Controlled-release carbamazepine (CBZ) could be more harmful than the regular form in special situations due to their respective biochemical characteristics. When primary treatment is not effective in acute intoxication, extracorporeal treatment (ECTR) could be an option. We recently applied ECTR to a patient with combined intoxication of topiramate and controlled-release CBZ who deteriorated despite receiving primary treatment. The patient improved after administering ECTR. Early ECTR intervention may be beneficial for the treatment of CBZ intoxication, especially of the controlled-release form.
Carbamazepine* ; Extracorporeal Circulation ; Humans

No abstract available.
Brain Edema* ; Cerebral Infarction* ; Magnetic Resonance Imaging ; Seizures

Artemisia annua is a wormwood. Because it may induce Cytochrome P450 2C19 enzyme, Artemisia annua may have an influence on antiepileptic drugs which are substrates for the enzyme. This influence may negatively affect seizure control of epilepsy patient. We present a patient whose seizures were induced by Artemisia annua, despite he was taking levetiracetam which is not a substrate for the hepatic enzyme. Therefore there would be another mechanism of seizure induction of Artemisia annua besides hepatic metabolism.
Anticonvulsants ; Artemisia ; Artemisia annua* ; Cytochrome P-450 Enzyme System ; Epilepsy* ; Humans ; Metabolism ; Seizures*

PURPOSE: To investigate the value of image post-processing software (FreeSurfer, IBASPM [individual brain atlases using statistical parametric mapping software]) and inversion time (TI) in volumetric analyses of the hippocampus and to identify differences in comparison with manual tracing. MATERIALS AND METHODS: Brain images from 12 normal adults were acquired using magnetization prepared rapid acquisition gradient echo (MPRAGE) with a slice thickness of 1.3 mm and TI of 800, 900, 1000, and 1100 ms. Hippocampal volumes were measured using FreeSurfer, IBASPM and manual tracing. Statistical differences were examined using correlation analyses accounting for spatial interpretations percent volume overlap and percent volume difference. RESULTS: FreeSurfer revealed a maximum percent volume overlap and maximum percent volume difference at TI = 800 ms (77.1 +/- 2.9%) and TI = 1100 ms (13.1 +/- 2.1%), respectively. The respective values for IBASPM were TI = 1100 ms (55.3 +/- 9.1%) and TI = 800 ms (43.1 +/- 10.7%). FreeSurfer presented a higher correlation than IBASPM but it was not statistically significant. CONCLUSIONS: FreeSurfer performed better in volumetric determination than IBASPM. Given the subjective nature of manual tracing, automated image acquisition and analysis image is accurate and preferable.
Adult* ; Brain ; Hippocampus ; Humans

Amyloidosis is a systemic disorder associated with clonal plasma cell dyscrasia. Nephrotic syndrome, congestive heart failure, autonomic and peripheral neuropathy is often associated features in amyloidosis. Early diagnosis is most important because of different prognosis by stage. The diagnosis can be delayed since symptoms of amyloidosis may vary or nonspecific. We describe a patient of myeloma-associated amyloidosis, who showed orthostatic intolerance as the first symptom of the disease.
Amyloidosis* ; Diagnosis ; Early Diagnosis ; Heart Failure ; Humans ; Nephrotic Syndrome ; Orthostatic Intolerance* ; Paraproteinemias ; Peripheral Nervous System Diseases ; Prognosis

Objectives: White matter hyperintensities are known to influence dementia in Alzheimer’s disease. Genetic components are suggested as putative risk factors for vascular pathology and cognitive decline. This study aimed to determine whether there is an association between candidate genetic polymorphisms and the severity of white matter hyperintensities in patients with Alzheimer’s disease. Methods: Seventy-five patients diagnosed with Alzheimer’s disease underwent genetic tests for specific alleles of apolipoprotein E, angiotensin-converting enzyme, and methylenetetrahydrofolate reductase. All patients underwent brain magnetic resonance imaging scans and neuropsychological tests. The severity of white matter hyperintensities was semiquantified using the CREDOS rating scale, and patients were divided into three groups according to their rating. Results:The severity of white matter hyperintensities was related to age and hypertension. However, none of the gene polymorphisms we tested was found to be associated with the severity of white matter hyperintensities. Conclusion:The genetic polymorphisms found in apolipoprotein E, angiotensin-converting enzyme and methylenetetrahydrofolate reductase did not contribute to white matter hyperintensities in Alzheimer’s disease.Only age and hypertension factors were found to be contributory to white matter hyperintensities.
Alzheimer Disease ; Dementia

Torticollis is an usual symptom that can be the result of various disorders, such as sternocleidomastoid muscle pathology, bony abnormalities of the cervical spine, disorders of the central or peripheral nervous system, various ocular diseases, and brain tumors, especially in children. A 12-month-old male visited our hospital because of torticollis. He was normal on systemic examination, with no neurological abnormality, and his cervical spine CT was also normal. About 4 weeks later, he revisited the emergency department due to vomiting with altered mental status, and was diagnosed with a cerebellar tumor with hemorrhage. Although torticollis is known to be an important sign of a posterior fossa tumor, associated neurological or ocular symptoms are usually present. We report here a patient with posterior fossa tumor where torticollis was the only initial presenting symptom.

Torticollis is an usual symptom that can be the result of various disorders, such as sternocleidomastoid muscle pathology, bony abnormalities of the cervical spine, disorders of the central or peripheral nervous system, various ocular diseases, and brain tumors, especially in children. A 12-month-old male visited our hospital because of torticollis. He was normal on systemic examination, with no neurological abnormality, and his cervical spine CT was also normal. About 4 weeks later, he revisited the emergency department due to vomiting with altered mental status, and was diagnosed with a cerebellar tumor with hemorrhage. Although torticollis is known to be an important sign of a posterior fossa tumor, associated neurological or ocular symptoms are usually present. We report here a patient with posterior fossa tumor where torticollis was the only initial presenting symptom.
Nervous System Diseases ; Torticollis

Rheumatoid meningoencephalitis is a rare, but severe complication of rheumatoid arthritis (RA). A 64-year-old woman with the history of RA presented with abnormal behaviors and memory impairments since stopping methotrexate due to asymptomatic meningitis before 1 month. Brain MRI still demonstrated leptomeningeal enhancement in right fronto-temporal area, compared with the previous. Brain biopsy revealed multiple yellowish suppurative streaks in dura, and microscopically lymphoplasmic infiltrations and fibroid necrosis surrounded by granuloma. Soon after beginning treatment with corticosteroid and methotrexate, her symptoms improved.
Arthritis, Rheumatoid ; Biopsy ; Brain ; Female ; Granuloma ; Humans ; Leiomyoma ; Magnetic Resonance Imaging ; Memory ; Meningitis ; Meningoencephalitis* ; Methotrexate* ; Middle Aged ; Necrosis

OBJECTIVE: To evaluate the effects of the implementation of critical pathway (CP) in stroke patients treated at a single university hospital. METHODS: A retrospective medical review collected data from 497 patients who had suffered acute stroke in the rehabilitation center. Stroke outcomes were compared between before and after the implementation of CP based on factors including demographic factors, stroke characteristics, pre-existing medical conditions, medical complications, functional states, and length of stay (LOS). RESULTS: After the implementation of CP, the patients showed significantly higher stage for upper proximal (p=0.008) and lower extremity (p=0.001) on Brunnstrom stage and significantly lower scores for modified Rankin Scale (p=0.003) at transfer. For those with pre-existing medical conditions, there were significantly increased osteoarthritis (p=0.002) and valvular heart disease (p=0.011). Regarding medical complications during acute inpatient rehabilitation, there were significantly decreased shoulder pain (p=0.001) and dysphagia (p=0.017), and significantly increased gastrointestinal symptoms (p=0.001). Functional gain and efficiency of stroke patients during rehabilitation center hospitalization did not significantly change after implementation of CP. But, shorter LOS of total hospitalization, pre-rehabilitation center hospitalization, and rehabilitation center hospitalization were evident. CONCLUSION: After the implementation of CP, patients less often developed complications and displayed no changes in functional gain and efficiency. They had shorter LOS of total hospitalization, pre-rehabilitation center hospitalization and rehabilitation center hospitalization.
Critical Pathways* ; Deglutition Disorders ; Demography ; Heart Valve Diseases ; Hospitalization ; Humans ; Inpatients ; Length of Stay ; Lower Extremity ; Osteoarthritis ; Rehabilitation ; Rehabilitation Centers ; Retrospective Studies* ; Shoulder Pain ; Stroke*