Is Conventional Angiography Always Superior to MR Angiography in Evaluatin of Cerebral Aneurysm?

Conventional angiography still remains the procedure of choice in evaluation of cerebral aneurysm. However, MRI and MR angiography can play different roles in vizualizing cerebral aneurysm. A 43-year-old male was evaluated for recurrent seizure attacks. The brain MRI showed non-enhancing iso-signal mass on T1WI, signal voiding mass with stalk-like structure on coronal T2WI in the right temporal region. MRA also revealed dark round signal. However, the conventional cerebral angiography failed to visualize it. Finally, the mass was confirmed as a huge aneurysm filled with intraluminal thrombus on operation. It should seem that contrast media could not fill the aneurysmal sac because of intraluminal thrombus in conventional angiography. But aneurysmal sac seemed to be visible on MRA as paramagnetic artifact of thrombus. So, it can be assumed that MRA is superior to the conventional angiography in some cases of cerebral aneurysm, especially when it is associated with intraluminal thrombus.

Laryngeal Electromyography: Clinical Application in Vocal Cord Palsy

Vocal cord paralysis is a comlex disorder which may result from numerous causes. It is often associated with trauma, disease in adjacent tissue, or a generalized neuroligical disorder. Laryngeal EMG is a useful technique for vocal cord paralysis. However it has not been used due to the uncertainties of normal human vocal cord physiology and the technical difficulties in performing these studies. We investigated the pathophysiology of vocal cord paralysis with laryngeal electromyography(LEMG). We studied 20 patients with idiopathic vocal cord paralysis. 6 patients were denervated in the cricothyroid(CT) and 6 patients in the thyroarytenoid(TA), and 3 patients in both CT and TA muscles. These indicated superior laryngeal neuropathy, recurrent laryngeal neuropathy, and proximal laryngeal or vagus neuropathy, respectively. LEMG proved to be a safe and effective procedure in the diagnosis of laryngeal neuropathy, and make it possible to use electromyography as a routine procedure in diagnosis laryngeal paralysis.

A Case of Symptomatic Paroxysmal Kinesigenic Choreoathetosis in Basal Ganglia Lesions

Paroxysmal choreoathetosis (dyskinesia) is classified into two subtypes: paroxysmal kinesigenic choreoathetosis(PKC) and dystonic choreoathetosis(PDC). PKC is also classified into two subgroups (idiopathic & symptomatic). PKC is characterized by choreoathetotic, dystonic and/or tonic movements induced by sudden voluntary movements, without loss of consciousness, urinary incontinence and clonic movement. Symptomatic PKC is associated with neurological disease such as cerebral palsy, multiple sclerosis, hypocalcemia, birth asphyxia, head injury and lesions of basal ganglia and premotor cortex. We report I case of symptomatic PKC, who showed characteristic symptoms of PKC and bilateral lesions of basal ganglia.

Two Cases of Neuroleptic Malignant Syndrome

The neuroleptic malignant syndrome (NMS), a serious and potentially fatal complication, has been reported to occur in some patients with administration od neuroleptic medications. Its major manifestations are muscular rigidity, autonomic instability, altered consciousness, and hyperthermia, often accompanied by raised creatine kinase (CK) and leukocytosis. Manifestations of NMS are attributed to dopamine receptor blockade in the striatum, increasing thermogenesis, and in the hypothalamus, impaired heat dissipation. Owing to the potential lethality of NMS, the early diagnosis is important. The authors report two survived patients with the NMS who were treated by generalized supportive care and drug therapy.