[show abstract][hide abstract] ABSTRACT: Diagnosis of aphasic status epilepticus is sometimes not easy because of its rarity and electroclinical dissociation. Although most cases are associated with organic brain lesions, nonketotic hyperglycemia (NKH)-related aphasic status epilepticus is rare, especially if it is isolated (without other clinical seizure activity). On the other hand, unlike other metabolic disorders, or hypoglycemia-related generalized seizures, focal motor seizure and epilepsia partialis continua can occur in 25% of NKH, with seizures being the initial manifestation in up to 50% of patients. However, the presentation of epileptic aphasia is rare in NKH patients. We report a rare case of NKH presenting initially as persistent and isolated aphasic status epilepticus. Brain magnetic resonance imaging did not reveal any focal lesion, but ictal electroencephalography (EEG) disclosed left frontotemporal continuous theta to delta waves, intermingled with epileptiform discharges. Correcting the hyperglycemia failed to improve the language disorder, and the seizure was controlled only by the addition of carbamazepine. Patients with NKH may initially present with isolated aphasic status epilepticus. Unlike stroke-related aphasia, accurate diagnosis is difficult if based solely on neurologic examination and brain neuroimaging. Use of EEG and blood sugar determination should be helpful in this special condition.
Clinical EEG and neuroscience: official journal of the EEG and Clinical Neuroscience Society (ENCS) 09/2013; · 1.82 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study aimed to investigate which cerebral cortices are involved in the central autonomic network and how they are linked to the peripheral (cardiac) autonomic network in Parkinson's disease (PD) patients and normal controls. 26 PD patients with autonomic dysfunction and 23 age- and sex-matched controls were evaluated by simultaneous spectral analysis of electroencephalography (EEG) and electrocardiography (ECG) recording along with autonomic questionnaires. Although the PD group has significantly more symptoms of autonomic dysfunction, frequency-domain HRV can not differentiate these two groups. However, different patterns of central oscillation and their correlation with peripheral autonomic indices could be found for the two groups. While the power of specific EEG bands under electrodes F4, F7, Cz and Pz (parietal-lateral premotor cortex, which is considered as a compensatory area for the relative deficiency of mesial frontal-striatal circuits in PD) correlated significantly with the power of peripheral heart rate variability (HRV) indices in the PD group, those under electrodes C3, P3, P4 and F8 had significant correlation in the control group. In conclusion, functional connectivity between areas of cerebral cortex and peripheral autonomic system can be measured and differs between PD patients with autonomic dysfunction and healthy controls. The central autonomic network may play a role in brain re-organization in PD patients with autonomic dysfunction.
Journal of the neurological sciences 01/2013; · 2.32 Impact Factor
[show abstract][hide abstract] ABSTRACT: Circadian variation of the onset time of acute ischemic stroke has been well studied. However, little is mentioned about the circadian variation of discharge-stroke severity and discharge-functional status. This study evaluated the impact of onset time on discharge-stroke severity and the functional status of acute ischemic stroke. Brain magnetic resonance imaging was performed on 274 acute ischemic stroke patients (66.42% male; mean age = 64.81 ± 12.80 years). All times of onset were assigned to 4-hourly periods (six groups) starting from midnight. Stroke severity/functional status was evaluated on admission and discharge using the National Institute of Health Stroke Scale (NIHSS) score/modified Rankin Scale (mRS) and Barthel Index (BI), respectively. Using mRS, but not NIHSS score and BI, it was possible to differentiate the best and worst groups on discharge. Patients in group 2 (4 to <8 am) and group 6 (8 to <12 pm) had best and worst functional status, respectively. To control other stroke risk factors, multiple logistic regression analyses were conducted to examine the role of onset time in discharge mRS. Aside from age, onset time was a significant indicator in mRS, while gender, hypertension, diabetes mellitus, hyperlipidemia, atrial fibrillation, and current smoking were not. In conclusion, there is also circadian variation of discharge-functional status in patients with acute ischemic stroke when assessed by mRS.
The Kaohsiung journal of medical sciences 01/2013; 29(1):32-6. · 0.50 Impact Factor
[show abstract][hide abstract] ABSTRACT: Our aim was to measure the relationship of FAS (-1377G>A and -670A>G), FASL (-844C>T) gene variants and risk of oral cancer.
Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis was used to determine the FAS and FASL polymorphisms in 294 oral squamous cell carcinoma (OSCC), 53 oral submucous fibrosis (OSF), and 84 oral leukoplakia (OL) patients, as well as in 333 healthy controls. A standardized questionnaire was applied to collect demographic data, and potential confounding factors. JMP statistical software was used to analyze the association.
FAS and FASL polymorphisms were not correlated with OSCC development or the malignant potential of OL by simple and multivariate logistic regression. However, a two- to fourfold difference in the risks of betel quid chewing, alcohol consumption, and smoking on OSCC development were observed between participants with different FAS polymorphisms. FAS polymorphisms were significantly correlated with the malignant potential of OSF. Multivariate logistic regression analysis indicated that FAS A(-1377)-G(-670) vs. G(-1377)-A(-670) haplotype (OR = 2.26, 95% CI = 1.16-4.41) was correlated with the malignant potential of OSF.
We suggest that FAS and FASL polymorphisms are not significantly correlated with OSCC development or malignant potential of OL. The impact of substance usage on OSCC development could be differentiated by FAS polymorphisms. FAS A(-1377)-G(-670) haplotype may play a role in the malignant potential of OSF.
Journal of Oral Pathology and Medicine 02/2010; 39(2):155-61. · 2.06 Impact Factor
[show abstract][hide abstract] ABSTRACT: Acute insular infarction, due to its anatomic and functional complexity and wide connections, may present with various clinical presentations, such as somatosensory deficits, gustatory disorder, vestibular-like syndrome, cardiovascular disturbances, neuropsychological disorders, movement disorders, autonomic dysfunction and empathy impairment. However, there was no mention of the symptoms involving the cerebellar system in the related literature. We present a case of pure left insular cortex infarction with isolated truncal ataxia and demonstrate a crucial relationship between the left insular cortex and the cerebellar system. The possible connections are through the spinocerebellar and dentatorubrothalamic pathway. In conclusions, left insular cortex lesions should be considered in the differential diagnosis of isolated truncal ataxia.