Loss of pain and temperature sensation due to lateral medullary infarction are well known and classically involve the ipsilateral side of the face and the lower part of the body on the controlateral side. This pattern of sensory loss below a certain level on the trunk, usually a sign of spinal cord disease, may also appear following a lesion in the lateral medullar, due to damage to the spinothalamic tract. A 72-year-old hypertensive man developed sudden dizziness, headache, and gait ataxia. On neurologic examination, he had left limb and gait ataxia. Five days later he noted loss of pain and temperature sensation on the right leg and trunk with a sensory level at T4 with preservation of touch, vibration, and joint position sense in all limbs. Brain MRI showed a small infarct in the left lower lateral medulla. Brain MR angiography showed stenosis of the right proximal carotid artery, left distal vertebral artery, and mid-basilar artery. We report a case of sensory defects with a sensory level on the trunk that occured as the result of lesion of the lower lateral medulla.
Aged ; Angiography ; Arteries ; Brain ; Carotid Arteries ; Constriction, Pathologic ; Dizziness ; Extremities ; Gait Ataxia ; Headache ; Humans ; Infarction ; Joints ; Leg ; Magnetic Resonance Imaging ; Medulla Oblongata ; Neurologic Examination ; Proprioception ; Sensation ; Spinal Cord Diseases ; Spinothalamic Tracts ; Vertebral Artery ; Vibration

Ebstein's anomaly of the tricuspid valve is a rare cardiac malformation, which constitutes>0.5% of all congenital heart disease. The basic malformation of Ebstein's anomaly is displacement of septal and posterior leaflets of the tricuspid valve from the normal atrio-ventricular annulus into the body of right ventricle. Recently, an old man complained cough, dyspnea and sputum production at our hospital. His chest X-ray showed left lower lung atelectasis and cardiomegaly. Bronchoscopic study revealed nonspecific inflammatory change in the left lower lung bronchus. In echocardiographic study, there are dilated right atrium, downward displacement of the tricuspid valve into the right ventricle and moderate degree of tricuspid valve regurgitation. These echocardiographic findings were suitable for diagnostic criteria of Ebstein's anomaly. The atelectasis was resolved by antibiotic therapy, and he has been managed by ACE inhibitor and diuretics through our outpatient department. The clinical manifestation and prognosis of Ebstein's anomaly are quite variable, and considerable proportions of the patients are able to survive through their adult life, but extremely rare cases exist until old age. Recently, I experienced a case of Ebstein's anomaly in a 74-year-old man, such old case is very rare, thus report this case with review of literature.
Adult ; Aged* ; Bronchi ; Cardiomegaly ; Cough ; Diuretics ; Dyspnea ; Ebstein Anomaly* ; Echocardiography ; Heart Atria ; Heart Defects, Congenital ; Heart Ventricles ; Humans ; Lung ; Outpatients ; Prognosis ; Pulmonary Atelectasis ; Sputum ; Thorax ; Tricuspid Valve ; Tricuspid Valve Insufficiency

A severe or prolonged drop in blood pressure caused by syncope can lead to border-zone infarction in the absence of coexisting large artery disease. Syncope due to defecation represent special cases of reflex syncope for which the mechanisms are poorly understood and probably multifactorial. We experienced a 56-year-old woman was recurrent loss of consciousness duration defecation. Brain MRI revealed multifocal high signals in T2WI and FLAIR image on both end-artery border zone, but brain MRA revealed normal finding. Thus, We report a rare case of an old woman patient with end-artery border zone infarction due to prolonged hypoperfusion that was caused by defecation syncope.
Arteries ; Blood Pressure ; Brain ; Defecation* ; Female ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Middle Aged ; Reflex ; Syncope* ; Unconsciousness

BACKGROUNDS: Free radical theory showed that aging might be correlating with the accumulation of oxidative damage into biomolecules of animals. Since the process was also observed in some neurodegenerative disease, the study on the subject could improve our understanding of the aging process. In this regard, our study laid focus on the effect of various anti-oxidants on the cells including mutant Cu/Zn-superoxide dismutase, which was reported to be deficient in various diseases or aging processes. METHODS: We tested retinol, Vitamin C, E and coenzyme Q10 on mutant Cu/Zn-superoxide dismutase(A4V) motor neuron cells using immunocytochemical study and accompanying statistical analysis. RESULTS: During our trial on the hydrogen peroxide treatment on A4V mutant cells, Vitamin A and C did not show any defensive effect on oxidative stress induced A4V cells while Vitamin E and coenzyme Q10 exhibited meaningful inhibitory effect against apoptosis relating protein expression. CONCLUSION: In case of oxidative damages induced by Cu/Zn-superoxide dismutase deficiencies, the protective role of some anti-oxidants like Vitamin E or coenzyme Q10 should be positively considered in forthcoming studies.
Aging ; Amyotrophic Lateral Sclerosis ; Animals ; Apoptosis* ; Ascorbic Acid ; Hydrogen Peroxide ; Immunohistochemistry ; Motor Neurons* ; Neurodegenerative Diseases ; Oxidative Stress ; Vitamin A ; Vitamin E ; Vitamins

BACKGROUNDS: The inflammatory reaction after cerebral ischemia involving adhesion molecules aggravates neurologic deficit. This study aimed to study the change of plasma level of the adhesion molecules after acute cerebral ischemia. METHODS: Nineteen patients with acute cerebral infarction and ten control subjects without a history of cerebrovascular disease were included in this study. The patient groups were subgrouped into large artery atherosclerosis and small artery occlusion groups according to TOAST classification. Plasma levels of sP-selectin, sE-selectin, sICAM-1 and sVCAM-1 were measured within 24 hours and in 6 to 8 days after acute ischemic infarction. RESULTS: The plasma level of sP-selectin was elevated in acute stroke patients within 24 hours and in 6 to 8 days after stroke onset compared with control group(p<0.05). But plasma levels of sE-selectin, sICAM-1 and sVCAM-1 were not different from those of control group. The plasma level of sP-selectin was significantly elevated in large artery artherosclerosis group compared with control group. CONCLUSION: This study suggest that P-selectin actively involves in inflammatory process after acute ischemic stroke, especially associated with atherosclerosis.
Arteries ; Atherosclerosis ; Brain Ischemia ; Cerebral Infarction ; Classification ; Humans ; Infarction ; Neurologic Manifestations ; P-Selectin ; Plasma* ; Stroke*

BACKGROUNDS: As the lifetime is prolonged, the chances of operation of elderly people are increased concomitantly. In general, elderly patients have more frequent and severe psychiatric problems as depression and cognitive dysfunction than young patients. But, the prevalence rate of depression and cognitive dysfunction pre and postoperatively is known a little. Also, the delirium which makes the surgeon embarrassed is high in dementia and elderly patients even diagnosed normally preoperatively. We tried to know how many elderly people has depression and cognitive dysfunction pre and postoperatively, also how many elderly patients become delirious postoperatively. METHOD: We obtained questionnaires from 100 elderly patients(mean age 75.0) undergoing operation pre and postoperatively. We used Short Portable Mental Status Questionnaire(SPMSQ) which calculated the wrong answer for the fact to evaluate the cognitive dysfunction and short version of Geriatric Depression Scale(GDS) which calculated the wrong answer defined previously to study the depression. The depression was suggestted if GDS score was above 6 and cognitive dysfunction was suggested if SPMSQ score was above 3. The dementia and postoperative delirium patients were diagnosed and managed by the psychiatrist and the operator. RESULTS: Pre and postoperative mean score of GDS was 10.1 and 9.5 respectively. Pre and postopera- tive incidence of depression was 65% and 67% respectively. Pre and postoperative mean errors of SPMSQ was 6.5 and 6.7 respectively. Pre and postoperative incidence of cognitive dysfunction was 30% and 31% respectively. The dementia patients were ten. The postoperative delirium patients were six. Three of them were dementia patients diagnosed preoperatively and the others had non-cognitive dysfunction preoperatively. CONCLUSION: The incidence of depression and cognitive dysfunction in elderly patients is relatively high. And the postoperative delirium is high in dementia patients. Even the patients diagnosed non- cognitive dysfunction preoperatively have high incidence rate than young people. So, we must do critical care with elderly patients pre and postoperatively and know the appropriate management of depression and cognitive dysfunction to prevent prolonged hospitalization, poor quality of life and conflict with patient`s family.
Aged ; Critical Care ; Delirium ; Dementia ; Depression* ; Hospitalization ; Humans ; Incidence ; Prevalence ; Psychiatry ; Quality of Life ; Surveys and Questionnaires

BACKGROUND: After the group education program for the families of stroke patients, we found there were improvement in family members' mental health state and coping skills. However, we also found that family caregiver's burden varied depending on patient and family factors. The purpose of this study, therefore, were to explore which factors affected caregiver's burden on family members of stroke patients and to make a background for suggesting an effective intervention strategies for them. METHOD: The subjects of this study were 187 family members of stroke patients who received the treatment from Hospital located in Seoul and Kyunggi area and they completed the written questionnaire. RESULTS: While Family member's health state, share of care responsibility, patient's functional status and family and friends support were predictors of subjective care burden, patients age and left hemiparesis among patient's functional status were predictors of objective care burden. CONCLUSIONS: Family members play a critical role in the long-term rehabilitation of a stroke patient. Hence reducing family members' care burden is very important for a patient as well as their family members. Therefore if we make intervention strategies considering these influential factors, it could be more effective to reduce family caregiver's burden.
Adaptation, Psychological ; Caregivers* ; Education ; Friends ; Gyeonggi-do ; Humans ; Mental Health ; Paresis ; Surveys and Questionnaires ; Rehabilitation ; Seoul ; Stroke*

BACKGROUND: The proliferation of vascular smooth muscle cells(VSMCs) is an important process in the pathogenesis of atherosclerosis. VSMCs proliferation is closedly related to the cytosolic calcium flux via L-type voltage dependent calcium channel. OBJECTIVES: To investigate the role of cytosolic Ca2+ in the proliferation of VSMCs. METHODS: The proliferation of aortic vascular smooth muscle cells of streptozotocin induced diabetic rats, acquired by enzymatic method. Cell counting, and calcium agonists(Bay K 8644 10(-6)M) or calcium antagonists(verapamil 10(-6)M). Cytosolic calcium ion was measured with Fura 2 method. Calcium channel gene expression was detected with RT-PCR method. RESULTS: VSMCs of diabetic rats were more proliferated than those of nondiabetic ones. Bay K 8644 enhanced VSMCs proliferation of both groups. Verapamil blocked the incremental effects induced by Bay K 8644. Expression of calcium channel gene was enhanced by Bay K 8644 and was reversed by vera- pamil. CONCLUSION: The enhanced proliferation of VSMCs is associated with the increment in cytosolic calcium, which is accompli shed through the expression of L-type voltage dependent calcium channel.
3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethyl-5-nitro-4-(2-(trifluoromethyl)phenyl)-, Methyl ester ; Animals ; Aorta* ; Atherosclerosis ; Calcium ; Calcium Channels ; Cell Count ; Cytosol ; Fura-2 ; Gene Expression ; Muscle, Smooth, Vascular* ; Rats* ; Streptozocin ; Verapamil

No abstract available.

Rhino-orbito-cerebral muconnycosis is an uncommon fatal fringal infection, almost exclusively seen in diabetic or other itnmunocompromised patients. Recurrent transient ischemic attacks(TIAs) as initial presenting sign of rhino-orbito-cerebral mycormycosis has not been reported to our knowledge. We report a patient with muconnycosis unusually presenting with recurrent TIAs, followed by central retinal artery occlusion, multiple cranial nerve palsies, and then cerebral infarction in the territory of middle cerebral artery.
Cerebral Infarction ; Cranial Nerve Diseases ; Humans ; Middle Cerebral Artery ; Mucormycosis* ; Retinal Artery Occlusion