Postural orthostatic tachycardia syndrome (POTS) refers to the presence of orthostatic intolerance with a heart rate (HR) increment of 30 beats per minute (bpm) or an absolute HR of 120 bpm or more. There are sporadic reports of the autonomic nervous system dysfunction in migraine and fibromyalgia. We report a case of POTS associated with migraine and fibromyalgia. The patient was managed with multidisciplinary therapies involving medication, education, and exercise which resulted in symptomatic improvement. We also review the literature on the association between POTS, migraine, and fibromyalgia.
Autonomic Nervous System ; Fibromyalgia ; Heart Rate ; Humans ; Migraine Disorders ; Mustard Compounds ; Orthostatic Intolerance ; Postural Orthostatic Tachycardia Syndrome

Fibromyalgia is a chronic pain syndrome of unknown etiology that is characterized by diffuse musculoskeletal pain, fatigue, sleep disturbance, memory disturbance, and exaggerated tenderness over particular paired locations. Fibromyalgia is found in 2% to 4% of the general population and more common in women, with symptoms usually appearing between 20 and 55 years of age. The diagnostic criteria for fibromyalgia syndrome established in 1990 by the American College of Rheumatology (ACR), includes widespread pain for at least 3 months and point tenderness upon the application of a 4 kg weight at 11 or more of the 18 characteristic tender points. The 2010 ACR preliminary diagnostic criteria have been developed, which are strongly correlated with the 1990 ACR criteria and provide an alternative approach to diagnosis. Patients with fibromyalgia syndrome have lower pain thresholds and experience an altered temporal summation to pain stimuli. The sensitization of pain perception occurs in the dorsal horn of patients with fibromyalgia. However, it is unknown whether sensitization is due to increased pain fiber facilitation, or decreased inhibition. Pregabalin is approved by the United States Food and Drug Administration for the management of fibromyalgia patients. Tricyclic antidepressants, cardiovascular exercise, cognitive behavioral therapy and patient education are also effective in reducing the pain experienced by fibromyalgia patients. This article provides an overview of fibromyalgia syndrome, which is currently thought to be partly responsible for chronic diffuse pain.
Animals ; Antidepressive Agents, Tricyclic ; Chronic Pain ; Cognitive Therapy ; Fatigue ; Female ; Fibromyalgia ; gamma-Aminobutyric Acid ; Horns ; Humans ; Memory ; Musculoskeletal Pain ; Pain Perception ; Pain Threshold ; Patient Education as Topic ; Rheumatology ; United States Food and Drug Administration ; Pregabalin

No abstract available.
Cerebellar Diseases ; Encephalitis ; Magnetic Resonance Imaging* ; Meningitis* ; Tuberculosis

Plasma cell Granuloma (PCG) is a form of idiopathic inflammatory pseudotumor (IPT). It is a rare entity character-ized by a nonneoplastic proliferation of inflammatory cells dominated by a polyclonal expansion of the plasma cells. This lesion has been discovered in many parts of the body including the central nervous system. We now report two cases of plasma cell granuloma involving the brain. The first case was a 42-year-old man who presented a right hemi-paresis. He had a lesion in the convexity of the left parietal region. The second case was a 58-year-old woman who was expressed confusion and a frontal-temporal headache. She had a lesion in the convexity of the left temporal region and mastoid bone. The diagnosis of PCG was confirmed by pathological and immunohistochemical studies revealing pre-dominant plasma cells in the affected tissues.
Adult ; Brain ; Central Nervous System ; Diagnosis ; Female ; Granuloma, Plasma Cell* ; Headache ; Humans ; Mastoid ; Middle Aged ; Plasma Cells* ; Plasma* ; Rabeprazole

BACKGROUND: Memory impairment results from various neurologic disorders. Among them, the memory loss associated with stroke is called amnesic stroke. Involved regions in the amnesic stroke are medial temporal lobe, thalamus, basal forebrain, retrosplenial region, and subcortical regions. Unilateral amnesic stroke is posterior cerebral artery territory including thalamus. Isolated infarction of hippocampal region has been rarely reported because hippocampus has dual blood supply from anterior choroidal cerebral artery and posterior cerebral artery. CASE REPORT: A 61-year old male with a history of diabetes for 6 years and hypertension for 13 years, was admitted with acute memory loss occurring 6 days before admission. He could not remember the exact date, place and recent events but could remember remote events about his personal and familial affairs. Brain MRI revealed an infarction in left hippocampal region and cerebral angiography showed multiple focal stenosis and luminal irregularity on left anterior choroidal, middle cerebral, basilar and both posterior cerebral arteries. COMMENTS: We report unilateral amnesic stroke only confined to left hippocampal region with literature review.
Amnesia ; Brain ; Cerebral Angiography ; Cerebral Arteries ; Choroid ; Constriction, Pathologic ; Hippocampus ; Humans ; Hypertension ; Infarction* ; Magnetic Resonance Imaging ; Male ; Memory Disorders* ; Memory* ; Middle Aged ; Nervous System Diseases ; Phenobarbital ; Posterior Cerebral Artery ; Prosencephalon ; Stroke ; Temporal Lobe ; Thalamus

We report a patient with a left anterior cerebral artery (ACA) infarct showing representational neglect. Representational neglect is some form of neglect to areas of imagined space. We believe that the description of our case gives further information about neglect syndrome and the functional asymmetry of the cerebral hemispheres because these observations are rare.
Anterior Cerebral Artery* ; Cerebrum ; Humans ; Infarction, Anterior Cerebral Artery*

BACKGROUND: Intracranial complications of paranasal sinus infection are rare and may be misdiagnosed during an initial evaluation because they often show subtle symptoms, which include elusive physical and neurological findings and imaging. The late recognition of these conditions and the delayed treatment can increase morbidity and mortality rates. We aimed to characterize the typical clinical features of intracranial complications associated with sinusitis. METHODS: Twelve patients who visited the Eulji Medical Center from 1994 to 2000, with sinogenic suppurative intracranial lesions were reviewed. Medical records and radiological studies were reviewed retrospectively. RESULTS: There were 12 cases with 15 sinogenic intracranial complications. The ratio of males to female was 2 : 1. The ages of patients ranged from 16 to 81 (average: 46.7). Four cases had meningitis, four had focal cerebritis, three had cavernous sinus throm-bophlebitis, two had subdural empyema, and two had epidural abscess or empyema. The primary lesions of paranasal sinusitis were located at the sphenoid in three, ethmoid sinus in two, frontal sinus in one and the multiple sinus in six. The outcome revealed complete recovery in six cases, mild neurologic sequelae in three cases, death in two cases and recurrence in one case. CONCLUSIONS: The type of intracranial complication and origin of paranasal sinusitis may be changing. Cases in which such complications are suspected, in order for an early diagnosis, a MRI should be considered. The successful management of intracranial complications consists of timely antibiotics therapy combined with surgical drainage of the loculated infection. (J Korean Neurol Assoc 19(5):457~463, 2001)
Anti-Bacterial Agents ; Cavernous Sinus ; Drainage ; Early Diagnosis ; Empyema ; Empyema, Subdural ; Epidural Abscess ; Ethmoid Sinus ; Female ; Frontal Sinus ; Humans ; Magnetic Resonance Imaging ; Male ; Medical Records ; Meningitis ; Mortality ; Recurrence ; Retrospective Studies ; Sinusitis

Parkinsonism is not commonly associated with intracranial tumors. The most common brain tumor causing parkinsonism is meningiomas. We are presenting two cases of meningiomas whose major manifestations included parkinsonism. In one, parkinsonian symptoms initially partially responded to L-dopa and bromocriptine. A CT scan taken for a stroke-like episode revealed a meningioma of left frontal convexity. After neurological sequelae of CO poisoning, the patient poorly responded to antiparkinsonian drugs. Surgical treatment of meningioma did not result in satisfactory control of extrapyramidal symptoms. In the other with a parasagittal meningioma, parkinsonian symptoms were postoperatiYely improved. Because no curative treatment is available for the majority of parkinsonian patients, early detection of an underlying neoplasm may result in a most rewarding outcome. It would be desirable to perform CT or MRI in cases of parkinsonism with other associated neurological manifestation. Unilaterality of parkinsonian symptoms may also be indication.
Brain Neoplasms ; Bromocriptine ; Frontal Lobe* ; Humans ; Levodopa ; Magnetic Resonance Imaging ; Meningioma* ; Neurologic Manifestations ; Parkinsonian Disorders* ; Poisoning ; Reward ; Tomography, X-Ray Computed

Cerebrospinal fluid (CSF) leak or shunt overdrainage is a well-known cause of orthostatic headaches and low CSF pressures. We report two cases of orthostatic headache with pneumocephalus on brain imaging. The orthostatic headache developed after drainage of spinal operation site and epidural block. Brain MRI revealed characteristic findings of CSF hypovolemia including pachymeningeal enhancement and mild subdural fluid collections. Air was also observed in the ventricular or subarachnoid space in both patients, which might enter the subarachnoid or ventricular space during a procedure via the pressure gradient or an injection.
Brain ; Drainage ; Headache ; Humans ; Hypovolemia ; Neuroimaging ; Pneumocephalus ; Subarachnoid Space

A 59-year-old man was admitted because of progressive proximal muscle weakness over 4 months. Serum creatine kinase was markedly increased and electromyography revealed myopathic pattern. Muscle biopsy showed nonspecific myopathic changes. No inflammatory change was shown. Thyroid function tests revealed very low thyroxine and low triiodo-L-thyronine, whereas thyroid-stimulating hormone was greatly increased as well as serum anti-thyroglobulin and microsome antibodies. The patient had hypothyroid myopathy due to Hashimoto's thyroiditis, which improved with L-thyroxine replacement.
Antibodies ; Biopsy ; Creatine Kinase ; Electromyography ; Humans ; Hypothyroidism ; Microsomes ; Middle Aged ; Muscle Weakness ; Muscular Diseases* ; Thyroid Function Tests ; Thyroid Gland* ; Thyroiditis* ; Thyrotropin ; Thyroxine