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

Pneumocephalus is commonly seen after craniofacial injury. The pathogenesis of pneumocephalus has been debated as to whether it was caused by ball valve effect or combined episodic increased pressure within the nasopharynx on coughing. Discontinuous exchange of air and cerebrospinal fluid due to “inverted bottle” effect is assumed to be the cause of it. Delayed tension pneumocephalus is not common, but it requires an active management in order to prevent serious complication. We represent a clinical case of a 57-year-old male patient who fell down from 3 m height, complicated by tension pneumocephalus on 5 months after trauma. We recommend a surgical intervention, but the patient did not want that so we observe the patient. The patient was underwent seizure and meningitis after 7 months after trauma, he came on emergency room on stupor mentality. Tension pneumocephalus may result in a neurologic disturbance due to continued air entrainment and it significantly the likelihood of intracranial infection caused by continued open channel. Tension pneumocephalus threat a life, so need a neurosurgical emergency surgical intervention.
Cerebrospinal Fluid ; Cerebrospinal Fluid Leak ; Cough ; Craniocerebral Trauma ; Emergencies ; Emergency Service, Hospital ; Humans ; Male ; Meningitis ; Middle Aged ; Nasopharynx ; Pneumocephalus* ; Seizures ; Stupor

OBJECTIVE: Extracranial-intracranial arterial bypass (EIAB) has proved to be useful in selected patients with artherosclerotic cerebral ischemia and moyamoya disease. But neurological deterioration (ND) after EIAB has occasionally been reported in spite of successful EIAB. We have performed EIAB in 150 patients with artherosclerotic cerebral ischemia and moyamoya disease during the recent 8 years. We analyzed the patients who exhibited ND after successful EIAB was performed for a selected group of patients with artherosclerotic cerebral ischemia and moyamoya disease. METHODS: Among 150 patients, the cause of the hemodynamic ischemia was atherosclerotic in 90 and moyamoya disease in 60. Eighteen patients experienced ND after successful EIAB. There were 14 patients with temporary neurologic deficit and 5 patients had a permanent deficit. We divided these 18 patients into two groups. Group 1 revealed relative hyperperfusion of a chronically hypoperfused area of the brain after successful EIAB. Group 2 showed hypoperfusion of the brain by the change of the flow pattern after successful EIAB. RESULTS: Of the 18 patients who experienced ND after successful EIAB, 8 patients belonged to group 1 and 10 patients belonged to group 2. We divided group II into four subgroups according to angiographic flow patterns. The first subgroup (2 patients) showed delayed filling of one division out of two divisions of the middle cerebral artery. The second subgroup (3 patients) showed collision between the orthograde flow and the retrograde flow from the grafted vessel, which resulted in more profound hypoperfusion. The third subgroup (2 patients) exhibited a complete occlusion of the preoperative stenotic artery. The fourth subgroup (3 patients) included the cases with marginal hypoperfusion in the periphery of the perfused region from the grafted extracranial artery. CONCLUSION: EIAB is a reliable, reasonably safe method for establishing new pathways of collateral circulation to the brain. However, this operation can have potential complications according to the relative hyperperfusion or hypoperfusion that's due to the altered flow pattern after the bypass.
Arteries ; Brain ; Brain Ischemia ; Cerebral Revascularization ; Collateral Circulation ; Glycosaminoglycans ; Hemodynamics ; Humans ; Ischemia ; Middle Cerebral Artery ; Moyamoya Disease ; Neurologic Manifestations ; Transplants

Orbital infarction syndrome is a rare complication of neurosurgical procedures. The authors recently experienced two patients suffered from acute proptosis, ophthalmoplegia, and blindness developed immediately after surgery for ruptured anterior communicating artery aneurysms. Both patients underwent standard frontotemporal craniotomies to clip their aneurysms. Retinal and choroidal nonperfusion, and ophthalmoplegia, which suggested hypoperfusion of the ophthalmic artery and its branches, consistent with the orbital infarction. We report two cases of orbital infarction syndrome and discuss possible mechanism with literature review.
Aneurysm ; Blindness ; Choroid ; Craniotomy ; Exophthalmos ; Humans ; Infarction* ; Intracranial Aneurysm* ; Neurosurgical Procedures ; Ophthalmic Artery ; Ophthalmoplegia ; Orbit* ; Retinaldehyde

OBJECTIVE: Hemifacial spasm has characteristic and specific electrophysiological finding, lateral spread response(LSR). We study the correlation between change of lateral spread response during microvascular decompression(MVD) and clinical outcome after MVD. METHODS: Sixty two patients with hemifacial spasm who were treated with microvascular decompression from March 2000 to February 2003 were included in this study. The monitoring of intraoperative facial electromyography(EMG) and brain stem auditory evoked potential were performed. RESULTS: In 28 (44.7%) patients, there was persistence of lateral spread response after vascular decompression in root exit zone of facial nerve. Among these 28 patients, 9 had mild hemifacial spasm at discharge. Three out of 34 patients who had intraoperative disappearance of lateral spread response after MVD had mild hemifacial spasm. But Both groups, disappearance of LSR (Group I), and persistence (Group II) had only 2 patients with mild hemifacial spasm, and 5 patients at 3 months, respectively. CONCLUSION: Although intraoperative EMG monitoring is very useful in assessing the efficacy of MVD, the clinical outcome of MVD in patient with hemifacial spasm does not always correlate with EMG finding. The prognostic value of intraoperative LSR monitoring in the long-term results is questionable.
Decompression ; Electromyography ; Evoked Potentials, Auditory, Brain Stem ; Facial Nerve ; Hemifacial Spasm* ; Humans ; Microvascular Decompression Surgery

OBJECTIVE: Patients undergoing intracranial operations often suffer from post-operative epidural hematoma (EDH). The incidence and risk factors for with the occurrence of EDH after intracranial operations are not well described previously. The objective of this study was to identify the risk factors and the incidence of post-operative EDH adjacent and regional to the craniotomy. METHODS: This was a retrospective study of 23 (2.4%) patients, between January 2005 and December 2011, who underwent epidural hematoma evacuation after primary intracranial during this period, 941 intracranial operations were performed. The control group (46 patients) and hematoma group (23 patients) were categorized on the basis of having undergone the same pre-operative diagnosis and treatment within 3 months of their operations. The ages of the hematoma and control group were individually matched to similar ages within 10 years of each other to minimize bias of age. RESULTS: Univariate analysis showed that the significant pre-operative and intra-operative factors associated with post-operative EDH were a pre-operative Glasgow Coma Scale (GCS) scored <8 (crude odds ratio 8.295), prothrombin ratio >1.0 (p=0.014), prothrombin time (PT) >11.3 sec (p=0.008), intra-operative blood loss >650 mL (p=0.003) and craniotomy size >7,420 mm2 (p=0.023). In multivariate analysis, intra-operative blood loss exceeding 650 mL (median of total patients) placed a patient at significantly increased risk for post-operative EDH. CONCLUSION: Recognizing the limitations of the study, large intra-operative blood loss, wide craniotomy area, prolonged PT and a pre-operative GCS <8 are presented implicated with an increased risk of post-operative EDH after intracranial surgery.
Bias (Epidemiology) ; Craniotomy ; Glasgow Coma Scale ; Hematoma ; Hematoma, Epidural, Cranial ; Humans ; Incidence ; Multivariate Analysis ; Odds Ratio ; Prothrombin ; Prothrombin Time ; Retrospective Studies ; Risk Factors