Recently, LEDs with various light qualities have been used in closed plant factories, and they are known to have different effects on the growth and quality of crops. Therefore, this study was conducted to investigate the change in growth and quality in mini red romaine lettuce using LEDs with various light qualities. Wide red spectrum (WRS)-LEDs, blue (B)-LEDs, blue + red (BR)-LEDs, red (R)-LEDs, and white (W)-LEDs were used as the artificial light sources. Regarding growth, the R-LED treatment showed the most positive effect, but the leaf shape was not normal and the Hunter b* value was not suitable because it was higher than that of the other treatments. The Hunter a*, SPAD, and NDVI values of the B- and BR-LED treatments were effective, but this was not the case for those of the R- and W-LED treatments. The anthocyanin reflectance index 1 (ARI1) was 20 times higher in the B-LED treatment than in the R-LED treatment, and the ascorbic acid content was the highest in the WRS-LED treatment. In the sensory evaluation, bitterness and sweetness showed opposite tendencies. Regarding the overall preference, the BR-LED treatment received the highest score. Correlation analysis showed that the bitterness was closely correlated with the anthocyanin content and leaf color. Taken together, BR-LEDs provided a good top fresh weight, dark red leaves, and high anthocyanin and ascorbic acid contents, with the highest overall preference; therefore, BR-LEDs were the most suitable for the cultivation of mini red romaine lettuce.
Wheat is cultivated worldwide and is the most widely distributed food crop. Wheat is a staple crop in many countries. However, the effects of various cultivation methods on the efficacy of wheat sprouts have not been determined. This study investigated wheat sprouts obtained using a standardized smart farm system (WS-S) to improve the effects of non-alcoholic fatty liver disease (NAFLD) and molecular mechanism. Wheat sprouts significantly attenuated the accumulation of lipid droplets in FFA-induced HepG2 cells through AMPK pathway activity. In vivo experiments showed that WS-S significantly lowered body weight gain and decreased adipose tissue, lipid, aspartate transaminase, and alanine aminotransferase levels in HFD/F-treated mice. Furthermore, WS-S stimulated the phosphorylation of ACC and peroxisome proliferator-activated receptor alpha via the AMPK pathway and inhibited SREBP-1/FAS signaling to inhibit de novo adipogenesis and increase fatty acid oxidation. These results suggest that WS-S ameliorates NAFLD by regulating fatty acid metabolism via the AMPK pathway.
This study investigated the effects of supplemental inter-lighting on paprika (cv. Nagano RZ) in South Korea in summer using various LED light sources. The following LED inter-lighting treatments were used: QD-IL (blue + wide-red + far-red inter-lighting), CW-IL (cool-white inter-lighting), and B+R-IL (blue + red (1:2) inter-lighting). To investigate the effect of supplemental lighting on each canopy, top-lighting (CW-TL) was also used. Additionally, a control without supplemental lighting was included for comparison. Significant variations were observed in the plant growth indexes 42 days after treatment. The SPAD values and total chlorophyll content in the last period of cultivation were significantly higher than those of the control. In November, the marketable fruit yield was significantly higher than that of the control. QD-IL, CW-IL, and CW-TL resulted in significantly higher values of total soluble solids than the control, and CW-IL resulted in higher values of ascorbic acid content than the control. Regarding the economic analysis, CW-IL resulted in the highest net income rate (12.70%) compared with the control. Therefore, the light sources of CW-IL were assessed as suitable for supplemental lighting due to the highest total soluble solids, ascorbic acid content, and net income rate obtained.
Korean ginseng (Panax ginseng) is a traditional herbal supplement known to have a variety of pharmacological activities. A smart farm system could provide potential standardization of ginseng seedlings after investigating plant metabolic responses to various parameters in order to design optimal conditions. This research was performed to investigate the effect of smart-farmed ginseng on memory improvement in a scopolamine-induced memory deficit mouse model and an LPS-induced microglial cell model. A smart farming system was applied to culture ginseng. The administration of its extract (S2 extract) under specific culture conditions significantly attenuated cognitive and spatial memory deficits by regulating AKT/ERK/CREB signaling, as well as the cortical inflammation associated with suppression of COX-2 and NLRP3 induced by scopolamine. In addition, S2 extract improved the activation of iNOS and COX-2, and the secretion of NO in LPS-induced BV-2 microglia. Based on the HPLC fingerprint and in vitro data, ginsenosides Rb2 and Rd were found to be the main contributors to the anti-inflammatory effects of the S2 extract. Our findings suggest that integrating a smart farm system may enhance the metabolic productivity of ginseng and provides evidence of its potential impact on natural bioactive compounds of medicinal plants with beneficial qualities, such as ginsenosides Rb2 and Rd.
OBJECTIVE: Studies on gait and autonomic dysfunction have been insufficient so far, particularly de novo Parkinson's disease (PD). The aim of this study was to identify the association between gait dynamics and autonomic dysfunction in patients with de novo PD. METHODS: A total 38 patients with de novo PD were retrospectively included in this study. Details of patients' dysautonomia were assessed using the Scales for Outcomes in Parkinson's Disease-Autonomic Dysfunction (SCOPA-AUT). For assessment of gait, a computerized gait analysis was performed using the GAITRite system for forward gait and backward gait. High SCOPA-AUT score (PD-HSAS) group and low SCOPA-AUT score (PD-LSAS) group were identified according to their SCOPA-AUT scores. RESULTS: Nineteen (50%) patients with high SCOPA-AUT scores above median value (12.5) were assigned into the PD-HSAS group and others were assigned to the PD-LSAS group. Compared with the PD-LSAS group, the PD-HSAS group exhibited slower gait, shorter stride, decreased cadence, increased double support phase, decreased swing phase, and increased variability in swing time. Total SCOPA-AUT score showed significantly positive correlations with gait variability and instability but a negative correlation with gait hypokinesia. In subdomain analysis, urinary dysautonomia was highly associated with impairment of gait dynamics. All significant results were found to be more remarkable in backward gait than in forward gait. CONCLUSION: Our findings suggest that alteration in gait dynamics, especially backward gait, is highly associated with autonomic dysfunction in patients with de novo PD.
In reinforcement learning, reward-driven feature learning directly from high-dimensional images faces two challenges: sample-efficiency for solving control tasks and generalization to unseen observations. In prior works, these issues have been addressed through learning representation from pixel inputs. However, their representation faced the limitations of being vulnerable to the high diversity inherent in environments or not taking the characteristics for solving control tasks. To attenuate these phenomena, we propose the novel contrastive representation method, Action-Driven Auxiliary Task (ADAT), which forces a representation to concentrate on essential features for deciding actions and ignore control-irrelevant details. In the augmented state-action dictionary of ADAT, the agent learns representation to maximize agreement between observations sharing the same actions. The proposed method significantly outperforms model-free and model-based algorithms in the Atari and OpenAI ProcGen, widely used benchmarks for sample-efficiency and generalization.
Algorithms , Reinforcement, Psychology , Learning , Reward
Although statins are established therapy for the secondary prevention of ischemic stroke, factors associated with adherence to statin treatment following ischemic stroke are not well known. To address this, we assessed the 6-month statin adherence using 8-item Morisky Medication Adherence Scale-8 in patients with acute ischemic stroke. Of 991 patients, 65.6% were adherent to statin at 6-month after discharge. Multiple logistic regression analysis showed that patients' awareness of hyperlipidemia (OR 1.62; 95% CI 1.07-2.43), large artery stroke subtype (versus non-large artery stroke, OR 1.79; 95% CI 1.19-2.68), and alcohol drinking habits (OR 1.64; 95% CI 1.06-2.53) were positively associated, while high statin dose (versus low dose, OR 0.6; 95% CI 0.40-0.90) and higher daily number of medication pills (OR 0.93; 95% CI 0.88-0.97) were found to have a negative association with self-reported good adherence to statin medication after acute ischemic stroke. However, stroke severity and diagnosis of hyperlipidemia were not associated with adherence. These results suggest that educational and motivational interventions may enhance statin adherence because modifiable factors were associated with statin adherence.
Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Medication Adherence/statistics & numerical data , Secondary Prevention/methods , Stroke/prevention & control , Aged , Female , Humans , Hyperlipidemias/complications , Hyperlipidemias/drug therapy , Male , Middle Aged
OBJECTIVE: Although Parkinson's disease (PD) is frequently accompanied by depression, brain perfusion deficits in PD with depression remain unclear. This study aimed to assess alterations in regional cerebral blood flow (rCBF) in depressed PD patients using 99mTc hexamethyl-propylene-amine-oxime single-photon emission computed tomography (SPECT). METHODS: Among 78 patients with PD, 35 patients were classified into the depressed PD group, while the rest (43 patients) was assigned to the nondepressed PD group based on the scores of the Geriatric Depressive Scale (GDS). All participants underwent brain SPECT imaging. The voxel-wise whole-brain analysis and region-of-interest (ROI) analysis of the limbic areas were conducted to compare rCBF between the depressed and nondepressed PD groups. RESULTS: The depressed PD patients demonstrated higher GDS scores than nondepressed patients, whereas between-group differences in the PD severity and cognitive function were not significant. Perfusion in the left cuneus was increased, while that in the right superior temporal gyrus and right medial orbitofrontal cortex was reduced in the depressed PD patients as compared with nondepressed PD patients. In addition, the ROI analysis demonstrated rCBF decreases in the amygdala, anterior cingulate cortex, hippocampus, and parahippocampal gyrus in the depressed PD group. A positive correlation was found between the GDS scores and rCBF in the left cuneus cluster in the depressed PD patients. CONCLUSION: This study identified the regional pattern of brain perfusion that distinguished depressed from nondepressed PD patients. Hyperperfusion in the occipital areas and hypoperfusion in the fronto-temporo-limbic regions may be potential imaging biomarkers for depression in PD.
Brain/blood supply , Brain/diagnostic imaging , Cerebrovascular Circulation , Depression/complications , Parkinson Disease/complications , Parkinson Disease/physiopathology , Aged , Female , Humans , Male , Parkinson Disease/diagnostic imaging , Tomography, Emission-Computed, Single-Photon
AIM: The aim of the present study was to investigate the point prevalence of dementia and mild cognitive impairment (MCI) in patients with Parkinson's disease (PD). METHODS: A total of 1200 patients with PD from 12 hospitals were included in the study. All patients were grouped into normal cognition, MCI and dementia subgroups. General cognitive status and dementia severity were assessed by the Korean version of the Mini-Mental State Examination, Clinical Dementia Rating and Global Deterioration Scale, and parkinsonian motor status was assessed by the Hoehn and Yahr staging score. Associated sleep behaviors and other medical conditions were checked. Prescribing patterns of antidementia medications were analyzed. RESULTS: Cognitive impairment was frequent in patients with PD; MCI was found in 38.9% of patients, whereas dementia was in 38.3% of patients. The prevalence of cognitive impairment increased with increasing age and longer disease duration, and the symptoms of postural instability and symptoms mimicking rapid eye movement sleep behavior disorder were associated with cognitive impairment. Many dementia patients (95.2%) and 23.6% of MCI patients were treated with antidementia drugs, with rivastigmine the most frequently used. CONCLUSION: The point prevalence of cognitive impairment in patients with PD was 77.2%. Cognitive impairment was associated with age, disease duration and specific parkinsonian motor/non-motor symptoms. Over 90% of the patients with dementia were treated with antidementia medication, and rivastigmine was the most frequently used for the management of dementia.
Cognitive Dysfunction/epidemiology , Cognitive Dysfunction/therapy , Dementia/epidemiology , Dementia/therapy , Parkinson Disease/complications , Adult , Aged , Aged, 80 and over , Cognitive Dysfunction/etiology , Dementia/etiology , Female , Humans , Male , Middle Aged , Prevalence , Republic of Korea/epidemiology
This study was to evaluate the influence on cognition and activities of daily living (ADL) by white matter hyperintensities (WMHs) based on the severity and location, as well as the interactions among WMHs, lacunes, and medial temporal atrophy (MTA). In 150 patients with amnestic mild cognitive impairment, WMHs were quantified with the use of a semiautomated volumetric method. Lacune counting and MTA assessment were performed by visual rating. The severer WMHs were, the more executive functions decreased. The influence on executive functions such as verbal fluency test and Stroop color reading test were greater in periventricular (PV) WMHs than deep WMHs, as well as bigger in anterior, middle, and posterior areas in order. The instrumental (I) ADL was strongly associated with the anterior (P = .028) and middle area (P = .014) of PVWMHs only. WMHs had synergistic interactions with lacunes in Controlled Oral Word Association Task-semantic (ß = -1.12; R(2) = .24; P = .039), Stroop color (ß = -2.07; R(2) = .15; P = .049), and IADL (ß = .23; R(2) = .20; P = .009). Anterior PVWMHs demonstrated the most powerful impact on frontal executive dysfunction and poor performance of IADL. WMHs had synergistic effects with the number of lacunes on them. Therefore, it is desirable to consider WMHs and lacunes simultaneously as potential imaging biomarkers for predicting cognition and IADL in aMCI.
Brain/pathology , Cognition , Cognitive Dysfunction/diagnosis , Leukoencephalopathies/diagnosis , Activities of Daily Living , Aged , Aged, 80 and over , Atrophy , Cognitive Dysfunction/pathology , Cognitive Dysfunction/psychology , Executive Function , Female , Humans , Leukoencephalopathies/pathology , Leukoencephalopathies/psychology , Magnetic Resonance Imaging , Male , Middle Aged , Predictive Value of Tests , Prognosis , Republic of Korea , Severity of Illness Index , Stroop Test
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.
Guillain-Barre Syndrome/diagnosis , Hepatitis A/diagnosis , Acute Disease , Electromyography , Guillain-Barre Syndrome/drug therapy , Guillain-Barre Syndrome/etiology , Hepatitis A/complications , Humans , Immunoglobulins, Intravenous/therapeutic use , Male , Young Adult
BACKGROUND: The purpose of this study is to compare the patterns of voiding dysfunction according to the locations of brainstem lesions. METHODS: Between November 2008 and December 2011, a total of 30 patients participated in this study. All 30 subjects, consisting of 16 men and 14 women, aged between 41 and 82 years (mean age, 63.0±11.0 years) underwent a urodynamic study within 7 days after the onset of a stroke. RESULTS: Twenty-one (70%) patients had a pontine lesion and 9 (30%) had a medullary lesion. Fourteen of these patients (46.7%) had bladder storage disorder, 7 patients (23.3%) had bladder emptying disorder, and 9 patients (30%) had a normal report. Five of the patients who had a medullary lesion (55.6%) had bladder emptying disorder, whereas only 2 patients who had a pontine lesion (9.5%) had bladder emptying disorder. Thirteen patients who had a pontine lesion (61.9%) showed bladder storage disorder. DISCUSSION: The descending pathway from the midbrain tegmentum is inhibitory, and the pathway from the pontine tegmentum is stimulatory. Because of their location pontine lesions could disrupt the descending fibers of the midbrain tegmentum and medullary lesions could disrupt the descending fibers of the pontine tegmentum.
Brain Stem Infarctions/pathology , Brain Stem Infarctions/physiopathology , Medulla Oblongata/pathology , Polycystic Ovary Syndrome/etiology , Urination Disorders/etiology , Acute Disease , Adult , Aged , Aged, 80 and over , Brain Stem Infarctions/complications , Female , Humans , Male , Medulla Oblongata/physiopathology , Middle Aged , Polycystic Ovary Syndrome/pathology , Polycystic Ovary Syndrome/physiopathology , Pons/pathology , Pons/physiopathology , Stroke/pathology , Stroke/physiopathology , Urination Disorders/pathology , Urination Disorders/physiopathology
The clinical implications of WMHs in aMCI are inconclusive. Moreover, clinical interactions between APOE genotypes and WMHs remain unclear. This study was conducted to investigate the relationship between WMHs and cognitive functions and how this relationship interacted with APOE genotype in people with aMCI. This study included a total of 1472 patients with aMCI from the Clinical Research Center for Dementia of South Korea (CREDOS) and divided them into 3 groups according to the severity of WMHs as assessed by visual ratings of brain magnetic resonance images. The associations of WMHs with the various cognitive domains and with APOE epsilon 4 (É4) status were evaluated. After multivariable adjustments, the severity of WMHs was independently associated with semantic/phonemic verbal fluency and Stroop test-color reading, while APOE É4 status was associated with verbal and visual memory-immediate, delayed recall, and recognition. Moreover, there were interaction between WMHs and APOE É4 status in semantic verbal fluency (animal, P=0.033; supermarket, P=0.047)/Stroop test-color reading (P=0.024). WMHs independently deleteriously affected frontal executive functions in aMCI patients, regardless of APOE É4 presence. Furthermore, APOE É4 possession caused a rapid decline in frontal executive functions with the increase in the WMHs severity (vs. absence), suggesting that WMHs and APOE É4 genotypes synergistically contribute to frontal executive dysfunctions in aMCI.
Apolipoproteins E/genetics , Brain/pathology , Cognitive Dysfunction/genetics , Aged , Cognition , Cognitive Dysfunction/blood , Cognitive Dysfunction/pathology , Executive Function , Female , Genotype , Humans , Magnetic Resonance Imaging , Male , Memory Disorders/blood , Memory Disorders/genetics , Memory Disorders/pathology , Neuroimaging , Neuropsychological Tests , Severity of Illness Index , Stroop Test
A healthy, 66-year-old, right-handed man was admitted to our university hospital and diagnosed with herpes zoster ophthalmicus (HZO). After 4 weeks, he complained of hemichorea on his left side. Brain MRI showed a focal hemorrhage in the right subthalamic area. No evidence of aneurysmal lesion or cerebral angiitis was observed on cerebral angiography.
Chorea/etiology , Herpes Zoster Ophthalmicus/complications , Intracranial Hemorrhages/etiology , Subthalamus/blood supply , Aged , Cerebral Angiography , Functional Laterality/physiology , Humans , Intracranial Hemorrhages/complications , Male , Syndrome
Although some studies have supported the association between white matter hyperintensities (WMH) and cognitive impairment, whether WMH are associated with the impairments in instrumental activities of daily living (IADLs) remains unknown. This cross-sectional study investigated differences in basic ADLs and IADLs among different severity of WMH in a large, well-defined registry of patients with amnestic mild cognitive impairment (aMCI). 1,514 patients with aMCI were divided into three groups according to the degree of WMH (1,026 mild, 393 moderate, and 95 severe). We compared the total IADL scores and analyzed the prevalence of the impairment for each IADL item for each group. The severity of WMH was associated with the impairments in IADLs. Among 15 Seoul IADL items, "using public transportation", "going out (short distance)", "grooming" and "participating in leisure activities/hobbies" showed greater positive association with the severity of WMH. WMH in patients with aMCI were associated with the impairments in IADLs but not in basic ADLs. These findings are likely to be more obvious with respect to using public transportation, going out (short distances), shopping, grooming and participating in leisure activities/hobbies.
Activities of Daily Living , Amnesia , Brain/pathology , Cognitive Dysfunction , Conditioning, Operant/physiology , Nerve Fibers, Myelinated/pathology , Aged , Aged, 80 and over , Amnesia/complications , Amnesia/pathology , Amnesia/psychology , Cognitive Dysfunction/complications , Cognitive Dysfunction/pathology , Cognitive Dysfunction/psychology , Cross-Sectional Studies , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neuropsychological Tests , Odds Ratio , Republic of Korea , Retrospective Studies
The SCI, the MCI, and the Alzheimer's disease (AD) are on a spectrum of disease progression; therefore, identification of the earliest signs of cognitive deterioration is becoming a crucial issue. The goal of this study was to examine symptom characteristics and distinguish predictive symptoms in patients with MCI compared with SCI, using caregiver questionnaires. We assessed the Korean Dementia Screening Questionnaire (KDSQ) and Seoul Instrumental activities of Daily Living (S-IADL) of 344 subjects with SCI and 697 with MCI. Multivariate logistic regression analyses were conducted after adjusting for age, sex, and educational status. Common and rare symptoms were similar between the SCI and MCI groups. The most distinguishing features of KDSQ were 'Finds it hard to go somewhere on his/her own using public transportation' (odds ratio=OR=4.56, p<0.0001), 'Has difficulty in operating appliances' (OR=2.47, p=0.001), and 'Keeps repeating the same question' (OR=2.03, p<0.0001). In S-IADL, the most outstanding features were 'using household appliances' (OR=3.99, p<0.0001), 'taking medication' (OR=2.38, p=0.01), and 'using public transportation' (OR=1.94, p=0.04). The dysfunction in 'using household appliance' and 'using public transportation' reflect the possibility of MCI rather than SCI. Therefore, it is suggested that these symptoms also have a discriminative and predictive power in identifying SCI.
Cognitive Dysfunction/diagnosis , Activities of Daily Living/psychology , Age Factors , Aged , Caregivers/psychology , Cognition Disorders/diagnosis , Cognition Disorders/psychology , Cognitive Dysfunction/psychology , Educational Status , Female , Humans , Logistic Models , Male , Neuropsychological Tests , Sex Factors , Surveys and Questionnaires
Thunderclap headache (TCH) refers to a sudden-onset, severe headache that features in subarachnoid hemorrhage, unruptured intracranial aneurysm, cerebral venous thrombosis, pituitary apoplexy, cervical artery dissection, and hypertensive reversible posterior leukoencephalopathy. TCH is a rare manifestation in cerebral or cerebellar infarctions. Herein, we report on a 60-year-old woman with a thunderclap headache as the first symptom of cerebellar infarction, in the absence of abnormal findings in the brain computed tomography (CT), CT angiography, and lumbar puncture. An urgent brain MRI showed an acute infarction of the right cerebellar hemisphere. The next day, the patient presented with right side ataxia. In emergency cases presenting with thunderclap headache, one should consider an expanded evaluation and/or close observation, with frequent neurological examinations, even though the findings are normal on the initial neurological examination, cerebrospinal fluid analysis, and brain CT.
Brain Infarction/pathology , Cerebellum/pathology , Headache Disorders, Primary/physiopathology , Female , Humans , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Middle Aged , Tomography, X-Ray Computed
Regional atrophy of gray matter (GM) in Alzheimer's disease (AD) is well known; however, the relationship between macroscopic and microscopic changes of cerebral white matter (WM) is uncertain. The aim of this study was to investigate the pattern of GM, WM atrophy, and microscopic WM changes in the same individuals with AD. All subjects (10AD and 15 healthy controls [HC]) underwent a MRI scanning at 1.5 T, including a 3-dimensional volumetric scan and diffusion tensor imaging (DTI). We performed statistical parametric mapping (SPM) with DTI to evaluate the patterns of the microscopic WM changes, as well as voxel-based morphometry (VBM) for GM and WM volume changes between patients with AD and HC. GM atrophy was detected, mainly in posterior regions, and WM atrophy was similarly distributed, but less involved on VBM analysis. Unlike WM atrophy on VBM analysis, microscopic WM changes were shown in the medial frontal, orbitofrontal, splenium of the corpus callosum, and cingulum on DTI analysis with SPM. We demonstrated that the pattern of macroscopic WM atrophy was similar to GM atrophy, while microscopic WM changes had a different pattern and distribution. Our findings suggest that WM atrophy may preferentially reflect the secondary changes of GM atrophy, while microscopic WM changes start earlier in frontal areas before GM and WM atrophy can be detected macroscopically.
Alzheimer Disease/pathology , Brain/pathology , Aged , Alzheimer Disease/psychology , Atrophy , Brain Mapping , Diffusion Tensor Imaging , Female , Humans , Image Processing, Computer-Assisted , Male , Nerve Fibers, Myelinated/pathology , Neuropsychological Tests
Erdheim-Chester disease (ECD) is a rare non-Langerhans form of histiocytosis. Cerebellar involvement is rare in this syndrome. We report a 37-year-old woman with slowly progressive cerebellar ataxia, dysmetria of limbs, nystagmus, and dysarthria, bilateral painful axillary masses, and generalized arthralgia. Brain MRI revealed cerebellar atrophy with focal lesions in the pons, middle cerebellar peduncle, and the cerebellum. She underwent incisional biopsy of her axillary masses which showed findings consistent with ECD. An MRI of her lower extremities revealed lesions in the diaphyses, metaphyses, and epiphyses of the proximal tibia and distal femur bilaterally. This is a rare case of cerebral ECD with progressive cerebellar syndrome associated with cerebellar atrophy.
