내측연수증후군에서 발생한 나비넥타이, 상향 및 반시이소안진

최광동,정대수,박경필,조재욱,김지수 대한임상신경생리학회 2004 Annals of Clinical Neurophysiology Vol.6 No.1

A 20-year-old man with bilateral medial medullary infarction showed transition of bowtie and upbeat nystagmus into hemi-seesaw nystagmus. Follow-up MRI revealed near complete resolution of the right medullary lesion. This transition of nystagmus suggests that the upbeat nystagmus was generated by bilateral lesions in the ascending pathways from both anterior semicircular canals (SCC), and that the hemi-seesaw nystagmus was caused by damage to the pathway from the left anterior SCC.

전정신경염과 양측성 전정신경병증

최광동,고의경 대한의사협회 2008 대한의사협회지 Vol.51 No.11

Vestibular neuritis is the second most common cause of peripheral vestibular vertigo. The key signs and symptoms are the acute onset of sustained rotatory vertigo without hearing loss, postural imbalance with Romberg's sign, and peripheral type nystagmus. Head thrust and caloric tests show ipsilateral hyporesponsiveness, but hearing test shows normal. Either an inflammation of the vestibular nerve or labyrinthine ischemia was proposed as a cause of vestibular neuritis. Recovery after vestibular neuritis is usually incomplete. Despite the assumed viral cause, the effects of corticosteroids, antiviral agents, or the two in combination are uncertain. Bilateral vestibulopathy is a rare disorder of the peripheral labyrinth or the eighth nerve. The most frequent etiologies include ototoxicity, autoimmune disorders, meningitis, neuropathies, sequential vestibular neuritis, cerebellar degeneration, tumors, and miscellaneous otological diseases. The two key symptoms are unsteadiness of gait and oscillopsia associated with head movements or when walking. The diagnosis is made with the simple bedside tests for defective vestibulo-ocular reflex (head thrust and dynamic visual acuity tests). Bilateral vestibulopathy is confirmed by the absence of nystagmus reaction to both caloric and rotatory chair tests. The spontaneous recovery is relatively rare and incomplete. Vestibular rehabilitation is supportive of the improvement, but the efficacy of physical therapy is limited.

만성 메틸브로마이드 중독에 의한 다발성 신경장애

최광동,신진홍,김대성,정대수,박규현,오차재,조병만,최정근 대한신경과학회 2002 대한신경과학회지 Vol.20 No.3

양측성전정기능장애에서 맞춤전정운동의 효과: 단일 기관에서의 선행 연구

최광동,최서영 대한평형의학회 2019 Research in Vestibular Science Vol.18 No.3

Objectives: Bilateral vestibulopathy is characterized with unsteadiness and oscillopsia when walking or standing, worsening in darkness and/or on uneven ground. To establish the effect of customized vestibular rehabilitation in bilateral vestibulo-pathy, we analyzed the questionnaires and functional status before and after treat-ment.Methods: Among 53 patients with customized vestibular rehabilitation from January 1st to November 30th in 2018, 6 patients (3 males; median age, 71 years; range, 54–75 years) who regularly exercised with good compliance were retrospectively enrolled. They were educated and trained the customized vestibular rehabilitation once a month or two by a supervisor during 40 minutes, and then exercised at home for 30 minutes over 5 days in a week. Dizziness handicap inventory (DHI), Korean vestibular disorders activities of daily living scale (vADL), Beck’s de-pression index (BDI), test for dynamic visual acuity (DVA), and Timed Up and Go test (TUG) were performed before and after the customized vestibular reha-bilitation.Results: The patients exercised for median 5.5 months (range, 2–10 months) with the customized methods of vestibular rehabilitation, which included gaze and posture stabilization and gait control exercises. DHI score and TUG was improved after rehabilitation (DHI before vs. after rehabilitation=33 vs. 16, p=0.027, TUG before vs. after rehabilitation=12 vs. 10, p=0.026). BDI, DVA, and vADL scores did not differ between before and after treatment.Conclusions: Customized vestibular rehabilitation can improve dizziness and balance state in bilateral vestibulopathy. The steady exercises adapted individual pecu-liarities is the most important for vestibular rehabilitation.

유전성 간헐성 어지럼증

최광동 대한평형의학회 2009 Research in Vestibular Science Vol.8 No.1

Acquired Ocular Motor Nerve Palsy in Neurology Clinics: A Prospective Multicenter Study

최광동,최서영,김지수,최재환,양태호,오선영,김성희,이학승,이승한,정성해,김효정,최정윤 대한신경과학회 2019 Journal of Clinical Neurology Vol.15 No.2

Background and Purpose This study aimed to determine the patterns and etiologies of acquired ocular motor nerve palsy (OMNP) diagnosed in neurology clinics. We also investigated the clinical features that may predict the causes other than microvascular ischemia in isolated OMNP. Methods We performed a prospective multicenter study that had recruited 298 patients with acquired OMNP from the neurology clinics of referral-based 9 university hospitals in Korea. We finally selected 235 patients with isolated OMNP and divided them into older (age ≥50 years, n=188) and younger (age <50 years, n=47) groups. We investigated the underlying etiologies of acquired OMNP. We also estimated the frequency of microvascular ischemia and other causes in isolated OMNP, and sought to determine the clinical features that can predict the causes other than microvascular ischemia. Results Abducens nerve palsy was the most common (40%) of the acquired OMNPs, followed by oculomotor nerve palsy (27%), trochlear nerve palsy (23%), and multiple OMNPs (10%). The etiologies included microvascular ischemia (47%), inflammatory (21%), stroke (5%), trauma (5%), neoplasm (3%), and others (2%), with the cause not being determined in 13% of the patients. Microvascular ischemia was the most common cause (83%) in patients aged ≥50 years with isolated OMNP, followed by inflammation (6%), stroke (6%), neoplasm (3%), and aneurysm (1%). Microvascular ischemia was more common in the older than the younger group (83% vs. 49%, p<0.001). The intensity of headache was the only risk factor for causes other than microvascular ischemia in isolated OMNP. Conclusions Vascular and inflammatory disorders are the most common causes of acquired OMNP diagnosed in neurology clinics. Microvascular ischemia was the predominant cause of isolated OMNP. Severe headache indicates causes other than microvascular ischemia in isolated OMNP.

자발현훈

최광동,김지수 대한임상신경생리학회 2007 Annals of Clinical Neurophysiology Vol.9 No.1

Vertigo is an illusion of rotation, which results from an imbalance within the vestibular system. This review focuses on two common presentations of spontaneous vertigo: acute prolonged spontaneous vertigo and recurrent spontaneous vertigo. Common causes of acute prolonged spontaneous vertigo include vestibular neuritis, labyrinthitis, and brainstem or cerebellar stroke. The history and detailed neurological/neurotological examinations usually provide the key information for distinguishing between peripheral and central causes of vertigo. Brain MRI is indicated in any patient with acute vertigo accompanied by abnormal neurological signs, profound imbalance, severe headache, and central patterns of nystagmus. Recurrent spontaneous vertigo occurs when there is a sudden, temporary, and largely reversible impairment of resting neural activity of one labyrinth or its central connections, with subsequent recovery to normal or near-normal function. Meniere’s disease, migrainous vertigo, and vertebrobasilar insufficiency (VBI) are common causes. The duration of the vertigo attack is a key piece of information in recurrent spontaneous vertigo. Vertigo of vascular origin, such as VBI, typically lasts for several minutes, whereas recurrent vertigo due to peripheral inner-ear abnormalities lasts for hours. Screening neurotological evaluations, and blood tests for autoimmune and otosyphilis are useful in assessment of recurrent spontaneous vertigo that are likely to be peripheral in origin.

Episodic Ataxias: Clinical and Genetic Features

최광동,최재환 대한파킨슨병및이상운동질환학회 2016 Journal Of Movement Disorders Vol.9 No.3

Episodic ataxia (EA) is a clinically heterogeneous group of disorders that are characterized by recurrent spells of truncal ataxia and incoordination lasting minutes to hours. Most have an autosomal dominant inheritance pattern. To date, 8 subtypes have been defined according to clinical and genetic characteristics, and five genes are known to be linked to EAs. Both EA1 and EA2, which are caused by mutations in KCNA1 and CACNA1A, account for the majority of EA, but many patients with no identified mutations still exhibit EA-like clinical features. Furthermore, genetically confirmed EAs have mostly been identified in Caucasian families. In this article, we review the current knowledge on the clinical and genetic characteristics of EAs. Additionally, we summarize the phenotypic features of the genetically confirmed EA2 families in Korea.

두부충동 검사

최광동,오선영,김지수 대한임상신경생리학회 2006 Annals of Clinical Neurophysiology Vol.8 No.1

발살바, 과호흡 유발안진

최광동 대한평형의학회 2010 Research in Vestibular Science Vol.9 No.-

central as well as peripheral vestibulopathies, including compensated peripheral vestibulopathies, perilymph fistula, acoustic neuroma, lesions at craniocervical junction, and cerebellar degeneration. A recent study documented that hyperventilation-induced nystagmus (HIN) beating to the side of reduced caloric response,hearing impairment, or abnormal auditory brainstem response may be a valuable sign for bedside detection of acoustic neuroma. Disruption of the central pathways compensating for a peripheral imbalance, increased neuronal excitability, changes in intracranial pressure, and metabolic changes on cerebellar calcium channels are potential mechanisms for the generation of HIN. The Valsalva maneuver may also produce vertigo and nystagmus in patients with craniocervical junction anomalies, perilymph fistula, and canal dehiscence syndromes. Presumably, Valsalva maneuver increases intracranial or tympanic pressure and exerts force directly at the site of the fistula or dehiscence, causing deflection of the cupula of the involved semicircular canal.