BACKGROUND: In orthostatic headache (OH) associated with low cerebrospinal fluid (CSF) pressure, loss of CSF vol-ume reflected by pachymeningeal enhancement (PCE) on brain magnetic resonance image (MRI) has been suggested as a pathogenenesis according to Monro-Kellie rule. We attempted to test the following hypotheses; 1) OH is caused by loss of CSF volume, 2) CSF volume loss in OH is caused by hyperabsorption of CSF or 3) by decreased production of CSF. METHODS: Nineteen patients with OH were recruited. Lumbar puncture, brain MRI and radioisotope cisternogra-phy (RIC) were performed in all of them. We evaluated duration of headache from onset to first evaluation, presence of PCE on MRI and CSF leakage (CSFL) on RIC. Firstly, we compared duration of headache between patients with and without PCE. Secondly, between those with and without PCE, we analyzed presence of CSF fistula and demonstration of CSFL on RIC. RESULTS: Mean duration (16.1 +/-19.6) of headache in 13 patients with PCE (66.7%) was significantly longer than in those without PCE (P=0.036). Among 19 patients, CSF fistula was detected in 13 patients (72%) and CSFL in 16 patients (88.9%). There was no significant difference in CSF fistula presence (P=0.114) and in demonstra-tion of CSFL between those with and without PCE. In 16 patients, delayed appearance of radioisotope along cerebral interhemispheric and sylvian regions was shown on RIC. CONCLUSIONS: Pain in OH may be caused by CSF volume loss, however, whether CSF volume loss is caused by CSF hyperabsorption or decreased production remains to be clarified.
Brain* ; Cerebrospinal Fluid ; Fistula ; Headache* ; Humans ; Magnetic Resonance Imaging* ; Spinal Puncture

No abstract available.
Adult* ; Humans ; Life Style*

BACKGROUND: Since 1985 when ILAE proposed its first classification system of epilepsy, many studies have reported the practical applicability of the system. However, its limitations have been elucidated. In order to find out the applicability and limitations of the ILAE classification system and the role that diagnostic parameters (semiology, EEG and MRI) take in the anatomical localization of localization-related epilepsies (LREs), we investigated the clinical data of adult patients with LRE in step-wise way. METHOD: We recruited 173 patients with newly-referred/diagnosed LRE from our departmental data registry. Idiopathic epilepsies were excluded. We evaluated the anatomical localization rate(LR) according to each diagnostic parameter, the concordant localization rate(CLR) between two parameters and between three parameters. LR in total patients by any one of three diagnostic parameters was also evaluated. MRI abnormalities were evaluated in those patients showing concordant localization between semiology and EEG. RESULTS: The highest anatomical LR(67.1%) was reported in the semiological parameter. CLR between semiology and EEG was 28.9%. CLR between three parameters was 16.2%. MRI abnormalities were seen in 60% of patients with concordant localization between semiology and EEG. Fifty six percent of electroclinically concordant patients showed concordant localization with an MRI and 79% of them were concordantly localized in the temporal lobe. The LR in total patients was 71.7%. In each of the evaluation steps, the temporal lobe LR was the highest. CONCLUSIONS: Total lobar LR by any one diagnostic parameter in all the patients was high according to the ILAE diagnostic criteria. Semiology was the best localizing parameter, however, combined evaluation with either EEG or MRI reduced the localizability. Even though the MRI study showed a significant discordance rate in patients with electroclinical localizations, it could identify the underlying etiology in a major proportion of the patients. This study showed the importance of an imaging study in the lobar localization of LREs combined with an electroclinical localization by the ILAE classification system.
Adult* ; Classification* ; Electroencephalography ; Epilepsies, Partial* ; Epilepsy* ; Humans ; Magnetic Resonance Imaging ; Temporal Lobe

BACKGROUND: Although the incidence of stroke does not decrease after 80 years of age. The significance of ischemic stroke (IS) after octogenarian age has not attracted the attention of neurologists. As a first step to investigate the significance of IS during that period, we compared the clinical characteristics of IS between OIS (octogenarian ischemic stroke group, ??80 years of age) and NOIS (non-octogenarian ischemic stroke group, 65-79 years of age). METHOD: Forty-nine OIS patients and 141 NOIS patients were recruited. Clinical characteristics including risk factors, IS subtype, Canadian Neurological Scale (CNS) score, treatment modality and short-term prognosis were evaluated and described. RESULTS: ypertension (65.3%) was the most common risk factor followed by smoking (28.6%) and previous stroke history (28.6%) in OIS. There was no significant difference in proportion of each IS risk factors between he two groups. OIS was more associated with subtypes of mixed etiology and cardiogenic embolism than NOIS (P<.05). Subclassification by the vascular territory of IS was similar between the two groups and the middle cerebral arterial territory was the most common site (71.1%) in OIS. CNS scores on the initial neurological examination was similarly associated with both OIS (8.0 3.3) and NOIS (7.5 2.8)(P>.05). IS was more associated with poor outcome at discharge (52.2%) than NOIS (18.2%)(P<.05). CONCLUSIONS: Ischemic stroke after octogenarian age is characterized by different etiopathogenesis and poor short-term outcome compared to IS under that age. OIS is more frequently caused by cardiogenic embolism or combined underlying etiology, however, the relationship between differences in etiopatho-genesis and poor short-term outcome remains to be clarified.
Aged, 80 and over* ; Embolism ; Humans ; Incidence ; Neurologic Examination ; Prognosis ; Risk Factors ; Smoke ; Smoking ; Stroke*

Fifty percents of patient with achondroplasia present neurological disturbances of varying degree. Congenital narrowing of the spinal canal in achondroplastics seems to be the main cause of the cord disturbance, and there are several other causes such as prolapse of intervertebral discs, spondyloarthitic degenerative manifestations and wedging of vertebral body. Surgical treatment of the cord disturbance consist of anterior decompression with fusion and posterior decompression. We experienced L1-2 disc herniation in achondroplasia with rapid progression of neurologic symptoms and treated with posterior decompression. Two years after operation, the patient had good result.
Achondroplasia ; Decompression ; Humans ; Intervertebral Disc ; Neurologic Manifestations ; Prolapse ; Spinal Canal

Among the side effects of simvastatin, elevated liver enzyme or creatine kinase activity has been occasionally report-ed, but overt myopathy is rare. We report two cases of simvastatin-induced myopathy with usual dosages of simvas-tatin. Two patients presented with general myalgia, markedly elevated creatine kinase activity, and mild proximal weak-ness. One patient had been treated with concomitant use of cyclosporine and simvastatin after renal transplantation, and another patient had diabetic nephropathy. We recommend careful monitoring when myalgia appears in a patient receiv-ing simvastatin. (J Korean Neurol Assoc 19(4):435~437, 2001)
Creatine Kinase ; Cyclosporine ; Diabetic Nephropathies ; Humans ; Kidney Transplantation ; Liver ; Muscular Diseases* ; Myalgia ; Simvastatin

Hyperkalemic periodic paralysis and paramyotona congenita share common clinical manifestations, such as autosomal dominant diseases with missense mutations at a gene encoding alpha-subunit of skeletal muscle voltage sensitive sodium channel (SCN4A). Exercise and cold provocation tests are physiological phenomena of clinical characteristics of these diseases. The authors experienced a case with hyperkalemic periodic paralysis and performed these tests comparing them with a patient with hypokalemic periodic paralysis and a normal person. Significant decremental changes of CMAPs were found by both tests in the case with hyperkalemic periodic paralysis, compared with those in a case of hypokalemic periodic paralysis or normal control. In conclusion, we suggest that exercise and cold provocation tests may be useful for the differential diagnosis between hyperkalemic periodic paralysis and hypokalemic periodic paralysis.
Diagnosis, Differential ; Electrodiagnosis ; Genes, vif ; Humans ; Hypokalemic Periodic Paralysis ; Muscle, Skeletal ; Mutation, Missense ; Paralysis ; Paralysis, Hyperkalemic Periodic* ; Physiological Phenomena ; Sodium Channels

PURPOSE: We investigated whether infantile vulvar abscesses are predictable features of rectovestibular fistula with a normal anus. MATERIALS AND METHODS: A retrospective analysis of five infants with vulvar abscesses and rectovestibular fistulae with normal anuses was performed. RESULTS: Four cases had a left vulvar abscess, and in one case the vulvar abscess was on the right side. All caregivers reported passage of stool from the vagina. The fistulae were almost uniformly located from the vestibule to the rectum above the anal dentate line, observable by visual inspection and probing under anesthesia. The first two cases were treated with division and closure of the fistulae after a diverting loop colostomy, and the remaining three cases with fistulotomy and curettage. There was no recurrence during the median follow-up period of 38 months. CONCLUSION: This unique rectovestibular fistula should be suspected in female infants with vulvar abscesses, especially when parents report passage of stool from the vagina. Fistulotomy and curettage may be an initial treatment and effective as a temporary diverting colostomy and delayed repair of the fistula.
Abscess/*pathology ; Female ; Humans ; Infant ; Reconstructive Surgical Procedures ; Rectovaginal Fistula/diagnosis/*pathology/surgery ; Retrospective Studies ; Treatment Outcome

OBJECTIVE: To evaluate the shapes and sizes of nasopharyngeal airways by using cone-beam computed tomography and to assess the relationship between nasopharyngeal airway shape and adenoid hypertrophy in children. METHODS: Linear and cross-sectional measurements on frontal and sagittal cross-sections containing the most enlarged adenoids and nasopharyngeal airway volumes were obtained from cone-beam computed tomography scans of 64 healthy children (11.0 +/- 1.8 years), and the interrelationships of these measurements were evaluated. RESULTS: On the basis of frontal section images, the subjects' nasopharyngeal airways were divided into the following 2 types: the broad and long type and the narrow and flat type. The nasopharyngeal airway sizes and volumes were smaller in subjects with narrow and flat airways than in those with broad and long airways (p < 0.01). Children who showed high adenoid-nasopharyngeal ratios on sagittal imaging, indicating moderate to severe adenoid hypertrophy, had the narrow and flat type nasopharyngeal airway (p < 0.01). CONCLUSIONS: Cone-beam computed tomography is a clinically simple, reliable, and noninvasive tool that can simultaneously visualize the entire structure and a cross section of the nasopharyngeal airway and help in measurement of adenoid size as well as airway volume in children with adenoid hypertrophy.
Adenoids ; Child ; Cone-Beam Computed Tomography ; Humans ; Hypertrophy

Background: Although the scallop sign is considered the most important risk factor for extensor tendon ruptures (ETRs) in patients with osteoarthritis of the distal radioulnar joint (DRUJ), previous reports provide a limited understanding of the changes at DRUJ, as risk factors were examined in plain radiographs of the wrist. The aim of this study was to assess the changes of DRUJ using axial images of computed tomography (CT) in patients with DRUJ osteoarthritis and associated ETRs and to evaluate the relationship between the changes of DRUJ and ETRs. Methods: Twelve patients with ETRs due to osteoarthritis of the DRUJ were enrolled. The changes of DRUJ were examined on axial images of CT and the following 8 parameters were measured: width of radius, anteroposterior (AP) length of radius, width of sigmoid notch (SN), AP length of SN, AP length of ulnar head, subluxation length of ulnar head, dorsal inclination of SN, and distance from Lister’s tubercle to SN. Radiological parameters of the DRUJ were measured in 60 control wrists without trauma or osteoarthritis, and the patient and control groups were statistically compared. Results: Statistically significant differences were observed between the patient and control groups in all the radiological parameters except for the AP length of SN and AP length of ulnar head. The width of radius, AP length of radius, width of SN, subluxation length of ulnar head, and dorsal inclination of SN were greater and the distance from Lister’s tubercle to SN was smaller in the patient group than in the control group. The width of SN, dorsal inclination of SN, and distance from Lister’s tubercle to SN were statistically significant risk factors among the 8 parameters. Conclusions ETRs due to osteoarthritis of the DRUJ was related to the changes of DRUJ, especially the changes around SN of the distal radius. In addition to the existing risk factors, a decreased distance from Lister’s tubercle to SN and increased dorsal inclination of SN were identified as new risk factors. Axial images of CT were effective to evaluate degenerative changes at the DRUJ.