Successful Treatment of Occipital Radiating Headache Using Pulsed Radiofrequency Therapy

Rheumatoid arthritis (RA) is a chronic inflammatory disease involving multiple joints. The cervical spine is often affected, and cases involving atlantoaxial joint can lead to instability. Anterior atlantoaxial subluxation in RA patients can lead to posterior neck pain or occipital headache because of compression of the C2 ganglion or nerve. Here, we report the successful treatment of a RA patient with occipital radiating headache using pulsed radiofrequency therapy at the C2 dorsal root ganglion.

Relationship to Magnetic Resonance Signal Hyperintensity in Globus Palidus and Blood Manganese Concentration in Cirrhotic Patients with Extrapyramidal Symptoms / 대한간학회지

BACKGROUND/AIMS: Increasing evidence suggests that manganese deposition in globus pallidus is responsible for MRI signal hyperintensity and for extrapyramidal symptoms in cirrhotics. However, the relationships between blood manganese, the severity of liver dysfunction, the pallidal signal intensity, and neurological signs have not been well established. METHODS: Blood manganese concentrations were measured together with brain MRI and neurological evaluation in six controls, six patients with Parkinson's disease with normal liver function, and fourteen cirrhotic patients with hepatic encephalopathy including six cirrhotics with extrapyramidal symptoms. The neurological state was evaluated using the Columbia scale and the pallidal index (PI). The ratio of globus pallidus to frontal subcortical white-matter signal intensity was measured-multiplied by 100. RESULTS: Pallidal signal hyperintensity was observed in 85.7% of cirrhotics, and the PI was higher in cirrhotics with extrapyramidal signs or high grade varices than those without them, but there was no increase in the Parkinson's disease patients. No correlations were demonstrated between the blood manganese level and PI as well as the Child-Pugh score. The blood manganese level was not significantly different between cirrhotics and other groups. However, there was an overt increase only in two cirrhotic patients with extrapyramidal signs. The Columbia scale did not reveal any correlations with the blood manganese level and the Child-Pugh score. CONCLUSIONS: Cirrhotics with extrapyramidal signs showed a significant increase in PI, but there was no increase in the patients with Parkinson's disease. The PI was not significantly correlated with the blood manganese level. These findings suggest that extrapyramidal signs in cirrhotics might be caused by a different mechanism than those in Parkinson's disease, which could possibly be related with manganese.

Clinical esxperiences of Carotid Endarterectomy for Carotid Stenosis / 대한흉부외과학회지

BACKGROUND: The purpose of carotid endarterectomy is to prevent stroke regardless of past neurologic events. Major concern in the carotid endarterectomy is the inadequate blood flow of ipsilateral hemisphere during clamping of the carotid artery. It is well known that internal carotid artery back pressure means collateral cerebral blood flow. Our study is intended to determine the guideline of shunt placement according to the carotid back pressure and electroencephalographic finding. MATERIAL AND METHOD: The study population comprised of 16 consecutive patients who underwent carotid endarterectomy for carotid stenosis in our institution between from February 1996 to March 1999. There were 14 men and 2 women between the ages of 56 and 78 years(mean age 66.25+/-6.53 years). The carotid stenosis in the operative site was ranged from 61% to 95%(mean 73.8+/-12.33%) and the mean carotid stenosis of the contralateral side was 60.99+/-25.03%. During the operation, electroencephalographic monitoring was taken in all cases. The internal carotid artery back pressure was measured to estimate the collateral cerebral blood flow, and in all patients with back pressure below 40 mmHg(11 patients) and patients with complete occulusion of contralateral carotid artery(2 patients), an internal shunt was installed. RESULT: One postoperative death occurred in a patient with large evolving cerebral infarction and severe ipsilateral carotid stenosis, who underwent emergent carotid endarterectomy. The cause of death was hemorrhagic infarction in the corresponding cerebral territory. We observed that immediate operation after a major stroke negatively influenced the postoperative outcome. No intraoperative ischemic neurologic complication developed. During the follow-up upto now(mean follow-up 21.5+/-11.85 months), there has been no early or late recurrence of stroke except one patient ,in whom cerebral infarction developed in the contralateral side on the first postoperative day. CONCLUSION: At least 4-6 weeks stabilization after a stroke is recommended for surgical management. The carotid endarterectomy is an effective surgical intervention for prevention of anticipated stroke and can be performed safely if an internal shunt is used in patients whose internal carotid arterial back pressure is below 40 mmHg.

Large Deep Infarcts found in Proximal Middle Cerebral Artery Steno-occlusive Disease: MRI and AngiographicFindings

PURPOSE: To determine the nature of large deep -seated infarcts without cortical infarct in patients withsteno-occlusive disease of the proximal middle cerebral artery(MCA) using magnetic resonance images(MRI) andangiography. MATERIALS AND METHODS: By means of MRI and MR angiography(MRA), we examined 24 patients with largedeep cerebral infarctions(>3cm in size) involving the basal ganglia, corona radiata and/or centrum semiovale, aswell as steno-occlusive lesion of the proximal MCA. According to location, infarctions were classified into fivegroups, as follows: Group 1: basal ganlgia and corona radiata; 2: basal ganglia, corona radiata and centrumsemiovale; 3: corona radiata and centrum semiovale; 4: corona radiata; 5: basal ganglia only. We evaluated thetopography of the lesions and correlated the results with the findings of angiography(all 24 MRA; the 13:conventional angiography). Involvement of the head of the caudate nucleus and the internal capsule were alsoevaluated. RESULTS: Fifteen of 24 cases(63%) were assigned to group 1 (4 proximal MCA(M1) occlusion and 11stenosis), and five of 24 (21%) with M1 occlusions to group 2. Group 3 comprised only one case with M1 occlusion.Two cases with both occlusion and stenosis were included in group 4, and only one case-with M1 stenosis-in group5. Infarctions at the caudate nucleus were seen in five cases, and at the internal capsule in two. On conventionalangiography(13 cases) cortical branches of the MCA were delineated through the leptomeningeal collaterals ofanterior or posterior cerebral arteries. CONCLUSION: Most large deep cerebral infarctions found in proximal MCAdiseases are thought to extend cephalad to the corona radiata. When large deep-seated infarctions with proximalMCA occlusion is observed more frequently than stenosis.

Abnormalities of Coagulation System In Cerebral Infarction

OBJECTIVE: To define the abnormalities of coagulation system in cerebral infarction and the effect of aspirin. BACKGROUND: Toghi et al(1990,1993) suggested that the coagulation system was enhanced at all stages of cerebral infarction and long term use of antiplatelet medication in chronic stroke patients was effective in reducing the elevated coagulant proteins level. METHOD: We determined fibrinogen, antithrombin III (ATIII), thrombin-antithrombin III complex(TAT) in plasma from 40 stroke patients - 32 acute (30days), and compared 14 patients receiving aspirin from acute stage with 10 patients not receiving aspirin. RESULT: The concentrations of fibrinogen and TAT were significantly elevated in acute and subacute stages, especially in subacute stage(P<0.01), whereas AT-III was decreased only in acute stage (P<0 05). Fibrinogen levels were significantly decreased in patients receiving aspirin than in patients not receiving aspirin during subacute stage (P<0.01). CONCLUSION: These results suggest that the coagulation system is enhanced during acute and subacute stages and early use of aspirin is effective in reducing the elevated fibrinogen in subacute stage.

A Case of Diffuse Leukoencephalopathy Caused by 5-Fluorouracil Derivatives

A stomach cancer patient is reported, who presented with asterixis and dysarthria, after the administration of 5-fluorouracil derivatives, and progressed to a state of arnnesia and disorientation. At first impression was metastatic brain tumor however7 the result of a cerebrospinal fluid cytology for malignancy was negative, and magnetic resonance imaging study(MRI) revealed diffuse hyperintense lesion of the white matter, indicative of leukoencephalopathy. Upon discontinuing the drugs, patient recovered significantly.lly predominant muscle weakness from distal myopathy with rimmed vacuole formation While we present a young female.

RISA (Radioiodinated Serum Albumin) Cisternographic Study in Diagnosis of the Hydrocephalus

Cisternography is isotopic demonstration of CSF dynamics, CSF rate & pathways, by scintillation scanning of the head after intrathecal administration of RISA. We have investigated the cisternographic findings in the hydrocephalus patients in view of the diagnosis and prognostic criteria. Cisternography provides the etiology & classification of hydrocephalus and reliable indication of CSF shunt operation. We found correlation between prolonged ventricular retention, delayed migration, inadequate clearance of the isotope and favorable response to shunting.

The Clinical Courses of Parkinson's Disease

The thirty-two patients of Parkinson's disease had been followed up at the Department of Neurology, Hanyang University Hospital from 1982 to 1985. The following results were obtained: 1. The age distributions at onset of illness are that the 6th decade in 41%, the 7th decade 35% in male and each of the 6th decade and 5th decade is 35% in female. 2. The mean of the duration of illness is 4.5 years and the mean duration of follow-up is 2.1 years. 3. The causes of Parkinson's diseases are idiopathic 44%, carbonmonoxide intoxication 31%, drugs 6%, and vascular disease 3% in sequence. 4. The common initial symptoms are slowness of movement 31%, tremor 31%, and rigidity 22%. 5. The slowness of movement and tremor are major observable symptoms in idiopathic origin and rigidity in carbomonoxide intoxication one. 6. The overall improvement rate on drug treatment is 75%. Various types of response fluctuation has been observed in 4 patients after 5-10 years of treatment.

Relationships of Cervical Spine and Related Symptoms

The width of cervical canal and distance of intervertebral space were measured in 83 normal adults and 208 adult patients who complained of related symptoms, as nuchal tightness, shoulder and interscapular pain, paresthesia of arms, etc. The following results were obtained: 1. The average width of spinal canal is more 14mm in roentgen distance. 2. The common symptoms are occipital headache, pain, paresthesia, & tightness. 3. The width of spinal canal & intervertebral space of patients are significantly narrower than those of controls.