Ischemic stroke associated with pituitary apoplexy is an extremely rare but devastating complication. Arterial stenosis or occlusion due to direct compression secondary to acute expansion of the hemorrhagic pituitary adenoma may induce ischemic stroke. In case of presentation of diffusion-perfusion or diffusion-clinical mismatch, urgent tumor resection to decompress the involved arteries should be performed to salvage ischemic penumbra. If emergent surgery is not possible, other therapeutic options are needed to prevent the progression of cerebral ischemia. Herein, we report the case of successful revascularization achieved in a patient with ischemic stroke who underwent balloon angioplasty and stent placement for the non-atherosclerotic steno-occlusion of intracranial internal carotid artery due to pituitary apoplexy.
{"title":"Successful Emergency Endovascular Treatment of Cavernous Internal Carotid Artery Stenosis Due to Compression by a Hemorrhagic Pituitary Tumor","authors":"Eugene Jung, S. Sung, Han-Jin Cho, Y. Kang","doi":"10.17340/jkna.2023.0095","DOIUrl":"https://doi.org/10.17340/jkna.2023.0095","url":null,"abstract":"Ischemic stroke associated with pituitary apoplexy is an extremely rare but devastating complication. Arterial stenosis or occlusion due to direct compression secondary to acute expansion of the hemorrhagic pituitary adenoma may induce ischemic stroke. In case of presentation of diffusion-perfusion or diffusion-clinical mismatch, urgent tumor resection to decompress the involved arteries should be performed to salvage ischemic penumbra. If emergent surgery is not possible, other therapeutic options are needed to prevent the progression of cerebral ischemia. Herein, we report the case of successful revascularization achieved in a patient with ischemic stroke who underwent balloon angioplasty and stent placement for the non-atherosclerotic steno-occlusion of intracranial internal carotid artery due to pituitary apoplexy.","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"14 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141058336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daeun Shin, Khanghee Choi, Yong-Won Kim, Woochan Choi
Incongruous visual field defects, such as sectoranopia, can result from lateral geniculate nucleus infarction. We present a rare case of right lateral geniculate nucleus infarction that manifests as a left inferior homonymous paracentral scotoma. According to the retinotopic organization of the visual tract, central vision from the macula is delivered to the occipital pole via the posterior portion of the lateral geniculate nucleus. Consequently, not only can occipital pole infarction lead to central visual loss, but partial lateral geniculate nucleus infarction can also produce similar manifestations of central visual loss.
{"title":"Homonymous Central Scotomatous Visual Field Defect in a Patient with Lateral Geniculate Nucleus Infarction","authors":"Daeun Shin, Khanghee Choi, Yong-Won Kim, Woochan Choi","doi":"10.17340/jkna.2023.0068","DOIUrl":"https://doi.org/10.17340/jkna.2023.0068","url":null,"abstract":"Incongruous visual field defects, such as sectoranopia, can result from lateral geniculate nucleus infarction. We present a rare case of right lateral geniculate nucleus infarction that manifests as a left inferior homonymous paracentral scotoma. According to the retinotopic organization of the visual tract, central vision from the macula is delivered to the occipital pole via the posterior portion of the lateral geniculate nucleus. Consequently, not only can occipital pole infarction lead to central visual loss, but partial lateral geniculate nucleus infarction can also produce similar manifestations of central visual loss.","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"12 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141051436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Coronavirus disease 2019 (COVID-19) is a serious infectious disease with multisystem alteration including neurological complications. COVID-19 associated encephalitis is a potentially fatal viral infection of the brain. Diffusion-weighted images (DWI) are a useful evaluation modality of cytotoxic edema in patients with encephalitis. We report on the reversible DWI change in a patient with COVID-19 associated encephalitis, who had diffused cytotoxic edema in the affected temporal lobe and accompanied status epilepticus. Sequential imaging showed that the cytotoxic edema in DWI confirmed recovery to normal after 12 days in the presence of cortical edema in fluid-attenuated inversion recovery image after aggressive neurocritical management. Thus, prompt, proper management is indispensable during the acute period and DWI may be a valuable tool for reflecting the clinical course of COVID-19 associated encephalitis.
{"title":"Reversible Cytotoxic Edema in Patients with COVID-19 Associated Encephalitis Presenting Status Epilepticus","authors":"H. Kim, Surim Seo, Joong-Goo Kim","doi":"10.17340/jkna.2023.0040","DOIUrl":"https://doi.org/10.17340/jkna.2023.0040","url":null,"abstract":"Coronavirus disease 2019 (COVID-19) is a serious infectious disease with multisystem alteration including neurological complications. COVID-19 associated encephalitis is a potentially fatal viral infection of the brain. Diffusion-weighted images (DWI) are a useful evaluation modality of cytotoxic edema in patients with encephalitis. We report on the reversible DWI change in a patient with COVID-19 associated encephalitis, who had diffused cytotoxic edema in the affected temporal lobe and accompanied status epilepticus. Sequential imaging showed that the cytotoxic edema in DWI confirmed recovery to normal after 12 days in the presence of cortical edema in fluid-attenuated inversion recovery image after aggressive neurocritical management. Thus, prompt, proper management is indispensable during the acute period and DWI may be a valuable tool for reflecting the clinical course of COVID-19 associated encephalitis.","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"37 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141053159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Seulgi Choi, S. Yoon, Soo Im Jang, Sae-Nal Lee, Ji Yoon Ann, Eun Ja Lee, Sung-Ho Woo, Kwang-Ki Kim, Hang-Rai Kim
Unruptured dural arteriovenous fistula (dAVF) manifests various symptoms including exophthalmos, headache, tinnitus, and retro-orbital pain. Transient global amnesia (TGA) is a clinical syndrome of reversible anterograde amnesia. Here, we report a 62-year-old woman with dAVF, manifested as TGA. This case emphasized that the clinicians should stay vigilance to the organic cause of TGA, especially in those complaining other symptoms besides amnesia such as pulsatile tinnitus and headache. Furthermore, our case supports a hypothetical patho-mechanism of venous congestion for TGA.
{"title":"Dural Arteriovenous Fistula Manifested as Transient Global Amnesia","authors":"Seulgi Choi, S. Yoon, Soo Im Jang, Sae-Nal Lee, Ji Yoon Ann, Eun Ja Lee, Sung-Ho Woo, Kwang-Ki Kim, Hang-Rai Kim","doi":"10.17340/jkna.2023.0060","DOIUrl":"https://doi.org/10.17340/jkna.2023.0060","url":null,"abstract":"Unruptured dural arteriovenous fistula (dAVF) manifests various symptoms including exophthalmos, headache, tinnitus, and retro-orbital pain. Transient global amnesia (TGA) is a clinical syndrome of reversible anterograde amnesia. Here, we report a 62-year-old woman with dAVF, manifested as TGA. This case emphasized that the clinicians should stay vigilance to the organic cause of TGA, especially in those complaining other symptoms besides amnesia such as pulsatile tinnitus and headache. Furthermore, our case supports a hypothetical patho-mechanism of venous congestion for TGA.","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"37 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141051863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: To investigate the patterns of blood pressure (BP) decrement during the tilt, to compare the pattern of orthostatic hypotension (OH) and sympathetic index (SI) from the Valsalva maneuver (VM), and to identify whether the pattern of OH can predict the severity of autonomic failure.Methods: From January 2015 to July 2017, 551 consecutive patients with neurogenic OH were enrolled. All patients performed a standardized battery of autonomic tests, including the head-up tilt (HUT) test and VM using Finometer devices for recording beat-to-beat BP. SIs were calculated from the VM. The composite autonomic severity score (CASS) adrenergic subscore was also obtained to evaluate the severity of sympathetic adrenergic failure.Results: We classified OH into nine groups according to the patterns of orthostatic BP decrement during HUT. The two most common patterns of OH were classic stable OH (n=193) and classic OH with delayed normalization (n=102). Patients with classic stable OH and classic OH with delayed worsening had a more severe degree of sympathetic adrenergic failure as assessed with SI 5 and SI 4 from the VM, and a higher CASS adrenergic subscore than patients with other patterns of OH. There were no differences of autonomic parameters between the two delayed OH groups.Conclusions: The different patterns of orthostatic BP decrement may reflect underlying different pathophysiologic mechanisms causing OH. The pattern of orthostatic BP decrement can help to predict the degree of sympathetic adrenergic autonomic failure.
研究背景目的：研究倾斜时血压（BP）下降的模式，比较来自瓦尔萨尔瓦手法（VM）的正位性低血压（OH）模式和交感神经指数（SI），并确定OH模式是否可以预测自主神经功能衰竭的严重程度：2015年1月至2017年7月，551名神经源性OH患者连续入组。所有患者都进行了一系列标准化的自律神经测试，包括仰头倾斜（HUT）测试和使用 Finometer 设备记录逐次搏动血压的 VM。根据 VM 计算出 SI。此外，还获得了综合自律神经严重程度评分（CASS）肾上腺素能子分数，以评估交感肾上腺素能衰竭的严重程度：结果：我们根据 HUT 期间正压血压下降的模式将 OH 分成了九组。最常见的两种OH模式是典型稳定型OH（193人）和典型OH伴延迟正常化型OH（102人）。与其他OH模式的患者相比，典型稳定型OH和典型OH延迟恶化型患者的交感肾上腺素能衰竭程度更严重（根据VM的SI 5和SI 4评估），CASS肾上腺素能亚项评分也更高。两组延迟OH患者的自律神经参数没有差异：结论：正静态血压下降的不同模式可能反映了引起 OH 的潜在的不同病理生理机制。正静态血压下降的模式有助于预测交感肾上腺素能自律神经功能衰竭的程度。
{"title":"A Detailed Classification of Neurogenic Orthostatic Hypotension According to the Pattern of Orthostatic Blood Pressure Drop in Patients with Orthostatic Intolerance","authors":"Jae-Joon Lee, Hyung Lee, H. Kim","doi":"10.17340/jkna.2023.0104","DOIUrl":"https://doi.org/10.17340/jkna.2023.0104","url":null,"abstract":"Background: To investigate the patterns of blood pressure (BP) decrement during the tilt, to compare the pattern of orthostatic hypotension (OH) and sympathetic index (SI) from the Valsalva maneuver (VM), and to identify whether the pattern of OH can predict the severity of autonomic failure.Methods: From January 2015 to July 2017, 551 consecutive patients with neurogenic OH were enrolled. All patients performed a standardized battery of autonomic tests, including the head-up tilt (HUT) test and VM using Finometer devices for recording beat-to-beat BP. SIs were calculated from the VM. The composite autonomic severity score (CASS) adrenergic subscore was also obtained to evaluate the severity of sympathetic adrenergic failure.Results: We classified OH into nine groups according to the patterns of orthostatic BP decrement during HUT. The two most common patterns of OH were classic stable OH (n=193) and classic OH with delayed normalization (n=102). Patients with classic stable OH and classic OH with delayed worsening had a more severe degree of sympathetic adrenergic failure as assessed with SI 5 and SI 4 from the VM, and a higher CASS adrenergic subscore than patients with other patterns of OH. There were no differences of autonomic parameters between the two delayed OH groups.Conclusions: The different patterns of orthostatic BP decrement may reflect underlying different pathophysiologic mechanisms causing OH. The pattern of orthostatic BP decrement can help to predict the degree of sympathetic adrenergic autonomic failure.","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"74 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141029231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Hwang, Kyong Jin Shin, Junseok Jang, Sungyeong Ryu
{"title":"Concurrence of Spinobulbar Muscular Atrophy and Seropositive Myasthenia Gravis","authors":"H. Hwang, Kyong Jin Shin, Junseok Jang, Sungyeong Ryu","doi":"10.17340/jkna.2023.0101","DOIUrl":"https://doi.org/10.17340/jkna.2023.0101","url":null,"abstract":"","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"249 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141056596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wernekinck commissure syndrome is a rare midbrain syndrome, usually resulting in selective destruction of the decussation of the superior cerebellar peduncle. This syndrome can present with symptoms such as bilateral cerebellar ataxia, ophthalmoplegia, and palatal tremor. Here, we report a 61-year-old female with acute onset of bilateral cerebellar ataxia and isolated superior rectus palsy diagnosed on Wernekinck commissure syndrome confirmed by magnetic resonance imaging.
{"title":"A Rare Midbrain Syndrome with Bilateral Cerebellar Ataxia and Isolated Superior Rectus Palsy: Wernekinck Commissure Syndrome","authors":"Khanghee Choi, Yong-Won Kim, Woochan Choi","doi":"10.17340/jkna.2023.0066","DOIUrl":"https://doi.org/10.17340/jkna.2023.0066","url":null,"abstract":"Wernekinck commissure syndrome is a rare midbrain syndrome, usually resulting in selective destruction of the decussation of the superior cerebellar peduncle. This syndrome can present with symptoms such as bilateral cerebellar ataxia, ophthalmoplegia, and palatal tremor. Here, we report a 61-year-old female with acute onset of bilateral cerebellar ataxia and isolated superior rectus palsy diagnosed on Wernekinck commissure syndrome confirmed by magnetic resonance imaging.","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"78 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141057214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Spinocerebellar ataxia type 6 (SCA6) is classified as a CAG repeat disorder, where the number of expanded CAG repeats often undergoes meiotic instability, when transmitted from one generation to the next. However, in SCA6, both normal and expanded CAG repeats tend to remain stable during transmission due to its relatively small repeat numbers. We herein report de-novo expansion of CAG repeats in SCA6 gene in a 41-year-old female patient, whose parents had normal repeat numbers.
{"title":"A Spinocerebellar Ataxia Type 6 Patient Caused by De Novo Expansion of Normal Range CAG Repeats","authors":"Da Eun Jung, C. Lyoo","doi":"10.17340/jkna.2023.0105","DOIUrl":"https://doi.org/10.17340/jkna.2023.0105","url":null,"abstract":"Spinocerebellar ataxia type 6 (SCA6) is classified as a CAG repeat disorder, where the number of expanded CAG repeats often undergoes meiotic instability, when transmitted from one generation to the next. However, in SCA6, both normal and expanded CAG repeats tend to remain stable during transmission due to its relatively small repeat numbers. We herein report de-novo expansion of CAG repeats in SCA6 gene in a 41-year-old female patient, whose parents had normal repeat numbers.","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"16 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141035813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Easy Tip for History Taking in Epileptic Seizures","authors":"Dae-Won Seo","doi":"10.17340/jkna.2024.0026","DOIUrl":"https://doi.org/10.17340/jkna.2024.0026","url":null,"abstract":"","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"19 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141024435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Iljung Hwang, Eun Jin Yang, Kyung Won Lee, Heuiseop Jung, Seunghee Na
{"title":"Anti-Ma2 Paraneoplastic Cerebellar Degeneration Responding to Immunotherapy","authors":"Iljung Hwang, Eun Jin Yang, Kyung Won Lee, Heuiseop Jung, Seunghee Na","doi":"10.17340/jkna.2023.0103","DOIUrl":"https://doi.org/10.17340/jkna.2023.0103","url":null,"abstract":"","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"14 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141057941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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