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Acute Pseudobulbar Palsy After Bilateral Paramedian Thalamic Infarction: A Case Report.

Hye Yeon LEE ; Min Jeong KIM ; Bo Ram KIM ; Seong Eun KOH ; In Sik LEE ; Jongmin LEE

Annals of Rehabilitation Medicine.2016;40(4):751-756. doi:10.5535/arm.2016.40.4.751

Bilateral paramedian thalamic infarction is a rare subtype of stroke caused by occlusion of the artery of Percheron, an uncommon variant originating from one of the posterior cerebral arteries. This type of stroke has several major clinical presentations: altered mental status, behavioral amnestic impairment, aphasia or dysarthria, ocular movement disorders, motor deficits, cerebellar signs, and others. Few cases of bilateral paramedian thalamic infarction-related pseudobulbar palsy characterized by dysarthria, dysphagia, and facial and tongue weakness have been reported. We report here a rare case of acute severe pseudobulbar palsy as a manifestation of bilateral paramedian thalamic infarction.
Aphasia ; Arteries ; Deglutition Disorders ; Dysarthria ; Infarction* ; Movement Disorders ; Posterior Cerebral Artery ; Pseudobulbar Palsy* ; Stroke ; Thalamus ; Tongue

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A Comprehensive Rehabilitation Approach in a Patient With Serious Neuropsychiatric Systemic Lupus Erythematosus.

Yong Jae KO ; Yang Gyun LEE ; Ji Woong PARK ; Sung Ho AHN ; Jin Myoung KWAK ; Yoon Hee CHOI

Annals of Rehabilitation Medicine.2016;40(4):745-750. doi:10.5535/arm.2016.40.4.745

Neuropsychiatric systemic lupus erythematosus (NPSLE) involves the central and peripheral nervous system in patients with systemic lupus erythematosus (SLE). It is essential to specify the problems faced by patients with NPSLE because it causes diverse disabilities and impairs quality of life. After performing a comprehensive evaluation, tailored management should be provided for the patient's specific problems. We report here the case of a 30-year-old female with SLE who experienced serious neuropsychiatric symptoms cerebral infarction followed by posterior reversible encephalopathy syndrome and peripheral polyneuropathy. We systemically assessed the patient using the International Classification of Functioning, Disability and Health model as a clinical problem-solving tool and provided comprehensive rehabilitation by focusing on her problems.
Adult ; Cerebral Infarction ; Female ; Humans ; International Classification of Functioning, Disability and Health ; Lupus Erythematosus, Systemic ; Lupus Vasculitis, Central Nervous System* ; Peripheral Nervous System ; Polyneuropathies ; Posterior Leukoencephalopathy Syndrome ; Quality of Life ; Rehabilitation*

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Holmes Tremor After Brainstem Hemorrhage, Treated With Levodopa.

Jae Hyun WOO ; Bo Young HONG ; Joon Sung KIM ; Seok Ho MOON ; Soo Yeon KIM ; Hye Young HAN ; Dong Yoon PARK ; Seong Hoon LIM

Annals of Rehabilitation Medicine.2013;37(4):591-594. doi:10.5535/arm.2013.37.4.591

Holmes tremor is a rare movement phenomenon, with atypical low-frequency tremor at rest and when changing postures, often related to brainstem pathology. We report a 70-year-old female patient who was presented with dystonic head and upper limb tremor after brainstem hemorrhage. The patient had experienced a sudden onset of left hemiparesis and right facial paralysis. Brain magnetic resonance imaging showed an acute hemorrhage from the brachium pontis through the dorsal midbrain on the right side. Several months later, the patient developed resting tremor of the head and left arm, which was exacerbated by a sitting posture and intentional movement. The tremor showed a regular low-frequency (1-2 Hz) for the bilateral sternocleidomastoid and cervical paraspinal muscles at rest. The patient's symptoms did not respond to propranolol or clonazepam, but gradually improved with levodopa administration. Although various remedies were attempted, overall, the results were poor. We suggest that levodopa might be a useful remedy for Holmes tremor. The curative or relieving effect of the dopaminergic agent in Holmes tremor needs more research.
Arm ; Brain ; Brain Stem ; Brain Stem Hemorrhage, Traumatic ; Clonazepam ; Facial Paralysis ; Female ; Head ; Hemorrhage ; Humans ; Levodopa ; Magnetic Resonance Imaging ; Mesencephalon ; Muscles ; Paresis ; Posture ; Propranolol ; Tremor ; Upper Extremity

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Treatment of Chronic Isolated Finger Flexor Tenosynovitis Through 50% Dehydrated Alcohol Installation.

Jae Eun SHIN ; Jung Hyun PARK ; Ho Sung YI ; Byung Kook YE ; Hyoung Seop KIM

Annals of Rehabilitation Medicine.2013;37(4):586-590. doi:10.5535/arm.2013.37.4.586

The isolated idiopathic finger flexor tenosynovitis is a rare condition, related to diversed etiologies. The traditional treatment of flexor tenosynovitis includes medications and injection of steroids. If the conservative treatment is not effective, surgical management is usually recommended. And alcohol installations have been rarely performed. We are reporting an extremely rare case of a 56-year-old man who had chronic idiopathic isolated finger flexor tenosynovitis which was treated through alcohol injections. The patient had not yet been treated despite of medication and serial injections of steroid. We performed 1 mL of 50% ethanol injection for the initial treatment and the second injection was done in the same way 10 months later due to the improvements of the patient's clinical symptoms and images of the follow-up ultrasonography. As a result, the authors suggest alcohol installation as an alternative non-surgical treatment for flexor tenosynovitis when other conservative managements are not effective enough.
Alcohols ; Ethanol ; Fingers ; Follow-Up Studies ; Humans ; Steroids ; Tenosynovitis

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Postpartum Sacral Stress Fracture Mimicking Lumbar Radiculopathy in a Patient With Pregnancy-Associated Osteoporosis.

Joohye PARK ; Eunjae OK ; Hye Jeong PARK ; Seok Ha HONG ; Jong In LEE

Annals of Rehabilitation Medicine.2013;37(4):582-585. doi:10.5535/arm.2013.37.4.582

Postpartum sacral fracture is relatively rare, and its diagnosis is often delayed. We herein report such a case of a 28-year-old patient who presented with an insidious-onset lower back pain, left buttock pain, and radicular symptoms mimicking lumbar radiculopathy. Laboratory tests showed a decreased 25-hydroxy vitamin D level, and the bone mineral densitometry of both femurs was below the expected range. Plain radiographs of the lumbar spine and pelvis showed no definite abnormality, but lumbosacral spinal magnetic resonance imaging identified a left sacral fracture. Symptoms were alleviated with rest and oral analgesic treatment.
Buttocks ; Densitometry ; Femur ; Fractures, Stress ; Humans ; Low Back Pain ; Magnetic Resonance Imaging ; Osteoporosis ; Pelvis ; Postpartum Period ; Radiculopathy ; Spine ; Vitamin D

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Compressive Neuropathy of the Posterior Tibial Nerve at the Lower Calf Caused by a Ruptured Intramuscular Baker Cyst.

Seock Ho MOON ; Sun IM ; Geun Young PARK ; Su Jin MOON ; Hye Jeong PARK ; Hyun Sook CHOI ; Yil Ryun JO

Annals of Rehabilitation Medicine.2013;37(4):577-581. doi:10.5535/arm.2013.37.4.577

Baker cyst is an enlargement of the gastrocnemius-semimembranosus bursa. Neuropathy can occur due to either direct compression from the cyst itself or indirectly after cyst rupture. We report a unique case of a 49-year-old man with left sole pain and paresthesia who was diagnosed with posterior tibial neuropathy at the lower calf area, which was found to be caused by a ruptured Baker cyst. The patient's symptoms resembled those of lumbosacral radiculopathy and tarsal tunnel syndrome. Posterior tibial neuropathy from direct pressure of ruptured Baker cyst at the calf level has not been previously reported. Ruptured Baker cyst with resultant compression of the posterior tibial nerve at the lower leg should be included in the differential diagnosis of patients who complain of calf and sole pain. Electrodiagnostic examination and imaging studies such as ultrasonography or magnetic resonance imaging should be considered in the differential diagnosis of isolated paresthesia of the lower leg.
Diagnosis, Differential ; Humans ; Leg ; Magnetic Resonance Imaging ; Nerve Compression Syndromes ; Paresthesia ; Popliteal Cyst ; Radiculopathy ; Rupture ; Tarsal Tunnel Syndrome ; Tibial Nerve ; Tibial Neuropathy

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Tuberculous Tenosynovitis and Ulnar Bursitis of the Wrist.

Sang Min LEE ; Won Jae LEE ; Ah Rom SONG

Annals of Rehabilitation Medicine.2013;37(4):572-576. doi:10.5535/arm.2013.37.4.572

Tuberculous infection of the hand is a rare form of extrapulmonary tuberculosis that, left untreated, can cause serious joint and tendon damage. We report the case of a 65-year-old male patient who presented with an insidious flexor weakness of the fifth finger but without any history of trauma. Magnetic resonance imaging revealed a partial tear of the fifth finger flexor tendon with a fluid collection in the tendon sheath and in the flexor compartment along the ulnar side. Under ultrasound guidance, this fluid collection was aspirated and analyzed for Mycobacterium tuberculosis using polymerase chain reaction. The assay was positive for the microorganism, confirming the diagnosis of tuberculous tenosynovitis and ulnar bursitis of the wrist. The early suspicion and diagnosis of this extrapulmonary disease facilitated anti-tuberculous chemotherapy and helped avoid a hasty injection of corticosteroid.
Bursitis ; Fingers ; Hand ; Humans ; Joints ; Magnetic Resonance Imaging ; Male ; Mycobacterium tuberculosis ; Polymerase Chain Reaction ; Tendons ; Tenosynovitis ; Tuberculosis ; Wrist

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Multiorgan With Renal Infarction Following Treatment of Cerebral Infarction.

Ji Hee KIM ; Chung KANG ; Hyo Jeong MOON ; Min Cheol JOO

Annals of Rehabilitation Medicine.2013;37(4):567-571. doi:10.5535/arm.2013.37.4.567

Acute renal infarction is a rare disease and it is often difficult to make a clinical diagnosis due to the non-specific clinical presentations and lack of the physicians' awarenesses. We experienced a case of a 72-year-old man who was diagnosed as multiorgan with renal infarction during the bridge therapy of cerebral infarction with atrial fibrillation. Computed tomogram (CT) with intravenous contrast of the abdomen and pelvis revealed left renal infarction with renal artery occlusion, multifocal splenic infarction, and ischemic colitis on rectum and sigmoid colon. The patient was treated with low molecular weight heparin for 10 days, his symptoms were improved and laboratory findings were normalized. Follow-up CT was performed on the 43th day, there were persisted left renal infarction with atrophic change shown and the splenic perfusion was improved.
Abdomen ; Atrial Fibrillation ; Awareness ; Cerebral Infarction ; Colitis, Ischemic ; Colon, Sigmoid ; Follow-Up Studies ; Heparin, Low-Molecular-Weight ; Humans ; Infarction ; Pelvis ; Perfusion ; Rare Diseases ; Rectum ; Renal Artery ; Splenic Infarction

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Adrenomyeloneuropathy Presenting With Adrenal Insufficiency.

Hee Dong PARK ; Sang Jun PARK ; Yong Min CHOI ; Jin Ho KANG

Annals of Rehabilitation Medicine.2013;37(4):563-566. doi:10.5535/arm.2013.37.4.563

Adrenomyeloneuropathy (AMN), one of the variants of X-linked adrenoleukodystrophy (ALD), is inherited peroxisomal disorder associated with the accumulation of very long chain fatty acids (VLCFA). AMN is characterized primarily by involvements of long ascending and descending tracts of the spinal cord and peripheral neuropathy, which leads to spastic paraparesis and urinary and erectile dysfunction. We experienced the AMN case of a 33-year-old man presenting bilateral progressive spastic paraparesis, impotence and urge incontinence with primary adrenal failures, as confirmed by increased serum of VLCFA concentrations. Considering that somatosensory evoked potentials in posterior tibial nerve was the only abnormal finding in electrophysiologic findings when compared with the severe spastic gait pattern shown, it is necessary to follow up with electrophysiologic studies.
Adrenal Insufficiency ; Adrenoleukodystrophy ; Erectile Dysfunction ; Evoked Potentials, Somatosensory ; Fatty Acids ; Gait Disorders, Neurologic ; Male ; Paraparesis, Spastic ; Peripheral Nervous System Diseases ; Peroxisomal Disorders ; Spinal Cord ; Tibial Nerve ; Urinary Incontinence, Urge

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The Therapeutic Effect of Neurologic Music Therapy and Speech Language Therapy in Post-Stroke Aphasic Patients.

Kil Byung LIM ; Yong Kyun KIM ; Hong Jae LEE ; Jeehyun YOO ; Ji Youn HWANG ; Jeong Ah KIM ; Sung Kyun KIM

Annals of Rehabilitation Medicine.2013;37(4):556-562. doi:10.5535/arm.2013.37.4.556

OBJECTIVE: To investigate the therapeutic effect of neurologic music therapy (NMT) and speech language therapy (SLT) through improvement of the aphasia quotient (AQ) in post-stroke aphasic patients. METHODS: Twenty-one post-stroke, nonfluent aphasia patients who had ischemic/hemorrhagic stroke on radiologic evaluation were divided into the NMT and SLT groups. They received NMT and SLT for 1 month. Language function was assessed by Korean version-Western Aphasia Battery before and after therapy. NMT consisted of therapeutic singing and melodic intonation therapy, and SLT consisted of language-oriented therapy. RESULTS: Significant improvements were revealed in AQ, repetition, and naming after therapy in the NMT group and improvements in repetition in the SLT group of chronic stroke patients (p<0.05). There were significant improvements in language ability in the NMT group of subacute stroke patients. However, there was no significant improvement in the SLT group of subacute stroke patients. CONCLUSION: We concluded that the two therapies are effective treatments in the chronic stage of stroke and NMT is effective in subacute post-stroke aphasic patients.
Aphasia ; Aphasia, Broca ; Humans ; Language ; Language Therapy ; Music ; Music Therapy ; Singing ; Speech Therapy ; Stroke

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