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

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 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

Metastatic brain parenchymal tumors are among the most important cause of death in patients with cancer, but many physicians didn't have any efforts to treat of metastatic tumors because of their poor responses of treatment. With the recent development of MR techniques, we could diagnose and treat them earlier. Recently many reports for prognostic factors of metastatic brain parenchymal tumors led to assume a more active attitude toward the diagnosis and treatment. We analysed 250 cases of metastatic brain parenchymal tumors diagnosed with the brain CT scan or MRI scan at Yonsei University, Severance Hospital from January, 1992 to December, 1995 and following results were obtained. 1. Metastatic brain parenchymal tumors are found in 254 cases(38.5%) of all intracranial neoplasms. 2. The most common primary tumor is lung cancer(154 cases, 61.6%) followed by breast cancer (30 cases, 12%), GI cancer (15 cases, 5.6%) in the order and melanoma (11.9%), rectal cancer (11.3%), lung cancer (8.6%) exhibit relatively high rate of intraparenchymal metastasis in the order. 3. The most common presenting symptom and sign is headache(52.8%) followed by motor deficit (32.4%), nausea and vomiting(21.6%). 4. Metastatic brain parenchymal tumors are detected simultaneously (73 cases, 28.8%), precociously (9 cases, 3.6%), after (153 cases, 61.2%) diagnosis of the primary tumor. Interval between the diagnosis of primary tumor and development of intracerebral metastasis is short in lung cancer (15.2 month) and long in breast cancer (43.1 month), nasopharyngeal cancer (51 month). In radiologic findings, the lesions were located in supratentorial areas in 186 cases, and in infratentorial in 36 cases. Ring type(63.6%) in enhancement is more than nodular type (33.2%). 5. Hemorrhages are found in 15 cases (7.6%) and calcifications in 2 cases. Density of lesions are hypodense(72.8%) than hyperdense on CT scan and high signal intensity in T1, or T2 weighted image of MRI are 66.7% and 88.9%. 6. Treatments for metastatic brain parenchymal tumors are conventional adiation therapy(165 cases, 66%), surgery(22 cases, 8.8%), gamma knife surgery (19 cases, 7.6%) in the order and there were 36 cases(14.4%) who didn't have any treatment. There are 132 cases(58.2%) who alive and 118 cases(47.2%) who dead. 7. Good predilicting findings in prognosis of metastatic brain parenchymal tumors are single lesion and supratentorial location. However, there are no significant value between prognosis and interval primary-to-metastasis, age, type of primary cancer, type of presenting symptom, size of edema.
Brain Neoplasms* ; Brain* ; Breast Neoplasms ; Cause of Death ; Diagnosis ; Edema ; Hemorrhage ; Humans ; Lung ; Lung Neoplasms ; Magnetic Resonance Imaging ; Melanoma ; Nasopharyngeal Neoplasms ; Nausea ; Neoplasm Metastasis ; Prognosis* ; Rectal Neoplasms ; Tomography, X-Ray Computed

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

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

Purpose: This study aimed to investigate the prevalence of peripheral neuropathy (PNP) and its related serum metabolites in de novo patients with Parkinson’s disease (PD). PNP is a type of frequent comorbidity in PD. Although the administration of levodopa has been described as a presumptive risk factor in its development, few studies have explored its effect on unmedicated PD patients. Materials and Methods: This study included 105 drug-naïve de novo PD patients. A standardized nerve conduction study (NCS) technique was used to evaluate motor or sensory neuropathy. We analyzed serologic tests including metabolic markers of vitamin B12, homocysteine (Hcy), and uric acid (UA). Results: We found abnormal nerve conduction velocity findings in 24 out of 105 total patients. Among them, 20 patients showed a type of combined motor-sensory, while three were a type of pure sensory and one was a pure motor. Nine patients had carpal tunnel syndrome. PD with PNP group demonstrated higher serum levels of Hcy and UA compared to PD without PNP group. Conclusion Our data demonstrated a potential role of Hcy and UA on PNP in de novo patients with PD. These results suggest the contribution of the inherent metabolic pathway in deterioration of the peripheral nervous system in PD.

A weight-holding tremor is a rare type of hand tremor that occurs only when someone holds some weight. Here we report three cases of isolated weight-holding tremors, of which one patient was diagnosed with Parkinson’s disease (PD) and the others as a variant of essential tremor (ET). A 68-year-old woman presented with a left-hand tremor that appeared only when she held objects with some weight. Her tremor was reminiscent of the re-emergent tremor of PD, and dopamine transporter imaging revealed reduced uptake at the right posterior putamen. A 21-year-old man and a 71-year-old woman also presented with similar weightholding tremors. However, these tremors were not re-emergent, and no signs of parkinsonism were observed during follow-up. Although the underlying etiologies of these tremors differed, all three tremors worsened as the held weight increased. These tremors could be isolated isometric tremors, but further research is needed to clarify the nature of this rare tremor.