In acute phase, cerebral infartion is usually hypodense on CT and hyperintense on T2-weighted MR image. This hyperintensity on T2-weighted MR image gradually approaches an isointensity stage after 2 or 3 weeks of onset. In the later stage, cerebral infarction is observed hyperintense on T2-weighted MR image. This sequential phenomenon is so-called "fogging effect". We experienced two cases of "fogging effect". The first case did not show abnormal signal intensity on TI or T2 weighted MR images taken after 14 days of onset and the second case also did not show abnormal signal intensity after 17 days of onset. Each case revealed hyperintense in T2-weighted image with contrast enhancement taken after 20 weeks and 8 weeks of onset, respectively. We present two cases with MRI and brief review of literatures.
Cerebral Infarction ; Magnetic Resonance Imaging ; Weather*

Crossed aphasia refers to a combination of aphasia and right hemiparesis in a left handed person or left hemiparesis and aphasia in a dextral. While crossed aphasia is not infrequent at all among left-handers, it remains an extremely rare event in dextrals. Its incidence is probably about 0.4% after right hemispheric lesions and prevalence is about 1% among right-handed aphasics. The neurobiological mechanisms of this phenomenon are unknown, and the neuropsychological correlations are only incompletely understood. We report a case of crossed aphasia in a 61-year-old right-handed woman who presented with sudden, severe global aphasia and left hemiplegia without any personal or family history of left-handedness. Brain MR image clearly showed a right hemispheric infarction in the territory of the right middle cerebral artery and brain SPECT also displayed reduction of regional cerebral blood flow in the right hemisphere sparing the left hemisphere. In this patient, cerebral dominance for speechseems to lay in the right hemisphere, while dominance for limb praxis seemsto lay in the left as the patient did not develop right limb apraxia. This case provides evidence that cerebral dominance for speech and handedness in dextrals can be dissociated. It also suggests that crossed aphasia in a dextral may be severe and persisting.
Aphasia* ; Apraxias ; Brain ; Dominance, Cerebral ; Extremities ; Female ; Functional Laterality ; Hand ; Hemiplegia ; Humans ; Incidence ; Infarction ; Middle Aged ; Middle Cerebral Artery ; Paresis ; Prevalence ; Tomography, Emission-Computed, Single-Photon

Pure word deafness refers to an inability to understand spoken language with relatively normal reading, writing and speaking as well as comprehension of nonverbal sounds. We report a case of 36 year-old right-handed man with a mitral valve prolapse who presented with a pure word deafness following bilateral primary auditory cortical infarction. The auditory deficit was specific for spoken language, while recognition of non-verbal sounds was normal. Pure tone threshold audiometry revealed mild sensorineural loss up to 2000 Hz and a moderate high frequency loss. Brainstem auditory evoked potentials were normal. Brain MRI showed that the infarction was confined to bilateral superior temporal gyri including primary auditory cortex.
Adult ; Audiometry ; Auditory Cortex ; Brain ; Comprehension ; Deafness* ; Evoked Potentials, Auditory, Brain Stem ; Humans ; Infarction ; Magnetic Resonance Imaging ; Mitral Valve Prolapse ; Writing

We report a case of 53-year-old woman with personification following right middle cerebral artery territory infarction. Although she knew that her paralyzed left limbs belonged to her, she behaved as if it is a separate person. Verbalization of hatred toward her left arm was frequently observed. She attributed her neurologic deficit to the left arm instead of herself, frequently complaining in a fashion that 'I(a person except for the left arm) am all right but he/she(left arm) is wrong'. This delusional beliefs were mainly confined to her paralysed left limb, and were accompanied by left spatial neglect, transient anosognosia for hemiplegia and right-left disorientation.
Agnosia ; Arm ; Delusions ; Extremities* ; Female ; Hemiplegia ; Humans ; Infarction ; Middle Aged ; Middle Cerebral Artery ; Neurologic Manifestations ; Stroke*

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

BACKGROUND AND OBJECTIVES: Behcet's disease (BD) may develop variable neuro logic manifestations. We herein report patients with neuroBD with special reference to clinical, cerebrospinal fluid (CSF), and radiological findings. METHODS: Twenty-six patients, who fulfilled international BD criteria, were enrolled. Twenty-four of them fulfilled the criteriae at the time of, and another two at a three and four month follow up after presenting neurological manifestations. Twenty-two patients had CSF examination. All but three patients had imaging studies (CT scan in 7 and MRI in 16). RESULTS: Most patients with neuroBD presented with focal neurologic deficits, followed by meningitic symptoms and behavioral changes or cognitive dysfunctions. The common initial neurological symptoms or signs were hypereflexia, headache, dysarthria, and disturbances of eye movement in order of frequency. One or more parameters of CSF examinations were abnormal in all but two patients. Mean WBC count was 165+/-279/mm3 (9-1320). Nine of them were neutrophilic (polys >50%). Protein was mildly ele vated up to 155 mg/dI. Neuroimaging studies showed abnormal findings in 18 patients (75 %). Increased signal intensity on T2 weighted image was the most common finding. Basal ganglia, midbrain, pons and thalamus were the common sites of involvement in that of frequency. Although most patients had a lesion in the brain parenchyme or meninges, one patient had venous sinus thrombosis and another one had myelitis. Clinical outcomes were good in that all but three patients improved. However, 10 of them (38 %) recurred during their follow-up period of average 36 months. CONCLUSIONS: Our findings suggest that neuroBD may present with variable neurologic manifestations and show characteristic neutrophilic CSF findings and multifocal brainstem or diencephalon involvements. The frequent recurrence, despite their good clinical outcomes, points up the need for careful long-term neuologic observations.
Basal Ganglia ; Brain ; Brain Stem ; Cerebrospinal Fluid* ; Diencephalon ; Dysarthria ; Eye Movements ; Follow-Up Studies ; Headache ; Humans ; Logic ; Magnetic Resonance Imaging ; Meninges ; Mesencephalon ; Myelitis ; Neuroimaging ; Neurologic Manifestations ; Neutrophils ; Pons ; Recurrence ; Sinus Thrombosis, Intracranial ; Thalamus

BACKGROUND & OBJECTIVES: It was well known that benign paroxysmal positional vertigo(BPPV) was caused by the involvement of the posterior semicircular canal, but there were a few reports about horizontal canal variant of BPPV. We studied the clinical features electronystagmographic (ENG) findings and the possible mechanism of BPPV of the horizontal canal(HBPPV). METHODS: We examined 10 cases of HBPPV with episodic vertigo and intense horizontal geotropic nystagmus provoked by rotation of the head in a supine position. Six patients underwent ENG and we recorded four patients' nystagmus, provoked by rotating head from extreme lateral, mid and nose-up position to extreme contralateral direction in supine position. RESULTS: All observed horizontal nystagmus beated towards the ground on both sides and were more pronounced when head was rotated to pathological side. In rotating to pathological side, nystagmus had mean latency of 2.6+/-1.8 seconds, peak velocity of slow phase of 66,8+/-19.7 degree/second and mean duration of 24.7+/-3.4 seconds. In rotating to healthy side the nystagmus had 3. 7+/- 2.9, 38.0+/-11.5 and 22.5+/-4. Secondary phase nystagmus occurred in 2 patients and fatigue was observed in 4 patients. The slow phase velocity of nystagmus was relative to the distance of head rotation. The duration of attack is 3 to 17 days(6.9+/-5.2days). Liberatory manuever had relatively a good effect. CONCLUSION: HBPPV represents the origin of horizontal semicircular canal and has a good prognosis Above findings support that mechanism of horizontal BPPV is canalolithiasis.
Fatigue ; Head ; Humans ; Nystagmus, Pathologic ; Prognosis ; Semicircular Canals* ; Supine Position ; Vertigo*

Leber's hereditary optic neuropathy (LHON) is an important cause of bilateral optic neuropathy in youth and occasionally associated with other neurological abnormalities (Leber's plus). The authors recently found out one family of LHON and another patient of Leber's plus with mitochondrial DNA (mtDNA) 11778 mutation. The presence of a point mutation of mtDNA was investigated by restriction length fragment polymorphism. Among 14 patients who had mtDNA 11778 mutation in the family, only two men had bilateral optic neuropathy. The other was a man of optic neuropathy with myelopathy. The age at onset of visual loss ranged from 14 to 25 (average 19.7). The time delay between involvement of the two eyes was I to 3 months Central visual field defect was observed in each of all affected eyes and worse in the earlier affected. The brain MRI and CSF studies revealed no abnormality. This study showed that the clinical manifestations and genealogical features of LHON in our patients are similar to those of previously reported cases in other countries.
Adolescent ; Brain ; DNA, Mitochondrial* ; Humans ; Magnetic Resonance Imaging ; Male ; Optic Atrophy, Hereditary, Leber ; Optic Nerve Diseases ; Point Mutation ; Spinal Cord Diseases ; Visual Fields

Thymectomy is considered as one of the important therapy for patients with myasthenia gravis(MG) for reducing the symptoms and hasting the time of remission. However, the efficacy of thymectomy in previous studies were not in concordant with each others. This study was designed to assess the effects of thymectomy in 84 MG patients. The patients were divided into two groups according to their medications before thymectomy : the patients who had been treated with anticholinesterase(ACE group) and the others who had been treated with both anticholinesterase and steroid(steroid group). The outcomes of thymectomy were divided into two group : ""success"" and ""failure"". The ""success"" outcomes included the patients with remission or improvements and the ""failure"" outcomes included the patients with improvement by immunosuppressive agents, unimprovement, and death. To find factors which might influence on the prognosis after thymectomy, the following variables were considered for statistics; The onset age of MG, gender, myasthenic crisis before operation, the clinical symptoms at the time of operation, and the pathologic findings of thymus. The results were as follows. Sixty-six patients were included in ACE group and 18 in steroid group. The success were occurred in 37 patients among ACE group(56%) and in 8 patients among steroid group(44.4%). In ACE group, the success more frequently occurred in the patients with thymic follicular hyperplasia(79.3%) than in those with thymoma(36%), and normal or atrophic thymus(41.7%). The Patients who had mild clinical symptoms at the operation also showed higher success rate. However, gender, the age of onset, and the presence of myasthenic cirsis before the operation did not influences on the results of the operation. In steroid group, the success rate was higher in the patients with shorter duration of steroid treatment before thymectomy(< 6 month) and follicular hyperplasia. In addition, the immunosuppressive treatments also gave symptomatic improvements in most patients with failure outcomes after thymectomy. In conclusion, thymectomy demonstrated beneficial effects in about half of MG patients. Follicular hyperplasia and mild symptoms at the operation were considered to be factors for predicting better results after thymectomy. Our findings also suggest that the longstanding steroid treatment before thymectomy may negatively affect on the successful thymectomy, especially on remission.
Age of Onset ; Humans ; Hyperplasia ; Immunosuppressive Agents ; Myasthenia Gravis* ; Prognosis ; Thymectomy* ; Thymus Gland

We analyzed 177 diabetic patients(80 males, 97 females) with the nerve con duction study (NCS) performed twice or more at the interval of more than one year in Severance Hospital from Jan 1, 1984 through Dec 31, 1994. We conclude as follows: 1)The NCS follow-ups showed that diabetic polyneuropathy was getting worsened electrophysiologically as time goes by. 2)The NCS revealed that the earlier change was noticed on the distal portion of sensory nerve fiber, though diabetes was known to cause a damage to both sensory and motor nerve fibes. 3)Considering that the NCS follow-ups revealed earlier and more marked changes in amplitude than in nerve conduction velocity, axonal degeneration seems to be more responsible for the pathogenesis of diabetic polyneuropathy rather than segmental demyelination.
Axons ; Demyelinating Diseases ; Diabetic Neuropathies ; Follow-Up Studies* ; Humans ; Male ; Nerve Fibers ; Neural Conduction*