• Journal of Physiology & Pathology in Korean Medicine
• /
• v.16 no.6
• /
• pp.1291-1296
• /
• 2002

Blood circulation of brain is divided into two major categories; anterior one from carotid artery and posterior one from vertebrobasilar artery. In stroke patients, it is important to diagnose which is involved, because there is many difference in the aspects of clinical menifestations and prognosis, especially in the acute stage. In some cases of vertebrobasilar infarction, such as Wallenberg's syndrome, charicteristic cranial nerve signs, eye movement disorders and cerebellar signs are appeared. And in Dejerine's syndrome, only pure motor or sensory defecits can be appeared without any brainstem signs. So It shoud be differenciated by Brain MRI from those of the cerebral hemisphere lesions. And in the cases that nausea, vomitting and dysphagia are the first menifestations, it is frequently misdiagnosed as internal medical disease, causing appropriate treatment delayed. In this case report, we are to describe the clinical menifestations and progresses of two cases of brainstem infarctions, review previously published case reports about them and compare them to our cases. The first is Dejerine's syndrome i.e. medial medullary infarction, the second is Wallenberg's syndrome i.e. lateral medullary infarction. Simultaneously we are to investigate the oriental medical approach in the bran stem infarctions.

• Annals of Clinical Neurophysiology
• /
• v.7 no.2
• /
• pp.75-79
• /
• 2005

Vestibular evoked myogenic potentials (VEMP) have been known to useful in documenting abnormality in patients with various vestibular disorders but the studies of VEMP in stroke patients are rare. We recorded VEMP in 17 consecutive patients with acute ischemic stroke in the brainstem lesions. All patients underwent magnetic resonance imaging and we compare VEMP results with the lesion documented by brain imaging. VEMP were defined to be abnormal when they were very asymmetrical (one is 2 times of more as large as the other), or absent in one side. VEMP abnormalities were found in 71%(12/17) of acute infarction patients with brainstem lesions. Most abnormalities found in the ipsilateral side of the lesion(9/12) but abnormalities in contralateral side of lesion were found in 25%(3/12) of patients.VEMP would be considered a useful complementary neurophysiological tool for the evaluation of brainstem dysfunction in acute stroke patients.

• Annals of Clinical Neurophysiology
• /
• v.8 no.1
• /
• pp.53-57
• /
• 2006

Background: Vstibular evoked myogenic potentials(VEMP) have been known to be useful documenting abnormality in patients with various vestibular disorders and brainstem lesions but the studies of VEMP in patients with hemispheric lesions are rare. Methods: We recorded VEMP in 21 consecutive patients with acute ischemic stroke in the supratentorial lesions without evidence of brainstem or vestibular end organ lesions. All patients underwent magnetic resonance imaging and the main outcome measures of VEMP were recorded in all subjects. We interpreted each parameters of VEMP using our normal laboratory data. Results: VEMP abnormalities(prolonged latency or asymmetry of amplitude) were found in 57%(12/21) of acute infarction patients with supratentorial lesions. Bilateral VEMP abnormalities were found in six patients and unilateral abnormalities were found in another six patients with ipsilateral abnormalities in the three and controlateral abnormalities in the three patients. Conclusions: VEMP abnormalities were found in supratentorial stroke patients in our studies and this findings suggest supranuclear control may affect the generation of VEMP potentials.

• Annals of Clinical Neurophysiology
• /
• v.7 no.1
• /
• pp.20-21
• /
• 2005

Myoclonus may originate from the cerebral cortex, subcortical structures, brainstem, spinal cord or peripheral nerve. But unilateral upper limb myoclonus related to cortical infarct is an unusual clinical picture. We report a 67-year-old man presented with myoclonus, associated with primary motor cortex infarction.

• Journal of Electrodiagnosis and Neuromuscular Diseases
• /
• v.20 no.2
• /
• pp.144-147
• /
• 2018

Although dysgeusia can occur as a consequence of stroke attacks, many physicians and patients tend to overlook it. A 50-year old woman complained of a 2-week history of abnormal sense of taste on the anterior two-thirds of right tongue. Blink reflex test demonstrated prolonged ipsilateral and contralateral R2 responses with the right supraorbital nerve stimulations, which suggest the lesion on the descending pathway. Brainstem magnetic resonance imaging (MRI) demonstrated abnormal findings in the right lower dorsal pons, anterior to 4th ventricle, lateral to inferior colliculus, and at the level of the pontomedullary junction, which was compatible with solitary tract nucleus and spinal trigeminal nucleus. Brainstem infarction should be considered in patients who have abnormal sense of taste. Additionally, blink reflex test may be helpful for the detection of central origin dysgeusia.

• Journal of Oriental Neuropsychiatry
• /
• v.12 no.1
• /
• pp.219-229
• /
• 2001

The brainstem include midbrain, pons & medulla. In acute stage of brainstem infarction, neurologic symptoms may be progressive. So we must pay special attention to Wallenberg's syndrome. In other words, Wallenberg's syndrome is dorsolateral medullary syndrome. A-54-years-old woman was admitted because of vertigo, ataxia & somatic sensory loss of left face and right half-body. Brain MRI showed high SI in T2W, low SI in T1W lesion left medullary infarction. We diagnosed the case as Shin-heo type Oriental medically and prescribed Gihwangemjakamibang. Diabetes mellitus was found out. So We have controlled diabetes mellitus by Occidental medical therapy. In the end, The symptoms of the patient became better. We know that cooperative(oriental & occidental) medical therapy is better than one medical therapy.Here we present one case of Wallenberg's syndrome who was admitted at Kunpo Wonkwang University Hospital Oriental Neuropsychiatry from 14th March to 6th April. 2001.

• Journal of Korean Neurosurgical Society
• /
• v.39 no.4
• /
• pp.277-280
• /
• 2006

Objective : The aim of this study is to determine which patients with progressively deteriorating acute cerebellar infarction would benefit from surgical treatment and which surgical procedure would best benefit them. Methods : Seventy six patients were treated at our hospital for cerebellar infarction over the past 3 years. Sixty nine patients received conservative management in the neurological department of our hospital. Among them, 7 patients [5 males and 2 females; average age, 49 yrs] were referred to neurosurgical department because of mental deterioration and underwent emergency surgery. Five patients underwent external ventricular drainage with suboccipital craniectomy and two patients underwent suboccipital craniectomy alone. Results : Of the 7 surgically treated patients, 4 patients experienced good recovery and 2 patients experienced moderate disability [disabled but independent] and 1 patient experienced severe disability [conscious but disabled]. There was no death. Conclusion : In patients conservatively treated for cerebellar infarction and showing mental deterioration and radiologically evident brainstem compression and ventricular enlargement, we strongly recommend suboccipital craniectomy [plus optional external ventricular drainage in case of showing hydrocephalus] as a first treatment option.

• The Journal of Internal Korean Medicine
• /
• v.40 no.2
• /
• pp.254-261
• /
• 2019

Internuclear Ophthalmoplegia (INO) is characterized by lesion side eye's adduction limitation in lateral horizontal gaze and nystagmus in the abducting eye due to lesions in the Medial Longitudinal Fasciculus (MLF). Brainstem infarction is one of the causes of INO, but related issues have seldom been reported in the Korean medical literature. The present case was a pontine infarction patient with INO who complained of diplopia and eye movement disorder. The patient was treated with Korean medicine treatment, including herbal medicine, acupuncture, cupping, and moxibustion for 30 days. Her changes in clinical symptoms were measured with a Numeric Rating Scale (NRS) and a length of External Ocular Movement (EOM), in which the patient's right eyeball moved to the left from the midline in the left gaze. After treatment, her clinical symptoms were improved. Diplopia decreased from NRS 10 to NRS 2, and eye movement disorder was improved such that EOM increased from 1mm to 5 mm. Therefore, integrative Korean medicine treatment may be effective in the treatment of INO patients caused by pontine infarction.

• Journal of Korean Neurosurgical Society
• /
• v.46 no.3
• /
• pp.221-225
• /
• 2009

Objective : Surgical treatment of posterior inferior cerebellar artery (PICA) aneurysms is challenging due to limited surgical accessibility. Endovascular approach has a benefit of avoiding direct injury to the brainstem or lower cranial nerves. Therefore, it has recently been considered an alternative or primary modality for PICA aneurysms. We retrospectively assessed outcomes following detachable coil embolization of saccular PICA aneurysms. Methods : From February 1997 to December 2007, we performed endovascular procedures to treat 15 patients with 15 PICA aneurysms. Fourteen patients with 14 PICA aneurysms morphology of which was saccular were reviewed retrospectively. Twelve patients had ruptured aneurysms. The aneurysms arose from the PICA origin site (n=12), the PICA lateral medullary segment (n=1), or the PICA tonsilomedullary segment (n=1). Results : Complete aneurysm occlusion was achieved in 10 patients, residual neck in 3, and residual sac in one. Radiological follow-up was performed in 7 patients with mean duration of 34.7 months (range, 1-97 months) and showed stable or complete occlusion in 6 patients. There were no rebleeding or retreatment after endovascular treatment. Thromboembolism was the only procedure-related complication (n=4 ; 28.6%). Asymptomatic PICA infarction occurred in two patients and symptomatic PICA infarction in two elderly patients with poor clinical grade. Of these procedural PICA infarction cases, 1 symptomatic PICA infarction patient developed ventriculitis and septic shock leading to death. The clinical outcome was good in 10 patients (71.4%). Conclusions : In the present study, detachable coil embolization has shown as an efficient modality for PICA saccular aneurysms challenging indications of microsurgery. However, thromboembolic complications should be considered, especially in poor clinical elderly patients with ruptured aneurysms.

• Journal of Physiology & Pathology in Korean Medicine
• /
• v.19 no.5
• /
• pp.1450-1455
• /
• 2005

Tremor is an most common abnormal movements disease which is to-and-fro shaking. It is caused by problems -with the nerves supplying certain muscles. It can affect the whole body or just certain areas. Parkinson's disease, Brain disease like injury of Frontal lobe, Cerebellum and Brainstem, drug and alcohol caused this symptom. It could be occured by physiological and Essential cause. In this paper, authors report three cases who showed tremor after Cerebral infarction. And we suggest that 'Ssanghwa-Tang' should be helpful for tremor patients.