Direct medical costs for stroke in Korea were determined, which seem to be lower than those of other developed countries. Female gender, young age, and first stroke were factors related to higher stroke cost.

Cerebrospinal fluid (CSF) leak or shunt overdrainage is a well-known cause of orthostatic headaches and low CSF pressures. We report two cases of orthostatic headache with pneumocephalus on brain imaging. The orthostatic headache developed after drainage of spinal operation site and epidural block. Brain MRI revealed characteristic findings of CSF hypovolemia including pachymeningeal enhancement and mild subdural fluid collections. Air was also observed in the ventricular or subarachnoid space in both patients, which might enter the subarachnoid or ventricular space during a procedure via the pressure gradient or an injection. Characteristic MRI findings of spontaneous intracranial hypotension or intracranial hypotension following lumbar puncture are pachymeningeal enhancement, subdural fluid collections or subdural hematoma, engorgement of cerebral venous sinuses, enlargement of the pituitary gland, crowding of the posterior fossa, and a decrease in the size of the prepontine cisterns.1,2 These abnormalities have been explained by the Monro-Kellie doctrine, 3 whereby the summed volume of the brain, cerebrospinal fluid (CSF), and intracranial blood is nearly constant in an intact cranium. Therefore, the intracranial blood volume will be affected if CSF leakage occurs, resulting in a compensatory intracranial hyperemia that manifests as changes in brain MRI findings. We unexpectedly found intracranial air in patients complaining of orthostatic headache. Intracranial hypotension with orthostatic headache is a rare cause of pneumocephalus, 1,2 and here we report on these cases, including the imaging findings. CASE REPORTCase 1.A 75-year-old man with congestive heart failure and atrial fibrillation was transferred to our hospital for the management of dyspnea and coughing. A chest x-ray indicated pulmonary edema. He had received posterolateral fusion with pedicle screw fixation of L 4 and L 5 foramina 5 years previously. However, he suffered from sustained painful dysesthesia on the right leg and received follow-up decompression surgery for L 4 and L 5 foramina stenosis 2 days before admission to our hospital, during which the dura was torn and dural plasty was performed.On the 18 th hospital day at the Department of Internal Medicine he complained of nuchal discomfort with headache. Neurological deficits were not observed and the headache was not aggravated by

We report unusual MRI findings (including those from diffusion-weighted imaging (DWI)) in a patient with recurrent Wernicke's encephalopathy with a remarkable cerebellar lesion. DWI showed high signal intensities in the superior portion of the cerebellar hemisphere and vermis area. After thiamine administration, clinical symptoms improved and the lesions with high signal intensities disappeared on follow-up DWI.

Postural orthostatic tachycardia syndrome (POTS) refers to the presence of orthostatic intolerance with a heart rate (HR) increment of 30 beats per minute (bpm) or an absolute HR of 120 bpm or more. There are sporadic reports of the autonomic nervous system dysfunction in migraine and fibromyalgia. We report a case of POTS associated with migraine and fibromyalgia. The patient was managed with multidisciplinary therapies involving medication, education, and exercise which resulted in symptomatic improvement. We also review the literature on the association between POTS, migraine, and fibromyalgia.

No abstract