Background
Orthostatic intolerance (OI) is a common clinical symptom in dizziness clinic. The head-up tilt table test (HUT) is one of the primary clinical examination for evaluating OI. There is no consensus on the optimum method for diagnosis of orthostatic hypotension (OH). Herein, we performed the additional squat combined with blood pressure (BP) monitoring for OI patients with normal HUT.
Methods
The study included 32 consecutive patients with orthostatic intolerance for 3 months since April, 2018 (Period I) and 27 patients with orthostatic intolerance for 3 months since April, 2019 (Period II) in dizziness clinic of Chungnam National University Hospital. During Period II, the additional squat combined with BP test was performed for normal HUT results in patients with OI. In squat combined orthostatic BP measurement, the first BP measurement was taken following 3 minutes of rest at the squat position; afterwards the patients were raised upright and the measurement was monitored for 2 minutes, using a continuous beat-to-beat BP monitoring.
Results
In this study, there was significant difference in OH diagnosis (p<0.001); 40.6% (13/32) by conventional HUT (Period I) vs. 92.5% (25/33) by conventional HUT and additional squat test for normal HUT (Period II). In patients with normal HUT, the positive OH was 86.7% (13/15) by the additional squat combined BP measurement (Period II).
Conclusions
In addition to HUT, squat test combined with BP measurement might be more informative for understanding and diagnosing the OH, particularly in patients with OI and normal HUT in dizziness clinic.

Neurolymphomatosis (NL) is characterized by the infiltration of malignant lymphoma cells into peripheral nerves, nerve roots, plexuses, or cranial nerves. This is a very rare complication of mantle-cell lymphoma. Diagnosing NL is made difficult by cerebrospinal fluid cytology and bone-marrow biopsy results often being negative. NL can appear as the only sign of recurrence in a patient with a previous diagnosis of lymphoma. Here we present two cases of NL in patients with mantle-cell lymphoma diagnosed by positron emission tomography with deoxy-fluoro-D-glucose integrated with computed tomography.

No abstract available.

Background
The standardized autonomic function test has become widely available. However, there are no reference data for this test for the Korean population. This study explored reference data for sudomotor and cardiovagal function tests for the Korean population.
Methods
The sweat volume by quantitative sudomotor axon reflex test, heart-rate response to deep breathing (HRdb), expiration:inspiration (E:I) ratio, and Valsalva ratio (VR) were measured in 297 healthy Korean volunteers aged from 20 to 69 years. Multivariate regression analysis was performed to evaluate the effects of age, sex, and body mass index on these variables. The 2.5th, 5th, 10th, 90th, 95th, and 97.5th percentile values were obtained for each investigation.
Results
The sweat volume was higher in males than in females. The HRdb and E:I ratio were negatively correlated with age, and were higher in males than in females. The VR was negatively correlated with age, but it was not correlated with sex.
Conclusions
This study has provided data on the reference ranges for sudomotor and cardiovagal function tests in healthy Korean adults.

Citations

• Abnormal quantitative sudomotor axon reflex test results in patients with tinnitus as a possible indicator of small fiber neuropathy
  Hye Lim Lee, Hyun Ji Lyou, Jae-Jun Song, Chi Kyung Kim
  Frontiers in Neurology.2024;[Epub]     CrossRef
• Generalized anhidrosis with preganglionic sudomotor dysfunction in Fabry disease: a case report
  Eun Bin Cho, Seung Joo Kim, Tae-Won Yang, Heejeong Jeong, Changhyo Yoon, Seunguk Jung, Ki-Jong Park
  Clinical Autonomic Research.2021; 31(4): 585.     CrossRef
• Interpretation of Autonomic Function Test
  Kee Hong Park, Eun Hee Sohn
  Journal of the Korean Neurological Association.2021; 39(2): 61.     CrossRef

Diabetic polyneuropathy (DPN) causes neuropathic pain with reduced quality of life as well as diabetic foot ulceration which sometimes resulted in amputation. Early detection and improved knowledge of pathogenic pathways are important to prevent and to manage DPN. The screening methods and several tests to diagnose DPN-quantitative sensory testing, skin biopsy, corneal confocal microscopy, etc.-will be described.

Skin biopsy with investigation of small nerve fiber in human epidermis and dermis has been proven to be a useful method for demonstration of small fiber neuropathy. Quantification of intraepidermal nerve fiber density using anti-Protein Gene Product 9.5 (PGP 9.5) antibody is standardized method to diagnose the small fiber neuropathy. Skin biopsy method also makes it possible to differentiate the type of nerve fibers by using different antibodies. Quantification of dermal structures with different type of nerve fibers could be used to invest pathophysiologic mechanism of diseased state.

Diabetic polyneuropathy (DPN) is the most common form of diabetic neuropathy, and causes a significant morbidity with an impact on the quality of life in the patients with diabetes. Since DPN frequently induces foot deformity and ulceration, which finally leads to foot amputation, the early detection and treatment is very important for the prevention of a permanent structural change. In the early stage of DPN, the diagnostic methods which can evaluate the function or structure of small nerve fibers should be employed because small nerve fibers are first involved in the course of DPN. However, the nerve conduction study cannot reflect the function of the small nerve fibers, and thus, has a definite limitation in the early diagnosis of DPN. For the early detection of DPN, electrodiagnostic data should be interpreted on a clinical context, along with the careful evaluation of the small nerve fiber functions using the tests such as the analysis of intraepidermal nerve fiber density.

Geographical differences in the incidence of amyotrophic lateral sclerosis (ALS) have been reported, and there are stillmany unresolved problems. The incidence as well as epidemiologic data of ALS is not known in Korea. Web-based multicenterregistry of ALS, the Korean ALS registry, was established at January, 2011. The aim of

High median nerve injury, defined as injury above the elbow, is very rare and characterized by flexion weakness of thumb and index finger and abnormal palmar sensation. Schwannoma of median nerve is rare and it usually causes no symptom or paresthesia only because it grows slowly. A 54-year-old woman experienced pain and weakness of the left thumb and index finger after a surgery of schwannoma removal at the left axilla. This case illustrates the clinical feature of high median nerve injury.

Neuropathic pain is defined as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system” which was suggested by the International Association for the Study of Pain (IASP) in 2008. Paresthesia, dysesthesia or allodynia are known as clinical features of neuropathic pain, however it could be present in nociceptive pain. Thorough history tacking and physical examination could be helpful to diagnose and to manage a patient with neuropathic pain properly. Pain terminology and grading system for neuropathic pain diagnosis will be discussed in here.