD patients and 31% in 55 PD patients. Prevalence of constipation was 32% and did not differ by dialysis mode. Older age, unemployed state, high cumulative illness rating scale and high BDI were associated with constipation. In multivariate analysis, BDI was an independent factor associated with constipation. The prevalence of constipation was 18% and 50% for patients with BDI or =15, respectively. The odd ratio for constipation in patients with BDI > or =15 was 3.4 (95% CI, 1.4-8.1). CONCLUSION: Careful psychogenic attention must be paid to ESRD patients with constipation.

A Case of Concurrent Pneumocystis carinii Pneumonia and CMV Pneumonia in a SLE Patient with Mycophenolate Mofetil / 대한신장학회지

A 36-year-old woman developed concurrent Pneumocystis carinii pneumonia (PCP) and cytomegalovirus (CMV) pneumonia. She was diagnosed as lupus nephritis two years ago and was on immunosuppressive therapy with prednisolone and mycophenolate mofetil. She developed dyspnea with moderate hypoxemia. Chest X-ray and HRCT showed diffuse interstitial infiltration and ground glass opacity. The diagnosis of concurrent PCP and CMV was performed by the virus culture and PCP PCR of bronchoalveolar lavage fluid. She recovered following treatment with trimethoprim-sulfamethoxazole, prednisolone, gancyclovir for three weeks.