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: In recent years, CyberKnife has emerged as an important treatment modality in the management of pituitary adenomas. Treatment results after performing CyberKnife and the complications of this procedure are reviewed. METHODS: Twenty-six patients with pituitary adenomas received stereotactic radiosurgery with the CyberKnife (CKRS). The follow-up periods ranged from 7 months to 47 months (mean+/-SD : 30+/-12.7 months). The patients consisted of 17 with non-functioning adenomas, 3 with prolactinomas and 6 with acromegaly. The change in the tumor volume, visual acuity, hormonal function, and complications by this therapy were analyzed in each case. RESULTS: The tumor control rate was 92.3%. Hormonal function was improved in all of the 9 (100%) functioning adenomas. Hormonal normalization was observed in 4 of the 9 (44%) patients with a mean duration of 16 months. In two patients (7.6%), visual acuity worsened due to cystic enlargement of the tumor after CKRS. No other complications were observed. CONCLUSION: CyberKnife is considered safe and effective in selected patients with pituitary adenomas. However, longer follow-up is required for a more complete assessment of late toxicity and treatment efficacy.
Acromegaly ; Adenoma ; Follow-Up Studies ; Humans ; Pituitary Neoplasms ; Prolactinoma ; Radiosurgery ; Treatment Outcome ; Tumor Burden ; Visual Acuity

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

We report a case of"painful tic convulsif"caused by a tortous vertebrobasilar system, and present the case of a 59-year-old woman with right-sided trigeminal neuralgia and hemifacial spasm. Using a novel sequence, a dilated and severely elongated vertebrobasilar artery was demonstrated by magnetic resonance imaging(MRI) and magnetic resonance angiography(MRA). During microvascular decompression, the findings of MRI were confirmed and decompression with teflon sheets between the nerves and offending arteries was successfully achieved. Postoperatively, the patient was relieved of pain and twitching.
Arteries ; Decompression ; Female ; Hemifacial Spasm ; Humans ; Magnetic Resonance Imaging ; Microvascular Decompression Surgery* ; Middle Aged ; Polytetrafluoroethylene ; Tics* ; Trigeminal Neuralgia

We report a case of"painful tic convulsif"caused by a tortous vertebrobasilar system, and present the case of a 59-year-old woman with right-sided trigeminal neuralgia and hemifacial spasm. Using a novel sequence, a dilated and severely elongated vertebrobasilar artery was demonstrated by magnetic resonance imaging(MRI) and magnetic resonance angiography(MRA). During microvascular decompression, the findings of MRI were confirmed and decompression with teflon sheets between the nerves and offending arteries was successfully achieved. Postoperatively, the patient was relieved of pain and twitching.
Arteries ; Decompression ; Female ; Hemifacial Spasm ; Humans ; Magnetic Resonance Imaging ; Microvascular Decompression Surgery* ; Middle Aged ; Polytetrafluoroethylene ; Tics* ; Trigeminal Neuralgia

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

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