We report the clinical features in one patients with episodic positional vertigo and apogeotropic direction changing horizontal positional nystagmus that does not fatigue, beating to the right with the head turned to the left and beating to the left with the head turned to the right. This syndrome probably represents a horizontal semicircular canal variant of benign positional vertigo. Free-floating debris and Cupula attached debris in one horizontal semicircular canal may explain many of the clinical and oculographic findings.
Fatigue ; Head ; Humans ; Nystagmus, Physiologic ; Semicircular Canals ; Vertigo*

Myoclouns is a complicated and poorly-understood phenomenon caused by many pathological conditions. Myoclonus which is triggered by sensory stimuli has been termed reflx myoclonus and divided into cortical, reticular and spinal types depending on the generator sites. Segmental myoclonus of spinal origin consists of synchronous rhythmical jerks confined to a group of muscles supplied by either one segment or several contiguous segments of the spinal cords. We present two cases of spinal reflex myoclonus. One was 50 years old female who showed complex myoclonic jerks involving the abdominal wall and paraspinal muscibs resembling 'belly dance'. The other was 26 years old male who showed intermittent synchronous upper cervical axial muscle contractions. In both cases, jerks were increased with certain stimuli, but disappeared during sleep. They showed normal EEGs and absence of enhancement of SSEPS.
Abdominal Wall ; Adult ; Electroencephalography ; Female ; Humans ; Male ; Middle Aged ; Muscle Contraction ; Muscles ; Myoclonus* ; Reflex ; Spinal Cord

We report a 18 years old man of brainstem encephalitis with acute ataxia, areflexia and gaze evoked vertical and horizontal nystagmus which is mimicking Miller Fisher syndrome. He had evidences of both peripheral neuropathy in nerve conduction studies and a brainstem encephalitis in MR findings. The possible relationship of the Miller Fisher syndrome and brainstem encephalitis are discussed with brief review of literature.
Adolescent ; Ataxia ; Brain Stem* ; Encephalitis* ; Humans ; Miller Fisher Syndrome* ; Neural Conduction ; Nystagmus, Pathologic ; Peripheral Nervous System Diseases

High dose intravenous immunoglobulin (IVIg) therapy can improve the clinical course of several immune mediciated diseases. We evaluated clinical effects and side effects of IVIg in Guillain-Barre syndrome (GBS). 19 Patients with GBS were studied prospectively in a placebo-controlled trial. 11 Patients were received high dose IVIg (400mg/kg for 5 days) and controls received only conservative treatment. The disability scores using modified Rankin scores before and after treatment of each group were compared. Four weaks later, mean Rankin Score of IVIg group was 2.5 + 0.7 and control group was 3.3+ 0.5which showed significant difference(p<0.05). There were no serious advers effer of promote early improvement with safety in acute phase of Guillan-Barre syndrome.
Guillain-Barre Syndrome* ; Humans ; Immunization, Passive* ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Prospective Studies

OBJECTIVES: To analyze the motor evoked potential (MEP) responses to a degree of voluntary contraction and stimulus intensity and to suggest the standardized optimal stimulation for MEP responses. METHODS: MEPs induced by a cortical stimulation were elicited at the thenar muscles in 15 normal subjects during the rest and gradual voluntary contraction, using the 10% of maximal voluntary contraction (MVC), 30%, 50%, and MVC. During rest and during each contraction, excitability threshold at rest (RET) and at contraction (CET) were determined. Consecutive stimuli were applied, according to the intensity of ratio increment (110% to 150% of excitation threshold). RESULTS: The RET showed a remarkable decrease (57.1+/-8.2% --> 47.4+/-8.7%) after the voluntary contraction (P<0.05). Shortening of latency reached the saturation level with 10% of MVC, irrespective of stimulus intensity. Amplitude reached a saturation level at 30% of MVC with 62.7% intensity of maximal output, which is equal to 140% intensity of its CET, and to 110% of RET. MEP amplitude at rest and at 10% of MVC were influenced by the excitation threshold (P<0.05), but those at above 30% of MVC were not related. CONCLUSION: The procedure for optimal facilitation for the MEPs is as follows; for minimal latency of MEPs, minimal contraction (10% of MVC) with RET intensity is enough. For maximal amplitude of MEPs, moderate contraction (30% MVC) with 110% intensity of RET is adequate.
Evoked Potentials, Motor ; Muscles ; Transcranial Magnetic Stimulation*

OBJECTIVES: This study was designed to measure sympathetic skin responses (SSRs) following magnetic stimulation of the cervicothoracic spine and to evaluate its clinical usefulness. METHODS: Fifteen healthy volunteers who had no dysautonomic symptoms or signs and a patient with C6 spinal cord transection participated in this study. To evoke SSR, we stimulated the C7 spinous process (SP) and T2 SP with 90 mm circular coil (Magstim 200). We recorded the sensory nerve action potential (SNAP) from the right middle finger to ascertain whether the C7 dorsal root was depolarized by the C7 SP stimulation. The same stimulation intensity by which SNAP had been obtained was used to evoke the SSR by the C7 and T2 SP stimulation. The recording of SSR was done in both palms. SNAP was recorded by the magnetic stimulation on the C7 SP in all subjects. RESULTS: By the C7 SP stimulation, the latency of SSR was 1.35 sec in the right palm, 1.33 sec in the left palm and by the T2 SP stimulation, the latency was 1.24 sec, 1.23 sec in order. The right-left difference was not found by each SP stimulation, but the latency of SSR by the T2 SP stimulation was faster than that by the C7 SP stimulation (p<0.01). The latency difference of C7 and T2 SP stimulation was 0.11 sec in the right palm, 0.10 sec in the left palm. In a case of C6 cord transection, SSR was evoked neither by the right median electric stimulation, nor by the C7 SP magnetic stimulation. However, SSR was successfully evoked by the T2 SP stimulation. CONCLUSION: We believe that the latency difference of C7 and T2 spinous process stimulation reflects the central conduction time of SSR.
Action Potentials ; Electric Stimulation ; Fingers ; Healthy Volunteers ; Humans ; Skin* ; Spinal Cord Injuries ; Spinal Nerve Roots ; Spine

OBJECTIVE: To evaluate the prevalence and prosthetic uses of lower extremity amputee in one Korean county. METHOD: We asked community health worker in Hwa Sung Goon to recruit lower extremity amputees. We contacted them by telephone and tried to know their prosthetic uses, adaptations and their behavior about prosthetic usage. Also, we recruited all lower extremity amputees in Hwa Sung Goon. RESULTS: In Hwa Sung Goon, the prevalence of lower extremity amputees was 35 persons per 100,000. 93.8% of them had prostheses, more than half of them were not satisfied with their prosthetic use. For last 10 years, they changed into new prosthesis per 2.3 years. CONCLUSION: In one Korean county, the prevalence of lower extremity amputees was 0.03%. Most of them used their prosthesis, and walked independently. Their compliances with rehabilitative intervention were very low.
Amputees* ; Community Health Workers ; Humans ; Lower Extremity* ; Prevalence ; Prostheses and Implants ; Telephone

No abstract available.
Female ; Hyperemesis Gravidarum* ; Hypokalemia* ; Myelinolysis, Central Pontine* ; Pregnancy

The vein of Galen malformation is a midline intracranial arteriovenous fistula with aneurysmal dilatation of the vein of Galen. This abnormality, though rare, is associated with a bleak prognosis and significant mortality. However, significant advancements have been made in understanding the pathophysiology of this abnormality, and improvements in both interventional neuroradiologic embolization and microneurosurgical techniques have contributed to a better outcome. In neuroradiologic embolization, children are likely to become agitated and confused and thereby jeopardize the entire procedure. For this reason, this procedure is performed with the children under general anesthesia. We experienced a case of neuroradiologic embolization under general anesthesia with propofol. The patient was a 9- year-old boy who weighed 29 kg. He was healthy and had no other abnormalities in our preoperative evaluation. Throughout the entire procedure, especially before and after closure of the fistula, hemodynamic changes and unexpected events did not appear.
Anesthesia, General ; Aneurysm ; Arteriovenous Fistula ; Arteriovenous Malformations ; Cerebral Veins* ; Child ; Dihydroergotamine ; Dilatation ; Fistula ; Hemodynamics ; Humans ; Male ; Mortality ; Prognosis ; Propofol ; Veins*

BACKGROUND AND OBJECTIVES: Mechanical circulatory support with extracorporeal membrane oxygenation (ECMO) and ventricular assist device has always been the optimal choice for treating the majority of medically intractable low cardiac output case. We retrospectively investigated our institution's outcomes and variables associated with a high risk of mortality. SUBJECTS AND METHODS: From 1999 to 2014, 86 patients who were of pediatric age or had grown-up congenital heart disease underwent mechanical circulatory support for medically intractable low cardiac output in our pediatric intensive care unit. Of these, 9 grown-up congenital heart disease patients were over 18 years of age, and the median age of the subject group was 5.82 years (range: 1 day to 41.6 years). A review of all demographic, clinical, and surgical data and survival analysis were performed. RESULTS: A total of 45 (52.3%) patients were successfully weaned from the mechanical assist device, and 25 (29.1%) survivors were able to be discharged. There was no significant difference in results between patients over 18 years and under 18 years of age. Risk factors for mortality were younger age (<30 days), functional single ventricle anatomy, support after cardiac operations, longer support duration, and deteriorated pre-ECMO status (severe metabolic acidosis and increased levels of lactate, creatinine, bilirubin, or liver enzyme). The survival rate has improved since 2010 (from 25% before 2010 to 35% after 2010), when we introduced an upgraded oxygenator, activated heart transplantation, and also began to apply ECMO before the end-stage of cardiac dysfunction, even though we could not reveal significant correlations between survival rate and changed strategies associated with ECMO. CONCLUSION: Mechanical circulatory support has played a critical role and has had a dramatic effect on survival in patients with medically intractable heart failure, particularly in recent years. Meticulous monitoring of acid-base status, laboratory findings, and early and liberal applications are recommended to improve outcomes without critical complication rates, particularly in neonates with single ventricle physiology.
Acidosis ; Bilirubin ; Cardiac Output, Low* ; Creatinine ; Critical Care* ; Extracorporeal Membrane Oxygenation ; Heart Defects, Congenital ; Heart Failure ; Heart Transplantation ; Heart-Assist Devices ; Humans ; Infant, Newborn ; Intensive Care Units* ; Lactic Acid ; Liver ; Mortality ; Oxygen ; Oxygenators ; Physiology ; Resuscitation ; Retrospective Studies ; Risk Factors ; Survival Rate ; Survivors