Cerebral venous thrombosis (CVT) is quite rare and underlying risk factors are diverse. We describe that 60-year-old man developed CVT after use of cyclosporine. He had suffered from leukocytoclastic vasculitis and urticarial vasculitis. Initial MR venogram revealed thrombosis in superior sagittal sinus, right transverse sinus and sigmoid sinus with multiple cortical and deep collateral veins. Anticoagulation was started and maintained for one year, then follow up MR venogram was normal. We suggest that cyclosporine might increase a risk of CVT.
Colon, Sigmoid ; Cyclosporine ; Follow-Up Studies ; Risk Factors ; Superior Sagittal Sinus ; Thrombosis ; Vasculitis ; Vasculitis, Leukocytoclastic, Cutaneous ; Veins ; Venous Thrombosis

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.
Arteries ; Blindness ; Carotid Arteries ; Head ; Ischemic Attack, Transient ; Ligaments ; Ossification, Heterotopic ; Temporal Bone

BACKGROUND: Seizures occur in 2-20% of stroke patients. Recent studies have reported that post-stroke seizures are associated with poorer functional outcomesand higher mortality. However there are no official guidelines on how to use antiepileptic drugs (AEDs) in stroke-related seizures. In this study we surveyed neurologists and neurosurgeons and compared the responses of subgroups categorized by department, specialty and workplace discrimination using a questionnaire containing questions concerning the present tendency to use AEDs in stroke patients. METHODS: 256 neurologists and neurosurgeons participated in the survey. The research instrument was a questionnaire comprising 9 parts and 30 questions. The questions concerned stroke mechanism, the prophylactic use of AEDs, and the choice of AED in early and late onset post-stroke seizures. RESULTS: Tendencies to use prophylactic AEDs in stroke differed depending on specialty and workplace(neurologist vs. neurosurgeon; 17.8% vs. 83.1%, p<0.001, hospital vs. university staff; 46.2% vs. 28.4%, p=0.05). The most commonly used prophylactic AEDs were valproic acid (75%) and levetiracetam (60%). Carbamazepine was the most commonly used AED and phenytoin and phenobarbital were still used in all subgroups to treat post-stroke seizures. CONCLUSIONS: There are significant differences between neurologists (17.8%) and neurosurgeons (83.1%) in the use of prophylactic AEDs after stroke. Valproic acid and levetiracetam are considered first-line prophylactic AEDs by neurosurgeon. Phenytoin and phenobarbital are still used in post-stroke seizure although they have been reported to have an adverse influence on motor recovery. We suggest that proper guidelines should be established for the use of AEDs in stroke-related seizures.
Anticonvulsants ; Carbamazepine ; Discrimination (Psychology) ; Humans ; Phenobarbital ; Phenytoin ; Piracetam ; Surveys and Questionnaires ; Seizures ; Stroke ; Valproic Acid

Obstructive sleep apnea (OSA) is a common disorder which is characterized by intermittent upper airway collapse occurring during sleep. It is well known that OSA often results in a wide range of comorbid disorders. I introduce here what OSA brings to the patients in neurologic department. Epidemiological studies have shown that OSA is associated with cognitive impairment, headache, metabolic syndrome, various cardiovascular diseases including hypertension, ischemic heart disease, arrhythmia, and stroke. Motor vehicle accident is not seemed to be related to a neurological condition but it can be also related in terms of excessive daytime sleepiness and decreased attention in patients with OSA. Obstructive respiratory events like apnea, hypopnea, and respiratory effort related arousal cause repetitive hypoxia, hypercarpnea, arousal, and decreased intrathoracic pressure. In turn, these can increase blood pressure, sympathetic activity, insulin resistance, and left ventricular wall tension. Consequentially, these processes can be considered as possible mechanism. Although further researches are needed to prove that OSA is independent cause of comorbid conditions, OSA especially in moderate or severe cases can develop and aggravate such conditions as risk factor. So we should know what OSA brings to us and pay attention whether OSA is combined in the patients whom we meet in neurological department.
Anoxia ; Apnea ; Arousal ; Arrhythmias, Cardiac ; Blood Pressure ; Cardiovascular Diseases ; Comorbidity ; Headache ; Humans ; Hypertension ; Insulin Resistance ; Motor Vehicles ; Myocardial Ischemia ; Neurology ; Risk Factors ; Sleep Apnea, Obstructive ; Stroke

A 24-year-old man was treated with anti-tuberculous therapy after being diagnosed with tuberculous meningitis. However, he developed abrupt onset of weakness in the lower extremities. Thoracic spinal magnetic resonance imaging (MRI) showed a soft tissue mass, a compressed posterior spinal cord. A total resection of the intradural extramedullary mass was performed. A histological examination revealed the infiltration of inflammatory cells with granulomatous lesions. Intradural extramedullary tuberculous granuloma is rare, but must be considered in the differential diagnosis of spinal cord compression.
Diagnosis, Differential ; Granuloma* ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Spinal Cord ; Spinal Cord Compression ; Tuberculosis, Meningeal* ; Young Adult

A 52-year-old woman developed episodic diplopia during a period of six months. Between the episodes, depression of the right eye was mildly impaired and lid lag was evident in the right eye on downward gaze. On resuming the primary position after prolonged leftward gaze, she developed a right esotropia and limitation of abduction, elevation, and depression in the right eye. Lid lag may be a sign suggesting oculomotor neuromyotonia in patients with episodic diplopia. The isolated lid lag without lid retraction suggests primary aberrant oculomotor regeneration as a mechanism of this phenomenon.
Depression ; Diplopia ; Esotropia ; Female ; Humans ; Isaacs Syndrome* ; Middle Aged ; Oculomotor Nerve ; Regeneration

We report adult-onset sleep terrors in a patient with idiopathic Parkinson's disease. A 42-year-old woman presented with abnormal behaviors during sleep. Neurologic examination revealed mild hypomimia, resting tremor and bradykinesia in her right upper limb indicating early Parkinson's disease. An episode would consist of sitting up in bed, screaming, then clapping her hands and more talking, shouting, screaming, and appearing frightened. Polysomnography documented 2 episodes of parasomnia which occurred in slow wave sleep indicating sleep terrors.
Adult ; Female ; Hand ; Humans ; Hypokinesia ; Neurologic Examination ; Night Terrors* ; Parasomnias ; Parkinson Disease* ; Polysomnography ; Tremor ; Upper Extremity

When dealing with a mumps infection, the complication of meningoencephalitis is quite rare. A 24-year-old soldier with a past MMR vaccination was admitted because of aseptic meningitis. His cognitive functioning was rapidly deteriorating with the swelling of both parotid glands. MR findings revealed discrete lesions in the brainstem and thalamus. He barely recovered within 2 months. Among adults with a failure to get the immunity despite vaccination, institutional crowding can lead to a fatal CNS complication such as mumps meningoencephalitis.
Adult* ; Brain Stem ; Crowding ; Humans ; Meningitis, Aseptic ; Meningoencephalitis* ; Military Personnel ; Mumps* ; Parotid Gland ; Thalamus ; Vaccination* ; Young Adult

We report a patient with idiopathic hypertrophic cranial pachymeningitis (IHCP) who presented with headache, tinnitus, hearing loss, dizziness and tongue atrophy. She initially was misdiagnosed as having an en plaque meningioma involving the posterior fossa and foramen magnum on the basis of brain MRI findings. A meningeal biopsy excluded meningioma and a diagnosis of IHCP was made. After immune modulating treatment, the patient's symptoms gradually improved. Our case shows IHCP should be included in the differential diagnosis of meningeal mass.
Atrophy ; Biopsy ; Brain ; Cranial Nerve Diseases* ; Cranial Nerves* ; Diagnosis ; Diagnosis, Differential ; Dizziness ; Foramen Magnum ; Headache ; Hearing Loss ; Humans ; Magnetic Resonance Imaging ; Meningioma* ; Meningitis* ; Tinnitus ; Tongue

Orthostatic hypotension rarely occurs as a result of central vasomotor failure. We report a 74-year-old man who presented with progressive orthostatic dizziness, and intermittent syncope that resulted from a ponto-medullary tumor. Orthostatic hypotension may develop due to the sympathetic failure of the vasomotor center, which is located in the rostral ventrolateral medulla.
Aged ; Brain Stem Neoplasms* ; Brain Stem* ; Dizziness* ; Humans ; Hypotension, Orthostatic ; Syncope