BACKGROUND: Hyperthermia is known to be one of the important poor prognostic factors of ischemic stroke. However, the prognostic role of fever in hemorrhagic stroke is not clear. We investigated whether the prognostic role of fever is influenced by the type of stroke. METHODS: We analyzed the linical data of patients who were admitted to our hospital within three days after the onset of stroke during 28 months. We divided the patients into three groups according to the degree of maximum temperature recorded during the first seven days; no fever (< OR=37.2 degrees C), low grade (37.3~38.0 degrees C) or high grade (> OR=38.1degrees C) fever. Using the modified Rankin disability scale (MRDS) at discharge, clinical outcome was dichotomized into favorable (MRDS 0~2) and unfavorable (MRDS 3~5) categories. The size of lesion, age, sex, alcohol, diabetes, hypertension, initial glucose level, hypercholesterolemia, heart disease, smoking, previous stroke, and initial National Institutes of Health Stroke Scale (NIHSS) were investigated. RESULTS: Of 217 patients, 46.1% had no fever, 36.9% had low grade fever, and 17.1% had high grade fever. Fever was strongly correlated with outcome in patients with stroke of any type (p<0.05). The size of lesion was also significantly correlated with the degree of fever in patients with ischemic stroke (p=0.01). Multivariate analysis in the logistic model revealed that fever and NIHSS were independent predictors for a poor prognosis. CONCLUSIONS: Fever in patients with acute stroke is an independent poor prognostic factor regardless of stroke type.
Body Temperature* ; Fever ; Glucose ; Heart Diseases ; Humans ; Hypercholesterolemia ; Hypertension ; Logistic Models ; Multivariate Analysis ; National Institutes of Health (U.S.) ; Prognosis ; Smoke ; Smoking ; Stroke*

Hemichorea is usually caused by lesions in the contralateral subthalamus and basal ganglia. Ipsilateral lesions have rarely been reported to be responsible for the abnormal movement. A 27 year-old woman with well-controlled hyper-thyroidism presented with sudden involuntary movements in the right limbs and a mild headache. The movements were random, irregular, repetitive, and most prominent in the right hand and forearm, but also found in the right leg and face. She experienced no weaknesses in the contralateral limbs. A brain magnetic resonance imaging(MRI) taken after 7 days showed early subacute hematoma in the right basal ganglia. There were no lesions in the left hemisphere. In a cerebral angiography, the bilateral major cerebral vessels were narrowed around the circle of Willis. We critically review previous reports of and explanations for the development of ipsilateral hemichorea.
Adult ; Basal Ganglia Hemorrhage* ; Basal Ganglia* ; Brain ; Cerebral Angiography ; Cerebral Hemorrhage ; Circle of Willis ; Dyskinesias ; Extremities ; Female ; Forearm ; Hand ; Headache ; Hematoma ; Humans ; Leg ; Subthalamus

BACKGROUND: The aim of this study is to compare the diagnostic power of transorbital Doppler (TOD) and magnetic resonance angiography (MRA) in detecting carotid siphon disease (CSD) confirmed by conventional angiography (CA) and elucidate the diagnostic role of TOD in CSD. METHODS: We recruited the patients who underwent TOD, MRA and CA within 2 months. TOD velocities above 75cm/sec or no flow was defined as abnormal. Carotid siphon on MRA and CA was divided into C2 & C4 segments; stenosis more than 50% or occlusion on the segment corresponding to the flow direction of TOD was defined abnormal. RESULTS: Sixty patients (44 males and 16 females, mean age: 55.4+/-12.2 years) were recruited. In 117 available carotid siphons 16 vessels (13.7%) were detected as abnormal by CA, 23 vessels (19.7%) by TOD, and 29 vessels (24.8%) by MRA. When CA was used as a gold-standard, the sensitivity and specificity of TOD were 75.0% and 89.1% while those of MRA were 87.5% and 85.1%, respectively. Positive predictive value was about half (52.2% in TOD and 48.3% in MRA) and negative predictive value was over 95% (95.7% in TOD and 97.7% in MRA). The diagnostic accuracy was 87.2% in TOD and 85.5% in MRA. When TOD and MRA were normal, CA was also normal in 98.7% and when both tests were abnormal, CA was abnormal in 78.6%. But when one of two tests was abnormal, CA was abnormal only in 16.7%. Diagnostic consistency of TOD & MRA was acceptable (kappa value = 0.409). Among 23 carotid siphons, which were abnormal on TOD, 11 vessels were normal on CA; false positive rate was 47.8%. But we could find the presumed causes of false positive results in most of cases, such as contralateral proximal ICA occlusion, ipsilateral ICA stenosis just proximal to carotid siphon, etc. CONCLUSIONS: Transorbital Doppler is as good as MRA in noninvasive detection of carotid siphon disease. Despite of the relatively low positive predictive value of TOD and MRA, the combination of their results increases the diagnostic accuracy in carotid siphon disease and may reduce the need of conventional angiography.
Angiography* ; Constriction, Pathologic ; Female ; Humans ; Magnetic Resonance Angiography ; Male ; Sensitivity and Specificity

No abstract available.
Chemoradiotherapy* ; Humans ; Risk Factors* ; Treatment Failure* ; Uterine Cervical Neoplasms*

PURPOSE: To compare the foveal thickness (FT) parameters measured by Stratus optical coherence tomography (OCT) and Spectralis OCT in various retinal diseases and to construct conversion formulas between the two types of OCT devices. METHODS: We examined 366 consecutive patients (475 eyes) with retinal diseases and 13 normal controls (13 eyes). The patients were categorized into eight retinal disease groups. The mean amount and distribution of foveal thickness differences (FTD) measured by Stratus and Spectralis OCT were determined, and conversion formulas were constructed for Stratus OCT FT from Spectralis OCT FT for each retinal disease group. RESULTS: Among retinal diseases, the mean FTD was significantly larger in exudative age-related macular degeneration (AMD) patients (mean +/- SD, 94.0 +/- 55.0 microm) compared to normal subjects (66.2 +/- 11.7 microm; p < 0.0001). The proportion of eyes with a mean FTD outside 1.96 standard deviations of normal subject FTD was greatest in the exudative AMD (50.0%) group and smallest in the macular hole (18.2%) group. The predicted FTs obtained through the conversion formulas showed lower variance than the actual FTD values, especially in the exudative AMD group. The prediction line for exudative AMD deviated most from that of normal subjects. CONCLUSIONS: FTD shows diverse values and variances among various retinal diseases, especially in exudative AMD, which indicates that Stratus OCT FT cannot be predicted from Spectralis OCT FT by FTD value alone. We constructed statistically significant conversion formulas, which provided more reliable methods to predict Stratus OCT-measured FT from Spectralis OCT measurements for different retinal disease groups.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Female ; Fovea Centralis/*pathology ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Retinal Diseases/*pathology ; Retrospective Studies ; *Tomography, Optical Coherence ; Young Adult

Adie's tonic pupil usually consists of mydriasis, defect in accommodation. Poor or absent light reflex, and tonic near reflex, It is usually unilateral, but rarelY observed bilaterally. The pupillary abnormalities often accompany areflexia, which is called Adie syndrome collechvely, Other autonomic dysfunction especially hypohidrosis. Are rarely reported in association with Adie syndrome. We recently experienced 2 cases of bilateral Adie's pupils in 2 women, one of whom had hypohidrosis, and the other had areflexia. So we report 2 cases with bilateral Adie's pupils with a review of literature.
Adie Syndrome ; Female ; Humans ; Hypohidrosis ; Mydriasis ; Reflex ; Tonic Pupil*

BACKGROUND: Coronary artery bypass graft (CABG) surgery is performed more frequently than before in Korea. Central nervous system (CNS) complications are often the major prognostic determinants following the surgery. We carried out a prospective study to clarify the incidence and risk factors of neurologic complications after CABG surgery. METHODS: A consecutive series of 150 patients undergoing 152 CABG operations from March 1995 to July 1997 by one cardiac surgeon was evaluated by a team of neurologists before and after the surgery. The patients received extensive preoperative examinations including the evaluation of intracranial & extracranial cerebral artery disease. RESULTS: In 44 operations (28.9%), we detected various neurologic complications, including encephalopathy (36 operations, 23.7%), cerebral infarction (5 operations, 3.3%), and seizure (7 operations, 4.6%). Eight patients died postoperatively including one due to neurologic complication. On univariate analysis, age, degree of intracranial artery disease (ICAD), duration of bypass time, hypotension index, duration of ventricular assistant device (VAD), intraoperative event, intra- or postoperative arrhythmia, reoperation, and postoperative bleeding were statistically significant risk factors of CNS complications (p< 0.05). After multivariate analysis, however, age alone remained significant (p=0.02). The degree of ICAD showed marginal significance (p=0.06). CONCLUSIONS: The incidence of CNS complication in the patients undergoing CABG surgery was 28.9%. Our results showed that age was an independent risk factor of CNS complications. And the possibility of ICAD as a risk factor was suggested. Further study with a large number of patients would be necessary to prove the above suggestion.
Arrhythmias, Cardiac ; Arteries ; Central Nervous System* ; Cerebral Arterial Diseases ; Cerebral Infarction ; Coronary Artery Bypass* ; Coronary Vessels* ; Hemorrhage ; Humans ; Hypotension ; Incidence ; Korea ; Multivariate Analysis ; Prospective Studies ; Reoperation ; Risk Factors ; Seizures ; Transplants

No abstract available.
Cheilitis ; Lip ; Sialadenitis

The authors experienced two cases of hydrochlorothiazide (HCTZ)-induced acute-onset bilateral myopia and shallowing of the anterior chambers. Two middle-aged women taking HCTZ, a sulfa derivative, visited our clinic complaining of acute bilateral visual deterioration. Both had good visual acuity without corrective lenses before taking HCTZ. A complete ophthalmologic examination revealed bilateral myopic shift, intraocular pressure elevation, shallowing of the anterior chambers, choroidal effusions, radiating retinal folds, and conjunctival chemosis. Approximately one week after HCTZ discontinuance, all ocular changes disappeared completely. Physicians should be aware of the adverse ocular effects of HCTZ and should manage patients accordingly.
Acute Disease ; Adult ; Anterior Chamber/drug effects ; Choroid/drug effects/*metabolism ; Cilia/drug effects/*metabolism ; Diuretics/*adverse effects ; Exudates and Transudates/*metabolism ; Female ; Humans ; Hydrochlorothiazide/*adverse effects ; Intraocular Pressure/drug effects ; Middle Aged ; Myopia/*chemically induced

Verrucous carcinoma is a low grade and well-differentiated, unusual variant of squamous cell carcinoma. It is a slowly-growing, fungating and verrucous tumor that may penetrate deep into the tissue. In contrast to its malignant clinical feature, the tumor tends to invade locally and metastasize rarely. In addition, it has benign histologic features. It usually occurs on the oropharynx, anogenital and plantar areas. Herein, we report an unusual case of verrucous carcinoma occurring on the triangular fossa of the auricle in a 51-year-old man.
Carcinoma, Squamous Cell ; Carcinoma, Verrucous* ; Humans ; Middle Aged ; Oropharynx