• 한국방사선학회논문지
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• 제14권7호
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• pp.957-964
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• 2020

본 연구는 현재 사용되고 있는 가장 빠른 Pulse Sequence 중 하나인 EPI기법과 T2 FLAIR 기법 두 가지를 함께 적용하여 사용하는 EPI-FLAIR기법을 급성 허혈성 뇌경색 환자에게 적용하여, EPI-FLAIR 기법의 진단적 유용성에 대하여 평가하였다. 연구 결과 정성적, 정량적 분석 결과 EPI-FLAIR 기법이 T2 FLAIR 기법과 비교 시 통계적으로 유의한 차이가 있음을 알 수 있었으며, 결론적으로 EPI-FLAIR 기법은 화질의 저하 없이 영상획득시간을 줄일 수 있어 허혈성 급성 뇌경색 및 뇌출혈, 신경학적 결핍, 경색 시기 진단이 필요한 환자의 여러 가지 뇌 병변 평가와 함께 비협조적인 환자들에게 발생하는 Motion Artifact를 줄일 수 있는 장점 있어 T2 FLAIR와 비교하여 충분한 진단적 가치가 있다고 사료된다.

• Parasites, Hosts and Diseases
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• 제59권3호
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• pp.227-233
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• 2021

Eosinophilic meningitis is defined as the presence of more than 10 eosinophils per µl in the cerebrospinal fluid (CSF), or eosinophils accounting for more than 10% of CSF leukocytes in patients with acute meningitis. Parasites are the most common cause of eosinophilic meningitis worldwide, but there is limited research on patients in Korea. Patients diagnosed with eosinophilic meningitis between January 2004 and June 2018 at a tertiary hospital in Seoul, Korea were retrospectively reviewed. The etiology and clinical characteristics of each patient were identified. Of the 22 patients included in the study, 11 (50%) had parasitic causes, of whom 8 (36%) were diagnosed as neurocysticercosis and 3 (14%) as Toxocara meningitis. Four (18%) patients were diagnosed with fungal meningitis, and underlying immunodeficiency was found in 2 of these patients. The etiology of another 4 (18%) patients was suspected to be tuberculosis, which is endemic in Korea. Viral and bacterial meningitis were relatively rare causes of eosinophilic meningitis, accounting for 2 (9%) and 1 (5%) patients, respectively. One patient with neurocysticercosis and 1 patient with fungal meningitis died, and 5 (23%) had neurologic sequelae. Parasite infections, especially neurocysticercosis and toxocariasis, were the most common cause of eosinophilic meningitis in Korean patients. Fungal meningitis, while relatively rare, is often aggressive and must be considered when searching for the cause of eosinophilic meningitis.

• International Journal of Computer Science & Network Security
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• 제21권2호
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• pp.120-130
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• 2021

The spinal cord or CSF surgery is a very complex process. It requires continuous pre and post-surgery evaluation to have a better ability to diagnose the disease. To detect automatically the suspected areas of tumors and symptoms of CSF leakage during the development of the tumor inside of the brain. We propose a new method based on using computer software that generates statistical results through data gathered during surgeries and operations. We performed statistical computation and data collection through the Google Source for the UK National Cancer Database. The purpose of this study is to address the above problems related to the accuracy of missing hybrid KNN values and finding the distance of tumor in terms of brain cancer or CSF images. This research aims to create a framework that can classify the damaged area of cancer or tumors using high-dimensional image segmentation and Laplace transformation method. A high-dimensional image segmentation method is implemented by software modelling techniques with measures the width, percentage, and size of cells within the brain, as well as enhance the efficiency of the hybrid KNN algorithm and Laplace transformation make it deal the non-zero values in terms of missing values form with the using of Frobenius Matrix for deal the space into non-zero values. Our proposed algorithm takes the longest values of KNN (K = 1-100), which is successfully demonstrated in a 4-dimensional modulation method that monitors the lighting field that can be used in the field of light emission. Conclusion: This approach dramatically improves the efficiency of hybrid KNN method and the detection of tumor region using 4-D segmentation method. The simulation results verified the performance of the proposed method is improved by 92% sensitivity of 60% specificity and 70.50% accuracy respectively.

• 한국임상수의학회지
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• 제38권3호
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• pp.143-146
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• 2021

A 2-year-old intact female Maltese dog was presented with generalized involuntary tremors and nystagmus without regular direction. The dog was conscious the whole time while it was trembling. Its involuntary tremors were alleviated at rest or during sleep. Magnetic resonance imaging (MRI) revealed asymmetric hydrocephalus and caudal occipital malformation. In cerebrospinal fluid (CSF) analysis, a trace of protein was found and total nucleated cell count (TNCC) was slightly increased. However, infectious pathogens were not found. In complete blood count, there was a mild leukocytosis. After the patient received anticonvulsants (midazolam, phenobarbital, KBr), diuretics (furosemide) with an anti-inflammatory drug (prednisolone, 0.5 mg/kg PO bid), and a proton-pump inhibitor (omeprazole), it showed no improvement. The patient was tentatively diagnosed with corticosteroid responsive tremor syndrome. So the anticonvulsants and diuretics were discontinued and the dose of prednisolone was increased to an immunosuppressive dose (1 mg/kg PO bid). After administering the immunosuppressive dose of prednisolone, the patient did not show nystagmus. Its tremors were much alleviated. However, they did not disappear. Five weeks later, the patient showed gradual improvement but still was trembling when moving around. Nine weeks later, its tremors were similar to before. So diazepam (0.3 mg/kg PO sid) was added to the treatment. After that, its tremors were alleviated more. Prednisolone and diazepam were maintained for about five months, with tapering of the dose of prednisolone (until 0.5 mg/kg PO sid). About 7 months later after the treatment was started, the dog was trembling rarely except when it was excited. Therefore, diazepam was discontinued. This case describes a refractory white dog shaker syndrome successfully managed with long-term administration of a steroid and diazepam.

• BMB Reports
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• 제55권4호
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• pp.181-186
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• 2022

Ventriculomegaly induced by the abnormal accumulation of cerebrospinal fluid (CSF) leads to hydrocephalus, which is accompanied by neuroinflammation and mitochondrial oxidative stress. The mitochondrial stress activates mitochondrial unfolded protein response (UPRmt), which is essential for mitochondrial protein homeostasis. However, the association of inflammatory response and UPRmt in the pathogenesis of hydrocephalus is still unclear. To assess their relevance in the pathogenesis of hydrocephalus, we established a kaolin-induced hydrocephalus model in 8-week-old male C57BL/6J mice and evaluated it over time. We found that kaolin-injected mice showed prominent ventricular dilation, motor behavior defects at the 3-day, followed by the activation of microglia and UPRmt in the motor cortex at the 5-day. In addition, PARP-1/NF-κB signaling and apoptotic cell death appeared at the 5-day. Taken together, our findings demonstrate that activation of microglia and UPRmt occurs after hydrocephalic ventricular expansion and behavioral abnormalities which could be lead to apoptotic neuronal cell death, providing a new perspective on the pathogenic mechanism of hydrocephalus.

• Journal of Korean Neurosurgical Society
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• 제65권4호
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• pp.582-590
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• 2022

Objective : Hydrocephalus after intracerebral hemorrhage (ICH) is known to be related to poor prognosis and mortality. We analyzed predictors of permanent hydrocephalus in the patients with surgically treated supratentorial ICH. Methods : From 2004 to 2019, a total of 414 patients with surgically treated primary supratentorial ICH were included. We retrospectively analyzed age, sex, preexisting hypertension and diabetes, location and volume of ICH, presence and severity of intraventricular hemorrhage (IVH), and type of surgery. Results : Forty patients (9.7%) required shunt surgery. Concomitant IVH was higher in the 'shunt required' group (92.5%) than in the 'shunt not required' group (67.9%) (p=0.001). IVH severity was worse in the 'shunt required' group (13.5 vs. 7.5, p=0.008). Craniectomy (47.5%) was significantly high in the 'shunt required' group. According to multivariable analysis, the presence of an IVH was 8.1 times more frequent and craniectomy was 8.6 times more frequent in the 'shunt required' group. In the comparison between craniotomy and craniectomy group, the presence of an IVH was related with a 3.9 times higher (p=0.033) possibility and craniectomies rather than craniotomies with a 7-times higher possibility of shunt surgery (p<0.001). Within the craniectomy group, an increase in the craniectomy area by 1 cm² was correlated with a 3.2% increase in the possibility of shunt surgery (odds ratio, 1.032; 95% confidence interval, 1.005-1.061; p=0.022). Conclusion : Presence of IVH, the severity of IVH and decompressive craniectomy were related to the development of shunt dependent hydrocephalus in the patients with ICH. The increasing size of craniectomy was related with increasing rate of shunt requirement.

• Pediatric Infection and Vaccine
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• 제29권1호
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• pp.46-53
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• 2022

뇌실염은 일반적으로 정맥 내 항생제를 통하여 치료하나, 불응성 뇌실염의 치료는 정맥 내 항생제 치료와 뇌실 내 항생제 치료의 병행이 요구되기도 한다. 이론적으로 항생제의 뇌실 내 투여는 정맥 내 단독 투여보다 뇌척수액에서 더 높은 항생제 농도에 도달할 수 있게 한다. 본 증례 보고는 기존의 전신 항생제 치료에 불응하는 폐렴 간균과 메티실린 내성 표피 포도상 구균에 각각 뇌실 내 겐타마이신과 반코마이신 투여를 통하여 뇌실염을 치료한 2례로서 이후에도 주요 합병증 등이 없어 이를 보고하는 바이다.

• Pediatric Infection and Vaccine
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• 제29권1호
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• pp.54-60
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• 2022

살모넬라 수막염은 소아청소년에서 흔하지 않은 병이나 심각한 신경학적 합병증을 일으킬 수 있다. 영아, 특히 3개월 미만의 연령과 악성 종양, 말라리아 감염, 인체면역결핍바이러스 감염과 같은 면역 저하 상태는 살모넬라 수막염의 위험인자로 알려져 있다. 본 증례에서는 고열과 구토, 의식 변화를 주소로 내원한 이전 특이병력 없던 건강한 8세 여아의 살모넬라 수막염 증례를 소개한다. 환자의 뇌척수액에서 D군 살모넬라가 배양되었으며, 뇌 자기공명영상 소견은 정상이었다. 면역 글로불린 수치와 림프구 수는 정상 범위였고, 차세대 염기서열 분석에서 원발성 면역결핍 질환을 일으키는 유전자 변이는 검출되지 않았다. 3세대 세팔로스포린 투약으로 환자의 증상은 빠르게 호전되었으며 합병증이나 후유증은 발생하지 않았다. 비장티푸스 살모넬라균은 면역이 정상인 소아에서 수막염을 일으킬 수 있으며 조기에 항생제를 투여하면 성공적으로 치료할 수 있다.

• Current Optics and Photonics
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• 제6권5호
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• pp.489-496
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• 2022

Our previous study on monitoring cerebral oxygenation with a variation of isoflurane concentration in a rat model showed that near-infrared spectroscopy (NIRS) signals have potential as a new depth of anesthesia (DOA) index. However, that study obtained results from the brain in a completely invasive way, which is inappropriate for clinical application. Therefore, in this follow-up study, it was investigated whether the NIRS signals measured in a minimally invasive model including the skull and cerebrospinal fluid layer (CSFL) are similar to the previous study used as a gold standard. The experimental method was the same as the previous study, and only the subject model was different. We continuously collected NIRS signals before, during, and after isoflurane anesthesia. The isoflurane concentration started at 2.5% (v/v) and decreased to 1.0% by 0.5% every 5 min. The results showed a positive linear correlation between isoflurane concentration and ratio of reflectance intensity (RRI) increase, which is based on NIRS signals. This indicates that the quality of NIRS signals passed through the skull and CSFL in the minimally invasive model is as good as the signal obtained directly from the brain. Therefore, we believe that the results of this study can be easily applied to clinics as a potential indicator to monitor DOA.

• 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.