간농양과 연관된 Klebsiella Pneumoniae 뇌수막염 증례

Background: Bacterial meningitis is one of neurologic emergency. Klebsiella pneumoniae is considered to be the uncommon pathogen for bacterial meningitis. We report the patient with Klebsiella pneumoniae meningitis associated with liver abscess. Case Report:A 65-year-old male was admitted due to fever, mental deterioration. In cerebrospinal fluid study, white blood cell was 12450/mm3, protein was 1028.5 mg/dL and glucose was uncheckable. We started treatment of antibiotics. Brain MRI showed diffuse high signal intensities along the sulcus in both hemispheres on fluid attenuated inversion recovery image. The culture of CSF yielded Klebsiella pneumoniae. Abdomen CT scan showed 3.5 cm lobulated low attenuated lesion in right hepatic lobe. Patient was received the drainage of liver abscess procedure. He recovered mental status after 7 days of treatment. Conclusion: Klebsiella pneumoniae has been considered to be an rare cause of meningitis especially immune-suppressive state. And if Klebsiella pneumoniae meningitis is diagnosed, we should search combined infection of other organs.ope

사건수면 양상으로 발현된 인슐린종

Parasomnia involve abnormal and unnatural movements, behaviors, emotions, perceptions, and dreams that occur while sleep. Chronic hypoglycemia causes neuroglycopenic symptoms such as mental confusion, abnormal behavior, personality change, diplopia, fatigue and headache without typical autonomic symptoms. We report a 59-year-old woman with hypoglycemia who initially developed parasomnia mimic symptoms in early morning sleep period and the final diagnosis was insulinoma. Abnormal nocturnal behaviors persist long duration in the fasting state or early morning, are considered as hypoglycemic symptoms of insulinomaope

Anticonvulsant Activity of Androsterone and Etiocholanolone

PURPOSE: Men with epilepsy often have sexual or reproductive abnormalities that are attributed to alterations in androgen levels, including subnormal free testosterone. Levels of the major metabolites of testosterone-androsterone (5alpha-androstan-3alpha-ol-17-one; 5alpha,3alpha-A), a neurosteroid that acts as a positive allosteric modulator of GABA(A) receptors, and its 5beta-epimer etiocholanolone (5beta-androstan-3alpha-ol-17-one; 5beta,3alpha-A)-also may be reduced in epilepsy. 5alpha,3alpha-A has been found in adult brain, and both metabolites, which also can be derived from androstenedione, are present in substantial quantities in serum along with their glucuronide and sulfate conjugates. This study sought to determine whether these endogenous steroid metabolites can protect against seizures. METHODS: The anticonvulsant activity of 5alpha,3alpha-A and 5beta,3alpha-A was investigated in electrical and chemoconvulsant seizure models in mice. The steroids also were examined for activity against extracellularly recorded epileptiform discharges in the CA3 region of the rat hippocampal slice induced by perfusion with 55 microM 4-aminopyridine (4-AP). RESULTS: Intraperitoneal injection of 5alpha,3alpha-A-protected mice in a dose-dependent fashion from seizures in the following models (ED50, dose in mg/kg protecting 50% of animals): 6-Hz electrical stimulation (29.1), pentylenetetrazol (43.5), pilocarpine (105), 4-AP (215), and maximal electroshock (224). 5beta,3alpha-A also was active in the 6-Hz and pentylenetetrazol models, but was less potent (ED50 values, 76.9 and 139 mg/kg, respectively), whereas epiandrosterone (5alpha,3beta-A) was inactive (ED50, <or=300 mg/kg). 5alpha,3alpha-A (10-100 microM) also inhibited epileptiform discharges in a concentration-dependent fashion in the in vitro slice model, whereas 5beta,3alpha-A was active but of lower potency, and 5alpha,3beta-A was inactive. CONCLUSIONS: 5alpha,3alpha-A and 5beta,3alpha-A have anticonvulsant properties. Although of low potency, the steroids are present in high abundance and could represent endogenous modulators of seizure susceptibility.ope

Prognostic Factors in Anterior Temporal Lobectomy Patients and Predictability of Prognosis by Discriminant Analysis

Background : Anterior temporal lobectomy (ATL) is by far the most commonly performed and successfully achieved surgical treatment available for patients with medically intractable temporal lobe epilepsy. The aim of this study was to find the factors related to the surgical outcome in order to predict the prognosis of ATL in an out-patient clinic (OPD) before surgery. M e t h o d s : We selected 54 patients with medically refractory nonlesional temporal lobe epilepsy who were treated with ATL between 1991 and 1996 in the Yonsei Epilepsy Program and were followed up for at least 2 years. We divided the 54 patients into a favorable prognosis group (Class I-II) (FPG) and an unfavorable prognosis group (Class III-IV) (UPG) according to Engel’s classification. We investigated the correlation of the clinical, neu-roimaging, and EEG findings between the two groups, and the predictability of the prognosis by discriminant analysis. R e s u l t s : Of the 54 patients who had ATL, 43 were FPG and 11 were UPG. Among the various factors, febrile convul-sion, medial temporal sclerosis (MTS) in MRI and localization in scalp interictal EEG were significantly higher in FPG than in UPG (p<0.05). Encephalitis and multifocal epileptiform discharges in EEG were significantly higher in UPG (p<0.05). Age, sex, onset age, seizure duration, aura, automatism, secondary generalization, seizure frequency before surgery, family history, I.Q., neurological deficits, interictal SPECT, PET, and cerebellar atrophy in MRI were not significantly different between FPG and UPG. We were able to predict correct surgical outcomes in 18 patients with 100% predictability by discriminant analysis. C o n c l u s i o n s : Among the many factors, the past history of febrile convulsion and encephalitis, MTS in MRI, and interictal EEG findings were significantly related to the post-surgical outcome. We can expect correct surgical outcome at OPD before surgery through the evaluation of these various factors. J Korean Neurol Assoc 17(6):816~822, 1999 Key Words : Anterior temporal lobectomy, Prognosis, Factors, Predictabilityope

IL-1β and IL-1 Receptor Antagonist Gene Polymorphisms in Myasthenia Gravis

Background: Myasthenia gravis (MG) is an autoimmune disorder characterized by an immune response against the nicotinic acetylcholine receptor at the neuromuscular junction. Genetic factors as well as abnormalities of immune regulation can increase the likelihood of MG. Proinflammatory cytokines interleukin (IL)-1α, IL-1β, and their receptor antagonist (IL-1Ra) play major roles in initiating and modulating immune responses. The aim of the present study was to analyze IL-1β and IL-1 Ra gene polymorphisms between MG patients and healthy controls. Methods: TaqI restriction fragment polymorphism (RFLP) in exon 5 of IL-1β and variable numbers of an 86-bp tandem repeat (VNTR) in intron 2 of IL-1Ra were analyzed in 80 patients with MG and 94 matched healthy control individuals. Results: In IL-1β TaqI RFLP, the genotype of A1/A1 and A1/A2 were 92.5% and 7.5% in patients with MG. In healthy controls, the frequencies of each genotype were 93.6% and 6.4% respectively. IL-1Ra polymorphism, the genotypes of A1/A1, A1/A2 and A1/A3 were 81.3%, 16.3%, and 2.5% in patients with MG. In healthy controls, the frequencies of each genotype were 87.2%, 7.4% and 3.2% respectively. There was no significant difference in the genotype frequencies of IL-1β TaqI RFLP and IL-1Ra polymorphism between patients and the control group. Conclusions: These data suggested that the IL-1β and IL-1Ra gene polymorphisms may not be associated with MG. However, further study is needed to clarify the possible role of IL-1β and IL-1Ra gene polymorphisms in the susceptibility to myasthenia gravis.ope

저산소뇌증 환자에서 혈청 Neuron-Specific Enolase 수치와 예후

Background: Hypoxic brain damage is a critical situation and needs emergent treatment. Even with a successful treatment of the underlying causative disease, the extent of injury to brain parenchyma is often severe and irreversible. Clinical outcome of hypoxic brain damage is determined by the degree of diffuse brain damage. Although neuroimaing and electrophysiological study help to predict the clinical outcome, it is often difficult to perform these test because of unstable vital sign and technical problem. Therefore, reliable and feasible methods for early prediction of prognosis need to be established. Methods: This study included 22 patients with hypoxic brain damage after resuscitation. Serum Neuron-Specific Enolase (NSE) level within 24 hours after resuscitation was measured by enzyme immunoassay. Clinical outcome was assessed by the use of Glasgow Outcome Scale (GOS) at 6 months after onset. Results: In 22 patients, 18 (81.8%) patients had poor outcome, and 4 (19.2%) patients showed favorable recovery. A serum NSE concentration above 20 ng/mL was found to be a predictor of poor outcome with a high positive predictive value (93.8%). Concentrations more than 22 ng/mL predicted poor outcome with a high specificity (100%) and a positive predictive value of 100%. Conclusion: In patients with hypoxic brain damage, serum NSE concentrations of >22 ng/mL was predictive of poor clinical outcome with a high specificity. We suggest that serum NSE may be a feasible and valuable biochemical marker for prediction of clinical outcome in hypoxic brain damageope

Excessive Daytime Sleepiness in Tension-Type Headache: A Population Study

Excessive daytime sleepiness (EDS) is a prevalent sleep-related complaint across the general population and has been reported to be associated with headache. Tension-type headache (TTH) is the most commonly encountered headache and accounts for a significant amount of disease burden. However, the association between EDS and TTH is currently scarce. In the present study, we investigated the impact of EDS on the prevalence and clinical presentation of TTH. We utilized data from the Korean Headache-Sleep Study, a national survey that sought to identify headache and sleep characteristics in Korean adults. Participants with an Epworth sleepiness scale score greater or equal to 11 were considered as having EDS. Of the 2,695 participants enrolled, 570 (21.2%) and 313 (11.6%) had TTH and EDS, respectively. EDS was highly prevalent in individuals with chronic tension-type headache (CTTH) than in those without headache (35.7 vs. 9.4%, p < 0.001). The prevalence of EDS in episodic tension-type headache (ETTH) individuals with a headache frequency <1 per month (8.3%, p = 0.511) and ETTH individuals with a headache frequency of 1-14 per month (13.5%, p = 0.054) was not significantly different from that in individuals without headache (9.4%). TTH participants with EDS had a higher headache frequency per month (4.3 ± 8.1 vs. 1.7 ± 4.2, p = 0.013), more severe headache intensity (Visual Analog Scale, 5.0 [3.0-6.0] vs. 4.0 [3.0-6.0], p = 0.008), a higher impact of headache (Headache Impact Test-6 score, 47.1 ± 7.3 vs. 43.5 ± 7.6, p < 0.001), and a higher prevalence of depression (12.7 vs. 3.2%, p < 0.001) than TTH participants without EDS. Consequently, CTTH is associated with higher EDS prevalence compared to ETTH and without headache. Moreover, TTH with EDS had more severe TTH symptoms compared to TTH without EDS.ope

원발성 가역적뇌혈관수축증후군에 의한 가역적후뇌병증

Background: Reversible cerebral vasoconstriction syndrome (RCVS) is an underdiagnosed disease characterized by severe headaches with or without seizures, focal neurological deficits, and constriction of cerebral arteries which resolves spontaneously in 1-3 months. Posterior reversible encephalopathy syndrome (PRES) is typically characterized by headache, altered mental functioning, seizures, and visual loss associated with imaging findings of bilateral subcortical and cortical edema with a predominantly posterior distribution. Case Report: We present 49-year-old and 46-year-old females with thunderclap headache and seizure. MRI shows reversible cortical and subcortical lesions in both fronto-parieto-occipital lobes. And magnetic resonance angiography shows reversible multifocal luminal narrowing of distal cerebral vessels. Conclusion: Primary RCVS may occur as a cause of PRES. We report two cases of non-hypertensive PRES with seizure due to primary RCVS presenting thunderclap headache.ope

Usefulness of Continuous Electroencephalography Monitoring in Intensive Care Unit

When we care critically ill patient in intensive care unit (ICU), many kinds of monitoring such as pulse oximetry, electrocardiogram, respir-ation, arterial blood pressure and etc. are needed. But for brain, continuous monitoring has been unavailable until recently. By mechanical development, continuous EEG monitoring (cEEG) is possible to use and provides functional information about brain function. Those ICUs caring for patients with status epilepticus should have access to cEEG monitoring for treatment and recognizing non-convulsive seizures. cEEG should be integrated into the multimodality brain monitoring approach of acutely brain-injured patients. Various kinds of quantitative EEG parameters can now be analyzed in combination with other neuromonitoring measures to detect early pathological changes preceding clinical detection of these events. Further studies show the impact on outcome and making cEEG monitoring out of the subspecialized ICU setting into the general ICU environmentope

Excessive daytime sleepiness is associated with an exacerbation of migraine: A population-based study

BACKGROUND: Previous studies have shown that migraine and sleep disturbances are closely associated. Excessive daytime sleepiness (EDS) is a common symptom of various types of sleep disturbance. Findings from clinic-based studies suggest that a high percentage of migraineurs experience EDS. However, the prevalence and clinical impact of EDS among migraineurs at the population level have rarely been reported. The objective of this study was to investigate the prevalence and impact of EDS among migraineurs using a population-based sample in Korea. METHODS: We selected a stratified random sample of Koreans aged 19 to 69 years and evaluated them using a semi-structured interview designed to identify EDS, headache type, and the clinical characteristics of migraine. If the score on the Epworth Sleepiness Scale (ESS) was more than or equal to 11, the participant was classified as having EDS. RESULTS: Of the 2,695 participants that completed the interview, 143 (5.3 %) and 313 (11.6 %) were classified as having migraine and EDS, respectively. The prevalence of EDS was significantly higher in participants with migraine (19.6 %) and non-migraine headache (13.4 %) compared to non-headache controls (9.4 %). Migraineurs with EDS had higher scores on the Visual Analogue Scale (VAS) for headache intensity (6.9 ± 1.8 vs. 6.0 ± 1.9, p = 0.014) and Headache Impact Test-6 (59.8 ± 10.2 vs. 52.5 ± 8.2, p < 0.001) compared to migraineurs without EDS. CONCLUSIONS: Approximately 20 % of migraineurs had EDS in this population-based sample. Excessive daytime sleepiness was associated with an exacerbation of some migraine symptoms.ope