Clinical Practice Guidelines for Oropharyngeal Dysphagia / 대한연하장애학회지

Objective@#Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. @*Methods@#Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. @*Results@#Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. @*Conclusion@#This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

Number Processing Error as a Clinical Manifestation of Hemispatial Neglect Following Hypoxic Brain Injury:a Case Report

Hemispatial neglect is a symptom where patients do not show response to stimuli on the contralesional side of their brain lesion. Although it is most common in the context of hemispheric stroke, several pathological processes including neurodegenerative disease, neoplasia, and trauma may cause this. Prevalence of hemispatial neglect is unknown and rarely reported among patients with hypoxic brain injury. Also, hemispatial neglect accompanying neglect dyslexia is rather hard to be recognized and symptoms involving numbers are exceptionally rare. We report a patient with hypoxic brain injury following cardiac arrest who showed signs of neglect dyslexia for numbers that provided a primary clue for the diagnosis of left hemispatial neglect. Early detection of different forms of cognitive dysfunction of hypoxic brain injury is highly essential in providing early neurorehabilitation for better prognosis.

Reversible Psychosis Caused by Disconnection of the Limbic System:Clinical Reasoning Using Diffusion Tensor Tractography

Injury to the limbic system can result in amnesia, language difficulties, behavioral abnormalities, and psychological disorders. We present a patient who suffered psychosis related to disconnection of the limbic system after intraventricular and orbitofrontal hemorrhages following removal of a sellar meningioma. Diffusion tensor tractography was valuable for evaluating the structural integrity of the injured limbic tracts and determining the regeneration of tracts corresponding to neuropsychiatric recovery after cognitive rehabilitation.

Number Processing Error as a Clinical Manifestation of Hemispatial Neglect Following Hypoxic Brain Injury:a Case Report

Hemispatial neglect is a symptom where patients do not show response to stimuli on the contralesional side of their brain lesion. Although it is most common in the context of hemispheric stroke, several pathological processes including neurodegenerative disease, neoplasia, and trauma may cause this. Prevalence of hemispatial neglect is unknown and rarely reported among patients with hypoxic brain injury. Also, hemispatial neglect accompanying neglect dyslexia is rather hard to be recognized and symptoms involving numbers are exceptionally rare. We report a patient with hypoxic brain injury following cardiac arrest who showed signs of neglect dyslexia for numbers that provided a primary clue for the diagnosis of left hemispatial neglect. Early detection of different forms of cognitive dysfunction of hypoxic brain injury is highly essential in providing early neurorehabilitation for better prognosis.

Reversible Psychosis Caused by Disconnection of the Limbic System:Clinical Reasoning Using Diffusion Tensor Tractography

Injury to the limbic system can result in amnesia, language difficulties, behavioral abnormalities, and psychological disorders. We present a patient who suffered psychosis related to disconnection of the limbic system after intraventricular and orbitofrontal hemorrhages following removal of a sellar meningioma. Diffusion tensor tractography was valuable for evaluating the structural integrity of the injured limbic tracts and determining the regeneration of tracts corresponding to neuropsychiatric recovery after cognitive rehabilitation.

Anatomical Localization of Motor Points of the Abductor Hallucis Muscle: A Cadaveric Study

OBJECTIVE: To identify the anatomical motor points of the abductor hallucis muscle in cadavers. METHODS: Motor nerve branches to the abductor hallucis muscles were examined in eight Korean cadaver feet. The motor point was defined as the site where the intramuscular nerve penetrates the muscle belly. The reference line connects the metatarsal base of the hallux (H) to the medial tubercle of the calcaneus (C). The x coordinate was the horizontal distance from the motor point to the point where the perpendicular line from the navicular tuberosity crossed the reference line. The y coordinate was the perpendicular distance from the motor point to the navicular tuberosity. RESULTS: Most of the medial plantar nerves to the abductor hallucis muscles divide into multiple branches before entering the muscles. One, two, and three motor branches were observed in 37.5%, 37.5%, and 25% of the feet, respectively. The ratios of the main motor point from the H with respect to the H-C line were: main motor point, 68.79%±5.69%; second motor point, 73.45%±3.25%. The mean x coordinate value from the main motor point was 0.65±0.49 cm. The mean value of the y coordinate was 1.43±0.35 cm. All of the motor points of the abductor hallucis were consistently found inferior and posterior to the navicular tuberosity. CONCLUSION: This study identified accurate locations of anatomical motor points of the abductor hallucis muscle by means of cadaveric dissection, which can be helpful for electrophysiological studies in order to correctly diagnose the various neuropathies associated with tibial nerve components.

Prolonged Motor Weakness With Syringomyelia in Japanese Encephalitis: A Case Study

Japanese encephalitis (JE) shows characteristic brain lesions, including bilateral thalamus, midbrain, internal capsule, basal ganglia, and occasionally involves an anterior horn cell. We encountered a case of a 44-year-old man who initially presented with encephalitis, which was finally diagnosed as Japanese encephalomyelitis with syringomyelia. The patient showed severe motor weakness followed by delayed recovery of functional motor activities. Cervical magnetic resonance imaging showed syrinx formation at the C5 level suggesting myelitis, and abnormal electromyographic findings were noted. Clinicians should consider the possibility that the spinal cord may be involved; an example would be syringomyelia due to myelitis in a case of JE presenting with severe and prolonged motor weakness.

The Effect of Two Different Opening Patterns of Neodymium:YAG Laser Posterior Capsulotomy on Visual Function

PURPOSE: To investigate the effects of two different opening patterns in neodymium:yttrium-aluminum-garnet (Nd:YAG) laser posterior capsulotomy on visual function. METHODS: A randomized prospective study was conducted on 62 pseudophakic eyes from 50 patients with posterior capsular opacification (PCO). Groups A and B underwent laser posterior capsulotomy with a cruciate opening and a modified circular opening, respectively. The best corrected visual acuity (BCVA), contrast sensitivity, and glare sensitivity were measured before and after laser posterior capsulotomy in both groups. The occurrences of intraocular lens (IOL) pittings were investigated and compared between the two groups. RESULTS: After laser capsulotomy, there were significant increases in BCVA, contrast and glare sensitivity in both groups and no significant differences between the two groups. However, group A had significantly more patients with three or more IOL pittings within a 1.5-mm radius from the IOL center (p = 0.047). In group A, these patients had significantly less contrast sensitivity (p = 0.023 in 1.6 cpd) and glare sensitivity (p = 0.043 in 1.6 cpd) than did patients with two or fewer IOL pittings. CONCLUSIONS: Nd:YAG laser posterior capsulotomy using a modified circular opening can be considered an effective method to manage PCO.