근력약화 시 감각신경활동전위진폭의 감소를 보인 갑상샘독성주기마비 1예

박소영,조중양,박종관,이동하,조용진,김한준,홍근식 대한임상신경생리학회 2007 Annals of Clinical Neurophysiology Vol.9 No.1

주기마비(periodic paralysis)는 반복되는 일시적인 근력 저하를 특징으로 하는 질환으로 일차성 주기마비와, 이차성 주기마비로 나눌 수 있다. 이차성 주기마비 중 갑상샘독성주기마비의 발병빈도는 입원한 갑상샘 중독 환자의 1.9%에서 발생하며 서양에 비해 동양에서 흔한 것으로 알려져 있다.1 갑상샘항진증에 합병된 저칼륨혈증주기마비는 일시적인 근력저하를 보이는 임상증상, 생화학적검사에서 저칼륨혈증과 갑상샘호르몬 변화, 신경전도검사에서 복합근활동전위진폭의 감소 등으로 진단한다. 저자들은 갑상샘독성주기마비 환자에서 근력약화 시에 신경전도검사상 복합근활동전위진폭의 감소와 함께 감각신경활동전위진폭의 감소를 경험하였기에 보고한다.

임상신경생리 분야에서의 신경생리적 검사법의 응용

이광우,박경석 대한임상신경생리학회 1999 Annals of Clinical Neurophysiology Vol.1 No.1

Since Hans Berger reported the first paper on the human electroencephalogram in 1920s, huge technological advance have made it possible to use a number of electrophysiological approaches to neurological diagnosis in clinical neurology. In majority of the neurology training hospitals they have facilities of electroencephalography(EEG), electromyography(EMG), evoked potentials(EP), polysomnography(PSG), electronystagmography(ENG) and, transcranial doppler(TCD) ete. Clinicials and electrophysiologists should understand the technologic characteristics and general applications of each electrophysiological studies to get useful informations with using them in clinics. It is generally agreed that items of these tests are selected under the clinical examination, the tests are performed by the experts, and the test results are interpretated under the clinical background. Otherwise these tests are sometimes useless and lead clinicians to misunderstand the lesion site, the nature of disease, or the disease course. In this sense the clinical utility of neurophysiological tests could be summerized in the followings. First, the abnormal functioning of the nervous system and its environments can be demonstrated when the history and neurological examinations are equivocal. Second, the presence of clinically unsuspected malfunction in the nervous system can be revealed by those tests. Finally the objective changes can be monitored over time in the patient's status. Also intraoperative monitoring technique becomes one of the important procedures when the major operations in the posterior fossa or in the spinal cord are performed. In 1996, the Korean Society for Clinical Neurophysiology(KSCN) was founded with the hope that it will provide the members with the comfortable place for discussing their clinical and academic experience, exchanging new informations, and learning new techniques of the neurophysiological tests. The KSCN could collaborate with the International Federation of Clinical Neurophysiology(IFCN) to improve the level of the clinical neurophysiologic field in Korea as will as in Asian region.1 In this paper the clinical neurophysiological tests which are commonly used in clinical neurology and which will be delt with and educated by the KSCN i the future will be discussed briefly in order of EEG, EMG, EP, PSG, TCD, ENG, and Intraoperative monitoring.

에틸린 글리콜 중독 이후 나타난 지연성 다발성뇌신경병 및 다발신경뿌리신경병

김민수,김선영,권지현,김욱주,정현철 대한임상신경생리학회 2013 Annals of Clinical Neurophysiology Vol.15 No.2

Multiple cranial and peripheral neuropathies as a delayed sequellae of ethylene glycol poisoning is a less well known clinical entity and its information about long-term electrophysiological and clinical outcomes is limited. We report a 45-year-old male who presented with acute renal failure and subsequently developed multiple cranial neuropathy, respiratory failure, and flaccid tetraparesis. Through sequential electrophysiological studies, we would like suggest that the main pathophysiology of ethylene glycol-related neuropathy is a demyelinating polyradiculoneuropathy with secondary axonal degeneration.

한 정신병원에서 발생한 급성 축삭성 길랑-바레 증후군으로 추정되는 환자들에 대한 임상적 연구

이동국,Lee, Dong Kuck 대한임상신경생리학회 2000 Annals of Clinical Neurophysiology Vol.2 No.2

Background : Guillain-$Barr{\acute{e}}$ syndrome(GBS) is characterized clinically by acute flaccid paralysis, areflexia, and albumino-cytologic dissociation. Based on electrophysiology and pathology, GBS can be divided into either predominantly demyelinating or predominantly axonal patterns. Objectives : The clinical and laboratory status of probable acute axonal GBS occurring at a mental hospital was evaluated. Methods : Eight schizophrenia patients with probable acute axonal GBS were analyzed. Results : The mean age of the patients was 38 years old. Most of the patients were men. All patients showed an acute ascending paraparesis and/or quadriparesis with areflexia, and all have a history of schizophrenia for 3~20 years. The diseases occurred predominantly in the summer and electrodiagnostic studies revealed axonal patterns. The patients were treated by supportive care, except one patient with intravenous immunoglobulin. The prognosis was improved in 3 ; no change in 4 and 1 became aggravated. One patient with acute motor-sensory axonal neuropathy had a recurrence after 10 months of the first attack. Conclusions : Axonal GBS has been considered uncommon clinically or electrophysiologically, but 8 probable acute axonal GBSs occurring at a mental hospital have been diagnosed in 3.5 years. 한 정신병원에 장기입원한 정신분열증환자에서 계속 발생한 8명의 급성 축삭성 GBS로 추정되는 환자들의 평균연령은 38세였으며 7명이 남자였다. 모든 환자들은 급성 상행성 양쪽하지 마비나 사지마비를 보이면서 심부 건반사가 소실되었다. 이 병은 주로 여름철에 많이 발생 하였으며 전기생리학적 검사상 축삭이 주로 손상된 소견을 보였다. IVIG치료를 한 1명을 제외한 나머지 환자들은 경제적 사정상 대증요법으로 치료하였다. AMAN형태의 환자 3명 중 1명에서 임상적 호전을 보였고, AMSAN형태의 환자 5명 중 2명에서 임상적 호전을 보였다. AMSAN형태의 환자중 1명에선 10개월 뒤 같은 증상이 재발하였다.

하지불안증후군이 중추신경계 질환임을 시사하는 임상적, 신경영상학적, 신경생리학적 증거들에 관하여

정기영 대한임상신경생리학회 2008 Annals of Clinical Neurophysiology Vol.10 No.2

Restless legs syndrome (RLS) is a sensorimotor neurological disorder in which the primary symptom is a compelling urge to move the legs, accompanied by unpleasant and disturbing sensations in the legs. Although pathophysiologic mechanism of RLS is still unclear, several evidences suggest that RLS is related to dysfunction in central nervous system involving brain and spinal cord. L-DOPA, as the precursor of dopamine, as well as dopamine agonists, plays an essential role in the treatment of RLS leading to the assumption of a key role of dopamine function in the pathophysiology of RLS. Patients with RLS have lower levels of dopamine in the substantia nigra and respond to iron administration. Iron, as a cofactor in dopamine production, plays a central role in the etiology of RLS. Functional neuroimaging studies using PET and SPECT support a central striatal D2 receptor abnormality in the pathophysiology of RLS. Functional MRI suggested a central generator of periodic limb movements during sleep (PLMs) in RLS. However, to date, we have no direct evidence of pathogenic mechanisms of RLS.

MEG의 임상적용

박현미 대한임상신경생리학회 2000 Annals of Clinical Neurophysiology Vol.2 No.1

Magnetoencephalography(MEG)는 대뇌에서 형성되는 자장을 측정하는 비침습적인(noninvasive) 방법으로 정상적, 비정상적 뇌의 전기생리학적(electrophysiologic) 기능을 알아내는 검사이다. 이러한 MEG의 전기생리학적 신호는 뇌 자기공명영상(MRI)과 합성하여 해부학적인 연개성의 정보를 제공받을 수 있는데 이것을 Magnetic Source Imaging(MSI) 이라 한다. 현재 MEG는 기본적인 고유 뇌기능연구 뿐만 아니라 뇌병변질환에서도 임상적으로 많은 유용성을 제공하고 있으며, 대뇌 수술시 필요한 뇌피질 고유기능 영역화(presurgical functional mapping), 경련성 환자에서 간질파(epileptiform discharge)의 기록, 두부외상(trauma), 노졸중(stroke), 치매(dementia) 등에서의 ALFMA(abnormal low frequency of magnetic activity)의 정보를 얻을 수 있는 것이 임상적 적용의 대표적인 예이다. 그 외 정신과영역이나, 소오 뇌질환, 그리고 신생아 뇌질환에 이르기까지 적용범위는 굉장히 다양하다. 뇌피질의 구(sulcus)에 위치한 신경세포에서 발생하는 미약한 자장을 측정하는 검사이기에 자장 세기의 특성상 특수 감지기(detector, sensor)가 필요하다. 감지된 자장을 분석하여 뇌 자기공명영상과 합치기까지 MEG의 기술적인 부분은 다른 뇌 영상처리방법과는 여러 가지 면에서 차이가 있다. 최근 들어 전체 뇌의 영역의 자장을 한꺼번에 감지 할 수 있는 Whole head multichannel system의 도입으로 좀더 적극적인 임상 적용이 가능하리라 본다. 전기생리학적 기능과 해부학적 영역을 동시에 알 수 있는, 시간적, 공간적 해상력이 뛰어난 검사로 향후 뇌신경생리기능 연구에 좀더 나은 정보를 제공하리라 보며 기본적 개념과 임상적 의의를 간략히 소개 하고자 한다.

특발성 발목터널 증후군에서 내측 발바닥 신경의 전기 생리학적 검사

안재영,김병준 대한임상신경생리학회 2006 Annals of Clinical Neurophysiology Vol.8 No.2

Background: Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the tibial nerve within fibrous tunnel on the medial side of the ankle. The most common cause of TTS is idiopathic. This is a retrospective study to define the lectrophysiological characteristics of idiopathic TTS. Methods: We reviewed the medical and electrophysiological records of consecutive patients with foot sensory symptoms referred to electromyography laboratory. Inclusion of patients was based on clinical findings suggestive of TTS. Among them, patients with any other possible causes of sensory symptoms on the foot were excluded. Control data were obtained from 19 age-matched people with no sensory symptoms or signs. Routine motor and sensory nerve conduction study (NCS) including medial plantar nerve (MPN) using surface electrodes were performed. Results: Twenty one patients (13 women, 8 men, 9 unilateral, 12 bilateral) were enrolled to have idiopathic TTS (total 31 feet). Tinel’s sign was positive in 16 feet (51.6%) of TTS and four feet (10.5%) in control group. The statistically significant electrophysiological parameter was difference of sensory conduction velocity (SCV) between sural nerve and MPN. Amplitude of sensory nerve action potential and SCV of MPN were not different significantly between idiopathic TTS feet and controls. Conclusion: Bilateral development in idiopathic TTS was more common. Tinel’s sign and difference of SCV between sural nerve and MPN may be helpful for the diagnosis of idiopathic TTS.

수술 소견과 자기공명영상 소견을 통한 발목터널 증후군의 원인 연구

손민기,박홍기,이영배 대한임상신경생리학회 2011 Annals of Clinical Neurophysiology Vol.13 No.2

Background: Tarsal tunnel syndrome (TTS) is an entrapment neuropathy that occurs in the ankle. Previous studies reported that this disease was due to physiologic factors and structural lesions in the ankle or foot. The authors investigated the causative factors of TTS and their frequency via operative findings. The diagnostic value of MRI was also evaluated based on the concordance between the operative findings and the MRI findings. Methods: This study was performed in retrospective by using medical record of the patients who underwent operations with TTS from August 2003 to May 2010. Physical examination, nerve conduction study, and MRI were conducted on patients who visited department of neurology or orthopedic surgery due to pain and sensory abnormality of their ankle and foot. Results: 34 patients underwent the operation. Ganglion accounted for the largest portion of the operative findings. In addition, varicose veins, intrinsic foot muscle hypertrophy, tenosynovitis, and fascia thickening were mainly observed. Of the 34 patients, 33 patients underwent pre-operative MRI, of whom 18 patients showed MRI findings consistent with the operative findings. Conclusions: Space-occupying lesions accounted for the majority of the causative factors in TTS patients who underwent the surgical treatment. In this study, the MRI appeared useful for identifying causes of TTS.

비복신경 외측분지의 신경전도검사

김성제,이동국 대한임상신경생리학회 2003 Annals of Clinical Neurophysiology Vol.5 No.2

The Lateral dorsal cutaneous branch of sural nerve (LDCB) is a terminal sensory branch of lower extremities. It can be injured frequently in peripheral nerves. However, the normal data of each component of nerve conduction study (NCS) of were not studied at this time. The Nerve Conduction Study of LDCB adults were assessed for amplitude, area, duration and nerve conduction velocity (NCV) in normal fifty. We also evaluated how age, sex and dexterity affect the various components of NCS. The Mean amplitude of LDCB was 9.45±1.93 μV, area was 4.05±0.55 μV/s, duration was 1.50±0.13 s, and NCV was 37.9±3.09 m/s, respectively. The amplitude of right was 10.1 μV in men, 8.65 μV in women. The area of right was 3.83 μV/s in less than 40 years and 4.24 μV/s in older than 40 years. The areas of left was 3.86 μV/s in less than 40 years and 4.30 μV/s in older than 40 years. The NCV was 39.0 m/s in less than 40 years and 36.7 m/s in older than 40 years. All of above differences were statistically significant. There were no statistically significant differences between right and left NCS. Normal data of LDCB could be applicable in peripheral neuropathy or nerve injury

발처짐 증상으로 발현된 총비골신경의 슈반세포종

조수현,이지훈,우호걸,정유진,김상범,신원철 대한임상신경생리학회 2014 Annals of Clinical Neurophysiology Vol.16 No.2

Foot drop is usually derived from peroneal nerve injury. Traumatic causes of peroneal nerve injury are more commonthan insidious causes including metabolic syndromes and mass lesions. We present a case with common peronealneuropathy due to schwannoma, which is extremely rare. Complete excision of the mass lead to a gradual improvementof the symptoms. Schwannoma should be considered as a cause of common peroneal neuropathy.(Korean J Clin Neurophysiol 2014;16:74-76)