Using a virtual reality power mobility device simulator to assess the driving skills of people with brain diseases.

Introduction: No previous study has explored the effectiveness of current prescription standards for evaluating power mobility device (PMD) maneuverability. To verify the current prescription standards for PMDs using a virtual reality (VR)-based PMD simulator and to present the possibility of using a VR-based PMD simulator as an alternative to current evaluation standards. Methods: A total of 52 patients with brain diseases were enrolled. All participants were over 18 years old and had gait disturbance or limited outdoor walking ability. Participants performed a driving ability test using a VR PMD simulator. Results: The driving ability test using the VR PMD simulator indicated that cognitive impairment, measured by the K-MMSE (p = 0.017), and unilateral neglect, measured by line bisection (p = 0.031), led to reduced driving ability and safety. In addition, patients with cognitive impairment or neglect presented driving stability problems, which were observed in the driving trajectory. There was also no correlation between driving scores and MBI subitems. Conclusion: In patients with brain lesions, a driving ability test using a VR PMD simulator can be a safe, objective method for comprehensively evaluating a driver's capacity, offering an alternative to the current prescription standards for PMDs.

Isolated Bilateral Cerebral Peduncular Infarction Manifesting Pseudobulbar Palsy and Quadriparesis: a Case Report.

Bilateral cerebral peduncular infarction (BCPI) is a very rare disorder among stroke patients. The main clinical manifestations in the previously reported BCPI case reports was associated with locked-in syndrome or persistent vegetative state. Here, we present a 51-year-old woman who had pseudobulbar palsy and quadriplegia. Magnetic resonance imaging showed an acute infarction in the middle areas of the cerebral peduncle with a unique "Mickey Mouse ears" sign. Diffusion tensor imaging and tractography showed relatively preserved corticospinal tracts, but the corticobulbar tracts were not detected. Magnetic resonance angiography showed posterior cerebral artery and vertebrobasilar artery occlusion. Cerebral perfusion insufficiency due to stenosis or occlusion of the vertebrobasilar artery and its branches may lead to BCPI. The prognosis and clinical manifestations of BCPI are related to the extent of the infarction in the involved cerebral peduncle and whether other territories are involved. Isolated BCPI may present a severe pseudobulbar palsy with relatively preserved limb function depending on the involvement pattern.

Tuberculosis Meningoencephalomyelitis in Good's Syndrome: a Case Report.

Good's syndrome is a rare disease characterized by thymoma associated with combined B- and T-cell immunodeficiency in adults. Due to the lack of early onset of symptoms, it is difficult to diagnose this disorder. A 44-year-old man diagnosed with thymic carcinoma was admitted to the hospital with quadriplegia for 6 months. Brain abscess and meningoencephalitis were identified in the magnetic resonance imaging (MRI) of the brain. Antibiotics, steroid, and intravenous immunoglobulin treatment were provided for 3 months. Follow-up MRI showed progression to C7-level. The radiologic findings were consistent with tuberculosis infection and thus, the patient was treated with anti-tuberculosis medication. MRI of the brain and spine showed an improved state of meningoencephalomyelitis. In a laboratory study, there were decreased levels of peripheral B-cell and CD4 T-cell and decreased CD4:CD8 ratio; therefore, it confirmed that cellular immunity deteriorated. In addition to clinical findings, we were able to diagnose the patient with Good's syndrome. Good's syndrome is a highly suspicious disease in patients with thymoma who have recurrent unusual infections. Immunologic tests should be performed for diagnosis in which it can prevent delayed diagnosis and allow timely treatment.