The majority of neurocritically ill patients have disorders of consciousness. Both level and content of consciousness should be assessed repeatedly throughout the course of patient care. In this review, we describe the definition and diagnostic criteria for disorders of consciousness, and the neurological examination and standardized neurobehavioral assessment tools as methods of assessing consciousness. Next, we will discuss neurophysiological and neuroimaging tests as tools for assessing consciousness: automated quantitative pupillometry, electroencephalogram, evoked potentials, brain imaging, functional near-infrared spectroscopy, and biomarkers. We discuss the clinical utility of each assessment tool and the importance of a multimodal approach in the diagnosis, treatment, and prognostication of disorders of consciousness.
{"title":"Approaches to Consciousness Assessment in Neurocritically Ill Patients","authors":"Dong-Wan Kang, Tae Jung Kim","doi":"10.17340/jkna.2024.0018","DOIUrl":"https://doi.org/10.17340/jkna.2024.0018","url":null,"abstract":"The majority of neurocritically ill patients have disorders of consciousness. Both level and content of consciousness should be assessed repeatedly throughout the course of patient care. In this review, we describe the definition and diagnostic criteria for disorders of consciousness, and the neurological examination and standardized neurobehavioral assessment tools as methods of assessing consciousness. Next, we will discuss neurophysiological and neuroimaging tests as tools for assessing consciousness: automated quantitative pupillometry, electroencephalogram, evoked potentials, brain imaging, functional near-infrared spectroscopy, and biomarkers. We discuss the clinical utility of each assessment tool and the importance of a multimodal approach in the diagnosis, treatment, and prognostication of disorders of consciousness.","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"20 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141051341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Saccade: Bedside Examination and Interpretation","authors":"H. Lee, In-Young Lee, Seong-Hae Jeong","doi":"10.17340/jkna.2024.0017","DOIUrl":"https://doi.org/10.17340/jkna.2024.0017","url":null,"abstract":"","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"18 21-22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141053734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vogt-Koyanagi-Harada (VKH) disease is a multisystem inflammatory disease that occurs when body tissues including melanocytes are damaged by autoimmunity. The typical symptoms of VKH are bilateral multifocal uveitis and serous retinal detachment. Our patient was misdiagnosed as idiopathic intracranial hypertension because there were no other characteristic neurological symptoms other than bilateral optic disc edema. However, intracranial pressure was normal and pleocytosis was found, so VKH disease could be diagnosed. Bilateral optic disc edema may be a initial manifestation of VKH disease.
{"title":"Vogt-Koyanagi-Harada Disease Presented with Bilateral Optic Disc Edema","authors":"Jae Han Park","doi":"10.17340/jkna.2023.0092","DOIUrl":"https://doi.org/10.17340/jkna.2023.0092","url":null,"abstract":"Vogt-Koyanagi-Harada (VKH) disease is a multisystem inflammatory disease that occurs when body tissues including melanocytes are damaged by autoimmunity. The typical symptoms of VKH are bilateral multifocal uveitis and serous retinal detachment. Our patient was misdiagnosed as idiopathic intracranial hypertension because there were no other characteristic neurological symptoms other than bilateral optic disc edema. However, intracranial pressure was normal and pleocytosis was found, so VKH disease could be diagnosed. Bilateral optic disc edema may be a initial manifestation of VKH disease.","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"27 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141031130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Seungwon Chung, Ji-Yoon Lee, Soyoon Im, Chan Young Lee, Geon Ha Kim
Sjögren’s syndrome (SS) is an autoimmune disease in which lymphocytes invade salivary and tear glands, leading to dry mouth and dry eyes. It is also associated with extraglandular manifestations. The most frequently reported neurological extraglandular manifestations are sensory polyneuropathies. Movement disorders have been reported in only 2% of primary SS patients. In this case, we present a case of primary SS initially manifesting as generalized chorea, which was initially misdiagnosed as tardive dyskinesia.
斯约格伦综合征（SS）是一种自身免疫性疾病，淋巴细胞侵入唾液腺和泪腺，导致口干和眼干。它还伴有腺外表现。最常见的神经系统腺外表现是感觉性多发性神经病。仅有 2% 的原发性 SS 患者出现运动障碍。在本病例中，我们介绍了一例最初表现为全身舞蹈症的原发性 SS 患者，该患者最初被误诊为迟发性运动障碍。
{"title":"Primary Sjögren’s Syndrome Presenting with Dyskinesia","authors":"Seungwon Chung, Ji-Yoon Lee, Soyoon Im, Chan Young Lee, Geon Ha Kim","doi":"10.17340/jkna.2023.0106","DOIUrl":"https://doi.org/10.17340/jkna.2023.0106","url":null,"abstract":"Sjögren’s syndrome (SS) is an autoimmune disease in which lymphocytes invade salivary and tear glands, leading to dry mouth and dry eyes. It is also associated with extraglandular manifestations. The most frequently reported neurological extraglandular manifestations are sensory polyneuropathies. Movement disorders have been reported in only 2% of primary SS patients. In this case, we present a case of primary SS initially manifesting as generalized chorea, which was initially misdiagnosed as tardive dyskinesia.","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"34 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141050794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Magnetic Resonance Imaging of Brain Injury after Attempted Hanging","authors":"Young-Mok Song","doi":"10.17340/jkna.2023.0084","DOIUrl":"https://doi.org/10.17340/jkna.2023.0084","url":null,"abstract":"","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"22 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141058308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Determination of Brain Death in Ethical Approach","authors":"Jin Park","doi":"10.17340/jkna.2024.0020","DOIUrl":"https://doi.org/10.17340/jkna.2024.0020","url":null,"abstract":"","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"16 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141024809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yujin Song, Hwajin Choi, Yunyoung Choi, Hyunkyum Cho, Dongyu Kim, Yo Han Jung
Herpes simplex encephalitis is known to cause intracranial hypertension and cerebral edema. When cerebral edema occurs, venous sinuses are compressed, resulting in congestion and thrombosis. An arteriovenous fistula may form as a result, particularly in conjunction with superior sagittal sinus thrombosis. In this report, the authors describe a patient with protein S and C deficiency who developed venous sinus thrombosis and dural arteriovenous fistula after experiencing herpes simplex encephalitis.
众所周知，单纯疱疹性脑炎会导致颅内高压和脑水肿。脑水肿发生时，静脉窦受压，导致充血和血栓形成。动静脉瘘可能会因此而形成，尤其是在上矢状窦血栓形成的情况下。在本报告中，作者描述了一名患有蛋白 S 和 C 缺乏症的患者，在经历了单纯疱疹性脑炎后，出现了静脉窦血栓和硬脑膜动静脉瘘。
{"title":"Venous Sinus Thrombosis and Dural Arteriovenous Fistula after Herpes Simplex Encephalitis in a Patient with Protein S, Protein C Deficiency","authors":"Yujin Song, Hwajin Choi, Yunyoung Choi, Hyunkyum Cho, Dongyu Kim, Yo Han Jung","doi":"10.17340/jkna.2023.0093","DOIUrl":"https://doi.org/10.17340/jkna.2023.0093","url":null,"abstract":"Herpes simplex encephalitis is known to cause intracranial hypertension and cerebral edema. When cerebral edema occurs, venous sinuses are compressed, resulting in congestion and thrombosis. An arteriovenous fistula may form as a result, particularly in conjunction with superior sagittal sinus thrombosis. In this report, the authors describe a patient with protein S and C deficiency who developed venous sinus thrombosis and dural arteriovenous fistula after experiencing herpes simplex encephalitis.","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"42 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141044919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Klebsiella pneumoniae Meningoencephalitis and Ventriculitis Originated from Renal Abscess in an Immunocompetent Patient","authors":"Ho Kyu Kim, Min Ji Song, Ji Hye Shin, Ji Hyun Kim","doi":"10.17340/jkna.2023.0088","DOIUrl":"https://doi.org/10.17340/jkna.2023.0088","url":null,"abstract":"","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"8 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141042273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Da Eun Nam, Seon Hyeok Hwang, Jun Yeop Yim, Byung-Ok Choi, Ki Wha Chung
Background: Charcot-Marie-Tooth disease type 1A (CMT1A) is caused by duplication of the 17p12 region including PMP22 gene. In CMT1A patients, anticipation showing increased severity by generations has been reported in the CMT1A patients. It has also been reported that severity increases in the non-de novo cases than in the de novo cases. This study was performed to examine epigenetic differences between CMT1A cases and controls as well as between de novo cases and non-de novo cases.Methods: This study examined 40 Korean CMT1A patients and 11 controls. Methylation level was determined using the SureSelect XT Methyl-Seq reagent kit and bisulfite sequence mapping program.Results: Many differentially methylated CpG sites (DMCs) were identified in the comparisonbetween cases and controls and between de novo cases and non-de novo cases. Most DMCs were located within or nearby genes related to the nervous system, mental stress, and motor ability.Conclusions: This study is the first epigenetic study to uncover the mechanism of clinical heterogeneity among CMT1A patients. We suggest that weak severity in the de novo cases than the non-de novo cases may be related to the epigenomic differences in the nerve and stress-related genes.
{"title":"Comparative Analysis on Methylation Levels of Nerve and Stress Related Genes in Charcot-Marie-Tooth Disease Type 1A Patients","authors":"Da Eun Nam, Seon Hyeok Hwang, Jun Yeop Yim, Byung-Ok Choi, Ki Wha Chung","doi":"10.17340/jkna.2023.0076","DOIUrl":"https://doi.org/10.17340/jkna.2023.0076","url":null,"abstract":"Background: Charcot-Marie-Tooth disease type 1A (CMT1A) is caused by duplication of the 17p12 region including PMP22 gene. In CMT1A patients, anticipation showing increased severity by generations has been reported in the CMT1A patients. It has also been reported that severity increases in the non-de novo cases than in the de novo cases. This study was performed to examine epigenetic differences between CMT1A cases and controls as well as between de novo cases and non-de novo cases.Methods: This study examined 40 Korean CMT1A patients and 11 controls. Methylation level was determined using the SureSelect XT Methyl-Seq reagent kit and bisulfite sequence mapping program.Results: Many differentially methylated CpG sites (DMCs) were identified in the comparisonbetween cases and controls and between de novo cases and non-de novo cases. Most DMCs were located within or nearby genes related to the nervous system, mental stress, and motor ability.Conclusions: This study is the first epigenetic study to uncover the mechanism of clinical heterogeneity among CMT1A patients. We suggest that weak severity in the de novo cases than the non-de novo cases may be related to the epigenomic differences in the nerve and stress-related genes.","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"6 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141024228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Although electroencephalography is known as non-invasive, long-term electroencephalography monitoring has a significant risk of pressure ulcers caused by electrodes. We investigated the incidence and risk factors of pressure ulcers in long-term electroencephalography monitoring for more than 24 hours.Methods: All patients who underwent long-term electroencephalography monitoring for more than 24 hours from January 2020 to December 2021 were reviewed. Their medical records were reviewed to evaluate the risk factors for pressure ulcers by electroencephalography electrodes. All patients were divided into the presence (lesion positive) and absence (lesion negative) of pressure ulcers confirmed by a clinician.Results: A total of 541 patients were analyzed in this study. Their mean age was 56.0±21.5, and the average duration of the long-term electroencephalography monitoring was 118.0±68.6 hours. Pressure ulcers were identified in 49 patients (9.1%). The odds ratios of age and recording time were 1.032 (95% confidence interval [CI], 1.008-1.056, p=0.009) and 1.022 (95% CI, 1.015-1.029, p<0.001), respectively. The odds ratio of pressure ulcer was 2.702 (95% CI, 1.461-4.999, p=0.002) in patients with comatose mentality (1 point for eye response of Glasgow coma scale).Conclusions: The pressure ulcers caused by electrodes in long-term electroencephalography monitoring can be preventable with due diligence in clinical settings. Risk factor control to prevent pressure ulcers due to electroencephalography electrodes is needed.
{"title":"Risk Factors for Pressure Ulcer by Electrodes in Long-term Electroencephalography Monitoring","authors":"Keuntae Kim, Yong-won Cho","doi":"10.17340/jkna.2023.0029","DOIUrl":"https://doi.org/10.17340/jkna.2023.0029","url":null,"abstract":"Background: Although electroencephalography is known as non-invasive, long-term electroencephalography monitoring has a significant risk of pressure ulcers caused by electrodes. We investigated the incidence and risk factors of pressure ulcers in long-term electroencephalography monitoring for more than 24 hours.Methods: All patients who underwent long-term electroencephalography monitoring for more than 24 hours from January 2020 to December 2021 were reviewed. Their medical records were reviewed to evaluate the risk factors for pressure ulcers by electroencephalography electrodes. All patients were divided into the presence (lesion positive) and absence (lesion negative) of pressure ulcers confirmed by a clinician.Results: A total of 541 patients were analyzed in this study. Their mean age was 56.0±21.5, and the average duration of the long-term electroencephalography monitoring was 118.0±68.6 hours. Pressure ulcers were identified in 49 patients (9.1%). The odds ratios of age and recording time were 1.032 (95% confidence interval [CI], 1.008-1.056, p=0.009) and 1.022 (95% CI, 1.015-1.029, p<0.001), respectively. The odds ratio of pressure ulcer was 2.702 (95% CI, 1.461-4.999, p=0.002) in patients with comatose mentality (1 point for eye response of Glasgow coma scale).Conclusions: The pressure ulcers caused by electrodes in long-term electroencephalography monitoring can be preventable with due diligence in clinical settings. Risk factor control to prevent pressure ulcers due to electroencephalography electrodes is needed.","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"46 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141043562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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