Elsberg syndrome is a rare disease of lumbosacral myeloradiculitis, mostly caused by herpes simplex virus type 2 (HSV-2). It frequently has concomitant myelitis, and immunocompromised patients can be fatal with ascending myelitis. Since anti-viral agents might lead to good recovery, clinicians need to be suspicious for conditions of cauda equina syndrome. Detection of viral DNA from cerebrospinal fluid ensures the diagnosis. We report a case of Elsberg syndrome caused by HSV-2 and are to delineate the clinical and radiologic spectrum.

PURPOSE: Most of studies dealing with abfractions are limited to the buccal surfaces of the teeth. In this study, we analyzed the cause for abfraction by investigating the incidence of palatal side abfractions in maxillary posterior teeth. MATERIALS AND METHODS: We investigated a total of 3193 maxillary posterior teeth by an intraoral examination, model observation, and observation of virtual model fabricated using model scanning. We recorded the results and classified them depending on the type of teeth, age, gender, and side of arches. We also performed Chi-square test to evaluate the statistical significance among the groups (α = 0.05). RESULTS: The incidence of palatal side abfraction of the maxillary molars (10.8%) was higher than the premolars (6.8%), and among them, the incidence of the 1st molars (39.1%) were the highest. The incidence of palatal side abfraction increased with age and was statistically significant (P < 0.05). There was no statistical significance in the difference by gender (P > 0.05); in the case of arches, left arch showed higher incidence and it was statistically significant (P < 0.05). CONCLUSION Palatal side abfraction in maxillary posterior teeth was frequently observed in the maxillary 1st molars, and the incidence increased with age. This result suggests that the main reason for abfraction is due to occlusal force.

Background: Early neurological deterioration is a critical determinant of functional outcome in patients with acute minor ischemic stroke. This study aimed to identify clinical predictors of early neurological deterioration in patients with acute minor ischemic stroke. Methods: A total of 739 patients who experienced acute minor ischemic stroke symptoms between January 2014 and December 2018 were enrolled in this study. All patients were presented within a 4.5-hour time window of stroke symptom onset. Early neurological deterioration was defined as an increment of at least one point in motor power or total National Institute of Health Stroke Scale (NIHSS) score deterioration ≥ 2 points within 3 days after admission. Unfavorable functional outcome was defined as a modified Rankin Scale score of ≥ 2 at 90 days after stroke onset. Demographic characteristics, risk factors for vascular diseases, stroke severity, stroke subtypes, and neuroimaging parameters were analyzed. Regression analysis was used to determine clinical predictors of early neurological deterioration. Results: Of the 739 patients, 78 (10.5%) patients had early neurological deterioration. Among the 78 patients with early neurological deterioration, 61 (78.2%) had unfavorable functional outcome at 90 days after stroke onset. In contrast, 131 of the remaining 661 (19.8%) patients without early neurological deterioration had unfavorable functional outcome. Multivariate analysis identified hemorrhagic transformation (odds ratio, 3.8; 95% confidence interval, 1.4-10.5; P = 0.010), higher NIHSS score at admission (odds ratio, 1.4; 95% confidence interval, 1.1-1.7; P = 0.003), arterial stenosis (odds ratio, 2.0; 95% confidence interval, 1.2-3.5; P = 0.014) and occlusion (odds ratio, 2.6; 95% confidence interval, 1.4-4.8; P = 0.004) in the territory of stroke as significant predictors of early neurological deterioration. Conclusions: The results of this study suggest that hemorrhagic transformation, higher NIHSS score at admission, and arterial steno-occlusive lesions in the territory of stroke are independent predictors of early neurological deterioration in patients with acute minor ischemic stroke.