The Grey Zone in Multiple Sleep Latency Test for Diagnosis of Narcolepsy: A Survey of Korean Neurologist

Objectives@#Clinicians often depend on the results of the the multiple sleep latency test (MSLT) for diagnosing narcolepsy, but the diagnosis can be confusing when there is a co-existence of obstructive sleep apnea (OSA). This study is aimed to address the diagnostic tendency and the strategies of treatment for narcolepsy and other hypersomnia in the grey zone. @*Methods@#We performed a web-based survey of Korean neurologists who were interested in narcolepsy and had experience with sleep studies. @*Results@#The results of this survey present their concerns according to the severity of comorbid OSA in analyzing the results of the MSLT. @*Conclusions@#This study also might help by providing the opinions of experienced Korean neurologists for the assessment and management of excessive daytime sleepiness.

Recurrent Bacterial Meningitis Associated with Inflammatory Nasal Polyp

In case of no head trauma history and intact immunity, adultonset recurrent bacterial meningitis is scarce. Parameningeal infection is the crucial latent cause of recurrent bacterial meningitis in adults. Nasal polyp can cause a variety of nasal symptoms, depending on its location and size. Chronic sinusitis with nasal polyp tends to have more severe symptoms than those without nasal polyp. We report a case of adult onset third recurrent bacterial meningitis associated with inflammatory nasal polyp.

Sleep Disorders and Risk of Motor Vehicle Accident

Driving is a complicated process that demands coordination between a range of neurocognitive functions, including attention, visuo-perception, and appropriate judgment, as well as sensory and motor responses. Therefore, several factors may reduce the driving performance of an individual, such as sleepiness, distraction, overspeeding, alcohol consumption, and sedative drugs, all of which increase the hazard of motor vehicle accidents. Among them, drowsy driving is a major cause of traffic accidents, leading to more serious injuries as compared to other causes of major traffic accidents. Although sleep disorders have been highly associated among drowsy drivers, they are often untreated and unrecognized as a disease. In particular, obstructive sleep apnea and narcolepsy are some sleep disorders that are highly related to traffic accidents. Insomnia, which can cause inadequate sleep duration and promote sedative effects from sleeping pills, may also cause traffic accidents. These conditions are especially applicable to commercial bus or truck drivers, nocturnal workers, and shift workers, who are highly vulnerable to drowsy driving. Therefore, assertive screening and management of sleep disorders are necessary in general private drivers and relevant occupational drivers.

Sleep Disorders and Risk of Motor Vehicle Accident

Driving is a complicated process that demands coordination between a range of neurocognitive functions, including attention, visuo-perception, and appropriate judgment, as well as sensory and motor responses. Therefore, several factors may reduce the driving performance of an individual, such as sleepiness, distraction, overspeeding, alcohol consumption, and sedative drugs, all of which increase the hazard of motor vehicle accidents. Among them, drowsy driving is a major cause of traffic accidents, leading to more serious injuries as compared to other causes of major traffic accidents. Although sleep disorders have been highly associated among drowsy drivers, they are often untreated and unrecognized as a disease. In particular, obstructive sleep apnea and narcolepsy are some sleep disorders that are highly related to traffic accidents. Insomnia, which can cause inadequate sleep duration and promote sedative effects from sleeping pills, may also cause traffic accidents. These conditions are especially applicable to commercial bus or truck drivers, nocturnal workers, and shift workers, who are highly vulnerable to drowsy driving. Therefore, assertive screening and management of sleep disorders are necessary in general private drivers and relevant occupational drivers.

Proposal for Prevention of Drowsy Driving-Related Motor Vehicle Accidents in Patients With Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is known to be associated with various health concerns, including sleepiness, fatigue, cognitive dysfunction, diminished quality of life, hypertension, cardiovascular diseases, and stroke. OSA-induced sleepiness at the wheel reduces vigilance and driving performance, which significantly increase the risk of motor vehicle accidents. Sleepiness-induced motor vehicle accidents are characterized by high morbidity and mortality. OSA is a well-established significant risk factor for drowsy driving-related motor vehicle accidents, which can be prevented through appropriate treatment. However, currently no clinical guidelines or regulations are available for evaluation or management of the risk of motor vehicle accidents in patients with OSA in Korea. In this review, we discuss the risk of motor vehicle accidents in patients with OSA, the effects of positive airway pressure therapy as a preventive measure to reduce this risk, and the published recommendations for OSA in other countries with regard to fitness to drive. We propose recommendations for screening, evaluation, and treatment of OSA with regard to the risk of motor vehicle accidents, which would serve as useful practical guidelines for sleep specialists in clinical practice. Further research is warranted to establish optimal strategies for effective improvements in OSA-related traffic safety.

Proposal for Preventing Motor Vehicle Accident Related to Drowsy Driving in Patients With Narcolepsy

Narcolepsy is a chronic sleep disorder characterized by irresistible sleep attacks, hypersomnolence, cataplexy (sudden loss of muscle tone provoked by emotion), and sleep paralysis. Individuals with narcolepsy are at a high risk of experiencing sleepiness while driving leading to road traffic accidents. To prevent such accidents, some countries have regulations for commercial and noncommercial drivers with narcolepsy. Evaluating sleepiness is essential. Therefore, several subjective reports and objective tests were used to predict the possibility of car crashes or near-misses. Brain stimulants are effective in treating narcolepsy and can reduce daytime sleepiness in these patients. However, no guideline has been established for the driving safety of patients with narcolepsy in Korea. The Korean Sleep Research Society has prepared this proposal for preventing motor vehicle accidents caused by drowsy driving in patients with narcolepsy.

Klebsiella pneumoniae Brain Abscess and Endophthalmitis after Acute Epiglottitis

Klebsiella pneumoniae is an unusual cause of brain abscess. Among the few cases of Klebsiella pneumoniae brain abscess that have been reported, most were associated with another underlying primary focus of infection. Endogenous endophthalmitis caused by Klebsiella pneumoniae is an infrequent but often devastating septic metastatic infection. We report a rare case of Klebsiella pneumoniae brain abscess and endophthalmitis after acute epiglottitis.

Isolated Trigeminal Neuralgia Presented Due to Cerebellopontine Angle Epidermoid Cyst

Trigeminal neuralgia (TN) is a paroxysmal shock like pain restricted to the innervations of the areas of one or more trigeminal branches. The pathogenesis of TN is uncertain and typically is idiopathic, but it may be due to a structural lesion. Various etiologies such as vascular anomaly, tumor, infectious agents, and multiple sclerosis have been implicated as possible causes. Here we report two young patients diagnosed with trigeminal neuralgia secondary to epidermoid cyst at the cerebellopontine angle.

Cerebral Microbleed Induced Seizure Misdiagnosed with Transient Ischemic Attack

Diagnosis of transient ischemic attack has been entirely dependent on the clinical history due to the absence of brain magnetic resonance imaging lesion. It is challenging to distinguish between transient ischemic attack and transient ischemic attack-mimics. Cerebral microbleeds would be found in 11.1–23.5% of incidental findings in elderly population. However, cerebral microbleeds have been known to lead to cognitive decline, dementia, seizure and even status epilepticus. We report a case of cerebral microbleeds induced epileptic seizure, visiting the emergency room with sudden onset unilateral motor weakness.

Lower Cranial Nerve Palsy Due to Vertebrobasilar Dolichoectasia

No abstract available.

Spontaneous Bilateral Carotid Artery Dissection Causing Abulia and Apathy

No abstract available.

Rheumatoid Meningitis: Neurologic Manifestation and Pathologic Findings

Rheumatoid meningitis, one of the most severe complications of rheumatoid arthritis, presents various symptoms such as headache, confusion, loss of consciousness, seizure, fever, and focal neurological deficits. A 63-year-old man with the history of rheumatoid arthritis presented with intermittent left leg weakness, seizures and later developed fever and confusion. Brain MRI demonstrated leptomeningeal enhancement in right fronto-parietal area. Brain biopsy revealed multifocal suppurative inflammation. After aggressive immunosuppressive treatment, he had gradually recovered and the lesion was reduced on a follow-up MRI.