The time course of recovery in vestibular neuritis varies between individuals. The aim of this study was to identify the predictors for the early or late recovery of vestibular neuritis. The inclusion criteria were patients 1) who had an acute onset of vertigo lasting at least 24 hours, 2) with a horizontal-torsional unidirectional spontaneous nystagmus, and 3) with a canal paresis of 20% or more on the bithermal caloric tests. The primary endpoint for this study was an early or late recovery of vestibular neuritis as a dependent variable. A functional level scale was used to define the late recovery (5 or more points) at seven days after the symptom onset. The secondary endpoint was the duration of hospitalization. One hundred twenty eight patients met the inclusion criteria for this study, and among them, 71 patients had an early recovery. Multiple logistic regression analysis showed that diabetes mellitus was the only independent significant variable for the prediction of a late recovery of vestibular neuritis. In addition, the diabetes mellitus was a predicting variable for long duration of hospitalization. Diabetes mellitus was a predictor for a late recovery of vestibular neuritis.

We report a case of an erythrodermic form of mycosis fungoides in a 68-year-old male, who showed generalized erythroderma with scales for 3 months. Lymphadenopathies in the inguinal and neck areas were present. Histopathological findings showed epidermotropism, perivascular atypical lymphocyte infilteration in the upper dermis, and dermatopathic lymphadenopathy in the inguinal lymph node. T cell markers were positively stained in the immunohistochemical study. These clinicopathological features were consistent with an erythrodermic form of mycosis fungoides(TNM IIl). The patient was treated with PUVA therapy and low dose chemotherapy.
Aged ; Dermatitis, Exfoliative ; Dermis ; Drug Therapy ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Lymphocytes ; Male ; Mycosis Fungoides* ; Neck ; PUVA Therapy ; Weights and Measures

PURPOSE: Mechanical thrombectomy using a Solitaire stent has been associated with a high recanalization rate and favorable clinical outcome in intra-arterial thrombolysis. To achieve a higher recanalization rate for mechanical Solitaire thrombectomy, we used an intra-arterial low-dose booster tirofiban injection into the occluded segment after stent deployment. We report the safety and recanalization rates for mechanical Solitaire thrombectomy with a low-dose booster tirofiban injection. MATERIALS AND METHODS: Between February and March 2013, 13 consecutive patients underwent mechanical Solitaire thrombectomy with low-dose booster tirofiban injection. The occlusion sites included the proximal middle cerebral artery (5 patients), the internal carotid artery (5 patients), the top of the basilar artery (2 patients) and the distal middle cerebral artery (M2 segment, 1 patient). Six patients underwent bridge treatment, including intravenous tissue plasminogen activator. Tirofiban of 250 µg was used in all patients except one (500 µg). All occluded vessels were recanalized after 3 attempts at stent retrieval (1 time, n=9; 2 times, n=2; 3 times, n=2). RESULTS: Successful recanalization was achieved in all patients (TICI 3, n=8; TICI 2b, n=5). Procedural complications developed in 3 patients (subarachnoid hemorrhage, n=2; hemorrhagic transformation, n=1). Mortality occurred in one patient with a basilar artery occlusion due to reperfusion brain swelling after mechanical Solitaire thrombectomy with low-dose booster tirofiban injection. Favorable clinical outcome (mRS≤2) was observed in 8 patients (61.5%). CONCLUSION: Our modified mechanical Solitaire thrombectomy method using a low-dose booster tirofiban injection might enhance the recanalization rate with no additive hemorrhagic complications.
Basilar Artery ; Brain Edema ; Carotid Artery, Internal ; Hemorrhage ; Humans ; Methods ; Middle Cerebral Artery ; Mortality ; Reperfusion ; Stents ; Thrombectomy* ; Tissue Plasminogen Activator

BACKGROUND: Steroid-responsive encephalopathy associated with subacute thyroiditis has, to our knowledge, not been reported previously. CASE REPORT: A 49-year-old woman was found collapsed and brought to our institution with decreased mentality, dysarthria, and gait disturbance. Brain magnetic resonance imaging and angiography were normal but blood tests revealed thyroid-autoantibody-negative thyrotoxicosis. Results of a (99m)technetium-pertechnetate scan were compatible with the thyrotoxic phase of subacute thyroiditis. 14-3-3 proteins were detected in cerebrospinal fluid. Her mental status began to improve from the day following steroid administration. Recurrent encephalopathy was found 2 months after the initial admission, which was also effectively treated with steroid. CONCLUSIONS:We speculate that steroid-responsive recurrent encephalopathy associated with subacute thyroiditis is a subtype of Hashimoto's encephalopathy, and consider that steroid treatment should not be delayed in suspected patients.
14-3-3 Proteins ; Angiography ; Brain ; Brain Diseases ; Dysarthria ; Female ; Gait ; Hashimoto Disease ; Hematologic Tests ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Thyroiditis, Subacute ; Thyrotoxicosis

BACKGROUND AND PURPOSE: Sudden cardiac death is one of the leading causes of death in patients with myotonic dystrophy type 1 (DM1). It has been proposed that a prolonged QT interval is associated with sudden cardiac death in several neurological diseases, including multiple system atrophy, idiopathic Parkinson's disease, and diabetic autonomic neuropathy. However, analyses of the corrected QT (QTc) interval in DM1 patients are rare in the literature. The purposes of this study were to determine the association between the QT interval and DM1, and the affecting factors. METHODS: Thirty-nine patients diagnosed with DM1 through genetic testing were enrolled. The QTc interval (calculated using Bazett's formula: QTc=QT/radicalRR) was compared between these patients and 39 normal healthy controls. The clinical and laboratory factors affecting QTc interval in the patient group were investigated. RESULTS: The QTc interval was significantly longer in the DM1 group (411.2+/-44.7 msec, mean+/-SD) than in the normal control group (355.6+/-20.6 msec). Intragroup analysis revealed that a prolonged QTc interval in DM1 patients was associated with being female and older, having a longer disease duration, and exhibiting abnormal electrocardiography findings. CONCLUSIONS: The higher incidence of sudden cardiac death in the DM1 population is associated with the observed prolonged QTc interval in those patients.
Cause of Death ; Death, Sudden, Cardiac ; Diabetic Neuropathies ; Electrocardiography ; Female ; Genetic Testing ; Humans ; Incidence ; Multiple System Atrophy ; Myotonic Dystrophy ; Parkinson Disease

A cerebral infarction involving the nodulus usually produce contralateral lateropulsion and ipsilateral spontaneous nystagmus to the lesion. Here, we report a case of atypical isolated nodular infarction showed ipsilateral lateropulsion and contralateral spontaneous nystagmus to the lesion with a normal head impulse test. A right-handed 70-year-old man developed sudden vertigo with an unsteady gait. Neurologic examination revealed spontaneous left-beating nystagmus with a torsional component. He also displayed imbalance of walking and axial lateropulsion to the right side. Head impulse test was normal. Magnetic resonance imaging indicated acute infarction in the right nodulus on diffusion-weighted images.
Cerebral Infarction ; Gait Disorders, Neurologic ; Head ; Infarction ; Magnetic Resonance Imaging ; Neurologic Examination ; Vertigo ; Vestibular Neuronitis ; Walking

In the metastatic CNS lymphoma, parenchymal involvement, especially in both temporal lobes, is rare. A 54-year-old man complained of memory impairment and personality changes that began two weeks prior. He had ulcerated skin lesions and multiple subcutaneous nodules. Brain MRI revealed a diffuse low in T1WI, high in T2WI, and contrast-enhancement in both temporal lobes. Treatment was done with acyclovir and dexamethasone, and symptoms were improved. One week later, symptoms were aggravated and a brain biopsy was performed. The result was a peripheral T-cell lymphoma. (J Korean Neurol Assoc 19(4):417~422, 2001)
Acyclovir ; Biopsy ; Brain ; Dexamethasone ; Humans ; Lymphoma ; Lymphoma, T-Cell* ; Lymphoma, T-Cell, Peripheral ; Magnetic Resonance Imaging ; Memory ; Middle Aged ; Skin ; T-Lymphocytes* ; Temporal Lobe* ; Ulcer

BACKGROUND: Though its cause has not been well established, premature ejaculation is the most prevalent form of male sexual dysfunction. Some recent studies suggest that penile hypersensitivity and hyperexcitability, earlier excitation of the sacral reflex arc, and abnormality with peripheral and central afferent nerve conduction pathways, are related to premature ejaculation. METHODS: The bulbocavernous reflex latency (BCRL) test and dorsal nerve somatosensory evoked potential (DNSEP) test were done in 15 normal subjects (mean age: 38.2 years) and 30 premature ejaculation patients (mean age: 40.2 years) without history of neurological disorders nor history of medication which influences the nervous system. RESULTS: The mean latency of BCR was shortened significantly in patients with premature ejaculation (33.1+/-3.08 msec) than in the control group (37.2+/-3.95 msec)(P<0.01). However, there were no significant differences in latency and amplitude of DNSEP tests between the two groups. CONCLUSIONS: Based on our results, the earlier excitation of the sacral reflex arc might be related to premature ejaculation. (J Korean Neurol Assoc 19(5):494~497, 2001)
Evoked Potentials, Somatosensory* ; Humans ; Hypersensitivity ; Male ; Nervous System ; Nervous System Diseases ; Neural Conduction ; Premature Ejaculation* ; Reflex*

BACKGROUND: Cortical hyperexcitability is proposed to be the putative basis for the physiological disturbances in migraine. Recent studies have demonstrated that divalproex sodium effectively prevents migraine. The cortical silent period (CSP) elicited by transcranial magnetic stimulation (TMS) reflects the cortical inhibition of the central motor pathway. METHODS: We studied the CSP of both first dorsal interossei muscles evoked by TMS in 15 migraine patients and 15 normal subjects. As a prophylactic therapy, 15 migraine patients were treated with divalproex sodium 500~750 mg/day. After 3 months, we studied the CSP in migraine patients for the purpose of comparing with results before medication. RESULTS: The CSP was shorter in migraine patients than in controls (135.8+/-27.8 msec vs 203.7+/-32.2 msec, p<0.001). After treatment with divalproex sodium, the CSP was significantly prolonged in migraine patients (196.9+/-31.0msec, p=0.001). CONCLUSIONS: The shortened CSP in migraine patients suggests increased excitability of the cortical neuron in migraine. The prolonged CSP after medication in migraine patients suggests that the divalproex sodium may play a role in the prophylaxis of migraine by decreasing cortical neuronal hyperexcitability. (J Korean Neurol Assoc 19(5):489~493, 2001)
Humans ; Migraine Disorders* ; Muscles ; Neurons ; Transcranial Magnetic Stimulation ; Valproic Acid*

To present a case of cauda equina syndrome (CES) caused by chronic inflammatory demyelinating polyneuropathy (CIDP) which seemed clinically similar to Charcot-Marie-Tooth disease type1 (CMT1). CIDP is an immune-mediated polyneuropathy, either progressive or relapsing-remitting. It is a non-hereditary disorder characterized by symmetrical motor and sensory deficits. Rarely, spinal nerve roots can be involved, leading to CES by hypertrophic cauda equina. A 34-year-old man presented with low back pain, radicular pain, bilateral lower-extremity weakness, urinary incontinence, and constipation. He had had musculoskeletal deformities, such as hammertoes and pes cavus, since age 10. Lumbar spine magnetic resonance imaging showed diffuse thickening of the cauda equina. Electrophysiological testing showed increased distal latency, conduction blocks, temporal dispersion, and severe nerve conduction velocity slowing (3 m/s). We were not able to find genetic mutations at the PMP 22, MPZ, PRX, and EGR2 genes. The pathologic findings of the sural nerve biopsy revealed thinly myelinated nerve fibers with Schwann cells proliferation. We performed a decompressive laminectomy, intravenous IgG (IV-IgG) and oral steroid. At 1 week after surgery, most of his symptoms showed marked improvements except foot deformities. There was no relapse or aggravation of disease for 3 years. We diagnosed the case as an early-onset CIDP with cauda equine syndrome, whose initial clinical findings were similar to those of CMT1, and successfully managed with decompressive laminectomy, IV-IgG and oral steroid.
Adult ; Biopsy ; Cauda Equina ; Charcot-Marie-Tooth Disease* ; Congenital Abnormalities ; Constipation ; Foot Deformities ; Humans ; Immunoglobulin G ; Laminectomy ; Low Back Pain ; Magnetic Resonance Imaging ; Nerve Fibers, Myelinated ; Neural Conduction ; Polyneuropathies* ; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating ; Polyradiculopathy* ; Recurrence ; Schwann Cells ; Spinal Nerve Roots ; Spine ; Sural Nerve ; Urinary Incontinence