Cranial mononeuropathies, manifesting particulary as opthalmoplegia or facial palsy, are common entities in the dia-betic population. However, sequential multiple cranial neuropathies due to diabetes are much less common. It is often associated with other conditions such as a brain tumor or head trauma. A 61-year-old diabetic man presented with ptosis, opthalmoplegia, and facial palsy which were manifestations of multiple cranial neuropathies involving the left 3rd, 4th, 6th, and 7th cranial nerves throughout five weeks. The pupils were not involved. The neurologic evaluation included a CSF study and a brain MRI with MRA. None of them produced any significant results. Blink reflexes revealed evidence of a left facial nerve lesion. The blood glucose was strictly controlled and steroid therapy was administered. The ptosis of the patientanjx left eyelid improved during treatment and he was discharged after 13 days. In a follow-up examination 3 months after onset, focal neurological deficits including opthalmoplegia and facial palsy on the left side were greatly improved and barely noticeable.
Blinking ; Blood Glucose ; Brain ; Brain Neoplasms ; Cranial Nerve Diseases* ; Cranial Nerves ; Craniocerebral Trauma ; Diabetes Mellitus* ; Eyelids ; Facial Nerve ; Facial Paralysis ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Mononeuropathies ; Pupil

BACKGROUND: Although a magnetic resonance imaging (MRI) is highly sensitive for changes associated with ischemic stroke, the detection of an acute ischemic lesion is usually impossible within 6 hours of the stroke onset on a conventional MRI. The perfusion MRI is a new imaging technique for diagnosing acute ischemic stroke. We evaluate the clinical usefulness of the perfusion MRI in predicting the final infarct extent in 18 patients with acute middle cerebral artery (MCA) territory ischemic stroke. METHOD: The perfusion MRI was performed within 6 hours after the stroke onset in all patients with a single-section dynamic contrast-enhanced T2*-weighted imaging in conjunction with a conventional routine MRI and MR angiography. Time-concentration curves and cerebral blood volume (CBV) maps were calculated from the dynamic MR imaging data by using numerical integration techniques. We compared findings of CBV maps with infarction on a follow-up CT or MRI. RESULTS: In 14 of 18 patients, the CBV in the occluded MCA territory were decreased. In the remaining 4 patients with a reversible ischemic neurologic deficit (RIND) or transient ischemic attack (TIA), the CBV were increased in 3 and normal in 1. Out of 14 patients with a decreased CBV, two had focal regions of increased CBV within the affected territory, indicating reperfusion hyperemia. The regions of increased or decreased CBV were eventually converted to infarction on follow-up images in all 14 patients. Out of 4 patients with RIND or TIA, one showed focal infarction in centrum semiovale on a follow-up image. CONCLUSIONS: The perfusion MRI was useful for the assessment of hemodynamic change about cerebral perfusion and may predict the extent of final infarction in acute MCA territory ischemic stroke. These results suggest that the perfusion MRI may play an important role in the diagnosis and management of acute ischemic stroke.
Angiography ; Blood Volume ; Diagnosis ; Follow-Up Studies ; Hemodynamics ; Humans ; Hyperemia ; Infarction ; Ischemic Attack, Transient ; Magnetic Resonance Imaging* ; Middle Cerebral Artery* ; Neurologic Manifestations ; Perfusion* ; Reperfusion ; Stroke*

Polyacrylamide hydrogel is used widely in plastic surgery due to its nontoxic, nonabsorbent nature. There have been reports of silicone leading to pulmonary embolism and acute respiratory distress syndrome with systemic adverse effects. However, there have been case reports only of local reactions involving polyacrylamide; systemic reactions appear to be rare. Furthermore, there has been no report of alveolar hemorrhage after polyacrylamide injection for breast augmentation. We treated a 53-year-old female with an alveolar hemorrhage that occurred 2 days after a polyacrylamide injection. On the day of admission, the patient had a fever with chills and dyspnea. The chest X-ray showed multiple infiltrations and chest computed tomography showed consolidation and a ground-glass appearance in both lung fields. The alveolar hemorrhage was confirmed at fiber-optic bronchoscopy and bronchoalveolar lavage. The symptoms and radiology findings improved after corticosteroid administration and conservative treatment. We report the first case of alveolar hemorrhage after a polyacrylamide injection for breast augmentation.
Breast* ; Bronchoalveolar Lavage ; Bronchoscopy ; Chills ; Dyspnea ; Female ; Fever ; Hemorrhage* ; Humans ; Hydrogel ; Lung ; Mammaplasty ; Middle Aged ; Pulmonary Embolism ; Respiratory Distress Syndrome, Adult ; Silicones ; Surgery, Plastic ; Thorax

Nephrotic syndrome causes a hypercoagulable state, leading to both venous and arterial thrombosis. Thromboembolic events occur frequently in patients with nephrotic syndrome. However, central venous thrombosis occurs less frequently as a complication of minimal change nephrotic syndrome. The pathogenic mechanisms are not yet unclear, but various alterations in coagulant and anti-coagulant factors may be responsible. We report a case of cerebral venous thrombosis associated with minimal change nephrotic syndrome. A 27-year-old man was admitted due to sudden, severe headache with nausea and vomiting. He complained of a continuous throbbing-type headache in bifrontal area. One month prior to the symptoms, he was diagnosed as having nephrotic syndrome based on clinical manifestations and biopsy findings. The routine laboratory findings showed that he had hyperlipidemia, hypoalbuminemia and proteinuria. In clotting factor analysis, fibrinogen, factor VII, VIII and von Willebrand factor were increased and factor XII, antithrombin III and protein S were decreased. The unenhanced brain CT scan showed a triangle-shape high density in a superior sagittal sinus and gadolinium enhanced brain MRI showed unenhanced blood clot in a superior sagittal sinus. Initial brain MR venography showed a lack of filling of a superior sagittal sinus and poor visualization of cortical veins.
Adult ; Antithrombin III ; Biopsy ; Brain ; Factor VII ; Factor XII ; Fibrinogen ; Gadolinium ; Headache ; Humans ; Hyperlipidemias ; Hypoalbuminemia ; Magnetic Resonance Imaging ; Nausea ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Phlebography ; Protein S ; Proteinuria ; Superior Sagittal Sinus ; Thrombosis ; Tomography, X-Ray Computed ; Veins ; Venous Thrombosis* ; Vomiting ; von Willebrand Factor

The typical manifestation of repeated migraine headache followed by ophthalmoplegia can be diagnosed as a ophthalmoplegic migraine. The diagnosis requires exclusion of other causes. MRI was useful in excluding other causes of ophthalmoplegia with headache and there is few abnormal findings on MRI in ophthalmoplegic migraine patients. A 55-year-old man with a familial and personal history of migraine was admitted due to left ptosis and diplopia followed by insidiously developed headache. The migraine headache and ophthalmoplegia were improved spontaneously within 3 days and within 4 weeks, respectively. MRI demonstrated gadolinium enhancement on the cisternal portion of left oculomotor nerve.
Diagnosis ; Diplopia ; Gadolinium* ; Headache ; Humans ; Magnetic Resonance Imaging* ; Middle Aged ; Migraine Disorders ; Oculomotor Nerve* ; Ophthalmoplegia ; Ophthalmoplegic Migraine*

Memory reconsolidation is ubiquitous across species and various memory tasks. It is a dynamic process in which memory is modified and/or updated. In experimental conditions, memory reconsolidation is usually characterized by the fact that the consolidated memory is disrupted by a combination of memory reactivation and inhibition of protein synthesis. However, under some experimental conditions, the reactivated memory is not disrupted by inhibition of protein synthesis. This so called "boundary condition" of reconsolidation may be related to memory strength. In Pavlovian fear conditioning, the intensity of unconditional stimulus (US) determines the strength of the fear memory. In this study, we examined the effect of the intensity of US on the reconsolidation of contextual fear memory. Strong contextual fear memory, which is conditioned with strong US, is not disrupted by inhibition of protein synthesis after its reactivation; however, a weak fear memory is often disrupted. This suggests that a US of strong intensity can inhibit reconsolidation of contextual fear memory.
Memory

BACKGROUND: Fluoxetine (Prozac), a selective serotonin reuptake inhibitor, has been shown to be effective in the treatment of depression. We investigated the effects of norfluoxetine, the major active metabolite of fluoxetine, on voltage-gated K+ currents in primary cultured hippocampal neurons, and determined the potency and modes of actions of norfluoxetine. METHODS: Voltage-gated K+ currents were studied in primary cultured rat hippocampal neurons using the whole-cell configuration of the patch-clamp technique. Electrophysiological recordings were done in hippocampal neurons between 5-10 days in culture. Transient A-type K+ currents (KA) and delayed-rectifier K+ (KDR) currents were isolated from whole-cell K+ currents using a pulse protocol. RESULTS: Norfluoxetine accelerated the decay rate of whole-cell K+ currents, and thus decreased the current amplitude at the end of a pulse in a concentration-dependent manner. Norfluoxetine inhibited KA and KDR currents in a concentration-dependent manner with IC50's of 0.93 and 0.70micro M, respectively. Norfluoxetine also reduced the areas of KA currents and the steady-state KDR current over the range of test potentials, and the reduction was voltage-dependent (greater increase at more positive potentials). From the onset of the fractional block of KA currents by norfluoxetine during the initial 40 ms of a clamp step, we calculated k1 = 53.26/micro M.s for the association rate constant, and k2 = 70.24/s for the dissociation rate constant. The resulting apparent KD was 1.32micro M, which is similar to the IC50 value obtained from the concentration-response curve. CONCLUSIONS: Our results indicate that norfluoxetine, the major metabolite of fluoxetine, at therapeutic levels, produces a concentration- and voltage-dependent inhibition of KA and KDR currents in primary cultured hippocampal neurons. These effects could perturb the neuronal excitability in the hippocampus, and may contribute to the therapeutic antidepressant action of fluoxetine.
Animals ; Depression ; Fluoxetine* ; Hippocampus ; Inhibitory Concentration 50 ; Neurons* ; Patch-Clamp Techniques ; Potassium Channels, Voltage-Gated* ; Rats* ; Serotonin

Hypercoagulability disorders are commonly encountered in clinical situations in patients with a variety of cancers. However, several hypercoagulability disorders presenting as first symptoms or signs in cancer patients have rarely been reported. We herein described a case of a woman with adenocarcinoma of the lung presenting with deep vein thrombosis, nonbacterial thrombotic endocarditis, recurrent cerebral embolic infarction, and heart failure.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung ; Endocarditis ; Endocarditis, Non-Infective ; Female ; Heart Failure ; Humans ; Infarction ; Lung ; Lung Neoplasms* ; Thrombophilia* ; Venous Thrombosis

Hypercoagulability disorders are commonly encountered in clinical situations in patients with a variety of cancers. However, several hypercoagulability disorders presenting as first symptoms or signs in cancer patients have rarely been reported. We herein described a case of a woman with adenocarcinoma of the lung presenting with deep vein thrombosis, nonbacterial thrombotic endocarditis, recurrent cerebral embolic infarction, and heart failure.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung ; Endocarditis ; Endocarditis, Non-Infective ; Female ; Heart Failure ; Humans ; Infarction ; Lung ; Lung Neoplasms* ; Thrombophilia* ; Venous Thrombosis

Urothelial carcinomas (UCs) can occur in the upper urinary tract or lower urinary tract. Upper urinary tract urothelial carcinoma (UUT-UC) is relatively a rare disease and accounts for only about 5% of UC cases. Sporadic cases of late-onset metastasis, associated with UC of the bladder, have occasionally been reported. In contrast, no late-onset distant metastatic UUT-UC without local recurrence has, to the best of our knowledge, been reported in the English literature. We report an extremely rare case of distant metastatic UC, mimicking lung adenocarcinoma that originated from UUT-UC 12 years previously.
Adenocarcinoma ; Lung ; Lung Neoplasms ; Neoplasm Metastasis ; Rare Diseases ; Recurrence ; Urinary Bladder ; Urinary Tract ; Urothelium