Saphenous Mononeuropathy after Repetitive Compression on the Knee in a Ballerina: A Case Report

Saphenous mononeuropathy is an uncommon neuropathy in clinical condition, which may incur from various surgical procedures, direct trauma, or entrapment, and most frequently involves at the adductor canal, or Hunter's canal. A 17-year old female, who was majoring in ballet, visited our rehabilitation clinic for numbness in the medial aspect of the left lower leg for the previous 9 months, without weakness. The electrodiagnostic study revealed only a delayed small potential in the left saphenous nerve. MRI examination showed soft tissue swelling in the medial side of the left knee. Accordingly, we diagnosed the patient with saphenous mononeuropathy around the knee, without lumbar plexopathy or femoral neuropathy. We report a case of saphenous mononeuropathy which developed after repetitive compression on the medial side of the knee without any other iatrogenic injury, and include a review of the relevant literature.

The Investigation of Faculties and Facilities in Industrial Accident Compensation Insurance Designated Hospitals

OBJECTIVE: To analyze the hospitals related rehabilitation, which were designated for industrial accident compensation insurance, focusing faculties and facilities by administrative district. METHOD: Total 1,031 hospitals having more than 30 beds were included. We investigated the numbers of hospital beds, medical departments, medical doctors, nurses, physical therapists, and occupational therapists of each hospital with official document of industrial accident compensation insurance. And we classified and analyzed all data by administrative district. RESULTS: The average of each objects were estimated as following orders: total number of hospital beds (131.5); medical departments (5.8); medical doctors (11.2); nurses (33.8); physical therapists (4.2); occupational therapists (0.9). The percentage of hospitals with department of rehabilitation medicine was 28.4% in total, 26.7% in hospital and 35.3% in general hospital. Mean numbers of hospital beds, medical departments, medical doctors, nurses and physical therapists did not showed disparity among the administrative districts. However, the percentages of hospitals with department of rehabilitation medicine and of hospitals with occupational therapists showed disparity among the administrative districts. The regional distribution of hospitals with department of rehabilitation medicine showed similar distribution, as that of occupational therapists. CONCLUSION: These results demonstrate faculties and facilities of hospitals under the industrial accident compensation insurance which are related with rehabilitation treatment. We believe that these results would be helpful for constructing certification system of rehabilitation hospital and for further research about rehabilitation treatment associated with industrial accident compensation insurance.

A Case of Conversion Disorder Presenting Hemiplegia

Patients with conversion disorder are often presented with critical symptoms or signs which could suggest severe organic disorders. Hysterical hemiparesis is a relatively rare presentation and it is difficult to diagnose because it is displayed as a unilateral motor weakness with or without sensory deficits. A previously healthy 23-years-old woman developed sudden onset of hemiplegia and hemianesthesia with loss of anal tone. Before the onset, she had a traffic accident. A through medical workup including X-rays, MRI, CT scans, EMG, and brain SPECT revealed no organic causes for such neurologic deficits. She gradually regained neurologic function over 2 months from the onset. Conversion disorder should be considered when symptom- related anatomic or physiologic abnormalities could not be proven with appropriate workup. Medical evaluation must be performed in advance to the diagnosis of conversion disorder to avoid misdiagnosis.

Persistent Autonomic Dysfunction in Guillain-Barre Syndrome: A case report

Autonomic dysfunction is a common manifestation in Guillain-Barre syndrome (GBS), but it rarely persists. We report a case involving a 22-year-old man who presented with glove-and-stocking type sensory loss, symmetric weakness, urinary distension, orthostatic hypotension, decreased perspiration, and the syndrome of inappropriate secretion of antidiuretic hormone. He was subsequently diagnosed as having GBS with autonomic failure that persisted for more than six months, despite regaining muscle strength. Orthostatic hypotension progressively improved after rehabilitation and administration of midodrine and fludrocortisone. Extensive evaluation and management should be performed in patients with GBS because severe autonomic dysfunction is a major source of disability.

Reversible Severe Dysphagia Presenting in Wernicke's Encephalopathy: A case report

Wernicke's encephalopathy is a relatively underestimated disorder caused by a deficiency of thiamine and manifests with a classical triad of ocular abnormalities, ataxia, and mental-status changes. Specific laboratory tests are unavailable and the disease remains a clinical diagnosis. Among paraclinical studies, magnetic resonance imaging is currently considered the most valuable method to confirm a diagnosis of Wernicke's encephalopathy. Treatment is based on supplementation of thiamine that is administered parentally. We report a case of Wernicke's encephalopathy that was treated with thiamine and showed the characteristic clinical findings, as well as an extremely rare symptom of severe dysphagia that improved concurrently with neurological recovery. Only a few cases of dysphagia in Wernicke's encephalopathy have been reported worldwide.

A Case of Fluoxetine Induced Mania in Poststroke Depression Patient: A case report

Poststroke depression is very common and has been reported in as many as 40~50% of poststroke patients. The fluoxetine is one of the most frequently prescribed drugs for the treatment of poststroke depression. This serotonin selective reuptake inhibitor, known as generally safe and well tolerated drug, has been recently reported to induce mania. We report a case of fluoxetine-induced mania. A 64 year-old male, who has taken 10 mg of fluoxetine daily due to poststroke depression, presented elevated mood, hyperactivity, regressed behavior, excessive planning, sleep deterioration, and talkativeness abruptly. We were suspicious of fluoxetine- induced manic state and discontinued immediately fluoxetine without prescription of mood stabilizer. His symptoms had been ceased over two weeks.