• Clinical and Experimental Pediatrics
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• v.51 no.8
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• pp.856-860
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• 2008

Purpose : This study aimed to examine the factors influencing the appearance of headache and backache following diagnostic lumbar puncture in children, focusing on the need for strict bed rest after lumbar puncture. Methods : We studied 70 two-fifteen-year-old pediatric patients who underwent diagnostic lumbar puncture from July 2005 to July 2007 at Konkuk University Hospital. We divided them into two groups. Patients in the first group (n=24) were allowed free mobility and patients in the second group (n=46) were to have strict bed rest for four hours after puncture. Data were analyzed by age, sex, number of puncture attempts, cell counts and pressure in the cerebrospinal fluid (CSF), duration of bed rest, and occurrence of headache and backache. Results : The rate of complications was not significantly related to sex, age, presence of enterovirus, CSF pressure, or postural headache. The occurrence of headache was significantly correlated with white blood cell (WBC) count in CSF (P=0.043). Symptom frequency did not differ significantly between the groups. Backache was significantly related to the frequency of puncture attempts (P=0.046). Conclusion : Strict bed rest following diagnostic lumbar puncture in children does not influence headaches and backaches. These are respectively related to the WBC count on the CSF profile and the frequency of attempts. Therefore, after lumbar puncture, absolute bed rest is not necessary and patients are more comfortable with free mobility.

• Clinical and Experimental Pediatrics
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• v.49 no.7
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• pp.745-750
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• 2006

Purpose : Enteroviruses are the most common cause of aseptic meningitis in patients of all ages. A definite diagnosis of enteroviral meningitis can be established by detection of virus directly in CSF specimens. But this is time-consuming and lacks sensitivity, so polymerase chain reaction(PCR) detecting of viral RNA in patient specimens such as CSF, stool has been demonstrated. But little is known about the influence of sampling time on the results of CSF PCR and stool PCR. We investigated diagnostic utility of PCR of CSF and stool according to sampling time after the onset of symptoms. Methods : PCR results were analyzed according to sampling time for 42 patients diagnosed aseptic meningits in our hospital from $11^{th}$ January to $30^{th}$ August, 2005. Results : The diagnostic yield of the test was higher of CSF specimens obtained ${\leq_-}2$ days after clinical onset(positive PCR results 9/18, 50 percent), compared with CSF collected >2 days after onset(positive PCR results 1/24, 4.2 percent)(P=0.001). Instead, positive PCR results of fecal specimens maintained highly(average 90.5 percent), 10 cases had also positive PCR results even 5-6 days after onset. 10 cases of CSF specimens had positive enterovirus PCR results containing coxsackievirus B5 (n=6), coxsackievirus B3(n=3). 38 cases of stool specimens had positive enterovirus PCR results containing echovirus 18(n=7), echovirus 9(n=3), coxsackievirus B5(n=8), coxsackievirus B3(n=3). 6 cases(coxackie B5) had positive CSF PCR and stool PCR, both. Conclusion : Stool PCR was clinically sensitive for detecting enterovirus during enteroviral meningits and could give a presumptive diagnosis throughout the disease course. A definite diagnosis was obtained by CSF PCR, but its utility was clearly lower for samples obtained >2 days after clinical onset. Therefore, it is recommended that, in addition to performance of CSF PCR, fecal samples obtained from patients with suspected enteroviral meningitis should be tested by PCR, especially when the duration of symptoms is >2 days.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup1
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• pp.99-107
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• 2001

Objective : Hydrocephalus and vasospasm are the common complications following subarachnoid hemorrhage (SAH). In spite of development of perioperative management and operative technique, hydrocephalus cause neurological deficit and poor prognosis. Usually CSF drainage procedure(external ventricular drainage(EVD) or shunt) is needed in hydrocephalus following SAH. The aim of this study was to investigate whether the need for shunting and the outcome after shunting in hydrocephaus following SAH can be related to the duration, daily and total amount of cerebrospinal fluid(CSF) drainage at EVD. Material and Method : IVH is one of several factors which cause hydrocephalus. In this retrospective study, firstly we investigated the incidence of IVH in total cases and frequency of IVH according to aneurysmal site and then prognosis of IVH following SAH. Among 629 patients with SAH, hydrocephalus was diagnosed by CT scan and symptoms. And then those 102 hydrocephalus following SAH were divided into two groups which were hydrocephalus with IVH group and without IVH group. In these two groups, we investigated and compared the incidence of hydrocephalus in all case, frequency of hydrocephalus according to aneurysmal site, the outcome according to H-H grade on admission and the need rate of shunt, etc. Of those hydrocephalus, 100 EVD procedures were done. The duration, daily and total amount of CSF drainage at EVD were investigated. Fifty cases expired during EVD was excluded. We analyzed whether the need rate of shunt and the final outcome after shunting can be related to IVH, the duration and daily and total amount of CSF drainage. Result : The incidence of hydrocephalus following SAH was 20%(with IVH group ; 64%, without IVH group ; 11%). As H-H grade on admission was better, the outcome of hydrocephalus was also better. The mortality rate of hydrocephalus with IVH was 64% which was higher than 40% that of hydrocephalus without IVH. The need rate of shunt in all cases of hydrocephalus following SAH was 20%, but those with IVH group excluding expired patients before shunt was 40%. This was very similar to 41% of the need rate of shunt in hydrocephalus without IVH. The total amount of CSF drainage was statistically related to the need rate of shunt(total amount : need rate of shunt/<1000cc : 15%, 1000-2000cc : 40%, >2000cc : 50%). The duration and daily amount of CSF drainage were not statistically related to the need rate of shunt, but as daily amount of CSF drainage was more and duration was longer, the need rate of shunt was increased(daily amount : need rate of shunt /<100cc : 16%, 100-200cc : 25%, >200cc : 40%//duration : need rate of shunt/<1week : 8%, 1-2weeks : 30%, >2weeks : 47%), and also the final outcome after shunting was poor. Especially the total amount of CSF drainage was significant related to the final outcome after shunting(total amount : GOS/<1000cc : I&II(3/4), 1000-2000cc : II(2/4), III(2/4), >2000cc : III&IV(6/7)). Conclusion : This study revealed that the incidence and mortality rate of hydrocephalus following SAH were influenced by IVH. So SAH associated IVH has the higher incidence of hydrocephalus and poor outcome. As the CSF drainage amount was more and duration of drainage was longer, the need rate of shunt was increased and the final outcome after shunting was poor. Especially the total amount of CSF drainage were strongly related to the need rate of shunt and the outcome after shunting.

• Progress in Medical Physics
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• v.10 no.1
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• pp.33-40
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• 1999

Purpose: To simulate and measure the signal intensity of various tissues near bone interface in 2D and 3D neurological MR images. Materials and Methods: In neurological proton density (PD) weighted images, every component in the head including cerebrospinal fluid (CSF), muscle and scalp, with the exception of bone, are visualised. It is possible to acquire images in 2D or 3D. A 2D fast spin-echo (FSE) sequence is chosen for the 2D acquisition and a 3D gradient-echo (GE) sequence is chosen for the 3D acquisition. To find out the signal intensities of CSF, muscle and fat (or scalp) for the 2D spin-echo(SE) and 3D gradient-echo (GE) imaging sequences, the theoretical signal intensities for 2D SE and 3D GE were calculated. For the 2D fast spin-echo (FSE) sequence, to produce the PD weighted image, long TR (4000 ms) and short TE$_{eff}$ (22 ms) were employed. For the 3D GE sequence, low flip angle (8$^{\circ}$) with short TR (35 ms) and short TE (3 ms) was used to produce the PD weighted contrast. Results: The 2D FSE sequence has CSF, muscle and scalp with superior image contrast and SNR of 39 - 57 while the 3D GE sequence has CSF, muscle and scalp with broadly similar image contrast and SNR of 26 - 33. SNR in the FSE image were better than those in the GE image and the skull edges appeared very clearly in the FSE image due to the edge enhancement effect in the FSE sequence. Furthermore, the contrast between CSF, muscle and scalp in the 2D FSE image was significantly better than in the 3D GE image, due to the strong signal intensities (or SNR) from CSF, muscle and scalp and enhanced edges of CSF. Conclusion: The signal intensity of various tissues near bone interface in neurological MR images has been simulated and measured. Both the simulation and imaging of the 2D SE and 3D GE sequences have CSF, fat and muscle with broadly similar image intensity and SNR's and have succeeded in getting all tissues about the same signal. However, in the 2D FSE sequence, image contrast between CSF, muscle and scalp was good and SNR was relatively high, imaging time was relatively short.

• Parasites, Hosts and Diseases
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• v.26 no.1
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• pp.27-32
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• 1988

The applicability of indirect immunoftuorescent antibody test (IFAT) was compared with enzyme-linked immunosorbent assay (ELISA) in sera from 163 cases of confirmed neurocysticercosis, 101 other neurologic and parasitic diseases and 100 normal controls. As antigen, frozen sections of a Taenia solium metacestode from a human brain was used in IFAT and cystic fluid was used in ELISA. For the detection of specific IgG antibody, IFAT was equally sensitive (89.6%) and specific (85.1%) as ELISA. The antibody titers by IFAT were correspondingly increased with mean absorbance of ELISA. The corresponding rate of positivity in the two techniques was 90.8%. Except for the difficulty in detecting antibodies in cerebrospinal fluid (CSF), IFAT was concluded to be very useful for the serodiagnosis of human neurocysticercosis.

• Journal of Veterinary Clinics
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• v.23 no.3
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• pp.337-339
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• 2006

A 4-year-old, spayed female Maltese dog was presented for evaluation of acute onset of generalized tremor, right-sided head tilt, horizontal nystagmus, and mild ataxia with 4-day duration. However, the dog was bright, alert, and responsive. The neurological examinations revealed that bilateral horizontal-, positional nystagmus, and mild ataxia. Menace responses were also absent in both eyes. Typically, moderate generalized intension tremors were noted in four limbs and the head. No abnormalities were found in hemogram, radiography, and magnetic resonance imaging(MRI). Cytologic examination of cerebrospinal fluid(CSF) revealed a mild nonsuppurative inflammation. Thus, steroid responsive tremor syndrome(SRTS) was strongly suspected because of its inflammatory and idiopathic features. The dog excellently responded to immunosuppressive doses of corticosteroid. Therefore, we definitively diagnosed the dog as SRTS based on the exclusion of other causes of the tremor, clinical signs, and response to treatment. This is a first case report of SRTS in our country and we here describe clinical and neurological features in SRTS.

• Clinical and Experimental Pediatrics
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• v.49 no.7
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• pp.751-756
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• 2006

Purpose : Our goals were to determine the frequency of headaches and backaches occurring as a side effect following lumbar puncture in children, and to investigate various factors that might influence the frequency of headaches and backaches. Methods : From October 2004 to February 2006, we enrolled 148 patients aged 2 to 15 years who received diagnostic lumbar puncture at the Presbyterian Medical Center, Chonju, Korea. Patient data were collected for age, sex, number of puncture attempts, volume of cerebrospinal fluid(CSF), bevel orientation of puncture needle, cell count in CSF, periods of absolute bed rest, and the frequency and duration of headaches and backaches. Results : Headaches occurred in 8 patients and backaches occurred in 40 patients. Headaches were found both to occur significantly more frequently in patients over age 10 and to last longer when the bevel orientation of the puncture needle was inserted toward the cranium rather than laterally. Backaches lasted longer in males than in females. The other factors evaluated showed no relationship at all to the frequency and duration of headaches and backaches. Conclusion : Following lumbar puncture, headaches were common in patients over age 10, and lasted longer when the bevel orientation was toward the cranium. Backaches lasted longer in males than in females. In light of these findings, we recommend taking special care when performing lumbar puncture for CSF examination in patients over age 10.

• Journal of Veterinary Clinics
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• v.32 no.5
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• pp.464-468
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• 2015

A 6-year-old, intact male maltese was presented with hindlimb ataxia of 4 day duration. Physical and neurological examinations revealed a bright, alert, and responsive dog, with no evidence of cranial nerve deficits, conscious proprioceptive deficits. Spinal reflexes of the hind and forelimbs were normal. Patellar, cranial tibial, and withdrawal reflexes were normal. Pain could not be elicited on manipulation of the neck or palpation of the spinal column. Survey radiographs of the vertebral column were unremarkable. Computed tomography (CT) scans in the transverse plane were performed. The results of CT imaging were unremarkable. Magnetic resonance imaging (MRI) in both sagittal and transverse planes was performed. The extent of the lesion was 25 mm in length by 4 mm in thickness. The spinal cord was deviated ventrally and appreared thinner. On T1-weighted and FLAIR images, a discrete hypointense lesion dorsal to the spinal cord was observed at L1-2 which was contiguous with the subarachnoid space. On T2-weighted images, this region was hyperintense, consistent with a fluid-filled structure. The signal intensity of the cysts was equivalent to cerebrospinal fluid (CSF). Surgical treatment involving dorsal laminectomy had successful outcomes.

• Nuclear Medicine and Molecular Imaging
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• v.40 no.3
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• pp.148-154
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• 2006

Purpose: Although radionuclide cisternography (RNC) is an useful study to detect cerebrospinal fluid (CSF) leakage in the patient with spontaneous intracranial hypotension (SIH), it sometimes fails to demonstrate the site of CSF leakage. The aim of the study is to improve the detection of leakage site of CSF and to reduce time for the study in RNC using modified protocol (m-RNC). Materials & methods : The study consists of 8 studies of 7 patients ($38{\pm}8$ years, M:F=2:5) with SIH, who underwent m-RNC following administration of 185-222 MBq of $^{99m}Tc$-DTPA into the lumbar subarachnoid space. Sequential images were obtained the whole spine with the head including urinary bladder at 10 minute, 30 minute, 1 hour, 2 hour, 4 hour and 6 hour. Radioactivity of extradural space and urinary bladder was evaluated. Results: Leakage site of CSF was identified in all 8 cases by m-RNC. Leakage site was cervicothoracic junction (CTJ, n=3), CTJ with C1-2 (n=2), CTJ with thoracic spine, thoracolumbar spine and lumbar spine (each n=1). All cases presented leakage sites within 1 hour and multiple sites, where CTJ was included in 6 cases. Only one case presented additional site in 6 hour image. Early radioactivity within the urinary bladder was noted in 6 cases, but that was fellowing after identification of the leakage site. Conclusion: Radionuclide cisternography is sensitive to detect the leakage site of CSF and is expected to improve the detection of CSF leakage site and reduce time for the study using modified protocol.

• Pediatric Infection and Vaccine
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• v.28 no.2
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• pp.92-100
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• 2021

Purpose: Rapid detection of etiologic organisms is crucial for initiating appropriate therapy in patients with central nervous system (CNS) infection. This study aimed to evaluate the diagnostic value of the BioFire^® Meningitis/Encephalitis (ME) panel in detecting etiologic organisms in cerebrospinal fluid (CSF) samples from febrile infants. Methods: CSF samples from infants aged <90 days who were evaluated for fever were collected between January 2016 and July 2019 at the Seoul National University Children's Hospital. We performed BioFire^® ME panel testing of CSF samples that had been used for CSF analysis and conventional tests (bacterial culture, Xpert^® enterovirus assay, and herpes simplex virus-1 and -2 polymerase chain reaction) and stored at -70℃ until further use. Results: In total, 72 (24 pathogen-identified and 48 pathogen-unidentified) CSF samples were included. Using BioFire^® ME panel testing, 41 (85.4%) of the 48 pathogen-unidentified CSF samples yielded negative results and 22 (91.7%) of the 24 pathogen-identified CSF samples yielded the same results (enterovirus in 19, Streptococcus agalactiae in 2, and Streptococcus pneumoniae in 1) as those obtained using the conventional tests, thereby resulting in an overall agreement of 87.5% (63/72). Six of the 7 pathogen-unidentified samples were positive for human parechovirus (HPeV) via BioFire^® ME panel testing. Conclusions: Compared with the currently available etiologic tests for CNS infection, BioFire^® ME panel testing demonstrated a high agreement score for pathogen-identified samples and enabled HPeV detection in young infants. The clinical utility and cost-effectiveness of BioFire^® ME panel testing in children must be evaluated for its wider application.