Intraarterial therapy for middle cerebral artery dissection with intramural hematoma detection on susceptibilityweighted imaging

윤창효,정승욱,정희정,조은빈,양태원,김승주,박기종,김승수,박현 대한신경집중치료학회 2019 대한신경집중치료학회지 Vol.12 No.2

Background: Intracranial artery dissection (IAD) may be an underdiagnosed cause of large vessel occlusion. The safety and efficacy of intra-arterial therapy (IAT) in patients with IAD are largely unknown. We report the case of a patient with IAD who was successfully treated with IAT. Case Report: A 27-year-old man with a sudden-onset sensory dominant aphasia was admitted to our hospital around 16 hours after disease onset. Brain magnetic resonance angiography revealed an occlusion in the left distal middle cerebral artery (MCA). On the susceptibility-weighted imaging, bead-shaped dark signals were observed in the left MCA bifurcation, and intramural hematoma was suspected. We performed thrombectomy and permanent stenting for the dissecting MCA occlusion and achieved complete recanalization. Conclusion: The IMH on susceptibility-weighted imaging led us to suspect that the large vessel occlusion was due to the IAD. Further research is needed to address the efficacy and safety of IAT in patients with IAD.

말벌쏘임 후 발생한 이상급성중증과민증과 지연 소뇌실조증

정희정,정승욱,윤창효,조은빈,양태원,박기종 대한신경과학회 2019 대한신경과학회지 Vol.37 No.3

Anaphylaxis usually develop immediately after wasp sting, but may develop even after few days later. Neurological complications after stings are uncommon, although several cases have been reported involving central and/or peripheral nervous system. Although wasp sting-induced encephalitis has been rarely reported, all reported cases showed mental change and severe neurological deterioration. Herein, we report an atypical case who showed biphasic anaphylaxis and delayed-onset cerebellar ataxia following a wasp sting, characterized by mild cerebellar ataxia and excellent response to corticosteroids.

지역사회 거주 노인에서 인지기능과 아포지질단백질 E 유전자형의 연관성: 고령군 운수면 지역 조사

권오대,최소영,박재한,윤창효,권혁환,신임희 대한신경과학회 2009 대한신경과학회지 Vol.27 No.4

Background: It is not clear whether polymorphism of the apolipoprotein E (ApoE) gene influences the cognition of community residents. The aim of this study was to establish the association between ApoE gene polymorphism and cognitive function in an elderly rural community in Korea. Methods: A total of 388 subjects aged 65 and over were recruited. Demographic characteristics, past history of illness, and scores on the Korean version of the Mini Mental State Examination (K-MMSE), the Geriatric Depression Scale – Short Form (GDS-S), and the Korean version of Instrumental Activities of Daily Living (K-IADL) were evaluated. The lipid profile and ApoE genotype were sampled from 377 of the participants. Results: Of the entire cohort, 75% had less than 6 years of education, and 30% were illiterate. The frequencies of the ApoE ε2, ApoE ε3, and ApoE ε4 alleles were 48 (6.6%), 372 (86.9%), and 49 (6.5%), respectively. The K-MMSE score was much lower in those with two ApoE ε3 alleles than in those with only one ( p=0.046). However, the numbers of ApoE ε2 alleles (p=0.976) and ApoE ε4 alleles (p=0.934) carried by the individual were not associated with K-MMSE score. Both K-IADL (p<0.001) and GDS-S (p<0.001) scores were significantly correlated with K-MMSE score. Grouping of the participants into three groups according to K-MMSE score (i.e., 0–17 , 18–24, and 25–30) also revealed that this score was correlated with K-IADL score (p<0001), GDS-S score (p<0.001), and the ApoE ε3 allele (p=0.035). Conclusions: These results suggest that the ApoE ε3 allele has a negative influence on cognitive function (K-MMSE) in this rural community. Surprisingly, we were unable to detect any relationship between the ApoE ε4 allele and cognitive function. There was a positive correlation between K-MMSE, K-IADL, and GDS-S scores. Background: It is not clear whether polymorphism of the apolipoprotein E (ApoE) gene influences the cognition of community residents. The aim of this study was to establish the association between ApoE gene polymorphism and cognitive function in an elderly rural community in Korea. Methods: A total of 388 subjects aged 65 and over were recruited. Demographic characteristics, past history of illness, and scores on the Korean version of the Mini Mental State Examination (K-MMSE), the Geriatric Depression Scale – Short Form (GDS-S), and the Korean version of Instrumental Activities of Daily Living (K-IADL) were evaluated. The lipid profile and ApoE genotype were sampled from 377 of the participants. Results: Of the entire cohort, 75% had less than 6 years of education, and 30% were illiterate. The frequencies of the ApoE ε2, ApoE ε3, and ApoE ε4 alleles were 48 (6.6%), 372 (86.9%), and 49 (6.5%), respectively. The K-MMSE score was much lower in those with two ApoE ε3 alleles than in those with only one ( p=0.046). However, the numbers of ApoE ε2 alleles (p=0.976) and ApoE ε4 alleles (p=0.934) carried by the individual were not associated with K-MMSE score. Both K-IADL (p<0.001) and GDS-S (p<0.001) scores were significantly correlated with K-MMSE score. Grouping of the participants into three groups according to K-MMSE score (i.e., 0–17 , 18–24, and 25–30) also revealed that this score was correlated with K-IADL score (p<0001), GDS-S score (p<0.001), and the ApoE ε3 allele (p=0.035). Conclusions: These results suggest that the ApoE ε3 allele has a negative influence on cognitive function (K-MMSE) in this rural community. Surprisingly, we were unable to detect any relationship between the ApoE ε4 allele and cognitive function. There was a positive correlation between K-MMSE, K-IADL, and GDS-S scores.

수근관증후군 환자에서 감각역치검사의 진단적 유용성

이효민,석정임,이동국,윤창효 대한신경과학회 2009 대한신경과학회지 Vol.27 No.4

Background: Carpal tunnel syndrome (CTS) is the most commonly reported nerve entrapment syndrome. When performing routine nerve conduction studies (NCS) in clinically diagnosed CTS, we sometimes confronted with patients who have no definite electrophysiological evidence of CTS. Current perception threshold (CPT) test can evaluate the functioning of all major subpopulations of sensory nerve. The purpose of this study is to determine clinically usefulness of the CPT test in idiopathic CTS. Methods: We prospectively studied 60 patients (90 hands) who were clinically diagnosed as CTS. Involved hands were grouped into three clinical grades (mild, moderate and severe). NCS was done using a standard technique and equipment. CPT test was measured at the distal interphalangeal joint of second, third and fifth fingers with electrical current of 5 Hz, 250 Hz and 2,000 Hz in frequency. Results: Of 60 patients (90 hands), 8 (13.1%) were men and 52 (86.9%) were women. Mean age at evaluation was 56.00±8.94 years old. Positive rate of NCS and CPT was 0.80 (0.72, 0.88) and 0.61 (0.51, 0.71), respectively. Sensitive and specificity of CPT test was 0.49 and 0.57. As the clinical severity of CTS deteriorate, CPT test showed abnormality in low frequency stimulation. Conclusions: CPT test is an effective and relatively simple procedure for measuring perception in CTS. But CTS test is difficulty and subjectively at interpretation. We suggested that the usefullness of CPT test is lower than NCS in diagnosis of CTS. Background: Carpal tunnel syndrome (CTS) is the most commonly reported nerve entrapment syndrome. When performing routine nerve conduction studies (NCS) in clinically diagnosed CTS, we sometimes confronted with patients who have no definite electrophysiological evidence of CTS. Current perception threshold (CPT) test can evaluate the functioning of all major subpopulations of sensory nerve. The purpose of this study is to determine clinically usefulness of the CPT test in idiopathic CTS. Methods: We prospectively studied 60 patients (90 hands) who were clinically diagnosed as CTS. Involved hands were grouped into three clinical grades (mild, moderate and severe). NCS was done using a standard technique and equipment. CPT test was measured at the distal interphalangeal joint of second, third and fifth fingers with electrical current of 5 Hz, 250 Hz and 2,000 Hz in frequency. Results: Of 60 patients (90 hands), 8 (13.1%) were men and 52 (86.9%) were women. Mean age at evaluation was 56.00±8.94 years old. Positive rate of NCS and CPT was 0.80 (0.72, 0.88) and 0.61 (0.51, 0.71), respectively. Sensitive and specificity of CPT test was 0.49 and 0.57. As the clinical severity of CTS deteriorate, CPT test showed abnormality in low frequency stimulation. Conclusions: CPT test is an effective and relatively simple procedure for measuring perception in CTS. But CTS test is difficulty and subjectively at interpretation. We suggested that the usefullness of CPT test is lower than NCS in diagnosis of CTS.

반복되는 두통과 혼동 그리고 점차 진행하는 인지기능장애로 발현한 신경세포핵내봉입체병

양태원,박기종,조은빈,정승욱,윤창효,김승주,강희영,정희정 대한신경과학회 2020 대한신경과학회지 Vol.38 No.4

Change of Apparent Diffusion Coefficient Immediately after Recanalization through Intra-Arterial Revascularization Therapy in Acute Ischemic Stroke

노지은,염정아,김영수,윤창효,박민규,박경필,백승국 대한영상의학회 2016 대한영상의학회지 Vol.74 No.4

Purpose: Intra-arterial revascularization therapy (IART) for acute ischemic stroke has become increasingly popular recently. However, early change in apparent diffusion coefficient (ADC) values after full recanalization in human stroke has not received much attention. The aim of this study was to evaluate ADC changes immediately after interventional full-recanalization in patients with acute ischemic stroke. Materials and Methods: ADC values of 25 lesions from 18 acute ischemic stroke patients were recorded with both pre- and post-recanalization ADC maps. Measurement was done by placing region of interests over the representative images of the lesion. For analysis, lesions were divided into territorial infarction (TI) and watershed infarction (WI). Results: Mean ADC values of the overall 25 lesions before IART were 415.12 × 10-6 mm2/sec, and increased to 619.08 × 10-6 mm2/sec after the IART. Average relative ADC (rADC) value for 22 TI increased from 0.59 to 0.92 (p < 0.000), whereas, average rADC value for 3 WI did not change significantly. Conclusion: There was a conspicuous increase of ADC values immediately after full-recanalization in TI lesions. On the other hand, WI lesions did not show significant change in ADC values after recanalization.

스테로이드로 치료한 후천특발전신무한증 환자의 예후

조은빈,김승주,양태원,정희정,윤창효,정승욱,박기종 대한근전도전기진단의학회 2019 대한근전도 전기진단의학회지 Vol.21 No.2

Objective: To elucidate the response to steroid therapy and prognosis in patients with acquired idiopathic generalized anhidrosis (AIGA). Method: We reviewed the medical records of patients seen at a tertiary neurology clinic between March 2017 and July 2019. Inclusion criteria required the diagnosis of widely distributed anhidrosis, affecting at least 50% of the entire body, in the absence of any other autonomic or neurologic dysfunction. The diagnosis and distribution of generalized anhidrosis were confirmed using thermoregulatory sweat test. Results: Six male patients were included with a mean age at onset of 32 years (range, 16~43 years). All patients received corticosteroid therapy with five consecutive days of intravenous 1g methylprednisolone and oral prednisolone. Five patients showed good response to steroid therapy. However, decreased sweating reappeared in more than a half of patients (N = 3/5) with a mean interval of 32 days (standard deviation, 7.5) until recurrence. The differentiated findings in patients with recurrence compared to those without were anhidrosis over a wider part of body on quantitative sudomotor axon reflex test and decreased heart rate variability to deep breathing. Conclusion: Corticosteroid therapy was effective in improving AIGA symptoms. However, recurrence rates seem to be high after treatment discontinuation and prognostic factors need to be confirmed.

Physiologic Flow Related Signal Intensity in Dural Sinuses on Time of Flight Magnetic Resonance Angiography: Changes Caused by Head Elevation

노지은,백승국,염정아,김영수,정희석,윤창효,한준희 대한영상의학회 2017 대한영상의학회지 Vol.77 No.6

Purpose: The presence of a flow-related signal in the normal dural sinus time of flight magnetic resonance angiography (TOF MRA) is common. This study aimed to identify changes in signal intensity in the dural sinus caused by changes in patient position. Materials and Methods: The researchers performed an elevation TOF MRA of the cerebral region in 52 patients, who showed abnormal flow-related signals in the dural sinuses on supine position. Flow-related signal intensity in the dural sinuses was then analyzed. Results: Flow-related signals were seen in 114 sites (52 patients), specifically in the internal jugular vein (IJV), sigmoid sinus (SS), inferior petrosal sinus (IPS), and cavernous sinus (CS) in 29 sites, 33 sites, 32 sites, and 20 sites, respectively. After head elevation, flow-related signal changes were then observed in the IJV, SS, IPS, and CS in 107 sites (107/114, 93.9%). There was loss of signal (62/114, 54.4%), or decrease (39/114, 34.2%), increase (6/114, 5.3%), or no change (7/114, 6.1%) in the signal intensity, and flow related signals were more frequent on the left than on the right. Conclusion: Flow-related signals in the dural sinuses on TOF MRA were decreased or disappeared by head elevation in 88.6% of the sites. Head elevation may help distinguish between pathologic and physiologic states.