No abstract available.

No abstract available.
Benzimidazoles ; Blood Pressure ; Stroke ; Tetrazoles

Vitamin K, a cofactor of coagulation cascade, is used for hemostasis in patients with abnormal coagulation status. However, it is uncertain whether administration of vitamin K elevates the risk of thrombotic events. We present a patient with trauma who developed acute multiple cerebral infarctions after receiving intravenous vitamin K for several days. We presume that vitamin K can be a contributing factor for embolism in a patient with trauma.
Cerebral Infarction ; Embolism ; Hemostasis ; Humans ; Vitamin K ; Vitamins

No abstract available.
Aneurysm ; Carotid Artery, Internal ; Hemianopsia

Previous studies have shown that patients with tandem occlusions involving extracranial internal carotid artery (ICA) and middle cerebral artery (MCA) have lower likelihood of recanalization by standard intravenous thrombolytic therapy. A 70-years-old man with a history of hypertension was admitted because of left hemiplegia and drowsiness which developed 47 minutes ago. On neurologic examination, he was drowsy and showed neglect syndrome as well as left hemiplegia. Brain CT angiography showed tandem occlusions at right extracranial ICA and proximal MCA. The administration of intravenous (IV) tissue plasminogen activator (tPA) did not improve his symptoms. We performed angioplasty and stenting for proximal ICA occlusion followed by mechanical thrombolysis for MCA occlusion. After the endovascular treatment, the MCA was recanalized and the patient recovered to show only mild left side weakness. This case shows successful treatment of hyperacute ischemic infarction from tendem occlusion of right MCA and proximal ICA with endovascular treatment following IV tPA thrombolysis.
Angiography ; Angioplasty ; Brain ; Carotid Artery, Internal ; Cerebral Infarction ; Hemiplegia ; Humans ; Hypertension ; Infarction ; Mechanical Thrombolysis ; Middle Cerebral Artery ; Neurologic Examination ; Sleep Stages ; Stents ; Thrombolytic Therapy ; Tissue Plasminogen Activator

Petechial cortical hemorrhages are common in Herpes simplex virus (HSV) encephalitis, however, cerebral hematoma is extremely rare. We report a case of a 47-year-old immunocompetent woman diagnosed with herpes encephalitis but complicated by cerebral hematoma despite of early diagnosis and treatment.
Acyclovir ; Early Diagnosis ; Encephalitis ; Encephalitis, Herpes Simplex ; Female ; Hematoma ; Hemorrhage ; Humans ; Meningoencephalitis ; Methylmethacrylates ; Middle Aged ; Polystyrenes ; Simplexvirus

We report an adult case of pontine infarct complicated by a community-acquired pneumococcal ventriculitis. An 85-year-old woman was referred to the hospital with left-sided weakness and persistent fever despite antibiotics therapy. Diffusion weight magnetic resonance image revealed high signal intensity on the right paramedian pontine and the occipital horn of the lateral ventricle. In the cerebrospinal fluid (CSF) examination, white blood cell count was 2,720 /mm3, glucose level was 4 mg/dL (simultaneous blood glucose level was 135 mg/dL), and CSF protein level was 2,025.4 mg/dL. On admission day 4, CSF culture showed Streptococcus pneumoniae. Despite continuous antibiotics treatment, she expired on admission day 7. In patients with pneumococcal ventriculitis, despite high mortality as in this case, early detection and treatment improve clinical outcome. Also aggressive treatment (intraventricular antibiotics injection, and pus drainage) should be considered.
Adult ; Aged, 80 and over ; Animals ; Anti-Bacterial Agents ; Blood Glucose ; Brain Stem ; Brain Stem Infarctions ; Cerebral Ventriculitis ; Diffusion ; Female ; Fever ; Glucose ; Horns ; Humans ; Lateral Ventricles ; Leukocyte Count ; Magnetic Resonance Spectroscopy ; Meningitis, Bacterial ; Streptococcus pneumoniae ; Suppuration

A 70-year-old man presented with acute dysarthria and dizziness. He denied any history of trauma or cervical manipulations within several weeks before symptom onset. We could make a presumptive diagnosis of left Wallenberg syndrome through the results of neurologic examination, which include left limb ataxia, alternating hyp(o)esthesia, spontaneous nystagmus to right side, and left side Honer's syndrome. Initial diffusion weighted imaging performed at admission showed small and discrete high signal lesions in left lateral medulla, left cerebellar hemisphere, and bilateral occipital areas. Contrast enhanced MRA demonstrated a filling defect in long segment of distal left vertebral artery. On 4th days after symptom onset, the patient developed a severe form of ipsilateral hemiparesis. Follow-up brain MRI showed a downward extension of the initial ischemic lesion in upper medulla to upper cervical region. This case suggests that a severe form of ipsilateral hemiparesis may be complicated in the clinical setting of acute lateral medullary infarction with vertebral artery occlusion.
Aged ; Ataxia ; Brain ; Diffusion ; Dizziness ; Dysarthria ; Follow-Up Studies ; Humans ; Infarction ; Lateral Medullary Syndrome ; Neurologic Examination ; Paresis ; Thrombosis ; Vertebral Artery

Gradual decline in cognitive function and behavioral changes are characteristic in degenerative dementia. Although acute to subacute subcortical lesion can affect behavior and cognition, few reports have described both cognitive and behavioral deficits in patients with right basal ganglia lesion. An 82-year-old man presented with memory impairment, pathological crying, delusion and other psychological symptoms that developed insidiously over the previous 2 months. Initially, the patient had been diagnosed with degenerative dementia, but brain MRI showed the hematoma in the right basal ganglia. Our case shows that cognitive dysfunction, behavioral and psychological symptoms including pathological laughing and delusion can be developed concurrently by the lesion of the right basal ganglia. Our case suggests that cerebrovascular disease should be considered in elderly patients presenting with subacute cognitive and behavioral deterioration, even when there were no other neurological signs.
Aged ; Aged, 80 and over ; Basal Ganglia ; Brain ; Cognition ; Crying ; Delusions ; Dementia ; Hematoma ; Hemorrhage ; Humans ; Memory

We describe a patient with isolated inferior rectus palsy due to midbrain infarction. A 68-year-old-man developed vertical diplopia of sudden onset which was maximal with a right lower side gaze. Neurological examination revealed weakness of the right inferior rectus muscle. Magnetic resonance imaging of the brain showed a focal infarction in the dorsomedial portion of the right midbrain tegmentum. The sole involvement of fascicular fibers of the inferior rectus muscle in the midbrain was accountable as the cause of this isolated inferior rectus palsy. We think that this is a case supporting the three-dimensional model of somatotopic fascicular arrangement of oculomotor nerve in the midbrain.
Brain ; Diplopia ; Humans ; Infarction ; Magnetic Resonance Imaging ; Mesencephalon ; Muscles ; Neurologic Examination ; Oculomotor Nerve ; Paralysis