Showing papers in "Journal of the Korean neurological association in 2003"

Neuroprotective Effect of Genistein Against beta Amyloid-Induced Neurotoxicity

Abstract: Background : Estrogen is beneficial to patients with Alzheimer's disease but has a limited clinical use due to its proliferative and oncogenic effects on non-neuronal estrogen responsive cells. Methods : In an attempt to find an estrogen substitute that retains the beneficial effects of estrogen with minimal side effects, we compared the neuroprotective and proliferative effects of genistein, a selective estrogen receptor agonist, with those of estrogen. Results : Genistein and 17 -estradiol showed comparable levels of protection against A-induced death of cultured SH-SY5Y human neuroblastoma cells, which was blocked by an estrogen receptor antagonist, ICI 182,780. On the other hand, 17 -estradiol, but not geninstein, induced proliferation of uterine endometrial cells. Conclusions : Our results suggest genistein as a potential alternative to estrogen in the treatment of Alzheimer's disease.

EEG Coherence in Alzheimer's Disease

Abstract: Background : EEG coherence can be used to evaluate the functional cortical connections and to get information about the synchronization of the regional cortical activity. We studied EEG coherence in patients affected by clinically probable Alzheimer’s disease (AD) in order to quantify the modifications in the cortico-cortical or cortico-subcortical connections. Methods : The EEGs were recorded in 62 AD patients and in 30 normal age-matched subjects from 16 electrodes with linked-ears reference. Spectral parameters and coherence were calculated by a multichannel autoregres sive model using 20 artifact-free 2-sec epoch in normal controls and AD patients. Results : In AD patients, alpha coher ence in frontal field and theta, alpha interhemispheric coherence was significantly decreased, whereas alpha, beta coher ence in posterior field was significantly increased. Some electrodes in the anterior field showed significant negative cor relation with MMSE, whereas other electrodes in the posterior field showed significant positive correlation with MMSE. Conclusions : This study suggests that coherence is a useful tool for understanding electrophysiologic change of AD and for correlating with the severity of cognitive dysfunction. And these coherence changes can be interpreted as the effects of neuronal loss and neocortical disconnection. J Korean Neurol Assoc 21(2):163~168, 2003

The validity and reliability of the Korean Modified Mini-Mental State (K-3MS) Examination

Abstract: Background: The Folstein Mini-Mental State Examination (MMSE) is a well-established and reliable cognitive screening instrument. However, recent investigations have reported limitations in the MMSE as a cognitive screening tool. The Modified Mini-Mental State Examination (3MS) taps a broader range of cognitive abilities by including evaluations of semantic fluency, delayed memory, remote personal information, and abstraction as well as those areas included in the MMSE. We report age- and education-specific reference values of the Korean Modified Mini-Mental State (K-3MS) Examination and the MMSE in the non-demented elderly population. We also evaluate the validity and reliability of the K-3MS for cognitive screening. Methods: The K-3MS and the MMSE were administered to 112 dementia patients and 99 controls, aged 5090 years old. K-WAIS, K-DRS, CDR were done with K-3MS in dementia patients. Test-retest reliability coefficients were obtained from 50 patients. NINCDS-ADRDA criteria for probable AD and NINDS-AIREN criteria for VaD were used. Results: The K-3MS correlated with the MMSE (r=0.94, p

Sleep Disorders In Maintenance Dialysis Patients with End-Stage Renal Disease

Abstract: Background: Patients with end-stage renal diseases (ESRD) have an increased risk of sleep problems such as daytime sleepiness, insomnia, restless legs syndrome (RLS), and obstructive sleep apnea syndrome (OSAS). However, presently there is limited data available, particularly in Asia. Methods: To investigate the prevalence of sleep complaints in ESRD patients, 100 patients at the maintenance hemodialysis (HD) and 100 patients at the continuous ambulatory peritoneal dialysis (CAPD) were surveyed using a specific questionnaire. Results: Patients had a mean age of 50.5814.03 years, with a mean body mass index (BMI) of 21.83.5 kg/. The mean duration of dialysis was 44.56 49.74 months. Fifty-six percent of the dialysis patients were poor sleepers. Daytime sleepiness occurred in 24% to 34% of the patients, and insomnia occurred in 35% of the patients, while restless legs syndrome was reported in 44% of the patients. The higher BMI group had a lower risk for insomnia when compared to the lower BMI group (OR=0.11, 95% CI=0.03-0.46). The OR of depression for insomnia was 2.8 (95% CI=1.02-7.69). There was no difference in the prevalence of sleep disturbances between the HD and CAPD patients groups. Conclusions : Complaints of sleep disturbance and daytime somnolence are very common in dialysis patients and likely contribute to the impaired quality of life experienced by many of these patients. Identifying and treating the sleep complaints in dialysis patients could contribute significantly to their quality of life and avoid potential side effects of nonspecific sedatives.

Prevalence of Parkinsonism in Ansan-city

Abstract: Background : The prevalence of neurodegenerative disorders are not well documented in Korea. We assessed the prevalence of Parkinsonism in an elderly population in Ansan-city, which is a newly industrialized community with rural origins. Methods : Randomly selected individuals were selected from a larger Ansan Cohort Study for this study. The sample in the Ansan cohort represented approximately 1.3% (4,700) of 362,625 adults (age>18) in the city registery in 1998. Among this group, 4,218 subjects (1,086 subjects, age>60) agreed to be interviewed and receive physical examination and neuropsychological tests by a neurologist and neuropsychologist. All participants including those who either had bradykinesia and at least one another possible cardinal sign of Parkinsonism at the neurologic screening, those who reported that they had PD, or those who were taking antiparkinsonian drugs were examined. Results : In our study, 16 subjects showed parkinsonism. The prevalence of Parkinsonism in this population was 0.37%. Prevalence increased with age, and the prevalence figures were 1.47% for those aged 60 years and older. Postural instability and gait disturbance type was more common in older age group. The results of the neuropsychological tests were as followings; (1) only 2 subjects showed low scores (

Toxocariasis: An Unusual Cause of Cerebral Infarction

Abstract: Human toxocariasis is a zoonotic parasitic disease caused by Toxocara canis or Toxocara cati larvae. Human infection is usually an outcome of accidental ingestion of the embryonated eggs, and the involvement of central nervous system is rare. We report a case of cerebral infarction which was caused by toxocariasis in adult, who had headache, abdominal pain and right side weakness. He had only a history of ingestion of raw liver of deer.

Human Neural Stem Cells Transplantation in Experimental Intracerebral Hemorrhage

Abstract: B a c k g r o u n d : Intracerebral hemorrhage (ICH) is associated with a considerable proportion of stroke and head injuries, but except for supportive care, there is no medical therapy available. Transplantation of human neural stem cells (NSCs) can be used to reduce behavioral deficit in experimental ischemic infarct model. However, effect of stem cell transplantation in experimental intracerebral hemorrhage (ICH) is unknown. We hypothesized that NSCs could migrate and differentiate into neurons or glial cells, and improve functional outcome in ICH. Methods : Experimental ICH was made by intrastriatal administration of bacterial collagenase in adult rats. Animals were randomized to receive intravenously either immortalized Lac-Z positive human NSCs (5×1 0 6 in 500μ L, n=15) or same volume of saline (n=12) on the following day. Animals were evaluated for 8 weeks after surgery with behavioral test battery. After 8 weeks, animals were sacrificed and the brains were sectioned. Transplanted NSCs were detected by X-gal histochem istry or β -gal immunohistochemistry, and differentiation of grafted NSCs were evaluated by double labeling of GFAP, NeuN, or neurofilament. Results : Transplanted NSCs migrated to the side of peri-hematomal areas, and differentiated into neurons and astrocytes. NSCs injection group showed improved performances on rotarod test after 2 weeks and on limb placing test after 5 weeks compared with control group (p<0.05) and these effect persisted up to 8 weeks. Conclusions : Intravenously injected NSCs enter rat brain with ICH, and differentiate into astrocytes or neuronal cell, which lead to functional recovery. These findings show the possibility that NSCs can be used to reduce neurological deficits in the experimental ICH. J Korean Neurol Assoc 21(2):183~190, 2003

The Reliability and Validity of The Migraine-Specific Quality of Life Questionnaire for Korean Migraine Suffers

Abstract: Background: Recurrent, often unpredictable, migraine attacks significantly interfere with daily functioning and productivity of patients with migraine. Quality of life measurement represents an important tool for evaluating migraine therapy and judging the impact of headache either on individuals or on society. The objective of this study was to test the reliability and validity of the translated version of MSQoL (Migraine-Specific Quality of Life) in Korean migraine patients. Methods: Participants, migraineurs from the Samsung Medical Center Migraine Clinic, were screened using the International Headache Society migraine criteria prior to enrollment through direct interview. This survey included the MSQoL, MIDAS (Migraine Disability assessment) and STAI (State-Trait Anxiety Inventory). Results: Sixty-five migraineurs were recruited. For the MSQoL, Cronbach's alpha was 0.93. Frequency and number of accompanying symptoms were predictive of the MSQoL. The negative correlation between the MSQoL scores and the MIDAS score was seen (r=-0.585, p

MTHFR A1298C Gene Polymorphism: Independent Risk Factor for Ischemic Stroke?

Abstract: Background: A genetic aberration in the MTHFR gene has been shown to result in reduced MTHFR enzyme activity and induced hyperhomocysteinemia Recently, a second genetic polymorphism in MTHFR at position 1298 was reported However, the association between the A1298C MTHFR polymorphism and ischemic stroke has not been reported Therefore, we attempted to determine whether the MTHFR C677T and A1298C gene polymorphisms were associated with ischemic stroke Methods: We enrolled 220 ischemic stroke patients and 203 healthy individuals and compared their fasting plasma homocysteine levels and analyzed the MTHFR C677T and A1298C polymorphisms Results: Plasma homocysteine levels were significantly higher (p 507 /L) than in control subjects (939298 /L) Despite a clear association between 677TT genotype and elevated homocysteine level, there was no association between MTHFR C677T polymorphism and ischemic stroke On the other hand, the odds ratio and 95% CI adjusted for other risk factors were 180 (108 to 300) for the 1298AC genotype, and 898 (100 to 8042) for the 1298CC genotype The adjusted odds ratio (AOR) for the 1298AC/CC genotypes were also significantly higher than that in the controls (AOR, 196; 95% CI, 119 to 324) However, in the analysis of combined genotypes with C677T and A1298C polymorphism, the AOR was not statistically significant Conclusions: MTHFR A1298C gene polymorphism may be an independent risk factor for ischemic stroke Our findings suggest that prediction of ischemic stroke may be possible by analyzing genetic defects

Relationships of Apolipoprotein E Genotypes with Vascular Risk Factors in Patients with Alzheimer's Disease

Abstract: ‡ Background : Apolipoprotein E-epsilon4 (APOE-e 4) is a known genetic risk factor for Alzheimer' s disease (AD), but its relationship with vascular risk factors is still controversial. Methods : We retrospectively studied 56 probable AD patients diagnosed by the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer' s Disease and Related Disorder' s Association (NINCDS-ADRDA) criteria. Results : The frequencies of APOE-e 2, 3, and 4 were 6.3%, 69.6%, and 24.1% in patients with AD. Compared to the no APOE-e 4 group (n=35), the APOE-e 4 group (n=21) revealed a higher frequency of male gender with no difference in age, educational level, dementia onset age, severity of dementia (CDR and K-MMSE), the frequencies of vascular risk factors (hypertension, diabetes, hypercholesterolemia), and total cholesterol level. High density lipoprotein (HDL)-cholesterol level was 36± 8 in the APOE-e 4 group and 43±11 in the no APOE-e 4 group with statistical significance (Student' s t-test, p=0.02). In adjusting for sex, the APOE-e 4 group still had a significantly lower HDL-cholesterol level than the no APOE-e 4 group (p=0.047). Conclusions : These results suggest that there may be the genetic influence of APOE- e 4 on serum HDL- cholesterol metabolism in AD patients. J Korean Neurol Assoc 21(1):41~45, 2003

Intravenous rt-PA Fibrinolytic Therapy in Acute Carotid Territory Ischemic Stroke with Severe Neurologic Deficits : The Implication of Arterial Recanalization for Stroke Outcome

Abstract: Background : Our previous pilot study demonstrated that intravenous recombinant tissue plasminogen activator(rtPA) fibrinolytic therapy was effective in treatment of effects of acute ischemic stroke within 3 hours of onset. We stud ied whether rt-PA was effective and safe in patients with acute carotid artery territory ischemic stroke with severe neu rologic deficits (National Institute of Health Stroke Scale (NIHSS) score >14 points) and whether arterial recanalization after rt-PA infusion influenced the initial neurologic improvements within 24 hours and the stroke outcome at 3 months. Methods : Twenty eligible patients had pre- and post-treatment computed tomogram and pre-treatment magnetic reso nance angiogram. Fourteen patients had post-treatment magnetic resonance angiogram at 24 hours after stroke onset. Endpoints examined included initial neurological improvement at 2 and 24 hours by NIHSS and clinical stroke outcome at 3 months by a modified Rankin scale and the effect of recanalizatio n on initial improvement and stroke outcome. Results : Out of 20 patients, 9 patients (45%) showed initial improvement at 2 hours and 10 patients (50%) at 24 hours. Five patients (25%) had intracranial hemorrhages (symptomatic; 2). Twelve patients (60%) showed good clinical stroke outcome at 3 months. Complete or partial recanalization was observed in 11 patients (55%) at 24 hours after stroke onset. Recanalization correlated with good initial improvement and stroke outcome (p<0.05 and <0.05). Conclusions : Recanalization may have an association with good clinical outcome after rt-PA infusion within 3 hours of stroke onset in patients with acute carotid artery territory stroke with severe neurologic deficits.

The Relationship between the Degree of Activity of Daily Living and Clinical Features in Alzheimer's Disease

Abstract: Background: The limitation of activities of daily living (ADL) is a critical problem in dementia patients in addition to cognitive dysfunction. In spite of many previous studies about the relationship between cognitive dysfunction, ADL and the nature of functional changes, there have not been any clear explanations about the liaisons between them due to various results form the diversity of objects and methods. The purpose of this study is to evaluate the relationship between ADL and clinical features in patients with Alzheimer's disease. Methods: One hundred thirty-four patients with Alzheimer's disease were enrolled to participate in the study. The physical activity of daily living (P-ADL) and the Korean instrumental activity of daily living (K-IADL) were evaluated in the patients. In addition, all subjects were tested by a Korean version of the expanded clinical dementia rating scale (CDR), and a Korean version of the mini-mental state examination (K-MMSE) and a Korean version of the neuropsychiatric inventory (NPI). Results: ADL was significantly correlated with cognitive functioning (r>-0.75, p0.72, p

Basic Electrophysiology of the Electroencephalography

Abstract: Although neuroimaging techniques and other diagnostic procedures has been developed, electroencephalography (EEG) is still very important for the evaluation of various brain diseases and functional studies of human brain. EEG is formed mainly by spatial and temporal summations of postsynaptic potentials generated from a large population of pyramidal cells that can be considered as a collection of oscillating dipoles. EEG shows continuous rhythmic oscillation depending on sleep-waking state. Alpha rhythms are generated in cortical areas acting as epicenters with local spread, although the precise cellular mechanism is still unknown. It’ been known that neurons in the nucleus reticular thalami are the pacemakers of sleep spindle. Alterations in the circuit of the reticular nuclei-thalamocortical relay neuron-cortical neuron are responsible for generalized spike and wave complexes. At the intracellular level, large paroxysmal depolarizing shifts produce focal epileptic spikes. Slow waves of EEG appear to be related to thalamocortical and/or corticothalamic deafferentation. The interpretation of routine EEG requires a well training from a qualified EEG teacher and reading adequate amount of EEG under supervision. Frequent misinterpretations of routine EEG have been observed in both local clinics and general hospitals. The most common findings of normal routine EEG misinterpreted as abnormal are normal variants and artifacts of various sources. There are considerable variations of normal EEG rhythms and pseudoepileptiform discharges. Eyeball movements produce prominent or subtle EEG changes over the frontal regions that are sometimes hard to be differentiated from abnormal slow waves over that region. Systematic approach was described for a good interpretation of routine EEG.

Volume Changes of Frontal Lobe and Hippocampus in Juvenile Myoclonic Epilepsy

Abstract: Background : In order to investigate the structural abnormalities in juvenile myoclonic epilepsy (JME), the volumes of the hippocampus and frontal lobe were measured. Methods : Nineteen JME patients and 19 age- and sex-matched normal controls underwent a 1.6 mm thick brain SPGR MRI. The volumes of the frontal lobe and hippocampus were measured with a volume of interest method. The differences of volumes between JME and normal groups were com- pared. The volumes were also compared between the early and late onset groups, and between the short and long seizure duration groups. The correlations between the volumes of the frontal lobe, hippocampus, or mid-sagittal area of the corpus callosum, and the age of seizure onset or the duration of disease were tested. Results : The cerebral volume was not found to be different between the JME and normal groups ( p=0.521). The left hippocampus was significantly smaller in the JME group ( p=0.032) while the left frontal lobe was significantly larger in the JME group ( p=0.004). The area of the rostral body of corpus callosum showed a significant positive correlation with the age of onset (r=0.561, p=0.012). The right frontal lobe volume showed a significant negative correlation with the duration of disease (r=- 0.511, p=0.025). Conclusions : These results imply that JME has volume changes in the frontal lobe and hippocampus. The volume reduction of the right frontal lobe in patients with a longer disease duration may suggest a progressive nature of JME. The smaller rostral body of the corpus callosum in patients with earlier seizure onset may suggest an ontogenic abnormality of JME. J Korean Neurol Assoc 21(1):54~61, 2003

Familial Idiopathic Striopallidodentate Calcifications

Abstract: Familial idiopathic striopallidodentate calcification is a disorder radiologically characterized by bilateral calcifications of the brain without abnormalities in the serum calcium level and related endocrinological parameters. We report a 70-year-old woman presented with slowly progressive gait disturbance, dementia and Parkinsonism. She had bilateral and symmetric calcifications of the basal ganglia, thalamus, dentate nucleus, and subcortical white matter on the brain CT. One son and two granddaughters also showed calcifications of the basal ganglia, suggesting an autosomal dominant inheritance.

Levosulpiride-induced Parkinsonim

Abstract: The present report discusses four cases of chronic renal failure, which developed symptoms of parkinsonism in response to levosulpiride. The temporal relationship between levosulpiride discontinuation and the disappearance of parkinsonism suggests a causal link. In addition, decreased striatal dopamine transporter bindings assessed by [I-123] IPT SPECT were observed in two patients suggesting that a dopamine blocking agent causes the dysfunction of nigrostriatal dopaminergic neurons and that such injury may be involved in the pathogenesis of drug-induced parkinsonism.

Clinical Characteristics of Benign Positional Vertigo

Abstract: Background: Benign positional vertigo (BPV) is characterized by episodic vertigo and nystagmus provoked by head motion. Though BPV is the most common cause of vertigo, systemic analysis of clinical features has been sparse. Methods: We analyzed clinical features of 194 patients who had been diagnosed as having BPV in a dizziness clinic from September 2000 to December 2002. The diagnosis of BPV was based on the typical nystagmus concurrent with vertigo elicited by positioning maneuvers. The nystagmus was observed by using Frenzel glasses, or recorded with video- or electro-oculography. According to the semicircular canal involved, we classified BPV into posterior, horizontal, and anterior canal types. The horizontal canal type was subdivided into geotropic or apogeotropic. Results: The patients included 149 women and 45 men. Mean age of the patients was 60.912.7 with no difference between women and men. Posterior (46.4%) and horizontal (40.7%) semicircular canals were most commonly involved. Most patients were idiopathic. Most patients (97.9%) were successfully treated with canalith repositioning procedure (CRP). Conclusions: BPV may involve each of the three semicircular canals. The involved canal can be identified by careful observation of the nystagmus induced by Hallpike maneuver or head turning in supine position. The horizontal canal is more commonly involved in BPV than previously known. High success rate of CRP is expected only when different method of CRP is applied to each patient depending on the canal involved.

Distribution of Cerebral Gray and White Matters in Juvenile Myoclonic Epilepsy: Voxel Based Morphometry

Abstract: Background : The brain MRI findings of juvenile myoclonic epilepsy (JME) usually appears normal upon visual inspection. The purpose of this study is to analyze the distributions of gray matter (GM) and white matter (WM) fea - tures with voxel based morphometry (VBM). Methods : Nineteen JME patients and 19 age and sex matched normal subjects underwent a volumetric MRI study. The MRIs were spatially normalized to our T1 template and segmented into GM, WM and CSF. The spatially normalized and segmented images were smoothed. The smoothed images of GM and WM were analyzed with t-tests. Statistical nonparametric mapping (SnPM) was also used without the assumption of normality. R e s u l t s : At the level of uncorrected p<0.05, there were brain regions with significantly decreased or increased GM and WM distributions in JME patients compared to those of the normal controls. GM decreased in the left dorsolateral-prefrontal lobe ( p=0.005), both medial prefrontal lobes ( p=0.01), both medial orbito-frontal lobes (p=0.005), and left middle inferior temporal gyrus ( p=0.005) while GM increased in both putamina (right: p=0.005, left: p=0.01), right caudate nucleus (p=0.005), right antero-superior temporal gyrus ( p=0.005), both medial parietal lobes (p=0.005), and both medial occipital lobes ( p=0.005). WM decreased in the right internal capsule ( p=0.005), left inter - nal capsule (p=0.05), and left temporal stem ( p=0.05) whereas WM increased in the right temporal stem ( p=0.05) and both occipital areas ( p=0.001). Conclusions : JME patients appear to have abnormal distributions of GM and WM in their brains. However, it is not determined whether this finding is an ontogenical abnormality or seizure related problem. J Korean Neurol Assoc 21(1):62~69, 2003

Ictal Hyperperfusion of Brain Structures Related to Ictal Dystonic Posturing in Temporal Lobe Seizures

Abstract: Background : Although dystonic posturing (DP) during temporal lobe seizures is known to be related to basal ganglia activation, the mechanism of the dystonic posturing has not been investigated in greater details. Methods : Thirty-two patients with mesial temporal lobe epilepsy (TLE) underwent ictal and interictal SPECTs. They were classified into two groups; 1) DP with ictal dystonia during ictal SPECT (N=15) and 2) Non-DP without dystonia (N=17). Ictal-interictal SPECT subtraction was performed as follows: co-registration, intensity normalization, subtraction, thresholding and then an overlay to SPGR MRI. The presence and intensity of ictal hyperperfusion were determined in frontal lobe, basal ganglia, temporal lobe and insular cortex. Results : The incidences of ictal hyperperfusion in DP vs. Non-DP were caudate nucleus [80.0% (12/15 patients) vs. 0% (0/17), p=0.001], putamen [93.3% (14/15) vs. 48.2% (8/17), p=0.005], globus pallidus [53.3% (8/15) vs. 23.5% (4/17), p=0.082], thalamus [80.0% (12/15) vs. 41.2% (7/17), p=0.026], insular cortex [46.7% (7/15) vs. 23.5% (4/17), p=0.051], orbitofrontal [46.7% (6/15) vs. 35.3% (7/17), p=0.053], medial frontal [6.7% (1/15) vs. 18.7% (2/17), p=0.621], dorsolateral frontal [13.3% (2/15) vs. 18.7% (2/17), p=0.737] in the hemisphere of epileptic side. In patients who showed ictal hyperperfusion in striatum and thalamus, the average intensity of hyperperfusion in DP vs. Non-DP was caudate nucleus 1.67 vs. 0.0, putamen 2.20 vs. 1.05, globus pallidus 1.2 vs. 0.65, thalamus 2.00 vs. 0.88 in the epileptic hemisphere. Conclusions : Caudate nucleus as well as putamen appeared to be important for producing ictal dystonia during TLE seizures. The greater intensity of ictal hyperperfusion in putamen, caudate nucleus and thalamus seems to be related to ictal dystonia.

Myeloneuropathy Following Chronic Abuse of Nitrous Oxide

Abstract: Past reports show that chronic abuse has resulted in serious sequalae of myeloneuropathy, optic neuritis and cerebral impairments. A 45-year-old male dentist developed an ascending paresthesia, severe gait ataxia, sensory loss for tactile sensation, proprioception and vibration of the four extremities. Laboratory findings revealed low serum vitamin levels and high levels of homocystein. Our case adds support to previous reports that nitrous oxide could cause neurologic complications by interfering with the utilization of vitamin .

Two Cases of Hypertensive Brainstem Encephalopathy

Abstract: Hypertensive encephalopathy is a medical disorder, which occurs with sudden increase of blood pressure (BP). The MRI findings of hypertensive encephalopathy are diffuse hyperintensity on T2-weighted images, predominantly within the cortex and subcortical white matter of the parieto-occipital lobe. The brainstem is rarely involved. Diffusion-weighted images do not show any abnormalities. We report two patients with hypertensive encephalopathy whose MRI showed exclusive brainstem involvement. They improved rapidly after BP control.

Multiple, Diffuse Brain Abscesses due to Listeria Monocytogenes

Abstract: CNS infection due to Listeria monocytogenes is a rare condition that occurs primarily in immunocompromised patients. A predilection for the brainstem has been proposed but definite abscess formation is extremely rare. We report a case of necrotizing meningoencephalitis with diffuse extensive abscesses caused by Listeria monocytogenes in a chronic diabetic patient, whose diagnosis was based on blood culture and MRI findings.

A Case of Paraneoplastic Limbic Encephalitis Associated with Immature Ovarian Teratoma

Abstract: Paraneoplastic limbic encephalitis is commonly associated with small cell lung carcinoma. A 31-year-old female presented with amnesia and bizarre behavior for 1 month. Brain T2-weighted MRI showed high signal intensity in right medial temporal region. Abdominal CT revealed a mass in right lower abdomen, and subsequent excisional biopsy disclosed immature ovarian teratoma. Most symptoms improved after resection of the tumor. Our case demonstrates that immature ovarian teratoma also can be associated with paraneoplastic limbic encephalitis with good prognosis.

Comparison of Results with Actigraphy and Polysomnography in Two Sleep Disorders -Obstructive Sleep Apnea Syndrome and Primary Insomnia-

Abstract: Background : Although actigraphy has been used to evaluated sleep-wake patterns and quality of sleep disorders patients, its usefulness in obstructive sleep apnea syndrome (OSAS) and primary insomnia is unclear. To investigate the value of actigraphy in OSAS and differentiating OSAS from primary insomnia, night polysomnography (PSG) and actigraphy were performed simultaneously. Methods : 31 OSAS patients and 21 primary insomnia patients were included (16 females, 36 males). Sleep latency, total sleep time, sleep efficiency and actual wake time, movement and fragmentation index (MFI) were obtained in actigraphy and compared with PSG results. Spearmann correlation analysis and Mann-Whitney U test were used. Results : The sleep efficiency and total sleep time are highly correlated in PSG and actigraphy (p0.05). OSAS had a significantly higher movement and fragmentation index (MFI) than that of primary insomnia (p

Treatment of Vascular Dementia: A Comprehensive Review

Abstract: Vascular dementia (VaD) is the second most common cause of dementia in the elderly after Alzheimer's disease. At present, there are only very limited data that might support either the prevention or the treatment of vascular dementia, despite a long history of attempts. Heterogeneity of vascular dementia complicated the study of treatment and its diag - nostic paradigm based on Alzheimer's disease made it impossible to identify cases early enough to prevent the develop- ment of dementia. A new concept, vascular cognitive impairment (VCI), has been proposed to underscore the impotance of early identification and treatment of vascular dementia. Prevention involves the control of putative vascu - lar risk factors (i.e. hypertension, diabetes, cardiac arrhythmias, smoking, hyperlipidemia) and the promotion of poten - tial protective factors. Primary and secondary prevention of stroke and cardiovascular disease decreases the burden of vascular dementia. Targets for the treatment of vascular dementia include 1) improvement of core symptoms (cognition, executive function, and behavior), 2) improvement of secondary factors affecting cognition (depression, anxiety, agita - tion), 3) slowing the progression of vascular dementia. Cholinesterase inhibitors used for Alzheimer's disease are also useful in vascular dementia, awaiting to be accepted as the first-line treatment for vascular dementia. J Korean Neurol Assoc 21(5):445~454, 2003

Cytoprotective Effect of Epigallocatechin gallate (EGCG) in Oxidative-stressed PC12 Cells Following $H_2O_2$ Exposure-Effect of EGCG on Phosphoinositide 3-kinase/Akt and Glycogen Synthase Kinase-3 Pathway

Abstract: Background: Neurodegenerative diseases (ND) are associated with oxidative stress, and antioxidants including epigallocatechin gallate (EGCG) have been tried as potential therapeutic regimens of an experimental model of ND. We performed this study to determine the neuroprotective role of EGCG on up stream and down stream signals in oxidative-stress-injured PC12 cells by exposing them to . Methods: Following 100 exposure, the viability of PC12 cells (not pretreated vs EGCG or z-AVD-fmk pretreated) was evaluated by using a MTT assay. Immunoreactivity (IR) of cytochrome c, caspase-3, poly (ADP-ribose) polymerase (PARP), PI3K/Akt and GSK-3 was examined by using a Western blot. Results: EGCG or z-VAD-fmk pretreated PC12 cells showed increased viability. Dose-dependent inhibition of caspase-3 activation and PARP cleavage was demonstrated by the pretreatment of both agents. However, the inhibition of cytochrome c release was only detected in EGCG pretreated cells. On the pathway through PI3K/Akt and GSK-3, however, the result of a western blot in EGCG pretreated cells showed decreased IR of Akt and GSK-3 and increased IR of p85a PI3K, phosphorylated Akt and GSK-3, and contrasted with that in z-VAD-fmk pretreated cells showing no changes. Conclusions: These data show that EGCG affects apoptotic pathways through upstream signals including PI3K/Akt and GSK-3 pathways as well as downstream signals including cytochrome c and caspase-3 pathways. Therefore, these results suggest that EGCG mediated activation of PI3K/Akt and inhibition GSK-3 could be a new protective mechanism on the pathogenesis of ND.

Congenital Ocular Motor Apraxia with Cerebellar Vermian Hypoplasia

Abstract: Congenital ocular motor apraxia is characterized by impaired voluntary saccades and abnormal head thrusts to induce a fixation. We report a case of a 7-year-old boy who shows typical finding of congenital ocular motor apraxia. He had a history of spasmus nutans. His developmental milestones were delayed. Brain MRI demonstrated cerebellar vermian hypoplasia, especially in the inferior portion. We report on a case of congenital ocular motor apraxia associated with cerebella vermian hypoplasia.

A Case of Idiopathic Ocular Neuromyotonia

Abstract: Ocular neuromyotonia (ONM) is an episodic involuntary contraction of one or more extraocular muscles, resulting from spontaneous neural discharges of ocular motor nerves. Previous radiation therapy to pituitary or other juxtasellar tumor and vascular compressions are the most common reported causes of ONM. We report one unique case of ONM involving the abducens nerve without any other organic brain lesion and prior radiation therapy.

A Case of Acute Colchicine-induced Myopathy with Myotonia in Behcet Disease.

Abstract: Colchicine has been used in the treatment of autoimmune diseases such as Behcet disease. Long-term use of colchicine can cause vacuolar myopathy on rare occasions. We report colchicine-induced myopathy with myotonia in Behcet disease. A 34-year-old man with Behcet disease presented progressive proximal weakness, myalgia, and difficulty in relaxation of grip after increasing the dosage of colchicine. Electrophysiological findings showed myotonic myopathy. Muscle biopsy revealed vacuolar myopathy. His symptoms were resolved with the discontinuation of colchicine.