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The artery of Percheron (AOP) is an uncommon variant of the posterior cerebral artery that supplies blood to the paramedian thalamus and rostral midbrain. AOP is often difficult to recognize with intracranial magnetic resonance angiography due to its small size. Although a number of case reports of AOP occlusion have been published, cause of the occlusion is mostly unclear. We experienced a case of AOP occlusion which resulted in bilateral thalamic infarction. It was most likely caused by a microembolism through right-left shunt.
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Background@#and Purpose Nelonemdaz (Neu2000) has both selective antagonism against 2B subunit of N-methyl-D-aspartate receptor and antioxidant activity. This drug provides sufficient evidence of neuroprotection in acute cerebral ischemia/reperfusion models. This phase III trial aims to determine this effect in patients.Design The Rescue on Reperfusion Damage in Cerebral Infarction by Nelonemdaz is a multicenter, double-blinded clinical trial. A total of 496 patients will be randomly assigned into the nelonemdaz (a total of 5,250 mg divided by 10 times for 5 days) and placebo groups. Patients will be included if they have an acute ischemic stroke (National Institutes of Health Stroke Scale score ≥8) caused by intracranial large vessel occlusion in the anterior circulation (Alberta Stroke Program Early CT Score ≥4), and if they are expected to undergo endovascular thrombectomy within 12 hours after stroke onset.Endpoints The primary endpoint is a favorable shift in the modified Rankin Scale (mRS) score at 90 days after the first dose of drug. The data will be analyzed by the Cochran–Mantel–Haenszel shift test. The secondary endpoints include functional independence (mRS 0–2) at 35 and 90 days, the favorable shift of mRS at 35 days, the proportion of mRS 0 at 35 and 90 days, and the occurrence rates of symptomatic intracranial hemorrhage within 7 days. @*Conclusion@#This trial will clarify the efficacy and safety of nelonemdaz in patients with acute ischemic stroke and endovascular thrombectomy. This study has been registered at ClinicalTrials. gov (NCT05041010).
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Electroencephalography (EEG) has been used for decades to evaluate and assess brain function. It is a useful method to diagnose brain disorders. However, confirmed interpretation of EEG is quite challenging because there is no standardized method for EEG reading and this may lead to interrater variability even among expert electroencephalographers. In this background, uniformly accepted nomenclature for EEG pattern were required to improve interrater agreement and to support communication for EEG research. American Clinical Neurophysiology Society (ACNS) established the standardized critical care EEG terminology since 2012 and has recently published the revised 2021 version of EEG terminology. This review covers new concepts of 2021 ACNS EEG terminology and clinical considerations of various EEG patterns.
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Background@#s: Proper distribution and supply of physicians are factors that affect national health care systems. This study investigated the payment distribution levels and the determinants that influence the salary levels of hospital hired physicians. @*Methods@#We analyzed 4,014 job advertisements posted on an internet invitation information site about physician recruitment from May 2016 to May 2019. We used univariate analysis to determine the relationship between average monthly salary and the other related variables. Multiple regression analysis was used to determine the predictors of physician salary level. @*Results@#The average monthly salary for the service physician was 15.4 million won, highest for orthopedic surgeons with 22.24 million won, and lowest for diagnostic laboratory physician with 11.4 million won. The factors significantly associated with average monthly salary were; non-major specialty, housing provision, no severance pay, and incentives(p<0.05). Non-major specialty, incentives, and the regions were predictors of the average standardized monthly salary(p<0.05). @*Conclusion@#Factors associated with average monthly salary as revealed by this study were; medical specialty, hospital regional location, housing provision, payment of retirement allowance, and payment of other incentives respectively. However, this study was a cross-sectional study, and further studies will be required.
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Poststroke epilepsy is the most common cause of epilepsy in adult. Acute symptomatic seizure is a provoked seizure usually caused by systemic metabolic disorders. If stroke patient has a seizure, it is very important to discriminate whether it is a poststroke epilepsy or provoked seizure. The reason is that there are differences in the approach to treatment and the continuation of antiepileptic drugs. We report a stroke mimic patient who had two different mechanisms of focal seizures.
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Purpose@#To report a successful case of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy performed in a noncompliant pediatric patient using the lateral decubitus position and a conventional slit-lamp-based laser system under general anesthesia.Case summary: Progression of a thick posterior capsular opacity with associated vision loss (best-correct visual acuity of 0.1) was detected in a nine-year-old child with a past history of cataract surgery in his right eye. Diagnosed with pediatric uveitis at the age of five, he had been treated previously using a combination of topical and systemic corticosteroids, which led to the development of the cataract and subsequent surgery 16 months later. Severe photophobia prevented outpatient-based laser treatment, and the patient underwent our modified procedure. Under general anesthesia, the patient was placed in a lateral decubitus position with the use of a long intubation tube. The height of the bed and table-based laser system was adjusted so as to minimize strain when positioning the child’s head. Successful laser capsulotomy was performed within 10 minutes, and the entire anesthesia time was less than 30 minutes. The patient experienced immediate improvement in symptoms, showing a visual acuity of 1.0, which has been sustained as of his most recent visit, 3 months postoperatively. The patient experienced no ocular or anesthesia- related complications. @*Conclusions@#Nd:YAG laser capsulotomy performed by careful positioning (lateral decubitus) under general anesthesia is a viable strategy for the safe and efficient removal of posterior capsular opacities in children with poor compliance.
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Purpose@#To report a successful case of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy performed in a noncompliant pediatric patient using the lateral decubitus position and a conventional slit-lamp-based laser system under general anesthesia.Case summary: Progression of a thick posterior capsular opacity with associated vision loss (best-correct visual acuity of 0.1) was detected in a nine-year-old child with a past history of cataract surgery in his right eye. Diagnosed with pediatric uveitis at the age of five, he had been treated previously using a combination of topical and systemic corticosteroids, which led to the development of the cataract and subsequent surgery 16 months later. Severe photophobia prevented outpatient-based laser treatment, and the patient underwent our modified procedure. Under general anesthesia, the patient was placed in a lateral decubitus position with the use of a long intubation tube. The height of the bed and table-based laser system was adjusted so as to minimize strain when positioning the child’s head. Successful laser capsulotomy was performed within 10 minutes, and the entire anesthesia time was less than 30 minutes. The patient experienced immediate improvement in symptoms, showing a visual acuity of 1.0, which has been sustained as of his most recent visit, 3 months postoperatively. The patient experienced no ocular or anesthesia- related complications. @*Conclusions@#Nd:YAG laser capsulotomy performed by careful positioning (lateral decubitus) under general anesthesia is a viable strategy for the safe and efficient removal of posterior capsular opacities in children with poor compliance.
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Influenza is an epidemical acute respiratory disease caused by viral infection. Several complications in the respiratory tract, such as pneumonia can occur. However, rare but serious neurological complications are also observed. Here, we described the prevalence, characteristics and suggestive pathomechanism of syncope after influenza infection season. Of 2.2% of patients diagnosed as influenza experienced syncope. None of the patients had severe cough, low blood pressure (BP) or dehydration. Patients suffered with frequent dizziness before syncope. Patient with long duration of loss of consciousness was more observed in those with high fever or positive orthostatic BP drop.
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Purpose@#We sought to evaluate the long-term outcomes for patients with exudative age-related macular degeneration (AMD) undergoing vitrectomy for breakthrough vitreous hemorrhage and to investigate possible prognostic factors. @*Methods@#Consecutive patients treated at two high-volume referral-based tertiary hospitals between July 2006 and Decem-ber 2019 were retrospectively reviewed. Surgery was performed using the standard three-port vitrectomy. The primary out-come was the change in best-corrected visual acuity (BCVA) over long-term follow-up, while secondary outcomes included the assessment of possible prognostic factors. @*Results@#Among 50 eyes from 50 patients included in this study, 23 (46%) were diagnosed with polypoidal choroidal vascu-lopathy (PCV) and 27 (54%) were diagnosed with neovascular AMD. Preoperative vision at the time of vitreous hemorrhage onset was 20 / 3,027 (logarithm of the minimum angle of resolution [logMAR], 2.18 ± 0.34). At 12 months after surgery, the mean BCVA improved to 20 / 873 (logMAR, 1.64 ± 0.76; p < 0.001). At 24 months, the BCVA was 20 / 853 (logMAR, 1.63 ± 0.75; p < 0.001). Univariate analysis revealed that older age (odds ratio [OR], 0.879; p = 0.007] and the presence of submac-ular hemorrhage (OR, 0.081; p= 0.022) were factors associated with a poor 2-year visual outcome. Multivariable regression showed that older age (OR, 0.876; p= 0.026) and neovascular AMD (as compared with PCV) (OR, 0.137; p= 0.014) were significant negative factors influencing the 2-year visual outcome. The mean injection interval prior to vitrectomy was 4.53 months, which extended to 27.64 months after vitrectomy ( p = 0.028). @*Conclusions@#Younger age, the absence of submacular hemorrhage, and PCV type were associated with a favorable 2-year visual outcome after vitrectomy for vitreous hemorrhage in patients with exudative AMD. Overall, vitrectomy resulted in im-proved visual acuity and patients showed a decreased need for anti-vascular endothelial growth factor therapy thereafter.
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BACKGROUND: Selecting the appropriate patients and reducing stroke onset to endovascular recanalization therapy (ERT) time are essential elements of a successful ERT. Since ERT is available only in large hospitals, proper patients transfer is important. The purpose of study is to examine the suitability of the transfer of acute stroke patients. METHODS: We retrospectively reviewed the medical records of patients who diagnosed as acute ischemic stroke from January to December in 2017. Patients were divided into two groups based on transfer (direct visit vs. transfer) and Alberta Stroke Program Early computed tomography (ASPECT) score (≥8 vs. <8) respectively. Each group was assessed by demographics, type and rate of reperfusion therapy, onset to reperfusion therapy time, stroke risk factors and neurological deficit severity. Interhospital distance and transfer time was calculated in transferred patients. RESULTS: Among the 455 patients, the 228 (50.2%) patients underwent interhospital transfer. The ratio of reperfusion therapy was not significant different between direct visit and transferred group (34.8% vs. 37.3%, p=0.397). The transferred patients tended to be older (p=0.003), female (p=0.001), more hypertension (p=0.019), less transient ischemic attack (p=0.001), longer onset to ERT time (178.55±85.92 vs. 131.48±82.89; p=0.001) lower ASPECT score (6.72±2.04 vs. 8.01±1.65; p<0.001) and higher National Institute of Health Stroke Scale (NIHSS) (p<0.001) and modified Rankin Scale (mRS) (p<0.001). High ASPECT score (≥8) patients were more direct visited (63.9%), shorter onset to ERT time (p=0.047), lower initial NIHSS and mRS (p<0.001), and greater in differences between mRS at admission and 3 months later (p=0.016). CONCLUSIONS: This study suggests emergency and interhospital transfer of acute stroke patients is inefficient, and systematization of transfer is necessary.
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Feminino , Humanos , Alberta , Demografia , Emergências , Procedimentos Endovasculares , Hipertensão , Ataque Isquêmico Transitório , Prontuários Médicos , Neuroimagem , Transferência de Pacientes , Reperfusão , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular CerebralRESUMO
PURPOSE: To compare long-term refractive outcomes associated with intravitreal anti-vascular endothelial growth factor (VEGF) versus laser photocoagulation treatment for retinopathy of prematurity (ROP). METHODS: A total of 52 eyes from 27 ROP patients treated at two tertiary referral-based hospitals from August 2006 to December 2013 were reviewed. The primary outcome was refractive error measured at the age of 4 years, accounting for within-patient inter-eye correlation. Secondary outcomes included the recurrence rate and treatment complications. RESULTS: The mean age at refraction was 4.7 ± 0.3 years in the laser group (n = 30) and 4.4 ± 0.3 years in the anti-VEGF group (n = 22). No significant differences were noted in gestational age, birthweight, post-menstrual age at treatment, or ROP stage/zone distribution between groups. Mean spherical equivalent was also not significantly different (−1.0 diopters in the laser group and −0.3 diopters in the injection group, p = 0.603). Clustered regression analysis revealed that only gestational age was significantly correlated with mean spherical equivalent (p < 0.001; 95% confidence interval, −0.007 to −0.002). Recurrence was noted in four eyes (13.3%) in the laser group, but this difference was not significant (p = 0.128). There were no major systemic complications reported in either group. CONCLUSIONS: Treatment type, whether laser or anti-VEGF injection, does not appear to influence long-term refractive outcomes in ROP. Concern regarding refractive outcomes should not be the most important factor when selecting ROP treatment modality.
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Criança , Pré-Escolar , Humanos , Fatores de Crescimento Endotelial , Idade Gestacional , Injeções Intravítreas , Terapia a Laser , Fotocoagulação , Recidiva , Erros de Refração , Retinopatia da Prematuridade , Fator A de Crescimento do Endotélio VascularRESUMO
No abstract available.
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Encefalopatias , Síndrome da Leucoencefalopatia Posterior , UremiaRESUMO
Toxoplasma encephalitis is an opportunistic infection that may occur in immunocompromised or advanced HIV (Human Immunodeficiency Virus) patients and lead to serious complications in the CNS. We report a 44-year-old man with toxoplasma encephalitis combined with HIV infection. He was admitted with headache and neck stiffness. Brain computed tomography showed normal findings. Tuberculous meningitis was suspected from CSF and serum tests. However, his symptoms continued to progress, and toxoplasma encephalitis was diagnosed based on brain magnetic resonance imaging and serum tests.
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Adulto , Humanos , Humanos , Encéfalo , Encefalite , Cefaleia , Infecções por HIV , HIV , Imageamento por Ressonância Magnética , Pescoço , Infecções Oportunistas , Toxoplasma , Tuberculose MeníngeaRESUMO
Burning mouth syndrome (BMS) is an intraoral chronic pain disorder characterized by continuous burning sensations. BMS occurs particularly in postmenopausal women, and its etiology is not definite and considered idiopathic. Various treatments such as analgesics, anticonvulsants, and antidepressants are found to be effective, but the definitive treatment has not been established. We report two cases of postmenopausal BMS that were relieved by clonazepam, and review the literature about the various possible etiologies and treatment modalities of BMS.
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Feminino , Humanos , Analgésicos , Anticonvulsivantes , Antidepressivos , Síndrome da Ardência Bucal , Queimaduras , Dor Crônica , Clonazepam , Pós-Menopausa , SensaçãoRESUMO
In Korea, current status of epilepsy and driving are challenging and there are lack of formal legal guidelines about driving in patients with epilepsy. According to the default standards in Korean Road Traffic law, patients with epilepsy are restricted or prohibited from driving except who are conditionally allowed to drive by the Aptitude Judgement Committee (AJC). Though the AJC consist of medical doctors and traffic officials, new regulation and guidelines are required for various type of seizure and characteristics of patients with epilepsy. This review outlines the current applicable legislation about epilepsy and driving in Korea as well as that of the overseas country calling for new laws to establish a consistent assessment.