Recovery from a Complicated Case of Central Pontine and Extrapontine Myelinolysis by Dopaminergic Treatment: One-Year Follow-up: A Case Report

Central pontine and extrapontine myelinolysis are well-recognized osmotic demyelination syndromes related to the rapid correction of hyponatremia, chronic alcoholism, and malnutrition. They are reported to show brain stem signs and various movement disorders. A 58-year-old man with a history of chronic alcoholism was admitted for dysarthria, dysphagia, and gait disturbance that had developed five days after a right forearm cellulitis. Magnetic resonance imaging revealed demyelinating patterns in the central portion of the pons and both thalami. He showed severe extrapyramidal symptoms with truncal swaying and postural instability that resulted in severe gait disturbance. Postural instability showed little improvement after conventional physical therapy, but his symptoms markedly improved after five days of dopamine administration. Cessation of dopamine agents was attempted two times, but postural instability and gait disturbance recurred. Therefore, medication was continued for one year. The patient showed stable gait and no further deterioration of postural instability during dopamine therapy.

The Sitting-Unsupported Balance Score as an Early Predictor of Functional Prognosis in Stroke Patients: A Pilot Study

OBJECTIVE: To evaluate the impact of initial "sitting-unsupported" Berg Balance Scale (SUB), the specific trunk control parameter, on patients' functional outcome, Korean version of Modified Barthel Index (K-MBI) at 6 months. METHODS: The charts of 30 patients retrospectively reviewed reviewed. The initial Korean version of Berg Balance Scale (K-BBS) including SUB along with patients' Korean version of Mini-Mental State Examination (K-MMSE), Glasgow Coma Scale (GCS), and other functional parameters that affect functional outcome were recorded. Cases were divided into low (group I) and high (group II) initial SUB score groups. Correlation and regression analysis were performed to assess the relationship between the initial SUB on the K-MBI at 6 months. RESULTS: The mean+/-standard deviation score of initial SUB/K-MBI at 6 months of groups I and II were 0.056+/-0.236/26.89+/-32.48, 3.58+/-0.515/80.25+/-18.78, respectively, and showed statistical significant differences to each other (p<0.05). K-MBI at 6 months was highly correlated with initial GCS, SUB, K-BBS, K-MMSE, and initial K-MBI (p<0.05). In multiple linear regression analysis, initial SUB and GCS scores remained significantly associated with K-MBI at 6 months. A logistic regression model revealed that initial SUB (p=0.004, odds ratio=16), initial K-MBI, GCS, and K-MMSE were all significant predictors of K-MBI scores at 6 months. CONCLUSION: Initial SUB scores could be helpful in predicting patient's potential functional recovery at 6 months. Further studies with concurrent controls and a larger sample group are required to fully establish this tool.

Diagnosis With Manometry and Treatment With Repetitive Transcranial Magnetic Stimulation in Dysphagia

Videofluoroscopic swallowing study (VFSS) used for the diagnosis of dysphagia has limitations in objectively assessing the contractility of the pharyngeal muscle or the degree of the upper esophageal sphincter relaxation. With a manometer, however, it is possible to objectively assess the pressure changes in the pharynx caused by pharyngeal muscle contraction during swallowing or upper esophageal sphincter relaxation, hence remedying the limitations of VFSS. The following case report describes a patient diagnosed with lateral medullar infarction presenting a 52-year-old male who had dysphagia. We suggested that the manometer could be used to assess the specific site of dysfunction in patients with dysphagia complementing the limitations of VFSS. We also found that repetitive transcranial magnetic stimulation was effective in treating patients refractory to traditional dysphagia rehabilitation.