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Transient paraplegia after neurolytic splanchnic block in a patient with metastatic colon carcinoma

  • Oguz, Gonca;Senel, Gulcin;Kocak, Nesteren
    • The Korean Journal of Pain
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    • 제31권1호
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    • pp.50-53
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    • 2018
  • We present a patient with metastatic colon carcinoma who developed paraplegia following a neurolytic splanchnic block. A 41-year old man with metastatic adenocarcinoma of the colon received a splanchnic neurolytic block using alcohol because of severe abdominal pain. Bilateral motor weakness and a sensorial deficit in both legs developed after the procedure. Diffusion magnetic resonance imaging revealed spinal cord ischemia between T8 and L1. The motor and sensorial deficits were almost completely resolved at the end of the third month. We think that anterior spinal artery syndrome due to reversible spasms of the lumbar radicular arteries using alcohol have resulted in transient paraplegia. The retrograde spread of alcohol to neural structures may have also contributed.

Management of Le Fort I fracture

  • Kim, Hak Su;Kim, Seong Eun;Lee, Hyun Tae
    • 대한두개안면성형외과학회지
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    • 제18권1호
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    • pp.5-8
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    • 2017
  • Among the classification of maxillary fracture, the Le Fort classification is the best-known categorization. Le Fort (1901) completed experiments that determined the maxilla areas of structural weakness which he designated as the "lines of weakness". According to these results, there are three basic fracture line patterns (transverse, pyramidal and craniofacial disjunction). A transverse fracture is a Le Fort I fracture that is above the level of the apices of the maxillary teeth section, including the entire alveolar process of the maxilla, vault of the palate and inferior ends of the pterygoid processes in a single block from the upper craniofacial skeleton. Le Fort fractures result in both a cosmetic and a functional deficit if treated inappropriately. In this article, authors review the management of a Le Fort I fracture with a case-based discussion.

Central Neurocytoma

  • Shin, Seung-Ho;Koh, Eun-Jeong;Choi, Ha-Young
    • Journal of Korean Neurosurgical Society
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    • 제39권2호
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    • pp.152-155
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    • 2006
  • Central neurocytoma is a rare, well-differentiated neuronal tumor and is usually located in the lateral or third ventricle of young adults. The occurrence of an intraventricular tumor with a characterisitic magnetic resonance image findings including isointense signal in T1-weighted images, the presence of a cystic component, small signal-void areas due to calcification, heterogenous and hyperintense "bubbly" appearance in T2-weighted images in a young patient should suggest preoperatively the diagnosis of central neurocytoma. The typical immunohistochemical finding, positivity for synaptophysin, is the main pathological feature. We experienced two cases of central neurocytomas with typical radiological and histopathological findings. We expect growth arrest of these cases by subtotal removal to avoid postoperative neurologic deficit followed by radiation therapy.

Variability of Platelet Reactivity on Antiplatelet Therapy in Neurointervention Procedure

  • Yi, Ho Jun;Hwang, Gyojun;Lee, Byoung Hun
    • Journal of Korean Neurosurgical Society
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    • 제62권1호
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    • pp.3-9
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    • 2019
  • As more intracranial aneurysms and other cerebrovascular pathologies are treated with neurointervention procedure, thromboembolic events that frequently lead to serious neurological deficit or fatal outcomes are increasing. In order to prevent the thromboembolic events, antiplatelet therapy is used in most procedures including coil embolization, stenting, and flow diversion. However, because of variable individual pharmacodynamics responses to antiplatelet drugs, especially clopidogrel, it is difficult for clinicians to select the adequate antiplatelet regimen and its optimal dose. This article reviews the neurointervention literature related to antiplatelet therapy and suggests a strategy for tailoring antiplatelet therapy in individual patients undergoing neurointervention based on the results of platelet function testing.

Clinical Applications of Functional Near-Infrared Spectroscopy in Children and Adolescents with Psychiatric Disorders

  • Lee, Yeon Jung;Kim, Minjae;Kim, Ji-Sun;Lee, Yun Sung;Shin, Jeong Eun
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • 제32권3호
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    • pp.99-103
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    • 2021
  • The purpose of this review is to examine the clinical use of functional near-infrared spectroscopy (fNIRS) in children and adolescents with psychiatric disorders. Many studies have been conducted using objective evaluation tools for psychiatric evaluation, such as predicting psychiatric symptoms and treatment responses. Compared to other tools, fNIRS has the advantage of being a noninvasive, inexpensive, and portable method and can be used with patients in the awake state. This study mainly focused on its use in patients with attention-deficit/hyperactivity disorder and autism spectrum disorder. We hope that research involving fNIRS will be actively conducted in various diseases in the future.

뇌동맥류에 의한 신경 압박의 GDC 색전 치료 반응 (Aneurysms Presenting with Neural Compression : Response to Treatment with Guglielmi Detachable Coils Embolization)

  • 박진영;안정용;허륭;최훈규;이병희;신문수;정봉섭
    • Journal of Korean Neurosurgical Society
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    • 제29권11호
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    • pp.1491-1498
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    • 2000
  • Objectives : Embolization of intracranial aneurysms by using Guglielmi detachable coils(GDC) is proving to be a safe method of protecting aneurysms from rupture. Occasionally, patients with unruptured intracranial aneurysms present with symptoms related to the aneurysm's mass effect on either the brain parenchyma or cranial nerves. In the present study, the authors conducted a retrospective review to evaluate the response to GDC embolization in a series of 6 patients presenting with cranial nerve dysfunction due to mass effect. Patients and Methods : Aneurysms were classified by size, shape, and amount of intraluminal thrombus. Patients were classified by duration of symptoms prior to GDC treatment(range<1 month to>4 years). Clinical assessment was performed within days of the GDC procedure and at later follow-up appointments(range 5-16 months, mean 9 months). Results : In the immediate post-GDC embolization period, one of the five patients had transient worsening of third nerve palsy, which later improved to better than baseline status. Two patients who presented with third nerve deficit from a internal carotid artery-posterior communicating artery junction aneurysm had complete recovery. One patient who presented with hemiparesis and dysarthria from a giant mid-basilar aneurysm showed improvement of these symptoms. One patient who presented with sixth cranial nerve deficit from a cavernous aneurysm showed no change at the 8-months follow-up examination. Conclusion : The endovascular treatment of intracranial aneurysms by using GDC is suggested as an alternative therapeutic method for improving or alleviating neurological deficits produced by mass effect.

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주의력결핍 과잉행동장애 아동에서 Osmotic-Controlled Release Oral Delivery System Methylphenidate 투여가 국소 대뇌관류에 미치는 영향 (A Study about Effects of Osmotic-Controlled Release Oral Delivery System Methylphenidate on Regional Cerebral Blood Flow in Korean Children with Attention-Deficit Hyperactivity Disorder)

  • 양영희;황준원;김붕년;강혜진;이재성;이동수;조수철
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • 제27권1호
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    • pp.64-71
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    • 2016
  • Objectives: The objective of this study was to examine the effects of osmotic-controlled release oral delivery system methylphenidate on changes in regional cerebral blood flow (rCBF) in children with attention-deficit hyperactivity disorder (ADHD) using single photon emission computed tomography (SPECT). Methods: A total of 26 children with ADHD (21 boys, mean age: $9.2{\pm}2.05$ years old) were recruited. Each ADHD participant was examined for changes in rCBF using technetium-99m-hexamethylpropylene amine oxime brain SPECT before and after 8 weeks methylphenidate medication. Brain SPECT images of pediatric normal controls were selected retrospectively. SPECT images of ADHD children taken before medication were compared with those of pediatric normal controls and those taken after medication using statistical parametric mapping analysis on a voxel-wise basis. Results: Before methylphenidate medication, significantly decreased rCBF in the cerebellum and increased rCBF in the right precuneus, left anterior cingulate, right postcentral gyrus, right inferior parietal lobule and right precentral gyrus were observed in ADHD children compared to pediatric normal controls (p-value<.0005, uncorrected). After medication, we observed significant hypoperfusion in the left thalamus and left cerebellum compared to pediatric normal controls (p-value<.0005, uncorrected). In the comparison between before medication and after medication, there was significant hyperperfusion in the superior frontal gyrus and middle frontal gyrus and significant hypoperfusion in the right insula, right caudate, right middle frontal gyrus, left subcallosal gyrus, left claustrum, and left superior temporal gyrus after methylphenidate medication (p-value<.0005, uncorrected). Conclusion: This study supports dysfunctions of fronto-striatal structures and cerebellum in ADHD. We suggest that methylphenidate may have some effects on the frontal lobe, parietal lobe, and cerebellum in children with ADHD.

A Study of the Reliability and Validity of the Korean Version of DSM-5 Symptom Measure-Inattention and Anger for Parent and Guardian of Child Age 6 to 17

  • Shin, Min-Sup;Kim, Bung-Nyun;Cho, Minji;Jang, Mirae;Shin, Hanbyul;Do, Ryemi;Park, Hyungseo;Yoon, Narae;Noh, Gahye;Song, Jae-Won;Ahn, Yebin;Shin, Jiyoon;Jang, Soomin;Noh, Eunjung;Lee, Eunhwa
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • 제32권2호
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    • pp.71-78
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    • 2021
  • Objectives: This study was conducted to investigate the reliability and validity of the Korean version of the DSM-5 Level 2 Cross-Cutting Symptom Measure-inattention [Swanson, Nolan and Pelham, version IV (SNAP-IV)] and anger [Patient-Reported Outcome Measurement Information System (PROMIS) Anger] for parents and guardians of children aged 6-17 years. Methods: We included 104 children and adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD), ADHD with anxiety and depression, depressive disorder, anxiety disorder, and tic disorder with somatic symptoms (ADHD=41, depression=9, anxiety=14, ADHD+anxious depression=11, tic+somatic symptoms=29). Their ages ranged from 8 years to 15 years. The participants' mothers completed the SNAP-IV, PROMIS Anger scale, Korean version of the IOWA Conners Rating Scale (K-IOWA), and Korean ADHD Rating Scale (K-ARS) so that the reliability and validity of the SNAP-IV and PROMIS Anger scales, which are DSM-5 scales for assessing inattention and anger of children and adolescents, could be examined. Results: The reliability coefficient of SNAP-IV (Cronbach's α) was 0.94. The correlation coefficients between SNAP-IV, K-IOWA inattention, and K-ARS inattention scores ranged from 0.73 to 0.86. The mean SNAP-IV scores of the ADHD and the ADHD+anxious depression groups were significantly higher than those of the anxiety and the tic+somatic symptoms groups. The reliability coefficient of the PROMIS Anger was 0.91. The correlation coefficient between PROMIS Anger and K-IOWA oppositional/defiant scores was 0.75. The PROMIS Anger mean score of the ADHD+anxious depression group tended to be higher than that of the other groups. Conclusion: These results suggest that the Korean version of the DSM-5 Level 2 Cross-Cutting Symptom Measure-inattention and anger for parent and guardian of child age 6-17 might be a reliable and valid test and may be useful for screening children and adolescents with ADHD.

Improvement of Cognitive Deficit in Alzheimer's Disease Patients by Long Term Treatment with Korean Red Ginseng

  • Heo, Jae-Hyeok;Lee, Soon-Tae;Oh, Min-Jung;Park, Hyun-Jung;Shim, Ji-Young;Chu, Kon;Kim, Man-Ho
    • Journal of Ginseng Research
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    • 제35권4호
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    • pp.457-461
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    • 2011
  • A 24-week randomized open-label study with Korean red ginseng (KRG) showed cognitive benefits in patients with Alzheimer's disease. To further determine long-term effect of KRG, the subjects were recruited to be followed up to 2 yr. Cognitive function was evaluated every 12 wk using the Alzheimer's Disease Assessment Scale (ADAS) and the Korean version of the Mini Mental Status Examination (K-MMSE) with the maintaining dose of 4.5 g or 9.0 g KRG per d. At 24 wk, there had been a significant improvement in KRG-treated groups. In the long-term evaluation of the efficacy of KRG after 24 wk, the improved MMSE score remained without significant decline at the 48th and 96th wk. ADAS-cog showed similar findings. Maximum improvement was found around week 24. In conclusion, the effect of KRG on cognitive functions was sustained for 2 yr follow-up, indicating feasible efficacies of long-term follow-up for Alzheimer's disease.

First Korean Case of 16p11.2 Duplication Syndrome Diagnosed by Chromosomal Microarray Analysis

  • Shim, Ye Jee;Park, So Yun;Jung, Nani;Kang, Seok Jin;Kim, Heung Sik;Ha, Jung-Sook
    • Journal of Interdisciplinary Genomics
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    • 제1권1호
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    • pp.10-13
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    • 2019
  • A 10-year and 5 month-old girl with developmental delay, intellectual disability, attention deficit hyperactivity disorder, poor weight gain, and microcephaly was transferred to our pediatric clinic for genetic evaluation. Her height was within the 5-10th percentile, and her weight was under the 3rd percentile. On the social maturity scale, her developmental status was scored as 3 years 9 months for social age, and the social quotient was 35.98. A chromosomal microarray analysis was performed and the microduplication at chromosome 16p was observed: arr[GRCh37] 16p11.2 (29580020_30190029)${\times}3$. Currently, the patient is diagnosed with Grade 2 intellectual disability and is attending a computerized cognitive rehabilitation class twice weekly. In addition, nutritional support and growth follow up are also ensured in the Pediatric Gastrointestinal and Endocrinology clinic.