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Pontine Necrosis Related with Radiation Therapy, Complicated with Spontaneous Hemorrhage.

Ha Min KIM ; Bo Young HONG ; Jong In LEE ; Joon Sung KIM ; Seong Hoon LIM

Brain & Neurorehabilitation.2017;10(1):e1-. doi:10.12786/bn.2017.10.e1

The brain necrosis induced by radiation therapy (RT) is an uncommon pathology of brain. A case of spontaneous hemorrhage at necrotic brain is also rare. A 52-year-old man who had nasopharyngeal carcinoma and had been treated with RT, presented with gait disturbance, dizziness, ataxia, dysarthria, and dysphagia. Magnetic resonance imaging (MRI) demonstrated progressed radiation necrosis of pons, and spontaneous hemorrhage at the site of necrosis. The hematoma was diminished by conservative treatment. However, the patient’s neurologic symptoms did not recover. Two years later, spontaneous bleeding recurred at necrotic brain. His neurologic symptoms worsened. One year later, his neurologic symptoms were more progressed. He showed severe dysphagia, profound weakness and respiratory failure. This case provides the description of relapsed spontaneous hemorrhage and medullary dysfunction caused by pontine necrosis and progressed post-radiation injury, complicated with hemorrhage, and urges caution in that the necrotic brain tissue may be vulnerable to bleeding.
Ataxia ; Brain ; Deglutition Disorders ; Dizziness ; Dysarthria ; Gait ; Hematoma ; Hemorrhage* ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Necrosis* ; Neurologic Manifestations ; Pathology ; Pons ; Respiratory Insufficiency

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Clinical Features of an Artery of Percheron Infarction: a Case Report.

Ahry LEE ; Hyun Im MOON ; Hee Kyu KWON ; Sung Bom PYUN

Brain & Neurorehabilitation.2017;10(1):e2-. doi:10.12786/bn.2017.10.e2

The artery of Percheron (AOP) is an uncommon variant of the paramedian artery, a solitary trunk branching off from the posterior cerebral arteries, supplying both paramedian thalami, and also often the rostral midbrain and the anterior thalamus. The typical clinical manifestations of the AOP infarction include altered mental status, cognitive impairment, and oculomotor dysfunction. We report a rare case with AOP infarction, and the clinical characteristics and rehabilitation courses for alertness disorder, cognitive dysfunction, and other accompanied symptoms.
Anterior Thalamic Nuclei ; Arteries* ; Cognition ; Cognition Disorders ; Infarction* ; Mesencephalon ; Ophthalmoplegia ; Posterior Cerebral Artery ; Rehabilitation ; Thalamus

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Current State and Prospects of Development of Blood-based Biomarkers for Mild Traumatic Brain Injury.

Hyun Haeng LEE ; Woo Hyung LEE ; Han Gil SEO ; Dohyun HAN ; Youngsoo KIM ; Byung Mo OH

Brain & Neurorehabilitation.2017;10(1):e3-. doi:10.12786/bn.2017.10.e3

The current understanding of the pathophysiology of mild traumatic brain injury (mTBI) is, without doubt, incomplete. Nevertheless, we tried to summarize the state-of-the-art explanation of how the brain is continuously injured even after a single impact. We also reviewed the real struggle of diagnosing mTBI, which culminated in showing the potential of blood-based biomarkers as an alternative or complementary way to overcome this difficulty. Pathophysiology of mTBI is subdivided into primary and secondary injuries. Primary injury is caused by a direct impact on the head and brain. Secondary injury refers to the changes in energy metabolism and protein synthesis/degradation resulting from the biochemical cascades as follows; calcium influx, mitochondrial dysfunction, fractured microtubules, and Wallerian degeneration, neuroinflammation, and toxic proteinopathy. Since the diagnosis of mTBI is made through the initial clinical information, it is difficult and inaccurate to diagnose mTBI without the absence of a witness or sign of head trauma. Blood-based biomarkers are expected to play an important role in diagnosing mTBI and predicting functional outcomes, due to their feasibility and the recent progress of targeted proteomics techniques (i.e., liquid chromatography tandem mass spectrometry [LC-MS/MS]).
Biomarkers* ; Brain ; Brain Concussion ; Brain Injuries* ; Calcium ; Chromatography, Liquid ; Craniocerebral Trauma ; Diagnosis ; Energy Metabolism ; Head ; Microtubules ; Proteomics ; Tandem Mass Spectrometry ; Wallerian Degeneration

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Transcranial Direct Current Stimulation as an Alternative Treatment in Patients with Alzheimer's Disease.

Yeo Jin KIM

Brain & Neurorehabilitation.2017;10(1):e4-. doi:10.12786/bn.2017.10.e4

Transcranial direct current stimulation (tDCS) is one of the brain stimulation techniques, which considered as an alternative treatment for Alzheimer's disease (AD). In AD, cognitive, behavior, and functional deteriorations are the result of synaptic dysfunction, neural circuit destabilization, and disrupted network activity, which are mainly caused by amyloid and tau deposition. tDCS modified neuronal resting membrane potential, synaptic plasticity, cortical neurotransmitters, astrocytes, cerebral blood flow, and functional connectivity, which could restore cognitive impairment. However, several small clinical studies that have been conducted so far have produced inconsistent results in patients with AD. Therefore, more systematic clinical studies are needed in the future.
Alzheimer Disease* ; Amyloid ; Astrocytes ; Brain ; Cerebrovascular Circulation ; Cognition Disorders ; Humans ; Membrane Potentials ; Neuronal Plasticity ; Neurons ; Neurotransmitter Agents ; Transcranial Direct Current Stimulation*

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Prognosis and Recovery of Motor Function with Lesion–Symptom Mapping in Patients with Stroke.

Kyoung Bo LEE ; Seong Hoon LIM

Brain & Neurorehabilitation.2017;10(1):e5-. doi:10.12786/bn.2017.10.e5

Although studies have demonstrated that several specific brain lesions are related to the recovery and functional prognosis in patients with stroke, it still remained to be illusive. Modern imaging techniques make us possible to identify regions that are commonly related to specific deficit. Superimposing individual lesions to identify an area related to a particular function is based on the assumption that these functional modules are in the same location in different individuals. It is traditional to overlay plots using ‘lesion subtraction.’ Additionally, voxel-based lesion-symptom mapping (VLSM) can be used to determine relationships between behavioral measures and its neural correlates in the brain. VLSM estimates statistical parameters on a voxel-by-voxel basis by calculating the correlations between t-scores for tasks and treating voxels as subjects, allowing fairly high spatial precision. Understanding their relative merits with regard to specific brain lesions should be useful in planning rehabilitation strategies and will become an important part of neurorehabilitation.
Brain ; Humans ; Neurological Rehabilitation ; Prognosis* ; Rehabilitation ; Stroke*

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Central and Extrapontine Myelinolysis after Alcohol Withdrawal and Correction of Hypernatremia in a Chronic Alcoholic: a Case Report.

Chan Woong JANG ; Han Kyul PARK ; Hyoung Seop KIM

Brain & Neurorehabilitation.2017;10(1):e6-. doi:10.12786/bn.2017.10.e6

Osmotic demyelination syndrome (ODS) is a demyelinating disorder related to the rapid correction of hyponatremia. It usually affects the pontine area; hence, the name central pontine myelinolysis (CPM). However, it rarely occurs with the correction of hypernatremia and hyperosmolarity and involves extrapontine areas. A 56-year-old chronic alcoholic had been admitted with a history of confusion. He had been in alcohol withdrawal for 4 days. Laboratory examinations showed severe hypernatremia and hyperosmolarity. After serum sodium level was normalized; however, his clinical course did not improve and deteriorated to semicoma progressively. Magnetic resonance imaging (MRI) revealed abnormal signal intensity in the pontine and extrapontine areas, including the basal ganglia, thalamus, and cerebral cortices. This is the first case report of combined central pontine and extrapontine demyelination after alcohol withdrawal and correction of hypernatremia in a chronic alcoholic.
Alcoholics* ; Basal Ganglia ; Cerebral Cortex ; Demyelinating Diseases ; Humans ; Hypernatremia* ; Hyponatremia ; Magnetic Resonance Imaging ; Middle Aged ; Myelinolysis, Central Pontine* ; Sodium ; Thalamus

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Clinical Use of Robots as a Part of Rehabilitation Medicine.

Kyung Hee DO ; Min Ho CHUN

Brain & Neurorehabilitation.2017;10(1):e7-. doi:10.12786/bn.2017.10.e7

During recent years, many robots have been used for rehabilitation therapy and the rehabilitation robots have also advanced considerably. These robots can eliminate the repetitive tasks of the occupational or physical therapist and provide high-intensity and high-dosage training for the patients. In general, the robots used for rehabilitation therapy are classified into therapeutic and assistive robots, and therapeutic robots can be further divided into end-effector and exoskeleton types. In the study, we reviewed the clinical use of robot-assisted therapy as a part of rehabilitation medicine, especially in patients with stroke and Parkinson's disease.
Humans ; Parkinson Disease ; Physical Therapists ; Rehabilitation* ; Robotics ; Stroke

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Hypoglycemic Encephalopathy in an Alcoholic: A case report.

Min Kyun SOHN ; Pil Soon CHOI ; Sung Kyum KIM ; Sung Ju JEE ; Tae Sung LEE

Brain & Neurorehabilitation.2008;1(2):197-200. doi:10.12786/bn.2008.1.2.197

Severe hypoglycemia leading to permanent brain damage is rare in non-diabetic population. We present one case where chronic alcoholism combined with prolonged fasting lead to such a state. A 51-year-old male patient, a chronic alcoholic, was found unconscious and brought to the emergency room. At the time of hospitalization, consciousness was stupor and he had a blood glucose of 5 mg/dl and MRI of the brain showed high signal density of the inner temporal gyrus and both hippocampus in T2 weighted imaging. There was no history of diabetes. After two months of rehabilitation, improvements were showed to Rancho Los Amigos recognition scale IV, fair grade of muscular strength in upper and lower limbs, FIM score of 21, and dysphagia was improved and nutrition supply was intaken orally. An alcoholic for a long period of time without adequate nutrient supply was experienced to develop into hypoglycemic encephalopathy and therefore reported.

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Influence of Associated Medical Diseases and Complications on Functional Improvement after Rehabilitation in Patients with Stroke.

Hae Kyung PARK ; Youn Joo KANG ; Hyun Jung KIM ; Kang Sik LEE ; Kyung Tae PARK

Brain & Neurorehabilitation.2008;1(2):190-196. doi:10.12786/bn.2008.1.2.190

OBJECTIVE: To investigate the influence of associated medical diseases and complications on functional improvement after in-patient through stroke rehabilitation. METHOD: We performed a retrospective analysis on medical records of 183 stroke patients who had admitted to the department of rehabilitation medicine. Functional Independence Measure (FIM), Modified Barthel Index (MBI) at admission and discharge were used to assess the functional status. We investigated medical diseases, such as hypertension, diabetes, myocardial infarct, atrial fibrillation osteoarthritis, rheumatoid arthritis, previous history of stroke and complications such as dementia, post-stroke depression, central post-stroke pain, complex regional pain syndrome, neglect and aphasia. RESULTS: Post-stroke patients with myocardial infarct, atrial fibrillation, osteoarthritis, dementia, aphasia and neglect significantly showed lower gain of FIM and MBI, lower FIM and MBI efficacy during inpatient rehabilitation compared to without those (p<0.05). However, hypertension, diabetes, previous history of stroke, post-stroke depression, rheumatoid arthritis, central post-stroke pain and complex regional pain syndrome did not significantly influence on gain and efficacy of FIM and MBI (p>0.05). Total numbers of associated medical diseases and complications negatively affect on FIM and MBI efficacy (p<0.05). CONCLUSION: Therefore, it may be important to early detect and manage associated medical diseases and complications in post-stroke patients during rehabilitation, which improve the overall functional recovery of the patients.

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The Effects of a Computer-assisted Cognition Training Program (RehaCom®) in Stroke Patients.

Sung Hun SHIN ; Ji Sung KIM ; Yong Kyun KIM

Brain & Neurorehabilitation.2008;1(2):181-189. doi:10.12786/bn.2008.1.2.181

OBJECTIVE: To evaluate the effect of computer-assisted cognitive training program (RehaCom®) on cognitive function of the patients with stroke. METHOD: Fifty seven subjects with stroke (34 males, 23 females) were enrolled and classified into two groups, experimental and control group. There was no significant difference between two groups in age, sex and lesion type distribution. Control group received conventional rehabilitation therapy including physical and occupational therapy. Experimental group received additional computer-assisted cognitive training using RehaCom software (Germany, 1996), 5 times per a week, 30 minutes per session, for 4 weeks. The RehaCom software consisted of reaction behavior, memory of words, topological memory programs. All patients were assessed their cognitive function using Computerized Neuropsychological Test (CNT), Lowenstein Occupational Therapy Cognitive Assessment (LOTCA) and Korean Version of Mini-Mental Status Examination (MMSE-K) before and after treatment. Functional independence measurement (FIM) was also applied for evaluation of functional status. RESULTS: There was no difference between two groups in the LOTCA, CNT and FIM scores at baseline. Four weeks later, scores of the MMSE and FIM were significantly improved in the experimental group compared to the control group (p<0.05). Especially, the improvement was significant in moderate cognitive impairment group (MMSE = 11~21) (p<0.05). In learned patients of experimental group, the score of the MMSE and LOTCA were significantly more improved than control group (p<0.05). CONCLUSION: Computer-assisted cognitive training would be useful as a additional tool of cognitive rehabilitation in patients with stroke. Especially, the effect of computer-assisted cognitive training program was far better in patients with moderate cognitive impairment and in patients who show learning in cognitive training program.

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