The most frequently reported neurological complication of a wasp sting is ischemic stroke. We treated a patient with wasp sting with unusual complications. A 52-year-old man was hospitalized for anaphylactic shock after multiple wasp stings. Although the patient recovered consciousness after 2 days, he had global aphasia and right hemiparesis. Brain magnetic resonance imaging and angiography revealed high-intensity signals in the left basal ganglia and cerebral cortex and stenosis of the left middle cerebral artery. After 2 days, the middle cerebral artery stenosis improved. After 5 days, diffusion-weighted imaging showed an enlarged lesion in the left frontal cortex. The infarct in this case was due to a predominantly unilateral vasoconstrictive hypoxic brain injury from wasp stings.
Brain Injuries

No abstract available.
Brain Injuries* ; Brain* ; Dentate Gyrus*

Atherosclerotic lesions at the aortic arch are recognized as critical sources of embolic strokes. However, there have been few case reports of aortic arch thrombus occurring without atherosclerotic changes, especially those related to iron deficiency anemia (IDA). A 44-year-old woman was admitted due to rapid-onset right hemiparesis and aphasia. Etiological investigations for cerebral infarction revealed no abnormality other than IDA. This is a rare case of cerebral embolic infarction caused by an aortic arch thrombus with IDA in a middle-aged woman.
Adult ; Anemia, Iron-Deficiency* ; Aorta, Thoracic* ; Aphasia ; Cerebral Infarction ; Female ; Humans ; Infarction* ; Iron* ; Paresis ; Stroke ; Thrombosis*

No abstract available.
Epilepsy

No abstract available.
Reflex* ; Seizures* ; Subarachnoid Hemorrhage*

PURPOSE: In hemodynamically unstable patients, tissue perfusion is decreased and various means of continuous observation are required. However, prior methods for observing hemodynamic instability are invasive and/or difficult for continual observation. The present study evaluated the usefulness of the perfusion index (PI) in monitoring hemodynamically unstable patients in the emergency department. METHODS: From December, 2009 to April, 2010, patients admitted to our hospital emergency department with signs of hemodynamic instability were studied. Vital signs and stroke volume index (SVI) and cardiac index (CI) were measured, and PI was continuously monitored by a Radical-7 pulse oximeter (Masimo, USA). Each variable was measured 1 hour before and after treatment, and treatment methods included fluid therapy and vasoconstrictors, according to the patient condition. Status on changes and correlation between variables following treatment were confirmed through the Wilcoxon rank test and Spearman correlation test, respectively. The standard level of significance was p<0.05. RESULTS: Of the 26 patients, 19 were male (73.1%), with an average age of 68.54+/-14.32 years. Significant changes in each variable 1 hour before and after treatment were mean arterial pressure 53.51+/-8.29mmHg / 74.68+/-12.95 mmHg (p<0.001), SVI 26.70+/-14.04/34.27+/-13.56(p<0.001), CI 2.12+/-1.02/3.12+/-1.53(p<0.001), and PI 1.23+/-1.00/1.77+/-1.32(p<0.001). Variations of heart rate (R=-0.430, p=0.032) and SVI (R=0.432, p=0.031) were correlated to the variation of PI (dPI). CONCLUSION: PI may be useful in monitoring hemodynamically unstable patients in the ER.
Arterial Pressure ; Cardiac Output ; Emergencies ; Fluid Therapy ; Heart Rate ; Hemodynamics ; Humans ; Male ; Oximetry ; Perfusion ; Stroke Volume ; Vasoconstrictor Agents ; Vital Signs

PURPOSE: In hemodynamically unstable patients, tissue perfusion is decreased and various means of continuous observation are required. However, prior methods for observing hemodynamic instability are invasive and/or difficult for continual observation. The present study evaluated the usefulness of the perfusion index (PI) in monitoring hemodynamically unstable patients in the emergency department. METHODS: From December, 2009 to April, 2010, patients admitted to our hospital emergency department with signs of hemodynamic instability were studied. Vital signs and stroke volume index (SVI) and cardiac index (CI) were measured, and PI was continuously monitored by a Radical-7 pulse oximeter (Masimo, USA). Each variable was measured 1 hour before and after treatment, and treatment methods included fluid therapy and vasoconstrictors, according to the patient condition. Status on changes and correlation between variables following treatment were confirmed through the Wilcoxon rank test and Spearman correlation test, respectively. The standard level of significance was p<0.05. RESULTS: Of the 26 patients, 19 were male (73.1%), with an average age of 68.54+/-14.32 years. Significant changes in each variable 1 hour before and after treatment were mean arterial pressure 53.51+/-8.29mmHg / 74.68+/-12.95 mmHg (p<0.001), SVI 26.70+/-14.04/34.27+/-13.56(p<0.001), CI 2.12+/-1.02/3.12+/-1.53(p<0.001), and PI 1.23+/-1.00/1.77+/-1.32(p<0.001). Variations of heart rate (R=-0.430, p=0.032) and SVI (R=0.432, p=0.031) were correlated to the variation of PI (dPI). CONCLUSION: PI may be useful in monitoring hemodynamically unstable patients in the ER.
Arterial Pressure ; Cardiac Output ; Emergencies ; Fluid Therapy ; Heart Rate ; Hemodynamics ; Humans ; Male ; Oximetry ; Perfusion ; Stroke Volume ; Vasoconstrictor Agents ; Vital Signs

BACKGROUND: Solid tumors require neovasculization for growth and metastasis. Recently, several angiogenic factors have been identified. Vascular endothelial growth factor (VEGF) is thought to be one such angiogenic factor and is also thought to be a selective mitogen for endothelial cells. In this study, we examined the expression of VEGF and its relationship with microvessel density, and we also determined its prognostic significance in gastric cancer patients. METHODS: One hundred one specimens resected from patients with gastric carcinomas were investigated by staining with a polyclonal antibody against VEGF. Correlations between the expression of VEGF, the microvessel density, various clinicopathologic factors, and the patient's survival were studied. RESULTS: The normal gastric mucosa was not immunoreactive with an anti-VEGF antibody. VEGF was mainly localized to the cytoplasm or the membrane of the carcinoma cell. Of the 101 tumors, strong VEGF expression was detected in 48 (47.5%) tumors. VEGF expression was correlated with depth of tumor invasion, lymph-node metastasis, and stage. Microvessel density, determined by immunohistochemical staining for CD31, was significantly higher in VEGF-strong tumors than in VEGF-weak tumors. Also, patients with VEGF-strong tumors had a significantly poorer prognosis than those with VEGF-weak tumors. However, multivariate analysis indicated that the expression of VEGF was not an independent prognostic factor in patients with gastric cancer. CONCLUSIONS: The fact that VEGF expression in gastric carcinomas was more prevalent in more advanced tumors means that VEGF may contribute to the progression of the tumor. Further study is needed to evaluate the significance of VEGF as a prognostic factor.
Angiogenesis Inducing Agents ; Cytoplasm ; Endothelial Cells ; Gastric Mucosa ; Humans ; Membranes ; Microvessels ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis* ; Stomach Neoplasms ; Vascular Endothelial Growth Factor A*

Wernicke encephalopathy is usually accompanied with peripheral neuropathy, known as dry beriberi. In contrast, wet beriberi presenting as cardiovascular symptoms rarely occurs. The acute type of wet beriberi can be fatal, if untreated quickly. It is reported that the cerebellar vermis has a role of the coordination and control of cardiovascular and autonomic reflex activities. We report a 58-year-old man showing acute wet beriberi in Wernicke encephalopathy with cerebellar vermis lesion.
Beriberi* ; Cerebellar Vermis ; Humans ; Middle Aged ; Peripheral Nervous System Diseases ; Reflex ; Wernicke Encephalopathy*

Paraneoplastic encephalitis presenting with partial clonic seizure is rare. We report a 57-year-old man with clonic seizure in his left arm. He had past medical history of recurrent thymoma and thymomectomy. Magnetic resonance imaging showed multiple brain lesions, but none of them were congruent with the partial seizure. His symptoms and brain lesions resolved after steroid therapy. This is the first reported case extralimbic encephalitis presenting as partial seizure with invasive thymoma in Korea.
Arm ; Brain ; Encephalitis* ; Humans ; Korea ; Magnetic Resonance Imaging ; Middle Aged ; Nervous System ; Paraneoplastic Syndromes ; Seizures* ; Thymoma*