No abstract available.
Arachnoid ; Superior Sagittal Sinus

Lateral medullary infarction can lead to central respiratory failure. However, in Wallenberg's syndrome, obstructive respiratory failure rarely develops. Here, we report a case of obstructive respiratory failure with stridor caused by unilateral lateral medullary infarction. A 74-year-old woman was admitted for acute right lateral medullary infarction. On the 12th day after the stroke, the patient developed respiratory failure necessitating endotracheal intubation. She could maintain good oxygen saturation and ventilation in intubated status without the assistance of mechanical ventilator, even during sleep. The pharyngo-laryngoscopy demonstrated the hypomobility of bilateral vocal cords. This case suggests that unilateral medullary infarction might be a cause of bilateral vocal cord palsy.
Aged ; Airway Obstruction ; Brain Stem Infarctions ; Female ; Humans ; Infarction ; Intubation, Intratracheal ; Lateral Medullary Syndrome ; Medulla Oblongata ; Oxygen ; Respiratory Insufficiency ; Respiratory Sounds ; Stroke ; Ventilation ; Ventilators, Mechanical ; Vocal Cord Paralysis ; Vocal Cords

Isolated left brachiocephalic artery with right aortic arch is extremely rare congenital anormaly. This malformation can cause subclavian steal phenomenon. We report the duplex sonographic and conventional angiographic findings of isolated left brachiocephalic artery in a 22-year-old female presented with dizziness.
Aorta, Thoracic ; Arteries ; Dizziness ; Female ; Humans ; Subclavian Steal Syndrome ; Young Adult

Renal artery stenosis (RAS) is defined as a narrowing of main renal artery or its major branches over 50%, and can be the cause of pulmonary edema, renal failure, malignant hypertension and cerebrovascular diseases. The renin-angiotensin-aldosterone system works as a key role. In this paper, we report a case of a 53 year-old patient with left middle cerebellar peduncle infarction, who showed malignant hypertension and RAS. The RAS was diagnosed by renal artery computed tomography angiography and treated with renal artery angioplasty, stenting and antihypertensive medication. In a young patient with ischemic stroke who has refractory hypertension against antihypertensive medications, RAS should be suspected and evaluated.
Angiography ; Angioplasty ; Cerebral Infarction ; Humans ; Hypertension ; Hypertension, Malignant ; Hypertension, Renovascular ; Infarction ; Pulmonary Edema ; Renal Artery ; Renal Artery Obstruction ; Renal Insufficiency ; Renin-Angiotensin System ; Stents ; Stroke

Cryptococcosis is a global invasive mycosis associated with significant morbidity and mortality. Fever, headache and vomiting are common clinical presentations of the cryptococcal meningitis. But ischemic stroke and cranial nerve impairment are rare neurologic complications. We report a case of cryptococcal meningoencephalitis presenting as cerebral infarction and multiple cranial nerve palsies.
Cerebral Infarction ; Cranial Nerve Diseases ; Cranial Nerves ; Cryptococcosis ; Fever ; Headache ; Meningitis, Cryptococcal ; Meningoencephalitis ; Stroke ; Vomiting

Cerebral venous thrombosis (CVT) rarely presents with cortical subarachnoid hemorrhage. A 54 year-old woman complained of intractable headache. Brain MR scan showed subarachnoid hemorrhage in the right parietal sulci on Fluid-Attenuated Inversion Recovery image. The venous phase of digital subtraction angiography demonstrated the thrombus and venous congestion in superior sagittal sinus and vein of Trolad. After 3 days of anticoagulation therapy, the symptoms disappeared.
Angiography, Digital Subtraction ; Brain ; Female ; Headache Disorders ; Humans ; Hyperemia ; Subarachnoid Hemorrhage ; Superior Sagittal Sinus ; Thrombosis ; Veins ; Venous Thrombosis

BACKGROUND: Smoking is a major risk factor of stroke, but not all smokers develop stroke. This individual difference could be explained by the variation of detoxification capacity. We investigated the relationship of smoking with the genetic polymorphism of a detoxification enzyme (glutathione S-transferase: GST). METHODS: This study was conducted as a case-control study. Conventional risk factors for stroke and 3 genetic polymorphisms of GST (GSTM1, GSTT1, and GSTP1) were studied in both 290 acute ischemic stroke patients and 290 age and sex matched controls. Smoking status was determined by urinary cotinine level. The effect of interaction of GST polymorphisms and smoking on stroke risk was investigated. RESULTS: Stroke patients had higher cotinine level compared to that of control (P<0.01). There was little difference between the patient group and control group with regard to the GST polymorphism alone, but significant interaction was noticed between the GST polymorphism and the smoking status. When we stratified the group according to the smoking status by cotinine level, stroke was significantly more frequent in GSTM1 null type and GSTT1, GSTP1 wild type of the high cotinine level group (OR and 95% CI: 2.115, 1.219-3.670; 2.620, 1.480-4.638; 2.212, 1.343-3.644 respectively). CONCLUSION: GST polymorphisms interact with the smoking and confer an increased risk of ischemic stroke, indicating that genetic polymorphism of GST might reveal smokers who are more susceptible to the ischemic stroke.
Case-Control Studies ; Cotinine ; Glutathione ; Glutathione Transferase ; Humans ; Individuality ; Polymorphism, Genetic ; Risk Factors ; Smoke ; Smoking ; Stroke

Several new antithrombotic drugs have been developed and approved to use in clinical practice recently. Dabigatran, a direct thrombin inhibitor, and rivaroxaban, a factor Xa inhibitor, have been approved in many countries including Korea to prevent stroke in patient with atrial fibrillation. Apixaban, another factor Xa inhibitor, showed good results in clinical trial and is waiting for approval for clinical use. New antiplatelet agent, terutroban, selective thromboxane A2 receptor inhibitor, failed to prove the efficacy over the aspirin in secondary stroke prevention. Vorapaxar, a new antiplatelet agent that inhibits thrombin through PAR-1 antagonism, showed a high incidence of intracranial hemorrhage in patient with a history of stroke.
Aspirin ; Atrial Fibrillation ; Benzimidazoles ; beta-Alanine ; Factor Xa ; Humans ; Incidence ; Intracranial Hemorrhages ; Korea ; Lactones ; Morpholines ; Naphthalenes ; Propionates ; Pyrazoles ; Pyridines ; Pyridones ; Receptors, Thromboxane A2, Prostaglandin H2 ; Stroke ; Thiophenes ; Thrombin ; Dabigatran ; Rivaroxaban

This article briefly reviews the research findings on post-stroke rehabilitative therapy mainly published in 2011. Topics on approaches for motor function recovery include the use of body-weight-supported treadmill, robotic training, virtual reality, functional electrical stimulation, intensive treatment and motor imagery. Rehabilitative strategies to improve functional recovery such as comprehensive cardiac rehabilitation, repetitive transcranial magnetic stimulation and transcranial direct current stimulation. Also, pharmacotherapy using noradrenaline agonist reboxetine and botulinum toxin injection are discussed in this review.
Botulinum Toxins ; Electric Stimulation ; Morpholines ; Norepinephrine ; Recovery of Function ; Stroke ; Transcranial Magnetic Stimulation

Cerebral venous sinus thrombosis (CVST) may be complicated with various intracranial hemorrhage such as petechial hemorrhage, hemorrhagic infarction, parenchymal hemorrhage, subarachnoid hemorrhage (SAH), and subdural hematoma (SDH). However, combination of these types of intracranial hemorrhages supervening on CVST is seldom reported. A 55-year-old female with rectal cancer presented with severe headache, nausea, vomiting and diplopia. She was diagnosed as having CVST in the superior sagittal sinus with left frontal parenchymal hemorrhage and was treated with anticoagulants. The CVST were extended to inferior sagittal and straight sinuses. Moreover, SDH along the left cerebral convexity and SAH in the left sylvian fissure were simultaneously observed. Our present case shows that combination of various types of hemorrhages is rare but may occur in advanced CVST.
Anticoagulants ; Diplopia ; Female ; Headache ; Hematoma ; Hematoma, Subdural ; Hemorrhage ; Humans ; Infarction ; Intracranial Hemorrhages ; Nausea ; Rectal Neoplasms ; Sinus Thrombosis, Intracranial ; Subarachnoid Hemorrhage ; Superior Sagittal Sinus ; Vomiting