Sturge-Weber 증후군 1례

하정상,박충서 최신의학사 1986 最新醫學 Vol.29 No.10

허혈성 뇌졸중에서의 항혈전 치료

하정상,이준 영남대학교 의과대학 2003 Yeungnam University Journal of Medicine Vol.20 No.1

Ischemic stroke is among the principal causes of death and disability in the elderly. Although control of blood pressure, decreased cigarette smoking, and modified dietary habits are among important reasons for stroke decline, the use of antithrombotic therapy, rigorously prescribed. Several antiplatelet agents are approved to reduce the risk of recurrent stroke. Aspirin is the best-studied and most widely used antiplatelet agent for stroke prevention; it provides approximately 15% to 25% relatively risk reduction for secondary prevention of stroke or the major vascular death. Combining 2 antiplatelet agents with different mechanism of action was demonstrated to provide a substantial increase in efficacy in several studies. Anticoagulation should be considered first with potential cardiac sources of embolism. Heparin reduces development of erythrocyte-fibrin thrombi that form in regions of vascular stasis especially within the heart, in severely stenosed arteries sometimes engrafted on white thrombi, in acute arterial occlusion. Heparin should not be indiscriminately given to all acute brain ischemia patients, but may contribute to treatment of large artery occlusion and severe stenosis, cardiogenic embolism with a high acute recrrence risk, and dural sinus and cerebral venous thromobosis.

원내감염의 세균학적 검색

하정상,전동석,김재룡,김재식,김중명 대한임상검사정도관리학회 1985 臨床檢査와 精度管理 Vol.7 No.2

가족성 경성 대마비

하정상,박충서,서보완,최원희,변영주 대한신경과학회 1985 대한신경과학회지 Vol.3 No.2

청신경의 가압, 감압 및 교호자극에 의한 청각뇌간유발전위 (BAEP) 반응의 변동에 관한 연구

하정상,이상도,박영춘 대한신경과학회 1989 대한신경과학회지 Vol.7 No.2

광범위한 뇌 석회침착을 수반한 특발성 부갑상선 기능저하증 1례

김욱년,하정상 영남대학교 의과대학 1997 Yeungnam University Journal of Medicine Vol.14 No.1

저자들은 경련을 주소로 내원한 특발성 부갑상선 기능저하증에서 뇌기저핵, 소뇌, 뇌실 주위의 광범위한 석회침착을 보인 환자를 치험하여 방사선학적 뇌단층촬영상 특징적 소견과 그 병태생리 및 임상증상과의 연관관계를 문헌고찰과 함께 보고 한다. Idiopathic hypoparathyroidism is frequeutly associated with intracranial calcification and neuropsychiatric abnormalities. The most commonly recognized central nervous system manifestations of chronic hypoparathyroidism are seizure, alteration of mental function and extrapyramidal signs. We present a case of hypoparathyroidism, demonstrating extensive intracranial calcification, not only basal ganglia, but also outside the extrapyramidal system. An 58-year-old woman presented with 30 year history of seizure and memory disturbance. The physical examination and several laboratory studies disclosed normal. However hypocalcemia, hyperphosphatemia with hypocalciuria and decreased parathormone level were demonstrated. Clinical symptoms and signs showed improvement after supplementary calcium and Vit D₃therapy.

Becker형 선천성 근긴장증 1례

윤성환,이준,하정상 영남대학교 의과대학 1999 Yeungnam University Journal of Medicine Vol.16 No.1

저자들은 최근 25세 여자 환자로 뚜렷한 가족력이 없으면서 3-4세경부터 발생한 근육의 강직현상과 현저한 근비대소견이 있는 환자를 경험하였다. 임상적으로 타진성 근긴장증을 보이고 전기생리적 검사로 새끼손가락 외향근에서의 운동과 반복신경자극에서 복합근육활동전위의 감소를 보였으며, 이두박근의 근생검 소견상 용적이 증가된 근섬유와 중심핵화현상이 관찰되었다. 환자는 mexiletin 경구 투여후 근육의 강직현상이 다소 호전되었다. 이에 문헌고찰과 함께 Becker형 선천성 근긴장증 1례를 보고하는 바이다. Congenital myotonia is a hereditary disorder of the skeletal muscle. The most characteristic features of the disease are myotonia and variable muscular hypertrophy. Molecular biologic investigations have revealed that mutations in the gene of the human skeletal muscle chloride ion channel protein are a cause of the disease. The Becker's type congenial myotonia is clinically similar to the autosomal dominantly inherited congenital myotonia (Thomsen's disease). Both disorders are characterized electrophysiologically by increased excitability of muscle fibers, reflected in clinical myotonia. In general, Becker's type congenital myotonia is more severe than Thomsen's disease in muscular hypertrophy and weakness. The authors recently experienced a 25-year-old female patient who has no family-related disease history and who has conspicuous muscular hypertrophy and the stiffness with muscles which occurred from the age of 3 or 4. Clinically she showed the authors a percussion myotonia. On electrophysiological study, exercise and repetitive stimulation of the abductor digiti quinti muscle disclosed a decline in the compound muscle action potential. Biopsy of biceps muscle revealed enlargement of muscle fibers with marked nuclear internalization. After the oral taking the Maxiletine, the patient showed a favorable turn a little with her stiffness of muscles. So we authors are reporting one case of Becker's type congenital myotonia with review of literatures.

잠복성 간질에 대한 항간제 투여의 뇌파상 효과

박충서,변영주,하정상 영남대학교 의과대학 1985 Yeungnam University Journal of Medicine Vol.2 No.1

1985년 1월부터 10월까지 본 영남대학교 의과대학 부속병원 신경과 외래를 찾은 두통환자 중에서 뇌파상 중등도 이상의 이상이 있는 환자가 580명이었다. 이들 중에서 간질의 간헐기 뇌파와 유사한 소견을 보이는 162명 환자들을 대상으로 투여한 항간제 및 뇌영양제 등을 단독 혹은 병용 투여한 후 치료효과를 분석한 결과 항간제투여군 29예에서 호전이 16예, 무변화가 13예이고, 항간제를 쓰지 않고 뇌 영양제를 사용했던 18예에서는 전예에서 호전을 보았다. 한편 항간제를 사용한 33예와 사용하지 않은 35예에서는 뇌파추적을 하지 못하였다. 수가 적어서 통계학적인 고찰은 하지 않았으며 앞으로 계획적인 계속 연구가 요망된다. The clinical state with EEG pattern similar to interval discharge of epileptics is named as latent epilepsy, which does not necessarily mean that the patient will develop epilepsy later. However, since there is possibility of developing epilepsy on later date, antiepileptic mainly dilantin was tried to control the abnormal EEG. Since january to October 1985, total 580 headache sases with more than moderately abnpormal EEG visited the Neurology clinic. Among them 162 cases with interval seizure pattern(ISP) of epilepsy were selected for the study. The main ISP was 1. diffuse theta and/or delta bursts and 2. spikes. Since the study is only analysis of clinical treatment of 162 cases without previous planning based on financial aid, about 30% of the patients did not return after the 1st EEG examination, in 42% failed to follow the EEG after the treatment and only remaining 28% of the cases were studied. Among 29 patients who were treated with Dilantin 100㎎ tid po, 16 improved and 13 not. Of the 13, 4 showed partial improvement and partial progression. Case 1. In 4 weeks of antiepileptic theray(AR), spikes disappeared but in 2 months developed bursts. Case 2. In 17days of AR,spikes and bursts disappeared but in 3 months bursts reccured. Case 3. In 1 week of AR, bursts disappeared but spikes developed. Case.4. In 3 months of AR, no change of spikes and bursts and she discontinued the AR. In 6 months she developed grandmal seizure. Eighteen cases, treated with other drugs except antiepileptics, all showed improvement. The other drugs were vincaprol, polygammalon, aronamin, ATP and hydergine. The improved cases had spikes more often than theta bursts. In view of the small number of the cases due to dropping most patients out of present study, it is considered meaningless to perform statistical analysis. Further well planned study with more patients is to be expected.

부분성 간질환자에서 난치성에 관여하는 인자

이세진,이영기,변영주,박미영,하정상 영남대학교 의과대학 1995 Yeungnam University Journal of Medicine Vol.12 No.2

영남대학교 의과대학 부속병원 신경과에서 1991년 1월부터 1993년 8월 사이에 발작의 임상양상이나 뇌파검사에서 부분성 발작으로 진단된 환자들 중에서 대상 기준 및 제외기준은 만족하는 비조절군 45례와 조절군 68례를 대상으로 하여 난치성에 관련된 임상변수들을 분석하여 다음과 같은 결과를 얻었다. 부분성 복합발작, 다종의 발작형, 군집성 발작양상이나 중첩성 발작형의 병력이 있는 경우에 약물치료에 대한 반응이 불량하였다(P<0.01). 치료전의 발작횟수가 많을 수록 항경련제 치료에 잘 반응하지 않았다(P<0.01). 경련의 명확한 원인이 규명된 경우, 신경학적 이상소견 및 정신심리적인 결함이 있는 경우에 치료에 잘 반응하지 않았다(P<0.01, P<0.05, P<0.01). 뇌파검사에서 배경파의 서파화, 국소성 서파, 간질파 및 이차적 양측성 동기화등의 이상소견이 있으면 치료에 대한 반응이 불량하였다.(P<0.01). 성별, 발병연령, 간질병소의 분포, 치료전의 유병기간, 가족력 및 신경방사선적 이상소견 등은 치료에 대한 예후와는 무관하였다. 이상의 결과에 비추어 보아, 난치성과 관련된 임상변수를 적어도 4개 이상 가진 환자에서는 치료에 잘 반응하지 않는 난치성 간질로 될 가능성이 크다고 할 수 있다. To evaluate the intractability of partial epileptic patients by variables, the author studied 113 patients (uncontrolled: 45, controlled:68) who were admitted to the Department of Neurology, College of Medicine, Yeungnam University from January, 1991 to August, 1993. The results were as follows. The items related to complex partial seizures, multiple seizure types and a histories of status epilepticus or clusters of seizures were significantly associated with drug- refractoriness (P<0.01). A high frequency of seizures before evaluation was associated with a poor outcome (P<0.01). The presences of known etiology of seizures, neurologic abnormalities and psychiatric disturbance were associated with limited treatment responses (P<0.01, P<0.05, P<0.01). An abnormal EEG findings such as background slowing, focal slowing, epileptiform discharges or secondarily bilateral synchrony were statistically significant (P<0.01). Age at onset, sex, distribution of epileptic foci, duration of seizure before evaluation, family history and abnormal neuroradiologic findings were not statistically significant. By these results, it was suggested that having at least four factors of the above variables were associated with limited treatment response.

급성 일산화탄소 중독증 환자의 임상적 고찰

하정상,최경찬,박미영,변영주,박충서 영남대학교 의과대학 1991 Yeungnam University Journal of Medicine Vol.8 No.1

급성 일산화탄소중독환자의 예후를 예측하는 기초자료를 얻고자 1985년 10월부터 1989년 4월까지 급성 일산화탄소중독으로 영남대학병원 응급실을 통해 COHb검사로 확진되어 입원치료한 116명의 환자를 대상으로 임상소견 및 검사 소견을 비교, 분석하고 이들 소견과 지연성 후유증과의 관련성을 조사하여 다음과 같은 성적을 얻었다. 1. 입원환자 116례의 내원시 의식상태는 기면상태의 군이 36.2%로 가장 많았으며, 남녀의 비는 1:1.5로 여자가 많았다. 2. 내원시 의식장애가 심할수로 동맥혈의 pH 및 PaCO₂는 감소하는 경향을 보였는데, 이는 대사성산증에 대한 소견으로 보인다. 3. 일산화탄소중독으로 인한 초기 검사소견중 백혈구증다증은 65.5%, 헤마토크리트의 상승 은 23.3%, 고혈당은 19.8%, GPT의 상승은 19.8%, creatinine의 상승은 0.9%, 뇨당검출은 12.1%였다. 4. 심전도 검사에서는 35.5%에서 이상소견을 보였는데 25.0%가 rhythm의 변화를, 15.5%가 ST, T절의 이상과 함께 나타났으나 전도장애의 이상은 없었다. 5. 뇌파검사에서는 경도이상의 이상소견을 보인 환자가 93.1%였으며, 이중 중등도의 이상소견을 보인 환자가 80.2%로 가장 많았다. 6. 입원환자중 지연성 후유증의 발생빈도는 7.8%였으며, 이들은 노출시간이 길고(>8시간),백혈구증다증(>20,000) 및 뇌파이상(>중등도)이 심하였다. To obtain the basic data of prognosis of acute carbon monoxide(CO) intoxication, one hundred and sixteen cases of CO intoxication defined by carboxyhemoglobin(COHb) and admitted via emergency room of Yeung-nam University Hospital from Oct. '85 to April' 89 have been clinically analyzed and evaluated, including delayed postanoxic encephalopathy(DPE) and the following results were obtained. 1. The ratio of male to female was 1 : 1.5 and mental state was drowsy mostly(26.2% of 116 cases) 2. The more disturbed the mental state, the more decreased was the arterial pH and PaCO₂, which may be the result of metabolic acidosis. 3. The early laboratory findings in patients of CO intoxication were as follows : leukocytosis-65.5%, increase of hematocrit-23.3%. hyperglycemia-19.8%, increase of GPT-19.8% increase of creatinine-0.9% , and glucosuria-12.1%. 4. The early findings of EKG were abnormal in 35.3% : change of rhythm-25.0%, abnormal ST segment-15.5% (change of rhythm and abonormal ST segment-5.2%) but the conduction disorder was not present. 5. The abnormal EEG above mild degree was 93.1%, of which moderate was most frequent(80.2%). 6. The incidence of DPE was 7.8% among all admitted CO patients. DPE cases had long duration of exposure time(8 hours), severe leukocytosis(20,000) and an abnormal EEG(MA).