We report the clinical features in one patients with episodic positional vertigo and apogeotropic direction changing horizontal positional nystagmus that does not fatigue, beating to the right with the head turned to the left and beating to the left with the head turned to the right. This syndrome probably represents a horizontal semicircular canal variant of benign positional vertigo. Free-floating debris and Cupula attached debris in one horizontal semicircular canal may explain many of the clinical and oculographic findings.
Fatigue ; Head ; Humans ; Nystagmus, Physiologic ; Semicircular Canals ; Vertigo*

Spinal cord infarction as a complication of spine surgery occurs rarely. Herein, a case of spinal cord infarction, which developed in a 69 year old woman following posterior decompression and internal fixation for a T11 bursting fracture, is descirbed. The anesthetic induction and intraoperative course were uneventful, except at the end of the procedure, where her blood pressure suddenly dropped from 130/90 to 90/60 mmHg. The patient was aggressively treated with a transfusion and vasopressor, the blood pressure then returned to its usual value within 10 minutes. However, during a physical examination in the recovery room, the patient was found to have flaccid lower limbs, with impaired sensory function below the T8 level. Her cord diameter had increased, and a high signal lesion was observed within the thoracic spinal cord, from T9 to T12 level on T2-weighted MR images, which was diagnosing as a spinal cord infarction, was and showed no improvement despite the immediate and aggressive treatment.
Aged ; Blood Pressure ; Decompression ; Female ; Humans ; Infarction* ; Lower Extremity ; Physical Examination ; Recovery Room ; Sensation ; Spinal Cord* ; Spine*

No abstract available.
Germ Cells* ; Neoplasms, Germ Cell and Embryonal*

No abstract available.
Cardiomyopathy, Hypertrophic* ; Ductus Arteriosus, Patent* ; Humans

Myoclouns is a complicated and poorly-understood phenomenon caused by many pathological conditions. Myoclonus which is triggered by sensory stimuli has been termed reflx myoclonus and divided into cortical, reticular and spinal types depending on the generator sites. Segmental myoclonus of spinal origin consists of synchronous rhythmical jerks confined to a group of muscles supplied by either one segment or several contiguous segments of the spinal cords. We present two cases of spinal reflex myoclonus. One was 50 years old female who showed complex myoclonic jerks involving the abdominal wall and paraspinal muscibs resembling 'belly dance'. The other was 26 years old male who showed intermittent synchronous upper cervical axial muscle contractions. In both cases, jerks were increased with certain stimuli, but disappeared during sleep. They showed normal EEGs and absence of enhancement of SSEPS.
Abdominal Wall ; Adult ; Electroencephalography ; Female ; Humans ; Male ; Middle Aged ; Muscle Contraction ; Muscles ; Myoclonus* ; Reflex ; Spinal Cord

We report a 18 years old man of brainstem encephalitis with acute ataxia, areflexia and gaze evoked vertical and horizontal nystagmus which is mimicking Miller Fisher syndrome. He had evidences of both peripheral neuropathy in nerve conduction studies and a brainstem encephalitis in MR findings. The possible relationship of the Miller Fisher syndrome and brainstem encephalitis are discussed with brief review of literature.
Adolescent ; Ataxia ; Brain Stem* ; Encephalitis* ; Humans ; Miller Fisher Syndrome* ; Neural Conduction ; Nystagmus, Pathologic ; Peripheral Nervous System Diseases

High dose intravenous immunoglobulin (IVIg) therapy can improve the clinical course of several immune mediciated diseases. We evaluated clinical effects and side effects of IVIg in Guillain-Barre syndrome (GBS). 19 Patients with GBS were studied prospectively in a placebo-controlled trial. 11 Patients were received high dose IVIg (400mg/kg for 5 days) and controls received only conservative treatment. The disability scores using modified Rankin scores before and after treatment of each group were compared. Four weaks later, mean Rankin Score of IVIg group was 2.5 + 0.7 and control group was 3.3+ 0.5which showed significant difference(p<0.05). There were no serious advers effer of promote early improvement with safety in acute phase of Guillan-Barre syndrome.
Guillain-Barre Syndrome* ; Humans ; Immunization, Passive* ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Prospective Studies

Dextran is a highly viscous polysaccharide liquid used for uterine distention during hysteroscopic surgery. Although generally safe, this agent has been recognized to cause non-cardiogenic pulmonary edema, intravascular coagulopathy, renal insufficiency, and anaphylactic reaction. We report the case of pulmonary edema following hysteroscopic surgery with dextran 40 and discuss the major side effects and the possible etiologies of the reported complication.
Anaphylaxis ; Dextrans* ; Hysteroscopy* ; Pulmonary Edema* ; Renal Insufficiency

BACKGROUND: Information on the long-term fate of patients with prosthetic valve is limited. Cerebral embolism is a major cause of late morbidity and mortality in patients with prosthetic valves even though recent prostheses are less thrombogenic and anticoagulants are administered. We investigated the long-term risk of the first ischemic and hemorrhagic stroke and effect of presumed risk factors on the development of stroke in patients with prosthetic valves. METHODS: In a retrospective study, 554 patients who survived the 30-days after cardiac valve replacement between June, 1985 and May, 1995 were included. End points were attacks of ischemic and hemorrhagic stroke. Risk of stroke at end points was calculated according to Kaplan-Meier method. The influence of several clinical variables on these stroke events was analyzed by univariate and mutivariate analyses. RESULTS: Thirty seven of 554 patients had 42 stroke events(34 ischemic stroke, 8 hemorrhagic stroke) during follow-up periods(mean: 52.9months). Six of these patients died from stroke. The cumulative stroke-free probability was 92.4% at 5years and 87.7% at 10years. The cumulative ischemic stroke-free probability was 93.7% at 5years and 89.4% at 10years. No or irregular use of anticoagulants was the only significant independent predictor(RR:4.99, 95%CI:2.01-12.41, p<0.01) of ischemic stroke. The cumulative hemorrhagic stroke-free probability was 98.7% at 5years and 98.1% at 10years. CONCLUSION: Regardless of the type of prostheses, patients with prosthetic valves, notably those without anticoagulants, are at high risk for ischemic stroke.
Anticoagulants ; Follow-Up Studies ; Heart Valves ; Humans ; Intracranial Embolism ; Mortality ; Prostheses and Implants ; Retrospective Studies ; Risk Factors ; Stroke* ; Thromboembolism

Color Doppler echocardiographic examination was performed to detect and evaluate semiquantitatively the severity of mitral regurgitation in 38 patients who underwent left ventriculography. The sensitivity and specificity of the technique in the detection of mitral regurgitation was 84% and 100% as compared with left ventriculography.Mitral regurgitation in the false negative cases was mostly mild. On the bases of the farthest distance reached by the regurgitation flow signal from the mitral value orifice, the severity of regurgitation was graded on a four point scale and these results were compared with those of angiography. A significant correlation(r=0.87) was found between Doppler imaging and angiography in the evaluation of the severity of mitral regurgitation.Also results was obtained for the evaluation based on the area covered by the regurgitant signals in the left atrial cavity & the regurgitant jet area(RJA) experssed as a percentage of the left atrial are(LLA) obtained in the same plane(RJA/LLA%). In conclusion, Color Doppler echocardiography is a useful noninvasvive thechique that is not only sensitive and specific in the identification of mitral regurgitation but also provides accurate estimation og its severity.
Angiography ; Echocardiography ; Echocardiography, Doppler, Color ; Humans ; Mitral Valve Insufficiency* ; Sensitivity and Specificity