We experienced a case of adult-onset Still's disease with dysphagia of soft tissue origin. A ... more We experienced a case of adult-onset Still's disease with dysphagia of soft tissue origin. A 38-year-old woman was admitted for intermittent high spiking fever, diffuse pain and swelling on anterior neck with dysphagia. Physical examination revealed a thin woman with trismus, board-like hardness of anterior neck, hepatomegaly, and erythematous evanescent rash on leg. Neck CT displayed bilateral cervical lymphadenopathy with soft tissue swelling, and tonsilitis. Chest and abdomen CT showed the inflammatory changes of multiple organs. Laboratory evaluation revealed neutrophilic leukocytosis, slightly increased alanine transaminase, negative antinuclear antibody and rheumatoid factor, and increased inflammatory markers. Skin, liver, colon, and pleural biopsy demonstrated the chronic inflammation. Videofluoroscopic swallowing study revealed laryngeal penetration with large amount residue in vallecular space and pyriform sinus, and incomplete cricopharyngeal relaxation. Gradual improvement in anterior neck pain and pulmonary edema and the decrease of effortful and multiple swallowing were observed with high dose steroid therapy. (J Korean Acad Rehab Med 2007; 31: 361-365)
Introduction: Previously, association between body mass index (BMI) and K-Modified Barthel Index ... more Introduction: Previously, association between body mass index (BMI) and K-Modified Barthel Index (KMBI) score was reported. However, few studies investigated the value of obesity as a predictive factor of 6 months functional outcome after stroke. Aims: The aim of this study is to examine whether BMI predicts the 6-month KMBI after stroke onset with adjustment for cardiovascular disease risk factors socioeconomic position and health behavior factors in stroke patients. Methods: This is an interim report of the Korean Stroke Cohort for Functioning and Rehabilitation (KosCo). The sample included 1,299 stroke patients, both ischemic and hemorrhagic, aged 18-92 years. FIM score was assessed at 6 months after stroke onset. Subjects were classified into three groups based on their baseline BMI categories at admission: normal (18.5 ≤ BMI < 23), overweight (23 ≤ BMI < 25), or obese (BMI ≥ 25) groups. Results: The mean age was 64.1 (±12.8) years. The distribution of overweight and obese groups was 28.5 % and 36.3 %, respectively. The mean 6-month KMBI was 85.6 (±27.6) and 88.0 (±26.0), respectively. The 6-month KMBI significantly increased in obese group compared to the normal BMI group after adjustment for confounding factors. In the ischemic stroke, the 6-month KMBI was increased in the obese group (p<0.05), but not in the hemorrhagic stroke. Conclusions: This hospital-based cohort study showed that obesity measured by BMI may predict good 6 months functional outcome, especially, for the ischemic stroke patients (Supported by Korea Centers for Disease Control and Prevention (2013E3301701)).
Introduction: Few studies investigated the diabetes mellitus (DM) as a predictable factor of 6 mo... more Introduction: Few studies investigated the diabetes mellitus (DM) as a predictable factor of 6 months K-Modified Barthel Index (KMBI) outcome after stroke. Aims: The aim of this study is to investigate whether DM predicts the outcome of KMBI at 6-month after stroke with adjustment for cardiovascular disease risk factors, socioeconomic position and health behavior factors. Methods: This is an interim report of the Korean Stroke Cohort for Functioning and Rehabilitation (KosCo). The sample included 1,199 stroke patients aged 45-92 years. FIM score was assessed at 6 months after onset. We divided subjects into two age groups: the middle aged (45-64 year-old) and the elderly (over 65 year-old). Subjects who met one of the following requirements were defined as having DM: taking an oral hyperglycemic agent, using insulin, clinical diagnosis of diabetes, or a fasting glucose level >125 mg/dL. Results: The mean age of the middle aged group was 55.8(±5.44) year-old and the elderly group was 74.3(±6.14)(p<0.001). The distribution of DM was 20.8% and 28.9%, respectively (p<0.001). The mean 6-Month KMBI was 91.7 (±20.7) and 78.4 (±33.1), respectively (p<0.001). The 6-Month KMBI significantly decreased in DM group compared to the non DM group after adjustment for confounding factors. In the middle aged group, the 6-Month KMBI decreased in DM group (p<0.01), but in the elderly group. Conclusions: This hospital-based cohort study showed that DM may predict poor 6-Month KMBI outcome, especially, for the middle aged group (Supported by Korea Centers for Disease Control and Prevention (2013E3301701)).
Objective: To investigate the correlation between the seventy of paralysis and hand sympathetic s... more Objective: To investigate the correlation between the seventy of paralysis and hand sympathetic skin response(SSR) in patients with Bell's palsy and to evaluate the clinical utility of hand SSR as a predicting factor of prognosis Method: Twenty patients with Bell's palsy and twenty normal controls were recruited. The seventy of paralysis was graded according to House-Brackmaim Facial Grading Scale(H-B FGS), and percent degeneration of Nasalis was determined by Facial Nerve Conduction Study (FNCS) Results: The difference of hand SSR amplitude between affected and unaffected side was significant (P
Objective: To investigate the correlation between functional evaluation scales and cognitive evok... more Objective: To investigate the correlation between functional evaluation scales and cognitive evoked potentials (CEPs) in chronic stroke patients. Method: Ten chronic stroke patients with middle cerebral arterial infarction (age 53.6±15.7 years, 5 men, 5 women, duration 210.5±143.2 days) were recruited. Korean mini- mental status examination (K-MMSE) scores of the subjects were ranked between 15∼24 points and the grades of Rancho Los Amigos level of cognitive function of the subjects were VI or VII. They received physical therapy using neuro-developmental technique and cognitive rehabilitation twice a day, 5 times a week, for total 4 weeks. Before and after the treatment, cognitive function tests including K- MMSE, Loewenstein occupational therapy cognitive assessment (LOTCA) and motor-free visual perception test (MVPT) and functional ability tests including functional independence measure (FIM) and Korean version of National Institutes of Health stroke scale (K-NIHSS) were done and CEPs were recorded. Results: The scores of K-MMSE, LOTCA, MVPT, FIM and K-NIHSS showed significant improvement, respectively (p<0.05). The P300 latencies significantly decreased from 420.2±34.8 msec to 391.5±36.4 msec (p<0.05). There were significant correlations between the percentage of change of P300 latencies and each percentage of change of K-MMSE, LOTCA and MVPT (r=0.863, p=0.001; r=0.745, p=0.013; r=0.806, p=0.005). There were significant correlations between the percentage of change of P300 latencies and each percentage of change of FIM and K-NIHSS (r=0.758, p=0.011; r=0.743, p=0.014). Conclusion: The CEPs would be a useful method for reflecting the effect of neuro-cognitive rehabilitation treatment and predicting the functional recovery in chronic stroke patients. (J Korean Acad Rehab Med 2008; 32: 637-643)
We wanted to report three cases of bruxism who were intractable to conventional management such a... more We wanted to report three cases of bruxism who were intractable to conventional management such as dental protection or medication but responded to motor point blocks (MPB) with botulinum toxin-A (BTX-A) on mastication muscles. Untreated, bruxism causes unfavorable complications of masseter hypertrophy, headache, temporomandibular joint destruction, and furthermore total dental wear and malnutrition. Our three patients had no previous history of bruxism or any neuromuscular disorder. They were presented with decreased cognitive function and severe bruxism about 6 months after brain injury. We managed the patients with MPB of BTX-A on each masseter and temporalis muscles. Bruxisms were markedly improved about 2 weeks after MPB without any complications. On follow-up 6 months after MPB, two of three patients remained free of bruxism and another patient revealed attenuated bruxism with decreased severity and frequency. Therefore, we think that MPB with BTX-A could be considered as a treatment option for severe bruxism in brain-injured patients.
Deep vein thrombosis (DVT) is a well-known complication of stroke and frequently develops in acut... more Deep vein thrombosis (DVT) is a well-known complication of stroke and frequently develops in acute stroke patients. Immobility in stroke patients increases the risk of DVT and pulmonary embolism (PE). The incidence of DVT in non-ambulatory stroke patients is more frequent than the incidence in ambulatory stroke patients. We report a case of DVT and PE in an ambulatory chronic stroke patient. Initial physical examination showed heat and swelling of hemiplegic leg. The patient was only able to ambulate with the assist of a monocane and a plastic leaf spring orthosis due to ankle dorsiflexor weakness. The patient was treated with anticoagulation and inferior vena cava filter placement. After long-term anticoagulation, follow-up studies revealed satisfactory resolution of DVT and PE. We present a case of DVT and PE which developed during the chronic stage of stroke, 2 years from the onset of stroke, and review the cause of DVT.
Objective: To know the usefulness of the Modified Mini- Mental State Exam (3MS) as a screening te... more Objective: To know the usefulness of the Modified Mini- Mental State Exam (3MS) as a screening test of cognitive function after stroke and the relationship between the 3MS with clock drawing task (CDT) and the 3MS with visual scan task (VST) in view of visual neglect and functional outcome. Method: We studied 17 patients with unilateral hemisphere stroke [7 right hemisphere stroke (RHS), 10 left hemisphere stroke (LHS)] who have a mean age of 59.4 years and a mean hospital stay of 34.3 days on final examination. None of them had the previous history of mental illness or the previous stroke attack. We performed the MMSE, 3MS, VST and CDT at the first week of onset of stroke and at discharge. Results: 1) 3MS was a valuable screening test of cognitive function like MMSE (p0.05). Conclusion: We think that 3MS is a valuable screening test of cognitive function after stroke. VST and CDTs are valuable screening tools in estimating unilateral neglect after stroke. But 3MS with CDT is not well correlated with functional outcome.
We experienced a case of adult-onset Still's disease with dysphagia of soft tissue origin. A ... more We experienced a case of adult-onset Still's disease with dysphagia of soft tissue origin. A 38-year-old woman was admitted for intermittent high spiking fever, diffuse pain and swelling on anterior neck with dysphagia. Physical examination revealed a thin woman with trismus, board-like hardness of anterior neck, hepatomegaly, and erythematous evanescent rash on leg. Neck CT displayed bilateral cervical lymphadenopathy with soft tissue swelling, and tonsilitis. Chest and abdomen CT showed the inflammatory changes of multiple organs. Laboratory evaluation revealed neutrophilic leukocytosis, slightly increased alanine transaminase, negative antinuclear antibody and rheumatoid factor, and increased inflammatory markers. Skin, liver, colon, and pleural biopsy demonstrated the chronic inflammation. Videofluoroscopic swallowing study revealed laryngeal penetration with large amount residue in vallecular space and pyriform sinus, and incomplete cricopharyngeal relaxation. Gradual improvement in anterior neck pain and pulmonary edema and the decrease of effortful and multiple swallowing were observed with high dose steroid therapy. (J Korean Acad Rehab Med 2007; 31: 361-365)
Introduction: Previously, association between body mass index (BMI) and K-Modified Barthel Index ... more Introduction: Previously, association between body mass index (BMI) and K-Modified Barthel Index (KMBI) score was reported. However, few studies investigated the value of obesity as a predictive factor of 6 months functional outcome after stroke. Aims: The aim of this study is to examine whether BMI predicts the 6-month KMBI after stroke onset with adjustment for cardiovascular disease risk factors socioeconomic position and health behavior factors in stroke patients. Methods: This is an interim report of the Korean Stroke Cohort for Functioning and Rehabilitation (KosCo). The sample included 1,299 stroke patients, both ischemic and hemorrhagic, aged 18-92 years. FIM score was assessed at 6 months after stroke onset. Subjects were classified into three groups based on their baseline BMI categories at admission: normal (18.5 ≤ BMI < 23), overweight (23 ≤ BMI < 25), or obese (BMI ≥ 25) groups. Results: The mean age was 64.1 (±12.8) years. The distribution of overweight and obese groups was 28.5 % and 36.3 %, respectively. The mean 6-month KMBI was 85.6 (±27.6) and 88.0 (±26.0), respectively. The 6-month KMBI significantly increased in obese group compared to the normal BMI group after adjustment for confounding factors. In the ischemic stroke, the 6-month KMBI was increased in the obese group (p<0.05), but not in the hemorrhagic stroke. Conclusions: This hospital-based cohort study showed that obesity measured by BMI may predict good 6 months functional outcome, especially, for the ischemic stroke patients (Supported by Korea Centers for Disease Control and Prevention (2013E3301701)).
Introduction: Few studies investigated the diabetes mellitus (DM) as a predictable factor of 6 mo... more Introduction: Few studies investigated the diabetes mellitus (DM) as a predictable factor of 6 months K-Modified Barthel Index (KMBI) outcome after stroke. Aims: The aim of this study is to investigate whether DM predicts the outcome of KMBI at 6-month after stroke with adjustment for cardiovascular disease risk factors, socioeconomic position and health behavior factors. Methods: This is an interim report of the Korean Stroke Cohort for Functioning and Rehabilitation (KosCo). The sample included 1,199 stroke patients aged 45-92 years. FIM score was assessed at 6 months after onset. We divided subjects into two age groups: the middle aged (45-64 year-old) and the elderly (over 65 year-old). Subjects who met one of the following requirements were defined as having DM: taking an oral hyperglycemic agent, using insulin, clinical diagnosis of diabetes, or a fasting glucose level >125 mg/dL. Results: The mean age of the middle aged group was 55.8(±5.44) year-old and the elderly group was 74.3(±6.14)(p<0.001). The distribution of DM was 20.8% and 28.9%, respectively (p<0.001). The mean 6-Month KMBI was 91.7 (±20.7) and 78.4 (±33.1), respectively (p<0.001). The 6-Month KMBI significantly decreased in DM group compared to the non DM group after adjustment for confounding factors. In the middle aged group, the 6-Month KMBI decreased in DM group (p<0.01), but in the elderly group. Conclusions: This hospital-based cohort study showed that DM may predict poor 6-Month KMBI outcome, especially, for the middle aged group (Supported by Korea Centers for Disease Control and Prevention (2013E3301701)).
Objective: To investigate the correlation between the seventy of paralysis and hand sympathetic s... more Objective: To investigate the correlation between the seventy of paralysis and hand sympathetic skin response(SSR) in patients with Bell's palsy and to evaluate the clinical utility of hand SSR as a predicting factor of prognosis Method: Twenty patients with Bell's palsy and twenty normal controls were recruited. The seventy of paralysis was graded according to House-Brackmaim Facial Grading Scale(H-B FGS), and percent degeneration of Nasalis was determined by Facial Nerve Conduction Study (FNCS) Results: The difference of hand SSR amplitude between affected and unaffected side was significant (P
Objective: To investigate the correlation between functional evaluation scales and cognitive evok... more Objective: To investigate the correlation between functional evaluation scales and cognitive evoked potentials (CEPs) in chronic stroke patients. Method: Ten chronic stroke patients with middle cerebral arterial infarction (age 53.6±15.7 years, 5 men, 5 women, duration 210.5±143.2 days) were recruited. Korean mini- mental status examination (K-MMSE) scores of the subjects were ranked between 15∼24 points and the grades of Rancho Los Amigos level of cognitive function of the subjects were VI or VII. They received physical therapy using neuro-developmental technique and cognitive rehabilitation twice a day, 5 times a week, for total 4 weeks. Before and after the treatment, cognitive function tests including K- MMSE, Loewenstein occupational therapy cognitive assessment (LOTCA) and motor-free visual perception test (MVPT) and functional ability tests including functional independence measure (FIM) and Korean version of National Institutes of Health stroke scale (K-NIHSS) were done and CEPs were recorded. Results: The scores of K-MMSE, LOTCA, MVPT, FIM and K-NIHSS showed significant improvement, respectively (p<0.05). The P300 latencies significantly decreased from 420.2±34.8 msec to 391.5±36.4 msec (p<0.05). There were significant correlations between the percentage of change of P300 latencies and each percentage of change of K-MMSE, LOTCA and MVPT (r=0.863, p=0.001; r=0.745, p=0.013; r=0.806, p=0.005). There were significant correlations between the percentage of change of P300 latencies and each percentage of change of FIM and K-NIHSS (r=0.758, p=0.011; r=0.743, p=0.014). Conclusion: The CEPs would be a useful method for reflecting the effect of neuro-cognitive rehabilitation treatment and predicting the functional recovery in chronic stroke patients. (J Korean Acad Rehab Med 2008; 32: 637-643)
We wanted to report three cases of bruxism who were intractable to conventional management such a... more We wanted to report three cases of bruxism who were intractable to conventional management such as dental protection or medication but responded to motor point blocks (MPB) with botulinum toxin-A (BTX-A) on mastication muscles. Untreated, bruxism causes unfavorable complications of masseter hypertrophy, headache, temporomandibular joint destruction, and furthermore total dental wear and malnutrition. Our three patients had no previous history of bruxism or any neuromuscular disorder. They were presented with decreased cognitive function and severe bruxism about 6 months after brain injury. We managed the patients with MPB of BTX-A on each masseter and temporalis muscles. Bruxisms were markedly improved about 2 weeks after MPB without any complications. On follow-up 6 months after MPB, two of three patients remained free of bruxism and another patient revealed attenuated bruxism with decreased severity and frequency. Therefore, we think that MPB with BTX-A could be considered as a treatment option for severe bruxism in brain-injured patients.
Deep vein thrombosis (DVT) is a well-known complication of stroke and frequently develops in acut... more Deep vein thrombosis (DVT) is a well-known complication of stroke and frequently develops in acute stroke patients. Immobility in stroke patients increases the risk of DVT and pulmonary embolism (PE). The incidence of DVT in non-ambulatory stroke patients is more frequent than the incidence in ambulatory stroke patients. We report a case of DVT and PE in an ambulatory chronic stroke patient. Initial physical examination showed heat and swelling of hemiplegic leg. The patient was only able to ambulate with the assist of a monocane and a plastic leaf spring orthosis due to ankle dorsiflexor weakness. The patient was treated with anticoagulation and inferior vena cava filter placement. After long-term anticoagulation, follow-up studies revealed satisfactory resolution of DVT and PE. We present a case of DVT and PE which developed during the chronic stage of stroke, 2 years from the onset of stroke, and review the cause of DVT.
Objective: To know the usefulness of the Modified Mini- Mental State Exam (3MS) as a screening te... more Objective: To know the usefulness of the Modified Mini- Mental State Exam (3MS) as a screening test of cognitive function after stroke and the relationship between the 3MS with clock drawing task (CDT) and the 3MS with visual scan task (VST) in view of visual neglect and functional outcome. Method: We studied 17 patients with unilateral hemisphere stroke [7 right hemisphere stroke (RHS), 10 left hemisphere stroke (LHS)] who have a mean age of 59.4 years and a mean hospital stay of 34.3 days on final examination. None of them had the previous history of mental illness or the previous stroke attack. We performed the MMSE, 3MS, VST and CDT at the first week of onset of stroke and at discharge. Results: 1) 3MS was a valuable screening test of cognitive function like MMSE (p0.05). Conclusion: We think that 3MS is a valuable screening test of cognitive function after stroke. VST and CDTs are valuable screening tools in estimating unilateral neglect after stroke. But 3MS with CDT is not well correlated with functional outcome.
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