Narcolepsy is a sleep disorder, which is characterized by excessive daytime sleepiness (EDS) that is typically associated with cataplexy, sleep fragmentation and other REM sleep-related phenomenon such as sleep paralysis and hypnagogic hallucination. Narcoleptic symptoms can be developed from various medical or neurological disorders. A 17-year-old male patient admitted for the evaluation of EDS which started three-month ago. He slept more than 18 hours a day with cataplexy and hypnagogic hallucination. He was obese with body mass index (BMI) of 30.4 kg/m2. After admission he was newly diagnosed to the thyrotoxicosis. T3 391.2 ng/dL (60-181), free T4 4.38 ng/dL (0.89-1.76), TSH <0.01 microIU/mL (0.35-5.5) were measured. His pulse rate ranged 70-90 beats per minute and blood pressure ranged 150/100-120/70 mmHg. Polysomnography revealed many fragmentations in sleep with many positional changes (81 times/h). Sleep onset latency was 33.5 min, sleep efficiency was 47.9%, and REM latency from sleep onset was delayed to 153.6 min. REM sleep percent was increased to 27.1%. Periodic limb movement index was 13.4/h. In the multiple sleep latency test (MSLT), average sleep latency was 0.4 min and there were noted 3 SOREMPs (Sleep Onset REM sleep period) on 5 trials. We couldn't discriminate the obvious sleep-wake pattern in the actigraph and his HLA DQB1 *0602 type was negative. His thyroid function improved following treatment with methimazole and propranolol. Vital sign maintained within normal range. Cataplexy was controlled with venlafaxine 75 mg. Subjective night sleep continuity and PLMS were improved with clonazepam 0.5 mg, but the EDS were partially improved with modafinil 200-400 mg. Thyrotoxicosis might give confounding role when we were evaluating the EDS, though sleep fragmentation was one of the major symptoms of narcolepsy, but enormous amount of it made us think of the influence of thyroid hormone. The loss of sleep-wake cycle, limited improvement of EDS to the stimulant treatment, and the cataplexy not supported by HLA DQB1 *0602 should be answered further. We still should rule out idiopathic hypersomnia and measuring CSF hypocretin level would be helpful.
Adolescent ; Benzhydryl Compounds ; Blood Pressure ; Body Mass Index ; Cataplexy ; Clonazepam ; Cyclohexanols ; Extremities ; Hallucinations ; Heart Rate ; HLA-DQ beta-Chains ; Humans ; Hypersomnolence, Idiopathic ; Intracellular Signaling Peptides and Proteins ; Male ; Methimazole ; Narcolepsy ; Nervous System Diseases ; Neuropeptides ; Polysomnography ; Propranolol ; Reference Values ; Sleep Deprivation ; Sleep Paralysis ; Sleep, REM ; Thyroid Gland ; Thyrotoxicosis ; Vital Signs ; Orexins ; Venlafaxine Hydrochloride

PURPOSE: The purpose of this study was to evaluate computed tomographic (CT) findings of deep neck space infection(DNSI) with particular attention to the differences in the spaces involved and in complications between odontogenic and nonodontogenic groups. MATERIALS AND METHODS: Forty-four patients(21 odontogenic and 23 nonodontogenic) were included in this study. Among odontogenic DNSls, 15 had the dental infection in the second or third mandibular molar. We compared the CT features between odontogenic and nonodontogenic DNSIs with special emphasis on the differences in the spaces involved and in the rate and type of complications. RESULTS: In all patients, CT clearly differentiated abscess from cellulitis. The most common spaces involved in 21 patients with odontogenic DNSl were the parapharyngeal(n=18), the submandibular(n=18), the anterior visceral(n=13), the masticator(n=9), and the sublingual(n=7) spaces. In contrast, in 23 patients with nonodontogenic DNSI, the anterior visceral space(n=14) was most frequently involved. The parapharyngeal, the submandibular, and the masticator spaces were statistically more frequently involved in odontogenic than in nonodontogenic DNSI(p<.05). Twenty-two patients had one or more complications shown by CT, of which airway compromise was more frequent and severe in odontogenicthan in nonodontogenic DNSI. CONCLUSION: We conclude that the parapharyngeal, the submandibular, and the masticator spaces are more significantly vulnerable in odontogenic DNSl than in nonodontogenic DNSl. The predilection for certain spaces of the neck in odontogenic DNSl seems to originate from the intimate relationship of the mandibular molars to the adjacent deep neck spaces.
Abscess ; Cellulitis ; Humans ; Molar ; Neck*

PURPOSE: The purpose of this study was to evaluate computed tomographic (CT) findings of deep neck space infection(DNSI) with particular attention to the differences in the spaces involved and in complications between odontogenic and nonodontogenic groups. MATERIALS AND METHODS: Forty-four patients(21 odontogenic and 23 nonodontogenic) were included in this study. Among odontogenic DNSls, 15 had the dental infection in the second or third mandibular molar. We compared the CT features between odontogenic and nonodontogenic DNSIs with special emphasis on the differences in the spaces involved and in the rate and type of complications. RESULTS: In all patients, CT clearly differentiated abscess from cellulitis. The most common spaces involved in 21 patients with odontogenic DNSl were the parapharyngeal(n=18), the submandibular(n=18), the anterior visceral(n=13), the masticator(n=9), and the sublingual(n=7) spaces. In contrast, in 23 patients with nonodontogenic DNSI, the anterior visceral space(n=14) was most frequently involved. The parapharyngeal, the submandibular, and the masticator spaces were statistically more frequently involved in odontogenic than in nonodontogenic DNSI(p<.05). Twenty-two patients had one or more complications shown by CT, of which airway compromise was more frequent and severe in odontogenicthan in nonodontogenic DNSI. CONCLUSION: We conclude that the parapharyngeal, the submandibular, and the masticator spaces are more significantly vulnerable in odontogenic DNSl than in nonodontogenic DNSl. The predilection for certain spaces of the neck in odontogenic DNSl seems to originate from the intimate relationship of the mandibular molars to the adjacent deep neck spaces.
Abscess ; Cellulitis ; Humans ; Molar ; Neck*

Although obstruction of the carotid artery after head trauma or non-penetrating injuries of the neck had been well known, reports of occlusion of middle cerebral artery following closed head trauma are rare. Up to now Jacque, et al, have found only 22 cases of posttraumatic middle cerebral artery occlusion including their own one case in the world literatures since DeVeer and Browder reported the first case in 1942. We report a case of posttraumatic middle cerebral artery occlusion. The patient developed right hemiplegia, aphasia and mental confusion 2 days following closed head trauma. Left cerotid angiograms revealed complete occlusion of the horizontal portion of the left middle cerebral artery distal to the origin of the lenticulostriate branches. Previously reported cases are review and possible pathophysiological mechanisms discussed.
Aphasia ; Carotid Arteries ; Craniocerebral Trauma ; Head Injuries, Closed ; Hemiplegia ; Humans ; Infarction, Middle Cerebral Artery* ; Middle Cerebral Artery* ; Neck

No abstract available.
Neck*

Cholesteatoma of the middle ear and mastoid sometimes destroys the posterior wall of the external auditory canal(EAC), and this phenomenon is termed as "automastoidectomy". During the past two years the authors reviewed the CT features of automastoidectomy in eight patients with middle ear cholesteatoma. There was a variable amount of the cholesteatomatous mass or debris within the mastoid cavity in all patients, of whom air collection was found in four. Interestingly, the site and pattern of the erosion of the EAC were nearly, identical between patients with air in the mastoid cavity and those without it . Air in the mastiod cavity was the only clue of the expulsion of the cholesteatoma. So, we think that the expulsion of the cholesteatoma might be predicted when the erosion of the EAC is present in patients with cholesteatoma in the mastoid cavity. CT clearly depicted associated complications caused by the cholesteatoma, such as ossicular destruction (n=8), the eroion of the facial nerve canal (n=2), the erosion of the lateral semicircular canal (n=2), the erosion of the tegmen (n=1), the erosion of the sigmoid sinus plate(n=1), the erosion of the superior esmicircular canal (n=1), and the erosion of the vestibule (n=1). Although much of the natural history of the middle ear cholesteatoma still remains to be determined, we think that careful evaluation of one type of possible progression of the disease will help us understand its clinical course. Moreover, our findings strongly support the use of CT for evaluation of "automustetomy" seen in many cases of cholesteatoma.es of cholesteatoma.
Cholesteatoma ; Cholesteatoma, Middle Ear ; Colon, Sigmoid ; Ear, Middle ; Facial Nerve ; Humans ; Mastoid ; Natural History ; Semicircular Canals

To evaluate the normal development of the paranasal sinuses in children with CT, authors prospectively studied with brain CT scans of 260 children without known sinus diseases, ranging in age from 7 days to 16 years. Maximal anteroposterior and transverse diameters(mm) and maximal cross-sectional area(mm2) of both sides of the maxillary sinus were measured with the aid of computer device. As to the ethmoidal and sphenoidal sinuses, we simply documented the presence of the aplastic ethmoidal sinus and calculated the age-incidence of the sphenoidal sinus pneumatization, respectively. There noted three phases in the development of the maxillary sinus. The anteroposterior and transverse diameters of the maxillay sinus increased nearly in parallel. The former was always greater than the latter. In no cases was the ethmoidal sinus aplastic and almost all sinuses were pneumatized even in infants as early as 7 days old. CT identified the conchal pattern of sphenoidal sinus pneumatization in infants as early as 11 days old. Sphenoidal sinus pueumatization was seen in 38% of the children under the age of 1 year, 82% of the children between the age of 1 and 2 years, and almost all children older than 2 years. The anteroposterior and transverse diameters of the maxillary sinus seem to reach the adult size by 8 years of age, and the conchal pattern of sphenoidal sinus pneumatization can be recognized earlier with CT than on the plain radiographs.
Adult ; Brain ; Child* ; Humans ; Infant ; Maxillary Sinus ; Paranasal Sinuses* ; Prospective Studies ; Tomography, X-Ray Computed

No abstract available.
Family Practice* ; Humans

No abstract available.
Empyema* ; Gastroenteritis* ; Salmonella* ; Urinary Bladder*

We examined several kinds of immunocompromied patients for onyr,homycosis. The incidence of onychomycosis in the patients with connective tissue disease treated with corticosteroid was significantly higher than the incidences in the patients with solid tumors trcated with chemotherapeutic agents, in the patients with leukernia (WBC<1, 000/cm3), and in the control patients. Although conventional corticosteroid trcatment do not disseminate the superficial fungal infection, it may perpetuate the low grade dermatophytosis.
Connective Tissue Diseases* ; Connective Tissue* ; Humans ; Immunocompromised Host ; Incidence ; Onychomycosis* ; Tinea