A 54 year-old woman presented with bilateral fatigable blepharoptosis with diurnal fluctuation and diplopia for 10 days. She had a 3 year history of hypertension and showed symptoms of bilateral ptosis, supranuclear upward gaze palsy, and vertical diplopia with the pupils promptly constricting to light. Bell's phenomenon and vertical oculocephalic responses were intact but an impaired convergence was noted in both eyes. A intramuscular neostigmine test was negative. T1 and T2-wighted MRI of the brain showed a small round high signal intensity lesion in the periaqueductal gray (PAG) region. Therefore, she was diagnosed with a midbrain ptosis due to midbrain hemorrhage. The PAG lesion was suggested as contributing to the fatigable blepharoptosis and supranuclear upward gaze palsy in the patient. We recommend that patients with clinical features of myasthenia limited to the ocular muscles and, having risk factors for cerebrovascular disease, be thoroughly evaluated for intracranial lesions if warranted.
Blepharoptosis ; Brain ; Diplopia ; Female ; Hemorrhage* ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Mesencephalon* ; Middle Aged ; Muscles ; Neostigmine ; Paralysis ; Periaqueductal Gray ; Pupil ; Risk Factors

BACKGROUND: Alzhiemeranjx disease (AD) and vascular dementia (VD) are common types of dementia. As a result of the development of new specific agents for AD, and because vascular dementia is a potentially preventable dementia, differentiating these diseases is of great importance. The role of EEG spectral analysis in the differential diagnosis between Alzheimer type and vascular dementia is still controversial. Since there have been few studies concerning the differential diagnosis of dementia by EEG, the present study has focused on this aspect. Usefulness of EEG in differen-tial diagnosis of dementia will be elucidated by clarifying relationship between type of dementia and spectral profile of EEG. METHODS: We analyzed the power spectra taken from 16 derivations and spectral profile was constructed by averaging twenty 2 sec epochs in three study groups (normal controls, AD and VD). Spectral profile was divided into three groups; (I) type A, showing a dominant 6.5-12 Hz peak (ii) type B, lacking a dominant peak in the 6.5-12 Hz (iii) type C, corresponding to a flat, low voltage, spectrum. To elucidate the relationship between spectral profile and other factors including diagnosis, statistical test was done. RESULTS: (1) In AD, type C profile was statistically more prevalent than in VD and type A profile was reversed. (2) In AD, Mini-Mental State Examination (MMSE) score was statistically lower in type C profile. (3) Spectral profile was not associated with age, age of symptom onset, and symptom duration. CONCLUSIONS: This study suggested that spectral profile is a useful tool for the differential diagnosis of dementia (AD and VD) and correlated with the severity of disease in AD.
Dementia ; Dementia, Vascular* ; Diagnosis ; Diagnosis, Differential* ; Electroencephalography*

Ommaya reservoir implantation has been used for sterile assessment into ventricular CSF or direct chemotherapy of chronic meningitis and meningeal involvement of malignancy since 1963. We experienced two cases with chronic meningitis, one was tuberculous meningitis with obstructive hydrocephalus which was not improved by repetitive shunt and the other was cryptococcal meningitis which was not improved by traditional chemotherapy of intravenous amphotericin B and oral flucytosine. Ommaya reservoir was implanted for daily CSF drainage of intractable hydrocephalus in the first patient and for direct injection of amphotericin B into ventricle in the second patient. Both of two cases were successfully managed by the reservoir. Therefore, Ommaya reservoir could be useful in patients with chronic meningitis which are not improved by traditional management.
Amphotericin B ; Drainage ; Drug Therapy ; Flucytosine ; Humans ; Hydrocephalus ; Meningitis ; Meningitis, Cryptococcal ; Tuberculosis, Meningeal

Spontaneous coronary artery dissection(SCD) is a rare entity that is infrequently diasnosed antemortem. The majority of patients have presented with acute myocardial infaction or sudden death. the etiology, prognosis and treatment of this entity remain ill-defined. We report two cases of SCD which were diagnosed by coronary agniogram and intracoronary ultrasound.
Coronary Vessels* ; Death, Sudden ; Humans ; Prognosis ; Ultrasonography

PURPOSE: To evaluate high-resolution CT(HRCT) findings of the miliary tuberculosis and their significancy. MATERIAL AND METHOD: We retrospectively studied clinical records, HRCT and chest radiographs of 14 patients with miliary tuberculosis. RESULTS: On HRCT, nodules were seen in all 14 cases, 10 of them evenly, and 4 were irregularly distributed. The size of each nodule was less than 1 mm in 7 cases, 1 --2ram in 6 cases, and 3mm or more in 1 case. The ground - glass opacity was accompanied in 8 cases, and fine reticular opacity was also noted in 8 cases. Other associated findings were pleural effusion (n=4), hilar and mediastinal lymphadenopathy (n=3), consolidation of the exudative tuberculosis (n=4). CONCLUSION: HRCT findings of miliary tuberculosis are diffusely distributed micronodules of variable size, less than 5mm in diameter. The ground-glass opacity can be combined.
Glass ; Humans ; Lymphatic Diseases ; Pleural Effusion ; Radiography, Thoracic ; Retrospective Studies ; Tuberculosis ; Tuberculosis, Miliary*

BACKGROUND: The role of family caregivers is becoming more important for the recovery of patients with stroke, as the prevalence of stroke is increasing. Consequently, the burden of caregiving can affect both patients' and caregiver's functional health. The purpose of this study was to make a novel caregiving burden scale and evaluate factors that influence the burden of the family caregiver. METHODS: The caregiver burden scale consists of four aspects: psycho-emotional, financial, physical and isolation from social activities. The questionnaire was administrated to the family care-givers of 118 patients with stroke who consented to be interviewed. Among 118 caregivers, we analyzed 106 caregivers who answered the questionnaire completely. We evaluated the construct validity and internal reliability of the burden scale and applied multiple regression analysis for the factors that influence caregiver's burden. RESULTS:1) Construct validity by factor analysis and Internal reliability was high 2) Among 106 caregivers, 40 (37.7%) approached subjective depression on the Beck Depression Inventory (BDI). There was a statistically significant difference(p<0.01) in the strength of burden between the groups with and without depression. 3)Of the variables, including patient's age, caregiver's age, duration of caregiving, education level of caregiver, and socio-economic status of family, only the BDI scores of caregivers and the Barthel Index scores of patients were correlated to the degree of caregiving burden. CONCLUSIONS: This caregiving burden scale can be a useful tool for the evaluation of caregiver's burden with stroke. We believe that thoughtful consideration and realistic support for family caregivers can be very important in the long-term management of patients with stroke. (J Korean Neurol Assoc 19(3):213~218, 2001)
Caregivers ; Depression ; Education ; Humans ; Prevalence ; Surveys and Questionnaires ; Stroke*

BACKGROUND: As the size of the elderly population has increased compared to the hole, there has been growing concern over potential health problems and geriatric hospitals for elderly people. However, despite the emerging needs for geriatric hospitals, there is no data on the clinical characteristics of patients being admitted to geriatric hospitals. To analyze the characteristics of elderly patients admitted to a geriatric hospital, we studied the medical records of patients admitted to Yong-in Hyoja Geriatric Hospital during a recent 20 months period. By clarifying the clinical characteristics of elderly patients admitted to a geriatric hospital, the basic data for understanding and treating elderly patients could be made. METHODS: We analyzed the medical records of 345 patients who were admitted to Yong-in Hyoja Geriatric Hospital from November 1997 to July 1999. The diagnosis of patients was largely subgrouped according to the existence of dementia, and subsequent detailed diagnoses were made. RESULTS: (1) The average age of patients was 74.59 years and there were slightly more females than males admitted (ratio, 1.15:1). (2) Most of the patients suffered from dementia (62.1%), of which vascular dementia was the most common(31.6%), followed by Alzheimer dementia(19.15%). (3) Compared to vascular dementia, patients with Alzheimer dementia had more severe cognitive dysfunction, psychosis, and agitation, while patients with vascular dementia had more problems in activities of daily living (ADL) and were more depressed than Alzheimer dementia (4) The average hospitalization duration was 3.54 months and incidence of significant illness after admission was 29.8%. The mortality rate was 10.9%. (5) The most common cause of death was infection (45.2%), followed by cardiovascular problems(16.2%). CONCLUSIONS: In addition to significant illnesses and mortality after admission, most patients admitted to geriatric hospitals have severe cognitive and behavioral problems. Therefore, adequate medical and neurological assessment and treatment for the aged is necessary.
Activities of Daily Living ; Aged ; Cause of Death ; Dementia ; Dementia, Vascular ; Diagnosis ; Dihydroergotamine ; Female ; Geriatrics ; Gyeonggi-do* ; Hospitalization ; Humans ; Incidence ; Male ; Medical Records ; Mortality ; Psychotic Disorders

The involvement of the nervous system in Kikuchi's disease (KD) is rare. Although some reports of meningeal involvement in KD were described in the literature from Japan, it has rarely been reported in Korea. A 23-year-old man presented with severe headache, fever, and vomiting. Cerebrospinal fluid (CSF) analysis revealed an opening pressure 300 mmH2O, WBC 283/mm3, glucose 44 mg/dl and protein 86 mg/dl. Multiple tender lymph nodes on the left anterior neck were found on the 9th day of his hospital stay. The lymph node biopsy disclosed histopathologic features typical of KD. We report a patient with KD accompanied by aseptic meningitis, emphasizing the importance of recognizing this disorder in diagnosing patients with meningitis.
Biopsy ; Cerebrospinal Fluid ; Fever ; Glucose ; Headache ; Histiocytic Necrotizing Lymphadenitis* ; Humans ; Japan ; Korea ; Length of Stay ; Lymph Nodes ; Lymphadenitis ; Meningitis ; Meningitis, Aseptic* ; Neck ; Nervous System ; Vomiting ; Young Adult

No abstract available.
Marchiafava-Bignami Disease* ; Thalamus

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by the presence of IgG autoantibody against platelet, low platelet count, and bleeding disorders. Anecdotal experience of renal transplantation adopting the use of 2 weeks of steroids treatment, perioperative intravenous immunoglobulin, and simultaneous splenectomy in a patient with ITP was reported recently. However, advantage of these procedures is not yet confirmed. Recently, we performed a case of uneventful renal transplantation in a patient with ITP without immunoglobulin treatment and no splenectomy. Although platelet counts have been under normal limit after transplantation, the anti-platelet antibody converted to negative postoperatively and the graft function has been stable until now. Our case report raised the question about the use of perioperative immunoglobulin and splenectomy in these particular patient groups waiting for renal transplantation.
Blood Platelets ; Hemorrhage ; Humans ; Immunoglobulin G ; Immunoglobulins ; Kidney Transplantation* ; Kidney* ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic* ; Splenectomy ; Steroids ; Transplants