Journal of Clinical Neurology (Seoul, Korea)最新文献

{"title":"Exercise Headache Associated With an Arteriovenous Fistula of the External Carotid Artery.","authors":"Kyusik Kang, Jae Hoon Kim, Byung-Kun Kim","doi":"10.3988/jcn.2022.18.1.93","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.1.93","url":null,"abstract":"Dear Editor, Exercise headache is a headache provoked by exercise or exertion.1 Symptomatic causes of exercise headache include subarachnoid hemorrhage, arterial dissection, reversible cerebral vasoconstriction syndrome, and, less commonly, space-occupying lesions, sinusitis, Chiari malformation, and pheochromocytoma.1 We report a patient with recurrent exercise-induced and coital headaches associated with an arteriovenous fistula between the external carotid artery and the external jugular vein. A 27-year old male presented with a 15-year history of severe left occipital headaches induced by physical exercise (e.g., anaerobic leg exercises at a gym) and a 3-year history of headaches during coitus. The exercise-induced headaches peaked within 10 minutes, and then subsided over a couple of hours. He described a left occipital throbbing without associated nausea or light or noise sensitivity. The intensity was 8/10 at about 10 minutes after the onset. The headaches during coitus increased with the degree of sexual excitement. Coughing and other Valsalva (straining) maneuvers did not provoke the headache. These headache attacks occurred over periods lasting 2 to 3 weeks, separated by pain-free periods lasting 6 months or longer. There was no history of neck trauma or surgery. The patient visited his nearest hospital and was started on nortriptyline, which was not effective at preventing the headaches; however, they did respond to acetaminophen. He underwent brain magnetic resonance (MR) imaging, which produced normal findings. However, computed tomography (CT) angiography of the head and neck demonstrated an arteriovenous fistula between the left external carotid artery and the left external jugular vein (Fig. 1A). He visited our hospital for a second opinion, where he underwent conventional angiography, which confirmed the fistula (Fig. 1B and C). Coil embolization was performed, and the final conventional angiography showed no residual filling of the fistula (Fig. 1D). He was followed up for 2.5 years, during which he was free of exercise-induced and coital headaches. Most arteriovenous fistulas in the head and neck region occur as a result of trauma, iatrogenic injury, or extensive infection of the neck. Congenital arteriovenous fistulas between the external carotid artery and jugular vein are rare, and they are characterized by symptoms and signs such as pulsatile mass, pulsatile tinnitus, facial pain, vertigo, and dyspnea.2,3 It is not clear why the carotid–jugular fistula caused the exercise headaches in the present case. Halbach et al.4 investigated six patients with arteriovenous fistulas of the internal maxillary artery, and found that the most common initial symptom was bruit, which was exacerbated by exercise. Two theories on the pathophysiology of secondary exercise headache in our patient may be proposed. First, increased blood pressure during exercise may result in venous or arterial distension, which may cause engorgement of the arter","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"93-95"},"PeriodicalIF":3.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1c/b5/jcn-18-93.PMC8762513.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39904198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extensive Medullo-Cervicothoracic Lesion in Acute Lymphoblastic Leukemia.","authors":"Mitsuko Nakajima, Mathilde Pauls, Sanjeev Rajakulendran","doi":"10.3988/jcn.2022.18.1.105","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.1.105","url":null,"abstract":"Dear Editor, The etiology of longitudinal spinal cord lesions includes inflammation, vascular causes, and malignancy. Acute leukemia in the spinal cord has been reported previously, but it usually only presents with constitutional symptoms and peripheral evidence of the disease. We report a case of leukemia presenting initially as spinal cord disease with imaging revealing a longitudinally extensive medullo-cervicothoracic lesion. A 73-year-old female presented with subacute progressive weakness in her arms and legs, numbness in her hands, and sphincteric disturbance over several weeks, which occurred during a lockdown period due to the coronavirus crisis in early 2020. She reported no bulbar symptoms or pain. She was systemically well with no history of fevers, weight loss, night sweats, recurrent infections, or bruising. Her breathing was unaffected. Her past medical history consisted of type 2 diabetes mellitus, hypothyroidism, squamous cell carcinoma, and lumbar spinal fusion. Salient findings in a neurological examination were asymmetric quadriparesis (left>right), spasticity, and hyperreflexia. There were no abnormal cranial nerve signs. A systemic examination produced unremarkable findings. Magnetic resonance imaging (MRI) of the neuraxis revealed a longitudinally extensive lesion that began at the level of the lower medulla and terminated at T3 (Fig. 1). The lesion exhibited heterogeneous enhancement after administering a contrast agent. The spinal cord appeared swollen, particularly in the cervical region. The differential diagnosis included an inflammatory etiology, malignancy, and a high-level (intracranial/cervicomedullary) arteriovenous fistula, which was less likely but still thought worthy of consideration. The findings of head MRI with contrast agent were normal. Screening blood tests demonstrated only a slightly elevated white blood cell count (13.4× 109/L), with no anemia and normal inflammatory markers. Screening revealed negativity for autoantibodies (including anti-aquaporin-4 and anti-myelin oligodendrocyte glycoprotein antibodies). A cerebrospinal fluid (CSF) examination identified a white blood cell count of 3/mL, elevated protein at 0.94 g/L, normal glucose, and matched oligoclonal bands with isoelectric focussing. The CSF and serum IgG index was 1.53. The presence of lymphoblasts in the CSF was suggestive of acute leukemia, most probably of B-lymphoid lineage, supported by demonstration of CD45-CD34+CD19+CD10blasts in CSF flow cytometry. Fluorodeoxyglucose positron-emission tomography did not demonstrate abnormal uptake in the bone marrow (BM). BM aspirate showed normal lymphocyte numbers and morphology, and the absence of lymphoblasts. Flow cytometry revealed a small population of phenotypically abnormal B cells, with CD45+CD34+CD38loCD19+CD10+sIg+ (lambda restricted) that accounted for 0.21% BM cellularity. The abnormal cells in CSF were CD45-, indicative of a precursor status. This was distinguished from primary CNS l","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"105-107"},"PeriodicalIF":3.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/af/f8/jcn-18-105.PMC8762490.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39904201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons from COVID-19 in Clinical Neurology.","authors":"Jin-Woo Park, Byung-Jo Kim","doi":"10.3988/jcn.2022.18.1.1","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.1.1","url":null,"abstract":"COVID-19 has had a considerable impact on society. One negative impact of this disease is the neurological dysfunctions that can result from SARS-CoV-2 infection, in addition to respiratory problems. One in 20 patients with COVID-19 complains of neurological complications,1 but whether COVID-19 provokes or triggers neurological problems remains unclear. There is a need for thorough research into the correlation between COVID-19 and neurological disorders. Before feasible research methods are set up, the only way to evaluate the causal relationship would be to carefully examine the temporal relationships between COVID-19 infection and neurological complications based on the accumulated clinical data. Since the COVID-19 outbreak, the Journal of Clinical Neurology (JCN) has published several reports related to COVID-19, including two original articles. The first report in JCN was a case report of recurrent transient ischemic attack in a 47-yearold male with COVID-19 who did not have risk factors related to stroke.2 He experienced transient symptoms with left-side weakness and amaurosis fugax at 5 days after being admitted to hospital due to COVID-19. Another case report was also a patient with ischemic stroke associated with endocarditis of unknown origin after COVID-19.3 There have been increasing concerns regarding acute stroke related to COVID-19. Although this association remains controversial, clinical evidence for it is accumulating. A meta-analysis suggested a relatively high mortality rate and a considerable number of antiphospholipid-antibody-positive cases in acute ischemic stroke patients with COVID-19 infection.4 A review article introduced angiotensin-converting enzyme-2 (ACE2) downregulation as a possible pathomechanism of COVID-19-related acute ischemic stroke, which may augment the vasoconstrictor effect of angiotensin II and eliminate the protective role of ACE2 in the cardiovascular and cerebrovascular systems. It is particularly interesting that the surface spike protein on the SARS-CoV-2 virus may bind to ACE2 receptors on platelets, triggering their activation and aggregation, which may play a harmful role in ischemic stroke. Although the incidence of stroke is not particularly high in COVID-19 patients, clinicians should be aware of this possibility. In addition to its pathological effects, COVID-19 also significantly impacts the healthcare system. The process and outcomes of recanalization therapy for ischemic stroke changed during the COVID-19 era in the Republic of Korea,5 because of prehospital delays and decreased opportunities for adequate rehabilitation before and after recanalization therapy. This is probably due to patients being more reluctant to visit a hospital, the presence of many safety processes for COVID-19 protection, and the reduced capacity of hospitals due to large numbers of COVID-19 patients. Indeed, the abrupt increase in patient numbers and the inability to accept critical patients in facilities have be","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"1-2"},"PeriodicalIF":3.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7b/ae/jcn-18-1.PMC8762498.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39814302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ramsay Hunt Syndrome Presenting as Acute Unilateral Combined Peripheral and Central Vestibulopathies.","authors":"Jae-Myung Kim, Kyung Wook Kang, Hyong-Ho Cho, Man-Seok Park, Seung-Han Lee","doi":"10.3988/jcn.2022.18.1.108","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.1.108","url":null,"abstract":"Dear Editor, A previously healthy 68-year-old female presented with spontaneous spinning vertigo with a 10-day history. She had been treated with intravenous acyclovir for 10 days before the onset of vertigo under a diagnosis of Ramsay Hunt syndrome (RHS). She denied otologic symptoms including hearing loss. The initial neurologic examinations revealed right-sided peripheral facial paralysis and spontaneous left-beating nystagmus (Fig. 1A). However, the direction of nystagmus shifted to the right side while looking toward the right, which suggested gazeevoked nystagmus (GEN) (Fig. 1A). Skew deviation was absent, but prominent right-sided veering tendency without limb ataxia was noted. Bedside head impulse tests (HITs) revealed abnormal catch-up saccades (CS) in the right. Bithermal caloric testing demonstrated right-canal paresis. However, video HITs showed decreases in the vestibulo-ocular reflex (VOR) gains in all six semicircular canals, with rightsided predominance (Fig. 1B and C). Cervical and ocular vestibular-evoked myogenic potentials were not observed when stimulating the right ear. Pure-tone audiometry was normal. GEN, bilateral abnormalities in video HITs, and severe prolonged vertigo with prominent imbalance were suggestive of a central vestibulopathy. Gadolinium-enhanced brain magnetic resonance imaging (MRI) revealed enhanced lesions in the brainstem (Fig. 1D-G). Therefore, a presumptive diagnosis of RHS with brainstem involvement was made based on the clinical and neuroradiologic findings. The addition of intravenous administration of dexamethasone and acyclovir for 7 days improved all of the symptoms except the facial paralysis. Patients with RHS often suffer from severe vertigo and/or otologic symptoms since the vestibulocochlear nerve is the most frequently involved cranial nerve.1,2 Accordingly, patients with RHS and vertigo typically present with acute peripheral vestibulopathy. However, RHS can be complicated by rare but serious central vestibular disorders involving the brainstem and/or cerebellum.3,4 Identifying central signs was essential for the correct diagnosis in our patient because she required additional treatment after discerning the central lesion.1 Our patient demonstrated clinical and laboratory features of combined peripheral and central vestibulopathies. A previous study of the etiologies and diagnoses of 55 patients with combined peripheral and central vestibulopathies identified only 1 case of RHS.4 That patient exhibited GEN as a central sign and other presentations consistent with unilateral peripheral vestibulopathy, but brain MRI was normal, in contrast to our case. There have been few studies of the neuro-otologic and vestibular evaluations in RHS with brainstem involvement.1 Dissociation in the VOR between different stimulation frequencies could be a significant feature of combined vestibulopathy.4 Our patient showed ipsilesional (unilateral) canal paresis in the caloric test (low-frequency VOR), but bi","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"108-110"},"PeriodicalIF":3.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e4/0b/jcn-18-108.PMC8762492.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39904202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autoimmune Encephalitis as an Adverse Event of COVID-19 Vaccination.","authors":"Hye-Rim Shin, Baik-Kyun Kim, Soon-Tae Lee, Aryun Kim","doi":"10.3988/jcn.2022.18.1.114","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.1.114","url":null,"abstract":"","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"114-116"},"PeriodicalIF":3.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1c/62/jcn-18-114.PMC8762504.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39904204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRI Negative Myelitis Induced by Pfizer-BioNTech COVID-19 Vaccine.","authors":"Gonçalo Cabral, Carolina Gonçalves, Filipa Serrazina, Francisca Sá","doi":"10.3988/jcn.2022.18.1.120","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.1.120","url":null,"abstract":"Dear Editor, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified in 2019 and is the causative agent of the worldwide Coronavirus disease 2019 (COVID-19) pandemic, which is associated with substantial mortality.1,2 The Pfizer-BioNTech COVID-19 vaccine was the first approved vaccine that exhibited 95% effectiveness against COVID-19.1,3 Although rare post vaccination neurological complications are well described.4 Here, we report a case of a male with transverse myelitis (TM) after receiving the second dose of the Pfizer-BioNTech COVID-19. A 33-year-old male presented with 2 weeks of progressive weakness of the lower limbs. The complaints started 2 days after receiving his second dose of the Pfizer-BioNTech COVID-19. For the first 2 days he found it very difficult to walk, and he also noticed the sensation of incomplete emptying of the bladder and nocturnal low back pain. He did not have any relevant past medical history. He denied a history of infection or previous systemic complaints, illicit drug use, recent medications, travels, or any other epidemiological context. Since the symptoms persisted, he was admitted to the emergency room for evaluation. The neurological examination revealed mild paraparesis with a proximal muscle strengths of 4+ and 4 in the left and right legs, respectively. The Achilles reflexes were more brisk than the others. Superficial cutaneous-abdominal reflexes were absent and plantar reflexes were equivocal. There was a decreased thermic sensation below the T12 dermatomal level. An extensive workup evaluation was performed. Laboratory results (including autoimmune and infectious serologies, including for COVID-19) were negative. The findings of cervical, thoracic, and lumbar spine magnetic resonance imaging (MRI) were unremarkable (Fig. 1A, B and C). Additional brain MRI (Fig. 1D, E and F) did not produce any clinically relevant findings. A CSF study showed mononucleated pleocytosis (24 cells) and mild hyperproteinorrhachia (56 mg/dL). CSF bacteriological cultures and PCR for neurotropic virus and Borrelia burgdorferi were negative. There was slight cerebral barrier function disorder, but the oligoclonal bands were negative. The symptoms of the patient gradually reduced without additional treatment, and he became asymptomatic, after 3 months of follow-up. We report a case of a male who experienced a monophasic transitory neurological dysfunction compatible with TM after receiving the second dose of the Pfizer-BioNTech COVID-19 vaccine. Although no lesions were visible in spine MRI (note that imaging performed during the convalescent phase can miss a cord lesion5), there was a demonstration of CSF inflammation. Additionally, other possible etiologies (compressive, acute SNC infection, primary demyelinating diseases, malignancy, or systemic autoimmune) were excluded. The patient’s clinical course was favorable and there was no need for any kind of treatment. TM is a rare immune-mediated process that re","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"120-122"},"PeriodicalIF":3.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/36/51/jcn-18-120.PMC8762507.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39904206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tracking Multifocal Epilepsy With Automated Electric Source Imaging in a Patient With Triple-X Syndrome.","authors":"Markus Gschwind, Barbora Zima, Krassen Nedeltchev, Pieter van Mierlo, Stephan Rüegg","doi":"10.3988/jcn.2022.18.1.96","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.1.96","url":null,"abstract":"Dear Editor, Pharmacoresistant epilepsy with polymorphic behavior remains a great challenge in clinical epileptology. Here we present a 20-year-old female with triple-X syndrome who was admitted because of variable seizures and the suspicion of nonepileptic events. Absences with deep breathing, wagging of the left arm, yawning, nausea, aggressiveness, and amnesia were replaced by turning the head to the left, stretching the left arm, and bending the right arm (“figure-of-4 sign”), followed by confusion. Similar seizures occurred up to seven times per day on up to 20 days per month, resulting in numerous consultations at the emergency department. Tonic-clonic seizures had occurred during her 3rd year of life, and at 8 years old she started to also show focal nonaware cognitive seizures, sometimes with bilateral spread. At that time, several routine electroencephalography (EEG) recordings revealed a right, paracentral epileptic focus. Valproic acid (1,500 mg daily) resulted in a seizure-free period of 6 years, but this had to be discontinued due to weight gain and hirsutism, and was subsequently changed to levetiracetam (2,000 mg daily), lamotrigine (100 mg daily), and lacosamide (200 mg daily), which failed to control the seizures and increased behavioral problems. Brain magnetic resonance imaging (MRI) findings were normal. The patient underwent long-term overnight video-EEG with a 25-channel montage (2017 IFCN guidelines), which revealed several epileptogenic foci with sharp waves in the right inferotemporal (T10–F10) region, in the right central region at C4–P4, and in the left central region (C3–P3) (Fig. 1A-C). We then ran the fully automatic EPILOG PreOp algorithm (Epilog NV, Ghent, Belgium) in order to quantify the interictal epileptic discharges and localize their electric source according to the patient’s own brain anatomy (Fig. 1D-F). To this end, we used the full 88-hour-long low-density EEG track together with the patient’s own 3-T magnetization prepared rapid gradient echo MRI scan, allowing for an anatomical head model with six tissue compartments (gray matter, white matter, CSF, skull, air cavities, and scalp). The electrode positions were estimated by calculating distances over the head after marking specific landmarks such as the inion, nasion, and auricular points.1,2 EEG source analysis was done using sLORETA as the inverse technique to localize each spike according to its onset, half height, and peak. A patient-specific head model was constructed from the MRI data, and the finite-difference method was used to calculate the lead fields that linked neuronal currents in the brain to the measured scalp potentials.1,2 After demonstrating the presence of multifocal epilepsy in our patient, we changed the pharmacologic treatment to brivaracetam (100 mg daily), higher-dose lamotrigine (500 mg daily, serum level of 8.7 mg/L; ref. 3–14 mg/L), and low-dose valproic acid (300 mg daily), which subsequently resulted in a remarkable improveme","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"96-98"},"PeriodicalIF":3.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d7/67/jcn-18-96.PMC8762506.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39904199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decreased Brain Surface Complexity in Children With Attention Deficit Hyperactivity Disorder.","authors":"Jin Joo Choi, Dong Woo Park, Dong Hyun Ahn, Woo-Suk Tae, Jin-Hwa Moon","doi":"10.3988/jcn.2022.18.1.123","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.1.123","url":null,"abstract":"Dear Editor, Various neuroimaging studies of attention deficit hyperactivity disorder (ADHD) have revealed abnormalities in the frontal cortex, left basal ganglia, and left inferior frontal gyrus.1 However, the results of these studies have been inconsistent and usually not replicable.1,2 To date, there is not a single neuroimaging marker for ADHD diagnosis. Surface-based morphometry (SBM) can be used to analyze various characteristics of the brain surface and estimate the cortical thickness (CT), local gyrification index (LGI), surface area, and fractal dimension (FD). Previous large-scale studies of CT revealed subtle differences between ADHD children and controls,1 whereas the few studies of LGI have found no difference between ADHD and control groups. FD characterizes the fractal patterns of geometric objects, and is currently used to estimate the cortical complexity. However, very few studies have applied FD analysis to ADHD.3 This study aimed to compare various SBM characteristics between ADHD children and controls. Children aged 8–15 years who were diagnosed with ADHD and age-matched controls who voluntarily participated were included. Patients with structural brain lesions, severe medical problems, full-scale intelligence quotient (FSIQ) <80, or impairments in hearing, vision, or movement were excluded. Neurological and neuropsychological examinations and neurocognitive function tests (NCFTs) were performed. ADHD was diagnosed based on ADHD Rating Scale-IV. Magnetic resonance imaging (MRI) was performed using a 3-T MRI scanner. The detailed acquisition methods are presented in Supplementary Table 1 (in the onlineonly Data Supplement). For SBM, coronal three-dimensional T1-weighted structural images were processed using the Computational Anatomy Toolbox (version 12, http://www.neuro. uni-jena.de/cat/). Group differences in CT, LGI, and FD were tested separately using analysis of covariance with age and sex as with 5,000 permutations. The multiple-comparison problem was corrected at the cluster level using threshold-free cluster enhancement to a family-wise error (TFCE-FWE), with a rate of p<0.05. The study included 11 patients and 19 controls, whose detailed demographics and NCFT data are presented in Supplementary Table 2 (in the online-only Data Supplement). Age, righthandedness, male-to-female ratio, and FSIQ did not differ significantly between the groups. The SBM analysis did not reveal any significant differences in CT and LGI between the groups. However, FD analysis showed significant group differences in multiple regions, with FD being lower in ADHD patients than in controls. Although group differences were observed in both the right and left cortexes, FD of the ADHD group was decreased most significantly (TFCEFWE-corrected p<0.05) in the left frontal, parietal, cingulate, and occipital cortexes (Fig. 1). No region in the ADHD group showed an increased FD. This study found that the cortical FD is significantly decreased in ADHD chi","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"123-125"},"PeriodicalIF":3.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/83/a6/jcn-18-123.PMC8762512.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39904207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combination of High-Density Lipoprotein Cholesterol and Lipoprotein(a) as a Predictor of Collateral Circulation in Patients With Severe Unilateral Internal Carotid Artery Stenosis or Occlusion.","authors":"Shuyin Ma,&nbsp;Meijuan Zhang,&nbsp;Huiyang Qu,&nbsp;Yuxuan Cheng,&nbsp;Shuang Du,&nbsp;Jiaxin Fan,&nbsp;Qingling Yao,&nbsp;Xiaodong Zhang,&nbsp;Mengying Chen,&nbsp;Nan Zhang,&nbsp;Kaili Shi,&nbsp;Yizhou Huang,&nbsp;Shuqin Zhan","doi":"10.3988/jcn.2022.18.1.14","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.1.14","url":null,"abstract":"<p><strong>Background and purpose: </strong>Collateral circulation is considered an important factor affecting the risk of stroke, but the factors that affect collateral circulation remain unclear. This study was performed to identify the factors associated with collateral circulation, especially blood lipids.</p><p><strong>Methods: </strong>The study involved patients who had undergone digital subtraction angiography and were confirmed as having severe unilateral stenosis or occlusion of the internal carotid artery (ICA). We classified the collateral circulation status of each patient as good (Grade 3 or 4) or poor (Grade 0, 1, or 2) according to the grading system of the American Society of Interventional and Therapeutic Neuroradiology/American Society of Interventional Radiology. We collected data on patients' characteristics and identified the factors that affect collateral circulation.</p><p><strong>Results: </strong>This study included 212 patients. The multivariate logistic regression analysis showed that the high-density lipoprotein cholesterol (HDL-C) concentration and a complete anterior half of the circle of Willis were independent protective factors for good collateral circulation, whereas elevated lipoprotein(a) [Lp(a)] and serum creatinine concentrations were independent risk factors for good collateral circulation. The area under the receiver operating characteristics curve (AUC) was 0.68 (95% confidence interval [CI], 0.61-0.76) for HDL-C and 0.69 (95% CI, 0.62-0.76) for Lp(a). A binary logistic regression model analysis of the joint factor of HDL-C and Lp(a) yielded an AUC of 0.77 (95% CI, 0.71-0.84).</p><p><strong>Conclusions: </strong>In patients with severe unilateral ICA stenosis or occlusion, the combination of HDL-C and Lp(a) is a useful predictor of collateral circulation.</p>","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"14-23"},"PeriodicalIF":3.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0e/16/jcn-18-14.PMC8762497.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39814653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel <i>KCND3</i> Variant in a Korean Family With SCA19.","authors":"Hongmin Ha,&nbsp;Minkyeong Kim,&nbsp;Bora Chung,&nbsp;Chan Hyun Lee,&nbsp;Seung Hwan Oh,&nbsp;Heeyoung Kang,&nbsp;Oh-Young Kwon","doi":"10.3988/jcn.2022.18.1.90","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.1.90","url":null,"abstract":"","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"90-92"},"PeriodicalIF":3.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fd/66/jcn-18-90.PMC8762501.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39904197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}