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.

Serious Neurological Disorders That Mimic Bell’s Palsy: A 10-Year Experience / 대한신경근육질환학회지

Background@#Unilateral peripheral facial nerve palsy may have a detectable cause (secondary facial nerve palsy) or may be idiopathic (Bell’s palsy). Facial palsy is attributable to various causes ranging from mild infection to severe neurological disorders. We investigated the prevalence and types of serious neurological disorders in patients with unilateral facial palsy. @*Methods@#We reviewed the medical records of patients with unilateral facial nerve palsy and identified patients diagnosed with facial palsy secondary to serious or life-threatening causes. We investigated the clinical characteristics, as well as electrodiagnostic and imaging findings in these patients. @*Results@#Of 924 patients with facial palsy, 11 patients (1.2%) were diagnosed with the following serious neurological disorders: acoustic schwannoma in two patients, facial nerve schwannoma, glossopharyngeal schwannoma, meningioma, epidermoid cyst, parotid gland tumor, pontine infarct, skull base osteomyelitis, brain metastasis, and pachymeningitis. @*Conclusions@#Although unilateral facial palsy is rarely associated with serious neurological disorders, early detection of the etiopathogenetic contributors is important for prompt initiation of optimal management. Therefore, clinicians should be mindful of disorders that can mimic Bell’s palsy.

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.

A Case of Sjögren Syndrome Involving Central Nervous System with Phonic Tic

No abstract available.

Comparison of Four Methods calculating Ankle Brachial Indexes for Coexistent Intracranial and Extracranial Artery Stenoses in the Patients with Ischemic Stroke

BACKGROUND: The ankle brachial index (ABI) is a useful screening tool for peripheral arterial disease. It has been documented that the cerebral atherosclerosis is more frequent in stroke patients with abnormal ABI than in those with normal ABI. The present study compared the different calculation methods of ABI for coexistent intracranial and extracranial arterial stenosis (IECAS) in ischemic stroke. METHODS: We reviewed the data of patients admitted for acute ischemic stroke or transient ischemic attack. The following four distinct ABIs were calculated: the ratio of the higher (ABI-H), lower (ABI-L), or either of the systolic blood pressures (SBPs) of the posterior tibial (ABI-PT) and dorsalis pedis (ABI-DP) arteries relative to the higher of the brachial SBP. We compared the values of these four ABI measures relative to the presence of any IECAS using receiver operating characteristic (ROC) curve analysis. RESULTS: ABI-H, ABI-L, ABI-PT, and ABI-DP were abnormal (≤ 0.9) in 19 (13.1%), 36 (24.8%), 29 (20%), and 30 (20.7%) of 145 patients, respectively. The area under the ROC curve was significantly larger for ABI-H, ABI-L, and ABI-DP than for ABI-PT for any type of IECAS. The extracranial stenosis was more frequent when any of the four ABIs was abnormal, while intracranial stenosis was not correlated with the four ABIs. The IECAS was more frequent for abnormal ABI-H and ABI-DP than for normal ABIs. CONCLUSIONS: Our studies suggested that ABIs based on a higher SBP of the PT or DP (i.e., ABI-H) are more strongly associated with the presence of IECAS than are those using the SBP of the PT (ABI-PT). Extracranial artery stenosis seems to be more strongly associated with ABI than is intracranial stenosis.

Carotid-Cavernous Fistula Due to Giant Aneurysm in a Postpartum Woman

A carotid-cavernous fistula (CCF) is an abnormal communication between the venous cavernous sinus and the carotid artery. The rupture of an intracavernous aneurysm is usually caused by trauma, but spontaneous rupture can also occur, with pregnancy being a contributing factor. We report a case of direct CCF due to rupture of a giant aneurysm in a postpartum woman.

Cervical Spine CT and MRI Findings in a Patient with Ossification of the Posterior Longitudinal Ligament

No abstract available.

Ulnar Neuropathy as a Complication of Face-down Positioning after Macular Hole Surgery / 대한임상신경생리학회지

No abstract available.

Vagus Nerve Palsy in Ramsay-Hunt Syndrome / 대한임상신경생리학회지

No abstract available.

Eye Movement Abnormalities and Neuroimaging Findings of Disequilibrium of Unknown Origin / 대한평형의학회지

BACKGROUND AND OBJECTIVES: Although disequilibrium is common type of dizziness in older people, it is sometimes difficult to identify a specific cause for this problem. The diffuse brain pathology including subcortical ischemia and atrophy can be a cause for patients with disequilibrium of unknown cause. Aim of this study is to identify the eye movements and neuroimaging features in patients with disequilibrium. MATERIALS AND METHODS: We performed a prospective investigation in patients with disequilibrium of unknown cause. We collected information on demographic characteristics and clinical features of disequilibrium. The impact of dizziness on everyday life was assessed by 25-item dizziness handicap inventory (DHI). Vestibular function test (VFT) includes smooth pursuit, saccade, optokinetic nystagmus, and rotatory chair test. Subcortical white matter lesions and brain atrophy were graded from brain magnetic resonance image (MRI). RESULTS: This study included 14 patients (12 female and 2 male), aged between 64 and 84 years, mean age 74.01+/-6.02 years. The score of DHI was 39.4+/-11.8 (20-58). Eye movements were abnormal in 13 patients and normal in only one patient. The degree of subcortical ischemia was mild in 7, moderate in 4, and severe in 3 patients. Ventricular brain ratio was 0.23+/-0.03. However, there was no significant relationship between MRI findings and the degree of oculomotor alterations (result of VFT). CONCLUSION: Patients with disequilibrium of unknown cause are usually elderly women. Alterations in oculomotor movements and diffuse brain pathology including white matter lesions and atrophy were observed in patients with disequilibrium of unknown cause.

WEBINO (Walleyed Bilateral Internuclear Ophthalmoplegia) Syndrome in Progressive Supranuclear Palsy

WEBINO (walleyed bilateral internuclear ophthalmoplegia) syndrome is a rare disorder characterized by bilateral exotropia on primary gaze, bilateral internuclear ophthalmoplegia, and impaired convergence. It is mainly reported in patients with cerebrovascular diseases and multiple sclerosis, but rare cases have also been described in patients with neurodegenerative diseases such as progressive supranuclear palsy (PSP). We report WEBINO syndrome in a PSP patient.

Recurrent Bilateral Bell's Palsy Who Suffered From Acute Pancreatitis

Bell's palsy is the most common cause of unilateral, lower motor facial palsy. Especially recurrent paralysis of the facial nerve is an unusual occurrence and reported in only 7-8%. We report a case of recurrent bilateral Bell's palsy who suffered from acute pancreatitis. Numerous complications can occur after acute pancreatitis, but recurrent bilateral Bell's palsy was not reported yet.

Clinical Analysis of Recurrent Bell's Palsy in One University Hospital / 대한임상신경생리학회지

BACKGROUND: Bell's palsy (BP) is the most common cause of unilateral lower motor facial palsy. Recurrent paralysis of the facial nerve is unusual and reported in only 7-8%. METHODS: A total of 394 consecutive patients with acute BP patients were enrolled at Daegu Catholic University Hospital from July 2005 to September 2012. We classified the patients into two groups-single BP and recurrent BP-and compared them by patient characteristics, clinical features, MRI findings, electrophysiologic findings and prognosis. The degree of BP was graded according to the House and Brackmann facial nerve grading system. RESULTS: Recurrent BP was observed in 31 (7.9%) patients. The number of recurrence was varied from 2 to 5. The recurrent BP (9.7%) had more incidence of family history and MRI enhancement than those of single BP (2.2%, p=0.047). The single BP (63.4%) had better recovery than recurrent BP (45.2%, p=0.045). CONCLUSIONS: The recurrent BP had more incidence of family history, MRI enhancement and poor prognosis than the single BP.

Clinical and Pathological Features of Clevudine Induced Myopathy

BACKGROUND: Clevudine (Revovir(R)) is a recently introduced antiviral drug, and clinical trials have demonstrated its potent, sustained antiviral activity without specific adverse events. However, several studies have found severe myopathy during clevudine therapy. Our study aimed to summarize the clinical and pathological features of clevudine-induced myopathy. METHODS: We analyzed the demographic data, clinical features, and pathologic findings of 18 consecutive hepatitis-B patients who developed skeletal myopathy during clevudine therapy. RESULTS: The 18 patients comprised 11 women and 7 men aged 48.2+/-14.0 years (mean+/-standard deviation; range 28-74 years). Each of the 18 patients was treated with clevudine for at least 5 months (range 5-20 months) before the development of symptoms. In all patients the main symptom was proximal muscular weakness that progressed slowly over several months. Elevated creatine kinase and myopathic patterns on electromyography were found. Muscle biopsies revealed severe myonecrosis associated with numerous ragged red fibers and cytochrome-c-oxidase-negative fibers, mitochondrial proliferation, and predominant type-II fiber atrophy. The muscle weakness gradually improved within 20 weeks after discontinuation of clevudine. CONCLUSIONS: Clevudine therapy can induce myopathy associated with mitochondrial toxicity. Careful clinical and laboratory monitoring of the skeletal muscle dysfunction is required in patients receiving clevudine therapy.

A Case of Hemichorea with Primary Somatosensory Cortical Infarction / 대한뇌졸중학회지

Hemichorea is caused by various diseases but stroke is the most common cause. The usual lesions of the stroke related hemichorea are the contralateral subthalamus or basal ganglia. Few cases with cortical lesion have been reported. But hemichorea with primary somatosensory cortical lesion has not yet been reported. We report a case with hemichorea after acute infarction of the contralateral primary somatosensory cortex.

Effects of Polychlorinated Biphenyls on the Development of Neuronal Cells in Growth Period; Structure-Activity Relationship

Polychlorinated biphenyls (PCBs) are accumulated in our body through food chain and cause a variety of adverse health effects including neurotoxicities such as cognitive deficits and motor dysfunction. In particular, neonates are considered as a high risk group for the neurotoxicity of PCBs exposure. The present study attempted to analyze the structure-activity relationship among PCB congeners and the mechanism of PCBs-induced neurotoxicity. We measured total protein kinase C (PKC) activities, PKC isoforms, reactive oxygen species (ROS), and induction of neurogranin (RC-3) and growth associated protein-43 (GAP-43) mRNA in cerebellar granule cells of neonatal rats with phorbol 12, 13-dibutyrate ([3H]PDBu) binding assay, western blot, ROS assay, and reverse transcription PCR (RT-PCR) analysis respectively following the different structural PCBs exposure. Only non-coplanar PCBs showed a significant increase of total PKC-alpha and betaII activity as measured with [3H]PDBu binding assay. ROS were more increased with non-coplanar PCBs than coplanar PCBs. The mRNA levels of RC-3 and GAP-43 were more induced with non-coplanar PCBs than coplanar PCBs, indicating that these factors may be useful biomarkers for differentiating non-coplanar PCBs from coplanar PCBs. Non-coplanar PCBs may be more potent neurotoxic congeners than coplanar PCBs. This study provides evidences that non-coplanar PCBs, which have been neglected in the risk assessment processes, should be added in the future to improve the quality and accuracy of risk assessment on the neuroendocrinal adverse effects of PCBs exposures.

Cryptococcal Meningoencephalitis Presenting as Cerebral Infarction and Multiple Cranial Nerve Palsies / 대한뇌졸중학회지

Cryptococcosis is a global invasive mycosis associated with significant morbidity and mortality. Fever, headache and vomiting are common clinical presentations of the cryptococcal meningitis. But ischemic stroke and cranial nerve impairment are rare neurologic complications. We report a case of cryptococcal meningoencephalitis presenting as cerebral infarction and multiple cranial nerve palsies.

Neurosyphilis Mimicking Herpes Simplex Encephalitis

No abstract available.

Thoracic Spinal Arteriovenous Fistula with Subarachnoid Hemorrhage

No abstract available.

Spontaneous Multi-Stage Gluteus Muscular Hemorrhage Following Long-Term Use of Clopidogrel

No abstract available.