A Case of Rotational Vertebral Artery Syndrome after Vertebral Artery Dissection / 대한이비인후과학회지

Rotational vertebral artery syndrome (RVAS), also called Bow-Hunter syndrome, is characterized by position-aggravated reversible vertebra-basillarischemia. By rotating the head to one side, the mechanical compression of a dominant vertebral artery (VA) in the setting of a hypoplastic contralateral VA might cause tinnitus, vertigo and syncope. A 60-year-old male experienced recurrent tinnitus and vertigo while rotating the head to the right side. Neck CT images showed no abnormal structures near the course of both VAs. In 3-phase dynamic neck CT angiography, a focal vertebral artery dissection was identified at the right C6 transverse foramen. Close observation and anticoagulation therapy were started to prevent thrombo-embolic complications. Herein, we report a case of RVAS with vertebral artery dissection with a review of the literatures.

Risk Factors and Clinical Features of Recurrent Benign Paroxysmal Positional Vertigo / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Benign paroxysmal positional vertigo (BPPV) is treated with appropriate canalith repositioning procedures, which are very effective for the treatment of BPPV. Nevertheless, the recurrence of BPPV may occur after the initial successful treatment. The purpose of this study was to investigate the risk factors and clinical features of recurrent BPPV.SUBJECTS AND METHOD: The retrospective study was performed for 227 patients who were diagnosed with BPPV and treated with appropriate canalith repositioning procedures from March 2013 to December 2014. We analyzed various clinical characteristics, locations and types of canalith for the whole BPPV patients, and the interval and frequency of recurrence in the patients of recurrent BPPV.@*RESULTS@#Of the total of 227 BPPV patients, 47 patients were recurrent BPPV (21%). The patients of recurrent BPPV were significantly older than those of non-recurrent BPPV (p=0.034). BPPV patients recurred more with increased age, with the significantly increased frequency of recurrence (p=0.010). Twenty two patients were posterior semicircular canal canalolithiasis (PSCC) (46.8%) and 25 patients were lateral semicircular canal canalolithiasis (LSCC) (53.2%). The number of canalith repositioning procedures was significantly higher in LSCC patients than in PSCC patients (p=0.041). The location change of affected canal were identified for 23 patients and the type change of LSCC to ipsilateral PSCC was the most common.@*CONCLUSION@#Age is an important prognostic factor to be considered in BPPV recurrence. Also, the affected semicircular canals were frequently changed in the recurrent BPPV.

Risk Factors and Clinical Features of Recurrent Benign Paroxysmal Positional Vertigo / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is treated with appropriate canalith repositioning procedures, which are very effective for the treatment of BPPV. Nevertheless, the recurrence of BPPV may occur after the initial successful treatment. The purpose of this study was to investigate the risk factors and clinical features of recurrent BPPV. SUBJECTS AND METHOD: The retrospective study was performed for 227 patients who were diagnosed with BPPV and treated with appropriate canalith repositioning procedures from March 2013 to December 2014. We analyzed various clinical characteristics, locations and types of canalith for the whole BPPV patients, and the interval and frequency of recurrence in the patients of recurrent BPPV. RESULTS: Of the total of 227 BPPV patients, 47 patients were recurrent BPPV (21%). The patients of recurrent BPPV were significantly older than those of non-recurrent BPPV (p=0.034). BPPV patients recurred more with increased age, with the significantly increased frequency of recurrence (p=0.010). Twenty two patients were posterior semicircular canal canalolithiasis (PSCC) (46.8%) and 25 patients were lateral semicircular canal canalolithiasis (LSCC) (53.2%). The number of canalith repositioning procedures was significantly higher in LSCC patients than in PSCC patients (p=0.041). The location change of affected canal were identified for 23 patients and the type change of LSCC to ipsilateral PSCC was the most common. CONCLUSION: Age is an important prognostic factor to be considered in BPPV recurrence. Also, the affected semicircular canals were frequently changed in the recurrent BPPV.

The Availability of Radiological Measurement of Femoral Anteversion Angle: Three-Dimensional Computed Tomography Reconstruction

OBJECTIVE: To assess the intra-rater and inter-rater reliability for measuring femoral anteversion angle (FAA) by a radiographic method using three-dimensional computed tomography reconstruction (3D-CT). METHODS: The study included 82 children who presented with intoeing gait. 3D-CT data taken between 2006 and 2014 were retrospectively reviewed. FAA was measured by 3D-CT. FAA is defined as the angle between the long axis of the femur neck and condylar axis of the distal femur. FAA measurement was performed twice at both lower extremities by each rater. The intra-rater and inter-rater reliability were calculated by intraclass correlation coefficient (ICC). RESULTS: One hundred and sixty-four lower limbs of 82 children (31 boys and 51 girls, 6.3±3.2 years old) were included. The ICCs of intra-rater measurement for the angle of femoral neck axis (NA) were 0.89 for rater A and 0.96 for rater B, and those of condylar axis (CA) were 0.99 for rater A and 0.99 for rater B, respectively. The ICC of inter-rater measurement for the angle of NA was 0.89 and that of CA was 0.92. By each rater, the ICCs of the intrarater measurement for FAA were 0.97 for rater A and 0.95 for rater B, respectively and the ICC of the inter-rater measurement for FAA was 0.89. CONCLUSION: The 3D-CT measures for FAA are reliable within individual raters and between different raters. The 3D-CT measures of FAA can be a useful method for accurate diagnosis and follow-up of femoral anteversion.

Terson Syndrome after Subarachnoid Hemorrhage Occurred by Thrombolysis and Mechanical Thrombectomy to Treat Acute Ischemic Stroke: A Case Report

Terson syndrome is a vitreous hemorrhage associated with subarachnoid hemorrhage. This can be caused by spontaneous, aneurysmal rupture or traumatic subarachnoid hemorrhage, but never has been reported as a consequence of hemorrhage due to thrombolysis and thrombectomy treatments of acute ischemic stroke patient. A 48-year-old man presented with left sided weakness was diagnosed as cerebral infarction on right middle cerebral artery territory due to complete occlusion of right distal internal carotid, middle cerebral, and anterior cerebral artery. He underwent thrombolysis and mechanical thrombectomy, and subarachnoid hemorrhage developed. Later, visual disturbance on right eye occurred so he was consulted to ophthalmology. Vitreous hemorrhage was found and surgery was recommended after two weeks of observation. After pars planar vitrectomy, visual acuity improved, along with functional ability. Therefore, possibilities of Terson syndrome in patients with subarachnoid hemorrhage have to be kept in mind to improve not only visual acuity but also rehabilitation outcome.

Evaluation of Satisfaction with Hearing Aids Using a Questionnaire Based on MarkeTrak Survey / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: MarkeTrak survey is a subjective evaluation method for hearing aid users. This investigation evaluated the level of subjective satisfaction in hearing aid users by adopting the MarkeTrak survey method. SUBJECTS AND METHOD: Ninety-seven subjects participated in this study and replied to the Korean version of 8th MarkeTrak survey. The satisfaction score regarding hearing aids used a 7-point scale to analyze the patient-related as well as hearing aids-related factors. RESULTS: Overall satisfaction rate was 60.8%. Among the patient-related factors, women showed significantly higher satisfaction rate (p<0.05) than men but the level of education affected the satisfaction rate (p<0.05). Hearing aids users showed significantly higher satisfaction rate in small group communication than in other circumstances (p<0.05). The factors related to the hearing aids did not have significant influence on the satisfaction rating. CONCLUSION: MarkeTrak survey is a useful questionnaire for evaluating satisfaction about not only hearing factors but also sociodemographic factors and hearing-aids related factors.

Retrospective Assessment of the Implementation of Critical Pathway in Stroke Patients in a Single University Hospital

OBJECTIVE: To evaluate the effects of the implementation of critical pathway (CP) in stroke patients treated at a single university hospital. METHODS: A retrospective medical review collected data from 497 patients who had suffered acute stroke in the rehabilitation center. Stroke outcomes were compared between before and after the implementation of CP based on factors including demographic factors, stroke characteristics, pre-existing medical conditions, medical complications, functional states, and length of stay (LOS). RESULTS: After the implementation of CP, the patients showed significantly higher stage for upper proximal (p=0.008) and lower extremity (p=0.001) on Brunnstrom stage and significantly lower scores for modified Rankin Scale (p=0.003) at transfer. For those with pre-existing medical conditions, there were significantly increased osteoarthritis (p=0.002) and valvular heart disease (p=0.011). Regarding medical complications during acute inpatient rehabilitation, there were significantly decreased shoulder pain (p=0.001) and dysphagia (p=0.017), and significantly increased gastrointestinal symptoms (p=0.001). Functional gain and efficiency of stroke patients during rehabilitation center hospitalization did not significantly change after implementation of CP. But, shorter LOS of total hospitalization, pre-rehabilitation center hospitalization, and rehabilitation center hospitalization were evident. CONCLUSION: After the implementation of CP, patients less often developed complications and displayed no changes in functional gain and efficiency. They had shorter LOS of total hospitalization, pre-rehabilitation center hospitalization and rehabilitation center hospitalization.

Medial Antebrachial Cutaneous Nerve Injury After Brachial Plexus Block: Two Case Reports

Medial antebrachial cutaneous (MABC) nerve injury associated with iatrogenic causes has been rarely reported. Local anesthesia may be implicated in the etiology of such injury, but has not been reported. Two patients with numbness and painful paresthesia over the medial aspect of the unilateral forearm were referred for electrodiagnostic study, which revealed MABC nerve lesion in each case. The highly selective nature of the MABC nerve injuries strongly suggested that they were the result of direct nerve injury by an injection needle during previous brachial plexus block procedures. Electrodiagnostic studies can be helpful in evaluating cases of sensory disturbance after local anesthesia. To our knowledge, these are the first documented cases of isolated MABC nerve injury following ultrasound-guided axillary brachial plexus block.