• Investigative Magnetic Resonance Imaging
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• v.13 no.1
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• pp.54-62
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• 2009

Purpose : Craniospinal neurenteric (NE) cysts are rare developmental non-neoplastic cysts of the central nervous system with diverse MR imaging findings. The purpose of this study was to evaluate various MR imaging findings of intracranial and intraspinal NE cysts. Materials and Methods : We retrospectively reviewed the MR imaging findings of six NE cysts that were confirmed by pathology. We evaluated anatomic location, signal intensity, size and enhancement pattern of NE cysts. Results : Two intracranial lesions were located extra-axially in the cerebellopontine angle and quadrigeminal cisterns. Three spinal lesions were intraduralextramedullary cysts, located ventral to the spinal cord, but one thoracic lesion was an intramedullary cyst. The signal intensity of the cysts was hyperintense on T1-weighted images as compared with the cerebrospinal fluid (CSF) for two intracranial lesions and one cervical lesion. In addition, all intracranial lesions showed diffusion restriction. For the remaining three spinal lesions, the signal intensity was nearly the same as the signal intensity of the CSF as seen on both T1- and T2-weighted images. On contrast-enhanced studies, two intracranial cysts showed a small nodular enhancement and one thoracic spinal lesion showed rim enhancement. Conclusion : NE cysts have various locations, signal intensities, and possible focal nodular or rim enhancement. Therefore, NE cysts can be included in the differential diagnosis of various craniospinal cystic or tumorous cystic lesions.

• Journal of Chest Surgery
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• v.35 no.4
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• pp.255-260
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• 2002

Paraplegia remains unresolved as the most dreaded operative complication with surgical treatment of descending thoracic and thoracoabdominal aortic diseases. In this study, the neuroprotective effect of trimetazidine that has been used clinically for ischemic heart disease was investigated in a rabbit spinal cord ischemia model. Material and Method: Thirty-three New Zealand white rabbits were randomized as follows: control group undergoing abdominal aortic occlusion but receiving no pharmacologic intervention(Group 1, n= 17); TMZ group(Group 2, n= 16) receiving 3 mg/kg trimetazidine intravenously before the occlusion of the aorta. Ischemia was induced by clamping the abdominal aorta just distal to the left renal artery for 30 minutes. Neurologic status was assessed at 2, 24, and 48 hours after the operation according to the modified Tarlov scale, then the lumbosacral spinal cord was processed for histopathologic examinations 48 hours after the final assessment. Result: The average motor function score was significantly higher in the TMZ group(3.20 $\pm$ 0.77 vs 1.13 $\pm$ 1.25 at 2 hours, 3.50 $\pm$ 0.76 vs 1.45 $\pm$ 1.57 at 24 hours, and 3.91 $\pm$ 0.30 vs 1.86 $\pm$ 1.86 at 48 hours after operation; p value$\leq$0.05). Histologic observations were correlated with the motor scores. Conclusion: The results suggested that trimetazidine reduced spinal cord injury during aortic clamping and that it may have clinical utility for the thoracoabdominal aortic surgery:

• Journal of Korean Medicine Rehabilitation
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• v.18 no.4
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• pp.39-61
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• 2008

Objectives : The present study was performed to investigate whether acupuncture stimulation in the rats affected regeneration properties of the injured sciatic nerve. A differential effect of acupuncture stimulation on the one point near the spinal nerve root controlling sciatic nerve activity and the other point in the peripheral area subordinated by injured nerve was compared. Materials and Methods: Rat sciatic nerves were injured by crush, and the effects on axonal regeneration on injured sciatic nerves were evaluated by acupuncture stimulation at two different regions. In proximal acupuncture stimulation group, acupuncture stimulation was performed on Huatuo Jiaji(EX B2) points located from L5 to S1 vertebral levels to stimulate the nearest spinal nerve root that innervates sciatic nerves. In distal acupuncture stimulation group, acupuncture stimulation was performed on Zusanli(ST 36) and Weizhong(BL 40) points to stimulate at peripheral area dominated by injured sciatic nerves. Acupuncture stimulation was given every other days for 1 or 2 weeks. Sciatic nerve tissues collected from acupuncture stimulation experimental groups, injury control group, and intact animal group were used for protein analysis by Western blotting or Hoechst nuclear staining. To determine axonal regeneration, Dil fluorescence dye was injected into the sciatic nerve 0.5 cm distal to the injury site in individual animal groups and Dil-labeled cells by retrograde tracing were measured in the DRG at lumbar 5 or in the spinal cord. DRG sensory neurons prepared from individual animal groups were used to measure the extent of neurite outgrowth and for immunofluorescence staining with anti-GAP-43 antibody. Results : Animal groups given proximal or distal acupuncture stimulation showed upregulation of GAP-43 and Cdc2 protein levels in the sciatic nerve at 7 days after injury. Cdk2 protein levels were strongly induced by nerve injury, but did not show changes by acupuncture stimulation. Phospho-Erk1/2 protein levels were elevated by acupuncture stimulation above those present in the injury control animals. These increase in regeneration-associated protein levels appeared to be related with increase cell proliferation in the injured sciatic nerves. Hoechst 33258 staining of sciatic nerve tissue to visualize nuclei of individual cells showed increased Schwann cell number in the distal portion of the injured nerve 7 and 14 days after injury and further increases by acupuncture stimulation particularly at the proximal position. Measurement of axonal regeneration by retrograde tracing showed significantly increased Dil-labeled cells in proximal acupuncture stimulation group compared to distal acupuncture stimulation group and injury control group. Finally, an evaluation of axonal regeneration by retrograde tracing showed increased number of Dil labeled cells in the DRG at lumbar 5 or in the ventral horn of the spinal cord at lower thoracic level at 7 days after nerve injury. Conclusions : The present data show that the proximal acupuncture stimulation at Huatuo Jiaji(EX B2) points governing injured sciatic nerves was more effective for axonal regeneration than the distal acupuncture stimulation. Further studies on functional recovery or associated molecular mechanisms should be critical for developing animal models and clinical applications.

• Journal of Korean Orthopaedic Sports Medicine
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• v.4 no.1
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• pp.29-35
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• 2005

Purpose: The anterior cruciate ligament(ACL) has a neuromuscular control function as evidenced by the presence within it of mechanoreceptor. Although these mechanoreceptors have been identified, the afferent somatosensory pathways from ACL to the cerebrum have yet to be demonstrated in their entirety. In order to trace these afferent pathway, we conducted a viral trans-synaptic tracing experiment using the neurotropic pseudorabies virus(PRV). Material and Methods: The PRV was injected into the ACL of rats and allowed to replicate and spread trans-synaptically for 6 to 7 days. The brain and spinal cord of each sacrificed rat was then removed and processed immunohistochemically to detect the presence of PRV. Results: PRV-immunoreactive neurons were found to be localized in several different regions from the spinal cord to the cerebrum. Four nuclei in the reticular formation of the brain stem demonstrated strong positive labeling: the mesencephalic reticular nucleus, magnocelluar reticular nucleus, paragigantocellular reticular nucleus, and gigantocellular reticular nucleus. Conclusions: This findings suggests that the nerve endings of the rat ACL project into the cerebrum and that the reticular formation may play an important role in the afferent pathway of those nerve endings.

• Anatomy & Biological Anthropology
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• v.29 no.4
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• pp.145-154
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• 2016

The purpose of this study was to provide basic biometric data on Korean adults through magnetic resonance imaging (MRI)-based measurements of the distances between the apex of sacral hiatus (SH) and the termination of dural sac (DS), and between SH and conus medullaris (CM) because they are critical to the performance of epidural neuroplasty. A total of 200 patients(88 males and 112 females) with back pain, who had no spine fracture, significant spinal deformity, and spondyloisthesis were selected for this study. The subjects were of mean age 54.3 (20~84) years and mean height 161.3 cm (135~187). T2-weighted MRI images were used for correlation analysis to evaluate the relationships between the distances, and variables such as sex and height. In all patients, the mean distance between SH and DS was $62.8{\pm}9.4mm$ and the mean distance between SH and CM was $232.2{\pm}21.8mm$. The minimum distance and the maximum distance between SH and DS were 34.8 mm and 93.9 mm respectively, and the minimum distance and the maximum distance between SH and CM were 155.0 mm and 284.0 mm respectively. In female patients, both the distances between the SH and DS, and between SH and CM were shorter when compared to those of the male patients(p<0.05). Both the distances between SH and DS and between SH and CM showed a significant correlation with height(p<0.01). The results of this study will provide a useful biometric data on the distances between SH and DS and between SH and CM in Korean in ensuring clinical safety and in the development of more effective catheterization techniques for epidural neuroplasty in Korean.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.1 no.2
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• pp.128-133
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• 2008

Nerve compression is caused by external force or internal pathology, which symptom develops along nerve distribution. There are median, ulnar and radial nerve compression neuropathies below elbow. Carpal tunnel syndrome at the flexor retinaculum is most common among all the entrapment neuropathies. Other causes of median nerve neuropathy include Struther's ligament, biceps aponeurosis, pronator teres, FDS aponeurosis and aberrant muscles, which induce pronator syndrome or anterior interosseous nerve syndrome. Ulnar nerve can be compressed at the elbow by arcade of Struther, medial epicondylar groove, FCU two heads, which develops cubital tunnel syndrome, at the wrist by ganglion, fracture of hamate hook and vascular problem, which develops Guyon's canal syndrome. Radial tunnel syndrome is caused by supinator muscle, which compresses its deep branch. Treatment is conservative at initial stage like NSAID, night splint or steroid injection. If symptom persists, operative treatment should be considered after electrodiagnostic or imaging studies.

• Journal of Korean Neurosurgical Society
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• v.29 no.6
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• pp.805-809
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• 2000

Hemangioblastoma of the central nervous system rarely occurs in cervicomedullary junction. The unique pathologic features of the tumor involving midline structures are grossly solid in consistency and accompanying extensive spinal cord enlargement. A 63-year-old women presented with progressive right motor weakness and tingling sensation. The MR image showed a well enhancing mass having a cyst and diffuse cord enlargement in the cervicomedullary junction. A total surgical resection was performed and hemangioblastoma was histologicaly verified. Postoperative MR image showed the disappearance of cord enlargement. The right motor weakness was also improved. The authors report a rare case of hemangioblastoma in cervicomedullary junction and the pathophysiology of the spinal cord enlargement are discussed.

• The Journal of Korean Physical Therapy
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• v.11 no.3
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• pp.71-79
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• 1999

본 연구의 목적은 균형 훈련이 중추신경계 손상자들의 자세 조절 및 중추감각신경전도로에 미치는 영향을 규명하는데 있다. 연구대상자는 중추신경계 손상자로써 실험군 10명, 통제군 10명 등 총 20명을 선정하였으며, 실험군은 본 연구의 훈련 프로그램에 따라 12주간 force platform을 이용하여 균형훈련을 실시토록하였다. 자세조절 변인의 측정은 운동처치 전, 처치 후 8주 및 12주 후에 대상자들의 동적 및 정적 자세에서의 흔들림을 Dynamic Balance System을 이용하여 측정하였고, 체성감각 유발전위의 말초신경 근위부 유발전위$(N_9)$ 잠복기, 척수 유발전위$(N_{13})$ 잠복기, 뇌 유발전위 $(N_{20})$ 잠복기는 Neurotec을 이용하여 측정 분석한 결과 다음과 같은 결론을 얻었다. 1. 정적 자세 조절 요인의 경우, 좌우 흔들림과 전후 흔들림은 실험군에서 8주 후부터 유의하게 (p<.05) 감소하였고, 실험군이 통제군에 비해 운동처치 8주 및 12주 후에 각각 유의하게(P<.05, P<.01) 흔들림이 감소하였다. 2. 전후 이동면과 전후 기울기면에서 동적 자세 조절의 변화는 전후 이동면에서 좌우 흔들림과 전후 흔들림은 실험군에서 8주 후부터 유의하게 (P<.05) 감소하였으며, 실험군이 통제군에 비해 운동처치 8주 및 12주 후에 각각 유의하게 (P<.05, p<.01) 흔들림이 감소하였다. 3. 체성감각 유발전위의 잠복기 변화는 실험군과 통제군에 있어서 말초신경 근위부 유발전위$(N_9)$ 잠복기와 척수 유발전위$(N_{13})$ 잠복기가 다소 증가하였으나 유의한 차이는 나타나지 않았으며, 실험군에 있어서 뇌 유발전위 $(N_{20})$ 잠복기는 8주 후부터 유의하게 (P<.05) 증가하였다. 이상의 결과를 종합해 볼 때, 12주의 균형 훈련은 자세 조절에 있어서 전후와 좌우의 흔들림을 감소시킴으로써 정적인 상태나 동적인 상태에서의 자세 안정성을 증가시킬 수 있음을 시사하고 있다. 이는 자세 조절에 필요한 항중력근의 긴장성 수축을 유발시킬 뿐만 아니라 근육 긴장분포를 조절할 수 있다는 것으로 신경근 조절 기능의 향상을 의미하는 것으로 사료된다. 또한 뇌 유발전위 $(N_{20})$ 잠복기의 증가는 중추신경계의 감각기능의 신경학적 회복을 의미하는 것으로 중추신경계의 감각 운동통합에도 영향을 미쳐 운동기능의 향상을 기대할 수 이을 것으로 사료된다.

• The Korean Journal of Pain
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• v.22 no.1
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• pp.107-111
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• 2009

Neuroablation should be performed cautiously because neuropathic pain can occur following denervation of a somatic nerve. A 34-year-old man presented with severe penile pain and allodynia following a selective neurectomy of the sensory nerve that innervated the glans penis for treatment of his premature ejaculation. He was treated with various nerve blocks, including continuous epidural infusion, lumbar sympathetic block and sacral selective transforaminal epidural blocks, as well as intravenous ketamine therapy. However, all of the treatments had little effect on the relief of his pain. We performed spinal cord stimulation as the next therapy. After this therapy, the patient has currently been satisfied for 3 months.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.7 no.1
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• pp.49-66
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• 2014

Traditionally, cervical interventions have been performed under fluoroscopy. But radiation exposure is the major concern when obtaining fluoroscopic images and even under real-time fluoroscopy with contrast media or CT guidance, some cases of serious spinal cord injuries, cerebellar and brain stem infarction have been reported by unintentional intra-arterial injections especially during the transforaminal root blocks. Recently, the use of ultrasound-guided cervical interventions have increased. Ultrasound offers visualization of soft tissues including major neurovascular structures and also allows to observe the spread of injectant materials around the target structure. Ultrasound is radiation free, easy to use and the image can be performed continuously while the injectant is visualized in real-time, increasing the precision of injection. Importantly, ultrasound allows visualization of major nerves and vessels and thus leads to improve safety of cervical interventions by decreasing the incidence of injury or injection into nearby vasculature. We therefore reviewed to investigate the feasibility of performing cervical interventions under real-time ultrasound guidance.