The Diagnostic Validity of Samatosensory Evoked Potentials in Meralgia Paresthetica

BACKGROUND: Meralgia paresthetica(MP) is clinically benign entrapment neuropathy which is characterized by paresthesias and sensory impairment in the cutaneous distribution of the lateral femoral cutaneous nerve(LFCN). The diagnosis of MP is mostly based on clinical symptoms. Sensory nerve conduction study of the LFCN have been of limited value because frequently they could not be recorded in able-bodied persons and also because lesions of the nerve may be localized proximally from the segment that is accessible to nerve conduction study. For these reasons, I studied simple bilateral somatosensory evoked potentials(SSEP) of LFCN to evaluate this clinical symptoms objectively. METHODS: 16 MP patients (mean age+/-SE : 50+/-3.21yrs) and 15 disease free adults(49+/-4.47yrs) were studied bilateral SSEP of LFCN. The stimulation site was anterolateral aspect of thigh and the recording site was Cz'. RESULTS: The mean latencies of P0 and N1 were prolonged on the affected side(P<0.05), The mean latency differences of P0 and N1 between two sides were increased in the patients with MP compare with those of controls.(P<0.001) The mean amplitude difference between two sides were increased in the patients with MP compare with that of controls(P<0.05). CONCLUSION: SSEP of LFCN can be used as a objective test to support the diagnosis of MP. I suggest more than 2.4msec difference for P0 latency between affected and unaffected side could be abnormal.

Mossy fiber Synaptic Reorganization and the Pattern of Sprouting in the Pilocarpine Epilepsy Model

BACKGROUND: The purpose of this study is to evaluate the synaptic reorganization and pattern of mossy fiber sprouting as a pathologic mechanism of chronic seizure in pilocarpine epilepsy model through histological alterations of hippocampus. METHOD: Sprague-Dawley, a sensitively damaged by pilocarpine stimulation, served as a experimental group(n=20). And the same dose of saline injected rats were served as a control group(n=10). They were implanted depth electrode in the hippocampus by a stereotaxic surgery, and injected pilocarpine 300mg/Kg intraperitoneally. They produced status epilepticus and the survival rats were monitored by a video-EEG monitoring system whether the spontaneous recurrent seizures occurring for more than 4 weeks. If more than 3 times spontaneous recurrent seizures were identified, then the rat hippocampus was examined by light microscope. RESULT: The pilocarpine injected group produced acute limbic seizure and developed to status epilepticus. The survival rats(n=10) became to chronic epilepsy state after silent period of everage 16.5 days. H&E staining demonstrated that loss of hilar polymorphic cell with ischemic changes and destruction of CA1 with damages of pyramidal cells in hippocampal subfields. Timm stains showed mossy fiber synatic reorganization in the supragranular and intragranular layer of dentate gyrus and infrapyramidal layer of CA3 hippocampal subfieid in pilocarpine induce seizure rats. CONCLUSION: These results suggest that chronic seizures in the pilocarpine epilepsy model is largely due to mossy fiber synatic reorganization, a consequence of supragranular mossy fiber sprouting. But intragranular and infrapyramidal axonal sprouting might have parts of role in synaptic reorganization. Additional research is required to determine the various patterns of axonal sprouting.

Case report for Blepharospasm requiring careful considerations in the application of the blepharoplasty

With the aging process, the senile lids are manifested by the excessive skin, decreased height of palpebral fissures with interference of the vision. Sometimes these patients often complained the blepharitis on the lateral canthal area and phtophobia. But there are many diseases to differentiate from senile lids such as dermatochalasia, blepharochalasia, hypertrophy of orbicularis oculi, herniation of orbital fat, myasthenia gravis, and blepharoptosis. Blepharospasm must also be differentiated because of sysmptoms similar to the above described senile lids. Essential blepharospam is an idiopathic progressively debilitating desease which involve bilateral spasm of the orbicularis oculi. So just only an conventional blepharoplasty could not get an improvement of symptoms and some times it makes the symptoms worsen. This case report is about blepharospasm patients visiting for blepharoplasty. And the patients got relatively the satisfied results with the injection of botulinum A toxin, aided by neurologist, instead of blepharoplasty. In conslutions, The blepharospasm in required to detect in preoperative evaluation for blepharoplasty. Once the blepharospasm is diagnosed, it is better to cooperate with neurologist and to do the blepharoplasty.

The Factors Related to Intractability in Patients with Partial Epilepsy / 영남의대학술지

To evaluate the intractability of partial epileptic patients by variables, the author studied 113 patients (uncontrolled: 45, controlled: 68) who were admitted to the Department of Neurology, College of Medicine, Yeungnam University from January, 1991 to August, 1993. The results were as follows. The items related to complex partial seizures, multiple seizure types and a histories of status epilepticus or clusters of seizures were significantly associated with drug-refractoriness (p<0.01). A high frequency of seizures before evaluation was associated with a poor outcome(p<0.01). The presences of known etiology of seizures, neurologic abnormalities and psychiatric disturbance were associated with limited treatment responses(p<0.01, p<0.05, p<0.01). An abnormal EEG findings such as background slowing, focal slowing, epileptiform discharges or secondarily bilateral synchrony were statistically significant (p<0.01). Age at onset, sex, distribution of epileptic foci, duration of seizure before evaluation, family history and abnormal neuroradiologic findings were not statistically significant. By these results, it was suggested that having at least four factors of the above variables were associated with limited treatment response.

Efficacy of Non-standard Surface Electrodes for Detecting Epileptiform DLwharges in Patients with Temporal Lobe Epilepsies

This study was aimed for comparison of efficacy in detecting epileptiform discharges, which was originating from mesiobasal temporal lobe, among the four non-standard non-mvasive skm surface electrodes such as ear lobe(Al/A2), zygomatic(Zl/Z2), surface sphenoidal(SS1/SS2) and true anterior temporal electrode(Tl/T2). The study was performed with simultaneous placement of the nonstandard electrodes including standard electrodes(F7/F8). The resul ts were as follows. Among the non-standard electrodes, zygomatic and true anterior temporal electrodes detected more epileptiform discharges compared to the other two electrodes, although there was no statistical significancy. Compared to the standard electrodes, zygomatic and true anterior temporal electrode showed statistically high significant detecting rate (p<0. 01). Also average detection rate of epileptiform discharges of the whole non-standard electrodes which was compared to the rate of the standard electrodes showed statistically significance (p<0.05). In conclusions, non-standard surface electrodes, especially zygomatic and true anterior temporal electrode, are considered as valuable to detect the epileptiform discharges from temporal lobe if they were used at the routine initial EEG examination.

Cytogenetic Characteristics and Related Genes in Human Meningiomas

Cytogenetic techniques were used to detect specific chromosomal losses and / or stuctural changes in 6 meningioma cell population of 11meningioma patients. Polymorphic DNA markers were uti.lized to investigate the loss of constitutional heterozygosity on chromosomes 8. 17 and 22 in 9 meningioma cell population of 1l meningioma patients. As a result, 5 cases(M-2.4,5.9, and 10) represented 45. XX. -22 or 45, XY.-22 as stem line. In addition to chromosome 22, other chromosomes were lost randomly. In one case(M-3) normal karyotypic pattern was oberved. The 9q+ structural change was also noted in case M-2. This structural change was thought to be the chromosomal involvement secondary to the loss of chromosome 22 in meningioma. Retentions of constitutional heterozygosity on chromosomes 8 and 17 were found in all cases. Loss of constitutional hererozygosity on chromosome 22 were found at Hind m RFLP of v-sis in cases M-1 and M-7. EcoRI RFLP of v-sis in case M-1. Bgl II RFLP of v-sis case M-1. Xba I RFLP of v-sis in cases M-6. M-9 and M-11. And EcoRI RFLP of bcr in all cases. Rearrangement of chromosome 22 in case M-1 was detected on the Xba I RFLP of v-sis as extra band(3.14kb). The reduction to hemizygosity on chromosome 22 was one important step in tumorigenesis of meningioma. Monosomy 22 might operate at the primary level of tumor initiation. Random losses of other chromosomes or structural changes as 9q+ were postula!ed to be related to tumor development.

Significance of Dexamethasone Suppression Test in Patients with Stroke / 영남의대학술지

The purpose of this study was to evaluate the effect of stroke on hypothalamic-pituitary axis using dexamethasone suppression test. The effects were evaluated according to age, sex, type, size, and lesion site of stroke. There tests were performed in 62 patients with stroke(cerebral infarction, 42 cases : intracerebral hemorrage, 20 cases) and 21 disabled controlled patients without intracranial diseases at Yeungnam University Hospital from June 1992 to June 1993. The results summarized as follows. 1. Cerebral infarction showed significantly higher frequency of DST non-suppression in stroke patients than control (p<0.05). 2. Patients with left hemisphere stroke showed more frequent abnormal neuroendocrine test results (p<0.01). 3. Patients with large infarction revealed strongly non-suppressed DST results(p<0.01). 4. Significantly higher basal cortisol level in patients with cerebral infarction was noted(p<0.01). 5. There are no statistical significance between DST results and sex, age, motor impairment, type of cerebral infarction.

A Case of Wilson's Disease Associated with Somatomotor Status Epileticus

Wilson's disease is a genetically transmitted autosomal recessive disorder of copper metabolism which affects the liver. Brain and other organs. The seizure in Wilson's disease is not infrequent but. It's report is very rare in Korea. The frequency of seizure is about 10 times more than that of general population The statistical proportions of types of seizure associated with Wilson's disease do not differ significantly from that seen in the general population. And the most common seizure type is focal motor form. The issue of the mechanisms producing seizure in Wilson's disease has attracted controversy, but the cause of seizure seems to be related with copper itself. Although the seizure is well controlled by anticonvulsants, the prognosis of seizure depends on the treatment of Wilson`s disease. We report a case of Wilson's disease associated with somatomotor status epilepticus.

Study on the changes of nerve conduction with wrist fixation in carpal tunnel syndrome / 영남의대학술지

The author studied 20 healthy adults (20 hands) as a control and 30 patients (40 hands) with carpal tunnel syndrome to evaluate the clinical usefulness of measuring nerve conduction velocity after wrist flexion in diagnosis of carpal tunnel syndrome. The median nerve conduction velocity over wrist to finger segment was measured before and after wrist flexion for 1, 2 and 5 minutes, using belly-tendon method for motor nerve distal latency (MNDL) and antidromic method for sensory nerve conduction velocity (SNCV). The results were as follows: 1. In control group, MNDL increased in 1 hand and SNCV decreased in 2 hands after wrist flexion. In patient group, MNDL increased in 2 hands and SNCV decreased in 3 hands after wrist flexion. 2. In both control and patient group, there were no significant changes in mean values of SNCV and MNDL between before and after wrist flexion. 3. Phalen's wrist flexion test was positive in 5 percent of control and 60 percent of patient group. 4. Tinel's sign was present in 10 percent of control and 33 percent of patient group.

The Clinical Study of the Brain CT Patterns in the Seventeen Global Aphasic patients

The lesion of the global aphasia often involves both Broca's and Wernicke's speech area, and is shown as broad lesion in the Brain CT However, practically there were several reports about the Brain CT findings of the global aphasia, which suggested atypical patterns that did not involve both language centers, simultaneously. Therefore we subdivided the patterns of Brain CT finding of the 17 global aphasic patients into 4 subtypes according to whether or not the cortical language area was involved. We obtained the following results; 1. Type A : Involvement of the both language areas : 9 cases (53%) 2. Type B : Involvement of only Broca's area with sparing of Wernicke's area : 3 cases(17%) 3. Type C : Involvement of only Wernicke's area with sparing of Broca's area : 1 case (6%) 4. Type D : Involvement only of subcortical area with sparing of cortical language areas : 4 cases (24%).

A Case Report of Cerebral Embolism from a Left Atrial Myxoma

Transient ischemic attacks or embolic strokes caused by the cardiac myxoma are very rare in its freguency. To detect cardiac myxoma, as a source of cerebral embolism originating from the heart, has a great significance because of the occurrence and recurrence of the possible stroke can be prevented by surgical procedure. We present a patient who showed typical clinical symptoms and signs of the left atrial myxoma which was subsequently diagnosed by 2-dimensional real time echocardiography and confirmed by sugery. Following the successful removal of the left atrial myxoma, now, the patient is in stable neurological condition.

A Case Report of Facial Diplegia Associated with Acute Viral Hepatitis type B

The Neuropsychiatric complications in acute viral hepatitis are uncommon. Despite the wide spread occurrence of this disease. Various complications of central and peripheral nervous involvement may arise during the course of viral hepatitis. Encephalitis, meningitis, neuritis, myelitis and mental disturbances such as depression, euphoria and insomnia complicating viral hepatitis has been reported several literatures. Also, bilateral facial nerve palsy is seen very infrequently in clinical practice and has an annual incidence of approximately 0.01% per total facial nerve palsy. The isolated cranial nerve palsy, especially facial nerve. Complicated by viral hepatitis has been suggested very rarely. This combination of bilateral facial nerve palsy and viral hepatitis B seems to be two phases of same disease. However, there were no such reports in Korea until now. Therefore, We present a case of bilateral peipheral facial nerve palsy associated with acute viral hepatitis type B.

Clinical Study of CT-diagnosed Olivopontocerebellar Atrophies / 영남의대학술지

The diagnosis of OPCA could be made clinically with important aid of brain CT scanning, although the definite and conclusive diagnosis only by postmortem pathological determination. We reviewed, clinically and with brain CT examination, 12 cases of patients with OPCA who were admitted to the Yeungnam University Hospital for a recent 5 years. The result were as following: 1. The distribution of age is from 49 to 72, mainly 50 to 60. Man is more frequent than women at the 4.5 times. 2. The interval period from Sx. Onset to diagnosis is 1 year to 6 years. 3. The usual initial Sxs. Were dizziness (58%), ataxia (33%), and other less frequent Sxs. Were weakness of low extremities, dysarthria, headache and urinary incontinence. The clinical manifestations at the initial diagnosis were cerebellar disturbance (100%), dysarthria (83%), and increased deep tendon reflexes (58%). 4. The results of brain CT finding are like this: the width of cerebellar sulci is more than 1mm, other 4 cases more than 2mm. the width of cerebellar pontine cistern of the patient if usually 3 to 4mm, other 2 cases extended to the 5 mm. the A. P and lateral lengths of 4th. ventricle is 4 mm and 4 to 8 mm respectively. 6 cases of whole patients show coincidentally cerebral atrophy.