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Transient Increase in Intrathoracic Pressure as a Contributing Factor to Cardioembolic Stroke
석흥열,서우근,은미연,권도영,박문호,오경미 대한신경과학회 2010 Journal of Clinical Neurology Vol.6 No.4
Background:The hemodynamic effects of increased intrathoracic pressure (ITP) have been the focus of many investigations. However, very little is known about the effects of elevated ITP on the occurrence of stroke. Case Report:Four young patients with a cardioembolic source of stroke were examined. In all cases the stroke was preceded by an increase in ITP that occurred during coughing, vomiting, or sexual intercourse. Conclusions:We suggest that cardioembolic stroke is facilitated by situations in which ITP is elevated.
석흥열,박건우,정기영 대한수면연구학회 2007 Journal of sleep medicine Vol.4 No.2
Sleep-related breathing disorders have been extensively reported as a frequent and major problem in patients with multiple system atrophy (MSA). Laryngeal stridor and obstructive sleep apnea are the most common sleep disordered breathing in MSA. We report laryngeal stridor in a patient with multiple system atrophy. A 56-year-old man presented with abnormal breathing sound different from snoring during sleep noticed by his bed partner. He is unaware of his nocturnal stridor. Polysomnography showed obstructive sleep apnea and laryngeal stridor. Laryngoscopy during wakefulness detects normal movement of vocal cord. CPAP (continuous positive airway pressure) eliminated laryngeal stridor and obstructive sleep apnea with pressures of 9 cmH₂O.
Patterns of Orthostatic Blood Pressure Changes in Patients with Orthostatic Hypotension
석흥열,김유환,김하욤,김병조 대한신경과학회 2018 Journal of Clinical Neurology Vol.14 No.3
Background and Purpose The objective of this study was to determine the patterns of blood pressure (BP) changes during the head-up tilt (HUT) test, particularly in terms of its clinical significance for patients with orthostatic hypotension (OH). Methods OH was divided into four categories based on systolic BP changes occurring within the first 10 minutes of the HUT test: sustained orthostatic hypotension (SOH), progressive orthostatic hypotension (POH), orthostatic hypotension with partial recovery (OHPR), and transient orthostatic hypotension (TOH). Results In total, 151 patients were analyzed: 65 with SOH, 38 with POH, 21 with OHPR, and 27 with TOH. POH patients exhibited the greatest reduction in systolic BP after HUT and were also the most likely to develop symptoms requiring early termination of the HUT test (42.1%, p<0.001). Additionally, SOH patients exhibited smaller heart-rate variation with deep breathing values (p=0.003) and Valsalva ratios (p=0.022) compared to POH patients. The sweat volume was greatest in OHPR patients. Conclusions Clinical characteristics, including the findings of autonomic function tests, differed between the OH patient groups. This might reflect differences in the underlying pathophysiologic mechanisms. Determining the patterns of BP changes during the HUT test may facilitate the development of effective management strategies in patients with OH.
The Impacts of Influenza Infection and Vaccination on Exacerbation of Myasthenia Gravis
석흥열,신하영,김종국,김병준,오지영,서범천,김선영,강사윤,안석원,배종석,김병조 대한신경과학회 2017 Journal of Clinical Neurology Vol.13 No.4
Background and Purpose Upper respiratory infection (URI), including influenza, may exacerbate the symptoms of myasthenia gravis (MG), which is an autoimmune disease that causes muscle weakness. There is also concern that the influenza vaccine may trigger or worsen autoimmune diseases. The objective of this study was to determine the impacts of influenza infection and vaccination on symptom severity in MG patients. Methods Patients diagnosed with MG were enrolled from 10 university-affiliated hospitals between March and August 2015. Subjects completed a questionnaire at the first routine follow-up visit after enrolling in the study. The patient history was obtained to determine whether a URI had been experienced during the previous winter, if an influenza vaccination had been administered before the previous winter, and whether their MG symptoms were exacerbated during or following either a URI or vaccination. Influenza-like illness (ILI) was defined and differentiated from the common cold as a fever of ≥38°C accompanied by a cough and/or a sore throat. Results Of the 258 enrolled patients [aged 54.1±15.2 years (mean±SD), 112 men, and 185 with generalized MG], 133 (51.6%) had received an influenza vaccination and 121 (46.9%) had experienced a common cold (96 patients) or ILI (25 patients) during the analysis period. MG symptoms were aggravated in 10 (40%) patients after ILI, whereas only 2 (1.5%) experienced aggravation following influenza vaccination. The rate of symptom aggravation was significantly higher in patients experiencing an ILI (10/25, 40%) than in those with the common cold (15/96, 15.6%, p=0.006). Conclusions The results of this study suggest that the potential risk of aggravating autoimmune disease is higher for ILI than for influenza vaccination, which further suggests that influenza vaccination can be offered to patients with MG.
진단 딜레마: 반복신경자극검사가 정상인 램버트-이튼근무력증후군
정유훈,석흥열 대한신경과학회 2022 대한신경과학회지 Vol.40 No.2
It is important for the diagnosis of Lambert-Eaton myasthenic syndrome (LEMS) to confirm the incremental response at high-rate stimulation or after brief exercise in the repetitive nerve stimulation (RNS) test. Therefore, it may be difficult to diagnose LEMS if the RNS test is normal initially. We report a patient with LEMS whose diagnosis was delayed due to normal RNS findings. We believe that anti-P/Q-type voltage-gated calcium channel antibody testing is crucial in the diagnosis of LEMS.