• 대한장애인치과학회지
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• 제13권1호
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• pp.33-36
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• 2017

뇌성마비 환자들은 식이자세와 잇솔질에 대해 스스로 행동할 수 없기 때문에 의과적 치과적인 문제에 더 취약할 수 밖에 없다. 낮은 사회경제적 지위와 심각한 운동장애를 가진 뇌성마비 환자들은 특히 치과치료에서 소외되기 쉽다. 의과적 치료와 함께 구강관리는 뇌성마비 환자들의 삶의 질에 매우 중요한 관련이 있다. 그러므로, 장애인들의 삶의 질을 향상시키고 의료혜택으로부터 소외되지 않도록 정기적인 검진과 예방치료를 받기 위해서는 국가차원에서 공공의료서비스 및 시스템이 필요하다.

• Clinical and Experimental Pediatrics
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• 제64권7호
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• pp.313-321
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• 2021

Here we describe the neurodevelopmental outcomes of very low birth weight (VLBW) infants (birth weight ≤1,500 g) at 3 years of age in the Neonatal Research Network of Japan (NRNJ) database in the past decade and review the methodological issues identified in follow-up studies. The follow-up protocol for children at 3 years of chronological age in the NRNJ consists of physical and comprehensive neurodevelopmental assessments in each participating center. Neurodevelopmental impairment (NDI)-moderate to severe neurological disability-is defined as cerebral palsy (CP) with a Gross Motor Function Classification System score ≥2, visual impairment such as uni- or bilateral blindness, hearing impairment requiring hearing amplification, or cognitive impairment with a developmental quotient (DQ) of Kyoto Scale of Psychological Development score <70 or judgment as delayed by pediatricians. We used death or NDI as an unfavorable outcome in all study subjects and NDI in survivors using number of assessed infants as the denominator. Follow-up data were collected from 49% of survivors in the database. Infants with follow-up data had lower birth weights and were of younger gestational age than those without follow-up data. Mortality rates of 40,728 VLBW infants born between 2003 and 2012 were 8.2% before discharge and 0.7% after discharge. The impairment rates in the assessed infants were 7.1% for CP, 1.8% for blindness, 0.9% for hearing impairment, 15.9% for a DQ <70, and 19.1% for NDI. The mortality or NDI rate in all study subjects, including infants without follow-up data, was 17.4%, while that in the subjects with outcome data was 32.5%. The NRNJ follow-up study results suggested that children born with a VLBW remained at high risk of NDI in early childhood. It is important to establish a network follow-up protocol and complete assessments with fewer dropouts to enable clarification of the outcomes of registered infants.

• Journal of Korean Neurosurgical Society
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• 제40권3호
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• pp.180-185
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• 2006

Objective : Middle cerebral artery occlusion[MCAO] has widely been used to produce ischemic brain lesions. The lesions induced by MCAO tend to be variable in size because of the variance in the collateral blood supply found in the mouse brain. To establish a less invasive and reproducible focal ischemia model in mice, we modified the technique used for rat photo thrombosis model. Methods : Male C57BL/6 mice were subjected to focal cerebral ischemia by photothrombosis of cortical microvessels. Cerebral infarction was produced by intraperitoneal injection of Rose Bengal, a photosensitive dye and by focal illumination through the skull. Motor impairment was assessed by the accelerating rotarod and staircase tests. The brain was perfusion-fixed for histological determination of infarct volume four weeks after stroke. Results : The lesion was located in the frontal and parietal cortex and the underlying white matter was partly affected. A relatively constant infarct volume was achieved one month after photothrombosis. The presence of the photothrombotic lesion was associated with severe impairment of the motor performance measured by the rotarod and staircase tests. Conclusion : Photothrombotic infarction in mice is highly reproducible in size and location. This procedure can provide a simple method to produce cerebral infarction in a unilateral motor cortex lesion. In addition, it can provide a suitable model for study of potential neuroprotective and therapeutic agents in human stroke.

• 정신신체의학
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• 제20권2호
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• pp.105-111
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• 2012

연구목적 : 본 연구는 경도인지장애(Mild cognitive impairment, 이하 MCI)와 알쯔하이머형 치매(Dementia of Alzheimer's type, 이하 AD)의 신경정신증상 빈도와 점수를 조사하고 비교 분석한 뒤, 인지기능과 Korean Neuropsychiatric Inventory(K-NPI) 결과와의 상관관계를 알아보고자 하였다. 방 법 : MCI 또는 AD를 진단받은 163명의 환자들을 세 군으로 분류하였다. K-NPI를 이용하여 MCI 환자 55명, 경도의 AD 환자 56명, 중등도 이상의 AD 환자 52명을 대상으로 신경정신증상을 조사하였고, 세 군간의 K-NPI의 부척도별 빈도와 composite score를 비교하였다. 결 과 : MCI군에서 가장 흔한 증상은 우울/불쾌감, 수면/야간행동, 불안, 과민/불안정 순이었다. 경도 AD군에서의 증상은 초조/공격, 우울/불쾌감, 불안, 무감동/무관심, 수면/야간행동 순으로 빈번하게 나타났다. 중등도 이상 AD 군에서는 무감동/무관심, 우울/불쾌감, 초조/공격, 망상 순이었다. 이 중 망상, 환각, 초조/공격, 무감동/무관심, 이상행동증상, 식욕/식습관의 변화의 빈도는 세 군 간에 통계적으로 유의한 차이를 나타내었다. 총 NPI 점수는 MMSE-KC 점수와는 음의 상관관계를, GDS와는 양의 상관관계를 보였고, 모두 통계적으로 유의하였다. 결 론 : 신경정신증상은 MCI, AD에서 흔히 보이는데, 본 연구에서는 MCI와 경도의 AD에서 이들 증상들이 유사한 양상을 나타내었다. 정신증은 중등도 이상 AD에서 가장 흔하게 나타났고, 이로 인해 더욱 빠른 인지기능의 저하를 초래할 수 있다. 따라서 MCI와 AD의 각 진행 단계에 따른 적절한 치료가 필요하다.

• Annals of Clinical Neurophysiology
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• 제1권2호
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• pp.99-105
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• 1999

Background and Objectives : The Motor evoked potentials (MEP) study may be useful in the evaluation of the degree of impairment in the motor nervous system and in the determination of the prognosis. The purpose of this study is to evaluate the status of central nervous system in acute and subacute state of cerebral ischemia by comparing the changes of MEP in the initial and follow-up study. Methods : Twenty patients with hemiparesis caused by ischemic stroke were recruited for this study. We tested MEP within 7 days and followed-up after 14 days after symptom onset. The cerebral motor cortex area, cervical area for upper extremity and lumbar area for lower extremity were stimulated by transmagnetic stimulator. The central motor conduction time(CMCT) was measured with the difference in MEP caused by stimulating the vertical area and spinal area. The CMCT of hemiparetic patients were classified into three groups-normal, delayed, and no evoked MEP groups. Results : The CMCT in hemiparetic side of acute ischemic stroke patients were singnificantly delayed (P < 0.05) compared with the control group. The CMCT of hemiparetic side in the follow-up study showed no sinificantly difference in comparison to the control group. The prognosis of motor improvement was better in the groups of delayed MEP than the groups of no evoked MEP. Conclusion : The CMCT of hemiparetic and contralateral sides were delayed in acute ischemic stroke, compared with control group and were returned to normal boundaries in subacute state. But in the most cases with no MEP response in the initial study, also showed no MEP response in the follow-up study. The recovery occurred in the subacute state in cases with mild hemiparesis, whereas recovery did not occur in the subacute stage in case with severe hemiparesis.

• 대한물리의학회지
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• 제5권3호
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• pp.385-394
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• 2010

Purpose : The present study was to examine the difference and severity of asymmetry in independently ambulating stroke survivors and to establish the association between gait asymmetry, velocity, and the motor function of lower extremity. Methods : The subjects used in this study were 43 subjects with hemiparesis being able to walk independently. Motor function of lower extremity was measured clinically with the Fugl Meyer-Lower /Extremity Assessment. Overground gait velocity and spatia-temporal parameters were collected by the GAITRite system. Results : Thirty(69.77%) patients showed statistically significant temporal asymmetry while 28(65.1%) exhibited statistically significant spatial asymmetry. One-way ANOVA results showed a main effect of temporal asymmetry group(normative, mild, severe) for gait velocity(F=74.129), FM-L/E(F=17.270), swing-stance symmetry(F=66.869, F=13.485, respectively), spatio-temporal asymmetry(F=13.166, F=31.800, respectively) 66, F=31.800, respectively). Gait velocity was negatively associated with temporal asymmetry(r=-.83), spatial asymmetry(r=-.60). Motor function of lower extremity was also associated with temporal asymmetry(r=-.58), and spatial asymmetry(r=-.50). Conclusion : The study attempted to establish the standard assessment of hemiparesis gait symmetry in light of the complex relationship with motor impairment and gait velocity. More future work will need to link the degree of gait asymmetry to clinically relevant outcomes to better establish the clinical significance of such observations.

• The Korean Journal of Pain
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• 제18권2호
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• pp.118-123
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• 2005

Background: A nerve ligation injury may produce a tactile allodynia. The effects of intrathecally delivered lamotrigine on allodynia induced due to fifth and sixth lumbar spinal nerves ligation in rats, using lumbar intrathecal catheters were examined. Methods: Sprague-Dawley rats (body weight 160-180 g) were prepared by tightly ligating the fifth and sixth left lumbar spinal nerves, with the implantation of a chronic intrathecal catheter for drug administration. Mechanical allodynia and allodynic threshold were measured using von Frey filaments and the updown method, respectively. After the baseline hind paw withdrawal thresholds had been obtained, lamotrigine (10, 30, 100 and $300{\mu}g$) was administered intrathecally. Thereafter, the dose-response curves and 50% effective dose ($ED_{50}$) were obtained. Motor dysfunction was assessed by observing the righting/stepping reflex responses and abnormal weight bearing. Results: Intrathecal administration of lamotrigine produced a dose-dependent antiallodynic action ($ED_{50}=61.7{\mu}g$). Mild motor weakness was observed with $300{\mu}g$ lamotrigine, but no severe motor impairment was found. Conclusions: It is suggested that intrathecal lamotrigine could produce moderate antagonism of mechanical allodynia at the spinal level in a rat neuropathic pain model with minimal motor weakness.

• 대한장애인치과학회지
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• 제7권1호
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• pp.15-20
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• 2011

뇌병변장애인은 뇌성마비, 외상성 뇌손상, 뇌졸중 등 뇌의 기질적 병변에 기인한 신체적 장애로 보행 또는 일상생활의 동작 등에 상당한 제한을 받는 사람으로 정의된다. 최근에 뇌병변 장애아동의 DMFT는 비 장애아동과 유사하거나 낮다는 연구가 있었다. 그러나, 본 증례는 중증유아기우식증이 나타난 뇌병변장애 1급 아동들을 치료한 것으로, 아동들의 공통점을 통해 중증유아기우식 우식증의 특별한 원인을 찾고자 하였다. 뇌병변으로 인한 일차적인 운동장애와 이차적인 치과치료를 받기 어려울 정도의 쇠약함, 잦은 입원, 당분이 많은 음식과 약물의 섭취, 구강위생관리 소홀, 늦은 치과 내원, 협조도 저하 등이 우식 유발인자를 높이고, 우식 예방인자를 낮추어 치아우식증을 유발할 수 있는 것으로 사료되었다. 뇌병변 장애아동을 치료할 때, 치과의사는 개인적인 우식 위험도 평가를 통해 철저한 우식 예방프로그램을 만들고, 부모와 의학적 주치의는 구강관리의 중요성을 인식하여 조기 치과 내원 및 홈케어에 신경을 써야 할 것이다.

• Journal of Preventive Medicine and Public Health
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• 제28권2호
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• pp.398-405
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• 1995

We experienced a case of occupational lead poisoning employed in a secondary lead smelting plant for 12 years. The patient was 39-year-old male and had been felt dizziness, recent memory impairment and intermittent severe abdominal pain for 2 years. On admission, blood lead level was $92.9{\mu}g/dl$, urinary lead level was $19.9{\mu}g/l$ and zinc protoporphyrin level was $226.0{\mu}g/dl$. On the blood test, hemoglobin was 10.6g/dl and showed normocytic normochromic anemia. There were no abnormal findings in the biochemical and hormonal tests. Decrease of I.Q. and use of words in speaking were found in the psychiatric and psychologic examinations. We observed the finding of motor polyneuropathy in the nerve conduction velocity test. Computed tomographic finding showed calcification lesions in the basal ganglia, dentate nuclei, caudate nuclei, and especially characteristic multiple calcifications were located in the subcortical white matter.

• Journal of Korean Neurosurgical Society
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• 제60권1호
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• pp.118-124
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• 2017

Brain abscess commonly occurs secondary to an adjacent infection (mostly in the middle ear or paranasal sinuses) or due to hematogenous spread from a distant infection or trauma. Pulmonary arteriovenous fistulas (AVFs) are abnormal direct communications between the pulmonary artery and vein. We present two cases of brain abscess associated with asymptomatic pulmonary AVF. A 65-year-old woman was admitted with a headache and cognitive impairment that aggravated 10 days prior. An magnetic resonance (MR) imaging revealed a brain abscess with severe edema in the right frontal lobe. We performed a craniotomy and abscess removal. Bacteriological culture proved negative. Her chest computed tomography (CT) showed multiple AVFs. Therapeutic embolization of multiple pulmonary AVFs was performed and antibiotics were administered for 8 weeks. A 45-year-old woman presented with a 7-day history of progressive left hemiparesis. She had no remarkable past medical history or family history. On admission, blood examination showed a white blood cell count of 6290 cells/uL and a high sensitive C-reactive protein of 2.62 mg/L. CT and MR imaging with MR spectroscopy revealed an enhancing lesion involving the right motor and sensory cortex with marked perilesional edema that suggested a brain abscess. A chest CT revealed a pulmonary AVF in the right upper lung. The pulmonary AVF was obliterated with embolization. There needs to consider pulmonary AVF as an etiology of cerebral abscess when routine investigations fail to detect a source.