Bong-Goo Yoo

Cerebral lipiodol embolism during transcatheter arterial chemoembolization.

Cerebral lipiodol embolism (CLE) is a rare complication that may occur during chemoembolization. The authors present three cases of CLE during transcatheter arterial chemoembolization for hepatocellular carcinoma. Multiple small nonconfluent hyperintense intracerebral lesions were found on the diffusion-weighted and fluid-attenuated inversion recovery MRI. Clinical signs completely resolved and MRI lesions markedly improved on follow-up evaluation within a 3-week period.

Acute Marchiafava-Bignami Disease with Widespread Callosal and Cortical Lesions

Marchiafava-Bignami disease (MBD) is a rare alcohol-related disorder that results in progressive demyelination and necrosis of the corpus callosum. The process may extend to the optic chiasm and tracts, cerebellar peduncle, subcortical resion, neighboring white matter, and rarely, cortical gray matter. We report a case of MBD in which fluid-attenuated inversion recovery and diffusion magnetic resonance imaging studies revealed symmetrical hyperintense lesions in the cerebral cortex in addition to the callosal lesions.

Acute pure motor demyelinating neuropathy with hyperreflexia and anti-GalNAc-GD1a antibodies

Department of Neurology, Dong-A University Medical Center, Busan, Republic of Korea Department of Neurology, Pusan National University School of Medicine, Busan, Republic of Korea Department of Neurology, Kinki University School of Medicine, Osaka, Japan Department of Neurology, Inje University College of Medicine, Busan, Republic of Korea Department of Neurology, Kosin University College of Medicine, Busan, Republic of Korea

Donepezil treatment in Alzheimer's disease patients with and without cerebrovascular lesions: A preliminary report

Aim:  Donepezil has not been evaluated in Korean patients with Alzheimers disease (AD) for up to 1 year. The objectives of this study were to evaluate the differential efficacy of donepezil in Korean AD patients with and without concomitant cerebrovascular lesions (CVL).

Epicardial Fat Thickness and Free Fatty Acid Level are Predictors of Acute Ischemic Stroke with Atrial Fibrillation

BACKGROUND Increased epicardial fat is known to be associated with the presence and chronicity of atrial fibrillation (AF). Free fatty acids (FFAs) are major components of epicardial fat; however, their potential association with AF in ischemic stroke has not been investigated. We aimed to assess the performance of echocardiographic epicardial fat thickness (EFT) and plasma FFA level in identifying patients with ischemic stroke and AF. METHODS We enrolled a total of 214 consecutive patients (mean age, 66.8 ± 12.3 years; 39.7% women) diagnosed with acute ischemic stroke between March 2011 and June 2014. The patients were divided into two groups: ischemic stroke with AF (n = 35, 16.4%) and ischemic stroke without AF (n = 179, 83.6%). RESULTS The ischemic stroke with AF group showed significantly higher serum FFA level (1379.7 ± 717.5 vs. 757.8 ± 520.5 uEq/L, p < 0.0001) and EFT (6.5 ± 1.2 vs. 5.3 ± 1.2 mm, p < 0.001) than the group without AF. Multivariable logistic regression analysis demonstrated that age (odds ratio [OR], 1.112), serum FFA level (OR, 1.002), and EFT (OR, 1.740) were independently associated with the ischemic stroke group with AF. EFT and FFA significantly improved the goodness-of-fit and discriminability of the simple regression model including age as a covariate (log likelihood difference, 21.35; p < 0.001; c-index difference, 17.9%; p < 0.001). CONCLUSIONS High EFT and serum FFA level were associated with ischemic stroke in patients with AF. Echocardiographic EFT and serum FFA level can play a significant role in identifying ischemic stroke with AF.

Ictal neuropsychological assessment in a patient with transient global amnesia.

Transient global amnesia (TGA) is a temporary amnestic syndrome characterized by anterograde amnesia and variable retrograde amnesia without other focal neurological deficits. Neuropsychological tests during attack in TGA have been rarely reported. We report a 62-year-old man with TGA who was evaluated with detailed neuropsychological tests during attack. Ictal neuropsychological tests showed encoding failure in verbal and visual memory with frontal/executive dysfunction.

Hashimoto's Encephalopathy Presenting with Acute Cognitive Dysfunction and Convulsion.

Hashimoto’s encephalopathy is an immune-mediated disorder characterized by acute or subacute encephalopathy related to increased anti-thyroid antibodies. Clinical manifestations of Hashimoto’s encephalopathy may include stroke-like episodes, altered consciousness, psychosis, myoclonus, abnormal movements, seizures, and cognitive dysfunction. Acute cognitive dysfunction with convulsion as initial clinical manifestations of Hashimoto’s encephalopathy is very rare. We report a 65-year-old man who developed acute onset of cognitive decline and convulsion due to Hashimoto’s encephalopathy.

Medication Adherence of Statin Users after Acute Ischemic Stroke

Although statins are established therapy for the secondary prevention of ischemic stroke, factors associated with adherence to statin treatment following ischemic stroke are not well known. To address this, we assessed the 6-month statin adherence using 8-item Morisky Medication Adherence Scale-8 in patients with acute ischemic stroke. Of 991 patients, 65.6% were adherent to statin at 6-month after discharge. Multiple logistic regression analysis showed that patients’ awareness of hyperlipidemia (OR 1.62; 95% CI 1.07–2.43), large artery stroke subtype (versus non-large artery stroke, OR 1.79; 95% CI 1.19–2.68), and alcohol drinking habits (OR 1.64; 95% CI 1.06–2.53) were positively associated, while high statin dose (versus low dose, OR 0.6; 95% CI 0.40–0.90) and higher daily number of medication pills (OR 0.93; 95% CI 0.88–0.97) were found to have a negative association with self-reported good adherence to statin medication after acute ischemic stroke. However, stroke severity and diagnosis of hyperlipidemia were not associated with adherence. These results suggest that educational and motivational interventions may enhance statin adherence because modifiable factors were associated with statin adherence.

O2-04-07: Treatment with donepezil in Korean Alzheimer patients with and without cerebrovascular factors: One-year follow-up study

randomized to receive either Vitamin E 800 IU vitamin C 200 mg alpha lipoic acid 600 mg/day; coenzyme Q 2400 mg per day (800mg 3 times per day), or placebo, for 16 weeks. CSF and plasma were obtained at baseline and after 16 weeks of treatment. Physical examination, blood tests and adverse event reports were used to monitor safety. The MMSE and ADCS-ADL were administered at baseline and week 16. CSF levels of A-beta42, tau and P-tau181 were measured by multiplex assays. F2-isoprostanes are measured by LC-MS methods. Clinical and CSF data were compared between groups using ANCOVA models. Results: 78 subjects with AD (50% women) were randomized. Study medications were well-tolerated, without differences in adverse events between groups. 74 subjects completed treatment and had successful serial lumbar punctures. At baseline, means (SD) were: age 72.8 (9.1), MMSE 22.9 (3.7); these did not differ between treatment arms. CSF levels of A-beta42, tau and P-tau-181 did not differ between treatment arms at baseline. Changes in CSF levels of A-beta42, tau and P-tau181 from baseline to week 16 did not differ between either treatment arm and placebo. Measurements of F2-isoprostanes are in progress. Conclusions: Treatment with a cytosolic antioxidant combination or with CoQ did not alter CSF biomarkers related to A-beta or tau in AD. The supplements, at the doses used, did not appear to influence AD pathologic processes in the brain sufficiently to alter CSF biomarkers. Supported by NIA grant AG10483.