Posterior reversible encephalopathy syndrome (PRES) involves predominantly posterior subcortical white matter and cortex. PRES is associated with an abrupt and severe increase in blood pressure or administration of various immuno-suppresants. We present a 18-year-old female with PRES. She was admitted to our hospital with seizures. She had been suffering from acute hypertension (170/100 mmHg) associated with acute renal failure. Brain MRI showed reversible biparietal cortical and subcortical edema. We report a case of hypertension-induced PRES associated with acute renal failure. (J Korean Neurol Assoc 19(5):541~543, 2001)
Acute Kidney Injury ; Adolescent ; Blood Pressure ; Brain ; Edema ; Female ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Posterior Leukoencephalopathy Syndrome* ; Seizures

PURPOSE: The aim of this study was to evaluate the utility of contrast-enhanced MRI with first-pass and delayed images in prediction of myocardial viability after acute myocardial infarction. MATERIALS AND METHODS: Ten patients (M:F=:4, mean age =6 5 years) with acute myocardial infarction underwent first-pass image after bolus injection of gadolinium (one image/sec for 120sec)and delayed image (7 2 minutes later). According to 60 segments on midventricular level, the assessment of MRI were concerned about location of lesion, depth of lesion, enhancement on first-pass image and enhancement pattern on delayed image. MRI findings were compared with wall motion on resting echocardiography and stress or follow-up echocardiography. RESULTS: 1) MRI findings were classified into 4 types: normal enhancement on first-pass and delayed images (type 1), normal enhancement on first-pass image and nontransmural hyperenhancement on delayed image (type 2), non-transmural enhancing defect on first-pass image and transmural enhancement with endocardial non-enhancing defect on delayed image (type 3), and transmural enhancing defect on first-pass image and transmural hyperenhancement on delayed image (type 4).2) Type 2 suggested viable myocardium and type 3 had high porbability of viability. Type was compatible with non-viable myocardium. CONCLUSION: Enhancing defect on first-pass image and involving thickness on both the first-pass image and delayed image in contrast enhanced MRI may predict myocardial viability.
Echocardiography ; Follow-Up Studies ; Gadolinium ; Humans ; Magnetic Resonance Imaging* ; Myocardial Infarction* ; Myocardium

A 68-year-old woman with progressive paraparesis and altered sensation lasting approximately five days was admitted to our clinic. Magnetic resonance imaging (MRI) revealed an advanced stage T7-8 epidural mass ventral to the spinal cord, which was believed to be a metastatic tumor considering the patient's age. A highly enhanced epidural mass and pedicle appeared during the MR scan. However, the pathologic findings were compatible with the diagnosis of a primary meningeal melanocytic tumor. Primary epidural melanomas are extremely rare lesions. This case was finally diagnosed as a primary thoracic spinal epidural melanoma.
Aged ; Central Nervous System ; Female ; Humans ; Magnetic Resonance Imaging ; Melanoma ; Paraparesis ; Sensation ; Spinal Cord

We report here on a case of acute aortic dissection after intravenous tissue plasminogen activator (t-PA) administration in a patient with acute ischemic stroke. A 75-year-old woman with a history of hypertension and diabetes mellitus presented with left hemiplegia and a decreased mentality. The admission studies revealed severe stenosis of the right middle cerebral artery and decreased cerebral perfusion. Initial chest radiography showed hypertensive cardiovascular changes and increased interstial markings on both lung fields. Cyanosis and cardiac arrest occurred 80 minutes after intravenous t-PA administration. Emergency cardiopulmonary resuscitation was done and chest CT showed a dissection involving the whole aorta and pericardial effusion due to bleeding. In spite of our earnest efforts, the patient died. It should be kept in mind that aortic dissection can occur after intravenous t-PA administration and an early clinical suspicion and diagnosis is needed to avoid this devastating complication.
Aged ; Aorta ; Cardiopulmonary Resuscitation ; Constriction, Pathologic ; Cyanosis ; Diabetes Mellitus ; Emergencies ; Female ; Heart Arrest ; Hemiplegia ; Hemorrhage ; Humans ; Hypertension ; Lung ; Middle Cerebral Artery ; Perfusion ; Pericardial Effusion ; Stroke ; Thorax ; Tissue Plasminogen Activator

BACKGROUNG AND OBJECTIVES: The aim of this study was to analyze the influence of changes in ventricular preload and afterload, atrial and ventricular pacing on the coronary flow reserve (CFR). METHOD: Five open chest anesthetized dogs were studied in five sequential stages:baseline, saline solution volume loading (293.8+/-29.2 ml for 10 min), atrial and ventricular pacing (120, 140, and 160 bpm), and aortic clamp. Coronary blood flow (CBF) was measured with electro-magnetic flowmeter. CFR was defined as the ratio of hyperemic CBF (hCBF) to resting CBF (rCBF). Hyperemia was induced by IV adenosine infusion (1 mg/kg/min). RESULTS: 1)After volume loading wtih saline solution, CFR significantly decreased (p<0.05) because rCBF was increased while hCBF remained unchanged. 2)Atrial pacing produced increase in rCBF but did not change hCBF. Consequently CFR singificantly reduced when heart rate (HR) increased from sinus rhythm to 120, 140, and 160 bpm (p<0.01). 3)Ventricular pacing produced decrease in hCBF but did not change rCBF. Consequently CFR significantly reduced as HR increased from sinus rhythm to 120 (p<0.05) , 140 (p<0.01), and 160 (p<0.01) bpm. 4)After aortic clamp, CFR significantly decreased (p<0.01) because rCBF increased while hCBF remained unchanged. CONCLUSION: We found that CFR is dependent on the changes in volume loading, HR, and ventricular afterload that may commonly occur in clinical situations.
Adenosine ; Animals ; Dogs* ; Flowmeters ; Heart Rate ; Hyperemia ; Sodium Chloride ; Thorax

Gastrointestinal (GI) dysfunction in Parkinson's Disease is common, but its pathophysiology is poorly understood. We performed esophageal manometry, radionuclide oropharyngeal and esophageal transit study in order to obtain the objective data of the frequency of dysphagia in the patients with Parkinson's and to evaluate the subjective symptoms and motor dysfunction of oropharynx and esophagus. Seventeen idiopathic Parkinson's disease patients(7 men and 10 women) and twenty age-matched controls were subjects for esophageal manometry , radionuclide oropharyngeal(O'IT) and esophageal transit study(ETT). Among 17 patients group, 10 patients were abnormal in esophageal manometry, and 14 were abnormal in radionuclide transit time(ETT). At the results of OTT & E'IT, there is significant difference between patient group and age-matched control group(contror group OTT ;2.64+1.9, ETT ;14.33+9.4 : patient group OTT ;34.21+ 71.6, ETT ; 115.98+116. Lsec) (P < 0. 05). However, there was no significant difference between those with complain of dysphagqa and those without complain of dysphagia. Moreover, there was no correlation among the results of O'IT & EIT, the findings of esophageal manometry, those with complain. Of dysphagia, and H-Y stage. In conclusion, it showed the oropharyngeal and esophageal dysfunction in most of Parkinson's disease patients, which was not related with the severity of dysphagia. The causable lesion of dysphagia involved diffusely throughout oropharynx, body of esophagus and lower esophageal sphincter. And, esophageal manometry and radionuclide transit study might be objective tools for evaluation of dysphagia. The relationship between motor dysfunction of oropharynx and esophagus and the severity of Parkinson's disease is remained to be clear.
Deglutition Disorders* ; Esophageal Sphincter, Lower ; Esophagus ; Humans ; Male ; Manometry ; Oropharynx ; Parkinson Disease*

BACKGROUND: The estimation of coronary flow velocity(CFV) is essential for assessing the impaired coronary flow reserve in patients whith angina pectoris and normal coronary arteries. But, intracoronary blood flow velocity measurement remains invasive,requiring cardiac catheterization and can not be repeated without risk during serial follow-up study. Transesophageal Doppler echocardiography(TEE) is a new noninvasive method of assessing CFV in the proximal portion of left anterior descending coronary artery. This study was performed to clarify the value of TEE in evaluating CFV, to compare the coronary flow patterns among various cardiac diseases, to estimate the coronary flow dynamics according to change of blood pressure, and to evaluate the parameters influencing CFV. METHODS: We studied 95 subjects, 51 men and 44 women, mean age 46. Normotensive subjects were 29, hypertensive patients 41, aortic stenosis 5, aortic regurgitation 4, mitral stenosis 8, and others 8. After transthoracic echocardiography(H-P Sonos 1000,2.5 MHz), transesophageal echocardiography was performed using a 5-Hz(omniplane)transesophageal probe connected to a H-P Sonos 1000 to assess CFV in the proximal portion of left anterior descending coronary artery. Doppler evaluation of left anterior descending coronary blood flow velocity was obtained in restiong conditions and after sublingual administraion of nitroglycerim(0.6mg), Blook pressure and heart rate were monitored thoughout the entire procedure. RESULTS: 1) The detection rate of CFV by TEE was 89.5%. 2) The morphology of CFV in proximal left anterior descending coronary artery was biphasic(greater diastolic and smaller systolic). 3) The baseline CFV in hypertensive patients was greater than in normotensive subjects(p<0.05) but there was no difference between two groups in diastolic/systolic CFV ratio. 4) The diastolic CFV and diastolic/systolic CFV ratio in patients with aortic stenosis were greater than in normotensive subjects(p<0.05). 5) The CFV was significantly decreased after administration of nitroglycerin(p<0.05) and the decrement of CFV correlated closely with the decrement of systolic(r=0.65, p<0.05) and diastolic blood pressure(r=0.57, p<0.05). 6) Major parameters influencing CFV were systolic blood pressure and heart rate. CONCLUSION: The CFV is influenced by various parameters and the TEE may be a useful, noninvasive tool to investigate the coronary flow dynamics.
Angina Pectoris ; Aortic Valve Insufficiency ; Aortic Valve Stenosis ; Blood Flow Velocity ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Coronary Vessels ; Echocardiography, Doppler* ; Echocardiography, Transesophageal ; Female ; Follow-Up Studies ; Heart Diseases ; Heart Rate ; Humans ; Male ; Mitral Valve Stenosis

OBJECTIVE : We investigated the relationship between the severity of the disease and the abnormality of some ocular movements in parkinson's disease. BACKGROUND: Disorders of eye movements have been described in diseases of the basal ganglia for over a century and ocular motor deficits of the saccadic and pursuit system have been reported in parkinsonian patients. METHOD : We studied the electro-oculography of the eye tracking and saccadic movement in 26 patients (11 males, 15 females) with Parkinson's disease. The severity of the disease was divided into two groups by Hoehn & Yahr(H-Y) staging, H-Y stage 1, 2(group A) and H-Y stage 3, 4 (Group B). Some patients antiparkinsonian drugs of L-dopa, dopamine agonist and anticholinergics. RESULT : The velocity of smooth pursuit and the velocity and latency of saccade were calculated and compared between two groups. Eye tracking test revealed decreased pursuit velocity leading to catch-up saccades, but normal phase relationship between eye and target movement, while saccadic eye movement had increased latency. These results showed more profound severity in more advanced stages of the disease. CONCLUSION : We suggest that ocular movement be often chosen as a simple but relevant example of general motor function, as well as criteria for staging of Parkinson's disease and basal ganglia play significant role in ocular movement.
Basal Ganglia ; Cholinergic Antagonists ; Dopamine Agonists ; Eye Movements ; Humans ; Levodopa ; Male ; Parkinson Disease* ; Pursuit, Smooth ; Saccades

We report a rare case that showed aggravation of neurological symptoms due to expansion of the synovial cyst at C7/T1 after several month of trauma and present the consideration of proper prevention and management. A 64-year old male was admitted by right arm weakness(GIV+) after a pedestrian traffic accident. According to computed tomography(CT) scan and electromyography(EMG), a brachial plexus injury was diagnosed and he was treated conservatively. After 7 months, he was re-admitted by the left side weakness(GIV-) with severe pain and magnetic resonance image(MRI) revealed the expanded cystic lesion at C7/T1 level which compressed the cord from left side. After administration of steroid, surgical resection was performed via posterior approach and partial laminectomy. The dural expansion was observed after total removal of cyst which was diagnosed as a pathologist and symptoms were completely recovered. Because of its possibility of expansion of the synovial cyst and critical myelopathic symptoms can be induced in cervical spine, immobilization should be in consideration for acute period of post-trauma, especially, in old-aged patients with degenerative facet joints. And surgical procedure should not be delayed if symptoms developed.
Accidents, Traffic ; Arm ; Brachial Plexus ; Humans ; Immobilization ; Laminectomy ; Magnetic Resonance Spectroscopy ; Male ; Spine ; Synovial Cyst ; Zygapophyseal Joint

BACKGROUND: In patients with myocardial infarction (MI) and chronic stable angina, the coronary flow reserve (CFR) is reduced not only in the region of myocardium perfused by the ischemia-related artery but also in the regions supplied by angiographically normal coronary arteries. The effect of myocardial stunning on the remote CFR is unknown, however. METHODS: In ten open-chest anesthetized dogs, left circumflex coronary artery was occluded for 15 minutes (myocardial stunning group, n=5) or for 30 minutes (MI group, n=5) and was followed by a reperfusion for 60 minutes. Before coronary occlusion and at 30 minutes and at 60 minutes after reperfusion, resting coronary blood flow (CBF) and maximal CBF after IV injection of each of adenosine (ADE) and acetylcholine (Ach) was measured with electromagnetic flow probe located in the proximal left anterior descending coronary artery. CFR was calculated as the ratio of maximal and resting CBF. RESULTS: At 30 minutes and 60 minutes after reperfusion, the remote resting CBF were significantly increased in both groups and the remote CFR was significantly decreased in both groups. The CFR of the MI group was lower than myocardial stunning group. The coronary vasodilator response to Ach was significantly lower than the response to ADE in both groups. CONCLUSION: After MI and myocardial stunning, there was severe coronary vasodilator abnormality in the remote myocardium and that was more marked after MI. The coronary vasodilator response to Ach was significantly lower than the response to ADE in both groups, suggesting endothelial dysfunction in remote myocardium.
Acetylcholine ; Adenosine ; Angina, Stable ; Animals ; Arteries ; Coronary Occlusion ; Coronary Vessels ; Dogs ; Humans ; Magnets ; Myocardial Infarction ; Myocardial Stunning* ; Myocardium ; Reperfusion