To analyze the relationship between brain lesion location and type of chronic dysphagia in patients with supratentorial stroke.
Data from 82 chronic stroke patients who underwent videofluoroscopic swallowing studies at >6 months after an initial stroke event were retrospectively analyzed. Delayed oral transit time, delayed pharyngeal transit time, and the presence of aspiration were extracted. A voxel-based lesion symptom mapping (VLSM) analysis was used to correlate types of dysphagia with specific brain lesions.
VLSM identified several clusters of voxels that significantly correlated with type of dysphagia. Delayed oral transit time mainly correlated with lesions in the left inferior frontal lobe and precentral gyrus; delayed pharyngeal time mainly correlated with lesions in the right basal ganglia and corona radiate; and aspiration was mainly correlated with lesions in the putamen.
Understanding the association between lesion location and dysphagia in chronic stroke patients is an important first step towards predicting permanent dysphagia after stroke. Improved understanding of the neural correlates of dysphagia will inform the utility of interventions for its treatment and prevention after stroke.
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To investigate the predictive value of the sympathetic skin response (SSR) in diagnosing complex regional pain syndrome (CRPS) by comparing three diagnostic modalities-SSR, three-phasic bone scans (TPBS), and thermography.
Thirteen patients with severe limb pain were recruited. Among them, 6 were diagnosed with CRPS according to the proposed revised CRPS clinical diagnostic criteria described by the International Association for the Study of Pain. SSR was measured in either the hands or feet bilaterally and was considered abnormal when the latency was prolonged. A positive TPBS finding was defined as diffuse increased tracer uptake on the delayed image. Thermographic findings were considered positive if a temperature asymmetry greater than 1.00℃ was detected between the extremities.
Five of 6 CRPS patients showed prolonged latency on SSR (83% sensitivity). TPBS was positive in the 5 CRPS patients who underwent TPBS (100% sensitivity). Thermography was positive in 4 of 5 CRPS patients who underwent the procedure (80% sensitivity). The remaining 7 non-CRPS patients differed on examination. SSR latencies within normal limit were noted in 4 of 7 non-CRPS patients (57% specificity). Results were negative in 4 of 5 non-CRPS patients who underwent TPBS (80% specificity), and negative in 3 of 5 non-CRPS patients who underwent thermography (60% specificity).
SSR may be helpful in detecting CRPS.
Citations
Evaluation of the Sympathetic Skin Response in Men with Chronic Prostatitis: A Case-Control Study
To assess the practical diagnostic value of facial nerve antidromic evoked potential (FNAEP), we compared it with the diagnostic value of the electroneurography (ENoG) test in Bell's palsy.
In total, 20 patients with unilateral Bell's palsy were recruited. Between the 1st and 17th days after the onset of facial palsy, FNAEP and ENoG tests were conducted. The degeneration ratio and FNAEP latency difference between the affected and unaffected sides were calculated in all subjects.
In all patients, FNAEP showed prolonged latencies on the affected side versus the unaffected side. The difference was statistically significant. In contrast, there was no significant difference between sides in the normal control group. In 8 of 20 patients, ENoG revealed a degeneration ratio less than 50%, but FNAEP show a difference of more than 0.295±0.599 ms, the average value of normal control group. This shows FNAEP could be a more sensitive test for Bell's palsy diagnosis than ENoG. In particular, in 10 patients tested within 7 days after onset, an abnormal ENoG finding was noted in only four of them, but FNAEP showed a significant latency difference in all patients at this early stage. Thus, FANEP was more sensitive in detecting facial nerve injury than the ENoG test (p=0.031).
FNAEP has some clinical value in the diagnosis of facial nerve degeneration. It is important that FNAEP be considered in patients with facial palsy at an early stage and integrated with other relevant tests.
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To evaluate the epidemiologic change of patients with spinal cord injury who were admitted to a Rehabilitation Hospital, Yonsei University College of Medicine, during 1987-1996 and 2004-2008.
Medical records of 629 patients with spinal cord injury admitted to the Rehabilitation Hospital, Yonsei University College of Medicine, from 2004 to 2008 were collected and reviewed retrospectively.
The male-to-female ratio decreased to 2.86:1, the mean age at injury increased, nontraumatic etiology increased, traffic accident remained to be the most common in traumatic spinal cord injury, and falling increased significantly. Tumor was the most common etiology in nontraumatic spinal cord injury, tetraplegia and incomplete injuries occurred more than paraplegia and complete injuries, indwelling catheter was the most common voiding method, and the duration of hospitalization decreased.
Many trends changed in epidemiology of spinal cord injury.
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Wilson's disease is an autosomal recessive disorder of abnormal copper metabolism. Although dysphagia is a common complaint of patients with Wilson's disease and pneumonia is an important cause of death in these patients, management of swallowing function has rarely been reported in the context of Wilson's disease. Hence, we report a case of Wilson's disease presenting with dysphagia. A 33-year-old man visited our hospital with a complaint of difficulty in swallowing, since about last 7 years and which had worsened since the last 2-3 months. He was diagnosed with Wilson's disease about 13 years ago. On the initial VFSS, reduced hyoid bone movement, impaired epiglottic movement and moderate amount of residue in the valleculae during the pharyngeal phase were noted. After 10 sessions of neuromuscular electrical stimulation for 1 hour per day, decreased amount of residue was observed in the valleculae during the pharyngeal phase on the follow-up VFSS.
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To assess prosthetic use by upper extremity amputees, and their difficulties with prostheses in activities of daily living and occupations.
This study is based on a survey of 307 subjects, who were using prostheses manufactured in the Center of Prosthetics and Orthotics. The survey questionnaire included items about general demographic characteristics, side and level of amputation, type of prosthesis and its use, and difficulties in the activities of daily living, employment and driving.
The most common type of prosthesis was the cosmetic hand type (80.2%). There were no statistically significant correlations between satisfaction with prosthesis and the amputation level or type of prosthesis. The most common difficulties in daily living activities experienced by amputees were lacing shoes, removing bottle-tops with a bottle opener, and using scissors. Only 7.3% of amputees received rehabilitation services. Less than half of the amputees (44.7%) used their prostheses for eight or more hours a day, and 76.9% used their prostheses for regular or irregular cosmetic purposes. After amputation, most of the respondents (69.0%) became unemployed or changed workplaces.
In our study, respondents preferred cosmetic usage to functional usage. Only 30.0% of respondents reported satisfaction with their prostheses. Many of the amputees had difficulties in complex tasks and either changed jobs or became unemployed. Clerical workers were the occupation group, which was most likely to return to work. The development of a more functional prosthetic hand and additional rehabilitation services are required.
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