• Journal of Yeungnam Medical Science
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• v.30 no.1
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• pp.25-30
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• 2013

Hyponatremia, the most common electrolyte disorder, has been rarely reported as causing rhabdomyolysis. Osmotic demyelination syndrome (ODS), a demyelinating disease of the central pons and/or other areas of the brain, is infrequently reported as associated with rapid correction of hyponatremia. This paper reports a case of ODS after correction of severe hyponatremia complicated by rhabdomyolysis. A 47-year-old female with a history of chronic alcoholism presented herself at the hospital with altered consciousness after three days of nausea and vomiting. She was on a thiazide diuretic for essential hypertension. Her blood tests upon her hospital admission showed hyponatremia ($Na^+$ 98 mEq/L), hypokalemia ($K^+$ 3.0 mEq/L), and elevation of her serum creatine phosphokinase (3,370 IU/L) with an increase in her serum myoglobin level 11,267 ng/mL). She was treated with intravenous fluid therapy that included isotonic and hypertonic salines along with potassium chloride. She became more alert, and her neurological condition gradually improved after the first five days of her therapy. On the ninth day after her admission, she developed progressive quadiaresis associated with dysarthria, dysphagia, and dystonia despite the resolution of her hyponatremia. Magnetic resonance imaging of her brain on 16th day revealed symmetrical areas of signal hyperintensity in her central pons, basal ganglia, and precentral gyrus in T2-weighted images, which are consistent with ODS. Her neurological symptoms steadily improved after six weeks with only supportive treatment and rehabilitation.

• Journal of Korean Neurosurgical Society
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• v.37 no.2
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• pp.112-115
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• 2005

Objective: Thalamic lesioning and deep brain stimulation(DBS) have proved to be beneficial to the treatment of essential tremor(ET). The authors compared the effects and complications of two modalities. Methods: A total of 34 patients with ET were treated with ventral intermediate(Vim) nucleus thalamotomy or Vim DBS from May 1999 to May 2003. The procedure of lesioning or stimulation were performed as usual manner with or without microelectrode recording. Postoperatively, utilizing the various combinations of frequency, voltage and pulse width optimized the stimulation. The degree of improvements of tremor and the occurrence of the complications were evaluated postoperatively and at follow-up. Results: There were 38 procedures, including 27 with Vim thalamotomy and 11 with DBS, in 34 patients. Of the thalamotomy group, left Vim lesioning is 25 and right one is 2. Follow-up duration ranged from 12 to 57 months. In the thalamotomy group, the rate of overall good outcome was 88.9% but 12 patients (44.4%) showed permanent adverse effects. In the cases of stimulation, the rate of overall good outcome was 90.9% and two patients had acceptable dysarthria. Conclusion: Both Vim thalamotomy and Vim DBS were effective for the treatment of ET, although perioperative adverse effects tended to be higher in patients who had thalamotomy. In cases of DBS, adjustments of stimulation parameters enabled an acceptable position to be achieved with tremor control and unwanted effects.

• Journal of Korean Neurosurgical Society
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• v.46 no.4
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• pp.346-350
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• 2009

Objective : The purpose of this study was to analyze in detail the relationship between outcome and time course of effect in medically refractory primary cervical dystonia (CD) with phasic type that was treated by bilateral globus pallidus internus (Gpi) deep brain stimulation (DBS). Methods : Six patients underwent bilateral implantation of DBS into the Gpi under the guide of microelectrode recording and were followed for $18.7{\pm}11.1$ months. The mean duration of the CD was $5.8{\pm}3.4$ years. The mean age at time of surgery was $54.2{\pm}10.2$ years. Patients were evaluated with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and relief scale using patient self-reporting. Results : The TWSTRS total scores improved by 64.5%, 65.5%, 75.8%, and 76.0% at 3, 6, 12 months, and at the last available follow-up after surgery, respectively. Statistically significant improvements in the TWSTRS scores were observed 3 months after surgery (p=0.028) with gradual improvement up to 12 months after surgery, thereafter, the improvement was sustained. However, there was no statistically significant difference between the scores at 3 and 12 months. Subjective improvement reported averaged $81.7{\pm}6.8%$ at last follow-up. Mild dysarthria, the most frequent adverse event, occurred in 3 patients. Conclusions : Our results show that the bilateral Gpi-DBS can offer a significant therapeutic effect from 3 months postoperatively in patients with primary CD with phasic type, without significant side effects.

• Clinical and Experimental Pediatrics
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• v.53 no.4
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• pp.607-611
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• 2010

Bickerstaff's brainstem encephalitis (BBE) is a rare disease diagnosed by specific clinical features such as 'progressive, relatively symmetric external ophthalmoplegia and ataxia by 4 weeks' and 'disturbance of consciousness or hyperreflexia' after the exclusion of other diseases involving the brain stem. Anti-ganglioside antibodies (GM, GD and GQ) in the serum or cerebrospinal fluid (CSF) are sometimes informative for the diagnosis of BBE because of the rarity of positive findings in other diagnositic methods: brain magnetic resonance imaging (MRI), routine CSF examination, motor nerve conduction study, and needle electromyography. We report a rare case of childhood BBE with elevated anti-GM1 antibodies in the serum, who had specific clinical symptoms such as a cranial polyneuropathy presenting as ophthalmoplegia, dysarthria, dysphagia, and facial weakness; progressive motor weakness; altered mental status; and ataxia. However, the brain MRI, routine CSF examination, nerve conduction studies, electromyography, somatosensory evoked potentials, and brainstem auditory evoked potentials were normal. BBE was suspected and the patient was successfully treated with intravenous immunoglobulins.

• Archives of Plastic Surgery
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• v.36 no.1
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• pp.80-83
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• 2009

Purpose: Isolated hypoglossal nerve palsy is a rare manifestation of various underlying disease. This article presents a rare complication of general anesthesia associated with an surgical procedure on a case of zygomatic fracture. Methods: An 18-year-old female patient was referred to our department by painful swelling on her left zygomatic area after the traffic accident. Left zygomatic complex fracture was identified on the simple x-ray and facial bone CT scan, and the fracture was treated with open reduction and internal fixation under general anesthesia. On the first postoperative day, she complained of difficulty in swallowing solid food, dysarthria and deviated tongue to her right side. There was no abnormal findings on the neurological examination, brain MRI and routine chemistry. She was diagnosed with transient hypoglossal nerve palsy and dexamethasone with multi-vitamins was administrated intravenously for 5 days. Results: The symptoms were completely resolved by the ninth postoperative day and the patient was discharged without any other complications. Conclusion: The hypoglossal(cranial nerve XII)nerve supplies motor innervation to all of the ipsilateral extrinsic and intrinsic tongue muscles. The hypoglossal nerve damage may caused by the compression between the airway and the hyoid bone during the endotracheal intubation, and direct trauma due to excessive pressure or neck extension. We described a rare case of unintended injury to hypoglossal nerve and care must be taken not to cause the hypoglossal nerve damage especially in facial plastic surgery with excessive neck extension under general anesthesia.

• The Journal of Korean Medicine
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• v.16 no.2 s.30
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• pp.100-114
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• 1995

This bibliographic study was designed to research indications of the Moschus which was representatively used for resuscitation in acute stage of stroke throughout successive books of oriental medicine. Especially, in this study, severe cases with disturbance of consciousness and acute stage of stroke were investigated. The results were summarized as the followings: 1. The Moschus was dried material which secreted from aromatic vescicle of Moschus moschiferus L.. which was pungent in flavor, warm in nature, nontoxic and strongly aromatic. The Moschus removed the obstruction in the channels and used to early stage of stroke. 2. The Moschus was aromatic resuscitatable medicine, which recovered disturbance of consciousness due to stroke. 3. The Moschus had excitatory actions of respirtory center and vascular motor center, heart stimulating action, inhibitatory action of the platelet aggregation and anti thrombin action and recovered cerebral ischemic change. According to these actions, the Moschus could be used cerebral infarction. 4. Prescriptions included the Moschus was used to symptoms of unconsciousness, secretion, stuporous mental state, dysarthria, facial palsy and hemiplegia. That was Angungwoohwangh wan(安宮牛黃丸), Woohwangchungshimwon(牛黃淸心元), Sahyangsohaphangwon(麝香蘇合香元), etc. According to the above mentioned results, the Moschus was aromatic resuscitatable medicine which was used for symptoms of conscius disturbance, convulsion, sudden fainting etc., promoted cerebral blood flow and had good effect on acute stage of stroke and severe cases with conscious disturbance. Therefore, it is considered that the Moschus must be studied for effect of cerebral infarction and hemorrhage in clinic with animal's and pharmacological experimental results.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.10 no.1
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• pp.159-184
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• 1997

A Literature study on the language disturbance, the results are as follows; 1. Utterance was closely concerned not only the vocal organs(pharynx, larynx, epiglottis, lips, tongue, vocal cord etc,) but also five viscera{especially heart, lung, kidney etc.) in The Yellow Emperor's Canon of Internal Medicine. It is very like the vocal mechanism in Medical science. 2. In the language disturbance, It is classified with dysarthria and dysphasia in Medical science. But in Oriental medicine, it is expressed the language disturbance as coma-speech lessness, stiff tongue-speechlessness, frightening-speechlessness etc. Especially in Oriental medicine, Non-utterance is called aphasia in literature study. 3. In the concern of the language disturbance and five viscera, $Heart{\cdot}Lung{\cdot}Kidney$ are counted of first importence. In differential diagnosis, It is divided sthenia-syndrome and asthenia-syndrome. Sthenia-syndrome is classified with wind-cold, fire-evil, adverseness of vital energy, stagnation of phlegm, is easy to cure. Asthenia-syndrome is classified with sexual desire, anxiety-meditation, fear, is hard to cure. 4. The pathogenesis of dysphasia originated from two factors; The first internal damages are consumption of body fluid caused by lung-dryness and yin-dificiency of lung & kidney. The second disease caused by exogenous evjls is sluggishness of lung-energy. 5. In many using points of acupuncture of the language disturbance, the order is LI-4(合谷), H-7(神門), K-l(湧泉), L-3(太衝), K-3(太谿), S-6(三陰交), H-5(通里), G-15(아門), C-23(廉泉), S-40(豊降), K-6(照海), L-7(列缺), S-36(足三里) etc.

• Phonetics and Speech Sciences
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• v.3 no.1
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• pp.135-143
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• 2011

This study evaluated the respiratory capacity of spastic cerebral palsy children who were grouped by GMFCS (Gross Motor Function Classification System) levels and identified the acoustic characteristics of three different types of Korean stops (stop consonants) which are needed for the temporal coordination of larynx and supra-larynx, in these children. Thirty-two children with dysarthria due to spastic cerebral palsy were divided into two subgroups: 14 children classified at GMFCS levels I~III were placed in Group 1 and 18 classified at GMFCS levels IV~V were placed in Group 11, and 18 children with normal speech were selected and placed in the control group. /a/ pronged phonation (sustained vowel /a/) and nine Korean VCV syllables were used. Examined acoustic characteristics were maximum phonation time (MPT) and closure duration and aspiration duration. The results were as follows: 1) The MPTs of the cerebral palsy (CP) groups, both Group I and Group II, were significantly shorter than those of the normal group. 2) The closure durations of the two CP groups were longer than those of the normal group for all 9 target syllables. 3) The aspiration durations of the two CP groups were longer than those of the normal group. 4) The closure duration of the normal and CP Group I was significantly different among tense, aspirated, and lax. However, the CP Group II was different from normal. 5) The aspiration duration of the normal and CP Group I was significantly different among aspirated, tense, and lax. However, the CP Group II was different from normal. 6) The place of articulation influenced less than the manner of articulation on closure and aspiration duration.

• Phonetics and Speech Sciences
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• v.3 no.1
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• pp.103-110
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• 2011

Idiopathic Parkinson's Disease patients' speech is hypokinetic dysarthria and their speech is possibly the consequence of impaired respiratory support. The purpose of this study was focused on the respiratory characteristics of speech breathing in de novo IPD who were not given prior vocal or anti-Parkinson treatment. A total of 40 subjects participated in the study: 20 de novo IPD patients between the ages of 50 and 80, and 20 normal subjects with similar age, height, and weight matches. Forced Expiratory Vital Capacity (FVC), Forced Expiratory Volume in 1 sec (FEV1) and $FEV_1$ as a percentage of FVC (FEV1/FVC) was measured with a PC-based spirometer (Cosmed). In addition, Maximum Phonation Time (MPT), Mean Airflow Rate (MFR), Subglottal Pressure (Psub) and the number of syllables produced per breath were measured with a Phonatory Aerodynamic System (Kay PENTAX). All subjects were asked to read a standardized Korean paragraph and the following measurements were obtained from the task. Results indicated no statistically significant differences in respiratory function (FEV1/FVC%) and aerodynamic function between the two groups, but the number of syllables per breath was significantly lower in the IPD patient group than in the normal group and it could be predicted by FVC and MFR. Therefore, the study shows that the MFR from the lungs during speech in de novo IPD patients is used inefficiently.

• The Journal of Internal Korean Medicine
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• v.37 no.2
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• pp.143-155
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• 2016

Objective: This study reports on three cases of cerebellar artery infarction patients treated by traditional Korean medicine.Method: Three patients with cerebellar artery infarction according to cerebellar artery were treated by traditional Korean medicine at the traditional Korean medicine hospital of Daejeon University. The posterior cerebral artery (PCA) infarction patient had ataxia, dysarthria, gait disturbance, and dizziness; the anterior inferior cerebellar artery (AICA) infarction patient had facial palsy, dizziness, and hearing loss; and the posterior inferior cerebellar artery (PICA) infarction patient had gait disturbance and dizziness. Acupuncture, herbal medicine, and pharmacopuncture were used as traditional Korean medicine treatments during hospitalization. We then observed any improvement in the symptoms.Results: The scale for the assessment and rating of ataxia (SARA) score (gait, stance) of the PCA infarction patient was reduced from 8.6 to 2.2, while the dizziness numerical rating scale (NRS) score was reduced from 10 to 2 after treatment. The Yanagihara score of the AICA infarction patient was reduced from 27 to 14, while the dizziness NRS score was reduced from 10 to 2 after treatment. The SARA score (gait, stance) of the PICA infarction patient was reduced from 7.4 to 1.0, and the dizziness NRS score was reduced from 10 to 1 after treatment.Conclusion: Traditional Korean medicine appears to be effective in treating cerebellar infarction symptoms.