• Journal of The Korean Society of Clinical Toxicology
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• v.18 no.1
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• pp.18-25
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• 2020

Purpose: We studied the impact of arterial oxygen tension (PaO₂) on the long term neurologic outcome in patients with acute carbon monoxide poisoning. Methods: The study population included 311 patients who presented to emergency department with acute CO poisoning from January 2015 to January 2018. These patients underwent arterial blood gas testing at the time of presentation. The baseline demographic, clinical, laboratory, and clinical outcome data were recorded. The primary outcome of interest was the long term neurologic status. Results: The normoxia group was significantly older and it had a higher incidence of diffusion weighted MRI abnormality, and this group needed multiple HBO sessions compared to the group with moderate or severe hyperoxia. Also, the incidence of altered mentality at discharge was higher in the normoxia group than that of the moderate hyperoxia group. The incidence of a poor long term neurologic outcome was 11.3%. The incidence of a poor long term neurologic outcome decreased as the PaO₂ increased. The PaO₂ was significantly lower in patients with a poor long term neurologic outcome than that of the patients with a good outcome 198 (165.2 to 231.1) mmHg in the good outcome group vs. 154 (119-162) mmHg in poor outcome, p<0.001). In multivariate logistic regression analysis, PaO₂ was selected as an independent factor of the poor long-term neurologic outcome (OR 0.981 (95% CI: 0.968 to 0.995)) Conclusion: Higher PaO₂ was independently associated with a lower incidence of a poor long-term neurologic outcome.

• Journal of the Korean Child Neurology Society
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• v.26 no.4
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• pp.240-245
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• 2018

Purpose: Early prediction of prognosis of children resuscitated from cardiac arrest is a major challenge. We investigated the utility of electroencephalography (EEG) and laboratory studies for predicting of neurologic outcome in children resuscitated from cardiac arrest. Methods: We retrospectively analyzed medical records of patients who were resuscitated from cardiac arrest from 2006 to 2015 at the Gil Medical Center. Patients aged one month to 18 years were included. EEG analysis included background scoring, reactivity and seizure burden. EEG background was classified score 0 (normal/organized), score 1 (slow and disorganized), score 2 (discontinuous or burst suppression), and score 3 (suppressed and featureless). Neurologic outcome was evaluated by Pediatric Cerebral Performance Category (PCPC) at least 6 months after cardiac arrest. Results: Total 26 patients were evaluated. Nine patients showed good neurologic outcome (PCPC 1, 2, 3) and 17 patients showed poor neurologic outcome (PCPC 4, 5, 6). Patients of poor neurologic outcome group showed EEG background score 3 in 88.2%, whereas 44.4% in patients of good neurologic outcome group (P=0.028). Electrographic ictal discharges except non-convulsive status epilepticus were presented in 44.4% of good neurologic outcome group and 5.9% of poor neurologic outcome group (P=0.034). Ammonia and lactate levels were higher and pH levels were lower in poor outcome group than good neurologic outcome group. Conclusion: Suppressed and featureless EEG background is associated with poor neurologic outcome and electrographic seizures are associated with good neurologic outcome.

• Journal of The Korean Society of Emergency Medicine
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• v.29 no.5
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• pp.493-499
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• 2018

Objective: This study aimed to identify the effects of serum potassium and lactate on neurologic outcomes in out-of-hospital post-cardiac arrest adult patients. Methods: This study was a single center, retrospective observational study. We recruited out-of-hospital post-cardiac arrest adult patients admitted to an intensive care unit from 2011 to 2017. Primary outcome was good neurologic outcome at discharge. To evaluate the prognostic impact of serum potassium and lactate, univariate and multivariate logistic regression analyses were performed. Results: A total of 57 patients were included in this study. The number of patients with good neurologic outcome was 19 (33.3%). In the univariate analysis, good neurologic outcome patients showed a higher smoking rate, shorter pre-hospital transportation time, higher rate of percutaneous coronary intervention, and lower severity score (all P<0.05). The good neurologic outcome patients also presented higher pH, lower partial pressure of carbon dioxide, and lower potassium regarding laboratory findings on the first hospital day (all P<0.05). In the multivariate analysis, the independent factors favoring good neurologic outcome were pre-hospital transportation time (adjusted odds ratio [aOR], 0.82; 95% confidence interval [CI], 0.69-0.97; P=0.019) and lower partial pressure of carbon dioxide on the first hospital day (aOR, 0.95; 95% CI, 0.91-0.99; P=0.034). Conclusion: Serum potassium and lactate were not significantly associated with good neurologic outcome in out-of-hospital post-cardiac arrest adult patients. The prognostic factors for good neurologic outcome were pre-hospital transportation time and initial partial pressure of carbon dioxide.

• Journal of Korean Neurosurgical Society
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• v.59 no.2
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• pp.161-164
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• 2016

Few preoperative extrapontine myelinolysis (EPM) cases with pituitary adenoma have been reported. No such case had long follow-up to see the outcome of EPM. We reported a 38-year-old man complaining of nausea, malaise and transient loss of consciousness who was found to have severe hyponatremia. Neurologic deficits including altered mental status, behavioral disturbances, dysarthria and dysphagia developed despite slow correction of hyponatremia. Endocrine and imaging studies revealed hypopituitarism, nonfunctional pituitary macroadenoma and extrapontine myelinolysis. Transsphenoidal surgery was performed after three weeks of supportive therapy, when neurological symptoms improved significantly. The patient recovered function completely 3 months after surgery. Our case indicates that outcome of EPM can be good even with prolonged periods of severe neurologic impairment.

• Journal of Trauma and Injury
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• v.26 no.3
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• pp.190-197
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• 2013

Purpose: Trauma is one of the major cause of death in Korea. This study focused on the survival rate and the neurologic outcome for patients with traumatic cardiac arrest (CA) at one emergency center. Methods: We retrospectively reviewed the medical records of patients with traumatic CA who were seen at a regional emergency medical center from January 2010 to December 2011. From among major trauma patients at that medical center, adults older than 18 years of age who had CA were included in this study. CA included out-of-hospital CA with arrival at the Emergency Department (ED) within three hours and in-hospital CA. We checked the survival rate and the neurologic outcome. Results: A total of 61 patients were analyzed: 32 patients had return of spontaneous circulation (ROSC), 6 patients survived to discharge (survival rate: 9.84%), and 4 were still alive 90 days after discharge. The Cerebral performance category (CPC) scores at 6 months after discharge showed 1 good and 5 poor in neurologic outcomes. Factors such as initial rhythm of CA, part with major injury, Revised Trauma Score (RTS) and pH, were significant for ROSC, survival, and neurologic outcome in patients with traumatic CA. Conclusion: In this study, patients who had traumatic CA showed a 9.84% survival rate and a 1.64% good neurologic outcome. The results are poorer than those for CA caused by disease. Multi-center, prospective studies are needed.

• Journal of Korean Neurosurgical Society
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• v.47 no.6
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• pp.428-432
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• 2010

Objective : An effective intervention has not yet been established for patients with acute occlusion of the internal carotid artery (ICA). The aim of our study was to investigate the feasibility, safety, and efficacy of emergent stent placement of carotid artery to improve neurologic symptoms and clinical outcome. Methods : Of 84 consecutive patients with severe ICA stenosis who were admitted to our institution from March 2006 to May 2009, 10 patients with acute ICA occlusion (11.9%) underwent emergency carotid artery stent placement. We reviewed their records for neurologic outcome using the National Institutes of Health Stroke Scale (NIHSS) score, before and at 7 days after stent placement; clinical outcome using the modified Rankin Scale score (mRS) and Glasgow Outcome Scale (GOS); frequency of procedure-related complications; and recurrence rate of ipsilateral ischemic stroke within 90 days. Results : Carotid lesions were dilated completely in all patients. Median NIHSS scores before emergency stent placement and at 7 days were 16.6 and 6, respectively, showing significant improvement. Eight patients (80%) had favorable outcomes (mRS score 0-2 and GOS 4-5). Complications occurred in two patients (20%): stent insertion failed in one and an intracerebral hemorrhage occurred in the other. Ipsilateral ischemic stroke did not recur within 3 months. Conclusion : Emergency carotid artery stent placement can improve the 7-day neurologic outcome and the 90-day clinical outcome in selected patients with acute cerebral infarction.

• Journal of Korean Neurosurgical Society
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• v.52 no.6
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• pp.523-527
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• 2012

Objective : The incidence of spontaneous spinal epidural hematoma (SSEH) is rare. Patients with SSEH, however, present disabling neurologic deficits. Clinical outcomes are variable among patients. To evaluate the adequate treatment method according to initial patients' neurological status and clinical outcome with comparison of variables affecting the clinical outcome. Methods : We included 15 patients suffered from SSEH. Patients were divided into two groups by treatment method. Initial neurological status and clinical outcomes were assessed by the American Spinal Injury Association (ASIA) impairment scale. Also sagittal hematoma location and length of involved segment was analyzed with magnetic resonance images. Other factors such as age, sex, premorbid medication and duration of hospital stay were reviewed with medical records. Nonparametric statistical analysis and subgroup analysis were performed to overcome small sample size. Results : Among fifteen patients, ten patients underwent decompressive surgery, and remaining five were treated with conservative therapy. Patients showed no different initial neurologic status between treatment groups. Initial neurologic status was strongly associated with neurological recovery (p=0.030). Factors that did not seem to affect clinical outcomes included : age, sex, length of the involved spinal segment, sagittal location of hematoma, premorbid medication of antiplatelets or anticoagulants, and treatment methods. Conclusion : For the management of SSEH, early decompressive surgery is usually recommended. However, conservative management can also be feasible in selective patients who present neurologic status as ASIA scale E or in whom early recovery of function has initiated with ASIA scale C or D.

• Journal of Oral Medicine and Pain
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• v.41 no.3
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• pp.118-125
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• 2016

Purpose: The aims of this study were to evaluate the clinical characteristics of patients with altered sensation and/or pain, and to determine outcome predictors affecting persistent neuropathy. Methods: Patients who complained an altered sensation or pain following trigeminal nerve trauma were involved in this study. To determine outcome predictors affecting persistent neuropathy, the patients were divided into two groups; transient vs. persistent, and the clinical phenotypes are compared between groups. Data were analyzed with t-tests, chi-square, and multiple regression analyses with 95% confidence interval and p<0.05 significance level. Results: A total of 111 patients were included: 23 with transient and 88 persistent groups. The panoramic result and pin-prick test score were statistically different between the groups. Radiating symptoms after blunt and pinprick stimuli were also significantly different between groups. The results revealed that the presence of a neurologic lesion in the panoramic view result, reduced sensation in the pinprick test, and radiation in the pinprick test could affect the persistent group. Conclusions: The presence of a neurologic lesion in panoramic view result and reduced sensation and radiating symptoms in the pin prick test would be defining features of one of the main clinical features of persistent neuropathy. These features could serve as outcome predictors diagnosing the permanent nerve injury in trigeminal nerve.

• Journal of Chest Surgery
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• v.47 no.6
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• pp.510-516
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• 2014

Background: Acute cerebral infarction is a major risk factor for postoperative neurologic complications in cardiac surgery. However, the outcomes associated with acute silent cerebral infarction (ASCI) have not been not well established. Few studies have reported the postoperative outcomes of these patients in light of preoperative Diffusion-weighted magnetic resonance imaging (DWI). We studied the postoperative neurologic outcomes of patients with preoperative ASCI detected by DWI. Methods: We retrospectively studied 32 patients with preoperative ASCI detected by DWI. None of the patients had preoperative neurologic symptoms. The mean age at operation was $68.8{\pm}9.5$ years. Five patients had previous histories of stroke. Four patients had been diagnosed with infective endocarditis. Single cerebral infarct lesions were detected in 16 patients, double lesions in 13, and multiple lesions (>5) in three. The median size of the infarct lesions was 4 mm (range, 2 to 25 mm). The operations of three of the 32 patients were delayed pending follow-up DWI studies. Results: There were two in-hospital mortalities. Neurologic complications also occurred in two patients. One patient developed extensive cerebral infarction unrelated to preoperative infarct lesions. One patient showed sustained delirium over one week but recovered completely without any neurologic deficits. In two patients, postoperative DWI confirmed that no significant changes had occurred in the lesions. Conclusion: Patients with preoperative ASCI showed excellent postoperative neurologic outcomes. Preoperative ASCI was not a risk factor for postoperative neurologic deterioration.

• Journal of Korean Neurosurgical Society
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• v.52 no.4
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• pp.396-403
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• 2012

Objective : The predictors of cranioplasty infection after decompressive craniectomy have not yet been fully characterized. The objective of the current study was to compare the long-term incidences of surgical site infection according to the graft material and cranioplasty timing after craniectomy, and to determine the associated factors of cranioplasty infection. Methods : A retrospective cohort study was conducted to assess graft infection in patients who underwent cranioplasty after decompressive craniectomy between 2001 and 2011 at a single-center. From a total of 197 eligible patients, 131 patients undergoing 134 cranioplasties were assessed for event-free survival according to graft material and cranioplasty timing after craniectomy. Kaplan-Meier survival analysis and Cox regression methods were employed, with cranioplasty infection identified as the primary outcome. Secondary outcomes were also evaluated, including autogenous bone resorption, epidural hematoma, subdural hematoma and brain contusion. Results : The median follow-up duration was 454 days (range 10 to 3900 days), during which 14 (10.7%) patients suffered cranioplasty infection. There was no significant difference between the two groups for event-free survival rate for cranioplasty infection with either a cryopreserved or artificial bone graft (p=0.074). Intergroup differences according to cranioplasty time after craniectomy were also not observed (p=0.083). Poor neurologic outcome at cranioplasty significantly affected the development of cranioplasty infection (hazard ratio 5.203, 95% CI 1.075 to 25.193, p=0.04). Conclusion : Neurologic status may influence cranioplasty infection after decompressive craniectomy. A further prospective study about predictors of cranioplasty infection including graft material and cranioplasty timing is necessary.