Grave's disease is an autoimmune disorder and affects thyroid gland and orbit. Ocular manifestations of this disease, referred to as Grave's ophthalmopathy are caused by deposition of antithyroglobulin immune complexes into extraocular muscles and orbital fats. Consequent increase in volume of orbital contents results in exopthalmos. Severe exopthalmos results in several significant visual consequences as follows: exposure keratitis, diplopia and optic neuropathy. Orbital decompression for Grave's ophthalmopathy has traditionally been performed through either an external or a transantral approach. The advent of intranasal endoscopes allowed for the development of a transnasal approach for medial and inferior orbital wall decompression. Recently, the authors experienced a case of Grave's ophthalmopathy complicated with exposure keratitis and performed endoscopic transnasal orbital decompression, so report this case with a review of literature.
Antigen-Antibody Complex ; Decompression* ; Diplopia ; Endoscopes ; Fats ; Keratitis ; Muscles ; Optic Nerve Diseases ; Orbit* ; Thyroid Gland

Background: The code stroke system is designed to identify stroke patients who may benefit from reperfusion therapy. It is essential for emergency physicians to rapidly distinguish true strokes from stroke mimics to activate code stroke. This study aimed to investigate the clinical and neurological characteristics that can be used to differentiate between stroke and stroke mimics in the emergency department (ED). Methods: We conducted a retrospective observational study of code stroke patients in the ED from January to December 2019. The baseline characteristics and the clinical and neurological features of stroke mimics were compared with those of strokes. Results: A total of 409 code stroke patients presented to the ED, and 125 (31%) were diagnosed with stroke mimics. The common stroke mimics were seizures (21.7%), drug toxicity (12.0%), metabolic disorders (11.2%), brain tumors (8.8%), and peripheral vertigo (7.2%). The independent predictors of stroke mimics were psychiatric disorders, dizziness, altered mental status, and seizure-like movements, while current smoking, elevated systolic blood pressure, atrial fibrillation on the initial electrocardiogram, hemiparesis as a symptom, and facial palsy as a sign suggested a stroke. In addition, the likelihood of a stroke in code stroke patients tended to increase as the number of accompanying deficits increased from the following set of seven focal neurological deficits: hemiparesis (or upper limb monoparesis), unilateral limb sensory change, facial palsy, dysarthria, aphasia (or neglect), visual field defect, and oculomotor disorder (P < 0.001). Conclusion Some clinical and neurological characteristics have been identified to help differentiate stroke mimics from true stroke. In particular, the likelihood of stroke tended to increase as the number of accompanying focal neurological deficits increased.

PURPOSE: To report a case of presumed intraocular natural killer/T-cell lymphoma (NKTL). CASE SUMMARY: A 61-year-old male presented with visual disturbance of the left eye for duration of 3 years. He had been treated with systemic chemotherapy and radiotherapy for nasal NKTL 1 year prior. Inflammatory reaction in the anterior chamber and vitreous opacity were observed in the left eye. The patient was diagnosed with uveitis in the left eye at a local clinic 3 years prior to visiting us. Because the patient did not respond to anti-inflammatory therapy, we performed diagnostic and therapeutic vitrectomy. Intraoperatively, vitreous opacity was thin sheet like in appearance. The vitreous specimen contained few lymphoid cells and was positive for Epstein Barr virus-encoded RNA (EBER). Systemic workups showed no metastasis to other organs. The patient was treated with systemic methotrexate chemotherapy and intravitreal methotrexate injected 3 times (once per week). During the 12-month follow-up period after the last intravitreal injection, the recurrence of lymphoma and related uveitis was not observed.
Anterior Chamber ; Eye ; Follow-Up Studies ; Humans ; Intravitreal Injections ; Lymphocytes ; Lymphoma ; Male ; Methotrexate ; Middle Aged ; Neoplasm Metastasis ; Recurrence ; RNA ; Uveitis ; Vitrectomy

PURPOSE: To evaluate the efficacy and safety of a pars plana Ahmed valve implantation combined with 23-gauge sutureless vitrectomy in the treatment of patients with medically uncontrolled neovascular glaucoma (NVG) in proliferative diabetic retinopathy (PDR). METHODS: The authors retrospectively reviewed the records of 11 consecutive patients with refractory NVG in PDR who underwent a 23-gauge sutureless vitrectomy combined with pars plana placement of an Ahmed valve implant. Control of intraocular pressure (IOP), pre- and postoperative best-corrected visual acuity and the development of intra- and postoperative complications were evaluated during the follow-up. RESULTS: The mean follow-up was 12.2 months (range, 8 to 25 months). Mean preoperative IOP was 35.9 +/- 6.3 mmHg and mean postoperative IOP at the last visit was 13.3 +/- 3.2 mmHg. Control of IOP (8 to 18 mmHg) was achieved in all patients, but 91% (10 of 11 patients) needed antiglaucoma medication (mean number of medications, 1.2 +/- 0.6). Postoperative visual acuity improved in 11 eyes, and the logarithmically to the minimum angle of resolution mean visual acuity in these eyes improved from 1.67 +/- 0.61 to 0.96 +/- 0.67. The complications that occurred were transient hypotony in one case, transitory hypertension in two cases, and postoperative vitreous hemorrhage which spontaneously cleared in two cases. CONCLUSIONS: We suggest the combination of 23-gauge pars plana vitrectomy and Ahmed valve implantation is safe and effective in PDR patients with refractory NVG.
Adult ; Aged ; Diabetic Retinopathy/*complications/pathology ; Female ; Follow-Up Studies ; *Glaucoma Drainage Implants ; Glaucoma, Neovascular/*complications/pathology/*surgery ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Vitrectomy/*methods

Tumor necrosis factor (TNF) inhibitors are increasingly used in treatment of rheumatoid arthritis (RA), ankylosing spondylitis, psoriatic arthritis, and inflammatory bowel diseases including Crohn's disease and ulcerative colitis. Rarely, anti-TNF therapy is associated with neurological complications, including both central and peripheral nervous system disorders. To the best of our knowledge, only one case of infliximab-associated multifocal motor neuropathy with conduction block in a patient with spondyloarthropathy has been reported to date in Korea. Here, we report on the case of a 58-year-old Korean woman affected by RA who developed multifocal motor neuropathy after infliximab treatment.
Arthritis, Psoriatic ; Arthritis, Rheumatoid* ; Colitis, Ulcerative ; Crohn Disease ; Female ; Humans ; Inflammatory Bowel Diseases ; Infliximab ; Korea ; Middle Aged ; Peripheral Nervous System Diseases ; Spondylarthropathies ; Spondylitis, Ankylosing ; Tumor Necrosis Factor-alpha

Spontaneous intracranial hypotension (SIH) results from spontaneous cerebral spinal fluid leakage, of unknown etiology, at the level of the spine. Physicians' unfamiliarity with SIH and a its varied clinical and radiographic manifestations may contribute to a delayed or erroneous diagnosis. We report an SIH patient whose subdural hematoma (SDH) clinically mimicked meningitis, but who recovered 1 week later, without any neurologic deficit, after an epidural blood patch (EBP) treatment.
Blood Patch, Epidural ; Hematoma, Subdural ; Humans ; Intracranial Hypotension ; Meningitis ; Neurologic Manifestations ; Spine

PURPOSE: To date, the benefits of central neck node dissection (CND) in patients with differentiated thyroid carcinoma (DTC) have not been clearly demonstrated and must be considered against the potential risks of the procedure. However, recent papers suggest that lymph node metastasis exerts a significant influence on survival and is associated with a higher risk of recurrence. The purpose of our study was to assess the recurrent laryngeal nerve and parathyroid risks of CND following total thyroidectomy in patients with DTC and to compare the results with those obtained in patients who underwent total thyroidectomy only. METHODS: We retrospectively analysed 143 consecutive patients with DTC (116 with papillary, 24 with follicular, and 3 with Hurthle cell carcinoma) operated on by a single experienced endocrine surgeon from January 1989 to January 1999. There were 61 total thyroidectomies with CND (Group 1) and 82 total thyroidectomies only (Group 2). Group 1 patients displayed evidence of macroscopic lymph node invasion during surgery. The definitions of the two main complications in the thyroid surgery were as follows: transient and permanent recurrent laryngeal nerve palsy (persisting hoarseness over six months after thyroidecomy), transient and permanent hypoparathyroidism (non-recovery of normal parathyroid function and calcemia below 8.0 mg/dl over six momths after thyroidectomy). RESULTS: There was no difference observed in the demographic data between the two groups. Three cases (4.9%) of transient hypocalcemia were detected in Group 1 and two cases (2.4%) in Group 2. Five cases (8.2%) of transient nerve palsy were presented in Group 1 and one case (1.2%) in Group 2. However, there was no significant statistical difference between the two groups (p=0.051). None of the patients demonstrated permanent nerve palsy. CONCLUSION: Following total thyroidectomy for DTC, CND does not increase the morbidity of parathyroid gland and recurrent laryngeal nerve. Therefore, in order to decrease the incidence of regional recurrence and avoid the risk of reoperation in the central neck area, we recommend cervical neck node dissection from the central neck compartment concomitant with total thyroidectomy when overt lymph nodes are palpated.
Hoarseness ; Humans ; Hypocalcemia ; Hypoparathyroidism ; Incidence ; Lymph Node Excision* ; Lymph Nodes* ; Neck* ; Neoplasm Metastasis ; Paralysis ; Parathyroid Glands ; Recurrence ; Recurrent Laryngeal Nerve ; Reoperation ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Vocal Cord Paralysis

Angiolymphoid hyperplasia with eosinophilia is a disorder of the skin and subcutaneous lesion of unknown cause. It is characterized by painless, vascular tumor-like nodules of various size, primarily affecting the head and neck region. The histological hallmark of angiolymphoid hyperplasia with eosinophilia is a benign angiomatous or angioma-like proliferation within the background of the stroma, which is heavily infiltrated by lymphocytes and eosinophils, and includes lymphatic follicles with prominent germinal centers. The authors have recently experienced a case of angiolymphoid hyperplasia with eosinophilia in a 29-year old male who had painless and enlarging nodules in the nasal cavity and the buccal mucosa for a year. We present this case with the review of literatures.
Adult ; Angiolymphoid Hyperplasia with Eosinophilia* ; Eosinophils ; Germinal Center ; Head ; Humans ; Lymphocytes ; Male ; Mouth Mucosa ; Nasal Cavity ; Neck ; Skin

PURPOSE: Recurrence is one of the most common complications after primary correction for hallux valgus deformities. The purpose of this study was to evaluate the usefulness of Scarf osteotomy with axial decompression in the treatment of recurrent hallux valgus. MATERIALS AND METHODS: From April 2006 to April 2011, 14 cases (12 patients) of recurrent hallux valgus were managed with shortening Scarf osteotomy. Preoperative and postoperative radiographs were reviewed for the measurement of the hallux valgus angle (HVA), intermetatarsal angle (IMA), and the amount of the 1st metatarsal shortening. Clinical outcomes including the visual analogue scale (VAS), the AOFAS score, and the range of motion [ROM] of the 1st metatarsophalangeal (MTP) joint were evaluated. RESULTS: The mean HVA decreased from 27.9 degrees to 5.2 and the mean IMA decreased from 12.9 to 3.4. The mean VAS improved from 5.3 to 0.3 and the mean AOFAS score improved from 41 to 90. The mean amount of the 1st metatarsal shortening was 3.4 mm (2-5). The mean ROM of the 1st MTP joint improved from 22 degrees (15-35) to 68 (55-75). CONCLUSION: Scarf osteotomy associated with axial decompression can be a useful revision procedure for the treatment of recurrent hallux valgus deformity.
Congenital Abnormalities ; Decompression ; Hallux Valgus* ; Hallux* ; Joints ; Metatarsal Bones ; Osteotomy* ; Range of Motion, Articular ; Recurrence

Phlorotannins (marine algal polyphenols) have been reported to exhibit beneficial biological activities, serving as both antioxidants and anti-inflammatory agents. Among marine algae, Ecklonia cava, a member of the Laminariaceae, is a very popular food regarded as healthy in Korea and Japan. Recently, benefits afforded by phlorotannins in the treatment of various clinical conditions have been reported, but any therapeutic effects of such materials in the treatment of neurodegenerative diseases such as stroke remain unclear. Also, the mechanisms of action of the algal components remain poorly understood. In the present in vivo study, administration of Ecklonia cava polyphenols (ECP) at 10 mg/kg and 50 mg/kg intraperitoneally (i.p.) significantly decreased infarct size and the extent of brain edema in the rat after induction of transient focal ischemia via middle cerebral artery occlusion (MCAO). Further, terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) assay revealed dose-dependent blockage of neuronal apoptosis upon intravenous ECP treatment. Neurobehavioral tests performed over the 6 days after MCAO revealed a reduction in neurological motor performance in control animals, but administration of ECP (50 mg/kg i.p.) prevented this decline. In vitro, a significant neuroprotective effect of ECP was evident when cell viability was assayed after induction of H2O2-mediated oxidative stress, upon retinoic acid treatment, in the differentiated neuroblastoma cell line SH-SY5Y. Interestingly, ECP blocked the rise in cytosolic calcium, in a dose-dependent manner, in differentiated SH-SY5Y cells exposed to H2O2. Together, the results suggest that ECP exerts neuroprotective effects in the focally ischemic brain by reducing Ca(2+)-mediated neurotoxicity.
Animals ; Anti-Inflammatory Agents ; Antioxidants ; Apoptosis ; Brain ; Brain Edema ; Calcium ; Cell Line ; Cell Survival ; Cytosol ; Infarction, Middle Cerebral Artery ; Ischemia ; Japan ; Korea ; Neuroblastoma ; Neurodegenerative Diseases ; Neurons ; Neuroprotective Agents ; Oxidative Stress ; Polyphenols ; Rats ; Stroke ; Tretinoin