BACKGROUND: Chemokines are molecules with chemotatic activities on selective leukocyte populations and are sub-grouped into alpha-chemokine acting primarily on PMNL (polymorphonuclear leukocyte) and beta-chemokines attracting mainly lymphocytes and monocytes. We conducted a prospective study to investigate the serum levels of interleukin (IL)-8, monocyte chemoattractant protein (MCP)-1, and macrophage inflammatory protein (MIP)-1 alpha in patients with acute ischemic stroke and carotid atherosclerosis. METHODS: Serum was sampled from patients with acute ischemic stroke (<24hrs), with persistent ischemic neurological deficits associated with atherosclerosis (>1 month), and from normal subjects without a history of vascular disease. Concentrations of chemokines were measured by enzyme linked immunosorbent assay ( ELISA ). RESULTS: Compared with carotid atherosclerotic patients and control subjects, the serum levels of IL-8 were significantly elevated in those with acute ischemic stroke. The serum levels of MCP-1 in patients with large artery disease were higher than those in patients with small vessel disease and cardioembolism. CONCLUSIONS: This study suggested that IL-8 can be involved in acute ischemic stroke and MCP-1 plays a role in the pathogenesis of atherosclerosis.
Arteries ; Atherosclerosis* ; Carotid Artery Diseases ; Chemokine CCL2* ; Chemokines ; Chemokines, CC ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Humans ; Interleukin-8* ; Interleukins ; Leukocytes ; Lymphocytes ; Macrophage Inflammatory Proteins* ; Macrophages* ; Monocytes* ; Prospective Studies ; Stroke* ; Vascular Diseases

BACKGROUND: The somatosensory evoked blink reflex(SBR) is a newly reported blink reflex elicited by electrical stimulation of peripheral nerves. Although it has been thought that SBR is a release phenomenon transmitted via brainstem reticular formation, the actual pathophysiological mechanism still remains unknown. In this study we investigated the correlation between the somatosensory evoked blink reflex and specific type of diseases where it was well documented. METHODS: SBR was examined on 118 patients, having various neurologic diseases; 39 cases with hemifacial spasm, 26 cases with parkinson's disease, 12 cases with dystonia, 19 cases with stroke, 17 cases with peripheral neuropathy, and 5 cases with other diseases. Somatosensory evoked blink reflex can be obtained by electrical stimuli on median nerves. Latency and amplitude of the SBR was measured by inspection of superimposed responses. RESULTS: Among the 118 patients, SBR was presented in 23 patients. The somatosensory evoked blink reflex was seen most often in hemifacial spasm, parkinson's disease and dystonia. CONCLUSION: We concluded that the somatosensory evoked blink reflex was not usually elicitable but it was relatively well presented in specific diseases which were known to have increased excitability of the blink reflex pathway.
Blinking* ; Brain Stem ; Dystonia ; Electric Stimulation ; Hemifacial Spasm ; Humans ; Median Nerve ; Parkinson Disease ; Peripheral Nerves ; Peripheral Nervous System Diseases ; Reticular Formation ; Stroke

A 21-year-old woman with gargoyloid face and short trunkal stature showed progressive quadriparesis. Cervical spine MRI showed circumferential compression of cervical spinal cord by thickened dura mater. Elevated urinary dermatan sulfate and decreased enzyme activity of -iduronidase revealed that she has mild form of mucopolysaccharidosis type I. Her weakness was improved with cervical laminectomy and duraplasty. In this case, progressing quadriparesis resulted from cervical spinal cord compression by thickened dura mater. Earlier surgical decompression could have been better for the patient.
Decompression, Surgical ; Dermatan Sulfate ; Dura Mater ; Female ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Mucopolysaccharidoses* ; Mucopolysaccharidosis I* ; Quadriplegia ; Spinal Cord Compression* ; Spinal Cord* ; Spine ; Young Adult

PURPOSE: Long-term follow-up results of concurrent bilateral or unilateral cementless hip arthroplasty were compared. MATERIALS AND METHODS: Forty eight and 49 patients with concurrent bilateral and unilateral hip artrhoplasties who had more than a 17-year follow-up time were selected. At final follow-up, mean ages were 69.1 and 66.7 years old in the bilateral and unilateral groups, respectively. Mean follow-up times were 21.5 and 22.4 years in the bilateral and unilateral groups, respectively. Clinical results were attained using Harris hip score and standardized anteroposterior and lateral view X-rays. RESULTS: The bilateral group had mean Harris scores of 44.3(standard deviation 3.78) preoperatively, and 81.2 (10.75) at final follow-up. For the unilateral group, the mean scores were 46.5(3.27) preoperatively, and 80.1 (12.05) at final follow-up. At final follow-up, an acetabular cup was securely located in 78.9% and 82.8% of the bilateral and unilateral groups, respectively, and all cases showed firm fixation of the femoral stem in both groups. Osteolysis around the cup and stem were found in 26.3% and 31.4% of the bilateral group and 16.6% and 17.1% of the unilateral group, respectively. Polyethylene wear rate was 0.17 mm/yr and 0.16 mm/yr in the unilateral and bilateral groups, respectively. Using the Kaplan-Meier method, 17-year survival rates for cup and stem were 78% and 89% in the bilateral group, respectively, and 78% and 86% in the unilateral group, respectively. CONCLUSION: In 17-year long-term follow-up, concurrent bilateral hip arthroplasty was insignificantly different clinically and radiologically from the result of unilateral hip arthroplasty.
Arthroplasty ; Follow-Up Studies ; Hip ; Humans ; Osteolysis ; Polyethylene ; Survival Rate

BACKGROUND: Dyskinesia is a common side effect complicating long-term levodopa therapy for Parkinson's disease. However, the pathogenesis of dyskinesia has not been completely understood. In recent animal studies, it has been reported that a NMDA (N-methyl-D-aspartate) antagonist reduced levodopa-induced dyskinesia. These findings suggest that the hyperfunction of NMDA receptors on striatal efferent neurons contributed to the pathogenesis of dyskinesia. Amantadine has also been recently shown to antagonize central NMDA receptors. In the present study, we observed amantadine efficacy in levodopa-induced dyskinesia in parkinsonian patients. METHODS:Twenty-two parkinsonian patients with levodopa-induced dyskinesia participated in a placebo-controlled, cross-over study. We prescribed 100 mg amantadine daily as a starting dose, which was built up every four days and titrated up to 400 mg a day. After two weeks of a wash-out period, a placebo was given with the same schedule. The doses of levodopa and other antiparkinsonian drugs were unchanged during this period. We assessed the duration and disability of dyskinesia (UPDRS part IV, item 32 and 33) based on diary and interview. RESULTS: Amantadine was superior to placebo in reducing the duration of dyskinesia in 9 patients (42.9%) and the disability of dyskinesia in 11 patients (52.4%). The reduction of the duration and disability of dyskinesia was correlated with the dose of amantadine. CONCLUSIONS These findings suggest that amantadine can improve levodopa induced dyskinesia and supports the view that the hyperfunction of NMDA receptors contributes to the pathogenesis of levodopa induced dyskinesia.
Amantadine* ; Animals ; Appointments and Schedules ; Cross-Over Studies ; Dyskinesias* ; Humans ; Levodopa ; N-Methylaspartate ; Neurons, Efferent ; Parkinson Disease ; Receptors, N-Methyl-D-Aspartate

BACKGROUNDS: The widespread N18 in the median nerve SEP is a broad negativity following positive far-field potentials and is widely distributed over the scalp. It is suggested that the N18 may be originated from subthalamus or upper brainstem nuclei. But there remains substantial controversy regarding its origin. Recently, it is proposed that the N18 is generated in the medulla. For the evaluation of its origin, we used nasopharyngeal electrode for recording SEP stimulated by median nerve stimulation. METHODS: Standard methods of recording SEP were used in 19 normal adults(36 sides, 19-68 years, 9 males). 11 patients with following locations of the lesions were studied: 2 high cervical cord, 1 ponto-medullary junction, 3 pons, and 5 thalamus. We evaluated the N18 potentials at ventral medulla level, using nasopharyngeal electrode and recorded them at scalp by non-cephalic reference recording. We compared the amplitude and duration of the N18 at scalp with those at nasopharyngeal electrode. RESULTS: The mean amplitude and duration of N18 at scalp showed no significant difference from that at nasopharyngeal electrode(1.76+/-0.4 microvolt, 16.48+/-2.47 msec and 1.75+/-0.4 microvolt, 16.56+/-2.19 msec, p>0.5). The N18 was absent in 2 patients with high cervical cord lesions. The amplitude and duration of the N18 were normal in all other patients with brainstem and thalamic lesions, including a patient with lesion at the ponto-medullary junction. CONCLUSIONS: These results suggested that N18 is generated in the medulla and not more rostrally in the brainstem.
Brain Stem ; Electrodes ; Evoked Potentials, Somatosensory* ; Humans ; Median Nerve ; Pons ; Scalp ; Subthalamus ; Thalamus

BACKGROUND: Various types of dystonia may be associated with Parkinson's disease (PD). This dystonic phenomenon is sometimes observed in untreated parkinsonian patients. However, it more commonly emerges as a side effect to long term levodopa (LD) therapy. We studied several factors which influence the risk of the occurrence of LD-induced dystonia (LID) in patients with PD. The types and involved sites in LID were also studied. METHODS: Ninety-six patients diagnosed as PD were evaluated. We analyzed the contribution of several factors such as sex, age at onset of parkinsonian symptoms, disease durations, H & Y stages, average LD doses, LD durations, and types of initial symptoms (tremor vs non-tremor) to the occurrence of LID. The types of LID were divided into: wearing-off, morning-off, peak-dose, and diphasic groups. RESULTS: LID was observed in 29 patients (30.2%). Among the 29 patients with LID, 11 were categorized as wearing-off dystonia, 10 as morning-off, 6 as peak-dose, and 2 as diphasic. LID occurred in the feet or toes of 23 patients, upper extremities of 3, and in the heads or necks of 3. Sixteen patients had dystonias on the same side of their initial symptoms, 4 on the opposite side, and 6 on both sides. Among the several factors, the types of initial symptoms, average LD doses, LD durations, age at onset of parkinsonian symptoms, and H & Y stages were found to significantly contribute to the occurrence of LID. CONCLUSIONS: Dystonia often appeared as a side effect to anti-parkinsonian medications. Wearing-off dystonia was the most common type of LID. LID was commonly seen on the same side of initial symptoms. Initial parkinsonian symptoms were thought to be the most important contributing factor of LID.
Dystonia* ; Foot ; Head ; Humans ; Levodopa* ; Neck ; Parkinson Disease* ; Risk Factors ; Toes ; Upper Extremity

BACKGROUNDS: Recent experimental studies demonstrate massive leukocytes extravasation at sites of cerebral ischemia even with the first hours of disease. Leukocytes are now considered to potentiate ischemic neural damage by microvasculature obstruction and generation of neurotoxic substances. Adhesion molecules mediate adhesion between endothelial cells and leukocytes as a precondition for extravasation of leukocytes at sites of tissue injury. We conducted a prospective study to investigate the serum level of ICAM-1, P-selectin, and E-selectin in patients with acute ischemic stroke, and with atherosclerosis. METHODS: Serum was sampled from patients within 24 hrs of acute ischemic stroke(n=20), from patients with previous (> 1 month) transient or persistent ischemic neurologic deficit associated with atherosclerosis(n=22), and control patients without a history of vascular disease(n=20). Concentrations of soluble ICAM-1(sICAM-1), P-selectin(sP-selectin), and E-electin(sE-selectin) were measured by enzyme-linked immunosorbent assay(ELISA). RESULTS: Compared with control subjects, sICAM-1 and sE-selectin were significantly elevated in patients with acute ischemic stroke and in previous symptomatic atherosclerosis(p=0.0001 and p=0.004). The serum level of sP-selectin in patients with acute ischemic stroke was higher than that in patients with previous symptomatic atherosclerosis and control subjects(p=0.0004). CONCLUSIONS: The results suggest a chronic elevation of ICAM-1 and E-selectin in patients with previous symptomatic atherosclerosis and also acute changes of them in patients with acute ischemic stroke. These findings indicate that acute changes of serum P-selectin occurred in response to acute ischemic stroke.
Atherosclerosis ; Brain Ischemia ; Cell Adhesion Molecules ; E-Selectin ; Endothelial Cells ; Humans ; Intercellular Adhesion Molecule-1 ; Leukocytes ; Microvessels ; Neurologic Manifestations ; P-Selectin ; Prospective Studies ; Stroke*

BACKGROUND AND PURPOSE: A variety of sensory disturbances such as tingling, numbness, muscle cramp, pain and burning are recognized in Parkinson's disease. There is a hypothesis that sensory symptoms of Parkinson's disease could be related to "release" of sensory centers from extrapyramidal systems. We investigated the characteristic features of sensory symptoms in Parkinsonian patients and the possibilities that sensory symptoms may be related to dopaminergic pathways. METHODS: We included 130 patients with Parkinson's disease. The patients with medical illness such as diabetes, arthritis or musculoskeletal disease were excluded. We studied 38 Parkinsonian patients with sensory complaints using electrophysiologic studies and neuroimaging. RESULTS: 1) Thirty-eight(29.2%) of 130 Parkinsonian patients(mean age ; 57.9 +/- 10.1 ; 13 men, 25 women) had sensory symptoms. 2) Among thirty-eight Parkinsonian patients with sensory symptoms, 19 patients had pain, 10 tingling sensation, 3 burning sense, and 2 muscle cramp. 3) The arm and leg were most common sites for sensory symptoms 4) Sensory complaints preceded motor symptoms in 17 patients(21.1 +/- 19.1 months) and followed in 13 patients(26.7 +/- 41.9 months). 5) In 25 patients(66%), sensory symptoms were improved with levodopa. 6) There was no significant correlation between sensory symptoms and motor disabilities. CONCLUSIONS: Many Parkinsonian patients had various sensory complaints as well as motor symptoms. In some patients, sensory symptoms preceded motor disabilities. It was also suggested that sensory symptoms in some patients with Parkinson's disease be related to dopaminergic pathways.
Arm ; Arthritis ; Burns ; Humans ; Hypesthesia ; Leg ; Levodopa ; Male ; Muscle Cramp ; Musculoskeletal Diseases ; Neuroimaging ; Parkinson Disease* ; Sensation

Corticobasal degeneration (CBD) is a progressive neurodegenerative disorder characterized by asymmetric parkinsonism associated with apraxia, cortical sensory loss, and alien-limb phenomenon. Neuropsychological testing in patients with CBD typically shows deficits in executive functions, praxis, language, and visuospatial functioning, but not in memory. We report a CBD patient with severely impaired memory function but relatively mild motor symptoms. Detailed neuropsychological assessment showed significant verbal and visual memory deficits accompanied by frontal executive dysfunctions. Our observations indicate that CBD can in rare cases present with severe episodic memory impairment associated with frontal executive dysfunctions in the early stage of illness.
Apraxias ; Executive Function ; Humans ; Memory ; Memory Disorders ; Memory, Episodic ; Neurodegenerative Diseases ; Neuropsychological Tests ; Parkinsonian Disorders