The objective is to review a case of pneumoparotitis and to discuss how knowledge of this unique presentation is important when making differential diagnoses in emergency medicine. A patient with recurrent subcutaneous emphysema of the head and neck is reviewed. Stenson's duct demonstrated purulent discharge. Physical examination revealed palpable crepitance of the head and neck. Fiberoptic laryngoscopy and barium esophagram were normal. Computed tomography demonstrated left pneumoparotitis and subcutaneous emphysema from the scalp to the clavicles. This is an unusual presentation of pneumoparotitis and malingering. Emergency physicians should be aware of pneumoparotitis and its presentation when creating a differential diagnosis for pneumomediastinum, which includes more life-threatening diagnoses such as airway or esophageal injuries.
Barium ; Clavicle ; Diagnosis ; Diagnosis, Differential ; Emergencies ; Emergency Medicine ; Head ; Humans ; Laryngoscopy ; Malingering ; Mediastinal Emphysema ; Neck ; Physical Examination ; Scalp ; Subcutaneous Emphysema

PURPOSE: To assess the correlation between retinal nerve fiber layer (RNFL) thickness measured by optical coherence tomography (OCT, Cirrus HD-OCT®) and visual acuity in optic neuritis, ischemic optic neuropathy and traumatic optic neuropathy. METHODS: Thirty-eight patients were recruited. RNFL thickness and visual acuity in optic neuritis, ischemic optic neuropathy and traumatic optic neuropathy were measured at least 6 months after the event. The correlation between log MAR best-corrected visual acuity (BCVA) and retinal nerve fiber thickness in each quadrant was analyzed. RESULTS: log MAR BCVA and RNFL thickness of each quadrant in optic neuropathy exhibited a statistically significant correlation. In optic neuritis, RNFL thickness of the superior quadrant was significantly thicker than in ischemic optic neuropathy and traumatic optic neuropathy (p = 0.009, 0.003). In addition, RNFL thickness of the inferior quadrant in optic neuritis was significantly thicker than in traumatic optic neuropathy (p = 0.012). CONCLUSIONS: There was a statistically significant correlation between log MAR BCVA and RNFL thickness by OCT in patients with optic neuropathies. The RNFL thickness may predict visual acuity after an optic neuropathy attack and help to differentiate malingering patients with impaired vision loss.
Humans ; Malingering ; Nerve Fibers* ; Optic Nerve Diseases* ; Optic Nerve Injuries ; Optic Neuritis ; Optic Neuropathy, Ischemic ; Retinaldehyde* ; Tomography, Optical Coherence ; Visual Acuity*

OBJECTIVE: This study explored the relationships among demographic (DVs) and clinical variables (CVs), neurocognitive (NOs) and functional outcome (FO) that could be used as prognostic factors for old aged patients with traumatic brain injury (TBI) undergoing or appointed disability evaluation (DE) after treatment. METHODS: A total of 162 subjects with TBI above the age of 55 years undergoing DE or appointed to do so after treatments were selected. The patients were divided into two subgroups according to age : a junior elderly group 55 to 64 years old and a senior elderly group over the age of 65. NOs and FO were evaluated using the Seoul Neuropsychological Screening Battery and Clinical Dementia Rating scale. RESULTS: Gender, age, and education level were shown to significantly impact the recovery of NOs after TBI. Other DVs and CVs such as area of residency, occupation, type of injury, or loss of consciousness were not found to significantly affect the recovery of NOs after TBI. Analysis of the relationships among DVs, CVs and NOs demonstrated that gender, age, and education level contributed to the variance of NOs. In FO, loss of consciousness (LOC) was included to prognostic factor. CONCLUSION: Gender, age and education level significantly influence the NOs of elderly patients with TBI. LOC may also serve as a meaningful prognostic factor in FO. Unlike younger adult patients with TBI, old aged patients with TBI did not show global faking-bad or malingering attitudes to DE for compensation, but assume that they could faking their performance in a test set available visual feedback.
Adult ; Aged* ; Brain Injuries* ; Compensation and Redress ; Dementia ; Disability Evaluation* ; Education ; Feedback, Sensory ; Humans ; Internship and Residency ; Malingering ; Mass Screening ; Occupations ; Prognosis ; Seoul ; Unconsciousness

OBJECTIVE: To study the application value of contrast vision in identifying the malingering decreased vision in the practice of clinical forensic medicine. METHODS: Thirty-one young and middle aged volunteers were selected and divided randomly into group 1 (16 persons with 32 eyes) and group 2 (15 persons with 30 eyes). The optotype contrast was 100%, 25%, 10% and 5%, respectively. The contrast vision of group 1 was tested. The contrast vision of group 2 was tested as follows: (1) the volunteers cooperated without inspector's interference; (2) the volunteers cooperated under inspector's interference; (3) the volunteers disguised decreased vision without inspector's interference; (4) the volunteers disguised decreased vision under inspector's interference. The data was then analyzed by statistics. RESULTS: There was a close correlation between contrast vision and contrast. As the contrast decreased, the vision acuity also decreased. The contrast vision curve of former two methods showed a good reproducibility while the contrast vision curve of latter two methods had a bad reproducibility. CONCLUSION The repetition of contrast curve with or without inspector's interference can be used to discriminate malingering vision. The acquired contrast curves can be provided to the court as direct evidence and can help enhance the verification conclusion.
Adult ; Contrast Sensitivity/physiology* ; Diagnosis, Differential ; Female ; Humans ; Male ; Malingering/psychology* ; Reproducibility of Results ; Sensitivity and Specificity ; Severity of Illness Index ; Vision Tests/statistics & numerical data* ; Vision, Binocular ; Vision, Low/psychology* ; Visual Acuity ; Young Adult

There has been a considerable increase in the number of patients with olfactory disorder due to head and facial injuries. Conventional olfactory function evaluation methods, such as T&T olfactometer, the Schneider test and the Alinamin test have been widely used in clinical practice. Among these, the Schneider test can determine whether the patient is a malingerer. A woman who sustained head and facial injuries visited our department with the chief complaint of anosmia. The patient underwent conventional olfactory function tests, including T&T olfactometer and the Schneider test. T&T olfactometer revealed olfactory loss, but the Schneider test did not. Thus, she was diagnosed with malingering. However, her diagnosis of olfactory disorder and concurrent trigeminal nerve injury was made definite during the follow-up period. We herein report a 30-year-old female patient with olfactory disorder who was misdiagnosed with olfactory malingering based on the negative result of the Schneider test. A brief review of the literature has been included.
Adult ; Craniocerebral Trauma ; Facial Injuries ; Female ; Follow-Up Studies ; Head ; Humans ; Malingering ; Olfaction Disorders ; Thiamine ; Trigeminal Nerve ; Trigeminal Nerve Injuries

OBJECTIVE: To develop an objective criteria with computerized dynamic posturography (CDP) for identification of non-organic or malingering symptoms of balance disorders. METHODS: One hundred and four normal subjects were instructed to feign balance disturbance after naturally performing on CDP. Paired t-test was used to determine if there was significant difference of CDP equilibrium scores between normal and malingering performance. The CDP records including raw curve of 50 subjects were critically evaluated by previously published seven criteria in indicating malingering performance. If the sensitivity of a criterion was greater than 90%, it would be accepted as our laboratory's identifying criterion. The CDP records of remaining 54 subjects were used to test the sensitivity and specificity of the accepted criteria. RESULTS: There were statistically significant differences of CDP equilibrium scores between normal and malingering performance (P < 0.01). The mean equilibrium scores of malingering performance were lower than that of normal performance. The sensitivity and specificity of our criteria for identifying malingerers were 92.5% and 98.2%, respectively. CONCLUSION It is necessary to identify malingering performance before analyzing the CDP equilibrium scores. Our identifying criteria of malingerers seems to be quite useful and accurate.
Adult ; Diagnosis, Computer-Assisted/methods* ; Diagnosis, Differential ; Female ; Forensic Medicine ; Humans ; Image Processing, Computer-Assisted ; Male ; Malingering/diagnosis* ; Neuropsychological Tests ; Postural Balance/physiology* ; Posture/physiology* ; Sensitivity and Specificity ; Vestibular Diseases/diagnosis*

PURPOSE: To describe the characteristics of the disabled patients visiting the eye clinic in our institute. METHODS: We carried out a retrospective analysis of 35 cases in our clinic from April 2004 to June 2008 using the McBride disability evaluation. We investigated the clinical features and the causes of disorders through visual acuity, visual field and ocular motility. RESULTS: Thirty-three (94.3%) of the 35 patients had disabilities due to trauma; twelve (34.3%) of them were caused by traffic accidents, and 21 (60%) of them were due to blows or lacerations. Other causes of disability were glaucoma and retinal break (5.8%). Nine patients (25.7%) had abnormal findings in the visual field examination, and nine other patients (25.7%) had limitations in ocular motility. Twenty-eight patients (80%) had decreased visual acuity, and nine (25.7%) had multiple symptoms. CONCLUSIONS: Considering the contribution of disability estimation of visual field and ocular motility in McBride disability evaluations, we considered the importance of repetitive examinations and evaluations. When patients complained of unexplained decreased visual acuity with no anatomical abnormalities, multifocal ERG and multifocal VEP should be considered in order to distinguish it from malingering or functional visual loss.
Accidents, Traffic ; Disability Evaluation ; Eye ; Glaucoma ; Humans ; Lacerations ; Malingering ; Retinal Perforations ; Retrospective Studies ; Visual Acuity ; Visual Fields

OBJECTIVE: We investigated whether Disability Evaluation (DE) situations influence patients' neuropsychological test performances and psychopathological characteristics and which variable play a role to establish an explanation model using statistical analysis. METHODS: Patients were 536 (56.6%) brain-injured persons who met inclusion and exclusion criteria, classified into the DE group (DE; n = 300, 56.0%) and the non-DE group (NDE; n = 236, 44.0%) according to the neuropsychological testing's purpose. Next, we classified DE subjects into DE cluster 1 (DEC1; 91, 17.0%), DE cluster 2 (DEC2; 125; 23.3%), and DE cluster 3 (DEC3; 84, 15.7%) via two-step cluster analysis, to specify DE characteristics. All patients completed the K-WAIS, K-MAS, K-BNT, SCL-90-R, and MMPI. RESULTS: In comparisons between DE and NDE, the DE group showed lower intelligence quotients and more severe psychopathologic symptoms, as evaluated by the SCL-90-R and MMPI, than the NDE group did. When comparing the intelligence among the DE groups and NDE group, DEC1 group performed worst on intelligence and memory and had most severe psychopathologic symptoms than the NDE group did. The DEC2 group showed modest performance increase over the DEC1 and DEC3, similar to the NDE group. Paradoxically, the DEC3 group performed better than the NDE group did on all variables. CONCLUSION: The DE group showed minimal "faking bad" patterns. When we divided the DE group into three groups, the DEC1 group showed typical malingering patterns, the DEC2 group showed passive malingering patterns, and the DEC3 group suggested denial of symptoms and resistance to treatment.
Brain ; Brain Injuries ; Denial (Psychology) ; Disability Evaluation ; Humans ; Intelligence ; Malingering ; Memory ; MMPI ; Neuropsychological Tests

It can be difficult to distinguish posttraumatic stress disorder (PTSD) from malingering because a person's responses after experiencing trauma depend on self-report, such as subjective complaints, and it is easy to find the diagnostic criteria for PTSD through the internet or other mass media. Therefore, it is important for clinicians to perceive patients' motivations and determine whether they have external incentives. We reviewed clinicians' and patients' interview styles, which can be useful for reducing malingering intent and detecting malingering patterns. To help clinicians differentiate PTSD from malingering, we also reviewed the diagnostic criteria (re-experience, avoidance and numbing, and hyperarousal) and the typical symptoms of true and malingered PTSD.
Internet ; Malingering ; Mass Media ; Motivation ; Stress Disorders, Post-Traumatic

In the fields of judicial psychiatric identification, about 40%-60% of the people maybe exaggerate their injury for personal profit. Though some psychological tests are effective in identification, they are limited in cunning liars. This article summarizes previous experimental mode, results and effects of event-related potential (ERP) in detecting cognitive malingering. ERP technology can be highly sensitive and specific. It is a kind of objective physiological index and is a promising technology in detecting cognitive malingering.
Brain Injuries/psychology* ; Cognition Disorders/psychology* ; Disability Evaluation ; Electroencephalography ; Event-Related Potentials, P300 ; Forensic Psychiatry/methods* ; Humans ; Malingering/psychology* ; Memory/physiology* ; Neuropsychological Tests ; Predictive Value of Tests ; Reproducibility of Results ; Sensitivity and Specificity