• Journal of Korean Neurosurgical Society
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• v.47 no.1
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• pp.48-50
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• 2010

Spontaneous intracranial hypotension is often idiopathic. We report on a patient presenting with symptomatic intracranial hypotension and pain radiating to the right leg caused by a transdurallumbar disc herniation. Magnetic resonance (MR) imaging of the brain revealed classic signs of intracranial hypotension, and an additional spinal MR confirmed a lumbar transdural herniated disc as the cause. The patient was treated with a partial hemilaminectomy and discectomy. We were able to find the source of cerebrospinal fluid leak, and packed it with epidural glue and gelfoam. Postoperatively, the patient's headache and log radiating pain resolved and there-was no neurological deficit. Thus, in this case, lumbar disc herniation may have been a cause of spontaneous intracranial hypotension.

• Kosin Medical Journal
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• v.33 no.2
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• pp.257-262
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• 2018

Guillain-$Barr{\acute{e}}$ syndrome (GBS) and acute disseminated encephalomyelitis (ADEM) are demyelinating neurologic disorders with different target organs. Although they share similar pathogenetic mechanism, reports of simultaneous occurrence of the 2 disorders are rare. A 2 year 6 month old girl visited our hospital for fever, cough, and general weakness. Although the muscle power of extremities showed mild weakness and voiding difficulty, initial deep tendon reflex of both knees and ankles was normal. A nerve conduction study to evaluate the weakness revealed the absence of F waves. Cerebrospinal fluid analysis demonstrated pleocytosis with lymphocyte predominance and elevated protein levels. Magnetic resonance imaging showed abnormal T2 hyperintensity in pons, medulla and spinal cord. Serum anti-GD1b antibody was positive. Based on clinical findings, laboratory findings, nerve conduction study, and neuroimaging, the diagnosis of GBS and ADEM was made. This is the first case of GBS accompanied by ADEM in Korea.

• Annals of Clinical Neurophysiology
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• v.21 no.1
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• pp.61-65
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• 2019

$Sj{\ddot{o}}gren^{\prime}s$ syndrome (SS)-associated polyradiculopathy is rarely reported. A 51-year-old woman presented with a history of gradual weakness in all four extremities for several months. Based on electrophysiological studies, spinal magnetic resonance imaging and cerebrospinal fluid examination, inflammatory polyradiculopathy was confirmed. During a search for the aetiology, the patient was ultimately diagnosed with SS. This study introduces SS-associated polyradiculopathy that primarily presented with motor symptoms, thus mimicking motor neuron disease.

• Pediatric Infection and Vaccine
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• v.7 no.1
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• pp.159-164
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• 2000

Mollaret meningitis is a rare syndrome first described by Mollaret in 1944, which is reccurent aseptic meningitis with characteristic clinical and spinal fluid cytologic findings. No etiology has been established. Several authors suggested the association with herpes virus infection, some found intracranial epidermoid tumor eventually in patients diagnosed of Mollaret meningitis. We experienced a case of 14-year old male who had 3 episodes of recurrent aseptic meningitis during four years. The patients initially presented with clinical and laboratory feature of bacterial meningitis, however, extensive serological investigation and cerebrospinal fluid analysis failed to reveal a specific cause. Immune system studies were unremarkable. Cranial computed tomography performed during the attack and magnetic resonance imaging when the patient was asymptomatic were both normal. A tentative diagnosis of Mollaret meningitis was established at the 3rd episode. We report this case with a review of related literatures.

• Journal of Veterinary Clinics
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• v.39 no.5
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• pp.235-239
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• 2022

A 10-year-old neutered male Siberian Husky presented with paraparesis and severe lethargy. On physical examination, the patient was unable to weight-bear and walk and exhibited significant muscle mass loss in both hindlimbs and generalized truncal alopecia with a dull coat of hair. On neurological examination, cranial lumbar vertebral pain, hind limb cross-extensor reflex, delayed hindlimb postural reaction, upper motor neuron bladder dysfunction, and total absence of cutaneous trunci reflex were identified. Computed tomography revealed diffuse idiopathic skeletal hyperostosis and spondylosis deformans of the cervical and thoracolumbar vertebrae. In addition, a generalized decrease in bone mineral density of the vertebrae was identified. Magnetic resonance imaging showed hyperplasia of the epidural fat compressing the spinal cord in the thoracolumbar region and concurrent mild multiple intervertebral disc herniations. No specific findings were observed in cerebrospinal fluid analysis. Blood analysis of thyroid function revealed decreased total T4 and free T4 levels, and increased TSH levels. The patient was tentatively diagnosed with spinal epidural lipomatosis (SEL) secondary to hypothyroidism. The patient was treated with levothyroxine, firocoxib, and gabapentin. Clinical signs gradually improved, and the patient showed normal ambulation 40 days after treatment initiation. SEL is extremely rare in dogs. To the best of our knowledge, this is the first case report of SEL secondary to hypothyroidism that was treated conservatively. Secondary SEL can be sufficiently managed by treating the underlying cause, if possible.

• Journal of Korean Neurosurgical Society
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• v.66 no.4
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• pp.393-399
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• 2023

Objective : Chiari II malformation (CM II) is still the main cause of severe morbidity and mortality in children with open neural tube defects (ONTDs). The goal of this study was to validate a CM II model in late-stage chick embryos with surgically induced ONTDs. Methods : To make the chick embryo model of ONTD, their neural tubes were opened for a length of 5-6 somites at the thoracic level in Hamburger and Hamilton stage 18 chick embryos (n=150). They were reincubated in ovo up to a total age of 17-21 days. A total of 19 embryos survived and were assigned to either the postoperative day (POD) 14-15 group (n=6) or the POD 17-18 group (n=13). Magnetic resonance imaging (MRI) and histopathologic findings of embryo heads with spinal ONTDs were compared with age-matched normal chick embryos. Results : The chick embryos with ONTDs demonstrated definite and constant structural changes, such as downward displacement of the cerebellum to just above the foramen magnum and narrow and small cerebrospinal fluid spaces in the crowded small posterior fossa. These morphologic features were more prominent in the POD 17-18 group than in the POD 14-15 group. Conclusion : This is the first description of CM II with spinal ONTD in a late-stage chick embryo model with MRI and histopathological analysis. The morphological changes of the posterior fossa in this study mimic those of CM II associated with spinal ONTD in humans. This model will facilitate investigation of the pathogenesis of CM II.

• Journal of Korean Neurosurgical Society
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• v.58 no.5
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• pp.487-490
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• 2015

Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a relapsing-remitting disorder for which steroid administration is a key to control the progression. CLIPPERS can exhibit radiological features similar to malignant lymphoma, whose diagnosis is confounded by prior steroid administration. We report a case of CLIPPERS accompanied by abnormal elevation of ${\beta}-2$ microglobulin in the cerebrospinal fluid (CSF). A 62-year-old man started to experience numbness in all fingers of his left hand one year ago, which gradually extended to his body trunk and legs on both sides. Magnetic resonance imaging demonstrated numerous small enhancing spots scattered in his brain and spinal cord. CSF levels of ${\beta}-2$ microglobulin were elevated; although this often indicates central nervous system involvement in leukemia and lymphoma, the lesions were diagnosed as CLIPPERS based on the pathological findings from a biopsy specimen. We emphasize the importance of biopsy to differentiate between CLIPPERS and malignant lymphoma because the temporary radiological response to steroid might be the same in both diseases but the treatment strategies regarding the use of steroid are quite different.

• Journal of Korean Neurosurgical Society
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• v.45 no.1
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• pp.1-4
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• 2009

Objective : In the present study, the authors investigated the clinical and imaging features as well as the therapeutic outcomes of SIH (spontaneous intracranial hypotension) patients. Methods : A retrospective review of 12 SIH patients was carried out. The diagnostic work-up included lumbar tapping and measurement of CSF opening pressure, radioisotope cisternography, brain and spinal magnetic resonance imaging (MRI), and computed tomography (CT) myelography. Autologous epidural blood patching was performed in patients who did not respond to conservative therapies, including analgesics, steroids, hydration and rest. Results : Typical postural headache was found in 11 (91%) patients. Nine (75%) patients showed pachymeningeal enhancement on their initial T1-weighted MR images. The CSF opening pressure was less than 60 mm$H_2O$ in 9 of 11 patients. Autologous epidural blood patching was performed in 7 patients, and all of them showed good responses. Conclusion : SIH can present with various clinical presentations and neuroimaging findings. Autologous epidural blood patching is thought to be the treatment of choice for patients with SIH.

• Archives of Plastic Surgery
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• v.48 no.3
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• pp.254-260
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• 2021

Background Myelomeningocele is a frequently seen condition at tertiary care hospitals. Its treatment involves a variety of plastic reconstructive techniques. Herein, we present a series of myelomeningocele patients treated using keystone flaps. Methods We gathered information regarding soft tissue reconstruction and the use of bilateral keystone flaps to treat myelomeningocele patients. We obtained data from clinical records and recorded the demographic characteristics of mothers and children with the condition. The size, level of defect, and complications detected during the follow-up were analyzed. Results A series of seven patients who underwent bilateral keystone flaps for myelomeningocele closure was analyzed. There were no cases of midline or major dehiscence, flap loss, necrosis, surgical site infections, or cerebrospinal fluid leakage. No revision procedures were performed. Minor complications included one case with minimal seroma and three cases with areas of peripheral dehiscence that healed easily using conventional measures. Conclusions The use of keystone flaps is an adequate option for closure of dorsal midline soft tissue defects related to myelomeningocele. This technique offers predictable results with an acceptable spectrum of complications. Robust blood flow can be predicted based upon anatomical knowledge.

• Parasites, Hosts and Diseases
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• v.59 no.6
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• pp.635-638
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• 2021

In this study, we intended to describe a human case of lumbosacral canal sparganosis in People's Republic of China (China). A 56-year-old man was admitted to Xiangya Hospital Central South University in Changsha, Hunan province, China after having an experience of perianal pain for a week. An enhancing mass, a tumor clinically suggested, was showed at the S1-S2 level of the lumbosacral spine by the examination of magnetic resonance imaging (MRI) with gadolinium contrast. The patient was received the laminectomy from S1 to S2, and an ivory-white living worm was detected in inferior margin of L5. In ELISA-test with cerebrospinal fluid (CSF) and serum samples, anti-sparganum antibodies were detected. He had a ingesting history of undercooked frog meat in his youth. By the present study, a human case of spinal sparganosis invaded in lumbosacral canal at the S1-S2 level was diagnosed in China. Although the surgical removal of larvae is known to be the best way of treatment for sparganosis, we administered the high-dosage of praziquantel, albendazole and dexamethasone to prevent the occurrence of another remain worms in this study.