We have noticed that several sentences in a review article by Drs. Jung and Roh published in J Clin Neurol [Circulating endothelial progenitor cells in cerebrovascular disease, J Clin Neurol 2008;4(4):139-147] are identical from those in an article by Dr. Rouhl et al. published in Stroke [Endothelial progenitor cell research in stroke: a potential shift in pathophysiological and therapeutical concepts, Stroke 2008;39(7):2158-2165]. The text of the Jung and Roh article neither mentions nor cites the article by Rouhl and colleagues. A review of this case by the editorial committee of Journal of Clinical Neurology concluded that Drs. Jung and Roh plagiarized the paper by Rouhl and colleagues. Drs. Jung and Roh have acknowledged the plagiarism in the original manuscript and given clear credit for the work of Dr. Rouhl and colleagues in a letter published in this issue as an "Apology". I regret that this has happened and that this plagiarism was not identified prior to publication.
Neurology ; Plagiarism ; Publications ; Stem Cells ; Stroke

Young adult stroke is not rare disease and have diverse causes. We studied 135 young adults aged 15 - 45 years who had been admitted to Severance Hospital with a diagnosis of cerebral infarction from January 1990 to June 1995. The results are as follows. 1. The diverse causes of earshot infarction in young adults have been found in most patients(88.2%). The major causes of cerebral infarction in young adults were atherosclerosis(32.6%) and cardioembolism(32.6%). The causes were significantly different between younger(15 - 30 years old) and older(31 - 45 years old) patients. 2. The major risk factors of atherosclerotic cerebral infarction were hypertension(29 patients), smoking(14 patients), and hyperlipidemia(11 patients). 3. The major causes of cardioembolism were valvular heart disease(21 patients) and prosthetic valve(I0 patients). The mitral valve prolapse was discovered only in one patient. 4. Fourteen patients had non-atherosclerotic vasculopathies. The moyamoya disease was the most common cause of them. 5. The other causes of cerebral infarction were found in 17 patients and the major causes were alcohol intoxication and postoperative thromboembolism. 6. The cerebral infarction occurred mostly in the carotid artery territory(95 patients) and the distribution of the involved vascular territory was not different between younger and older age groups. 7. The clinical outcomes were good in most patients (86, 7%). From the above results, we demonstrated that young adults with cerebral infarction had various causes and showed favorable clinical outcomes. We also found that the causes of cerebral infarction varied between younger and older groups. Our findings suggest that careful and thorough case-by-ease evaluation may be mandatory to clarify the causes of cerebral infarction in young adults.
Carotid Arteries ; Cerebral Infarction* ; Diagnosis ; Heart ; Humans ; Infarction ; Mitral Valve Prolapse ; Moyamoya Disease ; Rare Diseases ; Risk Factors ; Stroke ; Thromboembolism ; Young Adult*

Painful ophthalmoplegia is not common and may be due to variety of causes, of which distant metastsis of malignant lymphoma is rare. This is a case of painful ophthalmoplegia who has looked like Tolosa-Hunt syndrome at first showing normal CSF findings, increased erythrocyte sedimentation rate and some response to steroid. About 2 months later, however, pelvic malignant lymphoma (diffuse undifferentiated according to Rappaport classification) was found, followed by lymphomatous meningitis. The symptoms of pain and ophthalmoplegia were markedly improved after systemic and intrathecal chemotherapy and radiotherapy of whole brain for the metastatic malignant lymphoma.
Blood Sedimentation ; Brain ; Drug Therapy ; Lymphoma* ; Meningitis ; Ophthalmoplegia* ; Radiotherapy ; Tolosa-Hunt Syndrome

Painful ophthalmoplegia is an unusual presentation of malignant lymphoma. Moreover, spontaneous remission and exacerbation of it has quite rarely been reported. We present a patient who showed spontaneous remission and exacerbation of the painful ophthalmoplegia. Brain MR imagings showed infiltrating, iso-intensity mass a, TlWl and T2WI, and strong enhancement with gadolinium on TIWI in parasellar area. Malignant lymphoma of diffuse large cell type was found in cervical lymph node biopsy.
Biopsy ; Brain ; Gadolinium ; Humans ; Lymph Nodes ; Lymphoma* ; Ophthalmoplegia* ; Remission, Spontaneous*

Diphenylbydantoin-induced movement disorders have been rarely reported. They include choreoathetosis, orofacial dyskinesia, asterixis, dystonia, and ballismus. A patient with epllepsy, who showed orofacial dyskinesia with toxic cerebellar syrnptoms after longterm use of diphenylhydantoin is presented. The involuntary movement rapidily disappeared with a reduction of diphenylhydantoin dose.
Dyskinesias ; Dystonia ; Humans ; Movement Disorders* ; Phenytoin

To get a better insight into the clinical differentiation between vertigo of cerebrovascular origin and of aural origin, we investigated radiologically proven stroke patients who presented with vertigo as an initial clinical manifestation. Of 154 stroke patients, 30 patients with vertigo (20%) had the relevant lesion, demonstrated with the initial computerized tomographic scan (13 patients) or the follow-up magnetic resonance imaging (MRI) study (17 patients) of the brain. Every lesion was in the vertebrobasilar arterial territory; 19 in the cerebellum, 8 in the pons, and 3 in the medulla oblongata. Although 12 of the 30 patients (40%) presented with vertigo in isolation at the onset of stroke, eight patients (27%) developed additional neurologic abnormalities from four hours to seven days later. Patients with isolated vertigo (13%) had the small lesion exclusively in the cerebellum of the PICA medial branch territory. The most frequent accompanying neurological sign was swaying in the cerebellar and medullary lesion, and dysarthria in the pontine lesion. The direction of nystagmus or swaying did not match the lesion side in some patients. Our findings suggest that cerebellar stroke may commonly manifest isolated vertigo or vertigo with swaying mimicking labyrinthine disorder, particularly at the onset of the disease. MRI study and tests for truncal ataxia and lateropulsion may be crucial for the detection of vertigo of cerebrovascular origin.
Adult ; Cerebrovascular Disorders/complications/*radiography ; Diagnosis, Differential ; Female ; Human ; Male ; Nervous System Diseases/etiology ; Nystagmus, Pathologic/etiology ; Prospective Studies ; Sensation Disorders/*diagnosis ; *Tomography, X-Ray Computed ; Vertigo/complications/*radiography

The neurotoxicity of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) in rodents was investigated by measuring the locomotor activity and the changes of brain biogenic amines in MPTP-treated C57BL/6 mice. The mice showed a typical curved spine posture 24 hours after MPTP treatment. Total locomotor activity was reduced and the ratios of stereotyped activity/total locomotor activity were increased 24 hours after MPTP treatment. However no significant changes were observed 7 days after MPTP treatment. MPTP-induced changes of biogenic amines were evident only in corpus striatum, not in frontal lobe, midbrain and hippocampus; the levels of dopamine, dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) were reduced by 94%, 76.3% and 60.2% after 24 hours, and 81.9%, 61.3% and 26.1% after 6 days compared to control values respectively. The ratios of DOPAC/dopamine, HVA/dopamine and HVA/DOPAC were increased 24 hours and 7 day after MPTP treatment compared to control valuse in corpus striatum, but the degree of the 7 days was less than the 24 hours. The ratios of 5-HIAA/5-HT were incresed 24 hours and 7 days after MPTP treatment in corpus striatum, but there were no significant changes in the levels of 5-hydroxyindoleacetic acid (5-HIAA) and 5-hydroxtryptamine (5-HT). In conclusion, MPTP produced parkinsonism-like behavioral and biochemical changes in C57BL/ 6 mice.
1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine* ; Animals ; Biogenic Amines* ; Brain ; Corpus Striatum ; Dopamine ; Frontal Lobe ; Hippocampus ; Homovanillic Acid ; Mesencephalon ; Mice* ; Motor Activity* ; Posture ; Rodentia ; Spine

BACKGROUND: It is well known that a lacunar infarction may develop by an atherosclerosis of the large intracranial arteries at the site of the perforating arteries. However, their frequency, clinical, and radiological findings have rarely been described. METHODS: Carotid angiograpies were carried out in 26 Korean patients with lacunar infarctions in the carotid arterial territory. They all had classical lacunar symptoms with a computed tomogram (CT) or a magnetic resonance image (MRI) evidence of a small infarction. A transesophageal echocardiography (TEE) was carried out in fifteen patients when either an angiography result was normal, the potential source of cardioembolism was suggested, or no other atherothrom-botic causes of stroke were found. Tc-99m single positron emission computed tomograms (SPECT) were performed in nine patients. We divided patients into two groups; one for patients with MCA occlusive lesion, and another for those without it. The clinical and radiological features were compared between the two groups. RESULTS: Twenty patients (77%) demonstrated abnormal angiographic findings. Fourteen of them showed atherosclerotic changes in the proximal MCA at the site of the orifice of the lenticulostriatal arteries, while another three showed stenosis in the intracranial portion of the internal cerebral artery (ICA), and the other three in the extracranial ICA. Among six patients with normal angiograms, a TEE demonstrated embolic sources of embolism in two patients. The temporal profile and findings of MRI and SPECT in patients with MCA stenosis differed from those with ICA stenosis or normal angiograms. Unstable temporal profiles exclusively occurred in patients with MCA stenosis. The most patients with conglomatory aggregations of the lacune in a MRI showed MCA lesions. The SPECT findings were even more characteristic in that patients with MCA lesions showed relatively large areas of decreased perfusion. CONCLUSIONS: The atherosclerotic diseases at the orifice of the lenticulostri-atal arteries were the most common causes of lacunar infarctions in the carotid artery territory. They were clearly different from those without MCA occlusive lesions in terms of preceding transient ishemic attacks, unstable temporal profiles, uni-lateral multiple lacunes with conglomatory MRI findings, and widespread perfusion defects SPECT.
Angiography ; Arteries ; Atherosclerosis ; Carotid Arteries* ; Cerebral Arteries ; Constriction, Pathologic* ; Echocardiography, Transesophageal ; Electrons ; Embolism ; Humans ; Infarction ; Magnetic Resonance Imaging ; Middle Cerebral Artery* ; Perfusion ; Stroke ; Stroke, Lacunar* ; Tomography, Emission-Computed, Single-Photon

BACKGROUND AND OBJECTIVES: Stroke onset is known to vary by several factors. Although it has been known that stroke may develop most frequently in the morning, its association with the type of activity has quite rarely been described. METHODS: We prospectively investigated by interview the time of and the activity during or before the onset of stroke in patients with acute cerebral infarction from Aug. 1995 to Mar. 1996. The activities were subdivided into basal metabolic rate state, sedentary, light, moderate, and heavy movements based on the caloric expenditure. RESULTS: One hundred-twenty five patients were enrolled. The time of day when ischemic stroke most frequently occurred was from 8:00 AM to noon. The type of activity was significantly associated with stroke onset in that it developed most commonly during and just after sleep or resting. The relationship between the onset of stroke and such patterns of onset time and the activity was found only in the atherothrombotic infarction, but not in the other stroke types. CONCLUSION: We demonstrated that stroke has clear diurnal variation. Our observations also suggested that the activity may be significantly associated with stroke onset. These findings may be useful for better understanding of the pathogenesis and prevention of ischemic stroke.
Basal Metabolism ; Cerebral Infarction* ; Health Expenditures ; Humans ; Infarction ; Prospective Studies ; Stroke

BACKGROUND: There is a lack of basic epidemiological information on bacterial meningitis in children and adults in Korea. Therefore, more research is needed to investigate the causative organisms, clinical manifestations, and prognosis in Korean children and adults. METHODS: We analyzed retrospectively 148 medical records with final diagnosis of bacterial meningitis. The diagnosis of bacterial meningitis was based on culture-positive cases. RESULTS: Out of a total 148 patients, 71 were children and 77 were adults. In the children with community acquired meningitis, infection-related meningitis was the most common predisposing factor (23.3%). In adults, otitis media was the most common (21.7%). There were more frequent seizures in children than adults (38.1%, 17.1%, p<0.05). In community-acquired meningitis, Streptococcus pneumoniae was the most common type. However, in nosocomial meningitis, gram-negative bacilli was the most common type. The prognostic factors associated with mortality rate in adults were old age (>50 years), seizure (p<0.05), and mental change (p<0.001). CONCLUSIONS: Although a causative organism is not documented, we believe that our study will help to properly treat acute bacterial meningitis in children and adults regardless if it is community acquired or nosomial.
Adult ; Causality ; Child ; Cross Infection ; Diagnosis ; Epidemiology ; Humans ; Korea ; Medical Records ; Meningitis ; Meningitis, Bacterial* ; Meningitis, Pneumococcal ; Mortality ; Otitis Media ; Prognosis* ; Retrospective Studies ; Seizures