OBJECTIVE: The purpose of this study is to find the change in post-stroke cognitive function during subacute phase, and to investigate factors associated with this change. METHOD: The cognitive function was evaluated using Mini-Mental Status Examination (MMSE) at the beginning of rehabilitation (mean 23.1 ± 12.6 days after onset) and discharge (mean 88.1 ± 29.8 days after onset) in 56 stroke patients. At the same time functional status was also evaluated using modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS) and modified Barthel Index (MBI). Then we compared the improvements of MMSE scores between two time period according to age, sex, stroke profile, and initial functional status. We also determined the correlation between cognitive and functional gain. RESULTS: MMSE scores improved from rehabilitation start to discharge (3.14 ± 5.4, p = 0.000). MMSE scores improved more when patients were male, older than 65 years, and had hemorrhagic and cortical lesions (p<0.05). And, MMSE scores improved more when patients had a higher functional level initially (mRS≤2, NIHSS≤1, MBI≥75), (p<0.05) and improvement of MMSE score was significantly correlated with initial MBI score (r = 0.351, p<0.05). CONCLUSION: Cognitive function recovered during subacute phase of stroke, and improvement of cognitive function at this phase were associated with sex, age, stroke profiles, initial functional status. These results would provide us an information to plan cognitive rehabilitation in these patients.

Many people with muscular dystrophy develop dysphagia that can result in an inability to use the oral route in severe cases. In such cases, an alternative feeding method is selected, including a nasogastric tube or a gastrostomy.This case report describes a 40-year-old man with muscular dystrophy who was managed for swallowing difficulty and respiratory failure. Oromotor muscle weakness caused prolonged mealtimes, difficulty with swallowing a solidform diet, aspiration signs, and weight loss. Consequently, an alternative feeding method was required. An abdominal radiograph showed massive aerophagia, and the transverse colon was located over the stomach. As a result, the colon interfered with the puncture route, which could lead to colon perforation. Therefore, cervical esophagostomy was selected, where the patient obtained nutrition through a cervical esophagostomy tube. This case showed that when gastrostomy cannot be performed due to aerophagia, cervical esophagostomy can successfully support nutrition for the mid to long-term in muscular dystrophy patients.

Dysphagia aortica is a rare form of mechanical dysphagia characterized by extrinsic compression of the esophagus by the aorta. A 69-year-old male reported experiencing swallowing difficulties for five months, along with nausea, abdominal discomfort, weight loss, and severe reflux. Considering his age and a medical history of hypertension and stenosis of the cerebral artery, poststroke dysphagia was initially suspected. However, brain magnetic resonance imaging revealed no evidence of acute or subacute stroke. Further evaluation was achieved via enhanced chest computed tomography to locate the focus of the systemic inflammation. A thoracic aortic aneurysm about 8.7×5.0 cm in size, with signs of impending rupture, was observed. This case reinforces that a high possibility for dysphagia aortica should be considered under conditions of unclear etiology of dysphagia but the presence of associated symptoms, such as progressive intolerance to solids and ultimately to liquids, weight loss, and nausea.

Presbyesophagus is a unique cause of dysphagia in the elderly, which features incomplete relaxation of the lower esophageal sphincter, dilatation of the esophagus, decreased esophageal peristaltic pressures, abnormal esophageal contractions, and delayed emptying of the esophagus. An 88-year-old woman underwent surgery for a femur fracture.The day after surgery, respiratory arrest occurred during a meal. Breathing resumed after oxygen supply with airway opening. She complained of dysphagia and nausea during a meal, and the videofluoroscopic swallowing study and esophagography showed delayed emptying of the esophagus, abnormal esophageal contraction, and dilatation of the esophagus. This case shows that esophageal dysfunction in the elderly with poor general medical conditions can worsen abruptly.

Gallstone ileus is a well-known complication of cholelithiasis, but is relatively rare. Most ectopic gallstones are located in the small bowel; they are rarely found in the stomach and duodenum. We describe the imaging findings of a case of intragastric gallstone, as well as a case in which duodenal obstruction was caused by a large gallstone (Bouveret's syndrome).
Cholelithiasis ; Duodenal Obstruction ; Duodenum ; Gallstones* ; Ileus ; Stomach

PURPOSE: Authors studied the injection method of contrast medium in routine chest spiral CT scan to obtain the best image in the mediastinum. MATERIALS AND METHODS: Dynamic static scan had been performed in 5 normal volunteers as a pilot study. In consideration of the result of pilot study, Chest spiral CT was performed in 217 patients by three different methods. We used 100cc nonionic contrast medium. Average attenuation of great vessels in the mediastinum were assessed in various injection methods. Image quality was graded with three levels of score by two radiologists. RESULTS: Peak enhancement time of the great vessels on pilot at dynamic static scan were as follows :52 sec at ascending aorta, 45 sec at pulmonary artery, and 40 sec at SVC. In the study of spiral CT, the highest attenMarion in the great vessels was obtained after injection of 100cc of contrast medium(2cc/sec, with 35-40 second scan delay), althrough artifact from highly enhancing SVC was most common in this method. Image quality were highest in the scans obtained with other methods(3-2-1cc/sec for 10-15-40 seconds, with 40 second scan delay). CONCLUSION: For chest spiral CT, authors recommend that scans should be obtained after infusion of 70--80cc of contrast medium during 35--40sec to obtain maximal vascular enhacement of mediastinum.
Aorta ; Artifacts ; Healthy Volunteers ; Humans ; Mediastinum ; Pilot Projects ; Pulmonary Artery ; Thorax* ; Tomography, Spiral Computed*

Laryngeal schwannoma is extremely rare. We report the CT and MRI findings of a case occurring in a 65-year-oldwoman, and describe the pathologic correlation. Pre-contrast CT scanning revealed a right supraglot-tic mass witha slightly hyperdense central part and a hypodense peripheral part. Post-contrast CT scanning re-vealed anenhanced hyperdense central part and a rim-like hypodense peripheral part. The density of the pe-ripheral part waslower than that of muscle. The mass showed homogeneous low signal intensity on T1-weighted MR images, homogeneoushigh signal intensity on T2-weighted MR images, and an enhanced high signal intensity central part and a lowsignal intensity peripheral part on gadolinium enhanced T1-weighted images. The enhanced central part correlatedwith Antoni A areas and the peripheral part, showing low attenuation, correlated with Antoni B areas.
Gadolinium ; Magnetic Resonance Imaging ; Neurilemmoma* ; Tomography, X-Ray Computed

Diabetic thoracic polyradiculopathy is an unusual cause of severe, chronic abdominal pain in patient with diabetes mellitus of variable duration. The diagnosis can be made by careful history taking, physical examination and paraspinal and abdominal muscle electromyography. Since there are so many diseases that cause similar abdominal pain, it is hard to diagnose diabetic thoracic polyradiculopathy. A 41-year-old female patient with diabetes mellitus had been taken to the department of internal medicine due to unexplained chronic left upper quadrant abdominal pain. Upper gastrointestinal endoscopy, abdominal computed tomography, urologic and gynecologic examinations had been done but failed to find the cause of abdominal pain. We diagnosed chronic abdominal pain of the patient as diabetic thoracic polyradiculopathy confirmed by electromyography and report this case with a brief review of the related literatures.
Abdominal Muscles ; Abdominal Pain* ; Adult ; Diabetes Mellitus ; Diagnosis ; Electromyography ; Endoscopy, Gastrointestinal ; Female ; Humans ; Internal Medicine ; Physical Examination ; Polyradiculopathy*

OBJECTIVE: To compare the characteristics between geriatric depression scale (GDS), Hamilton depression rating scale (HDRS) and post-stroke depression scale (PSDS) in the aspect of diagnosis and severity assessment for post-stroke depression. METHOD: 45 post-stroke patients were included for this study. Subjects were classified through DSM-IV criteria into three different groups; depression-free, minor depression and major depression. GDS, HDRS, PSDS were also assessed in all subjects simultaneously. Three depression assessment scales were compared between groups based on DSM-IV criteria, and the sensitivity and specificity using cut-off value were analyzed. RESULTS: All scales showed the significant differences between depression group and depression-free group. GDS showed higher sensitivity and specificity than HDRS and PSDS and GDS showed the significant difference between minor depression and no depression group, but other scales did not. HDRS and PSDS in major depression group showed the significant differences compared with minor depression group (p<0.05), but GDS did not. CONCLUSION: GDS may be more useful to identify the presence of depression compared to GDRS and PSDS. However, to measure the severity of depression, HDRS and PSDS may be more useful than GDS.
Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Sensitivity and Specificity ; Stroke ; Weights and Measures

Akinetic mutism is a clinical syndrome in which the patient is unable to speak (mutism) or move (akinesia). Various brain lesions can induce akinetic mutism. We attended a 71-year-old woman who presented with akinetic mutism caused by bilateral anterior cerebral artery infarction. The patient improved after the administration of levodopa com-bined with carbidopa, in response to visual and verbal stimuli. Increased verbal output and spontaneous motor activities were also noted. Levodopa may be helpful to the treatment of akinetic mutism.
Aged ; Akinetic Mutism* ; Anterior Cerebral Artery* ; Brain ; Carbidopa ; Female ; Humans ; Infarction, Anterior Cerebral Artery* ; Levodopa* ; Motor Activity