ABSTRACT
Hyperglycemic state frequently presents with neurologic manifestations including choreoathetosis, ballismus, dysphagia, seizures, and coma. Also, hyperglycemic hemianopia has been rarely reported to cause temporary damage to the visual cortex, resulting in homonymous hemianopia. A 65-year-old man was admitted because of right homonymous hemianopia accompanied by hyperglycemia. Brain single-photon emission computed tomography showed focal hyperperfusion in the left occipital lobe. Herein we report a case of reversible homonymous hemianopia with cerebral hyperperfusion associated hyperglycemia without seizure.
ABSTRACT
In case of no head trauma history and intact immunity, adultonset recurrent bacterial meningitis is scarce. Parameningeal infection is the crucial latent cause of recurrent bacterial meningitis in adults. Nasal polyp can cause a variety of nasal symptoms, depending on its location and size. Chronic sinusitis with nasal polyp tends to have more severe symptoms than those without nasal polyp. We report a case of adult onset third recurrent bacterial meningitis associated with inflammatory nasal polyp.
ABSTRACT
Klebsiella pneumoniae is an unusual cause of brain abscess. Among the few cases of Klebsiella pneumoniae brain abscess that have been reported, most were associated with another underlying primary focus of infection. Endogenous endophthalmitis caused by Klebsiella pneumoniae is an infrequent but often devastating septic metastatic infection. We report a rare case of Klebsiella pneumoniae brain abscess and endophthalmitis after acute epiglottitis.
ABSTRACT
No abstract available.
Subject(s)
Cranial Nerve Diseases , Cranial Nerves , Hoarseness , Vertebrobasilar Insufficiency , Vocal Cord ParalysisABSTRACT
Diagnosis of transient ischemic attack has been entirely dependent on the clinical history due to the absence of brain magnetic resonance imaging lesion. It is challenging to distinguish between transient ischemic attack and transient ischemic attack-mimics. Cerebral microbleeds would be found in 11.1–23.5% of incidental findings in elderly population. However, cerebral microbleeds have been known to lead to cognitive decline, dementia, seizure and even status epilepticus. We report a case of cerebral microbleeds induced epileptic seizure, visiting the emergency room with sudden onset unilateral motor weakness.
Subject(s)
Aged , Humans , Brain , Dementia , Diagnosis , Emergency Service, Hospital , Epilepsy , Incidental Findings , Ischemic Attack, Transient , Magnetic Resonance Imaging , Seizures , Status EpilepticusABSTRACT
Trigeminal neuralgia (TN) is a paroxysmal shock like pain restricted to the innervations of the areas of one or more trigeminal branches. The pathogenesis of TN is uncertain and typically is idiopathic, but it may be due to a structural lesion. Various etiologies such as vascular anomaly, tumor, infectious agents, and multiple sclerosis have been implicated as possible causes. Here we report two young patients diagnosed with trigeminal neuralgia secondary to epidermoid cyst at the cerebellopontine angle.
Subject(s)
Humans , Cerebellopontine Angle , Epidermal Cyst , Multiple Sclerosis , Shock , Trigeminal NeuralgiaABSTRACT
Recurrent Guillain-Barré syndrome (GBS) is a rare, immune-mediated disease of the peripheral nervous system. It has been reported to occur at intervals ranging from four months to 10 years; published case studies suggest that 1%–6% of patients who have had GBS will experience recurrent attacks. The most commonly identified infections coinciding with GBS are Campylobacter jejuni, Haemophilus influenzae, Mycoplasma pneumonia, and cytomegalovirus, while an antecedent infection with Escherichia coli is very uncommon. In this case report, we present a rare episode of recurrent GBS, which followed a urinary tract infection (UTI) by E. coli, and an accompanying literature review. A 75-year-old woman with a prior history of acute motor axonal neuropathy (AMAN), a subtype of GBS, presented with subsequent weakness of limbs and areflexia following 10 days of fever, frequency, and dysuria. Base on nerve conduction studies, cerebrospinal fluid analysis and other clinical investigation, we diagnosed the patient with recurrent GBS caused by E. coli. The patient recovered with mild subjective weakness following treatment of intravenous immunoglobulin with ceftriaxone. We suggest that E. coli causes UTI could be one of the diverse trigger factors involved in recurrent GBS.
Subject(s)
Aged , Female , Humans , Axons , Campylobacter jejuni , Ceftriaxone , Cerebrospinal Fluid , Cytomegalovirus , Dysuria , Escherichia coli , Escherichia , Extremities , Fever , Guillain-Barre Syndrome , Haemophilus influenzae , Immunoglobulins , Neural Conduction , Peripheral Nervous System , Pneumonia, Mycoplasma , Polyneuropathies , Urinary Tract Infections , Urinary Tract , Uropathogenic Escherichia coliABSTRACT
BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a neurological complication caused by cerebral hyperperfusion. CASE REPORT: A 46-year-old male presented with decreased mental status, left facial palsy, and left-sided weakness after video-assisted thoracoscopic surgery for a solitary pulmonary nodule. During the surgery, phenylephrine was infused intravenously for general anesthesia-induced hypotension. High signal intensity at the right parietooccipital lobe was noted on fluid-attenuated inversion recovering imaging and diffusion-weighted imaging. His neurological symptoms improved two days after initial presentation. Follow-up diffusion-weighted imaging showed resolution of the brain lesions 10 days after the surgery. CONCLUSIONS: We report a patient who presented with PRES after administration of phenylephrine during resection of a solitary pulmonary nodule. PRES should be considered for patients presented with acute neurologic symptoms following surgical procedures.
Subject(s)
Humans , Male , Middle Aged , Brain , Facial Paralysis , Follow-Up Studies , Hypertension , Hypotension , Neurologic Manifestations , Phenylephrine , Posterior Leukoencephalopathy Syndrome , Solitary Pulmonary Nodule , Thoracic Surgery, Video-AssistedABSTRACT
Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of the vertebrates, as well as the synthetic analogs of these hormones that are synthesized in the laboratories. Two main classes of corticosteroids, glucocorticoids, and mineralocorticoids, are involved in a wide range of physiologic processes, including stress response, immune response, and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte levels, and behavior. Corticosteroids have been used for almost 60 years in medicine and their roles in patients have always been discussed by researchers and clinicians dedicated in the related field. Currently, they are still used in the treatment of patients with neurological disorders. Usually, corticosteroids are used in the treatment of various inflammatory diseases and conditions. In this review, we present five key indications, i.e., neuromyelitis optica, acute spinal cord injury, chronic inflammatory demyelinating polyneuropathy, myasthenia gravis, polymyositis/dermatomyositis for the systemic use of corticosteroids in neurology based on a mix of quality of evidence, prevalence, and impact on disease management.
Subject(s)
Humans , Adrenal Cortex , Adrenal Cortex Hormones , Carbohydrate Metabolism , Disease Management , Glucocorticoids , Inflammation , Metabolism , Mineralocorticoids , Myasthenia Gravis , Nervous System Diseases , Neurology , Neuromyelitis Optica , Polyneuropathies , Prevalence , Spinal Cord Injuries , Spinal Cord , VertebratesABSTRACT
Postoperative visual loss is a rare complication of general anesthesia in patients undergoing lung surgery. If the visual complication is permanent, it can greatly affect the patient's quality of life. Posterior reversible encephalopathy syndrome (PRES) leads to visual disturbances and may be associated with hypertension, renal disease, eclampsia, and chemotherapy. Although PRES is usually reversible, delayed diagnosis and treatment can result in permanent damage. We herein report a case of PRES in a patient with no medical history. The patient's symptoms included somnolence, visual loss, and headache. He was treated with conservative therapy, and his vision abruptly recovered three days after surgery. He was discharged from the hospital without neurologic complications 13 days after surgery.
Subject(s)
Female , Humans , Pregnancy , Anesthesia, General , Blindness , Delayed Diagnosis , Drug Therapy , Eclampsia , Headache , Hypertension, Renal , Lung , Posterior Leukoencephalopathy Syndrome , Quality of LifeABSTRACT
Most postoperative maxillary cysts develop more than 10 years after a Caldwell-Luc operation. They can manifest with cheek pain, swelling and dental and visual symptoms. Brain imaging should be performed to distinguish trigeminal nerve compression from various other possible causes. It should be treated by surgical intervention to relieve the above-mentioned symptoms. We report a patient who presented with compressive trigeminal neuropathy caused by a postoperative maxillary cyst.
Subject(s)
Humans , Cheek , Neuroimaging , Trigeminal Nerve , Trigeminal Nerve DiseasesABSTRACT
Most postoperative maxillary cysts develop more than 10 years after a Caldwell-Luc operation. They can manifest with cheek pain, swelling and dental and visual symptoms. Brain imaging should be performed to distinguish trigeminal nerve compression from various other possible causes. It should be treated by surgical intervention to relieve the above-mentioned symptoms. We report a patient who presented with compressive trigeminal neuropathy caused by a postoperative maxillary cyst.
Subject(s)
Humans , Cheek , Neuroimaging , Trigeminal Nerve , Trigeminal Nerve DiseasesABSTRACT
No abstract available.
Subject(s)
Arachnoid , Hypoglossal Nerve Diseases , Hypoglossal NerveABSTRACT
Brachial radiculoplexitis is characterized by acute onset of shoulder and arm pain followed by weakness and sensory loss. Brachial radiculoplexitis by herpes zoster is a rare disease, which can be diagnosed by careful history, electrodiagnosis and MRI. It has remained uncertain about clinical characteristics, treatment, and prognosis. Better understanding of this disease helps earlier diagnosis and prompt treatment to minimize neurologic sequale. We present two cases of subacute brachial radiculoplexitis preceded by herpes zoster infection.
Subject(s)
Arm , Brachial Plexus Neuropathies , Diagnosis , Electrodiagnosis , Herpes Zoster , Magnetic Resonance Imaging , Prognosis , Rare Diseases , ShoulderABSTRACT
Balo's concentric sclerosis is regarded as a rare variant of multiple sclerosis. Traditionally, Balo's concentric sclerosis was a post-mortem diagnosis, but the recent introduction of brain magnetic resonance imaging (MRI) scans may allow noninvasive access without biopsy. Brain MRI findings of Balo's concentric sclerosis is characteristic concentric configuration of alternating bands of white matter of different pathology, with relatively preserved myelination alternating with regions of demyelination in the cerebral white matter. We report a case of Balo's concentric sclerosis with recurrent optic neuritis.
Subject(s)
Humans , Biopsy , Brain , Demyelinating Diseases , Diagnosis , Diffuse Cerebral Sclerosis of Schilder , Magnetic Resonance Imaging , Multiple Sclerosis , Myelin Sheath , Optic Neuritis , PathologyABSTRACT
Glufosinate ammonium is the active ingredient in broad-spectrum contact herbicides such as BASTA(R) that inhibits the activity of glutamine synthetase, which is necessary for the production of the amino acid glutamine and for ammonia detoxification. Complications of glufosinate ammonium intoxication include gastrointestinal symptoms, loss of consciousness, convulsions, memory impairment, respiratory failure, and cardiovascular instability. We report herein a case of encephalopathy and reversible signal changes in the splenium of the corpus callosum, the bilateral corticospinal tracts, the hippocampi, and the cerebellar peduncles as seen in diffusion-weighted magnetic resonance imaging and fluid-attenuated inversion recovery images following BASTA(R) intoxication.
Subject(s)
Ammonia , Ammonium Compounds , Corpus Callosum , Glutamate-Ammonia Ligase , Glutamine , Herbicides , Magnetic Resonance Imaging , Memory , Pyramidal Tracts , Respiratory Insufficiency , Seizures , UnconsciousnessABSTRACT
BACKGROUND AND PURPOSE: No previous studies have investigated the relationship between various anti-ganglioside antibodies and the clinical characteristics of Guillain-Barre syndrome (GBS) in Korea. The aim of this study was to determine the prevalence and types of anti-ganglioside antibodies in Korean GBS patients, and to identify their clinical significance. METHODS: Serum was collected from patients during the acute phase of GBS at 20 university-based hospitals in Korea. The clinical and laboratory findings were reviewed and compared with the detected types of anti-ganglioside antibody. RESULTS: Among 119 patients, 60 were positive for immunoglobulin G (IgG) or immunoglobulin M antibodies against any type of ganglioside (50%). The most frequent type was IgG anti-GM1 antibody (47%), followed by IgG anti-GT1a (38%), IgG anti-GD1a (25%), and IgG anti-GQ1b (8%) antibodies. Anti-GM1-antibody positivity was strongly correlated with the presence of preceding gastrointestinal infection, absence of sensory symptoms or signs, and absence of cranial nerve involvement. Patients with anti-GD1a antibody were younger, predominantly male, and had more facial nerve involvement than the antibody-negative group. Anti-GT1a-antibody positivity was more frequently associated with bulbar weakness and was highly associated with ophthalmoplegia when coupled with the coexisting anti-GQ1b antibody. Despite the presence of clinical features of acute motor axonal neuropathy (AMAN), 68% of anti-GM1- or anti-GD1a-antibody-positive cases of GBS were diagnosed with acute inflammatory demyelinating polyradiculoneuropathy (AIDP) by a single electrophysiological study. CONCLUSIONS: Anti-ganglioside antibodies were frequently found in the serum of Korean GBS patients, and each antibody was correlated strongly with the various clinical manifestations. Nevertheless, without an anti-ganglioside antibody assay, in Korea AMAN is frequently misdiagnosed as AIDP by single electrophysiological studies.
Subject(s)
Humans , Male , Amantadine , Antibodies , Axons , Cranial Nerves , Facial Nerve , Guillain-Barre Syndrome , Immunoglobulin G , Immunoglobulin M , Korea , Ophthalmoplegia , PrevalenceABSTRACT
PURPOSE: The underlying cause of myasthenia gravis (MG) is unknown, although it likely involves a genetic component. However, no common genetic variants have been unequivocally linked to autoimmune MG. We sought to identify the genetic variants associated with an increased or decreased risk of developing MG in samples from a Korean Multicenter MG Cohort. MATERIALS AND METHODS: To determine new genetic targets related to autoimmune MG, a whole genome-based single nucleotide polymorphisms (SNP) analysis was conducted using an Axiom(TM) Genome-Wide ASI 1 Array, comprising 598375 SNPs and samples from 109 MG patients and 150 neurologically normal controls. RESULTS: In total, 641 SNPs from five case-control associations showed p-values of less than 10(-5). From regional analysis, we selected seven candidate genes (RYR3, CACNA1S, SLAMF1, SOX5, FHOD3, GABRB1, and SACS) for further analysis. CONCLUSION: The present study suggests that a few genetic polymorphisms, such as in RYR3, CACNA1S, and SLAMF1, might be related to autoimmune MG. Our findings also encourage further studies, particularly confirmatory studies with larger samples, to validate and analyze the association between these SNPs and autoimmune MG.
Subject(s)
Female , Humans , Male , Antigens, CD/genetics , Asian People/genetics , Calcium Channels/genetics , Genetic Predisposition to Disease/genetics , Genotype , Myasthenia Gravis/etiology , Polymorphism, Single Nucleotide/genetics , Receptors, Cell Surface/genetics , Ryanodine Receptor Calcium Release Channel/geneticsABSTRACT
Acute motor and sensory axonal neuropathy (AMSAN) are recently described subtypes of Guillain-Barre syndrome characterized by acute onset of distal weakness, loss of deep tendon reflexes, and sensory symptoms. A 21-yr-old male was transferred to our hospital due to respiration difficulties and progressive weakness. In laboratory findings, immunoglobulin M antibodies against hepatitis A were detected in blood and cerebrospinal fluid. The findings of motor nerve conduction studies showed markedly reduced amplitudes of compound muscle action potentials in bilateral peroneal, and posterior tibial nerves, without evidence of demyelination. Based on clinical features, laboratory findings, and electrophysiologic investigation, the patient was diagnosed the AMSAN following acute hepatitis A viral infection. The patient was treated with intravenous immunoglobulin and recovered slowly. Clinicians should consider this rare but a serious case of AMSAN following acute hepatitis A infection.