A Case of Pathologic Aerophagia with Mental Retardation Managed by Percutaneous Endoscopic Gastrostomy / 대한소아소화기영양학회지

We experienced a case of pathologic aerophagia in a 10-year-old girl who has mental retardation. It was observed that the abdomen was non-distended in the morning and became maximally distended in the evening. Increased passage of flatus, but normal eructation, was noted. Roentgenographic examination showed 'esophageal air sign', abnormal air shadow on proximal esophagus adjacent to the trachea, in simple chest X-ray and visible air swallowing fluoroscopically. We tried a percutaneous endoscopic gastrostomy (PEG) to decompress swallowed air in stomach. We suggest that placement of a PEG catheter in early life, especially in mentally retarded patients, that can be used as desufflator, can prevent the complications of aerophagia. 'Esophageal air sign' may be very helpful for early detection of pathologic aerophagia.

Vestibular Function Test of Vestibular Neuritis in Acute and Compensated Stage

BACKGROUND: Vestibular neuritis (VN) is a common peripheral vestibulopathy. VN is most likely a partial rather than a complete vestibular paralysis, It has a natural history of gradual recovery within 1-6weeks. The investigation of vestibulo-ocular reflex (VOR) change in acute and compensated VN are relatively few in Korea. We performed the vestibular function test including electronystagmography (ENG) and rotary chair test (RCT) in the patients with acute and compensated VN, and evaluated the efficacy of ENG and RCT to know the degree of compensation. METHODS: Tweenty-four patients with acute VN, 14 patients who had cllinically compensated VN during follow-up period and 30 normal controls were studied. Mean intervals from symptom onset to test were 3.6 days (acute) and 102.5 days (com-pensated). RESULTS: Eight patients had asymmetrically impaired pursuit, and ten patients had asymmetrcally impaired OKN during acute stage. The degree of side differences in pursuit and OKN gain was correlated with intensity of spon-taneous nystagmus. In the acute stage, the gain of the VOR was reduced at low frequency (0.01-0.16Hz), but it was normal at high frequency (0.32Hz). Prolonged phase lead and gain asymmetries were present at all range of frequency. In the compensated stage, the gain, phase and symmetry of the VOR at all range of frequency were not different from those of controls, except for prolonged phase lead and asymmetry at 0.01 Hz. The rate of the patients with unilateral canal paresis was 100% at acute stage and 50% at compensated stage in mono-thermal cold caloric stimulation. CONCLUSIONS: These results suggested that pursuit and OKN abnormalities may be found in acute peripheral vestibu-lopathy, in which coarse spontaneous nystagmus may contribute to the development of these abnormality. Absence of caloric response does not indicate an complete absence of vestibular function and RCT is a useful method in evaluation of VOR status in patients with acute and compensated VN.

Long Term Follow-up of Cyclic Vomiting Syndrome / 대한소아소화기영양학회지

Cyclic vomiting syndrome (CVS) is a disorder of unknown etiology that is characterized by its clinical pattern of intermittent episodes of severe vomiting, similar in time of onset and duration, with no symptoms during the intervening period. By definition, CVS is an idiopathic disorder that requires exclusionary laboratory testing. Not only can it be mimicked by many specific disorders, eg, surgical, neurologic, endocrine, metabolic, renal, but within idiopathic CVS there may be specific subgroups that have different mechanisms. It has been reported that CVS usually begins in toddlers and resolves during adolescence. Migraine is also self-limiting episodic condition of children and the clinical features of migraine and CVS show considerable similarity. It is proposed that CVS is a condition related to migraine. This paper reports clinical courses of long term follow-up and reversible EEG changes in three patients whose history included CVS. Clinical situations of attack interval, duration and associated symptoms had changed variablely in each patients through long term follow-up period. Cyclic vomiting subsided in two cases. Abnormal delta activity was seen during episodes and resolved at follow-up, when the patient asymptomatic. The brain wave changes support the interpretation of CVS as a migraine variant.

Clinical Charateristics of Chronic Daily Headache Patients Visit to University Hospital

BACKGROUND: Chronic daily headache(CDH) could be included all of the primary headache disorders with daily or near-daily headache lasting more than 4 hours/day for 15 days/month. Several studies have shown that patients with CDH are difficult to classify using the currently published International Headache Society(HIS) system. Recently, some authors recommended that CDH could be subclassified into transformed migraine(TM), chronic tension-type headache(CTTH), new daily persistent headache(NDPH) and hemicrania continua(HC). METHODS: We analysed 100 patients with CDH who were diagnosed in Taegu-Hyosung Catholic University Hospital from February 1996 to May 1998. To describe clinical features of CDH, we used our CDH protocol. RESULTS: (1) Most of the patients were in their 5th-7th decades, and female was predominantly affected(female to male ratio, 7.3:1). (2) The subclassification of CDH were CTTH in 59 patients, TM in 33 patients, NDPH in 7 patients, and HC in 1 patient. (3) Clinical characteristics of CDH were mostly bilateral location, mild to moderate intensity and dull nature. The mean onset age of CDH was 47.7 years, the onset time of the day was in the afternoon or anytime, the duration was more than 4 hours or 12 hours in 90 patients, and the frequency was near-daily or daily in 80 patients. Common associated symptoms were nausea, dizziness, insomnia, fatigue, photophobia, blurred vision, and scalp tenderness. (4) Daily use of analgesics was reported in 66 patients. CDH was aggravated during premenstrual period in 10 patients. Positive family history was shown in 26 patients. CONCLUSIONS: We present this report because knowledge of clinical characteristics and adequate protocol for CDH in clinical practice is necessary.

A Case of Marchiafava-Bignami Disease with Abnormal SPECT Findings

Marchiafa-Bignami disease(MBD) is a rare complication of chronic alcoholism and is pathologically characterized by a symmetrical primary demyelination of the corpus callosum with or without focal necrosis. The clinical features of the disease are quite variable, and the course is usually progressive and fatal. We present a case with characteristic clinical features and imaging findings, including SPECT, of MBD. A 51-year-old man was admitted due to mental confusion, violent behavior, and slowness of motion for 2 months. He had been a heavy alcoholic for about 20 years. He was in a stuporous state for 1 week beginning 2 weeks after his admission.. He then showed alertness but was still in a mute state. His cooperation and responses to noxious stimuli were very poor. A brain MRI showed focal cystic change in the enlarged corpus callosum and diffused high-signal intensity in the subcortical white matter, thalamus, and corpus callosum in T2WI. 99mTc-ECD SPECT revealed diffusely decreased cerebral perfusion in both frontal, temporal and pari-eto-occipital lobes.

Familial Periodic Vertigo and Ataxia: A Case Report

Familial periodic vertigo and ataxia is a rare, disabling condition of autosomal dominant episodes of vertigo and/or ataxia, sometimes associated with other brain stem symptoms such as diplopia, weakness and dysarthria. These attacks typically begin in early childhood or early adulthood, last for hours to days. Attacks may occur daily, or may be separated by longer intervals. We present a family with familial periodic vertigo and ataxia. A 20-year-old woman presented recurrent paroxysmal vertigo, nausea, vomiting and ataxia lasting for 2 to 4 hours since middle school age. Recently daily attacks disabled her from daily living activity. Neurologic examination in the attack-free interval revealed downbeat nystagmus at neutral position and bilateral gaze evoked coarse horizontal nystagmus. Her mother, 47-year-old female also had recurrent vertigo, ataxia and dysarthria lasting for 1 to 2 hours since childhood. Their symptoms are precipitated by fatigue, exertion, emotional stress and alcohol. Both patients showed good response to acetazolamide and flunarizine even though showed persistent objective nystamus

Ischemic Infarctions in Young Men Secondary to Traumatic and Spontaneous Intracranial Arteries Dissection

Arterial dissection begins with spontaneous or traumatic rent of intima, which sometimes allows blood to penetrate the layers of the arterial wall. Dissections of the craniocervical arteries are separated according to whether they are extracranial or intracranial, spontaneous or traumatic. Dissection of intracranial portions of the carotid system is rare, but it may be one of the important causes of ischemic stroke in the young adults. Cerebral angiography, MRI, and Doppler sonography are important diagnostic methods in this case. Initial treatment with anticoagulants or antiplatelet agents are effective in many cases, but sometimes surgical method is recommended. We presented ischemic infarctions in young men secondary to traumatic and spontaneous intracranial arteries dissection

A case of acute disseminated encephalomyelitis

Acute disseminated encephalomyelitis(ADEM) is an uncommon acute inflammatory disease of the CNS which follows viral infections or Vaccination. ADEM is thought to be an immune mediated disease. The classic featues of ADEM include an antecedent event, commonly a viral illness, followed after a latent period by acute onset of multifocal or diffuse CNS signs, the potential for extensive or even complete recovery, and pathologic evidence of perivascular inflammation and demyelination. We experienced a 43-year-old patient with ADEM and reviewed literatures.

A case of aseptic meningitis following intrathecal administration of methotrexate

Methotrexate(MTX) is currently one of the most important antineoplastic drugs used in chemotherapy. Intrathecal(IT) MTX is widely used to treat or prevent meningeal leukemia and lymphoma. Aseptic meningitis following IT MTX is not uncommon, but not reported frequently in neurological field. We report a case of aseptic meningitis following IT MTX in acute lymphocytic leukemia.

A case of idiopathic exercise-induced axial dystonia with ipsilateral upper extremity atrophy

Torsion dystonia (TD) is a clinical syndrome characterized by prolonged spasms of muscle contraction, which distort the body into typical dystonic posture. The pathological or biochemical basis of either the familial types or of most sporadic forms of idiopathic or primary TD is unknown. We present a 40-year old man who showed a kinesigenic axial dystonia with ipsilateral upper extremity atrophy for 14 years. The symptoms and signs were spontaneous onset, nonprogrwsive course, and induced by voluntary activity but relieved by rest and sleep and responded to trihexyphenidyl medication.

Herpes zoster with multiple cranial and upper cervical nerves involvement

Herpes zoster is a viral disease that produces inflammatory lesions in the posterior root ganglia and is characterized clinically by pain and a skin eruption in the distribution of the affected ganglia. Involvement of motor roots or the CNS occurs in a small percentage of the patients. There are few reports about multiple cranial and upper cervical nerve involvement. We report a herpes zoster with multiple cranial(VI, VII, VIII, XII) and upper cervical(C2,3) nerves involvement. The patient was a 79-year-old woman who presented with painful vesicular eruption on left side of face and neck. She complained of decreased hearing and hyperacusis of left ear. Neurologic examination showed decreased taste sensation of left anterior tongue, left facial palsy, and tongue deviation to the left side.

Three Cases of Acute Aseptic Meningitis Followed by Herper Zoster

Acute aseptic meningitis is a rare complication of herpes zoster. It is usually regarded as a complication of the cutaneous infection in patients with impaired cellular immunity. Herpes zoster virus is a rare cause of viral meningitis. In one of three patients with herpes zoster meningitis, varicella-zoster virus DNA was detected by the polymerase chain reaction in the cerebrospinal fluid. We report three cases of acute aseptic meningitis followed by herpes zoster.

Three Cases of Acute Aseptic Meningitis Followed by Herper Zoster

Acute aseptic meningitis is a rare complication of herpes zoster. It is usually regarded as a complication of the cutaneous infection in patients with impaired cellular immunity. Herpes zoster virus is a rare cause of viral meningitis. In one of three patients with herpes zoster meningitis, varicella-zoster virus DNA was detected by the polymerase chain reaction in the cerebrospinal fluid. We report three cases of acute aseptic meningitis followed by herpes zoster.

Comparison of the Pattern Reversal and Light Emitting Diodes Stimulating Visual Evoked Responses

This study was carried out to establish normal values and to compare the pattern reversal and light emitting diodes(LED) stimulating visual evoked potential(VEP) in 30 healthy volunteers (20 men and 10 women, age ranged from 24 to 56 years, with a mean age of 34 years). The result summarized in table 1, 2 and 3. VEP wave patterns were similar and easily reproducible with those different types of visual stimulation. As compared of normal values of pattern reversal and LED stimulating visual evoked responses, there are no significant variations of absolute latencies, amplitudes, absolute amplitude differences between two eyes, proportional amplitude differences between eyes, and duration differences between two eyes. Only differences were significant in latency differences between two eyes and duration of p. 100. These results suggest that pattern reversal and LED stimulating VEP test will be useful in clinical test according to various patient's conditions.

A Clinical Study on Caudate Hemorrhage

A clinical study was done on 16 cases of caudate hemorrhage which were confirmed with brain CT scan at Keimyung University Dongsan hospital from January 1985 to Februaty 1989 and conclusions obtained are as follow 1. The proportion of caudate hemorrhage was 4,9% of all spontaneous mtracranial parenchymal hemorrhage. 2. The most prevalent age group was 7th decade and sex ratio was slightly higher in female(1.7:1). 3, The most common cause of caudate hemorrhage was hypertension. 4, The major initial symptoms of caudate hemorrhage were nausea and vomiting, followed by headache and altered concsiousness, 5. The major neurologic signs on admission were behavioral abnormalities (disorientation and memory disturbance), neck stiffness, impaired consciousness and hemipareris 6. Hemorrhage involved head(11 cases), body(4 cases) and head and body (1 case) of Caudate, but not tail. 7. The prognosis of caudate hemorrhage is good in our senes, but sequelae such as anxiety, memory disturbance or mild hemiparesis remained in a few cases. 8. From above findings, the caudate nucleus seems to play some roleon memory or behavioral function.