RESUMEN
The symptoms of restless legs syndrome usually involve legs, but can extend to other body parts. However, isolated body parts other than the leg are rarely involved. A 36-year-old woman presented for evaluation with a tingling and burning sensation in the both hands for one year. These abnormal sensations appeared in the evening and night, resulting in difficulty in falling asleep. The symptoms were relieved by shaking and bending of hands and wrists. Pramipexole was increased to 0.375 mg, and 75 mg of pregabalin was added, but her abnormal nocturnal sensation was not improved. Overt hyperthyroidism was revealed by thyroid function test: free thyroxin 2.99 ng/dL and thyroid-stimulating hormone 0.009 µIU/mL. One month later, her symptom showed much improvement after taking methimazole 5 mg twice a day. We report a case of abnormal nocturnal sensation of hands in the patient with hyperthyroidism who responded with methimazole.
Asunto(s)
Adulto , Femenino , Humanos , Accidentes por Caídas , Quemaduras , Mano , Cuerpo Humano , Hipertiroidismo , Pierna , Metimazol , Pregabalina , Síndrome de las Piernas Inquietas , Sensación , Pruebas de Función de la Tiroides , Tirotropina , Tiroxina , MuñecaRESUMEN
Central pontine myelinolysis (CPM) is well-recognized osmotic demyelination syndrome that is related to various conditions such as rapid correction of hyponatremia and chronic alcoholism. Acute ataxia as a sole clinical sign in CPM is rare. We report a case of a 59-year-old man with dysarthria, intention tremor, and a significant gait ataxia starting after alcohol withdrawal, with radiological evidence of CPM. CPM should be included in the differential diagnosis of alcoholic patients who develop a sudden ataxia. Chronic alcohol abuse is one of the most commonly encountered predisposing factors. Alcohol withdrawal represents an additional vulnerability factor, being responsible for electrolyte imbalances which are not always demonstrable but are certainly involved in the development of CPM.
Asunto(s)
Humanos , Persona de Mediana Edad , Alcohólicos , Alcoholismo , Ataxia , Causalidad , Enfermedades Desmielinizantes , Diagnóstico Diferencial , Disartria , Ataxia de la Marcha , Hiponatremia , Mielinólisis Pontino Central , TemblorRESUMEN
Hemichorea have been reported in patients with nonketotic hyperglycemia. Usually, hemichorea and hyperglycemia are concomitant. A 73-year-old woman was admitted for investigation of an acute hemichorea. T1-weighted brain magnetic resonance imaging showed hyperintensity in the right putamen. Although she was a diabetic patient, she had no hyperglycemia. Interestingly, 4 weeks earlier, the patient was admitted due to nonketotic hyperglycemia. However, there were no hemichorea at that time. Although pathophysiologically controversial, a delayed hemichorea without nonketotic hyperglycemia should be considered as one of many different causes when evaluating acute hemichorea in diabetic patients.
Asunto(s)
Anciano , Femenino , Humanos , Encéfalo , Corea , Hiperglucemia , Imagen por Resonancia Magnética , PutamenRESUMEN
No abstract available.
Asunto(s)
Encéfalo , Caracol Conus , Quiste Dermoide , Imagen por Resonancia Magnética , RoturaRESUMEN
We report a 43-year old woman patient presented with contralateral trigeminal neuralgia induced by tactile stimulation and mastication after Bell's palsy. Trigeminal neuralgia is characterized by recurrent episodes of intense lancinating pain affecting the face localized to the sensory supply areas of the trigeminal nerve. Increased excitability of facial motor neurons and bainstem interneurons which mediate trigemio-facial reflex are thought to be the cause of contralateral trigeminal neuralgia after Bell's palsy.
Asunto(s)
Femenino , Humanos , Parálisis de Bell , Interneuronas , Masticación , Neuronas Motoras , Reflejo , Nervio Trigémino , Neuralgia del TrigéminoRESUMEN
Acute mountain sickness is an illness caused by climbing to a high altitude without prior acclimatization. Neurological consequences, like parkinsonism following acute mountain sickness without lesion of brain MRI have been reported rarely. A healthy 56-year-old man presented with dysarthria and gait disturbance. Neurological examination revealed tremor of hands, limb rigidity, and bradykinesia. The symptoms developed approximately 30 days following a 3,500 m climb of the Annapurna in the Himalayas. Brain MRI did not reveal any abnormalities including globus pallidus. The parkinsonism symptoms persisted for about 3 months before a complete recovered was made. We suggest that parkinsonism can develop after climbing to a high altitude but that the symptoms can be transient if a brain MRI detects no abnormalities.
RESUMEN
No abstract available.
Asunto(s)
Adulto , Humanos , Masculino , Hemoglobinas , Accidente CerebrovascularRESUMEN
BACKGROUND: The role of glycated hemoglobin (HbA1c) in the prediction of ischemic stroke in non-diabetic subjects is not clear. We performed a study to analyze the role of HbA1c in the risk prediction of ischemic stroke in non-diabetic Korean males adult. METHODS: A total of 307 non-diabetic male patients with ischemic stroke were enrolled, and 253 age-matched control subjects without a history of diabetes, hypertension, or cardiovascular disease were selected from a Health Check-up database. Anthropometric measurement data, fasting glucose level, lipid profile, and HbA1c level were available for all subjects. Associations of the variables and the presence or absence of ischemic stroke were analyzed. RESULTS: The ischemic stroke patient group had significantly higher HbA1c levels (5.8+/-0.5% vs. 5.5+/-0.5%, P<0.01) and mean systolic and diastolic blood pressure compared with the control group. Among the variables, smoking, low high density lipoprotein cholesterol, systolic blood pressure, and HbA1c were the significant determinants for ischemic stroke. The highest quartile of HbA1c showed a 9.6-fold increased odds ratio for ischemic stroke compared with the lowest quartile of HbA1c (odds ratio, 9.596; 95% confidence interval, 3.859 to 23.863, P<0.01). The proportion of ischemic stroke patients showed a significant trend for increment as the deciles of HbA1c increased (P for trend <0.01). CONCLUSION: Higher HbA1c indicated a significantly increased risk for ischemic stroke after adjusting for other confounding variables in non-diabetic Korean adult males. HbA1c might have significance in predicting the risk for ischemic stroke even in the non-diabetic range.
Asunto(s)
Adulto , Humanos , Masculino , Pueblo Asiatico , Presión Sanguínea , Enfermedades Cardiovasculares , Colesterol , HDL-Colesterol , Ayuno , Glucosa , Hemoglobinas , Hipertensión , Lipoproteínas , Oportunidad Relativa , Humo , Fumar , Accidente CerebrovascularRESUMEN
Neurological manifestations are commonly observed in systemic lupus erythematosus (SLE). However, cerebellar involvement has rarely been reported. We report a case of SLE presented with cerebellar ataxia as an initial manifestation after influenza vaccination. A 38-year-old woman who had not been diagnosed with SLE presented with dysarthria and gait disturbance after influenza vaccination. On admission, cerebellar ataxia and bilateral sixth cranial nerve palsy were observed. Influenza vaccination may have triggered autoimmunity in the patient with SLE.
Asunto(s)
Adulto , Femenino , Humanos , Enfermedades del Nervio Abducens , Autoinmunidad , Ataxia Cerebelosa , Disartria , Marcha , Vacunas contra la Influenza , Gripe Humana , Lupus Eritematoso Sistémico , Manifestaciones Neurológicas , VacunaciónRESUMEN
Ginkgo nuts have been eaten as oriental medicine and food since ancient times in Korea. However, the potential toxicity of the ginkgo nuts is not well-known. It has been reported that 4-O-methoxypyridoxine in ginkgo nuts causes generalized seizures but no status epilepticus. This report describes a 58-year-old male presented with status epilepticus after overconsumption of ginkgo nuts. After treatment with anticonvulsants and pyridoxine, symptoms were resolved. The toxicity of ginkgo nuts should be considered as a cause of status epilepticus.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Anticonvulsivantes , Ginkgo biloba , Corea (Geográfico) , Medicina Tradicional de Asia Oriental , Nueces , Piridoxina , Convulsiones , Estado EpilépticoRESUMEN
Brain-MR studies are sensitive to intracranial ischemia and vascular flow. However, brain MR study for brain death is clinically limited because keeping the ventilation is difficult during study. In our hospital, three 'brain death patients' brain-MR studies were performed under the anesthetic Mapleson's circuit-F system. Three patients' clinical states were not changed after the studies. We confirmed that brain herniation, absent intracranial flow void, no intracranial contrast enhancement, poor gray/white matter differentiation, and prominent nasal enhancement findings. The value of brain-MR study for brain death may be possible.
Asunto(s)
Encéfalo , Muerte Encefálica , Isquemia , VentilaciónRESUMEN
Even a single brain infarct can cause dementia when it occurs in functionally critical areas of the brain. A 71- year-old female developed sudden cognitive impairment without any other focal neurologic deficits. A brain MRI revealed a bilateral anterior fornix infarction. Neuropsychological evaluation revealed verbal and visual memory deficits, visuospatial dysfunction, and frontal executive dysfunction. The cognitive impairment did not improve for 3 months and the patient showed impairments in daily activities. We report a patient who demonstrated strategic infarct dementia after a bilateral anterior fornix infarction.
Asunto(s)
Femenino , Humanos , Encéfalo , Demencia , Demencia Vascular , Fórnix , Infarto , Imagen por Resonancia Magnética , Trastornos de la Memoria , Manifestaciones NeurológicasRESUMEN
Atonic seizures exhibits loss of postural tone, resulting in head drops or falling. When this event is extremely brief, It has been known as a drop attack. Atonic seizure are firmly placed under the category of generalized seizures. However, a various phenomena satisfying the above description has been recognized in patients with partial seizures. A 13-year-old girl had brief episodes of drop attacks. She complained of weakness of both legs in the absence of consciousness loss. These episodes occurred at a frequency of 4 or 5 time per day for 1 year. Her developmental and physical examinations were normal. Also, the brain MRI was normal. However, her Interictal EEG showed the repetitive spike and wave complexes on C(z) electrode. She was controlled completedly by antiepileptic drungs. We report a patient who suffered from focal atonic seizures characterized by drop attack.
Asunto(s)
Adolescente , Femenino , Humanos , Encéfalo , Estado de Conciencia , Electrodos , Electroencefalografía , Cabeza , Pierna , Imagen por Resonancia Magnética , Examen Físico , Convulsiones , SíncopeRESUMEN
BACKGROUND AND PURPOSE: There is no clear description about the patterns of each mechanism of striatocapsular infarctions. The aims of our study were to elucidate differences in the distributions of lesions of acute middle cerebral artery (MCA) infarctions involving the striatocapsular region and to compare those following embolic striatocapsular infarctions with those originating from MCA disease. METHODS: We prospectively enrolled patients with acute infarcts located in the lenticulostriate artery territory that were not lacunar infarcts. Brain coronal diffusion-weighted imaging (DWI) was obtained and magnetic resonance angiography (MRA) was carried out to evaluate the distribution of infarct lesions and MCA stenosis in all patients. The types of infarct distribution were divided into three categories: (1) dominant in the distal territory (DD), (2) distributed equally between the distal and proximal territories (DE), and (3) dominant in the proximal territory. We performed tests for embolic sources (transthoracic echocardiography, transesophageal echocardiography, Holter monitoring, and contrast-enhanced MRA including the aortic arch) in most patients. Stroke mechanisms were classified into stroke from proximal embolism, MCA disease, and stroke of undetermined etiology. RESULTS: A total of 47 patients (28 men and 19 women; mean age, 62 years) were recruited. A proximal embolic source was significantly more prevalent in patients with a DE lesion than in those with a DD lesion. The most common proximal embolic source was of cardiac origin. In contrast, symptomatic MCA stenoses were more common in patients with a DD lesion than in those with a DE lesion. CONCLUSIONS: These results suggest that the dominant area of striatocapsular infarction on coronal DWI is an important clue for stroke etiology. Coronal DWI could therefore be helpful to determining the mechanisms in patients with striatocapsular infarctions that are currently described as having an "undetermined etiology" according to the Trial of Org 10172 in Acute Stroke Treatment classification.
Asunto(s)
Femenino , Humanos , Masculino , Arterias , Encéfalo , Clasificación , Constricción Patológica , Ecocardiografía , Ecocardiografía Transesofágica , Electrocardiografía Ambulatoria , Embolia , Infarto , Angiografía por Resonancia Magnética , Arteria Cerebral Media , Estudios Prospectivos , Accidente Cerebrovascular , Accidente Vascular Cerebral LacunarRESUMEN
Seafood is a vehicle for the transmission of intoxication. The Neptunea are sublittoral species of the marine prosobranch mollusk. Tetramine toxin is found in the salivary gland of Neuptunea. A woman developed blurred vision, dizziness, headache, diarrhea, numbness and gait disturbance one hour after ingesting conchs. Neurological examination showed dysesthesia, and motor weakness. Laboratory and electrophysiological studies were normal. The next day, she recovered from her symptoms. We report a patient with dysesthesia and motor weakness due to Neuptunea species' tetramine toxin.
Asunto(s)
Femenino , Humanos , Diarrea , Mareo , Marcha , Cefalea , Hipoestesia , Moluscos , Examen Neurológico , Parestesia , Glándulas Salivales , Alimentos MarinosRESUMEN
Giant cell arteritis (GCA) is an autoimmune vasculitic disorder of unknown origin. Systemic GCA causing cerebral infarction due to intracranial arteritis is rare. Early diagnosis and anti-inflammatory treatment of the GCA are necessary to prevent systemic involvement. A 66-year-old woman presented with dysarthria and left hemiparesis. A brain MRI showed ischemic lesions in the right temporoparietal area. We report a pathological case of GCA with clinical and neuroradiological evidence of cerebral infarction.
Asunto(s)
Anciano , Femenino , Humanos , Arteritis , Encéfalo , Infarto Cerebral , Disartria , Diagnóstico Precoz , Arteritis de Células Gigantes , Células Gigantes , Imagen por Resonancia Magnética , Paresia , PatologíaRESUMEN
BACKGROUND: To study social stigma of people with epilepsy (PWE) in Korea, focusing on which factors are associated with social stigma. METHODS: Data were collected from 400 adult epilepsy patients (51% male, mean age:32.9 years, range:19-64 years). Patients were recruited from 10 epilepsy centers in Korea. Clinical information about seizures was obtained by neurologists and the other information was collected by using self-completed questionnaires including stigma of epilepsy scale and several scales or questions. RESULTS: Thirty one percent of PWE felt stigmatized by epilepsy, 9% of them highly so. The presence of stigma of epilepsy was associated with duration of epilepsy, seizure remission or frequency, generalized tonic clonic seizures in the last 2 years, seizure-related injuries in the last year, the actual discrimination from society, all subscales of QOLIE-31, education, introverted and neurotic personality, helplessness, control, and confidence in problem solving, anxiety and depression, and self-esteem. Multivariate analysis identified discrimination from society, introverted personality, problem solving control, and emotional subscale of QOLIE-31. CONCLUSION: Our data showed the prevalence of social stigma of PWE in Korea might be not high unexpectedly and suggested that the actual discrimination from society and patients' coping style including personality might be important in feeling social stigma of epilepsy. Our results would be basic information for the further studies to clarify the causative factors to generate the stigma of epilepsy.
Asunto(s)
Adulto , Humanos , Masculino , Ansiedad , Depresión , Discriminación en Psicología , Educación , Epilepsia , Corea (Geográfico) , Análisis Multivariante , Prevalencia , Solución de Problemas , Encuestas y Cuestionarios , Convulsiones , Estigma Social , Pesos y MedidasRESUMEN
BACKGROUND: Auditory auras are rare but may have localizing value in patients presenting with epilepsy. We conducted the study to correlate the clinical characteristics, EEG and MRI findings in patients with auditory auras. METHODS: We identified 44 epileptic patients (23 male, 21 female) with auditory auras from Yonsei epilepsy registry between 1989 and 2000. All had routine EEG and MRI. These patients were subjected for the classification of lobar epilepsies based on the clinical-EEG-MRI correlations, which aimed at demonstrating 1) the association of auditory auras with temporal lobe epilepsy and 2) the localizing value of auditory auras to the neocortical temporal lobe epilepsy. RESULTS: Auditory auras were elementary in twenty-three, complex in eighteen, and both in three. Twenty patients described auditory aura only, and 24 patients described other associated auras including cephalic sensation, emotional, experiential, autonomic, epigastric, visual, vestibular, and somatosensory phenomena. The classification based on the Clinic-EEG-MRI correlations revealed that 33 of 44 patients (75%) were classified as temporal lobe epilepsy, however, it did not suggest any strong correlations with neocortical temporal lobe epilepsy. CONCLUSION: Auditory aura was strongly related with the temporal lobe epilepsy but it did not provide any further localizing value of seizure origin in patients with TLE.