A global increase in the incidence of tuberculosis has prompted the need for earlier diagnosis, treatment, and isolation of the disease. In tuberculosis, concomitant tuberculous meningitis and vascular complications such as intracranial aneurysms and subarachnoid hemorrhage are very rare. Because of the poor prognosis of tuberculous meningitis as well as intracranial aneurysm and subarachnoid hemorrhage, early diagnosis and management are crucial. We present the case of a 76-year-old woman who had two intracranial aneurysms complicated by subarachnoid hemorrhage, who had concomitant tuberculous meningitis. She remained well with medical management.

Vascular dementia (VaD) is a history-laden disease entity that dates back to the 19th century when arteriosclerotic brain atrophy due to hardening of the arteries was perceived as the major cause of senile dementia. Its existence had been overshadowed by the emergence of Alzheimer's disease (AD) in the past century and research on AD dominated the field of dementia. Interest in VaD has been revived in recent years as vascular lesions have been shown to make great contributions to the development of dementia, particularly in the elderly. VaD has now evolved into the concept of vascular cognitive impairment (VCI), which encompasses not only VaD but also AD with cerebrovascular disorder and VCI with no dementia. The concept of VCI is intended to maximize the therapeutic potential in dementia management because the vascular component may be amenable to therapeutic intervention particularly in the early stages of cognitive impairment. Subcortical ischemic vascular dementia (SIVD) is pathologically driven by severe stenosis and the occlusion of small vessels that culminate into white matter ischemia and multiple lacunar infarctions in the subcortical structures. The relatively slow progression of symptoms and clinical manifestations associated with cholinergic deficits often make the differentiation of SIVD from AD difficult. The recent development of in vivo amyloid imaging enabled further pathological breakdown of SIVD into pure SIVD and mixed dementia with subcortical ischemia based on the absence or existence of amyloid pathology in the brain. In this article, the authors reviewed the emerging concepts of VaD/VCI and the clinical manifestations, biomarkers, treatments, and preclinical models of SIVD based on the pathophysiologic mechanisms of the disease.
Aged ; Alzheimer Disease ; Amyloid ; Arteries ; Atrophy ; Biomarkers ; Brain ; Cerebrovascular Disorders ; Constriction, Pathologic ; Dementia ; Dementia, Vascular* ; Humans ; Ischemia ; Pathology ; Stroke, Lacunar

The spinocerebellar ataxia type 2 (SCA 2) is an autosomal dominant cerebellar ataxia that commonly presents with cerebellar ataxia, hyporeflexia, and slow saccades. Recent clinical series described movement disorder in the SCA 2 such as Parkinsonism or dystonia. Dystonia can be observed in and even be the presenting feature of the SCA 2. We report two patients with genetically confirmed SCA 2 displaying a slowly progressive syndrome combined with cerebellar ataxia and craniocervical segmental dystonia.
Cerebellar Ataxia ; Dystonia* ; Humans ; Movement Disorders ; Parkinsonian Disorders ; Reflex, Abnormal ; Saccades ; Spinocerebellar Ataxias*

A few patients with Parkinson's disease (PD) crave large amounts of levodopa therapy far beyond those needed to alleviate their symptoms, even in the state of overdose complication. Such harmful pattern of compulsive dopaminergic drug use is called as dopamine dysregulation syndrome (DDS). We report a chronic stage PD patient presenting with high fever and altered mentality, who had the DDS as well as the Parkinsonism hyperpyrexia syndrome (PHS).
Dopamine* ; Fever ; Humans ; Levodopa ; Parkinson Disease ; Parkinsonian Disorders*

BACKGROUND: Human Herpes Virus 6 (HHV6) is commonly associated with encephalitis following bone marrow transplantation. However, hippocampal atrophy and global hypometabolism are rare findings in HHV6 encephalitis. CASE REPORT: A 41-year-old right-handed woman with acute lymphoblastic leukemia presented with fever and mental changes 2 weeks after receiving a sibling bone marrow transplant. The patient's cerebrospinal fluid (CSF) was positive for HHV-6 deoxyribonucleic acid (DNA), but was negative for other viral DNA. Brain magnetic resonance imaging revealed atrophic changes in bilateral medial temporal lobes. Following 4 weeks of ganciclovir therapy, a CSF exam was negative for HHV-6 DNA and the patient's neurological symptoms partially improved. However, she was disoriented and had severe retrograde and anterograde amnesia. 18F-fluorodeoxyglucose-positron emission tomography indicated global hypometabolism in the medial temporal lobes and the fronto-parietal cortices. CONCLUSIONS: This is a rare and unusual case of hippocampal atrophy in the acute stage of HHV6 encephalitis. Our imaging findings may reflect the chronic indolent course of HHV6 encephalitis.
Adult ; Amnesia, Anterograde ; Amnesia, Retrograde ; Atrophy ; Bone Marrow Transplantation* ; Bone Marrow* ; Brain ; Cerebrospinal Fluid ; DNA ; DNA, Viral ; Encephalitis* ; Female ; Fever ; Ganciclovir ; Herpesvirus 6, Human ; Humans* ; Limbic Encephalitis ; Magnetic Resonance Imaging* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Siblings ; Temporal Lobe

Surgical management of acral lentiginous melanoma on the toe poses a difficult challenge because of the lack of surrounding tissue. A full-thickness skin graft after excision may provide a good cosmetic outcome, but graft failure can occur due to limited blood flow of the toe and the thin skin covering over the deep fascia in the pressure bearing area may cause gait disturbance. A negative-pressure device can be beneficial for fixing the graft and stimulating the growth of granulation tissue. A 55-year-old woman diagnosed with malignant melanoma on the right third toe underwent wide excision, after which secondary intention healing was initiated using negative-pressure therapy. When the wound had regenerated enough granulation tissue after 2 weeks, a full-thickness skin graft was performed, which was secured with negative-pressure therapy. The graft was successfully taken after a week thereafter. Accordingly, the use of negative-pressure therapy in the surgical management of acral lentiginous melanoma may be a good option because it facilitates full-thickness skin graft survival in an avascular surface area and aids in the thickening of the pressure bearing area, where acral lentiginous melanoma is likely to occur.
Cosmetics ; Fascia ; Female ; Gait ; Graft Survival ; Granulation Tissue ; Humans ; Intention ; Melanoma ; Skin ; Toes ; Transplants ; Ursidae

Mirror writing is the simultaneous process of reversing individual letters and composing word strings in the reverse direction. This phenomenon appears rarely only after brain damage. We present the case of a 65-year-old, right-handed man with mirror writing following a left temporo-parietal lobe infarction. He preferred to write in the mirror direction with his left hand, but he did not show any visual-spatial disturbance and allochria. We think that damage to the dominant writing program of the brain, releases the normally suppressed contralesional writing program and this uninhibited program induces the mirror writing.
Aged ; Brain ; Functional Laterality* ; Hand* ; Humans ; Infarction* ; Writing

Recent evidence suggests that a high level of serum LH during follicular recruitment and development is associated with poor reproductive outcome. Consequently, exogenous LH administration for controlled ovarian hyperstimulation(COH) in in vitro fertilization and embryo transfer(IVF-ET) may be harmful to folliculogenesis. The purpose of this clinical study was to evaluate and compare the efficacy of human menopausal gonadotropin(hMG) and human follicle-stimulating hormone(hFSH) for COH with long protocol of gonadotropin-releasing hormone(GnRH) agonist in IVF-ET program. Randomized clinical trial was performed in 125 patiens undergoing IVF-ET at Seoul National University Hospital from May to Septebmer, 1995. The inclusion criteria of patients included age < 40 years and normal semen analysis, and the study population was also classified into two groups by the etiology of infertility : Group T - 95 patients with only tubal factor and Group O - 30 patients with endometriosis or anovulatory factor. There were no statistically significant differences in dosage(29.0+/-7.9 vs 26.0+/-6.8 ampoules) and duration(12.3+/-1.3 vs 12.2+/-1.5 days) of gonadotropin administration, serum E2 level on hCG day(1,943+/-1,255 vs 1,580+/-1,067 pg/mL), cancellation rate(7.5% vs 6.7%), number of oocytes retrieved(9.9+/-6.0 vs 11.3+/-6.0), fertilization rate(68.4% vs 64.5%), number of embryos transferred(4.7+/-2.0 vs 4.7+/-2.0), and preganancy rate per cycle(26.3% vs 24.4%) and per ET(28.4% vs 26.2%) between hMG(N=80) and hFSH(N=45) Groups. In Group T, no significant differnces in results of IVF-ET were also detected between hMG (N=61) and hFSH(N=34) Groups. In Group O, serum E2 level on hCG day was significantly higher in hMG Group (N=19) compared with hFSH Group(N=11), but other results of IVF-ET were similar in both Groups. As this study could not demonstrate any significant differences in results of IVF-ET between hMG and hFSH when used for COH in IVF-ET program, it could be concluded that hFSH is at least as efficacious as hMG for COH.
Embryo Transfer* ; Embryonic Structures* ; Endometriosis ; Female ; Fertilization ; Fertilization in Vitro* ; Follicle Stimulating Hormone* ; Follicle Stimulating Hormone, Human ; Gonadotropins* ; Humans* ; Infertility ; Oocytes ; Semen Analysis ; Seoul

Henoch-Sch nlein purpura is a systemic small-vessel IgA dominant vasculitis involoving the capillaries, arterioles, or venules. It is characterized by the classic tetrad of abdominal pain, arthralgia, typical rash, and renal involvement, all of which can occur in any order and at any time over several days to weeks. The central nervous system and lungs may be involved. The gastrointestinal tract is involved in more than 50 percent of patients, manifested most commonly by abdominal pain and gastrointestinal bleeding. And rarely may occur intussusception, bowel nerosis, perforation and intramural hematoma of the duodenum. We report a case of intramural hematoma of the duodenum with Henoch-Sch nlein purpura in 48 year old female patient which was demostrated by upper gastrointestinal endoscopy, abdominal CT scan, hypotonic duodenography and histologic finding of duodenal biopsy. She was treated with supportive care and improved rapidly without any serious gastrointestinal complications.
Abdominal Pain ; Arterioles ; Arthralgia ; Biopsy ; Capillaries ; Central Nervous System ; Duodenum ; Endoscopy, Gastrointestinal ; Exanthema ; Female ; Gastrointestinal Tract ; Hematoma* ; Hemorrhage ; Humans ; Immunoglobulin A ; Intussusception ; Lung ; Middle Aged ; Purpura* ; Tomography, X-Ray Computed ; Vasculitis ; Venules

Cerebrospinal fluid (CSF) can provide vital informative about pathological processes occurring in the brain. In particular, the CSF concentrations of Abeta42, tTau, and pTau181 are useful for the early diagnosis of Alzheimer's disease (AD). However, many studies have demonstrated that confounding factors related to the preanalytical processing of CSF can seriously influence measurements of these AD biomarkers. It is therefore important to develop a standardized protocol for the acquisition and handling of CSF, particularly with regard to the types of tube used for collection and storage, the proper aliquot volume, blood contamination, and the number of tube transfers and freeze-thaw cycles, because these aspects of the procedure have been shown to affect AD biomarker measurements. A survey of the impact of several individual preanalytical procedures on the measurement of AD biomarkers in CSF was conducted for this review article, and the implications of the differences among them are discussed. Furthermore, following a review of the procedures used in Korean and international biomarker laboratories, a consensus was reached among a cooperative Korean multicenter research group regarding a standardized protocol for the analysis of AD biomarkers in CSF. All efforts were made to be stringent regarding the controversial issues associated with this protocol, thus minimizing the confounding influence of various factors on current investigations using established AD biomarkers and on future studies using novel biomarkers of AD and other neurodegenerative disorders.
Alzheimer Disease* ; Biomarkers* ; Blood Volume ; Brain ; Cerebrospinal Fluid* ; Consensus* ; Early Diagnosis ; Korea ; Neurodegenerative Diseases ; Pathologic Processes