Thrombotic thrombocytopenic purpura(TTP) is characterized by fluctuating neurologic signs, microangiopathic hemolytic anemia, thrombocytopenia, fever and renal abnormalities. Neurologic involvement occurs in over 90% of patients with TTP. TTP is rarely associated with large intracerebral hemorrhage and peripheral neuropadiy. The authors report a case of TTP associated with large intracerebral hemorrhage confirmed by brain MRI and peripheral neuropathy diagnosed electrophysiologic findings and sural nerve biopsy.
Anemia, Hemolytic ; Biopsy ; Brain ; Cerebral Hemorrhage* ; Fever ; Humans ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Peripheral Nervous System Diseases ; Purpura, Thrombotic Thrombocytopenic* ; Sural Nerve ; Thrombocytopenia

Rhinocerebral mucormycosis, which is a fulminant and progressive disease often seen in debilitated hosts! Requires a high degree of clinical suspicion to promptly diagnose and an aggressive medical and surgical therapy. The prognosis is grave, especially in case of bilateral cavernous sinus thrombosis. We report a case of 69-year-old female patient with bilateral cavernous sinus thrombosis caused by rhinocerebral mucormycosis, who showed orbital swelling and lateral bulging of bilateral cavernous sinus in orbital CT, and large branching nonseptate hypae in biopsed specimen of the left periorbital necrotic tissue.
Aged ; Cavernous Sinus Thrombosis ; Cavernous Sinus* ; Female ; Humans ; Mucormycosis* ; Orbit ; Prognosis

BACKGROUND: There were many studies about the changes of cognitive or non-cognitive domain and behavioral and psychological symptoms with the progression of Alzheimer's disease. But they assessed the changes individually so could not explain comprehensively the global change of disease progression. Also they studied by clinical dementia rating scale(CDR) which could not successfully explain the latest stage. So we have evaluated the cognitive, non-cognitive domain and behavioral and psychological symptoms at the same time and evaluated the changes with the expanded clinical dementia rating scale. Also we evaluated the relationship of each scale and assessed sensitivity change at the different stage of disease. METHODS: Twenty-three mild cognitive impairment(MCI) subjects and eighty-seven patients with Alzheimer's disease were recruited. The Korean version of Mini-Mental State Examination(K-MMSE), the Korean version of the neuropsychiatric inventory(NPI), the Extended version of the Korean Clinical Dementia Rating Scale(CDR), the Activity of Daily Living(ADL), the Severe Dementia Scale(SDS) and the Short form of Samsung Dementia Questionnaire(S-SDQ) were performed. RESULTS: It was found that all of them were well correlated each other(r>-0.73 and p<0.05) except NPI. Physical activity of daily living(P-ADL) was most related to Korean version of instrumental activity of daily living(K-IADL) (r=0.86 and p<0.01), SDS to K-MMSE(r=0.93 and p<0.01) and S-SDQ to K-IADL(r=0.86 and p<0.01). P-ADL and S-SDQ revealed the ceiling effect at CDR 4 and K-IADL at CDR 3. CONCLUSION: The cognitive and non-cognitive function were declined according to disease progression. The changes of behavioral and psychological symptoms were relatively independent of cognitive function. SDS, P-ADL and CDR were proved to be more sensitive in advanced stage of dementia and K-IADL, S-SDQ were more adequate in milder stage of dementia or MCI.
Alzheimer Disease ; Dementia ; Disease Progression ; Humans ; Motor Activity

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

No abstract available.
Hemangioma, Cavernous, Central Nervous System

Segmental Spinal Instrumentation is effective operative procedure in unstable fracture and fracture-dislocation of the thoracolumbar spine, providing rigid spinal stability and reduces needs of external support and complications. Fifty nine patients with unstable fracture and fracture-dislocation of thoracolumbar spine were treated with Harrington rod instrumentation and sublaminar wiring(31 patients) and Luque rod instrumentation with sublaminar wiring(28 patients) in Hyun Dai Hae Seong Hospital, Ulsan, Paik Hospital, Pusan from Dec. 1983 to April 1986. We have analyzed the results of treatment about two type of S.S.I. and obtained following conclusions; l. In 59 patients, T12 level injury was 17 cases, Ll level was 25 cases and so T12 and Ll involvement were 71%. 2. By Francis Denis classification, 28 cases were burst type fracture, 20 cases were fracture-dislocation type, 6 cases were seat belt type and 5 cases were wedge compression type. 3. In Harrington rod with S.S.I., initial kyphotic angle was 22.4° and postoperative angle was 7.4° and correction rate was 66.9%; in Luque rod with S.S.I., preoperative kyphotic angle was 21.7° and postoperative angle was 6.5° and correction rate 69.6%. So there was no difference of correction rate in two type of S.S.I. 4. In Harrington rod with S.S.I., the loss of reduction was 1.2° and the loss was 7%; in Luque rod with S.S.I., the loss of reduction was 7.2° and the loss rate was 48%. So the loss of reduction of Luque rod with S.S.I. was greater than that of Harrington rod with S.S.I. 5. After removal of implants, Luque rod with S.S.I. patients have better range of motion than Harrington rod with S.S.I. patients clinically, but it needs more follow-up because of a few cases(18 cases).
Busan ; Classification ; Follow-Up Studies ; Humans ; Range of Motion, Articular ; Seat Belts ; Spine ; Surgical Procedures, Operative ; Ulsan

The coexistence of multiple sclerosis (MS) and systemic lupus erythematosus (SLE) is very rare. A 31-years old woman with SLE was admitted because of recurrent optic neuritis. She had positive antinuclear antibody and increased anti-Ro, anti-La and anti-RNP antibodies. T2 weighted MRI showed high signal intensity lesions in left anterior midbrain, internal capsule, and centrum semiovale and corpus callosum. We report a case of multiple sclerosis-like attacks in a patient with SLE.
Adult ; Antibodies ; Antibodies, Antinuclear ; Corpus Callosum ; Female ; Humans ; Internal Capsule ; Lupus Erythematosus, Systemic* ; Magnetic Resonance Imaging ; Mesencephalon ; Multiple Sclerosis* ; Optic Neuritis

Dislocations or fractures of the limbs can arise from muscle contraction during epileptic seizures. Dislocation complication of the bilateral temporomandibular joint from seizures is reported very rarely. A 36-year-old woman, who had no history of epilepsy, presented recurrent dislocations of the bilateral temporomandibular joint and generalized tonic-clonic seizures. EEG showed intermittent generalized slow activity. We report a case of bilateral temporomandibular joint dislocation that occurred during generalized tonic-clonic seizures, which has not previously been reported in Korea.
Adult ; Dislocations* ; Electroencephalography ; Epilepsy ; Extremities ; Female ; Humans ; Korea ; Muscle Contraction ; Seizures* ; Temporomandibular Joint*

BACKGROUND: Epilepsy and antiepileptic drugs may be associated with cognitive dysfunction. P300 event-related potentials have been used to assess cognitive function. In this study we investigated the effect of antiepileptic drugs on P300 event-related potentials in epileptic patients. METHODS: P300 latency in event-related potentials was recorded during an auditory oddball paradigm in 29 patients, 10 with generalized epilepsy and 19 with partial epilepsy. The relationships between antiepileptic drugs and P300 latency prolongation were analyzed. RESULTS: P300 latency was prolonged in 31% (9/29) patients with epilepsy. There were no significant relationships between etiology of epilepsy, type of seizure, or type of antiepileptic drugs and P300 latency prolongation. The number or serum level of antiepileptic drugs and treatment duration were related to latency prolongation, but these relations were not significant. CONCLUSION: The prolongation of P300 latency in event-related potentials is not significantly related to antiepileptic drug. This finding suggests that P300 may not be a sensitive additional procedure to assess the cognitive status in epileptic patients.
Anticonvulsants* ; Epilepsies, Partial ; Epilepsy ; Epilepsy, Generalized ; Event-Related Potentials, P300 ; Evoked Potentials* ; Humans ; Seizures