• Journal of Korean Neurosurgical Society
• /
• 제58권2호
• /
• pp.150-154
• /
• 2015

Cerebral venous sinus thrombosis (CVST) following a closed head injury in pediatric patients is a rare condition, and an early spontaneous recanalization of this condition is extremely rare. A 10-year-old boy was admitted with a mild, intermittent headache and nausea five days after a bicycle accident. The brain computed tomography showed an epidural hematoma at the right occipital area with pneumocephalus due to a fracture of the occipital skull bone. The brain magnetic resonance imaging and the magnetic resonance venography demonstrated a flow signal loss from the right sigmoid sinus to the right jugular vein. The diagnosis was sigmoid sinus thrombosis, so close observations were selected as a treatment for the patient because of his gradually improving symptoms; however, he complained of vomiting 14 days the after conservative treatment. The patient was readmitted for a further examination of his symptoms. The laboratory and the gastroenterological examinations were normal. Due to concern regarding the worsening of the sigmoid sinus thrombosis, the brain magnetic resonance venography was rechecked and it revealed the recanalization of the venous flow in the sigmoid sinus and in the jugular vein.

• Journal of Yeungnam Medical Science
• /
• 제30권1호
• /
• pp.36-38
• /
• 2013

While epidural abscesses are rare in hemodialysis patients, they can cause severe neurological complications that can be fatal because only nonspecific symptoms appear in the early stages of the infection. Their incidence increased recently due to intravenous drug abuse, invasive spinal surgery, percutaneous vertebral procedures, and the development of diagnostic modalities. The increased number of cases is related to the use of dialysis catheters in hemodialysis patients. If a patient has fever and back pain, doctors should eliminate the possibility of other common diseases and consider spinal epidural infection. Early diagnosis and proper treatment are important to prevent neurological complications. In this paper, the symptoms, blood work, magnetic resonanceimaging (MRI) findings, and clinical course of two hemodialysis patients who developed spinal epidural abscesses are described.

• Journal of Korean Neurosurgical Society
• /
• 제50권1호
• /
• pp.68-71
• /
• 2011

We present a case of Neuro-Behçet's disease with an unpredictable clinical course. A 47-year-old man was admitted to the neurosurgery department of our hospital with a mild headache. Three days after admission, his consciousness suddenly decreased and respiratory distress progressed rapidly. A brain MRI revealed that the previously observed abnormal signal had extended markedly to both the thalamic areas and the entire brain stem, and the surrounding brain parenchyma were compressed by cerebral edema. Based on the patient's symptoms of recurrent oral and genital ulcers, skin lesions, and uveitis, a rheumatologist made a diagnosis of Behçet's disease with CNS involvement. The patient was treated with high-dose methylprednisolone with respiratory assistance in the intensive care unit for 9 days and his neurologic symptoms improved remarkably. Neuro-Behçet's disease must be considered in the differential diagnosis in rapidly deteriorated young neurological patients along with a stroke, low-grade glioma, multiple sclerosis, and occlusive venous disease.

• 대한유전성대사질환학회지
• /
• 제14권1호
• /
• pp.29-36
• /
• 2014

Mucopolysaccharidoses (MPSs) are a group of rare inherited metabolic diseases caused by deficiency of lysosomal enzymes. MPSs are clinically heterogeneous and characterized by progressive deterioration in visceral, skeletal and neurological functions. The aim of this article is to review the treatment of MPSs, the unmet needs of current treatments and vision for the future including recent clinical trials. Until recently, supportive care was the only option available for the management of MPSs. Hematopoietic stem cell transplantation (HSCT), another potentially curative treatment, is not routinely advocated in clinical practice due to its high risk profile and lack of evidence for efficacy. From the early 2000s, enzyme replacement therapy (ERT) was approved and available for the treatment of MPS I, II and VI. ERT is effective for the treatment of many somatic symptoms, particularly walking ability and respiratory function, and remains the mainstay of MPS treatment. However, no benefit was found in the neurological symptoms because the enzymes do not readily cross the blood-brain barrier (BBB). In recent years, intrathecal (IT) ERT, substrate reduction therapy (SRT) and gene therapy have been rapidly gaining greater recognition as potential therapeutic avenues. Although still under investigation, IT ERT, SRT and gene therapy are promising MPS treatments that may prevent the neurodegeneration not improved by ERT.

• 대한두개안면성형외과학회지
• /
• 제18권3호
• /
• pp.186-190
• /
• 2017

We report a case of free flap deterioration which may have been induced by pressure gradient resulting from cranial defect overlying a ventriculoperitoneal shunt (VP shunt). The patient, male and aged 78, had a VP shunt operation for progressive hydrocephalus. Afterwards, the scalp skin flap surrounding the VP shunt collapsed and showed signs of necrosis, exposing part of the shunt catheter. After covering the defect with a radial forearm free flap, the free flap site showed signs of gradual sinking while the vascularity of the flap remained unimpaired. An agreement was reached to remove the shunt device and observe the patient for any neurological symptoms, and after the shunt was removed and the previous cranial opening filled with fibrin glue by Neurosurgery, we debrided the deteriorated flap and provided coverage with 2 large opposing rotational flaps. During 2 months' outpatient follow-up no neurological symptoms appeared, and the new scalp flap displayed slight depression but remained intact. The patient has declined from any further follow-up since.

• 국제물리치료학회지
• /
• 제10권2호
• /
• pp.1785-1790
• /
• 2019

Background: Lumbar disc herniation (LDH) causes neurological symptoms by compression of the dura mater and nerve roots. Due to the changed in proprioception inputs that can result in abnormal postural pattern, delayed reaction time, and changed in deep tendon reflex. Objective: To investigate the effects of lumbar stabilization exercises on motor neuron excitability and neurological symptoms in patients with LDH. Design: Randomized Controlled Trial (single blind) Methods: Thirty patients with LDH were recruited; they were randomly divided into the balance center stabilization resistance exercise group (n=15) and the Nordic walking group (n=15). Each group underwent their corresponding 20-minute intervention once a day, four times a week, for four weeks. Participants' motor neuron excitability and low back pain were assessed before and after the four-week intervention. Results: There were significant differences in all variables within each group (p<.05). There were significant differences between the experimental and control groups in the changes of upper motor neuron excitability and pain (p<.05), but not in the changes of lower motor neuron excitability and Korean Oswestry Disability Index. Conclusion: Lumbar stabilization exercises utilizing concurrent contraction of deep and superficial muscles improved low back function in patients with LDH by lowering upper motor neuron excitability than compared to exercises actively moving the limbs. Lumbar stabilization exercises without pain have a positive impact on improving motor neuron excitability.

• 대한신경과학회지
• /
• 제36권4호
• /
• pp.341-344
• /
• 2018

It is uncommon for Fabry's disease (FD) patient to present with an isolated ischemic stroke without other typical symptoms or signs of FD. A 48-year-old woman presented with recurrent limb weakness and her brain magnetic resonance imaging revealed multiple ischemic brain lesions. Ten years ago, the patient had been diagnosed with heterozygote FD by the genetic test, but she had not shown any typical symptoms or sign of FD so far. Isolated organ involvement could occur in heterozygote FD.

• 대한정형외과학회지
• /
• 제54권4호
• /
• pp.372-376
• /
• 2019

가성통풍으로 인한 수근관 증후군은 드물게 발생한다. 저자들은 수근관 내 종괴로 인한 급성 정중신경 압박 증세로 내원한 65세 여자환자에게 종괴 절제술과 횡수근 인대 절개술을 시행하고 조직검사를 통해 가성통풍으로 진단된 증례를 경험하여 문헌 고찰과 함께 보고하고자 한다.

• 대한한방소아과학회지
• /
• 제25권1호
• /
• pp.90-110
• /
• 2011

Objectives: The purpose of this study is to examine the parental recognition and utilizing patterns of oriental medical care in children who live in Seong-Dong district. Methods 802 day-care center children's parents participated in the survey on recognition and utilizing patterns of oriental medical care, and 702 of the surveys were analyzed. Results: 1. 38.33% has received previous oriental medical treatments and most were received at the children's age under 12-24 months. Majority of the treatments took place in the clinical settings. By recommendation, some also received their treatment at the medical centers. One of the reasons why they receive oriental medical treatments was that they prefer to balance their treatment with the orental medical treatments along with the western's. 2. 53.85% of those who received oriental medical treatments were satisfied with their treatments. The effective treatment results were the major reason for the satisfaction. 3. 49.56% of those who had oriental medical treatments chose specific oriental medical facilities for the children's ailment. Most specific oriental medical facilities were local oriental medical clinics. Reputation fame were the main reason in choosing the clinics. 4. In 2009, 55.26% had received care in the specific oriental medical clinics for the diseases, such as respiratory symptoms, systemic symptoms, gastrointestinal symptoms, skin problems, neurological and psychiatric disease for infants, and respiratory symptoms, gastrointestinal symptoms, systemic symptoms, skin problems, neurological and psychiatric symptoms, urinary symptoms and musculoskeletal symptoms for toddlers. 5. The average duration of herbal treatment were 7-14 days, preferably 4-6 days, and preferred number of medical visits were once a week on Saturdays and preferred day for night cares were on Friday nights. Average treatment fee per treatment was less than 10,000 won which coincided with the preferred treatment fee per visit. 6. The very first medical institutions chosen by parents once their children are ill are the following; Western medical institutions, western medical clinics, pharmacies, oriental medical clinics, health centers, and lastly, oriental medical institutions. The major concerns in receiving oriental medical cares include pesticides in herbs and hazardous substances in heavy metals. Preferred form of oriental medicine was decoction, the negative feedback of oriental medicine was mostly due to the bitter taste of the oriental herbal decoctions. Preferred frequency of intake was twice a day with less than 10cc~20cc per single intake. Conclusions: Taken all together, we conclude that the growing recognition of Oriental Pediatric medicine is needed among parents.

• Journal of Korean Neurosurgical Society
• /
• 제37권4호
• /
• pp.275-281
• /
• 2005

Objective: The prolactinoma is the most common pituitary tumor and sometimes shows severe invasiveness to the adjacent cavernous sinus, especially in the male patient. The dopamine agonist can be used as an alternative treatment modality to surgery. But, the transsphenoidal or transcranial approach for tumor removal has been more preferred treatment option of neurosurgeons in invasive prolactinoma. Especially rapid decompression of mass effect and resolution of the neurologic deficit is demanded. The prospective study is done in order to identify the therapeutic efficacy of bromocriptine as an initial treatment option for the invasive prolactionomas. Methods: Twenty patients with invasive prolactinoma were studied. Preoperative neurological and endocrinological evaluations were done, and size and invasiveness of the tumor was estimated on MRI. Bromocriptine was administrated by increasing dose planning reaching maximum dose at 1 month of treatment, with close neurological and endocrinological monitoring. At 3months after treatment, MRI was taken and decision was made whether to continue bromocriptine or to have surgical intervention. Results: Thirteen patients showed excellent result with only bromocriptine treatment. These patients showed not only marked reduction of tumor volume and prolactin level, but also, improving clinical symptoms and other hormonal deficits. 13patients who had visual field defect and decreased visual acuity had all improved visual symptoms. But, the remaining 4patients required surgical treatment due to insufficient reduction of tumor size inspite of normalized prolactin level within 3months. Remaining 2patients had $20{\sim}30%$ of tumor size reduction, but prolactin level was not normalized. One patient required radiation therapy. Conclusion: Bromociptine can be used as initial treatment for the invasive prolactinomas with careful monitoring of the neurological and endocrinological status. It should be carefully followed up for tumor size reduction within 3 months after initiation of treatment.