Diagnostic Usefulness of Neuromuscular Ultrasound in Anatomical Localization of Peripheral Nerve Injury: Detailed Lesion Localization Using Neuromuscular Ultrasound in a Patient with Traumatic Ulnar Nerve Injury at the Hand

In the evaluation of peripheral nerve injury, nerve conduction studies and needle electromyography mainly focus on anatomical localization and functional evaluation of lesions. Whereas neuromuscular ultrasound has an advantage in structural assessment of lesions. In addition, muscle ultrasound can also be used to demonstrate muscle denervation without causing pain. We report a case of traumatic ulnar nerve injury at hand in which muscle ultrasound contributed to precise localization by provided detailed information about the extent of muscle denervation.

Isolated Dorsal Ulnar Cutaneous Nerve Injury Occurring During Activities of Daily Living

The dorsal ulnar cutaneous nerve (DUCN) is the sensory branch of ulnar nerve supplying sensation to the dorsal ulnar aspect of the hand. Isolated DUCN injury is known rare. We report 3 cases of isolated DUCN injury caused by stretch injury and mild blunt injury during activities of daily living. Isolated DUCN injury may more frequently occur than we thought. Nerve conduction study and ultrasonography are useful method to localize the lesion and to evaluate the structural etiology.

Sural Nerve Entrapment by Hypertrophic Peroneal Tubercle of the Calcaneus

No abstract available.

Concurrence of Acute Cerebral Infarction and Peripheral Neuropathy Associated with Hypereosinophilic Syndrome

Hypereosinophilic syndrome is a rare disorder involving the eosin concentration being elevated to more than 1500/µL in the peripheral blood for 6 months, and it causes various complications in the heart, skin, and nervous and respiratory systems. The simultaneous occurrence of neurological complications of hypereosinophilic syndrome is rare. Here we report a patient with hypereosinophilic syndrome who suffered from acute cerebral infarction and peripheral neuropathy during the same period.

Hypoglycemic Cognitive Impairment Presenting as Anomic Aphasia

No abstract available.

Clinical Significance of Perverted Head-Shaking Nystagmus / 대한평형의학회지

OBJECTIVES: We investigated clinical significance of head shaking nystagmus (HSN) and perverted HSN (pHSN) in patients with peripheral and central vestibular disorders. METHODS: We reviewed medical records of 822 consecutive subjects who were referred to a dizziness clinic. We performed neurologic examination including video-oculography in darkness for 60 seconds before, during and for 100 seconds after head-shaking. HSN was considered to develop when post-head-shaking nystagmus last at least 5 beats with latency from end of head-shaking of no more than 5 seconds, and a velocity at least 3°/sec. RESULTS: In control group (n=45), there were observed spontaneous nystagmus (SN) in 2.2%, HSN in 17.8%, pHSN in 6.7%. In patients with peripheral vestibular disorder group (n=397), there were observed SN in 14.1%, HSN in 40.6%, pHSN in 9.8%. In patients with central vestibular disorder group (n=217), there were observed SN in 17.5%, HSN in 24.0%, pHSN in 13.4%. In unspecified dizziness group (n=208), there were observed SN in 1.9%, HSN in 13.0%, pHSN in 1.9%. pHSN was frequently observed in central vestibular disorders such as stroke, vestibular migraine, cerebellar ataxia, and vertebro-basilar insufficiency. However, pHSN was also observed at higher rate than expected in peripheral vestibular disorders including benign paroxysmal positional vertigo especially involving vertical canals, Meniere disease and even in unilateral vestibulopathy. CONCLUSIONS: Our results show that perverted HSN in dizzy populations was frequently observed not only in cases of central vestibular disorders but also in peripheral disorders. Perverted HSN can develop by any conditions that cause difference in vestibular velocity storage in vertical component of vestibular-ocular reflex.

Histological Evidence of Artery to Artery Embolism from Calcified Atherosclerotic Plaque of Carotid Artery

Artery to artery embolism is one of the main causes of cerebral infarction, and it can originate from many locations. Here we report a case of cerebral infarction in which calcified cerebral emboli were detected in brain computed tomography (CT). The calcified emboli were thought to originate from a carotid plaque that showed calcification and ulceration. We present histologic and micro-CT findings of a carotid plaque as a source of artery to artery embolism.

Carpal Tunnel Syndrome Caused by Scar Tissue Invasion of Median Nerve Fascicles

No abstract available.

Loss of the Horizontal Vestibulo-Ocular Reflex in a Patient With Wernicke Encephalopathy

No abstract available.

Initiation of Smooth Pursuit in Acute Cerebellar Infarction: A Preliminary Study / 대한평형의학회지

BACKGROUND AND OBJECTIVES: The cerebellar lesion causes an initiation deficit of smooth-pursuit eye movement depending on the location of the lesion. We investigated the initiation of smooth pursuit in patients with cerebellar infarction and in healthy subjects, using step-ramp stimuli. MATERIALS AND METHODS: Ten patients with cerebellar infarction documented by brain magnetic resonance imaging and fifty healthy subjects are recruited. To estimate the initiation of smooth pursuit, the onset latency and initial acceleration during the first 100ms of the horizontal smooth pursuit were estimated using the step-ramp target stimuli (5degrees/sec, 10degrees/sec, and 20degrees/sec). RESULTS: In healthy subjects, onset latency of pursuit was shortened and initial acceleration was increased as target velocity was increasing. In patients with unilateral cerebellar infarction, the onset latency of ipsilesional smooth pursuit was significantly delayed at the target velocities of 10degrees/sec and 20degrees/sec. For the fast target velocity of 20degrees/sec, there was significant decrease of the initial acceleration of contralesional pursuit. CONCLUSION: In comparison with the healthy subjects, the patients with unilateral cerebellar lesions showed significant delay of pursuit onset and decrease of initial eye acceleration in the fast target velocity. These results support that the cerebellar lesions affect not only steady-state smooth pursuit gain but also the processing time required to initiate smooth pursuit, i.e., onset latency and initial acceleration. More extensive study is needed to confirm the role of cerebellum for parametric adjustment of each component of smooth pursuit.

Pathophysiology of Vestibular Migraine / 대한평형의학회지

Vestibular migraine (VM) is an increasingly recognized cause of episodic recurrent vertigo. However, the pathophysiology of VM is still a matter of speculation. An understanding of the relationship between migraine and the vestibular system increases knowledge of the pathogenesis of both migraine and vertigo. The pathophysiology of VM has been known to be related to cortical spreading depression, neurotransmitters (i.e., serotonin, noradrenaline, dopamine, calcitonin gene-related peptide) and calcium ion channel disorder. Moreover, VM is related with Meniere's disease, benign paroxysmal positional vertigo, motion sickness, cerebellar dysfunction, or comorbid psychotic disorder. This review refines recently proposed pathophysiological concept for VM and relationships between migraine and other related disorders.

Ocular Vestibular Evoked Myogenic Potentials Produced by Stimulation With Bone-conducted Vibration in Healthy Subjects / 대한평형의학회지

BACKGROUND AND OBJECTIVES: To provide the empirical basis for using ocular vestibular evoked myogenic potentials (oVEMPs) in response to bone-conducted vibration (BCV) stimulation to indicate vestibular function in normal subjects. MATERIALS AND METHODS: In response to bone-conducted tone burst (90 dB nHL and 100 dB nHL with frequencies 500 Hz and 1,000 Hz, the oVEMPs were measured in 45 healthy controls. The early negative component (n10) of the oVEMP to brief BCV of the forehead and at each mastoid process is recorded by surface electromyography electrodes just beneath the eyes. We used a hand-held vibrator (Bruel and Kjaer 4810 Mini-Shaker) placed on the forehead, in the midline at the hairline (Fz) and at each mastoid process and quantified the individual differences in n10 magnitude, latency and symmetry to Fz and mastoid BCV at each frequency. RESULTS: In normal subjects, n10 responses were symmetrical in the two eyes during Fz and both mastoid stimuli and the latencies of the onset were consistent among subjects. Response rate is similar between Fz and mastoid stimuli. However, at each stimulation site, response rate is higher on 500 Hz than on 1,000 Hz stimulation. During the mastoid stimuli, the onset latency is slightly shorter and amplitude is larger than the Fz stimuli. The average amplitudes decreased with age and average latency (to peak) increased slightly with increasing age. CONCLUSION: Clear oVEMP responses to bone-conducted Fz and mastoid stimuli were evoked from normal subjects. It is concluded that bone-conducted stimuli as well as air conduction can evoke myogenic potentials from the ocular muscles.

Recurrent Streptococcus Pneumoniae Meningoencephalitis in a Patient With a Transethmoidal eningoencephalocele

We report a case of recurrent Streptococcus Pneumoniae meningoencephalitis with a transethmoidal meningoencephalocele (TEME) but without cerebrospinal fluid (CSF) leakage. A 35-year-old man was admitted with S. pneumoniae meningitis. He had suffered from four episodes of recurrent pneumococcal meningitis during the previous 4 years. A computed tomography scan of the paranasal sinus showed the TEME protruding through a bony defect of the right frontal base. However, the patient did not have symptoms that could be attributable to CSF leakage, and radioisotope cisternography did not identify a leak. Brain magnetic resonance imaging revealed cortical lesions overlying the TEME, and electroencephalography revealed epileptiform discharges in frontal regions. Appropriate antibiotics therapy without steroids was given to improve his condition. The presented case suggests that even in the absence of clinically demonstrable CSF leakage, an occult skullbase defect and its associated meningoencephalocele should be considered in patients with recurrent bacterial meningitis.

Glomangiomyoma on the Face

We report a rare case of glomangiomyoma in a 25-year-old man who had an asymptomatic, 1.5 × 1.5cm sized, round, skin-colored, soft mass on the right cheek. Histopathologically, the lesion was consistent with glomangiomyoma which showed irregularly dilated vessels lined by endothelial cells and several outer layers of glomus cells, and smooth muscles distributed within the tumor. The tumor cells were characterized immunohistochemically by the presence of smooth muscle actin, muscle specific actin, and vimentin. To our knowledge, this is the first case report of glomangiomyoma on the facial location in the Korean literature.

Alterations of Cell Cycle Regulation and Apoptosis Related Factors in Skin Tumors / 대한피부과학회지

BACKGROUND: Tumor growth and progression is dependent on a variety of factors including; increased cell survival, i. e. resistance to undergo apoptosis, increased proliferation, and the inability to undergo growth arrest or differentiation. The cyclins are a growing group of proteins that form the regulatory subunits in complexes with a specific catalytic protein kinase(cyclin-dependent kinase(CDK)) partner. Tumor suppressor gene such as Rb, p53 and cell cycle regulatory proteins such as p16, p27, WAF1(p21, or Cip 1) also act as a regulator of cyclin and CDK. Apoptosis regulatory proteins such as bcl-2, bcl-x act as a blocking protein of apoptosis and Ki-67 is frequently used as a marker for cell proliferation. OBJECTIVE: The purpose of this study was to investigate the alterations of cell cycle regulation and apoptosis in skin tumors. METHODS: We compared expressions for cyclin A, cyclin E, WAF1, Ki-67, p53, p27, Rb, bcl-2 and bcl-x in paraffin embedded samples from 5 normal adult skin tissues, 10 basal cell epithelioma, 10 squamous cell carcinoma, 10 Bowen's disease, 5 keratoacanthoma and 5 solar keratosis by immunohistochemical staining method. RESULTS: The stainings of the tumors showed some differences from normal tissues in expression of antigens according to the differentiation state and nature of tumors. CONCLUSION: These results support an important role for cell cycle and apoptosis regulatory proteins in the regulation of growth and differentiation of malignant keratinocyte in these cutaneous neoplasms. Aberrant expression of such proteins may participate in the multistep process of carcinogenesis.

Two Cases of Alopecia Areata limited to the Eyebrows / 대한피부과학회지

The eyebrows consist of thickened arches of skin, which bear numerous short, thick hairs directed obliquely to the surface. Alopecia areata is a nonscarring hair loss condition, which is considered to be an autoimmune disease. The patchy loss of hairs occurring in alopecia areata may not only involve the scalp, but also the eyebrows, making it a disfiguring disease. This condition almost always involves the scalp, so alopecia areata only involving the eyebrows is very rare. We report two cases of alopecia areata limited to the eyebrows without involving any other sites during the disease course in healthy girls.

A Case of Semicircular Lipoatrophy / 대한피부과학회지

Semicircular lipoatrophy is an apparently rare disease that primarily affects adult woman. The lesion is characterized by a band-like semicircular depression, 2-4cm in width on the anterolateral aspects of the thighs. The overlying skin is normal. Usually, there are no subjective symptoms. There is no treatment, but most cases resolve in a few years. We experienced a typical case of semicircular lipoatrophy in a 43 years old woman. The patient showed an unilateral semicircular depressed lesion on the anterolateral aspect of the right thigh. Histopathologically, the lesion exhibited decrease in size of the individual adipocytes. The lesion resolved after 9 months without treatment.

Multiple Eccrine Hidrocystoma Treatedwith 1% Topical Atropine Sulfate

We report a case of multiple eccrine hidrocystoma (MEH) in a 57-year-old woman who had asymptomatic, discrete, skin-colored, shiny, firm papulovesicles on the face. These lesions enlarged during summer or when the patient did housework, and decreased in sue during winter or rest. Histologic examination showed a dilated, unilocular, cystic, invaginated structure within the middle dermis. The wall of the cyst generally consisted of two layers of Rat or cuboida1 epithelial cells. Decapitation secretion and myoepithelial cells were not observed. The lesions improved markedly with 1% topical atropine sulfate.

Two Cases of Unilateral Nevoid Telangiectasia

Unilateral nevoid telangiectasia(UNT) is a rare disorder and is characterized by superficial telangiectatic lesions distributed along the dermatomes unilaterally and usually on the upper part of the body. It has been said to be related to increased estrogen receptors in the involved skin. The lesions may be congenital or acquired.Acquired cases are typically associated with physiologic conditions such as pregnancy, puberty, hormonal therapy or cirrhosis, but the condition is also described in alcoholism without cirrhosis, carcinoma metastatic to the liver, and in hepatitis C. We present two cases of UNT in a 26-year-old man with heavy alcoholism and in a puberta1 16-year-old girl.

A Considered Case as Primary Cutaneous Mucormycosis / 대한의진균학회지

Mucormycosis is an invasive fungal infection, caused by members of the order Mucorales, that usually occurs in immunocompromised individuals. It manifests itself in a variety of ways and rarely may be confined to the cutaneous tissues. We report a case of primary cutaneous mucormycosis associated with longstanding diabetes mellitus and liver cirrhosis. A 53-year-old woman was presented because of cutaneous discoloration and bullae on the both lower extremities. Cutaneous lesions consisted of necrotic blackish discoloration with bullae and ill-defined margins with extending nature. A biopsy specimen from the cutaneous lesion revealed large, broad, nonseptate hyphae branched at right angles. Our patient was successfully treated with intravenous administration of amphotericin B and surgical debridement of necrotic tissue.