Yung-Yee Chang

The prevalence of protein C, protein S, and antithrombin III deficiency in non-APS/SLE Chinese adults with noncardiac cerebral ischemia.

Protein C (PC), protein S (PS), and antithrombin III (AT-III) are vital thrombin antagonists in circulation. However, the prevalence of these natural inhibitors for cerebral ischemia is barely mentioned in the Chinese population. The prevalence of PC, PS, and AT-III deficiency in Chinese adults with cerebral ischemia is reported. The study subjects were free of antiphospholipid antibody syndrome or systemic lupus erythrematosus. Cardiac, liver, and renal function were normal. An overall rate of thrombophilia was 27%. PS deficiency was the most common disorder, followed by PC with PS and PC deficiency. There was only one patient with AT-Ill deficiency. No gender was specific for thrombophilia. However, PS deficiency was predilected in young adults. A positive correlation between PC and AT-III was achieved in patients with a normal PC activity but not PC deficiency. There was no correlation between AT-III or PS. The odds ratios of PC and PS were 5.29 and 2.86, respectively. Accordingly, an inability for thrombin antagonization by the PC/PS axis may relate to the occurrence of cerebral ischemia in the Chinese population. AT-III seems to display a minor role only.

The increase of blood anticardiolipin antibody depends on the underlying etiology in cerebral ischemia

Although anticardiolipin antibody (aCL) has been suggested to be a potent risk factor for thrombosis and atherosclerosis in multiple arterial beds, conflicting results exist between aCL and cerebral ischemia in the general stroke population. To elucidate if this discrepancy relates to the heterogeneity of underlying etiologies, the blood beta2-glycoprotein I dependent-aCL in 432 Taiwanese adults was examined. The associated cerebral ischemia in these patients was classified into five subtypes according to the cause of cerebral ischemia. The results were compared with those in 100 healthy controls. A definite increase of aCL-IgG isotype was found in 41 patients (9.35%) and four controls (4.0%). The relative risk was 2.52. The frequency of increased aCL-IgG was 12.2%, 12.8%, 8.8%, 3.9%, and 3.5% in patients with large-artery atherosclerotic disease, stroke of unknown etiology, small-artery occlusive disease, cardioembolism, and stroke of other known etiology, respectively. Only patients with large-artery atherosclerotic disease (p<0.025) and stroke of unknown etiology (p<0.05) had higher frequencies of increased aCL than those in control subjects. The frequencies of abnormal results of activated partial thromboplastin time, antinuclear factor, Coombs’ test, and venereal disease research laboratory were 2.84%, 1.22%, 1.02%, and 1.34% in these 41 patients, respectively. Accordingly, aCL-IgG selectively increases in patients with large-artery atherosclerosis and stroke of unknown etiology, reflecting selective activation of humoral immunity for aCL in the pathogenesis of cerebral ischemia.

Bilateral cheiro-oral syndrome and traumatic subdural hematoma

Typical bilateral cheiro-oral syndrome was encountered in a 74-year-old man who had bilateral subdural hematoma after a minor head injury. The delayed grave neurologic deficits occurred 1 month later without expansion of the hematoma. Removal of the lesions reversed both cheiro-oral syndrome and his late-onset neurological disabilities.

Antiplatelet Drugs Induce Apoptosis in Cultured Cancer Cells

In order to understand if antiplatelet drugs possess direct antineoplastic property, we tested the apoptotic effect of 5 popularly marketed antiplatelet drugs in Taiwan in 6 cultured cancer cell lines (Hep 3B hepatocarcinoma, U87-MG malignant glioma, PC-3 prostate adenocarcinoma, HeLa cervical adenocarcinoma, HL-60 preleukemia and K-562 chronic myelogenous leukemia). While acetylsalicylate and flunarizine exerted no effect on these cancer cells, pentoxifyline (PTX), dipyridamole (DYA) and ticlopidine hydrochloride (T. HCl) displayed a time and dose-dependent apoptotic effect on them except for HL-60 and K-562 cells. PTX induced apoptosis in U87-MG, Hep 3B and HeLa cells, DYA in HeLa cells, while T. HCl in U87-MG, Hep 3B, PC-3 and HeLa cells. Adriamycin also provoked apoptotic effect in all 6 cell lines but neither PTX, DYA nor T. HCl acted synergy with adriamycin to HeLa cells, implicating that they may share a similar pathway for inducing apoptosis. Therefore, our results show that the antiplatelet drugs do possess antineoplastic property in vitro. A co-administration of antiplatelet drugs is noteworthy for an alternative adjunctive therapy in cancer patients.

Babinski-Nageotte syndrome: a case report.

A 68-year-old man developed a sudden onset of the left Wallenbergs syndrome with additional left hypoglossal nerve palsy and contralateral hemiparesis sparing the face. The clinical constellation, known as Babinski-Nageotte syndrome, is regarded as a combination of the medial and lateral medullary syndrome. Magnetic resonance imaging showed potential of in vivo confirmation of the underlying vascular insult, which clearly demonstrated an infarct area in the left half of the medulla oblongata.

Decreased muscular radionuclide uptake in Tc-99m MIBI scintigraphy during paralytic phase of thyrotoxic periodic paralysis.

The underlying pathophysiology of thyrotoxic periodic paralysis (TPP) is still obscure. From histologic surveys, vacuole formation and abundant mitochondrial abnormalities ranged from swelling, matrical pallor, pleomorphism, and reduced cristae were often disclosed in the muscle fibers during paralytic periods. In a 47-year-old man experiencing 2 episodes of transient paralysis, hyperthyroidism with TPP was diagnosed. During the acute paralytic phase, a significant reduction of radionucleotide uptake in the quadriceps on Tc-99m sestamibi scintigraphy was found, aside from the previous morphologic findings, that it further suggests impaired mitochondrial integrity and cellular viability in TPP.

Transtentorial cerebellar c-jun expression after focal cerebral cortical injury in mice.

Delayed and remote effect of focal cerebral cortical lesion on cerebellum remains unclear. The c-Jun, an inducible transcription factor of cellular immediate early gene, is the predominant transcription factor and consistent marker for neurons that respond to stress or injury. We use a mouse cryogenic injury model to study the spatial and temporal changes of c-jun in the cerebellum after focal neocortical lesion. A transient and moderate expression of c-jun mRNA was found in the cerebellum with central dominance since 3 day postinjury and gradually subsided within 2 weeks. A distinct increment of c-Jun protein expression in Purkinje cells of the bilateral cerebellar hemispheres with focal connotation in the vermis was detected since 1 week postinjury. These findings suggest that the delayed and remote c-jun expression of the cerebellum, functionally connected with the cerebral cortex, indicate transneuronal gene activation.

Metastatic Brain Tumor Manifesting as Lacunar Syndrome in Adults

Lacunar syndrome can be an initial manifestation of the metastatic brain tumor in young adults. Two patients were encountered with previously undiagnosed lung cancer, one with anaplastic carcinoma and the other with adenocarcinoma. A neurologic syndrome occurred in the morning with unusual headache and stroke-like episodes, presenting an acute ataxic hemiparesis and a pure motor hemiparesis, respectively. Papilloedema was a universal finding. The headache and neurologic deficits responded rapidly to glucocorticoid. A preexisting intracranial mass with an outburst of brain edema is thought to be the mechanism in this situation.

Low Dose Propranolol-Induced Delirium: 3 Cases Repot and a Review of Literature

Delirium in 3 elderly patients with recent cerebral infarction and pre-existing brain dysfunction receiving low dose propranolol is described. The dose ranged from 30 to 60 mg/day and the interval between delirium onset and drug initiation was 3-7 days. One patient exhibited ictal mydriasis and sinus tachycardia. Hypoalbuminemia was found in 1 patient. Discontinuation of propranolol abolished their delirious pictures 2-5 days later. Their delirium may be attributed to central beta blockade or anticholinergic effect. Preexisting brain damage, old age and hypoalbuminemia may predispose such patients to neuropharmacotoxicity of low dose propranolol.

An abnormal cholesterol profile in young adults with normocholesterolemic cerebral ischemia.

An abnormal cholesterol fraction can still be able to provoke cascades of lipidic atherogenesis even when the serum TC level is within normal range (< 200 mg%). However, there is a shortage of convincing data concerning cerebral atherogenesis in young Asians who have a different diet habit and living style from those in western countries. In this study, we examined the lipoprotein-cholesterol profile in young Taiwanese patients with noncardiac cerebral ischemia (NCCI) whose serum TC level was < 200 mg% and 200-250 mg%. The results showed a decrease of HDLC and an increase of VLDLC in patients with TC < 200 mg%, but only a decrease of HDLC in patients with TC = 200-250 mg%. The cholesterol fraction metabolism is obviously perplexed in NCCI subjects. These findings were not related to their associated risk factors. Accordingly, a derangement of cholesterol fraction with normal serum TC level can also incite lipidic cerebral atherogenesis in young Taiwanese adults. Therefore, a detailed evaluation of cholesterol profile should be born in mind in young eastern NCCI patients despite of a normal serum TC level. Tailored measure of diet and living should be modified to prevent lipidic atherogenesis in our society in future.