• Annals of Clinical Neurophysiology
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• 제2권2호
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• pp.81-88
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• 2000

한 정신병원에 장기입원한 정신분열증환자에서 계속 발생한 8명의 급성 축삭성 GBS로 추정되는 환자들의 평균연령은 38세였으며 7명이 남자였다. 모든 환자들은 급성 상행성 양쪽하지 마비나 사지마비를 보이면서 심부 건반사가 소실되었다. 이 병은 주로 여름철에 많이 발생 하였으며 전기생리학적 검사상 축삭이 주로 손상된 소견을 보였다. IVIG치료를 한 1명을 제외한 나머지 환자들은 경제적 사정상 대증요법으로 치료하였다. AMAN형태의 환자 3명 중 1명에서 임상적 호전을 보였고, AMSAN형태의 환자 5명 중 2명에서 임상적 호전을 보였다. AMSAN형태의 환자중 1명에선 10개월 뒤 같은 증상이 재발하였다.

• Annals of Clinical Neurophysiology
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• 제1권2호
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• pp.160-167
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• 1999

Although somatosensory evoked potentials(SSEPs) have been utilized as the useful diagnostic tools in evaluating the wide variety of pathological conditions, such as focal lesions affecting the somatosensory pathways, demyelinating diseases, and detecting the clinically occult abnormality, their neural generators is still considerably uncertain. To appreciate the basis for uncertainties about the origins of SSEPs, consider criteria that must be met to establish a causal relationship between activity in a neural structure and a spine/ scalp-recorded potential. Electrode locations and channel derivations for SSEPs recordings are based on two principles:(1) the waveforms are best recorded from electrode sites on the body surface closest to the presumed generator sources along the somatosensory pathways, and(2) studies of the potential-field distribution of each waveform of interest dictate the best techniques to be used. In this article, authors will describe followings focused on ;(1) the concepts of near field potentials(NFPs) and far field potentials(FFPs) - the voltage of NFPs is highly dependent upon recording electrode position, FFPs are unlike NFPs in that they are widely distributed, their latencies and amplitudes are independent of recording electrode.(2) appropriate montage settings to detect the significant potentials in the median nerve and posterior tibial nerve SSEPs(3) neural generators of various potentials(P9, N13, P14, N18, N20, P37) and their clinical significance in interpretating the results of SSEPs. Especially, Characteristics of N18(longduration, small superimposed inflection) suggested that N18 is a complex wave with multiple generators including brainstem structures and thalamic nuclei. And N18 might be used as the parameter of braindeath. Precise understanding on these facts provide an adequate basis utilizing SSEPs for numerous clinical purposes.

• Journal of Korean Neurosurgical Society
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• 제41권6호
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• pp.359-366
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• 2007

Trigeminal neuralgia is a condition associated with severe episodic lancinating facial pain subject to remissions and relapses. Trigeminal neuralgia is often associated with blood vessel cross compression of the root entry zone or more rarely with demyelinating diseases and occasionally with direct compression by neoplasms of the posterior fossa. If initial medical management fails to control pain or is associated with unacceptable side effects, a variety of surgical procedures offer the hope for long-lasting pain relief or even cure. For patients who are healthy without significant medical co-morbidities, direct microsurgical vascular decompression [MVD] offers treatment that is often definitive. Other surgical options are effective for elderly patients not suitable for MVD. Percutaneous retrogasserian glycerol rhizotomy is a minimally invasive technique that is based on anatomic definition of the trigeminal cistern followed by injection of anhydrous glycerol to produce a weak neurolytic effect on the post-ganglionic fibers. Other percutaneous management strategies include radiofrequency rhizotomy and balloon compression. More recently, stereotactic radiosurgery has been used as a truly minimally invasive strategy. It also is anatomically based using high resolution MRI to define the retrogasserian target. Radiosurgery provides effective symptomatic relief in the vast majority of patients, especially those who have never had prior surgical procedures. For younger patients, we recommend microvascular decompression. For patients with severe exacerbations of their pain and who need rapid response to treatment, we suggest glycerol rhizotomy. For other patients, gamma knife radiosurgery represents an effective management strategy with excellent preservation of existing facial sensation.

• Annals of Clinical Neurophysiology
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• 제25권2호
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• pp.84-92
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• 2023

Background: Clinical spectrum of immunoglobulin M (IgM) monoclonal gammopathy varies from IgM monoclonal gammopathy of unknown significance (IgM-MGUS) to hematological malignancies. We evaluated the clinical features, electrophysiological characteristics, and prognosis of patients with peripheral neuropathy associated with IgM monoclonal gammopathy (PN-IgM MG). Methods: We retrospectively evaluated 25 patients with PN-IgM MG. Peripheral neuropathy was classified as axonal, demyelinating, or undetermined, based on electrophysiological studies. We classified the enrolled patients into the IgM-MGUS and malignancy groups, and compared the clinical and electrophysiological features between the groups. Results: Fifteen patients had IgM-MGUS and 10 had hematologic malignancies (Waldenström's macroglobulinemia: two and B-cell non-Hodgkin's lymphoma: eight). In the electrophysiological evaluation, the nerve conduction study (NCS) criteria for demyelination were met in 86.7% of the IgM-MGUS group and 10.0% of the malignancy group. In particular, the distal latencies of the motor NCS in the IgM-MGUS group were significantly prolonged compared to those in the malignancy group (median, 9.1 ± 5.1 [IgM-MGUS], 4.2 ± 1.3 [malignancy], p = 0.003; ulnar, 5.4 ± 1.9 [IgM-MGUS], 2.9 ± 0.9 [malignancy], p = 0.001; fibular, 9.3 ± 5.1 [IgM-MGUS], 3.8 ± 0.3 [malignancy], p = 0.01; P-posterior tibial, 8.3 ± 5.4 [IgM-MGUS], 4.4 ± 1.0 [malignancy], p = 0.04). Overall treatment responses were significantly worse in the malignancy group than in the IgM-MGUS group (p = 0.004), and the modified Rankin Scale score at the last visit was higher in the malignancy group than in the IgM-MGUS group (2.0 ± 1.1 [IgM-MGUS], 4.2 ± 1.7 [malignancy], p = 0.001), although there was no significant difference at the initial assessment. Conclusions: The risk of hematological malignancy should be carefully assessed in patients with PN-IgM MG without electrophysiological demyelination features.

• 대한영상의학회지
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• 제81권1호
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• pp.243-247
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• 2020

우리는 이전까지 드물게 보고된 고혈당 관련 삼투압성 탈수초화 증후군의 연속 자기공명영상 소견을 보고하고자 한다. 당뇨병을 앓고 있는 61세 남자 환자가 전신쇠약과 심한갈증을 주소로 내원하였고 며칠 후 구음장애, 삼킴장애, 운동조절장애를 보였다. 혈액검사상 고혈당을 제외한 전해질 수치는 정상이었다. 뇌 자기공명영상에는 교뇌에서 대칭적이고 종괴 효과가 없으며 주변 부위를 침범하지 않는 T2 신호 이상이 보여 삼투압성 탈수초화 증후군에 합당한 소견이었다. 환자는 임상적인 증상의 호전을 보였으나 추후 촬영한 뇌 자기공명영상은 악화되는 소견을 보였다.