Lesion Sites on Computed tomography Scan in 7 Cases of Conduction Aphasia

The lesions on computerized tomography (CT) scan were evaluated in 7 cases of conduction aphasia. On Modified Westem Aphasia Battery (MWAB), all the patients showed fluent aphasia with some paraphasic errors, good comprehension, marked repetition dificit and variable degree of impairment in naming. The three most common lesions on CT scan were supramarginal gyrus and it's white matter, primary auditory cortex, and insular region, which were involved in 6,5,4 cases out of 7 respectively. Of the three lesions, one or variable combinations of them may be the critical structures for repetition difict in these patients, as has been reported in previous studies. In 5 cases Wermicke area was relatively intact and prominent involvement was seen in only 2 cases, which is thought to be associated with relative preseration foaural comprehension in conduction aphasia.

A Clinical Study on Guillain-Barr'e Syndrome

Authors reviewed clinical recordings of 102 patients who were diagnosed as Guillain-Barre syndrome from 1979 to 1983 at Seoul National University Hospital. Among them, eighty-five cases were selected for the clinical study of Guillain-Barre syndrome through application of strict diagnostic criteria. And the following results were obtained. 1) There was a male preponderance (2.5:1) and an apparent predilection for the first and the second decades in this series. 2) Seasonal predilection was in summer and fall over five years. As judged from the uneven monthly incidence rate in each year, some epidemic tendency is likely to be in Guillain-Barre syndrome. 3) Sixty cases (71%) of this series had a history of antecedental events. The onset of neuritic symptoms occurred within one week from the preceding events in twenty-nine cases and one to two weeks in twenty cases. 4) The neuritic symptoms started from lower limbs in fifty cases (59%), upper limbs in eighteen (21%), cranial nerve distribution in six (7%) and developed nearly simultaneously in eleven (13%). 5) Most of the disabilities of the patients were devided into flaccid paralysis of limbs, cranial nerve dysfunction, autonomic dysfunction, respiratory difficulty and sensory abnormalities (paresthesia and myalgia). Autonomic dysfunction was observed in nine cases (11%), respiratory difficulty in thirty-one (37%), sensory abnormality in thirty-two (38%), and cranial nerve dysfunction in forty-seven (55%). 6) Authors devided the crainal nerve dysfunction into facial diplegia which was the most frequent form, bulbar palsy the next, masticatory muscle weakness the third, and ocular paresis the least. 7) There were two cases of Fisher syndrome (2.4%), three cases of polyneuritis cranialis (3.5%), and two cases of recurrence (2.4%) in this series. 8) Two cases (2.4%) died of respiratroy and bulbar dysfunction. Five cases (6%) had residual disability in motor function till six months follow-up.

A Clinical Study on Crises in Myasthenia Gravis

The authors reviewed the medical records of 103 patients who were diagnosed and treated as myasthenia gravis (MG)at Seoul National University Hospital from March 1979 to March 1984. Among them 16 cases were selected according to the criteria of crisis in MG defined by Blaugrund SM et al(1964) and were studied with a special emphasis on crisis as a natural course of MG in Korea. The authors studied about the incidence of crisis, the aggravating factors or causes, the relationship between crisis and thymus pathology, and the clinical appllcability of the modified classification of crises in MG including a newly-defined steroid-inducd crisis. The results were not significantly different from those by others in general. The incidence rate of crisis was 16% and highest in the female group having the onest of MG in the fourth decade of life. Four patients(25%) had thymomas(2, noninvasive: 2, invasive). The intervals between the onset of MG and the first crises were significantly shorter in male patients and thymoma group, showing the more fulminant course in them. Some probable risk factors were suggested, though not analyzed statistically, which might foretell the prognosis of each patient having MG and might help management and prevention of crisis. They were as follows: (1) Female with onset of MG in her fourth decade, (2) Male with duration less than one year, (3) Patient with thymoma, (4) Patient classified into Osserman's group III, (5) Patient with brittle MG, (6) Patient with an infectious process, especially with repiratory infection Early detection of respiratory insufficiency, intensive respiratory care, and removal of aggravating causes as soon as possible played the critical role in the management of patients at crises. It could also be concluded that steroid therapy was an important therapeutic step during crisis in brittle myasthenics. The outcome of crises was 19% of fatality rate in crises(3 deaths among 16 cases) and 3% mortality rate in MG. There was no recurrence in 11 survivors and followup was lost in two other survivors.

Computed Tomography of Japanese Encephalitis with Clinical Correlation

The computed tomographic (CT) and clinical findings in 9 patients with serologically confirmed Japanese encephalitis were reviewed. In 6 patients with prominent pyramidal and extrapyramidal symptoms and signs, the main CT finding was low density areas in the thalamus, internal capsule, basal ganglia, and midbrain. Low density areas were compatible with the anatomical distribution of pathologic lesions in Japanese encephalitis. Diffuse low density in the periventricular white matter was evident in 5 of 6 cases, with ventricular compression in 2 cases, between the 1st and 7th day of illness. There was enlargement of the third and lateral ventricles and cortical sulci dilatation in 3 cases on or after the 21st day of illness. In once CT scan obtained on the 10th day of illness, diffuse low density in the periventricular white matter was observed with enlargement of lateral ventricles and cortical sulci dilatation. Gyral enhancement was noted in 3 of 4 cases within 4 days after the onset of symptoms. There was a limited correlation between the clinical and CT findings.

Three Cases of Olivopontocerebellar Atrophies

No abstract available.

Electroencephalographic and Computed Tomographic Findings of the West Syndrome

Electroencephalograhic and brain computed tomographic findings in 12 children with West syndrome were analysed. All the patients presented infantile spasms and psychomotor retardation. The results were as following. 1) EEG findings were abnormal in all. Hypsarrhythmia was present in 90%. 2) The serial EEG records improved with the reduction of spasms after ACTH treatment. But no change was observed with the reduction or cessation of spasms after other antiepileptic drugs. 3) Brain CT findings were abnormal in 5 out of 9 cases. Diffuse cerebral atrophy with fronto-temporal predominance was demonstrated in 4 cases. Multiple small low denstities were observed in one case. 4) The spasms were intractable to ACTH treatment for those with structural brain abnormalities on brain CT. 5) It seems that brain CT constitutes a valuable diagnostic tool in distinguishing between idiopathic and symptomatic cases and for greater prognostic accuracy, and serial EEG records can give a guide to the treatment.

Two Cases of Oculopharyngeal Muscular Dystrophy in One Family

The authors encountered 2 siblings who showed progressive ophthalmoplegia and bulbar palsy. The patients were studied with various laboratory aids and thought to be as oculopharyngeal muscular dystrophy. The oculopharyngeal muscular dystrophy is a rare form of muscular dystrophy. The authors present the cases as familial oculopharyngeal muscular dystrophy.

Pseudohypoparathyroidism and Basal Ganglia Calcification: Case Report

No abstract available.

A Clinical Study on Spontaneous Subarachnoid Hemorrhage: with a special reference to intracranial complications

The authors reviewed the medical records of 94 patients who met the strict diagnostic criteria of spontaneous subarachnoid hemorrhage (SAH). They were diagnosed and treated at Seoul National University Hospital from January 1983 to June 1984. The interrelationships among the age, clinical status on admission, findings on brain computerized tomography (CT), site of the ruptured aneurysm and the intracranial complicaions (ventricular dilatation, vasospasm, rebleeding) and their outcome were studied. Conclusions obtained are as follows: 1) The local clot on CT (especially associated with ICH and /or IVH) was more frequently found in clinically poor patients than in good ones. 2) Cerebral angiography (TFCAs, 53 cases) revealed the anterior communicating artery (A-COM) to be the most common site of aneurysm in 21 cases (39.6%) and multiple aneurysms in 5 cases (9.4% : two in 4 cases, three in 1 case) and no aneurysm in 9 cases (17%). Vasospasm on angiography was found in 27 cases (50.9%). 3) Ventricular dilatation, which was measured on the first CT after SAH, was detected in 43 cases (45.7%). High incidence was found in the cases showing a local clot on CT (53.4%), especially associated with intraventricular hemorrhage (IVH; 83.3%), and in the cases of A-COM aneurysm rupture (52.4%; probably due to IVH). 4) The clinical vasospasm was edtected in 41 cases (43.6%). The interval between SAH and the development of clinical vasospasm ranged from from 3 to 35 days (mean 9.8 days). Thirty-five cases (85.4%) of them suffered from clinical vasospasm within 14 days. The incidence of clinical vasospasm steeply increased in the elderly patients (Fifties: 60%, Sixties: 66.7%) but that of findings of vasospasm on angiography (angiographic vasospasm) slowly increased with age. The local clot on CT seemed to be the most important factor of vasospasm, both clinically (51.7%) and angiographically (75%). The site of vasospasm on angiography was closely related with that of the ruptured aneurysm. 5) Rebleeding occurred in 21 cases (22.3%) with the interval ranging from 2 hours to 38 days (mean 10.1 days) after SAH and 14 cases (66.7%) of them rebled within 10 days. The shorter the interval after SAH, the higher the incidence. There were no definitely related factors affecting the rebleeding but it seemed to be affected to some extent by ICH and/or IVH on CT (31.3%). 6) Thirty-five cases (37.2%) diedof various causes. Mortality seemed to be most closely related with the clinical status on admission. Other related iactros were the aging, the local clot on CT (53.4%), especially associated with ICH and/or IVH (69.7%), and the development of various systemic or intracranial complications. Mortality seemed to be more closely related with ventricuar dilstation and rebleeding than with vasospasm. But it was suggested that vasospasm should be regrarded as a major cause of disabilities and an indirect cause of death.

Focal Seizure Disorder with Spontaneous Regression of Epileptogenic Lesion on Serial Computed Tomography

During a period of four years the authors experienced eighteen cases of focal seizure disorder, showing small ring or nodular enhancement with surrouding low density on CT scans. In fifteen cases, the epileptogenic lesions decreased in size or resolved completely on serial CT scans. Three cases were explored surgically. Males and famales were equally affected. Their age ranged from six to fourtyfive years and fifteen patients were under the age of thirty years. The principal symptoms and signs consisted of focal siezures (17 cases), generalized seizure during sleep (1 case), focal neurological deficits (14 cases), and intracranial hypertension (4 cases). The lesions of CT scans were found frequently in the parietal and frontal lobes. The clinical course of this self-limited disorder was variable and well correlated with the change of CT findings. The histological findings were the typical tuberculoma and the caseating gramuloma containing calcium in two cases. In one case the enhancing nodule of CT scan was not resected and the tissue specimen around the nodule revealed nonspecific inflammation. The cause of this disorder might be tuberculoma, but in some cases we could not rule out cysticercosis.

Oligoclonal Bands in Cerebrospinal fluid of Neurologic patients

The authors studied the diagnostic value of the oligoclonal band in cerebrospinal fluid in various neurological disorders. Cerebrospinal fluid of thirty-one patients including eight cases of multiple sclerosis was tested for oligoclonal band by agarose gel electrophoresis using the Helena Titan Gel High Resolution Protein System. Oligoclonal bands were detected in eleven cases of various disorders (two cases of optic neuritis, three cases of multiple sclerosis, three cases of CNS cysticercosis, and three cases of other disorders). This study suggested that detection of oligoclonal band in CSF was of usdful diagnostic aid in multiple sclerosis in addition to CSF IgG/Albumin ratio and CSF IgG index.

3 Case of Shy-Drager Syndrome

Shy-Drager syndrome is a multisystem degenerative disorder of the central nervous system in which progressive autonomic failure such as orthostatic hypotension, urinary or fecal incontinence, impotence and anhidrosis is a main feature. The nonautonomic neurological abnormalities include parkinsonia, cerebellar and pyramidal signs. In 1984 we met 3 such cases at Seoul National University Hospital and present them here with a brief review of literatures.

Effect of Lorazepam injection on Status Epilepticus

Status epilepticus is a neurological emergency requiring immediate effective care to avoid permanent brain damage or death. There is no single ideal pharmacological agent that can be used for status epilepticus. The author has studied the effect of intravenous lorazepam in the tratment of status epilepticus occurring in eighteen patients. Lorazepam controlled status epilepticus in sixteen (88%) of the eighteen patents, showed no side effect such as depressant action on respiratory and cardiovascular system. Also it seemed that lorazepam acted rapidly and its effect lasted at least for over eight hours. Except a few cases who had had prolonged hangover, the injection seemed to be handy and safe treatment without requiring EKG monitoring and repeated electrolyte check etc. as in dilantinization.

Effect of Lorazepam injection on Status Epilepticus

Status epilepticus is a neurological emergency requiring immediate effective care to avoid permanent brain damage or death. There is no single ideal pharmacological agent that can be used for status epilepticus. The author has studied the effect of intravenous lorazepam in the tratment of status epilepticus occurring in eighteen patients. Lorazepam controlled status epilepticus in sixteen (88%) of the eighteen patents, showed no side effect such as depressant action on respiratory and cardiovascular system. Also it seemed that lorazepam acted rapidly and its effect lasted at least for over eight hours. Except a few cases who had had prolonged hangover, the injection seemed to be handy and safe treatment without requiring EKG monitoring and repeated electrolyte check etc. as in dilantinization.

A Clinical Study on Cysticercosis

Authors reviewed the clinical features and diagnostic approaches in 70 patients of cysticercosis who had been diagnosed at Seoul National University Hospital from 1978 to 1982. The ages of the 70 patients ranged from 4 to 65 years at the time of the diagnosis (mean age 36.9years) with 62.9 percent between the age 20 and 50 years. Male were more frequently involved than female (2:1). Forty-seven patients (67.1%) presented with neurological symptoms and signs, among which epileptic seizures (66%) was the most common one. Subcutaneous nodules were observed in 36 patients (50.1%) and 24 patients of them had no abnomal clinical findings other than subcutaneous nodules. Computed tomography (CT), employed in 46 patients, showed multiple low densties in 31 patients (67.4%).

A Clinical Study on Cysticercosis

Authors reviewed the clinical features and diagnostic approaches in 70 patients of cysticercosis who had been diagnosed at Seoul National University Hospital from 1978 to 1982. The ages of the 70 patients ranged from 4 to 65 years at the time of the diagnosis (mean age 36.9years) with 62.9 percent between the age 20 and 50 years. Male were more frequently involved than female (2:1). Forty-seven patients (67.1%) presented with neurological symptoms and signs, among which epileptic seizures (66%) was the most common one. Subcutaneous nodules were observed in 36 patients (50.1%) and 24 patients of them had no abnomal clinical findings other than subcutaneous nodules. Computed tomography (CT), employed in 46 patients, showed multiple low densties in 31 patients (67.4%).

Neurological Complications of Acute Hemorrhagic Conjunctivitis in Korea

No abstract available.

Neurological Complications of Acute Hemorrhagic Conjunctivitis in Korea

No abstract available.