• Journal of Korean Neurosurgical Society
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• 제58권3호
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• pp.304-307
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• 2015

Only a few cases of anterior longitudinal ligament (ALL) injury related with retropharyngeal hematoma without fracture have previously been reported. The treatment of choice for retropharyngeal hematoma is generally considered to be conservative care, but we believe that early surgery of this pathology would be better in certain situations. Here, we describe two cases with life-threatening large retropharyngeal hematomas related with ALL injuries and operated on at an early stage. Two previously healthy patients visited the emergency room with neck pain and dyspnea after falling. Serious neck swelling was observed and lateral neck X-ray showed severe widening of the prevertebral space. Due to dyspnea progression, emergency endotracheal intubation was performed. Although there was no primary cause of the retropharyngeal hematoma on preoperative examination, ALL tearing was intraoperatively confirmed during early surgery. The in-hospital evolutions of the patients were favorable after surgery. We should bear in mind the possibility of ALL injury and perform early surgery where possible given the earlier convalescence and good prognosis.

• 대한임상검사과학회지
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• 제46권1호
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• pp.38-45
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• 2014

Intraoperative Neurophysiological Monitoring (INM) inspection has a very important role. While preserving the patient's neurological function be sure to safe surgery, neurological examination should thank. Cerebello pontine angle tumor surgery, especially in the nervous system is more important to the meaning of INM. In cochlear nerve, facial nerve, trigeminal nerve, which are intricate brain surgery, doctors are only human eye and brain to the brain that it is virtually impossible to distinguish the nervous system. They receives a lot of help from INM. In this paper, we examined six kinds broadly. First, the methods of spontaneous EMG and Free-running EMG, which can instantly detect a damage inflicted on a nerve during surgery. Second, methods of triggered EMG and direct nerve electrical stimulation, which directly stimulate a nerve using electricity to distinguish between nerves and brain tumors. Third, the method of knowing a more accurate neurologic status by informing neurological surgeons about Free-running EMG wave forms that are segmetalized into four. Fourth, three ways of knowing when a patient will be awaken from intraoperative anesthesia, which happens due to a weak anesthetic. Fifth, a method of understanding the structures of a brain tumor and a facial nerve as five dividend segments. Sixth, comparisons between cases normal facial nerve recovery and occurrence of a facial nerve paralysis during the postoperative course.

• Safety and Health at Work
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• 제3권4호
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• pp.243-256
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• 2012

This article schematically reviews the clinical features, diagnostic approaches to, and toxicological implications of toxic encephalopathy. The review will focus on the most significant occupational causes of toxic encephalopathy. Chronic toxic encephalopathy, cerebellar syndrome, parkinsonism, and vascular encephalopathy are commonly encountered clinical syndromes of toxic encephalopathy. Few neurotoxins cause patients to present with pathognomonic neurological syndromes. The symptoms and signs of toxic encephalopathy may be mimicked by many psychiatric, metabolic, inflammatory, neoplastic, and degenerative diseases of the nervous system. Thus, the importance of good history-taking that considers exposure and a comprehensive neurological examination cannot be overemphasized in the diagnosis of toxic encephalopathy. Neuropsychological testing and neuroimaging typically play ancillary roles. The recognition of toxic encephalopathy is important because the correct diagnosis of occupational disease can prevent others (e.g., workers at the same worksite) from further harm by reducing their exposure to the toxin, and also often provides some indication of prognosis. Physicians must therefore be aware of the typical signs and symptoms of toxic encephalopathy, and close collaborations between neurologists and occupational physicians are needed to determine whether neurological disorders are related to occupational neurotoxin exposure.

• 한국임상수의학회지
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• 제31권5호
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• pp.445-448
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• 2014

7년령 수컷 말라뮤트 견이 정기적인 치과진료를 목적으로 내원하였다. 신체검사 상에서 뒷다리의 운동 실조가 확인되었으며, 우측 뒷다리의 고유 자세반응이 미약하게 지연되었다. 감별진단을 위한 MRI 검사에서, 허리뼈 1번과 2번 사이 척수강에 경막외 낭종이 확인되었다. 낭종은 디스크 바로 등쪽에서 척수실질 배쪽을 등쪽으로 심하게 압박하고 있었으며, T1 저신호, T2 고신호 및 낭종 벽을 따라 조영증강이 확인되었다. 편측성 추궁절제술을 통해 낭종을 제거하였고, 조직검사 결과 낭종의 벽은 섬유소 및 섬유아세포가 혼재되어 있었으며 일부분에서 호염성 디스크 물질이 확인되어 디스크 낭종으로 진단하였다. 환자는 수술 후 신경증상은 정상적으로 회복하였으며, 6개월 후 신체검사에서 정상적인 보행 이 관찰되었다.

• 의료법학
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• 제25권1호
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• pp.61-86
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• 2024

본 연구는 경막외 혈종 발생과 관련한 문헌 및 척추 수술 후 경과관찰 상의 과실에 관한 판결 중 요추 MRI 검사 여부에 대해 판단한 하급심 판결에 관해 검토함으로써 척추 수술 후 환자에 대한 지속적이고 세밀한 경과관찰의 중요성을 확인했다. '수술 후 MRI 검사나 협진을 게을리한 사례', '수술 후 통증 및 증상 호소에도 MRI 검사를 지체한 사례', '시술 후 신경학적 증상 발현에도 바로 귀가 조치한 사례'에서는 경과관찰 상의 과실이 인정되었다. '증상에 대해 조치하여 후유증상 발생에 과실이 인정되지 않은 사례', '검사 시행에 대한 의사의 재량범위를 인정한 사례'에서는 경과관찰 상의 과실이 인정되지 않았다. 본 연구가 척추 수술을 받은 환자에 대해 지속적인 세밀한 경과관찰이 필요하다는 것과 특히 새로운 신경학적 증상을 보이는 경우 신속한 MRI 검사 및 진단과 수술적 처치 내지 전원 조치의 중요성에 대한 인식을 높임으로써 척추 수술 후 경과관찰과 관련한 의료사고 및 분쟁의 예방에 도움이 되기를 바란다.

• Journal of Korean Neurosurgical Society
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• 제29권5호
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• pp.684-687
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• 2000

Primary anaplastic oligodendroglioma in brain stem is extremely rare. The authors present a case of a anaplastic oligodendroglioma arising from pons. A 29 year-old male patient was admitted because of cranial nerve palsy and visual disturbance. Neurological examination revealed bilateral sixth and left seventh cranial nerve plasies. Near-total resection of tumor mass was performed through midline suboccipital appraoch. Tumor was not related with choroid plexus and major vessels but it was firmly attached to the fourth ventricle floor. Tumor was considered to be arised from the tegmental portion of pons, growing dorsally into the 4th ventricle. Hitopathological exmination revealed primary anaplastic oligodendroglioma. Postoperative course was uneventful. The authors believe that this type of tumor with dorsally growing pattern can be successfully resected without major neurological deficit.

• Journal of Korean Neurosurgical Society
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• 제41권4호
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• pp.252-254
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• 2007

Ependymal cysts are neuroepithelial cysts, typically found in the central white matter of the temporoparietal and frontal lobes. Clinical symptoms usually result from neurological deficits referable to these regions, from seizures, and chronic headaches associated with increased intracranial pressure. We describe here a case of ependymal cyst on the right fronto-parietal lobe, presenting with tremor and weakness. The cyst was resected surgically and presurgical neurological abnormalities were improved. An exploratory surgery with establishment of an adequate route of drainage and histological examination of the cyst wall are mandatory in the management of patients with a progressive and symptomatic intraparenchymal cyst.

• 한국임상수의학회지
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• 제41권4호
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• pp.223-227
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• 2024

Air accumulation in the cranial cavity is referred to as pneumocephalus. Tension pneumocephalus is a neurosurgical emergency that can cause headaches, seizures, reduced consciousness, and even death owing to increased intracranial pressure. We report a case of tension pneumocephalus. The patient underwent a frontal sinusotomy for a mass invading the frontal sinus and nasal cavity. One month later, the patient was admitted to the emergency room with seizures and neurotic symptoms, and computed tomography (CT) revealed tension pneumocephalus with significant gas dilatation of both lateral ventricles. Prompt treatment of the dural defect resulted in the immediate improvement of neurological signs. A CT re-examination 1 week after surgery showed that the pneumocephalus had completely resolved. Tension pneumocephalus should be considered a potential complication in patients with worsening neurological signs after skull base surgery. An accurate diagnosis requires an understanding of imaging features and a high index of suspicion, and immediate intervention is essential.

• Clinical and Experimental Pediatrics
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• 제46권2호
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• pp.137-142
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• 2003

목 적 : 신생아기의 뇌파검사가 대뇌질환에 얼마나 예민한 검사인가를 조사하고, 초음파 검사와 비교하여 얼마나 예민하고 특이도가 높은 검사 방법인지를 조사하였다. 그리고 뇌파검사가 신생아의 신경학적 예후를 평가하는데 얼마나 가치가 있는지를 조사하기 위하여 본 연구를 시행하였다. 방 법 : 신경계 질환의 기능평가를 위하여 뇌파검사를 시행한 87명의 신생아를 대상으로 하였으며 출생 후 3일 이내에 뇌파검사를 시행하였다. 출생 후 3일 이내에 시행한 초기 뇌 초음파검사 소견을 7일 이후에 시행한 자기공명영상검사 또는 초음파검사 소견과 비교하였다. 결 과: 뇌파 검사는 신생아의 뇌손상을 진단하는데 초음파 검사보다 높은 감수성과 특이성을 보이는 것으로 나타났다. 신경학적 예후에 대한 뇌파 소견의 감수성은 경증의 장애에 대해서는 91.7%, 중등도 이상의 장애에 대해서는 100.0%로 나타났으나, 초기 초음파 소견은 각각 20.8%, 18.8%로 나타났다. 결 론 : 뇌파검사는 신생아의 뇌손상을 진단하는데 민감한 검사이고, 후기 신경학적 예후를 예측하는데 유용한 검사로 사료된다.

• 수면정신생리
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• 제3권2호
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• pp.1-17
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• 1996

To demonstrate the clinical usefulness of electroencephalography (EEG) and factors increasing the usefulness of EEG, the authors evaluated each relationship between EEG related factors and clinical variables, and neuroimaging studies (CT and MRI)-related factors, and factors which are related with routine neurological examination for 207 patients who had been evaluated with both of EEG and neuroimaging study(CT or/and MRI). The results were as follows: 1) Abnormality of EEG findings had significant relationships with chief complaints, diagnosis, medication use, seizure attack, pathological reflex, and level of consciousness. However there were no significant correlations between abnormality of EEG findings and neuroimaging studies (CT and MRI)- related factors. 2) Laterality of EEG findings had significant relationships with abnormality, laterality, and focality of CT findings, and also with abnormality of MRI findings. But there were no significant correlations between laterality of EEG findings and clinical variables, and neurological examination-related factors. 3) Anterior-posterior distribution of EEG findings was significantly related with medication use. 4) Focality of EEG findings had significant relationships with sex, sensory dysfunction sign, and cerebellar dysfunction sign. But there were no significant correlations between focality of EEG findings and neuroimaging studies(CT and MRI) related factors. 5) Abnormal EEG pattern had significant correlations with various factors, such as age, chief complaints, duration from onset of symptom to taking MRI, seizure attack, abnormality and nature of lesion in CT findings, cortical atrophy in MRI findings, motor dysfunction sign, sensory dysfunction sign, and pathological reflex. 6) With abnormality on sleep activation, age, age of onset, seizure attack, ventricular enlargement in CT findings, and abnormality of MRI findings were significantly correlated. 7) With abnormality on hyperventilation activation, duration of illness and laterality of MRI findings were significantly correlated. Above results may suggest that abnormality of EEG findings is more closely related with functional change of the brain than structural changes of the brain and laterality of EEG findings is vice versa. And also that medication use has an influence on anterior versus posterior distribution of EEG findings and focality of EEG findings is not related with structural changes of the brain. Activation with sleep may be effective to show age differences and provocation of seizure activity and hyperventilation may be effective to detect the abnormal EEG findings by cerebrovascular insufficiency.