Diaschisis is classically defined as a sudden inhibition of function, produced by an acute focal disturbance in a remote area which is anatomically connected through fiber tracts. Transhemispheric diaschisis can underlie some diffuse symptoms of acute supratentorial stroke such as agitation, confusion, and coma. We experienced a patient with right middle cerebral artery infarction, presenting a quadriparesis and hypoesthesia at sensory level. This case suggests the diaschisis exacerbate the initial focal deficit such as weakness and sensory loss.
Coma ; Dihydroergotamine ; Humans ; Hypesthesia ; Infarction, Middle Cerebral Artery* ; Quadriplegia* ; Stroke

Central nervous system toxicity is the most commonly recognized problem during treatment with carbamazepine (CBZ). The most common side effects of CBZ are drowsiness, incoordination, and vertigo. However, unusual conditions such as movement disorders, seizure aggravation, and encephalopathy have also been attributed to CBZ therapy. In case 1, cognitive dysfunction and exacerbation of preexisting gait disturbance were observed in a 63-year-old female who had frontal lobe epilepsy, schizencephaly, and lissencephaly treated with CBZ. The neurological symptoms were resolved 24 hours after the withdrawal of CBZ and induced with the reintroduction of CBZ. In case 2, myoclonic jerks occurred in a 37-year-old female when CBZ was readministered after a 4-day-withdrawal period of CBZ. The myoclonic jerks disappeared 12 days after CBZ was discontinued. In both cases, plasma CBZ levels were within the therapeutic range. We report two cases with encephalopathy and myoclonic jerks as unusual side effects of CBZ, with the plasma levels of CBZ being within the therapeutic range.
Adult ; Ataxia ; Carbamazepine ; Central Nervous System ; Epilepsy, Frontal Lobe ; Female ; Gait ; Humans ; Lissencephaly ; Malformations of Cortical Development ; Middle Aged ; Movement Disorders ; Myoclonus* ; Plasma ; Seizures ; Sleep Stages ; Vertigo

We present two patients with clinical features suggestive of a hyperkinetic form of encephalitis lethargica described by von Economo. While undergoing treatment for viral meningoencephalitis, they both developed comatose mentality, oromandibular dyskinesia, chorea, myoclonic jerk, oculogyric crisis, opistotonus, respiratory failure, and autonomic dysfunction. One patient died of autonomic failure while the other improved several months later. In both patients, cerebrospinal fluid exmamination revealed only pleocytosis. A brain MRI and EEG showed no specific findings. In order to control severe hyperkinetism and autonomic failure, medical treatments including L-dopa, clonazepam, and steroid pulse therapy were administereed in both cases while electroconvulsive therapy was tried in one of the cases. However, they all failed. These cases and previous reports informed us of the presence of sporadic form of encephalis.
Brain ; Cerebrospinal Fluid ; Chorea ; Clonazepam ; Coma ; Dyskinesias ; Electroconvulsive Therapy ; Electroencephalography ; Encephalitis* ; Encephalitis, Viral ; Humans ; Leukocytosis ; Levodopa ; Magnetic Resonance Imaging ; Meningoencephalitis ; Myoclonus ; Respiratory Insufficiency

Phospholipase C (PLC) isozymes play significant roles in transmembrane signal transduction. PLC- 1 is one of the key regulatory enzymes in signal transduction for cellular proliferation and differentiation. The exact mechanisms of this signal transduction of tissue damage and subsequent regeneration, however, were not clearly documented. This study was planned to determine the biological significance of PLC isozymes following irradiation in rat small intestine. Sprague-Dawley rats were irradiated to the entire body by a single dose of 8 Gy. The rats were divided into 5 groups according to the sacrifice days after irradiation. The expression of PLCs in each group was examined by the immunohistochemistry and immunoblotting. The histologic findings were observed using hematoxylin and eosin staining. The regenerative activity, which was estimated by mitotic count and proliferatin cell nuclear antigen (PCNA) immunostaining, was highest in Group III (5th day after irradiation). By the immunohistochemistry, the expression of PLC- 1 was higher in Group III and Group II (3rd day after irradiation), and was found in the regenerative zone of the mucosa. The expression of PLC- 1 was highest in Group I (1st day after irradiation) and was dominantly in the damaged surface epithelium. The immunostaining of PLC- 1 was negative in all groups. The results of the immunoblotting study was compatible to that of the immunohistochemical study. Group II and III showed positive bands for PLC- 1, and group I and II for PLC- 1. These results suggest that PLC- 1 plays a significant role in mucosal regeneration following irradiation. PLC- 1 may play a role in radiation - induced mucosal damage.
Animals ; Cell Proliferation ; Eosine Yellowish-(YS) ; Epithelium ; Hematoxylin ; Immunoblotting ; Immunohistochemistry ; Intestine, Small* ; Isoenzymes* ; Mucous Membrane ; Phospholipases* ; Rats ; Rats, Sprague-Dawley ; Regeneration* ; Signal Transduction ; Type C Phospholipases*

A 77-year-old woman presented with bilateral leg weakness, accompanied by severe axial back and radicular pain, after a L4–5 epidural injection. She had been receiving misappropriated epidural injections for the last few months. A contrast-enhanced magnetic resonance image showed rim enhancing, spinal canal compromising cystic lesion at the posterior epidural space of L4–5. During surgery, a severely central compromised non-communicating cystic lesion located at posterior epidural space was resected. A histological report of this lesion confirmed a pseudocyst containing a degenerated synovial tissue. Herein, we report our experience of cauda equine syndrome after epidural injection with successful treatment.
Aged ; Cauda Equina* ; Epidural Space ; Female ; Humans ; Injections, Epidural* ; Leg ; Polyradiculopathy* ; Spinal Canal

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*

The present report discusses four cases of chronic renal failure, which developed symptoms of parkinsonism in response to levosulpiride. The temporal relationship between levosulpiride discontinuation and the disappearance of parkinsonism suggests a causal link. In addition, decreased striatal dopamine transporter bindings assessed by [I-123] IPT SPECT were observed in two patients suggesting that a dopamine blocking agent causes the dysfunction of nigrostriatal dopaminergic neurons and that such injury may be involved in the pathogenesis of drug-induced parkinsonism.
Dopamine ; Dopamine Plasma Membrane Transport Proteins ; Dopaminergic Neurons ; Humans ; Kidney Failure, Chronic ; Parkinsonian Disorders ; Tomography, Emission-Computed, Single-Photon

Pseudolymphoma or lymphoid hyperplasia is a rare clinicopathologic disease which occurs in a variety of sites including the skin, orbit, salivary glands, gastrointestinal tract, lung, and other organs. Lymphoid hyperplasia of the gastrointestinal tract can be categorized into four clinicopathologic groups: focal lymphoid hyperplasia of the stomach, focal lymphoid hyperplasia of the small intestine, focal lymphoid hyperplasia of the rectum, and nodular lymphoid hyperplasia of the gastrointestinal tract. We experienced two cases of nodular lymphoid hyperplasia of the small intestine with hypogammaglobulinemia (IgA deficiency) and without hypogammaglobulinemia presented with epigastric discomfort. Esophagogastroduodenoscopy and small bowel series showed 0.2~.5 cm sized small, numerous Yamada-I or Yamada-II polypoid lesions from the duodenal bulb to the terminal ileum in two cases. Histologic finding of the duodenal bulb showed small round mature lymphocyte infiltration and reactive follicle with germinal center in two cases. We report two cases with a brief reviews of literature.
Agammaglobulinemia ; Endoscopy, Digestive System ; Gastrointestinal Tract ; Germinal Center ; Hyperplasia* ; Ileum ; Intestine, Small ; Lung ; Lymphocytes ; Orbit ; Pseudolymphoma ; Rectum ; Salivary Glands ; Skin ; Stomach

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

A 22-year-old woman with a history of acute lymphoblastic leukemia was hospitalized for headache and vomiting. CT scan showed a well-defined, ring like enhancing mass in the left frontal lobe with surrounding edema and midline shift. Magnetic resonance imaging demonstrated a round homogeneous mass with a ring of enhancement in the left frontal lobe. Tl-201 brain SPECT showed increased focal uptake coinciding with the CT and MRI abnormality. Aspiration of the lesion performed through a burr hole yielded many neutrophils, a few lymphocytes and histiocytes with some strands of filamentous microorganism-like material. Modified AFB stained negative for norcardia. Gram stain showed a few white blood cells and no microorganism. Antibiotics were started and produced a good clinical response. After one month, CT scan showed markedly reduction in size and extent was observed.
Anti-Bacterial Agents ; Brain Abscess* ; Brain* ; Edema ; Female ; Frontal Lobe ; Headache ; Histiocytes ; Humans ; Leukocytes ; Lymphocytes ; Magnetic Resonance Imaging ; Neutrophils ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Tomography, Emission-Computed, Single-Photon* ; Tomography, X-Ray Computed ; Vomiting ; Young Adult