The Role of Neurologists in Pain Management – Based on the Survey Conducted by the Korean Neurological Association in 2020

Background@#Pain is one of the most common chief complaints in neurological field. Authors try to inform the current situation of pain medicine in neurological practice and present an effective method for pain-related education during neurology residency and for practicing neurologists. @*Methods@#A survey was conducted from November 16 to November 27, 2020 for members of the Korean Neurological Association, and the results were analyzed. @*Results@#About two-thirds of neurologists replied that more than 25% of their patients were suffered from diverse pain including headache, spine pain or neuropathic pain. Despite many patients are visiting to neurologist for pain treatment, most neurologists are aware that they have not received sufficient practical pain education in the past and present. Therefore, they want more educational opportunities in pain medicine including interventional pain management and physical and pharmacologic therapies for more effective treatment. @*Conclusions@#More follow-up studies on pain treatment and education should be conducted. It is also essential that the members of the society continue to interest and participate in the change of the pain education program.

Content Analysis of Korean Videos Regarding Restless Legs Syndrome on YouTube

Objective@#To evaluate the accuracy and quality of Korean videos associated with restless legs syndrome (RLS) on YouTube. @*Methods@#A YouTube search was performed on April 1, 2020 using the term “restless legs syndrome” in the Korean language. Two reviewers coded the source, content, and demographics of the included videos. Video quality was assessed using the modified DISCERN (mDISCERN) instrument. @*Results@#Among the 80 videos analyzed, 44 (55.0%) were reliable, and 36 (45.0%) were misleading. There was a trend toward a higher number of mean daily views in the misleading videos than in the reliable videos. Most of the misleading videos (72.2%) advocated complementary and alternative medicine as a primary treatment for RLS. Although the reliable videos had higher mDISCERN scores than the misleading videos, the overall quality of the reliable videos was low. @*Conclusion@#Many Korean videos regarding RLS on YouTube involve a risk of exposure to misinformation and are of unsatisfactory quality.

Content Analysis of Korean Videos Regarding Restless Legs Syndrome on YouTube

Objective@#To evaluate the accuracy and quality of Korean videos associated with restless legs syndrome (RLS) on YouTube. @*Methods@#A YouTube search was performed on April 1, 2020 using the term “restless legs syndrome” in the Korean language. Two reviewers coded the source, content, and demographics of the included videos. Video quality was assessed using the modified DISCERN (mDISCERN) instrument. @*Results@#Among the 80 videos analyzed, 44 (55.0%) were reliable, and 36 (45.0%) were misleading. There was a trend toward a higher number of mean daily views in the misleading videos than in the reliable videos. Most of the misleading videos (72.2%) advocated complementary and alternative medicine as a primary treatment for RLS. Although the reliable videos had higher mDISCERN scores than the misleading videos, the overall quality of the reliable videos was low. @*Conclusion@#Many Korean videos regarding RLS on YouTube involve a risk of exposure to misinformation and are of unsatisfactory quality.

The Role of Neurologists in Pain Management – Based on the Survey Conducted by the Korean Neurological Association in 2020

Background@#Pain is one of the most common chief complaints in neurological field. Authors try to inform the current situation of pain medicine in neurological practice and present an effective method for pain-related education during neurology residency and for practicing neurologists. @*Methods@#A survey was conducted from November 16 to November 27, 2020 for members of the Korean Neurological Association, and the results were analyzed. @*Results@#About two-thirds of neurologists replied that more than 25% of their patients were suffered from diverse pain including headache, spine pain or neuropathic pain. Despite many patients are visiting to neurologist for pain treatment, most neurologists are aware that they have not received sufficient practical pain education in the past and present. Therefore, they want more educational opportunities in pain medicine including interventional pain management and physical and pharmacologic therapies for more effective treatment. @*Conclusions@#More follow-up studies on pain treatment and education should be conducted. It is also essential that the members of the society continue to interest and participate in the change of the pain education program.

Pathologic Finding of Thymic Carcinoma Accompanied by Myasthenia Gravis

BACKGROUND AND PURPOSE: The World Health Organization (WHO) has classified thymic carcinoma and other thymomas (types A, AB, and B) as different neoplasms. Myasthenia gravis (MG) is an early sign of thymoma and theoretically does not accompany thymic carcinoma; however, cases of thymic carcinoma with MG have been reported. Whether thymic carcinoma can accompany MG has yet to be established. METHODS: The medical records of patients who underwent thymectomy for MG between 1990 and 2011 in a single hospital were reviewed. All cases with the diagnostic code of "thymic carcinoma" or "thymoma type C" (old terminology) were selected. A pathologist re-reviewed the pathologic specimens using the new WHO criteria. The rate of thymic carcinoma among these MG patients was then calculated. RESULTS: A total of 81 patients with MG had thymic tumors, 10 of whom had thymic carcinomas or thymoma type C. Seven cases of well-differentiated thymic carcinomas (type B3) were excluded, leaving three (3.7%) cases of thymic carcinoma with MG. All three of these cases were type B3 thymoma with a focal squamous cell carcinoma component that was very small and well demarcated. In addition, two out of the three tumors were found to be at an early clinical stage. All of the cases survived without recurrence over follow-up periods of at least 5 years. CONCLUSIONS: Thymic carcinoma transformation from thymoma can occur during the early stages of thymoma. The association of this condition with MG is not as rare as was previously thought. Thymic carcinomas accompanying MG had a predominant B3 thymoma component with a focal thymic carcinoma area (squamous cell carcinoma).

Tooth Loss Is Associated with Brain White Matter Change and Silent Infarction among Adults without Dementia and Stroke

Periodontal disease is a predictor of stroke and cognitive impairment. The association between the number of lost teeth (an indicator of periodontal disease) and silent infarcts and cerebral white matter changes on brain CT was investigated in community-dwelling adults without dementia or stroke. Dental examination and CT were performed in 438 stroke- and dementia-free subjects older than 50 yr (mean age, 63 +/- 7.9 yr), who were recruited for an early health check-up program as part of the Prevention of Stroke and Dementia (PRESENT) project between 2009 and 2010. In unadjusted analyses, the odds ratio (OR) for silent cerebral infarcts and cerebral white matter changes for subjects with 6-10 and > 10 lost teeth was 2.3 (95% CI, 1.38-4.39; P = 0.006) and 4.2 (95% CI, 1.57-5.64; P < 0.001), respectively, as compared to subjects with 0-5 lost teeth. After adjustment for age, education, hypertension, diabetes mellitus, hyperlipidemia, and smoking, the ORs were 1.7 (95% CI, 1.08-3.69; P = 0.12) and 3.9 (95% CI, 1.27-5.02; P < 0.001), respectively. These findings suggest that severe tooth loss may be a predictor of silent cerebral infarcts and cerebral white matter changes in community-dwelling, stroke- and dementia-free adults.

Exofocal Anterograde Transsynaptic Neuronal Death in the Globus Pallidus: Two Case Reports

BACKGROUND: Exofocal neuronal death in the substantia nigra (SN) is a well-known form of anterograde transsynaptic cell death. Exofocal neuronal death could theoretically also occur in the globus pallidus (GP) after striatal injury. CASE REPORT: Case 1. A 70-year-old woman visited the emergency room because of decreased mentality. On admission, blood-gas analysis indicated that her oxygen tension was 69.1 mm Hg. The caudate nucleus, putamen, and temporooccipital cortex on both sides of the brain exhibited high-intensity diffusion-weighted magnetic resonance imaging (MRI) signals. At 10 days after admission, new high-intensity signals had developed in the SN and GP on both sides. Case 2. A 48-year-old man visited the emergency room because of right-sided weakness. Lesions were noted in the left caudate nucleus and putamen. At 4 days after admission, newly developed high-intensity MRI signals were observed in the left SN and GP. CONCLUSIONS: Exofocal neuronal death can occur in the GP as well as in the SN; these findings need to be clearly distinguished from those of recurrent ischemic injuries, such as recurrent stroke.

Multiple Ischemic Stroke as an Initial Manifestation of a Concealed Pancreatic Adenocarcinoma

No abstract available.

Multiple Cerebral Infarcts Following Acute Plasmodium vivax Infection / 대한뇌졸중학회지

Cerebral malaria is a severe neurological complication of Plasmodium falciparum infection. Cerebral malaria can lead to cerebral infarction by several mechanisms including systemic inflammatory response. The systemic inflammatory response is known to rarely occur in Plasmodium vivax infection. We report a patient who developed multiple cerebral infarctions following Plasmodium vivax infection.

Sequential Involvement of the Nervous System in Subacute Combined Degeneration

PURPOSE: Subacute combined degeneration (SCD) involves progressive degeneration of the spinal cord, optic nerve, and peripheral nerves. Vitamin B12 (VB12) is a co-factor in myelin synthesis. Because each cell that constitutes the myelin component in the central nervous system and peripheral nervous system is different, it is improbable that these cells undergo simultaneous degeneration. However, the sequence of degeneration in SCD has not been established. MATERIALS AND METHODS: In this study, we analysed medical records and electrophysiological data of patients who showed neurological symptoms and whose serum VB12 levels were lower than 200 pg/mL. RESULTS: We enrolled 49 patients in this study. Their mean VB12 level was 68.3 pg/mL. Somatosensory evoked potential (SEP) study showed abnormal findings in 38 patients. Of the 40 patients who underwent visual evoked potential (VEP) study, 14 showed abnormal responses. Eighteen patients showed abnormal findings on a nerve conduction study (NCS). In this study, abnormal posterior tibial nerve SEPs only were seen in 16 patients, median nerve SEPs only were seen in 3 patients, abnormal VEPs only in two, and abnormal NCS responses in one patient. No patient complained of cognitive symptoms. CONCLUSION: In SCD, degeneration appears to progress in the following order: lower spinal cord, cervical spinal cord, peripheral nerve/optic nerve, and finally, the brain.

Sacral Herpes Simplex Infection Mimicking as Herpes Zoster in the Immune-Competent Patient

No abstract available.

Long-Term Outcomes of Acute Ischemic Stroke in Patients Aged 80 Years and Older

PURPOSE: Short life expectancy influences decision-making when treating very old patients with acute ischemic stroke (AIS). We investigated mortality and survival duration in very old AIS patients (> or =80 years) who received hospital care. PATIENTS AND METHODS: Mortality data were obtained from medical records, structured telephone inquiries, death certificates from the Korean National Statistical Office, and social security data 5+/-1.9 years after stroke onset. Age, gender, vascular risk factors, and functional outcomes from modified Rankin scales (MRS) at discharge were analyzed as predictors of mortality. RESULTS: Among 134 patients, 92 (68.7%) died. On Kaplan- Meier analysis, duration of survival of patients aged 80-84 years was longer than those aged 85-89 or 90-94 (24+/-6.4, 8+/-7.3, 7+/-2.0 months, respectively, p=0.002). Duration of survival of patients discharged in a state of MRS 0-1 was longer than the remaining groups at 47+/-4.8 months (p<0.001). In Cox proportional hazard analysis, age and MRS at discharge were independent predictors of mortality. CONCLUSION: Long-term outcomes of very old patients with AIS are not uniformly grave, therefore predictors of mortality and estimated duration of survival should be considered during decision- making for treatment.

A Case With Suspected Tick Paralysis

Tick paralysis is caused by a neurotoxin secreted by female tick. Characteristic initial manifestation is bilateral flaccid ascending paralysis similar to Guillain-Barr? syndrome. The predominant electrophysiological abnormality is a reduction in complex muscle action potentials. Here, we present a 62-year-old man who initially experienced a sudden biting pain on his scalp. Subsequently he developed bilateral lower extremity paralysis that ascended symmetrically involving the upper extremities. Within 2 weeks, the patient showed a full recovery without treatment.

Electrophysiological Tests in Generalized Tetanus

BACKGROUND: Tetanus toxin selectively blocks inhibitory synapses in the brainstem as well as the spinal cord. Therefore, in contradiction to Stiff Person syndrome, patients with generalized tetanus usually show abnormal masseter silent periods as well as abnormal F/M amplitude or H/M amplitude ratios. This study aimed to verify the characteristics of electrophysiological findings of generalized tetanus. METHODS: The authors retrospectively studied clinical and electrophysiological characteristics of 7 patients with generalized tetanus, who were admitted to the neurology department of Hallym Medical Center from 1995 to 2005. RESULTS: All the seven patients showed abnormal masseter silent periods. Three of them showed somewhat improvement in the silent period at follow-up study as trismus was improving. Full NCSs done in two patients did not show any abnormalities except an increased F/M amplitude ratio. One patient with a wound site in his left finger showed an abnormal F/M amplitude ratio only in the right upper extremity without involvement of other extremities. Another patient showed an increased H/M amplitude ratio without an increased F/M amplitude ratio. (In this patient we did not conduct full NCS tests.) CONCLUSIONS: The Masseter silent period could be used as a diagnostic tool and parameter of clinical improvement in patients with generalized tetanus.

A Case of Neurologic Symptom in Association with Intoxication after Ingestion of Codfish Intestine

No abstract available.

Features of the Myelopathy in Patients with Electrical Burn

BACKGROUND: Electrical injury can cause serious damage to any part of the nervous system. However spinal cord injury by electricity itself rarely develops. If develops, it can be either electrical myelopathy (immediate or delayed), spinal atrophic paralysis and/or amyotrophic lateral sclerosis-like disease. We are going to report the clinical, electrophysiological and radiographic features of electrical myelopathy (immediate or delayed) of 18 patients. METHODS: We retrospectively reviewed the clinical, electrophysiological and radiographic data of patients who were diagnosed as electrical myelopathy. RESULTS: Among 1,306 patients with electrical injury, 18 patients (1.4%) had electrical myelopathy. Fifteen patients (83%) had motor symptoms and 16 patients (89%) had sensory symptoms or signs. It is interesting for seven patients to appear their neurological symptoms or signs with a day after electrical injury. Somatosensory evoked potentials (SEP) which were done in 17 patients showed abnormal central conduction defects in 12 patients (70.5%). Magnetic resonance images (MRI) of spinal cord, however, did not show any abnormalities in all the tested patients (15 patients). CONCLUSIONS: Clinically, electrical myelopathy can cause not only motor but also sensory symptoms or signs. Interestingly, there were several immediate as well as delayed forms of electrical myelopathy In most patients with electrical myelopathy, SEP was a useful method to detect objective abnormalities but MRI was not.

Reversible Diffuse Brain Edema in Acute Encephalopathy with Shigellosis

Shigellosis is an acute inflammatory colitis by infection to one of the members of the genus Shigella. It is known that various CNS symptoms including headache and seizure can develop with shigellosis. Encephalopathy with severe brain edema in shigellosis were rarely reported even in children as well as in adults. We report a rare case of acute encephalopathy with shigellosis showing severe diffuse brain edema which resolved rapidly with administration of steroids in an adult.

Delayed-Onset Continuous Bruxism with Olivary Hypertrophy After Top of the Basilar Syndrome

Delayed-onset continuous bruxism due to brain stem infarction has not yet been reported. A 49-year old man presented with quadriplegia and ophthalmoplegia. Brain MRI showed acute infarction in the bilateral midbrain, right thalamus and the superior cerebellum. One month later, the patient developed bruxism which persisted during sleep. A palatal myoclonus was not observed. Follow up MRI taken 4 months later showed bilateral olivary hypertrophy. We suggest that the patient's bruxism may be related to the olivary hypertrophy. The bruxism generator may be located in the pontine-reticular-formation (PRF). Bilateral large midbrain lesions interrupting the cortical inhibition may have produced bilateral olivary hypertrophy, which could stimulate the PRF, producing continuous bruxism.

A Case of Polyneuropathy Suggesting Diphtheritic Neuropathy

No abstract available.

Features of the Peripheral Nerve Injury in Patients with High Voltage Electrical Burn

BACKGROUND: The peripheral nerve is known to be vulnerable to electrical injury. However, the character and mechanism of electrical injury to the peripheral nerve is not well established in clinical conditions. METHODS: We retrospectively reviewed the nerve conduction study (NCS) data of patients who had high voltage electrical injury in their upper extremities. RESULTS: Among 16 extremities studied, nine had abnormal NCS findings. Nine of 12 extremities, whose input/output were distal to wrist, showed abnormal NCS findings. In contrast, all four extremities, whose input/output points were their forearm, had normal NCS findings. In the patients who had abnormal NCS findings, the distal portion experienced more severe damage than the proximal portion. CONCLUSIONS: Input/output points are important factors in the electrical injury to the peripheral nerve. Joule heating seems to be a more important mechanism of electrical peripheral nerve injury.