Jong Sung Kim

Pure or predominantly sensory transient ischemic attacks (ps-TIAs) are uncommon, and underlying vascular abnormalities have rarely been described. The author reports 5 patients with TIAs which were of short duration, stereotypical and purely or predominantly sensory in nature. Brain MRI did not reveal any lesions, while angiography demonstrated focal stenoses in the proximal portion of the posterior cerebral artery (PCA). It is concluded that ps-TIAs strongly suggest the presence of PCA disease. Repeated compromise of small vessels supplying the posterior-lateral part of the thalamus seems to be the pathogenic mechanism.

Although post-stroke emotional incontinence (EI) often occurs after lenticulocapsular strokes, what factors determine the development of EI in these patients has not been identified. I prospectively studied the development of EI in 25 patients (13 men and 12 women, mean age 58.5 years) with single, unilateral, first-ever stroke (24 infarcts and one hemorrhage) of ≤ 2 cm in diameter at 2–6 months after the stroke. The patients with major depression were excluded. The lesion location was analysed by CT and/or MRI. The results showed that 13 patients (52 %) had post-stroke EI. The presence of EI was not related to age, gender, the presence of motor or sensory dysfunction, Barthel index score or the size and the laterality of the lesion. Among the lesions involving mainly the globus pallidus, dorsally located lesions were more often associated with EI than ventrally located ones. I conclude that EI is frequent in the patients with small lenticulocapsular stroke, more often associated with the lesions affecting the dorsal than the ventral part of the globus pallidus. The findings appear to be consistent with alleged chemical neuroanatomy that serotonergic fibers are particularly abundant in the internal globus pallidus.

Objectives: To assess the clinical features of and risk factors for recurrent pontine base infarction. Methods: This study includes 5 patients with unilateral pontine base infarction who developed another infarction on the opposite side and, for comparison, 10 follow-up period-matched patients with unilateral pontine base infarction who did not develop recurrent pontine infarction. MRI and angiogram studies were performed in all cases. The two groups were compared. Results: The patients with recurrent pontine base infarction developed quadriparesis, dysarthria and dysphagia. MRI showed bilateral infarcts abutting on the basal surface of the pons. Angiogram studies revealed diseased basilar artery in 3 patients. There were no differences regarding age, gender, angiogram findings and frequency of hypertension, diabetes mellitus, cigarette smoking and hypercholesterolemia between the patients with recurrent stroke and those without. However, the former had a significantly higher number of risk factors for atherosclerosis (p < 0.05) and higher frequency of coronary heart disease (p < 0.05) than the latter. Conclusions: The number of risk factors for atherosclerosis and a concomitant presence of coronary heart disease may be factors related to recurrent pontine base infarction in patients with unilateral pontine infarction. The main pathogenesis of recurrent pontine base infarction seems to be basilar artery branch atherothrombosis.

Using the 10-item Spielberger Trait Anger Scale, the authors interviewed 145 patients with stroke regarding inability to control anger or aggression (ICAA). Poststroke depression and emotional incontinence were also assessed. ICAA was present in 47 patients (32%) and was closely related to motor dysfunction, dysarthria, emotional incontinence, and lesions affecting frontal–lenticulocapsular–pontine base areas. ICAA seems to be one of the major behavioral symptoms in patients with stroke.

A 66-year-old man suddenly developed weakness in his right index finger. He had diabetes mellitus for 26 years and had been treated with insulin during the last 4 years. However, he had never experienced paresthesia or weakness in the extremities. Two days later, he had mild left temporal headache followed by visual dimness in his right visual field. On examination the next day, he was alert without dysarthria or aphasia. There was right homonymous hemianopia. Other cranial nerves were within normal limits. Motor examination revealed mild weakness (IV/V) of his right index finger. The weakness was most severe at the distal interphalangeal joint, extension being slightly more severely …

Background: Altered food preference or preoccupation with certain food after stroke has been rarely described in the literature. Methods: We report four Korean patients who developed altered food preference secondary to unilateral cortical infarction. Results: Two patients showed preoccupation with meat such as Pulgogi or Kalbi (roast beef flavored with ingredients), which had not been their preference prior to the occurrence of stroke. All the patients became intolerant to the smell and taste of mackerel, and two disfavored hot Kimchi (cabbage salted with hot pepper). Quantitative taste assessment done in the patients revealed decreased taste perception in a variable pattern along with dysgeusia. Imaging studies showed that the region commonly involved was the frontal opercular area corresponding to the taste cortex. Conclusion: It is suggested that strokes involving the taste cortex may produce altered food preference associated with decreased taste sensation.

Background: Although poststroke depression has been shown to be related to decreased sexual activity (SA), the relationship between poststroke emotional incontinence (EI) and SA has not been properly investigated. Methods: We examined 70 nondepressed, sexually active patients with first-ever stroke approximately 3 months after stroke and conducted a follow-up interview approximately 2 years after stroke in 55 of them. EI (excessive/inappropriate laughing/crying) and SA (libido, coital frequency, erectile function) were assessed with the use of a standardized questionnaire. Results: Of these 70 patients, 24 (34%) had EI 3 months after stroke, which had resolved 2 years after stroke. Libido, coital frequency and erectile function were reported to have declined in 49, 65 and 26% of the patients, respectively, 3 months after stroke, and in 44, 49 and 20% of the patients 2 years after stroke. Multivariate analyses showed that low coital frequency before stroke (CFBS) was significantly (p < 0.05) related to decreased poststroke coital frequency, while the presence of EI (p < 0.05) and low CFBS (p < 0.05) was significantly associated with decreased erectile function 3 months after stroke. Two years after stroke, the presence of EI 3 months after stroke was significantly related to decreased libido, coital frequency and erectile function (p < 0.05 each). Age, gender, laterality of stroke, Barthel Index score, motor dysfunction and the presence of hypertension and diabetes mellitus were not independently related to SA 3 months and 2 years after stroke. Conclusion: The presence of EI is a factor related to decreased poststroke SA, more so in chronic than in subacute stages.

Background: Small cortical strokes may cause predominant weakness restricted to a particular group of fingers. However, clinical, radiologic, and etiopathogenetical studies have rarely been done in these patients. Method: The author analyzed clinical and radiologic features of 12 patients with small cortical infarcts who had predominant weakness of particular fingers. Results: The patients were divided into two groups: Eight patients had predominant involvement of ulnar-sided fingers (PIUF), and four had predominant involvement of radial-sided fingers (PIRF). Sensory symptoms were also present in eight patients, and the severity correlated with that of motor impairment. Radiologic–clinical correlation showed that the lesions related to PIUF were located significantly more medially than those associated with PIRF in the presumed hand representation area of the motor cortex. In addition, the PIUF was closely associated with severe proximal vessel stenosis or occlusion, whereas the PIRF was often related to emboligenic stroke. Conclusions: The results agree with traditionally alleged topography for fingers in the human motor cortex: ulnar fingers—medial and radial fingers—lateral. However, whether this result indicates a point-to-point somatotopical representation or differential threshold of excitability in individual neurons remains unknown. Sensory topography seems to be closely associated with that of motor function in individual subjects. The motor cortex representing ulnar-sided fingers may be a borderzone area between large arteries.

Five patients are described who developed unilateral narrowing of the palpebral fissure that was aggravated by smiling. They had ischaemic lesions involving mainly the contralateral lenticulocapsular area. This rare but distinct symptom may be an action induced focal eyelid dystonia, and could be described as ‘smile-wink’ phenomenon.