ABSTRACT
OBJECTIVES: Bilateral vestibulopathy is characterized with unsteadiness and oscillopsia when walking or standing, worsening in darkness and/or on uneven ground. To establish the effect of customized vestibular rehabilitation in bilateral vestibulopathy, we analyzed the questionnaires and functional status before and after treatment. METHODS: Among 53 patients with customized vestibular rehabilitation from January 1st to November 30th in 2018, 6 patients (3 males; median age, 71 years; range, 54–75 years) who regularly exercised with good compliance were retrospectively enrolled. They were educated and trained the customized vestibular rehabilitation once a month or two by a supervisor during 40 minutes, and then exercised at home for 30 minutes over 5 days in a week. Dizziness handicap inventory (DHI), Korean vestibular disorders activities of daily living scale (vADL), Beck's depression index (BDI), test for dynamic visual acuity (DVA), and Timed Up and Go test (TUG) were performed before and after the customized vestibular rehabilitation. RESULTS: The patients exercised for median 5.5 months (range, 2–10 months) with the customized methods of vestibular rehabilitation, which included gaze and posture stabilization and gait control exercises. DHI score and TUG was improved after rehabilitation (DHI before vs. after rehabilitation=33 vs. 16, p=0.027, TUG before vs. after rehabilitation=12 vs. 10, p=0.026). BDI, DVA, and vADL scores did not differ between before and after treatment. CONCLUSIONS: Customized vestibular rehabilitation can improve dizziness and balance state in bilateral vestibulopathy. The steady exercises adapted individual peculiarities is the most important for vestibular rehabilitation.
Subject(s)
Humans , Male , Activities of Daily Living , Compliance , Darkness , Depression , Dizziness , Exercise , Gait , Pilot Projects , Posture , Rehabilitation , Retrospective Studies , Visual Acuity , WalkingABSTRACT
Scrub typhus is an infective acute febrile disorder caused by the intracellular parasite Orientia tsutsugamushi. Neurological manifestations of scrub typhus are meningoencephalitis, cerebellitis, transverse myelitis, papilledema, and cranial nerve palsy. However, opsoclonus-myoclonus syndrome associated with scrub typhus has been rarely reported. A 59-year-old man developed vertigo, nausea, vomiting, and imbalance following scrub typhus infection for eight days. Examination showed eschar at the axilla, decreased mentality, and opsoclonus-myoclonus syndrome. Video-oculography disclosed opsoclonus with an amplitude of 15°–20° and a frequency of 6–8 Hz. The serum antibody titers to Orientia tsutsugamushi were 1:5,120, and cerebrospinal fluid analysis revealed pleocytosis. Brain magnetic resonance imaging was normal. Neurological symptoms and signs completely improved by systemic steroid and antibiotics treatment. Various mechanisms including direct disseminating inflammation or indirect immune modulation may give rise to neurological complications following scrub typhus.
Subject(s)
Humans , Middle Aged , Anti-Bacterial Agents , Axilla , Brain , Cerebrospinal Fluid , Cranial Nerve Diseases , Encephalitis , Inflammation , Leukocytosis , Magnetic Resonance Imaging , Meningoencephalitis , Myelitis, Transverse , Nausea , Neurologic Manifestations , Ocular Motility Disorders , Opsoclonus-Myoclonus Syndrome , Orientia tsutsugamushi , Papilledema , Parasites , Scrub Typhus , Vertigo , VomitingABSTRACT
Transient global amnesia (TGA) is characterized by abrupt onset temporary dysfunction of anterograde and retrograde amnesia without other neurologic deficits. We encountered a 53-year-old man who developed recurrent TGA while working in a hot and humid machinery room (33degrees C and 64% relative humidity). Heat exposure and physical exertion may facilitate the leakage of cytokines into the systemic circulation so as to cause a cerebral endothelial insult. Functional insufficiency of the hippocampus and its connections caused by physical and environmental factors may be related to recurrent attacks.
Subject(s)
Humans , Middle Aged , Amnesia, Retrograde , Amnesia, Transient Global , Cytokines , Hippocampus , Hot Temperature , Neurologic Manifestations , Physical ExertionABSTRACT
No abstract available.
Subject(s)
Cavernous Sinus , Central Nervous System Vascular Malformations , Tolosa-Hunt SyndromeABSTRACT
BACKGROUND AND PURPOSE: The Ankle-Brachial Index (ABI) is the ratio of blood pressure in the lower legs to that in the arms. The intima-media thickness (IMT) of extracranial carotid arteries determined by B-mode ultrasound is a measurable index of the presence of atherosclerosis. A low ABI and a high carotid IMT are independently related to increased risk of cardiovascular events. This study examined the association between carotid IMT and ABI in patients with ischemic stroke. MATERIALS AND METHODS: Retrospectively, 116 hospitalized patients with ischemic stroke were recruited. Using a pulse wave velocity ABI device along with carotid duplex sonography, we measured carotid IMT and ABI and investigated the correlation between average values. RESULTS: There was a significant difference in carotid IMT between the normal and abnormal ABI groups (P=0.0262). The group with an abnormal ABI was more than five times as likely to have increased carotid IMT as the group with a normal ABI (age, sex-adjusted OR 5.67 (95% CI 1.85~17.38)). The ABI and carotid IMT showed a weak inverse linear correlation in patients with ischemic stroke (correlation coefficient -0.378 after adjusting for age and sex). CONCLUSION: Our study suggests that an abnormal ABI is associated with a high carotid IMT in patients with ischemic stroke.
Subject(s)
Humans , Ankle Brachial Index , Arm , Atherosclerosis , Blood Pressure , Carotid Arteries , Carotid Intima-Media Thickness , Leg , Pulse Wave Analysis , Retrospective Studies , Stroke , UltrasonographyABSTRACT
The World Health Organization declared that a new strain of novel swine-origin influenza A (H1N1) virus was responsible for the pandemic infection in June 2009. We report a case of encephalitis diagnosed as the H1N1 virus infection. We describe a 17-year-old patient who had a seizure attack, diagnosed with a H1N1 virus infection via real time reverse-transcriptase polymerase chain reaction (RT-PCR). The H1N1 virus infection can be causative of the encephalitis, as with other influenza virus infections. Careful monitoring is essential for reducing complications.
Subject(s)
Adolescent , Animals , Humans , Male , Encephalitis, Viral/diagnosis , Influenza A Virus, H1N1 Subtype/pathogenicity , Swine/virologyABSTRACT
Myasthenia gravis (MG), which is the most common autoimmune neuromuscular junction disorder, is characterized by weakness of musdes and increased fatigability after repetitive use, and recovery after rest. The diagnosis is based on a detailed history, physical examination, and pharmacological, electrophysiological, and immunological testing. Stapedial reflex abnormalities are noted, so the stapedial reflex decay test (SRDT) can be attempted. There are no reports regarding the SRDT in Korea. We report a case of MG presenting hyperacusia and ptosis that was diagnosed by the SRDT. We recommend using the SRDT in the clinical diagnosis of MG.
Subject(s)
Hyperacusis , Immunologic Tests , Korea , Myasthenia Gravis , Neuromuscular Junction Diseases , Physical Examination , ReflexABSTRACT
Carney complex (CNC) is an autosomal dominant disorder that involves the heart, multiple endocrine systems, testis, skin, breast, and bone. We report a case of a 38-year-old woman, diagnosed with CNC, with a mass involving the petrous bone, a pituitary adenoma, a cavernous angioma, multiple cerebral aneurysms, and venous malformations. CNC should be included in the differential diagnoses of patients who have an atrial myxoma, brain tumor, or intracranial vascular malformations.
Subject(s)
Adult , Female , Humans , Aneurysm , Brain Neoplasms , Breast , Carney Complex , Diagnosis, Differential , Endocrine System , Heart , Hemangioma, Cavernous , Intracranial Aneurysm , Myxoma , Petrous Bone , Pituitary Neoplasms , Skin , Testis , Vascular MalformationsABSTRACT
Resuscitation bag (RB) is widely used for artificial ventilation and adequate ventilation during resuscitation, or for patient transport, when high concentration of inspired oxygen (70-100%) must be supplied. The purpose of this study was to investigate the effect of oxygen flow and the length of corrugated tube as a reservoir on the oxygen concentration in the adult type and pediatric type resuseitation bag. Each 24 mm corrugated tube (0, 20,40, 60, 80, 100 cm) was attached to the inlet valve, oxygen flow of 1, 3, 5, 7, 9, 11, 13 or 15 L/min was delivered to oxygen inlet site of RB. and oxygen concentration was measured for 10 times. To eliminate the possibility that ventilatory pattern affect the oxygen concentration, RB was manually handled with normal ventilatory pattern ; in advlt type, tidal volume was 800 cc, respiratory rate was 10/min and 1:E ratio was 1:2, in pediatric type, tidal volume was 100 cc, respiratory rate was 20/min and 1:E ratio was 1:2. In adult RB, a 15 L oxygen flow without reservoir delivered less than 50% oxygen. To get more than 70% oxygen, one must administer more than a 15 L oxygen flow with reservoir of 60 cm corrugated tube, oxygen flow of 9 L/min with 80 cm corrugated tube or a 7 L flow of oxygen with 100 cm corrugated tube. And to provide more than 80%, oxygen of more than a 11 L flow with reservoir of 100 cm should be delivered. In pediatric RB, a 15 L oxygen flow without reservoir get more than 70% oxygen. A 20 cm corrugated tube as a reservoir increased abruptly oxygen concentration, and A 40 cm tube with more than a 7 L flow delivered more than 95% oxygen, but above 60cm tube there is little increase in the oxygen concentration. These results indicated that to get more than 70% oxygen, 60 cm and 40 cm corrugated tube is required in adult type RB and pediatric type RB respectively as an oxygen reservoir.