Post Infectious Cerebellar Ataxia with Abnormal Brain Magnetic Resonance Imaging and Single Photon Emission Computed Tomography Findings / 대한평형의학회지

A 84-year-old woman presented with a two weeks history of dizziness, slurred speech and ataxia. The neurological exam showed spontaneous left beating nystagmus, horizontal gaze evoked nystagmus and limb ataxia. A few weeks earlier, she had an upper airway infection. Brain MRI revealed diffuse leptomeningeal enhancement in the both cerebellar hemisphere and brain single photon emission computed tomography (SPECT) showed hyperperfusion in both cerebellar hemisphere. Extensive laboratory studies with cerebrospinal fluid analysis did not reveal any etiologic factors. She was started on methylprednisolone (1 g/day for 7 days), gradually improved over the weeks. Post infectious cerebellar ataxia is a neurologic complication that occasionally follows systemic viral and bacterial infections. This case demonstrates that cerebellar abnormalities can be detected by brain magnetic resonance imaging and SPECT.

Clinical Characteristics of Neonatal Seizures / 대한소아신경학회지

PURPOSE: Neonatal seizures are major morbidities of various neurological insults in neonates and have the predictive value for neurodevelopmental outcome. Nevertheless, it is difficult to detect seizures in this period and to verify underlying causes. In this study, we investigated the clinical features of neonatal seizures and proved the role of brain MRI in detection of underlying neurological insults. METHODS:Twenty-four patients(M:F=7:17) with neonatal seizures are recruited among 1,157 neonates born between Mar. 2004 and Jan. 2005. Seizure types are classified based upon Volpe's criteria. Retrospective reviews of medical records and interictal electroencephalograms are performed. RESULTS:Subtle seizure is the most common seizure type(9 patients:37.5%). In 4 patients, two types of seizures are noted. Among 20 patients with brain ultrasound, thirteen patients show normal findings. In contrast, out of 16 patients with brain MRI, fourteen patients have abnormal findings. Among 13 patients with normal brain ultrasound, seven patients have abnormal findings in brain MRI. Abnormal background activities of interictal electroencephalograms are noted in twenty one patients(87.5%). Subsequent seizures are detected in 3 patients. CONCLUSION:Clinical features of neonatal seizures are variable, and more than two types of seizures can be noted in one patient. Background activity of the electroencephalogram may help in diagnosis of neonatal seizures and Brain MRI should be considered in detection of underlying cause.

Magnetic Resonance Imaging Findings Based on Clinical Subtypes of Cerebral Palsy

OBJECTIVE: To consider the relation between MRI findings and clinical subtypes of cerebral palsy (CP). METHOD: The subjects comprised 83 patients with CP. We analyzed the brain MRI findings such as periventricular leukomalacia (PVL), brain atrophy, infarction or hemorrhage, basal ganglia lesion, migration anomaly and delayed myelination with consideration of clinical subtypes of CP. RESULTS: Of the 83 MRI findings, 69 abnormalities (83.1%) were the followings; PVL in 47 cases{17 spastic diplegics (SD), 17 spastic quadriplegics (SQ), 5 spastic hemiplegics (SH), 4 atonic or hypotonic quadriplegics, 2 ataxic quadriplegics and2 mixed quadriplegics (MQ)}, brain atrophy in 6 cases (3 SQ, 1 SD, 1 SH and 1 MQ), infarction or hemorrhage in 7 cases (5 SH and 2 SQ), migration anomaly in 2 cases (1 SQ and 1 SH), delayed myelination in 3 cases (2 SQ and 1 SH) and basal ganglia lesion in 4 cases (3 MQ and 1 atonic quadriplegic). 33 cases of 47 PVL and 2 cases of 6 brain atrophy were preterm CPs. There was no difference in severity of CP between preterm and fullterm CPs. CONCLUSION: The results of this study would be helpful in estimating the brain lesions in various clinical subtypes of CP.

3-D Morphometric Study of Brain MRI with Obsessive-Compulsive Disorder / 신경정신의학

OBJECTIVES: Neurobiological models for obsessive-compulsive disorder(OCD) have consistently implicated prefrontal-striatal circuits in the pathophysiology of this disorder. But, prior studies have inconsistently found alteration in caudate and frontal lobe volumes in patients with OCD. This study was undertaken in the hope that semi-automated linear transformation methods would elucidate the morphometric differences of various parts of brain between OCD and normal control group. METHODS: Thirteen patients meeting the DSM-IV criteria for OCD, and 9 psychiatrically normal comparison subjects participated in the study. 3-D brain MRIs using Spoiled gradient-recalled (SPGR) sequence were acquired for each subjects. After spatially normalized according to Talairach and Tournoux's coordinates, the gray and white matters were segmented by semiautomated methods using fuzzy algorithm. Each lobal volumes was measured according to Talairach and Tournoux's coordinates, and the region of interests of caudate nuclei was manually traced. The frontal lobe was divided into 3 subregions; dorsolateral prefrontal cortex, orbital frontal cortex, mesial frontal cortex accoring to the coordinates and Broadman's cytoarchitectonics. RESULTS: Only the volume of left and right frontal gray matter showed a significant difference between OCD and normal subjects. In OCD, the frontal gray matter volume was increased in tendency. There's no difference in laterality and no coorelation with clinical severities. CONCLUSION: Findings of increased frontal gray matter volumes in patients implicate a structural abnormality of these brain regions in the pathophysiology of OCD. The increased frontal gray matter volumes reflect a epiphenomena due to increased cerebral blood flows and metabolic rates before the structural changes may occur.