A 84-year-old woman presented with a two weeks history of dizziness, slurred speech and ataxia. The neurological exam showed spontaneous left beating nystagmus, horizontal gaze evoked nystagmus and limb ataxia. A few weeks earlier, she had an upper airway infection. Brain MRI revealed diffuse leptomeningeal enhancement in the both cerebellar hemisphere and brain single photon emission computed tomography (SPECT) showed hyperperfusion in both cerebellar hemisphere. Extensive laboratory studies with cerebrospinal fluid analysis did not reveal any etiologic factors. She was started on methylprednisolone (1 g/day for 7 days), gradually improved over the weeks. Post infectious cerebellar ataxia is a neurologic complication that occasionally follows systemic viral and bacterial infections. This case demonstrates that cerebellar abnormalities can be detected by brain magnetic resonance imaging and SPECT.
Aged, 80 and over ; Ataxia ; Bacterial Infections ; Brain ; Cerebellar Ataxia ; Cerebrospinal Fluid ; Dizziness ; Female ; Humans ; Magnetic Resonance Imaging ; Methylprednisolone ; Nystagmus, Pathologic ; Tomography, Emission-Computed, Single-Photon

Multifocal motor neuropathy (MMN) is an uncommon, asymmetric motor neuropathy. As MMN is a treatable disorder, its differentiation from lower motor neuron disease is important. Evidence of conduction block (CB) or positive IgM anti-GM1 is considered one of important markers for the diagnosis. However, some patients with atypical MMN have no detectable CB or anti-GM1 antibody. We experienced a case of MMN with focal nerve enlargement on ultrasound. Ultrasound can be a valuable tool in supporting the diagnosis of MMN.
Diagnosis ; Humans ; Immunoglobulin M ; Motor Neuron Disease ; Peripheral Nervous System Diseases ; Ultrasonography

We report a case of proximal internal carotid arterial spasm following pterional removal of pituitary adenoma. We discuss the possible mechanism of vasospasm associated with tumor resection.
Carotid Artery, Internal* ; Pituitary Neoplasms* ; Spasm

HPV E2 protein is known to act as a negative regulator of transcription and the disruption of E2 open reading frame by HPV integration can release suppression of E6 and E7 mRNA expression, resulting in uncontrolled cellular growth and malignant transformation by inactivating tumor suppressor gene products (p53, pRb). YY1 mutation of HPV URR has been suggested as one of indicator that explains development of cervical neoplasia by episomal type of HPV. To extend this hypothesis, we examined whether mutation(s) in specific sites of HPV URR is functionally related to the invasiveness of cervical neoplasia and the physical status of HPV DNA. The URR sequences were obtained by PCR amplification of HPV-16 genome from CIN and invasive cancer patients, cloned into pUC18 for sequencing, and into pBLCAT8+ for functional CAT assay. Our previous data classified HPV-infected patients into three groups: 3 cancer cases carrying episomal HPV DNA; 12 cancer cases carrying integrated HPV DNA; 12 CIN cases carrying episomal HPV DNA. The specific variants in HPV-16 URR were found in Korean women: GA transition at nt 7520 (100%, 27/27), AC transition at nt 7729 (70%; 19/27), and GA transition at nt 7841 (78%; 21/27). Selective mutations were observed at the YY1-binding sites of HPV-16 URR in the 3 patients with invasive cervical cancer, who having the episomal forms of HPV-16 DNA: AC transition at nt 7484 and GA transition at nt 7488 (YY1-binding site 2; from 7481 to 7489). Additionally, CT transition at nt 7785 (YY1-binding site 3; from 7781 to 7790) was found from 2 of 3 patients. No YY1 site mutations were detected in the 12 CIN patients and in the HPV-integrated invasive cancer patients. To determine whether these mutations have effect on the expression of HPV E6/E7 genes driven by URR, the transient transfection assay was employed using URR-CAT reporter plasmid. The relative activities of three URR mutants from episomal HPV-16 DNA of cervical cancers were 2- to 4-fold higher than that of HPV-16 URR prototype. In contrast, the URRs from integrated HPV-16 DNA in cervical cancer and from episomal HPV-16 DNA in CIN, where no mutation of the YY1-binding site was detected, showed similar levels of promoter activity to that of URR prototype.Our results support the hypothesis that the mutation at YY1 binding site is functionally related to the development of cervical neoplasia caused by episomal HPV-16 DNA in Korean cervical cancer patient. Thus, mutation in YY1 site of episomal HPV-16 URR may play a role of HPV integration in the progression of cervical cancer.
Animals ; Binding Sites ; Cats ; Clone Cells ; DNA* ; Female ; Genes, Tumor Suppressor ; Genome ; Human papillomavirus 16* ; Humans ; Open Reading Frames ; Plasmids ; Polymerase Chain Reaction ; RNA, Messenger ; Transfection ; Uterine Cervical Neoplasms

OBJECTIVE: Spontaneous intracranial hemorrhage is still common cause of death in the hematologic disorder including leukemia. The authors examine laboratory & radiological findings in patients with intracranial hemorrhage caused by hematologic disorder. METHODS: From March 1998 to May 2002, 42 patients with hematologic disease complicated by intracranial hemorrhage were transferred from hematology department. The patients were normotensive and had not trauma history. In all patients, intracranial hemorrhages were diagnosed with the brain computerized tomography. Surgical treatment was performed in one case. RESULTS: Underlying hematologic disorders included aplastic anemia (4), acute myeloblastic leukemia (20), acute lymphoblastic leukemia (6), chronic myeloblastic leukemia (8), myelodysplastic syndrome (2), multiple myeloma (1), and polycythemia vera (1). Intracranial hemorrhage subtypes consisted of intracerebral hemorrhage (39) including mainly subcortical lobar hemorrhage (28), and subarachnoid hemorrhage (3). Twenty (48%) of the 42 patients had multifocal hematomas. Thirty six patients (86%) had moderate and severe thrombocytopenia (less than 100x10(9)/L). Twenty four patients (57%) had moderate and severe leukocytosis (greater than 20x109/L). CONCLUSION: It showed that (1) the risk factors of intracranial hemorrhage in hematologic disorders are thrombocytopenia, leukocytosis and disseminated intravascular coagulopathy ; (2) intracerebral hemorrhage in hematologic disorders occur preferentially in the subcortical portion ; (3) intracranial hemorrhage in hematologic disorders consist of various combinations of subcortical lobar hemorrhage, subarachnoid hemorrhage, subdural hemorrhage and intraventricular hemorrhage ; (4) intracerebral hemorrhage in hematologic disorders tend to be multiple.
Anemia, Aplastic ; Brain ; Cause of Death ; Cerebral Hemorrhage ; Granulocyte Precursor Cells ; Hematologic Diseases ; Hematology ; Hematoma ; Hematoma, Subdural ; Hemorrhage ; Humans ; Intracranial Hemorrhages* ; Leukemia ; Leukemia, Myeloid, Acute ; Leukocytosis ; Multiple Myeloma ; Myelodysplastic Syndromes ; Polycythemia Vera ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Risk Factors ; Subarachnoid Hemorrhage ; Thrombocytopenia

OBJECTIVES: The purpose of this study is to evaluate the radiological charactersitics related to the formation of peritumoral edema in meningiomas. METHODS: Fifty patients with meningioma were examined by magnetic resonance images and cerebral angiography. The predictive factors associated peritumoral edema, such as, tumor size, peritumoral rim (cerebrospinal fluid cleft), shape of tumor margin, signal intensity of tumor in T2WI, and pial blood supply were evaluated. RESULTS: Tumor size, peritumoral rim and pial blood supply correlated with peritumoral edema on univariate analyses. But in multivariate analyses, pial blood supply was statistically significant as a factor for peritumoral edema in meningioma. CONCLUSION: In our results, pial blood supply is significant contributing factor for peritumoral edema in meningioma.
Cerebral Angiography ; Edema* ; Humans ; Meningioma* ; Multivariate Analysis

OBJECTIVE: Adipose tissue is derived from the embryonic mesoderm and contains a heterogenous stromal cell population. Authors have tried to verify the characteristics of stem cell of adipose derived stromal cells (ADSCs) and to investigate immunohistochemical findings after transplantation of ADSC into rat brain to evaluate survival, migration and differentiation of transplanted stromal cells. METHODS: First, ADSCs were isolated from human adipose tissue and induced adipose, osseous and neuronal differentiation under appropriate culture condition in vitro and examined phenotypes profile of human ADSCs in undifferentiated states using flow cytometry and immunohistochemical study. Human ADSCs were transplanted into the healthy rat brain to investigate survival, migration and differentiation after 4 weeks. RESULTS: From human adipose tissue, adipose stem cells were harvested and subcultured for several times. The cultured ADSCs were differentiated into adipocytes, osteoctye and neuron-like cell under conditioned media. Flow cytometric analysis of undifferentiated ADSCs revealed that ADSCs were positive for CD29, CD44 and negative for CD34, CD45, CD117 and HLA-DR. Transplanted human ADSCs were found mainly in cortex adjacent to injection site and migrated from injection site at a distance of at least 1 mm along the cortex and corpus callosum. A few transplanted cells have differentiated into neuron and astrocyte. CONCLUSION: ADSCs were differentiated into multilineage cell lines through transdifferentiation. ADSCs were survived and migrated in xenograft without immunosuppression. Based on this data, ADSCs may be potential source of stem cells for many human disease including neurologic disorder.
Adipocytes ; Adipose Tissue ; Adult* ; Animals ; Astrocytes ; Brain ; Cell Line ; Corpus Callosum ; Culture Media, Conditioned ; Flow Cytometry ; Heterografts ; HLA-DR Antigens ; Humans* ; Immunosuppression ; Mesoderm ; Nervous System Diseases ; Neurons ; Phenotype ; Rats* ; Stem Cells* ; Stromal Cells

Papillary thyroid carcinoma (PTC) is the most common type of thyroid malignancy and has relatively favorable prognosis. Blood-borne metastases of PTC are very rare among the thyroid malignancies. Moreover a case of blood-borne central nervous system metastasized PTC with only unilateral Horner's syndrome, and without any abnormalities in laboratory or physical examinations has not been described before. A 53-year-old female patient had been managed in ophthalmologic clinic due to vague symptoms of right monocular blurred vision with eye dryness for 3 months, but showed no signs of improvement. So it was performed a magnetic resonance imaging and magnetic resonance angiography to evaluate the possibilities of cerebral lesion. And a left frontal mass was incidentally found, and the tumor turned out to be a PTC that had metastasized to brain, regional lymph node, cervical, thoracic spine, and lung. We describe a PTC with extraordinary initial symptoms that metastasized to an unusual site. We recommend that if a papillary thyroid tumor with unusual symptoms or at an advanced stage is found, further investigation should be performed for distant metastasis.
Brain* ; Central Nervous System ; Female ; Horner Syndrome* ; Humans ; Lung ; Lymph Nodes ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Middle Aged ; Neoplasm Metastasis* ; Physical Examination ; Prognosis ; Spine ; Thyroid Gland ; Thyroid Neoplasms*

BACKGROUND: External ventricular drainage (EVD) is one of the most frequently performed operative procedures in neurosurgery. A retrospective analysis was conducted for patients who underwent EVD to determine the incidence rate of post-procedural intracranial hemorrhage and to identify underlying risk factors. METHODS: Patients who underwent EVD between January 2003 and January 2011 were selected. Catheter-induced hemorrhage (CIH) was defined as any evidence of new hemorrhage on the post-procedural computerized tomography (CT) scan obtained within 24 hours of catheter insertion. The rate of hemorrhage was calculated, and the possible risk factors were statistically analyzed. RESULTS: The data of 229 patients were analyzed. Twenty-one patients developed CIH, for an incidence rate of 9.17%. The factors that increased the rate of CIH were age > or =60 years, bilateral catheter insertion, and pre-existing heart disease. The patients > or =60 years of age had a 2.8-fold increased risk of CIH. A history of heart disease contributed to a 20-fold increased risk of CIH (p < 0.001). Those three parameters were evaluated by multiple logistic regression analysis and patients who had all three risk factors were 18 times more likely to have CIH than patients with no factors. CONCLUSION: CIH is a frequent complication that cannot be over looked in patients who undergo EVD insertions. Age > or =60 years, bilateral catheter insertion, and a history of heart disease are the three most significant risk factors for CIH. Since these risk factors are not modifiable, all possible contributors should be considered to minimize the risk such as skilled maneuvers and techniques or high blood pressure.
Catheters ; Drainage ; Heart Diseases ; Hemorrhage ; Humans ; Hypertension ; Incidence ; Intracranial Hemorrhages ; Logistic Models ; Neurosurgery ; Retrospective Studies ; Risk Factors ; Surgical Procedures, Operative

BACKGROUND: External ventricular drainage (EVD) is one of the most frequently performed operative procedures in neurosurgery. A retrospective analysis was conducted for patients who underwent EVD to determine the incidence rate of post-procedural intracranial hemorrhage and to identify underlying risk factors. METHODS: Patients who underwent EVD between January 2003 and January 2011 were selected. Catheter-induced hemorrhage (CIH) was defined as any evidence of new hemorrhage on the post-procedural computerized tomography (CT) scan obtained within 24 hours of catheter insertion. The rate of hemorrhage was calculated, and the possible risk factors were statistically analyzed. RESULTS: The data of 229 patients were analyzed. Twenty-one patients developed CIH, for an incidence rate of 9.17%. The factors that increased the rate of CIH were age > or =60 years, bilateral catheter insertion, and pre-existing heart disease. The patients > or =60 years of age had a 2.8-fold increased risk of CIH. A history of heart disease contributed to a 20-fold increased risk of CIH (p < 0.001). Those three parameters were evaluated by multiple logistic regression analysis and patients who had all three risk factors were 18 times more likely to have CIH than patients with no factors. CONCLUSION: CIH is a frequent complication that cannot be over looked in patients who undergo EVD insertions. Age > or =60 years, bilateral catheter insertion, and a history of heart disease are the three most significant risk factors for CIH. Since these risk factors are not modifiable, all possible contributors should be considered to minimize the risk such as skilled maneuvers and techniques or high blood pressure.
Catheters ; Drainage ; Heart Diseases ; Hemorrhage ; Humans ; Hypertension ; Incidence ; Intracranial Hemorrhages ; Logistic Models ; Neurosurgery ; Retrospective Studies ; Risk Factors ; Surgical Procedures, Operative