The pure motor variant of Guillain-Barre syndrome (PMGBS) has features of rapidly progressive, symmetric limb paralysis and areflexia, and lacks any sensory symptoms or signs. The PMGBS initially presenting with hemiparesis is very rare. We report a 59 year-old-male who presented with left-sided weakness 1 day prior to admission, and with right-sided weakness about 2 days following admission. In our case, clinical features and electrophysiological tests were consistent with an atypical PMGBS.
Extremities ; Guillain-Barre Syndrome* ; Paralysis ; Paresis*

We report a 72-year-old female patient with spontaneous rupture of the left external iliac vein. She visited our hospital for abdominal and back pain. She had the abnormal finding of hemoperitoneum. We performed an emergency operation with diagnosis of left ovarian cyst rupture though she suffered from spontaneous rupture of the left external iliac vein. This case provides insight to the experience of spontaneous rupture of the left external iliac vein.
Aged ; Back Pain ; Emergencies ; Female ; Hemoperitoneum ; Humans ; Iliac Vein ; Ovarian Cysts ; Rupture ; Rupture, Spontaneous

No abstract available.
Blinking ; Meningioma* ; Trigeminal Neuralgia*

Levosulpiride is one of the most frequently prescribed medicines in Korea. An adverse drug reaction (ADR) after taking levosulpiride was reported at a community pharmacy in Korea. A 31-year-old woman reported the symptoms of lactation and amenorrhea after taking levosulpiride; an evaluation of whether these symptoms were caused by the medication was therefore necessary. Several tools can be used to determine if the ADR resulted from the administered drug or other factors, including the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) criteria, the Naranjo scale, and the Korean causality assessment algorithm (Ver. 2). The causality was evaluated as “possible” by the WHO-UMC and Naranjo scales, but as “probable” by the Korean causality assessment algorithm (Ver. 2). In conclusion, the information provided did not indicate definite causality and there were slight differences in the results obtained from each assessment method.
Adult ; Amenorrhea ; Drug-Related Side Effects and Adverse Reactions ; Female ; Global Health ; Humans ; Hyperprolactinemia* ; Korea ; Lactation ; Methods ; Pharmacies* ; Weights and Measures

Changes of bone turnover with aging are responsible for bone loss and play a major role in osteoporosis. Among the early postmenopausal women, as are known by previous study, there are about 35% ""fast bone losers and bone turnover is more uncoupled in osteoporotic group than in normal control. So, early detection of such fast losers"" and women who have high turnover rate is important to prevent postmenopausal osteoporosis and spontaneous fracture. Dual-energy X-Ray absorptiometry (DEXA), however, cannot reflect current bone loss because changes in bone mineral density (BMD) are only seen after 1 or more years of bone densities declining. In this study, we have measured a battery of new sensitive and specific markers of bone turnover which reflect current bone loss. To investigate the changing pattern of those markers, 674 healthy women including 451 postmenopausal women were classified, according to their menopausal period (less than 5 years, 5-10 years, more than 10 years). Bone formation was assessed by serum osteocalcin (OC), bone-specific alkaline phosphatase (BSAP) and bone resorption by the urinary excretion of deoxypyridinoline (DPD), cross-linked N-telopeptide of type I collagen (NTX). All Biochemical markers, except OC, significantly increased after menopause (p < 0.05). NTX and BSAP remained elevated after 10 years of menopause. These data indicated that the overall rates of both bone formation and bone tesorption increased after menopause and remained high in elderly women.
Absorptiometry, Photon ; Aged ; Aging ; Alkaline Phosphatase ; Biomarkers ; Bone Density ; Bone Resorption ; Collagen Type I ; Female ; Fractures, Spontaneous ; Humans ; Menopause ; Osteocalcin ; Osteogenesis ; Osteoporosis ; Osteoporosis, Postmenopausal

PURPOSE: To evaluate the usefulness of fast magnetic resonance (MR) sequences combined with MR arterialportography in the preoperative assessment of hepatocellular carcinoma. MATERIALS AND METHODS: Twelve patients suffering from nodular hepatocellular carcinoma complicated by liver cirrhosis underwent T2-weighted turbo spinecho and T1-weighted multisection FLASH with and without fat-suppression MR imaging during single breath-holdsession in each sequence. MR arterial portography was performed with Gd-DTPA injected through a catheter into the superior mesenteric or splenic artery during the T1-weighted FLASH sequence. The pathologic findings of surgical specimen or follow-up lipiodol CT findings were compared with the MR imaging. RESULTS: MR arterial portography depicted 17 of the 19 masses (sensitivity, 89%) and the sensitivity of non-contrast fast MR sequences was 74%(14/19). The sensitivity for combined interpretation of all the above sequences was 89% (17/19). MR arterial portography showed perfusion defects from two cysts, one hemangioma, one inflammatory mass, and innumerable tiny regenerating nodules. Static T1-and T2-weighted imaging clearly differentiated, however, benign lesions and true hepatocellular carcinoma. CONCLUSION: MR arterial portography combined with other fast MR imaging allows tissue characterization as well as high detection rate in the evaluation of hepatocellular carcinoma complicated with cirrhosis.
Carcinoma, Hepatocellular ; Catheters ; Ethiodized Oil ; Follow-Up Studies ; Gadolinium DTPA ; Hemangioma ; Liver Cirrhosis ; Magnetic Resonance Imaging ; Perfusion ; Portography* ; Splenic Artery

Schizophrenia-like psychiatric symptoms in patients with MELAS are rarely reported. A 34-year-old male was admitted because of visual hallucinations, persecutory delusions and generalized seizure. He also presented with repeated headache, vomiting, and left homonymous hemianopsia. We report a 34-year-male with MELAS presenting psychiatric symptoms before the establishment of the diagnosis by gene analysis.
Adult ; Delusions ; Diagnosis ; Hallucinations ; Headache ; Hemianopsia ; Humans ; Male ; MELAS Syndrome* ; Schizophrenia ; Seizures ; Vomiting

Acute motor and sensory axonal neuropathy (AMSAN) are recently described subtypes of Guillain-Barre syndrome characterized by acute onset of distal weakness, loss of deep tendon reflexes, and sensory symptoms. A 21-yr-old male was transferred to our hospital due to respiration difficulties and progressive weakness. In laboratory findings, immunoglobulin M antibodies against hepatitis A were detected in blood and cerebrospinal fluid. The findings of motor nerve conduction studies showed markedly reduced amplitudes of compound muscle action potentials in bilateral peroneal, and posterior tibial nerves, without evidence of demyelination. Based on clinical features, laboratory findings, and electrophysiologic investigation, the patient was diagnosed the AMSAN following acute hepatitis A viral infection. The patient was treated with intravenous immunoglobulin and recovered slowly. Clinicians should consider this rare but a serious case of AMSAN following acute hepatitis A infection.
Acute Disease ; Electromyography ; Guillain-Barre Syndrome/*diagnosis/drug therapy/etiology ; Hepatitis A/complications/*diagnosis ; Humans ; Immunoglobulins, Intravenous/therapeutic use ; Male ; Young Adult

We found a case of hypoplasia of vertebral artery with fibromuscular dysplasia in an 82-yr-old Korean female cadaver during a routine dissection course. In the present case, intracranial hypoplasia in left vertebral artery and bilateral origin of posterior inferior cerebellar artery at the vertebrobasilar junction were recognized. Histopathologically, left vertebral artery showed intimal type of fibromuscular dysplasia both in its extracranial and intracranial courses. These results indicate that the association of fibromuscular dysplasia and hypoplasia does exist in the vertebral artery, although the etiologies are not verified yet.
Aged, 80 and over ; Female ; Fibromuscular Dysplasia/*pathology ; Heart Ventricles/abnormalities/*pathology ; Humans ; Republic of Korea ; Vertebral Artery/*pathology

Thunderclap headache refers to a sudden and severe headache that comes unexpectedly, reminding one of a clap of thunder. The initial description of this type of headache was in association with an unruptured intracranial aneurysm. It is known to be a presenting feature of subarachnoid hemorrhage, unruptured intracranial aneurysm, cerebral venous thrombosis, cervical artery dissection, spontaneous intracranial hypotension, pituitary apoplexy, retroclival hematoma, and hypertensive reversible posterior leukoencephalopathy. A formula for diagnostic assessment of thunderclap headache, such as brain computed tomographic scan and spinal tap, should be established. We experienced a case of cerebral infarction presented with thunderclap headache, diagnosed using diffusion weighted magnetic resonance imaging. We suggest that, even when these patients have shown non-specific findings on neurological examination, brain computed tomography, and cerebrospinal fluid analysis, diffusion MRI should be considered for differential diagnosis of thunderclap headache in emergency medical services.
Arteries ; Brain ; Cerebral Infarction ; Diagnosis, Differential ; Diffusion ; Diffusion Magnetic Resonance Imaging ; Emergency Medical Services ; Headache ; Headache Disorders, Primary ; Hematoma ; Humans ; Infarction, Middle Cerebral Artery ; Intracranial Aneurysm ; Intracranial Hypotension ; Leukoencephalopathies ; Magnetic Resonance Imaging ; Neurologic Examination ; Pituitary Apoplexy ; Spinal Puncture ; Subarachnoid Hemorrhage ; Venous Thrombosis