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

BACKGROUND: Coagulation abnormalities account for 1% to 5% of the causes of adult stroke. The importance of pro-thrombotic condition as a cause of stroke has been the subject of intense controversy. The role of protein S deficiency in the etiology of stroke and the clinical pattern of cerebral infarction caused by the prothrombotic state are still unclear. We investigated clinical characteristics of cerebral infarction caused by free protein S (FPS) deficiency. METHODS: We enrolled patients with cerebral infarction over 2 years. Cerebral infarction was classified into transient ischemic attack, lacunar infarction, embolic infarction, and thrombotic infarction. We assayed free protein S, prothrom-bin time (PT), and activated partial thromboplastin time (APTT) within 24 hours after stroke and measured free protein S and protein S Ag at 3 months after cerebral infarction. All patients underwent a cardiological examination and neu-roimaging study, and cerebral angiography was done only when necessary. RESULTS: Eight patients (1.67%) among 474 patients with cerebral infarction had FPS deficiency as a cause of stroke. Four were male and four were female. The history of venous thrombosis was not noted. The age of patients were from 24 to 83 years old at the time of stroke. Two patients had family members with FPS deficiency. The types of stroke were variable, such as thrombotic infarction in 3 patients, lacunar infarction in 4 patients, and embolic infarction in one patient. Cerebral arterial stenosis was noted in 3 patients. Other associated risk factors of stroke were smoking, hypertension, pregnancy, low HDL cholesterol, sinus bradycardia, left ventricular hypertrophy on EKG, and old age. All patients had normal PT, APTT, and liver function test. CONCLUSIONS: FPS deficiency can be a risk factor for cerebral infarction in young patients as well as old patients. Free protein S (FPS) deficiency may increase risk of cerebral infarction in the presence of other risk factors of stroke but this requires confirmation by a large study in unselected patients.
Adult ; Aged, 80 and over ; Bradycardia ; Cerebral Angiography ; Cerebral Infarction* ; Cholesterol, HDL ; Constriction, Pathologic ; Electrocardiography ; Female ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Infarction ; Ischemic Attack, Transient ; Liver Function Tests ; Male ; Partial Thromboplastin Time ; Pregnancy ; Protein S Deficiency* ; Protein S* ; Risk Factors ; Smoke ; Smoking ; Stroke ; Stroke, Lacunar ; Venous Thrombosis

BACKGROUND: Postoperative triple H therapy is regarded as a mainstay for prophylaxis and treatment of delayed ischemic neurologic deficit (DIND) after subarachnoid hemorrhage (SAH). However, there are doubts about its effectiveness. This study was performed to assess hypervolemic dynamic fluid therapy in patients with ruptured cerebral aneurysms. METHODS: The authors retrospectively studied a total of 393 patients with ruptured cerebral aneurysms, consisting of early surgery with or without intraoperative ventriculostomy during a recent 5 year period (July 1998~June 2003). Hypervolemic dynamic fluid therapy was initiated postoperatively in patients with DIND. Since January 2001, however, patients were maintained in normovolemia and normotension, and when DIND had manifested, low molecular weight dextran was only added. The incidence of DIND and outcome according to Glasgow Outcome Scale at 6 months of the normovolemic group were compared with the hypervolemic group. All patients were followed for at least 14 days after the admission including clinical assessment, TCD recording, CT scanning, CVP measurements, and nimodipine infusion. RESULTS: Subjects in the two treatment groups were similar with regard to age, sex, Fisher grade, Hunt-Hess grade, aneurysm location, and aneurysm size. No differences were found between the two groups regarding the incidence of DIND (29/182: 15.9% vs 29/211: 13.7%). Surgical outcome in the normovolemic group (good, 171/211: 81.0%) was comparable to the hypervolemic group (good, 154/182: 84.6%). CONCLUSIONS: Although careful fluid management to avoid hypovolemia may reduce the risk of DIND after SAH, prophylactic hypervolemic dynamic fluid therapy is unlikely to confer an additional benefit.
Aneurysm ; Dextrans ; Fluid Therapy ; Glasgow Outcome Scale ; Humans ; Hypovolemia ; Incidence ; Intracranial Aneurysm* ; Molecular Weight ; Neurologic Manifestations ; Nimodipine ; Retrospective Studies ; Subarachnoid Hemorrhage ; Tomography, X-Ray Computed ; Ventriculostomy

BACKGROUND: Neocortical temporal lobe epilepsy (NTLE) appears to have different characteristics in clinical and electrophysiological aspects from mesial temporal lobe epilepsy (MTLE). Many semiological studies on TLE have been performed. We investigated ictal EEG patterns to differentiate NTLE from MTLE. METHODS: One hundred twenty nine scalp ictal EEG recordings came from 27 pathologically proven TLE patients were analyzed by 1) frequency of ictal discharge at EEG seizure onset (alpha, beta, theta & delta), 2) distribution patterns of ictal EEG onset (diffuse, lateralized & regionalized), 3) electrode of maximum amplitude at initial regionalized portion of ictal EEG, and 4) mesial to lateral and anterior to posterior amplitude ratio of ictal discharges in temporal electrodes. RESULTS: One hundred seven seizures came from MTLE (23 patients) and twenty-two seizures from NTLE (4 patients). Ictal EEG onset with delta wave was observed more frequently in MTLE (42.7%) than in NTLE (14.3%), but beta wave onset was noted more frequently in NTLE (14.3%) than MTLE (0%). Initial ictal EEG discharges were lateralized on ipsilateral hemisphere in 22.0% of MTLE and in 28.6% of NTLE, regionalized over ipsilateral temporal region in 36.6% and 23.8% respectively, and showed diffuse nonlateralized onset in 41.5% of MTLE and 47.6% of NTLE. Both TLE groups revealed most often their maximum negativity of ictal EEG onset at sphenoidal electrode (MTLE: 59.3%, NTLE: 42.8%). Mesial to lateral amplitude ratio of ictal EEG was significantly larger in MTLE group than NTLE group. The amplitude ratio of anterior to posterior temporal electrodes was greater in NTLE group than in MTLE group. CONCLUSION: Delta frequency of ictal onset EEG is more suggestive of MTLE while beta frequency may suggest NTLE. Initial ictal EEG patterns with their maximum on sphenoidal electrode do not differentiate MTLE from NTLE. NTLE has wide vertical and narrow horizontal electrical field, but MTLE has wide horizontal and narrow vertical electrical field.
Electrodes ; Electroencephalography* ; Epilepsy, Temporal Lobe* ; Humans ; Scalp ; Seizures ; Temporal Lobe*

It is well known that the mortality rate is very high in the patients with cerebrovascular disease (CVD). The most common cause of death in the ischemic CVD patients is myocardial infarction. The purpose of this study is to evaluate the diagnostic significance of myocardial perfusion SPECT for coronary artery disease (CAD) in ischemic CVD. We studied in 64 patients with transient ischemic attack and ischemic stroke diagnosed by means of the clinical history and brain CT and MRI. Electrocardiography, myocardial perfusion SPECT and coronary angiography were performed. We checked hypertension, diabetes, smoking, alcohol drinking and hyperlipidemia as the risk factors in ischemic CVD and CAD. The myocardial perfusion SPECT was abnormal in 37 out of 64 patients(57.8%) with ischemic CVD. There was a increasing tendency in the prevalence of myocardial perfusion abnormality in the elderly patients (more than 65 years old). The incidence of abnormal myocardial perfusion SPECT was not significantly different among TIA, lacunar infarction, minor infarction and major infarction. The long standing hypertension and hyperlipidemia were siginificant risk factors in the ischemic CVD and CAD as having the abnormal myocardial perfusion SPECT (p<0.05). There were not significantly different between resting EKG and myocardial perfusion SPECT results. Coronary artery stenosis was identified in 5 out of 7 patients receiving coronary arteriography. The results suggested that ischemic stroke is frequently associated with coronary artery disease. So myocardial perfusion SPECT as an active investigation for CAD in Ischemic CVD should be considered in order to optimal management.
Aged ; Alcohol Drinking ; Angiography ; Brain ; Cause of Death ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Diagnosis* ; Electrocardiography ; Humans ; Hyperlipidemias ; Hypertension ; Incidence ; Infarction ; Ischemic Attack, Transient ; Magnetic Resonance Imaging ; Mortality ; Myocardial Infarction ; Perfusion* ; Prevalence ; Risk Factors ; Smoke ; Smoking ; Stroke ; Stroke, Lacunar ; Tomography, Emission-Computed, Single-Photon*

No abstract available.

OBJECTIVE: The aim of this study is to evaluate the effects of intracranial-extracranial arterial bypass(EIAB) surgery on cerebrovascular reserve capacity(CRC) in patients with hemodynamic cerebral ischemia and to assess the significance of transcranial doppler(TCD) examination before and after EIAB surgery. METHODS: In 29 consecutive patients who underwent EIAB surgery due to symptomatic internal carotid artery or middle cerebral artery(MCA) occlusion, 21 patients were studied using preoperative and postoperative digital subtraction angiogram(DSA), SPECT, and TCD examination. After measuring mean radioactivity count of a region of interest, relative regional cerebral blood flow(rrCBF) was quantitated by the following formula: lesional radioactivity count/contralateral radioactivity count x 100%. CRC was calculated as the percentage change from baseline flow after a vasodilatory challenge. RESULTS: Postoperative DSA showed good collateral circulation through the bypass except 4 patients. Preoperative mean value of rCRC improved significantly after EIAB surgery from -14.8+/-2.6% to 6.9+/-2.7%(p<0.01). Intraoperatively, flow velocity of superficial temporal artery(STA) and MCA just after anastomoses increased remarkably in comparison with the values just before anastomoses(p<0.01). There was no correlation between the change of pre- and postoperative flow velocity and the change of rrCBF. In patients with the increase of flow velocity after surgery manifested good collateral circulation through the bypass. The difference was statistically significant(repeated measures ANOVA, p<0.05). Over a mean follow-up period of almost 3 years, no patient had another episode of brain ischemia. CONCLUSION: We believe that the measurement of flow velocity is expected a good method to evaluate the degree of collateral circulation through the bypass.
Brain Ischemia* ; Carotid Artery, Internal ; Collateral Circulation ; Follow-Up Studies ; Hemodynamics* ; Humans ; Radioactivity ; Tomography, Emission-Computed, Single-Photon

Sunitinib is a multi-targeted tyrosine-kinase inhibitor used for gastrointestinal stromal tumors and renal cell carcinoma (RCC). Several recent studies have reported sunitinib-induced hypothyroidism and thyroid dysfunction; however, the underlying mechanisms are not clear. Here, we report a patient with metastatic RCC, who developed destructive thyroidtis due to sunitinib treatment. The course followed in this case may be useful in understanding the clinical course of sunitinib-induced thyroiditis.
Carcinoma, Renal Cell ; Gastrointestinal Stromal Tumors ; Humans ; Hypothyroidism ; Indoles ; Pyrroles ; Thyroid Gland ; Thyroiditis

No abstract available.
Arterial Pressure* ; Aspirin ; Erythromelalgia* ; Thrombocytosis

Deep cerebral venous thrombosis is a rare condition associated with edema, infarction or hemorrhage in basal ganglia, thalamus and periventricular white matter. It presents nonspecific clinical manifestations such as altered consciousness, headache, focal neurological deficit, nausea and vomiting. Extrapyramidal signs are very rare in deep cerebral venous thrombosis. We report a patient who presented micrographia, hypophonia and bradykinesia as an early manifestation of deep cerebral venous thrombosis.
Basal Ganglia ; Consciousness ; Edema ; Headache ; Hemorrhage ; Humans ; Hypokinesia* ; Infarction ; Nausea ; Parkinsonian Disorders* ; Thalamus ; Venous Thrombosis* ; Vomiting