An independent medical examination (IME) is a medical evaluation performed by a medical professional on a patient who was not previously involved in the treatment of that patient, to evaluate the patient’s course of prior treatment and current condition. IMEs are conducted by doctors, psychologists, and other licensed healthcare professionals in essentially all medical disciplines, depending on the purpose of the exam and the claimed injuries. Such examinations are generally conducted in the context of a legal or administrative proceeding, at the request of the party opposing the patient’s request for benefits. Conducting an independent medical examination does not establish a typical doctor-patient relationship as exists when a clinician treats a patient. Thus, a “limited doctor-patient relationship” exists when conducting independent medical examinations.

Central pontine myelinolysis (CPM) is well-recognized osmotic demyelination syndrome that is related to various conditions such as rapid correction of hyponatremia and chronic alcoholism. Acute ataxia as a sole clinical sign in CPM is rare. We report a case of a 59-year-old man with dysarthria, intention tremor, and a significant gait ataxia starting after alcohol withdrawal, with radiological evidence of CPM. CPM should be included in the differential diagnosis of alcoholic patients who develop a sudden ataxia. Chronic alcohol abuse is one of the most commonly encountered predisposing factors. Alcohol withdrawal represents an additional vulnerability factor, being responsible for electrolyte imbalances which are not always demonstrable but are certainly involved in the development of CPM.
Alcoholics* ; Alcoholism ; Ataxia ; Causality ; Demyelinating Diseases ; Diagnosis, Differential ; Dysarthria ; Gait Ataxia ; Humans ; Hyponatremia ; Middle Aged ; Myelinolysis, Central Pontine* ; Tremor

Hemichorea have been reported in patients with nonketotic hyperglycemia. Usually, hemichorea and hyperglycemia are concomitant. A 73-year-old woman was admitted for investigation of an acute hemichorea. T1-weighted brain magnetic resonance imaging showed hyperintensity in the right putamen. Although she was a diabetic patient, she had no hyperglycemia. Interestingly, 4 weeks earlier, the patient was admitted due to nonketotic hyperglycemia. However, there were no hemichorea at that time. Although pathophysiologically controversial, a delayed hemichorea without nonketotic hyperglycemia should be considered as one of many different causes when evaluating acute hemichorea in diabetic patients.
Aged ; Brain ; Chorea ; Female ; Humans ; Hyperglycemia* ; Magnetic Resonance Imaging ; Putamen

Treatment-induced neuropathy in diabetes (also referred to as insulin neuritis) is considered a rare iatrogenic small fiber neuropathy caused by an abrupt improvement in glycemic control in the setting of chronic hyperglycemia. The prevalence and risk factors are unknown. It presents with neuropathic pain, symptoms of autonomic dysfunction, or a combination of both. We present a case that illustrates the range of presentations of the acute treatment-induced small fiber neuropathy in a patient with diabetes mellitus.
Acute Pain* ; Blood Glucose* ; Diabetes Mellitus ; Diabetic Neuropathies ; Erythromelalgia ; Humans ; Hyperglycemia ; Insulin ; Neuralgia ; Prevalence ; Risk Factors

No abstract available.
Brain* ; Conus Snail* ; Dermoid Cyst* ; Magnetic Resonance Imaging ; Rupture

BACKGROUND: The pain-screening questionnaire is a self-reported description of the intensity and nature of pain. This study aimed to develop the Korean Neuropathic Pain Questionnaire (KNPQ) and to assess its reliability and validity regarding the diagnosis of neuropathic pain. METHODS: Four screening tools and two rating scales were translated and modified to develop the preliminary KNPQ. Following a development phase and a pilot study, we generated the final 25-item version of the KNPQ. Each item was rated on a numerical scale of 0-10. The validation procedure was performed in 62 patients with neuropathic pain (21 with central pain and 41 with peripheral pain) and in 34 patients with nonneuropathic pain. The internal consistency between items was assessed to determine the reliability of the KNPQ, and its concurrent validity was determined by evaluating the relationship between the Visual Analogue Scale (VAS) and KNPQ scores. RESULTS: The KNPQ was not influenced by age, sex, or pain duration. The 25-item questionnaire demonstrated high internal consistency. The total score of the KNPQ was correlated with the global pain intensity on a VAS. These items were able to differentiate neuropathic pain from nonneuropathic pain with a sensitivity of 84% and a specificity of 44% (when using a cut-off point of 46). CONCLUSIONS: The newly developed KNPQ may be used for the initial screening of neuropathic pain patients. However, it cannot be used to differentiate central neuropathic pain from peripheral neuropathic pain.
Humans ; Mass Screening ; Neuralgia ; Pain Measurement ; Pilot Projects ; Surveys and Questionnaires ; Reproducibility of Results ; Sensitivity and Specificity ; Weights and Measures

No abstract available.
Adult ; Hemoglobins ; Humans ; Male ; Stroke

BACKGROUND: The role of glycated hemoglobin (HbA1c) in the prediction of ischemic stroke in non-diabetic subjects is not clear. We performed a study to analyze the role of HbA1c in the risk prediction of ischemic stroke in non-diabetic Korean males adult. METHODS: A total of 307 non-diabetic male patients with ischemic stroke were enrolled, and 253 age-matched control subjects without a history of diabetes, hypertension, or cardiovascular disease were selected from a Health Check-up database. Anthropometric measurement data, fasting glucose level, lipid profile, and HbA1c level were available for all subjects. Associations of the variables and the presence or absence of ischemic stroke were analyzed. RESULTS: The ischemic stroke patient group had significantly higher HbA1c levels (5.8+/-0.5% vs. 5.5+/-0.5%, P<0.01) and mean systolic and diastolic blood pressure compared with the control group. Among the variables, smoking, low high density lipoprotein cholesterol, systolic blood pressure, and HbA1c were the significant determinants for ischemic stroke. The highest quartile of HbA1c showed a 9.6-fold increased odds ratio for ischemic stroke compared with the lowest quartile of HbA1c (odds ratio, 9.596; 95% confidence interval, 3.859 to 23.863, P<0.01). The proportion of ischemic stroke patients showed a significant trend for increment as the deciles of HbA1c increased (P for trend <0.01). CONCLUSION: Higher HbA1c indicated a significantly increased risk for ischemic stroke after adjusting for other confounding variables in non-diabetic Korean adult males. HbA1c might have significance in predicting the risk for ischemic stroke even in the non-diabetic range.
Adult ; Asian Continental Ancestry Group ; Blood Pressure ; Cardiovascular Diseases ; Cholesterol ; Cholesterol, HDL ; Confounding Factors (Epidemiology) ; Fasting ; Glucose ; Hemoglobins ; Humans ; Hypertension ; Lipoproteins ; Male ; Odds Ratio ; Smoke ; Smoking ; Stroke

BACKGROUND: Lambert-Eaton myasthenic syndrome is well known to be a classical paraneoplastic syndrome of small cell lung carcinoma (SCLC). Three cases of seronegative myasthenia gravis (MG) and SCLC were previously reported. CASE REPORT: A 65-year-old man developed a severe progressive respiratory failure with clinical features of MG. Tests showed a decremental response in the repetitive nerve stimulation test, abnormal single-fiber electromyography, and positive acetylcholine receptor antibody. SCLC was confirmed by the lung biopsy. CONCLUSIONS: This case represents the first case of seropositive MG and SCLC.
Acetylcholine ; Aged ; Electromyography ; Humans ; Lambert-Eaton Myasthenic Syndrome ; Lung ; Myasthenia Gravis ; Paraneoplastic Syndromes ; Respiratory Insufficiency ; Small Cell Lung Carcinoma

Ginkgo nuts have been eaten as oriental medicine and food since ancient times in Korea. However, the potential toxicity of the ginkgo nuts is not well-known. It has been reported that 4-O-methoxypyridoxine in ginkgo nuts causes generalized seizures but no status epilepticus. This report describes a 58-year-old male presented with status epilepticus after overconsumption of ginkgo nuts. After treatment with anticonvulsants and pyridoxine, symptoms were resolved. The toxicity of ginkgo nuts should be considered as a cause of status epilepticus.
Anticonvulsants ; Ginkgo biloba ; Humans ; Korea ; Male ; Medicine, East Asian Traditional ; Middle Aged ; Nuts ; Pyridoxine ; Seizures ; Status Epilepticus