Isolated Dysphagia Caused by Failure of Cricopharyngeal Muscle Relaxation after Left Lateral Medullary Lacunar Infarction: A case report

Dysphagia can be caused by various mechanisms such as impaired tongue movement, delayed swallowing reflex, decreased pharyngeal peristalsis, incomplete closure of epiglottis and cricopharyngeal dysfunction. Cricopharyngeal muscle, forming the upper esophageal sphincter, acts as a muscular sling between the pharynx and the esophagus. Normally, it closes constantly at rest and opens during laryngeal elevation through active relaxation on the one hand and passive traction by the antero-cephalad laryngeal movement on the other. If its incoordination or hypertonicity happens, dysphagia can develop. Cricopharyngeal muscle dysfunction is caused by various situations such as neuromuscular diseases, postoperative changes and stroke, particularly after brainstem stroke. We report a case of isolated dysphagia caused by failure of active relaxation of cricopharyngeal muscle without aspiration after left lateral medullary lacunar infarction.

Evaluating patients with abdominal pain originating in the abdominal wall / 대한내과학회지

BACKGROUND/AIMS: We analyzed patients with abdominal pain of undetermined etiology, referred to physiatrists by gastroenterologists, and determined the clinical features of patients with abdominal wall pain. METHODS: A retrospective chart review of 100 patients referred by gastroenterologists over 4 years was performed. A visceral etiology of abdominal pain was excluded by the gastroenterology work-up using radiologic and endoscopic studies, and medical treatment. The clinical features and outcomes of abdominal wall pain were examined. We determined the long-term outcome by telephone. RESULTS: Of 100 patients with abdominal pain of undetermined etiology, 89% of the patients were identified as having pain arising in the abdominal wall, and the right flank area was the most common site of pain. The pain had a musculoskeletal origin in 90.4% of the patients and a neurogenic origin in 9.6%. Treatment by the physiatrists resulted in complete or partial pain relief in 73% of the patients. The diagnosis remained unchanged after a mean of 22.67 (range 6.5-55) months in 95.5% of the patients. Long-term effects of management were seen in 73.6% of the patients. CONCLUSIONS: In a small group of patients with abdominal pain of unknown etiology, the source of pain could be in the abdominal wall. Recognizing abdominal wall pain could lead to an accurate diagnosis, reduced medical costs and effective treatment.

A New Method for Vestibulo-Collic Reflex

OBJECTIVE: Vestibulo-collic reflex (VCR) has been thought to be a simple and reliable test in evaluating the vestibular function. But it can only be examined by actively contracting the sternocleidomastoid muscle (SCM) and it would be impossible to conduct the examination without the cooperation of the subject. The aim of this study was to demonstrate a new method for VCR in the absence of the subject's cooperation. METHOD: Records were collected from 20 volunteers. Each subject was properly positioned on the bed with the head flexed, ipsilaterally bent and contralaterally rotated. An active electrode was placed over the belly of the SCM. 100 dB clicks were delivered through headphones. We compared the active contraction and passive positioning of the SCM in terms of the P1 latency and amplitude. RESULTS: Vestibular-evoked myogenic potentials (VEMPs) were recorded without actively contracting the SCMs for all the subjects by using our new method. There was no difference in P1 latency and amplitude between the active contraction and passive positioning of the SCM. CONCLUSION: With our new method, VEMPs can be recorded without actively contracting the SCM. It may be useful for evaluating the vestibular function of children and patients who cannot cooperate.

The Discharge Destination of Rehabilitation Inpatients in a Tertiary Hospital

OBJECTIVE: To identify the factors which can delay home discharges or transfers to other hospitals of rehabilitation inpatients in a tertiary hospital and the change of discharge destination during past 6 years. METHOD: This was a retrospective study of patients with a diagnosis of stroke, traumatic brain injury or spinal cord injury who were admitted to our hospital in 1996, 1999, 2001 and 2003. Demographic data, length of stay, discharge destination and functional status by the FIM(TM) instrument were studied by a medical record review. RESULT: Patients who were transferred to other hospitals or discharged with delay showed significantly lower admission and discharge FIM scores, lower FIM efficiencies, longer length of stays and longer intervals between the onset and admission to a rehabilitation ward. CONCLUSION: Lower functional outcome was associated with a longer length of stay and discharge to another hospital. It would be necessary to establish the long term rehabilitation care facilities with extended rehabilitation program for the patients with lower functional gains in a rehabilitation unit of the tertiary hospitals.

Quality of Life in Primary Caregivers for the Home-Bound Severe Stroke Patients

OBJECTIVE: To evaluate the level of depression, anxiety and quality of life in primary caregivers for the severe stroke patients. METHOD: We studied a sample of 44 severe stroke patients and their primary caregivers. Functional status of the severe stroke patients was evaluated by Modified Barthel Index (MBI). We collected the data through interviewing the caregivers and using the Beck Depression Inventory (BDI), State- Trait Anxiety Inventory (STAI), Ego-strength scale, Short Form Health Survey-36 (SF-36) and Family APGAR (Adaptation, Partnership, Growth, Affection and Resolve) score. RESULTS: The average level of depression in caregivers was low. The mean socres of STAI were 41.5 for state anxiety and 44.3 for trait anxiety, respectively. Ego-strength scale was significantly inversely related to BDI score and trait anxiety inventory score, but positively related to SF-36 score. The most influencing factor for the SF-36 score was the BDI score. CONCLUSION: Primary caregivers for the home-bound severe stroke patients demonstrated a lower level of quality of life, especially mental health, general health and vitality component. Community based rehabilitation should more focus on the evaluation and support for caregiver's psychologic status and their quality of life.