• Annals of Clinical Neurophysiology
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• 제4권2호
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• pp.140-145
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• 2002

Neurologic sequelae of tuberculous meningitis include hemiparesis, paraparesis, quadriparesis, aphasia, developmental delay, dementia, blindness, visual field defect, deafness, cranial nerve palsies, epilepsy, and hypothalamic and pituitary dysfunction. But cervical epidural abscess and cervical spondylitis are rare. A 64-year-old woman who was diagnosed as tuberculous meningitis presented a severe neck pain and stiffness after 3 weeks of anti-tuberculous medication. Electromyography and cervical X-ray showed a cervical spondylosis with polyradiculopathy. But cervical MRI showed an acute cervical epidural abscess and mild cervical spondylitis. After continuous anti-tuberculous medication with supportive care, she showed a slow clinical improvement. But about 1 month of anti-tuberculous therapy, she presented a more aggravation of neck pain, neck stiffness, radicular pain, and neck motion limitation. Follow-up cervical MRI showed an more advanced cervical spondylitis. Afterthen she has recovered slowly by cervical laminectomy with posterior stabilization and continuous anti-tuberculous medication.

• Annals of Clinical Neurophysiology
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• 제4권2호
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• pp.98-107
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• 2002

Multifocal motor neuropathy (MMN) is a chronic immune-mediated peripheral myelinopathy. The major clinical features include slowly progressive, painless, and asymmetric weakness, usually of distal limb muscle. Early in the course of the disease, weakness is not necessarily associated with muscle atrophy, owing to the initial primary involvement of peripheral myelin. Chronic progressive weakness is often associated with some degree of concurrent axonal loss and subsequent muscle atrophy. Sensory symptoms are usually mild or absent, and involvement of cranial and respiratory muscles is rare. The findings of multifocal motor conduction block, abnormal temporal dispersion, and focal conduction slowing at segments not at risk for common entrapment or compression injury, associated with normal sensory conduction studies along the same segments, are the hallmark electrophysiologic features of MMN. The slow progression and absence of upper motor neuron signs are the major clinical points that separate MMN from amyotrophic lateral sclerosis. The role of GM1 antibodies, found in high titers in 22~84% of MMN patients, remains uncertain. The contention that MMN is an autoimmune disorder is largely based on the often dramatic improvement in symptoms following the administration of intravenuos immunoglobulin or cyclophosphamide.

• Annals of Clinical Neurophysiology
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• 제2권2호
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• pp.130-134
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• 2000

저자들은 최근 글을 쓰는 자세에서는 진전이 나타나지 않고 글을 쓸 때에만 진전이 나타나는 전형적인 원발성 진전 A형을 경험하였기에 이를 보고하며, 본 증례를 통해 원발성 서자진전 A형은 표현 양상으로는 서로 다르나 병태생리적으로 서자경련과 유사한 질환임을 추정해 볼 수 있었다.

• Annals of Clinical Neurophysiology
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• 제1권1호
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• pp.70-75
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• 1999

Trancranial Doppler(TCD) monitoring is a new application of ultrasonography which allows the nonivasive detection of blood flow velocity in the horizontal (M1) segment of the middle cerebral artery (MCA) and detects microembolic phenomena in the cerebral circulation. Recent studies emphasized the potential of using this technique in vascular surgery (carotid endarterectomy, cardiopulmonary bypass), interventional and intensive care setting. Although the disparity between CBF and blood flow velocity and number of microemboli could be used to prevent cerebral ischemic and embolism based on clinical studies. A reduction of more than 60% of MCA can reflex hemodynamic ischemic state and acoustic feedback of high intensity transient signals(HITS) from the TCD monitoring unit has a direct influence on surgical technique. TCD monitoring can immediately provide information about thromboembolism and hemodynamic changes, which may be a useful tool in the study and prevention of stroke.

• Annals of Clinical Neurophysiology
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• 제1권1호
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• pp.55-59
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• 1999

Vasoconstriction of intracerebral arteries is the leading cause of delayed cerebral infarction and mortality following aneurysmal subarachnoid hemorrhage. Transcranial Doppler studies show and increase in the flow velocities of basal cerebral arteries, which usually start around day 4 following a subarachnoid hemorrhage, and peaking by days 7 to 14. Angiographic studies confirm the presence of at least some degree of MCA vasospasm when the flow velocities are higher than 100 cm/sec. Mean velocities in the 120 to 200 cm/sec range correspond to 25 to 50% luminal narrowing. MCA and ACA vsospasm is detected with around 90% specificity. Sensitivity is 80% and 50% respectively. A 200cm/sec threshold and rapid flow velocity increase exceeding 50 cm/sec on consecutive days, has been associated with subsequent infarction. Transcranial Doppler is also used to monitor the effects of endovascular treatment of vasospasm. Flow velocities decrease following successful angioplasty or papaverine infusion. Overall, transcranial Doppler studies are considered to have acceptable accuracy for the evaluation of vasospasm in aneurysmal subarachnoid hemorrhage, with limitations that have to be taken into consideration in the clinical setting.

• Annals of Clinical Neurophysiology
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• 제1권1호
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• pp.60-63
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• 1999

Transcranial Doppler(TCD) is an important diagnostic tool for evaluating the patients with stroke. It has some advantages and unique role when compared with other neuroimaging modalities. Recent development of transcranial color-coded Doppler(TCD) improves the limitation and pitfalls of TCD. The current indications of TCD are as follows: 1. Screening and evaluation of the intracranial major vessels 2. early detection and follow-up of vasospasm due to SAH 3. emboli detection (high-imtensity transient signals, HITs) 4. dignosis and follow-up of subclavian steal 5. evaluation of intracranial collaterals when the extracranial ICA has severe stenosis or occlusion 6. evaluation of cerebral perfusion pressure (intracranial pressure) 7. evaluation of arteriovenous malformation 8. diagnosis and follow-up of arterial dissenction 9. diagnosis and follow-up of venous sinus thrombosis (experimental).

• Annals of Clinical Neurophysiology
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• 제2권2호
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• pp.95-100
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• 2000

Purpose : Primary writing tremor(PWT) can be classified as either type A or type B depending on whether tremor appeared during writing or whilst writing and also on adopting the hand postures normally used for writing. Through the clinical experience author has had an impression that PWT type B may not be purely dependant on specific writing postures. The objective of this study was to clarify whether PWT type B have writing posture-specificity or not. Results : The data indicated that type B PWT is not writing posture-specific. Various pronation and supination postures could evoke tremor as well as writing postures. Furthermore most of other pronation- and supination-related tasks could evoke tremors as well as action of writing. Conclusions : The present data suggest that PWT should be limited only on the pure form of task-spesific PWT type A.

• Annals of Clinical Neurophysiology
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• 제1권1호
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• pp.39-46
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• 1999

Transcranial doppler ultrasonography (TCD) is a new, non-invasive and easily applicable method to evaluate cerebral hemodynamics. Last 10 years, its use in Korea has been dramatically expanded, but the qualification of TCD laboratory has yet to be settled. Since duplex sonography is seldom used in Korea, we have to depend totally on TCD to evaluate cerebral hemodynamic changes. Thus, all of the available data from every detectabler cerebral arteries has to be obtained for accurate interpretation of TCD measurements. Moreover, flow direction and wave form should be concerned in addition to the flow velocity. In this article, I present technique to measure the anterior, meddle and posterior cerebral arteries, the internal carotid artery siphon and at cervical level, and the vertebral and the basilar artery, and normal values for these measurements which is essential for the adequate interpretation.

• Annals of Clinical Neurophysiology
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• 제1권1호
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• pp.47-54
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• 1999

The Doppler in neurosonologic examination could be applied to blood flow to determine its movement, the direction of its movement, and how fast it is. Indicies of the Doppler study denoted velocity, direction, and amount of RBC in the examined vessel. Systolic. diastolic, and mean blood flow velocities represent velocity of RBCs in a sample volume. Blood flow direction to the probe means direction of RBC to the probe. Size of amplitude displays toe amount of the RBCs passing the sample volume. Spectral broadening means presence of turbelence. The RBC movements and hemodynamics at the examined vessels can be estimated by analysis of Doppler indicies The formation and meaning of each of neurosonologic Doppler study is described in the present review.

• Annals of Clinical Neurophysiology
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• 제2권2호
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• pp.63-69
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• 2000

The majority of patients who present with muscle pain does not have a definable myopathic disorder in the usual sense, despite intensive evaluation. Currently, most of these individuals are diagnosed with the syndrome of fibromyalgia, a condition that has been discussed under a number of different names for approximately a century. Fibromyalgia is a form of nonarticular rheumatism characterized by widespread musculoskeletal aching and stiffness, as well as tenderness on palpation at charateristic sites, called tender points. The American College of Rheumatology in 1990 set criteria for the diagnosis of fibromyalgia as that includes at least 3 months of widespread pain and the presence of at least 11 of 18 specific tender points on examination.