Thrombotic thrombocytopenic purpura(TTP) is characterized by fluctuating neurologic signs, microangiopathic hemolytic anemia, thrombocytopenia, fever and renal abnormalities. Neurologic involvement occurs in over 90% of patients with TTP. TTP is rarely associated with large intracerebral hemorrhage and peripheral neuropadiy. The authors report a case of TTP associated with large intracerebral hemorrhage confirmed by brain MRI and peripheral neuropathy diagnosed electrophysiologic findings and sural nerve biopsy.
Anemia, Hemolytic ; Biopsy ; Brain ; Cerebral Hemorrhage* ; Fever ; Humans ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Peripheral Nervous System Diseases ; Purpura, Thrombotic Thrombocytopenic* ; Sural Nerve ; Thrombocytopenia

Rhinocerebral mucormycosis, which is a fulminant and progressive disease often seen in debilitated hosts! Requires a high degree of clinical suspicion to promptly diagnose and an aggressive medical and surgical therapy. The prognosis is grave, especially in case of bilateral cavernous sinus thrombosis. We report a case of 69-year-old female patient with bilateral cavernous sinus thrombosis caused by rhinocerebral mucormycosis, who showed orbital swelling and lateral bulging of bilateral cavernous sinus in orbital CT, and large branching nonseptate hypae in biopsed specimen of the left periorbital necrotic tissue.
Aged ; Cavernous Sinus Thrombosis ; Cavernous Sinus* ; Female ; Humans ; Mucormycosis* ; Orbit ; Prognosis

Postictal sequential serum prolactin concentrations were observed in 28 patients with various type of seizures who were hospitalized at Keimyung University Hospital. Of 28 epileptic patients, 18 male and 10 female, age ranged from 18 years to 79 years (mean 42 years), 15 with generalized seizures, 13 with focal seizures (5 with simple partial seizures and 8 with partial seizures with generalization). Symptomatic epilepsy and epileptic patients with factors which may affect serum prolactin concentrations were excluded in this study. Serum prolactin concentrations were measure at 15, 30 and 60 minutes after convulsion and 24 hours after convulsion for the base line serum prolactin level. Patients with generalized seizsures and significant elevation of serum prolactin concentrations at 15, 30 and 60 minutes after ictus (Table 1). Same results were obtained in patients with simple partial seizures at 30 minutes and 60 minutes after ictus, and 15 minutes and 30 minutes after ictus in patients with partial seizures with secondary generalization (Table 2 and 3). Level of serum prolactin concentrations were higher in patients with generalized seizure than the other type of seizures. Therefore, measuring serum prolactin level could help differentiate postictal state and other causes of mental change, and also differentiative various type of seizures.
Epilepsies, Partial ; Epilepsy ; Female ; Generalization (Psychology) ; Humans ; Male ; Prolactin* ; Seizures*

Hypereosinophilic syndrome (HES) is characterized by a persistent eosinophilia of l,500/mm3 lasting for at least 6 months associated with multi-system involvement and no other identifiable cause. A 45-year-old man had hypereosinophilia, cardiopathy, and acute paraplegia. Following corticosteriod with antipletelet agent therapy, paraplegia was improved rapidly and circulating eosinophils were normalized. We postulated that embolic phenomenon was due to hypercoagulable state by eosinophil-derived proteins and/or to direct infiltration by eosinophils.
Eosinophilia ; Eosinophils ; Humans ; Hypereosinophilic Syndrome* ; Middle Aged ; Paraplegia*

F waves are motor responses produced by antidromic activation of motoneurons following stimulation of motor axons peripherally. The F wave is useful in evaluating proximal motor nerve conduction, in assessing the integrity of the ventral root, and in measuring the motor neuron excitability. This study was undertaken to assess the integrity of the lower motor neurons in amyotrophic lateral sclerosis(ALS). F-wave latency(FWL), F-wave conduction velocity(FWCV), F ratio, F-response frequency, and distal MNCV were determined in the median and tibial nerves of 9 patients with ALS. The results were compared with 32 healthy adult volunteers as controls. In patients with ALS, in contrast,to the control subjects, the mean FWL was prolonged, the mean FWCV and distal MNCV slowed, and the mean F-response frequency reduced. These results are thought to reflect some degree of loss of the lower motor neurons.
Adult ; Amyotrophic Lateral Sclerosis* ; Axons ; Humans ; Motor Neurons ; Neural Conduction ; Spinal Nerve Roots ; Tibial Nerve ; Volunteers

Among 73 patients with possible and definite tuberculous meningitis, 14 cases showed a sudden unexpected polymorphonuclear (PMN) CSF pleocytosis during treatment. Patients with superimposed bacterial meningitis were excluded. Eleven patients(15. 1%) matched inclusion criteria. The intervals between the onset of the treatment and the onset of the PMN CSF pleocytosis were 7-54 days(mean 17.2+ 14.4 days). The mean duration of PMN CSF pleocytosis was 14.2+12.4 days. A PMN CSF pleocytosis may develop occasionally weeks or months after the start of the treatment for tuberculous meningitis. Though the cause is uncertain, we suggest that probably its cause is superimposed acute meningeal inflanunation by the release of Mycobacterium from tuberculomas or.delayed Jarisch-Herxheimer reaction.
Humans ; Leukocytosis* ; Meningitis, Bacterial ; Mycobacterium ; Tuberculoma ; Tuberculosis, Meningeal*

Wilson's disease is an autosomal recessive disorder resulting from an excessive accumulation of copper in the liver, cornea, kidneys, and in the basal ganglia of the brain. The prominent speech disturbances of Wilson's disease include monopitch, monoloudness, slow rate, low pitch, delayed in initiating speech and rarely palilalia. A19-year-old woman developed palilalia which was characterized by compulsive repetition of a phrase with increasing rapidity and with a decrescendo of voice volume. Although she had been suffering from liver cirrhosis for the past 8 months, the palilalia was the only neurological sign at initial examination. She showed a low serum ceruloplasmin, low serum copper, increased urinary copper excretion, and Kayser-Fleischer rings. Brain magnetic resonance images showed high signals in the bilateral basal ganglia in T2-weighted images, and slight cortical atrophy.
Atrophy ; Basal Ganglia ; Brain ; Ceruloplasmin ; Copper ; Cornea ; Female ; Hepatolenticular Degeneration* ; Humans ; Kidney ; Liver ; Liver Cirrhosis ; Voice

BACKGROUND: Adie's tonic pupil consists of mydriasis, accommodation defect, decreased light reflex, and tonic near reflex. When tonic pupil is combined with hypo- or areflexia, it is called Holmes-Adie syndrome. CASE: Fifty-two-year-old and 37-year-old female patients showed unilateral dilated irregular pupil, decreased light reflex, and decreased or absent DTR. When 0.125% pilocarpine was dropped on the dilated pupil, the pupil was constricted after pilocarpine application. Somatosensory evoked potentials were within normal ranges, and H-reflex responses were absent or delayed.
Adie Syndrome* ; Adult ; Evoked Potentials, Somatosensory ; Female ; H-Reflex ; Humans ; Mydriasis ; Pilocarpine ; Pupil ; Reference Values ; Reflex ; Tonic Pupil

Stiff-man syndrome is a rare disorder characterized by intermittent spasms and stiffness of the axial and limb muscles, associated with an electromyographic pattern of continuous motor unit activity in affected muscles. The cause of this disorder is unknown, but it has been associated with autoimmune disease and with endocrine disorder. We present a 49 year old female patient with clinical and electrophysiologic features of stiff-man syndrome and postoperative panhypopituitarism, whose muscle stiffness and spasm resolved with diazepam, clonazepam and prednisolonereplacement therapy.
Autoimmune Diseases ; Clonazepam ; Diazepam ; Extremities ; Female ; Humans ; Middle Aged ; Muscles ; Spasm ; Stiff-Person Syndrome*

Clinical studies were made on 37 cases with thalamic hemorrhage diagnosed by computed tomographic scan and only localized on the thalamic area, were admitted to the Keimyung University Dongsan hospital from January 1981, to December 1985. The age and sex distribution, symptoms and neurologic signs on admission, relationship between the hospital course and many factors affecting the prognosis such as age, side of lesion, level of consciousness, volume of the hematoma, degree of hydrocephalus and ventricular hemorrhage were analysed. The results were summarized as follows; 1. The most prevalent age group was above 51 years of age with 41-50 years, 21-30 years and 31-40 years of age in the order of frequency. Male to female ratio was 15:22. 2. The clinical symptoms on admission in the order of frequency were the impairment of consciousness, headache, nausea and vomiting, speech disturbance and hemiparesis, dizziness and voiding difficulties. The neurologic signs on admission showed hemiparesis, hyperreflexia, and positive Babinski sign, impaired consciousness, hemisensory deficit, central facial nerve palsies, dysarthria, sluggish and unreactive light reflex, small pupil and absent gag reflex, impaired vertical gaze, papilledema, aphasia and abducens nerve palsies in that order. 3. The hospital course had no significant relationship with the age of the patients and the side of hematoma but there was a significant relationship between the alert-drowsy group and the stuporcoma group (P<0.01). 4. The hospital course had no significant relationship with the degree of volume of hematoma and hydrocephalus. The hospital course had a significant relationship with ventricular hemorrhage (P<0.05) but the hospital course of the improved group had no significant tendency to the rate of improvement.
Abducens Nerve Diseases ; Aphasia ; Consciousness ; Dizziness ; Dysarthria ; Facial Nerve ; Female ; Headache ; Hematoma ; Hemorrhage* ; Humans ; Hydrocephalus ; Male ; Miosis ; Nausea ; Neurologic Manifestations ; Papilledema ; Paralysis ; Paresis ; Prognosis* ; Reflex ; Reflex, Abnormal ; Reflex, Babinski ; Sex Distribution ; Vomiting