Acute hemorrhagic encephalomyelitis (AHEM) is a severe form of encephalitis characterized by fulminant clinical course and presence of hemorrhagic necrosis of the white matter. Mycoplasma pneumoniae (M. pneumoniae) have severe central nervous syndrome complication with encephalitis as that most common pediatric manifestations, but have been extremely rare report with AHME. A 10-year-old boy was referred to emergency room because of drowsy mental status, weakness of left side extremities and truncal ataxia. His deep tendon reflexes were hyperactive, neck stiffness sign and Babinski sign were both positive. Motor power were decreased on the both left upper and lower extremities. The sequences of T2-weighted and gradient recalled echo (GRE) showed hyper-intense lesions on multifocal white natter areas with hemorrhagic signal. Cerebrospinal fluid (CSF) analysis showed the pleocytosis with neutrophil dominant. The results of deoxyribonucleic acid (DNA) test and culture of M. pneumoniae were reported negative in CSF, but immunoglobulin M (IgM) was positive in blood. He received intravenous high dose corticosteroid and macrolide. After discharge, his neurologic function gradually returned to normal including sitting and standing without support. We reported the previously healthy boy with M. pneumonia related AHEM. The early diagnosis with brain MRI and the aggressive immunosuppressive treatment may be beneficial for recovery.
Ataxia ; Brain ; Cerebrospinal Fluid ; Child ; DNA ; Early Diagnosis ; Emergency Service, Hospital ; Encephalitis ; Extremities ; Humans ; Immunoglobulin M ; Leukocytosis ; Leukoencephalitis, Acute Hemorrhagic* ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Mycoplasma pneumoniae* ; Mycoplasma* ; Neck ; Necrosis ; Neutrophils ; Pneumonia ; Pneumonia, Mycoplasma* ; Reflex, Babinski ; Reflex, Stretch ; White Matter

STUDY DESIGN: Case report. OBJECTIVES: We report the case of a long, solitary, rosary-shaped neurofibroma that was misdiagnosed as another disease due to the patient's surgical history involving repetitive procedures and its abnormal appearance. SUMMARY OF LITERATURE REVIEW: Neurofibroma is an intradural-extramedullary spinal tumor. It is generally not difficult to diagnose due to its frequent occurrence and specific magnetic resonance imaging (MRI) findings. However, to date, neurofibromatosis stigmata and long, solitary, rosary-shaped neurofibromas have rarely been reported. MATERIALS AND METHODS: A 60-year-old woman was admitted to our hospital due to persistent pain, despite previous surgery and repetitive procedures. On physical examination, vision loss, hearing loss, skin discoloration, or subcutaneous nodules were not observed. A neurologic examination revealed normal motor and sensory function and voiding sensation. No pathologic reflexes such as the Babinski sign were observed. Previous sequential MRIs revealed intradural lesions that progressed from the thoracic vertebra 11 to the lumbar vertebra 3. She had no signs of neurofibromatosis stigmata, and the neurologic examination was unremarkable. The initial diagnosis was based on serial MRIs, which revealed a parasite infestation, a spinal cord tumor (myxopapillary-type ependymoma with hemorrhage), arachnoiditis, and vascular malformations. Total mass excision was performed, and the final diagnosis was neurofibroma. RESULTS: There were no signs of a tumor remnants or local recurrence in a 1-year follow-up MRI study. CONCLUSIONS: Although intradural spinal tumors are very rare, their clinical features are nonspecific and resemble other degenerative spinal diseases, including spinal stenosis and disc herniation. These diseases may easily be overlooked by physicians.
Arachnoid ; Arachnoiditis ; Christianity ; Diagnosis ; Diagnostic Errors ; Ependymoma ; Female ; Follow-Up Studies ; Hearing Loss ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neurofibroma* ; Neurofibromatoses ; Neurologic Examination ; Parasites ; Physical Examination ; Recurrence ; Reflex ; Reflex, Babinski ; Sensation ; Skin ; Spinal Cord Neoplasms ; Spinal Diseases ; Spinal Stenosis ; Spine ; Vascular Malformations

We report a case of aortic dissection masquerading as acute ischemic stroke followed by intravenous thrombolysis. A 59-year-old man presented with dizziness. After examination, the patient had a seizure with bilateral Babinski signs. Soon after identifying multiple acute infarctions in both hemispheres on diffusion-weighted brain magnetic resonance (MR) imaging, tissue plasminogen activator (t-PA) was administered. Both common carotid arteries were invisible on MR angiography, and subsequent chest computed tomography revealed an aortic dissection. The emergency operation was delayed for 13 hours due to t-PA administration. The patient died of massive bleeding.
Angiography ; Brain ; Carotid Artery, Common ; Dizziness ; Emergencies ; Hemorrhage ; Humans ; Infarction ; Middle Aged ; Reflex, Babinski ; Seizures ; Stroke* ; Thorax ; Tissue Plasminogen Activator

Intracranial dural arteriovenous fistula (dAVF) usually results in various problems in the brain. But it can be presented as a myelopathy, which may make early diagnosis and management to be difficult. We recently experienced a case of cervical myelopathy caused by intracranial dAVF. A 60-year-old man presented with a 3-year history of gait disturbance due to a progressive weakness of both legs. Neurological examination revealed spastic paraparesis (grade IV) and Babinski sign on both sides. Magnetic resonance imaging showed serpentine vascular signal voids at C2-T1 on T2-weighted image with increased signal intensity and swelling of spinal cord at C1-C4. We performed a brain computed tomography angiography and found intracranial dAVF with multiple arteriovenous shunts. Venous drainages were noted at tentorial veins and cervical perimedullary veins. After Onyx embolization, the patient showed gradual improvement in motor power and gait disturbance. The venous drainage pattern is a well-known prognostic factor of dAVF. In our case, the intracranial dAVF drained to spinal perimedullary vein, which seemed to result in the ischemic myelopathy. Although it is rare condition, it sometimes can cause serious complications. Therefore, we should keep in mind the possibility of intracranial dAVF when a patient presents myelopathy.
Angiography ; Arteriovenous Fistula ; Brain ; Central Nervous System Vascular Malformations* ; Drainage ; Early Diagnosis ; Gait ; Humans ; Ischemia ; Leg ; Magnetic Resonance Imaging ; Middle Aged ; Neurologic Examination ; Paraparesis, Spastic ; Reflex, Babinski ; Spinal Cord ; Spinal Cord Diseases* ; Spinal Cord Ischemia ; Veins

A 50-year-old man with liver cirrhosis and esophageal varix for 3 years was diagnosed with hematemesis and treated for a bleeding varix. However, bleeding recurred 11 days later, and he developed drowsiness with left hemiparesis. His left upper and lower extremity muscle strengths based on the manual muscle test at the onset were grade 2/5 and 1/5, respectively. The Babinski sign was positive. His serum ammonia level was elevated to 129.9 microg/dL (normal, 20-80 microg/dL). Magnetic resonance imaging revealed restriction on diffusion and T2-hyperintensities with decreased apparent diffusion coefficient values in the bilateral frontoparietooccipital cortex. The effect was more severe in the right hemisphere and right parietooccipital cortices, which were compatible with hepatic encephalopathy. Although the patient's mental status recovered, significant left-sided weakness and sensory deficit persisted even after 6 months. Diffusion tensor tractography (DTT) performed 3 months post-onset showed decreased volume of the right corticospinal tract. We reported a patient with hepatic encephalopathy involving the corticospinal tract by DTT.
Ammonia ; Diffusion Tensor Imaging ; Diffusion* ; Esophageal and Gastric Varices ; Hematemesis ; Hemorrhage ; Hepatic Encephalopathy* ; Humans ; Liver Cirrhosis ; Lower Extremity ; Magnetic Resonance Imaging ; Middle Aged ; Muscle Strength ; Paresis ; Pyramidal Tracts* ; Reflex, Babinski ; Rehabilitation ; Sleep Stages ; Varicose Veins

We describe a rare case of cerebral venous thrombosis and liver infarction with HELLP syndrome in a 25-year-old woman with eclampsia. She had complained of epigastric pain and had visited a local hospital for treatment. Also, signs of fetal distress were presented. After an emergency cesarean section, generalized tonic-clonic seizure occurred twice at a 10-minute interval. The patients was transferred to our emergency room, and the neurologic examination at that time, revealed a deep drowsy mentality and positive Babinski's sign; the deep tendon reflex was two positive. The laboratory findings revealed thrombocytopenia, an elevated liver function test, abnormal coagulation profiles. A bilateral ischemic change with left basal ganglia hemorrhage was seen on brain CT, and multiple foci of ill defined low-density lesions, mainly in the subcapsular portion of the liver and perivascular space, were visible on the abdominal CT. There was a faint showing of the deep venous system on the angiogram of both carotid arteries and a cerebral venous thrombosis was confirmed by using 4-vessel angiography. During the following 2 days, the cerebral hemorrhage and the low-density lesion were resolved through applications of heparin, and the patient returned to a nearly alert mental status. Finally she died of a hemorrhagic shock as a complication of disseminated intravascular coagulation.
Adult ; Angiography ; Basal Ganglia Hemorrhage ; Brain ; Carotid Arteries ; Cerebral Hemorrhage ; Cesarean Section ; Disseminated Intravascular Coagulation ; Eclampsia ; Emergencies ; Emergency Service, Hospital ; Female ; Fetal Distress ; HELLP Syndrome* ; Heparin ; Humans ; Infarction* ; Intracranial Thrombosis ; Liver Function Tests ; Liver* ; Neurologic Examination ; Pregnancy ; Reflex, Babinski ; Reflex, Stretch ; Seizures ; Shock, Hemorrhagic ; Thrombocytopenia ; Tomography, X-Ray Computed ; Venous Thrombosis*

No abstract available.
Guillain-Barre Syndrome* ; Ophthalmoplegia* ; Reflex, Babinski*

BACKGROUND: Small subcortical infarctions of basal ganglia can be divided into either lacunes or striatocapsular infarctions by size of lesion. However, there are some controversies concerning the size criteria of lacune and striatocapsular infarction. To better understand differences among these patients, we elucidated clinical and other properties of deep small basal ganglia infarctions (DSBIs), which could not be clearly classified as either lacunes or striatocapsular infarction by their sizes only. METHODS: We analyzed 27 patients with acute ischemic lesion of basal ganglia with which the size varying from 1.5 cm to 3 cm in their maximal diameters. We assessed clinical features, laboratory data, stroke risk factors, and radiologic findings such as MRI and MR angiography. RESULTS: These patients could be largely divided into two distinct groups, either with or without associated cortical symptoms and signs. The most common clinical feature was motor weakness that was found in all but one patient. Sensory disturbances, altered deep tendon reflexes, and positive Babinski signs were also commonly found. Ten of the 27 patients showed cortical manifestations such as eyeball deviation, visual field defect, aphasia and neglect. Eight of the 10 patients with cortical manifestations showed MCA or ICA stenotic lesions. CONCLUSIONS: We found that many patients with 1.5 cm to 3 cm sized DSBIs could have the features of either lacune or striatocapsular infarction. Careful evaluation of clinical and radiologic findings should be performed in patients with clinically appearing lacunar syndrome in order to differentiate lacunar infarction of small vessel disease from striatocapsular infarction of other various pathophysiologies. Echocardiogram, cerebral angiogram and perfusion and diffusion MRI could be recommended for further evaluation and to better understand the pathogenesis in these patients.
Angiography ; Aphasia ; Basal Ganglia* ; Cerebral Infarction ; Diffusion Magnetic Resonance Imaging ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Perfusion ; Reflex, Babinski ; Reflex, Stretch ; Risk Factors ; Stroke ; Stroke, Lacunar ; Visual Fields

We report the case of a 58-year-old man who developed multiple cerebral infarctions after ingesting accidently a 5% hydrogen-peroxide detergent solution. A 3~5% hydrogen peroxide solution is commercially available as an oxidant and detergent. Neurologic examination of this patient revealed grade III weakeness in both upper and lower limbs and bilateral positive Babinski signs. CT and MRI revealed bilateral multiple brain infarctions in the anterior and the middle vascular territories. The likely mechanism of pathogenesis must be paradoxical cerebral air embolism. Decompression through Nasogastric tube and hyperbaric oxygenation therapy were used to treating this patient. In spite of our intensive care, the patient expired 21days after ICU admission.
Brain Infarction ; Cerebral Infarction ; Decompression ; Detergents ; Eating* ; Embolism, Air* ; Humans ; Hydrogen Peroxide* ; Hydrogen* ; Hyperbaric Oxygenation ; Critical Care ; Lower Extremity ; Magnetic Resonance Imaging ; Middle Aged ; Neurologic Examination ; Reflex, Babinski

A Foville syndrome is rare. A 46-year-old man with a 3-year history of Behcet's disease presented with a right facial palsy and a limitation in the rightward movements of the eyes. On neurologic examination, there was no movement of eyes in the right hemifield during all kinds of eye movements, including saccade, smooth pursuit, vestibulo-ocular reflex, and optokinetic nystagmus. However, all the eye movements were normal in the left hemifiled except for slowed saccades toward the right. Additional features were right infranuclear facial paresis and extensor plantar response on left side. Brain MRI revealed high signal intensity lesions in the right pons both in the dorsal tegmentum and in the basis. Neurological signs resolved gradually with steroid treatment. Different clinical features between abducens nucleus syndrome and paramedian pontine reticular formation syndrome are briefly discussed. To the authors' knowledge, this is the first case report of a Foville syndrome caused by neuro-Behcet's disease.
Brain ; Brain Stem Infarctions* ; Eye Movements ; Facial Paralysis ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neurologic Examination ; Nystagmus, Optokinetic ; Pons ; Pursuit, Smooth ; Reflex, Babinski ; Reflex, Vestibulo-Ocular ; Reticular Formation ; Saccades