• 한국임상수의학회지
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• 제39권5호
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• pp.235-239
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• 2022

A 10-year-old neutered male Siberian Husky presented with paraparesis and severe lethargy. On physical examination, the patient was unable to weight-bear and walk and exhibited significant muscle mass loss in both hindlimbs and generalized truncal alopecia with a dull coat of hair. On neurological examination, cranial lumbar vertebral pain, hind limb cross-extensor reflex, delayed hindlimb postural reaction, upper motor neuron bladder dysfunction, and total absence of cutaneous trunci reflex were identified. Computed tomography revealed diffuse idiopathic skeletal hyperostosis and spondylosis deformans of the cervical and thoracolumbar vertebrae. In addition, a generalized decrease in bone mineral density of the vertebrae was identified. Magnetic resonance imaging showed hyperplasia of the epidural fat compressing the spinal cord in the thoracolumbar region and concurrent mild multiple intervertebral disc herniations. No specific findings were observed in cerebrospinal fluid analysis. Blood analysis of thyroid function revealed decreased total T4 and free T4 levels, and increased TSH levels. The patient was tentatively diagnosed with spinal epidural lipomatosis (SEL) secondary to hypothyroidism. The patient was treated with levothyroxine, firocoxib, and gabapentin. Clinical signs gradually improved, and the patient showed normal ambulation 40 days after treatment initiation. SEL is extremely rare in dogs. To the best of our knowledge, this is the first case report of SEL secondary to hypothyroidism that was treated conservatively. Secondary SEL can be sufficiently managed by treating the underlying cause, if possible.

• 한국전문물리치료학회지
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• 제29권1호
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• pp.48-53
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• 2022

Background: The gastrocnemius tightness can easily occur. Gastrocnemius tightness results in gait disturbance. Thus, various interventions have been used to release a tight gastrocnemius muscle and improve gait performance. Moreover, focal muscle vibration (FMV) has recently been extensively researched in terms of tight muscle release and muscle performance. However, no study has investigated the effects of FMV application on medial gastrocnemius architectural changes. Objects: In this study, we aimed to investigate the effects of FMV on medial gastrocnemius architecture in persons with limited ankle dorsiflexion. Methods: Thirty one persons with <10° of passive ankle dorsiflexion participated in this study. We excluded persons with acute ankle injury within six months prior to study onset, a history of ankle fracture, leg length discrepancy greater than 2 cm, no history of neurological dysfunction, or trauma affecting the lower limb. The specifications of the FMV motor were as follows: a fixed frequency (fast wave: 150 Hz) and low amplitude (0.3-0.5 mm peak to peak) of vibration; the motor was used to release the medial gastrocnemius for 15 minutes. Each participant completed three trials for 10 days; a 30-second rest period was provided between each trial. Medial gastrocnemius architectural parameters [muscle thickness (MT), fiber bundle length (FBL), and pennation angle (PA)] were measured via ultrasonography. Results: MT significantly decreased after FMV application (p < 0.05). FBL significantly increased from its baseline value after FMV application (p < 0.05). PA significantly decreased from its baseline value after FMV application (p < 0.05). Conclusion: FMV application may be advantageous in reducing medial gastrocnemius excitability following a decrease in the amount of contractile tissue. Furthermore, FMV application can be used as a stretching method to alter medial gastrocnemius architecture.

• Journal of Genetic Medicine
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• 제19권1호
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• pp.22-26
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• 2022

Cerebrotendinous xanthomatosis (CTX) is a rare genetic disease caused by a deficiency of enzymes for the synthesis of bile acid, resulting in the accumulation of cholestanol with reduced chenodeoxycholic acid (CDCA) production and causing various symptoms such as chronic diarrhea in infancy, juvenile cataracts in childhood, tendon xanthomas in adolescence and young adulthood, and progressive neurologic dysfunction in adulthood. Because oral CDCA replacement therapy can effectively prevent disease progression, early diagnosis and treatment are critical in CTX. This study reports the case of CTX in a 10-year-old male who presented with Achilles tendon xanthoma and mild intellectual disability. Biochemical testing showed normal cholesterol and sitosterol levels but elevated cholestanol levels. Genetic testing showed compound heterozygous variants of CYP27A1, c.379C>T (p.Arg127Trp), and c.1214G>A (p.Arg405Gln), which confirmed the diagnosis of CTX. The patient had neither cataracts nor other focal neurologic deficits and showed no abnormalities on brain imaging. The patient received oral CDCA replacement therapy without any adverse effects; thereafter, the cholestanol level decreased and no disease progression was noted. The diagnostic possibility of CTX should be considered in patients with tendon xanthoma and normolipidemic conditions to prevent neurological deterioration.

• 대한중풍순환신경학회지
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• 제15권1호
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• pp.90-96
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• 2014

Drooling causes inconvenience and develops complications, therefore it can be very stressful to patients and caregivers. Drooling caused by neurological disabilities appears to be the consequence of dysfunction in the coordination of the swallowing mechanism. However, there is no explanation about drooling by brain injury in oriental medicine literature. This is the case report about a stroke patient with drooling improved by electro-acupuncture therapy. The patient already applied scopolamine patch, and improved drooling before admission. However, caregiver concerned about side effects, so we stopped using scopolamine patch and applied electro-acupuncture for drooling treatment. The patient was treated by 4 acupuncture points on either side of Yeomcheon(CV 23), and Jichang(ST 4), Hyeopgeo(ST 6) with mixed low frequency electro stimulation. Although we stopped using scopolamine patch, drooling maintained improved state without a change, futhermore after 16 days later, drooling had disappeared until the patient discharged. This result showed electro-acupuncture is useful method to improve drooling caused by brain injury.

• Investigative Magnetic Resonance Imaging
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• 제2권1호
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• pp.14-30
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• 1998

망간은 체내 필수원소의 하나이며 주로 간과 뇌의 기저핵게 축적되며 간을 통하여 배설된다. 망간은 체내 대사가 매우 빠르기 때문에 직업적 망간 폭로를 측정하는데 어려움이 있다. 특히 용접공과 같이 망간 폭로가 간헐적이거나 불규칙한 경우에는 혈중 및 요중 망간과 같은 기존 생체폭로지표로는 장기간에 걸친 폭로량을 정확하게 반영하기 힘들다. 뇌자기공명영상이 대두됨에 따랄 뇌내에 축적된 망간을 영상으로 확인하는 것이 가능하게 되었다. 초기에는 만성간부전 및 장기간에 걸친 정맥영양주입환자 등에서 뇌기저부의 고신호간도 소견이 보고되었다. 망간은 상자성 물질로 뇌자기공명영상에서 T1 이완시간을 단축시켜 T1 강조영상에서 고신호강도를 나타난다. 망간축적에 따른 고신호강도는 주로 담창구, 흑질, 피간 및 뇌하수체 등에서 나타난다. 저자들은 최근까지 국내 및 국외에서 직업적 및 비직업적으로 망간에 폭로된 사람에서 보고된 뇌자기공명영상소견을 수집하여 분석하였다. 우선 T1강조영상에서 관찰되는 고신호 강도와 연령, 성별, 직업적 망간 폭로 및 신경학적 이상 유무간의 관계를 분석하였다. 생물학적 폭로지표와 고신호강도간의 관계도 분석하였다. 고신호강도와 뇌내 망간축적, 신경세포손상 및 신경학적 이상간의 관계에 대한 문헌들을 분석하였다. T1강조영상에서 나타나는 고신호강도는 뇌내 망간축적 정도를 반영한다. 이러한 관계를 이용하여 신호강도를 분석하므로써 뇌내 망간축적 정도를 추정할수 있다. 뇌내 망간축적은 기저핵의 신경세포손상을 초래한다. 그러나 신경학적 이상은 비교적 단기간에 걸친 망간 축적과는 무관하게 보인다. 이는 신경학적 이상소견은 마간의 누적축적량과 관련되어 있기 때문인것으로 추정된다. 뇌자기 공명영사에서 관찰되는 고신호강도 소견은 표적 장기의 망간적 축적량을 반영하는데는 충분하지 못한 것으로 보인다. 따라서이러한 놔자기공명영상의 특성 및 비용-효과적인 측면을 고려할 대 망간폭로집안에서의 망간폭로정도를 추정하기 위하여 놔자기공명영상을 사용하는 것은 바람직하지 않다고 보인다. 그러나 망간과 관련된 건강장해가 의심되는 파킨슨증 환자에서 망간폭로를 확인 및 추정하는 데에는 매우 유용하게 활용할 수 있다.

• 한국임상수의학회지
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• 제23권3호
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• pp.340-343
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• 2006

10년령의 암컷 비글 견이 우측으로의 사경과 중등도의 보행실조가 급성으로 발병하여 내원하였다. 12일 전에 임상증상이 나타났으며, 이는 내원 일까지 점진적으로 호전되고 있는 상태였다. 환견은 활발하고 의식이 명료하며 외부자극에 잘 반응하였다. 신경 검사 상에서 약간의 우측으로의 사경과 보행실조가 관찰되었고 따라서 전정계 질환을 의심할 수 있었다. 임상증상, 자기공명영상, 그리고 뇌척수액 검사를 통해서 중추성 전정계 질병을 감별하였다. 검이경 검사를 통해서 고막의 존재와 정상 형태를 확인하였다. 방사선 및 자기공명영상 검사상에서 고실불룩과 측두골의 암석부분에서 이상소견을 발견할 수 없었다. 갑상선 자극 호르몬 자극 시험을 통해서 갑상선 기능 저하증을 감별하였다. 임상증상은 퇴원 2주 후 완전히 사라졌다. 따라서 임상증상, 전정계 기능이상을 유발하는 다른 원인들의 감별, 그리고 시간에 따른 증상의 완화를 통해서 특발성 전정계 질병으로 진단 할 수 있었다.

• Journal of Korean Neurosurgical Society
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• 제29권11호
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• pp.1491-1498
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• 2000

Objectives : Embolization of intracranial aneurysms by using Guglielmi detachable coils(GDC) is proving to be a safe method of protecting aneurysms from rupture. Occasionally, patients with unruptured intracranial aneurysms present with symptoms related to the aneurysm's mass effect on either the brain parenchyma or cranial nerves. In the present study, the authors conducted a retrospective review to evaluate the response to GDC embolization in a series of 6 patients presenting with cranial nerve dysfunction due to mass effect. Patients and Methods : Aneurysms were classified by size, shape, and amount of intraluminal thrombus. Patients were classified by duration of symptoms prior to GDC treatment(range<1 month to>4 years). Clinical assessment was performed within days of the GDC procedure and at later follow-up appointments(range 5-16 months, mean 9 months). Results : In the immediate post-GDC embolization period, one of the five patients had transient worsening of third nerve palsy, which later improved to better than baseline status. Two patients who presented with third nerve deficit from a internal carotid artery-posterior communicating artery junction aneurysm had complete recovery. One patient who presented with hemiparesis and dysarthria from a giant mid-basilar aneurysm showed improvement of these symptoms. One patient who presented with sixth cranial nerve deficit from a cavernous aneurysm showed no change at the 8-months follow-up examination. Conclusion : The endovascular treatment of intracranial aneurysms by using GDC is suggested as an alternative therapeutic method for improving or alleviating neurological deficits produced by mass effect.

• The Korean Journal of Pain
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• 제29권4호
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• pp.239-248
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• 2016

Background: The present study was undertaken to evaluate the incidence of chronic persistent post-surgical pain (CPPP) and the role of signal transduction genes in patients undergoing staging laparotomy for carcinoma ovary. Methods: The present observational study was undertaken following institutional ethical committee approval and informed consent from all the participants. A total 21 patients of ASA grade I to III with age 20-70 years, scheduled for elective staging laparotomy for carcinoma ovary were included. Patients were excluded if had other causes of pain, cognitive dysfunction or chronic neurological disorders. Statistical analysis of pool data was done using SPSS version-17. For various scales like GPE, PDQ, NPSI, the visual analogue scale (VAS), global perceived effect (GPE), the pain DETECT questionnaire (PDQ), and neuropathic pain symptoms inventory (NPSI), one factor repaeted measure ANOVA applied with simple contrast with baseline as on post-operative day 1 (considered as reference and compared with subsequent time-interval), and the P values were adjusted according to "Bonferroni adjustments". In patients with CPPP, the ${\Delta}ct$ values of mRNA expressions of genes at the end of postoperative day 90 were compared with the baseline control values by one factor repeated ANOVA. P value < 0.005 significant. Results: The present study demonstrates 38.1% (8 out of 21 patients) incidence of CPPP. The functional status and quality of life as were observed to be significantly diminished in all patients with chronic pain. An up-regulation in the mRNA expression of signal transduction and a positive correlation was noted between the mRNA expression of signal transduction genes and VAS score in all patients with CPPP at the end of postoperative day 90. Conclusions: The reported incidence of CPPP in patients with carcinoma ovary was 38.1%. An up-regulation and positive correlation between mRNA expression of signal transduction genes and VAS score depicts its potential role in the pathogenesis of CPPP.

• The Korean Journal of Pain
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• 제23권2호
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• pp.116-123
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• 2010

Background: Pamidronate is a potent inhibitor of osteoclast-mediated bone resorption. Recently, the drug has been known to relieve bone pain. We hypothesized that direct epidural administration of pamidronate could have various advantages over oral administration with respect to dosage, side effects, and efficacy. Therefore, we evaluated the neuronal safety of epidurally-administered pamidronate. Methods: Twenty-seven rats weighing 250-350 g were equally divided into 3 groups. Each group received an epidural administration with either 0.3 ml (3.75 mg) of pamidronate (group P), 0.3 ml of 40% alcohol (group A), or 0.3 ml of normal saline (group N). A Pinch-toe test, motor function evaluation, and histopathologic examination of the spinal cord to detect conditions such as chromatolysis, meningeal inflammation, and neuritis, were performed on the 2nd, 7th, and 21st day following administration of each drug. Results: All rats in group A showed an abnormal response to the pinch-toe test and decreased motor function during the entire evaluation period. Abnormal histopathologic findings, including neuritis and meningeal inflammation were observed only in group A rats. Rats in group P, with the exception of 1, and group N showed no significant sensory/motor dysfunction over a 3-week observation period. No histopathologic changes were observed in groups P and N. Conclusions: Direct epidural injection of pamidronate (about 12.5 mg/kg) showed no neurotoxic evidence in terms of sensory/motor function evaluation and histopathologic examination.

• Journal of Korean Neurosurgical Society
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• 제60권6호
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• pp.635-643
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• 2017

Objective : Acute basilar artery occlusion (BAO) is associated with severe neurological dysfunction and high mortality rates. The benefits of mechanical thrombectomy in BAO have not been explored in recent clinical trials. Therefore, we analyzed outcomes of stent retriever mechanical thrombectomy for BAO, and compared with anterior circulation occlusions (ACO). Methods : In total, 161 consecutive patients (24 BAO, 137 ACO) who underwent mechanical thrombectomy with the stent retriever between January 2013 and August 2016 enrolled in our study. All patients underwent clinical assessment with the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS). Radiological results were used to evaluate thrombolysis in cerebral infarction (TICI) scores and successful recanalization was defined by TICI 2b or 3. Results : Mean NIHSS scores at 24 hours and 30 days were significantly higher in the BAO group than the ACO group (p=0.021, p=0.001). mRS at 90 days was significantly higher in the BAO group (4.2) compared with the ACO group (3.0) (p=0.003). The BAO group (2.0) performed fewer stent retriever passages than the ACO group (2.7) (p=0.049). There were no significant differences between the two groups in terms of complications, but the BAO patients experienced a higher mortality (16.6%) rate than ACO patients (5.8%) (p=0.001). In subgroup analysis of BAO, patients with short procedure times achieved successful recanalization (p=0.001) and successfully recanalized patients exhibited more favorable mRS at 90 days (p=0.027). Conclusion : In our study, mechanical thrombectomy of BAO patients showed worse clinical outcome and higher mortality rate than ACO patients. However, mechanical thrombectomy with a stent retriever in BAO is an effective treatment, because successfully recanalized patients showed good clinical outcome in BAO patients.