Intensive Rehabilitation Therapy Following Brain Tumor Surgery: A Pilot Study of Effectiveness and Long-Term Satisfaction.

OBJECTIVE: To evaluate the effectiveness of intensive rehabilitation to support recovery of neurological function after brain tumor surgery and assess long-term satisfaction. METHODS: This retrospective study included patients with neurological impairment after brain tumor surgery who underwent intensive rehabilitation therapy between December 2013 and May 2017. To assess effectiveness of rehabilitation, functional outcomes (motor, cognition, and activities of daily living [ADL]) were compared between brain tumor group and a control group enrolling stroke patients who received equivalent rehabilitation during the study period. Long-term satisfaction with rehabilitation was evaluated by surveying family caregivers. RESULTS: This study included 21 patients with benign brain tumor, 14 with malignant brain tumor, and 108 with stroke. Significant and similar improvement in motor, cognition, and ADL function were noted in both the brain tumor group and the stroke group. Malignancy status did not influence the extent of functional improvement. According to medical records and surveys, 9 (69.2%) patients with malignant tumor and 2 (11.8%) with benign tumor had expired by the time of the survey. Most family caregivers confirmed that rehabilitation was effective for functional improvement (>60%), expressing overall satisfaction and stating they would recommend such therapy to patients with similar conditions (approximately 70%). CONCLUSION: Intensive rehabilitation may help promote functional improvement following brain tumor surgery regardless of malignancy compared with stroke patients. Family caregivers expressed overall satisfaction with rehabilitation at long-term follow-up. These findings support the provision of intensive rehabilitation therapy for neurologic function recovery following brain tumor surgery.

Motor Neuron Disease Presenting With Acute Respiratory Failure: A Case Study.

Motor neuron diseases (MNDs) refer to a heterogeneous group of progressive neurologic disorders caused by degeneration of motor neurons. The diseases affect either the upper motor neurons, lower motor neurons, or both, and are characterized by weakness, atrophy, fasciculation, spasticity, and respiratory failure. We report a case of a 61-year-old male patient with no past history of cardiovascular or pulmonary disease, who presented with only dyspnea, and no indication of any other symptom such as muscle weakness, atrophy, or bulbar dysfunction. Neuromuscular conduction study, including a study of the phrenic nerve, confirmed the diagnosis of MND. The patient greatly improved giving respiratory assistance at night, using a noninvasive ventilator. This case indicates that MNDs should be considered as differential diagnoses for patients showing acute respiratory failure of unknown causes. This report will aid in the prompt diagnosis and treatment of MNDs.

Comparison of ultrasound-guided anterior and posterior approaches for needle insertion into the tibialis posterior in hemiplegic children with spastic cerebral palsy.

OBJECTIVE: Although the tibialis posterior is a potentially difficult muscle to locate for botulinum toxin injection because of its deep location, needle insertion is usually performed using anatomic landmarks for guidance. Accordingly, the ultrasonographic anatomy of the lower leg was investigated in hemiplegic children with spastic cerebral palsy to improve the safety and the accuracy of needle placement into the tibialis posterior. DESIGN: Twenty-five subjects (2 yrs 2 mos to 5 yrs 11 mos; 12 boys, 13 girls; Gross Motor Function Classification System levels I-II) were recruited. B-mode, real-time ultrasonography was performed using a 5- to 12-MHz linear array transducer. During anterior and posterior approaches, safety window width (tibia to the neurovascular bundle) and depth (skin to the midpoint of the tibialis posterior) were measured at the upper third and at the midpoint of the tibia. RESULTS: For the anterior approach, the safety window width at the upper third of the tibia (mean [SD], 0.63 [0.12] cm, range, 0.44-0.93 cm) was significantly larger than that at the midpoint (0.38 [0.09] cm, range from 0.22 to 0.59 cm, P < 0.05) of the affected leg. However, for the posterior approach, the safety window width at the midpoint (0.74 [0.23] cm, range from 0.21 to 1.18 cm) was significantly larger than that at the upper third of the tibia (0.48 [0.23] cm, range from 0.10 to 0.97 cm, P < 0.05) on the affected leg. CONCLUSIONS: Ultrasonographic guidance is a useful, safe, and accurate tool for needle insertion into the tibialis posterior. Considering the safety window width, this study suggests needle placement at the upper third point of the tibia for the anterior approach and at the midpoint for the posterior approach.

Clinical features and associated abnormalities in children and adolescents with corpus callosal anomalies.

Callosal anomalies are frequently associated with other central nervous system (CNS) and/or somatic anomalies. We retrospectively analyzed the clinical features of corpus callosal agenesis/hypoplasia accompanying other CNS and/or somatic anomalies. We reviewed the imaging and clinical information of patients who underwent brain magnetic resonance imaging in our hospital, between 2005 and 2012. Callosal anomalies were isolated in 13 patients, accompanied by other CNS anomalies in 10 patients, associated with only non-CNS somatic anomalies in four patients, and with both CNS and non-CNS abnormalities in four patients. Out of 31 patients, four developed normally, without impairments in motor or cognitive functions. Five of nine patients with cerebral palsy were accompanied by other CNS and/or somatic anomalies, and showed worse Gross Motor Function Classification System scores, compared with the other four patients with isolated callosal anomaly. In addition, patients with other CNS anomalies also had a higher seizure risk.

Novel Influenza A (H1N1)-Associated Acute Necrotizing Encephalopathy: A Case Report.

Several cases of acute necrotizing encephalopathy (ANE) with influenza A (H1N1) have been reported to date. The prognosis of ANE associated with H1N1 is variable; some cases resulted in severe neurologic complication, whereas other cases were fatal. Reports mostly focused on the diagnosis of ANE with H1N1 infection, rather than functional recovery. We report a case of ANE with H1N1 infection in a 4-year-old Korean girl who rapidly developed fever, seizure, and altered mentality, as well as had neurologic sequelae of ataxia, intentional tremor, strabismus, and dysarthria. Brain magnetic resonance imaging showed lesions in the bilateral thalami, pons, and left basal ganglia. To our knowledge, this is the first report of ANE caused by H1N1 infection and its long-term functional recovery in Korea.