No abstract available.
Female ; Pregnancy ; Pregnancy, Ectopic*

Vertigo, a definite rotational sensation, consists of a variety of syndromes. The purpose of this study was to accumulate information on various aspects of vertigo or dizziness. We performed a retrospective study about vertigo patients, who had admitted to our hospital for recent 2 years. From January 1994 to December 1995, 214 patients with the complaints of 'vertigo' and 'dizziness', who admitted to the department of Neurology, Ewha Womans University Hospital, were accepted for this study. All data were recorded on computer-oriented questionnaires in digital forms. The study forms consisted of five parts; (1) history and associated symptoms, (2) physical, neurologic and bedside examinations, (3) laboratory and brain imaging studies, (4) special tests including brainstem auditory evoked potentials and (5) clinical diagnosis. Of these 214 patients, secure diagnosis could be made in 186 patients or 86.9%. Of these, 92 patients had peripheral causes of vertigo, and 94 had central causes. Vestibular disorders accounted for the largest proportion of complaints of vertigo(48/92 or 52%). Of 94 patients with central causes of vertigo, vertebrobasilar insufficiency was the leading cause(25/94 or 27%). The most common site of the brain lesion proved by MRI was cerebellum(23/94 or 25%). BAEP study revealed abnormal findings in 6 cases of the 16 patients with central causes. This study not only offered a clinical information about vertigo, but also could be beneficial for further researches.
Brain ; Diagnosis ; Dizziness ; Evoked Potentials, Auditory, Brain Stem ; Female ; Humans ; Magnetic Resonance Imaging ; Neuroimaging ; Neurology ; Surveys and Questionnaires ; Retrospective Studies ; Sensation ; Vertebrobasilar Insufficiency ; Vertigo

No abstract available.
Reference Values*

We report a very rare case of trichilemmal carcinoma (TLC) involving the upper eyelid. To the best of our knowledge, this is the first report of trichilemmal carcinoma of the upper eyelid in Korea. A 51-year-old man presented to our hospital complaining of a bloody discharge from his left upper eyelid. He had a soft and lobulated mass on the palpebral conjunctiva. An incisional biopsy revealed trabecular growth of tumor cells with clear cytoplasm, prominent nucleoli, frequent mitoses, and foci of trichilemmal keratinization. Immunohistochemically, the lesion was positive for p53 and negative for CD 34. A diagnosis of TLC was made, and total excision of the mass and reconstruction of the eyelid were performed. Trichilemmal carcinoma is a rare malignant tumor, though it appears to be an indolent neoplasm with no metastatic potential. The treatment of choice for trichilemmal carcinoma of the eyelid is complete excision with tumor-free margins due to the locally invasive nature of the lesion.
Carcinoma, Skin Appendage/*pathology/surgery ; Diagnosis, Differential ; Eyelid Neoplasms/*pathology/surgery ; Follow-Up Studies ; *Hair ; Humans ; Male ; Middle Aged ; Mohs Surgery ; Skin Neoplasms/*pathology/surgery

No abstract available.
Classification* ; Seizures*

Although several cases of apneic seizures have been reported in neonates, epileptic seizures presented with apnea only in adults are very rare. We present a 19-year-old man who suffered from viral encephalitis and frequent episodes of apneic seizures. Ictal EEGs, recorded during apneic episodes, showed repetitive sharp waves or rhythmic theta activ-ities arising from the left or right independent bitemporal region. Ictal SPECT was performed during one episode of apnea accompanied by ictal EEG discharges arising from the left posterior temporal area. Ictal-interictal subtraction SPECT coregistered with MRI revealed that the seizures were originated from the left posterior mid-lateral temporal cortex. Previous studies, with ictal EEG or brain stimulation, suggested that apneic seizures might be mediated through the limbic and the associated cortical systems. This is a very rare case of partial seizures presented with apnea in an adult patient, which was supported by ictal EEG and ictal-interictal subtraction SPECT coregistered with MRI.
Adult* ; Apnea* ; Brain ; Electroencephalography ; Encephalitis ; Encephalitis, Viral ; Epilepsy ; Humans ; Infant, Newborn ; Magnetic Resonance Imaging ; Seizures* ; Temporal Lobe ; Tomography, Emission-Computed, Single-Photon ; Young Adult

Purpose: Treatment for epilepsy primarily involves antiseizure medications (ASMs), which can be characterized using the clinical data warehouse (CDW) database. In this study, we compared retention rates and time to successful treatment for various ASMs to reflect both efficacy and adverse effects in patients with newly diagnosed epilepsy. Materials and Methods: We identified newly diagnosed epilepsy patients with ASM treatment for more than 12 months using CDW of a tertiary referral hospital. Clinical characteristics were compared between groups with successful and unsuccessful treatment. Cox regression analysis was performed to evaluate independent variables of age, sex, comorbidities, and attributes of ASM regimens. Results: Of 2515 eligible participants, 46.2% were successfully treated with the first ASM regimen, and 74.7% with all ASM regimens with the median time-to-treatment success of 14 months. Participants with second-generation ASM as the first ASM were more likely to be successfully treated with the first regimen compared to those with first-generation ASM (51.6% vs. 42.3%, p<0.001) and more successfully treated [hazard ratio (HR)=1.26; 95% confidence interval (CI): 1.15–1.39]. Overall, valproic acid was the most common ASM across a wide range of ages under 65 years, while levetiracetam in patients aged over 65 years or lamotrigine in female adult patients. Clinical factors associated with less favorable treatment outcomes included renal disease (HR=0.78; 95% CI: 0.66–0.92), liver disease (HR=0.65; 95% CI: 0.52–0.81), depression (HR=0.70; 95% CI: 0.57–0.84), and mechanical ventilation (HR=0.58; 95% CI: 0.50–0.67). Conclusion Second-generation ASMs have the advantage of more successful treatment with fewer ASM regimen changes compared with first-generation drugs. Various comorbid conditions as well as age and sex should be considered when selecting ASMs.

Background: Post-cardiac arrest syndrome (PCAS) is one of the critical conditions which can result in a more serious brain injury. Early and accurate prognostication is crucial for deciding the patient’s therapeutic plan and setting the treatment goal. This study aimed to establish the prognostication values of quantitative electroencephalography (QEEG) in PCAS patients. Methods: We recruited 183 PCAS patients treated with therapeutic hypothermia. Electroencephalography (EEG) data within 72 hours after cardiac arrest (CA) and clinical data were collected. QEEG analysis including power spectral density (PSD) and connectivity analysis of default mode network (DMN) with imaginary coherence were performed. Results: There were significantly different patterns of PSD between neurologic good and poor outcome groups; absolute and relative power of the alpha 2 and beta 1 frequency (10-15 Hz) bands were increased in all brain regions of good outcome group. However, the relative power of the delta band and higher frequency bands over fast alpha (beta 3 and gamma bands over 20 Hz) were poor outcome markers. We found out that connectivity of DMN were significantly decreased in the poor outcome group compared with the good outcome group. Conclusions These findings suggest that QEEG analysis could quantify and automate the interpretation of EEG. Furthermore, they can improve the prognostic values for neurologic outcomes relatively accurately and objectively in PCAS patients treated with hypothermia compared with traditional visual grading.

BACKGROUND & OBJECTIVES: Repetitive transcranial magnetic stimulation (rTMS) can modulate the excitability of cortical networks, possibly reduce the excitability by low frequency stimulation. In this study, we are conducting a study using 1 Hz rTMS in patients with intractable neocortical epilepsy. We wish to see whether 1Hz rTMS induces considerable changes in the cortical excitability and whether it leads to a significant reduction in seizure frequency in individual patients. METHODS: Patients with intractable neocortical epilepsy were recruited, and 1 Hz rTMS (110% of resting motor threshold, 1800 stimuli twice a day) was delivered to the seizure focus for 5 consecutive days. Resting motor threshold (r-MT), MEP amplitudes at different intensities, intracortical inhibition (ICI) and intracortical facilitation (ICF) were measured as TMS indices for motor cortical excitability. TMS measures were repeated before and after daily rTMS session, and again after 2 weeks. RESULTS: Four patients (aged 15 to 53, 3 females and 1 male, 2 TLE and 2 FLE) were described here:cortical excitability in 2 neocortical TLE patients showed lower r-MT and reduced ICF in ipsilateral hemisphere to epileptic focus. One of them with cortical dysplasia showed increased r-MT and ICI, and decreased ICF after daily rTMS session. This patient was seizure-free for 10 weeks, after which the seizure frequency returned to the baseline. CONCLUSIONS: Our preliminary data shows that 1 Hz rTMS may decrease cortical excitability and/or intracortical facilitation, and increase intracortical inhibition after daily rTMS. These findings suggest possible therapeutic effects of low frequency rTMS for patients with intractable neocortical epilepsy.
Epilepsy* ; Female ; Humans ; Male ; Malformations of Cortical Development ; Seizures* ; Transcranial Magnetic Stimulation*

BACKGROUND: Women with epilepsy tend to have hormonal and metabolic disturbances. This study was performed to investigate whether epileptic women with specific epileptic syndromes or antiepileptic drugs (AEDs) are at risk for metabolic and/or menstrual abnormalities. METHODS: Women with epilepsy aged 15 to 50 years old, currently on AED medications for more than 6 months, were recruited for this study. Subjects checked their oral temperature each morning. Serum tests for lipid profiles, insulin, glucose, and leptin were performed on menstrual cycle days 2 to 3. HOMA-index, as a marker of insulin resistance, was calculated. RESULTS: In total 57 patients, 19 women were diagnosed as primary generalized epilepsy (PGE) and the other 38 as localization-related epilepsy (LRE). Among them, 42 patients were on monotherapy; 19 women on carbamazepine (CBZ), 12 on valproate (VPA), and 11 on lamotrigine (LTG). Body mass index increased in VPA group (24.43+/-3.61) compared to CBZ (22.03+/-2.45) or LTG (21.68+/-2.14) group (p=0.046), and metabolic syndrome was more commonly associated in VPA group (5/12, 41.7%) than in CBZ (1/19, 5.3%) or LTG (0%) group (p=0.005). Epileptic women on VPA experienced menstrual irregularity (7/12, 58.8%) more frequently, compared to CBZ (4/19, 21.1%) or LTG (3/11, 27.3%) group (p=0.089). No differences were observed between PGE and LRE groups. CONCLUSIONS: Women with epilepsy on VPA tend to be more obese, and more frequently have metabolic and/or menstrual abnormalities than epileptic women on CBZ or LTG..
Anticonvulsants ; Body Mass Index ; Carbamazepine ; Epilepsies, Partial ; Epilepsy* ; Epilepsy, Generalized ; Female ; Glucose ; Humans ; Insulin ; Insulin Resistance ; Leptin ; Menstrual Cycle ; Middle Aged ; Prostaglandins E ; Valproic Acid