Résumé
BACKGROUND: The efficacy of sumatriptan(SMN) in acute management of migrane has been well established. In Korea, however, a clinical study comparing the utility of oral(PO) and subcutaneous(SQ) regimen had not been conducted yet. This study was directed to compare the two regimens of SMN in terms of the efficacy as well as the adverse events in a singed-out Korea patient group. METHODS: The 91 migrane patients were recruited and randomly assigned to either PO or SQ regimen as the initial treatment of acute migrane attack. Then, they were forwarded to the other regimen as an open cross-over trial. The treatment responses and adverse events were assessed and rated by the subjects. RESULTS: Eighty one patient successfully tried at least one regimen of SMN. Overall, the proportion of excellent treatment response was 90.7%(PO) and 94.1%(SQ), with the occurrence of adverse events being 67.4%(PO) and 76.5%(SQ) respectively. In 18 patients who were able to complete cross-over procedure, the efficacy was 94.4% both in PO and SQ regimen, with the occurrence of adverse events 72.2% in both of two regimen. Although the SQ regimen tends to induce faster treatment response regardless of the cross-over completion, it bears no statistical significance. CONCLUSION: We conclude that the PO and SQ regimens of SMN show very comparable clinical utility in achieving therapeutic responses as well as in producing adverse events. The treatment efficacy was excellent but higher occurrence of side effects in this study, although mostly in mild degree, suggests that optimal dose adjustment strategy needs to be elaborated in Korea.
Sujets)
Humains , Corée , Migraines , Sumatriptan , Résultat thérapeutiqueRésumé
BACKGROUD: It is generally acknowledged that a close relationship exists between chronic alcohol abuse and the occurrence of alcohol withdrawal seizure(AWS). About one third of AWS patients have been reported to be followed by delirium tremens (DT). OBJECTIVES: We assessed the factors that have influence on the development of DT in AWS patients. METHODS: We investigated clinical features and laboratory findings of 39 AWS patients who were admitted. The following factors were analyzed ; duration of alcohol intake, interval from last drinking to onset of AWS, interval from AWS to treatment, number of seizure, fever, laboratory findings (Mg, K, Na, Ca, P, respiratory alkalosis). RESULT: Fourteen patients developed DT(35.8%). There was fever in 36% of AWS patients with DT(5/14) and in 8% of AWS patients without DT(2/25). Number of seizure (p<.05) and interval from AWS to treatment(p<.01) showed statistically significant difference. But other factors were insignificant statistically. CONCLUSION: Our study suggests that number of seizure and interval from AWS to treatment seem to be significantly related to the development of DT in AWS patients.
Sujets)
Humains , Délirium trémens , Crises épileptiques du sevrage alcoolique , Alcoolisme , Délire avec confusion , Consommation de boisson , Fièvre , Facteurs de risque , Crises épileptiques , Crises convulsives fébrilesRésumé
Severe morphologic changes in the central nervous system(CNS) have been recognized in aucte carbon monoxide(CO) poisoning. These have been usually located in globus palIidus, hippocarnpus, substantia nigra, cerebral white matter, cortical gray mattr, and cerebellum. It is well known that lesions in the CNS are shown both in the globus pallidus and cerebral white matter on neuroradiologic studies using CT or MRI. However we recently experienced two patients of aucte CO poisoning with residual neurologic sequelae, showing the bilateral lesions in the globus pallidus and substantia nigra on MRI performed 10 to 11 days after acute CO poisoning. Experimental studies were performed to investigate the correlation between the physlological data, such as duratlon of CO exposure, change of blood pressure, and termmal carboxyhemoglobin (HbCO) concentration in the blood, and the severities of pallidal and nigral lesions in acute CO exposured cats. Twelve mature cats, weighing 2.7-3.8kg, were exposured to 0.3% CO gas for 95-215 min. using artificial ventilation. The systemic blood pressure and electrocardiograrn were monitored continuously during CO exposure. HbCO concentration in the blood was analyzed immediatelly when CO exposure was terrninated. One to 12 days after CO poisoning, animals were killed and the brain was examined morphologically. Then the correlation between the physiological data and the severities of ischemic change in the globus pallidus and substantia nigra was examined. The results were summerized as follows; 1. The duration of CO ex.posure was ranged from 95 to 215 minutes, and the degree of BP drop from 14 to 76%. There were various hnds of abnorrnalities, such as cardiac arrhythmia and ischemic pattem on EKG, and terrninal HbCO concentration in the blood was ranged from 36 to 79.3%. 2. Morphologically, there was focal necrosis with intense infiltration of macrophages in the globus pallidus of a cat. In the globus pallidus of the remaining 11 cats, the severity of ischemic change was 27.3 to 95.6%.
Sujets)
Animaux , Chats , Humains , Troubles du rythme cardiaque , Pression sanguine , Encéphale , Monoxyde de carbone , Carbone , Carboxyhémoglobine , Cervelet , Électrocardiographie , Globus pallidus , Macrophages , Imagerie par résonance magnétique , Nécrose , Intoxication , Substantia nigra , VentilationRésumé
We reviewed 27 patients wlth cerebellar infarction which was demonstrated by brain CT and/or MRI. Infarction occurred in the territory of posterior inferior cerebellar artery (PICAj in 16 patients, and the territory of the superior cerebellar artery(SCA) was involved in 5 patients. Antenor inferior cerebellar artery(AICA) infarcts occurred in 3 patients. Both PICA and SCA temtories were involved in 2 patients. In the remaining 1 patient, the infarct encompassed the borderzone between the SCA and PICA territories. The main symptoms and signs were sudden onset of vertigo, dizziness, nausea, vomiting, dysmetria, ataxia, nystagmus, and headache. There were signs of associated brain stem infarction or occipitotemporal infarction; rostral basilar artery syndrome, classic SCA syndrome, Wallenberg syndrome, internuclear ophthalmoplegia, facial palsy, hearing impairment. Presumed cerebral embolism was the main stroke mechanism in the SCA terntories. Six patients with brainstem compression or brainstem involvement showed consciousness deterioration, and only one of them died as a result of extensive cerebellar infarctions involving both SCA and PICA territories Cerebellar infarction may run a more benign course than previously thought.
Sujets)
Humains , Artères , Ataxie , Artère basilaire , Encéphale , Tronc cérébral , Infarctus du tronc cérébral , Ataxie cérébelleuse , Conscience , Sensation vertigineuse , Paralysie faciale , Céphalée , Perte d'audition , Infarctus , Embolie intracrânienne , Syndrome de Wallenberg , Imagerie par résonance magnétique , Nausée , Troubles de la motilité oculaire , Pica , Accident vasculaire cérébral , Vertige , VomissementRésumé
Herpes zoster may be associated with a number of neurological complication. Herper zoster ophthalmicus and delayed contralateral hemiparesis is a well-described entity. We report a patient who had acute cerebral infarction 8 weeks after herpes zoster ophthalrnicus. Brain CT disclosed large cerebral infarction in the right middle cerebral artery territory. Decompressivecraniectomy was perforrned because of the impending uncal herniation on the 4th admission day. Pathological finding of resected brain parenchyrna and meninges showed the early cerebral infarction without evidence of vasculitis or er;cephalitis. Postoperatively the patient was improved.