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Intravascular large B-cell lymphoma (IVLBCL) is a rare form of non-Hodgkin’s lymphoma that selectively involves the lumina of vessels, and may present as ischemic stroke. A 62-year-old man presented with progressive aphasia, dementia, seizure and stroke-like symptom. Brain magnetic resonance imaging revealed dynamic progressive fluid attenuated inversion recovery lesions and multiple punctate microbleeds in the bilateral subcortical region. A kidney biopsy revealed IVLBCL. We report a patient with IVLBCL presenting as rapidly progressive encephalopathy.

Heat stroke (HS) is a medical emergency and life threatening condition, characterized by body temperature over 40°C. This can lead to dysfunction of multiple organs such as the heart, liver, kidneys, lungs, blood coagulation system, and central nervous system. Neurological complications include change in consciousness, cerebellar dysfunction, convulsions, aphasia, muscular weakness, and parkinsonism. Cerebellar syndrome is the most common neurological finding in HS. We report a case of HS presenting with status epilepticus, without any other neurological manifestations. A 42 year old man, previously diagnosed with bipolar disorder, was admitted to the emergency room with high fever and repetitive generalized tonic-clonic seizures. He had been found unconscious after 4 hours of heavy physical work under extremely hot weather conditions. He was diagnosed with HS accompanied by status epilepticus, and treated with emergency body cooling and antiepileptics. Five days after admission, he regained consciousness and the laboratory parameters that were initially abnormal returned to normal values. On day 14, he was discharged without any neurological complications.

Background The objective of the study was to evaluate the predictive value of plasma D-dimer at admission after acute ischemic stroke, and to assess its effect on short-term functional outcome. Methods Fasting plasma D-dimer was measured in 290 consecutive patients (61.7% men, mean age 67.0±12.3 years) within 3 days after the onset of acute ischemic stroke. The outcomes were measured at 3-months after stroke onset, by the modified Rankin Scale (mRS). Results Atrial fibrillation, hypertension, diabetes and involvement of the insular cortex, the levels of serum high sensitive C-reactive protein and D-dimer, as well as incidence of women and age, were all significantly higher in the poor outcome group (P

Parvovirus B19 (PVB19) infection is a rare cause of meningoencephalitis. A 53-year-old previously healthy woman presented with fever, headache, and multiple erythema on the both legs. Cerebrospinal fluid study revealed pleocytosis and elevated opening pressure and protein level. Brain MRI showed multiple, asymmetric, hyperintensity in the brain stem, basal ganglia, white matter, and gray matter. Anti-B19 IgM antibody and PCR for PVB19 were positive in serum. Clinician should consider PVB19 infection in any case of acute febrile illness with erythema and meningoencephalitis

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.

Hydrogen sulfide is a colorless gas and frequently lethal occupational hazard that causes tissue hypoxia with prominent neurological signs. Depending on the amount of exposure, many neurotoxic effects such as headache, disequilibrium, and loss of consciousness have been reported. However, a few address the brain MRI findings in hydrogen sulfide poisoning. We report serial brain MRI findings in a patient with hydrogen sulfide intoxication. J Korean Neurol Assoc 33(4):334-337, 2015

Background/Objectives: Detection of atrial fibrillation (AF) is important for diagnosis of cardioembolic stroke. Few studies that cardioembolic stroke relate to some biomarkers such as high sensitive C-reactive protein (hs-CRP), free fatty acid (FFA), pro-brain natriuretic peptide (pro-BNP) and D-dimer have been reported. FFAs are major components of epicardial fat. Increased epicardial fat thickness (EFT) is known to be associated with the presence of AF. The object of this study is to find the useful markers to distinguish stroke with AF in acute ischemic stroke. Design/Method: Total 214 consecutive patients (mean age, 66.8±12.3 years; 39.7% women; 16.4% AF group) with acute ischemic stroke within 72 hours of onset were retrospectively enrolled. We analyzed the EFT and the several biomarkers between stroke with and without AF. Results: Age, heart rate, FFA, pro-BNP, hs-CRP, HDL and the frequency of woman were significantly higher in AF group (p Conclusions: The combination of EFT, FFA and pro-BNP can be a useful marker for the prediction of the AF in acute ischemic stroke.

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.

Introduction: As indicators of the systemic inflammatory response, the neutrophil-to-lymphocyte ratio (NLR) have been proposed to predict the clinical outcome in cardiovascular disease, diabetes, and various malignancies. We assessed the significance of NLR as a predictor of the outcome in patients with acute ischemic stroke. Methods: We retrospectively analyzed the clinical characteristics, laboratory parameters, and NLR in 356 consecutive patients (62.2% men, mean age 65.8±13.0 years) within 3 days after the onset of acute ischemic stroke between July 2012 and March 2015. The NLR was calculated from the differential counts by dividing the neutrophil number by the lymphocyte number at the time of admission. All subjects were divided into four groups according to quartiles of the NLR. Outcomes were measured as 3-month modified Rankin scale (mRS) score. A good functional outcome was defined as a mRS of 0-2 points, whereas a poor outcome was defined as a mRS of >2 points. Multivariate logistic regression analysis was used to assess association among the clinical, inflammatory and serological parameters including NLR and mRS scores. Results: The frequency of atrial fibrillation, heart failure, hypertension, and diabetes, the NIHSS score at admission, and the level of hs-CRP, D-dimer and the NLR were each significantly higher in the poor outcome group (p < 0.05). The cut-off values of NLR and NIHSS score at admission for prediction of the poor outcome were 2.135 (sensitivity 0.864 and specificity 0.533) and 3.5 (sensitivity 0.862 and specificity 0.787), respectively. In age-adjusted analysis, the NLR were significantly correlated with 3-month mRS score (partial r = 0.329, p < 0.001) and NIHSS score at discharge (partial r = 0.301, p < 0.001). Multivariate logistic regression analysis demonstrated that age of ≥65 (OR, 10.2; 95% CI, 3.31-31.21, p < 0.001), presence of diabetes mellitus (OR, 3.3; 95% CI, 1.36-8.12, p = 0.008), NIHSS score of ≥4 (OR, 26.4 95% CI, 9.81-71.15, p < 0.001), NLR of ≥2.135 (OR, 9.2; 95% CI, 3.18-26.4, p < 0.001) were independently associated with poor functional outcome. Conclusion: The NLR is a useful marker for short-term functional outcome in acute ischemic stroke. The NLR may have a role in risk stratification for predicting poor outcome.

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.

Introduction: N-terminal pro-brain natriuretic peptide (NT-proBNP) predicts poor outcome in cardiovascular disease. The prognostic value of NT-proBNP in acute ischemic stroke is limited and remains controversial. We sought to determine whether NT-proBNP at admission were associated with short-term functional outcome after acute ischemic stroke. Methods: We measured fasting serum NT-proBNP in consecutive 357 patients (62.2% men, mean age 65.8±13.0 years) within 3 days after the onset of acute ischemic stroke. Outcomes were measured as 3-month modified Rankin Scale (mRS) score. A good functional outcome was defined as a mRS of 0-2 points, whereas a poor outcome was defined as a mRS of >2 points. Multivariate logistic regression was used to assess association between the clinical and serological parameters including NT-proBNP and mRS scores. Results: The frequency of atrial fibrillation, heart failure, hypertension, and diabetes, the NIHSS score at admission, and the level of NT-proBNP, hs-CRP, creatine kinase-MB and D-dimer were each significantly higher in the poor outcome group (p

Background: Behavioral and psychological symptoms may be the presenting manifestations of dementia syndrome, appearing before cognitive alterations and heralding the onset of the dementia. Behavioral and psychological symptoms in vascular dementia (VaD) are rarely reported. We investigated the prevalence and related factors of behavioral and psychological symptoms in VaD and compared the severity and relative frequency of symptoms between small-vessel VaD and large-vessel VaD. Methods: Behavioral and psychological symptoms of 67 patients in VaD were determined using the Korean version of neuropsychological inventory (K-NPI). The following parameters were recorded and analyzed: education level, dementia duration, Korean version of Mini-mental Status Examination (K-MMSE), clinical dementia rating (CDR), global deterioration scale (GDS), Barthel index (BI), instrumental activity of daily living (IADL) and geriatric depression scale. Results: Based on MRI, patients were classified as having small-vessel and large-vessel VaD. The study group was composed of 27 large-vessel and 40 small-vessel disease. No differences were found between small-vessel and large-vessel VaD in the severity of cognition and ADL, use of psychotrophic medication and risk factors for stroke. Apathy was most prevalent (60%), followed by depression (43%), anxiety (37%), aberrant motor (34%), irritability (33%), night-time behavior (30%), agitation (28%) and disinhibition (28%) in VaD. Apathy was more common in small-vessel VaD than large-vessel VaD (P=0.011). Total K-NPI score was correlated with severity of deep white matter changes, CDR, GDS, BI and IADL. Multiple regression analysis revealed that total K-NPI score and prevalence of individual K-NPI sub-items were independently associated with number of microbleeds, severity of white matter changes, GDS and diabetes mellitus. Conclusions: Behavioral and psychological symptoms are relatively common in VaD. Patients with small-vessel and large-vessel VaD reveal different profiles of neurobehavioral symptoms. Apathy are more common in small-vessel VaD, reflecting disruption of white matter tracts.