Seok-Beom Kwon

Safety and Efficacy of Ultrasound-Guided Fiducial Marker Implantation for CyberKnife Radiation Therapy

Objective To evaluate the safety and technical success rate of an ultrasound-guided fiducial marker implantation in preparation for CyberKnife radiation therapy. Materials and Methods We retrospectively reviewed 270 percutaneous ultrasound-guided fiducial marker implantations in 77 patients, which were performed from June 2008 through March 2011. Of 270 implantations, 104 were implanted in metastatic lymph nodes, 96 were in the liver, 39 were in the pancreas, and 31 were in the prostate. During and after the implantation, major and minor procedure-related complications were documented. We defined technical success as the implantation enabling adequate treatment planning and CT simulation. Results The major and minor complication rates were 1% and 21%, respectively. One patient who had an implantation in the liver suffered severe abdominal pain, biloma, and pleural effusion, which were considered as major complication. Abdominal pain was the most common complication in 11 patients (14%). Among nine patients who had markers inserted in the prostate, one had transient hematuria for less than 24 hours, and the other experienced transient voiding difficulty. Of the 270 implantations, 261 were successful (97%). The reasons for unsuccessful implantations included migration of fiducial markers (five implantations, 2%) and failure to discriminate the fiducial markers (three implantations, 1%). Among the unsuccessful implantation cases, six patients required additional procedures (8%). Conclusion The symptomatic complications following ultrasound-guided percutaneous implantation of fiducial markers are relatively low. However, careful consideration of the relatively higher rate of migration and discrimination failure is needed when performing ultrasound-guided percutaneous implantations of fiducial markers.

The clinico-radiologic properties of deep small basal ganglia infarction: Lacune or small striatocapsular infarction?

OBJECTIVE Deep small basal ganglia infarction (DSBI) cannot be clearly classified as either lacune or striatocapsular infarction by their sizes only. We tried to elucidate clinical and other properties of DSBI to understand better in pathophysiology of ischemic lesion of basal ganglia. METHODS We analyzed 36 patients with acute ischemic lesion of basal ganglia with the size varying from 1.5 to 3 cm in maximal diameters. We assessed clinical features, laboratory data, risk factors of stroke, and radiologic findings such as MRI and MR angiography. RESULTS Patients with DSBI could be largely divided into two distinctive groups, small infarction with cortical sign (SICS) and lacunar syndrome (LS) according to their presence of cortical manifestations. Total of 11 patients were in SICS group and they showed cortical manifestations such as eyeball deviation, visual field defect, aphasia and neglect. They also showed severer non-cortical neurologic deficit compared with LS group. Whereas LS group showed various MRA patterns, 7 patients of SICS group (63.6%) showed proximal MCA stenosis in MRA. CONCLUSIONS We found that many patients with DSBI could have the features of either lacune or striatocapsular infarction. Although they have similar morphologic characteristics but they are presumed to have different pathophysiologic mechanism.

Highly task‐specific oromandibular dystonia in a telephone operator

S. Y. Kang, H. Kim, H.-I. Ma, Y. J. Kim, S.-B. Kwon, S. H. Hwang and Y. H. Sohn Department of Neurology, Hallym University College of Medicine, Seoul; Graduate Program in Speech and Language Pathology, Department of Rehabilitation Medicine, & Research Institute of Rehabilitation Medicine; and Department of Neurology and Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea

A Case of Vascular Hemichorea Responding to Topiramate

Although vascular chorea often comes into remission spontaneously, a few patients may remain with persistent movement disorder. Most movements respond well to neuroleptics as well as other antidopaminergic drugs, but some patients show poor responses to those neuroleptics. Topiramate is a widely used of broad-spectrum anticonvulsant possessing a complex mechanism of action. It has been proven to enhance gamma-aminobutyrate acid activity and to be effective in the control of other movement disorders. We describe a 63-year-old woman with intractable vascular hemichorea which was controlled with anti-convulsant, topiramate.

Normal diffusion-weighted MRI during the acute stage of central pontine myelinolysis.

ABSTRACT Central pontine myelinolysis (CPM) is rare demyelinating disorder characterized by loss of myelin in the center of the basis pontis. The clinical features of CPM vary depending on the involved areas. Diffusion-weighted imaging (DWI) is thought to be useful for early detection during the acute phase, but its utility in this context has not been investigated thoroughly. We report the case of a CPM patient with normal initial DWI findings even at 1 week after symptom onset. To the best of our knowledge, no such cases of CPM have previously been reported.

Ischemic Stroke among the Patients with End-Stage Renal Disease Who Were Undergoing Maintenance Dialysis

Purpose In spite of higher incidence of stroke in end-stage renal disease (ESRD) patients compared to general population, the risk factor for stroke which is specific to ESRD is not fully understood. The ESRD patients who develop stroke may have certain additional risk factors compared to ESRD patients without stroke. We used registered data of Hallym Stroke Registry to elucidate the factors which affect development of ischemic stroke among the dialysis patients. Materials and Methods We recruited patients with acute ischemic stroke in ESRD patients undergoing maintenance dialysis. Dialysis patients without stroke were selected as control group with age and gender matching. We compared the demographic features, stroke risk factors, and laboratory findings in ESRD patients with or without ischemic stroke. Results The total of 25 patients with ESRD developed ischemic stroke. Fifty ESRD patients without stroke were chosen as the control group. The mean age of acute ischemic stroke patients was 59.80±9.94 and male gender was 48%. The most common ischemic stroke subtype was small vessel occlusion (n=12), followed by large artery atherosclerosis (n=7). The patients with stroke had more frequent history of hypertension and higher systolic/diastolic blood pressure at the time of admission than the ESRD patients without stroke. Total cholesterol and LDL-cholesterol levels were significantly lower in the stroke group. In multivariate analysis, LDL-cholesterol was found to be the only risk factor for ischemic stroke. Conclusion The results of our study reveal that LDL-cholesterol is associated with greater risk for ischemic stroke in the patients on dialysis.

Ipsilateral Tilt and Contralateral Sensory Change of Neck in Cortical Infarction

Background Numerous neck muscles are involved in neck movements, and so isolated neck weakness is extremely uncommon in cerebral infarction. Case Report We report herein the case of a 65-year-old woman with hypertension and acute cortical infarction, presenting with ipsilateral head tilt and contralateral sensory changes in the neck and shoulder area, which has never been described before. Conclusions Transient neck weakness and sensory deficits can occur in acute cortical infarction. The motor representation of the neck muscles can be at the same level of the cortical sensory representation, near to the level of the trunk representation, which is in contrast to Penfields findings. Several possible mechanisms for the ipsilateral tilt are described.

P2-7 Comparison of chronic inflammatory demyelinating polyneuropathy with and without diabetes

investigated whether A-waves have any value or not in electrodiagnosis of diabetic polyneuropathy. Methods: Forty-five diabetic patients, mean age of 60 years, and 100 healthy volunteers were included to the study. Motor nerve conduction study was carried out in bilateral median nerves and tibial nerves. A-waves were collected during F-wave study. A-wave was defined by the following criteria: supramaximally-elicited reproducible waveforms with amplitude greater than 0.03 mV, cleanly separated from M-waves, with constant latency, amplitude, and waveform, and present in response to at least 6 of 10 consecutive electric stimuli. Results: In healthy subjects, no A-waves were elicited either in tibial or median nerves. In diabetic subjects, median A-wave was recorded in some with marked prolonged distal latency, suggesting carpal tunnel syndrome. In tibial nerve, A-waves were detected in 32 (71%) of the patients. 24 patients (54%) had bilateral A-waves. The mean tibial CMAP amplitude of the bilaterally A-wave positive nerves was 4.4 mV, while A-wave negative nerves had mean of 8.2 mV (p < 0.01). F-wave latencies were 53.8 ms and 50.6 ms, respectively (p < 0.05). No statistically significant differences were found either in motor conduction velocity or distal latency time. Discussion: In the Japanese people, A-wave is a frequent finding in deep peroneal nerve study, suggesting minor traumatic injury by the traditional sitting custom on the knee. On the other hand, tibial A-wave is extremely rare in the Japanese subjects. Therefore, the fact that 71% of the diabetic patients showed the tibial A-wave was rather surprising. A-wave positive nerves were characterized by a fall in CMAP amplitude, and prolonged minimal F-wave latency. Conclusion: Tibial A-wave in diabetic patients is another electrophysiological finding of diabetic polyneuropathy.

Fluctuating cognitive dysfunction due to intracranial steal phenomenon

Background and aims: There have been many reports showing the striatum may play an integrative role in cognitive information processing in motor as well as in non-motor tasks. Nevertheless, recently there has been increasing interest in the non-motor functions of globus pallidus especially in their roles in cognitive processing. We report a case presenting behavioral and cognitive dysfunction after focal left globus pallidus infarction. Case: A 71-yearold right handed manpresented with abnormal behavior that occurred about 3 days before admission. Examination revealed mild disorientation, inattention, apathy, amnesia, decreased verbal fluency and emotional blunting without any alterations to consciousness. There was no past history of psychiatric illness oralcohol and drug abuse.A brain magnetic resonance imaging showed high signal in left basal ganglia especially left globus pallidus on T2 and diffusion weighted image. Neuropsychological assessment that was performed 7 days after admission revealed decreased frontal executive function with mild bilateral parieto-temporal dysfunction. After a 2 week period, he showed gradual improvement in recent memory disturbance and apathy, but sustained some cognitive deficits including inattention and decreased verbal fluency. Conclusions: There are a few reports of globus pallidus lesion affects on cognitive and behavior change, in which mentioned that disruption of interconnected frontal-subcortical circuit, the limbic-striatal-pallidal-thalamic and the limbic-thalamo-cortial circuits leads to cognitive impairment. This case suggests that strategic infarction dementia can possibly be developed by a single globus pallidus lesion.