1.Ischemic stroke as an initial presentation of primary bone marrow lymphoma
Mi-Yeon Eun ; June Woo Ahn ; Dong Won Baek ; Ji Yun Jeong ; Jaechun Hwang
Neurology Asia 2020;25(1):59-62
Various cancer types have been associated with cancer-related cerebral infarction. In this study, we
describe the first case of cancer-related cerebral infarction in which the underlying disease was primary
bone marrow lymphoma (PBML). A 79-year-old man presented with abruptly developed bilateral lower
extremity weakness and confusion. Diffusion-weighted imaging on admission showed multiple cortical
and subcortical embolic infarction lesions in multiple vascular territories. Diagnostic evaluations to
determine the embolic source revealed no abnormalities. Laboratory testing demonstrated elevated
D-dimer (2.59 μg/mL) but no other prothrombotic abnormalities. In suspicion of cancer-related stroke,
we performed chest CT, abdomen CT, and FDG-PET to detect the hidden malignancy. Findings
revealed no evidence of cancer; however, they did reveal signs of anemia (hemoglobin 9.0 g/dL).
Bone marrow aspiration biopsy showed large atypical B cell involvement suggestive of high-grade B
cell lymphoma. The patient was diagnosed with primary bone marrow diffuse large B-cell lymphoma
initially presenting with ischemic stroke. Our case suggests that primary bone marrow cancer may be a
candidate for the differential diagnosis of hidden malignancy in patients with suspected cancer-related
stroke. Bone marrow biopsy may be essential for establishing an appropriate differential diagnosis in
patients with abnormal hematologic findings.
2.Coexistence of Anti-Hu and Anti-SOX1 Autoantibodies in Atezolizumab-related Encephalitis
Mi-Yeun EUN ; Hyungseok HAH ; Jaechun HWANG
Journal of the Korean Neurological Association 2024;42(1):48-52
Although immune checkpoint inhibitor-related encephalitis has been reported, its underlying mechanism and treatment strategies remain unclear. Here, we present the case of a 60-yearold male patient with small cell lung cancer who developed autoimmune encephalitis during treatment with atezolizumab. Notably, this case involved the concurrent detection of two paraneoplastic autoantibodies (anti-Hu and anti-SOX1). Encephalitis was treated by discontinuing atezolizumab and administering steroids, despite the persistence of the antibodies. This case provides insights into the interaction between immune checkpoint inhibitors and paraneoplastic autoantibodies.
3.Vertebrobasilar Insufficiency Caused by Lateral Head Tilting.
Jaechun HWANG ; Pamela SONG ; Soo kyoung RYU ; Cindy W YOON ; Dae Won SEO
Journal of the Korean Neurological Association 2009;27(4):388-392
Vertebrobasilar insufficiency (VBI) in rotatory vertebral artery occlusion syndrome can be caused by voluntary head turning in the yaw plane. We report a case of VBI for head tilting in the roll plane. Transcranial Doppler on left head tilting resulted in decreased blood flow in both vertebral arteries. A CT angiogram revealed that the stenotic left vertebral artery was very close to an enlarged thyroid gland, suggesting mechanical compression of the vertebral artery during head tilt.
Head
;
Thyroid Gland
;
Vertebral Artery
;
Vertebrobasilar Insufficiency
;
Vertigo
4.Improved Adherence to Positive Airway Pressure Treatment after Covering National Health Insurance in Patient with Obstructive Sleep Apnea: A Tertiary Sleep Center Review
Hyo-Eun YOON ; Chang-Jin JEON ; Jaechun HWANG ; Ho-Won LEE ; Ji-Ye JEON
Journal of Sleep Medicine 2021;18(1):22-28
Objectives:
Obstructive sleep apnea (OSA) is a common clinical disease which has been associated with cardiovascular disease and sudden death. Positive airway pressure (PAP) is the most effective treatment for OSA; however, most patients experience difficulties in tolerating machines, masks, or economic burdens. In Korea, National Health Insurance (NHI) application for PAP started in July 2018. Therefore, this study aimed to evaluate the PAP adherence and factors contributing to good adherence after NHI coverage in Korea.
Methods:
A retrospective study was performed to examine 89 patients with OSA who were treated with PAP in 2019. All medical records were analyzed to obtain demographic and clinical data, including personal history, polysomnographic data, and PAP results.
Results:
A total of 66 participants were included, of which 56 (84.8%) were maintained on PAP therapy after 3 months, and 32 of 42 (76.1%) were maintained on PAP therapy after 6 months; prolonged rapid eye movement (REM) sleep latency, increased nonREM (NREM) apnea-hypopnea index (AHI), and supine AHI significantly contributed to good PAP adherence for 3 months. At 6 months, prolonged REM sleep latency, increased NREM AHI, supine AHI, and increased arousal index significantly contributed to good PAP adherence. However, comorbid hypertension contributed to poor PAP compliance.
Conclusions
PAP adherence in patients with OSA was 84.8% after 3 months, and 76.1% after 6 months after NHI coverage in a regional tertiary sleep center in Korea. Prolonged REM sleep latency and increased supine AHI and NREM AHI significantly contributed to good adherence, whereas comorbid hypertension was a factor for poor PAP compliance.
5.Improved Adherence to Positive Airway Pressure Treatment after Covering National Health Insurance in Patient with Obstructive Sleep Apnea: A Tertiary Sleep Center Review
Hyo-Eun YOON ; Chang-Jin JEON ; Jaechun HWANG ; Ho-Won LEE ; Ji-Ye JEON
Journal of Sleep Medicine 2021;18(1):22-28
Objectives:
Obstructive sleep apnea (OSA) is a common clinical disease which has been associated with cardiovascular disease and sudden death. Positive airway pressure (PAP) is the most effective treatment for OSA; however, most patients experience difficulties in tolerating machines, masks, or economic burdens. In Korea, National Health Insurance (NHI) application for PAP started in July 2018. Therefore, this study aimed to evaluate the PAP adherence and factors contributing to good adherence after NHI coverage in Korea.
Methods:
A retrospective study was performed to examine 89 patients with OSA who were treated with PAP in 2019. All medical records were analyzed to obtain demographic and clinical data, including personal history, polysomnographic data, and PAP results.
Results:
A total of 66 participants were included, of which 56 (84.8%) were maintained on PAP therapy after 3 months, and 32 of 42 (76.1%) were maintained on PAP therapy after 6 months; prolonged rapid eye movement (REM) sleep latency, increased nonREM (NREM) apnea-hypopnea index (AHI), and supine AHI significantly contributed to good PAP adherence for 3 months. At 6 months, prolonged REM sleep latency, increased NREM AHI, supine AHI, and increased arousal index significantly contributed to good PAP adherence. However, comorbid hypertension contributed to poor PAP compliance.
Conclusions
PAP adherence in patients with OSA was 84.8% after 3 months, and 76.1% after 6 months after NHI coverage in a regional tertiary sleep center in Korea. Prolonged REM sleep latency and increased supine AHI and NREM AHI significantly contributed to good adherence, whereas comorbid hypertension was a factor for poor PAP compliance.
8.Isolated Posteroinferior Cerebellar Artery Dissection Diagnosed by High-Resolution Vessel Wall MRI.
Hea Ree PARK ; Jaechun HWANG ; Ye Sel KIM ; Juhyeon KIM ; Hyunjin JO ; Young Hee JUNG ; Jihoon CHA ; Sung Tae KIM ; Gyeong Moon KIM
Journal of the Korean Neurological Association 2016;34(3):209-212
Arterial dissection is an important cause of stroke. We report two cases of isolated posterior inferior cerebellar artery (PICA) dissection diagnosed by high-resolution vessel-wall MRI (HRVW-MRI). One subject complained of abrupt-onset vertigo and headache, and the other subject had headache, vertigo, and Horner syndrome. Conventional MRA showed only focal dilatation of the PICA, but HRVW-MRI revealed intramural hematoma and double-lumen contour in the PICA, suggesting arterial dissection. We suggest that the use of HRVW-MRI should be considered when diagnosing isolated PICA dissection in a PICA infarct with an unknown cause.
Arteries*
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Dilatation
;
Headache
;
Hematoma
;
Horner Syndrome
;
Magnetic Resonance Imaging*
;
Pica
;
Stroke
;
Vertigo
9.Ischemic Stroke in Takayasu's Arteritis: Lesion Patterns and Possible Mechanisms.
Jaechun HWANG ; Suk Jae KIM ; Oh Young BANG ; Chin Sang CHUNG ; Kwang Ho LEE ; Duk Kyung KIM ; Gyeong Moon KIM
Journal of Clinical Neurology 2012;8(2):109-115
BACKGROUND AND PURPOSE: The purpose of the present study was to use brain magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) to identify the mechanism of stroke in patients with Takayasu's arteritis (TA). METHODS: Among a retrospective cohort of 190 TA patients, 21 (3 males and 18 females) with a mean age of 39.9 years (range 15-68 years) who had acute cerebral infarctions were included in lesion pattern analyses. The patients' characteristics were reviewed, and infarction patterns and the degree of cerebral artery stenosis were evaluated. Ischemic lesions were categorized into five subgroups: cortical border-zone, internal border-zone, large lobar, large deep, and small subcortical infarctions. RESULTS: In total, 21 ischemic stroke events with relevant ischemic lesions on MRI were observed. The frequencies of the lesion types were as follows: large lobar (n=7, 33.3%), cortical border zone (n=6, 28.6%), internal border zone (n=1, 4.8%), small cortical (n=0, 0%), and large deep (n=7, 33.3%). MRA revealed that 11 patients had intracranial artery stenosis. CONCLUSIONS: Hemodynamic compromise in large-artery stenosis and thromboembolic mechanisms play significant roles in ischemic stroke associated with TA.
Arteries
;
Brain
;
Cerebral Arteries
;
Cerebral Infarction
;
Cohort Studies
;
Constriction, Pathologic
;
Hemodynamics
;
Humans
;
Infarction
;
Magnetic Resonance Angiography
;
Magnetic Resonance Imaging
;
Male
;
Retrospective Studies
;
Stroke
;
Takayasu Arteritis
;
Thromboembolism
;
Vasculitis
10.The Need for a Well-Organized, Video-Assisted Asthma Education Program at Korean Primary Care Clinics.
Yee Hyung KIM ; Kwang Ha YOO ; Jee Hong YOO ; Tae Eun KIM ; Deog Kyeom KIM ; Yong Bum PARK ; Chin Kook RHEE ; Tae Hyung KIM ; Young Sam KIM ; Hyoung Kyu YOON ; Soo Jung UM ; I Nae PARK ; Yon Ju RYU ; Jae Woo JUNG ; Yong Il HWANG ; Heung Bum LEE ; Sung Chul LIM ; Sung Soo JUNG ; Eun Kyung KIM ; Woo Jin KIM ; Sung Soon LEE ; Jaechun LEE ; Ki Uk KIM ; Hyun Kuk KIM ; Sang Ha KIM ; Joo Hun PARK ; Kyeong Cheol SHIN ; Kang Hyeon CHOE ; Ho Kee YUM
Tuberculosis and Respiratory Diseases 2017;80(2):169-178
BACKGROUND: The purpose of this study was to assess the effect of our new video-assisted asthma education program on patients' knowledge regarding asthma and asthma control. METHODS: Adult asthmatics who were diagnosed by primary care physicians and followed for at least 1 year were educated via smart devices and pamphlets. The education sessions were carried out three times at 2-week intervals. Each education period lasted at most 5 minutes. The effectiveness was then evaluated using questionnaires and an asthma control test (ACT). RESULTS: The study enrolled 144 patients (mean age, 56.7±16.7 years). Half of the patients had not been taught how to use their inhalers. After participating in the education program, the participants' understanding of asthma improved significantly across all six items of a questionnaire assessing their general knowledge of asthma. The proportion of patients who made errors while manipulating their inhalers was reduced to less than 10%. The ACT score increased from 16.6±4.6 to 20.0±3.9 (p<0.001). The number of asthmatics whose ACT score was at least 20 increased from 45 (33.3%) to 93 (65.3%) (p<0.001). The magnitude of improvement in the ACT score did not differ between patients who received an education session at least three times within 1 year and those who had not. The majority of patients agreed to the need for an education program (95.8%) and showed a willingness to pay an additional cost for the education (81.9%). CONCLUSION: This study indicated that our newly developed education program would become an effective component of asthma management in primary care clinics.
Adult
;
Asthma*
;
Education*
;
Humans
;
Nebulizers and Vaporizers
;
Pamphlets
;
Physicians, Primary Care
;
Primary Health Care*