Incidental Finding of Killian-Jamieson Diverticulum in a Patient with Acute Cerebral Infarction: A Case Report / 대한연하장애학회지

Since dysphagia is a common occurrence after a stroke, assessing the swallowing function in stroke patients is important. Killian-Jamieson diverticulum is a rare esophageal diverticulum that leads to various complications.However, few studies have reported the presence of the Killian-Jamieson diverticulum subsequent to a cerebral infarct. A 66-year-old woman diagnosed with left periventricular white matter infarction complained of dysphagia.A suspected diverticulum observed in the first videofluoroscopic swallowing study (VFSS) was thought to be unrelated to the patient’s symptoms. However, since the patient continued to complain of dysphagia, computed tomography was performed to detect any anatomical abnormalities that could cause dysphagia. An approximately 12 mm-sized Killian-Jamieson diverticulum was found on the left side of the esophagus at the C5-6 level. A reversed flow from the diverticulum was observed in the following VFSS. No treatment was administered as the caregiver disagreed with the patient’s aggressive treatment options, which included surgical procedures such as diverticulectomy and cricopharyngeal myotomy. Only periodic VFSS follow-up was continued. The association between Killian-Jamieson diverticulum and cerebral infarction remains unclear. This case underlines the importance of considering an esophageal diverticulum in patients with aggravated swallowing difficulties after cerebral infarction.

Dysphagia due to Physiological Constriction after Stroke: A Case Report / 대한연하장애학회지

The aortic arch normally causes no symptomatic physiological constriction of the esophagus. Symptoms of dysphagia are generally observed in the presence of specific conditions, such as an aortic aneurysm. In the present case, during a videofluoroscopic swallowing study (VFSS), the authors incidentally found that despite the absence of an aortic lesion, the dysphagia observed in a stroke patient was caused by compression from the aortic arch. The patient complained of discomfort when swallowing, similar to a bolus lodged in the chest, which was consistent with compression by the aortic arch found on the VFSS and chest computed tomography (CT). After undergoing dysphagia therapy, the VFSS after 52 days revealed improved swallowing function; however, the sensation of food lodging in the chest due to compression by the aortic arch persisted. We conclude that although the physiological constriction of the esophagus by the aortic arch is usually asymptomatic, the constriction can be a factor that exacerbates the swallowing function in patients with dysphagia, and should therefore be considered during the differential diagnosis.

Dysphagia due to Physiological Constriction after Stroke: A Case Report / 대한연하장애학회지

The aortic arch normally causes no symptomatic physiological constriction of the esophagus. Symptoms of dysphagia are generally observed in the presence of specific conditions, such as an aortic aneurysm. In the present case, during a videofluoroscopic swallowing study (VFSS), the authors incidentally found that despite the absence of an aortic lesion, the dysphagia observed in a stroke patient was caused by compression from the aortic arch. The patient complained of discomfort when swallowing, similar to a bolus lodged in the chest, which was consistent with compression by the aortic arch found on the VFSS and chest computed tomography (CT). After undergoing dysphagia therapy, the VFSS after 52 days revealed improved swallowing function; however, the sensation of food lodging in the chest due to compression by the aortic arch persisted. We conclude that although the physiological constriction of the esophagus by the aortic arch is usually asymptomatic, the constriction can be a factor that exacerbates the swallowing function in patients with dysphagia, and should therefore be considered during the differential diagnosis.

Self-Knotting of Nasogastric Tube in a Stroke Patient with Dysphagia: A Case Report / 대한연하장애학회지

In cases of inadequate nutrition among individuals with dysphagia, nasogastric tube insertion is considered for nutritional supplementation. Typically, the complications of nasogastric tube insertion are not severe. In rare cases, however, nasal or nasopharyngeal injury caused by the self-knotting of nasogastric tubes can occur. This paper presents a case of spontaneous knotting of a nasogastric tube and its removal in a patient with aspiration pneumonia caused by dysphagia. This case shows that self-knotting must be considered when there is strong resistance during the removal of a nasogastric tube.

Diagnosis of Ulnar Neuropathy Caused by Intraneural Ganglion at Elbow with Ultrasound

An intraneural ganglion in the peripheral nerve and the resulting ulnar neuropathy at the elbow are uncommon and may show various symptoms ranging from local pain to motor and sensory impairment. We report a case of a 76-year-old man who was diagnosed with ulnar neuropathy caused by an intraneural ganglion derived from the elbow. We also discuss the pathophysiology, treatment, prognosis, and diagnostic value of ultrasonography in neuropathy caused by a ganglion.

Diagnosis of Ulnar Neuropathy Caused by Intraneural Ganglion at Elbow with Ultrasound

An intraneural ganglion in the peripheral nerve and the resulting ulnar neuropathy at the elbow are uncommon and may show various symptoms ranging from local pain to motor and sensory impairment. We report a case of a 76-year-old man who was diagnosed with ulnar neuropathy caused by an intraneural ganglion derived from the elbow. We also discuss the pathophysiology, treatment, prognosis, and diagnostic value of ultrasonography in neuropathy caused by a ganglion.

Prevalence and Risk Factors for Carbapenem-Resistant Enterobacteriaceae Colonization in Patients with Stroke

This retrospective case-control study investigated the prevalence and risk factors of carbapenem-resistant Enterobacteriaceae (CRE) colonization in stroke patients within 6 months of onset. Forty-three patients confirmed to have CRE colonization in our hospital from January 2017 to December 2018 were included in this study. The control group included 44 stroke patients who had carbapenem-susceptible Enterobacteriaceae colonization. The patients were age- (± 3 years) and sex-matched. Their demographic and clinical characteristics were analyzed to identify the risk factors for CRE colonization using multivariate logistic regression analysis. During the study period, the prevalence of CRE was 2.9% (105/3,657). In the univariate analysis, factors associated with CRE colonization included the use and duration of antibiotic intake; admission to intensive care unit (ICU); and use of enteral feeding tube, urethral Foley catheter, tracheostomy, and central venous catheter. In the multivariate analysis, use and duration of antibiotic intake and admission to ICU persisted as independent factors. CRE should be considered when antibiotics are administered to a stroke patient, especially if the administration period is more than 2 weeks, and if the stroke patient has been admitted to the ICU. This study suggests preventing post-stroke infections and, if possible, reducing ICU admissions and preventing CRE transmission in all stroke patients admitted to the ICU.

Calcaneal Osteomyelitis Presenting as a Paradoxical Reaction during Treatment of Multidrug-Resistant Tuberculosis

Tuberculosis in the foot progresses gradually; thus, diagnosis is usually delayed, and early treatment is rarely provided. If osteomyelitis occurs due to delayed diagnosis and treatment, surgical treatment should be considered. We report the case of a 46-year-old man with osteomyelitis of the calcaneus who was diagnosed with multidrug-resistant pulmonary tuberculosis and he was treated with anti-tuberculosis drugs. Bilateral adrenal masses, abscess of both testes and a small wound in the left plantar heel were observed. Both adrenal masses and abscess were regarded as paradoxical reaction of anti-tuberculosis treatment. After 1 month, he developed a pain in the left plantar heel that was compatible with calcaneal osteomyelitis in radiological features. He underwent right orchiectomy for right scrotal abscess aggravation and surgical treatment for left calcaneal osteomyelitis. Mycobacterium tuberculosis was confirmed by polymerase chain reaction. The patient was immobilized by cast for 8 weeks and the heel pain gradually improved.

Association of Brain Lesions and Videofluoroscopic Dysphagia Scale Parameters on Patients With Acute Cerebral Infarctions

OBJECTIVE: To investigate the characteristics and risk factors of dysphagia using the videofluoroscopic dysphagia scale (VDS) with a videofluoroscopic swallowing study (VFSS) in patients with acute cerebral infarctions. METHODS: In this retrospective study, the baseline VFSS in 275 stroke patients was analyzed. We divided patients into 8 groups according to lesion areas commonly observed on brain magnetic resonance imaging. Dysphagia characteristics and severity were evaluated using the VDS. We also analyzed the relationship between clinical and functional parameters based on medical records and VDS scores. RESULTS: In comparison studies of lesions associated with swallowing dysfunction, several groups with significant differences were identified. Apraxia was more closely associated with cortical middle cerebral artery territory lesions. Vallecular and pyriform sinus residue was more common with lesions in the medulla or pons. In addition, the results for the Korean version of the Modified Barthel Index (K-MBI), a functional assessment tool, corresponded to those in the quantitative evaluation of swallowing dysfunctions. CONCLUSION: A large cohort of patients with cerebral infarction was evaluated to determine the association between brain lesions and swallowing dysfunction. The results can be used to establish a specific treatment plan. In addition, the characteristic factors associated with swallowing dysfunctions were also confirmed.