• Title/Summary/Keyword: Neurological

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Comparison of Weighted Needle Pinprick Sensory Thresholds and Sensory Nerve Conduction Studies in Diabetic Patients (당뇨병 환자에서의 가중침자 감각역치와 감각신경 전도검사와의 비교)

  • Ryoo, Jae-Kwan
    • Journal of Korean Physical Therapy Science
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    • v.3 no.1
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    • pp.929-941
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    • 1996
  • This study was conducted to determine the association between weighted needle pinprick sensory threshold(PPT) and sensory nerve conduction studies. The subjects were 53 healthy controls, 31 diabetic patients without peripheral neuropathic symptoms(DM) and 36 diabetic patients with peripheral neuropathic symptoms(DN). PPT was measured on the index and little fingers, bilaterally, as well as under the lateral malleolus, bilaterally. In electrophysiologic assessment the left and right median, ulnar and sural nerves were studied. Mean PPT in DN, DM and controls was high in turn on each sites tested. Age controlled PPT was significantly different among three groups on right little finger(p<0.05) and left malleolus(p<0.05), but on other sites, not statistically significantly different between DN and DM. The results were as follows: Sensory nerve conduction velocity and amplitude on each nerve tested were statistically significantly different among three groups(p<0.05). Correlation of PPT with sensory nerve conduction velocity and amplitude were statistically significant on each site and ranged from -0.4203(left malleolus) to -0.5649(right index finger) and from -0.3897(left index finger) to -0.6200(right index finger), respectively. When electrophysiological study is not feasible, measurement of PPT may be helpful for the assessment of peripheral sensory neurological function.

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Comparison of Clinical Characteristics and Polysomnographic Findings between REM Sleep Behavior Disorder with and without Associated Central Nervous System Disorders (중추신경계질환 동반 여부에 따른 렘수면 행동장애의 임상 특성과 수면다원기록소견 소견 비교)

  • Lee, Yu-Jin;Jeong, Do-Un
    • Sleep Medicine and Psychophysiology
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    • v.12 no.1
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    • pp.58-63
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    • 2005
  • Objectives: REM sleep behavior disorder (RBD), characterized by excessive motor activity during REM sleep, is associated with loss of muscle atonia. In recent years, it has been reported that RBD has high co-morbidity with CNS disorders (especially, Parkinson's disease, dementia, multiple system atrophy, etc.). We aimed to assess differences in clinical and polysomnographic findings among RBD patients, depending on the presence or absence of central nervous system (CNS) disorders. Methods: The medical records and polysomnographic data of 81 patients who had been diagnosed as having RBD were reviewed. The patients were classified into two groups: associated RBD (aRBD, i.e., with a clinical history and/or brain MRI evidence of CNS disorder) and idiopathic RBD (iRBD, i.e., without a clinical history and/or brain MRI evidence of CNS disorder) groups. Twenty-one patients (25.9%) belonged to the aRBD group and 60 patients (74.1%) belonged to the iRBD group. The clinical characteristics and polysomnographic findings of the two groups were compared. Results: Periodic limb movement disorder (PLMD), i.e., PLMI (periodic limb movement index)>5, was observed more frequently in the aRBD group than in the iRBD group (p<0.001, Fisher's exact test). Also, obstructive sleep apnea syndrome (OSAS), i.e., RDI (respiratory disturbance index)>5, was found more frequently in the aRBD group (p=0.0042, Fisher's exact test). The percentages for slow wave sleep and sleep efficiency were significantly lower in the aRBD group than in the iRBD group. Conclusion: We found that 1 out of 4 RBD patients had associated CNS disorders, warranting more careful neurological evaluation and follow-up in this category of RBD. In this category of RBD patients, we also found more frequent PLMD and OSAS. These patients were also found to have lower slow wave sleep and sleep efficiency. In summary, RBD patients with associated CNS disorders suffer from more disturbed sleep than those without them.

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Quantitative Evaluation of the Corticospinal Tract Segmented by Using Co-registered Functional MRI and Diffusion Tensor Tractography (정상인에서 기능적 뇌 자기공명영상과 확산텐서영상 합성기법을 이용한 피질척수로의 위치에 따른 정량적 분석)

  • Jang, Sung-Ho;Hong, Ji-Heon;Byun, Woo-Mok;Hwang, Chang-Ho;Yang, Dong-Seok
    • Investigative Magnetic Resonance Imaging
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    • v.13 no.1
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    • pp.40-46
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    • 2009
  • Purpose : The purpose of this study was to investigate the quantitative evaluation of the corticospinal tract (CST) at the multiple levels by using functional MRI (fMRI) co-registered to diffusion tensor tractography (DTT). Materials and Methods : Ten normal subjects without any history of neurological disorder participated in this study. fMRI was performed at 1.5 T MR scanner using hand grasp-release movement paradigm. DTT was performed by using DtiStudio on the basis of fiber assignment continuous tracking algorithm (FACT). The seed region of interest (ROI) was drawn in the area of maximum fMRI activation during the motor task of hand grasp-release movement on a 2-D fractional anisotropy (FA) color map, and the target ROI was drawn in the cortiocospinal portion of anterior lower pons. We have drawn five ROIs for the measurement of FA and apparent diffusion coefficient (ADC) along the corona radiata (CR) down to the medulla. Results : The contralateral primary sensorimotor cortex (SM1) was mainly found to be activated in all subjects. DTT showed that tracts originated from SM1 and ran to the medulla along the known pathway of the CST. In all subjects, FA values of the CST were higher at the level of the midbrain and posterior limb of internal capsule (PLIC) than the level of others. Conclusion : Our study showed that co-registered fMRI and DTT has elucidated the state of CST on 3-D and analyzed the quantitative values of FA and ADC at the multiple levels. We conclude that co-registered fMRI and DTT may be applied as a useful tool for clarifying and investigating the state of CST in the patients with brain injury.

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Development of a Korean Standard Structural Brain Template in Cognitive Normals and Patients with Mild Cognitive Impairment and Alzheimer's Disease (정상노인 및 경도인지장애 및 알츠하이머성 치매 환자에서의 한국인 뇌 구조영상 표준판 개발)

  • Kim, Min-Ji;Jahng, Geon-Ho;Lee, Hack-Young;Kim, Sun-Mi;Ryu, Chang-Woo;Shin, Won-Chul;Lee, Soo-Yeol
    • Investigative Magnetic Resonance Imaging
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    • v.14 no.2
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    • pp.103-114
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    • 2010
  • Purpose : To generate a Korean specific brain template, especially in patients with Alzheimer's disease (AD) by optimizing the voxel-based analysis. Materials and Methods : Three-dimensional T1-weighted images were obtained from 123 subjects who were 43 cognitively normal subjects and patients with 44 mild cognitive impairment (MCI) and 36 AD. The template and the corresponding aprior maps were created by using the matched pairs approach with considering differences of age, gender and differential diagnosis (DDX). We measured several characteristics in both our and the MNI templates, including in the ventricle size. Also, the fractions of gray matter and white matter voxels normalized by the total intracranial were evaluated. Results : The high resolution template and the corresponding aprior maps of gray matter, white matter (WM) and CSF were created with the voxel-size of $1{\times}1{\times}1\;mm$. Mean distance measures and the ventricle sizes differed between two templates. Our brain template had less gray matter and white matter areas than the MNI template. There were volume differences more in gray matter than in white matter. Conclusion : Gray matter and/or white matter integrity studies in populations of Korean elderly and patients with AD are needed to investigate with this template.

The clinical study on 44 cases of patient with Thoracolumbar Compression Fracture (흉(胸)·요추(腰椎) 압박골절(壓迫骨折) 환자(患者)에 대한 임상적(臨床的) 고찰(考察))

  • Lim, Jeoung-Eun;Kim, Kee-Hyun;Hwang, Hyeon-Seo
    • Journal of Acupuncture Research
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    • v.17 no.2
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    • pp.41-51
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    • 2000
  • Clinical observation was made on 44 cases of stable thoracolumbar compression fracture that were confirmed through simple x-ray and neurological examination. They were hospitalized and treated by acupuncture and moxibustion, bed rest, herb medicine and physical therapy. If necessary, patient was given an enema. The results obtained are as follows. 1. The patient distribution ratio, in regard to sex, was shown to be 1: 13.7 for males to females. In regard to age, it was shown that people in their 60's was the most predominant case, followed by people in their 70's, 80's, 50's and 40's, respectively. 2. In regard to contributing factors, it was observed that accidental falls were most frequent, followed by reasons unknown, repetitive lifting of heavy objects, overlaboring and bruise in that order. 3. In regard to duration of illness before treatment, it was found that treatment within 1 week was most predominant, followed by over 4 weeks, and 1-2 weeks, respectively. 4. With regard to the duration of hospitalization, hospitalization within 2 weeks was found to be most predominant, followed by 2-4 weeks. 5. In regard to the level of the affected vertebral body; The affected vertebral bodies distributed between T3 to L5 except for T7; T12 was found to be most predominant, followed in turn by L1 and L5. 6. In regard to the number of affected vertebral bodies, 2 was the most frequent followed by 1 and 3, in that order. The average of the number of affected vertebral bodies was observed to be 2.8 and single vertebral body compression fracture was shown to have no clinical and statistical difference as compared with multiple vertebral body compression fractures. 7. In regard to the grade of the seriousness of symptoms, it was found that Grade IV was most predominant, followed by Grade III. 8. With regard to signs at the first medical examination, low back pain was seen in the highest number, and followed in order by gait disturbance, flank pain, flexion-extension disturbance, disturbance of rotation to right or left, and bowel dysfunction. 9. Concerning the effect of treatment, good results were most predominantly seen, and 95.5% of total patients showed fair results. 10. The duration of admission treatment due to the grade of clinical symptoms was as follows; In the case of the Grade IV, it was observed that within 2 weeks was most predominant and for Grade III was 2-4 weeks. It was also found that the grade of clinical symptoms was not in proportion to the duration of admission treatment. 11. In regard to the result of treatment due to the grade of clinical symptoms; It was found that in the case of Grade IV, within 2 weeks was most predominant, and for Grade III, it was found to be 2-4 weeks. 12. Intestinal obstruction was shown in 50% of total patients; In the case of duration of constipation, more than 1 week was found to be most predominant, followed by 2 and 4 days respectively. 13. With regard to the treatment of intestinal obstruction, using acupuncture and moxibustion, herb - medicine and enema together were found to be most effective. 14. Intestinal obstruction was mostly seen in the case of Grade IV.

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Effects of Head Acupuncture Versus Upper and Lower Limbs Acupuncture on Signal Activation of Blood Oxygen Level Dependent(BOLD) fMRI on the Brain and Somatosensory Cortex (두침과 상하지 침자극이 뇌와 뇌의 체성감각피질에 미치는 영향에 대한 fMRI Study)

  • Park, Jung-Mi;Gwak, Ja-Young;Cho, Seung-Yeon;Park, Seong-Uk;Jung, Woo-Sang;Moon, Sang-Kwan;Ko, Chang-Nam;Cho, Ki-Ho;Kim, Young-Suk;Bae, Hyung-Sup;Jang, Geon-Ho;Bang, Jae-Seung
    • Journal of Acupuncture Research
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    • v.25 no.5
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    • pp.151-165
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    • 2008
  • Objectives : To evaluate the effects of Head Acupuncture versus Upper and Lower Limbs Acupuncture on signal activation of Blood Oxygen Level Dependent(BOLD) fMRI on the Brain and Somatosensory Cortex. Subjects and Methods : 10 healthy normal right-handed female volunteer were recruited. The average age of the 10 subjects was 30 years old. The BOLD functional MRI(fMRI) signal characteristics were determined during tactile stimulation was conducted by rubbing 4 acu-points in the right upper and lower limbs($LI_1$, $LI_{10}$, $LV_3$, $ST_{36}$). After stimulation of Head Acupuncture in Sishencong($HN_1$), $GB_{18}$, $GB_9$, $TH_{20}$ of Left versus Upper and Lower Limbs Acupuncture($LI_1$, $LI_{10}$, $LV_3$, $ST_{36}$ of Right) and took off needles. Then the BOLD fMRI signal characteristics were determined at the same manner. Results : 1. When touched with cotton buds(sensory stimulation), left Parietal Lobe, Post-central Gyrus, primary somatosensory cortex(BA 1, 2, 3), and primary motor cortex(BA 4) were mainly activated. When $ST_{36}$ was stimulated, Frontal Lobe, Parietal Lobe, Cerebellum, and Posterior Lobe as well as Inter-Hemispheric displaying a variety of regions. 2. In signal activation before and after Head Acupuncture reaction, it showed signal activation after removing the acupuncture needle and right Somatosensory Association Cortex, Postcentral Gyrus, and Parietal Lobe were more activated. 3. In reactions of before and after Upper and Lower Limb Acupuncture, it also showed signal activation after removing the acupuncture needle and bilateral Occipital Lobe, Lingual Gyrus, visual association cortex, and Cerebellum were activated. 4. After acupuncture stimulation, In Upper and Lower Limb Acupuncture Group, left frontal Lobe, Precentral Gyrus and Bilateral parietal lobe, Postcentral Gyrus and Primary Somatosensory Cortex(BA 2) were activated. In Head Acupuncture Group, which has most similar activation regions, but especially right Pre-Post central Gyrus, Primary Somatosensory Cortex(BA 3), Primary Motor Cortex, frontal Lobe and Parietal Lobe were activated. Conclusions : When sensory stimulation was done with cotton buds on four acup-points($LI_1$, $LI_{10}4, $LV_3$, $ST_{36}$), while bilaterally activated, contralateral sense was more dominant. It showed consistency with cerebral cortex function. When $ST_{36}$ was stimulated Frontal Lobe, Parietal Lobe, Cerebellum, Posterior Lobe as well as Inter-Hemispheric were stimulated. In Head Acupuncture, it showed more contralateral activation after acupuncture. In Upper and Lower Limb Acupuncture, it showed typically contralateral activation and deactivation of limbic system after acupuncture stimulation. Therefore, there were different fMRI BOLD signal activation reaction before and after Head Acupuncture vs Upper and Lower Limb Acupuncture which might be thought to be caused by acu-points' sensitivity and different sensory receptor to response acupuncture stimulation.

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Comparison of Weighted Needle Pinprick Sensory Thresholds and Sensory Nerve Conduction Studies in Diabetic Patients (당뇨병(糖尿病) 환자(患者)에서의 가중침자(加重針刺) 감각역치와 감각신경(感覺神經) 전도검사(傳導檢査)와의 비교(比較))

  • Yoo, Jae-Kwan;Kim, Seong-Ah;Lee, Jong-Young
    • Journal of Preventive Medicine and Public Health
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    • v.28 no.4 s.51
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    • pp.899-910
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    • 1995
  • This study was conducted to determine the correlation between weighted needle pinprick sensory threshold(PPT) and sensory nerve conduction tests. The subjects were 53 healthy controls, 31 diabetic patients without peripheral neuropathic symptoms(DM) and 36 diabetic patients with peripheral neuropathic symptoms(DN). PPT was measured on the index and little fingers, bilaterally, as well as under the lateral malleolus, bilaterally. In electrophysiologic assessment the left and right median, ulnar and sural nerves were studied. Each mean PPTs was high in order of controls, DM and DN. Age adjusted PPT was significantly different among three groups on right little finger(p<0.05) and left malleolus(p<0.05), but not significantly different between DN and DM on other sites. Each sensory nerve conduction velocity and amplitude was statistically significantly different among three groups(p<0.05). Correlations of PPT with sensory nerve conduction velocity and amplitude were statistically significant on each site and ranged from -0.4203(left malleolus) to -0.5649(right index finger) and from -0.3897(left index finger) to -0.6200(right index finger), respectively. When electrophysiological study is not feasible, measurement of PPT may be helpful for the assessment of peripheral sensory neurological function.

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Identification of novel mutations of the ATP7A gene and prenatal diagnosis of Menkes disease by mutation analysis (DNA 분석을 이용한 ATP7A 유전자의 새로운 돌연변이 발견과 멘케스병의 산전 진단)

  • Choi, Jin-Ho;Kim, Gu-Hwan;Yoo, Han-Wook
    • Journal of Genetic Medicine
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    • v.4 no.1
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    • pp.38-44
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    • 2007
  • Purpose : Menkes disease is an X-linked recessively inherited disorder caused by the mutation of the ATP7A gene encoding copper-transporting P-type AT Pase. The phenotypic features are progressive neurological degeneration, mental retardation, loose skin, and vascular complications. Early diagnosis and treatment are very important for the prognosis of Menkes disease. Here, we describe nov el mutations of the ATP7A gene and prenatal diagnosis by mutation analysis. Methods : Five unrelated Korean Menkes patients were included in this study. They presented with depigmented wool-like hair, progressive neurologic deterioration, and hypotonia in infancy. Serum copper and ceruloplasmin levels w ere decreased. Brain magnetic resonance imaging revealed tortuous intracranial vessels. Mutation analysis has been carried out using cDNA from cultured skin fibroblasts or genomic DNA from peripheral leukocytes. Prenatal diagnosis was performed in two cases using chorionic villi samples or amniocytes. Results : Four novel mutations have been identified from four different families; c.3511+1G>A (p.E1099_N1171delinsMfsX 18), c.4005+5 G>A (p.V1268_R1335del), c.1870_2172del (p.S624_Q724del), and c.3352 G>A (p.G1118S). T he remaining one was previously reported (c.1933 C>T (p.V 1268_R1335del)). On prenatal DNA analysis, one w as diagnosed as normal, while the other turned out to be a female heterozygote with p.S624_Q724del mutation of the ATP7A gene. Conclusion : We identified 4 novel mutations of the ATP7A gene. Prenatal diagnosis in families at risk is critical in order to choose preventiv e options including an early treatment with copper-histidine therapy or therapeutic termination. Most mutations of the ATP7A gene were frame-shift mutations and prenatal diagnosis has been successfully carried out.

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Probabilistic Anatomical Labeling of Brain Structures Using Statistical Probabilistic Anatomical Maps (확률 뇌 지도를 이용한 뇌 영역의 위치 정보 추출)

  • Kim, Jin-Su;Lee, Dong-Soo;Lee, Byung-Il;Lee, Jae-Sung;Shin, Hee-Won;Chung, June-Key;Lee, Myung-Chul
    • The Korean Journal of Nuclear Medicine
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    • v.36 no.6
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    • pp.317-324
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    • 2002
  • Purpose: The use of statistical parametric mapping (SPM) program has increased for the analysis of brain PET and SPECT images. Montreal Neurological Institute (MNI) coordinate is used in SPM program as a standard anatomical framework. While the most researchers look up Talairach atlas to report the localization of the activations detected in SPM program, there is significant disparity between MNI templates and Talairach atlas. That disparity between Talairach and MNI coordinates makes the interpretation of SPM result time consuming, subjective and inaccurate. The purpose of this study was to develop a program to provide objective anatomical information of each x-y-z position in ICBM coordinate. Materials and Methods: Program was designed to provide the anatomical information for the given x-y-z position in MNI coordinate based on the Statistical Probabilistic Anatomical Map (SPAM) images of ICBM. When x-y-z position was given to the program, names of the anatomical structures with non-zero probability and the probabilities that the given position belongs to the structures were tabulated. The program was coded using IDL and JAVA language for 4he easy transplantation to any operating system or platform. Utility of this program was shown by comparing the results of this program to those of SPM program. Preliminary validation study was peformed by applying this program to the analysis of PET brain activation study of human memory in which the anatomical information on the activated areas are previously known. Results: Real time retrieval of probabilistic information with 1 mm spatial resolution was archived using the programs. Validation study showed the relevance of this program: probability that the activated area for memory belonged to hippocampal formation was more than 80%. Conclusion: These programs will be useful for the result interpretation of the image analysis peformed on MNI coordinate, as done in SPM program.

The Analysis of the Need Rate of Shunt and the Outcome in Hydrocephalus Following SAH - Relationship between the Outcome and the Duration, Daily and Total Amount of CSF Drainage at EVD - (자발성 지주막하출혈 후 발생하는 수두증에 대한 단락술의 필요성 및 예후에 관한 분석 - 뇌실외배액술의 기간, 일일배액량 및 총배액량과 예후관계 -)

  • Lee, Won Chang;Choi, Chang Hwa
    • 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.

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