OBJECTIVES: To understand the current status of appraisal of post-concussion syndrome disability and the reasons for the changes in re-appraisal opinions. METHODS: The cases that were judged as "post-concussion syndrome and ten-level disability" in the first appraisal and re-appraised for psychiatric impairment by the Academy of Forensic Science in 2019 were analyzed retrospectively. RESULTS: There were 75 cases, including 58 cases with pre-hospital emergency medical records, among which 39 cases were clearly recorded to be without a history of coma; 74 cases had emergency medical records, among which 44 cases were recorded of having a history of coma; 43 cases had follow-up medical records, among which 24 cases had a history of psychiatric follow-up. The most complained symptoms of the appraisee in appraisal and examination include headache, dizziness, poor sleep at night, irritability, memory loss, fatigue and inattention. The main reasons for the re-appraisal application include doubts about the history of coma, doubts about the credibility of mental symptoms, post-concussion syndrome didn't meet the disability criteria, and objections to the original appraisal procedure or the original appraisal agency. The appraisal opinions of a total of 47 cases were changed. Seven of them did not meet the disability criteria, and the main reason was that there was no clear history of coma and no head injury was admitted; the coma history of the 40 other cases had to be confirmed by the court before they can be clearly identified as disabilities. The reason was that the records about the history of coma were inconsistent or there were alterations and additional information. CONCLUSIONS In the past, the conditions for appraisal of post-concussion syndrome disability were too lax and must be further standardized and strictly controlled.
Brain Concussion/diagnosis* ; Craniocerebral Trauma ; Headache/psychology* ; Humans ; Mental Disorders ; Post-Concussion Syndrome/psychology* ; Retrospective Studies

Excessive weight gain in children diagnosed with celiac disease (CD) is becoming more common. We describe 2 siblings (9-year and 6 months-old female and 6-year and 9 months-old male) with obesity showing attenuated gastrointestinal and atypical symptoms in which CD was diagnosed in the absence of a known family history of CD. After children's diagnosis, CD in their parents was also investigated. It was detected in their father affected by overweight. The presentation of patients with CD has changed. While patients with overweight and obesity commonly have symptoms such as abdominal pain, reflux, headache, and constipation due to lifestyle factors, CD should also be considered in patients with or without a family history of CD. Careful nutritional status assessment and follow-up monitoring after the diagnosis of CD are mandatory, especially in subjects who are already overweight at the presentation of this disease.
Abdominal Pain ; Celiac Disease ; Child ; Constipation ; Diagnosis ; Fathers ; Female ; Follow-Up Studies ; Headache ; Humans ; Life Style ; Nutritional Status ; Obesity ; Overweight ; Parents ; Recognition (Psychology) ; Siblings ; Weight Gain

Fibromyalgia (FM) is a contested illness with ill-defined boundaries. There is no clearly defined cut-point that separates FM from non-FM. Diagnosis of FM has been faced with several challenges that occur, including patients' health care-seeking behavior, symptoms recognition, and FM labeling by physicians. This review focuses on important but less visible factors that have a profound influence on under- or over-diagnosis of FM. FM shows different phenotypes and disease expression in patients and even in one patient over time. Psychosocial and cultural factors seem to be a contemporary ferment in FM which play a major role in physician diagnosis even more than having severe symptom levels in FM patients. Although the FM criteria are the only current methods which can be used for classification of FM patients in surveys, research, and clinical settings, there are several key pieces missing in the fibromyalgia diagnostic puzzle, such as invalidation, psychosocial factors, and heterogeneous disease expression. Regarding the complex nature of FM, as well as the arbitrary and illusory constructs of the existing FM criteria, FM diagnosis frequently fails to provide a clinical diagnosis fit to reality. A physicians' judgment, obtained in real communicative environments with patients, beyond the existing constructional scores, seems the only reliable way for more valid diagnoses. It plays a pivotal role in the meaning and conceptualization of symptoms and psychosocial factors, making diagnoses and labeling of FM. It is better to see FM as a whole, not as a medical specialty or constructional scores.
Chronic Pain ; Classification ; Diagnosis ; Dyssomnias ; Fatigue Syndrome, Chronic ; Fibromyalgia ; Headache ; Humans ; Judgment ; Musculoskeletal Diseases ; Patient Selection ; Phenotype ; Psychology ; Reproducibility of Results ; Surveys and Questionnaires

Insomnia is the most common sleep complaint encountered in primary care. It affects both the individual and society through the burden of medical, psychiatric, interpersonal and social consequences. The management of patients affected by insomnia depends on the accurate diagnosis of the condition, consideration of the possible aetiologies, the duration of the insomnia and its impact on both the individual and society. Herein, we discuss the appropriate management of insomnia in the community.
Headache ; diagnosis ; Humans ; Sleep ; Sleep Initiation and Maintenance Disorders ; diagnosis ; physiopathology ; psychology

In modern society, stress is one of the most significant problems affecting physical as well as mental health. Stress, which is defined as a situation in which the homeostasis of the physiological system of one's mind and body is threatened, is composed of two concepts: stressors and stress reactions. A stressor is the stimulus that is perceived as a threat and arouses a stress reaction, such as a disaster or serious life event. Stress reactions are physical and mental symptoms, for example, chest tightness, dizziness, abdominal pain, dyspepsia, headache, and agitation, which are mediated by the sympathetic nervous system and stress hormones such as cortisol. These reactions, along with stress-related unhealthy behaviors, result in serious chronic diseases, including cancers and cardiovascular disease. Stress coping methods are classified into two components: cognitive behavioral interventions for stressors and mind-body interventions to reduce the stress response. Various interventions have been identified: progressive muscle relaxation, autogenic training, relaxation response, biofeedback, the emotional freedom technique, guided imagery, diaphragmatic breathing, transcendental meditation, and mindfulness-based stress reduction. Meditation and progressive muscular relaxation are well-known and widely used procedures to reduce the stress response and to improve quality of life. Further studies to establish an evidence-based standardized program that can be easily applied at the individual level are needed.
Abdominal Pain ; Autogenic Training ; Biofeedback, Psychology ; Cardiovascular Diseases ; Chronic Disease ; Dihydroergotamine ; Disasters ; Dizziness ; Dyspepsia ; Freedom ; Headache ; Homeostasis ; Hydrocortisone ; Imagery (Psychotherapy) ; Meditation ; Mental Health ; Muscle Relaxation ; Quality of Life ; Relaxation ; Respiration ; Stress, Psychological ; Sympathetic Nervous System ; Thorax

PURPOSE: Rapid and noninvasive detection of increased intracranial pressure (IICP) is important in evaluating a clinically unstable, unconscious patient. The purpose of this study was to measure the mean intraocular pressure (IOP) of patients with intracranial hemorrhage and correlate the results to the variable clinical features associated with intracranial hemorrhage. METHODS: Patients admitted to the emergency department were sorted into two groups based on their IOP results as measured using a Tono-Pen. The hemorrhage group consisted of patients suffering with intracranial hemorrhage and the normal group consisted of patients without intracranial hemorrhage. Patients with glaucoma or trauma of the ocular or facial area were excluded from this study. RESULTS: Mean IOP (30.45+/-9.13 mmHg) of the hemorrhage group (52 patients, 34 male, 18 female, mean age 58.28+/-14.39 years) was higher than the mean IOP (16.14+/-2.24 mmHg) of the normal group (39 patients, 23 male, 16 female, mean age 52.69+/-17.79 years) (p<0.001). Whether or not the intracranial hemorrhage was traumatic or nontraumatic, severe, or mild to moderate, accompanied with IICP or non-IICP, requiring an emergency or non-emergency operation, the IOP measured did not show any statistical significance. CONCLUSION: The IOP of the hemorrhage group was higher than the IOP of the normal group, but to determine the clinical usefulness of this measurement when accompanying presentation of headache or traumatic brain injury in the emergency department will require further investigation.
Brain ; Brain Injuries ; Emergencies ; Female ; Glaucoma ; Headache ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Intracranial Pressure ; Intraocular Pressure ; Male ; Manometry ; Stress, Psychological ; Unconscious (Psychology)

PURPOSE: Rapid and noninvasive detection of increased intracranial pressure (IICP) is important in evaluating a clinically unstable, unconscious patient. The purpose of this study was to measure the mean intraocular pressure (IOP) of patients with intracranial hemorrhage and correlate the results to the variable clinical features associated with intracranial hemorrhage. METHODS: Patients admitted to the emergency department were sorted into two groups based on their IOP results as measured using a Tono-Pen. The hemorrhage group consisted of patients suffering with intracranial hemorrhage and the normal group consisted of patients without intracranial hemorrhage. Patients with glaucoma or trauma of the ocular or facial area were excluded from this study. RESULTS: Mean IOP (30.45+/-9.13 mmHg) of the hemorrhage group (52 patients, 34 male, 18 female, mean age 58.28+/-14.39 years) was higher than the mean IOP (16.14+/-2.24 mmHg) of the normal group (39 patients, 23 male, 16 female, mean age 52.69+/-17.79 years) (p<0.001). Whether or not the intracranial hemorrhage was traumatic or nontraumatic, severe, or mild to moderate, accompanied with IICP or non-IICP, requiring an emergency or non-emergency operation, the IOP measured did not show any statistical significance. CONCLUSION: The IOP of the hemorrhage group was higher than the IOP of the normal group, but to determine the clinical usefulness of this measurement when accompanying presentation of headache or traumatic brain injury in the emergency department will require further investigation.
Brain ; Brain Injuries ; Emergencies ; Female ; Glaucoma ; Headache ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Intracranial Pressure ; Intraocular Pressure ; Male ; Manometry ; Stress, Psychological ; Unconscious (Psychology)

C1 lateral mass and C2 pedicle (C1LM-C2P) fixation is a relatively new technique for atlantoaxial stabilization. Complications from C1LM-C2P fixation have been rarely reported. The authors report unilateral rod migration into the posterior fossa as a rare complication after this posterior C1-C2 stabilization technique. A 23-year-old man suffered severe head trauma and cervical spine injury after vehicle accident. He was unconscious for 2 months and regained consciousness. He underwent C1LM-C2P fixation for stabilization of type II odontoid process fracture described by Harms. The patient recovered without a major complication. Twenty months after operation, brain computed tomogram performed at psychology department for disability evaluation showed rod migration into the right cerebellar hemisphere. The patient had mild occipital headache and dizziness only regarding the misplaced rod. He refused further operation for rod removal. To our knowledge, this complication is the first report regarding rod migration after Harms method. We should be kept in mind the possibility of rod migration, and C1LM-C2P fixation should be performed with meticulous technique and long-term follow-up.
Brain ; Consciousness ; Craniocerebral Trauma ; Disability Evaluation ; Dizziness ; Follow-Up Studies ; Headache ; Humans ; Odontoid Process ; Spine ; Unconscious (Psychology) ; Young Adult

Reversible posterior leukoencepalopathy syndrome (RPLS) was noted by a reversible syndrome of headache, altered mental status, seizure, and visual loss associated with findings indicating predominantly posterior leukoencephalopathy on imaging studies. We report a successful treatment of RPLS after secondary ABO incompatibility kidney transplantation with blood pressure control. A 41-year-old female whose primary kidney disease was chronic glomerulonephritis had graft failure developed after living donor kidney transplantation (1st kidney transplantation). She was admitted to our hospital for 2nd ABO incompatibility kidney transplantation. She had undergone 6 times of plasmapheresis and received additional two doses of rituximab (375 mg/m2) and intravenous immunoglobulin (0.5 g/kg) before kidney transplantation. She received basiliximab induction therapy, tacrolimus, steroid and mycophenolate mofetile after transplantation. The ABO antibody titer had been low (below 1:1) and evidences of rejection were not detected. Generalized tonic clonic type seizure, eyeball deviation, facial cyanotic change and loss of consciousness occurred at post operation 7th day. Several minutes later, she recovered her consciousness without disability and neurologic deficit. She did not represent attacks any more after we controlled blood pressure without withdrawal of immunosuppressants or dose reduction.
Adult ; Antibodies, Monoclonal ; Antibodies, Monoclonal, Murine-Derived ; Blood Pressure ; Consciousness ; Female ; Glomerulonephritis ; Headache ; Humans ; Immunoglobulins ; Immunosuppressive Agents ; Kidney ; Kidney Diseases ; Kidney Transplantation ; Leukoencephalopathies ; Living Donors ; Neurologic Manifestations ; Plasmapheresis ; Posterior Leukoencephalopathy Syndrome ; Recombinant Fusion Proteins ; Rejection (Psychology) ; Seizures ; Tacrolimus ; Transplants ; Unconsciousness ; Rituximab

OBJECTIVES: This study aimed to identify the essential symptoms for diagnosing Hwabyung. METHODS: We assessed 221 patients with depressive disorders, anxiety disorders, somatoform disorders, adjustment disorder, and so-called Hwabyung, using a structured diagnostic interview schedule that included the Korean version of SCID-I and the preliminary diagnostic criteria for Hwabyung. To select essential symptoms for diagnosing Hwabyung, we performed statistical analyses including factor analysis and logistic regression RESULTS: Statistical analysis revealed that sensations of heat, an epigastric mass, and something pushing up in the chest ; feelings of unfair treatment ; anger ; respiratory stuffiness ; palpitations; headaches ; sighing ;"haan" ; depressive mood ; frightening easily ; dry mouth; and many thoughts were the essential symptoms for a diagnosis of Hwabyung. CONCLUSION: Based on these results, we suggest a research diagnostic criteria for Hwabyung.
Adjustment Disorders ; Anger ; Anxiety Disorders ; Appointments and Schedules ; Depressive Disorder ; Discrimination (Psychology) ; Headache ; Hot Temperature ; Humans ; Logistic Models ; Sensation ; Somatoform Disorders ; Thorax