Vertigo, a definite rotational sensation, consists of a variety of syndromes. The purpose of this study was to accumulate information on various aspects of vertigo or dizziness. We performed a retrospective study about vertigo patients, who had admitted to our hospital for recent 2 years. From January 1994 to December 1995, 214 patients with the complaints of 'vertigo' and 'dizziness', who admitted to the department of Neurology, Ewha Womans University Hospital, were accepted for this study. All data were recorded on computer-oriented questionnaires in digital forms. The study forms consisted of five parts; (1) history and associated symptoms, (2) physical, neurologic and bedside examinations, (3) laboratory and brain imaging studies, (4) special tests including brainstem auditory evoked potentials and (5) clinical diagnosis. Of these 214 patients, secure diagnosis could be made in 186 patients or 86.9%. Of these, 92 patients had peripheral causes of vertigo, and 94 had central causes. Vestibular disorders accounted for the largest proportion of complaints of vertigo(48/92 or 52%). Of 94 patients with central causes of vertigo, vertebrobasilar insufficiency was the leading cause(25/94 or 27%). The most common site of the brain lesion proved by MRI was cerebellum(23/94 or 25%). BAEP study revealed abnormal findings in 6 cases of the 16 patients with central causes. This study not only offered a clinical information about vertigo, but also could be beneficial for further researches.
Brain ; Diagnosis ; Dizziness ; Evoked Potentials, Auditory, Brain Stem ; Female ; Humans ; Magnetic Resonance Imaging ; Neuroimaging ; Neurology ; Surveys and Questionnaires ; Retrospective Studies ; Sensation ; Vertebrobasilar Insufficiency ; Vertigo

Melkersson-Rosenthal syndrome (MRS) is a rare form of hereditary angioedema characterized by a triad of orofacial swelling, relapsing facial paralysis, and a fissured tongue. However, the classic triad is not frequently seen in its complete form, and monosymptomatic or oligosymptomatic forms are more common. Case: A 20-year-old man presented with recurrent labial swelling 9 months ago and recently with a fissured tongue. The surface of the tongue showed deep furrows characteristic of lingua plicata, and an edematous enlargement was observed on the lower lips. Upon neurologic examination, a left sided facial palsy of a peripheral type was noted without abnormalities in the taste sense or lacrimation. An electromyography of the left frontal muscle showed positive sharp waves and fibrillation potentials. Biopsies performed on the lower lips revealed the congested vessels and perivascular inflammatory cells. We report a 20-year-old man with a classical triad of symptoms of Melkersson-Rosenthal syndrome.
Angioedemas, Hereditary ; Biopsy ; Electromyography ; Estrogens, Conjugated (USP) ; Facial Paralysis ; Humans ; Lip ; Melkersson-Rosenthal Syndrome* ; Neurologic Examination ; Tongue ; Tongue, Fissured ; Young Adult

BACKGROUND AND SIGNIFICANCE: Because of the diverse clinical and radiologic manifestations of Neuro-Behcet disease, it is sometimes difficult to differentiate with multiple sclerosis or tumorous condition. We report two cases of Neuro-Behcet disease underwent by stereotaxic biopsy showing vasculitis without any evidence of malignancy, initially misdiagnosed as solitary tumor and metastatic tumor, respectively. CASE: A 35-year-old male admitted due to right hemiparesis. Brain CT showed low density mass shadow in left thalamus. Under the impression of low grade astrocytoma, stereotaxic biopsy was performed. Dense perivascular lymphocytic infiltration with petechial microhemorrhage mixed with hemosiderin pigment was noted in thalamic region. The other patient (male, 44yrs old) admitted due to seizure. On MRI, there are multiple inhomogenous signals on right occipital and left frontal lobe and left thalamus. Under the impression of metastatic tumor, work-up about the primary tumor was done without any positive findings. To determine the primary focus, stereotaxic biopsy was performed. Only reactive gliosis and mild perivascular lymphocytic infiltration was noted in pathologic specimen. With the retrospective careful history taking and follow-up image study, two patients were confirmed as having a Behcet's disease.
Adult ; Astrocytoma ; Biopsy ; Brain ; Follow-Up Studies ; Frontal Lobe ; Gliosis ; Hemosiderin ; Humans ; Magnetic Resonance Imaging ; Male ; Multiple Sclerosis ; Paresis ; Retrospective Studies ; Seizures ; Thalamus ; Vasculitis

Moyamoya disease is a rare clinical entity, diagnosed by cerebral angiography and characterized by occlusion of the bilateral internal carotid artery system and development of collateral arteries. The etiology of moyamoya disease is unknown but some cases were reported to be associated with many other diseases such as hereditary, infectious, autoimmune, and metabolic disorders. A 16-year-old female was admitted with right side motor weakness, visual dis-turbance, malar rash, and emotional lability. Physical examination showed hair loss on frontal and bitemporal areas. Neurologic examinations revealed right hemiparesis and left homonymous hemianopsia. Brain magnetic resonance image showed high signal lesions in the right occipito-temporal and left high frontal area in T2-weighted image. Cerebral angiography showed focal obstructions of supraclinoid portion of both internal carotid arteries and multiple collateral vessels consistent with Moyamoya disease. The clinical features and serologic test of anti-nuclear antibody, anti-double stranded deoxyribonucleic acid antibody and cryoglobulin confirmed the diagnosis of systemic lupus ery-thematosus. We report a case of Moyamoya disease associated with systemic lupus erythematosus which might con-tribute to the etiological variability of Moyamoya disease.
Adolescent ; Angiography ; Arteries ; Brain ; Carotid Artery, Internal ; Cerebral Angiography ; Diagnosis ; DNA ; Exanthema ; Female ; Hair ; Hemianopsia ; Humans ; Lupus Erythematosus, Systemic* ; Moyamoya Disease* ; Neurologic Examination ; Paresis ; Physical Examination ; Serologic Tests

BACKGROUND AND OBJECTIVES: To evaluate the brain MR angiography(MRA) as a tool of diagnosis and follow up study in acute ischemic stroke. METHODS: We reviewed 90 patients of acute ischemic stroke who received thrombolytic therapy and underwent brain MRI with MRA from September 1994 to July 1995. They were divided into two groups according to carotid system and vertebrobasilar system and then positive MRA findings were defined as stenosis or occlusion of vessels in relation with MRI lesions. RESULTS: The positive MRA was shown more than 80% in large arteries and lower than 23% in small arteries. And also the MRA was shown the degree stenosis and underlying vessel abnormalities but could not precisely analyze the degree of improvement of vascular patency in this study. CONCLUSIONS: The MRA as a routine method addition to the MRI provides relatively reliable and noninvasive screening test and provides information that can be more complete evaluation and prognosis in patients of acute ischemic stroke.
Angiography* ; Arteries ; Brain ; Constriction, Pathologic ; Diagnosis ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Mass Screening ; Prognosis* ; Stroke* ; Thrombolytic Therapy ; Vascular Patency

OBJECTIVE: To assess long term outcomes of aggressive rehabilitative treatment on canalicular sequestered lumbar disc herniations METHOD: Clinical outcomes of twenty four patients with sequestered disc herniation with symptomatic radicular pain were evaluated prospectively and longitudinally for one year. All patients received aggressive rehabilitative treatment including transforaminal epidural steroid injection, pelvic stabilization exercise, physical therapy, and back school. Clinical outcomes were measured by visual analogue scale (VAS) for back and radicular pain, Oswestry Disability Index (ODI) for back pain before treatment, posttreatment one, three, six, and twelve months. After twelve months, we categorized patients' satisfaction. Four patients were dropp RESULTS: The averages of VAS for lower extremity and back pain reduced significantly from 6.6 and 5.8 at pretreatment to 0.7 and 0.9 at 12 months posttreatment, respectively (p<0.001). The averages of ODI reduced significantly from 73.5% at pretreatment to 22.3% at posttreatment 12 months (p<0.001). Sixteen of twenty patients (80.0%) were satisfied with their current status posttreatment 12 months. CONCLUSION: Sequestered disc herniations could be treated successfully by aggressive rehabilitative treatment. Clinical improvement was achieved from posttreatment one month and persisted for twelve months. Operation might be delayed until aggressive rehabilitation treatment fail to treat sequestered disc herniations.
Back Pain ; Exercise ; Follow-Up Studies* ; Humans ; Lower Extremity ; Prospective Studies ; Rehabilitation

The Guglielmi Detachable Coil(GDC), a soft platinum alloy micro-coil, has been used to treat certain intracranial aneurysms for recent several years. This detachable platinum coil was soldered to a stainless steel delivery guidewire. Intra-aneurysmal thrombosis was then initiated by applying a low positive direct electric current to the guidewire. Thrombosis occurred because of the attraction of negatively charged platinum coil positioned within the aneurysm. The passage of electric current detached the platinum coil tithin the clotted aneurysm from the stainless steel guide wire by electrolysis in 4 to 12 minutes. A 24-year-old unmarried woman visited our hospital complaining of severe headache on the right occipital area. The MRI and angiography demonstrated an unruptured right posterior communicationg artery aneurysm, emasured 10 x 15 mm in diameter with a medium sized neck. We tried GDC therapy for the aneurysm not to subject the patient to craniectomy, and the angiograhy after two times of GDC trials revealed a successful occlusion of the aneurysm . Adicussion about the problems during and after the procedure was presented, along with a brief review of the literature including the theoretical basis, clinical results and comparison with surgical treatment.
Alloys ; Aneurysm ; Angiography ; Arteries ; Electrolysis ; Female ; Headache ; Humans ; Intracranial Aneurysm* ; Magnetic Resonance Imaging ; Neck ; Platinum ; Single Person ; Stainless Steel ; Thrombosis ; Young Adult

BACKGROUND: Overstimation of blood pressure(BP) by clinic measurements occur in about 20 to 30% of subjects(white-coat hypertension) who may, consequently, be misdiagnosed as hypertensives and received unnecessary medications. The clinical significance of white-coat hypertension and its effects on the cardiovascular wystem have not been studied systematically.This study was designed to evaluate the influences of white-coat hypertension and white-coat effect, defined as difference between clinic and ambulatory BP, on the LV mass and diastolic function. METHODS: LV mass index was calculated and LV systolic and diastolic function were assessed by the analysis of mitral and pulmonary venous flow velocity in 45 untreated essential hypertensives and 20 normotensives(NT). Ambulatory BP monitoring classified hypertensives as white-coat hypertensives(WCHT,n=20) and sustained hypertensives(SHT, n=25). RESULTS: 1) Left ventricular systolic indices were not different among the three groups. 2) Left ventricular mass inedx of WCHT(114.5+/-36.3g/m2) was similar to that of SHT(115.6+/-34.9g/m2) and was significantly greater than that of NT(86.5+/-37.7g/m2)(p<0.05). 3) Some of left ventricular diastolic parameters(isovolumic relaxation time, E/A ratio, A velocity, pulmonary systolic fraction, ratio of systolic to diastolic forward flow velocity) of WCHT and SHT were significantly different from those of NT(p<0.05), but there were no differences between two hypertensive groups. 4) Even though both systolic and diastolic white-coat effect in WCHT were significantly greater than those of SHT(o<0.05),white-coat effect did not influence on the left ventricular mass or function in both groups. CONCLUSION: An increased left ventricular mass and diastolic dysfunction in WCHT suggests that white-coat hypertension could not be considered as an entirely innocuous clinical condition.
Blood Pressure Monitoring, Ambulatory ; Hypertension* ; Relaxation

The purpose of this study is to evaluate the sealing effect of several root-end filling materials using spectrophotometric analysis. 180 single root teeth with one canal were instrumented and canal filled. Root resected and root end preparation was made. Teeth were randomly classified to 5 experimental group(MTA, EBA, IRM, TCP, ZOE) and 1 control group according to root-end filling material MTA group used PRO ROOT MTA, EBA group used Super EBA, TCP group used NEW APATITE LINER TYPE II main component of which is alpha-tricalcium phosphate(TCP). According to manufacture's instruction experimental material was mixed and retrfilled. After 2% methylene blue solution penetration absorbance for each test sample was measured with spectrophotometer (JASCO UV-530, Japan). The mean absorbance of control and experimental group was as follows; MTA : 0.092, IRM : 0.226, Super EBA : 0.255, ZOE : 0.374, Control : 0.425, TCP : 0.501 and the result analyzed by Turkey test at P=0.05 level. Conclusions of this study are as follows; 1. The absorbance increase in follwing sequence MTA, IRM, Super EBA, ZOE, Control, TCP. 2. MTA showed the least leakage but was not significant with IRM or Super EBA and was significant with control or TCP(p<0.05). 3. TCP had the most leakage and was not significant with control group.
Methylene Blue ; Tooth ; Turkey ; Pemetrexed

Paragangliomas are rare and slowly growing pulsating hypervascular tumors arising from neural crest cell derivatives throughout the body. In the head and neck, they originate from the branchiometric family of paraganglioma, neuroendocrine tissue that lies along the carotid artery or aorta. Despite their propensity for locally aggressive behavior, metastases of the tumors are quite rare. We report an unusual case of carotid body paraganglioma showing multiple spinal metastases and demonstrated by spinal angiography.
Angiography ; Aorta ; Carotid Arteries ; Carotid Body Tumor* ; Carotid Body* ; Head ; Humans ; Neck ; Neoplasm Metastasis* ; Neural Crest ; Paraganglioma