Radiation-induced neuropathy is a rare but well recognized clinical entity although peripheral nerves are considered to be relatively resistant to irradiation. We report three patients with radiation-induced lumbosacral plexopathy, whose characteristic clinical and electrophysiological features can be summarized as follows: 1) 55-58 year old women who were previously treated with radiotherapy for uterine cervix carcinoma: 2) the latent period is to 10 from 13 years: 3)predominantly motor involvement with slowly progressive paraparesis, asymmetrical onset and worse in distal muscle group: 4) painless at onset, with variable degree of sensorv changes: 5)decreased or absent knee and ankle jerks :6)axonal damage in electrophysiologic study: 7)frequent myokymic discharges. Myokymic discharges occur in bursts at regular rate of 0.1 to 8 Hz. In myokymic bursts with more spikes, interburst interval is longer but interspike Interval is shorter.
Ankle ; Cervix Uteri ; Female ; Humans ; Knee ; Paraparesis ; Peripheral Nerves ; Radiotherapy

The antihypertensive effects of tripamide was studied in 19 cases of essential hypertension. After 4 weeks treatment with daily dosage of Tripamide (Normonal(R)) 15mg, the dosage was adjusted to 30mg in 10 cases. Before and after treatment laboratory tests were performed in 11 cases. The obtained results were as follows: 1) After 4 weeks treatment with daily dosage of Tripamide 15mg, mean systolic and diastolic blood pressure was decreased by 25 mmHg (12.7%) and 9.7 mmHg (8.5%) respectively(p<0.01), and in 58% of the cases, good or fair control of blood pressure was resulted. 2) After final treatment, mean systolic and diastolic blood pressure was decreased by 29.7 mmHg(15.1%) and 15.0 mmHg(120.5%) respectively(p<0.005) and in 79% of the cases, good or fair control of blood pressure was resulted. 3) There was no significant changes in the values of sodium, potassium, BUN, creatinine, uric acid, cholesterol, SGOT, SGPT and calcium after treatment. 4) There was no significant side effect except one case of mild fatigue and tingling sense of extrmities which were subsided spontaneousely.
Alanine Transaminase ; Aspartate Aminotransferases ; Blood Pressure ; Calcium ; Cholesterol ; Creatinine ; Fatigue ; Hypertension ; Potassium ; Sodium ; Uric Acid

Antiphospholipid antibody syndrome (APS) has been considered as a distinct clinical entity, usually associated with systemic lupus erythematosus (SLE) or with other connective tissue disease. Prominent clinical features include venous thrombosis, arterial occlusions, thrombocytopenia, hemolytic anemia, recurrent fetal loss, livedo reticularis and neurologic manifestations. Antiphospholipid antibodies (aPL) represent a spectrum of phospholipid-binding antibodies, including the lupus anticoagulant(LA), anticardiolipin antibody (aCL), and the biologic false-positive serologic test for syphilis (BFP-STS). Primary antiphospholipid syndrome (PAPS) which has been recently described is a complication of autoimmune aPL with lack of serologic and clinical features of SLE. We present a young female patient with PAPS who showed progressive dementia, diffuse cerebral atrophy, renal arteriolar occlusions, livedo reticularis, and valvular heart disease. To our knowledge, our patient is the first described with the clinical and mangetic resonance imaging(M-RI) findings in this entity.
Anemia, Hemolytic ; Antibodies ; Antibodies, Anticardiolipin ; Antibodies, Antiphospholipid ; Antiphospholipid Syndrome* ; Atrophy* ; Brain* ; Connective Tissue Diseases ; Dementia* ; Female ; Heart Valve Diseases ; Humans ; Livedo Reticularis ; Lupus Erythematosus, Systemic ; Neurologic Manifestations ; Serologic Tests ; Syphilis ; Thrombocytopenia ; Venous Thrombosis

The efficacy and safety of oral sumatriptan as a 100mg conventional tablet was evaluated in the acute treatment of migrame in a single-blind, randomized, placebocontrolled, parallel-group study. Thirty patients were assigned to the sumatriptan group And other 30 to placebo group. Each patient was treated a total of three attacks. Patients recorded details of each attack and response to treatment on a diary card. Sumatriptan was significantly more effective than placebo in relieving headache(moderate/severe reduced to mild/none) at 4 hr(67.2 vs 15.4%; P< 0.001). Overall therapeutic effect of sumatriptan was excellent(89.6 vs 23%; P< 0.001). Compared with placebo, more patients on sumatriptan were pain7free by 2 hr(33.6 vs 0%; P< 0. 001) and 4 hr (25.7 vs 2. 0%; P< 0.001). The proportion of patients who required rescue medication was significantly (P< 0. 001) lower 'in the sumatriptan group when compared with the placebo group(2.4 vs 21%). The overall incidence of patients reporting a dverse events was 39% in sumatriptan group and 10% in placebo (P= 0. 005). The most commonly reported events in the sumatriptan-treated patients were nausea and/or vomiting, chest discomfort, general weakness, tightness of head; these were however generally mild, transient and tolerable. It is concluded that oral sumatriptan is an effective, well-tolerated prompt remedy for acute attacks of migraine.
Head ; Humans ; Incidence ; Migraine Disorders* ; Nausea ; Sumatriptan* ; Thorax ; Vomiting

BACKGROUND AND PURPOSE: Platelet aggregation plays an important role in thrombogenesis. Thus antiplatelet agents, such as aspirin and ticlopidine, have been in usage to prevent for recurrent ischemic stroke. Triflusal is known to selectively inhibit cyclooxygenase in platelet rather than in vessel wall. And thus can be more beneficial in its antiplatelet aggregatory effect. There has been no comparative study between triflusal and ticlopidine on its antiplatelet aggregatory effect and side effects till now. Our comparative study between these two agents is to provide useful information on clinical utilization. METHODS: Triflusal(900mg/day) and ticlopidine(500mg/day) were administered in 31 and 37 patients, who suffered from acute ischemic stroke. Their efficacy in platelet aggregation and the incidence of clinical and laboratory side effects were compared in one week and one month after the administration of the drugs. RESULTS: Platelet aggregation was more effectively inhibited in triflusal group, especially induced by collagen or epinephrine(p<0.01). No significant difference was noted in the incidence of side effects in both groups. In five patients of the ticlopidine group, the drug was withdrawn due to skin rash and/or increased liver enzymes. CONCLUSION: Triflusal had more effectively inhibited platelet aggregation in this study. Severe side effects even requiring discontinuation of the drug were noted in five patients of ticlopidine group.
Aspirin ; Blood Platelets ; Collagen ; Exanthema ; Humans ; Incidence ; Liver ; Platelet Aggregation ; Platelet Aggregation Inhibitors ; Prostaglandin-Endoperoxide Synthases ; Stroke ; Ticlopidine*

Carotid endarterectomy is superior to medical treatment in preventing secondary stroke in patients with symptomatic high grade carotid stenosis. Transluminal angioplasty is a promising procedure as an alternative treatment for these patients. We report two cases of carotid angioplasty with Palmaz-Schatz stent in patients with carotid artery occlusive disease. One patient presented with decreased right visual acuity because of retinal arterial embolism. The angiogram demonstrated a discrete tight stenosis of right internal carotid artery carotid stenting with Palmaz-Schatz coronary stent was performed without any significant complications. The other patient presented with recurrent episodes of cerebral infarction, for which he had undergone left carotid erdarterectomy 3-years ago. The carotid angiogram demonstrated tight stenoses of both internal carotid arteries. Carotid artery stenting was performed at left and right internal carotid arteries without any complications. We suggest that stenting may be an effective and safe therapeutic alternative to surgical treatment in some selected patients with carotid artery occlusive disease.
Angioplasty* ; Carotid Arteries* ; Carotid Artery, Internal ; Carotid Stenosis* ; Cerebral Infarction ; Constriction, Pathologic ; Embolism ; Endarterectomy, Carotid ; Humans ; Retinaldehyde ; Stents* ; Stroke ; Visual Acuity

FitzGerald and Jankovic(1989)' reported 10 patients with marked gait difficulty and no or only minimal upper limb involvement and coined the term 'lower body parkinsonism' (LBP). They further suggested that LBP was a homogeneous subgroup of parkinsonism, distinct from idiopathic Parkinson's disease (IPD), attributable to vascular etiology. In order to verify the validity of this clinical entity, five cases with LBP were compared with 44 cases with typical idiopathic Parkinson's disease (IPD) with respect to their clinical and neuroradiological findings. Mean age at onset was significantly older in LBP group (63.2*6.3 years) than IPD group (53.9*5.9 years). Gait disturbance was the initial motor symptom in 80% of LBP cases and 16% of IPD cases. Duration of symptoms tended to be shorter in LBP group than IPD group (3.2*2.7, 5.2*3. Lyears, respectively), although statistically not significant. Response to, L-dopa was poor in all but one case with LBP, while most cases with IPD showed good response (43 of 44 cases). On brain MRI in LBP group, four of five cases had multiple small ischernic lesions in both periventricular white matter and basal ganglia. However, one case with LBP showed normal brain MR finding and improved with L-dopa treatment, whose diagnosis proved to idiopathic Parkinson's disease. We conclude that LBP is unusual but not rare, and may be a part of clinical spectrum of either vascular parkinsonism or idiopathic Parkinson's disease. Although LBP is a heterogeneous group, most cases may be caused by multiple lacunar infarctions.
Basal Ganglia ; Brain ; Diagnosis ; Gait ; Humans ; Levodopa ; Magnetic Resonance Imaging ; Numismatics ; Parkinson Disease ; Parkinsonian Disorders* ; Stroke, Lacunar ; Upper Extremity

Schizencephaly is a congenital brain anomaly, a disorder of cell migration characterized by gray matter-lined clefts, which is caused by faulty migration of the subependymal neuroblasts. The cleft may be closed (Type I) or open by a cavity communicating with the lateral ventricle (Type II). We identified the characteristic features of schizencephaly on CTs in one patient and on MRIs in 15 patients. Age at detection ranged from 16 months to 37 years. Three patients had bilateral clefts and 13 patients had unilateral cleft. Twelve patients had closed lip cleft whlle four patients had open lip cleft. Small sized unilateral closed cleft, the most comrnon type, was found in ten patients. Three patients had multiple clefts. Clinically these patients presented with seizures in 15 patients, motor disturbance in six patients, speech impairment in five patients, developemental delay in four patients, and mental retardation in three patients. The presence and severity of these symptoms correlated with the size and location of the lesions. Associated cerebral anomalies included ventricular dilatation in seen patients, agenesis of septum pallucidum in seven patients, other neuronal migration disorder in four patients, agenesis or dysgenesis of corpus callosum in three patients, septo-optic dysplasia in two patients, abnormal extension of svlvian fissure in one patient, and arteriovenous malformation in one patient.
Arteriovenous Malformations ; Brain ; Cell Movement ; Corpus Callosum ; Dilatation ; Humans ; Intellectual Disability ; Lateral Ventricles ; Lip ; Magnetic Resonance Imaging ; Malformations of Cortical Development* ; Neuronal Migration Disorders ; Seizures ; Septo-Optic Dysplasia

BACKGROUND: Recently a non-Jewish German family with writer's cramp was reported to have DYT1 mutation, expanding the phenotypic spectrum of DYT1. Although functional brain surgery has been tried for generalized dystonia, surgical outcome in focal dystonia patients with DYT1 mutation has not yet been reported. We investigated the clinical features and response to thalamotomy in familial writer's cramp with DYT1 mutation. METHODS: Family members were examined and clinically affected cases were video-taped. For the detection of DYT1 mutation, PCR-RFLP(restriction fragment length polymorphism) and heteroduplex analyses were performed as screening tests. Additional DNA sequencing was performed for the proband case to confirm the GAG deletion. RESULTS: Among this clinically homogeneous non-Jewish Korean family, five members in three generations were affected. Age of onset ranged from 7 to 20 years. Writing difficulty was the initial and the main disabling problem for all the affected individuals. All had the bilateral writer's cramp in succession. Dystonia remained focal and task-specific for the entire period after onset. Unilateral thalamotomy was performed in three patients, with remarkable improvement. Surgical benefit remained unchanged during the follow-up period of 6-8 years. DYT1 mutation cosegregated with the affected members. CONCLUSIONS: This study adds another evidence that DYT1 phenotype can present with purely focal and task-specific dystonia in all the affected members of a family. Marked and sustained improvement following thalamotomy in three of our patients suggests that stereotaxic thalamotomy is beneficial in familial focal dystonia with DYT1 mutation. (J Korean Neurol Assoc 19(2):110~115, 2001)
Age of Onset ; Brain ; Dystonia ; Dystonic Disorders* ; Family Characteristics ; Follow-Up Studies ; Heteroduplex Analysis ; Humans ; Mass Screening ; Phenotype ; Sequence Analysis, DNA ; Writing

BACKGROUND: Recently a non-Jewish German family with writer's cramp was reported to have DYT1 mutation, expanding the phenotypic spectrum of DYT1. Although functional brain surgery has been tried for generalized dystonia, surgical outcome in focal dystonia patients with DYT1 mutation has not yet been reported. We investigated the clinical features and response to thalamotomy in familial writer's cramp with DYT1 mutation. METHODS: Family members were examined and clinically affected cases were video-taped. For the detection of DYT1 mutation, PCR-RFLP(restriction fragment length polymorphism) and heteroduplex analyses were performed as screening tests. Additional DNA sequencing was performed for the proband case to confirm the GAG deletion. RESULTS: Among this clinically homogeneous non-Jewish Korean family, five members in three generations were affected. Age of onset ranged from 7 to 20 years. Writing difficulty was the initial and the main disabling problem for all the affected individuals. All had the bilateral writer's cramp in succession. Dystonia remained focal and task-specific for the entire period after onset. Unilateral thalamotomy was performed in three patients, with remarkable improvement. Surgical benefit remained unchanged during the follow-up period of 6-8 years. DYT1 mutation cosegregated with the affected members. CONCLUSIONS: This study adds another evidence that DYT1 phenotype can present with purely focal and task-specific dystonia in all the affected members of a family. Marked and sustained improvement following thalamotomy in three of our patients suggests that stereotaxic thalamotomy is beneficial in familial focal dystonia with DYT1 mutation. (J Korean Neurol Assoc 19(2):110~115, 2001)
Age of Onset ; Brain ; Dystonia ; Dystonic Disorders* ; Family Characteristics ; Follow-Up Studies ; Heteroduplex Analysis ; Humans ; Mass Screening ; Phenotype ; Sequence Analysis, DNA ; Writing