This study identified the explanatory power of the Korean rehabilitation patient group (KRPG) v1.1 for acquired brain injury (ABI) on medical expenses in the rehabilitation hospitals and the correlation of functional outcomes with the expenses. Here, the design is a retrospective analysis from the claim data of the designated rehabilitation hospitals. Data including KRPG information with functional status and medical expenses were collected from 1 January and 31 August 2018. Reduction of variance (R2) was statistically analyzed for the explanation power of the KRPG. Association between functional status and the medical expenses was carried out using the Spearman's rank order correlation (rho). From the claim data of 365 patients with ABI, the KRPG v1.1 explained 8.6% of variance for the total medical expenses and also explained 9.8% of variance for the rehabilitation therapy costs. Cognitive function and spasticity showed very weak correlation with the total medical expenses (rho = −0.17 and −0.14, respectively). Motor power and performance of activities of daily living were associated weakly (rho = −0.27 and −0.30, respectively). The KRPG and related functional status in ABI reflects the total medical expenses and rehabilitation therapy costs insufficiently in the designated rehabilitation hospitals. Thus, the current KRPG algorithm and variables for ABI may need to be ameliorated in the future.
Activities of Daily Living ; Brain Diseases ; Brain Injuries ; Brain ; Cognition ; Diagnosis-Related Groups ; Fee-for-Service Plans ; Humans ; Muscle Spasticity ; Neurological Rehabilitation ; Rehabilitation ; Retrospective Studies

BACKGROUND: Argyria is a rare irreversible cutaneous pigmentation disorder caused by prolonged exposure to silver. Herein, we report a case of generalized argyria that developed after chronic ingestion of soluble silver-nano particles and presented with muscle weakness. CASE PRESENTATION: A 74-year-old woman visited our emergency room, complaining of fever and mental deterioration. She was diagnosed with acute pyelonephritis and recovered after antibiotic therapy. At presentation, diffuse slate gray-bluish pigmented patches were noticed on her face and nails. Two months prior to visiting our hospital, she was diagnosed with inflammatory myopathy and given steroid therapy at another hospital. We performed a nerve conduction study that revealed polyneuropathy. In skin biopsies from pigmented areas of the forehead and nose, the histopathologic results showed brown-black granules in basement membranes of sweat gland epithelia, which are diagnostic findings of argyria. We reviewed pathology slides obtained from the left thigh muscles and found markedly degenerated myofibers with disorganization of myofibrils without inflammatory reactions, consistent with unspecified myopathy, rather than inflammatory myopathy. The patient was diagnosed with generalized argyria with polyneuropathy and myopathy and transferred to a rehabilitation institution after being tapered off of steroids. CONCLUSIONS: Clinicians should be aware of clinical manifestations of argyria and consider it in differential diagnosis when they examine patients who present with skin pigmentation and muscle weakness.
Aged ; Argyria* ; Basement Membrane ; Biopsy ; Diagnosis, Differential ; Eating ; Emergency Service, Hospital ; Female ; Fever ; Forehead ; Humans ; Muscle Weakness* ; Muscles ; Muscular Diseases ; Myofibrils ; Myositis ; Neural Conduction ; Nose ; Pathology ; Pigmentation Disorders ; Polyneuropathies ; Pyelonephritis ; Rehabilitation ; Silver ; Skin ; Skin Pigmentation ; Steroids ; Sweat Glands ; Thigh

It is not a common case for neurosurgery department and the other departments to perform joint operation at the same time. Patients with severe head injury are a condition in which vital signs are unstable due to severe brain swelling and increased intracranial pressure, and emergency surgery is required. A 44-year-old man visited the trauma center with a motorcycle accident. The Glasgow Coma Scale score at the time of emergency department was 3 points, and the pupil was fixed at 6 mm on both sides. His medical history was unknown. His vital signs including blood pressure (BP), heart rate, respiratory rate and oxygen saturation were stable. Associated injuries included multiple fractures of whole body. Brain computed tomography revealed subarachnoid hemorrhage, intraventricular hemorrhage and severe cerebral edema. During the preparation of the craniectomy, abdominal ultrasonography performed because of decreased BP resulted in a large amount of hemoperitoneum. The bi-coronal craniectomy and splenectomy were performed simultaneously for about 4 hours. After fifty days of treatment, he was discharged with Glasgow Outcome Scale-extended 4 points and is undergoing rehabilitation. In severe polytrauma patients, active concurrent surgery is a good method to save their lives.
Adult ; Blood Pressure ; Brain ; Brain Edema ; Craniocerebral Trauma* ; Emergencies ; Emergency Service, Hospital ; Fractures, Multiple ; Glasgow Coma Scale ; Head* ; Heart Rate ; Hemoperitoneum ; Hemorrhage ; Humans ; Intracranial Pressure ; Joints ; Methods ; Motorcycles ; Multiple Trauma ; Neurosurgery ; Oxygen ; Pupil ; Rehabilitation ; Respiratory Rate ; Splenectomy* ; Subarachnoid Hemorrhage ; Trauma Centers ; Ultrasonography ; Vital Signs

Acute hemorrhagic leukoencephalitis (AHLE) is an acute, rapidly progressing, fulminant demyelinating disease. It is a rare disease of the central nervous system with high mortality; survivors commonly present with significant neurological deficit. We report the case of a 16-month-old girl who survived AHLE and presented with the associated neurologic deficit. The patient came into the emergency department with febrile seizure. She showed bilateral pinpoint-sized pupils and hyperactive deep tendon reflexes. Her mental status was initially drowsy and rapidly progressed to stupor. Extensive demyelination and microbleeds were found in the cerebral white matter, thalamus and left cerebellum on Magnetic resonance imaging (MRI) scans. Her mental status was improved by intravenous administration of immunoglobulin and methylprednisolone. Five months after being discharged, increased white matter connectivity was found on color-coded follow-up MR diffusion tensor imaging (DTI) as compared to previous MRI. We therefore suggest adding the DTI technique when a follow-up MRI is performed in patients with AHLE. It could be useful to visualize the status of axonal injury and to encourage patients and their parents to continue the rehabilitation program.
Administration, Intravenous ; Axons ; Central Nervous System ; Cerebellum ; Child ; Demyelinating Diseases ; Diffusion Tensor Imaging* ; Diffusion* ; Emergency Service, Hospital ; Female ; Follow-Up Studies* ; Humans ; Immunoglobulins ; Infant ; Leukoencephalitis, Acute Hemorrhagic* ; Magnetic Resonance Imaging ; Methylprednisolone ; Mortality ; Neurologic Manifestations ; Parents ; Pupil ; Rare Diseases ; Reflex, Stretch ; Rehabilitation ; Seizures ; Seizures, Febrile ; Stupor ; Survivors ; Thalamus ; White Matter

Acute hemorrhagic leukoencephalitis (AHLE) is an acute, rapidly progressing, fulminant demyelinating disease. It is a rare disease of the central nervous system with high mortality; survivors commonly present with significant neurological deficit. We report the case of a 16-month-old girl who survived AHLE and presented with the associated neurologic deficit. The patient came into the emergency department with febrile seizure. She showed bilateral pinpoint-sized pupils and hyperactive deep tendon reflexes. Her mental status was initially drowsy and rapidly progressed to stupor. Extensive demyelination and microbleeds were found in the cerebral white matter, thalamus and left cerebellum on Magnetic resonance imaging (MRI) scans. Her mental status was improved by intravenous administration of immunoglobulin and methylprednisolone. Five months after being discharged, increased white matter connectivity was found on color-coded follow-up MR diffusion tensor imaging (DTI) as compared to previous MRI. We therefore suggest adding the DTI technique when a follow-up MRI is performed in patients with AHLE. It could be useful to visualize the status of axonal injury and to encourage patients and their parents to continue the rehabilitation program.
Administration, Intravenous ; Axons ; Central Nervous System ; Cerebellum ; Child ; Demyelinating Diseases ; Diffusion Tensor Imaging* ; Diffusion* ; Emergency Service, Hospital ; Female ; Follow-Up Studies* ; Humans ; Immunoglobulins ; Infant ; Leukoencephalitis, Acute Hemorrhagic* ; Magnetic Resonance Imaging ; Methylprednisolone ; Mortality ; Neurologic Manifestations ; Parents ; Pupil ; Rare Diseases ; Reflex, Stretch ; Rehabilitation ; Seizures ; Seizures, Febrile ; Stupor ; Survivors ; Thalamus ; White Matter

We report a case of Brown-Sequard syndrome (BSS) caused by an accidental stab injury of the cervical spine that shows clear magnetic resonance imaging (MRI) findings and clinical presentation. A 42-year-old woman was brought into the emergency department after a stab injury on the right side of the posterior neck from a knife that was lying in a fruit basket after slipping. The patient complained of hemiparesis of the right-side extremities, and ipsilateral hypoesthesia and contralateral sensory loss of pain and temperature were also found on neurological examination. MRI showed a signal change of the C6-7 cord level and the tract of the stab wound through the posterior neck. Irrigation and primary closure of the laceration was performed under the impression of BSS. The neurologic deficit was improved with rehabilitation therapy.
Adult ; Brown-Sequard Syndrome* ; Cervical Vertebrae ; Deception ; Emergency Service, Hospital ; Extremities ; Female ; Fruit ; Humans ; Hypesthesia ; Lacerations ; Magnetic Resonance Imaging ; Neck ; Neurologic Examination ; Neurologic Manifestations ; Paresis ; Rehabilitation ; Spinal Cord Injuries ; Spine* ; Wounds, Stab

Occasionally, unexpected neurological deficits occur after lumbar spinal surgery. We report a case of monoparesis after lumbar decompressive surgery. A 63-year-old man, who had undergone decompression of L4-5 for spinal stenosis 4 days previously in the other hospital, visted the emergency department with progressive weakness in the left leg and hypoesthesia below sensory level T7 on the right side. He had been cured of lung cancer with chemotherapy and radiation therapy 10 years previously, but detailed information of radiotherapy was not available. Whole spine magnetic resonance (MR) imaging showed fatty marrow change from T1 to T8, most likely due to previous irradiation. The T2-weighted MR image showed a high-signal T4-5 spinal cord lesion surrounded by a low signal rim, and the T1-weighted MR image showed focal high signal intensity with focal enhancement. The radiological diagnosis was vascular disorders with suspicious bleeding. Surgical removal was refused by the patient. With rehabilitation, the patient could walk independently without assistance 2 months later. Considering radiation induced change at thoracic vertebrae, vascular disorders may be induced by irradiation. If the spinal cord was previously irradiated, radiation induced vascular disorders needs to be considered.
Bone Marrow ; Decompression ; Delayed Diagnosis* ; Diagnosis ; Drug Therapy ; Emergency Service, Hospital ; Hemorrhage ; Humans ; Hypesthesia ; Leg ; Lung Neoplasms ; Middle Aged ; Paresis ; Radiotherapy ; Rehabilitation ; Spinal Cord* ; Spinal Stenosis ; Spine ; Thoracic Vertebrae

The dilated cardiomyopathy is the common type of cardiomyopathy, and its distinctive characteristic is the systolic dysfunction. Not many reports were issued about the efficacy of cardiac rehabilitation in patients with an advanced dilated cardiomyopathy until yet. A 50-year-old man who was diagnosed with dilated cardiomyopathy with congestive heart failure was admitted to the emergency room after a sudden collapse and a ventricular fibrillation was presented in the actual electrocardiogram. After three months, the patient participated in an 8-week cardiac rehabilitation program with electrocardiogram monitoring for 50 minutes per session at five times per week. The maximal oxygen consumption improved from 13.5 to 19.4 mL/kg/min during this time. At 3.9 metabolic equivalents, the myocardial oxygen demand decreased from 21,710 to 12,669 mmHg.bpm and the Borg's scale of perceived exertion decreased from 15 to 9. The left ventricular ejection fraction improved from 14% to 19%. So in this case report will be presented a patient after a successful cardiac rehabilitation program. Before this the patient suffered from a much more advanced dilated cardiomyopathy and was resuscitated from cardiac arrest.
Cardiomyopathies ; Cardiomyopathy, Dilated* ; Electrocardiography ; Emergency Service, Hospital ; Heart Arrest ; Heart Failure ; Humans ; Metabolic Equivalent ; Middle Aged ; Oxygen ; Oxygen Consumption ; Rehabilitation* ; Stroke Volume ; Ventricular Fibrillation

PURPOSE: To Carry out a low vision quality of life questionnaire and to evaluate subjective quality of life of low-vision patients. METHODS: The subject were 250 patients whose visual acuity was between hand motion and 0.3 among the patients at our clinic. The normal control group included 60 patients. After a review of the literature, we selected a useful questionnaire to assess quality of life in low vision patients and translated the questionnaire into Korean. The questionnaire used had 25 items concerning low vision and each question was multiple-choice, and the sum of the total points was used to assess of the quality of life. RESULTS: The range of scores was from 0 to 125 points (the higher the score, the higher the quality of life). Fifty-one patients among 250 patients in the low vision group replied to our questionnaire. Fifty patients among 60 patients in the control group replied. The average low vision quality of life (LVQOL) score for patients with low vision (67.3+/-26.7) was significantly lower than the average score of those with normal vision (114+/-9.72). There was no statistically significant difference between the average score of patients questioned by mail versus telephone CONCLUSIONS: The score of low vision patients was significantly lower than that of the control group, so this questionnaire can be applied to low vision patients specifically to evaluate quality of life. Optimally, the the questionnaire shoud be administered before and after the low vision consultation. The comparision of prerehabilitation score with postrehabilitation score might be helpful to evaluate the quality of life in a post rehabilitation state.
Hand ; Humans ; Postal Service ; Quality of Life* ; Surveys and Questionnaires ; Rehabilitation ; Telephone ; Vision, Low* ; Visual Acuity

PURPOSE: To Carry out a low vision quality of life questionnaire and to evaluate subjective quality of life of low-vision patients. METHODS: The subject were 250 patients whose visual acuity was between hand motion and 0.3 among the patients at our clinic. The normal control group included 60 patients. After a review of the literature, we selected a useful questionnaire to assess quality of life in low vision patients and translated the questionnaire into Korean. The questionnaire used had 25 items concerning low vision and each question was multiple-choice, and the sum of the total points was used to assess of the quality of life. RESULTS: The range of scores was from 0 to 125 points (the higher the score, the higher the quality of life). Fifty-one patients among 250 patients in the low vision group replied to our questionnaire. Fifty patients among 60 patients in the control group replied. The average low vision quality of life (LVQOL) score for patients with low vision (67.3+/-26.7) was significantly lower than the average score of those with normal vision (114+/-9.72). There was no statistically significant difference between the average score of patients questioned by mail versus telephone CONCLUSIONS: The score of low vision patients was significantly lower than that of the control group, so this questionnaire can be applied to low vision patients specifically to evaluate quality of life. Optimally, the the questionnaire shoud be administered before and after the low vision consultation. The comparision of prerehabilitation score with postrehabilitation score might be helpful to evaluate the quality of life in a post rehabilitation state.
Hand ; Humans ; Postal Service ; Quality of Life* ; Surveys and Questionnaires ; Rehabilitation ; Telephone ; Vision, Low* ; Visual Acuity