• Clinical and Experimental Pediatrics
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• 제50권8호
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• pp.761-766
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• 2007

목 적 : 소아에서 진단 목적으로 척수액 검사를 시행한 환아에서 천자 후 부작용으로 발생하는 두통의 발생 빈도와 영향을 끼치는 인자들에 대해 알아보고자 본 연구를 하였다. 방 법 : 2005년 3월부터 2006년 2월까지 조선대학교 병원 소아과에서 진단 목적으로 요추천자를 시행한 4세에서 13세 사이의 환아 중 뇌수막염이 의심되었던 44명을 대상으로 하였다. 요추천자 후 두통의 발생빈도와 성별, 연령, 요추 천자 횟수, 척수액 양, 두통의 과거력, 척수액 압력, 척수액내 백혈구 수의 각 인자들과 두통 발생사이의 상관성, 두통의 발생 시작시간과 지속시간 및 치료에 대해서 조사하였다. 결 과 : 천자 후 두통의 발생빈도를 보면 전체 44명 중 16명(36.4%)에서 발생했으며, 남녀가 각 39.4%(13명), 27.2%(3명)로 성별에서는 유의한 차이는 없었다. 두통의 과거력이 있는 6명중 50%(3명)에서 두통이 발생하였고, 과거력이 없는 38명 중 36.1 %(13명)에서 발생하여 두통의 과거력이 있는 경우 두통이 의의 있게 많이 발생하였다(P=0.037). 척수액내 백혈구 세포수가 많을수록 요추 천자 후 두통의 발생은 통계학적으로 의의 있게 많았다(P=0.012). 그 외 연령, 척수액 검사 횟수, 척수액 양, 척수액 압력과 천자 후 두통 발생 사이에는 통계학적 상관성이 없었다. 결 론 : 요추 천자 후에 두통은 기존의 다른 연구에서 보다 발생 빈도가 더 높았으며 두통의 과거력이 있는 경우와 척수액내 백혈구 세포수는 소아에서 척수액 검사 후 발생한 두통에 영향을 주는 인자로 생각된다.

• The Korean Journal of Physiology and Pharmacology
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• 제20권4호
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• pp.425-432
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• 2016

In addition to classical synaptic transmission, information is transmitted between cells via the activation of extrasynaptic receptors that generate persistent tonic current in the brain. While growing evidence supports the presence of tonic NMDA current ($I_{NMDA}$) generated by extrasynaptic NMDA receptors (eNMDARs), the functional significance of tonic $I_{NMDA}$ in various brain regions remains poorly understood. Here, we demonstrate that activation of eNMDARs that generate INMDA facilitates the ${\alpha}$-amino-3-hydroxy-5-methylisoxazole-4-proprionate receptor (AMPAR)-mediated steady-state current in supraoptic nucleus (SON) magnocellular neurosecretory cells (MNCs). In $low-Mg^{2+}$ artificial cerebrospinal fluid (aCSF), glutamate induced an inward shift in $I_{holding}$ ($I_{GLU}$) at a holding potential ($V_{holding}$) of -70 mV which was partly blocked by an AMPAR antagonist, NBQX. NBQX-sensitive $I_{GLU}$ was observed even in normal aCSF at $V_{holding}$ of -40 mV or -20 mV. $I_{GLU}$ was completely abolished by pretreatment with an NMDAR blocker, AP5, under all tested conditions. AMPA induced a reproducible inward shift in $I_{holding}$ ($I_{AMPA}$) in SON MNCs. Pretreatment with AP5 attenuated $I_{AMPA}$ amplitudes to ~60% of the control levels in $low-Mg^{2+}$ aCSF, but not in normal aCSF at $V_{holding}$ of -70 mV. $I_{AMPA}$ attenuation by AP5 was also prominent in normal aCSF at depolarized holding potentials. Memantine, an eNMDAR blocker, mimicked the AP5-induced $I_{AMPA}$ attenuation in SON MNCs. Finally, chronic dehydration did not affect $I_{AMPA}$ attenuation by AP5 in the neurons. These results suggest that tonic $I_{NMDA}$, mediated by eNMDAR, facilitates AMPAR function, changing the postsynaptic response to its agonists in normal and osmotically challenged SON MNCs.

• Pediatric Infection and Vaccine
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• 제21권3호
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• pp.219-224
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• 2014

Streptococcus bovis에 의한 신생아 침습감염을 보고한 사례는 많지 않으며, 지금까지 보고된 증례는 대부분 Streptococcus pasteurianus가 원인이었다. 저자들은 생후 28일에 열이 나서 온 환자의 혈액과 뇌척수액에서 분리된 균주를 16S rRNA와 tuf 유전자 염기서열분석을 통해 Streptococcus lutetiensis로 동정할 수 있었다. 환자의 혈액에서 배양된 균주는 자동화 장비(VITEK 2)에서 Streptococcus infantarius로 동정되었고 뇌척수액에서 자란 균주는 동정되지 않았다. 환자는 항균제 투여 2일째부터 열이 떨어지고 전신상태가 호전되었으며, 14일간 항균제 사용 후 신경학적 합병증 없이 퇴원하였다. 저자들은 S. bovis군에 의한 침습 감염 환자에서 정확한 균주 동정을 위해 분자유전학적 검사기법이 도움이 될 수 있음을 확인하였고 본 증례의 원인 균주가 신생아 침습감염의 원인으로 알려진 사례가 없어 보고하는 바이다.

• Clinical and Experimental Pediatrics
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• 제61권8호
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• pp.245-252
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• 2018

Purpose: This study investigated patterns of ischemic injury observed in brain images from patients with neonatal group B Streptococcal (GBS) meningitis. Methods: Clinical findings and brain images from eight term or near-term newborn infants with GBS meningitis were reviewed. Results: GBS meningitis was confirmed in all 8 infants via cerebrospinal fluid (CSF) analysis, and patients tested positive for GBS in both blood and CSF cultures. Six infants (75.0%) showed early onset manifestation of the disease (<7 days); the remaining 2 (25.0%) showed late onset manifestation. In 6 infants (75%), cranial ultrasonography showed focal or diffuse echogenicity, suggesting hypoxic-ischemic injury in the basal ganglia, cerebral hemispheres, and periventricular or subcortical white matter; these findings are compatible with meningitis. Findings from magnetic resonance imaging (MRI) were compatible with bacterial meningitis, showing prominent leptomeningeal enhancement, a widening echogenic interhemisphere, and ventricular wall thickening in all infants. Restrictive ischemic lesions observed through diffusion-weighted imaging were evident in all eight infants. Patterns of ischemic injury as detected through MRI were subdivided into 3 groups: 3 infants (37.5%) predominantly showed multiple punctuate lesions in the basal ganglia, 2 infants (25.0%) showed focal or diffuse cerebral infarcts, and 3 infants (37.5%) predominantly showed focal subcortical or periventricular white matter lesions. Four infants (50%) showed significant developmental delay or cerebral palsy. Conclusion: Certain patterns of ischemic injury are commonly recognized in brain images from patients with neonatal GBS meningitis, and this ischemic complication may modify disease processes and contribute to poor neurologic outcomes.

• The Korean Journal of Pain
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• 제14권1호
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• pp.12-18
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• 2001

Background: It is controversial whether the change in nitric oxide (NO) expression in the dorsal root ganglia (DRG) may be responsible for developtment and/or maintenance of painful diabetic neuropathy. The aim of this study was to clarify the role of NO in the pathogenesis of painful diabetic neuropathy. Methods: The effect of L-nitroargine methylester (L-NAME) or sodium nitroprusside (SNP) on allodynia was measured in streptozotocin (STZ)-induced diabetic rats. NO concentration was measured in the cerebrospinal fluid (CSF) and plasma of the diabetic rats. NADPH-diaphorase (NADPH-d) histochemistry was performed on the DRG and spinal cords of the STZ-induced diabetic rats. Results: L-NAME, an inhibitor of nitric oxide synthase, alleviated allodynia, while SNP, a nitric oxide donor, aggravated allodynia in diabetic rats. Plasma NO level in the diabetic rats was significantly decreased compared with control rats. NO level in the CSF of diabetic rats did not differ from that of the control rats. NADPH-d positive cells were decreased in the DRG of diabetic rats. However, NADPH-d histochemistry in the diabetic spinal cord was not different from that of the control rats. Conclusions: Downregulation of NO expression in the diabetic rats may not be causally related to the development and/or maintenance of painful diabetic neuropathy.

• Investigative Magnetic Resonance Imaging
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• 제20권3호
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• pp.167-174
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• 2016

Purpose: To identify magnetic resonance imaging (MRI) findings of leukemic infiltration of optic nerve and optic neuritis in leukemic patients with emphasis of clinical findings as reference standard to differentiate them. Materials and Methods: MRI and clinical findings of 7 patients diagnosed as leukemic infiltration of optic nerve (n = 5) and optic neuritis (n = 2) in our institution between July 2006 and August 2015were reviewed retrospectively. In particular, MR imaging findings involved perineural enhancement and thickening of optic nerve and its degree, signal intensity, laterality (unilateral/bilateral), intraconal fat infiltration and its degree, and associated central nervous system abnormalities. Results: Of 5 cases of leukemic infiltration of optic nerve, 4 cases showed positive cerebrospinal fluid (CSF) study for leukemia relapse and 1 case was positive on bone marrow (BM) biopsy only. Moreover, of 5 leukemic infiltration of optic nerve, 2 cases showed the most specific MR findings for leukemic central nervous system involvement including 1 prominent leptomeningeal enhancement and 1 chloroma. However, other MR imaging findings of the patients with leukemic infiltration or optic neuritis such as thickening and perineural enhancement of optic nerves are overlapped. Conclusion: Enhancement and thickening of optic nerve were overlapped MR findings in leukemic infiltration of optic nerve and optic neuritis. Our findings suggest that enhancing optic nerve thickening with associated central nervous system MR abnormality favors the diagnosis of leukemic infiltration of optic nerve, especially in patients with history of acute lymphoblastic leukemia. However, CSF and BM study were required for differentiation between leukemic infiltration of optic nerve and optic neuritis.

• Journal of Korean Neurosurgical Society
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• 제59권5호
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• pp.512-517
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• 2016

Objective : The pathophysiology of idiopathic Chiari malformation (CM) type 1 is disturbance of free cerebrospinal fluid (CSF) flow and restoration of normal CSF flow is the mainstay of treatment. Additional migration of the medulla oblongata in pediatric patients is referred to as CM type 1.5, but its significance in adult patients is unknown. This study is to compare surgical outcomes of adult idiopathic CM type 1.5 with that of type 1. Methods : Thirty-eight consecutive adult patients (M : F=11 : 27; median, 33.5; range, 18-63) with syringomyelia due to idiopathic CM type 1 were reviewed. Migration of the medulla oblongata was noted in 13 patients. The modified McCormick scale (MMS) was used to evaluate functional status before and one year after surgery. All patients underwent foramen magnum decompression and duroplasty. Factors related to radiological success (${\geq}50%$ decrease in the diameter of the syrinx) were investigated. The follow-up period was $72.7{\pm}55.6$ months. Results : Preoperative functional status were MMS I in 11 patients and MMS II in 14 of CM type 1 and MMS I in 8 and II in 5 of CM type 1.5. Of patients with MMS II, 5/14 patients in group A and 3/5 patients in group B showed improvement and there was no case of deterioration. Radiological success was achieved in 32 (84%) patients and restoration of the cisterna magna (p=0.01; OR, 46.5) was the only significant factor. Conclusion : Migration of the medulla oblongata did not make a difference in the surgical outcome when the cisterna magna was restored.

• 한국임상수의학회지
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• 제27권4호
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• pp.440-444
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• 2010

5.2 kg의 7살령 중성화 된 수컷 시추가 심각한 신경증상(paddling, 무의식, 실명, 발작)으로 내원하였다. 내원 당시 ECG 상에 심실 유래의 심박동 약 140회의 가속성 심실 고유박동(AVIR)이 지속적으로 나타났다. 이 환축은 자기공명영상법(MRI)과 뇌척수액검사(CSF)를 통해 파종성 육아종성 뇌수막염(GME)로 잠정 진단 내려졌다. 신경증상은 스테로이드제와 항경련제, 이뇨제, 항생제, 20% 만니톨 정맥 주사 등으로 호전 되었으며 부정맥은(AIVR) mexiletin으로 통제되었다. 신경학적인 문제에 대한 응급 처치 후 증상의 호전에도 불구하고 항부정맥제 처치 없이는 심장의 리듬이 불안정 했기 때문에 항부정맥 처치는 신경증상이 완전히 소실 될 때까지 유지되었다.

• Radiation Oncology Journal
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• 제38권1호
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• pp.26-34
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• 2020

Purpose: Intensity-modulated radiotherapy (IMRT) allows for more precise treatment, reducing unwanted radiation to nearby structures. We investigated the safety and feasibility of IMRT for anaplastic ependymoma patients below 3 years of age. Materials and Methods: A total of 9 anaplastic ependymoma patients below 3 years of age, who received IMRT between October 2011 and December 2017 were retrospectively reviewed. The median equivalent dose in 2 Gy fractions was 52.0 Gy (range, 48.0 to 60.0 Gy). Treatment outcomes and neurologic morbidities were reviewed in detail. Results: The median patient age was 20.9 months (range, 12.1 to 31.2 months). All patients underwent surgery. The rates of 5-year overall survival, freedom from local recurrence, and progression-free survival were 40.6%, 53.3%, and 26.7%, respectively. Of the 9 patients, 5 experienced recurrences (3 had local recurrence, 1 had both local recurrence and cerebrospinal fluid [CSF] seeding, and 1 had CSF seeding alone). Five patients died because of disease progression. Assessment of neurologic morbidity revealed motor dysfunction in 3 patients, all of whom presented with hydrocephalus at initial diagnosis because of the location of the tumor and already had neurologic deficits before radiotherapy (RT). Conclusion: Neurologic morbidity is not caused by RT alone but may result from mass effects of the tumor and surgical sequelae. Administration of IMRT to anaplastic ependymoma patients below 3 years of age yielded encouraging local control and tolerable morbidities. High-precision modern RT such as IMRT can be considered for very young patients with anaplastic ependymoma.

• 한국멀티미디어학회논문지
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• 제22권10호
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• pp.1168-1177
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• 2019

In order to diagnose and prevent Alzheimer's Disease (AD), it is becoming increasingly important to develop a CAD(Computer-aided Diagnosis) system for AD diagnosis, which provides effective treatment for patients by analyzing 3D MRI images. It is essential to apply powerful deep learning algorithms in order to automatically classify stages of Alzheimer's Disease and to develop a Alzheimer's Disease support diagnosis system that has the function of detecting hippocampus and CSF(Cerebrospinal fluid) which are important biomarkers in diagnosis of Alzheimer's Disease. In this paper, for AD diagnosis, we classify a given MRI data into three categories of AD, mild cognitive impairment, and normal control according by applying 3D brain MRI image to the Faster R-CNN model and detect hippocampus and CSF in MRI image. To do this, we use the 2D MRI slice images extracted from the 3D MRI data of the Faster R-CNN, and perform the widely used majority voting algorithm on the resulting bounding box labels for classification. To verify the proposed method, we used the public ADNI data set, which is the standard brain MRI database. Experimental results show that the proposed method achieves impressive classification performance compared with other state-of-the-art methods.