The Pisa syndrome is a rare extrapyramidal side effect caused by neuroleptic treatment. Its characteristics are the twist-ing and bending to one side of the upper thorax, the neck, and the head. To our knowledge, there have been no reports of Pisa syndrome in risperidone therapy. We report four male patients with Pisa syndrome in risperidone therapy. Significant points to be noted here are the absence of any extrapyramidal symptoms prior to risperidone therapy, occur-rence in risperidone therapy with small dosages, and delayed spontaneous recovery on discontinuation of risperidone.
Head ; Humans ; Male ; Neck ; Risperidone* ; Thorax

The Pisa syndrome is a rare extrapyramidal side effect caused by neuroleptic treatment and its characteristics are twisting and bending to one side of the upper thorax, the neck and the head. When its chatacteristics show both sides, we call it 'Metronome Pisa syndrome'. We report the case of a 53-year-old woman who suffered Metronome Pisa syndrome following risperidone therapy. Risperidone therapy in old ages should be cautious even if its dosage is minimal.
Female ; Head ; Humans ; Middle Aged ; Neck ; Risperidone* ; Thorax

Olivary hypertrophic degeneration (OHD) is caused by lesions in dentato-rubro-olivary pathway(myoclonic triangle) and responsible for palatal myoclonus and other involuntary movements. We report the clinical features and magnetic resonance imaging(MRI) findings of 5 patients with OHD. All patients had previous brainstem hemorrhage mainly involving pontine tegmentum in four patients and right superior cerebellar peduncle in one patient T2-weighted MR] revealed round or oval shaped high signal area in the ventral or ventrolateral portion of the medulla. Their clinical presentations were as followings: palatal myoclonus (4 case), ocular myoclonus (3 case), pharyngeal and laryngeal myoclonus (2 case), limb myoclonus (2 case), head shaking (I case) and perioral tremulous movement (1 case). The frequency of myoclonus was 70-170/minute and the median time interval between the insult of the primary lesion and the onset of myoclonic symptoms was 2 months. OHD shown as hyperintense lesions on T2 weighted MRI should be differentiated from ischemic, neoplastic or other pathologic lesions. The characteristic clinical presentations and the location of primary lesions involving myoclonic triangle may be helpful in differential diagnosis from primary medullary lesions.
Brain Stem ; Brain* ; Diagnosis, Differential ; Dyskinesias ; Extremities ; Head ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Myoclonus

We report a case of speech disturbance as an unrecognized adverse effect of the selective acetylcholinesterase inhibitor, donepezil. A 79-year-old woman presented with progressive memory disturbance that began 3 years ago. A brain MRI and neuropsychological test suggested that she had Alzheimer's disease. She showed transient dysarthria 14 days after the initiation of donepezil. Isolated speech disturbances were not observed. Clinicians should be alert to the possibility of dysarthria as an adverse effect of donepezil. (J Korean Neurol Assoc 19(2):170~172, 2001)
Acetylcholinesterase ; Aged ; Alzheimer Disease ; Brain ; Dysarthria* ; Female ; Humans ; Magnetic Resonance Imaging ; Memory ; Neuropsychological Tests

We report a case of speech disturbance as an unrecognized adverse effect of the selective acetylcholinesterase inhibitor, donepezil. A 79-year-old woman presented with progressive memory disturbance that began 3 years ago. A brain MRI and neuropsychological test suggested that she had Alzheimer's disease. She showed transient dysarthria 14 days after the initiation of donepezil. Isolated speech disturbances were not observed. Clinicians should be alert to the possibility of dysarthria as an adverse effect of donepezil. (J Korean Neurol Assoc 19(2):170~172, 2001)
Acetylcholinesterase ; Aged ; Alzheimer Disease ; Brain ; Dysarthria* ; Female ; Humans ; Magnetic Resonance Imaging ; Memory ; Neuropsychological Tests

The current perspective for the pathophysiology of normal pressure hydrocephalus is focusing on stiffness of the central nervous tissue, especially on a type of cerebrovascular disorder. Rigid intracranial vessels and tissues derived by either vascular risk factors or aging may lead into impaired dynamics of the cerebrospinal fluid such as increased pulsatility and decreased absorption of the cerebrospinal fluid. Enlarged ventricle may result in a decrease of blood perfusion in brain parenchyma, and in turn global hypoxia and neuro-inflammation along with a breakdown of the blood-brain-barrier. Deterioration of the glymphatic pathway, the crucial disposal pathway of the waste product of the brain, also might contribute to the irreversible injury of the nervous tissue by deposition of abnormal toxic proteins including amyloid beta. Of note, the pathophysiology of the normal pressure hydrocephalus is moving to a type of cerebrovascular disorder instead of the etiology of idiopathic.

The current perspective for the pathophysiology of normal pressure hydrocephalus is focusing on stiffness of the central nervous tissue, especially on a type of cerebrovascular disorder. Rigid intracranial vessels and tissues derived by either vascular risk factors or aging may lead into impaired dynamics of the cerebrospinal fluid such as increased pulsatility and decreased absorption of the cerebrospinal fluid. Enlarged ventricle may result in a decrease of blood perfusion in brain parenchyma, and in turn global hypoxia and neuro-inflammation along with a breakdown of the blood-brain-barrier. Deterioration of the glymphatic pathway, the crucial disposal pathway of the waste product of the brain, also might contribute to the irreversible injury of the nervous tissue by deposition of abnormal toxic proteins including amyloid beta. Of note, the pathophysiology of the normal pressure hydrocephalus is moving to a type of cerebrovascular disorder instead of the etiology of idiopathic.

The current perspective for the pathophysiology of normal pressure hydrocephalus is focusing on stiffness of the central nervous tissue, especially on a type of cerebrovascular disorder. Rigid intracranial vessels and tissues derived by either vascular risk factors or aging may lead into impaired dynamics of the cerebrospinal fluid such as increased pulsatility and decreased absorption of the cerebrospinal fluid. Enlarged ventricle may result in a decrease of blood perfusion in brain parenchyma, and in turn global hypoxia and neuro-inflammation along with a breakdown of the blood-brain-barrier. Deterioration of the glymphatic pathway, the crucial disposal pathway of the waste product of the brain, also might contribute to the irreversible injury of the nervous tissue by deposition of abnormal toxic proteins including amyloid beta. Of note, the pathophysiology of the normal pressure hydrocephalus is moving to a type of cerebrovascular disorder instead of the etiology of idiopathic.

The ocular tilt reaction (OTR) represents a fundamental pattern of eye hand coordination in roll plane and consists of head tilt, conjugate eye torsion, hypotropia, all toward the same side. OTR can be observed not only in patients with peripheral vestibular dysfucntion but also in these with lesions of the graviceptive pathway, which runs from the vestibular nuclei, crossing the midline at the caudal pons, to the intersititial nucleus of Cajal in the rostral midbrain. We present two patients showed complete OTR with the caudal pontine lesions. The first patient was a 65-year-old woman and the lesions involved the dorsolateral portion of pontomedullary junction and cerebellum which was corn patible with AICA and PICA territorial infarction, a magnetic resonanse image(MRI). The ipsiversive OTR in the first patient might be secondary to the ipsilateral vestibular nuclear lesion. The second patient was a 60 year old man and revealed the infarctions in tegmental portion of caudal pons and cerebellum on MRI. The contraversive OTR in the second patient may be secondary to the pontine tegmental lesion involving medial longitudinal fasciculus which is a structure responsible for ascending crossed contralateral graviceptive pathway. OTR is a sensitive brainstem sign of lateralizing and localizing value and our presenting cases support that OTR represents vestibular tone imbalance in the graviceptive pathways.
Aged ; Brain Stem ; Cerebellum ; Female ; Hand ; Head ; Humans ; Infarction ; Magnetic Resonance Imaging ; Mesencephalon ; Middle Aged ; Pica ; Pons ; Vestibular Nuclei ; Zea mays

Recurrent zoster myelitis is quite rare. We present a previously healthy 27-year-old woman who developed recurrent attacks of myelopathy shortly after the characteristic skin rashes of herpes zoster. Magnetic resonance imaging studies demonstrated each lesion in the spinal cord at the same segments as the skin lesions. She had two attacks at opposite sites at the same spinal cord level and complete recovery after being treated with intravenous acyclovir. We suspect that direct invasion of varicella zoster virus was the cause of recurrent myelopathy in our patient.
Adult ; Case Report ; Female ; Herpes Zoster/complications* ; Human ; Magnetic Resonance Imaging ; Myelitis/virology* ; Myelitis/diagnosis ; Recurrence