Transient global amnesia(TGA) is not a rare event in the elderly, which is characterized by transient inability to form the new memory traces plus retrograde amnesia with benign prognosis. The etiology is unknown, but suggested causes have included transient ischemic attack, migraine, epilepsy, brain tumor, drug intoxication, other toxic/metabolic disturbances, or hysteria. Especially, TGA associated with ischemic stroke is important on the elderly patients and necessary to be differentiated with other causes, for stroke prevention. As far as we know, the case of TGA due to cerebral infarction confirmed by brain imaging study is extremely rare in the literature. We report the case of 67 year-old female patient with typical TGA showing ischemic lesion on the right temporal area on MRI and discussed its significance as one of the cause of TGA.
Aged ; Amnesia, Retrograde ; Amnesia, Transient Global* ; Brain Neoplasms ; Cerebral Infarction ; Epilepsy ; Female ; Humans ; Hysteria ; Infarction* ; Ischemic Attack, Transient ; Magnetic Resonance Imaging ; Memory ; Migraine Disorders ; Neuroimaging ; Prognosis ; Stroke

A 57-year-old female was hospitalized for visual disturbance and right hemiparesis. MRI revealed cortical and sub-cortical infarcts in the left occipito-parietal area. One week later, she experienced paroxysmal electric shock like pain on the dorsum of her right hand. All analgesics failed to relieve her pain, but an antiepileptic drug eradicated the pain completely. This unusual seizure could have been misdiagnosed as a thalamic or pseudothalamic pain syndrome had an ictal EEG not been performed. We report the post-stroke somatosensory seizure, only with unilateral ictal pain. (J Korean Neurol Assoc 19(1):49~51, 2001
Analgesics ; Electroencephalography ; Female ; Hand ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Paresis ; Seizures* ; Shock ; Stroke

Cavernous hemangiomas rarely involve the female genital tract. It is difficult to identify vascular malformations when these lesions are concealed in the vagina or deep vulva area. We present a rare case of vaginal cavernous hemangioma in a 30-year-old primiparous woman with an early severe postpartum hemorrhage (PPH) and delayed continuous bleeding from the episiotomy site. She was treated successfully with transarterial embolization of the left vaginal artery. To our knowledge, this is the first reported case of PPH caused by rupture of a vaginal hemangioma during vaginal delivery in English literature.
Adult ; Arteries ; Episiotomy ; Female ; Hemangioma ; Hemangioma, Cavernous* ; Hemorrhage ; Humans ; Postpartum Hemorrhage* ; Postpartum Period* ; Rupture ; Vagina ; Vascular Malformations ; Vulva

We report unusual MRI findings (including those from diffusion-weighted imaging (DWI)) in a patient with recurrent Wernicke's encephalopathy with a remarkable cerebellar lesion. DWI showed high signal intensities in the superior portion of the cerebellar hemisphere and vermis area. After thiamine administration, clinical symptoms improved and the lesions with high signal intensities disappeared on follow-up DWI.
Cerebellum ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Thiamine ; Wernicke Encephalopathy*

Cerebrospinal fluid (CSF) leak or shunt overdrainage is a well-known cause of orthostatic headaches and low CSF pressures. We report two cases of orthostatic headache with pneumocephalus on brain imaging. The orthostatic headache developed after drainage of spinal operation site and epidural block. Brain MRI revealed characteristic findings of CSF hypovolemia including pachymeningeal enhancement and mild subdural fluid collections. Air was also observed in the ventricular or subarachnoid space in both patients, which might enter the subarachnoid or ventricular space during a procedure via the pressure gradient or an injection.
Brain ; Drainage ; Headache ; Humans ; Hypovolemia ; Neuroimaging ; Pneumocephalus ; Subarachnoid Space

Phenylpropanolamine (PPA) is the major ingredient of over-the-counter drugs, including diet pills and nasal decon-gestants. We present a case of ICH induced by PPA in diet pills in a 36-year-old woman. She didn't have any medical concerns when she began taking diet pills, containing PPA, since 10 days before admission. A brain CT showed large ICHs on the right basal ganglia and lateral ventricle. Physicians should be alerted to the potential fatal side effects of PPA, in commonly used OTC drugs. (J Korean Neurol Assoc 19(3):298~301, 2001)
Adult ; Basal Ganglia ; Brain ; Cerebral Hemorrhage* ; Diet ; Female ; Humans ; Lateral Ventricles ; Nonprescription Drugs ; Phenylpropanolamine*

PURPOSE: To compare the measurements of central corneal thickness (CCT) obtained using two kinds of spectral domain optical coherence tomography (OCT), Pentacam®, and ultrasound pachymetry (USP). METHODS: CCT was measured by Cirrus OCT®, Spectralis OCT®, Pentacam®, and USP in 32 eyes from 32 subjects without ocular disease of the anterior segment. RESULTS: The average CCT measurements using Cirrus OCT®, Spectralis OCT®, Pentacam®, and USP were 549.2 ± 28.7 µm, 545.2 ± 25.4 µm, 554.0 ± 27.8 µm, and 548.4 ± 27.9 µm respectively. The measurements were significantly highly correlated with each other (Pearson's correlation coefficient r > 0.9, all p-values < 0.001), but were significantly different (p < 0.001). The CCT 95% limits of agreement between Cirrus OCT® and Spectralis OCT®, Cirrus OCT® and Pentacam®, Cirrus OCT® and USP, Spectralis OCT® and Pentacam®, and Spectralis OCT® and USP were 27.70 µm, 26.1 µm, 26.97 µm, 22.91 µm, 35.59 µm, and 32.15 µm, respectively. CONCLUSIONS: The CCT values measured using the four devices were highly correlated with each other, but the measurement using Pentacam® was significantly thicker than that using USP. The measurements of the two kinds of spectral domain OCT were similar to those using USP. Therefore, these differences should be considered in clinical use, and measurements cannot be considered interchangeable.
Corneal Pachymetry* ; Tomography, Optical Coherence* ; Ultrasonography*

A young woman developed a hemilateral tonic spasm associated with multiple sclerosis. Her symptoms included brief recurrent episodes of abnormal, often painful, posturing of one or more extremities without alteration of consciousness. An area of demyelination in the contralateral cerebral peduncle was observed on a magnetic resonance imaging. The tonic attacks abated with carbamazepine therapy. The pathophysiology may involve ephaptic transmission between demyelinated fibers in acute plaques within the corticospinal tract secondary to axonal irritation by lymphokines. (J Korean Neurol Assoc 19(2):167~169, 2001)
Axons ; Carbamazepine ; Consciousness ; Demyelinating Diseases ; Extremities ; Female ; Humans ; Lymphokines ; Magnetic Resonance Imaging ; Multiple Sclerosis* ; Pyramidal Tracts ; Spasm* ; Tegmentum Mesencephali

A young woman developed a hemilateral tonic spasm associated with multiple sclerosis. Her symptoms included brief recurrent episodes of abnormal, often painful, posturing of one or more extremities without alteration of consciousness. An area of demyelination in the contralateral cerebral peduncle was observed on a magnetic resonance imaging. The tonic attacks abated with carbamazepine therapy. The pathophysiology may involve ephaptic transmission between demyelinated fibers in acute plaques within the corticospinal tract secondary to axonal irritation by lymphokines. (J Korean Neurol Assoc 19(2):167~169, 2001)
Axons ; Carbamazepine ; Consciousness ; Demyelinating Diseases ; Extremities ; Female ; Humans ; Lymphokines ; Magnetic Resonance Imaging ; Multiple Sclerosis* ; Pyramidal Tracts ; Spasm* ; Tegmentum Mesencephali

BACKGROUND: Impairment of cognitive function is often present in patients with carotid artery stenosis but the details of this dysfunction have rarely been reported. Our purpose was to elucidate the cognitive dysfunction in patients with unilateral severe carotid stenosis using comprehensive neuropsychological testing, and also to identify the specific underlying clinical and radiological factors. METHODS: We analyzed the results of neuropsychological testing, the clinical history, and MR findings in 16 consecutive patients with angiographically proven severe (70-99%) stenosis of the extra cranial internal carotid artery (ICA). Cognitive functions were examined using the Seoul Neuropsychological Screening Battery and the Neglect Battery. We excluded patients with cortical infarction and those with contra lateral ICA occlusion or severe stenosis. RESULTS: Our comprehensive neuropsychological testing revealed obvious cognitive deficits in all patients with unilateral severe ICA stenosis, the most common being frontal executive impairment. The mean cognitive score on the memory test was also significantly lower in patients with symptomatic ICA stenosis than in asymptomatic patients (29.33+/-10.98, mean+/-SD, p < 0.05). The total score on the global cognitive test was significantly lower in patients with an ischemic lesion on MRI than in no lesion patients (113.23+/-34.78, p < 0.05). The presence of symptoms related to the ICA stenosis was related to cognitive dysfunction even when there were no ischemic lesions on MRI. SPECT revealed ipsilateral cortical hypoperfusion in 9 of 12 patients (75%). CONCLUSIONS: Cognitive deficits are common in patients with unilateral severe ICA stenosis. Our findings suggest that an additional mechanism beyond the structural lesion such as chronic hypoperfusion may affect cognitive function in patients with high-grade ICA stenosis.
Carotid Artery, Internal ; Carotid Stenosis* ; Constriction, Pathologic ; Humans ; Infarction ; Magnetic Resonance Imaging ; Mass Screening ; Memory ; Neuropsychological Tests ; Seoul ; Tomography, Emission-Computed, Single-Photon