Ischemic stroke is a serious neurological complication of infective endocarditis. Intravenous tissue plasminogen activator (t-PA), which has only been approved for treatment of hyperacute stroke, has been excluded as an ischemic stroke treatment due to infective endocarditis according to current expert consensus guidelines. Here, we describe a case of a hyperacute stroke patient treated with intravenous t-PA, who was later diagnosed with infective endocarditis.

No Abstract Available.
Case-Control Studies*

A 49-year-old woman with anemia who developed headache and seizure after blood transfusion was diagnosed with posterior reversible encephalopathy syndrome (PRES). Magnetic resonance imaging showed typical PRES findings including lesions in bilateral parieto-occipital subcortical white matter and overlying cortex. Only a few cases of PRES after transfusion have been reported and this case is unique in that there was a latent period between infusion and development of PRES. We postulate that rapid change of hemoglobin level may disrupt cerebral autoregulation and result in delayed PRES. We suggest that neurological symptoms after blood transfusion should be appropriately investigated.

PURPOSE: To report a rare case of lymphocytic hypophysitis in a 31-year-old woman who presented with gradually progressive bilateral visual loss during the third trimester of pregnancy. METHODS: Ophthalmologic examination revealed best corrected visual acuity of 0.02 OD and counting fingers at 20 cm OS. Pupil examination revealed no relative afferent pupillary defect in either eye and intraocular pressure was normal in both eyes. A visual field test revealed nearly total visual defect sparing superotemporal area OD and total defect OS. An MRI of the head was performed. RESULTS: At the time of transsphenoidal surgery following the patient's delivery, a frozen biopsy of the lesion revealed diffuse lymphocytic infilteration and fibrosis of the pituitary gland consistent with the diagnosis of lymphocytic hypophysitis. Postoperatively the patient was treated for hypopituitarism. At 5 weeks postoperative, her best corrected visual acuity was 1.0 OU, and visual field defects resolved in both eyes. On follow-up by telephone for postoperative 7 months, the patient remained visually asymptomatic. CONCLUSIONS: The clinical presentation of lymphocytic hypophysitis may mimic pituitary adenoma, lymphoma, germinoma, and histiocytosis. The diagnosis should be suspected in any pregnant or postpartum patient with an intrasellar or suprasellar mass.
Adult ; Biopsy ; Diagnosis ; Female ; Fibrosis ; Fingers ; Follow-Up Studies ; Germinoma ; Head ; Histiocytosis ; Humans ; Hypopituitarism ; Intraocular Pressure ; Lymphoma ; Magnetic Resonance Imaging ; Pituitary Gland ; Pituitary Neoplasms ; Postpartum Period ; Pregnancy Trimester, Third ; Pregnancy* ; Pupil ; Pupil Disorders ; Telephone ; Visual Acuity ; Visual Field Tests ; Visual Fields

BACKGROUND: Several antibiotics can be used to treat ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii (CRAB-VAP) including high-dose sulbactam. However, the effectiveness of high-dose sulbactam therapy is not well known. We report our experience with high-dose sulbactam for treatment of CRAB-VAP. METHODS: Medical records of patients with CRAB-VAP who were given high-dose sulbactam between May 2013 and June 2015 were reviewed. RESULTS: Fifty-eight patients with CRAB-VAP were treated with high-dose sulbactam. The mean age was 72.0 ± 15.2 years, and the acute physiology and chronic health evaluation II (APACHE II) score was 15.1 ± 5.10 at the time of CRAB-VAP diagnosis. Early clinical improvement was observed in 65.5% of patients, and 30-day mortality was 29.3%. Early clinical failure (odds ratio [OR]: 8.720, confidence interval [CI]: 1.346-56.484; p = 0.023) and APACHE II score ≥ 14 at CRAB-VAP diagnosis (OR: 10.934, CI: 1.047-114.148; p = 0.046) were associated with 30-day mortality. CONCLUSIONS: High-dose sulbactam therapy may be effective for the treatment of CRAB-VAP. However, early clinical failure was observed in 35% of patients and was associated with poor outcome.
Acinetobacter baumannii* ; Acinetobacter* ; Anti-Bacterial Agents ; APACHE ; Diagnosis ; Humans ; Medical Records ; Mortality ; Pneumonia, Ventilator-Associated* ; Sulbactam*

No abstract available.
Tonsillectomy*

Takotsubo cardiomyopathy is considered a neurogenic heart disease resulting from impaired autonomic function and is known to be associated with various neurological and medical conditions. To our knowledge, although tetanus is frequently accompanied by autonomic instability, there has been no report of Takotsubo cardiomyopathy in patients with tetanus. Here we describe a patient with Takotsubo cardiomyopathy as a manifestation of autonomic instability in severe tetanus.

Sequestration of disc herniation is important cause of failure of chemonucleolysis. It is important to recongnize this particular variety of disc herniation before considering enzymatic discetomy. Disc herniation were classified into three-anatomical categories. type I: Subligamentous Herniation type II: Extra-ligamentous Herniation type III: Free-extraligamentous Herniation, Sequestratid disc. one-hundred and eight-six cases of herniatid intervertebral disc were evaluated in Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University and in Department of Orthopedic Surgery, Inchon Christian Hospital from March 1982 to March 1988. The results of study are as follows; l. Among 186 patients, type III sequestrated disc patients were 32 cases(17.2%). 2. The ratio between male and female was about 2:l. 3. The duration of symptoms in type II,III were longer than type I. 4. On examination, the physical changes were more common in type III than in other types. Positive well leg rasing test was prominant finding especially in type III. 5. The myelographic findings, in type III, were irregularity of dural sac at the level of vertebra body both on obligue and lateral view. 6. The C-T findings, in type III, were irregular protruded disc, or caudal or cephalsd migrated disc materials.
Clinical Study ; Female ; Gangwon-do ; Humans ; Incheon ; Intervertebral Disc ; Intervertebral Disc Chemolysis ; Leg ; Male ; Orthopedics ; Spine

Arteriovenous malformations (AVMs) are congenital anomalies of the cerebrovascular system. AVM harbors 2.2% annual hemorrhage risk in unruptured cases and 4.5% annual hemorrhage risk of previously ruptured cases. Stereotactic radiosurgery (SRS) have been shown excellent treatment outcomes for patients with small- to moderated sized AVM which can be achieved in 80–90% complete obliteration rate with a 2–3 years latency period. The most important factors are associated with obliteration after SRS is the radiation dose to the AVM. In our institutional clinical practice, now 22 Gy (50% isodose line) dose of radiation has been used for treatment of cerebral AVM in single-session radiosurgery. However, dose-volume relationship can be unfavorable for large AVMs when treated in a single-session radiosurgery, resulting high complication rates for effective dose. Thus, various strategies should be considered to treat large AVM. The role of pre-SRS embolization is permanent volume reduction of the nidus and treat high-risk lesion such as AVM-related aneurysm and high-flow arteriovenous shunt. Various staging technique of radiosurgery including volume-staged radiosurgery, hypofractionated radiotherapy and dose-staged radiosurgery are possible option for large AVM. The incidence of post-radiosurgery complication is varied, the incidence rate of radiological post-radiosurgical complication has been reported 30–40% and symptomatic complication rate was reported from 8.1% to 11.8%. In the future, novel therapy which incorporate endovascular treatment using liquid embolic material and new radiosurgical technique such as gene or cytokine-targeted radio-sensitization should be needed.

OBJECTIVE: Direct revascularization surgery is regarded as the most effective method of treatment of adults with moyamoya disease. These patients, however, have a higher risk of perioperative ischemic complications than do patients with atherosclerotic stroke, and are at risk for ischemic complications in the hemisphere contralateral to the one operated on. We investigated the incidence and risk factors for ischemic stroke in the contralateral hemisphere after surgical treatment of adults with moyamoya disease. METHODS: We retrospectively reviewed the medical records and results of neuroimaging studies on 79 hemispheres of 73 consecutive patients with adult moyamoya disease (mean+/-SD age, 37.96+/-11.27 years; range, 18-62 years) who underwent direct bypass surgery over 6 years. RESULTS: Ischemic complications occurred in 4 of 79 (5.1%) contralateral hemispheres, one with Suzuki stage 3 and three with Suzuki stage 4. Three patients showed posterior cerebral artery (PCA) involvement by moyamoya vessels. Advanced stage of moyamoya disease (Suzuki stages 4/5/6; p=0.001), PCA involvement (p=0.001) and postoperative hypotension (mean arterial blood pressure <80% of preoperative mean arterial blood pressure) on the first (p<0.0001) and second (p=0.003) days after surgery were significantly correlated with postoperative contralateral ischemic complications. CONCLUSION: In patients with advanced moyamoya disease and involvement of the PCA, intentional hypotension can result in ischemic stroke in the hemisphere contralateral to the one operated on. Careful control of perioperative blood pressure is crucial for good surgical results.
Adult ; Arterial Pressure ; Blood Pressure ; Cerebral Revascularization ; Humans ; Hypotension ; Incidence ; Medical Records ; Moyamoya Disease ; Neuroimaging ; Passive Cutaneous Anaphylaxis ; Perioperative Period ; Posterior Cerebral Artery ; Retrospective Studies ; Risk Factors ; Stroke