Vascular dementia is defined as a clinical syndrome of acquired intellectual impairment resulting from a brain injury due to a cerebrovascular disorder. It incorporates various vascular pathophysiological mechanisms and changes in the brain, and has diverse cause and clinical manifestations. The main suptypes of vascular dementia include 1) multi-infarct dementia, 2) strategic infarct dementia, and 3) subcortical vascular dementia. Both multi-infarct dementia and strategic infarct dementia show heterogeneity in etiologies, changes of the brain, as well as clinical manifestations. On the contrary, subcortical vascular dementia is suggested to be a more homogenous group. To better understand the clinical features of vascular dementia, cases corresponding to each subtype of vascular dementia are briefly discussed this review.
Brain ; Brain Injuries ; Cerebrovascular Disorders ; Dementia ; Dementia, Multi-Infarct ; Dementia, Vascular* ; Population Characteristics

Stroke is one of the leading causes of death in Korea. According to the report from Korean national statistical office, the mortality rate of stroke was 73.2/100,000 persons in 2000. In Western countries, stroke mortality rates declined gradually from 1970, which accelerated markedly around 1990. Since then, there has been no further decrease in stroke mortality rates until now and the situation has been similar in Korea. In the past, hemorrhagic stroke in Korea similar to other Far East Asian countries. However, the ratio of hemorrhagic to ischemic stroke has been reversed since mid-1980s. This trend might be due to the westernization of diet and life style as well as better control of hypertension. The case fatality rate from one of the large hospital-based stroke registry was 7.2% within 30 days after the onset of acute ischemic stroke, which is similar to those of other series from western countries with an advanced medical care systems. It may be attributed to the inclusion of more asymptomatic or milder patients with small lesions detected by neuroimaging. Importantly, the delay of hospital visit after the onset of stroke and the lower compliance for secondary prevention remain serious problems in managing acute stroke in Korea. Despite recent advances in the diagnosis and management of stroke, there has not been a nationwide population-based epidemiologic data on stroke in Korea. Therefore the application of Internet technology to develop multi center cooperative hospital-based registry could be an important step toward a long-waited nationwide stroke registry.
Asian Continental Ancestry Group ; Cause of Death ; Compliance ; Diagnosis ; Diet ; Epidemiology* ; Far East ; Humans ; Hypertension ; Internet ; Korea* ; Life Style ; Mortality ; Neuroimaging ; Secondary Prevention ; Stroke*

Prior brief ischemic insult was reported to protect the hippocampal CA1 neurons from delayed neuronal death following global ischemia. Mechanisms of such protective effects have, however, remained unclear. The study was conducted to confirm whether the preceding cortical infarction exerts protective effects on the adjacent hippocampal CA1 neurons against the subsequent global ischemia and to reactive astrocytosis to the mechanisms of protective effects. Male, mongolian gerbils, aged 12-15 weeks and weighing 70-90g, were anethetized with ketamine by intraperitoneal injections, and a small cortical infarction in the unilateral parietal cortex was made by infusing of magnetic ferrite particles which were followed by subsequent global ischemia for 5 minutes on 1, 3 and 7 days later. One week following the subsequent global ischemia, the neuronal degeneration in the hippocampal CA1 regions was examined by Hematoxylin-eosin stain. Immunohistochemistry using GFAP antibody was carried out for evaluating the time course of astrocytic reactivity after 1, 3, and 7 days of cortical infarction. The neuronal degeneration of CA1 regions in the ipsilateral hippocampus preceded by the cortical infarction was less severe than those in the contralateral ones. The differences of neuronal degeneration between both of hemispheres was clearly more prominent in animals whose global ischemia was induced at 1 and 3 days cortical infarctions than 7 days. However, the reactivity of GFAP astrocyte was minimal at 1 day but markedly increased at 3 and 7 days after cortical infarction. This present study confirmed that the preceding cortical infarction may protect the adjacent ipsilateral CA1 neurons from the subsequent global ischemic insult with its protective effect being most remarkable at 1 and 3 days but less at 7 days after cortical infarction. However, the degree of reactive astrocytosis measured by GFAP immunohistochemistry did not correlate well with the degree of neuroprotection, thus it did not fully account for the mechanisms of such protective effect.
Animals ; Astrocytes ; CA1 Region, Hippocampal ; Gerbillinae ; Gliosis ; Hippocampus ; Humans ; Immunohistochemistry ; Infarction* ; Injections, Intraperitoneal ; Ischemia ; Ketamine ; Male ; Neurons* ; Rabeprazole

Acute infarcts of the anterior inferior cerebellar artery (AICA) territory are unusual. Furthermore incomplete AICA infarcts are perplexing because of its variations of vascular anatomy and inconsistent clinical features. We present a case with clinical features of AICA infarction, which consist of ipsilateral peripheral-type facial palsy, vertigo, and contralateral facial and upper limb sensory changes without motor weakness. The patient had hypertension and was a current smoker. The high signal intensity on inferior pontine tegmental area was found on MRI and the R2 interneuronal dysfunction was note on Blink reflex. The angiographic findings didn't show any focal vascular lesions, which is contrary to the pathogenesis of AICA infarction published previously. On the clinical ground, the present case reserves to attention in that patients with peripheral-type facial palsy should be properly evaluated and with thorough neurological examination and we could differentiate between the incomplete AICA infarcts such as Gasperini syndrome and Bell's palsy.
Arteries ; Bell Palsy ; Blinking ; Facial Paralysis* ; Humans ; Hypertension ; Infarction ; Interneurons ; Magnetic Resonance Imaging ; Neurologic Examination ; Upper Extremity ; Vertigo

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

Resection of the bowel is necessary for the repair of a ventral hernia after recovery from trauma in some cases. In such instances, polyester or polypropylene meshcannot be used due to the possibility of infection; we had to use biological mesh instead. We report a case in which a traumatic hernia was repaired with Permacol (Covidien, Norwalk, CT, USA). A 42-year-old male patient had been injured by a factory machine seven months prior to admission. At that time, he had abdominal wall injury and small bowel perforation. His abdominal wall had been a defect after operation. A CT scan of the abdomen showed that the left abdominal wall, which is lateral to left rectus abdominis muscle had only one muscle layer, an external oblique muscle, and that a previous abdominal incision had a defect along the entire incision. During the exploration, 10 cm of small bowel was removed due to firm adhesion to the previous surgical scar. Permacol mesh was applied and fixed with transfascial fixations and tacks by using the intraperitoneal onlay mesh technique. There were no complications after the surgery and the patient was discharged without any problems.
Abdomen ; Abdominal Wall ; Adult ; Cicatrix ; Collagen ; Hernia ; Hernia, Ventral ; Humans ; Inlays ; Male ; Muscles ; Polyesters ; Polypropylenes ; Rectus Abdominis ; Transplants

Neuroleptic malignant syndrome is a rare, but potentially life-threatening adverse event associated with the use of neuroleptic agents. We describe the case of a 47-year-old schizophrenic woman who was treated with clozapine for years. The patient developed acute renal failure with pulmonary edema, and underwent mechanical ventilation and hemodialysis.
Acute Kidney Injury ; Antipsychotic Agents ; Clozapine* ; Female ; Humans ; Middle Aged ; Neuroleptic Malignant Syndrome* ; Pulmonary Edema ; Renal Dialysis ; Respiration, Artificial ; Rhabdomyolysis

A gastric carcinoma with the endoscopic features resembling submucosal tumor (SMT) is rare, and reportedly account for only 0.1% to 0.63% of all resected gastric carcinomas. The preoperative diagnosis of SMT-like gastric carcinoma is challenging, and thus, diagnosis is usually made intraoperatively or postoperatively. Furthermore, mucinous adenocarcinoma is an uncommon histologic subtype of gastric carcinoma characterized as an elevated lesion resembling SMT due to abundant mucin pools in submucosa. Here, we report two cases in which a gastric mucinous adenocarcinoma was mistaken as a SMT.
Adenocarcinoma ; Adenocarcinoma, Mucinous ; Gastric Mucins ; Mucins ; Stomach ; Stomach Neoplasms

No abstract available.
Heart Neoplasms*

BACKGROUND & OBJECTIVES: After introduction of MRI with excellent capability of diagnosis In intracerebral hemorrhage (ICH), old ICH is more readily detected in patients with ischemic stroke. However, very few studies have addressed the identification of clinical significance of mixed stroke. The aims of the study are to elucidate the incidence and the location of the coexisting ICH in non-embolic ischemic stroke. Also we tried to seek the difference of the vascular risk factors between ischemic strokes combined with and without ICH. MEHTODS: Having 222 patients with non-embolic ischemic stroke as subjects, we reviewed the clinical data and MRIs of them retrospectively. We have defined mixed stroke as ischemic stroke combined with MR evidence of coexisting old ICH. The diagnosis of old ICH was made on the basis of the following findings; T2 weighted image showing a low signal intensity lesion with or without a hyperintesity area within it, and Tl weighted image revealing a low intensity lesion in the corresponding area. The frequency of vascular risk factors in the patients with mixed stroke was compared to that of those with pure ischemic stroke. RESULTS: MRI examinations showed old coexisting ICH in 10.4% (23) of 222 non-embolic ischemic stroke patients. Of 23 patients, nineteen patients had old ICH associated with multiple lacunar infarction and others were cortical infarction. The anatomic distribution of the hemorrhage was as follows; basal ganglia and internal capsule 19(78.3%), thalamus 3(13.1%), corona radiata 1 (4.3%), cerebellum 1 (4.3%). Analyzing the vascular risk factors, no significant difference was noted between lacunar infarctions and mixed stroke. CONCLUSION: The results of the study support that lacunar infarction and hypertensive ICH are bases on similar vascular pathophysiology. Therefore, old intracerebral hemorrhage may have a similar significance as a risk factor like previous ischemic stroke and inadvertent anti-thrombotic therapy might be avoided in certain stroke subtypes, which must be defined in future study.
Basal Ganglia ; Cerebellum ; Cerebral Hemorrhage ; Diagnosis ; Hemorrhage ; Humans ; Incidence ; Infarction ; Internal Capsule ; Magnetic Resonance Imaging ; Retrospective Studies ; Risk Factors ; Stroke* ; Stroke, Lacunar ; Thalamus