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김의중,오선영,최하철,신병수,임미혜 대한신경과학회 2009 대한신경과학회지 Vol.27 No.3
Central pontine myelinolysis (CPM) is a neurologic disorder that is usually related to rapid correction of hyponatremia and chronic alcoholism. CPM involves concentrated, symmetric, noninflammatory demyelination within the central pons; this pathology also occurs in extrapontine regions. Frequently observed clinical manifestations are sudden weakness, dysphagia, dysarthria, loss of consciousness, and locked-in syndrome. We describe herein a case of CPM predominated by cerebellar signs without typical symptoms, but with involvement of the cerebellum or cerebellar peduncle. Central pontine myelinolysis (CPM) is a neurologic disorder that is usually related to rapid correction of hyponatremia and chronic alcoholism. CPM involves concentrated, symmetric, noninflammatory demyelination within the central pons; this pathology also occurs in extrapontine regions. Frequently observed clinical manifestations are sudden weakness, dysphagia, dysarthria, loss of consciousness, and locked-in syndrome. We describe herein a case of CPM predominated by cerebellar signs without typical symptoms, but with involvement of the cerebellum or cerebellar peduncle.
김의중,최병관,최창화 대한신경외과학회 2004 Journal of Korean neurosurgical society Vol.35 No.6
Objective : The fusion procedure can be an option on reoperative HNP cases. It is done routinely or on case-bycase basis. There have been no clear guideline and results about the instability rate that really needs fusion procedure. This study is done to clarify the need of fusion procedure and prognosis in the reoperation of lumbar disc herniation by regarding stability rate. Methods : Total 27 cases with reoperative lumbar disc surgery were reviewed. Instability was tested preoperatively with X-ray findings which method was proposed by Dupuis in 1976. All operative procedures were done under microscopic magnification. The laminectomy and facetectomy amount was measured by the difference between the pre and postoperative X-ray findings. The stability test and final outcome were rated at least 6 months after the reoperation. The final results were categorized into excellent, good, fair, poor group according to the back, leg pain, walking ability, restriction of average daily life and use of analgesics. Results : The average translation were 4.95%(flexion) with 5.04%(extension) for lumbar joints and 3.39%(flexion) with 4.17%(extension) for lumbosacral junction. Average flexion angulation were -2.3 for lumbar joints and 9.1 for lumbar sacral junction. The average amount of removed facet joint was 10.2%. Average 68.1% of facet joint remains after the reoperation. Conclusion : Fusion procedure is needed only in limited cases of recurrent disc herniation for the reason of possible instability. Routine fusion procedure should be avoided regarding stability problem. In literatures, the fusion rates shows extreme ranges from 0 to 100 % according to the authors. The prognosis was comparable with previous reports where most of the average good or excellent outcomes were ranging 60~70% of the cases without fusion procedures.