OBJECTIVE: Voiding dysfunction after stroke and traumatic brain injury has been known to be a predictive factor of death or severe disability, and an important factor on hospital discharge. Thus we aim to investigate its prevalence, related factors and natural course of brain injury related voiding dysfunction for proper rehabilitation after brain injury. METHOD: Two hundred ten brain injury patients (male 130, female 80) admitted in 5 university hospitals were included. The cognitive function was assessed using the Korean version-Mini mental state examination (K-MMSE), and bladder function was evaluated with the International Prostate Symptom Score (IPSS) and voiding diary. We excluded the patients that had previous urologic and gynecologic problem. RESULTS: Overall, 43.7% of total patients had voiding difficulty and the most common symptom was nocturia (80.6%), which was followed by frequency (72.6%) and urgency (40.3%). Patients with incontinence had lower K-MMSE scores than continent patients. There was no significant difference of rate of incontinence in relation with sex, cause of brain injury, and lesion site. Prevalence of urinary symptoms decreased as the duration after brain injury was longer. The quality of life score showed a high correlation with the total IPSS score (p<0.05). CONCLUSION: The overall results demonstrate that voiding dysfunction after brain injury is influenced by onset time and cognitive function after brain injury.
Brain ; Brain Injuries ; Female ; Hospitals, University ; Humans ; Nocturia ; Prevalence ; Prostate ; Quality of Life ; Stroke ; Urinary Bladder

TGF-beta-induced tolerogenic-antigen presenting cells (Tol-APCs) could induce suppression of autoimmune diseases such as collagen-induced arthritis (CIA) and allergic asthma. In contrast, many studies have shown that NKT cells are involved in the pathogenesis of Th1-mediated autoimmune joint inflammation and Th2-mediated allergic pulmonary inflammation. In this study, we investigated the effect of CD1d-restricted NKT cells in the Tol-APCs-mediated suppression of autoimmune disease using a murine CIA model. When CIA-induced mice were treated with Tol-APCs obtained from CD1d+/- or CD1d-/- mice, unlike CD1d+/- APCs, CD1d-/- Tol-APCs failed to suppress CIA. More specifically, CD1d-/- Tol-APCs failed to suppress the production of inflammatory cytokines and the induction of Th2 responses by antigen-specific CD4 T cells both in vitro and in vivo. Our results demonstrate that the presence of CD1d-restricted NKT cells is critical for the induction of Tol-APCs-mediated suppression of CIA.
Animals ; Antibodies/blood ; Antibody Formation/immunology ; Antibody Specificity/immunology ; Antigen-Presenting Cells/*immunology ; Antigens, CD1d/immunology ; Arthritis, Experimental/blood/*immunology/*prevention & control ; Collagen Type II/immunology ; Cytokines/blood ; Immune Tolerance/*immunology ; Inflammation Mediators/blood ; Mice ; Natural Killer T-Cells/*immunology ; Th1 Cells/immunology

OBJECTIVE: To emphasize the need for precise diagnosis of amyotrophic lateral sclerosis (ALS), a progressive and degenerative disease of upper and lower motor neurons that often present initially with weakness at the upper or lower extremities, and frequently misdiagnosed as myelopathy, radiculopathy, peripheral neuropathy or arthropathy that may ultimately lead to unnecessary treatments including surgical procedures. METHOD: We retrospectively reviewed medical records of 331 ALS patients who visited our hospital between 1998 and 2008. Symptoms at onset, progression of disease, radiologic findings, surgeries prior to diagnosis of ALS, outcome after surgery or conservative treatments, and electrodiagnostic study results were reviewed. RESULTS: Among the 331 patients with ALS, 34 (10.3%) had a history of surgical procedure and 37 (11.1%) underwent conservative treatment prior to diagnosis of ALS. 34 patients with a mean disease duration at diagnosis of 20.0+/-14.9 months, had surgery for symptoms that were later attributable to ALS. In 30 of the 34 patients, symptoms did not resolve after the intervention. 37 patients with a mean disease duration at diagnosis of 16.6+/-14.3 months, underwent conservative treatments such as physical therapy prior to diagnosis of ALS. Only in one patient (2.7%), symptoms improved after conservative treatment. CONCLUSION: In the absence of a single confirmatory study for the diagnosis of ALS, clinical findings may be misinterpreted, leading to an erroneous diagnosis. Therefore, closer and more careful follow-up is necessary for patients with limb weakness in the absence of sensory symptoms, or bulbar abnormalities such as dysarthria and dysphagia.
Amyotrophic Lateral Sclerosis ; Deglutition Disorders ; Dysarthria ; Extremities ; Follow-Up Studies ; Humans ; Lower Extremity ; Medical Records ; Motor Neurons ; Peripheral Nervous System Diseases ; Radiculopathy ; Retrospective Studies ; Spinal Cord Diseases