• Annals of Clinical Neurophysiology
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• v.10 no.2
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• pp.104-108
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• 2008

Background: The compression of 7th cranial nerve by arteries is one of the various causes of hemifacial spasm (HFS). A few previous studies were revealed the relation between the compression of 7th cranial nerve and common trunk anomaly. We evaluated the common trunk anomalies in patients with HFS using MRI and MRA. Methods: From January 2001 to December 2005, 41 consecutive patients (9 men, mean age $54.5{\pm}12.6$) with HFS underwent MRI and MRA. T2 axial images and time-of-flight angiographies were reviewed for identification of the compression at root exit zone by two neuroradiologists and one neurologist. Results: Thirty-seven patients showed neurovascular compression on the lesion side. Twenty patients of them were shown the compression of 7th cranial nerve by anterior inferior cerebellar artery (AICA), and seventeen patients of them were shown the compression by posterior inferior cerebellar artery (PICA). Twenty-four patients of the thirty-seven patients had common trunk anomaly. In control, twelve of twenty-one subjects had common trunk anomaly, that the frequencies of common trunk anomaly of two groups were 58.8% in HFS and 57.1% in controls. In the twenty-four patients with common trunk anomaly, eighteen patients had dominant-AICA, and six patients had dominant-PICA. The rate of nerve compression by common trunk anomaly in the HFS with unilateral common trunk, dominant-AICA was 76.5% and dominant-PICA was 100%. Conclusions: This study also revealed that AICA was most common compressive artery. There was no difference between the HFS groups and control groups in frequency of common trunk anomaly. Thus, we could not demonstrate the relationship between common trunk anomaly and HFS.

• Journal of Korean Neurosurgical Society
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• v.29 no.8
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• pp.1001-1007
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• 2000

Objective : We analysed diverse clinical features of the cavernous angioma. Also, we report the experience in differ-ent methods of the management and their results. Method : Data from 80 patients who were confirmed pathologically or diagnosed radiologically between Jan. 1990 and Sept. 1998 at our hospital were analysed. Variable factors that were examined were : clinical features, effects of treatment, and complications. Results : There were 47 male and 33 female patients. The age at the first presentation was from 3 to 57(mean 34.1) years old. Clinical features were seizure in 28 cases(38%), bleeding in 24 cases(32%), neurologic deficits in 12 cases(16%), headache in 10 cases(14%), and six incidental cases. The locations of lesion were cerebral and cerebellar hemisphere in 45 cases(56.2%), brainstem, basal ganglia, and thalamus in 32 cases(40%), multiple in 3 cases (3.8%). Seizure was common at the third decade and occurred frequently with the cavernous angioma in temporal (43%) or frontal lobe(39%). Bleeding was frequent after the third decade with peak at the fourth decade and had high incidence in brainstem or thalamus. The gamma-knife radiosurgery was done in 47 cases. Rebleeding occurred in 3 cases, but it was within postradiosurgery 1 year. Symptomatic radiation change occurred in 2 cases of 8 radiation change on MRI. On follow-up MRI, no evidence of rebleeding was found in 30 cases. Also, The lesion size was decreased in 3 cases. Resection was performed in 23 cases ; total 20, subtotal 2, partial 1. Postoperative complication occurred in 6 cases(26.1%). After surgery, 7(63.6%) of 11 seizure patients had outcome of seizure-free. Subclinical rebleeding occurred in one of two subtotal resected cases. In 11 patients, conservative management was done. There was neither rebleeding nor symptom aggravation during follow-up period of mean 17.2 months. Conclusion : The solution for prevention of rebleeding is complete removal of the lesion located at noneloquent area or accessible region, especially for the patients who presented symptoms or intractable seizure. However, the Gamma knife radiosurgery is considered when the lesions are located at eloquent area or when severe postoperative morbidity is expected.

• Clinical and Experimental Pediatrics
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• v.52 no.7
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• pp.804-810
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• 2009

Purpose : We investigated whether ictal single-photon emission computed tomography (SPECT) with prolonged injection of technetium-99m (99mTc) ethyl cysteinate dimer during repeated spasms can localize the epileptogenic foci in children with infantile spasms. Methods : Fourteen children with infantile spasms (11 boys, 3 girls; mean age, $2.2{\pm}1.3$ years) were examined. When a cluster of spasms was detected during video electroencephalography (EEG) monitoring, $^{99m}Tc$ ethyl cysteinate dimer was slowly and continuously injected for 2 minutes to determine the presence of ictal SPECT. For 7 children, the ictal and interictal SPECT images were visually analyzed, while for the remaining 7 children, the SPECT images were analyzed using the subtraction ictal SPECT coregistered to magnetic resonance imaging (MRI) (SISCOM) technique. Subsequently, we analyzed the association between the ictal SPECT findings and those of other diagnostic modalities such as EEG, MRI, and positron emission tomography (PET). Results : Increase in cerebral blood flow on ictal SPECT involved the epileptogenic foci in 10 cases6 cases analyzed by visual assessment and 4 analyzed by the SISCOM technique. The ictal SPECT and video-EEG findings showed moderate agreement (Kappa=0.57; 95% confidence interval, 0.18-0.96). Conclusion : Ictal SPECT with prolonged injection of a tracer could provide supplementary information to localize the epileptogenic foci in infantile spasms.

• The Journal of Internal Korean Medicine
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• v.41 no.3
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• pp.326-338
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• 2020

Background: Alzheimer's disease (AD) is a chronic neurodegenerative disease that causes disorientation, mood swings, problems with language, and difficulty remembering recent events. Acetylcholinesterase inhibitors (AchEIs) and memantine have been used to slow the course of the disease, but they can neither modify its progression nor prevent disease onset. Previous studies have suggested that Kami-guibi-tang (KGT) could be beneficial for supporting cognitive function in AD patients, but few clinical trials have been published. This pilot study aimed to evaluate the effect of KGT in improving cognitive function in AD patients. Methods: The study will be a randomized, placebo-controlled, double-blind, single-center trial conducted using subjects diagnosed with mild AD by neurologists. Study subjects will be randomly assigned to either a treatment or control group. The treatment group will receive KGT granules for 24 weeks, while the control group will receive placebo granules. AchEI administration will be maintained in both groups during the entirety of the study. Subjects will be assessed using the following exams: the Seoul Neuropsychologic Screening Battery (SNSB) for cognitive function; brain magnetic resonance imaging (MRI) for brain metabolite, neurotransmitter, and cerebral blood flow (CBF) measurements; the Korean version of Quality of Life-Alzheimer's Disease (KQol-AD) for quality of life; the Caregiver-Administered Neuropsychiatric Inventory (CGA-NPI) for neurobehavioral symptoms; blood tests for amyloid and tau proteins and general blood parameters; and electrocardiography (ECG) before and after taking the medication. Discussion: Our findings will provide insight into the feasibility of large-scale trials to consolidate evidence for the efficacy of KGT for dementia treatment. Registration ID in CRIS: KCT0002904 (Clinical Research Information Service of the Republic of Korea).

• Journal of Radiation Industry
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• v.12 no.4
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• pp.325-332
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• 2018

Carotid angiography covering the aortic arch includes contrast-enhanced magnetic resonance angiography (CEA), which is applied to a large region and usually employs contrast media. However, the use of contrast media can be dangerous in infants, pregnant women, and patients with chronic renal failure (CRF). Follow-up patients informed of a lesion may also want to avoid constant exposure to contrast media. We aimed to apply time-of-flight (TOF) angiography to a large region and compare its usefulness with that of CEA. Ten patients (mean age, 58 years; range, 45~75 years) who visited our hospital for magnetic resonance angiography (MRA) participated in this study. A 3.0 Tesla Achieva magnetic resonance imaging (MRI) system (Philips, Netherland) and the SENSE NeuroVascular 16-channel coil were employed for both methods. Both methods were applied simultaneously to the same patient. Three TOF stacks were connected to cover the aortic arch through the circle of Willis, and CEA was applied in the same manner. For the quantitative assessment, the acquired images were used to set the regions of interest (ROIs) in the common carotid artery (CCA) bifurcation, internal carotid artery, external carotid artery, middle cerebral artery, and vertebral artery, and to obtain the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR) for the soft tissues. Three radiologists and one radiological resident performed the qualitative assessment on a 5-point scale - 1 point, "very bad"; 2 points, "bad"; 3 points, "average"; 4 points, "good"; and 5 points, "very good" - with regard to 4 items: (1) sharpness, (2) distortion, (3) vein contamination, and (4) expression of peripheral vessels. For the quantitative assessment, we estimated the mean SNR and CNR in each of the 5 ROIs. In general, the mean SNR was higher in TOF angiography (166.1, 205.2, 154.39, 172.23, and 161.95) than in CEA(92.05, 95.43, 84.76, 73.69, and 88.3). Both methods had a similar mean CNR: 67.62, 106.71, 55.9, 73.74, and 63.46 for TOF angiography, and 67.82, 71.19, 60.52, 49.45, and 64.07 for CEA. In all ROIs, the mean SNR was statistically significant (p<0.05), whereas the mean CNR was insignificant (p>0.05). The mean values of TOF angiography and CEA for each item in the qualitative assessment were 4.2 and 4.28, respectively for item 1; 2.93 and 4.55, respectively, for item 2; 4.6 and 3.13, respectively, for item 3; and 2.88 and 4.65, respectively, for item 4. Therefore, TOF angiography had a higher mean for item 3, and CEA had a higher mean for items 2 and 4; there was no significant difference between the two methods for item 1. The results for item 1 were statistically insignificant (p>0.05), whereas the results for items 2~4 were statistically significant (p<0.05). Both methods have advantages and disadvantages and they complement each other. However, CEA is usually applied to a large region covering the aortic arch. Time-of-flight angiography may be useful for people such as infants, pregnant women, CRF patients, and followup patients for whom the use of contrast media can be dangerous or unnecessary, depending on the circumstance.

• The Korean Journal of Nuclear Medicine
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• v.31 no.3
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• pp.320-329
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• 1997

Neuroanatomic substrate of autism has been the subjects of continuing investigation. Because previous studies had not demonstrated consistent and specific neuroimaging findings in autism and most studies comprised adults and school-aged children, we performed a retrospective review in search of common functional and anatomical abnormalities with brain SPECT using Tc-99m ECD and correlative MRI The patient population was composed of 18 children aged 28 to 89 months(mean age : 55 months) who met the diagnostic criteria of autism as defined in the DSM-IV and CARS. Brain SPECT was performed after intravenous injection of 185-370MBq of Tc-99m ECD using brain dedicated annular crystal gamma camera. MRI was performed in all patients including T1, T2 axial and T1 sagittal sequences. SPECT data were visually assessed. Thirteen patients had abnormal SPECT scan revealing focal areas of decreased perfusion. Decreased perfusion of cerebellar vermis(12/18), cerebellar hemisphere(11/18), thalami(13/18), basal ganglia(4/18), posterior parietal(7/18), and temporal(4/18) area were noted on brain SPECT. Whereas, only 3 patients had abnormal MR findings which were subtle volume loss of parieto-occipital white matter in 3 and mild thinning of posterior body of corpus callosum in 2 and slightly decreased volume of cerebellar vermis in 1. Comparison of the numbers of abnormal findings revealed that regional cerebral blood flow (rCBF) abnormalities seen on SPECT were more numerous than anatomical abnormalities seen on MRI. In conclusion, extensive perfusion impairment involving cerebellum, thalami and parietal lobe were found in this study. SPECT may be more sensitive in reflecting pathophysiology of autism than MRI. However, further studies are mandatory to determine the significance of thalamic and parietal perfusion impairment in autism.

• Journal of The Korean Society of Clinical Toxicology
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• v.14 no.2
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• pp.151-154
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• 2016

Increased plasma insulin levels are often observed in exogenous insulin overdose patients. However, plasma insulin level may decrease with time. We report a case of low plasma insulin level hypoglycemia after insulin lispro overdose. The patient was a 37-year-old man with no previous medical history who suspected insulin lispro overdose. Upon arrival, his Glasgow coma scale was 3 points and his blood sugar level (BSL) was 24 mg/dl. We found five humalog-quick-pen (insulin lispro) in his bag. There was no elevation of glucose level, despite an initial 50 ml bolus of 50% glucose and 150 cc/hr of 10% dextrose continuous intravenous infusion. He also suffered from generalized tonic-clonic seizure, which was treated with lorazepam and phenytoin. We conducted endotracheal intubation, after which he was admitted to the intensive care unit (ICU). There were recurrent events of hypoglycemia below BSL<50 mg/dl after admission. We repeatedly infused 50 ml 50% glucose 10 times and administered 1 mg of glucagon two times. The plasma insulin level was 0.2 uU/ml on initial blood sampling and 0.2 uU/ml after 5 hours. After 13 hours, his BSL stabilized but his mental status had not recovered. Diffuse brain injury was observed upon magnetic resonance imaging (MRI) and severe diffuse cerebral dysfunction was found on electroencephalography (EEG). Despite 35 days of ICU care, he died from ventilator associated pneumonia.

• Proceedings of the Korean Society for Cognitive Science Conference
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• 2005.05a
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• pp.273-277
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• 2005

본 연구는 한국어 어말어미 산출시 나타나는 대뇌 활성화 영역을 살펴보기 위하여 실시되었다. 두 가지 실험이 실시되었다 실험 1은 어말어미의 기본형을 주고 이를 의문형, 명령형으로 산출하는 고립단어 실험을 실시하였다. 통제 조건으로 모음변환조건(C1)과 아라비아문자보기(C2)를 사용하였다. 실험 1의 결과 ‘어말어미-C1’ 조건에서 좌반구의 측두엽과 전두엽부분의 의 활성화 superior temporal gyrus와 inferior frontal gyrus의 활성화가 관찰되었다. ‘어말어미-C2’ 의 조건에서 우반구에서 후두엽의 활성화와 좌반구에서의 후두엽, 전두엽, lingual G, Cuneus, fusiform G, inferior occipital G에서의 활성화를 관찰할 수 있었다. 실험 2는 명령형과 의문형 어미의 형태점화효과와 관련된 대뇌 활성화 영역을 관찰하기 위하여 Er-fMRI 기법을 이용하여 실시되었다. 실험 조건은 어미동일조건, 어간반복조건, 무관련 조건으로 구성되었다. 피험자들은 점화자극이 제시된 후 신호가 제시되고 나오는 표적단어를 의문형 또는 명령으로 산출하도록 하는 과제를 실시하였다. 뇌 활성화 영역을 분석한 결과 의문형과 명령형을 산출할 때의 활성화 영역에서 $^{\ast}^{\ast}^{\ast}$를 볼 때의 영역을 빼기 (substraction)한 결과 공통적으로 좌반구 브로카 영역이 활성화되었고, 의문형과 명령형 안에서 어미동일조건에서 무관련 조건을 뺀 경우에는 좌반구의 superior temporal G 영역의 활성화가 관찰되었다. 이들 결과를 종합해 볼 때 어말어미 산출 그 자체와 직접 관련되는 영역으로는 좌반구의 측두엽과 전두엽 부분이 관찰되었다. 특히 한국어 어말어미 산출시 나타나는 형태점화 양상과 관련된 대뇌영역으로 발견된 브로카 영역에서의 활성화는 어미 변환과 관련된 영역이라기보다는 산출시 관련되는 articulation, motor coordinate관련 영역으로 추정되고, 측두엽의 활성화는 형태소, 의미 관련 지식의 data base로 추정된다. 또한 우반구 전두엽 부분에서 관찰된 활성화는 억제관련 영역으로 짐작된다.

• The Journal of Internal Korean Medicine
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• v.25 no.2
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• pp.307-313
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• 2004

In the early stage of stroke, the symptoms of constipation, chest discomfort and insomnia may appear in addition to the general symptoms such as specific limb weakness, dysphasia, headache, dizziness etc.. We administered Daeseungkitang(大承氣湯) to the patient diagnosed with cerebral infarction by MRI. He clearly displayed the usual syndromes of stroke(實證), endogenous wind stirring in the liver(肝風內動) and acceleration of upper chest functions(上焦火盛), ascertainned by Oriental Medical methods. After treatment with Daeseungkitang(大承氣湯), the constipation, chest discomfort and insomnia improved along with improvement of general symptoms of stroke.

• Korean Journal of Psychosomatic Medicine
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• v.5 no.2
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• pp.205-213
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• 1997

The aim of this study is to find the relationship between interictal psychiatric symptoms and seizure-related variables such as structural changes, regional interictal perfusion changes, the number of interictal epileptic discharges and the presence of accompanying generalized tonic clonic seizure(GTC). The subjects were 75 patients (47 males : mean age $28.3{\pm}7.7$) with intractable epilepsy, Interictal psychiatric symptoms were rated by Symptom Checklist-90-R(SCL-90-R). Each of 4 seizure variables was measured by MRI, $^{99m}TC-HMPAO$ SPECT and the prolonged EEG monitoring. The mean SCL-90-R subscale T-scores and the ratio of the patients with definite psychiatric symptoms(T-score > 65 at any one subscale of SCL-90-R) were compared among the groups with different seizure variables. Demographic variables and clinical variables were not statistically different among the groups with different seizure variables. The patients with right mesial temporal sclerosis had higher mean SCL-90-R scores for obsessive compulsive symptom, interpersonal sensitivity, depression, hostility and psychotic symptoms than the patients with left mesial temporal sclerosis, and they also showed higher ratio of definite psychiatric symptoms. The presence of interictal epileptic discharges was related with higher T-scores of paranoid subscale. The areas of hypoperfusion, the presence of the GTC, and other clinical seizure variables showed no significant influences on the mean SCL-90-R subscale T-scores. from these results, the authors speculated that interictal subictal epileptic dischrages may be related with psychiatric symptoms of the intractable epileptic patients, especially with right mesial temporal sclerosis.