폐결핵과 동시에 발병한 ANCA연관혈관염

석정임,박성훈,김경찬 대한신경과학회 2012 대한신경과학회지 Vol.30 No.1

Antineutrophil cytoplasmic antibodies (ANCA) are closely linked to primary systemic vasculitis, and ANCA detection has became an important diagnostic hallmark of ANCA-associated vasculitis (AAV). However, it has been reported that tuberculosis is associated with positivity for ANCA and it is difficult to differentiate clinically between tuberculosis and AAV. We report a patient with the concomitant appearance of AAV and pulmonary tuberculosis. Positivity for ANCA should be carefully interpreted as indicative of AAV, especially in countries with a high prevalence of tuberculosis.

비우세손을 주로 침범한 수근관증후군의 임상적 특징

석정임,이동국,박기영 대한임상신경생리학회 2012 Annals of Clinical Neurophysiology Vol.14 No.2

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발병초기 벨마비 환자의 진단에서 순목 반사(blink reflex)의 유용성

석정임,이동국,김창형 대한임상신경생리학회 2012 Annals of Clinical Neurophysiology Vol.14 No.1

Background: Bell’s palsy is the most common disease of cranial nerve. While most electrodiagnostic tests can detect the abnormality of facial nerve several days later in Bell’s palsy, blink reflex usually reveals the abnormality earlier than other tests. Therefore, we investigated the diagnostic usefulness of blink reflex in the early stage of Bell’s palsy. Methods: We performed a prospective investigation in patients with facial palsy. We enrolled patients with Bell’s palsy who were evaluated within 7 days of symptom onset and excluded patients with secondary causes of facial palsy. We analyzed the findings of blink reflex according to age, sex, evaluation time, and severity of facial palsy. Results: Of 320 consecutive patients with facial palsy, a total of 204 patients were enrolled. Blink reflex was normal for 10 patients and abnormal for 194 patients. The time interval between the symptom onset and the evaluation time was not associated with the result of blink reflex,but House-Brackmann grade was significantly related to the result of blink reflex (P<0.001). Patients with mild Bell’s palsy often showed normal blink reflex. Conclusions: Our study shows that blink reflex is useful diagnostic test regardless of evaluation timing in the early stage of Bell’s palsy, although it could be normal in patients with mild Bell’s palsy.

Ultrasonographic evaluation of common compression neuropathies in the upper limb

석정임 대한임상신경생리학회 2020 Annals of Clinical Neurophysiology Vol.22 No.1

Neuromuscular ultrasonography has emerged over the last decade as a useful tool for diagnosing peripheral nerve disorders. It has been studied extensively with a particular focus on the assessment of compression neuropathies. Neuromuscular ultrasonography complements electrodiagnostic studies well by visualizing both the nerve anatomy and surrounding structures, providing useful data that cannot be obtained using the latter methodology only. This review article summarizes and synthesizes the literature focusing on the diagnostic role of neuromuscular ultrasonography in common compression neuropathies of the upper limb.

Immobilization-induced rhabdomyolysis patients with peripheral neuropathy: clinical, laboratory and imaging findings

석정임,이인희,Ki Sung Ahn,Gun Woo Kang,Je Wan Lee,Sang Gyu Kwak 대한임상신경생리학회 2020 Annals of Clinical Neurophysiology Vol.22 No.1

Background: Peripheral nerve injury rarely occurs in patients with rhabdomyolysis. Based on our experience and previous reports, we consider prolonged immobilization a risk factor for the development of peripheral neuropathy in rhabdomyolysis patients. Methods: This study analyzed 28 patients with rhabdomyolysis due to prolonged immobilization. We analyzed their demographic and laboratory data, clinical and imaging findings, and outcomes, and compared these factors between patients with and without neuropathy. Results: Seven of the 28 patients had peripheral neuropathy, including sciatic neuropathy or lumbosacral plexopathy. Compared to those without neuropathy, the patients with neuropathy were younger (p = 0.02), had higher peak creatine kinase (CK) levels (p = 0.02), had higher muscle uptake in bone scans (p = 0.03), and more frequently exhibited abnormal muscle findings in computed tomography (CT) (p = 0.004). Conclusions: Patients with prolonged immobilization-induced rhabdomyolysis and neuropathy had higher CK levels, increased uptake on bone scans, and more-frequent abnormal muscles on CT than those without neuropathy. These findings indicate that peripheral neuropathy is more likely to develop in patients with severe muscle injury.

횡문근융해 환자에서 발생한 말초신경병의급성-아급성기의 임상 특징과 전기진단검사 소견

석정임,이인희,안기성,강건우,김재훈 대한신경과학회 2019 대한신경과학회지 Vol.37 No.1

Background: Rhabdomyolysis is a syndrome caused by injury to skeletal muscle and characterized by myalgia and swelling of the affected muscles. Peripheral nerve injury rarely occurs in patients with rhabdomyolysis. Methods: We reviewed the medical records of 8 consecutive patients with peripheral neuropathies associated with rhabdomyolysis. We assessed the clinical characteristics and electrodiagnostic findings of eight patients. Results: In seven patients, rhabdomyolysis occurred after prolonged immobilization. In one patient, blunt trauma was a cause of rhabdomyolysis. All patients presented with weakness and paresthesia in lower extremities and electrodiagnostic tests showed peripheral nerve injury suggesting sciatic neuropathy or lumbosacral plexopathy. Although rhabdomyolysis itself recovered completely in all patients, neurologic deficits from neuropathy recovered partially and slowly. Conclusions: Sciatic nerve or lumbosacral plexus was injured in all eight patients. Among the various causes of rhabdomyolysis, prolonged immobilization is associated with development of peripheral neuropathy.

Sonographic evaluation of the diaphragm in patients with unilateral diaphragmatic paralysis

석정임,Kyung Chan Kim,Hye Joo Rha,Sung Rok Lee 대한임상신경생리학회 2018 Annals of Clinical Neurophysiology Vol.20 No.2

Evaluation of diaphragm function is challenging because no single test has a high diagnostic yield. We describe ultrasound findings in three cases with acquired unilateral diaphragmatic elevation. These cases confirm that sonographic evaluation is a valid tool for identifying diaphragm dysfunction. In addition, ultrasound measurements of diaphragm thickness and the contractility can be used to determine if a diaphragm is paralyzed and suggest the duration of paralysis (i.e., acute or chronic).

Churg-Strauss 증후군에서 관찰된 말초신경병증의 임상 및 전기생리학적 특징

석정임,배종석,주은연,민태훈,최동철,김병준 대한신경과학회 2004 대한신경과학회지 Vol.22 No.2

Background: Churg-Strauss syndrome (CSS) is characterized by disseminated vasculitis and eosinophilia in patients with asthma. This study was performed to delineate the characteristics of peripheral neuropathy and to identify the factors associated with the severity of neurologic disability. Methods: We reviewed the medical records of 12 consecutive patients with Churg-Strauss syndrome who had been diagnosed at Samsung Medical Center. The diagnosis of CSS was based on the American college of Rheumatology 1990 criteria. Results: Of the 12 patients, 9 had neurologic involvement. Six had neurologic symptoms as presenting manifestations. All neurologic manifestations were peripheral neuropathy; 5 had multiple mononeuropathy, 2 had distal symmetric polyneuropathy, and 2 had mononeuropathy. Neurologic disability score depended on the rapidity of steroid treatment. Conclusions: Neurologic involvement is common and develops early in patients with CSS, usually manifesting as peripheral neuropathy. Neurologic disability score showed that early steroid therapy was related with less neurologic disability.

원인이 밝혀지지 않은 균형장애에서 안구운동검사 및 뇌자기공명영상검사 결과

석정임,고재용,이동국 대한평형의학회 2014 Research in Vestibular Science Vol.13 No.4

Background and Objectives: Although disequilibrium is common type of dizziness in older people, it is sometimes difficult to identify a specific cause for this problem. The diffuse brain pathology including subcortical ischemia and atrophy can be a cause for patients with disequilibrium of unknown cause. Aim of this study is to identify the eye movements and neuroimaging features in patients with disequilibrium. Materials and Methods: We performed a prospective investigation in patients with disequilibrium of unknown cause. We collected information on demographic characteristics and clinical features of disequilibrium. The impact of dizziness on everyday life was assessed by 25-item dizziness handicap inventory (DHI). Vestibular function test (VFT) includes smooth pursuit, saccade, optokinetic nystagmus, and rotatory chair test. Subcortical white matter lesions and brain atrophy were graded from brain magnetic resonance image (MRI). Results: This study included 14 patients (12 female and 2 male), aged between 64 and 84 years, mean age 74.01±6.02 years. The score of DHI was 39.4±11.8 (20−58). Eye movements were abnormal in 13 patients and normal in only one patient. The degree of subcortical ischemia was mild in 7, moderate in 4, and severe in 3 patients. Ventricular brain ratio was 0.23±0.03. However, there was no significant relationship between MRI findings and the degree of oculomotor alterations (result of VFT). Conclusion: Patients with disequilibrium of unknown cause are usually elderly women. Alterations in oculomotor movements and diffuse brain pathology including white matter lesions and atrophy were observed in patients with disequilibrium of unknown cause.

클레부딘(clevudine)유발근병증의 임상과 병리특성

석정임,김대성,남태승,송현석,박영은,김선영,허소영,이동국,조희영,이창훈,박민수,김영수 대한신경과학회 2013 대한신경과학회지 Vol.31 No.1

Background: Clevudine (Revovir ®) is a recently introduced antiviral drug, and clinical trials have demonstrated its potent,sustained antiviral activity without specific adverse events. However, several studies have found severe myopathy during clevudine therapy. Our study aimed to summarize the clinical and pathological features of clevudine-induced myopathy. Methods: We analyzed the demographic data, clinical features, and pathologic findings of 18 consecutive hepatitis-B patients who developed skeletal myopathy during clevudine therapy. Results: The 18 patients comprised 11 women and 7 men aged 48.2±14.0 years (mean±standard deviation; range 28-74years). Each of the 18 patients was treated with clevudine for at least 5 months (range 5-20 months) before the development of symptoms. In all patients the main symptom was proximal muscular weakness that progressed slowly over several months. Elevated creatine kinase and myopathic patterns on electromyography were found. Muscle biopsies revealed severe myonecrosis associated with numerous ragged red fibers and cytochrome-c-oxidase-negative fibers, mitochondrial proliferation, and predominant type-II fiber atrophy. The muscle weakness gradually improved within 20 weeks after discontinuation of clevudine. Conclusions: Clevudine therapy can induce myopathy associated with mitochondrial toxicity. Careful clinical and laboratory monitoring of the skeletal muscle dysfunction is required in patients receiving clevudine therapy.