자발생 두개내 저압 환자의 방사성 동위원소 뇌조조영술 소견

문대혁(Dae Hyuk Moon),이희경(Hee Kyung Lee),류진숙(Jin Sook Ryu),신중우(Jung Woo Shin),정동진(Dong Jin Jung),김재승(Jae Seung Kim),임주혁(Joo Hyuk Im),이명종(Myoung Chong Lee),정선주(Sun Joo Jung) 대한핵의학회 1998 핵의학 분자영상 Vol.32 No.6

N/A Purpose: Radionuclide cisternography may be helpful in understanding pathophysiology of postural headache and low CSF pressure in patients with spontaneous intracranial hypotension. The purpose of this study was to characterize radionuclide cisternographic findings of spontaneous intracranial hypotension. Materials and Methods: The study population consists of 15 patients with spontaneous intracranial hypotension. Diagnosis was based on their clinical symptoms and results of lumbar puncture. All patients underwent radionuclide cisternography following injection of 111 to 222 MBq of Tc-99m DTPA into the lumbar subarachnoid space. Sequential images were obtained between 1/2 hour and 24 hour after the injection of Tc-99m DTPA. Radioactivity of the bladder, soft tissue uptake, migration of radionuclide in the subarachnoid space, and extradural leakage of radionuclide were evaluated according to the scan time. Results: Radionuclide cisternogram showed delayed migration of radionuclide into the cerebral convexity (14/15), increased soft tissue uptake (11/15), and early visualization of bladder activity at 30 min (6/10) and 2 hr (13/13). Cisternography also demonstrated leakage site of CSF in 4 cases and 2 of these were depicted at 30 min. Epidural blood patch was done in 11 patients and headache was improved in all cases. Conclusion: The characterstic findings of spontaneous intracranial hypotension were delayed migration of radionuclide and early visualization of the soft tissue and bladder activity. These scintigraphic findings suggest that CSF leakage rather than increased CSF absorption or decreased production may be the main pathophysiology of spontaneous intracranial hypotension. Early and multiple imaging including the bladder and soft tissue is required to observe the entire dynamics of radionuclide migration.

Adie 증후군과 동반된 원발성 Sjogren 증후군

김선희 ( Seon Hee Kim ),김영학 ( Young Hak Kim ),조유숙 ( You Sook Cho ),김찬 ( Chan Kim ),최승원 ( Seung Won Choi ),유빈 ( Bin Yoo ),이명종 ( Myoung Chong Lee ),문희범 ( Hee Bom Moon ) 대한류마티스학회 1995 대한류마티스학회지 Vol.2 No.2

Sjogren`s syndrome is a heterogenous autoimmune disease characterized by progressive destruction of the exocrine glands and accompanied by a variety of autoimmune phenomena. Sjogren`s syndrome patients can develop symptoms of ocular and oral dryness as well as extraglandular complications including central and peripheral nervous system disease. Sometimes neuropathy precedes the diagnosis of Sjogren`s syndrome. Adie`s syndrome is characterized by tonic pupil and the absence of tendon reflex. Sweating abnormality and chronic peripheral polyneuropathy can also be present. We report a case of primary Sjogren`s syndrome preceded by Adie`s syndrome with peripheral neuropathy. A 26-year-old woman was admitted for photophobia and paresthesia. On examination. her pupils were anisocoric and did not react to light but constricted promptly to pilocarpin. Sensation decreased on her left side of body and deep tendon reflexes were absent. Biopsy of minor salivary gland demonstrated infiltration by lymphocyte consistent with Sjogren`s syndrome, but Schirmer test was negative. So she was diagnosed as Adie`s syndrome with peripheral neuropathy. Five month later she complained of dry eye and dizziness. Rose bengal staining was positive. Sjogren`s syndrome was diagnosed and she was discharged with local therapy for the sicca symptoms.

동맥경화성 뇌혈관 질환의 발생양상 및 위험인자에 대한 고찰

이재홍,김종성,이명종 울산대학교 의과대학 1992 울산의대학술지 Vol.1 No.1

To study the etiologic characteristics of intracranial and extracranial artery occlusive disease in Korea, we analyzed risk factor data from 40 patients(32 men and 8 women with a mean age of 52.0 years) with symptomatic, angiographically proven atherosclerotic cerebrovascular disease from September 1991 to November 1992. Thirty-four patients had an intracrnial arterial lesion, while 9 had an extracranial one. Middle cerebral artery (MCA) occlusion or stenosis was found in 24 patients in which 18 had an isolated MCA lesion(17 had a MCA trunk lesion and 1 had a branch occlusion). Distal internal carotid artery(ICA), anterior cerebral artery, and vertebro-basilar artery occlusion or stenosis were seen in 6, 3, and 9 patients, respectively. Only three patients with intracranial artery disease had a significant stenosis or occlusion in the proximal ICA at the same time. Among the risk factors, hypertension(76%) and longstanding cigarette smoking(62%) were the most significant predictors of the presence of intracranial arterial occlusive disease, while hypertension and diabetes were the most significant in the extracranial disease. The predominance of intracranial artery occlusive diseases in Koreans may be related to the difference in risk factors compared with the Caucasians.

가족성 팔목터널 증후군 1가족례

이명종,김광국,이상암,마효일,윤준오 울산대학교 의과대학 1993 울산의대학술지 Vol.2 No.1

This is a report of familial carpal tunnel syndrome(CTS) occuring in four members of two generations of a Korean family. One of those with CTS had surgical release and its pathologic finding was nonspecific fibrotic change. The age of those affected by CTS ranged form 35 to 76 years of age. Family pedigree suggests an autosomal dominant gene. This is belived to be the first case report of familial carpal tunnel syndrome in Korea.

뇌출혈로 발현한 척추기저동맥의 동맥경화성 폐색 일례

남병극,이재홍,이순금,이명종 울산대학교 의과대학 1996 울산의대학술지 Vol.5 No.1

Background : There have been some reports of intracranial hemorrhage which were attributed to atherosclerotic occlusive disease of major intracranial arteries, mostly the carotid system. The vertebrobasilar system very rarely presents hemorrhage as a result of occlusion or stenosis. We report a case of cerebellar and subarachnoid hemorrhage with vertebrobasilar atherosclerotic occlusion. Case report : A patient with severe vertigo, diplopia and ataxia of sudden onset was managed with intraarterial thrombolytic therapy for the left vertebral artery occlusion. After that, the arterial occlusion and the neurologic deficits resolved rapidly. Four years later, he developed a sudden headache and vertigo. Brain CT revealed right cerebellar hemorrhage with adjacent subarachnoid hemorrhage. Follow-up angiography showed occlusion of the right vertebral artery with fine collateral vessels. Rupture of small collateral vessels secondary to the atherosclerotic occlusion of the distal vertebral artery was postulated as the underlying cause of hemorrhage. Conclusion : Atherosclerotic occlusive disease of the vertebrobasilar system may bring about intracranial hemorrhage just like moyamoya disease does in the carotid system. The same pathomecha-nism seems to play in these clinical situations.

체위변화로 유발된 Reflex epilepsy 1례

조광덕,황연미,이명종 울산대학교 의과대학 1992 울산의대학술지 Vol.1 No.1

Reflex epilepsies are associated with specific physical stimulation and are classified in accordance with specific triggering mechanisms, such as flashing lights, sudden noise, thuch and movement. There have been reports of primery reading epilepsy and musicogenic epilepsy in Korea but no report of posture induced epilepsy to date. We report a 46-years-old male patient who experienced recurrent generalized convulsion during postural change, without significant changes of blood pressure and pulse rate. The seizures were confirmed by ictal EEG during postural change and responded to anticonvulsant treatment.

수지근에서 Neural Communication 의 전기생리학적 연구

이상암,김광국,이명종 울산대학교 의과대학 1993 울산의대학술지 Vol.2 No.2

It is well known that variations of the innervation in intrinsic hand muscles are common, A detailed anatomic study revealed that Riche -Cannieu anastomosis, a neutral anastomosis between the recurrent branch of the median nerve and the deep branch of the ulnar nerve, was in 77% of cadaveric dissections. Few electrophysiologic study of such anastomosis, however, has been done in a large population. The first group studied consisted of 88 limbs of 44 unselected subjects without Martin-Gruber anastomosis(MGA). The compound muscle action potentials(CMAP) were recorded by surface electrodes placed over the abductor pollicis brevis(APB), first dorsal interosseous(FDI), and abductor digiti quinti(ADQ) muscles with the stimulation at the wrist. The innervation of FDI by the median nerve was detected in 81(92.1%) of 88 limbs, and the innervation of APB by the ulnar nerve in 77(87.5% ). In no case, innervation of ADQ by the median nerve was found. The mean median nerve innervation ratio(MNIR) of FDI was 8.8%, and mean ulnar nerve innervation ratio(UNIR) of APB 23.5%. The second group, 37 MGA -detected limbs of 27 subjects, was also studied in order to evaluate the contribution of MGA to the innervation in intrinsic hand muscles. There was no significant difference in the incidence of anomalous innervation of each muscle in both groups.

정신분열병 증상을 동반한 진행성 핵상 마비 1례

박종익,조영래,홍진표,이민규,한오수,이명종 대한신경정신의학회 2001 신경정신의학 Vol.40 No.1

저자들은 환청과 망상을 주소로 정신과를 방문한 진행성 핵상 마비 환자를 진단하고 치료하였다. 진행성 핵상 마비는 보행 장해, 치매, 수직성 안구 운동의 장해가 특징적인 증상이며, 아직까지 특별한 치료법은 알려져 있지 않다. 정신과적 증상으로는 인지기능의 장해, 정동 및 행동의 변화, 수면 장해, 정신병적 증상 등이 있으며 정신분열병과 비슷한 증상을 보이는 경우는 극히 드물다고 한다. 본 증례에서는 파킨슨 증상과 정신병적 증상이 비슷한 시기에 발현된 진행성 핵상 마비의 예를 보고하면서 진단적 중요성을 강조하고자 한다. We have experienced a rare case of progressive supranuclear palsy with hallucination and delusion. The common manifestations of progressive supranuclear palsy are gait disturbance, mental change and sign of vertical ophthamoplegia but no efficacious therapy has been known. Neuropsychiatric symptom clusters include cognitive impairment, affective and behavioral changes, sleep disturbance, and psychotic symptoms. Though schizophrenia-like psychosis has been reported but this is certainly rare. Addressing a case of progressive supranuclear palsy, in whom parkisonian symptoms appeared with concurrent psychotic symptoms, we emphasize accurate diagnosis.

Proximal Vertebral Artery Stenosis에 의한 Lateral Medullary Syndrome 치험 1예

김종성,권태원,이명종,김건언 대한혈관외과학회 1996 Vascular Specialist International Vol.12 No.1

We are reporting a case of proximal vertebral artery stenosis causing lateral medullary syndrome treated by vertebral artery reconstruction. The patient is a 52 years old male who fuffered from dizziness, visual disturbance, and left side weakness for 7 months. The diagnosis of high grade stenosis of the vertebral artery near origin was confirmed by cerebral MRI and 4 vessel angiography. Angioplasty of the vertebral artery was performed using saphenous vein patch graft after plication of artery to prevent kinking. Postoperative course was uneventful and the symptoms of ataxic gate, dizziness, and visual disturbance were relieved.

Triflusal과 ticlopidine의 혈소판 응집 억제 효과와 부작용 발현에 대한 비교연구

김현각,김종성,이명종 대한신경과학회 1998 대한신경과학회지 Vol.16 No.1