Anti-neural antibodies have been implicated in the pathogenesis of nerve damage in patients with Guillain-Barre syndrome, leprosy, and other motor neuron diseases. Considering exposure of damaged nerve tissue to the immune system during traumatic injuries, the resulting anti-neural antibodies formed in patients with nervous system injury may affect the healing process of nerve tissues or induce nerve damage at the injury sites or other sites. To date, however, no information is available on the prevalence of anti-neural antibodies in sera from patients with traumatic nervous system injury and controls. In this study, serum samples were obtained from 185 patients with traumatic nervous system injury and 291 controls and antibodies were obtained detected by an enzyme linked-immunosorbent assay(ELISA) against ceramide, asialo-GM₁(AGM₁),and galactocerebroside(GC), The results were then analyzed based on nerve injury sites, severity, and presence or absence of associated injuries, duration after injury, etc.

The results obtained were as follows:

1) The major immunoglobulin class was IgM against the ceramide, GC, and AGM₁, antigens in sera from patients with traumatic nervous system injury.

2) Among 185 patients with traumatic nervous system injury, a significant level of antibodies were detectable in 75(40.5%) against ceramide, in 71(38.4%) against AGM₁, and in 57(30.8%) against GC antigen, respectively. In contrast, of 291 serum specimens form controls, 55(18.9%) were reactive with ceramide, 43(14%) with AGM₁,and 38(13.0%) with GC respectively. The seroprevalence of antineural antibodies was thus significantly higher among patients with traumatic nervous system injury than among controls(p0.01).

3) There was no significant difference of the prevalence rate and the mean value of antineural antibodies among three patients groups, one with head injury, a second with spinal cord injury, and a third, amputation. However serum antibody reactivity was higher in the sever head injury and incomplete spinal cord injury sub-groups than in those who suffered from other associated injuries.

4) The value of anti-neural IgM antibodies gradually decreased in most patients with traumatic nervous system injury within two to three months after trauma. In about six to ten months after injury, the value of IgM antibodies significantly decreased below the normal values of these antibodies.

This study thus showed that patients with traumatic nervous system injury had a significant level of circulating anti-neural antibodies. However, further follow-up studies on these patients ate desirable to understand the role of antineural antibodies in the pathogenesis of nerve damage.

We have analysed electroencephalographic findings, brain CT findings and evoked potentials findings in cerebral palsied patients from 5 months to 19 years old. Neuromuscular type distribution in order was 77.0% of spastic type, 11.5% of mixed type and 9.9% of athetoid type. Topographic distribution of spasitc type was 53.1% of spastic diplegia, 33.5% of spastic tetraplegia and 12.4% of spastic hemiplegia. Fraquency of possible risk factors in order was 30.6% of prematurity, 28.6% of low birth weight, and 19.8% of perinatal asphyxia. The indicence of seizure was 36.5% . Abnormal findings of brain CT scan and EEG were 56.9% and 46.7%, respectively. In addition, abnomal VEP(visual evoked potential) and BAEP(brainstem auditory evoked potential) findings were 7.9% and 9.9% respectively.

We studied to find out the differences in management of neurogenic bladder dysfunction between traumatic and non-traumatic spinal cord lesion, and of those differences were existed what kind of factors could contribute to those differences.

The subjects of this study were 32 spinal cord lesion patients with neurogenic bladder dysfunction(11 patients of traumatic group and 21 patients of non-traumatic group) who had been admitted to Seoul National University Hospital from March, 1989 to July, 1991.

The results were as follows:

1) The period between initiation of management and establishment of balanced bladder in non-traumatic group was shorter than that of traumatic group.

2) The outcome of non-traumatic group was better than that of traumatic group in aspect of final voiding type.

3) We think that those major factors which contributed to the good results in non-traumatic group were relatively good preservation of filling sense and less incidence of detrusor shincter dyssynergia.

Seventeen patients with persistent vegetative state were evaluated for the causes, types of the brain injury, Glasgow Coma scales, medical complications, EEG and somatosensory evoked potential studies.

The mean age of patients was 42.9±8.5 years(range:9∼76)(Table 1). The causes were trauma, stroke, cerebral hypoxia and tumor as shown in table 2. The most common type of the brain injury was intracranial hemorrhage(Table 3). Initial Glasgow coma scale score was 6.3±1.3 and minimal improvement to 9.6±1.1 in 3 months after onset(Table 4). infection(respiratory and genitourinary) was the most common complication during the vegetative state(Table 5). EEG during awakening showed marked abnormal pattern. Cortical somtosensory evoked potentials were abnormal in 72.2%, absent potential in 8 cases(44.4%) and others showed diminishing amplitude or delayed latency of the N1 response(Table 7).

It is obvious that the essence of rehabilitation of the spinal cord injuries must lie in restoring the activities of body to re-integration himself into the community.

Thus, in "the spinal cord injuries", the social adjustment is the final achievement and the important aspect of rehabilitation.

This study is that 118 Veterans with the spinal cord injuries were interviewed to assess their social adjustment.

This result was analyzed their problems and further developed information are discussed for their social rehabilitation program.

This experiment was designed to define decreasing effect of intravesical pressure by ultrasound therapy on distended bladder of rabbit in vivo. Thereby we suggest and strengthen the basis for the clinical application of ultrasound therapy on hyperreflexic detrusor.

Eighteen normal male rabbits were used. Intravesical pressure at 5 minutes in ultrasound therapy group was significantly decreased, and intravesical temperature in the group was significantly higher than control group(p0.05). While the differences of the pressure and temperature at 10 minutes were not significant between the groups.

The purpose of this study was to know what changes in serum beta-endorphin level indirectly as low frequency TENS was applied to the meridian and non-meridian points.

The results were as follows:

1) On applying TENS to the meridian and non-meridian point, the mean changed values of the ACTH were 9.17±3.78, 11.41±7.31, 5.28±4.87 pg/ml and 7.57±2.37, -3.18±2.16, -7.22±3.57 pg/ml respectively at 15, 30, 60 minute after the TENS was applied.

2) The mean changed values of the ACTH were not statistically signficant(p>0.05) at 15, 30 minute, but statistically significant(0.05) at 60 minute after the TENS was applied.

3) on applying TENS to the meridian and non-meridian points the mean changed values of the Cortisol were 8.07±1.93, 7.13±1.20, 4.32±1,37 ㎍/100ml and 4.96㎍1.41, 2.97±1.25, -0.84±1.16 ㎍/100ml respectively at 15, 30, 60 minute after the TENS was applied.

4) The mean changed values of the Cortisol were not statistically significant(p>0.05) at 15 minute but statistically significant(p<0.05) at 30, 60 minute after the TENS was applied.

We concluded that the analgesic effect by the stimulation is related to nervous system and humoral factor such as the neurotransmitter and the hormone.

Cerebral infarction is a ischemic syndrome of specific vessels, depends not only on the site of the occlusion but on previous brain damage, collateral circulation, and variation of the region supplied by a particular artery, including aberrations in the circle of Willis.

SPECT of regional cerebral blood flow was performed using ^99mTc-HMPAO uptake in 27patients with brain infarcts during the acute and subacute period(Onset to Days 33).

All patients had normal brain CT prior to SPECT. Twenty five of 27 patients had abnormal ^99mTc-HMPAOfCBF SPECT. Twenty-four had unilateral involvement and the other one had bilateral involvements. Sixty-eight percents of the defects were found in the left cerebral hemisphere, according to the distribution of the lesions(total number:39 lesions), fifteen were in the frontal, thirteen in the pariental, and the remainders were elsewhere. Twenty(74 percents) had a significant correlation between clinical signs and scan lesion site.

Brain SPECT has been used efficiently in the evaluation of cerebral infarcts and ischemia without evidence of brain CT lesions, brain SPECT allows us to look accurately and effectively at the functional abnormalities resulting from small structural defects.

The radiologic evaluation of low back pain syndrome has been widely used in many clinics. With a few exception, it does not give us positive findings in many cases inspite of persistent complain.

The objective of this study was to provide an aid in diagnosis and objective follow up-reeval-uation by presenting reliable radiologic parameters. The radiologic parameters, such as lumbar lordosis, sacral inclination, and lumbosacral joint angle were taken with Wiltse and Winter's method.

The parameters were taken in 20 cases of low back pain group 20 cases of non-low back pain group, In low back pain group, the mean degree of lumbar lordosis, the mean degree of sacral inclination, and mean degree of lumbosacral joint angle were 27.7 ⁑ 6.3⁗, 37.5 ⁑ 7.1⁗, and 9.0 ⁑ 6.9⁗respectively. In non-low back pain group, the mean degree of lumbar lordosis, the mean degree of lumbar lordosis, the mean degree of sacral inclination, and the mean degree of lumbosacral joint angle were 21.7 ⁑ 7.0⁗,31.3 ⁑ 7.0⁗, and 10.2 ⁑ 5.6⁗ respectively. There were statistically significant increases in lumbar lordosis and sacral inclination in low back pain group.

electrodiagnostic examination of the lateral antebrachial cutaneous nerve(LACN) that is the sensory branch the musculocutaneous nerve is useful to screen the upper trunk, lateral cord in brachial plexus and C5/C6 roots. But its clinical usability is relatively poor at now and normal values of the musculocutaneous SEP are not gotten yet in Korean. In this study, we tried to get the SEPs of LACN in 52 healthy Korean aged from 20 to 29 years old.

Stimulation were performed at the elbow where it penetrates the fascia to become the cutaneous nerve and recording at C3 or C4 of 10~20 EEG recording system. We performed together its sensory nerve conduction & superficial radial nerve SEP as the basic data for the inter or intra-nerve comparision at the same time and aquired their normal values.

Results are followings(mean⁑1SD).

1) The distal latency, the peak to peak amplitude, conduction velocity in LACN peripheral conduction were 1.84 ⁑ 0.14 msec, 28.9 ⁑ 10.7 ㎶, 65.4 ⁑ 5.07 m/sec respectively.

2) The peak latencies of the LACN SEP were 15.1 ⁑ 0.80, 21.3 ⁑ 1.29, 30.4 ⁑ 1.39 and 40.8 ⁑ 1.191 msec in order of N1, P1, N2, P2 respectively.

3) The peak latencies of the superfical radial nerve SEP were 17.6 ⁑ 0.91, 23.4 ⁑ 2.58, 32.7⁑ 1.46 and 42.7 ⁑ 2.06 msec in order of N1, P1, N2, P2 respectively.

4) There is no significant difference between right and left sides, male and female in peripheral conduction and SEP study statistically.

5) There was significant correlation between the initial negative peak(N1) latency of SEP and height of the subject.

The action tibialis posterior muscle is to adduct the forepart of the foot and to aid in inversion and plantar flexion. Hypertonicity of this muscle was well known as a main cause of equinovarus or inversion of the foot and internal rotation deformity of the ankle. Percutaneous motor point block to tibialis posterior muscle might be a considerable method as a physiatric management for the ankle deformity by hypertonicity of the muscle. The posteromedial approach to the muscle has been used in needle electrode insertion of electromyography sampling the flexor digitourm is high in posteromedial approach widely used. because the tibialis posterior is heavily overladen with surrounding muscles and lined by neurovascular bundles. We preferred anterior approach to posteromedial approach.

Percutaneous motor point block to tibialis posterior muscle by anterior approach was done with 7% aqueous solution of phenol in 7 cerebral palsied. We suggest anterior approach to the muscle may be safer, easier, and more effective than the posteromedial approach.

Sensory nerve action postentials(SNAP) of median nerve and ulnar nerve were examined antidromically with ring electrode recording at the ring finger and stimulation at the wrist(distance 12cm) in 39 healthy adults(23 male, 14 female) and were compared according to distal latency, amplitude, duration of SNAP, respectively.

The results were as follows;

1) The mean values of distal latency of median/ulnar SNAP were 2.75 ⁑ 0.23 msec / 2.71 ⁑ 0.24 msec with no significant difference between the two nerves(P>0.05).

2) The mean values of amplitude of median/ulnar SNAP were 57.08 ⁑ 17.60 ㎶ / 44.58 ⁑ 21.14 ㎶ with significant difference between the two nerves(P<0.0001).

3)The mean values of duration of median/ulnar SNAP were 1.36 ⁑ 0.26 ⁑ / 1.37 ⁑ 0.22 msec with no significant difference between the two nerves(P>0.05).

4) The difference of distal latencies between median/ulnar SNAP was 0.14 ⁑ 0.15 msec

Decompression sickness is commonly divided into two types on the basis of the severity of clinical signs. The manifestations of Type Ⅱ decompression sickness are more serious and those involving the central nervous system. Patients with spinal cord injury in Type Ⅱ decompression sickness, were assigned a neurological level of injury, severity of injury, and level of ambulation. Among the 46 cases of Type II decompression sickness, spinal cord involvements were present in 69.6%(n=32:27 males, 5 females; mean age=33.5 years). Fourteen(43.8%) subjects had neurological level of injury to the lower thoracic cord. 7(21.9%) cervical cord, 5 midthoracic cord, 3 upper thoracic cord, and 3 subjects were injury level to the lumbar cord. The degree of incompleteness as reflected in the Frankel grades of incompleteness showed that 15(46.9%) subjects were Frankel D, 8 Frankel C, 8 Frankel E, 1 Frankel B, and none was Frankel A. We paid particular attention to ambulation level. Functional community walker was recorded in 24(75.0%) subjects, functional household walker in 6(18.8%) and 2(6.3%) subjects remained nonfunctional walker.

The H-reflex study reveals differential finding according to each levels and various calf muscles in posterior compartment of lower leg. So, we studied how H-reflex responses undergo a change in accordance with each levels and various muscles of posterior calf.

Then, The results were as follows;

1) On the recording method by the surface electrode. H-wave represents a maximum amplitude of response on the level 5, as more distal site than midcalf location

2) Through the intramuscular recording method by monopolar needle electrode, the muscles of the posterior compartment of the lower leg are obtained each other differential, characteristic configuration, especially among the six muscles, the soleus shows a highest amplitude of H-response and modified H:M ratio(X=0.86).

3) The minimal latency of M and H responses was increment in proportion to the recording electrode is located more distally.

Therefore, this study indicates that a distal recording site is preferred to a midcalf location if the H-reflex per se is to be assessed.

Prematurity is the main factor influencing the occurrence of brain damage in twins, it is rate that twining itself plays a leading role in the etiology of cerebral palsy. Several authors have reported brain damage in the surviving twin who had a stillborn macerated co-twin, and they considered the pathogenic mechanism accounting for brain lesions as twin embolization syndrome.

Twin embolization syndrome, a complication following in-utero dimise of one twin is the passage of thromboplastin like material or embolic debris into circulation of the surviving twin, which results in a variety of ischemic or vascular disruptive defects of the central nervous system is the most common complication reported in monozygotic twin survivors.

We describe a patient with cerebral palsy and seizure in whom MRI demonstrated a porencephalic cyst on parieto-occipital area, left with periventricullar leukomalacia and normal myelinization pattern considering of his age.

The patient was the product of a twin pregnancy with stillborn, macerated co-twin, but had mo history of dystocia, prematurity or abruptio placenta.

So, we consider that the most likely interpretation for the pathogenesis of cerebral lesion in this patient with cerebral palsy and seizure is twin embolization syndrome.

Reff syndrome is neurodegenerative disorder in girls characterized by globol deceleration of psychomotor development and subsequent loss of acquired cognitive and motor skills, occurring after 6~18 months of apparently normal development.

In 1966, Andreas Rett reported 31 girls who had mental regression, abnormal neurologic examinations, curious and repetitive hand-wringing, stereotypic movements, and other peculior behavioral manifestations.

There is no known biologic market for Rett syndrome. So diagnosis should be focused on well-defined clusters of developmental and clinical deviations.

We experienced one case of Rett syndrome in 4 years old girl and reported the case with clinical, rediologic, histologic findings.

We experienced a case of peripheral neuropathy secondary to folic acid deficiency who had symptoms of general weakness, and abnormal position and vibration sensation.

The clinical symptoms, signs and electrodiagnostic findings improved after folic acid treatment. The clinical manifestations. laboratory data and electrodiagnostic findings of this rare disease were reviewed.

Cervical Angina Sydrome is a disorder characterized by precordial pain and left upper extremity radiating pain with pressure due to cervical degenerative spondylitis or herniated intervertebral disc.

We experienced a case of normal cardiac study, but abnormal cervical X-ray, MRI(Magnetic Resonance Image), NCV and EMG of the patient who had been got Cervical Angina Syndrome. We report the case with literature review.

Herpes zoster occurs most commonly in middle & late life and appears to be associated with complication in man more commonly than in woman. The role of primary infection and secondary reactivation in the genesis of HZ is not clear.

Herpes zoster paralysis may be complicated by neurological symptom & sign which are not generally well recognized. Motor paralysis in the limb is extremely rare in herpes zoster, to my knowledge, about 100 cases have been collected at present, and more over, none in Korea.

This complication appears within days or several months after HZ eruption and is usually associated with a good prognosis.

Recovery may take several months or even years and is not alwasy completeed. This case has left upper trunk Brachial plexopathy after left C5, C6 dermatome herpes zoster eruption. I briefly reviewed of herpes zoster paralysis & clinical findings.