Sang-Won Ha

Changes in regional brain glucose metabolism measured with F-18-FDG-PET in essential tremor.

Background There is growing evidence that essential tremor (ET) is a multiple-system disorder. Previous PET studies in ET typically have measured brain oxygen consumption and cerebral blood flow. Purpose To compare ET patients with control subjects to investigate any regional change in cerebral glucose metabolism through statistical parametric mapping (SPM) analysis of F-18-fluorodeoxyglucose positron emission tomography (F-18-FDG-PET). Material and Methods We studied 17 patients with ET (17 men; mean age, 67.3 ± 4.8 years) and age-sex matched normal subjects. All subjects underwent FDG-PET imaging, and evaluated severity of tremor symptoms was measured as score on the Fahn-Tolosa-Marin rating scale (FTM). We also evaluated detailed the medical history and neurological examinations in all patients. Results The mean age of tremor onset was 57.6 ± 12.9 years and the mean FTM score was 15.1 ± 4.9. Brain FDG-PET analysis demonstrated hypometabolism in the medial frontal lobe, medial temporal lobe, and the precuneus of parietal lobe. However, there was no significant difference of glucose metabolism in the cerebellum. Conclusion We propose that motor symptom of ET are caused by electrophysiological disturbances within cortical–cerebellar networks, rather than degenerative process of cerebellum, because the metabolism of the cerebellum was normal at rest. Furthermore, the abnormal glucose metabolism in the cerebral regions that do not mainly participate in motor function suggest that these regions may play a role as early markers of non-motor manifestations.

Sepsis Associated Encephalopathy Accompanied by Bilateral Corticospinal Tract Lesions in Diffusion Weighed Image

평가받은 적은 없으나 기본적인 일상생활을 독립적으로 수행하였 으며, 이외의 병력이나 투약력은 없었다. 2일 전 하루 종일 잠을 잤고, 당일 아침 열과 함께 의식변화를 보였다. 체온은 38.6°C, 혈압 102/65 mmHg, 호흡수 20/분, 심박수 110/분이었다. 신경학적 진찰에서 의식은 혼미(stupor)하였고, 시 간, 장소에 대한 지남력은 없었고, 간단한 명령수행만 가능하였다. 경미한 구음장애 외에 뇌신경검사나 뇌간반사는 정상이었다. 앉은 자세 유지가 어려웠고, 사지의 전반적으로 위약이 있었으나(MRC 4 등급) 편측화징후나 국소화징후, 바빈스키반사 등의 병적 반사는 없 었다. 혈액검사에서 백혈구 24,640/mm, C-반응단백질 197.5 mg/L, 아 스파르테이트/알라닌아미노전이효소(aspartate aminotransferase/alanine aminotransferase) 16/7 U/L, 총빌리루빈 0.3 mg/dL, 프로트롬빈 시간 국제표준화비율 1.57이었다. 응급실 방문 당시 혈당은 236 mg/dL였으며, 보호자가 자려는 환자를 강제로 깨워 연한 음식 형태 의 식사는 한 상태였다. 집 근처 병원에서 메트포르민(metformin) 과 술포닐우레아(sulfonylurea) 계열의 경구 혈당강하제 투약 중이 던 자로, 2일 전 의식이 저하되어 죽으로 식사하면서 보호자가 2일 전부터 당뇨병약을 주지 않은 상태였다. 당화혈색소는 7.6% (참고 치: 3.5-6.4%)였고, 이외에 일반화학검사 및 갑상선기능검사 등의 혈액검사는 정상이었다. 뇌 CT에서 특이소견은 없었고, 뇌척수액 검사에서 개방압 16 cmH2O, 백혈구 2/mm, 단백질 39.3 mg/dL, 단순포진바이러스 및 비정형결핵균 유전자증폭검사(HSV & MTB PCR), 뇌척수액 배양검사(CSF culture)에서 감염 의심소견은 없었 다. 가슴경유심초음파검사에서 정상 좌심실 수축기능과 비심장판 막성 심실조동이 보였으며 감염심내막염의 징후는 없었다. 소변검 사에서 색이 탁하고 백혈구와 아질산염(nitrite)이 검출되어 요로감 염을 의심하고 항균제 치료를 시작하였다. 뇌파검사에서는 전반적 인 서파가 보인 것 이외에 뇌전증모양방전은 확인되지 않았다. 확

Transient Global Amnesia Caused by Bilateral Medial Temporal-Lobe Infarction

Transient global amnesia (TGA) is defined by a sudden onset of anterograde and retrograde amnesia that lasts up to 24 h. The clinical feature of this syndrome has been discussed in recent studies. Several etiological factors, such as epileptic phenomena, migraine-related mechanisms, focal ischemia, and venous flow abnormalities, have been implicated in its pathophysiology.1 A 68-year-old male visited our emergency room with temporary memory loss. He was taking medications for hypertension and benign prostate hypertrophy. His guardian described that the patient complained of a sudden onset of lightheadedness and mild headache while watching television the night prior to admission. After waking up the next day, he could not remember the events of the previous night and asked Transient Global Amnesia Caused by Bilateral Medial Temporal-Lobe Infarction

Hypertension and Neuropsychiatric Symptoms in Patients with Drug-Naïve Alzheimer's Disease

Background and Purpose Neuropsychiatric symptoms (NPS) such as anxiety, depression, and delusions affect up to 90% of all patients with Alzheimers disease (AD). NPS is associated with significant caregiver burden and patient distress. Given the severe burden of NPS in AD, it is critical to know potential modifiable risk factors of NPS in AD. This study explores the association between hypertension and NPS in patients with drug-naïve AD. Methods We reviewed medical records of 149 patients with AD with (n=80) and without (n=69) hypertension. NPS were assessed using the Korean version of Neuropsychiatric Inventory (K-NPI). Affective, psychotic, and behavior symptom clusters were assessed separately. Results The total score of K-NPI was not significantly different between patients with AD with and without hypertension. Among K-NPI domains, scores of depression/dysphoria (p=0.045), anxiety (p=0.022), and apathy/indifference (p=0.037) were significantly higher in patients with AD with hypertension. Systolic blood pressure (BP) was associated with higher total K-NPI and affective symptom cluster scores. Diastolic BP was associated with affective symptom cluster scores. Conclusions Results suggest that hypertension increases risk of specific NPS in patients with AD. Among NPS, hypertension was associated with affective symptom cluster.

Hydrocephalus in Patient with Multiple System Atrophy: Innocent Bystander or Guilty Party?

Background Normal pressure hydrocephalus (NPH) is a poorly understood condition, which typically presents with the triad of gait disturbance, urinary incontinence and cognitive decline. Diagnosis of NPH is often challenging due to its varied presentation and overlap with other neurodegenerative diseases including multiple system atrophy (MSA). Case Report A 68-year-old male developed rapidly progressive gait difficulty, urinary incontinence and memory impairment. Neurologic examination showed parkinsonism affecting the right side and impaired postural reflexes. Brain MRI showed enlargement of the ventricles and narrowing of the high convexity cerebrospinal fluid (CSF) spaces with relative dilated Sylvian fissure, the supporting features of NPH. 18F-fluorinated-N-3-fluoropropyl-2-b-carboxymethoxy-3-b-(4-iodophenyl) nortropane (18F-FP-CIT) PET showed decreased FP-CIT binding in the left posterior putamen and 18F-fluorodeoxyglucose PET showed decreased metabolism in the left basal ganglia, consistent with findings of MSA. CSF removal was performed and the symptoms were improved. The patient underwent ventriculo-peritoneal shunt and his gait and cognition improved. Conclusions NPH is a potentially treatable neurological disorder. Therefore, it is necessary to consider the possibility of accompanying NPH when hydrocephalus is present in other neurodegenerative diseases.