Cerebrovascular disease is uncommon in patients with HIV, occurring in up to 1.9% of patients, 0.2% were presenting with transient ischemic attacks. The central nervous system is the first part of the body to be affected by the human immunodeficiency virus. This case report is a unique presentation of a 33-year-old male who presented with focal neurologic deficits that lasted for one hour with a background of promiscuous history. The patient was positive for HIV screening test and CD4 count and was started on a combination of antiretroviral therapy. This is the first documented case report in the Philippines. This case report demonstrates the need for a high index of suspicion for early detection of the cause in HIV-positive patients with recurrent transient ischemic attacks, given the high morbidity and mortality that is associated with this condition if delayed or undiagnosed.

We performed a revisionary open reduction and internal fixation for treating nonunion of the mid-shaft of the left clavicle with an autogenous cancellous bone graft. On postoperative day 4, the patient presented with neurologic deficits in the left upper extremity. We removed the implant and made a superior angulation to decompress the brachial plexus. At 6 months postoperatively, callus bridging and consolidation were visible and all hand and elbow functions were fully recovered. Our case suggests that brachial plexus neuropathy may be caused by stretching and compression after reduction and straightening of the nonunion site around adhesions or scar tissue. Therefore, care should be taken whether there are the risk factors that can cause brachial plexus neuropathy when revision surgery is performed for treating nonunion of a clavicle shaft fracture.
Bony Callus ; Brachial Plexus Neuropathies ; Brachial Plexus ; Cicatrix ; Clavicle ; Elbow ; Hand ; Humans ; Neurologic Manifestations ; Risk Factors ; Transplants ; Upper Extremity

PURPOSE: Respiratory syncytial virus (RSV) infection can cause various neurological complications. This study aimed to investigate the RSV-associated neurologic manifestations that present with seizures. METHODS: We retrospectively reviewed the medical records of patients aged less than 15 years with laboratory-confirmed RSV infections and seizures between January 2011 and December 2016 in a regional hospital in South Korea. RESULTS: During this period, 1,193 patients with laboratory-confirmed RSV infection were identified. Of these, 35 (35 of 1,193, 2.93%; boys, 19; girls, 16; mean age: 20.8±16.6 months) presented with seizure. Febrile seizure was the most common diagnosis (27 of 35, 77.1%); simple febrile seizures in 13 patients (13 of 27, 48.1%) and complex febrile seizures in 14 (14 of 27, 51.9%). Afebrile seizures without meningitis or encephalopathy were observed in 5 patients (5 of 35, 14.3%), seizures with meningitis in 2 (2 of 35, 5.7%), and seizure with encephalopathy in 1 (1 of 35, 2.9%) patient. Lower respiratory symptoms were not observed in 8 patients. In a patient with encephalopathy, brain diffusion-weighted magnetic resonance imaging revealed transient changes in white matter, suggesting cytotoxic edema as the mechanism underlying encephalopathy. Most patients recovered with general management, and progression to epilepsy was noted in only 1 patient. CONCLUSION: Although febrile seizures are the most common type of seizure associated with RSV infection, the proportion of patients with complex febrile seizures was higher than that of those with general febrile seizures. Transient cytotoxic edema may be a pathogenic mechanism in RSV-related encephalopathy with seizures.
Brain ; Brain Diseases ; Child ; Diagnosis ; Edema ; Epilepsy ; Female ; Humans ; Korea ; Magnetic Resonance Imaging ; Medical Records ; Meningitis ; Neurologic Manifestations ; Respiratory Syncytial Viruses ; Retrospective Studies ; Seizures ; Seizures, Febrile ; White Matter

PURPOSE: The prevalence of osteoporotic sacral fractures is increasing. Traditionally, conservative treatment is the 1st option, but it can increase the risk of comorbidity in the elderly. To reduce the complications and allow early mobility, iliosacral screw fixation with cement augmentation will be one of the treatment options for patients with osteoporotic sacral fractures. MATERIALS AND METHODS: This study reviewed 25 patients (30 cases) who had undergone percutaneous iliosacral screw fixation with cement augmentation for osteoporotic sacral fractures from July 2012 to December 2018 with a minimum follow up of six months. The clinical outcomes were assessed using the measures of pain (visual analogue scale [VAS] score), hospital stay and the date when weight-bearing started. All patients were evaluated radiologically for pull-out of screw, bone-union, and cement-leakage. RESULTS: Bone union was achieved in 30 cases (100%). The mean duration of the hospital stay was 24 days (4–66 days); weight-bearing was performed on an average nine days after surgery. The VAS scores immediately (3.16) and three months after surgery (2.63) were lower than that of the preoperative VAS score (8.3) (p<0.05). No cases of cement-leakage or neurologic symptoms were encountered. Two patients (6.7%) experienced a pulling-out of the screw, but bone-union was accomplished without any additional procedures. CONCLUSION: Percutaneous iliosacral fixation with cement augmentation will be an appropriate and safe surgical option for osteoporotic sacral fractures in the elderly in terms of early weight-bearing, pain reduction, and bone-union.
Aged ; Comorbidity ; Follow-Up Studies ; Humans ; Length of Stay ; Neurologic Manifestations ; Osteoporotic Fractures ; Prevalence ; Sacrum ; Weight-Bearing

Hemodialysis patients rarely experience neurologic symptoms related to their vascular accesses. However, occlusion of venous drainage induces extreme venous hypertension and in rare cases cause intracranial venous congestion. We report a patient with cerebral venous infarction resulting from reflux flow into the cranium induced by an arteriovenous jump graft to the internal jugular vein. Clinicians should take into account the possibility of neurologic deficit related to intracranial venous hypertension in hemodialysis patients.
Arteriovenous Fistula ; Drainage ; Humans ; Hyperemia ; Hypertension ; Infarction ; Jugular Veins ; Neurologic Manifestations ; Renal Dialysis ; Skull ; Transplants ; Veins

BACKGROUND: The accurate grading of chemotherapy-induced peripheral neuropathy (CIPN) represents an unsolved issue. This study evaluated usefulness of the reduced version of Total Neuropathy Score TNS (TNSr) and the correlation of this scale with various electrophysiological parameters. METHODS: Neuropathic symptoms and quality of life were assessed using the neuropathy symptom scale and the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group Neurotoxicity (FACT/GOG-NTX) scale. A detailed neurologic examination, nerve conduction study (NCS), and the current perception threshold (CPT) were also performed. The TNSr score was calculated by a single examiner. We divided the patients with small fiber neuropathy and large fiber neuropathy and compared each variable between groups. Also, we analyzed correlations of the TNSr score with various parameters (NCS data, CPT score, and neuropathy symptom scales). RESULTS: Of 30 recruited patients, 16 (53%) had large fiber neuropathy, and the other 14 (47%) had small fiber neuropathy. Patients with large fiber neuropathy had a lower sural sensory nerve action potential (SNAP) (p=0.000), lower peroneal compound muscle action potential (CMAP) (p=0.002), higher National Cancer Institute-Common Terminology Criteria for Adverse Events (NCI-CTCAE, NTC) sensory grade (p=0.029) and higher TNSr score (p=0.000). There were no differences in any domain of the FACT/G, neuropathy symptom scale, or FACT/GOG-NTX between the two groups. The TNSr score was most significantly correlated with the sural SNAP (p=0.000), NTC-sensory grade (p=0.000), neuropathy symptom scale (p=0.001), FACT/GOG-NTX score (p=0.009), and pin score (p=0.002). CONCLUSIONS: The TNSr score is correlated with sensory peripheral neurotoxicity and also present the symptom severity in CIPN.
Action Potentials ; Breast Neoplasms ; Breast ; Erythromelalgia ; Humans ; Neural Conduction ; Neurologic Examination ; Neurologic Manifestations ; Peripheral Nervous System Diseases ; Polyneuropathies ; Quality of Life

BACKGROUND: Rhabdomyolysis is a syndrome caused by injury to skeletal muscle and characterized by myalgia and swelling of the affected muscles. Peripheral nerve injury rarely occurs in patients with rhabdomyolysis. METHODS: We reviewed the medical records of 8 consecutive patients with peripheral neuropathies associated with rhabdomyolysis. We assessed the clinical characteristics and electrodiagnostic findings of eight patients. RESULTS: In seven patients, rhabdomyolysis occurred after prolonged immobilization. In one patient, blunt trauma was a cause of rhabdomyolysis. All patients presented with weakness and paresthesia in lower extremities and electrodiagnostic tests showed peripheral nerve injury suggesting sciatic neuropathy or lumbosacral plexopathy. Although rhabdomyolysis itself recovered completely in all patients, neurologic deficits from neuropathy recovered partially and slowly. CONCLUSIONS: Sciatic nerve or lumbosacral plexus was injured in all eight patients. Among the various causes of rhabdomyolysis, prolonged immobilization is associated with development of peripheral neuropathy.
Electrodiagnosis ; Humans ; Immobilization ; Lower Extremity ; Lumbosacral Plexus ; Medical Records ; Muscle, Skeletal ; Muscles ; Myalgia ; Neurologic Manifestations ; Paresthesia ; Peripheral Nerve Injuries ; Peripheral Nervous System Diseases ; Rhabdomyolysis ; Sciatic Nerve ; Sciatic Neuropathy

Adipsic hypernatremia is a rare disease where patients do not feel thirst even in the increased serum osmotic pressure and results in electrolyte imbalance, severely increased osmotic pressure and neurologic symptoms like nausea, vomiting, and seizures. We report a 12-year-old male patient who had underwent a trans-sphenoidal surgery for craniopharyngioma newly diagnosed with adipsic hypernatremia after having growth hormone replacement for growth hormone deficiency. The patient visited emergency room complaining of generalized weakness, tremor in both legs, and poor oral intake including water after starting growth hormone replacement therapy. Laboratory test revealed serum sodium 168 mmol/L and serum osmolality 329 mOsm/kg, despite the patient didn't feel any thirst at all. We treated him with scheduled water intake of 2.5 L a day with intranasal vasopressin. He admitted to Soonchunhyang University Gumi Hospital and Soonchunhyang University Seoul Hospital for 4 times during the following 8 months and serum sodium level and osmolality was controlled by scheduled water intake combined with intranasal vasopressin treatment. It is still unclear whether growth hormone replacement worked as a trigger of hypernatremia.
Child ; Craniopharyngioma ; Drinking ; Emergency Service, Hospital ; Growth Hormone ; Gyeongsangbuk-do ; Humans ; Hypernatremia ; Leg ; Male ; Nausea ; Neurologic Manifestations ; Osmolar Concentration ; Osmotic Pressure ; Rare Diseases ; Seizures ; Seoul ; Sodium ; Thirst ; Tremor ; Vasopressins ; Vomiting ; Water

With increasing sensitivity, availability, and use of magnetic resonance imaging (MRI) in the past three decades, there is also an increase in incidental abnormal findings. The most common findings of these incidental abnormalities are white matter lesions that are interpreted as demyelinating based on radiological criteria. MRI findings suggestive of multiple sclerosis (MS) in patients without typical MS symptoms and with normal neurologic findings are now defined as a radiologically isolated syndrome (RIS) which reported relatively low incidence, especially hard to find case report in Korea. The natural history and pathophysiologic processes of RIS remain largely unknown. The nature, prevalence, and long-term prognosis of RIS, as well as the role of disease-modifying therapy should be established in the future.
Demyelinating Diseases ; Humans ; Incidence ; Korea ; Magnetic Resonance Imaging ; Multiple Sclerosis ; Natural History ; Neurologic Manifestations ; Prevalence ; Prognosis ; White Matter

The syndrome of the trephined is a neurologic phenomenon that manifests as sudden decline in cognition, behavior, and sensorimotor function due to loss of intracranial domain. This scenario typically occurs in the setting of large craniectomy defects, resulting from trauma, infection, and/or oncologic extirpation. Cranioplasty has been shown to reverse these symptoms by normalizing cerebral hemodynamics and metabolism. However, successful reconstruction may be difficult in patients with complex and/or hostile calvarial defects. We present the case of a 48-year-old male with a large cranial bone defect, who failed autologous cranioplasty secondary to infection, and developed rapid neurologic deterioration leading to a near-vegetative state. Following debridement and antibiotic therapy, delayed cranioplasty was accomplished using a polyetheretherketone (PEEK) implant with free chimeric latissimus dorsi/serratus anterior myocutaneous flap transfer for vascularized resurfacing. Significant improvements in cognition and motor skill were noted in the early postoperative period. At 6-month follow-up, the patient had regained the ability to speak, ambulate and self-feed—correlating with evidence of cerebral/ventricular re-expansion on computed tomography. Based on our findings, we advocate delayed alloplastic implantation with total vascularized soft tissue coverage as a viable alternative for reconstructing extensive, hostile calvarial defects in patients with the syndrome of the trephined.
Cognition ; Craniocerebral Trauma ; Debridement ; Follow-Up Studies ; Free Tissue Flaps ; Hemodynamics ; Humans ; Male ; Metabolism ; Middle Aged ; Motor Skills ; Myocutaneous Flap ; Neurologic Manifestations ; Postoperative Period ; Reconstructive Surgical Procedures