Transient global amnesia(TGA) is not a rare event in the elderly, which is characterized by transient inability to form the new memory traces plus retrograde amnesia with benign prognosis. The etiology is unknown, but suggested causes have included transient ischemic attack, migraine, epilepsy, brain tumor, drug intoxication, other toxic/metabolic disturbances, or hysteria. Especially, TGA associated with ischemic stroke is important on the elderly patients and necessary to be differentiated with other causes, for stroke prevention. As far as we know, the case of TGA due to cerebral infarction confirmed by brain imaging study is extremely rare in the literature. We report the case of 67 year-old female patient with typical TGA showing ischemic lesion on the right temporal area on MRI and discussed its significance as one of the cause of TGA.
Aged ; Amnesia, Retrograde ; Amnesia, Transient Global* ; Brain Neoplasms ; Cerebral Infarction ; Epilepsy ; Female ; Humans ; Hysteria ; Infarction* ; Ischemic Attack, Transient ; Magnetic Resonance Imaging ; Memory ; Migraine Disorders ; Neuroimaging ; Prognosis ; Stroke

To apply rehabilitation program for stroke patients' functional improvement, various factors such as timing for initiation of rehabilitation, intensity of therapy, and individual compliances should be considered. Both animal and neuroimaging studies suggested that greater intensity of therapy is associated with increased cortical reorganization and subsequent functional recovery, and repetition also may play a major role in inducing and maintaining brain plasticity. However, the proper intensity of rehabilitation therapy has not been well established yet. In this review, we examined the previous studies assessing the effect of intensity and repetition of therapy on functional recovery. From the randomized controlled trials and meta-analysis, increased intensities of treatment and repetitions are shown to be effective in improving activities of daily living and gait function, but limited evidences in functional outcomes of upper extremities. It is difficult to provide standardized optimal intensities and repetitions in clinical practice because of the variability in components of rehabilitation therapies, patients' motivation and participation, the degree of therapists' involvement, and reimbursement and healthcare system. Clinical practice guidelines of US, Europe and Korea recommended that intensive rehabilitation and repetitive task training should be provided to post stroke patients in rehabilitation unit. Further studies are needed to investigate the effective delivery system of rehabilitation program in terms of repetition and intensity.
Activities of Daily Living ; Animals ; Brain ; Delivery of Health Care ; Europe ; Gait ; Humans ; Korea ; Motivation ; Neuroimaging ; Plastics ; Stroke ; Upper Extremity

PURPOSE:Hypochondroplasia is a skeletal dysplasia characterized by poor childhood growth and an inadequate pubertal growth spurt. Final height attainment of hypochondroplasia has been reported to range between 120 and 152cm. Increased availability of growth hormone with the introduction of recombinant human growth hormone has allowed for clinical trials in a number of growth hormone sufficient children with growth problems. The purpose of this study was to assess the growth promoting effect of human growth hormone in children with hypochondroplasia. METHODS:Five patients with hypochondroplasia diagnosed by clinical and radiological findings between 1993 and 1997 at our hospital was aged 3 and 1/2 -11 and 1/2 years. Each patients continuously received human growth hormone 0.6-0.7U/Kg/week, intramuscularly or subcutaneously in 6-7 divided dose for 2 years. Standard auxologic assessment was carried out every 3 month interval in the first year after commencement of therapy and then same assessment was 6 monthly. Bone age was assessed 6 monthly using Gleurich-Pyle method. RESULTS:Mean height velocity of pretreatment and year 1 and 2 of GH treatment were 3.9+/-0.7, 6.5+/-1.8 and 5.7+/-1.5cm/year, respectively. Mean height standard deviation score for chronological age of pretreatment and year 1 and 2 of GH treatment were -2.7+/-0.3, -2.4+/-0.3 and -2.2+/-0.4, respectively. The increase in the height velocity diminishes over the subsequent year. The increment of bone age after GH treatment were same as the increments of chronological age. CONCLUSION: Short-term GH therapy increases the height velocity of children with hypochondroplasia, but the effect of GH therapy on final height remains unknown.
Child* ; Growth Hormone* ; Human Growth Hormone ; Humans

Purpose: Silicone tube intubation is the most common method for treatment of nasolacrimal drainage disorder or repair of lacerated canaliculus. However, some cases are prolapsed earlier than expected, subsequently affecting the success rate of silicone tube intubation. The author introduced a successful reposition of the prolapsed silicone tube. Methods: This study is a retrospective case series of 11 patients who were treated with reposition of prolapsed silicone tube using hole and lacrimal probe method. In all cases, the tubes were prolapsed within 2 months after the first surgery due to careless rubbing of the medial canthus by the patient. In all 11 cases, the development of a biofilm on tube was not observed at the time when the tube was prolapsed. All patients underwent immediate reposition of prolapsed tube without local anesthesia in the outpatient operating room on the day they visited. Results: In all 11 cases, the prolapsed silicone tube was repositioned without any complications using this hole and lacrimal probe method. At 6-month follow-up examination, all patients presented with a well-positioned silicone tube up to the day of extubation without replacing it with a new silicone tube. Conclusions This hole and lacrimal probe method is effective for the repositioning of prolapsed silicone tube after bicanalicular intubation of lacrimal system. This procedure includes easy performance in a short time and without local anesthesia in the outpatient operating room.

Purpose: Silicone tube intubation is the most common method for treatment of nasolacrimal drainage disorder or repair of lacerated canaliculus. However, some cases are prolapsed earlier than expected, subsequently affecting the success rate of silicone tube intubation. The author introduced a successful reposition of the prolapsed silicone tube. Methods: This study is a retrospective case series of 11 patients who were treated with reposition of prolapsed silicone tube using hole and lacrimal probe method. In all cases, the tubes were prolapsed within 2 months after the first surgery due to careless rubbing of the medial canthus by the patient. In all 11 cases, the development of a biofilm on tube was not observed at the time when the tube was prolapsed. All patients underwent immediate reposition of prolapsed tube without local anesthesia in the outpatient operating room on the day they visited. Results: In all 11 cases, the prolapsed silicone tube was repositioned without any complications using this hole and lacrimal probe method. At 6-month follow-up examination, all patients presented with a well-positioned silicone tube up to the day of extubation without replacing it with a new silicone tube. Conclusions This hole and lacrimal probe method is effective for the repositioning of prolapsed silicone tube after bicanalicular intubation of lacrimal system. This procedure includes easy performance in a short time and without local anesthesia in the outpatient operating room.

A 57-year-old female was hospitalized for visual disturbance and right hemiparesis. MRI revealed cortical and sub-cortical infarcts in the left occipito-parietal area. One week later, she experienced paroxysmal electric shock like pain on the dorsum of her right hand. All analgesics failed to relieve her pain, but an antiepileptic drug eradicated the pain completely. This unusual seizure could have been misdiagnosed as a thalamic or pseudothalamic pain syndrome had an ictal EEG not been performed. We report the post-stroke somatosensory seizure, only with unilateral ictal pain. (J Korean Neurol Assoc 19(1):49~51, 2001
Analgesics ; Electroencephalography ; Female ; Hand ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Paresis ; Seizures* ; Shock ; Stroke

BACKGROUND: There has been on increasing emphasis on the importance of monitoring the safety of participants in a clinical trial to protect patients and maintain the integrity of the trial. The independent data monitoring committee (IDMC) has become common component of randomized clinical trials in recent years. METHODS: It is important to consider the implications of different approaches that are being used in various countries. IDMC guidelines in Korea, US, and Europe were reviewed and compared to provide the objective, composition and operation of IDMC in detail. RESULTS: IDMC is a group of experts in related subject are as who perform interim data monitoring to make a recommendation to the sponsor or organizer regarding appropriateness of trial continuation and the need for modifications of the trial. Independence of IDMC is preferred in order to minimize influence of factors unrelated to scientific, medical and ethical considerations that should underlie decision-making. CONCLUSION: IDMC has become an increasingly important component of clinical trials in recent years. Practical operating procedures need to be developed considering the future regulatory status of data monitoring committees.
Clinical Trials Data Monitoring Committees* ; Europe ; Humans ; Korea

Purpose: This study aimed to determine whether limited T2-weighted-only lumbar spine MRI is clinically available to patients visiting pain intervention clinic for radicular pain. Materials and Methods: A total of 110 patients (mean age: 63.5 ± 16.1 years) with low back pain (LBP) or sciatica who underwent limited T2-weighted-only lumbar MRI using T2-weighted sagittal and axial sequences were enrolled. All MRI scans were reviewed by two radiologists for degenerative spinal lesions that most correlated with each patient’s symptoms. All patients received spinal injections. Treatment response was recorded based on patients’ subjective evaluations and an 11-point numerical rating scale. Clinical characteristics and changes in the diagnosis of patients who had undergone previous MRI or additional MRI within six months were also analyzed. Results: Using limited T2-weighted-only lumbar spine MRI, acquisition time and cost for imaging examinations were effectively reduced. Pathologic lesions corresponding to clinical symptoms were detected in most (95%) patients. Symptoms had improved in 78.1% of patients at the 6-month follow-up. Further imaging work-up was not performed for any subject during the study period because there was clear indication (no doubt) for other diagnoses on the limited T2-weighted-only lumbar spine MRI or during the clinical follow-up. Conclusion Limited T2-weighted-only lumbar spine MRI comprising T2-weighted sagittal and axial images may sufficiently detect degenerative changes of the lumbar spine in patients with LBP and sciatica. Treatment responses are satisfactory, effectively reducing scan time and costs.

PURPOSE: Vigabatrin is a widely used antiepileptic drug that greatly increases whole brain gamma- aminobutyric acid(GABA). But little is known about the anticonvulsant effect of vigabatrin on pilocarpine-induced seizures in the immature rats. This study was conducted to determine the effects of vigabatrin on pilocarpine-induced seizures in the immature rats. METHODS: Six to eight day old Sprague-Dawley rats were classified into control(n=5) and vigabatrin-treated(n=5) groups that were pretreated with 30mg/kg of vigabatrin. Animals received vigabatrin or saline, intraperitonealy, for 6 days, once a day. And on the 5th day, right and left cortical electrodes were placed in 10-14 day old animals using stereotaxic instrument. The following day 2.5-hour EEG recordings were obtained to monitor the latency to first electrographic seizures and to first status epilepticus induced by intraperitoneal injection of pilocarpine(200mg/kg). Data were analyzed using the log-rank test. RESULTS: Electrographic seizures and status epilepticus were seen in 80% of vigabatrin-treated group, and in 100% of control group rats. And the latency to first seizure was 8.8+/-2.0 minutes in control group and 20.5+/-5.2 minutes in vigabatrin-treated animals(P<0.02), and to status epilepticus was 12.2+/-1.2 minutes in control group and 29.3+/-6.3 minutes in vigabatrin-treated group(P<0.03). CONCLUSION: It was confirmed that 30mg/kg of vigabatrin administration for 6 days did not affect the body weight gain and behavior of immature rats and had an anticonvulsant effect. These findings might demonstrate that the prolonged latency to seizure, and to status epilepticus, was a time to reduce GABA that was elevated in the brain by vigabatrin administration below the seizure threshold, by pilocarpine.
Animals ; Body Weight ; Brain ; Electrodes ; Electroencephalography ; gamma-Aminobutyric Acid ; Injections, Intraperitoneal ; Pilocarpine ; Rats* ; Rats, Sprague-Dawley ; Seizures* ; Status Epilepticus ; Vigabatrin*

PURPOSE: We report a case of infraduction limitation improvement and orthotropia at primary position in a patient with traumatic isolated inferior rectus muscle rupture after immediate repair surgery of the ruptured muscle. CASE SUMMARY: A 47-year-old man came to our emergency department complaining of right eyelid contusion and conjunctival laceration after trauma due to the metal part of a high pressure hose. Right hypertropia of 20 prism diopters was observed at primary gaze and right hypertropia of 30 prism diopters was observed at down gaze. The right eye showed a -4 infraduction limitation. We sutured the distal part of the ruptured inferior rectus muscle with surrounding tissue, including the Tenon's capsule and the part of the muscle stump, to its original insertion. Orthotropia at primary position and 8-prism-diopters of right hypertropia on down gaze was observed one day after surgery. At 40 days after surgery, the patient had orthotropia at primary position and 4-prism-diopter right hypertropia on down gaze. Infraduction limitation of the right eye improved to -1. CONCLUSIONS: Immediate repair of complete traumatic isolated inferior rectus muscle rupture can correct the limitation of extraocular movement and achieve orthotropia at primary position.
Contusions ; Emergency Service, Hospital ; Eyelids ; Humans ; Lacerations ; Middle Aged ; Rupture* ; Strabismus ; Tenon Capsule