The staged decompression(posterior and anterior) of foramen magnum was performed in the patient with Chiari I malformation associated with basilar invagination. Three years prior to admission, the patient was admitted due to ataxia and dysmetria. After the posterior decompression of foramen magnum, the patient's cerebellar sign improved significantly. But spastic gait disturbace was noted two years later. We performed a transoral anterior decompression to relieve brain stem compression, and an occipitocervical fusion with contoured rod to prevent possible instability. Following the operation, the spasticity improved. The authors believe this sets the successful staged decompression of Chiari I malformation associated with basilar invagination.
Ataxia ; Brain Stem ; Cerebellar Ataxia ; Decompression* ; Foramen Magnum ; Gait Disorders, Neurologic ; Humans ; Muscle Spasticity

OBJECTS: The purpose of this study is to estimate the values of foot pressure of the stance phase during a gait cycle in hemiplegic gait. METHOD: Thirty patients who had a stroke and forty healthy adults were evaluated by the EMED-SF system to analyze the stance phase of hemiplegic gait. The stance phase was evaluated by 6 points according to the foot pressure and center of pressure proposed by Lee et al.2) RESULTS: 1) In hemiplegics, the stance time of involved limb decreased compared with that of the uninvolved limb and increased that of control groups (p<0.05). 2) In hemiplegics, the midstance time increased but the loading response and terminal stance decreased compared with the uninvolved limb and controls (p<0.05). 3) In hemiplegics, the midstance time decreased and the loading response and terminal phase increased according to the increased Brunnstrom stage (p<0.05). CONCLUSION: The results showed that an analysis of stance phase by the measurement of plantar pressure was a valuable parameter in the gait analysis of hemiplegic patients.
Adult ; Extremities ; Foot ; Gait ; Gait Disorders, Neurologic ; Humans ; Stroke

OBJECTIVE: The aim of this study is to evaluate the acceleration of the center of mass (COM) of the body in stroke patients. METHOD: Seventeen stroke patients and 9 normal subjects were participated. Three dimensional gait analysis was used to classify gait phases for the reference. The accelerometer held over the COM were used to record vertical and medio- lateral accelerations of the COM of the body. Modified Ashworth scale and Brunnstrom stage were used to evaluate the clinical status of stroke patients. RESULTS: In normal subjects, the acceleration showed symmetric pattern. The maximum peak of vertical acceleration occurred in loading response. In stroke patients, the acceleration wave was characterized by asymmetry and polyphasicity. Maximum peak in affected side was higher than that in unaffected side (p<0.05). There were significant correlations between several elements of hemiplegic gait and the correspondent acceleration values; interval of successive peak I in vertical acceleration vs. step time, walking velocity and swing symmetry ratio vs. mean peak I, swing symmetry ratio vs. affected side peak I, step length symmetry ratio vs. peak I symmetry ratio. CONCLUSION: The accelerometer can be an easy and useful way to evaluate gait characteristics in stroke patients.
Acceleration ; Gait Disorders, Neurologic ; Gait* ; Humans ; Stroke* ; Walking

A 48-year-old man was admitted due to sudden disorientation and dysarthria. He has been drinking almost everyday for the past 25 years. At the time of the admission, he was alert but confused. Neurologic examination revealed disorientation to time, memory disturbances, decreased amount of speech, dysarthria, limitation of extraocular movement, ataxia of left limbs, and unsteady gait. He was treated with thiamine under the impression of Wernick's encephalopathy. Ataxia of limbs and unsteady gait improved but limitation of extraocular movement and disturbed higher cortical function remained. MRI of the brain taken 24 hours after the onset showed asymmetrical bilateral paramedian thalamic high signal lesions on 72-weighted images. We report here a case of bilateral paramedian thalamic infarction clinically mimicking Wernicke's encephalopathy.
Ataxia ; Brain ; Drinking ; Dysarthria ; Extremities ; Gait Disorders, Neurologic ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Memory ; Middle Aged ; Neurologic Examination ; Thiamine ; Wernicke Encephalopathy*

The medulloblastoma, a neoplastic emtity which was first identified and described in 1925 by Bailey and Cushing, is a highly malignant, rapidly growing tumor mainly confined to the first decade of life. The medulloblastoma rarely calcifies. Many investigator have reported that medulloblastoma may exhibit calcification only on microscopic examination. Roentgenographic evidence of calcification was found in one case of 54 patients with medulloblastomas by McRae, and in only one case of 96 patients with medulloblastomas by Kalan. A twelve-year-old Korean male was admitted to Seoul National University Hospital on May 1, 1972 with the complaints of severe occipital headache, vomiting, and unsteady gait of five months duration. Neurological examination revealed bilateral papilledema of 3 diopters, signs of cerebellar dysfunction on the left side including truncal ataxia, adiadochokinesia, positive Romberg test and markedlv distured tandem gait. Horizontal nystagmus with quick component directed to the left side was also found. Plain skull films showed suture separation and an abnormal calcific shadow measuring about 2 by 2.5cm in the posterior fossa. Reflux brachial angiogram showed marked bowing of anterior cerebral artery, and elevation of middle and posterior cerebral arteries suggesting a large mass in the posterior fossa causing obstruction of CFS pathways resulting in marked dilatation of ventricular system. Exploring the posterior fossa, a soft grayish tumor mass was removed partially. Microscopic diagnosis was medulloblastoma of desmoplastic type with calcification. Postoperatively CSF leakage through the incision site was encountered, but was controlled to be healed up by compression bandage. The patient showed no significant change of neurological status by the time of discharge. The patient was scheduled to undergo Co60 radiation therapy after discharge.
Anterior Cerebral Artery ; Ataxia ; Cerebellar Diseases ; Compression Bandages ; Diagnosis ; Dilatation ; Gait ; Gait Disorders, Neurologic ; Headache ; Humans ; Male ; Medulloblastoma* ; Neurologic Examination ; Nystagmus, Pathologic ; Papilledema ; Posterior Cerebral Artery ; Research Personnel ; Seoul ; Skull ; Sutures ; Vomiting

In this paper, the research has been conducted by the Microsoft kinect for windows v2 for obtaining the walking trajectory data from hemiplegic patients, based on which we achieved automatic identification of the hemiplegic gait and sorted the significance of identified features. First of all, the experimental group and two control groups were set up in the study. The three groups of subjects respectively completed the prescribed standard movements according to the requirements. The walking track data of the subjects were obtained straightaway by Kinect, from which the gait identification features were extracted: the moving range of pace, stride and center of mass (up and down/left and right). Then, the bayesian classification algorithm was utilized to classify the sample set of these features so as to automatically recognize the hemiplegia gait. Finally, the random forest algorithm was used to identify the significance of each feature, providing references for the diagnose of disease by ranking the importance of each feature. This thesis states that the accuracy of classification approach based on bayesian algorithm reaches 96%; the sequence of significance based on the random forest algorithm is step speed, stride, left-right moving distance of the center of mass, and up-down moving distance of the center of mass. The combination of step speed and stride, and the combination of step speed and center of mass moving distance are important reference for analyzing and diagnosing of the hemiplegia gait. The results may provide creative mind and new references for the intelligent diagnosis of hemiplegia gait.
Algorithms ; Bayes Theorem ; Gait ; Gait Analysis ; methods ; Gait Disorders, Neurologic ; diagnosis ; Hemiplegia ; complications ; Humans ; Walking

Phenytoin is a commonly used antiepileptic drug, and its narrow therapeutic index causes various toxicities. Although acute toxicity commonly causes ataxia, few cases have been reported of permanent cerebellar atrophy. A 49-year-old female with epilepsy was prescribed oral phenytoin. After three years of medication, seizure was controlled, but she developed unsteady gait and dysarthria. On admission, the patient showed severe bilateral ataxia, gingival hypertrophy, nystagmus, and dysarthria. Phenytoin toxicity was the impression, and phenytoin was omitted. Serum phenytoin level was 46.9 mg/L (therapeutic range being 10~20 mg/L). Brain magnetic resonance imaging (MRI) was performed to rule out other brain lesions, and diffuse cerebellar atrophy was revealed. After rehabilitation, mild bilateral ataxia remained, standing balance was poor, and the patient was able to walk 70 meters with minimal assist using roller walker. We review a case of chronic phenytoin toxicity that manifested as cerebellar ataxia and later showed atrophy of cerebellum.
Ataxia ; Atrophy ; Brain ; Cerebellar Ataxia ; Cerebellum ; Dysarthria ; Epilepsy ; Female ; Gait Disorders, Neurologic ; Gingival Hypertrophy ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Phenytoin ; Seizures ; Walkers

The brain necrosis induced by radiation therapy (RT) is an uncommon pathology of brain. A case of spontaneous hemorrhage at necrotic brain is also rare. A 52-year-old man who had nasopharyngeal carcinoma and had been treated with RT, presented with gait disturbance, dizziness, ataxia, dysarthria, and dysphagia. Magnetic resonance imaging (MRI) demonstrated progressed radiation necrosis of pons, and spontaneous hemorrhage at the site of necrosis. The hematoma was diminished by conservative treatment. However, the patient’s neurologic symptoms did not recover. Two years later, spontaneous bleeding recurred at necrotic brain. His neurologic symptoms worsened. One year later, his neurologic symptoms were more progressed. He showed severe dysphagia, profound weakness and respiratory failure. This case provides the description of relapsed spontaneous hemorrhage and medullary dysfunction caused by pontine necrosis and progressed post-radiation injury, complicated with hemorrhage, and urges caution in that the necrotic brain tissue may be vulnerable to bleeding.
Ataxia ; Brain ; Deglutition Disorders ; Dizziness ; Dysarthria ; Gait ; Hematoma ; Hemorrhage* ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Necrosis* ; Neurologic Manifestations ; Pathology ; Pons ; Respiratory Insufficiency

OBJECTIVES: There is increasing evidence that the cerebellum plays an important role in cognition and psychiatric symptoms as well as motor coordination. The concept of cognitive dysmetria has been making cerebellar function in schizophrenia the focus of current studies. In other words, disruption in the cortico-cerebellum-thalamic -cortical circuit could lead to disordered cognition and clinical symptoms of schizophrenia. The purposes of this study were to determine cerebellar dysfunction in male schizophrenic patients semiquantitatively with ICARS and to investigate the clinical and cognitive correlates of ICARS in patients. METHODS: We compared the scores of cerebellar neurologic sign using ICARS in 47 male patients with a DSM-IV-TR diagnosis of schizophrenia with 30 gender and age-matched healthy control subjects. The semiquantitative 100-point ICARS consists of 19 items divided into 4 unequally weighted subscores: posture and gait disturbances, kinetic functions, speech disorders and oculomotor disorders. All subjects were also assessed with cognitive function test. Cognitive functions were evaluated by Korean-Mini Mental Status Examination(K-MMSE), Verbal fluency test, and Clock drawing test. The patients were administered Korea version of Positive and Negative Symptom Scale(K-PANSS) to assess the symptom severity. RESULTS: Schizophrenic patients had significantly higher scores on the ICARS than control subjects with posture and gait disturbances, kinetic functions, and oculomotor disorders. They also showed more significant impairments in cognitive function tests than control subjects. There was a significant correlation between ICARS and negative symptoms of patients. In cognitive function test, Clock drawing test was significantly associated with negative symptoms. In addition, Clock drawing test was negatively correlated with the total score of ICARS. CONCLUSION: In this study, we confirmed that schizophrenic patients have significant impairments in cognitive and cerebellar function, and that those were related with negative symptoms of schizophrenic patients. These results support a role of the cerebellum in schizophrenia. It is meaningful that we used a structured, and reliable procedure for rating neurological soft signs, ICARS. We hope that future prospective studies using a similar design help that rate of neurological sign should have been visible with the progression of illness.
Cerebellar Ataxia ; Cerebellar Diseases ; Cerebellum ; Cognition ; Diagnosis ; Gait ; Hope ; Humans ; Iron-Dextran Complex ; Korea ; Male ; Neurologic Manifestations ; Posture ; Schizophrenia ; Speech Disorders

OBJECTIVE: To identify the clinical characteristics of proper robot-assisted gait training group using exoskeletal locomotor devices in non-ambulatory subacute stroke patients. METHODS: A total of 38 stroke patients were enrolled in a 4-week robotic training protocol (2 sessions/day, 5 times/week). All subjects were evaluated for their general characteristics, Functional Ambulatory Classification (FAC), Fugl-Meyer Scale (FMS), Berg Balance Scale (BBS), Modified Rankin Scale (MRS), Modified Barthel Index (MBI), and Mini-Mental Status Examination (MMSE) at 0, 2, and 4 weeks. Statistical analysis were performed to determine significant clinical characteristics for improvement of gait function after robot-assisted gait training. RESULTS: Paired t-test showed that all functional parameters except MMSE were improved significantly (p<0.05). The duration of disease and baseline BBS score were significantly (p<0.05) correlated with FAC score in multiple regression models. Receiver operating characteristic (ROC) curve showed that a baseline BBS score of '9' was a cutoff value (AUC, 0.966; sensitivity, 91%-100%; specificity, 85%). By repeated-measures ANOVA, the differences in improved walking ability according to time were significant between group of patients who had baseline BBS score of '9' and those who did not have baseline BBS score of '9' CONCLUSION: Our results showed that a baseline BBS score above '9' and a short duration of disease were highly correlated with improved walking ability after robot-assisted gait training. Therefore, baseline BBS and duration of disease should be considered clinically for gaining walking ability in robot-assisted training group.
Classification ; Gait Disorders, Neurologic ; Gait* ; Humans ; Physical Therapy Modalities ; Rehabilitation ; ROC Curve ; Sensitivity and Specificity ; Stroke* ; Walking