No abstract available.
Central Nervous System* ; Graft vs Host Disease* ; Multiple Sclerosis* ; Stem Cell Transplantation ; Transplants*

A 25-year-old man presented with blurred vision and chronic headache. His brain MRI revealed bilateral frontal pachymeningeal enhancement with leptomeningeal enhancement. The patient had experienced recurrent oral ulcer and had anterior uveitis and papulopustules skin lesion. We diagnosed him with hypertrophic pachymeningitis (HP) associated with neuro-Behcet's disease (NBD). There have been few reports describing HP in patients with NBD. We report a case of NBD presenting as HP.
Adult ; Brain ; Headache Disorders ; Humans ; Magnetic Resonance Imaging ; Meningitis* ; Oral Ulcer ; Skin ; Uveitis, Anterior

Flexor spasm caused by stroke has been rarely reported. We describe a 79-year-old man who suddenly presented with flexor spasm of left limb and neck muscles. His symptoms consisted of recurrent episodes of brief paroxysmal flexor contractions of left limb and neck muscles without alteration of consciousness. Brain Magnetic Resonance Imaging revealed acute infarction in right basal ganglia. The abnormal movement was not associated with any epileptiform discharges in the video-electroencephalography monitoring. It was controlled with carbamazepine and phenytoin.
Aged ; Basal Ganglia* ; Brain ; Carbamazepine ; Consciousness ; Dyskinesias ; Extremities ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Neck Muscles ; Phenytoin ; Spasm* ; Stroke

BACKGROUND: Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor and nonmotor symptoms such as cognitive impairment and neuropsychiatric symptoms. The aim of this study was to investigate the spectrum of neuropsychiatric symptoms in PD according to cognitive function. METHODS: One hundred twenty seven patients with PD were consecutively recruited. They had undergone an intensive interview with a neurologist and the Seoul Neuropsychological Screening Battery-dementia version, and were divided into three groups: 27 patients in PD with normal cognition (PDNC), 57 in PD with mild cognitive impairment (PDMCI), and 43 in PD with Dementia (PDD). Forty five healthy controls without memory complaints were also recruited. The caregivers of all participants administered the Caregiver-Administered Neuropsychiatric Inventory (CGA-NPI). RESULTS: There were significant differences in the CGA-NPI score (22.8+/-20.9 vs. 6.4+/-10.1 vs. 1.7+/-3.9 vs. 1.0+/-1.6, p<0.001), and the prevalence of neuropsychiatric symptoms (100% vs. 64.9% vs. 37.0% vs. 44.4%, p<0.001) among PDD, PDMCI, PDNC and control groups. Depression was the most common symptom (43.3%), followed by anxiety (31.5%), apathy (26.8%), and night-time behavior (26.8%) in all PD patients. Delusion, hallucination, and aberrant motor behavior were observed frequently in PDD, but were rare in PDMCI. CONCLUSIONS: Depression was the most common neuropsychiatric symptom in PD. The presence of delusion, hallucination, or aberrant motor behavior may suggest PDD. The neuropsychiatric symptoms were not prevalent in PD with normal cognition.
Anxiety ; Apathy ; Caregivers ; Cognition ; Delusions ; Dementia ; Depression ; Hallucinations ; Humans ; Mass Screening ; Memory ; Mild Cognitive Impairment ; Neurodegenerative Diseases ; Parkinson Disease ; Prevalence

No abstract available.
Angiography, Digital Subtraction ; Venous Thrombosis

No abstract available.
Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Myasthenia Gravis

BACKGROUND: Obstructive sleep apnea (OSA) contributes to the development of cardiovascular diseases. The aim of this study is to analyze the association between OSA and cardiovascular diseases in adult. METHODS: We recruited 718 consecutive subjects (611 male, 44.8+/-12.7 years old) diagnosed as OSA based on overnight polysomnography. The prevalence of hypertension, diabetes mellitus, myocardial infarction and stroke was defined and compared with that in general adult population (the Third Korea National Health and Nutritional Examination Survey, KNHANES III 2005). Correlation between the prevalence and OSA severity was analyzed after adjusting age, sex, body mass index, smoking, and alcohol consumption. RESULTS: Prevalence of vascular diseases was higher in OSA than general population. Prevalence of hypertension was 39.0% (13.0% from KNHANES III), diabetes 8.2% (5.2%), myocardial infarction 3.0% (0.6%) and stroke 7.2% (1.6%). Apnea-hypopnea index as the marker of OSA severity significantly correlated with hypertension (p=0.01). CONCLUSIONS: Cardiovascular diseases were more prevalent in OSA. Prevalence of hypertension increased proportionally to OSA severity.
Adult ; Alcohol Drinking ; Body Mass Index ; Cardiovascular Diseases ; Diabetes Mellitus ; Humans ; Hypertension ; Korea ; Male ; Myocardial Infarction ; Polysomnography ; Prevalence ; Respiration ; Sleep Apnea, Obstructive ; Smoke ; Smoking ; Stroke ; Vascular Diseases

BACKGROUND AND PURPOSE: Elevated plasma total homocysteine (tHcy) levels are reported to be associated with an increased risk of Alzheimer's disease (AD). However, the mechanism by which homocysteine contributes to the pathogenesis of AD is as yet unknown. The aim of this study was to elucidate the relationship between white matter changes (WMC) and medial temporal lobe atrophy (MTA) on brain magnetic resonance imaging (MRI), and plasma levels of tHcy in AD patients. METHODS: Seventy-two patients with a clinical diagnosis of probable AD were recruited to the study. Plasma tHcy levels, vascular risk factors, and WMC and MTA on brain MRI were evaluated in all patients. The AD patients were classified into two groups: those with no or minimal WMC (69.2+/-8.8 years, mean+/-SD, n=36) and those with moderate-to-severe WMC (74.6+/-4.6 years, n=36) on brain MRI. RESULTS: In a univariate logistic regression analysis, the risk of moderate-to-severe WMC in AD was significantly associated with increasing age, female gender, lower education level, hypertension, high plasma tHcy levels, and lower Mini-Mental State Examination (MMSE) score. Multivariate logistic regression analysis revealed only high plasma tHcy as the independent and significant risk factor for moderate-to-severe WMC [odds ratio (OR; adjusted for age, gender, education level, MMSE score, and hypertension comparing the top tertile - tHcy levels > or =12.9 micromol/L - with the bottom tertile - tHcy levels < or =9.4 micromol/L)=7.35; 95% confidence interval, confidence interval=1.36-39.84; p=0.02], and age as a borderline significant risk factor (OR=1.08, 95% CI=0.99-1.19, p=0.09) in AD patients. Plasma tHcy levels were not correlated significantly with either right or left MTA. CONCLUSIONS: Our results suggest that the vascular pathway mediates the association between elevated plasma tHcy levels and AD.
Alzheimer Disease ; Atrophy ; Brain ; Female ; Glutamates ; Guanine ; Homocysteine ; Humans ; Hypertension ; Leukoaraiosis ; Logistic Models ; Magnetic Resonance Imaging ; Plasma ; Risk Factors ; Temporal Lobe ; Pemetrexed

BACKGROUND: Obstructive sleep apnea (OSA) is known to be an independent risk for cardiovascular diseases. The carotid intima.media thickness (IMT) is a surrogate marker of subclinical atherosclerosis. The aim of this study was to measure the carotid IMT in subjects with or without OSA and quantify its correlation with OSA severity. METHODS: Subjects were categorized into OSA and non-OSA groups based on polysomnography findings. The carotid IMT was considered a marker of atherosclerosis. The independent relationship between carotid IMT and OSA severity was analyzed using multiple linear regression. The presumed confounders were age, sex, body mass index, blood pressure, blood lipid and glucose profiles, smoking and alcohol drinking statuses, medications, being overweight, and having hypertension, diabetes mellitus, or hyperlipidemia. RESULTS: The carotid IMT was larger in OSA subjects (n=82, 0.620+/-0.096 mm [mean+/-SD]) than in non-OSA subjects (n=22, 0.551+/-0.078 mm; p=0.006), and was independently correlated with OSA severity (p<0.001). However, it was not affected by any of the other variables investigated. CONCLUSIONS: Subjects with OSA showed an increased IMT, with the thickness being correlated with the OSA severity. This finding suggests that accelerated atherosclerosis in OSA is the mechanism linking OSA and future cardiovascular events.
Alcohol Drinking ; Anoxia ; Atherosclerosis ; Biomarkers ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases ; Carotid Arteries ; Carotid Intima-Media Thickness ; Diabetes Mellitus ; Glucose ; Hypertension ; Linear Models ; Overweight ; Polysomnography ; Sleep Apnea, Obstructive ; Smoke ; Smoking ; Ultrasonography, Doppler

BACKGROUND: REM sleep behavior disorder (RBD) commonly occurs in old-age group and shows very good response to clonazepam. However, clonazepam can aggravate or even precipitate sleep-disordered breathings (SDBs) that is highly prevalent among elderly people. Melatonin has been known to be effective in RBD treatment and is much less likely to increase the airway resistance. The aim is to document the efficacy of melatonin therapy in RBD with co-existing significant SDB. METHODS: We recruited consecutive patients who have both RBD and significant SDB (apnea-hypopnea index, AHI>15) confirmed by nocturnal polysomnography. Melatonin was started at the dose of 0.5 mg/night and increased according to the clinical response. Successful response is defined when symptoms are free or reduced in frequency more than 90% and any physical injury or violence should not be present. RESULTS: Eleven among 16 RBD patients were eligible and enrolled (eight male, median age 69 years, range 54-89). All had significant obstructive sleep-disordered breathings (mean AHI = 28.8, range 22.6-35.2). Melatonin was prescribed(dosage 2-8 mg/night, treatment duration, 7-35 months). Nine patients showed successful response (2-8 mg/night) but two showed unsatisfactory response to 6 mg or 8 mg/night. Two of nine patients with favorable response complained of mild sleepiness. CONCLUSIONS: Melatonin can be effective for controlling RBD with co-existing SDB. Effective dosage range is variable without intolerable adverse effect.
Aged ; Airway Resistance ; Clonazepam ; Humans ; Male ; Melatonin* ; Polysomnography ; REM Sleep Behavior Disorder* ; Sleep Apnea Syndromes* ; Sleep Apnea, Obstructive ; Sleep, REM* ; Violence