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Is an Isolated Weight-Holding Tremor a New Subtype of Isometric Tremor?
용석우,박동규,윤정한,백종삼 연세대학교의과대학 2020 Yonsei medical journal Vol.61 No.7
A weight-holding tremor is a rare type of hand tremor that occurs only when someone holds some weight. Here we report three cases of isolated weight-holding tremors, of which one patient was diagnosed with Parkinson’s disease (PD) and the others as a variant of essential tremor (ET). A 68-year-old woman presented with a left-hand tremor that appeared only when she held objects with some weight. Her tremor was reminiscent of the re-emergent tremor of PD, and dopamine transporter imaging revealed reduced uptake at the right posterior putamen. A 21-year-old man and a 71-year-old woman also presented with similar weightholding tremors. However, these tremors were not re-emergent, and no signs of parkinsonism were observed during follow-up. Although the underlying etiologies of these tremors differed, all three tremors worsened as the held weight increased. These tremors could be isolated isometric tremors, but further research is needed to clarify the nature of this rare tremor.
원발성 정상압수두증 환자에서 보행장애와 중뇌 크기의 상관관계
용석우,이필휴,안영환,허균 대한신경과학회 2005 대한신경과학회지 Vol.23 No.1
Background: While gait disturbance is an important feature of idiopathic normal pressure hydrocephalus (NPH), there are only tentative theories explaining its pathophysiology. The mesencephalic locomotor region has been suggested as the anatomical substrate for the development of hypokinetic gait. We evaluated the correlation between gait disturbance and midbrain diameter to investigate the role of mesencephalic locomotor region in development of NPH gait. Methods: We enrolled 21 patients with NPH and 20 age-matched control subjects. Maximal diameter of midbrain and pons and the width of lateral and third ventricle were measured at midsagittal T1-weighted MRI and axial T2-weighted MRI, respectively. Gait disturbance, cognitive dysfunction, and incontinence were semi quantified. Results: Maximal midbrain diameter was significantly smaller in NPH group, as compared to the controls (14.8±0.9 vs. 17.1±0.7 mm, p<0.001). There was an inverse correlation between the midbrain diameter and the ventricular width (r=-0.562, p=0.008 in third ventricle and r=-0.510, p=0.018 in lateral ventricle). Severity of gait disturbance were negatively correlated with midbrain diameter (r=-0.598, p=0.004), but degree of cognitive dysfunction and incontinence showed no significant correlation with brainstem diameter nor ventricular width. Conclusions: This study suggests that midbrain atrophy is significantly associated with gait disturbance in NPH. Furthermore, this study implies the possible role of midbrain structures including mesencephalic locomotor region in the genesis of NPH gait.
용석우,이필휴,여승현,이재혁 대한신경과학회 2005 대한신경과학회지 Vol.23 No.4
Progressive ataxia and palatal tremor (PAPT) is a subgroup of symptomatic palatal tremors which is characterized by palatal tremor and idiopathic progressive cerebellar ataxia. Here, we report a 59 year-old-male who presented with a 5 months history of progressive cerebellar ataxia, and was discovered to have both a symptomatic palatal tremor and torsional nystagmus. Various studies searching for the cause of the ataxia and the palatal tremor all came out negative, thus defining this patient as a PAPT.
지주막하출혈로 인한 폐쇄성 수두증의 치료로 뇌실-복막단락술을 한 후 발생한 가역적 파킨슨증후군 2예
이재혁,용석우,이필휴,신용삼,방오영 대한신경과학회 2004 대한신경과학회지 Vol.22 No.5
Parkinsonism associated with obstructive hydrocephalus due to idiopathic aqueductal stenosis or after shunt revision has been occasionally reported in the literature. Their Levodopa effectiveness and good prognosis has also been reported. However, the etiology and pathophysiology has not been well elucidated. We herein report two cases of parkinsonism associated obstructive hydrocephalus due to SAH. Interestingly, in both cases, parkinsonism occurred after a V-P Shunt and not after obstructive hydrocephalus.
정상압 수두증의 지름술 대체요법으로서의 반복적인 요추전자에 대한 연구
임태성,용석우,문소영 대한치매학회 2008 Dementia and Neurocognitive Disorders Vol.7 No.2
Background: Normal pressure hydrocephalus (NPH) is one of the reversible dementia and a shunt operation can improve major symptoms of NPH. However, selected cases of NPH patients can be treated by shunt operation because of high complication rate. We experienced some cases of prolonged clinical improvement of NPH after one or two lumbar punctures (LP) and evaluated the predictors of prolonged improvement of NPH symptoms by repeated LP. Methods: Thirty-one NPH patients were retrospectively evaluated (age 72.5±5.8 yr). Gait disturbance, urinary incontinence and cognitive impairment were semi-quantified. We divided the patients into three groups (non-responders, transient responders and long-term responders) according to their responses after LP. We analyzed the characteristics of the groups. Results: Gait disturbance (p=0.046) and urinary incontinence (p=0.040) score and total NPH symptom score (p=0.007) after cerebrospinal fluid (CSF) drainage were more significantly improved in long term responders than transient responders. On multiple logistic regression analysis, total NPH score improvement was the only predictor of the long-term responders (p=0.03, odd ratio=0.148). Conclusions: Our study showed that some of NPH patients could maintain favorable courses for at least one year after LP without shunt operation. Repeated LP could be an alternative treatment in selective NPH patients.
좌측 중대뇌 동맥 경색 환자에서 나타난 우측 눈감기 실행증과 편측 Meige 증후군
김지원,여승현,용석우,이필휴 대한신경과학회 2007 대한신경과학회지 Vol.25 No.3
Apraxia of eyelid closure is an uncommon condition characterized by difficulties in voluntary eye closing with preserved normal blinking. Meige’s syndrome is a disorder of adults, and is characterized by prolonged symmetric dystonic contraction of the orofacial muscles and blepharospasm. We report a case of apraxia of eyelid closure on the right eye with Meige’s syndrome on the left eye complicating a left middle cerebral artery territory infarction.
Pretarsal Motor Persistence의 임상적 특징 및 근전도 소견
주억식,이필휴,이재혁,용석우 대한신경과학회 2005 대한신경과학회지 Vol.23 No.1
Pretarsal motor persistence (PMP), a subtype of apraxia of the eyelid opening, is characterized by the inability to open the eyelids at will due to persistent activity of orbicularis oculi muscles following voluntary closure. Here, we describe clinical characteristic and the synchronous EMG recording from the levator palpebrae and orbicularis oculi muscles of PMP in patient with essential blepharospasm, idiopathic Parkinson's disease, and progressive supranuclear palsy.
뇌하수체 전엽 호르몬 이상을 동반한 중격-시신경 형성장애 1예
이진우,황의경,김태호,윤형영,정재호,최용원,안재홍,김선용,정윤석,김호성,용석우 대한내분비학회 2009 Endocrinology and metabolism Vol.24 No.1
Septo-optic dysplasia (SOD) is a rare congenital malformation syndrome that is manifested by a triad of optic nerve hypoplasia, midline brain abnormalities and hypopituitarism. It is known to be associated with homeobox gene HESX1 mutation in some familial cases. We experienced a case of SOD in a 23 year-old male who presented with short stature and delayed puberty. The basal serum levels of testosterone and IGF-1 were low and the prolactin level was high. The combined pituitary stimulation study revealed decreased growth hormone responses. Brain MRI revealed complete agenesis of the corpus callosum, hypoplasia of the anterior pituitary gland and herniation of the third ventricle into the pituitary fossa. On the neurologic and ophthalmologic examinations, there was no definite abnormality except mild optic atrophy on the optical coherence tomography. Genetic analysis using polymerase chain reaction with direct sequencing revealed no HESX1 mutation.