Isolated abducens nerve paresis related to ruptured vertebral artery (VA) aneurysm is rare. It usually occurs bilaterally or ipsilaterally to the pathologic lesions. We report the case of a contralateral sixth nerve palsy following ruptured dissecting VA aneurysm. A 38-year-old man was admitted for the evaluation of a 6-day history of headache. Abnormalities were not seen on initial computed tomography (CT). On admission, the patient was alert and no signs reflecting neurologic deficits were noted. Time of flight magnetic resonance angiography revealed a fusiform dilatation of the right VA involving origin of the posterior inferior cerebellar artery. The patient suddenly suffered from severe headache with diplopia the day before the scheduled cerebral angiography. Neurologic examination disclosed nuchal rigidity and isolated left abducens nerve palsy. Emergent CT scan showed high density in the basal and prepontine cistern compatible with ruptured aneurismal hemorrhage. Right vertebral angiography illustrated a right VA dissecting aneurysm with prominent displaced vertebrobasilar artery to inferiorly on left side. Double-stent placement was conducted for the treatment of ruptured dissecting VA aneurysm. No diffusion restriction signals were observed in follow-up magnetic resonance imaging of the brain stem. Eleven weeks later, full recovery of left sixth nerve palsy was documented photographically. In conclusion, isolated contralateral abducens nerve palsy associated with ruptured VA aneurysm may develop due to direct nerve compression by displaced verterobasilar artery triggered by primary thick clot in the prepontine cistern.
Abducens Nerve ; Abducens Nerve Diseases ; Aneurysm ; Aneurysm, Dissecting ; Angiography ; Arteries ; Brain Stem ; Cerebral Angiography ; Diffusion ; Dilatation ; Diplopia ; Follow-Up Studies ; Headache ; Hemorrhage ; Humans ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Muscle Rigidity ; Neurologic Examination ; Neurologic Manifestations ; Paresis ; Subarachnoid Hemorrhage ; Vertebral Artery

Bilateral abducens nerve palsy related to ruptured aneurysm of the anterior communicating artery (ACoA) has only been reported in four patients. Three cases were treated by surgical clipping. No report has described the clinical course of the isolated bilateral abducens nerve palsy following ruptured ACoA aneurysm obliterated with coil. A 32-year-old man was transferred to our institution after three days of diplopia, dizziness and headache after the onset of a 5-minute generalized tonic-clonic seizure. Computed tomographic angiography revealed an aneurysm of the ACoA. Magnetic resonance imaging showed focal intraventricular hemorrhage without brain stem abnormalities including infarction or space-occupying lesion. Endovascular coil embolization was conducted to obliterate an aneurysmal sac followed by lumbar cerebrospinal fluid (CSF) drainage. Bilateral paresis of abducens nerve completely recovered 9 weeks after ictus. In conclusion, isolated bilateral abducens nerve palsy associated with ruptured ACoA aneurysm may be resolved successfully by coil embolization and lumbar CSF drainage without directly relieving cerebrospinal fluid pressure by opening Lillequist's membrane and prepontine cistern.
Abducens Nerve ; Abducens Nerve Diseases ; Aneurysm ; Aneurysm, Ruptured ; Angiography ; Arteries ; Brain Stem ; Cerebrospinal Fluid Pressure ; Diplopia ; Dizziness ; Drainage ; Headache ; Hemorrhage ; Humans ; Infarction ; Intracranial Aneurysm ; Magnetic Resonance Imaging ; Membranes ; Paresis ; Seizures ; Subarachnoid Hemorrhage ; Surgical Instruments

No abstract available.
Cystadenocarcinoma, Mucinous* ; Female* ; Humans ; Mucins*

To characterize the clinical manifestations, and histologic features of CNS lymphoma in immunocompetent patients, we collected 15 cases of biopsy proven primary CNS lymphoma. Evidences of systemic lymphoma, HIV infection, and immune-compromising diseases were absent at the diagnosis. Brain MRI had been taken before radiation or chemotherapy, and pathologic specimens were classified according to working formulation and some cases underwent immunological marker studies. Mean duration of illness was 1. 8 months, mild CSF protein elevation(mean=58mg%) was observed in 5 of 6 patients, CSF cytology was positive in 2 of 7, and the recurrence rate was 69%. In MR imaging, tumor size was variable, and 5 patients had multiple lesions at diagnosis. All patients showed homogeneous(87%) or heterogeneous(13%) gadolinium enhancement, and secondary tumor change was shown in I case. The tumor had high tendency in abutting on CSF space(60%), and there was no relationship between histologic types and MR imaging I s. Classified by working formulation, the intermediate grade lymphomas(diffuse large cell and small cell cleaved types) were 14 out of 15(93%) and I showed low grade(small lymphocytic). B-cell lymphoma was 8 out of 9, and T-cell was only 1. As compared with the previous reported pathologic data of AIDS-related CNS lymphoma, the histology of lymphoma in immunocompetent patients were less malignant than those related to AIDS and immune-compromised patients.
Biopsy ; Brain ; Diagnosis ; Drug Therapy ; Gadolinium ; HIV Infections ; Humans ; Lymphoma* ; Lymphoma, B-Cell ; Magnetic Resonance Imaging ; Recurrence ; T-Lymphocytes

OBJECTIVES: To evaluate an association between depression and altered immunity, we examined peripheral T lymphocyte or natural killer (NK) cell measures plasma ACTH and cortisol using the flow cytometry in acute and unmedicated patients with major depressive disorder (MDD). METHODS: Forty-two patients with MDD from the outpatient clinic and forty normal controls from the hospital staff were recruited. We applied Hamilton Rating Scale for Depression (HAM-D) and Hamilton Rating Scale for Anxiety (HAM-A) for depressed subjects. Peripheral T lymphocyte or NK cell measures (CD3, CD4, CD8, or CD56) and plasma hormones (ACTH and cortisol) were obtained from all subjects. RESULTS: There were no statistical differences in CD3, CD4, CD8, or CD56 between the two subjects. The number of CD56 cells negatively correlated with HAM-D scores (r=-0.42, p<0.01), but did not correlate with HAM-A scores in patients with MDD. The number of CD56 cells showed strong negative correlation with CD4/CD8 (r=-0.47, p<0.01) in the control group, but not in the depressed group. Patients with MDD had higher cortisol level than controls within the normal range. CONCLUSION: The trait of immunological imbalance and HPA axis abnormality were shown in patients with MDD. Especially, the severity of depression, but not the anxiety, could be reflected as decreased number of CD56 (NK T) cells in acute and unmedicated state.
Adrenocorticotropic Hormone ; Ambulatory Care Facilities ; Anxiety ; Axis, Cervical Vertebra ; Depression ; Depressive Disorder, Major* ; Flow Cytometry ; Humans ; Hydrocortisone ; Killer Cells, Natural ; Lymphocytes ; Natural Killer T-Cells* ; Plasma ; Reference Values

OBJECTIVE: Obtaining real-time image is essential for neurosurgeons to minimize invasion of normal brain tissue and to prompt diagnosis of intracranial event. The aim of this study was to report our three-year experience with a mobile computed tomography (mCT) for intraoperative and bedside scanning. METHODS: A total of 357 mCT (297 patients) scans from January 2009 to December 2011 in single institution were reviewed. After excluding post-operative routine follow-up, 202 mCT were included for analysis. Their medical records such as diagnosis, clinical application, impact on decision making, times, image quality and radiologic findings were assessed. RESULTS: Two-hundred-two mCT scans were performed in the operation room (n=192, 95%) or intensive care unit (ICU) (n=10, 5%). Regarding intraoperative images, extent of resection of tumor (n=55, 27.2%), degree of hematoma removal (n=42, 20.8%), confirmation of catheter placement (n=91, 45.0%) and monitoring unexpected complications (n=4, 2.0%) were evaluated. A total of 14 additional procedures were introduced after confirmation of residual tumor (n=7, 50%), hematoma (n=2, 14.3%), malpositioned catheter (n=3, 21.4%) and newly developed intracranial events (n=2, 14.3%). Every image was obtained within 15 minutes and image quality was sufficient for interpretation. CONCLUSION: mCT is feasible for prompt intraoperative and ICU monitoring with enhanced diagnostic certainty, safety and efficiency.
Brain ; Catheters ; Decision Making ; Follow-Up Studies ; Hematoma ; Intensive Care Units ; Korea ; Medical Records ; Neoplasm, Residual

In order to determine the survival rate and prognostic factors of patients with intracranial oligodendroglioma as predictors of survival, a retrospective analysis of a total of 68 cases treated between 1982 and 1992 at our institute was performed. The 5-year and 10-year survival rates were 84.5% and 55.1% respectively while the median survival time was 116+/-5.3 months. The significant factors identified by the univariate analysis included the presence of preoperative seizure, the pre- and postoperative status, the presence of signs of increased intracranial pressure before operation and pathologic grade of the tumors. Factors such as age, types of chief complaints, blood types, the preoperative neurologic deficit, the size of tumor, the enhancement of tumor, cysts in tumor, the extent of removal and the postoperative seizure had no correlations with survival rates. The only significant prognostic factor determined by the multivariate analysis was the pathological grade(p=0.04).
Humans ; Intracranial Pressure ; Multivariate Analysis* ; Neurologic Manifestations ; Oligodendroglioma* ; Retrospective Studies* ; Seizures ; Survival Rate*

BACKGROUND AND OBJECTIVE: NT-proBNP, a sensitive and specific marker of congestive heart failure (CHF), is also useful in monitoring the effectiveness of treatment and in predicting prognosis. However, the usefulness of NT-proBNP for measuring the functional capacity as a component of the quality of life (QoL) in patients with CHF remains to be discovered. The Korean Activity Scale/Index (KASI) is a Koreanized tool for measuring the functional capacity in patients with cardiac diseases during daily activities, thus representing the physical domain of the QoL. The purpose of this study was to evaluate the relationship between NT-proBNP and the KASI. SUCJECTS AND METHODS: Between July, 2003 and September, 2003, the NT-proBNP levels were measured in 76 patients with CHF that visited the OPD or who were hospitalized. They were asked to fill out a self-administered questionnaire, from which their KASI scores were obtained. NYHA Fc and Heart Failure scores were also obtained from a history taking and physical examination conducted by the investigator. RESULTS: The level of NT-proBNP increased with increasing NYHA Fc (p<0.001 by Kruskall-Wallis test). The Spearman correlation coefficient between NT-proBNP and the KASI score was -0.730 (p<0.001), which was higher than that between the HF and KASI scores (rho=-0.557, p<0.001). The level of NT-proBNP also had a positive correlation with the HF score (rho=0.706, p<0.001). CONCLUSION: The level of NT-proBNP has a strong negative correlation with the KASI score, reflecting the functional capacity during daily activities. This suggests that NT-proBNP is useful in measuring the functional capacity as an element of the QoL in patients with CHF.
Estrogens, Conjugated (USP)* ; Heart Diseases ; Heart Failure* ; Humans ; Physical Examination ; Prognosis ; Quality of Life ; Research Personnel ; Surveys and Questionnaires

This study aims to know cagA and vacA genotypes and the molecular epidemiology of H. pylori strains isolated from patients with gastroduodenal disorders and normal healthy persons of Korea using PCR genotyping, RAPD fingerprinting, and PCR-RFLP. PCR genotyping for cagA genotyping showed that 143 H. pylori isolates tested in this study were cagA positive strains. All the isolates were confirmed as type sla genotype and 13 isolates (9%) among of 143 strains were confirmed as containing the RS2 element. All 143 isolates showed individually unique RAPD profiles. PCR-based RFLP was done to assess the sequence diversity of H. pylori flagella genes. From all H. pylori isolates, 30 distinct patterns were found with HhaI digestion of 1.5 kb flaA segment and 12 distinct patterns were produced with MboI digestion. Among 30 persons, from whom multiple isolates could be obtained, 27 (90%) were confirmed to be colonized with an identical H. pylori strain and 3 (10%) were shown to be infected with the different strains. Among 5 persons attended in follow-up study, 4 were infected with identical strain for 1 year, 1 carried different strains after 1 year. Genotypes of isolates recovered from children were shown to be identical to those of their parents, suggesting that children acquire H. pylori infection from their parents.
Child ; Colon ; Dermatoglyphics ; Digestion ; Flagella ; Follow-Up Studies ; Genotype ; Helicobacter pylori* ; Helicobacter* ; Humans ; Korea* ; Molecular Epidemiology* ; Parents ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length

We have previously demonstrated that transferrin binding protein (TfBP) is a reliable marker for mature oligoden-drocytes (OLGs) in the avian central nervous system (CNS). Unlike mammalian CNS in which OLGs are generated largely postnatally, avian OLGs are differentiated during embryonic development of CNS. In this study, several aspects of TfBP(+/-) OLG development were immunohistochemically examined in the embryonic chick cerebellum : (1) change in shapes of immature cells with respect to time and to location within the cerebellum, (2) possible sites of origin, and (3) pathways of precursor cell migration. Our results indicate that TfBP expression gradually increases and extends from the deep portion of the white matter to gray matter with proportion to progress of cerebellar development. A few TfBP? cells were first observed in the deep portion of the cerebellum at E9. At E13, TfBP(+/-) cells were distributed evenly within the white matter. At E17, many TfBP(+/-) OLGs were located at granular layer and at the near place of Purkinje cell layer. At E20, a large number of TfBP cells appeared at the granular layer with a few in the molecular layer. Our data demonstrated distinct patterns of morphology and location of TfBP(+/-) OLGs in the cerebellum during development and suggest a role of TfBP in OLG development.
Animals ; Carrier Proteins ; Cell Movement ; Central Nervous System ; Cerebellum* ; Chick Embryo ; Embryonic Development ; Female ; Oligodendroglia ; Pregnancy ; Transferrin