BACKGROUND: Acute posthypoxic myoclonic seizure is not an uncommon presentation in clinical practices. However, there have been only a few reports which include detailed description on the treatment of acute posthypoxic myoclonic status. METHODS: We retrospectively analyzed the etiology, clinical course, nature and duration of myoclonus after hypoxic brain damage during a ten year period from 1992 to 2002. Patients who had possible explanations for myoclonic seizure other than hypoxic-ischemic events were excluded. RESULTS: Eighty-two patients aged 24 to 81 years old were included in this study. All but 3 patients with pulmonary edema had a history of cardiorespiratory arrest caused by probable cardiogenic origin, acute asthma attack and upper airway obstruction. Ictal EEGs demonstrated intermittent generalized spike and polyspike activities or biPLEDs. Most patients died within a week and 6 patients remained in persistent vegetative states. The clinical outcome was not affected by the drug response of myoclonic status epilepticus or etiology of hypoxia. CONCLUSIONS: Posthypoxic myoclonic status reflects severe and diffuse cortical damage, and implies a very poor prognosis. It may be a transient manifestation of severe cortical damage before massive and irreversible neocortical neuronal death, and aggressive anticonvulsant drug treatment would not be necessary in most patients.
Aged, 80 and over ; Airway Obstruction ; Anoxia ; Asthma ; Electroencephalography ; Humans ; Hypoxia, Brain ; Myoclonus ; Neurons ; Persistent Vegetative State ; Prognosis ; Pulmonary Edema ; Retrospective Studies ; Seizures ; Status Epilepticus*

A 37-year-old male patient was transferred from a local orthopedic clinic due to status epilepticus following a myelography with diatrizoate. On his laboratory findings, metabolic acidosis was prominent. Non-enhanced brain CT scan showed a high densinty in the subarchnoid space. With careful respiratory support, hydration, correction of acid-base balance, administration of dexamethasone, and anticonvulsant therapy, he completely recovered after 3 days. Diatrizoate is an ionic, iodinated and hyperosmolar X-ray contrast medium. It must not be injected intrathecally because of the risk to the central nervous system. The possible mechanisms are anaphylactic reaction due to iodine hypersensitivity, hyperosmolar effect, and direct chemotoxicity by ionicity and chemical structure itself.
Acid-Base Equilibrium ; Acidosis ; Adult ; Anaphylaxis ; Brain ; Central Nervous System ; Dexamethasone ; Diatrizoate* ; Humans ; Hypersensitivity ; Injections, Spinal ; Iodine ; Male ; Myelography ; Orthopedics ; Status Epilepticus* ; Tomography, X-Ray Computed

PURPOSE: To report a case of recurrent external ophthalmomyiasis caused by Lucilia sericata Meigen in a healthy patient. CASE SUMMARY: A 72-year-old male, who was diagnosed 7 months earlier with ophthalmomyiasis and obtained permanent relief by surgical treatment, presented with severe tearing, redness, foreign body sensation, pain in both eyes and aural discomfort in the left ear. On presentation, visual acuity in both eyes was hand movement. On slit lamp examination, total corneal epithelial defect with stromal infiltrations was observed. However, there were no motile organisms in his eyes due to previous removal of maggots at a local clinic. On physical examination, eschar change was observed at the inferomedial area of the left lower eyelid. On otorhinolaryngological examination, several motile organisms with tympanic membrane perforation were observed in the left external acoustic meatus. The patient was treated with topical antibiotic eye drops hourly with systemic antibiotics, and 6 larvae were removed from the external acoustic meatus using otoscopy. Microscopic findings of the removed larvae revealed L. sericata in their third stage of development. After 1 month, corneal epithelial defect and stromal infiltration improved. However, visual acuity in both eyes was 0.1 due to remaining stromal opacities. CONCLUSIONS: In a healthy patient without any predisposing factors, recurrent ophthalmomyiasis accompanied with aural myiasis can develop under poor hygiene conditions.
Aged ; Anti-Bacterial Agents ; Causality ; Ear ; Ear Canal ; Eyelids ; Foreign Bodies ; Hand ; Humans ; Hygiene ; Larva ; Male ; Myiasis ; Ophthalmic Solutions ; Otoscopy ; Physical Examination ; Sensation ; Tears ; Tympanic Membrane Perforation ; Visual Acuity

The portosystemic venous shunts within the hepatic parenchyma, a rare disease can lead to hepatic encephalopathy. The etiology of intrahepatic portosystemic venous shunt may be either congenital or acquired such as secondary to portal hypertension due to chronic liver damage. A 61-year-old women was admitted to our hospital with recurrent encephalopathy. Liver function tests, abdominal computerized tomography, ultrasound and arterial portography revealed an intrahepatic portosystemic venous shunt in a noncirrhotic liver. Thus, recurrent encephalopathy should be closely evaluated for detection of rare causes.
Female ; Hepatic Encephalopathy* ; Humans ; Hypertension, Portal ; Liver ; Liver Function Tests ; Middle Aged ; Portography ; Rare Diseases ; Ultrasonography

Beau's line is a grooved transverse line on the fingernail or toenail, and is considered as a kind of nail disorder, It is known to occur with temporary arrest of nail matrix proliferation. The causes of Beau's line comprise severe systemic illness as well as drug ingestion. A 51-year-old male patient had developed Beau's line on all his fingers after about three months of oxcarbazepine administration. These nail changes disappeared spontaneously with nail growth two months later. The authors report a case of oxcarbazepine induced Beau's line.
Carbamazepine ; Eating ; Fingers ; Humans ; Male ; Middle Aged ; Nails

OBJECTIVE: To report successful cases of extubation from invasive mechanical ventilation at our institution using pulmonary rehabilitation consisting of noninvasive ventilation (NIV) in neuromuscular patients with experience of reintubation. METHODS: Patients who experienced extubation failure via the conventional weaning strategy but afterwards had extubation success via NIV were studied retrospectively. Continuous end-tidal CO₂ (ETCO₂) and pulse oxyhemoglobin saturation (SpO₂) monitoring were performed. Extubation success was defined as a state not requiring invasive mechanical ventilation via endotracheal tube or tracheotomy during a period of at least 5 days. RESULTS: A total of 18 patients with ventilatory failure who initially experienced extubation failure were finally placed under part-time NIV after extubation. No patient had any serious or long-term adverse effect from NIV, and all patients left the hospital alive. CONCLUSION: NIV may promote successful weaning in neuromuscular patients with experience of reintubation.
Humans ; Neuromuscular Diseases* ; Noninvasive Ventilation* ; Oxyhemoglobins ; Rehabilitation ; Respiration, Artificial ; Retrospective Studies ; Tracheotomy ; Weaning*

Transvenous embolization has become the treatment of choice for cavernous sinus dural arteriovenous fistula(cDAVF). However, there are potential complications associated with this procedure such as cranial nerve palsies and venous perforations. A 66-year-old woman presented with a 2-week left periorbital swelling and conjunctival injection. Brain MRI showed engorgement of the left superior ophthalmic vein. Cerebral angiography revealed a dural arteriovenous shunt of the cavernous sinus with retrograde venous drainage into the superior ophthalmic vein. Her proptosis and conjunctival injection resolved completely after transvenous embolization of cDAVF. However, an abducens nerve palsy developed the day after the procedure, which, fortunately, resolved spontaneously. She was symptom-free at the follow- up evaluation 2 months later. The abducens nerve palsy related to the transvenous embolization of cDAVF was presu- med due to either dense packing of the sinus, venous thrombosis, or direct nerve injury. We report a case of transient abducens nerve palsy associated with transvenous embolization of cDAVF, suggesting the benign course of this com- plication.
Abducens Nerve ; Abducens Nerve Diseases ; Aged ; Brain ; Cavernous Sinus ; Caves ; Central Nervous System Vascular Malformations ; Cerebral Angiography ; Cranial Nerve Diseases ; Drainage ; Exophthalmos ; Female ; Humans ; Veins ; Venous Thrombosis

A 61-year-old woman was presented with fever and pain in both flanks. Computed tomography (CT) revealed a septated heterogenous giant mass suggesting a huge suprarenal cyst. Percutaneous drainage was performed. Escherichia coli was cultured in blood, urine and aspirated fluid from the cyst. Therefore, it was initially diagnosed as infected renal cyst with acute pyelonephritis. However, follow-up CT after drainage of the cyst and surgical findings revealed the cyst grew not from the kidney but from the adrenal gland. Postoperative finding and pathologic study confirmed it was originated from adrenal. We describe a case of E.coli infected huge adrenal pseudocyst misunderstood as an infected renal cyst because of indistinct anatomical boundary and association with acute pyelonephritis.
Adrenal Glands ; Bacteremia* ; Drainage ; Escherichia coli ; Female ; Fever ; Follow-Up Studies ; Humans ; Kidney ; Middle Aged ; Pyelonephritis*

BACKGROUND: Hyperhomocysteinemia increase the risk of vascular disease, dementia and cognitive impairment. The effect of homocysteine on cognitive function may be as a consequence of direct neurotoxicity or indirectly through cerebrovascular disease. Thus we examined the association between homocysteine levels and cognitive function, and assess whether this may be mediated by cerebral white matter lesions. METHODS: Non-dementic participants were recruited from March to December 2005, and underwent brain MRI. White matter hyperintensities(WMH) were rated visually by 4-class WMH grades. Informations of age, gender, education and vascular risk factor were obtained from interview. Cognitive function were assessed by using K-MMSE and HDS-R. The cross-sectional relationship between homocysteine level and cognitive test score was assessed by multiple regression analysis. RESULTS: Severe WMH groups more exposed to vascular risk factor such as age, hypertension and higher levels of homocyteine. More severe WMH grades also had lower K-MMSE and HDS-R score. Higher group of homocysteine concentration were significantly related to poorer performances on K-MMSE and HDS-R tests. In multiple linear regression analyses for the relationship between homocysteine and cognitive performances, higher homocysteine level was also related to lower cognitive performances. Adding cerebral WMH changes to the level of homocysteine did not significantly change the effect of homocysteine on cognitive ability, and cerebral WMH had a separate and additive effect with homocysteine. CONCLUSIONS: Elevated homocysteine level is associated decreased cognitive score and cerebral white matter lesion on MRI is independent association to the cognitive abilities.
Brain ; Dementia ; Education ; Homocysteine* ; Hyperhomocysteinemia ; Hypertension ; Linear Models ; Magnetic Resonance Imaging ; Risk Factors ; Vascular Diseases

PURPOSE: Retinal blood vessels and cerebral small vessels possess similar characteristics anatomically, physiologically and embryologically. We studied the availability of abnormal fundus findings of patients who had an atherothrombotic ischemic stroke and who have the risk factors. METHODS: Fundus photographs and brain images were taken in patients who had a first-ever symptomatic ischemic stroke of large artery atherosclerosis (LAA) or small vessel occlusion (SVO) from March 2004 to February 2005. We analyzed the association between fundus abnormalities and ischemic stroke subtypes. RESULTS: Based on brain MRI and MRA, a total of 47 patients were classified into SVO and LAA groups. The SVO group consisted of 27 patients (mean age: 69.7 years), and the LAA group consisted of 20 patients (mean age: 65.4 years). The control group comprised 15 patients (mean age: 64.9 years). The baseline characteristics were similar among the three groups. The severity of the retinal arteriolar narrowing and sclerosis were associated with hypertension. Compared to the control group, both the SVO and LAA groups showed more severe arteriolar sclerosis, the SVO group showed more severe arteriolar narrowing and the LAA group showed more frequent AV crossing and retinal exudate. CONCLUSIONS: Retinal arteriolar abnormalities such as arteriolar narrowing and sclerosis are more severe in atherothrombotic ischemic stroke patients. Indirectly, retinal microvascular changes may indicate the status of the cerebral vasculature. Thus, analysis of fundus findings is useful for predicting an atherothrombotic ischemic stroke and planning follow-up examinations.
Arteries ; Arterioles* ; Atherosclerosis ; Brain ; Exudates and Transudates ; Follow-Up Studies ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Retinal Vessels ; Retinaldehyde* ; Risk Factors ; Sclerosis ; Stroke*