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

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.
Brain Injuries* ; Brain* ; Dentate Gyrus*

No abstract available.
Epilepsy

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

PURPOSE: In this study, a case of toxic encephalopathy and optic neuropathy due to methyl bromide poisoning is reported. CASE SUMMARY: A 31-year-old male presented with dysarthria, gait disturbance and bilateral visual impairment. He was treated with intravenous methylprednisolone for bilateral optic neuritis 1 year prior. He previously worked in a fumigation warehouse and was exposed to methyl bromide in the past 3 years. His corrected visual acuity was 20/30 in both eyes. The patient had reduced color vision and enlarged central scotoma in both eyes. His mentality was alert but exhibited slow response, ataxia and dysarthria. Brain magnetic resonance imaging (MRI) revealed high signals in the brainstem, cerebellum and midbrain. His serum and urine methyl bromide concentrations were significantly elevated. The patient was treated with intravenous methylprednisolone 1.0 g/day for 5 days. MRI showed resolution of the multiple brain lesions observed previously. Ten days after steroid therapy, his visual acuity was 20/20 in both eyes and his neurologic manifestations were completely recovered at 2 months after treatment. CONCLUSIONS: Taking a detailed occupational history is necessary in patients with optic neuropathy. The probability of toxic optic neuropathy should be considered when patients are exposed to toxic materials.
Adult ; Ataxia ; Brain ; Brain Stem ; Cerebellum ; Color Vision ; Dysarthria ; Fumigation ; Gait ; Humans ; Magnetic Resonance Imaging ; Male ; Mesencephalon ; Methylprednisolone ; Neurologic Manifestations ; Neurotoxicity Syndromes ; Optic Nerve Diseases* ; Optic Neuritis ; Poisoning ; Scotoma ; Vision Disorders ; Visual Acuity

Clinical education is difficult for actual practice of medical students. In particular, the practice in the field of obstetrics is more difficult to many students. Moreover, the education of sub-fields of obstetrics such as birth or abortion needs many materials of women's reproductive organs. However, the ordinary paper-based textbooks have some limitations for clinical education of obstetrics. The electronic textbook system based on multimedia data enables that many student, doctor, and public user overcome these difficulties, as a computer assisted learning. We developed multimedia database system which is connected with web using ODBC(Open DataBase Connectivity)and ASP(Active Server Page)/IDC(Internet DataBase Connection). Many text and multimedia data are gathered in the database. This system serves various multimedia data using internet and intranet in the student's class or home. In conclusion, providing multimedia data of obstetrics using ODBC, ASP/IDC method reduce the limitation of clinical education. This model of the electronic textbook would be a reference to develop multimedia database on the network.
Computer Communication Networks ; Education ; Humans ; Internet ; Learning ; Multimedia* ; Obstetrics ; Parturition ; Students, Medical

Electroencephalography (EEG) has been used for decades to evaluate and assess brain function. It is a useful method to diagnose brain disorders. However, confirmed interpretation of EEG is quite challenging because there is no standardized method for EEG reading and this may lead to interrater variability even among expert electroencephalographers. In this background, uniformly accepted nomenclature for EEG pattern were required to improve interrater agreement and to support communication for EEG research. American Clinical Neurophysiology Society (ACNS) established the standardized critical care EEG terminology since 2012 and has recently published the revised 2021 version of EEG terminology. This review covers new concepts of 2021 ACNS EEG terminology and clinical considerations of various EEG patterns.

Poststroke epilepsy is the most common cause of epilepsy in adult. Acute symptomatic seizure is a provoked seizure usually caused by systemic metabolic disorders. If stroke patient has a seizure, it is very important to discriminate whether it is a poststroke epilepsy or provoked seizure. The reason is that there are differences in the approach to treatment and the continuation of antiepileptic drugs. We report a stroke mimic patient who had two different mechanisms of focal seizures.

Narcolepsy is characterized by excessive daytime sleepiness, cataplexy, sleep paralysis and hypnagogic hallucinations. Only a few studies have focused on non-rapid eye movement (NREM) and REM parasomnias in narcolepsy. We report a narcolepsy without cataplexy patient presenting parasomnia as an initial symptom. A 18-year-old boy was admitted to hospital for abnormal behavior of sitting up during sleep over 2 years. He had a symptom of lethargy without cataplexy and subjective excessive daytime sleepiness, but his family found him often asleep during daytime. He underwent 3 times of polysomnography (PSG) including 1 multiple sleep latency test (MSLT) after the last PSG. The last PSG showed 1 episode of abrupt sitting. Three sleep REM onset period was observed in MSLT which was not detect in PSG. Parasomnia as an initial symptom of narcolepsy is a rare clinical entity. The MSLT may be useful in the evaluation of patients with parasomnia and unexplained hypersomnia.
Adolescent ; Cataplexy ; Disorders of Excessive Somnolence ; Eye Movements ; Hallucinations ; Humans ; Lethargy ; Male ; Narcolepsy ; Parasomnias ; Polysomnography ; Sleep Arousal Disorders ; Sleep Paralysis