Hyun- Jung

White Matter Hyperintensity as a Factor Associated with Delayed Mood Disorders in Patients with Acute Ischemic Stroke

Background: Mood disorder is a frequent complication of stroke. Comorbid depressive and anxiety disorders are very common, indicating that it is advisable to assess both disorders at the same time. The aim of the present study was to examine the prevalence of post-stroke depression (PSD) and poststroke anxiety (PSA) at baseline and to evaluate factors related to delayed PSD and PSA at 3 months after stroke onset. Methods: This was a prospectively registered and retrospectively analyzed study of patients with acute ischemic stroke between January 2009 and March 2010. Patients included in this study were interviewed in order to evaluate their Hospital Anxiety and Depression Scale (HADS) scores. In this study, each depression and anxiety score was dichotomized into ‘nondepressive and nonanxious’ (HADS-D and HADS-A ≤7) and ‘depressive and anxious’ (HADS-D and HADS-A >7). Multiple logistic regression analysis was used to evaluate the independent factors of depressive and anxious symptoms 3 months after stroke onset. Results: Of the 133 patients, 47.4% were ‘depressive’ and 56.4% were ‘anxious’ at baseline. The depressive and anxious groups had a significantly higher frequency of severe white matter hyperintensity (WMH) than the nondepressive and nonanxious groups (p < 0.05). The independent factors of PSD and PSA at 3 months were deep white matter hyperintensities (DWMH) and modified Rankin scale 0 to 1 at 3 months. Conclusion: In conclusions, the results of our study demonstrated that delayed depression and anxiety after ischemic stroke were related to the severity of DWMH and unfavorable outcomes at 3 months, regardless of anti-anxiety treatment. Our results suggested that WMH might be associated with pathomechanism of delayed depression and anxiety.

Right-to-left shunts as a cause of juxtacortical spots in patients with migraine.

Backgrounds:  Juxtacortical spots on fluid‐attenuated inversion recovery (FLAIR) images can be frequently detected in patients with migraine. However, the origins of the cerebral lesions (including juxtacortical spots on FLAIR images) found in the previous studies are not known. We sought to investigate the association between juxtacortical spots on FLAIR images and right‐to‐left shunt (RLS) in migraine patients.

Hirayama disease presenting as isolated triceps atrophy

We describe an atypical case of Hirayama disease (HD) presenting as unilateral triceps atrophy. HD is juvenile muscular atrophy involving predominantly the seventh and eighth cervical, and the first thoracic spinal segments of the distal upper extremities. In contrast to typical HD, our patient presented with isolated triceps atrophy, innervated by the sixth and seventh cervical segments. We discuss the differences with previously reported HD and the mechanisms involved in the development of HD.

Myasthenia Gravis Aggravated by Steroid-Induced Isolated Mediastinal Tuberculous Lymphadenitis

Background Myasthenia gravis (MG) is occasionally aggravated by chronic infection, of which there are many kinds. Case Report We report herein the case of a 56-year-old woman with MG aggravated by the activation of isolated mediastinal tuberculous lymphadenitis (MTL) during corticosteroid administration. The possibility of MTL had been disregarded in the differential diagnosis of aggravation of MG weakness, because MTL without pulmonary manifestations is uncommon even in areas where tuberculosis is endemic. Conclusions This case suggests that chronic infections such as tuberculosis should be considered in myasthenic patients with progressive exacerbation if definite evidence for aggravating factors of MG is not obtained.

Palatal tremor as a manifestation of epilepsia partialis continua caused by acute precentral gyral infarction

We describe a patient with palatal tremor (PT) as a manifestation of focal seizure caused by acute cortical infarction. Brain MRI showed acute infarction in the left precentral gyrus without evidence of brainstem lesions or hypertrophy of the inferior olivary nucleus. We discuss the differences between our patient and previous reports of symptomatic PT and the mechanisms involved in the development of PT associated with cortical lesions.

Hemidystonia as an Initial Manifestation of Leptomeningeal Metastasis

A 76-year-old woman gradually developed action dystonia of the left hand and foot. Leptomeningeal metastasis of the right fronto-parietal area associated with gastric adenocarcinoma was found on the brain magnetic resonance imaging (MRI) and positron emission tomography (PET) studies. We discuss the mechanisms involved in the development of secondary hemidystonia and review dystonia associated with cortical lesions.