Cut-off Value of Wada Memory Score in Verbal and Visual Memory Domain

BACKGROUND: The cut-off value which determine pass or fail in Wada memory test has not been thoroughly studied, especially in regard to modality-specific memory domains. To investigate the optimal cut-off value, we tried to know what value is appropriate to forecast good postoperative memory outcome in verbal and visual memory domains. METHODS: Eighteen temporal lobe epilepsy patients underwent preoperative Wada test and pre- and postoperative neuropsychological evaluation. Corrected Wada memory score (cWMS) was calculated by ipsilateral Wada retention score divided by pre-Wada score. As a measure of postoperative memory outcome, neuropsycholgical asymmetry index (NPAI) was defined as [(postoperative memory score ? Preoperative memory score) / their mean] and analyzed in verbal and visual memory domains respectively. We made six arbitrary cut-off cWMS values (40, 50, 60, 70, 80, and 90%) and dichotomized the patients into pass or fail group at each arbitrary cut-off value. Verbal and visual NPAIs were compared statistically between two groups. RESULTS: Verbal NPAIs were significantly different between pass and fail groups at 80% cut-off value (p=0.044). Visual NPAIs were significantly different between two groups at 50% (p=0.043) and 60% (p=0.003) cut-off values. CONCLUSIONS: Higher cut-off values may be better for differentiating good and poor postoperative memory outcomes in verbal memory domain, and, in contrast, lower cut-off values may be better in visual memory domain. The verbal and visual memory in Wada test should be analyzed with different cut-off values.

Effect of decompressive partial temporal lobectomy on extensive panhemispheric infarction of middle cerebral artery with impending herniation process

Acute infarction in the whole territory of the middle cerebral artery (MCA) can lead to massive cerebral edema, raised intracranial pressure and cerebral herniation which may result in come and death ultimately. There are same reports which mentioned that craniectomy or stroketomy was an effective life-saving procedure and favorable outcome would be expected after the procedure. In this study, the effect of decompressive partial temporal lobectomy was evaluated in twelve patients of extensive panhemispheric infarction of middle cerebral artery(MCA). We investigated radiologically proven patients of extensive panhemispheric infarction of MCA with impending herniation process, who were admitted to our hospital from March 1991 to June 1996, prospectively and retrospectively. Decompressive partial temporal lobectomy was performed in twelve patients and eighteen patients were treated by only conventional medical treatment(control group). Prognosis were compared between two groups to analyse the effect of the decompressive lobectomy. Fourteen out of the 18 controls(78%) and five out of 12 patients who were treated by decompressive lobectomy(41%) expired due to herniation process. The mortality between two groups was significantly different(P(0.05). Four patient had relatively good outcome(by Barthel index score) and all of them belonged to the decompressive lobectomy group. These results suggest that the decompressive lobectomy be an effective life saving procedure for malignant cerebral edema after a total MCA infarction.

Clinical Analysis of Thyrotoxic Periodic Paralysis

Thyrotoxic periodic paralysis (TPP) is associated with hypokalemia and occurs sporadically and usually in young adult males. We report ten cases with TPP ; all were males, mean onset age was 32.4 years old. The duration of attack. Varied from 10 to 18 hours. The distribution of paralysis was confined to limb muscles; more severe in proximal limbs and lower extremities. Potassium levels during acute attack correlated with the severity of paralysis and ECG changes, but not with the severity of decrease in TSH level. In all cases, administration of potassium salts was successful in treatment of acute attack. A patient had further attack in spite of euthyroid state under the treatment of thyrotoxicosis for one year. Another patient was free from paralytic attacks by chronic administration of the potassium salt and acetazolamide without treatment of thyrotoxicosis.

Cerebral Aneuysm Associated with Arteriovenous Malformation: 4 Cases

Cerebral aneurysms associated with arteriovenous malformation (AVM) have been reported with a variable incidence, averaged 10% of total AVM cases. It has been AVM. We report four cases of the intracranial aneurysm associated with AVM. Three cases of aneurysm were located in distal portion of feeding artery, and one case was proximal on major feeding artery. And bleeding resulted from rupture of aneurysm. Three of them located in the posterior circulation. Removal of aneurysm and AVM was successfully accomplished in 3 cases.