It has been known that right ACA occlusions can cause callosal disconnection syndrome. A 61-year old right-handed man was admitted because of a left ACA occlusion. MRI showed infarction of the medial frontal cortex and the anterior two-thirds of the corpus callosum. He presented with weakness and gait initiation failure in the right leg with grasp reflex, suspicious alien hand sign, and tactile anomia in the right hand. He was diagnosed with transcortical motor aphasia. He was unable to successfully complete written tasks in response to dictations and writing down spontaneous answers. He wrote down incorrect words and demonstrated paragraphism with his left hand. He could copy simple items but not written words and complex items with his left hand. Finally, he had difficulties in writing answers in response to complex verbal and written commands with his left hand, but preserved the ability to simple verbal commands, somato-sensory, and visually guided tasks. We attribute these results to the anterior callosal disconnection of the right sensorimotor cortex from the left language area.
Anomia ; Anterior Cerebral Artery ; Aphasia, Broca ; Corpus Callosum ; Emigrants and Immigrants ; Gait ; Hand ; Hand Strength ; Humans ; Infarction ; Leg ; Magnetic Resonance Imaging ; Middle Aged ; Reflex ; Writing

BACKGROUND: Although relapses are known to be common in optic neuritis, there are only a few follow-up studies concerning recurrent optic neuritis. The aim of this study is to characterize the difference between monophasic and recurrent optic neuritis by analyzing clinical and laboratory spectrums of index event. METHODS: We performed a partially retrospective and prospective cohort study of patients with optic neuritis. The patients with optic neuritis were included by review of their medical records and neuroimaging studies and then followed up for the relapses of optic neuritis. Excluded were those who showed any evidence of multiple sclerosis, and those with prior demyelinating attacks. RESULTS: Thirteen of 43 enrolled patients had a recurrent optic neuritis during a mean (SD) follow up period of 58.0 (21.2) months, yielding a 5-year cumulative rate of recurrence of 39.5 percent. The patients who had CSF pleocytosis were more likely to develop a recurrent attacks (P<0.05), but neither clinical findings nor the other laboratory results appeared to influence recurrence. CONCLUSIONS: We suggest that this disorder have a distinctive feature in terms of relapse and CSF pleocytosis compared with monophasic optic neuritis.
Cohort Studies ; Follow-Up Studies ; Humans ; Leukocytosis ; Medical Records ; Multiple Sclerosis ; Neuroimaging ; Optic Neuritis* ; Prospective Studies ; Recurrence ; Retrospective Studies

Flumazenil, an imidazobenzodiazepine, is the first benzodiazepine antagonist and is being used to reverse the adverse pharmacological effects of benzodiazepine. There have been a few reports on the central nevous system side effects with its use. We report a patient with generalized ballism following administration of flumazenil. The mechanism through which flumazenil induced this symptom is unknown. It is conceivable that flumazenil may antagonize the GABA-benzodiazepine receptor complex and induce dopamine hypersensitivity, thus induce dyskinesic symptoms.
Diagnosis, Differential ; Dyskinesias/etiology* ; Female ; Flumazenil/adverse effects* ; GABA Modulators/adverse effects* ; Human ; Middle Aged

It is generally believed that tumor necrosis factor alpha (TNF a) plays an crucial role in the pathogenesis of bacterial meningitis through various mechanisms such as endothelial damage, induction of adhesion molecule on the endothelial cell, recruitment of leukocytes in the cerebrospinal fluid(CSF). We performed this study to analyze the relationship of TNF alpha level with the severity of inflammation in the CSF. In a rabbit meningitis model, we attempted to evaluate whether antibiotics induced bacteriolysis can induce the elevation of the TNF alpha level and pleocytosis in CSF, and whether dexamethasone can suppress this elevation of TNF alpha. We also tried to assess the effective administation timing of dexamethasone. Meningitis was induced by intracistemal inoculation of Streptococcus pneumoniae. We designed four groups : Group 1. Untreated conrol (N=5); Group 2. Lone ceftriaxone at 6 hours after inoculation (N=5) ; Group 3. Dexamethasone at 30 minutes before ceftriaxone treatment (N=5); Group 4. Dexamethasone at 30 min. after ceftriaxone treatment (N=5). CSF TNF alpha level and cell count was assessed with regular time interval. The results were as follows: First, the CSF bacterial counts (measured by colony forming units) of group 1 was significantly higher than the other groups after ceftriaxone treatment (P<0. 05). Second, the CSF WBC counts of group 3 and 4 were significantly lower than those of group 1 and 2 at 6 and 14 hours after ceftriaxone treatment (P<0.05). Third, the CSF TNF alpha titers of group 1 and 3 were significantly lower than those of group 2 and 4 at 2 hours after ceftriaxone treatment (P<0.05). Fourth, after 14 hours, the CSF TNF alpha titers of group 1 kept on rising and became significantly higher than those of other groups (P Anti-Bacterial Agents ; Bacterial Load ; Bacteriolysis ; Ceftriaxone ; Cell Count ; Dexamethasone* ; Endothelial Cells ; Inflammation* ; Leukocytes ; Leukocytosis ; Meningitis ; Meningitis, Bacterial ; Meningitis, Pneumococcal* ; Streptococcus pneumoniae ; Tumor Necrosis Factor-alpha

BACKGROUND: Enterococci are important cause of nosocomial infections. Recently, vancomycin-resistant enterococci (VRE) has been increasingly reported as significant nosocomial pathogens. Therefore, accurate identification of enterococcal species is a prerequisite step for the appropriate antibiotic treatment and epidemiologic surveillance. We wanted to know the usefulness of PCR method compared with Vitek automatic identification system. METHODS: Totally 105 isolates were identified on the species level by Vitek (GPI card and software version R06.1), methyl-alpha-D-glucopyranoside test, and PCR methods. RESULTS: Among 105 enterococcal isolates, 59 were identified as E. faecium, 11 E. faecalis, 6 E. gallinarum by Vitek. But 29 isolates (28%) were unidentified. Subsequently all of these isolates were analyzed by PCR, the results of which were as follows: 17 E. faecium, 5 E. casseliflavus, 7 E. gallinarum. Two isolates identified as E. gallinarum by Vitek were reidentified as E. casseliflavus by PCR and other methods for phenotypic characterization. CONCLUSOIN: PCR method was more accurate and sensitive than Vitek for the identification of enterococci species.
Cross Infection ; Epidemiological Monitoring ; Polymerase Chain Reaction*

A 42-year-old woman who had undergo a subtotal gastrectomy for stomach cancer, developed transient bilateral cortical blindness and hemiplegia after the removal of a subclavian vein catheter. A brain MRI, transcranial doppler sonogram and visual evoked potentials revealed no abnormalities. She returned to normal neurologic status 4 days after onset. There have been a few cases of transient cortical blindness after an insertion or removal of the subclavian vein catheter. However, caution should be taken for this possibility whenever the subclavian catheter is inserted or removed.
Adult ; Blindness, Cortical* ; Brain ; Catheters* ; Evoked Potentials, Visual ; Female ; Gastrectomy ; Hemiplegia ; Humans ; Magnetic Resonance Imaging ; Stomach Neoplasms ; Subclavian Vein*

A 15-year-old Schnauzer, showing right exophthalmos, was diagnosed as adenocarcinoma originated from the third eyelid gland. On computed tomography, a normal right third eyelid gland was not observed. Instead, a heterogeneous cystic mass invaded the retrobulbar space and displaced the eye globe dorsolaterally. In addition, lysis of the bony nasolacrimal duct was found, which was considered the tumor invasion. These findings indicated that third eyelid gland adenocarcinoma should be considered when a retrobulbar mass is found ventromedial to the globe without observation of the normal third eyelid and accompanies osteolysis of the bony nasolacrimal duct in dogs showing exophthalmos.

BACKGROUND: Stable xenon-CT has been known to be a useful technique for measuring cerebral blood flow (CBF) and its direct correlation with CT anatomy. We evaluated the usefulness and limitations of stable xenon-CT cerebral hemodynamic status. METHODS: Xenon-CT was administered to 23 patients. Ten were normal controls and 13 were stroke patients (acute 4, subacute 5, chronic 2, hemorrhagic 2). Time dependent Xenon concentrations within various tissue segments of the brain was used to derive both the local partition-coefficient (lamda) and CBF in each tissue volume (voxel) of the CT image. RESULTS: In the controls, the regional CBF (rCBF) (ml/100 gm/min) was as follows: frontal 22.9+/-7.3(Mean+/-SD), inferior temporal 23.9+/-3.2, superior temporal 27.4+/-7.3, parietal 30.0+/-10.1, occipital 24.3+/-8.4, cerebellar hemisphere 24.3+/-8.3, thalamus 31.1+/-7.1, and corona radiata 18.1+/-4.7. The cortical differences was within 10%. In the stroke patients, the rCBF in the infarcted area ranged from 0 to 26.5 ml/100 gm/min and interhemispheric cortical difference was above 50%. The routine CT revealed no abnormalitiy, particularly in acute stroke (within 6 hours after onset). However, a xenon-CBF showed perfusion defect which correlated with clinical signs. CONCLUSIONS: With xenon CT, CBF can be obtained within a few hours of stroke onset, result of which can be correlated with CT. In an acute stroke state, a Xenon-CBF map can be a more sensitive method than routine CT imaging. Low value of blood-flow and patient's in cooperation may limit use of Xe-CT.
Brain ; Cerebral Infarction ; Hemodynamics ; Humans ; Perfusion ; Rabeprazole ; Regional Blood Flow ; Stroke ; Thalamus ; Xenon

Hemodialysis is a safe and effective treatment for uremic patients but hemodynamic changes during hemodialysis is suggested to be the possible cause of encephalopathy. However, few studies have evaluated the cerebral circulation of and the effects of hemodialysis. Therefore, this study was performed to evaluate the cerebral blood flow by transcranial doppler. The study populations were 12 male patients who ranged in age from 28 to 58 years(mean:57) and were receiving maintenance hernodialysis for 3.8 years(0.5-11.5 years). Mean blood flow velocity(MFV), pulsatility index(PI) and resistance index(RI) were measured in carotid artery(CA), middle cerebral artery(MCA), anterior cerebral artery(ACA) and posterior cerebral artery(PCA) before, during and after hemodialysis. Simultaneously, we also checked variables(body weight, blood pressure, arterial blood gases, hematocrits, and other biochemical parameters) which might affect cerebral blood flow. MFV during(70.5+/-20.3 vs. 60.0+/-211cm/sec) and after(vs. 60.6+/-13.7cm/sec, p<0.01) hemodialysis in CA showed significant reduction as compared to the that of before hemodialysis, but other vessels(MCA, ACA and PCA) showed no significant changes. There were no significant changes in PI and RI before, during and after hemodialysis. Body weight, PaCO(2), blood urea nitrogen and hematocrit changed significantly during and after hemodialysis as compared to those of before hemodialysis, but correlation between changes of MFV and these variables was not observed. Hemodialysis and its associated physiologic changes are not associated with cerebral blood flow, and this result suggests the well-preservation of autoregulation of cerebral blood flow during and after hemodialysis.
Arterial Pressure ; Blood Flow Velocity* ; Blood Urea Nitrogen ; Body Weight ; Gases ; Hematocrit ; Hemodynamics ; Homeostasis ; Humans ; Male ; Renal Dialysis*

BACKGROUND: Recent studies have shown increasing evidence for microglial activation in neuronal degeneration in Parkinson's disease (PD), although the cause of PD remains unclear. Recent studies have also shown that 1alpha, 25-dihydroxyvitamin D3 (vitamin D3) exert neuroprotective effects by inducing an increased expression of neurotrophic factors, suggesting the possibility of vitamin D3 for the treatment of PD and other neurodegenerative diseases. The purpose of this study was to investigate the effect of vitamin D3 on 6-hydroxydopamine (6-OHDA)-induced neurotoxicity and microglial activation in adult rats. METHODS: Adult male Sprague-Dawley rats were subcutaneously injected with vitamin D3 or 0.1% ethanol for seven consecutive days and then infused unilaterally with 6-OHDA in the medial forebrain bundle. After 7 days of injection with 6-OHDA, the substantia nigra was examined by immunohistochemistry. RESULTS: The number of tyrosine hydroxylase (TH)-positive neurons in the lesioned substantia nigra pars compacta of vitamin D3 and ethanol groups was 84.8 +/- 18.84 and 52.6 +/- 13.23, respectively, fewer than that of the contralateral side (122.35 +/- 9.79 and 123.81 +/- 12.11, respectively) (P<0.05). The vitamin D3 group showed significantly higher numbers of the TH-positive neurons than that of the ethanol group (P<0.05). CD11b-positive microglial immunoreactivity was stronger in the lesion side than that of the normal side, and it was much weaker in the vitamin D3 group than that of the ethanol group (P<0.05). CONCLUSIONS: These results indicate that vitamin D3 protects dopaminergic neurons from the neuronal injury induced by 6-OHDA, possibly by the mechanism involving microglial activation.
Adult ; Animals ; Cholecalciferol ; Dopaminergic Neurons* ; Ethanol ; Humans ; Immunohistochemistry ; Male ; Medial Forebrain Bundle ; Microglia ; Models, Animal* ; Nerve Growth Factors ; Neurodegenerative Diseases ; Neurons ; Neuroprotective Agents ; Oxidopamine* ; Parkinson Disease ; Rats* ; Rats, Sprague-Dawley ; Substantia Nigra ; Tyrosine 3-Monooxygenase