Seong Beom Koh

Regional grey matter abnormalities in juvenile myoclonic epilepsy: a voxel-based morphometry study.

Visual assessment of structural MRI is, by definition, normal in patients with juvenile myoclonic epilepsy (JME), a major subsyndrome of idiopathic generalized epilepsy (IGE). However, recent quantitative MRI studies have shown structural abnormalities in cortical and thalamic grey matter (GM) in JME. Voxel-based morphometry (VBM) is a fully automated, unbiased, operator-independent MRI analysis technique that detects regionally specific differences in brain tissue composition on a voxel-wise comparison between groups of subjects. Using VBM, we examined structural differences in cortical and subcortical GM volume (GMV) between 25 JME patients (15 women, mean age=22.7+/-5.1 years) and age- and sex-matched 44 control subjects (27 women, mean age=23.1+/-4.3 years). We also performed a correlation analysis to delineate a possible relationship between the GMV increases or reductions and the increasing duration of epilepsy. Group comparison showed GMV increases in the superior mesiofrontal region bilaterally and GMV reductions in the thalamus bilaterally in JME patients (P<0.05, corrected for multiple comparisons using false discovery rate). Correlation analysis revealed that bilateral thalamic GMV had negative correlations with the duration of epilepsy (P<0.05, corrected for multiple comparisons after small volume corrections; P<0.05, Pearson correlation test). Our findings of GMV increases in the superior mesiofrontal regions and progressive thalamic atrophy could further support the pathophysiological concept of the functional abnormalities in thalamocortical circuit in JME.

Microstructural white matter abnormality and frontal cognitive dysfunctions in juvenile myoclonic epilepsy

Purpose:u2002 Previous neuroimaging studies provide growing evidence that patients with juvenile myoclonic epilepsy (JME) have both structural and functional abnormalities of the thalamus and frontal lobe gray matter. However, limited data are available regarding the issue of white matter (WM) involvement, making the microstructural WM changes in JME largely unknown. In the present study we investigated changes of WM integrity in patients with JME, and their relationships with cognitive functions and epilepsy‐specific clinical factors.

Quantification of bradykinesia during clinical finger taps using a gyrosensor in patients with Parkinson’s disease

This study aims to develop a quantitative measure of bradykinesia which can be conveniently used during clinical finger taps test in patients with Parkinson’s disease. A miniature, light-weight gyrosensor free from gravitational artifact was used for measurement of finger taps in order to impose minimal constraint on patients. Forty Parkinson’s disease patients and 14 age-matched control subjects participated in the experiments. Subjects’ finger taps in both right and left hands were scored by two independent neurologists according to the unified Parkinson’s disease rating scale and were also measured by a gyrosensor. Four performance indices were derived from the gyrosensor signal of the index finger. All indices showed significant differences between control and patients (Pxa0<xa00.001) and also significant correlations with the clinical finger taps score (rxa0=xa0–0.73xa0toxa0−0.80, Pxa0<xa00.001). ANOVA showed significant differences in all indices among different finger taps scores (Pxa0<xa00.001), and post hoc tests showed significant differences in indices between most pairs of non-neighboring and part of neighboring pairs of finger taps scores (Pxa0<xa00.01). The results suggest that indices from a gyrosensor can be used as quantitative measures of bradykinesia during the finger taps test.

The feasibility of color Doppler ultrasonography for caudal epidural steroid injection.

&NA; Although it entails a radiation hazard risk, the use of fluoroscopy during caudal epidural steroid injection has increased to help place the medication more accurately and allowed physicians to maximize the procedures therapeutic success rate. To investigate the feasibility of using real‐time high resolution ultrasonography for guiding the epidural needle into the caudal epidural space and to confirm any vascular intake of medication, we performed color Doppler ultrasonography while medication was being injected into the caudal epidural space of 53 patients with low back pain and sciatica. We defined the injection as being successful if unidirectional flow (observed as one dominant color) of the solution was observed with color Doppler ultrasonography through the epidural space beneath the sacrococcygeal ligament, with no flows being observed in other directions (observed as multiple colors). The correct placement of the medication was then confirmed by fluoroscopy. In 52 of the 53 subjects, the medications were successfully injected into the caudal epidural space with ultrasonography assistance. In fluoroscopy, of these 52 patients, 50 revealed correct placement of the medicine into the epidural space. In conclusion, ultrasonography may be a reliable imaging modality for caudal epidural steroid injection, and its several advantages such as its convenience and the lack of a radiation hazard, make it preferable to fluoroscopy.

Reversible splenial abnormality in hypoglycemic encephalopathy

IntroductionLesions involving the splenium of the corpus callosum (SCC) have been rarely reported in cases of hypoglycemic brain injury.MethodsWe identified signal abnormalities in the SCC in three adult patients with hypoglycemic encephalopathy by using diffusion-weighted imaging (DWI) on a 1.5-T MR scanner. Repeat DWI was performed in all patients following a marked clinical improvement, and MR angiography and routine MRI were also performed. We examined each patient’s detailed medical history and blood laboratory tests in order to exclude other conditions causing similar SCC abnormalities.ResultsInitial DWI was performed during which each patient showed altered mental status that was attributed to profound hypoglycemia. We observed an identical pattern of DWI abnormality characterized by high signals in the SCC with apparent diffusion coefficient reductions that were reversed completely within several days following appropriate correction of hypoglycemia. T2-weighted or FLAIR images also showed no residual lesion in the SCC and MR angiography was normal in all patients.ConclusionThese case reports suggest that the SCC should be added to the list of selective vulnerability to hypoglycemia and that hypoglycemia, in turn, be included in the differential diagnosis of reversible SCC abnormalities.

Altered thalamocortical functional connectivity in idiopathic generalized epilepsy.

Aberrant thalamocortical network has been hypothesized to play a crucial role in the fundamental pathogenesis underlying idiopathic generalized epilepsy (IGE). We aimed to investigate alterations of thalamocortical functional network in patients with IGE using thalamic seed‐based functional connectivity (FC) analysis, and their relationships with frontal cognitive functions and clinical characteristics.

Correlation of Coronary Artery Atherosclerosis with Atherosclerosis of the Intracranial Cerebral Artery and the Extracranial Carotid Artery

Background: Investigating atherosclerosis of the coronary artery in ischemic stroke patients is clinically important because comorbidity is relatively common in such patients. We studied the relationship of atherosclerosis of the coronary artery to atherosclerosis of the intracranial cerebral artery and extracranial carotid artery. Further investigation was performed for determining the factors independently associated with coronary artery atherosclerosis in ischemic stroke patients. Methods: We consecutively recruited ischemic stroke patients who had no history of coronary artery disease, and they underwent vascular examination. Patient-based vascular assessment was performed with magnetic resonance angiography of the cerebral arteries and computed tomography coronary angiography. The factors independently associated with coronary artery stenosis (≧50%) were obtained from the conventional vascular risk factors and cerebral arterial stenosis using the logistic regression model. Results: Coronary artery stenosis was observed in 25.4% of the patients and this was associated with age (OR: 1.16, 95% CI: 1.03–1.30) and the presence of stenosis of the extracranial carotid artery (OR: 11.37, 95% CI: 1.88–68.75) after logistic regression analysis. Intracranial arterial stenosis was not independently related to coronary stenosis. Conclusion: Careful concern about coronary artery disease is needed when treating ischemic stroke patients who have atherosclerosis of the extracranial carotid artery.

Clinical and laboratory characteristics of cerebral infarction in tuberculous meningitis: A comparative study

Cerebral infarction as a complication of tubercular (TB) meningitis is not uncommon, but an adequate comparison of patients with and without stroke has not been carried out. This study was performed to evaluate the clinical characteristics of cerebral infarction secondary to TB meningitis, and to investigate predictive factors for cerebral infarction in patients with TB meningitis. Patients with TB meningitis were recruited over a period of 56 months. They were divided into two groups, those with and those without stroke. Demographic features and clinical, laboratory, and neuroradiological findings were compared between the two groups. We classified strokes into subtypes using neuroimaging findings. Of the 38 patients who were diagnosed with TB meningitis, eight also experienced cerebral infarction. The percentage of cerebrospinal fluid leukocytes that were neutrophils was significantly higher in patients with stroke (68%) than in patients without stroke (31%; p=0.0001). Upon initial CT imaging, meningeal enhancement was found in 11 patients, and of these patients, six experienced stroke. There were no significant differences between the groups with respect to other clinical and laboratory features, including demographic features, time between meningitis onset and treatment initiation, peripheral white blood cell count, and cerebrospinal fluid findings. Five of the eight patients who developed stroke had lacunar infarcts. One of the three patients with territorial nonlacunar infarction died due to herniation. When treating patients with TB meningitis, the possibility of cerebral infarction should be considered when patients develop focal neurological signs, meningeal enhancement on a CT scan, and sustained polymorphic cerebrospinal fluid pleocytosis.

The relationship of pain and health‐related quality of life in Korean patients with Parkinson’s disease

Backgroundu2002–u2002 Parkinson’s disease (PD) is a chronic progressive neurodegenerative disorder. Increasing attention has been focused on the pain and health‐related quality of life (HrQOL) in patients with PD.

Intracranial hypotension induced by cervical spine chiropractic manipulation

Study Design. Case report. Objectives. We report a case of intracranial hypotension ensuing after a spinal chiropractic manipulation leading to cerebrospinal fluid (CSF) isodense effusion in the upper cervical and thoracic spine. Summary of Background Data. The etiology of intracranial hypotension is not fully understood, but CSF leakage from spinal meningeal diverticula or dural tears may be involved. Methods. A 36-year-old woman presented with neck and both shoulder pain 4 days earlier. She undertook a spinal chiropractic manipulation. After this maneuver, she complained of a throbbing headache with nausea and vomitting. Her headache worsened, and lying down gave the only measure of limited relief. In CSF study, it showed dry tapping. Brain MRI showed pachymeningeal gadolinum enhancement. Thoracic spine MRI showed CSF leakage. After admission to the hospital, she was treated by hydration and pain control over several days. However, her headache did not improve. Results. She was treated by epidural blood patch. Afterwards, her headache was improved. This is the first case of spontaneous intracranial hypotension in which spinal chiropractic manipulation coincided with the development of symptoms and in which a CSF collection in the upper cervical and thoracic spine was demonstrated radiographically in Korea. Conclusions. From this case, we can understand the etiology of intracranial hypotension and consider the complication of chiropractic manipulation.