말초신경초음파검사를 이용한 흔한 신경포착부위 검사; 단면적기준치와 정상변이

석정임,이상법,배창범 대한신경과학회 2015 대한신경과학회지 Vol.33 No.1

Background: Neuromuscular ultrasound has emerged over the last decade as a useful tool for diagnosing peripheral neuropathy. Because nerve enlargement is the most important diagnostic marker of an abnormal nerve, quantification of nerve size is essential. Methods: We included 80 healthy volunteers aged 21–60 years. The nerve cross-sectional area (CSA) was measured in all participants at the following common compressive sites: bilateral median nerve at the carpal tunnel and forearm, ulnar nerve at the wrist and medial epicondyle, radial nerve at the spiral groove, peroneal nerve at the fibular head and popliteal fossa, and tibial nerve at the popliteal fossa. Anatomical variants were also evaluated, including a bifid median nerve and persistent median artery. Results: The CSAs were 9.58±1.55, 6.87±1.61, 4.72±0.91, 6.64±1.33, 6.48±1.68, 12.35±3.55, and 26.98±6.92 mm2 (mean±SD) for the median nerve at the carpal tunnel and forearm, ulnar nerve at the wrist and medial epicondyle, radial nerve at the spiral groove, peroneal nerve at the fibular head, and tibial nerve at the popliteal fossa, respectively. The nerve CSA was significantly larger in men than in women and was correlated with body mass index, weight, and height. A bifid median nerve and persistent median artery were seen in 12 (7.5%) and 4 (2.5%) of 160 hands, respectively. Conclusions: The information produced in this study can serve as reference data when evaluating these nerve sites using ultrasound.

Ultrasonographic evaluation of common compression neuropathies in the upper limb

석정임 대한임상신경생리학회 2020 Annals of Clinical Neurophysiology Vol.22 No.1

Neuromuscular ultrasonography has emerged over the last decade as a useful tool for diagnosing peripheral nerve disorders. It has been studied extensively with a particular focus on the assessment of compression neuropathies. Neuromuscular ultrasonography complements electrodiagnostic studies well by visualizing both the nerve anatomy and surrounding structures, providing useful data that cannot be obtained using the latter methodology only. This review article summarizes and synthesizes the literature focusing on the diagnostic role of neuromuscular ultrasonography in common compression neuropathies of the upper limb.

Immobilization-induced rhabdomyolysis patients with peripheral neuropathy: clinical, laboratory and imaging findings

석정임,이인희,Ki Sung Ahn,Gun Woo Kang,Je Wan Lee,Sang Gyu Kwak 대한임상신경생리학회 2020 Annals of Clinical Neurophysiology Vol.22 No.1

Background: Peripheral nerve injury rarely occurs in patients with rhabdomyolysis. Based on our experience and previous reports, we consider prolonged immobilization a risk factor for the development of peripheral neuropathy in rhabdomyolysis patients. Methods: This study analyzed 28 patients with rhabdomyolysis due to prolonged immobilization. We analyzed their demographic and laboratory data, clinical and imaging findings, and outcomes, and compared these factors between patients with and without neuropathy. Results: Seven of the 28 patients had peripheral neuropathy, including sciatic neuropathy or lumbosacral plexopathy. Compared to those without neuropathy, the patients with neuropathy were younger (p = 0.02), had higher peak creatine kinase (CK) levels (p = 0.02), had higher muscle uptake in bone scans (p = 0.03), and more frequently exhibited abnormal muscle findings in computed tomography (CT) (p = 0.004). Conclusions: Patients with prolonged immobilization-induced rhabdomyolysis and neuropathy had higher CK levels, increased uptake on bone scans, and more-frequent abnormal muscles on CT than those without neuropathy. These findings indicate that peripheral neuropathy is more likely to develop in patients with severe muscle injury.

클레부딘(clevudine)유발근병증의 임상과 병리특성

석정임,김대성,남태승,송현석,박영은,김선영,허소영,이동국,조희영,이창훈,박민수,김영수 대한신경과학회 2013 대한신경과학회지 Vol.31 No.1

Background: Clevudine (Revovir ®) is a recently introduced antiviral drug, and clinical trials have demonstrated its potent,sustained antiviral activity without specific adverse events. However, several studies have found severe myopathy during clevudine therapy. Our study aimed to summarize the clinical and pathological features of clevudine-induced myopathy. Methods: We analyzed the demographic data, clinical features, and pathologic findings of 18 consecutive hepatitis-B patients who developed skeletal myopathy during clevudine therapy. Results: The 18 patients comprised 11 women and 7 men aged 48.2±14.0 years (mean±standard deviation; range 28-74years). Each of the 18 patients was treated with clevudine for at least 5 months (range 5-20 months) before the development of symptoms. In all patients the main symptom was proximal muscular weakness that progressed slowly over several months. Elevated creatine kinase and myopathic patterns on electromyography were found. Muscle biopsies revealed severe myonecrosis associated with numerous ragged red fibers and cytochrome-c-oxidase-negative fibers, mitochondrial proliferation, and predominant type-II fiber atrophy. The muscle weakness gradually improved within 20 weeks after discontinuation of clevudine. Conclusions: Clevudine therapy can induce myopathy associated with mitochondrial toxicity. Careful clinical and laboratory monitoring of the skeletal muscle dysfunction is required in patients receiving clevudine therapy.

폐결핵과 동시에 발병한 ANCA연관혈관염

석정임,박성훈,김경찬 대한신경과학회 2012 대한신경과학회지 Vol.30 No.1

Antineutrophil cytoplasmic antibodies (ANCA) are closely linked to primary systemic vasculitis, and ANCA detection has became an important diagnostic hallmark of ANCA-associated vasculitis (AAV). However, it has been reported that tuberculosis is associated with positivity for ANCA and it is difficult to differentiate clinically between tuberculosis and AAV. We report a patient with the concomitant appearance of AAV and pulmonary tuberculosis. Positivity for ANCA should be carefully interpreted as indicative of AAV, especially in countries with a high prevalence of tuberculosis.

횡문근융해 환자에서 발생한 말초신경병의급성-아급성기의 임상 특징과 전기진단검사 소견

석정임,이인희,안기성,강건우,김재훈 대한신경과학회 2019 대한신경과학회지 Vol.37 No.1

Background: Rhabdomyolysis is a syndrome caused by injury to skeletal muscle and characterized by myalgia and swelling of the affected muscles. Peripheral nerve injury rarely occurs in patients with rhabdomyolysis. Methods: We reviewed the medical records of 8 consecutive patients with peripheral neuropathies associated with rhabdomyolysis. We assessed the clinical characteristics and electrodiagnostic findings of eight patients. Results: In seven patients, rhabdomyolysis occurred after prolonged immobilization. In one patient, blunt trauma was a cause of rhabdomyolysis. All patients presented with weakness and paresthesia in lower extremities and electrodiagnostic tests showed peripheral nerve injury suggesting sciatic neuropathy or lumbosacral plexopathy. Although rhabdomyolysis itself recovered completely in all patients, neurologic deficits from neuropathy recovered partially and slowly. Conclusions: Sciatic nerve or lumbosacral plexus was injured in all eight patients. Among the various causes of rhabdomyolysis, prolonged immobilization is associated with development of peripheral neuropathy.

Ultrasonographic findings of the normal diaphragm: thickness and contractility

석정임,김신엽,Francis O. Walker,곽상규,권두혁 대한임상신경생리학회 2017 Annals of Clinical Neurophysiology Vol.19 No.2

Background: Neuromuscular ultrasound can be used to assess the diaphragm. Before it can be used clinically, the reference ranges of diaphragm thickness and contractility must be determined. Methods: We measured the thickness of the diaphragm and the diaphragmatic thickening fraction (DTF) in 80 healthy volunteers with ultrasound and collected their demographic information to determine if age, sex, and body mass index (BMI) influence these measures. Results: The thickness of the diaphragm at resting end expiration was 0.193 ± 0.044 cm on the right side and 0.187 ± 0.039 cm on the left. The DTF was 104.8 ± 50.6% on the right side and 114.9 ± 49.2% on the left. Sex, weight, height, and BMI significantly affected the thickness of the diaphragm, but had little effect on the DTF. Conclusions: Normal reference values for the diaphragm should be helpful when evaluating the diaphragm. The DTF appears more useful than resting diaphragm thickness because it is affected less by individual variation.

Sonographic evaluation of the diaphragm in patients with unilateral diaphragmatic paralysis

석정임,Kyung Chan Kim,Hye Joo Rha,Sung Rok Lee 대한임상신경생리학회 2018 Annals of Clinical Neurophysiology Vol.20 No.2

Evaluation of diaphragm function is challenging because no single test has a high diagnostic yield. We describe ultrasound findings in three cases with acquired unilateral diaphragmatic elevation. These cases confirm that sonographic evaluation is a valid tool for identifying diaphragm dysfunction. In addition, ultrasound measurements of diaphragm thickness and the contractility can be used to determine if a diaphragm is paralyzed and suggest the duration of paralysis (i.e., acute or chronic).

저긴장아 증후군 소아의 전기생리학적검사 결과 : 10년간의 경험

석정임,주인수,이진수,김성환 대한임상신경생리학회 2006 Annals of Clinical Neurophysiology Vol.8 No.1

Background: Floppy infant syndrome has a number of different etiologies. Methods: One hundred twenty-three consecutive patients of floppy infant syndrome were included in this study. We reviewed all the electrophysiologic tests of these patients and the medical record of patients showing abnormalities in the electrophysiologic studies. Results: Of the 123 patients, twenty-six (21.1%) showed definite abnormalities in electrophysiologic tests; 8 myopathies, 14 neuropathies and 4 unclassified. The neuropathy was further classified as 5 neuronopathies and 9 sensorimotor polyneuropathies. With muscle or sural nerve biopsy and genetic test, a final diagnosis was made of Duchenne muscular dystrophy in 4, Becker muscular dystrophy in 1, spinal muscular atrophy in 2, and metachromatic leukodystrophy in 1. Conclusions: About 21% of patients presented with floppy infant syndrome showed abnormalities in the neuromuscular system. The electrophysiologic test is valuable to guide further investigations in diagnosing the cause of floppy infant syndrome.

Churg-Strauss 증후군에서 관찰된 말초신경병증의 임상 및 전기생리학적 특징

석정임,배종석,주은연,민태훈,최동철,김병준 대한신경과학회 2004 대한신경과학회지 Vol.22 No.2

Background: Churg-Strauss syndrome (CSS) is characterized by disseminated vasculitis and eosinophilia in patients with asthma. This study was performed to delineate the characteristics of peripheral neuropathy and to identify the factors associated with the severity of neurologic disability. Methods: We reviewed the medical records of 12 consecutive patients with Churg-Strauss syndrome who had been diagnosed at Samsung Medical Center. The diagnosis of CSS was based on the American college of Rheumatology 1990 criteria. Results: Of the 12 patients, 9 had neurologic involvement. Six had neurologic symptoms as presenting manifestations. All neurologic manifestations were peripheral neuropathy; 5 had multiple mononeuropathy, 2 had distal symmetric polyneuropathy, and 2 had mononeuropathy. Neurologic disability score depended on the rapidity of steroid treatment. Conclusions: Neurologic involvement is common and develops early in patients with CSS, usually manifesting as peripheral neuropathy. Neurologic disability score showed that early steroid therapy was related with less neurologic disability.