Repetitive Questioning and Writing in a Patient with Transient Global Amnesia

구대림,김진아,남현우 대한신경과학회 2017 Journal of Clinical Neurology Vol.13 No.4

두피전극과 경질막밑 전극으로 동시 기록한 발작기 뇌파에서의 뚜렷한 시간차이: 안쪽관자엽간질 환자 1예

구대림,송파멜라,변소영,이정화,유남태,주은연,서대원,홍승철,홍승봉 대한임상신경생리학회 2011 Annals of Clinical Neurophysiology Vol.13 No.2

We present a recordings of 37-year-old woman with simultaneous ictal scalp and subdural electrodes. The ictal rhythm on subdural electrocorticography (ECoG) started earlier (median 24.5 sec) and ended later (median 2.0 sec) compared to ictal rhythm on scalp EEG. Eight ictal ECoG recordings were well localized to left temporal area, whereas ictal scalp EEG recordings were not. Our case shows the obvious timing relations between two recordings, and different electrophysiologic information about localization of ictal onset zone.

Clinical Considerations of Obstructive Sleep Apnea with Little REM Sleep

구대림,남현우 대한신경과학회 2016 Journal of Clinical Neurology Vol.12 No.4

Background and Purpose Obstructive sleep apnea (OSA) is more severe during rapid eye movement (REM) sleep than during non-REM sleep. We aimed to determine the features of patients with OSA who experience little REM sleep. Methods Patients with a chief complaint of sleep-disordered breathing were enrolled. All subjects underwent overnight polysomnography (PSG) and completed questionnaires on sleep quality. Patients were divided into the following three groups according to the proportion of REM sleep detected in overnight PSG: little REM sleep [REM sleep <20% of total sleep time (TST)], normal REM sleep (20–25% of TST), and excessive REM sleep (>25% of TST). Mul¬tiple logistic regression analyses were applied to the data. The success rate of continuous posi¬tive airway pressure (CPAP) titration was estimated in these groups. Results The age and body mass index of the patients were 47.9±15.9 years (mean±SD) and 25.2±4.1 kg/m2, respectively. The 902 patients comprised 684 (76%) men and 218 (24%) wom¬en. The apnea-hypopnea index (AHI) in the little-REM-sleep group was 22.1±24.4 events/hour, which was significantly higher than those in the other two groups (p<0.05). Multiple lo¬gistic regression showed that a higher AHI (p<0.001; odds ratio, 1.512; 95% confidence inter¬val, 1.020–1.812) was independently predictive of little REM sleep. The titration success rate was lower in the little-REM-sleep group than in the normal-REM-sleep group (p=0.038). Conclusions The AHI is higher and the success rate of CPAP titration is lower in OSA pa¬tients with little REM sleep than those with normal REM sleep.

항 GQ1b 항체와 연관된 급성 단안성 외안근마비

구대림,박기형,김희태,이규용,이영주 대한신경과학회 2004 대한신경과학회지 Vol.22 No.6

Some authors found the anti-GQ1b IgG antibody in some of their patients with acute postinfectious ophthalmoparesis without ataxia, “atypical MFS” or “acute ophthalmoparesis (AO)”. Antecedent illness, acute ophthalmoparesis, CSF albuminocytologic dissociation, and the anti-GQ1b IgG antibody are useful markers for diagnosing AO. AO can be considered a variant or atypical form of MFS. We report two monocular AO patients who had the anti-GQ1b IgG antibody along with a literature review.

Clinical Usefulness of Intraoperative Motor-Evoked Potential Monitoring during Temporal Lobe Epilepsy Surgery

구대림,이원구,홍승철,서대원 대한신경과학회 2019 Journal of Clinical Neurology Vol.15 No.3

Background and Purpose We aimed to determine the effectiveness of intraoperative neurophysiological monitoring focused on the transcranial motor-evoked potential (MEP) in patients with medically refractory temporal lobe epilepsy (TLE). Methods We compared postoperative neurological deficits in patients who underwent TLE surgery with or without transcranial MEPs combined with somatosensory evoked potential (SSEP) monitoring between January 1995 and June 2018. Transcranial motor stimulation was performed using subdermal electrodes, and MEP responses were recorded in the four extremity muscles. A decrease of more than 50% in the MEP or the SSEP amplitudes compared with baseline was used as a warning criterion. Results In the TLE surgery group without MEP monitoring, postoperative permanent motor deficits newly developed in 7 of 613 patients. In contrast, no permanent motor deficit occurred in 279 patients who received transcranial MEP and SSEP monitoring. Ten patients who exhibited decreases of more than 50% in the MEP amplitude recovered completely, although two cases showed transient motor deficits that recovered within 3 months postoperatively. Conclusions Intraoperative transcranial MEP monitoring during TLE surgery allowed the prompt detection and appropriate correction of injuries to the motor nervous system or ischemic stroke. Intraoperative transcranial MEP monitoring is a reliable modality for minimizing motor deficits in TLE surgery.

정상 수면의 생리

구대림,김주한 한양대학교 의과대학 2013 Hanyang Medical Reviews Vol.33 No.4

Sleep is a highly organized and complicated state that is fundamental to life. We have an absolute need to sleep during about one-third of our lives. There are two types of sleep, non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. NREM sleep is divided into stages 1, 2 and 3 which is representing a degree of relative depth in sleep. Each sleep stage shows unique features including some variations in electroencephalographic waves, eye movements, and muscle tone. Although sleep pattern changes are associated with aging, how sleep physiology and sleep patterns change over an individual’s life span is not well-defined. Circadian rhythms, which are the daily rhythms in physiology and behavior, regulate the sleep-wake cycle. Comprehensive understanding of normal sleep physiology should be very important to better understand not only the effects of sleep related diseases but also the impacts of pathological sleep on various diseases of other systemic organs. This review aims to enhance knowledge focused on normal sleep physiology and its regulation.

The Relationship between Obstructive Sleep Apnea and Functional Dyspepsia

구대림,남현우 대한수면연구학회 2020 Journal of sleep medicine Vol.17 No.1

Objectives: Functional dyspepsia is one of the most common functional gastrointestinal disorders. We aimed to investigate the relationship between obstructive sleep apnea (OSA) and functional dyspepsia in patients with the complaint of sleep-disordered breathing. Methods: We prospectively recruited patients who visited the institute for the evaluation of sleep-disordered breathing. All patients underwent overnight polysomnography and submitted their responses to sleep questionnaires. A validated Korean version of the Rome III criteria was used to estimate functional dyspepsia. Functional dyspepsia was classified into two subtypes of epigastric pain syndrome and postprandial distress syndrome. Results: Out of 130 subjects with sleep disturbances, a total of 79 patients (60 men, 19 women) were enrolled. The mean (±standard deviation) age was 46.9±13.4 years. Functional dyspepsia was diagnosed in 8 (10%) patients. Patients with functional dyspepsia showed significantly higher values of Stanford Sleepiness Scale, the proportion of N1 sleep, arousal index, and apnea-hypopnea index compared to patients without functional dyspepsia (p=0.018, p=0.021, p=0.041, and p=0.039, respectively). With respect to OSA severity, 12% of patients with moderate OSA and 22% patients with severe OSA had functional dyspepsia. Severe OSA was significantly associated with a higher proportion of postprandial distress syndrome (p=0.030). Conclusions: Our patients with snoring or OSA revealed that functional dyspepsia is associated with more severe daytime sleepiness and apnea-hypopnea index compared to those without functional dyspepsia. In addition, postprandial distress syndrome was a prevalent subtype of functional dyspepsia in patients with severe OSA.

허혈성 뇌졸중 환자에서 망막 미세혈관 변성의 의의

구대림,고성호,김현영,이규용,이영주,김희태,김승현,김주한,김명호 대한신경과학회 2006 대한신경과학회지 Vol.24 No.5

Background: Retinal microvascular abnormalities reflect cerebral microvascular changes. However, there is few clinical data on the relationship between retinal microvascular changes and intracranial arterial stenosis or stroke subtypes. We examined the association between white matter changes (WMCs) or large artery stenosis and retinal microvascular changes, stroke subtypes. Methods: We investigated demographic features, retinal microvascular changes, intracranial large arterial stenosis, WMCs and stroke subtypes in 100 acute ischemic stroke patients over 2 years who had taken retinal photography and underwent brain MRI with MR angiography. Retinal photography was evaluated for specific retinal microvascular change by grader using standardized protocol. Intracranial arterial stenosis was defined by MR angiography. WMCs were coded from 1 for normal to 8 for most severe degree. And we defined “White matter lesion” as grade 3 or more. Stroke subtypes were classified by TOAST criteria. Results: Among the retinal microvascular changes, retinal hemorrhage, arteriovenous nicking, focal and generalized arteriolar narrowing and venous congestion were significantly correlated with intracranial large arterial stenosis. There was no relationship between the retinal microvascular changes and stroke subtypes. And only focal arteriolar narrowing was significantly correlated with WML. Conclusions: Retinal microvascular changes seen in patients with ischemic stroke were related to intracranial large arterial stenosis. We might suggest that the pathogenesis of retinal microvascular changes is related to that of large arterial atherosclerosis.

원전 건설의 경제성 제고

대림산업(주) 한국원자력산업회의 1999 원자력산업 Vol.19 No.1

社會敎化事業の再檢討

大林宗嗣 朝鮮社會事業協會 1940 朝鮮社會事業 Vol.18 No.9