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Although risk factors for acute coronary syndrome (ACS) and atherothrombotic cerebral infarction (ACI) are common, it is unknown if the risk factors for these two conditions are similar. The purpose of our study was to elucidate differences in carotid artery atherosclerotic features between ACS and ACI. We measured carotid artery ultrasound-based atherosclerotic parameters in 61 ACS and 33 ACI patients. In the ACS patients, 31 had single-vessel coronary artery disease (SVD) and 30 had multivessel coronary artery disease (MVD). The maximum intima–media thickness (IMT) of the common carotid artery was higher in ACS patients with MVD than in ACS patients with SVD (P

We report a case with 46-year-old man diagnosed with mitochondrial cardiomyopathy in the dilated phase of hypertrophic cardiomyopathy. Since cardiac magnetic resonance imaging, beta-methyl-p-I123-iodophenyl-pentadecanoic myocardial scintigraphy, and positron emission tomography/computed tomography revealed no remarkable findings, we performed electron microscopic examination, which aided in diagnosing mitochondrial cardiomyopathy. Muscle biopsy was also compatible with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes and DNA analysis also concluded it. Since muscle biopsy is less invasive for patients compared to endomyocardial biopsy, cardiologists need to consider it. The diagnosis of mitochondrial cardiomyopathy is helpful because it is a genetic condition and also for consideration of device therapy, as well as management for acute crisis.

In posterior reversible encephalopathy syndrome, isolated involvement of the brainstem is rare. In addition, there have been a few reports describing a concomitant occurrence of stroke and a brainstem variant of posterior reversible encephalopathy syndrome. We here report a patient with isolated pontine involvement of posterior reversible encephalopathy syndrome accompanied by fresh ischemic cerebral infarction in the left corona radiata detected by brain magnetic resonance imaging. Follow-up brain magnetic resonance imaging on hospital day 14 showed a marked improvement of signal changes in the pons; however, cerebral infarction in the left corona radiata enlarged despite medical treatment. Although rare, clinicians should be aware of the co-occurrence of posterior reversible encephalopathy syndrome and ischemic infarctions, especially in patients with untreated/uncontrolled hypertension and chronic kidney disease. We discuss the possible mechanism related to brainstem posterior reversible encephalopathy syndrome and stroke, reviewing the previous case reports.

Background Meningeal carcinomatosis and hypercoagulability associated with malignancy are typical late stage complications in cancer patients. The co-occurrence of meningeal carcinomatosis and cerebral infarction related to hypercoagulability associated with malignancy in an individual as the initial manifestation of malignancy has not been previously reported. Case presentation Herein, we report the case of an 80-year-old patient who presented with meningeal carcinomatosis and hypercoagulability related to malignancy as the initial manifestation of occult gastric cancer. The patient displayed consciousness disturbance, mild left facial paralysis, and bilateral positive Babinski’s sign. Using brain magnetic resonance imaging, the patient was diagnosed as having acute multiple cerebral infarctions. Cerebrospinal fluid (CSF) cytology showed adenocarcinoma and upper gastrointestinal endoscopy disclosed scirrhous gastric cancer. The patient presented with headache, fever, and meningeal irritation with a subacute course. Tuberculous or fungal meningitis was initially suspected; however, cytological evidence of adenocarcinoma in the CSF led to the diagnosis of meningeal carcinomatosis. Conclusion The comorbidity of hypercoagulability associated with malignancy and meningeal carcinomatosis should be considered in a patient presenting with multiple cerebral infarctions, progressive disturbance of consciousness, fever, and meningeal irritation.

Acute hemicerebellitis, marked by headache with or without cerebellar signs, is a rare clinical entity involving a unilateral cerebellar hemisphere. The pathogenesis of acute hemicerebellitis remains unclear, and the disease rarely occurs in adults. Here, we report an 18-year-old woman who presented with a lack of coordination of the right hand and leg lasting longer than one week, following a pulsatile headache. A neurological examination disclosed ocular dysmetria, right-sided limb ataxia and slight truncal ataxia. Cerebrospinal fluid analysis showed mononuclear pleocytosis. The serology and autoimmune studies were unremarkable. Brain magnetic resonance imaging (MRI) revealed a focal signal change in the right cerebellar hemisphere and vermis. Acute hemicerebellitis was diagnosed, and the patient was treated with intravenous methylprednisolone sodium succinate and acyclovir. Subsequently, the headache resolved, and the cerebellar signs were markedly improved. Twenty days after admission, she became asymptomatic and brain MRI showed resolution of cerebellar hyperintensity on the right side. In conclusion, we identified only 6 additional patients with adult-onset acute hemicerebellitis from previous reports, highlighting the importance of recognizing this rare clinical entity. Its clinical outcome is usually favorable, but in the acute phase, attention should be directed toward clinical symptoms that are suggestive of increased intracranial pressure.

OBJECTIVE The aim of this study was to evaluate the relationship between fatty liver disease (FLD) and cerebrovascular disease. METHODS We conducted a cross-sectional study of 76 consecutive healthy subjects who participated in a two-day hospitalized health checkup program. The maximal intima-media thickness (IMT) of the common carotid artery and bifurcation of the carotid artery as well as the plaque score (PS) were evaluated on carotid artery ultrasonography. Fluid attenuated inversion recovery brain MRI was used to determine the presence of asymptomatic cerebral lesions and periventricular hyperintensity. Brain MR angiography was used to evaluate the degree of intracranial main artery stenosis (ICAS). FLD was diagnosed based on the ultrasonographic pattern. RESULTS The PS and IMT did not differ between the FLD (n=24) and non-FLD (n=52) groups. There was a tendency toward a higher percentage of multiple lacunar lesions in the non-FLD group than in the FLD group. ICAS was significantly more frequent in subjects in the FLD group than those in the non-FLD group (25.0% vs. 5.8%). A logistic regression analysis revealed that age and FLD were significant determinants of ICAS. CONCLUSION Our study findings suggest a significant association between ICAS and FLD.

Clinicoradiological correlations observed in patients with small cortical infarctions have supported somatotopic representation of different parts of body areas in primary motor cortex. However, isolated shoulder weakness because of infarction in precentral gyrus has rarely been described. We report an 80-year-old woman with isolated shoulder palsy because of cortical ischemic infarction in the base of the left precentral gyrus as confirmed by brain magnetic resonance imaging. In our patient, cardiogenic embolism or Trousseau syndrome associated with lung cancer was considered the cause of ischemic infarction. Physicians should consider small cortical infarction, when a patient complains of sudden onset of shoulder weakness without pain. In line with the previous reports, a responsible cortical lesion in our patient corresponded to motor shoulder area in the motor homunculus reported to be located more medially to the hand area.

A 72-year-old man with diabetes mellitus and hypertension was admitted to our hospital with lightheadedness. The patient showed lateropulsion to the right side, but his neurological findings were otherwise normal. Brain magnetic resonance images showed a fresh ischemic infarct in the left dorsal part of the lower pons. Body lateropulsion is characterized by an irresistible falling to one side and has been reported in lesions in several brain regions. However, it has rarely been reported in pontine lesions. We suggest that physicians should be aware that pontine lesions can cause isolated body lateropulsion without other neurological deficits.

A 66-year-old man was admitted to our hospital with muscle pain, fatigue and appetite loss that had lasted for a month. The patient was somnolent and had nuchal stiffness with a high fever. Cerebrospinal fluid (CSF) tests demonstrated lymphocytic pleocytosis with a decreased CSF-blood glucose ratio. The tests for tuberculous, fungal and carcinomatous meningitis and herpetic meningoencephalitis were negative. Endocrinological exams showed hypopituitarism and diabetes insipidus. A pituitary MRI showed an enlargement of the pituitary stalk. A diagnosis of lymphocytic hypophysitis with aseptic meningitis was made after the exclusion of secondary hypophysitis. Lymphocytic hypophysitis with aseptic meningitis can mimic subacute meningoencephalitis.

A 79-year-old woman who had diabetes mellitus for 22 years developed coma 1 day after influenza A virus infection. Diabetic ketoacidosis (DKA) was diagnosed based on high serum glucose levels (902 mg/dL), an arterial pH of 7.19 and large urine ketone (3 + ). Subsequently, the patient was treated with insulin and fluid therapy. After improvement in serum glucose levels, diffusion-weighted magnetic resonance imaging (MRI) showed acute infarction in the bilateral middle and posterior cerebral artery territories (Fig. 1). No severe stenosis in major cerebral arteries on magnetic resonance angiography was detected. Transthoracic and transesophageal echocardiography did not show any potential cardiac source of embolism including patent foramen ovale or thrombi in the left ventricle. In the present patient, brain lesions on MRI were located in the white matter, but not in cortices, suggesting microcirculatory impairment by hyperglycemia-induced hypercoagulability and/or hyperviscosity. DKA is associated with thrombotic risks, such as abnormalities in coagulation factors, platelet activation and blood volume, and cerebral edema as a result of DKA might predispose to stroke; however, DKA associated with stroke is rare in adults.