OBJECTIVE: To investigate the correlation between the motor evoked potentials (MEPs) amplitude of 1st dorsal interosseus in affected limbs and affected hand function after stroke. METHOD: We enrolled 109 patients with acute and subacute 1st attack stroke. Transcranial magnetic stimulation (TMS) was applied to the motor cortex and MEP was recorded at the 1st dorsal interossei (DI) muscle. MEP parameters were latency of the affected side, latency ratio (latency of affected side/latency of unaffected side), amplitude of affected side and amplitude ratio (amplitude of affected side/latency of unaffected side). Hand function tests (HFT) including hand power measures and a nine hole peg test (NHPT) were conducted and the ratios of the value of the affected hand to unaffected hand were used for the analysis. The Korean version of the modified Barthel index (K-MBI) and the manual muscle test (MMT) of finger flexion were also evaluated. Correlation between MEP parameters and the clinical variables such as HFT, K-MBI and MMT grades were analyzed. RESULTS: While MEPs in the affected 1st DI were recorded in fifty six patients, MEPs were not recorded in forty nine patients. The responsiveness of MEPs was significantly correlated with the HFT, K-MBI and MMT grades. The amplitude ratio had the most significant correlation with the HFT and MMT grade in this MEP study. Also, the amplitude ratio had more significant correlations with the K-MBI score compared with other MEP parameters. CONCLUSION: We concluded that the amplitude ratio may be a useful MEPs parameter for indicating hand function.
Evoked Potentials, Motor ; Extremities ; Fingers ; Hand ; Humans ; Motor Cortex ; Muscles ; Organometallic Compounds ; Stroke ; Transcranial Magnetic Stimulation

OBJECTIVE: To investigate whether intermittent oro-esophageal (OE) tube feeding could improve swallowing function in brainstem stroke patients. METHOD: 23 patients suffering from dysphagia after acute brainstem stroke were enrolled in this study. All patients used nasogastric tubes for feeding. In a prospective, single blinded, randomized case control study conducted between January 2007 and April 2009, 11 patients were randomized to the study group who were fed with OE tube and received traditional swallowing treatment, and 12 patients were randomized to the control group who were fed with nasogastric tube and received traditional swallowing treatment. The effects of each treatment were assessed using functional dysphagia scale (FDS), penetration-aspiration scale (PAS), and American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS). RESULTS: The pretreatment evaluation showed no significant difference between the two groups for all parameters. After treatment, FDS, ASHA NOMS improved in both groups (p<0.05). But, PAS score improved only in the study group (p<0.05). In comparison between two groups, FDS, PAS and ASHA NOMS scores showed significant improvement in study groups (p<0.05) than control groups. CONCLUSION: OE tube can be a possible substitute for nasogastric tube in patients suffering from dysphagia after brainstem stroke. And it suggests that OE tube feeding may be used to facilitate recovery of swallowing function.
American Speech-Language-Hearing Association ; Brain Stem ; Brain Stem Infarctions ; Case-Control Studies ; Deglutition ; Deglutition Disorders ; Enteral Nutrition ; Humans ; Prospective Studies ; Stress, Psychological ; Stroke

OBJECTIVE: To evaluate an effect of balloon catheter dilatation on post-swallow laryngeal elevation, total pharyngeal transit time and pharyngeal remnant in stroke patients with cricopharyngeal dysfunction. METHOD: The 20 stroke patients with cricopharyngeal dysfunction in videofluoroscopic swallow study were recruited for the study. Using 16 Fr foley catheter, balloon was positioned across the upper esophageal sphincter under video-fluoroscopy. Balloon catheter dilatation was done for 3 minutes and each ballooning was repeated 6 times for a minute. We compared pre-balloon dilatation and post-balloon dilatation values. 3 factors were evaluated, which were laryngeal elevation, total pharyngeal transit time, and post-swallow pharyngeal remnant. RESULTS: There was no significant difference in laryngeal elevation after balloon dilatation. However, total pharyngeal transit time (p<0.01) and pharyngeal remnant (p<0.001) were significantly reduced after balloon dilatation. CONCLUSION: There were significant decrements of post-swallow total pharyngeal transit time and pharyngeal remnant after balloon dilation procedure. Balloon dilation of upper esophageal sphincter can produce relief of dysphagia in stroke patients with cricopharyngeal dysfunction.
Catheters ; Deglutition ; Deglutition Disorders ; Dilatation ; Esophageal Sphincter, Upper ; Humans ; Stroke

OBJECTIVE: To investigate if adding fiberoptic endoscopic evaluation of swallowing (FEES) to the videofluoroscopic swallowing study (VFSS) will improve the detection of abnormalities related to swallowing and pharyngolaryngeal structures. METHOD: Sixty-nine subjects (47 men, aged 64.8+/-12.0 years) with dysphagia were evaluated using VFSS and FEES simultaneously. VFSS and FEES were independently interpreted by two different examiners, who were blinded to the results of the other study. The foods that were examined were a 5-ml semi-blended diet (SBD), plain yogurt, boiled rice (NRD), and 2-ml (small fluid, SF) and 5-ml (large fluid, LF) diluted liquid barium. The detection rates of penetration or aspiration and of the pharyngeal residues in VFSS and FEES were compared. RESULTS: Combining FEES with VFSS raised the detection rates of penetration (p=0.008 for SF and LF; p<0.001 for SBD, yogurt, and NRD) and of the pharyngeal residues (p<0.001 for SF, SBD, yogurt, and NRD; p=0.001 and 0.002 for LF in the vallecula and pyriform sinus, respectively) in all the food types. Adding FEES also improved the detection of fluid aspiration (p=0.03 and 0.02 for SF and LF, respectively). Oral and pharyngeal lesions such as candidiasis, and other mucosal abnormalities, were also detected by FEES. CONCLUSION: Combining FEES with VFSS raised the diagnostic sensitivities of penetration, aspiration, and pharyngeal residues compared to the evaluation using VFSS alone. It also enabled the visualization of the abnormal structural changes in the pharyngolarynx. FEES can be performed safely by physiatrists.
Aged ; Barium ; Candidiasis ; Deglutition ; Deglutition Disorders ; Diet ; Fees and Charges ; Humans ; Male ; Pyriform Sinus ; Yogurt

OBJECTIVE: Cell therapy has been extensively studied as a gene complementation approach in muscular dystrophy including Duchenne muscular dystrophy (DMD), and adipose tissue has recently been identified as a uniquely abundant and adequately accessible source of pluripotent cells. In the present work, we investigated myogenic potentials of adipose-derived stem cells (ADSCs) depending on culture media and isolation with using surface markers. METHOD: Human ADSCs were obtained by liposuction and cultured in two different media; control and myogenic media. In addition we attempted to isolate ADSCs by utilizing surface markers: CD45 and CD133. The following observations were made to evaluate myogenic differentiation as the expression of myogenic regulatory factors (MyoD, Myf-5 and Myf-6) and desmin by RT-PCR and immunoflurescence study. RESULTS: Conversion of ADSCs to myogenic phenotype was observed by indirect immunoflurescence study of MyoD and Myf-5 in regardless of media type and isolation method. In addition mRNA of MyoD and Myf-5 were positive in both culture media, and there were no differences of MyoD and Myf-5 responses between CD45- and CD45-CD133-ADSCs. However, secondary myogenic regulatory factor (Myf-6) was not expressed constantly, and desmin were negative in all cultural condition. CONCLUSION: Our findings suggest that human ADSCs might have myogenic potentials. However, further studies are needed to express the secondary myogenic regulatory factors and proteins in myoblasts.
Adipose Tissue ; Complement System Proteins ; Culture Media ; Desmin ; Genes, vif ; Humans ; Lipectomy ; Muscular Dystrophies ; Muscular Dystrophy, Duchenne ; Myoblasts ; Myogenic Regulatory Factors ; Phenotype ; Proteins ; RNA, Messenger ; Stem Cells ; Tissue Therapy

OBJECTIVE: To investigate the pain-related behaviors and the changes of CX3CR1 expression in the dorsal root ganglion (DRG) in a rat model of lumbar disc herniation. METHOD: A total of 90 male Sprague-Dawley rats were used. A laminectomy was performed to expose left L5 nerve roots and corresponding DRG. Autologous nucleus puplosus was implanted on the left L5 nerve root proximal to the DRG without mechanical compression. Sham operation was also done with the same procedure as mentioned above. Thermal hyperalgesia and mechanical allodynia were assessed at 1, 5, 10, 20 and 30 days after surgery. Real time PCR and immunohistochemistry after behavioral test were performed. RESULTS: In the lumbar disc herniation rats, significant reduction of thermal withdrawal latency indicating thermal hyperalgesia was shown on the ipsilateral hindpaw on postoperative day 1 (p<0.01) and peaked on day 10 (p<0.05) and maintained throughout day 30 (p<0.05). The reduction of mechanical allodynia threshold, indicating mechanical allodynia, was observed on the ipsilateral hindpaw on postoperative day 1 (p<0.01) and continued throughout day 30 (p<0.01). Real time PCR showed the decrease in mRNA expression of CX3CR1 in the ipsilateral DRG on day 1 (p<0.05) and the significant increase on day 20 (p<0.05). The immunoreactivity for CX3CR1 was also increased in ipsilateral DRG on day 10 and 20. CONCLUSION: These data suggest that lumbar disc herniation induces thermal hyperalgesia and mechanical allodynia and upregulates the expression of CX3CR1 in dorsal root ganglion. Expression of CX3CR1 might be associated with subacute neuropathic pain after intervertebral disc herniation.
Animals ; Diagnosis-Related Groups ; Ganglia, Spinal ; Humans ; Hyperalgesia ; Immunohistochemistry ; Intervertebral Disc ; Laminectomy ; Male ; Neuralgia ; Rats ; Rats, Sprague-Dawley ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; Salicylamides ; Spinal Nerve Roots

VATER syndrome is defined as the combinations of three or more of the followings; Vertebral defect, Anal atresia, Esophageal atresia and/or Tracheo-Esophageal fistula, Renal dysplasia, and Radial-ray limb anomalies. A 21-month old female patient was admitted. She had the history of anastomosis of trcheo-esophageal fistula, V-P shunt operation due to hydrocephalus, and spina bifida. Upon admission, physical examinations showed increased deep tendon reflexes of all four extremities with grade 1 spasticity and popliteal angle being 45 degrees, bilaterally. The overall development of the patient was delayed. The imaging study showed hydrocephalus, periventricular leukomalatic change, underdevelopment of the cerebral cortex, atrophy of corpus callosum, Arnold-Chiary malformation, a vascular malformation along the intradural space from lower cervical to nearly entire thoracic vertebral level, multiple vertebral anomalies, and the fusion of multiple ribs. Furthermore hydronephrosis of the left kidney was detected. Follow-up of natural history and management of the patient is needed.
Anus, Imperforate ; Atrophy ; Cerebral Cortex ; Corpus Callosum ; Esophageal Atresia ; Esophagus ; Extremities ; Female ; Fistula ; Heart Defects, Congenital ; Humans ; Hydrocephalus ; Hydronephrosis ; Kidney ; Muscle Spasticity ; Natural History ; Physical Examination ; Radius ; Reflex, Stretch ; Ribs ; Spinal Dysraphism ; Spine ; Trachea ; Vascular Malformations

Freezing of gait (FOG), which is the most common symptoms in Parkinson's disease, is a unique gait disorder that patients are unable to initiate or continue locomotion. However, the pathophysiology of FOG has been poorly understood. We report two cases, one case is a 26-year old man and the second case is a 65-year old man, who showed FOG following hypoxic brain injuries caused by sudden cardiac arrest and hypovolemic shock, respectively. Brain F-18 FDG-PET images demonstrated the diffuse cortical hypometabolism in case 1 patient, and the decreased metabolism of the subcortical structures in case 2 patient. Two patients showed the typical features of FOG (turning, destination, and tight quarter hesitations combined with kinesia paradoxa) and the abnormal patterns of temporospatial data in kinematic gait analysis. We present two cases of FOG following hypoxic brain injury with reviewing of some literatures.
Brain ; Brain Injuries ; Death, Sudden, Cardiac ; Freezing ; Gait ; Humans ; Locomotion ; Parkinson Disease ; Shock ; Weather

Anterior spinal artery syndrome refers to the paralysis of the bilateral upper extremities, bladder dysfunction and the sensory deficit of pain and temperature below the level of injury. A 64 year-old female got a cardiac arrest event after stent insertion into the coronary artery. After CPR, she underwent the motor deficit (Z-T) of the bilateral upper extremities without any sensory deficit; proprioception, vibration and pain. The brain MRI showed no abnormality, but high signal intensity was detected in C3-C7 level by T2 sagittal plane and at the anterior horn area of gray matter by axial view of spine MRI. The ventilator has been applied after CPR. By the fluoroscopy, the movement of the diaphragm was decreased, and the nerve conduction study of both phrenic nerves showed no responses.
Animals ; Anterior Spinal Artery Syndrome ; Brain ; Cardiopulmonary Resuscitation ; Coronary Vessels ; Diaphragm ; Female ; Fluoroscopy ; Heart Arrest ; Horns ; Humans ; Neural Conduction ; Paralysis ; Phrenic Nerve ; Proprioception ; Respiratory Paralysis ; Spinal Cord ; Spinal Cord Ischemia ; Spine ; Stents ; Upper Extremity ; Urinary Bladder ; Ventilators, Mechanical ; Vibration

Cerebral air embolism is an unusual event that is mainly an iatrogenic cause, such as open heart surgery. We present a case of cerebral air embolism in a patient undergoing ASD patch repair with cardiopulmonary bypass. He had a status epilepticus, loss of consciousness and marked left limb weakness immediately after the operation. Diffusion-weighted MRI with angiography showed acute infarction in right entire hemisphere with patent internal carotid and intracranial arteries, and glucose PET brain scan showed severe decreased uptakes in right hemisphere. He recovered markedly with mild motor impairment of left upper and lower limbs in the 6 months after onset.
Angiography ; Arteries ; Brain ; Cardiopulmonary Bypass ; Embolism, Air ; Extremities ; Glucose ; Heart ; Humans ; Infarction ; Lower Extremity ; Status Epilepticus ; Thoracic Surgery ; Unconsciousness