Oro-facial dyskinesia is characterized by involuntary repetitive movements of the tongue, lip, or jaw, which is known to be derived by variable causes. Pre- and post-synaptic dopamine receptor abnormalities by degenerative changes in the brain seem to be the key pathophysiology, but the exact mechanism still remained to be unknown. Metoclopramide can pass the blood-brain barrier, which is known for a selective presynaptic autoregulating dopamine D2 receptor antagonist in the brain, and is usually prescribed for dyspepsia, nausea and vomiting. In particular, it was also reported to improve the symptoms of diurnal bruxism after brain injury. With reviewing some of literatures, we present a case of 27 year old man with traumatic brain injury who showed improvement of oro-facial dyskinesia after taking oral metoclopramide.
Blood-Brain Barrier ; Brain ; Brain Injuries* ; Bruxism ; Dyskinesias* ; Dyspepsia ; Jaw ; Lip ; Metoclopramide* ; Nausea ; Receptors, Dopamine ; Receptors, Dopamine D2 ; Tongue ; Vomiting

A 43-year-old man with no notable medical history was admitted due to sudden onset dysarthria and right side weakness. The man was diagnosed with acute infarction of left basal ganglia (BG) and uncontrolled diabetes mellitus (DM). After 9 hours post the thrombolysis, mental change and left side weakness symptoms were newly observed, and the man was additionally diagnosed with acute infarction in right BG.The man showed symptoms of quadriplegia and was fed through nasogastric tube. He showed motor aphasia, and no signs of phonation, but showed some indications of intact cognition. After rehabilitation therapies, the man showed marginal improvement in motor function, but still lacked any meaningful changes functionally. This is the first case of symmetric bilateral BG infarction, which one-sided infarction additionally occurred within 24 hours post the treatment of contralateral infarction through thrombolysis. Also,the features observed were atypical while the patient has no previous external causes related with bilateral BG infarction.
Adult ; Aphasia, Broca ; Basal Ganglia* ; Cognition ; Diabetes Mellitus ; Dysarthria ; Humans ; Infarction* ; Phonation ; Quadriplegia ; Rehabilitation ; Thrombolytic Therapy

Terson syndrome is a vitreous hemorrhage associated with subarachnoid hemorrhage. This can be caused by spontaneous, aneurysmal rupture or traumatic subarachnoid hemorrhage, but never has been reported as a consequence of hemorrhage due to thrombolysis and thrombectomy treatments of acute ischemic stroke patient. A 48-year-old man presented with left sided weakness was diagnosed as cerebral infarction on right middle cerebral artery territory due to complete occlusion of right distal internal carotid, middle cerebral, and anterior cerebral artery. He underwent thrombolysis and mechanical thrombectomy, and subarachnoid hemorrhage developed. Later, visual disturbance on right eye occurred so he was consulted to ophthalmology. Vitreous hemorrhage was found and surgery was recommended after two weeks of observation. After pars planar vitrectomy, visual acuity improved, along with functional ability. Therefore, possibilities of Terson syndrome in patients with subarachnoid hemorrhage have to be kept in mind to improve not only visual acuity but also rehabilitation outcome.
Aneurysm ; Anterior Cerebral Artery ; Cerebral Infarction ; Hemorrhage ; Humans ; Middle Aged ; Middle Cerebral Artery ; Ophthalmology ; Rupture ; Stroke* ; Subarachnoid Hemorrhage* ; Subarachnoid Hemorrhage, Traumatic ; Thrombectomy* ; Treatment Outcome ; Visual Acuity ; Vitrectomy ; Vitreous Hemorrhage

West Nile virus (WNV) is the most widespread arbovirus in the world. It can cause serious or fatal central nervous system (CNS) infection. We present a case of 58-year-old man who developed neuropsychologic and psychiatric impairment such as cognitive impairment, depressive symptoms, health concerns and thought disorder after West Nile virus encephalitis. This is the first imported case of West Nile virus infection in Korean.
Arboviruses ; Central Nervous System ; Depression ; Encephalitis* ; Humans ; Middle Aged ; Neuropsychological Tests ; West Nile virus*

Central pontine and extrapontine myelinolysis are well-recognized osmotic demyelination syndromes related to the rapid correction of hyponatremia, chronic alcoholism, and malnutrition. They are reported to show brain stem signs and various movement disorders. A 58-year-old man with a history of chronic alcoholism was admitted for dysarthria, dysphagia, and gait disturbance that had developed five days after a right forearm cellulitis. Magnetic resonance imaging revealed demyelinating patterns in the central portion of the pons and both thalami. He showed severe extrapyramidal symptoms with truncal swaying and postural instability that resulted in severe gait disturbance. Postural instability showed little improvement after conventional physical therapy, but his symptoms markedly improved after five days of dopamine administration. Cessation of dopamine agents was attempted two times, but postural instability and gait disturbance recurred. Therefore, medication was continued for one year. The patient showed stable gait and no further deterioration of postural instability during dopamine therapy.
Alcoholism ; Brain Stem ; Cellulitis ; Deglutition Disorders ; Demyelinating Diseases ; Dopamine ; Dopamine Agents ; Dysarthria ; Follow-Up Studies* ; Forearm ; Gait ; Humans ; Hyponatremia ; Magnetic Resonance Imaging ; Malnutrition ; Middle Aged ; Movement Disorders ; Myelinolysis, Central Pontine* ; Pons

OBJECTIVE: To compare the pain and functional improvement of suprascapular nerve block (SSNB) and intra-articular hyaluronic acid (HA) injection in post-stroke patients with hemiplegic shoulder pain. METHOD: In total, 24 stroke patients were randomly assigned in the SSNB group (n = 12) or the HA group (n = 12). Ultrasound (US) guided SSNB with 10 cc of 1% lidocaine and US guided intra-articular injection with 2 cc of HA was done in each group 3 times weekly. Visual analogue scale (VAS), Fugl-Meyer scale (FMS), Wolf motor function test (WMFT), Brunnstrom stage, modified Ashworth scale (MAS), range of motion (ROM) of shoulder joint and brief pain inventory (BPI) concerning the interference of patient's function (activity, mood, walking, work, relationship, sleep and enjoy) were assessed before the injection, one week and four weeks after first injection. RESULTS: Both groups showed significant improvements in pain assessed by VAS, but the changes between the two groups were not significantly different. There were no significant improvements and did not show any significant differences between the two groups in FMS, WMFT, Brunnstrom stage, MAS and ROM of shoulder joint. On several items of the BPI concerning the interference of patient's function (activity, mood, work, and enjoy), only SSNB group showed significant improvement, even though the differences between the two groups were not significant. CONCLUSION: Both SSNB and intra-articular HA injection were safe and effective in pain and functional ability in hemiplegic shoulder pain. But comparing the interference of patient's function caused by pain, only SSNB showed significant improvement.
Hemiplegia ; Humans ; Hyaluronic Acid* ; Injections, Intra-Articular ; Lidocaine ; Nerve Block* ; Range of Motion, Articular ; Shoulder Joint ; Shoulder Pain* ; Stroke ; Ultrasonography ; Walking ; Wolves

OBJECTIVE: To investigate the effects of robot-assisted arm training on motor and functional recovery of upper limb in patients with subacute stroke. METHOD: Thirty one subacute stroke patients were randomly divided into 2 groups. Robot-assisted arm training group received robot-assisted therapy using Armeo(R)Spring (Hocoma Inc., Zurich, Switzerland) for thirty minutes per day and five times every week during four weeks while control group received conventional arm training with same duration and frequency as robotic group. Outcome measures were used manual muscle test (MMT) for motor strength, Fugl-Meyer assessment (FMA), Manual function test (MFT) for arm function, Korean-modified Barthel index (K-MBI) for activities of daily living, Korean-mini mental state examination (K-MMSE) and Computerized Neuro-Cognitive Function test software-40 (CNT-40) for cognitive function. All recruited patients underwent these evaluations before and after four weeks robot-assisted arm training. RESULTS: Robot-assisted training on upper limb after subacute stroke showed improvement on motor strength, arm function, and activities of daily living. But change values in terms of MMT, FMA, MFT, K-MBI exhibited a no statistically significant difference compared with conventional group (p>0.05). CONCLUSION: In patients with upper limb deficits after subacute stroke, Robot-assisted arm training was considered to facilitate motor and functional recovery of upper limb. But robot-assisted arm training did not significantly improve motor and arm function at 4 weeks compared with conventional arm training group. Further research is required about the comparison of conventional rehabilitation therapy group and the questions about the duration, severity of stroke.
Activities of Daily Living ; Arm* ; Humans ; Outcome Assessment (Health Care) ; Rehabilitation ; Stroke* ; Upper Extremity

The brainstem is a compact, stalklike structure. It carries nearly all information between the brain and the remainder of body. It is a corridor to all major sensory, motor, cerebellar, cranial nerve pathways but it is not simply a conduit for information. It has numerous nuclei of the cranial nerves. Therefore, when a patient has a lesion in the brainstem, he or she will demonstrate a variety of symptoms regarding level of consciousness, motor control, muscle tone, posture, vegetative function and other essential function. Here, we will discuss about the non-motor symptoms caused by the brainstem lesions and the strategy for the rehabilitation.
Brain ; Brain Stem* ; Consciousness ; Cranial Nerves ; Deglutition ; Humans ; Posture ; Rehabilitation* ; Sensation

Palatal tremor and Kernohan-Woltman notch phenomenon are rare motor symptoms that can show up in patients with lesion in brain stem or cerebellum. Patients with palatal tremor accompany ataxia, internuclear ophthalmoplegia, dysphagia, dysarthria and Kernohan-Woltman notch phenomenon causes ipsilateral motor deficits. Although its rarity, these conditions exhibit unexpected symptoms as well as considerable disability, which can raise etiologic and prognostic concerns for rehabilitation team. These two motor symptoms are discussed in this review.
Ataxia ; Brain Stem* ; Cerebellum ; Deglutition Disorders ; Dysarthria ; Humans ; Ocular Motility Disorders ; Rehabilitation ; Tremor

The brain stem consists of medulla oblongta, pons and midbrain. It is sited in posterior cranial fossa. It contains numerous intrinsic neuron cell bodies and their processes, some of which are the brain stem homologues of spinal neuronal groups. These include the sites of termination and cells of origin of axons that enter or leave the brain stem through the cranial nerves. Cranial nerves provide sensory, motor and autonomic innervations of structures that are mostly in the head and neck. The reticular formation is an extensive network of neurons that extends throughout the length of brain stem and is continuous rostrally to diencephalon and caudally to its spinal counterpart. Clinically, damage to the brain stem is often devastating and life threatening. This is because it is a structurally and functionally compact region. Therefore, it is important to build basic knowledge about neuroanatomy of brain stem.
Axons ; Brain Stem* ; Cranial Fossa, Posterior ; Cranial Nerves ; Diencephalon ; Head ; Mesencephalon ; Neck ; Neuroanatomy* ; Neurons ; Pons ; Reticular Formation