No abstract available.
Anxiety* ; Depression* ; Epilepsy, Temporal Lobe* ; Temporal Lobe*

Pharmacologic therapy is still the primary management for epilpsy; however, surgical treatment is a reasonable therapeutic option for patients suffering from medically intractable seizures, especially temporal lobe epilepsy having a documented unilateral epileptogenic area. Thirty nine patients with pharmaco-resistant complex partial seizures underwent anterior temporal lobectomy and hippocampectomy in 38 cases and frontal cortisectomy in one case. On pathological examination, hippocampal sclerosis was a predominent pathologic finding and was identified in 18 cases. Other non-neoplastic lesions consisted of 5 cases of vascular lesions(2 cavernous angiomas, 2 arteriovenous malformations and 1 angiomatosis), 3 cases of fibrous nodule, 2 cases of cicatrical changes of cerebral cortex, and 1 case of parasitic infection. Neoplasms including two cases of oligodendroglioma and one case of anaplastic astrocytoma were also noted. In seven cases, there was no detectable lesion on gross and microscopic examination. On post-operative follow-up, seizures were completely terminated in most cases(31 cases, 79%). The rest of the patients also displayed marked alleviation of symptoms. The seizures tended to recur more aften among the patients with neoplasm or no pathologically detectable lesion. In order to detect any minute pathological lesion, thorough gross and microcsopic examinations are considered to be essential.

The Lambert-Eaton myasthenic syndrome (LEMS) is a rare disorder of neuromuscular transmission that is frequently associated with malignancy, particulary small cell carcinoma of the lung. To our knowledge, there was no report of LEMS in Korean listeratures and this might be the first case in this country. The patient is a 55 year old man with muscle weakness and fatigability of proximal lower limbs for 2 months. Bronchogenic carcinoma is confirmed radiologically and pathologically. The electrophysiological studies suppert the clinical diagnosis of LEMS with (1) low amplitude of evoked compound muscle potential to a single supramaximal stimulus on nerve, (2) significant decremental response at low rates of stimulation and (3) marked incremental response at high rates of stimulation.
Carcinoma, Bronchogenic ; Carcinoma, Small Cell ; Diagnosis ; Humans ; Lambert-Eaton Myasthenic Syndrome* ; Lower Extremity ; Lung ; Middle Aged ; Muscle Weakness

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

Role of intraoperative ECoG is uncertain and still controversial. We investigated the correlation of preexcision ECoG (pre-ECoG) patterns with MRI findings and the correlation of the presence or absence of residual spikes in postexcision ECoG (post-ECoG) with surgical outcome. We retrospectively studied 29 temporal lobectomized patients (follow-up period: > 16 mons). The ECoG was performed using two subdural strips on the mesiobasal and lateral temporal lobe. Topography and frequency of epileptiform discharges (ED) in pre-ECoG were analyzed and correlated with hippocampal atrophy only or hippocampal and lateral temporal atrophy in MRI. Among the 15 patients with hippocampal atrophy only, pre-ECoG showed mesial temporal dominant ED in 8 ( 53.3 %), diffuse ED in 3 ( 20.0 %) and lateral temporal dominant ED in 4 ( 26.7 %). In 14 patients with hippocampal and lateral temporal atrophy, mesial temporal dominant ED showed in 2 ( 14.3%), diffuse ED in 8 ( 57.1 %), and lateral temporal dominant ED in 4 ( 28.6%). Compared to patients with hippocampal atrophy only, there was statistically significant widespread epilepiiform discharges on the mesial and lateral temporal area in patients with hippocampal and lateral temporal atrophy( p<0.05 ). All of 6 patients without residual spikes and 19 out of 23 patients with residual spikes in post-ECoG were seizure free or aura only after surgery. But presence or absence of residual spikes post-ECoG is not statistically correlated with surgical outcome (p>0.3).
Atrophy ; Epilepsy ; Humans ; Magnetic Resonance Imaging* ; Retrospective Studies ; Seizures ; Temporal Lobe

This study was performed to evaluate, in complex partial seizure, the incidence and nature of MRI abnormality and the correlation between MRI and interictal nasopharyngeal EEG findings. MRI findings were also correlated with age of seizure onset, duration and clinical response to anticonvulsants. For this study, high field MR imaging and interictal nasopharyngeal EEG were performed in 122 patients with complex partial seizures. The patients were distributed in all age groups(mean age:26 years) and include 64 males and 58 females. The average duration of seizure disorder was 10.8 years. Abnormal MRI findings were discovered in 74 of 122 patients, in which mesial temporal sclerosis was most common(58.1%). And other abnormalities were neuroglial tumor(l3.5%), infectious lesion (10.8%), vascular lesion (6.8%), hemiatrophy (4.19@), cystic mass (2.7%) and others (4.1%). There were only slight difference in seizure duration(p<0.1) and anticonvulsant response(p<0.1) between abnormal and normal MRI groups in complex partial seizure patients. But there was no significant difference in age of onset between two groups(p>0.1).
Age of Onset ; Anticonvulsants ; Electroencephalography ; Epilepsies, Partial* ; Epilepsy ; Female ; Humans ; Incidence ; Magnetic Resonance Imaging* ; Male ; Sclerosis ; Seizures

No abstract available.
Dermatitis, Allergic Contact

Syringomyelia is caused by heterogeneous etiologies. Syringomyelia secondary to arachnoiditis complicated by tuberculous meningitis is rarely reported entity, which has not been reported in Korea. We present a patient who had recovered from tuberculous meningitis and developed some years later a progessive disorder of the spinal cord clinically resembling syringomyelia, which was subsequently confirmed by MRI. The patient was treated with syringo-subarachnoid shunt.
Arachnoid ; Arachnoiditis ; Humans ; Korea ; Magnetic Resonance Imaging ; Spinal Cord ; Syringomyelia* ; Tuberculosis, Meningeal*

Cerebral arterial embolism which resulted in total occlusion of right proximal middle cerebral artery was occured in 33 years old female patients with severe mitral stenosis and atrial fibrillation during percutaneous mitral balloon valvuloplasty(PMV). The occluded artery could be detected by transfemoral carotid angiography and recanalized immediately by intra-arterial infusion of urokinase. There were no cerebral hemorrhage by CT scan after intra-arterial urokinase infusion and the patients discharged without any neurologic sequale 7 days after thrombolysis. We report a case of successful recanalization with intraarterial infusion of urokinase in patient with cerebral arterial embolism occurred during PMV.
Adult ; Angiography ; Arteries ; Atrial Fibrillation ; Cerebral Hemorrhage ; Embolism* ; Female ; Humans ; Infusions, Intra-Arterial* ; Intracranial Embolism ; Middle Cerebral Artery ; Mitral Valve Stenosis ; Tomography, X-Ray Computed ; Urokinase-Type Plasminogen Activator*

Intracerebral metastases are among the most feared complication of systemic malignant disease and most occur late in the course of the systemic cancer so often are viewed as a terminal maifestation for which diagnosis and treatment are neigher required nor desirable. However, this situation is changing. Improved survival rates with many kinds of cancer have led increasingly to instances where the neurologic complications themselves limit the quality of life, forcing physicians to assume a more active attitude toward the diagnosis and treatment of the neurologic disorder. The authors analysed 125 cases of intracerebral metastatic tumors which are diagnosed with the brain CT scan at Yonsei University, Severance Hospital from January, 1979 to December, 1984 and following results were obtained. 1. Intracerebral metastatic tumors are found in 125 cases(31.2%) of all intracranial neoplasm. 2. The most common primary tumor is lung ca. (50.4%) followed by chorioca. (8%), breast ca. (8%) and GI tract ca. (6.4%) in the order while 16 casese (12.8%) were of unknown primary tumor. 3. Chorioca. (14.9%), melanoma(5.6%), lung ca.(4.2%), kidney ca.(3.3%) and breast ca.(2.3%) exhibit relatively high rate of intracerebral metastasis in the order whereas stomach ca.(0.2%), hepatoma (0.3%) and cervix ca (0.1%), which constitute most common primary maliqnancies in Korea, revealed very low rate of intracerebral metastasis. 4. The youngest patient was 11 years old and the oldest 80. Most intracerebral metastatic tumors, 97%, occur above 30 years of age and peak in the 6th decade (32%). In age below 40, chorioca. Is the most common pimary tumor and the age above 40, lung ca. 5. There is no sexual difference between male and female. In male most conmon primary site is lung (64.6%) followed by GI tract(7.7%)and in female, lung (35%), chorioca. (16.7%) in the order. 6. The most common presenting symptom and sign is headache (58.4%) followed by motor deficit (48.0%), mental deterioration (43.2%) and nausea or vomiting (32.8%). 7. In most of intracerebral metastases the onset is gradual with duration of less than 3 months in 84% whereas in a few patients, 8 cases (6.4%), the onset is apoplectic and the primary sites that revealed apoplectic onset are lun. (3 cases), chorioca. (3 cases), liver (3 cases), unknown (1 cases). 8. Intracerebral metastases are detected simultaneously (50.5%), precociously (3.7%) or after (45.9%) diagnosis of the primary tumor. 9. Average interval between the diagnosis of primary tumor and development of intracerebral metastasis is 9.1 months in total and short in lung, stomach, kidney and liver cancer whereas and long in breast, rectum cancer and sarcoma. 10. In 96 cases who can be reevaluated with brain CT, the findings are as follows; 1) Metastatic lesions are multiple in 67.7% and single in 32.3%. 2) Most intracerebral metastases are located supratentorially (77.%), in 4.2%; infratentorially and in 18.8%; both. 3) Density of lesions are variable from hypodense to hyperdense and intracerebral metastases from chorioca., breast, kidney and nasopharynx ca. Are likely to iso to hyper than hypodense. Calcifications are rare and observed only in 2 cases (2%). 4) Most cases (98.5%) reveal perifocal edema of variable degree while a few patients (11.5%) reveal no edema. 5) Most metastatic lesions demonstrate variable contrast enhancement with nodular type (52.1%), rign type (25.0%), combined (15.6%) and a few patients (7.3%) fail to enhance. 6) Hemorrhages are found in 11 cases (11.5%) and chorioca. (4 cases), hepatoma 3 cases) and lung ca, (3 cases) are the most frequent offenders. 11. Radiation, surgery and chemotherapy seems to improve the prognosis.
Brain ; Brain Neoplasms ; Breast ; Carcinoma, Hepatocellular ; Cervix Uteri ; Child ; Criminals ; Diagnosis ; Drug Therapy ; Edema ; Female ; Gastrointestinal Tract ; Headache ; Hemorrhage ; Humans ; Kidney ; Korea ; Liver ; Liver Neoplasms ; Lung ; Male ; Nasopharynx ; Nausea ; Neoplasm Metastasis ; Neoplasms, Unknown Primary ; Nervous System Diseases ; Prognosis ; Quality of Life ; Rectal Neoplasms ; Sarcoma ; Stomach ; Survival Rate ; Tomography, X-Ray Computed ; Vomiting