OBJECTIVE: To investigate the correlation between the severity of paralysis and hand sympathetic skin response (SSR) in patients with Bell's palsy and to evaluate the clinical utility of hand SSR as a predicting factor of prognosis. METHOD: Twenty patients with Bell's palsy and twenty normal controls were recruited. The severity of paralysis was graded according to House-Brackmann Facial Grading Scale (H-B FGS), and percent degeneration of Nasalis was determined by Facial Nerve Conduction Study (FNCS). RESULTS: The difference of hand SSR amplitude between affected and unaffected side was significant (p<0.05). There was significant correlation between H-B FGS and the difference of hand SSR amplitude (p<0.05). There was significant correlation between percent degeneration and the difference of hand SSR amplitude (p<0.05). There were significant correlations between the difference of hand SSR amplitude at 5 days and percent degeneration at 9 and 14 days (p=0.026, p=0.001). CONCLUSION: The difference of hand SSR amplitude between affected and unaffected side was useful for the indication of the severity of paralysis. And, hand SSR would be useful for an early prognostic predictor in Bell's palsy.
Bell Palsy* ; Facial Nerve ; Hand* ; Humans ; Paralysis ; Prognosis ; Skin*

Neurocysticercosis is the most common parasitic disease of the central nervous system. Generally, the spinal cord involvement of neurocysticercosis is very rare. We experienced a 52-year-old female patient presented with tetraplegia. She was diagnosed as mixed type neurocysticercosis involving brain parenchyma, ventricle and cervical spinal cord. She underwent an operation of intradural mass removal with cervical laminectomy. In spite of gradual improvement in activities of daily livings, muscle power and sensation, she revealed the fluctuation of mental status and tetraplegia, possibly associated with perilesional inflammation, twice during the period of admission. So, we administered prednisolone 20 mg and albendazole 800 mg a day for a week per event and then her mental status and aggravated tetraplegia were improved. After comprehensive rehabilitation for 4 months, her ASIA impairment scale changed from ASIA C to ASIA D with the improvement of modified Bathel index, Functional independence measure and Mini-mental status examination scores.
Albendazole ; Asia ; Brain ; Central Nervous System ; Female ; Humans ; Inflammation ; Laminectomy ; Middle Aged ; Neurocysticercosis* ; Parasitic Diseases ; Prednisolone ; Quadriplegia* ; Rehabilitation ; Sensation ; Spinal Cord

OBJECTIVE: We studied the clinical utility of surface electromyography (SEMG) for the assessment of chronic low back pain (CLBP). METHOD: We compared electrical activity from electrodes placed on the 16 lumbar paraspinal areas between 25 CLBP patients and 25 control subjects in static neutral standing posture and dynamic flexion-reextension state. The CLBP patients and the control subjects were matched for age, gender, and body mass index (BMI) to adjust for any confounding effects. We analyzed amplitudes and areas of electrical activity on lumbar paraspinal muscles in neutral standing posture and dynamic flexion-reextension state. RESULTS: In the static neutral posture, there are increased amplitudes of electrical activity in CLBP compared with controls (p<0.01). In the dynamic flexion-reextension state, area ratio of electrical acitivity during the extension state to electrical acitivity during flexion state are significantly decreased in CLBP compared with controls (p<0.01). The presence of lumbar radiculopathy or the severity of LBP is not well correlated with the electrical acitivity on SEMG. The sensitivity and the specificity of SEMG are 72% and 80% respectively. CONCLUSION: These results indicate that SEMG is a useful method for the assessment of CLBP.
Body Mass Index ; Electrodes ; Electromyography* ; Humans ; Low Back Pain* ; Paraspinal Muscles ; Posture ; Radiculopathy ; Sensitivity and Specificity

Behcet disease defined as multisystemic vasculitis of unknown origin in which musculoskeletal, cardiovascular, gastrointestinal, pulmonary and/or central nervous system were involved. Neurological involvement is one of the most devastating manifestation of Behcet disease. We experienced a patient who was a 42-year-old female, admitted for right hemiplegia and dysarthria with high fever and she had been diagnosed as tuberculous meningitis at first. The physical examination revealed recurrent oral and genital ulcerated lesion. The brain MRI showed multifocal infarctions in medulla, pons, midbrain, both posterior limb of internal capsule and left periventricular white matter. After 6 months, she was aggravated right hemiplegia with erythematous skin lesion. The follow-up brain MRI showed the inactivated non-enhanced multifocal lesions compared with previous findings. So we confirmed neuro-Betchet disease and started immunosuppressive therapy with steroid, but despite of intensive care she was bedridden state at discharge and expired with septic pneumonia 8 months later. We report the neuro-Behcet disease with recurrent cerebral infarction showing poor prognosis.
Adult ; Behcet Syndrome ; Brain ; Central Nervous System ; Cerebral Infarction* ; Dysarthria ; Extremities ; Female ; Fever ; Follow-Up Studies ; Hemiplegia ; Humans ; Infarction ; Critical Care ; Internal Capsule ; Magnetic Resonance Imaging ; Mesencephalon ; Physical Examination ; Pneumonia ; Pons ; Prognosis ; Skin ; Tuberculosis, Meningeal ; Ulcer ; Vasculitis

We wanted to report three cases of bruxism who were intractable to conventional management such as dental protection or medication but responded to motor point blocks (MPB) with botulinum toxin-A (BTX-A) on mastication muscles. Untreated, bruxism causes unfavorable complications of masseter hypertrophy, headache, temporomandibular joint destruction, and furthermore total dental wear and malnutrition. Our three patients had no previous history of bruxism or any neuromuscular disorder. They were presented with decreased cognitive function and severe bruxism about 6 months after brain injury. We managed the patients with MPB of BTX-A on each masseter and temporalis muscles. Bruxisms were markedly improved about 2 weeks after MPB without any complications. On follow-up 6 months after MPB, two of three patients remained free of bruxism and another patient revealed attenuated bruxism with decreased severity and frequency. Therefore, we think that MPB with BTX-A could be considered as a treatment option for severe bruxism in brain-injured patients.
Botulinum Toxins* ; Brain Injuries* ; Brain* ; Bruxism* ; Follow-Up Studies ; Headache ; Humans ; Hypertrophy ; Malnutrition ; Mastication ; Muscles ; Temporomandibular Joint ; Tooth Wear

OBJECTIVE: To know the correlation between the grading of facial neuropathy by facial nerve conduction study (FNCS) and dysphagia severity by videofluoroscopic swallowing study (VFSS) in patients with acute peripheral facial palsy (PFP). METHOD: Twenty patients with acute PFP were recruited for this study. The causes of acute PFP were limited to idiopathic Bell's palsy and Ramsay-Hunt syndrome. The time interval from the onset of PFP to study of FNCS and VFSS was 10 to 14 days. The severity of PFP was graded according to House-Brackmann facial nerve grade (H-B FNG). Percent degeneration grade (PDG) was determined by FNCS. Baseline-to-peak amplitude of compound muscle action potentials in orbicularis oris muscle was used as an evaluation parameter. Oral transit time (OTT), pharyngeal transit time (PTT), pharyngeal delay time (PDT) and dysphagia limit were obtained by VFSS. RESULTS: There was a significant correlation between PDG and H-B FNG. The severity of oropharyngeal dysfunction was increased as the severity of the PDG increases. Delayed OTT, delayed PDT, and/or reduced dysphagia limit were revealed as a presentation of oropharyngeal dysfunction in acute PFP. CONCLUSION: The severity of PFP and oropharyngeal dysfunction were significantly correlated. And so we think that precise evaluation and adequate management of oropharyngeal dysfunction will be needed in acute PFP patients.
Action Potentials ; Bell Palsy ; Deglutition ; Deglutition Disorders ; Facial Nerve ; Facial Nerve Diseases* ; Facial Paralysis ; Humans

OBJECTIVE: To assess the clinical utility of the swallowing provocation test (SPT) and water swallowing test (WST) as a predictive factor of supraglottic penetration (SP) and subglottic aspiration (SA) in stroke patient with dysphagia. METHOD: Fourty-one patients suffered from ischemic stroke with dysphagia and 20 normal controls were recruited. We performed 2-step SPT (0.4 ml, 2.0 ml) via nasopharyngeal tube and 2-step WST (10 ml, 30 ml) per oral, combined with the videofluoroscopic swallowing study (VFSS) to determine the presence of SP and SA. RESULTS: The cutoff values of the swallowing provocation latency in SPT for the detection of SP and SA were 2.45 sec, 2.75 sec (first step) and 2.25 sec, 2.34 sec (second step). For SPT, the sensitivity and specificity were 78.8%, 64.3% (first step) and 71.4%, 77.8% (second step) for the SP, and 77.8%, 76.7% (first step) and 75.0%, 66.7% (second step) for the SA. For WST, the sensitivity and specificity were 66.7%, 90.9% (first step) and 70.0%, 90.9% (second step) for the SP, and 61.1%, 56.5% (first step) and 72.2%, 60.9% (second step) for the SA. CONCLUSION: SPT was more useful for the detection of SA than WST in stroke patient with dysphagia.
Deglutition Disorders ; Deglutition* ; Humans ; Sensitivity and Specificity ; Stroke* ; Water*

Ethylene glycol is commonly incorporated into automotive antifreeze agents and a variety of other commercial products. Ethylene glycol poisoning can cause life-threatening metabolic acidosis, cardiopulmonary failure, and renal failure that may be fatal. We present an unusual case of a patient who ingested a large amount of ethylene glycol for the purpose of suicide and developed multiorgan damage, including acute renal failure followed by uremic pericarditis and cardiac tamponade. This unusual complication was effectively managed with echocardiography-guided percutaneous pericardiocentesis and continuous catheter drainage for 3 days. After intensive hemodialysis and supportive care, the patient made a good recovery with near normal cardiac and renal function. Physicians should be aware of the possibility of acute pericarditis and cardiac tamponade in cases of acute renal failure caused by ethylene glycol poisoning.
Acidosis ; Acute Kidney Injury ; Cardiac Tamponade ; Catheters ; Drainage ; Ethylene Glycol ; Ethylenes ; Humans ; Pericardiocentesis ; Pericarditis ; Renal Dialysis ; Renal Insufficiency ; Suicide

Totally implanted central venous access devices for chemotherapy (chemoport) are being used increasingly in lung cancer patients. Vascular catheters are associated with various complications including infection, thrombosis as well as spontaneous fractures and embolization of the catheter, which is known as 'pinch-off syndrome'. 'Pinch-off syndrome' refers to the compression of a subclavian central venous catheter between the clavicle and first rib resulting in an intermittent or permanent obstruction, which can lead to tears, transection, or embolization. We report two cases of fractured and embolized implanted subclavian venous catheters in which the fragments were removed percutaneously. A 62-year-old man presented with back pain with a duration of a few weeks. The chest radiograph revealed complete transsection and embolization of the catheter into the right atrium. In addition, a 47-year-old woman with a chemoport had a grade 3 pinch-off sign in a chest radiograph demonstrating complete transsection and embolization of the catheter into the pulmonary artery. Both cases were managed by retrieving the embolized distal fragment percutaneously and removing the proximal section of the catheter.
Back Pain ; Catheters ; Central Venous Catheters ; Clavicle ; Drug Therapy ; Female ; Fractures, Spontaneous ; Heart Atria ; Humans ; Lung Neoplasms* ; Lung* ; Middle Aged ; Pulmonary Artery ; Radiography, Thoracic ; Ribs ; Thrombosis ; Vascular Access Devices

Recently, intra-Muscular Stimulation (IMS) therapy is being increasingly used for musculoskeletal pain. This procedure is generally regarded as a safe procedure for the general public. Some cases of iatrogenic pneumothorax caused by acupuncture have been reported in the medical literature. However, a case of an IMS therapy associated pneumothorax has not reported. We experienced two cases of iatrogenic pneumothorax after IMS therapy. A 62 year-old man received IMS therapy on the right shoulder due to posterior neck pain. After IMS therapy, acute dyspnea and chest discomfort developed. The other patient was a 74 year-old woman who also received IMS therapy. This patient experienced a nonproductive cough and acute dyspnea after the treatment. As the popularity of this form of alternative medicine increases, we might expect to see more cases of iatrogenic pneumothorax. Physicians should be aware of the adverse events associated with IMS therapy.
Acupuncture ; Aged ; Complementary Therapies ; Cough ; Dyspnea ; Female ; Humans ; Middle Aged ; Musculoskeletal Pain ; Neck Pain ; Pneumothorax* ; Shoulder ; Thorax