Stroke is a most common neurological disease leading to mortality and morbidity. Many clinical evidences confirm that medical treatment including thrombolytic and antithrombotic therapy may improve the clinical outcome in patients with acute ischemic stroke. However, little information exists about effectiveness and safety of reperfusion surgery such as emergency carotid endarterectomy and extracranial-intracranial bypass surgery in patients with acute ischemic stroke and limits its wide application. Recent pooled analysis of three randomized controlled clinical trials-DECIMAL (decompressive craniectomy in malignant middle cerebral artery infarcts) trial; DESTINY (decompressive surgery for the treatment of malignant infarction of the middle cerebral artery) trial; and HAMLET (hemicraniectomy after middle cerebral artery infarction with life-threatening edema trial) reported decompressive surgery undertaken within 48 hours of stroke onset in patients with malignant middle cerebral artery infarction reduced mortality and morbidity. However, decompressive surgery in patients with malignant middle cerebral artery infarction should be done according to the clinical conditions of individual patients. No clear evidences are present on that craniotomy, minimally invasive surgery, and early clot evacuation are effective on functional outcome of patients with spontaneous intracerebral hemorrhage compared with initial conservative therapy. In conclusion, a lot of well-designed studies are needed to recommend appropriate surgical management in patients with acute ischemic and hemorrhagic stroke.
Cerebral Hemorrhage ; Craniotomy ; Edema ; Emergencies ; Endarterectomy, Carotid ; Humans ; Infarction ; Infarction, Middle Cerebral Artery ; Middle Cerebral Artery ; Reperfusion ; Stroke

Thrombomodulin (TM) is thrombin receptor present on the luminal surface of endothelial cells. Because the thrombin-TM complex acts as an anticoagulant, the functional variants or deficiency of TM may lead to increment of thrombotic tendency. In this study, we screened the genetic variants of the TM gene in patients with myocardial infarction (MI) and analyzed the genotype to elucidate the effects of genetic variations of TM gene on the development of the MI. We screened a promoter region and coding sequence of the TM gene using single strand conformation polymorphism-heteroduplex analysis and identified three common genetic variants: those were TM G-33A, TM Ala455Val, and TM C1922T. The genotype frequencies were investigated in the patients with MI (n=234) and control subjects (n=291) by the method of allele-specific oligomer hybridization. The frequencies of mutant genotypes (TM -33A, TM 455Val, and TM 1922T) were higher in patient group compared to the control subjects in males while there were no significant differences in females. In the multiple logistic regression analysis, TM 455Val and TM 1922T alleles were independent risk factors for MI (OR[95% CI: 1.799[1.125-2.878] p=0.014 and 5.624[1.019-31.025], p=0.048, respectively) in males. However, the genetic variations were not independent risk factors for MI in females. There were significant linkage disequilibriums among three genetic variants. These linkage disequilibriums explain the similar effects of three genetic variants on the development of MI. To investigate the effect of the TM G-33A mutation on TM promoter activity, the two TM promoter constructs (pTM-355 and pTM-125, bearing TM -33G or TM -33A) containing of firefly luciferase gene were transfected into HepG2, BAE, and CHO cells. The promoter activities were higher in the promoter constructs with TM -33G compared to the constructs with TM -33A in pTM-355. These results suggest the possibility of the positive predisposing effect of TM -33A allele on MI in males. The functional study for TM Ala455Val and TM C1922T should be followed to elucidate the genotype effects of these mutations on the development of MI. In this study, we identified three genetic variants of TM gene and showed the significant associations between genetic variants and MI in males. These results proposed that TM gene is an attractive candidate for genetic risk factor for MI in Koreans.
Alleles ; Animals ; CHO Cells ; Clinical Coding ; Cricetinae ; Endothelial Cells ; Female ; Fireflies ; Genetic Variation ; Genotype ; Humans ; Linkage Disequilibrium ; Logistic Models ; Luciferases ; Male ; Myocardial Infarction* ; Phenobarbital ; Promoter Regions, Genetic ; Receptors, Thrombin ; Risk Factors* ; Thrombomodulin

Leiomyosarcoma of the prostate is a rare malignant tumor. It originates from the smooth muscles of the prostatic gland and is usually found during old ages. Prognosis is usually poor especially in childhood. We report a case of leiomyosarcoma of the prostate measured 320gm in 64 years old man.
Humans ; Leiomyosarcoma* ; Middle Aged ; Muscle, Smooth ; Prognosis ; Prostate*

BACKGROUND: The purpose of this study was to describe a pure lower motor neuron disease in adults that is isolated to the upper limbs over time and to emphasize a differential diagnosis from other motor neuron diseases or motor neuropathies. METHODS: We reviewed retrospectively five male patients who had a bilateral upper limb weakness without any sensory changes confirmed by clinical and electrophysiological examinations at least 2 years after onset. RESULTS: Initially weakness remained largely confined to the arms. It then progressed slowly during the follow-up periods ranging from about 5 to 7 years since onset. However, weakness and muscle atrophy spared the lower limbs, respiratory and bulbar musculatures. The patients did not develop any bulbar dysfunctions or pyramidal tract signs. They were still able to ambulate at the end of follow-up. CONCLUSIONS: Brachial amyotrophic diplegia presenting with severe weakness that is completely confined to the upper limbs over time, without upper motor neuron signs, might be a stable and relatively benign variant of motor neuron disease. It should be differentiated from other motor neuropathies.
Adult ; Amyotrophic Lateral Sclerosis ; Arm ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Lower Extremity ; Male ; Motor Neuron Disease ; Motor Neurons ; Muscular Atrophy ; Pyramidal Tracts ; Retrospective Studies ; Upper Extremity

No abstract available.
Plasma Exchange* ; Plasma* ; Purpura, Thrombotic Thrombocytopenic*

Cerebral infarcts rarely occur following head injury. Carotid artery dissection is usually proposed mechanism in such cases. We experienced a case of middle cerebral artery (MCA) infarct occurred just after head trauma without evidence of vascular abnormality. A 59-year-old male was transported to the emergency room immediately after traffic accident. He had right zygomatic fracture without neck injury. Left hemiparesis was noticed, and brain CT revealed hyperdense MCA sign in the right side. His neurologic status deteriorated over 2 days, and brain MRI showed total right MCA infarct with midline shift. Cerebral angiography was unremarkable. Two months later he had improved so much, but left hemiparesis with right MCA infarction re-developed. We suggest head trauma immediately can induce cerebral infarct without neck vessel injury, and in differential diagnosis of focal neurologic deficit after trauma, cerebral infarct as well as hemorrhage or contusion must be considered.
Accidents, Traffic ; Brain ; Carotid Arteries ; Cerebral Angiography ; Contusions ; Craniocerebral Trauma* ; Diagnosis, Differential ; Emergency Service, Hospital ; Head* ; Hemorrhage ; Humans ; Infarction, Middle Cerebral Artery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Middle Cerebral Artery* ; Neck ; Neck Injuries ; Neurologic Manifestations ; Paresis ; Zygomatic Fractures

Among the many advances in acute ischemic stroke (AIS) management, thrombolysis with intravenous (IV) tissue plasminogen activator (tPA) within 3 hours after symptom onset has been the only approved pharmacological therapy in AIS. However, IV administration of tPA has many limitations in clinical practice, and the proportion of eligible patients remains quite low. Many clinical trials have attempted to overcome this by increasing the therapeutic time window and enhancing the efficacy of reperfusion by the intra-arterial (IA) approach with novel mechanical devices. In addition, the application of new thrombolytic agents and identification of suitable thrombolytic candidates by multimodal brain imaging is another field of active research in thrombolytic therapy. We reviewed AIS management, focusing on thrombolysis with IV therapy, IA therapy, and IV-IA bridging therapy.
Fibrinolytic Agents ; Humans ; Neuroimaging ; Reperfusion ; Stroke ; Thrombolytic Therapy ; Tissue Plasminogen Activator

Varicella zoster virus (VZV) infection is a relatively common viral infection of the cranial nerves, especially the trigeminal and facial nerves. However, the involvement of the isolated vagus nerve has been rarely reported. We report a 65-year-old man with isolated vagus nerve palsy after a VZV infection. He presented with headache, dysphagia and hoarseness with sudden onset. He had vesicles localized on the concha of the right ear. The VZV IgG and IgM antibody titer in the serum was elevated.
Aged ; Chickenpox* ; Cranial Nerves ; Deglutition Disorders ; Ear ; Facial Nerve ; Headache ; Herpesvirus 3, Human* ; Hoarseness ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Paralysis* ; Vagus Nerve*

Rhinocerebral mucormycosis is a very rare, but mostly fatal fungal infection, usually found in diabetic or other immunocompromised hosts. It has a characteristic pattern of spread, invasion of vessel walls with subsequent local thrombotic infarction or direct invasion. But we found two cases contrast to these typical patterns of spread. Our cases initially originated in the nasal cavity and progressed to the cavernous sinus in usual manner, but after then, extended along the trigeminal nerve into the pons. MRI demonstrated the perineural spread, which was confirmed by pathology.
Cavernous Sinus ; Immunocompromised Host ; Infarction ; Magnetic Resonance Imaging ; Mucormycosis* ; Nasal Cavity ; Pathology ; Pons* ; Trigeminal Nerve

Rhinocerebral mucormycosis is a very rare, but mostly fatal fungal infection, usually found in diabetic or other immunocompromised hosts. It has a characteristic pattern of spread, invasion of vessel walls with subsequent local thrombotic infarction or direct invasion. But we found two cases contrast to these typical patterns of spread. Our cases initially originated in the nasal cavity and progressed to the cavernous sinus in usual manner, but after then, extended along the trigeminal nerve into the pons. MRI demonstrated the perineural spread, which was confirmed by pathology.
Cavernous Sinus ; Immunocompromised Host ; Infarction ; Magnetic Resonance Imaging ; Mucormycosis* ; Nasal Cavity ; Pathology ; Pons* ; Trigeminal Nerve