1.Atrial Fibrillation Following Middle Cerebral Artery Infarct.
Sa Yoon KANG ; Joung Ho RHA ; Chung Kun HA
Journal of the Korean Neurological Association 2000;18(5):551-555
BACKGROUND: Atrial fibrillation (AF), commonly considered as a cardiac embolic source, can itself be induced by stroke. We therefore tried to find and analyze this 'stroke-induced' AF. METHODS: From the Inha University Stroke Registry of the past 2 years, 143 middle cerebral artery (MCA) territorial infarct patients who had been admitted within 48 hours after stroke onset were recruited to participate in the study. Electrocardiograms (EKG) on admission and follow-up during hospitalization were analyzed. Also, MCA infarct was subdivided according to insular involvement by brain imaging. RESULTS: Among 143 MCA territorial infarcts, 38 patients had AF on admission (Rt:21; Lt:17). Of those, insular involvements of the MCA infarct was noted in 32 patients. All the patients had a follow-up EKG and AF disappeared in 3 patients (Rt:2; Lt:1). In the remaining 105 patients, 10 patients subsequently developed new AF within 1 week after hospitalization. All those 10 patients had right-sided MCA infarcts and insular involvements were present in 9 patients. In summary, among the 48 MCA infarct associated with AF, 13 AF (Rt:12; Lt:1) were presumed to be the consequence and not the cause of stroke. CONCLUSIONS: Though human insular stimulation and inactivation studies have suggested that AF would be more common in left insular destructive lesions, it was not always supported in clinical series. From our study, presumed 'stroke-induced' AF was highly associated with right insular lesions. The mechanism of arrhythmogenesis by ischemic stroke might be more complicated than previously expected and, not merely the simple inactivation of an anatomical substrate, the insular cortex.
Atrial Fibrillation*
;
Electrocardiography
;
Follow-Up Studies
;
Hospitalization
;
Humans
;
Middle Cerebral Artery*
;
Neuroimaging
;
Stroke
2.Performance Rate of Thrombolytic Therapy and Acute Prognosis of Hyperacute Ischemic Stroke.
Seong Ho CHOI ; Joung Ho RHA ; Mira KIM ; Choong Kun HA
Journal of the Korean Neurological Association 2001;19(5):447-451
BACKGROUND: Tissue plasminogen activator (tPA) is known to be effective if given within 3 hours after the onset of ischemic stroke. However, no study has been performed regarding what proportion of patients with acute ischemic stroke are actually given tPA within this time window. We therefore tried to figure out the performance rate of thrombolytic therapy and acute prognosis in hyperacute ischemic stroke patients. METHODS: We prospectively registered all the acute ischemic stroke patients. Thrombolyic therapy was decided strictly according to the NINDS tPA protocol and clinical monitoring was done by the NIH Stroke Scale (NIHSS). If tPA was not given, the reason was recorded. RESULTS: Among 613 acute stroke patients during a period of 2.5 years, there were 146 (23.8%) hyperacute ischemic stroke patients within 3 hours after onset. Even in the 29 cases of in-hospital stroke, the rate of early detection and management was only 27.6% (8 cases). Among the hyperacute stroke population, 56 (38.4%) patients were treated with the thrombolytic agent and 27 patients showed positive responses. Thrombolytic therapy was not tried in the remaining 90 patients. The most common reason was expectation of favorable outcome without thrombolysis. But among these patients, subsequent neurological worsening was noticed in 9 patients, particularly in those with vertebrobasilar stroke. CONCLUSIONS: Urgent notice and management of ischemic stroke needs to be more emphasized not only to the general public, but also to medical personnel. More close observation is especially needed in vertebrobasilar stroke cases (J Korean Neurol Assoc 19(5):447~451, 2001)
Humans
;
National Institute of Neurological Disorders and Stroke
;
Prognosis*
;
Prospective Studies
;
Stroke*
;
Thrombolytic Therapy*
;
Tissue Plasminogen Activator
3.A Case of Fly Catcher's Tongue Phenomenon in Hallervorden-Spatz Disease.
Choong Kun HA ; Sa Yoon KANG ; Joung Ho RHA ; Il Keun LEE
Journal of the Korean Neurological Association 2000;18(2):255-257
Hallervorden-Spatz disease (HSD) is a rare, progressive, autosomal recessive hereditary disorder characterized by pyramidal and extrapyramidal signs, speech disturbances, mental deterioration and retinal degeneration during childhood or adolescence. In late-onset form after the age of 20, parkinsonian features may be the predominant clinical manifestation. Meanwhile, involuntary tongue movements are rare and poorly understood, which have been reported in tardive dyskinesia, neuroacanthocytosis, chronic epilepsy, and after head trauma. We report a case of a patient with 'fly catcher's tongue' as a major clinical presentation, accompanied with mild parkinsonism, and typical MR findings of HSD.
Adolescent
;
Craniocerebral Trauma
;
Diptera*
;
Epilepsy
;
Humans
;
Movement Disorders
;
Neuroacanthocytosis
;
Pantothenate Kinase-Associated Neurodegeneration*
;
Parkinsonian Disorders
;
Retinal Degeneration
;
Tongue*
4.Two Cases of Rhinocerebral Mucormycosis with Perineural Extension to the Pons.
Yong Soo SHIM ; Joung Ho RHA ; Jee Hyun KWON ; Choong Kun HA
Journal of the Korean Neurological Association 1999;17(6):895-900
Rhinocerebral mucormycosis is a very rare, but mostly fatal fungal infection, usually found in diabetic or other immunocompromised hosts. It has a characteristic pattern of spread, invasion of vessel walls with subsequent local thrombotic infarction or direct invasion. But we found two cases contrast to these typical patterns of spread. Our cases initially originated in the nasal cavity and progressed to the cavernous sinus in usual manner, but after then, extended along the trigeminal nerve into the pons. MRI demonstrated the perineural spread, which was confirmed by pathology.
Cavernous Sinus
;
Immunocompromised Host
;
Infarction
;
Magnetic Resonance Imaging
;
Mucormycosis*
;
Nasal Cavity
;
Pathology
;
Pons*
;
Trigeminal Nerve
5.Two Cases of Rhinocerebral Mucormycosis with Perineural Extension to the Pons.
Yong Soo SHIM ; Joung Ho RHA ; Jee Hyun KWON ; Choong Kun HA
Journal of the Korean Neurological Association 1999;17(6):895-900
Rhinocerebral mucormycosis is a very rare, but mostly fatal fungal infection, usually found in diabetic or other immunocompromised hosts. It has a characteristic pattern of spread, invasion of vessel walls with subsequent local thrombotic infarction or direct invasion. But we found two cases contrast to these typical patterns of spread. Our cases initially originated in the nasal cavity and progressed to the cavernous sinus in usual manner, but after then, extended along the trigeminal nerve into the pons. MRI demonstrated the perineural spread, which was confirmed by pathology.
Cavernous Sinus
;
Immunocompromised Host
;
Infarction
;
Magnetic Resonance Imaging
;
Mucormycosis*
;
Nasal Cavity
;
Pathology
;
Pons*
;
Trigeminal Nerve
6.A Case of Pulmonary Embolism After Cesarean Delivery.
Ki Cheol KIL ; Dae Ho KANG ; Jong Kun LEE ; Eun Jeong BAIK ; Young LEE ; Jong Gu RHA ; Soo Pyung KIM
Korean Journal of Obstetrics and Gynecology 2000;43(1):124-127
Pulmonary Embolism, one of the causes of maternal death, is a life threatening disease that needs early and accurate diagnosis. We have exprerienced a case of a fatal pulmonary embolism which was diagnosed by lung perfusion scan on the postoperative 1 day after cesarean delivery and was managed with heparin therapy. We present this case with a brief review of literatures.
Diagnosis
;
Heparin
;
Lung
;
Maternal Death
;
Perfusion
;
Pulmonary Embolism*
7.A Case of Middle Cerebral Artery Infarct Developed Immediately After Head Injury.
Jee Hyun KWON ; Joung Ho RHA ; Sa Yoon KANG ; Choong Kun HA
Journal of the Korean Neurological Association 2000;18(1):106-108
Cerebral infarcts rarely occur following head injury. Carotid artery dissection is usually proposed mechanism in such cases. We experienced a case of middle cerebral artery (MCA) infarct occurred just after head trauma without evidence of vascular abnormality. A 59-year-old male was transported to the emergency room immediately after traffic accident. He had right zygomatic fracture without neck injury. Left hemiparesis was noticed, and brain CT revealed hyperdense MCA sign in the right side. His neurologic status deteriorated over 2 days, and brain MRI showed total right MCA infarct with midline shift. Cerebral angiography was unremarkable. Two months later he had improved so much, but left hemiparesis with right MCA infarction re-developed. We suggest head trauma immediately can induce cerebral infarct without neck vessel injury, and in differential diagnosis of focal neurologic deficit after trauma, cerebral infarct as well as hemorrhage or contusion must be considered.
Accidents, Traffic
;
Brain
;
Carotid Arteries
;
Cerebral Angiography
;
Contusions
;
Craniocerebral Trauma*
;
Diagnosis, Differential
;
Emergency Service, Hospital
;
Head*
;
Hemorrhage
;
Humans
;
Infarction, Middle Cerebral Artery
;
Magnetic Resonance Imaging
;
Male
;
Middle Aged
;
Middle Cerebral Artery*
;
Neck
;
Neck Injuries
;
Neurologic Manifestations
;
Paresis
;
Zygomatic Fractures
8.A Case of Cerebral Infarct in Combined Antiphospholipid Antibody and Ovarian Hyperstimulation Syndrome.
Eun Jung KOO ; Joung Ho RHA ; Byoung Ick LEE ; Myeong Ok KIM ; Choong Kun HA
Journal of Korean Medical Science 2002;17(4):574-576
Ovarian hyperstimulation syndrome is a serious complication of ovulation induction and has a diverse clinical spectrum from edema to thromboembolism. Antiphospholipid antibody syndrome, one of the well known hypercoagulable states, can be also manifested as an arterial or venous thrombosis and recurrent spontaneous abortion. Sometimes a patient with antiphospholipid antibodies might not notice a miscarriage and seek for assisted reproduction treatment, which harbors a chance of developing ovarian hyperstimulation syndrome. If this happens, the ovarian hyperstimulation syndrome can exacerbate the thrombotic complication of underlying antiphospholipid antibody syndrome, resulting in a catastrophic vascular event. The authors experienced a case of middle cerebral artery infarct, which developed during ovarian hyperstimulation syndrome in a 33-yr-old woman with a previous history of fetal loss. An elevated titer of anticardiolipin antibodies was noticed and persisted thereafter. The authors suggest screening tests for the presence of antiphospholipid antibodies before controlled ovarian hyperstimulation.
Adult
;
Antibodies, Anticardiolipin/blood
;
Antiphospholipid Syndrome/*complications/pathology
;
Female
;
Humans
;
Iatrogenic Disease
;
Infarction, Middle Cerebral Artery/*etiology/pathology
;
Magnetic Resonance Angiography
;
Ovarian Hyperstimulation Syndrome/*complications/pathology
;
Ovulation Induction
;
Pregnancy
;
*Pregnancy Complications/pathology
9.Laparoscopic Excision of a Retroperitoneal Cystic Lymphangioma Encasing the Renal Vessels.
Hye Young LEE ; Kyung Suk HAN ; Young Taek OH ; Kun Ho RHA
Korean Journal of Urology 2005;46(6):640-643
A 55-year-old woman, with a retroperitoneal cystic mass, incidentally found during evaluation for the cause of right upper quadrant pain, was referred to our hospital from a local clinic. Computed tomography, performed at our hospital, revealed a multilobulated cystic lesion in the right perinephric space, encasing the renal vessels, suggestive of a cystic lymphangioma. A cystic abdominal lymphangioma is a rare tumor in adults, which is difficult to diagnose preoperatively. Surgical excision is known as the treatment of choice; however, only three cases of laparoscopic excision have been reported. We report a case of a successful laparoscopic excision of a retroperitoneal cystic lymphangioma encasing the renal vessels of the renal hilum.
Adult
;
Female
;
Humans
;
Laparoscopy
;
Lymphangioma
;
Lymphangioma, Cystic*
;
Middle Aged
;
Renal Artery
;
Renal Veins
10.Clinical Predictors of Obstructive Sleep Apnea.
Hea Won KONG ; Hun Jae LEE ; Yoon Seok CHOI ; Joung Ho RHA ; Choog Kun HA ; Dae Ung HWANG ; Yeon Ok KIM ; Chang Ho YUN
Journal of the Korean Neurological Association 2005;23(3):324-329
BACKGROUND: Obstructive sleep apnea (OSA) is a common sleep disorder that causes daytime dysfunction and cardiovascular diseases. Nocturnal polysomnography (NPSG) is the standard method of evaluating OSA; however, it is time-consuming, inconvenient, and expensive. Selective performance of NPSG would be possible if we could better predict those who are more likely to have clinically significant OSA. The aim of this study is to define clinical and anthropometric predictors of OSA. METHODS: We included 100 consecutive patients in whom OSA was clinically suspected. Structured sleep interview, anthropometric measurement, and NPSG were performed in all subjects. Presence of OSA was defined when the apnea-hypopnea index was five or more. Parameters from sleep interview and anthropometric data were investigated with multiple logistic regression using the SAS program (ver 8.1, USA) to identify independent predictors of OSA. RESULTS: OSA was diagnosed in seventy-six patients after NPSG. Univariate analysis showed that the male sex, co-existing diabetes, overweight (BMI>or=25), habitual alcohol drinking, large neck circumference (>or=40 cm), high waist circumference/hip circumference (WC/HC) ratio (>or=0.94), and observed apnea were significantly more frequent in OSA patients (p<0.05). Using multivariate analysis, large neck circumference (>or=40 cm) (adjusted OR=4.43, 95% CI: 1.05~18.61) and high WC/HC ratio (adjusted OR=3.48, 95% CI: 1.12~10.80) were found to be the independent predictors of OSA on the NPSG. CONCLUSIONS: We report the predictors of OSA that could be easily identified by clinical and anthropometric evaluations before performing NPSG. This might aid the clinical decision whether or not to perform NPSG in subjects with clinically suspected OSA syndrome.
Alcohol Drinking
;
Apnea
;
Cardiovascular Diseases
;
Humans
;
Logistic Models
;
Male
;
Multivariate Analysis
;
Neck
;
Overweight
;
Polysomnography
;
Sleep Apnea, Obstructive*
;
Waist-Hip Ratio