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Zolpidem-Induced Arousal by Paradoxical GABAergic Stimulation: A Case Report With F-18 Flumazenil Positron Emission Tomography and Single Photon Emission Computed Tomography Study.

Changjae KIM ; Bum Sun KWON ; Ki Yeun NAM ; Jin Woo PARK ; Ho Jun LEE

Annals of Rehabilitation Medicine.2016;40(1):177-181. doi:10.5535/arm.2016.40.1.177

Zolpidem is a non-benzodiazepine drug that has selectivity for the gamma-aminobutyric acid (GABA) receptors. We experienced paradoxical effect of zolpidem in a 48-year-old male patient with hypoxic-ischemic brain injury after cardiac arrest. The patient was in stupor and could not communicate. His Glasgow Coma Scale (GCS) was E2M4V2 and Rancho Los Amigos (RLA) was grade III to IV. Zolpidem was prescribed to induce sedation but paradoxically, he became alert (GCS 15, RLA VII) and was able to communicate. The arousal lasted for 2 hours repeatedly following each administration of the medication. While he was alert, electroencephalogram showed the reversal of slow wave into beta range fast activity and F-18 flumazenil positron emission tomography (PET) showed increased GABAergic receptor activity in both frontoparietotemporal cortices. Single photon emission computed tomography (SPECT) also showed increased cerebral perfusion and reversal of cerebellar diaschisis.
Anoxia ; Arousal* ; Brain Injuries ; Electroencephalography ; Electrons* ; Flumazenil* ; gamma-Aminobutyric Acid ; Glasgow Coma Scale ; Heart Arrest ; Humans ; Male ; Middle Aged ; Perfusion ; Positron-Emission Tomography* ; Stupor ; Tomography, Emission-Computed, Single-Photon*

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Calcaneal Osteomyelitis due to Non-tuberculous Mycobacteria: A Case Report.

Tae Im YI ; Seung A HA ; Yeo Reum CHOE ; Joo Sup KIM ; Kye Won KWON

Annals of Rehabilitation Medicine.2016;40(1):172-176. doi:10.5535/arm.2016.40.1.172

Osteomyelitis is a bone infection caused by bacteria or other germs. Gram-positive cocci are the most common etiological organisms of calcaneal osteomyelitis; whereas, non-tuberculous mycobacteria (NTM) are rarely documented. We reported a case of NTM calcaneal osteomyelitis in a 51-year-old female patient. She had been previously treated in many local clinics with multiple local steroid injection over 50 times and extracorporeal shock-wave therapy over 20 times with the impression of plantar fasciitis for 3 years prior. Diagnostic workup revealed a calcaneal osteomyelitis and polymerase chain reaction assay on bone aspirate specimens confirmed the diagnosis of non-tuberculous mycobacterial osteomyelitis. The patient had a partial calcanectomy with antitubercular therapy. Six months after surgery, a follow-up magnetic resonance imaging showed localized chronic osteomyelitis with abscess formation. We continued anti-tubercular therapy without operation. At 18-month follow-up after surgery and comprehensive rehabilitation therapy, she was ambulating normally and able to carry out her daily activities without any discomfort.
Abscess ; Bacteria ; Diagnosis ; Fasciitis, Plantar ; Female ; Follow-Up Studies ; Gram-Positive Cocci ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Nontuberculous Mycobacteria ; Osteomyelitis* ; Polymerase Chain Reaction ; Rehabilitation

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Bilateral Cranial IX and X Nerve Palsies After Mild Traumatic Brain Injury.

Seung Don YOO ; Dong Hwan KIM ; Seung Ah LEE ; Hye In JOO ; Jin Ah YEO ; Sung Joon CHUNG

Annals of Rehabilitation Medicine.2016;40(1):168-171. doi:10.5535/arm.2016.40.1.168

We report a 57-year-old man with bilateral cranial nerve IX and X palsies who presented with severe dysphagia. After a mild head injury, the patient complained of difficult swallowing. Physical examination revealed normal tongue motion and no uvular deviation. Cervical X-ray findings were negative, but a brain computed tomography revealed a skull fracture involving bilateral jugular foramen. Laryngoscopy indicated bilateral vocal cord palsy. In a videofluoroscopic swallowing study, food residue remained in the vallecula and pyriform sinus, and there was reduced motion of the pharynx and larynx. Electromyography confirmed bilateral superior and recurrent laryngeal neuropathy.
Brain ; Brain Injuries* ; Cranial Nerve Diseases ; Craniocerebral Trauma ; Deglutition ; Deglutition Disorders ; Electromyography ; Glossopharyngeal Nerve ; Humans ; Laryngoscopy ; Larynx ; Middle Aged ; Paralysis* ; Pharynx ; Physical Examination ; Pyriform Sinus ; Skull Fracture, Basilar ; Skull Fractures ; Tongue ; Vocal Cord Paralysis

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A Wide Spectrum of Axial Mesodermal Dysplasia Complex With Rhombencephalic Anomaly: A Case Report.

Kang Won KIM ; Jeoung Hwan SEO ; Myoung Hwan KO ; Yu Hui WON ; Sung Hee PARK

Annals of Rehabilitation Medicine.2016;40(1):162-167. doi:10.5535/arm.2016.40.1.162

Axial mesodermal dysplasia complex (AMDC) arises in variable combinations of craniocaudal anomalies such as musculoskeletal deformities, neuroschisis, or rhombencephalic developmental disorders. To the best of our knowledge, the co-existence of AMDC with associated musculoskeletal anomalies, medullary neuroschisis with mirror movements, and cranial nerve anomalies has not yet been reported. Here, we report the case of a 4-year-old boy whose clinical features were suggestive of Goldenhar syndrome and Poland syndrome with Sprengel deformity. Moreover, he showed mirror movements in his hands suspected of rhombencephalic malformation, and infranuclear-type facial nerve palsy of the left side of his face, the opposite side to the facial anomalies of Goldenhar syndrome. After conducting radiological studies, he was diagnosed with medullary neuroschisis without pontine malformations and Klippel-Feil syndrome with rib anomalies. Based on these findings, we propose that clinical AMDC can be accompanied by a wide variety of musculoskeletal defects and variable degrees of central nervous system malformations. Therefore, in addition to detailed physical and neurological examinations, imaging studies should be considered in AMDC.
Central Nervous System ; Child, Preschool ; Congenital Abnormalities ; Cranial Nerves ; Facial Nerve ; Goldenhar Syndrome ; Hand ; Humans ; Klippel-Feil Syndrome ; Male ; Medulla Oblongata ; Mesoderm* ; Neurologic Examination ; Paralysis ; Poland Syndrome ; Rhombencephalon ; Ribs

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Ureteral Rupture Caused by a Suprapubic Catheter in a Male Patient With Spinal Cord Injury: A Case Report.

Hye Jung CHOI ; Chang Han LEE ; Heesuk SHIN

Annals of Rehabilitation Medicine.2016;40(6):1140-1143. doi:10.5535/arm.2016.40.6.1140

Spinal cord injury (SCI) may lead to urinary system disturbances. Patients with SCI usually have neurogenic bladder, and treatment optionss for this condition include clean intermittent catheterization and a permanent indwelling urethral or suprapubic catheter. Complications of catheterization include urinary tract infection, calculi, urinary tract injury, bladder contraction, bladder spasm, renal dysfunction, bladder cancer, and so forth. To the best of our knowledge, ureteral rupture is an unusual complication of catheterization, and ureteral rupture has been rarely reported in SCI patients. Therefore, here we report a case of ureteral rupture caused by a suprapubic catheter used for the treatment of neurogenic bladder with vesicoureteral reflux in a male patient with SCI. Due to SCI with neurogenic bladder, ureteral size can be reduced and the suprapubic catheter tip can easily migrate to the distal ureteral orifice. Thus, careful attention is required when a catheter is inserted into the bladder in patients with SCI.
Catheterization ; Catheters* ; Humans ; Intermittent Urethral Catheterization ; Male* ; Rupture* ; Spasm ; Spinal Cord Injuries* ; Spinal Cord* ; Ureter* ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Bladder, Neurogenic ; Urinary Calculi ; Urinary Catheterization ; Urinary Tract Infections ; Vesico-Ureteral Reflux

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Effects of Radiation Therapy on Established Neurogenic Heterotopic Ossification.

Chan Ho LEE ; Su Jung SHIM ; Hyun Jung KIM ; Hyuna YANG ; Youn Joo KANG

Annals of Rehabilitation Medicine.2016;40(6):1135-1139. doi:10.5535/arm.2016.40.6.1135

Heterotopic ossification (HO) is frequently seen on rehabilitation units after spinal cord injuries, fractures, brain injuries, and limb amputations. Currently, there is no effective treatment for HO other than prophylaxis with anti-inflammatory medications, irradiation, and bisphosphonate administration. These prophylactic treatments are not effective for managing ectopic bone once it has formed. Here we describe three cases of established neurogenic HO treated with radiation therapy (RT). All patients had decreased serum alkaline phosphatase (ALP) and bone-specific ALP levels with decreased pain but increased range of motion immediately after RT. Post-treatment X-rays revealed no further growth of the HO. All patients maintained clinical and laboratory improvements 4 or 6 months after the RT. Our results suggest that RT is safe and effective in decreasing pain and activity of neurogenic HO.
Alkaline Phosphatase ; Amputation ; Brain Injuries ; Extremities ; Humans ; Ossification, Heterotopic* ; Radiotherapy ; Range of Motion, Articular ; Rehabilitation ; Spinal Cord Injuries

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Identification of a Heterozygous SPG11 Mutation by Clinical Exome Sequencing in a Patient With Hereditary Spastic Paraplegia: A Case Report.

Ja Young OH ; Hyun Jung DO ; Seungok LEE ; Ja Hyun JANG ; Eun Hae CHO ; Dae Hyun JANG

Annals of Rehabilitation Medicine.2016;40(6):1129-1134. doi:10.5535/arm.2016.40.6.1129

Next-generation sequencing, such as whole-genome sequencing, whole-exome sequencing, and targeted panel sequencing have been applied for diagnosis of many genetic diseases, and are in the process of replacing the traditional methods of genetic analysis. Clinical exome sequencing (CES), which provides not only sequence variation data but also clinical interpretation, aids in reaching a final conclusion with regards to genetic diagnosis. Sequencing of genes with clinical relevance rather than whole exome sequencing might be more suitable for the diagnosis of known hereditary disease with genetic heterogeneity. Here, we present the clinical usefulness of CES for the diagnosis of hereditary spastic paraplegia (HSP). We report a case of patient who was strongly suspected of having HSP based on her clinical manifestations. HSP is one of the diseases with high genetic heterogeneity, the 72 different loci and 59 discovered genes identified so far. Therefore, traditional approach for diagnosis of HSP with genetic analysis is very challenging and time-consuming. CES with TruSight One Sequencing Panel, which enriches about 4,800 genes with clinical relevance, revealed compound heterozygous mutations in SPG11. One workflow and one procedure can provide the results of genetic analysis, and CES with enrichment of clinically relevant genes is a cost-effective and time-saving diagnostic tool for diseases with genetic heterogeneity, including HSP.
Diagnosis ; Exome* ; Genetic Diseases, Inborn ; Genetic Heterogeneity ; Humans ; Spastic Paraplegia, Hereditary*

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Effect of Radial Extracorporeal Shock Wave Therapy in Patients With Fabella Syndrome.

Pyong Hwa SEOL ; Kang Wook HA ; Yun Hee KIM ; Ho Jun KWAK ; Seung Wan PARK ; Byung Ju RYU

Annals of Rehabilitation Medicine.2016;40(6):1124-1128. doi:10.5535/arm.2016.40.6.1124

The fabella is a small sesamoid bone generally located in the tendon of the lateral head of the gastrocnemius behind the lateral condyle of the femur. Fabella syndrome is the occurrence of posterolateral knee pain associated with the fabella. It is a rare cause of knee pain that is often misdiagnosed. Fabella syndrome can be managed with conservative or surgical treatment. We applied radial extracorporeal shock wave therapy as a new treatment strategy for fabella syndrome and achieved a successful outcome.
Femur ; Head ; Humans ; Knee ; Sesamoid Bones ; Shock* ; Tendons ; Ultrasonography

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Influence of Low Peak Respiratory Exchange Ratio on Cardiac Rehabilitation in Patients With Coronary Artery Disease.

Chul KIM ; Hee Eun CHOI ; Ki Hoon LEE ; Young Joo KIM ; Sang Jae LEE

Annals of Rehabilitation Medicine.2016;40(6):1114-1123. doi:10.5535/arm.2016.40.6.1114

OBJECTIVE: To compare and analyze the effects of cardiac rehabilitation (CR) in two groups based on the peak respiratory exchange ratio (RER(peak)) 1.1 values using the exercise tolerance test (ETT) results, and to investigate the reasons for early termination of ETT. METHODS: Patients with acute coronary syndrome who participated in CR exercise training were selected and all subjects underwent 6 weeks of CR exercise training. ETT was performed on a treadmill using a Modified Bruce Protocol before and after CR exercise training. According to the result of the first ETT, the subjects were divided into two groups: those with an RER(peak)≥1.1 (n=33) and those with an RER(peak)<1.1 (n=22). We investigated the reasons for ETT termination and compared the effect of CR between the groups. RESULTS: The reasons for the early termination of the first ETT in the RER(peak)<1.1 group were subjective dyspnea, abnormal cardiovascular responses, leg fatigue and other problems. After a 6-week CR, the peak oxygen consumption (VO2(peak)) and ETT time increased, and the rate of perceived exertion (RPE) and RPP (rate pressure product) at stage 3 decreased in both the RER(peak)<1.1 and RER(peak)≥1.1 groups. CONCLUSION: CR exercise training improved exercise capacity, not only in the RER(peak)≥1.1 group, but also in the RER(peak)<1.1 group. This means that patients with a lower exercise tolerance could also benefit from the effects of CR. Thoughtful consideration to identify the direct and indirect causes for the early termination of ETT would be necessary to improve the efficiency of CR.
Acute Coronary Syndrome ; Coronary Artery Disease* ; Coronary Vessels* ; Dyspnea ; Exercise Test ; Exercise Tolerance ; Fatigue ; Humans ; Leg ; Oxygen Consumption ; Rehabilitation*

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The Comparison of M-B CDI-K Short Form and K-ASQ as Screening Test for Language Development.

Seong Woo KIM ; Ji Yong KIM ; Sang Yoon LEE ; Ha Ra JEON

Annals of Rehabilitation Medicine.2016;40(6):1108-1113. doi:10.5535/arm.2016.40.6.1108

OBJECTIVE: To investigate the usefulness of the communication domain in the Korean version of Ages and Stages Questionnaire (K-ASQ), and short form of the Korean version of MacArthur-Bates Communicative Development Inventories (M-B CDI-K), as screening tests for language developmental delay. METHODS: Data was collected between April 2010 and December 2013, from children who visited either the Department of Physical Medicine and Rehabilitation or the Developmental Delay Clinic, presenting with language development delay as their chief complaint. All the children took the short form of M-B CDI-K and K-ASQ as screening tests, and received diagnostic language assessments including Sequenced Language Scale for Infants (SELSI) or Preschool Receptive-Expressive Language Scale (PRES). RESULTS: A total of 206 children, mean age 29.7 months, were enrolled. The final diagnoses were developmental language disorder, global developmental delay, autism spectrum disorder, cerebral palsy, etc. The M-B CDI-K short form and the communication domain of the K-ASQ had 95.9% and 76.7% sensitivity, and 82.4% and 85.3% specificity, with regards to diagnostic language assessments. The M-B CDI-K short form showed higher negative predictive value and better accuracy than the communication domain of the K-ASQ. CONCLUSION: The screening ability of K-ASQ was not sufficient for children with language development delay, and the M-B CDI-K short form should be implemented for additional screening.
Autism Spectrum Disorder ; Cerebral Palsy ; Child ; Diagnosis ; Equipment and Supplies ; Humans ; Infant ; Language Development Disorders ; Language Development* ; Mass Screening* ; Physical and Rehabilitation Medicine ; Sensitivity and Specificity

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