BACKGROUND AND PURPOSE: Dystonia is not understood and its pathophysiology is uncertain. The fundamental motor abnormality is an abnormality of muscle command signals, in such that the wrong agonists may be activated for too long, there is abnormal co-contraction of agonists and antagonist, and there is excessive and misdirected action of synergists and postural fixators. The reciprocal inhibition of H reflex has been studied for the evaluation of pathophysiology in tonus abnormalities. Lelli et al.(1991) found the similarities in reciprocal inhibition studies between dystonia and Parkinson's disease. He suggested that abnormalities of reciprocal inhibition appear to be a physiologic overlap between two disorders. There is, however, controversy about the results of reciprocal inhibition studies in both disorders. The cutaneous reflex study is another valuable test for the evaluation of the pathophysiology in tonus abnormalities. In an attempt to clarify the pathophysiologic mechanisms of both disorders, we performed cutaneous reflex tests and compared the findings of both disorders with those of the control group. METHODS: 50 normal persons as a control group, 10 patients with dystonia, and 10 patients with Parkinson's disease participated in this study. Cutaneous reflex responses were recorded in the first dorsal interosseous muscle following electrical stimulation of the digital nerves of the index finger. RESULTS: Each mean amplitude of I1 of cutaneous reflex responses in patients with dystonia and in patients with Parkinson's disease is significantly decreased as compared with those of the control group. CONCLUSION: The results from this study lead us to conclude that both dystonia and Parkinson's disease might have abnormalities of inhibitory supraspinal influences on spinal mechanisms.
Dystonia* ; Electric Stimulation ; Fingers ; H-Reflex ; Humans ; Parkinson Disease* ; Reflex*

Ataxia is one of the most serious neurological symptoms in elderly The clarification of the related anatomical structures are necessary for the understanding of pathophysiologic mechanisms of ataxia. We have recently experienced a case of thalamic infarct in the territory of thalamogeniculate artery. The localization of lesion was based on CT and MR imaging. At first time, right hemiparesis and ataxia were prominent. Hemiparesis was transient but ataxia had been persistent for several months. It has been suspected that thalamus could be the part of neural circuits in balancing. Our case support this suggestion clinically. Based on clinical observations, a plausible extrapolation can be made to thalamic ataxia. It maybe related with dysfunction of dentatorubrothalamic and corticopontine pathway. Thus our case led us to conclude that thalamus could be engaged in balance control of human body.
Aged* ; Arteries ; Ataxia* ; Human Body ; Humans ; Magnetic Resonance Imaging ; Paresis ; Thalamus

SUNCT syndrome is a headache syndrome characterized by short-lasting(usually 15-120 sec), unilateral head paroxysms localized in the peri-ocular area, accompanied by conjunctival injection, lacrimation, nasal stuffiness, rhinorrhea, and subclinical forehead sweating, all on the symptomatic side. We experienced a new SUNCT syndrome case. 57-year-old patient had been suffering from right orbital pain attacks since he was 54. The pain, of an ""electrical"" or ""burning"" character, was moderate to severe in intensity. Single attacks lasted for 30-60 seconds each and were accompanied by prominent ipsilateral conjunctival injection and tearing as well as slight rhinorrhea. His symptoms were relieved by carbamazepine. Carbamazepine treatment seemingly brought about marked decrease in the frequency and severity of attacks. This case may be the first reported SUNCT syndrome case in Korea. Furthermore this case may shed light on the nosologic point view of SUNCT syndrome. The suspected pathophysiology of trigeminal neuralgia is expansion of the low threshold portions of the receptive fields owing to loss of surround inhibition. Carbamazepine facilitate afferent inhibition and depress excitatory transmission in the trigeminal nucleus. So the effectiveness to carbamazepine has been considered as one of diagnostic criteria of trigeminal neuralgia. Through the survey of previous reported cases including our case, it is suspected that SUNCT syndrome be closer to trigeminal neuralgia rather than cluster headache. We discussed several viewpoints for the nosologic aspect of SUNCT syndrome in this report.
Carbamazepine* ; Cluster Headache ; Forehead ; Head ; Headache Disorders ; Humans ; Korea ; Middle Aged ; Orbit ; SUNCT Syndrome* ; Sweat ; Sweating ; Trigeminal Neuralgia ; Trigeminal Nuclei

BACKGROUND AND SIGNIFICANCE: Oro-facial dyskinesia are stereotyped movements, consisting of smacking and pursing of the lips, lateral deviation and protrusion of the tongue, and occasionally lateral deviation and protrusion of the jaw. Oro-facial dyskinesia rarely occur with Huntington's disease, acquired hepatocerebral degeneration, or other choreatic disorders. Spontaneous oro-facial dyskinesias occur in the elderly and had been said to result from edentulousness. It is important to clarify the pathophysiology of senile oro-facial dyskinesia for the prevention and proper treatment. I have had a doubt on the current concept that edentulism is the main etiologic factor of senile oro-facial dyskinesia. Through the clinical experience, I have had an impression that edentulism might not be the primary underlying cause of senile oro-facial dyskinesia. CASE AND METHODS: I have recently experienced four cases of senile oro-facial dyskinesia. There were no history of being exposed to neuroleptics. I tried to clarify the role of edentulism in senile oro-facial dyskinesia through clinical observations, electrophysiologic studies, and pharmacologic trials. CONCLUSION: Two patients said that wearing of denture might be responsible for the development of oro-facial dyskinesia. EMG studies with some procedures showed somewhat consistent results between two patients who were tested. EMG activities were increased by wearing of denture and decreased by touching on the perioral area with examiner's hand. Furthermore two patients who were medicated with dopamine receptor blocker showed marked clinical improvements. These results suggested that senile degenerative changes of central nervous systems might be the primary cause of senile oro-facial dyskinesia.
Aged ; Antipsychotic Agents ; Central Nervous System ; Chorea ; Dentures ; Dyskinesias* ; Hand ; Hepatolenticular Degeneration ; Humans ; Huntington Disease ; Jaw ; Lip ; Receptors, Dopamine ; Tongue

BACKGROUND & PURPOSE: Although several investigators have been studying EMG activities in projected movements, a complete and satisfactory understanding of the EMG patterns is still lacking. This present study is an attempt to define these patterns for certain stereotyped movements in a normal population, and to investigate the electrophysiologic mechanisms of abnormal movements in common extrapyramidal disorders. METHODS: 10 Patients with Parkinson's disease and 10 patients with cerebellar disease were tested with several different tasks, using stereotyped elbow flexions. They include fast active flexion(FAF), slow active flexion(SAF), fast passive flexion(FPF), slow passive flexion(SPF), and Antagonist-inhibition task. The recorded EMG activities from biceps(agonist) and triceps(antagonist) were analysed by being compared with normal patterns of the control group. RESULTS AND CONCLUSIONS: In most patients with Parkinson's disease, EMG patterns during some smooth flexion tasks(active and passive) were abnormal and were characterised by persistent co-contractions both in biceps and triceps. The EMG patterns during a fast flexion task(active and passive) were also abnormal in about half of all patients with Parkinson's disease. This study demonstrates that both slow and fast movements are abnormal in patients with Parkinson's disease, however slow movements are more difficult than fast movements in patients with Parkinson's disease. In a task designed to investigate antagonist inhibition before agonist activities, a majority of the patients with Parkinson's disease showed normal inhibition patterns. This study suggests that, contrary to previous claims, slowness of movement be not due to either failure to relax, or rigidity in antagonist muscles. In patients with cerebellar disease, EMG patterns during a fast flexion task showed prolongation of the initial biceps and/or triceps components, and it is suggested that this abnormality might be an elemental feature of dysmetria. All patients with cerebellar disease.
Basal Ganglia ; Basal Ganglia Diseases ; Cerebellar Ataxia ; Cerebellar Diseases* ; Cerebellum ; Dyskinesias ; Elbow ; Humans ; Muscles ; Parkinson Disease* ; Research Personnel

BACKGROUND: Although several investigators have been studying EMG activity in projected movment, a complete and satisfactory understanding of the EMG patterns is still lacking. This present study is an attempt to define these patterns for certain stereotyped movement in a normal population, and to investigate the electrophysiologic mechanisms of abnormal movements in extrapyramidal disorders. METHODS: 5 Patients with Parkinson's disease and 5 patients with cerebellar disease performed several different stereotyped elbow flexion tasks, and the EMG patterns from biceps and triceps were compared with control group. RESULTS: In patients with Parkinson's disease characterized, EMG pattern during a smooth felxion task was almost always abnormal and was chracterised by alternating activity in biceps and triceps. The EMG patterns during a fast flexion task were also usually abnormal although they were always composed of bursts of EMG activity of normal duration appearing alternately in the agonist and antagonist muscles. So, This study demonstrates that both slow and fast movement are clearly abnormal in these patients with diesase of the basal ganglia. In a task designed to investigate antagonist inhibition before agonist activity, a majority of the patients performed normally. CONCLUSIONS: This study suggest that, contrary to previous claims, slowness of movement is not due either to failure to relax or to rigidity of agtagonist muscles. In patients with cerebellar disease, EMG pattern during a fast flexion task showed prolongation of the initial biceps and/or triceps components, and it is suggested that this abnormality might be an elemental featrure of dysmetria. 3 of 5 patients showed the normal pattern of smooth felxion indicating that, with cerebellar deficits, smooth movements are better preserved than fast movements. The timing of the cessation of triceps activity before the initiation of biceps activity in an alternating movement was abnormal in 4 of 5 patients; this abnormality might be an elemental feature of dysdiadochokinesia.
Basal Ganglia Diseases ; Basal Ganglia* ; Cerebellar Ataxia ; Cerebellar Diseases ; Cerebellum ; Dyskinesias ; Elbow ; Humans ; Muscles ; Parkinson Disease ; Research Personnel

Post-traumatic encephalopathy is characterized by the combination of upper motor neurons, basal ganglia, cerebellar, and psychiatric disturbances. A "striatal" variant, with predominant parkinsonism, is uncommon and may be difficult to distinguish from idiopathic Parkinson's disease. A 38-year-old man, who had history of head injuries associated with brief losses of consciousness, developed a resting tremor and rigidity of the left lower extremity. Upon admission, he showed masked face and bradykinesia without dementia or other neurologic abnormalities. Brain MRI and SPECT studies showed no abnormalities. A BAEP study revealed an abnormal prolongation of inter-peak latencies between wave III and V.
Adult ; Basal Ganglia ; Brain ; Brain Injuries ; Consciousness ; Craniocerebral Trauma* ; Dementia ; Head* ; Humans ; Hypokinesia ; Lower Extremity ; Magnetic Resonance Imaging ; Masks ; Motor Neurons ; Parkinson Disease ; Parkinsonian Disorders* ; Tomography, Emission-Computed, Single-Photon ; Tremor

Post-traumatic encephalopathy is characterized by the combination of upper motor neurons, basal ganglia, cerebellar, and psychiatric disturbances. A "striatal" variant, with predominant parkinsonism, is uncommon and may be difficult to distinguish from idiopathic Parkinson's disease. A 38-year-old man, who had history of head injuries associated with brief losses of consciousness, developed a resting tremor and rigidity of the left lower extremity. Upon admission, he showed masked face and bradykinesia without dementia or other neurologic abnormalities. Brain MRI and SPECT studies showed no abnormalities. A BAEP study revealed an abnormal prolongation of inter-peak latencies between wave III and V.
Adult ; Basal Ganglia ; Brain ; Brain Injuries ; Consciousness ; Craniocerebral Trauma* ; Dementia ; Head* ; Humans ; Hypokinesia ; Lower Extremity ; Magnetic Resonance Imaging ; Masks ; Motor Neurons ; Parkinson Disease ; Parkinsonian Disorders* ; Tomography, Emission-Computed, Single-Photon ; Tremor

We tried to correlate brain CT findings with clinical state at admission and outcome at discharge in 42 selected cases from 94 adult patients under the diagnosis of tuberculous meningitis at Seoul National University Hospital during last four years from 1981. Their clinical state at admission and outcome at discharge were classified into three groups by severity of symptoms, respectively. The final outcome of them were well correlated with their clinical states at admission. Observed abnormal brain CT findings in this series were hydrocephalus (74%), dirthy cisternal enhancement (52%), infraction (38%), periventricular low density (36%), and tuberculoma (19%). The poorer the clinical state at admission and outcome at discharge, the more frequent the abnormal brain CT findings, especially of periventricular low density and infraction. But periventricular low density without infarction seemed to affect more deleterious effect on clinical state at admission than on final outcome.
Adult ; Brain* ; Diagnosis ; Humans ; Hydrocephalus ; Infarction ; Seoul ; Tuberculoma ; Tuberculosis, Meningeal*

BACKGROUND AND OBJECTIVE: Transient global amnesia(TGA) is a neurological syndrome affecting preferentially middle-aged or elderly people and characterized by sudden onset of transient impairment of antegrade amnesia with variably retrograde amnesia. TGA was defined over 30 years ago, but the etiology remain unclear. Several mechanisms have been proposed, including arterial thromboembolic ischemic attacks in both posterior cerebral artery territories, epilepsy, and migraine. Although many studies have reported TGA, only a few reported cerebral perfusion studies using SPECT because of the brief duration of the episode. Technetium-99m-ethyl cysteinate dimmer(ECD) is superior to sensitivity of lesion detection and lesion to normal contrast, probably due to lower back diffusion from the brain to the blood and its excellent radiochemical stability. So we evaluate pathophysiologic mechanism of TGA by using 99mTC-ECD SPECT with or without acetazolamide(ACZ) stress. METHODS: We evaluated six patients with transient global amnesia, four women and two men, age ranges 56 to 78 years, mean 62.2 years. Measurements of CBF and vascular reserve using 99mTC-ECD with or without ACD stress were performed during or after TGA episode. RESULTS: One patient, who was evaluated in TGA episode showed that regional cerebral blood flow was decreased in both anteroinferior frontal, both temporal, right thalamus, both inferior parietal and left parietal region with impaired vascular reserve in left inferior temporal and right thalamus. Others, who were evaluated more than 6days in TGA episode showed that regional cerebral blood flow was decreased in left temporal (4), both temporal region (1), left thalamus (2) and both basal ganglia (1) with preserved vascular reserve except one, showed impaired vascular reserve in left thalamus. CONCLUSION: This result show that severe hypoperfusion of bilateral temporal region and impaired vascular reserve in left temporal region in TGA episode. Other patients who were recovered from TGA showed hypoperfusion of left temporal region and preserved vascular reserve. 99mTc-ECD with acetazolamide SEPCT that sensitively detects localized impaired cerebraovascular reserve should help elucidate these processes. But further study with more cases is necessary for evaluation of pathophysiology of TGA.
Acetazolamide ; Aged ; Amnesia ; Amnesia, Retrograde ; Amnesia, Transient Global* ; Basal Ganglia ; Brain ; Diffusion ; Epilepsy ; Female ; Humans ; Male ; Migraine Disorders ; Perfusion ; Posterior Cerebral Artery ; Rabeprazole ; Technetium* ; Thalamus ; Tomography, Emission-Computed, Single-Photon*