좌심방까지 진행된 원발폐선암종에 의해 발생한 급성 뇌경색

추인성,이현진,김동욱,김후원,김진호,안성환 대한신경과학회 2011 대한신경과학회지 Vol.29 No.4

Malignancy-related cerebral embolism, which is generally attributed to hypercoagulability, is an uncommon cause of ischemic stroke. However, ischemic stroke developed with intracardiac extension of lung cancer has rarely been reported. We report a case of acute embolic stroke caused by pulmonary adenocarcinoma that invaded the right inferior pulmonary vein and extended into the left atrium. Microembolism developing as a result of lung cancer may have been the cause of stroke in this case.

오노디세포(Onodi cell)점액종의 압박으로 유발된 급성 시각신경병증

추인성,최지윤,김대현,김후원,김진호,안성환 대한신경과학회 2009 대한신경과학회지 Vol.27 No.4

Acute optic neuropathy occurs commonly as a result of ischemia and inflammation, but paranasal sinus disease without infection is generally dismissed. We report a rare case of acute optic neuropathy caused by compression of a mucocele in an Onodi cell, which is an uncommon anatomical variation of the ethmoid sinus. The mucocele was confirmed by imaging and endoscopic sinus surgery. An Onodi-cell lesion should be considered in the differential diagnosis of acute optic neuropathy. Acute optic neuropathy occurs commonly as a result of ischemia and inflammation, but paranasal sinus disease without infection is generally dismissed. We report a rare case of acute optic neuropathy caused by compression of a mucocele in an Onodi cell, which is an uncommon anatomical variation of the ethmoid sinus. The mucocele was confirmed by imaging and endoscopic sinus surgery. An Onodi-cell lesion should be considered in the differential diagnosis of acute optic neuropathy.

뇌부종이 있는 뇌경색 환자들에서 만니톨과 신부전의 연관성

추인성,봉정빈,안성환,김후원,김진호,강현구 대한신경집중치료학회 2016 대한신경집중치료학회지 Vol.9 No.2

Background: Renal failure is one of the most common side effects of mannitol. However, very little is known regarding the cause, incidence, risk factors, and outcome of mannitol-induced renal failure. The goal of this study is to determine the predicting factors of mannitol-induced renal failure. Methods: We retrospectively reviewed the medical records of all ischemic stroke patients who were treated with mannitol due to brain edema from January 2008 to December 2010 at Chosun university hospital. From among 125 patients, 25 patients who received mannitol for less than 3 days were excluded and 100 patients were selected. Furthermore, 15% or 25% mannitol was administered intravenously as an intermittent bolus and the maximum dose was less than 200 g/day. Renal failure was defined as an increase in the creatinine level of > 0.5 mg/dL if the baseline value was < 2 mg/dL or an increase in the creatinine level of > 1 mg/dL if the baseline value was > 2 mg/dL. Results: Fourteen patients (14%) were diagnosed as having mannitol-induced renal failure. Glucose level before the use of mannitol and peak osmolality during mannitol treatment were associated with renal failure in univariate analysis. In logistic regression analysis of suspected factors (P<0.1), independent predictive factors of mannitol-induced renal failure were glucose level before the use of mannitol, (odd ratio, 1.01; 95% CI, 1.00–1.03; P<0.043) and peak osmolality (odds ratio, 1.04; 95% confidence interval, 1.01–1.08, P=0.01). Conclusions: Strict glucose control before mannitol treatment may reduce the rate of occurrence of renal failure. However, the rate of recovery from renal failure was not confirmed in our study because of the short follow up period.

대상포진의 중추신경계 침범에 관련된 요인

추인성,김만영,정지연,허욱,김진호,김후원 대한신경과학회 2015 대한신경과학회지 Vol.33 No.1

Background: Herpes zoster is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body, often in a stripe. Central nervous system(CNS) involvements are uncommon complications of herpes zoster. The exact mechanism and risk factors are still unknown. Methods: We retrospectively reviewed the clinical data of patients who was admitted at our hospital due to herpes zoster from 2003 to 2013. The patients under age 15, herpes zoster infection without skin lesions, and cases not confirmed by a dermatologist were excluded. CNS involvements are defined as meningitis, encephalitis, single or multiple cranial neuropathies and all cases were evaluated with brain magnetic resonance imaging, spinal tapping, serological tests and confirmed by a neurologist. We compared the herpes zoster patients with CNS involvement to those without CNS involvement. Age, sex, body mass index, associated chronic medical illnesses, site and extent of skin lesion and development of post herpetic neuralgia were compared between two groups. Results: Total 1,131 subjects (male 460, female 671) were recruited. A group with CNS involvement was 91(8.04%). Sex, body mass index, associated chronic medical illnesses, extent of skin lesion were not different between two groups. A group with CNS involvement showed younger age(p<0.01), more facial and cervical skin lesions(p<0.01), lesser development of post herpetic neuralgia(p=0.048). Conclusions: CNS involvement is not a rare complication of herpes zoster and more frequent in patients with younger age and faciocervical zoster.

항 강글리오사이드 항체 양성환자의 임상적 특징

정지연,추인성 조선대학교 의학연구원 2015 The Medical Journal of Chosun University Vol.40 No.3

Guillain-Barré syndrome can be classified with several subtypes along with the union of each symptom. Autoimmune mechanism is accepted for pathogenesis. It is often difficult to predict the causative antibodies of the various types of Guillain- Barré syndrome, because there are considerable mismatches of causative antibody to clinical phenotype as well as phenotype or antibody heterogeneities. We investigated the clinical characteristics of the patients with positivity of anti-gangliosides antibody in the serum. Nineteen patients were enrolled who showed the positivity of anti-GM1 antibody, anti-GQ1b antibody and anti-GD1b antibody, who had visited the department of neurology of Chosun University Hospital. We classified the three patient groups; 8 patients had positivity for anti-GM1 antibody, 10 patients for anti-GQ1b antibody and 8 patients for GD1b antibody. The result of statistical analysis showed no clinical difference within the groups. Therefore, prediction of causative autoantibody can be risky when we considered only the symptoms and course of disease of Guillain-Barré syndrome.

상향 안진과 측방 주시 유발 안진이 동반된 일측성 상부연수경색 1예

이승안 · 김형민 · 추인성 · 류종현 · 조경원 · 안성환 · 임건한 · 김후원 · 김진호 조선대학교 의학연구원 2008 The Medical Journal of Chosun University Vol.33 No.1

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급성기 뇌경색에서의 혈관내 치료: 과거, 현재, 미래

정지연,강현구,추인성,안성환 조선대학교 의학연구원 2015 The Medical Journal of Chosun University Vol.40 No.3

For patients suffering from acute ischemic stroke from cerebral artery occlusion, reperfusion is necessary to save the ischemic penumbra. Therefore, early and complete recanalization of an occluded artery is the main therapeutic goal of acute ischemic stroke. Among the many advances in management of acute ischemic stroke, thrombolysis with intravenous (IV) tissue plasminogen activator (t-PA) within 4.5 hours after symptom onset has been the only approved pharmacological therapy. However, IV t-PA has many limitations in clinical practice, low eligible patients and low recanalization rates, particularly in cases of larger proximal artery occlusions. In addition, there are many complications, including symptomatic intracranial hemorrhage (approximately 6%). In contrast, higher recanalization rates and an extended therapeutic time window have been reported for intra-arterial (IA) thrombolysis. According to studies until 2013, no studies proving the advantages of IA thrombolysis have been reported. However it was reported that studies in 2015 showed its possibility. Therefore, the purpose of this article is to cast a light on failures of previous studies, and try to assess the differences with studies in 2015. In addition, crucial points for successful IA thrombolysis will be discussed.

정맥 내 혈전 용해술을 받은 80세 이상과 미만 뇌경색 환자의 예후와 합병증 비교

허욱,주창일,정지연,김후원,김진호,추인성 조선대학교 의학연구원 2014 The Medical Journal of Chosun University Vol.39 No.4

Proportion of elderly patients is gradually increasing in the republic of Korea. However, intravenous recombinant tissue plasminogen activator (rt-PA) therapy is recently not recommended in elderly acute ischemic stroke patients, although old age is not a proven contraindication to intravenous rt-PA. The purpose of this study was to investigate the safety and prognosis of intravenous thrombolysis in elderly patients.

경동맥 스텐트 내부에서 보인 움직이는 혈전

강현구,추인성,김범준,정진성 대한신경과학회 2016 대한신경과학회지 Vol.34 No.3

Arteriovenous Malformation with an Occlusive Feeding Artery Coexisting with Unilateral Moyamoya Disease

안성환,추인성,김진호,김후원 대한신경과학회 2010 Journal of Clinical Neurology Vol.6 No.4

Background:Arteriovenous malformations (AVMs) with vascular abnormalities, including aneurysms, have been reported frequently. However, the coexistence of AVM and unilateral moyamoya disease is rare. We report herein an AVM patient who presented with acute ischemic stroke with unilateral moyamoya disease and occlusion of the feeding artery. Case Report:A-41-year old man was admitted with sudden dysarthria and facial palsy. Brain computed tomography and magnetic resonance imaging revealed an acute infarction adjacent to a large AVM in the right frontal lobe. Cerebral angiography revealed occlusions of the proximal right middle cerebral and proximal anterior cerebral arteries, which were the main feeders of the AVM. Innumerable telangiectatic moyamoya-type vessels between branches of the anterior cerebral artery and dilated lenticulostriate arteries on the occluded middle cerebral artery were detected. However,a nidus of the AVM was still opacified through the distal right callosomarginal artery, which was supplied by the remaining anterior cerebral artery and leptomeningeal collaterals from the posterior cerebral artery. Conclusions:While AVM accompanied by unilateral moyamoya disease is rare, our case suggests an association between these two dissimilar vascular diseases.