Hong-Ki Song

Paroxysmal stabbing headache in the multiple dermatomes of the head and neck: a variant of primary stabbing headache or occipital neuralgia?

A paroxysmal stabbing or icepick-like headache in the multiple nerve dermatomes, especially involving both trigeminal and cervical nerves, has not been fully explained or classified by the International Classification of Headache Disorder, 2nd Edition (ICHD-II). Of patients with acute-onset paroxysmal stabbing headache who had visited the Hallym University Medical Center during the last four years, 28 subjects with a repeated stabbing headache involving multiple dermatomes at the initial presentation or during the course were prospectively enrolled. All patients were neurologically and otologically symptom free. A coincidental involvement of both trigeminal and cervical nerve dermatomes included seven cases. Six cases involved initially the trigeminal and then cervical nerve dermatomes. Five cases showed an involvement of the cervical and then trigeminal nerve dermatomes. The remaining patients involved multiple cervical nerve branches (the lesser occipital, greater occipital and greater auricular). Pain lasted very shortly and a previous history of headache with the same nature was reported in 13 cases. Preceding symptom of an infection and physical and/or mental stress were manifested in seven and six subjects, respectively. All patients showed a self-limited benign course and completely recovered within a few hours to 30 days. Interestingly, a seasonal gradient in occurrence of a stabbing headache was found in this study. A paroxysmal stabbing headache manifested on multiple dermatomes can be explained by the characteristics of pain referral, and may be considered to be a variant of primary stabbing headache or occipital neuralgia.

Cellular and regional specific changes in multidrug efflux transporter expression during recovery of vasogenic edema in the rat hippocampus and piriform cortex.

In the present study, we investigated the characteristics of drug efflux transporter expressions following status epilepticus (SE). In the hippocampus and piriform cortex (PC), vasogenic edema peaked 3-4 days after SE. The expression of breast cancer resistance protein (BCRP), multidrug resistance protein-4 (MRP4), and p-glycoprotein (p-GP) were decreased 4 days after SE when vasogenic edema was peaked, but subsequently increased 4 weeks after SE. Multidrug resistance protein-1 (MRP1) expression gradually decreased in endothelial cells until 4 weeks after SE. These findings indicate that SE-induced vasogenic edema formation transiently reduced drug efflux pump expressions in endothelial cells. Subsequently, during recovery of vasogenic edema drug efflux pump expressions were differentially upregulated in astrocytes, neuropils, and endothelial cells. Therefore, we suggest that vasogenic edema formation may be a risk factor in pharmacoresistent epilepsy. [BMB Reports 2015; 48(6): 348-353]

Clinical feasibility of immediate overnight switching from slow-release carbamazepine to oxcarbazepine in Korean patients with refractory partial epilepsy.

We assessed the clinical variables predicting the feasibility of immediate overnight switching from slow-release carbamazepine to oxcarbazepine in Korean patients with refractory partial epilepsy. Thirty patients aged 15 years or older with refractory partial epilepsy, who had been treated with slow-release carbamazepine as monotherapy or in combination therapy, were switched overnight from slow-release carbamazepine (mean dose at switching, 900 mg/day) to oxcarbazepine. Of these 30 patients, 29 (96.7%) had been treated with a slow-release formulation of carbamazepine. The proportion of patients with polytherapy was 85.3%. Overall, 9 of 30 (30%) switched patients experienced clinically significant adverse events until 2 weeks after switching, including 2 with seizure aggravation. The only clinical variable related to the failure of overnight switching was the number of seizures at baseline.

Citation Classics in Stroke: The Top-100 Cited Articles on Hemorrhagic Stroke

Background: Stroke is a disastrous disease and a major health burden worldwide, especially in Korea. Hemorrhagic stroke (HS) accounts for approximately 20% of all the types of strokes. It is important to be able to evaluate stroke diagnoses and evolving treatments. Objective: We aimed to identify the top-100 cited articles and assess a paradigm shift that occurred in the field of HS. Methods: We searched all articles that had been cited more than 100 times using the Web of Science citation search tool during January 2016. Among a total of 2,651 articles, we identified the top-100 cited articles on HS. Results: The number of citations for the articles analyzed in this study ranged from 1,746 to 211, and the number of annual citations ranged from 125.6 to 5.5. Most of the articles that were published in Stroke (35%) and Journal of Neurosurgery (22%), originated in the United States (n = 56), were original articles (64%), and dealt with the natural history or etiology (n = 37) and vasospasm in subarachnoid hemorrhage (n = 8). Conclusions: We analyzed the top-100 cited articles in the field of HS based on citation rates. The results provide a unique perspective on historical and academic developments in this field.

Unusual Intracranial Arterial Calcification and Vitamin D Deficiency

Although intracranial arterial calcifications (IACs) are encountered in approximately 85% of patients with acute ischemic stroke (IS), the significance of IAC in plaque instability is still controversial. Because most tissues including brain tissue have vitamin D receptors, vitamin D deficiency might play multiple roles in variable sites. Here, we report a novel presentation of IS with IAC including anterior cerebral artery involvement due to vitamin D deficiency. In conclusion, although the role of IAC in cerebral infarction is still controversial, we suggest that insufficient vitamin D should be examined and treated appropriately in all patients with IS. We believe that this article provides important implications for the treatment of vitamin D deficiency in patients with IS.