BACKGROUND: Neuron-specific enolase (NSE) is a useful indicator of neuronal injury in acute cerebral infarction. We investigated the changes in serial serum NSE levels in patients with acute cerebral infarction. METHODS: We measured serial serum NSE levels at 24, 48, 72, and 96 hours, and 2 weeks after the onset of cerebral infarction in 30 patients (15 territorial and 15 lacunar infarctions). We also measured the NSE levels in age-matched controls (n=15) who had no evidence of acute stroke or other neurological disorders. The NSE level was measured using a radioimmunoassay. RESULTS: The initial serum NSE level was significantly higher in the cerebral infarction group than in the control group (6.6+/-2 vs 4.7+/-1.6 ng/mL [mean+/-SD], p=0.006). This difference was also observed between the territorial and lacunar infarction groups until 72 hours after the cerebral infarction. The serum NSE level peaked at 72 hours after the infarction in both lacunar and territorial infarction groups. The correlation between the NSE level and the score on the NIH Stroke Scale was strongest at 48 hours after the cerebral infarction (r=0.469). CONCLUSIONS: Serum NSE level can be a good indicator for distinguishing lacunar from territorial infarction during the acute stage of cerebral infarction.
Cerebral Infarction ; Humans ; Infarction ; Nervous System Diseases ; Neurons ; Phosphopyruvate Hydratase ; Stroke ; Stroke, Lacunar

No abstract available.
Dysarthria ; Skull ; Skull Base ; Tongue

Foot drop usually results from lesions affecting the peripheral neural pathway related to dorsiflexor muscles, especially the peroneal nerve. Although a central nervous system lesion is suspected when there is a lack of clinical evidence for a lower motor neuron lesion, such cases are extremely rare. We describe a patient with sudden isolated foot drop caused by a small acute cortical infarction in the high convexity of the precentral gyrus. This report indicates that a cortical infarction may have to be considered as a potential cause of foot drop.
Central Nervous System ; Cerebral Infarction* ; Foot* ; Humans ; Infarction ; Motor Neurons ; Muscles ; Neural Pathways ; Peroneal Nerve

Relapse of herpes simplex virus (HSV) encephalitis rarely occurs after acyclovir treatment. We experienced a case of relapsing HSV encephalitis in the contralateral temporal lobe, resulting in Kluver-Bucy syndrome, after a full dose acyclovir treatment. Sudden behavioral and emotional changes after HSV encephalitis treatment suggest relapsing HSV encephalitis as well as temporal lobe epilepsy.
Acyclovir ; Encephalitis ; Encephalitis, Herpes Simplex ; Herpes Simplex ; Kluver-Bucy Syndrome ; Methylmethacrylates ; Polystyrenes ; Recurrence ; Simplexvirus ; Temporal Lobe

Dementia with Lewy bodies (DLB) usually presents with progressive cognitive decline and parkinsonism. We report a 68-year-old man who showed parkinsonism including resting tremor and mild cognitive decline. After anticholinergic medication, he showed recurrent visual hallucination. Neuropsychological tests revealed frontal and memory impairments. PET showed hypometabolism in the primary visual and visual association cortices. It is necessary to consider the possibility of DLB as well as anticholinergic side effect when visual hallucination occurs during the treatment of parkinsonism.
Aged ; Cholinergic Antagonists ; Dementia ; Hallucinations ; Humans ; Lewy Bodies ; Memory ; Neuropsychological Tests ; Parkinsonian Disorders ; Tremor

Thrombotic thrombocytopenic purpura(TTP) is an uncommon fatal disorder of young adults characterized by thrombocytopenia, microangiopathic hemolytic anemia, fluctuating neurologic dysfunction, fever, and renal dysfunction. The fluctuating neurologic dysfunction, which is mainly due to small arteriolar or capillary ischemic vasculopathy, suggests impending stroke. We report a 72-year-old woman who has had recurrent and progressive transient ischemic attacks and confusion after a large amount of bloodletting. She recovered completely after intensive plasmapheresis and immunosuppressant treatment. This case illustrates that aggressive treatment, even in old age, may prevent permanent neurologic deficits when stroke is impending and complicated by TTP.
Aged ; Anemia, Hemolytic ; Bloodletting ; Capillaries ; Female ; Fever ; Humans ; Ischemic Attack, Transient ; Neurologic Manifestations ; Plasmapheresis ; Purpura, Thrombotic Thrombocytopenic ; Stroke ; Thrombocytopenia ; Young Adult

No abstract available.
Adult ; Brain Ischemia/diagnosis/*etiology ; Cerebral Angiography ; Fatal Outcome ; Female ; Humans ; Hyperventilation/complications ; Moyamoya Disease/*complications/diagnosis/therapy ; Risk Factors ; Stroke/diagnosis/*etiology ; Thyroid Crisis/*complications/diagnosis/therapy

No abstract available.
Brain Abscess* ; Brain* ; Magnetic Resonance Spectroscopy ; Protons*

BACKGROUND AND PURPOSE: We examined the characteristics of sleep disturbances and sleep patterns in the caregivers of patients with amnestic mild cognitive impairment (aMCI) and dementia. METHODS: We prospectively studied 132 patients (60 with aMCI and 72 with dementia) and their caregivers, and 52 noncaregiver controls. All caregivers and controls completed several sleep questionnaires, including the Pittsburgh Sleep Quality Index (PSQI). The patients were administered neuropsychological tests and the neuropsychiatric inventory to evaluate their behavioral and neuropsychiatric symptoms of dementia (BPSD). RESULTS: The PSQI global score was 6.25+/-3.88 (mean+/-SD) for the dementia caregivers and 5.47+/-3.53 for the aMCI caregivers. The Insomnia Severity Index (ISI) and short form of the Geriatric Depression Scale (GDS-S) predicted higher PSQI global scores in aMCI caregivers, and higher scores for the ISI, Epworth Sleepiness Scale (ESS), and GDS-S in dementia caregivers. BPSD, including not only agitation, depression, and appetite change in dementia patients, but also depression, apathy, and disinhibition in aMCI patients, was related to impaired sleep quality of caregivers, but nighttime behavior was not. Age and gender were not risk factors for disturbed sleep quality. CONCLUSIONS: Dementia and aMCI caregivers exhibit impaired quality of sleep versus non-caregivers. ISI, GDS-S, and ESS scores are strong indicators of poor sleep in dementia caregivers. In addition, some BPSD and parts of the neuropsychological tests may be predictive factors of sleep disturbance in dementia caregivers.
Alzheimer Disease ; Apathy ; Appetite ; Caregivers* ; Dementia* ; Dementia, Vascular ; Depression ; Dihydroergotamine ; Humans ; Mild Cognitive Impairment* ; Neuropsychological Tests ; Prospective Studies ; Risk Factors ; Sleep Initiation and Maintenance Disorders ; Surveys and Questionnaires

It is controversial whether isolated lesions of mammillothalamic tract (MTT) produce significant amnesia. Since the MTT is small and adjacent to several important structures for memory, amnesia associated with isolated MTT infarction has been rarely reported. We report a patient who developed amnesia following an infarction of the left MTT that spared adjacent memory-related structures including the anterior thalamic nucleus. The patient s memory deficit was characterized by a severe anterograde encoding deficit and retrograde amnesia with a temporal gradient. In contrast, he did not show either frontal executive dysfunction or personality change that is frequently recognized in the anterior or medial thalamic lesion. We postulate that an amnesic syndrome can develop following discrete lesions of the MTT.
Aged ; Amnesia/*etiology ; Cerebral Infarction/*complications ; Humans ; Male ; Mamillary Bodies/*physiopathology ; Neuropsychological Tests ; Thalamus/*physiopathology