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Normal Values of the Regional Cerebral Blood Flow (rCBF) in Rat Using Digital Autoradiographic Method.

Byung Woo YOON ; Seung Bong HONG ; Jae Kyu ROH

Journal of the Korean Neurological Association.1991;9(3):386-388.

To get the normal values of regional cerebral blood flow (rCBF) in rat brain in our laboratory, we used the digital autoradiographic method with C-14 iodoantipyrine (IAP) in 8 Wistar rats. The rats were anesthetized with 1.5% halothane during the experimental procedure. Right femoral artery and vein were cannulated for blood pressure monitoring. Arterial sampling - and injection of radiotracer. Fifty uCi of C-14 IAP was constantly injected over 30 seconds using infusion pump and 10 to 15 arterial samples were obtained with micropipettes At the end of 30 seconds the brain was removed and freezed in liquid nitrogen. Coronal sections of the brain were exposed to film and the images were analyzed by computer-based digital analyzer system. Values of the regional cerebral blood flow in ml/l00g brain/min were as follows. Frontal cortex, 110.7 +/- 31.0; parietal cortex, 120.9 +/- 31.0; temporal cortex, 123.4 +/- 30.5; occipital cortex, 111.2 +/- 31.; cingulate cortex, 112.8 +/- 32.4; pyriform cortex, 1043 +/- 33.8; entorhinal cortex, 114.5 +/- 40.9; corpus callosum, 55.2 +/- 17.2; caudatoputamen 105.3 +/- 39.8, thalamus, 114.6 +/- 35.0; Cal region of hippocanpus, 79.4 +/- 33.3; CA2. 80.2 +/- 34.9; CA3, 83.4 +/- 37.2; dentate gyrus, 80.0 +/- 37.1. These normal values of rCBF in rat brain may be used as a standard index for future experimental researches on therapy and pathophysiology of cerebral ischemia using autoradiographic measurement of rCBF.
Animals ; Blood Pressure Monitors ; Brain ; Brain Ischemia ; Corpus Callosum ; Dentate Gyrus ; Entorhinal Cortex ; Femoral Artery ; Gyrus Cinguli ; Halothane ; Infusion Pumps ; Nitrogen ; Rabeprazole ; Rats* ; Rats, Wistar ; Reference Values* ; Thalamus ; Veins

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A Case of Acute Paraplegia in Hypereosinophilic Syndrome.

Kyung Mu YOO ; Young Choon PARK

Journal of the Korean Neurological Association.1991;9(3):380-385.

Hypereosinophilic syndrome (HES) is characterized by a persistent eosinophilia of l,500/mm3 lasting for at least 6 months associated with multi-system involvement and no other identifiable cause. A 45-year-old man had hypereosinophilia, cardiopathy, and acute paraplegia. Following corticosteriod with antipletelet agent therapy, paraplegia was improved rapidly and circulating eosinophils were normalized. We postulated that embolic phenomenon was due to hypercoagulable state by eosinophil-derived proteins and/or to direct infiltration by eosinophils.
Eosinophilia ; Eosinophils ; Humans ; Hypereosinophilic Syndrome* ; Middle Aged ; Paraplegia*

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A Case of Myositis Ossificans Progressiva.

Kyung Mu YOO ; Hyun Yoon KO ; Jin Do HUH ; Young Duk JOH ; Bang HUR ; Man Ha HUH

Journal of the Korean Neurological Association.1991;9(3):374-379.

A case of myositis ossificans progressiva is reported. The patient, a 22-year -old progressive ossification for 16 years with severe motion limitation. Bone CT and MRI, bone scanning and muscle biopsy showed multiple ossifying lesions in the connective tissue. All labolatory findings are normal. But serum alkaline pbosphatase become worse with disodium etidronate(EHDP) therapy. The case is presented with the review of literatures.
Biopsy ; Connective Tissue ; Humans ; Magnetic Resonance Imaging ; Myositis Ossificans* ; Myositis*

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Clinical Features of Essential Tremor.

Sang Su KIM ; Dae Hyun KIM ; Jae Woo KIM

Journal of the Korean Neurological Association.1999;17(4):528-533.

BACKGROUND: Essential tremor is one of the most common types of movement disorders. Although it is sometimes prefaced with the term 'benign', it often causes significant disabilities. Clinical characteristics and responses to various drugs have not been investigated systematically in Korea. Therefore, we studied the clinical features, electrophysiologic findings, and drug responsiveness of essential tremor. METHODS: Forty-five patients were included in the study by clinical criteria for essential tremor. We investigated their clinical features including tremor type, involved sites, family history, and responsiveness to alcohol. We used an electromyography study to evaluate the contraction patterns between agonist and antagonist muscles and the frequency of tremor. Primidone and propranolol were prescribed to all the patients (N=30) with a sufficient washout period (more than 2weeks) for drug responsiveness. Drug responsiveness was estimat-ed with self-assessment scales. RESULTS: The mean age of patients at the onset of the tremor was 45 years and the average duration of the tremor was 11.1 years. Kinetic tremor was dominant in 17 patients (37.8%) and postural tremor in 28 patients (62.2%). Family history was found in 18 patients (40%) and alcohol reduced tremors in 18 (64.8%) out of 28 patients with sufficient alcohol intake. Co-contraction was seen in 18 patients (40%), alternative contraction in 15 (33.6%), and mixed contraction in 3 (6.7%). Mean frequency was 6.7 Hz. Propranolol reduced tremor in 24 patients (80%), and primidone in 27 patients (90%). CONCLUSIONS: It was concluded that essential tremor was heterogenous clinically and electrophysiologically. Primidone was found more effective than propranolol in reducing tremor.
Electromyography ; Essential Tremor* ; Humans ; Korea ; Movement Disorders ; Muscles ; Primidone ; Propranolol ; Self-Assessment ; Tremor ; Weights and Measures

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Levodopa Induced Dystonia in Parkinson's Disease.

Jong Kuk KIM ; Jae Kwan CHA ; Sang Ho KIM ; Jae Woo KIM

Journal of the Korean Neurological Association.1999;17(4):520-527.

BACKGROUND: Various types of dystonia may be associated with Parkinson's disease (PD). This dystonic phenomenon is sometimes observed in untreated parkinsonian patients. However, it more commonly emerges as a side effect to long term levodopa (LD) therapy. We studied several factors which influence the risk of the occurrence of LD-induced dystonia (LID) in patients with PD. The types and involved sites in LID were also studied. METHODS: Ninety-six patients diagnosed as PD were evaluated. We analyzed the contribution of several factors such as sex, age at onset of parkinsonian symptoms, disease durations, H & Y stages, average LD doses, LD durations, and types of initial symptoms (tremor vs non-tremor) to the occurrence of LID. The types of LID were divided into: wearing-off, morning-off, peak-dose, and diphasic groups. RESULTS: LID was observed in 29 patients (30.2%). Among the 29 patients with LID, 11 were categorized as wearing-off dystonia, 10 as morning-off, 6 as peak-dose, and 2 as diphasic. LID occurred in the feet or toes of 23 patients, upper extremities of 3, and in the heads or necks of 3. Sixteen patients had dystonias on the same side of their initial symptoms, 4 on the opposite side, and 6 on both sides. Among the several factors, the types of initial symptoms, average LD doses, LD durations, age at onset of parkinsonian symptoms, and H & Y stages were found to significantly contribute to the occurrence of LID. CONCLUSIONS: Dystonia often appeared as a side effect to anti-parkinsonian medications. Wearing-off dystonia was the most common type of LID. LID was commonly seen on the same side of initial symptoms. Initial parkinsonian symptoms were thought to be the most important contributing factor of LID.
Dystonia* ; Foot ; Head ; Humans ; Levodopa* ; Neck ; Parkinson Disease* ; Risk Factors ; Toes ; Upper Extremity

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Delayed-onset Movement Disorders after Carbon Monoxide Intoxication.

Hwa Young CHEON ; Seung Min KIM ; Il Saing CHOI

Journal of the Korean Neurological Association.1999;17(4):514-519.

BACKGROUND: Presently, it is well known that there are neurological and systemic complications after carbon monox-ide (CO) intoxication. Until recently, delayed-onset movement disorders after CO intoxication were rarely reported. We analyzed 32 patients with delayed onset movement disorders after CO intoxication. METHODS: We reviewed the medical records of 242 patients admitted to the Yonsei University Medical Center from January 1986 to December 1996 due to CO intoxication. Patients were analyzed with respect to movement disorders, onset, latency, and radiological findings. RESULTS: Among the 242 patients of CO intoxication, 32 (13.2%) patients had delayed-onset movement disorders. Of these, 23 (71.9%) had parkinsonism, 5 (15.6%) had dystonia, 3 (9.4%) had chorea, and 1 (3.1%) had myoclonus. The mean age of the patients was 46.66 +/-16.91 years. Among the 4 patients with CO intoxication occuring at age 17 or younger (Childhood group), 2 had parkinsonism and 2 had focal dystonia. The mean age of the Childhood group was 1 7 . 7 5 +/-6.99 years. Among the 28 patients with CO intoxication occuring at age 18 or older (Adult group), 21 (75%) had parkinsonism, 3(10.7%) dystonia, 3(10.7%) chorea, and 1(3.6%) myoclonus. Among the 3 patients with dystonia in the Adult group, 1 had focal dystonia and 2 had segmental dystonia. The mean age of the adult group was 50.79 +/-1 3 . 4 6 years. The mean latency between CO intoxication and the onset of movement disorders was 27.20 +/-27.94 weeks in the Childhood group and 9.60 +/-14.97 weeks in the Adult group. The mean latency between CO intoxication and the onset of movement disorders was 6.44 +/-6.76 weeks in parkinsonism, 41.76 +/-27.99 weeks in dystonia, 4.0 weeks in chorea, and 8.0 weeks in myoclonus. The mean latency in dystonia was longer than in the others. Among the 23 patients who underwent brain computed tomography, 12 (52.2%) had abnormal findings. Low density lesions were found in the globus pallidus (13.0%), cerebral white matter (13.0%), and both globus pallidus and cerebral white matter (17.4%). One (14.3%) patient showed cortical atrophy while another patient showed both cortical atrophy and low density in cerebral white matter. CONCLUSIONS: The development of a delayed-onset movement disorder after CO intoxication is not rare. In our research, the radiological findings of patients with delayed-onset movement disorders after CO intoxication were inconsistant. The findings revealed no correlations with the various types of delayed-onset movement disorders.
Academic Medical Centers ; Adult ; Atrophy ; Brain ; Carbon Monoxide* ; Carbon* ; Chorea ; Dystonia ; Dystonic Disorders ; Globus Pallidus ; Humans ; Medical Records ; Movement Disorders* ; Myoclonus ; Parkinsonian Disorders

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A New Approach in Clinical Usefulness of Foramen Ovale Electrode in Epilepsy Surgery.

Ok Jun KIM ; Byung In LEE

Journal of the Korean Neurological Association.1999;17(4):505-513.

BACKGROUND: Foramen ovale electrode(FOE) was introduced for the lateralizing purposes of mesio-temporal lobe(MTL) seizures which were often not clearly identified by extracranial EEGs. An analysis of interictal and ictal EEG features recorded from FOE was conducted to evaluate its clinical usefulness. METHODS: A multipolar, three-contact FOE was implanted bilaterally in 16 intractable epileptic patients for the lateralizing purposes of a MTL onset of seizures due to the evidence of bilateralities recorded from extracranial EEGs. A detailed analysis of the electrical pattern and temporal relationships in 16 patients was conducted. RESULTS: After a long-term telemetry recording with FOE, all patients revealed a clear onset of seizures originating from one or both sides of the MTL and underwent ATL. The lateralization of interictal epileptiform discharges (IEDs) in scalp EEG and FOE were concordant with the operation sites in 12 patients and 8 patients respectively. Among various configurations of IEDs recorded from FOE, periodic spikes or sharp waves with/without fast activities were dominant features in the operation site, but polyspikes, isolated spikes or sharp waves, and positive spikes were more common in the non-operation site. Five patients showed ictal onset discharges concordant with the operation site in the scalp EEG, but 10 patients in FOE. Rhythmic fast beta, alpha frequency activity, repetitive spikes or sharp waves prevailed over other FOE seizure onset patterns in the operation site, but delta and theta slowing, positive spikes prevailed in the non-operation site. A "start-stop-start" pattern was 100% concordant with the operation site. The time interval between bilateral FOE recorded ictal onset was 16.53 sec when the ictal discharge started from the operation site and 7.92 sec when started from the non-operation site. The time interval between FOE and scalp EEG ictal onset was 22.82 sec in the operation site and 8.61 sec in the non-operation site. Among various spreading patterns of ictal epileptiform discharge, FOE contralateral FOE ipsilateral temporal lobe, or contralateral temporal lobe was the most common feature(47.71%). No serious complications resulted from implantation of FOE in this series. CONCLUSIONS: Our results indicated that FOE was very useful in confirming the laterality of MTL. The configurations of IEDs and ictal discharges recorded from FOE were also useful for further determination of lateralization. The "start-stop-start" pattern of ictal discharges was especially a quite reliable marker, which should be cautiously detected during the analysis of ictal events. FOE could also provide useful information about the spreading patterns of ictal discharges.
Electrodes* ; Electroencephalography ; Epilepsy* ; Foramen Ovale* ; Humans ; Scalp ; Seizures ; Telemetry ; Temporal Lobe

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Comparison of Perirolandic Sensorimotor Function Using Somatosensory Evoked Potentials and Brain Stimulation in Patients with Epilepsy.

Dae Won SEO ; Seung Bong HONG

Journal of the Korean Neurological Association.1999;17(4):498-504.

BACKGROUND: The detection of the phase reversal of somatosensory evoked potentials (SEP) has been well known to be a safe and reproducible method for defining the sensorimotor cortex. Brain stimulation (BS) has also been used to identify functional loci. The two tests, however have not to be compared in the cortical localization of the sensorimotor cortex yet. METHODS: We recorded the cortical potentials to median nerve stimulation from subdural grids which were in the frontoparietal areas of 12 epilepsy patients. After looking for phase reversals, we compared positive motor and sensory responses by brain stimulation from each electrode. In addition, the maximal amplitude areas of precentral positivity (max-P20) and postcentral negativity (max-N20) were analyzed, which were then compared with BS results. RESULTS: All patients showed phase reversals (average:4.7+1.61) on cortical SEP to median nerve stimulation. The electrodes before the phase reversal line had positive motor responses in 75% among electrodes with positive motor responses. The electrodes after the phase reversal line had positive sensory responses in 88.9% among electrodes with positive sensory responses. The maximal amplitude areas were recorded within a 2cm distance to the central sulcus. Max-P20's were located on the areas where BS showed a finger in 5 patients, hand in 3, forearm in 2, and tongue motor response in 2. Max-N20's were recorded on the areas where BS revealed a hand in 4 patients, forearm in 1, and undetected sensory responses in 7. CONCLUSIONS: These results suggest that SEP is different from BS in the functional localization of the perirolandic area. Thus, combined functional evaluation of the periolandic area by SEP as well as by BS is helpful in assessing sensorimotor functions.
Brain* ; Electrodes ; Epilepsy* ; Evoked Potentials, Somatosensory* ; Fingers ; Forearm ; Hand ; Humans ; Median Nerve ; Tongue

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Lateralizing and Prognostic Value of Some Ictal Manifestations in Surgical Treatment of Mesial Temporal Lobe Epilepsy.

Ji Eun KIM ; Sang Do YI

Journal of the Korean Neurological Association.1999;17(4):491-497.

BACKGROUND: Various ictal manifestations of temporal lobe epilepsy have possibly the value of both lateralizing and localizing the epileptogenic zone. Some ictal manifestations such as hand automatism, dystonic limb posture, head turning, and speech phenomenon might distinguish patients with good surgical outcomes from patients with poor out-comes. METHODS: To determine ictal behavioral differences in patients from these groups, we analyzed 207 seizures from 75 patients (group A) who were seizure free after surgery and 172 seizures from 60 patients (group B) who experienced seizures after surgery. All patients had received an anterior temporal lobectomy with amigdalohippocampectomy, and were followed up for at least 1 year. RESULTS: The lateralizing value of ictal semiology was evaluated in group A. Head turning (HT) was shown in 42% of seizures and had a lateralizing significance. Forced HT indicated a contralateral epileptogenic region. Non-forced HT suggested an ipsilateral epileptogenic region. Unilateral dystonic limb posture with or without automatism of the other side occurred in 53% of seizures and had a lateralizing significance, localizing the seizure onset to the contralateral hemisphere. Abnormal speech and vocalization did not have any lateralizing significance. Contralateral dystonic limb posture without ipsilateral automatism was significantly more frequent in group B (p=0.003) as abnormal speech was more frequent in group A (p=0.001). Non-versive head turning had a higher tendency to occur in group A (p=0.0051). There were no statistically significant differences between the two groups in incidences of versive head turning, unilateral hand automatism without dystonic limb posture, vocalization, and normal speech. CONCLUSIONS: Some ictal manifestations might be helpful in predicting the surgical outcome of temporal lobe epilepsy(TLE) patients. The presence of unidentifiable ictal speech could reflect good surgical outcome in TLE patients. When presurgical video analysis reveal an ictal semiology of contralateral dystonic arm posture without ipsilateral hand automatism, careful presurgical evaluation of the epileptogenic region should be contemplated.
Anterior Temporal Lobectomy ; Arm ; Automatism ; Epilepsy, Temporal Lobe* ; Extremities ; Hand ; Head ; Humans ; Incidence ; Posture ; Seizures ; Temporal Lobe*

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Effect of Material-specificity on the Wada Memory Test in Medial Temporal Lobe Epilepsy with Hippocampal Sclerosis.

Sung Ho PARK ; Hyun Woo NAM ; Sang Kun LEE ; Kwang Woo LEE ; Jae Kyu ROH

Journal of the Korean Neurological Association.1999;17(4):486-490.

BACKGROUNDS: The Wada test is a useful method in predicting the laterality of a epileptogenic zone. However, past research reveals that material specificity has an influence on the lateralization We examined the material-specificity of memory and its change in epileptic patients to discover reasonable items on the Wada test for the proper lateralization of the epileptogenic zone. METHODS: We analyzed 45 patients with video-EEG-confirmed medial temporal lobe epilepsy (mTLE) and definite hippocampal atrophy by an MRI. Eight items were presented during the Wada test including 3 common objects, 1 geometric object, 1 color, 1 word, 1 phrase, and 1 math expression. We checked recognition memo-ry after recovery of hemiparesis and normalization of EEG. RESULTS: For the right mTLE group, recognition memory following a right hemisphere injection was significantly better than a left hemisphere injection for all categories. For the left mTLE group, a significant difference of scores was found for the left versus right hemisphere injection for common objects. When injected to the left hemisphere, all the items helped lateralization, but when injected to the right hemisphere, a phrase did not help with lateralization. CONCLUSIONS: Items with strong unilateral encodings do not help lateralizing the epileptogenic zone.
Atrophy ; Electroencephalography ; Epilepsy, Temporal Lobe* ; Humans ; Magnetic Resonance Imaging ; Memory* ; Paresis ; Sclerosis* ; Sensitivity and Specificity ; Temporal Lobe*

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