A 38-year-old woman, affected by chronic myeloid leukemia, received a BMT from his HLA identical brother. A mild acute graft-versus-host disease (GVHD) developed during the first month after the BMT. A typical clinical and electrophysiological feature of myasthenia gravis (MG) developed 3 months after the BMT requiring medication with pyridostigmine and steroids. Laboratory findings including acetylcholine receptor antibody and other autoantibodies were negative. MG is a well-characterized autoimmune disease which, on rare occasions, is also diagnosed as chronic GVHD after BMT. We report a first case of MG during an acute GVHD period. Since the patient had a myasthenic symptom during an acute GVHD period and no evidence of antibody mediated autoimmunity, this is likely to be an immune complication of acute GVHD. (J Korean Neurol Assoc 19(1):60~61, 2001
Acetylcholine ; Adult ; Autoantibodies ; Autoimmune Diseases ; Autoimmunity ; Bone Marrow Transplantation* ; Bone Marrow* ; Female ; Graft vs Host Disease ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Myasthenia Gravis* ; Pyridostigmine Bromide ; Siblings ; Steroids

BACKGROUND: The neuropsychiatric derangements in dementing patients are common and troublesome in their managements. The purpose of this study is to compare the behavioral changes in patients with subcortical vascular dementia (SVaD) and to those in patients with Alzheimer's disease (AD) by using the Korean version of the neuropsychiatric inventory (K-NPI). METHODS: The K-NPI was administrated to the close caregivers of 19 patients with AD (who met the criteria of the NINCDS-ADRDA for probable AD) and 14 patients with SvaD (who met the criteria of the NINDS-AIREN criteria for probable or possible VaD). Groups were matched for age, education and dementia severity. We evaluated the prevalence, the composite score (frequency X severity) of each behavioral domain in K-NPI between two groups. RESULTS: The most common behavioral disturbances were anxiety (63%) in AD and apathy/indifference (93%) in SVaD. Patients with SVaD had significantly greater total K-NPI scores than patients with AD and exhibited apathy/indifference, agitation/aggression and anxiety more frequently. Composite score of apathy/indifference over 4.7 point discriminates between AD and SVaD with accuracy of 75.8%. CONCLUSIONS: The K-NPI provides behavioral profiles that differentiate patients with SVaD from patients with AD. Patients with SVaD are more behaviorally disturbed. Clinicians need to pay more attention to the behavioral disturbances when managing the patients with SVaD.
Alzheimer Disease* ; Anxiety ; Caregivers ; Dementia ; Dementia, Vascular* ; Education ; Humans ; Prevalence

The present report discusses four cases of chronic renal failure, which developed symptoms of parkinsonism in response to levosulpiride. The temporal relationship between levosulpiride discontinuation and the disappearance of parkinsonism suggests a causal link. In addition, decreased striatal dopamine transporter bindings assessed by [I-123] IPT SPECT were observed in two patients suggesting that a dopamine blocking agent causes the dysfunction of nigrostriatal dopaminergic neurons and that such injury may be involved in the pathogenesis of drug-induced parkinsonism.
Dopamine ; Dopamine Plasma Membrane Transport Proteins ; Dopaminergic Neurons ; Humans ; Kidney Failure, Chronic ; Parkinsonian Disorders ; Tomography, Emission-Computed, Single-Photon

No abstract available.
Lupus Erythematosus, Systemic* ; Pseudotumor Cerebri*

BACKGROUND: The apolipoprotein E (APOE) epsilon4 allele is over-represented in Alzheimer's disease, atherosclerosis, and ischemic heart disease. We investigated whether specific APOE polymorphism is a risk factor for ischemic cerebrovas-cular disease in the Korean population. METHODS: We compared 98 patients with ischemic cerebrovascular disease with 209 controls similar in age and dwelling areas. APOE genotypes were determined by restriction fragment-length poly-morphism analysis. The association of the APOE with: stroke subtypes, white matter hyperintensities, lipid profiles, and potential vascular risk factors, including: age, sex, hypertension, diabetes mellitus, lipid disorders, smoking habit, cardiac diseases, presence of past history and family history of ischemic cerebrovascular diseases, was examined. RESULTS: Overall, patients with ischemic cerebrovascular disease had no difference in APOE allele frequency with controls (p>0.05). Also, neither stroke subtypes nor white matter high signal intensities were associated with APOE polymorphism (p>0.05). APOE epsilon4 carriers exhibited more frequent personal stroke histories compared with non-epsilon4 subjects (p<0.01). CONCLUSIONS: Our data suggests that the APOE epsilon4 is not associated with ischemic cerebrovascular disease in the Korean population. However, an association between APOE epsilon4 and personal history supports the possibility that the APOE is a susceptibility locus for the risk of ischemic cerebrovascular diseases. (J Korean Neurol Assoc 19(1):19~23, 2001
Alleles ; Alzheimer Disease ; Apolipoprotein E4* ; Apolipoproteins E ; Apolipoproteins* ; Atherosclerosis ; Diabetes Mellitus ; Gene Frequency ; Genotype* ; Heart Diseases ; Humans ; Hypertension ; Korea* ; Myocardial Ischemia ; Risk Factors ; Smoke ; Smoking ; Stroke

We experienced a rare clinical manifestation of a digoxin induced catatonic stupor without other features of digoxin toxicity. This case suggests that the neurological manifestation of digoxin toxicity can occur without the usual side effects. Also, a serum digoxin level should be checked in any elderly patient presenting with abnormal cerebral func-tions, irrespective of whether or not the dose of digoxin has been changed. (J Korean Neurol Assoc 19(4):438~439, 2001)
Aged ; Digoxin ; Humans ; Neurologic Manifestations ; Stupor*

BACKGROUND/AIMS: Eosinophilia has numerous diverse causes, and in many patients, it is not possible to establish the cause of eosinophilia. Recently, toxocariasis was introduced as one cause of eosinophilia. The aims of this study were to evaluate the prevalence of toxocariasis and the clinical impact of albendazole treatment for toxocariasis in patients suspected of eosinophilia of unknown origin. METHODS: We performed a retrospective chart review. After evaluation of cause of eosinophilia, the patients suspected of eosinophilia of unknown origin performed immunoglobulin G antibody specific assay for the Toxocara canis larval antigen by enzyme-linked immunosorbent assay. RESULTS: This study evaluated 113 patients, 69 patients (61%) were suspected of eosinophilia of unknown origin. Among these 69 patients, the frequency of T. canis infection was very high (45 patients, 65.2%), and albendazole treatment for 45 eosinophilia with toxocariasis was highly effective for a cure of eosinophilia than no albendazole group regardless of steroid (82.3%, p = 0.007). Furthermore, among the nonsteroid treated small group (19 patients), albendazole treatment for eosinophilia were more effective than no albendazole group, too (83.3% vs. 28.6 %, p = 0.045). CONCLUSIONS: The prevalence of toxocariasis was high among patients suspected of eosinophilia of unknown origin; therefore, evaluation for T. canis infection is recommended for patients with eosinophilia of unknown origin. Furthermore, for patients suspected of eosinophilia of unknown origin who have positive results for T. canis, albendazole treatment may be considered a valuable treatment option.
Albendazole ; Enzyme-Linked Immunosorbent Assay ; Eosinophilia* ; Humans ; Hypereosinophilic Syndrome ; Immunoglobulin G ; Prevalence* ; Retrospective Studies ; Toxocara canis ; Toxocariasis*

BACKGROUND/AIMS: Eosinophilia has numerous diverse causes, and in many patients, it is not possible to establish the cause of eosinophilia. Recently, toxocariasis was introduced as one cause of eosinophilia. The aims of this study were to evaluate the prevalence of toxocariasis and the clinical impact of albendazole treatment for toxocariasis in patients suspected of eosinophilia of unknown origin. METHODS: We performed a retrospective chart review. After evaluation of cause of eosinophilia, the patients suspected of eosinophilia of unknown origin performed immunoglobulin G antibody specific assay for the Toxocara canis larval antigen by enzyme-linked immunosorbent assay. RESULTS: This study evaluated 113 patients, 69 patients (61%) were suspected of eosinophilia of unknown origin. Among these 69 patients, the frequency of T. canis infection was very high (45 patients, 65.2%), and albendazole treatment for 45 eosinophilia with toxocariasis was highly effective for a cure of eosinophilia than no albendazole group regardless of steroid (82.3%, p = 0.007). Furthermore, among the nonsteroid treated small group (19 patients), albendazole treatment for eosinophilia were more effective than no albendazole group, too (83.3% vs. 28.6 %, p = 0.045). CONCLUSIONS: The prevalence of toxocariasis was high among patients suspected of eosinophilia of unknown origin; therefore, evaluation for T. canis infection is recommended for patients with eosinophilia of unknown origin. Furthermore, for patients suspected of eosinophilia of unknown origin who have positive results for T. canis, albendazole treatment may be considered a valuable treatment option.
Albendazole ; Enzyme-Linked Immunosorbent Assay ; Eosinophilia* ; Humans ; Hypereosinophilic Syndrome ; Immunoglobulin G ; Prevalence* ; Retrospective Studies ; Toxocara canis ; Toxocariasis*

Actinomycosis is a rare form of disease that is caused by Actinomyces such as A. israelii and A. bovis, which may take the form of an acute or a subacute disease progression. 55% of this disease arises in the head and neck area, and the remaining 45% of the disease occurs in the chest and the gastrointestinal tract, Our cases show the rare routes of invasion of actinomycosis. The first case was a 40-year-old man complaining of headache for 5-6 months and of a recently developed trismus. Soft brownish bulging mass was observed in his posterior nasopharyngeal wall. CT showed the skull base involvement, and biopsy confirmed actinomycosis. The patient was successfully cured with penicillin. The second case was a 49-year-old female presenting a firm and fragile mass in her left nasal cavity. She was treated with endoscopic removal of the mass including the adjacent mucosa followed by ampicillin administration for 8 months. The last case was a 78-year-old female having a painful mass on the right cheek, Diagnosis was confirmed with the fine needle aspiration biopsy. She was successfully treated with surgical excision and antibiotic treatment. We present, with the appropriate review, 3 cases of actinomycosis that developed in three different areas of the head.
Actinomyces ; Actinomycosis* ; Adult ; Aged ; Ampicillin ; Biopsy ; Biopsy, Fine-Needle ; Cheek ; Diagnosis ; Disease Progression ; Female ; Gastrointestinal Tract ; Head* ; Headache ; Humans ; Middle Aged ; Mucous Membrane ; Nasal Cavity ; Nasopharynx ; Neck* ; Penicillins ; Skull Base ; Thorax ; Trismus

A 49-year-old woman presented with stupor and paraplegia following an induced hypotension. The temporal relationship to the induced hypotension and the absence of a clear embolic source on diagnostic tests support a causal association between the hypotensive episode and the ischemic infarct. However, despite the association, a cause-and-effect relationship could not be automatically inferred.
Brain Infarction/*chemically induced ; Cerebrovascular Accident/*chemically induced ; Female ; Human ; Infarction/*chemically induced ; Middle Aged ; Preoperative Care/*adverse effects ; Propanolamines/*adverse effects ; Spinal Cord/*blood supply ; Spinal Stenosis/surgery