Niopam is a newer, nonionic, watersoluble contrast medium used predominately in cisternographic and myelographic studies with metrizamide lately. The former has fewer, less severe and shorter adverse reactions than the latter. Until now there were no reports on meningitis complicating Niopam CT cisternography or myelography. Now we present a case of aseptic purulent meningitis complicating Niopam CT cisternography.
Iopamidol* ; Meningitis* ; Metrizamide ; Myelography

In order to observe the effects of various click polarity and stimulus rate on brainstem auditory evoked potentials (BAEPs), we measured the absolute latency, interwave latency and amplitude. Variations of IV-V wave complex in different stimulus rate and polarity were also observed. Observations were made on 50 normal subjects(32 males and 18 females) aged 8 to 56. The results are summarized as follows, 1. With rarefaction click stimulation, the absolute latencies of wave I and wave V were shortest, and wave I and wave III amplitudes were most increased as compared with condensation or alternating-polarity. 2. The absolute latencies of wave I and wave V were most prolonged and wave V amplitude was highest with condensation clicks. 3. I - III, III -V and I - V interwave latencies were not significantly changed between any of polarities. 4. By increasing stimulus rate from 10 click / sec to 50 click / sec, absolute and interwave latencies were significantly prolonged. Except wave V amplitude at condensation and alter-nating-polarity clicks, all wave amplitudes were decreased significantly. 5. The waveforms were classified into 5 types according to configuration of IV - V wave complex. At any conditions, type A and B were present most frequently. We proposed that if one is to employ only a single stimulus polarity, rarefaction clicks should be used because this will produce the earliest and largest wave I. Condensation can be used in those cases in whom rarefaction does not produce clar waveforms, or when wave V appears absent. The use of alternating-polarity clicks as the only mode of stimulation is discouraged because of the possibility of phase cancellations.
Brain Stem* ; Evoked Potentials, Auditory, Brain Stem* ; Humans ; Male

Recent studies have revealed that mossy fiber(MF) axons of dentate granule cells undergo synaptic reorganization in both electrical kindling models of temporal lobe epilepsy (TLE) and human TLE. This synaptic reorganization has been demonstrated by Timm histochemistry which selectively labels synaptic terminals of MF because of unusually high zinc content. Of MF. In electrical kindling model and human TLE Timm granules were distributed throughout the supragranular layer of dentate gyrus where they are not normally present. These supragranular Timm granules are regarded as MF synaptic reorganization. Kindling model of generalized epilepsy can be made by repeated intraperitoneal injections of subconvulsive dosage of pentylenetetrazol (PTZ). The present study is designed to test the hypothesis that MF synaptic reorganization might be developed in PTZ kindling model In this study, the supragranular Timm granules by Timm histochemistry were scored and depth EEG was recorded in dentate gyrus of various stages of PTZ kindling rats. The scores of supragranular Timm granules were 0. 33+0.17 in stage I seizure (n=9) ; 0. 38 + 0. 14 in stage II seizure (n=13) ; 0. 44 + 0. 18 in stage III seizure (n=9) ; 1. 40+0.16 in 3 consecutive or total 5-7 stage TV or V seizure (n=10) ; 1. 86+ 0.26 in 7-10 consecutive or total 10-15 stage IV or V seizure (n=7) ; 2.50+0.22 in 1215 consecutive or total 20-30 stage IV or V seizure (n=6) ; and 0. 30+0.15 in salinen controls (n=lo). Statistical analysis showed the supragranular Timm scorwere significantly higher in stage IV or V seizure than in control and in stage 1, I or, I seizure (p<0.05 ), and tended to increase with increasing numbers of stage IV or V seizure. Depth EEG recording from dentate gyrus showed 6-9Hz rhythmic waves in saline injected control, single or polyspikes or normal waves during stage I seizure, 4-6Hz slow waves or spike-waves complexes lasting 1-2 seconds during stage II seizure, 4-6Hz slow waves or spike-waves complexes lasting 3-6 seconds during stage III seizure, 8-15Hz spikes lasting over 10 seconds during stage IV seizure and 10-30HZ spikes lastmg over 20 seconds durmg stage V seizure The results demonstrate the development of MF synaptic reorganization and a sound correlation between MF synaptic reorganization and the progression of the kindlmg phenomenon in PTZ kindling models. These findings suggest that MF synaptic reorganization might be a critical event underlying the development and . Maintenance of kindling phenomenon and epileptic state.
Animals ; Axons ; Dentate Gyrus* ; Electroencephalography ; Epilepsy, Generalized ; Epilepsy, Temporal Lobe ; Humans ; Injections, Intraperitoneal ; Pentylenetetrazole* ; Presynaptic Terminals ; Rats* ; Seizures ; Zinc

The development of pentylenetetrazol (PTZ) kindling has been controversial, authors confirmed the development of kindling phenomenon in experimental rats following every second or third day intraperitoneal administration of PTZ(20-25mg/kg) to experimental rats and same amount of saline to control rats. The developmental stage of motor seizure could be categorized into five stages (stage I; clonic seizure of face and neck, stage II; clonic seizure of face, neck and forelimbs, stage III; clonic seizure of forelimbs and body with brief rearing, stage IV; falling and generalized clonic seizure, stage V; falling and generalized tonic-clonic seizure with tonic extension of hindlimbs). Linear regression analysis showed that the stages of motor seizure were increased with the number of PTZ injections (Y=0.1361X + 0.1943, p < 0.05). The persistence of kindling state was also observed after a 5-months pause of PTZ injection. This study suggested that PTZ kindling model in rats could be a good animal model of generalized epilepsy.
Animals ; Epilepsy, Generalized ; Forelimb ; Linear Models ; Models, Animal ; Neck ; Pentylenetetrazole* ; Rats* ; Seizures

Autopsy ; Biopsy ; Biopsy, Fine-Needle ; Child ; Diagnosis ; Drug Therapy ; Female ; Head ; Heart Arrest ; Humans ; Infant ; Magnetic Resonance Imaging ; Mandible ; Mandibular Osteotomy ; Mouth ; Neck ; Osteosarcoma ; Parents ; Pediatrics ; Prognosis ; Radiotherapy ; Rhabdomyosarcoma ; Sarcoma ; Sublingual Gland ; Submandibular Gland ; Ultrasonography

This study was retrospectively undertaken to evaluate clinical manifestations, electroencephalographic findings, response to antiepileptic drugs and prognosis of 80 benign childhood epilepsy with centrotemporal spikes (BCECT) patients seen between 1967 and 1993 and followed up for more than 2 years. The age of onset ranges from 3 to 15 years. In 93 percent of patients, seizures appeared between 4 to 12 year-old, with peak of 5 year-old. The main manifestations of partial seizure were hemifacial spasm (53%) and oropharygeal signs (52%) with hypersalivation, abnormal sensation of mouth, gutteral sounds, swallowing difficulty and feeling of suffocation. The types of seizure consist of partial seizure(66%) and partial seizure with secondary generalization (34%). Distributions of seizure attack were nocturnal sleep (83%), diurnal sleep state(4%) and waking state (13%). The typical EEG findings were slow diaphasic high voltage centrotemporal spikes with unilateral (94%) and bilateral foci(6%) with normal background. In addition to typical EEG findings, there were associated with multifocal independent sharp-waves (8.9%) and generalized sharp-wave discharges (7.8%). BCECT patients were well controlled by antiepileptic drugs and had good prognosis. During the follow-up period (2-17years), we observed that all patient were well adapted to school and society. Seizures did not occur after adolescent period.
Adolescent ; Age of Onset ; Anticonvulsants ; Asphyxia ; Child ; Child, Preschool ; Deglutition ; Electroencephalography ; Epilepsy ; Epilepsy, Rolandic* ; Follow-Up Studies ; Generalization (Psychology) ; Hemifacial Spasm ; Humans ; Mouth ; Prognosis ; Retrospective Studies ; Seizures ; Sensation ; Sialorrhea

This is a report of 2-cases of mandibular prognathism corrected by Intraoral oblique splitting osteotomy of mandibular rami. The Intraoral oblique splitting osteotomy is a modification of sagittal split osteotomy of ramus and it is documented by Yoshida, on 1985. By this method, authors obtained the following results. 1. The patients' esthetic, psychological and functional problems were dissolved by setback of mandibular prognathism. 2. The postoperative infection splitted bone segments fracture, paresthesia of the face and T.M.J. dysfunction were not appeared. 3. Postoperative intermaxillary fixation was maintained for 8 weeks. The patients could open their mouths in normal range after a week of intermaxillary fixation removal. 4. The soft tissue changes of lower lip and chin were about 1:1 to the hard tissue changes. 5. During intermaxillary fixation period and postoperative orthodontic treatment, slight relapse was observed. Now, the patients are under postoperative orthodontic treatment.
Chin ; Humans ; Lip ; Methods ; Mouth ; Osteotomy* ; Paresthesia ; Prognathism* ; Recurrence ; Reference Values

This study was performed to evaluate the usefulness of dermatomal somatosensory evoked potentials(D-SSEP) and segrnental somatosensory evoked potentials(S-SSEP) for the diagnosis of lurnbosacral radiculopathy. D-SSEP and S-SSEP were recorded from 30 healthy controls and 16 patients with lumbosacral radiculopathy(LA radiculopathy: 10 cases, L5: 13 cases, SI: 4 cases) who was diagnosed by clinical findings CT and/or MRI. D-SSEP were abnormal in 40%, 30.7% and 25% of the patients with IA, L5 and Sl radiculopathy respectively and S-SSEP were abnormal in 20%, 38% and 50% of the patients with IA, L5 and Sl radiculopathy respectively. The proportion of abnormal findings in the' patients with L4, L5 and Sl radiculopathy was increased to 50%, 46. 1% and 50% respectively by administering both of D-SSEP and S-SSEP. In conclusion, D-SSEP and S-SSEP are simple and noninvasive test but insensitive studies for diagnosis of lumbosacral radiculopathy. The diagnostic sensitivity could be increased by usmg both of these two studies.
Diagnosis ; Evoked Potentials, Somatosensory* ; Humans ; Magnetic Resonance Imaging ; Radiculopathy*

BACKGROUND: Information on the long-term fate of patients with prosthetic valve is limited. Cerebral embolism is a major cause of late morbidity and mortality in patients with prosthetic valves even though recent prostheses are less thrombogenic and anticoagulants are administered. We investigated the long-term risk of the first ischemic and hemorrhagic stroke and effect of presumed risk factors on the development of stroke in patients with prosthetic valves. METHODS: In a retrospective study, 554 patients who survived the 30-days after cardiac valve replacement between June, 1985 and May, 1995 were included. End points were attacks of ischemic and hemorrhagic stroke. Risk of stroke at end points was calculated according to Kaplan-Meier method. The influence of several clinical variables on these stroke events was analyzed by univariate and mutivariate analyses. RESULTS: Thirty seven of 554 patients had 42 stroke events(34 ischemic stroke, 8 hemorrhagic stroke) during follow-up periods(mean: 52.9months). Six of these patients died from stroke. The cumulative stroke-free probability was 92.4% at 5years and 87.7% at 10years. The cumulative ischemic stroke-free probability was 93.7% at 5years and 89.4% at 10years. No or irregular use of anticoagulants was the only significant independent predictor(RR:4.99, 95%CI:2.01-12.41, p<0.01) of ischemic stroke. The cumulative hemorrhagic stroke-free probability was 98.7% at 5years and 98.1% at 10years. CONCLUSION: Regardless of the type of prostheses, patients with prosthetic valves, notably those without anticoagulants, are at high risk for ischemic stroke.
Anticoagulants ; Follow-Up Studies ; Heart Valves ; Humans ; Intracranial Embolism ; Mortality ; Prostheses and Implants ; Retrospective Studies ; Risk Factors ; Stroke* ; Thromboembolism

This study was performed to evaluate the effects of acute withdrawal of antiepileptic drugs in epileptic patients during continuous BEG monitoring. One hundred sixty-five withdrawals in 134 patients who were candidates for epileptic surgery were included for this study. Clinical features and frequency of seizure were observed after drug withdrawal with daily monitoring of serum drug level. The phases after withdrawal of antiepileptics were divided into phase of therapeutic drug level, phase of falling drug level, and phase of subtherapeutic or undetectable(zero) drug level. There were significant increase in frequency of seizure and seizure of secondary generalization after acute withdrawal of antiepileptic drugs. Number of seizure during the period of drugs withdrawals was not correlated with onset age of epilepsy, duration of epilepsy, duration of medication, and number of administrated antiepiteptic drugs. The number of frequency of seizure before drug withdrawal was correlated with the number of frequency of withdrawal seizure. The number of seizure frequency after carbamazepine withdrawal was significantly higher during the phase of subtherapeutic or zero drug level, and not during phase of rapid falling antiepileptic drug level.
Age of Onset ; Anticonvulsants* ; Carbamazepine ; Epilepsy ; Generalization (Psychology) ; Humans ; Seizures*