Child Behavior Disorders ; etiology ; Child, Preschool ; Dyskinesias ; etiology ; Encephalitis ; complications ; diagnosis ; Female ; Humans ; Sleep Wake Disorders ; etiology

A 68-year-old woman with poorly controlled diabetes mellitus presented to the emergency department with choreoathetoid movements affecting the upper and lower left limbs. Computed tomography of the brain did not show any intracranial abnormalities. However, subsequent magnetic resonance (MR) imaging of the brain revealed an increased T1 signal in the right basal ganglia, raising the suspicion of nonketotic hyperglycaemic chorea-hemiballismus. Management consisted of adjusting her insulin dose to achieve good glycaemic control. The patient subsequently recovered and was discharged after eight days. There are many causes of basal ganglia T1 hyperintensity, including hyperglycaemia in patients with poorly controlled diabetes mellitus. This case emphasises the importance of MR imaging in the early diagnosis of hyperglycaemia as a cause of chorea-hemiballismus, to enable early treatment and a better clinical outcome.
Aged ; Brain ; diagnostic imaging ; Chorea ; diagnosis ; etiology ; Diagnosis, Differential ; Dyskinesias ; diagnosis ; etiology ; Female ; Humans ; Hyperglycemia ; complications ; diagnosis ; Magnetic Resonance Imaging ; methods ; Tomography, X-Ray Computed ; methods

PURPOSE: Lennox-Gastaut syndrome (LGS) is one of the most devastating pediatric epileptic syndromes characterized by various disabling seizures, generalized forms of abnormal epileptiform EEG features and progressive psychomotor retardation. Corpus callosotomy is one of treatment options in patients with intractable LGS without definitive focal cortical pathology. This study was designed to evaluate efficacy and safety of corpus callosotomy in patients with LGS. PATIENTS AND METHODS: Thirty patients (21 boys, 9 girls) with LGS who had corpus callosotomy at Severance Children's Hospital from October 2003 to January 2007, were enrolled with mean follow-up of 34.6+/-14.0 months. We retrospectively reviewed medical records, video-EEG monitoring, MRI, seizure outcome and postoperative complications. RESULTS: Mean age of corpus callosotomy was 100.7+/-56.4 months. Twenty-four patient (80.0%) underwent total corpus callosotomy and 6 (20.0%) underwent resection of the anterior 4/5 of corpus callosum. Seizure outcomes were as follows: 5 patients (16.7%) were Engel class I, 9 (30.0%) were class II, 6 (20.0%) were class III and 10 (33.3%) were class IV. Postoperative complications were seen in 4 patients (13.3%), such as hemorrhage (2 patients), involuntary movement (1 patient) and transient ataxia (1 patient), but all were recovered completely. Subsequent resective surgery was performed in 5 patients of Engel class III and IV, whose EEG features became lateralized without complete seizure control. Satisfactory surgical outcomes (class I and II) were achieved in 46.7% of total patients. CONCLUSIONS: Corpus callosotomy could be effective and safe treatment in medically intractable LGS without focal pathology.
Ataxia ; Corpus Callosum ; Dyskinesias ; Electroencephalography ; Follow-Up Studies ; Hemorrhage ; Humans ; Intellectual Disability ; Medical Records ; Postoperative Complications ; Retrospective Studies ; Seizures ; Spasms, Infantile

OBJECTIVETo explore the impacts of acupuncture and rehabilitation on post-stroke abnormal patterns of limb movement and evaluate them via rehabilitation method.

METHODSNinety cases of post-stroke movement disorder were randomly divided into an acupuncture-rehabilitation group, a body acupuncture group and a medication group, 30 cases in each group. In medication group, the conventional medication in neurological department was administered. In acupuncture-rehabilitation group and body acupuncture group, on the basis of the therapy as medication group, scalp acupuncture (such as parietal area and anterior parietal area, etc.), rehabilitation training and traditional body acupuncture [such as Jianyu (LI 15) and Fengshi (GB 31),etc.] were supplemented. The continuous electric stimulation was applied in body acupuncture group. The treatment lasted for 8 weeks. The assessment of clinical efficacy, Fugl-Meyer score, Modified Ashworth scale (MAS), range of motion (ROM) and shoulder pain score were taken as observation indices for rehabilitation evaluation before and after treatment in each group.

RESULTSThe effective rate was 93.1% (27/29) in acupuncture-rehabilitation group, which was superior to 66.7% (20/30) in body acupuncture group and 57.1% (16/28) in control group (both P<0.01) separately. After treatment, Fugl-Meyer score, MAS, ROM of the lower limbs and shoulder joint and shoulder pain score (except medication group) were all remarkably improved as compared with those before treatment in each group (all P<0.01). The improvements in Fugl-Meyer score, MAS, ROM of the upper limbs and shoulder pain score in acupuncture-rehabilitation group were significantly superior to those in body acupuncture group and medication group (P<0.05, P<0.01).

CONCLUSIONAcupuncture and rehabilitation therapy and traditional body acupuncture remarkably improve in post-stroke movement disorder. But acupuncture and rehabilitation therapy is apparently superior to traditional body acupuncture. This therapy can effectively prevent and treat post-stroke abnormal patterns and it is greatly significant in the improvement of survival quality for the patients.

Acupuncture Therapy ; Adult ; Aged ; Dyskinesias ; etiology ; physiopathology ; prevention & control ; rehabilitation ; therapy ; Female ; Humans ; Male ; Middle Aged ; Range of Motion, Articular ; Stroke ; complications

Objective: To summarize the clinical characteristics of patients with Takotsubo syndrome (TTS) from China and compare these features with patients from Europe/North America. Methods: We reviewed case reports published between 1990 and 2020 with the key words of "Takotsubo syndrome" "stress cardiomyopathy" "apical balloon syndrome" and "broken heart syndrome", in Wanfang, CNKI, Pubmed and Web of Science databases, and 1 294 articles were identified, including 128 articles reporting 163 cases in China and 1 166 articles reporting 1 256 cases in Europe/North America. The characteristics of demographics, triggers, symptoms, electrocardiogram, echocardiography, left ventriculogram,coronary angiography, treatment and prognosis were analyzed and compared between Chinese and European/North American cases. Results: A total of 1 294 articles (1 419 cases: 163 from China, 1 256 from Europe/North America) were included in the final analysis. The characteristics of Chinese cases included: (1) demographic:the age was (59.6±16.9) years, which was similar with that of European/North American ((59.7±17.4) years, P=0.90), and female accounting for 78.5% (128/163), which was lower than that of European/North American (85.4% (1 073/1 256), P=0.02). (2) Triggers:mental triggers accounted for 48.5% (79/163), physical triggers accounted for 43.6% (71/163), and no triggers accounted for 7.9% (13/163), respectively. Compared with Europe/North America, the ratio of patients with mental triggers was higher in China, while the ratio of patients with physical triggers and no triggers was lower (P<0.05). (3) Symptoms: chest pain (52.8% (86/163)), chest tightness (35.0% (57/163)), shortness of breath (33.1% (54/163)), dizziness (16.0% (26/163)), sweating (15.3% (25/163)), palpitations (12.3% (20/163)), syncope (9.2% (15/163)) abdominal pain/diarrhea (8.6% (14/163)), hypotension (7.4% (12/163)), and fatigue (1.2% (2/163)) were illustrated in sequence. Compared with patients in Europe/North America, the ratio of patients with chest tightness, dizziness, sweating, palpitations, abdominal pain/diarrhea was higher in Chinese patients, while the ratio of patients with hypotension was lower in Chinese patients (P<0.05). (4) Electrocardiogram: main manifestations were myocardial ischemia symptoms, such as ST-segment elevation (63.8% (104/163)), T wave inversion (46.0% (75/163)), ST-segment depression (8.6% (14/163)). Compared with European/North American, the ratio of patients with ST-segment elevation, T wave inversion, and atrioventricular block was higher in Chinese patients (P<0.05). (5) Echocardiography and imaging:apical dyskinesia (59.5% (97/163)) and apical/left ventricular bulbar dilation (36.2%(59/163)) dominated the echocardiography findings. Compared with European/North American, the ratio of patients with apical dyskinesia, apical/left ventricular bulbar dilation, and mitral regurgitation was higher in Chinese patients, while the ratio of patients with dyskinesia in other parts and left ventricular ejection fraction<50% was lower in Chinese patients (P<0.05). Left ventricular angiography showed 36.2% (59/163) of apical dyskinesia in Chinese patients, which was higher than that reported in European/North American patients, and 38.7% (63/163) of apical/left ventricular bulbar dilation was reported in Chinese patients, which was similar to that reported in European/North American patients. Coronary angiography showed percent of no stenosis or stenosis less than 50% was 87.1% (142/163), which was similar to that reported in European/North American patients (P>0.05). The typical type of TTS accounted for 96.3% (157/163), which was significantly higher than that reported in European/ American patients, while the ratio of basal type and midventricular type was lower (P<0.01). (6) Treatment and prognosis:the applied drugs in China were listed in order as following, β-blockers (41.1% (67/163)), antiplatelet agents (37.4%(61/163)), ACEI/ARB (36.2%(59/163)), anticoagulants (27.0%(44/163)), diuretics (19.6% (32/163)), etc. Compared with Europe/North America, the ratio of antiplatelet agents, anticoagulants, statins, diuretics, and nitrates use was higher in China (P<0.05), while the use of oxygen therapy and IABP was similar (P>0.05). The hospital mortality in China was 5.5% (9/163), during 1-year follow-up the recurrence rate was 3.7% (6/163) and the mortality was 0. The prognosis was similar with that in Europe/North America. Conclusions: Compared with TTS cases in Europe/North America, TTS cases in China also occur usually in middle-aged and elderly women, most of whom have mental/physical triggers and typical imaging manifestations, followed by a low hospital mortality rate and recurrence rate.
Abdominal Pain/complications* ; Adult ; Aged ; Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; Anticoagulants ; Arrhythmias, Cardiac/complications* ; China/epidemiology* ; Diuretics ; Dizziness/complications* ; Dyskinesias/complications* ; Electrocardiography ; Europe/epidemiology* ; Female ; Humans ; Hypotension/complications* ; Middle Aged ; Platelet Aggregation Inhibitors ; Stroke Volume ; Takotsubo Cardiomyopathy/etiology* ; Ventricular Function, Left

BACKGROUND: The authors present the results of a series of corpus callosotomies in 6 patients performed from 1998 to 2001 at the Samsung Medical Center. METHODS: Patients with medically intractable siezures, frequent drop attacks, poorly localized partial seizures with secondary generalization and generalized seizures were accepted as candidates (patients aged 14-29 years, 3 male and 3 female, with mean age at surgery of 18.6 years). Preoperatively, the frequency of seizures ranged from 2 to 600 per month. The standard microsurgical technique performed was a corpus callosotomy by the same surgeon under general anesthesia (anterior two-thirds corpus callosotomy was done in 4 cases, total callosotomy was done in 2 cases). In two cases, an additional cortical resection after electrocorticography using subdural electrode monitoring was carried out. The results were evaluated after a mean follow-up of 22 months (range, 4-34). We evaluated the effect of surgery according to the Engel classification. RESULTS: Complete freedom from seizures was noted in 2 cases (33%). More than 75% of reduction in seizure frequency was noted in 3 cases (50%). There was no significant reduction in frequency of seizure in one case. The highest rate of significant improvement was noted in the patients with drop attacks (75%(3/4)) and generalized tonic-clonic seizures (75%(3/4)). In one patient, pseudoaneurysm was complicated postoperatively but successful treatment was performed by endovascular procedure. Otherwise, there were no major postoperative complications except for brief mutism, slow activity and abnormal movement of one leg during the several weeks postoperatively. CONCLUSION: We conclude that corpus callosotomy is a safe alternative treatment for the medically intractable seizures, especially drop attack and generalized epilepsy.
Anesthesia, General ; Aneurysm, False ; Classification ; Corpus Callosum ; Dyskinesias ; Electrodes ; Endovascular Procedures ; Epilepsy* ; Epilepsy, Generalized ; Female ; Follow-Up Studies ; Freedom ; Generalization (Psychology) ; Humans ; Leg ; Male ; Mutism ; Postoperative Complications ; Seizures ; Syncope