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간질의 전산화단층뇌촬영상

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 Computed transverse axial tomography in epilepsy 
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[한글] 간질은 뇌신경계 질환 중 가장 많은 빈도를 차지하는 질환 중의 하나로 기질적 장애 유무를 감별함은 환자의 진단, 치료방침 결정 및 예후 판정에 결정적인 역활을 하는 것으로 오래전부터 이용하여 왔던 뇌파검사와 뇌동맥촬영, 뇌실조영술로는 이것의 감별진단이 불충분하였는데 최근 전산화 단층뇌촬영술의 개발로 이 분야의 큰 전환점이 이루어지고 있다. 이에 저자는 연세의대 부속 세브란스 병원에서 간질환자 중 임상상 및 각종 검사상 기질적 병변이 있는 것으로 사료되어 전산화단층뇌촬영을 실시한 450예를 관찰 분석하여 다음과 같은 결론을 얻었다. 총 450예 중 전산화단층뇌촬영 결과 이상소견이 있는 것으로 판명된 경우는 218예로 48%였으며 환자의 연령이 많을수록 이상소견이 증가되는 경향이었고 전신성간질 보다는 초점성간질에서 특히 임상상 두통이나 뇌압상승 및 국소적 신경학적 소견이 동반될 때 이상소견이 많았다. 뇌파검사상 원발성뇌피질하간질일 때는 전산화단층뇌촬영상 이상소견이 거의 없었으나 이차성뇌피질하 간질이나 국소적인 spike나 slow wave가 있을 때 특히 slow wave를 보이면 이상소견이 발견되는 경우가 많았다. 전산화단층뇌촬영상 간질의 원인으로 추정되는 기질적 병변은 뇌종양, 염증성질환, 뇌혈관질환, 뇌위축증, 뇌수종, 뇌연화증, 낭미충증 등이 있었는데 30세 이상에서는 뇌종양과 뇌혈관질환이, 30세 이하에서는 염증성 변화와 뇌수종이 발견되는 경우가 많았다. 또 한 전반성간질에서는 뇌위축을, 초점성간질에서는 뇌종양, 낭미충증 및 뇌연화증 등을 보이는 경향이었으며 국소적인 기질적 병변위치는 대부분 전두엽과 두정엽에 국한되어 있었다. 간질환자의 병력 기간과 전산화단층뇌촐영상의 이상소견 발견율은 병력이 길수록 발견율이 낮은 역비례의 관계를 보여 주었다. 이와 같은 관찰성적으로 저자는 간질의 감별진단, 치료 방침 및 예후 판정에 있어서 특히 기질적 병변의 의심이 있을 때에는 전산화단층뇌촬영이 필요 불가결한 검사라는 것을 알 수 있었다.
[영문] Epilepsy is one of the most frequent disorders involving the brain, and detection of organic lesions is very important for both the determination of a therapeutic plan and the prognosis of the patient. Electroencephalography has been used routinely to study patients with epilepsy and is valuable in detectio of functional abnormality, however when organic lesion is suspected, cerebral angiography, P.E.G and brain scanning have been performed. But previous studies have been insufficient to rule out organic lesions and establish the etiology. Computerized transverse axial tomography has been used recently, as well as the EEG, to study patients with epilepsy in America and some Europian countries, thus alleviating the need for angiography and P.E.G. with their considerable morbidity except in small numbers of patients. The history of CT scan in Korea is short, having begun in 1977. Reports of the efficacy of CT scan in the evaluation of epilepsy are rare, prompting the present investigation. Computed axial tomographic examination of 45p patients with epilepsy in Severance Hospital, Yonsei University was reviewed and analysed and the following results were obtained. The studies were abnormal in 218(48%) among 450 patients and increasing numbers of abnormal findings were detected in the older age group. Those with focal seizures showed more abnormal findings(60%) than generalized epilepsy. Particularly patients with headache, increased I.C.P. or focal neurological signs revealed considerably increased abnormality. Patients who showed findings of primary subcortical epilepsy in EEG did not have remarkable abnormality, however those with secondary subcortical epilepsy, paroxismal focal spike or cortical slow wave showed increased abnormality, and patients with findings of cortical slow wave showed considerable CT abnormality. In the various types of organic lesion including tumor, inflamation, cerebrovascular disease, hydrocephalus, cortical atrophy, cerebromalacia, cysticercpsis, CT remarkably increased the ability to establish etiology. Especially notable was the increased number of tumors in patients over 30 and inflamation in those under 30 years of age. Patients with generalized epilepsy frequently showed cortical atrophy, and patients with focal seizures showed a tendency toward tumor, inflamation, cysticercosis and cerebromalacia. Most frequent locations of abnormal findings were the frontal and paietal lobes, and the frequency of abnormal findings in CT decreased inversely with the duration of symptoms. In patients with the various electroclinical types of epilepsy, CT gave accurate information about the frequency, topograpgy, and severity of morphological abnormalities. It markedly increased the ability to eatablish etiology. Therefore when organic lesion of the brain is suspected, CT should be used in conjunction with EEG for the datermination of prognosis and therapeutic plan in epilepsy.
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