Biomedical subjects

Hsiang-Yu Yu

Publications and source records attributed to Hsiang-Yu Yu.

5 recordsLinked to original sources

PubMed2006

Selective posterior cerebral artery amobarbital test in patients with temporal lobe epilepsy for surgical treatment.

PURPOSE: To evaluate whether the selective posterior cerebral artery amobarbital test (PCAAT) can predict postoperative memory function in patients with temporal lobe epilepsy (TLE) for surgical treatment and its clinical safety. METHODS: The database included adult patients with intractable TLE undergoing presurgical evaluation at Taipei Veterans General Hospital between 1995 and 2002. The PCAAT was carried out on patients who had failed conventional intracarotid amobarbital test (IAT) or had IAT results that evoked a concern of postoperative memory function decline. A battery of learning and memory testing was performed immediately before and after injection of amobarbital into the peduncular segment of the posterior cerebral artery (PCA) on the presumed hemisphere of epileptogenicity. Neuropsychological assessments were followed in surgically treated patients. RESULTS: A total of 16 patients completed PCAAT successfully and underwent anterior temporal lobectomy (ATL). Four patients failed PCAAT angiographic procedures due to technical difficulty in one patient, transient signs of vasospasm in two patients, and subarachnoid hemorrhage in one patient. Of the 12 patients who performed well in PCAAT learning and memory testing items by free recall or recognition, only 1 patient demonstrated postoperative memory decline in follow-up neuropsychological assessments. In contrast, two of the four patients with a deficit in PCAAT memory testing showed postoperative memory decline. Regarding subjective memory function (not necessarily associated with objective memory decline), patients not seizure-free after ATL were more likely to have memory complaints (in 3 out of 6 patients) than patients with seizure-free outcomes (in 1 out of 10 patients). CONCLUSIONS: The PCAAT memory test reliably predicts postoperative memory function in patients with TLE for surgical treatment. However, the inherent risks of PCAAT must be considered and it should be used judiciously.

Adult↗

PubMed2006

Isolated acute hearing loss as the presenting symptom of leptomeningeal carcinomatosis.

Leptomeningeal carcinomatosis is characterized by diffuse infiltration of the meninges by metastatic cancer. We report a rare case of leptomeningeal carcinomatosis with an initial presentation of isolated acute hearing loss. Progressive unsteady gait and multiple cranial nerve palsies ensued. Computed tomography of the chest with contrast revealed a 2 cm nodule over the right upper lung. Cytology of cerebrospinal fluid confirmed the diagnosis of adenocarcinoma. The patient was discharged after diagnosis. Isolated acute hearing loss is a rare initial presentation in leptomeningeal carcinomatosis, not necessarily with a known history of malignancy. A high index of suspicion is mandatory for accurate diagnosis.

Acute Disease↗

PubMed2004

Multiple sclerosis in Taiwan.

BACKGROUND: There is only 1 report about multiple sclerosis (MS) prevalence in Taiwan, and this was published in 1976 and involved only 25 patients. The clinical features and prevalence of MS in Taiwan still remain to be clarified. The aim of this study was to determine the prevalence and delineate the clinical features of MS in Taiwanese patients. METHODS: We retrospectively identified 43 ethnic Chinese multiple sclerosis (MS) patients over a 14-year period. The MS prevalence in Taiwan was estimated based on Bureau of National Health Insurance (BNHI) data. The clinical data (gender, family history, age at onset, initial symptoms, clinical course, disability and laboratory findings, evoked response and neuroimaging) were recorded, collected and analyzed. RESULTS: The MS prevalence in Taiwan was as low as 1.9 per 100,000. The distribution of most of the clinical features of our patients, like those in other Asian series, was different from Western series except for the percentage of the conventional form and sensory disturbances. Cerebrospinal fluid analysis for IgG index and OCB seemed to be less sensitive in the diagnosis of MS in our series. CONCLUSIONS: The prevalence of MS in Taiwan, as in other Asian countries, was low; the optic-spinal form occurred very often, but predominant spinal cord involvement was not unusual, as well as there being less functional disability. A larger, prospective study is needed to provide more conclusive information.

Adolescent↗

PubMed2003

Magnetoencephalographic analysis of bilaterally synchronous discharges in benign rolandic epilepsy of childhood.

The purpose of this study was to examine the spatial and temporal relationship between bilateral foci of bilaterally synchronous discharges in benign rolandic epilepsy of childhood (BREC) using a whole-scalp neuromagnetometer. We simultaneously recorded interictal magnetoencephalographic (MEG) and electroencephalographic (EEG) signals in six children with BREC. Interictal spikes were classified into three groups: bilaterally synchronous discharges (BSDs), unilateral discharges on right side (UD-R), and unilateral discharges on left side (UD-L). We used equivalent current dipole (ECD) modelling to analyse the cortical sources of interictal spikes. Both BSDs and UDs were found in Patients 1-4, whereas only UDs were identified in Patients 5 and 6. The ECDs of interictal spikes were located in rolandic regions, 10-20mm anterior and lateral to hand somatosensory cortices. Multi-dipole analysis of BSDs showed two ECDs in homotopic motor areas of the hemispheres. During BSDs, the right-sided activation preceded the left-sided activation by 15-21 milliseconds in Patients 1 and 2. In Patients 3 and 4, the activation occurred 17-20 milliseconds earlier in the left than the right hemisphere. Within the same hemisphere, the sources of BSDs and UDs were located in similar areas. In conclusion, our results imply the cortical epileptogenicity in bilateral perirolandic areas in BREC. The sequential activation during BSDs in both hemispheres suggest the existence of synaptic connections, possibly via the corpus callosum, between bilateral irritative foci.

Brain Mapping↗

PubMed2003

Olfactory auras in patients with temporal lobe epilepsy.

PURPOSE: To investigate olfactory auras in patients with temporal lobe epilepsy (TLE). METHODS: We reviewed medical records of 217 Chinese patients who underwent temporal lobectomy for medically intractable TLE between 1987 and 1998 in Taiwan. Patients with olfactory auras asked for detailed characteristics of their auras. RESULTS: In all, 12 (5.5%) patients had olfactory auras, seven men and five women. All patients except one described and characterized the unpleasant olfactory auras. Olfactory auras were usually combined with other auras, most frequently sensations of epigastric rising, nausea, and fear. Association with gustatory hallucination was uncommon, in only one patient. On neuroimaging study, 11 patients had structural lesions involving the mesial temporal structures, two exclusively involving the amygdala. Histologic diagnosis included gliosis of the mesial temporal regions in seven (58.3%) patients, neoplasm in four (33.3%) patients, and arteriovenous malformation in one patient. Postoperatively, eight patients were seizure free. Three patients had rare seizures; however, none reported residual olfactory auras. CONCLUSIONS: Olfactory auras are infrequent in TLE. In this study, mesial temporal sclerosis is the most common etiology rather than tumors. Mesial temporal structures, especially the amygdala, may play important roles in the genesis of olfactory auras.

Adolescent↗