• 대한안과학회지
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• 제59권12호
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• pp.1195-1200
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• 2018

목적: 상직근 비대가 동반된 환자에서 상직근 및 하직근 수술 이후 발생한 전안부허혈을 경험하였으며, 현재까지 두 개의 직근수술 이후 발생한 전안부허혈은 국내에서 보고된 바 없어 이를 보고하고자 한다. 증례요약: 80세 남자 환자가 3년 전부터 발생한 복시를 주소로 내원하였다. 제일눈위치에서 30프리즘디옵터의 우안 상사시를 보였고, 눈운동검사에서 우안의 하전운동장애가 관찰되었다. 안와 전산화단층촬영검사에서 우안 상직근 비대 소견이 관찰되었다. 우안 상직근 후전술 및 하직근절제술을 시행하였다. 수술 후 2일째 전안부 검사상 우안의 미만성 각막부종과 데스메막주름이 관찰되었고, 전방 방수흐림 및 동공산대가 관찰되었다. 전안부허혈 진단하에 경구 스테로이드 45 mg으로 치료를 시작하였으며, 1% prednisolone acetate와 0.5% levofloxacin 점안약을 사용하였다. 수술 후 1개월째 제일눈위치에서 정위를 보였고 각막부종, 동공이상이나 전방의 염증은 관찰되지 않았다. 결론: 본 증례를 통해 두 개의 직근을 수술할 때도 전안부허혈의 발생 가능성을 항상 염두에 두어야 함을 알 수 있으며, 고령의 환자에서 수직근수술을 시행할 때 더욱 주의할 것을 권유한다.

• The Korean Journal of Physiology
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• 제6권2호
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• pp.49-56
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• 1972

This experiment was designed to explore specific functional relationship between the vestibular canals and the extraocular oblique muscles by observing the isometric tension responeses of the muscles to the selected vestibular canal excitation. The vestibular excitation was simulated by either stimulation of the individual canal nerve or endolymphatic fluid displacement in each canal. Each canal nerve was subjected to square wave pulses with a monopolar wire electrode placed closely to the ampullary nerve endings for electrical stimulation, and a fine stainless cannula was introduced into the each canal toward the ampulla and a minute amount $(0.5{\sim}3.5\;microliter)$ of fluid was injected in or ejected out by means of a microsyringe connected to the cannula to produce ampullopetal or ampullofugal displacement of endolymphatic fluid. The superior oblique muscle was contracted by the excitation of homolateral canals and was relaxed by contralateral canals. On the contrary, the inferior oblique was contracted by the contralateral canals and was relaxed by the homolateral canals. Summation of excitatory and inhibitory canal effects from the bilateral vestibular system was demonstrable on the tension changes of the oblique muscles. Excitation of either dual or triple canals of the unilateral vestibular system also caused summation effect on the tension response of the oblique pair; thus multiple signals from the different ampullary receptors seems to be converged into the relevant ocular motor muclei. Since the superior and inferior obliques are known to receive their motor fibers from the contralateral trochlear nuclei and intermediate nuclei of the homolateral oculomotor complex respectively, the above experimental evidences indicate that the ocular motor nuclei for oblique muscles receive excitatory signals from the contralateral vestibular canals and inhibitory signals from the homolateral canals.

• Physical Therapy Rehabilitation Science
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• 제12권3호
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• pp.207-213
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• 2023

Objective: The purpose of this study was to understand the complex anatomical structure and function of the midbrain to better understand the patient's symptoms and plan effective treatment including pharmacological and rehabilitation interventions. Design: A single case study Methods: A 17-year-old girl presented with acute onset of drowsiness, gait disturbance, mutism, and ptosis. Physical examination revealed postural instability, rigidity of all limbs, and limitations in extraocular movement. The brain MRI revealed an isolated acute infarction in the bilateral midbrain. Considering the location of the infarction, the presenting symptoms were the result of an impairment of the dopaminergic pathway in addition to lesions in the nuclei of the oculomotor nerve. Levodopa/carbidopa was prescribed. And the intensive and comprehensive rehabilitation program was done. Results: As a result of the study, through comprehensive intervention, which encompassed assessments such as the manual muscle test, Korean Modified Barthel Index score, and Trail-making test, significant enhancements in the patient's condition were observed. These findings provide evidence supporting the effectiveness of the intervention in promoting the patient's physical functioning and overall well-being. Conclusions: The results of this case highlight the significance of comprehending the intricate anatomical structure and functional aspects of the midbrain, which led us to approach appropriate pharmacological and rehabilitation interventions. Through active communication among the medical team, we were able to establish a therapeutic plan, which demonstrated that effective treatment can be achieved.