RESUMEN
BACKGROUND AND PURPOSE: We aimed to determine the effectiveness of intraoperative neurophysiological monitoring focused on the transcranial motor-evoked potential (MEP) in patients with medically refractory temporal lobe epilepsy (TLE). METHODS: We compared postoperative neurological deficits in patients who underwent TLE surgery with or without transcranial MEPs combined with somatosensory evoked potential (SSEP) monitoring between January 1995 and June 2018. Transcranial motor stimulation was performed using subdermal electrodes, and MEP responses were recorded in the four extremity muscles. A decrease of more than 50% in the MEP or the SSEP amplitudes compared with baseline was used as a warning criterion. RESULTS: In the TLE surgery group without MEP monitoring, postoperative permanent motor deficits newly developed in 7 of 613 patients. In contrast, no permanent motor deficit occurred in 279 patients who received transcranial MEP and SSEP monitoring. Ten patients who exhibited decreases of more than 50% in the MEP amplitude recovered completely, although two cases showed transient motor deficits that recovered within 3 months postoperatively. CONCLUSIONS: Intraoperative transcranial MEP monitoring during TLE surgery allowed the prompt detection and appropriate correction of injuries to the motor nervous system or ischemic stroke. Intraoperative transcranial MEP monitoring is a reliable modality for minimizing motor deficits in TLE surgery.
Asunto(s)
Humanos , Electrodos , Epilepsia del Lóbulo Temporal , Potenciales Evocados Somatosensoriales , Extremidades , Monitorización Neurofisiológica Intraoperatoria , Monitoreo Intraoperatorio , Músculos , Sistema Nervioso , Accidente Cerebrovascular , Lóbulo TemporalRESUMEN
Ceftriaxone is commonly used for the treatment of bacterial infection. But it may precipitate in bile causing biliary sludge, pseudolithiasis and gallstone especially in children. We report a case of ceftriaxone-induced acute pancreatitis in an old woman. An 83-year-old woman was admitted for treatment of renal stone. She had received intravenous ceftriaxone for 11 days. After percutaneous nephrolithotomy, she was discharged. After 12 days, she visited the emergency department due to epigastric pain. Laboratory finding was suggestive of gallstone pancreatitis and abdominal computed tomography revealed gallbladder stone, which was absent previously. After conservative care, she received cholecystectomy and discharged without sequelae.
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Adulto , Anciano de 80 o más Años , Niño , Femenino , Humanos , Infecciones Bacterianas , Bilis , Ceftriaxona , Colecistectomía , Servicio de Urgencia en Hospital , Vesícula Biliar , Cálculos Biliares , Nefrostomía Percutánea , PancreatitisRESUMEN
BACKGROUND: Recently, anti-ganglioside complex (GSC) antibodies were discovered among the various subtypes of Guillain-Barré syndrome. GSC is the novel glycoepitopes formed by two individual ganglioside molecules. CASE REPORT: We present a 36-year-old man with overlap Miller Fisher syndrome and acute bulbar palsy who had anti-GSC antibody that provided diagnostic robustness. CONCLUSION: Anti-GSC testing could be considered important in patients who show atypical manifestation with negative antibody reaction against each constituent ganglioside.
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Adulto , Humanos , Anticuerpos , Parálisis Bulbar Progresiva , Gangliósidos , Síndrome de Guillain-Barré , Síndrome de Miller FisherRESUMEN
Vertical gaze palsy is usually associated with lesions of the rostral midbrain and thalamo-mesencephalic junction. The rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF), the interstitial nucleus of Cajal, and the posterior commissure located in the midbrain are the critical area in supranuclear control of vertical eye movements. We describe a case of vertical one-and-a-half syndrome accompanying contralateral abduction and incomplete depression palsy due to thalamo-mesencephalic infarction. These vertical eye movement abnormalities are presumed to be caused by damage to the ipsilateral riMLF, interstitial nucleus of Cajal, and oculomotor fascicles.
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Infarto Cerebral , Depresión , Movimientos Oculares , Infarto , Mesencéfalo , Parálisis , Tegmento MesencefálicoRESUMEN
STUDY DESIGN AND OBJECTIVE: To evaluate the descriptive patterns of radiating leg pain due to lumbar herniated intervertebral disc, and the correlation between the patterns and various factors such as age, gender, occupation, education, duration of symptom, straight leg raising test, and degree of disc herniation on magnetic resonance imaging. MATERIALS AND METHODS: One hundred and three patients who had lower back pain and radiating leg pain were diagnosed with lumbar herniated intervertebral disc. We investigated the descriptions of their radiating leg pain, and standardized and classified 44 adjective words to 11 groups by the Korean McGill pain questionnaire. We analyzed the frequencies of each word and the correlation between the frequencies and the various factors. RESULTS: The pattern of pain descriptions tended to exhibit certain characteristic traits. The word 'flashing' was the most common (72.8%), followed by the word 'jerking'(62.1%). Descriptions of most patients included either the word 'flashing' or 'jerking'(92.2%). However, there was no significant relation between the frequencies of each word and any factors (p>0.05, chisquare). CONCLUSIONS: The pattern of patients' descriptions for radiating pain of lumbar herniated intervertebral disc is either the word 'flashing'or 'jerking'. This is a useful description to diagnosis and plan for the treatment of lumbar herniated intervertebral disc.