No abstract available.
Measles*

Acute infarcts of the anterior inferior cerebellar artery (AICA) territory are unusual. Furthermore incomplete AICA infarcts are perplexing because of its variations of vascular anatomy and inconsistent clinical features. We present a case with clinical features of AICA infarction, which consist of ipsilateral peripheral-type facial palsy, vertigo, and contralateral facial and upper limb sensory changes without motor weakness. The patient had hypertension and was a current smoker. The high signal intensity on inferior pontine tegmental area was found on MRI and the R2 interneuronal dysfunction was note on Blink reflex. The angiographic findings didn't show any focal vascular lesions, which is contrary to the pathogenesis of AICA infarction published previously. On the clinical ground, the present case reserves to attention in that patients with peripheral-type facial palsy should be properly evaluated and with thorough neurological examination and we could differentiate between the incomplete AICA infarcts such as Gasperini syndrome and Bell's palsy.
Arteries ; Bell Palsy ; Blinking ; Facial Paralysis* ; Humans ; Hypertension ; Infarction ; Interneurons ; Magnetic Resonance Imaging ; Neurologic Examination ; Upper Extremity ; Vertigo

Background AND PURPOSE: Status epilepticus (SE) is one of the major neurological emergency that requires immediate treatment to avoid significant morbidity and mortality. Thus, understanding the cause, features and prognosis of SE is important for the evaluation and treatment of this condition. We retrospectively reviewed the possible cause and clinical outcome of adult patients treated for SE at the Hallym Univrsity Hospital from 1994 to 1998. METHODS: For the identification of patients, we searched the data bank for patients meetinf criteria of SE who were 18 year or older, and their medical records were reviewed. We also investigated the relationships between cause, response to anticonvulsant therapy and short-term clinical outcome. RESULTS: The selected 127 patients wer 84 males and 43 females, aged 18 to 85 yeats (meen age: 49.5 years). The possible etiologies of SE were withdrawal of AED (n=27, 21.3%), anoxia (n=22, 17.3%), CNS infection (n=20, 15.7%), stroke (n=16, 12.6%), alcohol-related (n=15, 11.8%), metabolic (n=8, 6.3%), unknown (n=7, 5.5%), drug inroxicatio (n=5, 3.9%), trauma (n=4, 3.2%) and cerebral tumor (n=3, 2.4%). in 77 patients (n=77, 60.6%), SE was successfully aborted with first-line therapy, which usually included diazepam with or without phenytoin. The food responders to AEDs occurred in patients with AED withdrawal, alcohol-related, stroke, unknown, and trauma, The poor response related to anoxia, drug intoxication and CNS infection. Seventy nine patients (62.2%) had food outcome, but nineteen patients (14.9) were died. Anoxia, drug intoxication, CNS infection and metabolic abnormalities were associated with particularly poor outcome compared with other etiologies. CONCLUSION: This study indicates that the etiology of SE may help predict both the intial response to drug therapy and short-term clinical outcome.
Adult* ; Anoxia ; Diazepam ; Drug Therapy ; Emergencies ; Female ; Humans ; Male ; Medical Records ; Mortality ; Phenytoin ; Prognosis ; Retrospective Studies ; Status Epilepticus* ; Stroke

Cerebral rete mirabile is an entity of particular disease which showed the specific angiographic findings. Many authors have been reported this disease with various discussion in opinion. It's exact pathogenesis and etiology were however unable to establish. Authors had experienced a total of 10 cases with cerebral rete mirabile from 3 period of 1973 to 1977, which were confirmed by cerebral angiography. We attempted to analyze it clinically and discussed with the review of literature. The result were summarized as following; 1) In age and sex distribution, 8 patients were over 20 years old age and 2 cases were below 20. 7 cases were female and 3 male. 2) Majority of cases(8 of 10 cases) were accompanied with subarachnoid hemorrhage and only 2 cases were non-hemorrhagic which all were over 20 years. 3) In 8 cases with subarachnoid hemorrhage initial symptoms were mainly impairment of consciousness and signs of meningeal irritation such as headache and vomiting etc. Other common initial symptoms in both non-hemorrhagic and hemorrhagic cases were hemiparesis, speech disturbance and seizure. 4) All cases disclosed the characteristic angiographic findings of cerebral rete mirabile. A patient showed nonfilling of left carotid system and anomaly of left vertebral artery. Aneurysm of anterior communicating artery was combined in other case. It is our consideration that vertebral angiography must be helpful in this disease to demonstrate the collateral circulation and an abnormal findings of vertebrobasilar system.
Aneurysm ; Angiography ; Arteries ; Cerebral Angiography ; Collateral Circulation ; Consciousness ; Female ; Headache ; Humans ; Male ; Paresis ; Seizures ; Sex Distribution ; Subarachnoid Hemorrhage ; Vertebral Artery ; Vomiting ; Young Adult

BACKGROUND: The anterior spinal artery infarction constitutes a classical syndrome of vascular myelopathy. The causes of the anterior spinal artery syndrome are various, but most episode probably occur as the result of atherosclerosis or dissection of the aorta and its branches. However, few cases reported developed with spinal structural abnormalities. CASE: A 65-year-old man presented with sudden paraparesis. There was no evidence of hypertension, diabetes and smoking. Motor weakness was more prominent on the left side and progressed. Loss of pain and temperature senses were shown at the level of 71 with preservation of touch, joint perception and vibration senses. The DTR's of legs were depressed and extensor toe signs were presented. A C-spine MRI showed high signal intensity on 72 weighted image and low signal on 71 weighted image(C6-71) with cervical spinal stenosis at the C4-C7 spinal level and mild cervical disc protrusion (C6-C7, C7-T1). After three months later, follow up cervical MRI showed somewhat decreased size of high signal intensity on 72 weighted image and more prominent low signal on 71 image. DISCUSSION: In our case, we could not find any usual cause of anterior spinal artery infarction. However only cervical spinal stenosis associated with mild cervical disc protrusion was present. In stenotic cervical canal, the anterior spinal artery can be more vulnerable to extrinsic compression and the infarction may early develop with insignificant trigger event, such as disc protrusion. We concluded that the ischemic change of anterior two thirds of cervical spinal cord might develop due to the compression of the anterior spinal artery by cervical stenosis and mild cervical intervertebral disc protrusion.
Aged ; Anterior Spinal Artery Syndrome* ; Aorta ; Arteries ; Atherosclerosis ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Hypertension ; Infarction ; Intervertebral Disc ; Joints ; Leg ; Magnetic Resonance Imaging ; Paraparesis ; Smoke ; Smoking ; Spinal Cord ; Spinal Cord Diseases ; Spinal Stenosis* ; Toes ; Vibration

Rhino-orbito-cerebral mucormycosis is an uncommon fulminant fungal infection that occurs usually in debilitated or immune suppressed patients. Intracranial lesions such as cerebral ischemia mostly develop secondary to vascular injuries like thrombosis of cavernous sinus or internal carotid artery and also from arteritis. However, intracranial hemorrhage complicated by mucormycosis is very rare. We report a patient with a fatal complicaton of intracranial hemorrhage presumably due to arteritis by mucormycosis. A 66-year-old female patient with uncontrolled diabetes mellitus developed complete ophthalmoplegia in her left eye for two days. Rhinoscopic examination revealed black necrotic turbinate. Orbital CT scan and Brain MRI showed soft tissue material at the left orbital apex and mild deformities in the left lateral cavernous sinus. On the basis of radiological evidence and biopsy, a diagnosis of mucormycosis was established, and the patient underwent surgical debridement followed by an Amphotericin B infusion. On the following day, she suddenly developed a right hemiparesis and stupor. An immediate brain CT scan revealed a large intracranial hemorrhage in the left frontal head region. Removal of the hematoma and a biopsy was performed immediately. A pathological examination revealed a fungal invasion of the small arterial wall and an acute inflammatory reaction of the surounding tissues.
Aged ; Amphotericin B ; Arteritis ; Biopsy ; Brain ; Brain Ischemia ; Carotid Artery, Internal ; Cavernous Sinus ; Congenital Abnormalities ; Debridement ; Diabetes Mellitus ; Diagnosis ; Female ; Head ; Hematoma ; Humans ; Intracranial Hemorrhages* ; Magnetic Resonance Imaging ; Mucormycosis* ; Ophthalmoplegia ; Orbit ; Paresis ; Stupor ; Thrombosis ; Tomography, X-Ray Computed ; Turbinates ; Vascular System Injuries

OBJECTIVE: To investigate the effects of obturator nerve blocks with ultrasound guided intraneural alcohol injection. METHOD: Nine quadriplegic patients suffering hip adductor spasticity were included in this study. The obturator nerve was identified at just below inguinal ligament area on anteromedial surface of upper leg at supine position. An 23 G needle was inserted into anterior branch of obturator nerve under real time ultrasonography. The 50% alcohol solution was injected 3~5 ml at a time within the epineurium of the anterior branch of obturator nerve until the expanding nerve was visualized. We examed modified Ashworth scale (MAS) of hip adductor and passive range of movement of hip abduction at supine position at study entry, 1, 4, and 12 weeks after ultrasound guided intraneural injection. RESULTS: There were statistically significant improvement was seen in MAS of hip adductors and hip abduction angle at 1, 4, and 12 weeks after ultrasound guided intraneural injection, compared with parameters measured at previous injection (p<0.05). CONCLUSION: Ultrasound guided intraneural alcohol injection into anterior branch of obturator nerve for treatment of hip adductor spasticity in patients with quadriplegia is an effective and safe procedure for relieving localized spasticity of the hip adductors.
Hip ; Humans ; Leg ; Ligaments ; Muscle Spasticity ; Needles ; Obturator Nerve ; Peripheral Nerves ; Quadriplegia ; Stress, Psychological ; Supine Position

Infective endocarditis is rare in end-stage renal disease (ESRD) patients, who have a poorer prognosis than the general population. Candida endocarditis is rare and has a poor prognosis among causes of infective endocarditis. A 45-year-old male was admitted with sepsis combined with a hematoma on his right back. Candida famata was cultured in his blood. We treated him with antifungal agents. Echocardiography was performed to identify vegetations and diagnose endocarditis. In this case, surgical therapy was impossible because the patient's condition had deteriorated. We also administered antibiotics because methicillin-resistant Staphylococcus aureus was cultured from his sputum and a perianal abscess. The symptoms did not improve despite the ongoing treatment. Metabolic acidosis, hypotension, and a decreased state of consciousness developed and he died. We report a rare case of Candida endocarditis in an ESRD patient on hemodialysis.
Abscess ; Acidosis ; Anti-Bacterial Agents ; Antifungal Agents ; Candida* ; Consciousness ; Echocardiography ; Endocarditis* ; Hematoma ; Humans ; Hypotension ; Kidney Failure, Chronic* ; Male ; Methicillin-Resistant Staphylococcus aureus ; Middle Aged ; Prognosis ; Renal Dialysis ; Sepsis ; Sputum

PURPOSE: We evaluated the results of arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures without cortical window along with any additional bone grafts. MATERIALS AND METHODS: From March 2006 to March 2009, twelve patients with arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures over 5 mm in depression and displacement on the articular surface in computed tomography (CT) were enrolled in this study. We reduced or removed the depressed fracture fragment using freer without making a cortical window. Then, we accomplished internal fixation by a cannulated screw. All cases have not received bone graft. Both the postoperative clinical and radiological results were evaluated by the Rasmussen system. RESULTS: The fractures were healed completely in an average of 9 (range from 7 to 12) weeks. According to Rasmussen classification, we obtained satisfactory clinical results as excellent in 8 cases, good in 3 cases, and fair in 1 case; and radiological results were excellent in 7 cases and good in 5 cases. CONCLUSION: We consider that arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures without cortical window and any additional bone grafts is are a useful methods for attaining satisfactory results.
Arthroscopy ; Depression ; Displacement (Psychology) ; Humans ; Knee Joint ; Tibia ; Tibial Fractures ; Transplants

Eleven cases of paragonimus brain abscess which were surgically treated from 1975 to 1978 were reviewed. All patients received supplementary bithionol therapy. Ten patient's clinical condition improved. Only one patient died due to post operative wound infections.
Bithionol ; Brain Abscess* ; Brain* ; Humans ; Paragonimus* ; Wound Infection