Hypoglycemic hemiplegia is an under-recognized manifestation of hypoglycemia and mimics cerebrovascular dis-ease, especially in elderly patients. We report a 70-year-old diabetic woman with hypoglycemic hemiplegia, whose dif-fusion- and perfusion- weighted images showed large cortical high signal intensities and hypoperfusion of the right hemisphere during the period of hypoglycemia. We suggest that the regional cerebral blood redistribution and selective vulnerability in hypoglycemia are responsible for the laterality of neurological deficits observed during hypoglycemic episodes.
Aged ; Female ; Hemiplegia* ; Humans ; Hypoglycemia ; Magnetic Resonance Imaging*

The generally accepted taste pathway in an animal projects ipsilaterally from the solitary nucleus. However, the path-way of gustatory fibers in the human brainstem has not been sufficiently clarified. A 57-year-old hypertensive man was admitted with sudden dizziness and hemiageusia. A neurological examination revealed also a diminution of taste on the left half of his tongue. A MRI showed a high signal intensity in the right lower pontine area. This case suggests that the unilateral lesion of the pons may lead to contralateral taste disturbances.
Ageusia ; Animals ; Brain Stem ; Cerebral Infarction ; Dizziness ; Facial Nerve ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Middle Aged ; Neurologic Examination ; Pons ; Solitary Nucleus ; Tongue

In early thrombolytic therapy for acute focal ischemic stroke, the start of treatment within therapeutic time window is one of the most important thing. Recently, new imaging modalities such as SPECT, transcranial doppler, diffusion/ perfusion-weighted MRI, and MR anglography have been implicated to avoid time consumption and delayed therapy. Of these, MR angiography is nomnvasi and rapid technique to visualize large and medium-sized arteries. We explored the usefulness of MR angiography in early thrombolytic therapy. Arterial occlusion of three patients with severe ischemic stroke were demonstrated on MR anglography and wluch were treated with Urokmase (10, 000-20, 000 units/kg) by intravenous infusion within 2-4 hours after symptom onset. Recanalization and brain lesion was assessed by repeated MR angiography and MRI or CT 24 hours later. Clinical improvement was observed in two patients 5-24 hours after initiation of treatment. In one patient hemorrhagic infarction without clinical deterioration was detected by follow-up computed tomography. Recanalization was documented on repeated MR angiography of three patients. MR angiography can document occlusion of stroke-related vasculature without delay of thrombolytic therapy and repeated MR anglography can reveal whether recanalization has occurred.
Angiography ; Arteries ; Brain ; Follow-Up Studies ; Humans ; Infarction ; Infusions, Intravenous ; Magnetic Resonance Angiography* ; Magnetic Resonance Imaging ; Stroke ; Thrombolytic Therapy ; Tomography, Emission-Computed, Single-Photon

Herpes zoster may be associated with a number of neurological complication. Herper zoster ophthalmicus and delayed contralateral hemiparesis is a well-described entity. We report a patient who had acute cerebral infarction 8 weeks after herpes zoster ophthalrnicus. Brain CT disclosed large cerebral infarction in the right middle cerebral artery territory. Decompressivecraniectomy was perforrned because of the impending uncal herniation on the 4th admission day. Pathological finding of resected brain parenchyrna and meninges showed the early cerebral infarction without evidence of vasculitis or er;cephalitis. Postoperatively the patient was improved.
Brain ; Cerebral Infarction ; Herpes Zoster* ; Humans ; Meninges ; Middle Cerebral Artery ; Paresis* ; Vasculitis

The effects of bee venom on humans are variable from local to lethal reactions. However, ischemic stroke following bee venom acupuncture has rarely been reported. We report a case of a person who developed an ischemic stroke after bee venom acupuncture. The patient, who had a small cortical infarction one year ago, experienced anaphylatic symptoms several minutes after bee venom acupuncture. Shortly thereafter, he became confused and had aggravation of the left hemiparesis. A brain MR T2-weighted image showed a high signal intensity lesion on the right anterior border zone. A cerebral angiography revealed a right proximal internal carotid artery occlusion with collateral circulation via an anterior communicating artery. The presumed mechanism in this case was a hemodynamic infarction due to the bee venom induced anaphylactic shock. We alert the possibility for another disaster caused by inadvertent bee venom acupuncture for stroke patients.
Acupuncture* ; Anaphylaxis ; Arteries ; Bee Venoms* ; Bees* ; Brain ; Carotid Artery, Internal ; Cerebral Angiography ; Collateral Circulation ; Disasters ; Hemodynamics ; Humans ; Infarction ; Paresis ; Stroke*

BACKGROUND: The associations between angiotensinogen M235T polymorphism and essential hypertension or ischemic stroke are still controversial. The aims of this study were to observe the associations of the angiotensinogen M235T polymorphism with hypertension or ischemic stroke, and to elucidate whether angiotensinogen M235T polymorphism was related to ischemic stroke itself or to hypertension. METHODS: We analyzed a particular polymorphysm in exon 2 of the angiotensinogen gene, a threonine to methionine substitution at position 235 (M235T), by a polymerase chain reaction in sixty patients with symptomatic ischemic stroke, one hundred patients with hypertension, and one hundredcontrol subjects without cardiovascular risks. Cardioembolic stroke was excluded. RESULTS: The three groups differed with respect to age and sex, but not total cholesterol, low-density lipoprotein, triglyceride, or body mass index. However, the distribution of angiotensinogen M235T genotypes was not different among the ischemic stroke group, hypertensive group, and control subjects. The TT genotype of angiotensinogen M235T was not significantly associated with ischemic stroke or hypertension (adjusted odds ratio (OR) = 1.02, 95% confidence interval (CI), 0.44 to 2.41, adjusted OR = 0.74, 95% CI=0.41 to 1.33, respectively), adjusting for age and sex. CONCLUSIONS: We found no significant associations between the angiotensinogen 235T alleles and hypertension or ischemic stroke in the Korean population. (J Korean Neurol Assoc 19(1):24~28, 2001
Alleles ; Angiotensinogen* ; Body Mass Index ; Cholesterol ; Exons ; Genes, vif ; Genotype ; Humans ; Hypertension ; Lipoproteins ; Methionine ; Odds Ratio ; Polymerase Chain Reaction ; Stroke* ; Threonine ; Triglycerides

Thromboangiitis obliterans (Buerger's disease) is an inflammatory, thromboccluisive vasclar disease that usually involves small and medium sized arteries and veins of the distal extremities of young male smokers. Involvement of cerebral blood vessels in Buerger's disease is rare, but clinical and Pathological demonstration has ionally been found. We describe three patients with cerebral infarction who had amputated their distal extremities due to thromboangiitis obliterans. - they had . No clinical, laboratory, a,ngiographic evidence of vasculitis, source of emboli, and atherosclerotic risk factors except heavy smoking.
Arteries ; Blood Vessels ; Cerebral Infarction ; Extremities ; Humans ; Male ; Risk Factors ; Smoke ; Smoking ; Thromboangiitis Obliterans* ; Vasculitis ; Veins

BACKGROUND: To clarify the clinicoradiological correlation and prognosis of acute ischemic stroke involving para-median territory of pons. METHODS: We studied 37 patients with first-ever ischemic stroke involving paramedian terri-tory of pons and divided them based on the shape and level of lesion shown in their MRI. The clinical features, MRI findings, and prognosis were assessed. RESULTS: The paramedian infarctions extending to the basal surface were found in 28 patients (76%), and small infarctions separated from the basal surface were found in 9 patients (24%). In patients with infarction extending to the basal surface, 23 patients (82%) had progressive or fluctuating onset, whereas all patients with small infarction separated from the basal surface had non-progressive onset. In the group with upper pon-tine lesion (14 patients), dysarthria-clumsy hand syndrome was found in 4 patients, ataxic hemiparesis (AH) in 3, pure motor hemiparesis (PMH) in 2, and pure sensory stroke in 1. In the group with middle and lower pontine lesion (22 patients), PMH was found in 9, AH in 3, and sensory motor stroke in 2. The mean Modified Rankin Disability Scale scores on admission and after follow-up (mean 29 months) of the group with upper pontine lesion were 2.36 +/-0.50 and 1 . 0 0 +/-0.55, those with mid-lower pontine lesions, 3.48 +/-0.51 and 1.17 +/-0.49 (P<0.01 and P>0.05 respectively). CONCLUSIONS: Paramedian pontine infarction extending to the basal surface usually presents with progressive onset. Paramedian pontine infarction most often produces classic lacune syndrome of which PMH is the most common. In our study, patients with mid-lower paramedian pontine infarction had more severe initial neurological deficits than those with upper paramedian pontine infarction. However, a late outcome was found to be favorable in both groups.
Follow-Up Studies ; Hand ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Paresis ; Pons ; Prognosis* ; Stroke

BACKGROUND AND OBJECTS: It is common to find cerebral infarction without a history of stroke on neuroimaging. This study was to determine the frequency, MRI characteristics of these lesions, and the risk factors related with silent brain infarcts in patients with first-ever ischemic stroke. METHOD: Sixty seven patients with acute ischemic stroke, who hospitalized in our hospital from April 1992 to May 1994, were reviewed. Brain MRI was performed in all patients. We evaluated frequency, site, size, and anatomic location of silent infarcts and compared the risk factors of the patients with silent infarcts with that of the ones without silent infarcts. RESULTS AND CONCLUSIONS: The prevalence of silent infarct was 58.2% ( (39/67). The predilection sites were in the right hemisphere and subcortical area (basal ganglia, thalamus), and their sizes were less than 1 cm mostly. The significant risk factor of silent infarcts was hypertension(P<0.01), and the other risk factors, such as age, sex, DM, and EKG abnormality, were not remarkable.
Brain* ; Cerebral Infarction ; Electrocardiography ; Ganglia ; Humans ; Magnetic Resonance Imaging* ; Neuroimaging ; Prevalence ; Risk Factors* ; Stroke*

Introduction: Lung Injury Score (LIS) provides a quantitative method for scoring acute lung injury that usually occurs after sepsis. The aim of this study is to evaluate the LIS in prediction the patients outcome and determine the relationship between the LIS and mortality rate, acute physiology and chronic health evaluation II (APACHE II) score and multiple organ failure (MOF) score. METHODS: Patients admitted to Intensive Care Unit (ICU), Severance Hospital Yonsei University College of Medicine from November 1995 to March 1996 were included. LIS at admission and discharge, APACHE II score with MOF score and duration of ICU stay between survivors and nonsurvivors were compared. Relationship of LIS between mortality rate and APACHE II score and MOF score were evaluated. RESULTS: LIS is higher in nonsurvivors than survivors at admission and discharge with statistical significance. LIS of survivors and nonsurvivors at discharge was lower and higher than those at admission (p<0.05) respectively. Correlation coeffcient of LIS with mortality rate, MOF score and APACHE II score were 0.60 (p<0.05), 0.23 and 0.17. CONCLUSIONS: LIS score was highly correlated with mortality rate. Therefore LIS is a good predictor of outcome in the intensive care unit.
Acute Lung Injury ; APACHE ; Humans ; Intensive Care Units* ; Critical Care* ; Lung Injury* ; Lung* ; Mortality ; Multiple Organ Failure ; Sepsis ; Survivors