BACKGROUND: The relationship between the anterior site of acute myocardial infarction(MI) and occurrence of stroke has become a recent subject of much debate in the relevant literature. The object of this study was to examine the incidence of ischemic stroke during the hospitalization after an acute MI and to identify predictors of MI-related stroke. METHOD: We performed retrospective analysis of 452 patients with acute MI admitted to department of Neurology or Cardiology from January 1990 to August 1997. Patients with a stroke during hospitalization after acute MI were recruited for this study. RESULT: Thirteen cases were recorded. Seventy-seven percent (10/13) of the strokes occurred within 4 days after onset of MI. Multivariate analysis identified the following as independent predictors of stroke : History of hypertension(OR. 2.6: CI, 1.1 to 5.9), previous stroke(OR, 22.3: CI, 5.9 to 84.9) and congestive heart failure (CHF)(OR, 15.4: CI, 2.2-108.6). Transthoracic echocardiography(TTE) was performed in 349/452(77%) during hospitalization. The incidence of left ventricular thrombosis(LVT) in patients with anterior MI who received thrombolytic and anticoagulant therapy was not significantly different from that in patients with anterior MI who didn't(2.6% vs 6.1%, p=0.265). Stroke developed in only one of these patients with LVT. Thrombolytic and anticoagulant therapy were more frequently used in patients without stroke compared with stroke.(p<0.05). CONCLUSION: The incidence of stroke after acute MI is 2.9% and more frequent within the 4 days after MI. History of hypertension, previous stroke and congestive heart failure (CHF) were the factors independently favoring the occurrence of stroke, but there is no relation between the occurrence of stroke and anterior site of MI. Although intravenous thrombolytics followed by full anticoagulation treatment appeared to provide protection against ischemic stroke, it has no effect in the incidence of left ventricular thrombi in this study.
Cardiology ; Heart Failure ; Hospitalization ; Humans ; Hypertension ; Incidence ; Multivariate Analysis ; Myocardial Infarction* ; Neurology ; Retrospective Studies ; Stroke*

Foreign body ingestion in children is commonly encountered and this usually resolves spontaneously. Single magnet ingestion usually does not need additional medical treatment. However, multiple magnets can attract each other in intestinal loops and several complications can develop such as bowel obstruction and fistula formation. In this situation, endoscopic and/or surgical intervention is inevitably required. Therefore, making the correct diagnosis is needed for cases of magnets ingestion, and this should be done as soon as possible for children. We report here on a case of gastroduodenal fistula and duodenal obstruction caused by the interaction of four magnets.
Child ; Duodenal Obstruction ; Eating ; Fistula ; Foreign Bodies ; Humans ; Intestinal Fistula ; Intestinal Obstruction ; Magnets

A case of liver cell adenoma that was incidentally found at postmortem examination of a neonate who died of E. coli sepsis is described. The adenoma was a sharply demarcated, not encapsulated mass located subcapsularly in the right lobe, and was pale tan to light yellowish round nodule of 0.9 cm in diameter. Microscopically, the tumor was composed of sheets and cords of uniform and slightly enlarged hepatocytes separated by dilated sinusoids. There were no portal zones or central veins to suggest the normal lobular architecture. The nuclei were bland and the cytoplasm varied from clear to acidophilic, containing lipid vacuoles. Ultrastructural examination showed that the hepatocytes of the tumor had highly differentiated organelles, reminiscent of normal hepatocytes.
Adenoma/*pathology ; Female ; Humans ; Infant ; Infant, Newborn ; Infant, Newborn, Diseases/*pathology ; Liver Neoplasms/*pathology

Although some cases of benign positional vertigo are associated with a chronic ipsilateral sensorineural hearing loss, an association with simultaneous ipsilateral sudden deafness is rare. We report a 53-year old woman with sudden deaf-ness with simultaneous positional vertigo in the same ear characterized by benign paroxysmal positional vertigo of pos-terior semicircular canal type. After a modified Epley particle-repositioning maneuver, the patient's vertigo was resolved. Clinical and neuro-otologic evaluations suggested that the lesion responsible for this patient was probably located within inner ear rather than within the vestibulocochlear nerve. (J Korean Neurol Assoc 19(4):410~412, 2001)
Ear ; Ear, Inner ; Female ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden* ; Humans ; Middle Aged ; Semicircular Canals ; Vertigo* ; Vestibulocochlear Nerve

BACKGROUND AND OBJECTIVES: Qualitative oculomotor abnormalities have been reported in parkinsonian patients for many years, but conflicting results have been obtained. This study was performed to evaluate the correlation between the severity of the disease and the abnormalities of the ocular movements in idiopathic parkinson's disease. METHODS: We gave the vestibular function tests in patients with idiopathic parkinson's disease and normal controls. Eye movement recordings were made with automated electronystagmography and rotation test was performed. A total of 46 patients (mean age : 61.2+/-6.7) and 24 controls (mean age : 60.5+/-4.3) were studied. The severity of the disease was divided into two groups by modified Hoehn & Yahr staging ; H-Y stage 1 and 2 as a mild group and stage 3 and 4 as a severe group. RESULTS: Saccadic latency and accuracy, pursuitic gain and velocity, vestibulo-ocular reflex (VOR) suppression by vision were significantly altered in patients, whereas mean velocity of optokinetic nystagmus (OKN) and VOR gain in darkness were normal. Alteration of saccadic latency and accuracy, pursuitic gain and velocity, VOR suppression by vision were profound in the severe group compared with a mild group and controls, but the above parameters did not differ between a mild group and controls. In a hemiparkinson's group, saccadic latency and accuracy, pursuitic gain, OKN mean velocity and gain was not different between the both sides. CONCLUSION: The results indicate that severe Parkinson's disease damages nigrostriatal or other specific pathways which were involved in the regulation of the saccadic, pursuitic and pursuitic-mediated visual fixation system. In a hemiparkinson's group asymmetric damage of dopaminergic innervation which was involved in the regulation of ocular movements was not found.
Darkness ; Electronystagmography ; Eye Movements ; Humans ; Nystagmus, Optokinetic ; Parkinson Disease* ; Reflex, Vestibulo-Ocular ; Vestibular Function Tests

Carcinoma of Gall bladder remains a terminal illness in most patients despite improved diagnostic capabilities, better perioperative care and a more aggresive surgical approch based on improved knowledge of this tumors natural histiory. Overall 5-year survival rates remain below 5%. This failure to significantly improve patient oucome is largely due to late recognition of gall badder cancer. Authors experienced 21 cases of gall bladder cancer confirmed by operation at the Kwang Ju Christian hospital from march 1983 to March 1991, and the results obtained were summarized as follows. (continue...)
Gallbladder Neoplasms ; Gwangju ; Humans ; Perioperative Care ; Survival Rate ; Urinary Bladder*

BACKGROUND: In brain ischemia, increased arachidonic acid metabolism can play important roles in neuronal dam-age. Ibuprofen was reported to have a protective role against neuronal damage in focal brain ischemia and reperfusion. The present study was designed to investigate whether ibuprofen can inhibit the global ischemia-induced neuronal dam-age and changes of polyamine (PA) level which is known to related to the neuronal damage, breakdown of blood brain barrier, and brain edema. METHODS: Male Mongolian gerbils were used in this study. Transient global ischemia was induced by occlusion of bilateral common carotid arteries for 3 min with microclips. Ibuprofen was administered imme-diately after ischemia. The animals were sacrificed one day after ischemia for PA measurement and sacrificed 5 days after ischemia for histological evaluation. Histological examination was performed by counting surviving neuronal cells in one mm of CA1 area in dorsal hippocampus. RESULTS: Cerebral cortex and hippocampal putrescine(PU) levels in vehicle-treated ischemic group significantly increased comparing to sham-operated animals and the increase of PU was attenuated by ibuprofen administration (50 mg/kg). Hippocampal spermine level decreased significantly after ischemia. Hippocampal neuronal cell damage in CA1 area was markedly observed in vehicle-treated animals compared to sham operated animals. Ibuprofen administration at the dose of 50 mg/kg significantly inhibited hippocampal CA1 neuronal damage compared to vehicle-treated animals. CONCLUSIONS: Ibuprofen attenuates PA response following transient glob-al ischemia and may have putative neuroprotective effect against neuronal damage induced by global ischemia.
Animals ; Arachidonic Acid ; Blood-Brain Barrier ; Brain Edema ; Brain Ischemia ; Carotid Artery, Common ; Cerebral Cortex ; Gerbillinae* ; Hippocampus ; Humans ; Ibuprofen* ; Ischemia* ; Male ; Metabolism ; Neurons* ; Neuroprotective Agents ; Reperfusion ; Spermine

BACKGROUND: Vestibular neuritis (VN) is a common peripheral vestibulopathy. VN is most likely a partial rather than a complete vestibular paralysis, It has a natural history of gradual recovery within 1-6weeks. The investigation of vestibulo-ocular reflex (VOR) change in acute and compensated VN are relatively few in Korea. We performed the vestibular function test including electronystagmography (ENG) and rotary chair test (RCT) in the patients with acute and compensated VN, and evaluated the efficacy of ENG and RCT to know the degree of compensation. METHODS: Tweenty-four patients with acute VN, 14 patients who had cllinically compensated VN during follow-up period and 30 normal controls were studied. Mean intervals from symptom onset to test were 3.6 days (acute) and 102.5 days (com-pensated). RESULTS: Eight patients had asymmetrically impaired pursuit, and ten patients had asymmetrcally impaired OKN during acute stage. The degree of side differences in pursuit and OKN gain was correlated with intensity of spon-taneous nystagmus. In the acute stage, the gain of the VOR was reduced at low frequency (0.01-0.16Hz), but it was normal at high frequency (0.32Hz). Prolonged phase lead and gain asymmetries were present at all range of frequency. In the compensated stage, the gain, phase and symmetry of the VOR at all range of frequency were not different from those of controls, except for prolonged phase lead and asymmetry at 0.01 Hz. The rate of the patients with unilateral canal paresis was 100% at acute stage and 50% at compensated stage in mono-thermal cold caloric stimulation. CONCLUSIONS: These results suggested that pursuit and OKN abnormalities may be found in acute peripheral vestibu-lopathy, in which coarse spontaneous nystagmus may contribute to the development of these abnormality. Absence of caloric response does not indicate an complete absence of vestibular function and RCT is a useful method in evaluation of VOR status in patients with acute and compensated VN.
Compensation and Redress ; Electronystagmography ; Follow-Up Studies ; Humans ; Korea ; Natural History ; Paralysis ; Paresis ; Reflex, Vestibulo-Ocular ; Vestibular Function Tests* ; Vestibular Neuronitis*

Sarcoidosis is a multisystem disorder of unknown cause. The involvement of the nervous system occurs 5% to 27% of patients with sarcoidosis, and neurosarcoidosis without systemic involvement is rare and difficult to diagnose. We present a case of 58-year-old woman with clinical features of multiple cranial and peripheral polyneuropathy with noncaseating granulomatous inflammation. Extensive testing for occult systemic sarcoidosis was negative. Sural nerve biopsy showed several perineural noncaseous granulomatous inflammation with prominent epithelioid cells. Oral steroid therapy led to some improvement. We report a patient with multiple cranial and peripheral polyneuropathy without systemic involvement, suspected sarcoidosis.
Biopsy ; Cranial Nerve Diseases ; Epithelioid Cells ; Female ; Humans ; Inflammation ; Middle Aged ; Nervous System ; Polyneuropathies ; Sarcoidosis ; Sural Nerve

Incidence. Risk factors. Precipitating factors and clinical symptoms and signs were obsenied in 52 patients with borderzone infarction. The proportion of borderone infarction was 10% of all infarction. The site of borderzone infarction was subcortical borderzone in 23 cases, posterior borderzone in 20 cases and anterior borderzone in 17 cases. Borderzone infarction was localized in unilateral single borderzone in 45, unilateral multiple borderzone in 4 and bilateral borderzone in 3 cases. Risk factors of borderzone infarction were hypertension, smoking, hyperlipidemia, previous stroke history. Diabetes mellitus and cardiac disease. The frequency of hypertension was higher in borderzone infarction than in territorial infarction. Precipitating factors of borderzone infarction were dehydration due to sweating, diarrhea or vomiting and moderate or severe anemia. Neurologic findings in patients with borderzone infarction were hemiparesis, aphasia. Homonymous hemianopsia, rnental change and hemihypoesthesia. Aphasia was developed in 53.6% of all left hemispheric single borderzone infarction and the type of language disturbance was global. Sensory, motor, anomic or thanscortical motor aphasia. From the above results, it is postulated that the frequency of hypertension is higher and the frequency of cardiac disease is lower and that precipitating factors, can lead to hemodynarnic cerebral hypoperfusion, such as severe vomiting, sweating, diarrhea and anemia are more common in borderzone infarction than in territorial infarction.
Anemia ; Aphasia ; Aphasia, Broca ; Dehydration ; Diabetes Mellitus ; Diarrhea ; Heart Diseases ; Hemianopsia ; Humans ; Hyperlipidemias ; Hypertension ; Incidence ; Infarction* ; Neurologic Manifestations ; Paresis ; Precipitating Factors ; Risk Factors ; Smoke ; Smoking ; Stroke ; Sweat ; Sweating ; Vomiting