Development of pictogram-based content of self-management health information for Korean patients with chronic obstructive pulmonary disease.

BACKGROUND: Adherence to self-management greatly impacts patients with chronic obstructive pulmonary disease (COPD) patients. However, most patients with COPD have a limitation in understanding text-based self-management plans owing to low health literacy. Thus, strategies to improve self-management in patients with COPD should be developed. OBJECTIVES: This study aimed to develop pictogram-based content comprising self-management health information for patients with COPD. METHODS: Items for COPD self-management health information were selected based on in-depth interviews with patients and text network analysis conducted in our previous study and a systematic literature review to develop preliminary pictogram-based content. Then, 30 patients with COPD and 10 healthcare professionals (HCPs) were recruited to evaluate the preliminary content using a client satisfaction questionnaire with a maximum score of 32. RESULTS: Content was developed with one item related to disease knowledge while the other 20 concerned self-management. Patients (28.70 ± 2.94) and HCPs (27.40 ± 2.84) evaluated the content as high quality with adjustments made to increase the size of the letters and shorten the number of items for readability. Twenty-one items were collated in the final booklet, while 14 of the 21 items were incorporated into a poster. CONCLUSIONS: This study indicates that the pictogram-based content was sufficiently well designed and received good evaluations from both patients with COPD and HCPs. Therefore, it may have prospects for enhancing self-management in patients with COPD. However, the effect of the content on the outcomes of older patients with COPD and low health literacy will need to be validated in future research.

Effect of self-management education using pictogram-based content of health information on outcomes in Korean patients with chronic obstructive pulmonary disease: A randomized controlled trial.

OBJECTIVES: This study aimed to evaluate the effects of pictogram-based self-management education on the symptom experience, self-efficacy, self-management adherence, and health-related quality of life (HRQoL) in individuals with chronic obstructive pulmonary disease (COPD). METHODS: Sixty COPD patients were enrolled from a pulmonology clinic at C hospital in southwestern Korea and subsequently randomized into two groups. RESULTS: A significant improvement in self-efficacy scores was noted (t = -2.16, p = .035) in the intervention group compared to the control group. No significant differences were observed in symptom experience (t = 0.48, p = .637), self-management adherence (t = -0.33, p = .742), and HRQoL (t = -0.52, p = .608). CONCLUSION: Our findings suggest that the utilization of pictogram-based content in self-management education can be an effective tool for enhancing self-efficacy among COPD patients. Further research is required to evaluate the long-term effects on a broader sample size.

Acculturation Among Chinese Married Immigrant Women in South Korea: A Structural Equation Modeling Analysis.

INTRODUCTION: The purpose of this study was to determine acculturation and the associated factors among Chinese immigrant married women in South Korea. METHODOLOGY: Data collected from 220 participants through an online survey at four health family support centers in South Korea were analyzed in an acculturation model, which included family environment, ego-resilience, acculturative stress, stress-coping style, and acculturation. RESULTS: The fit indices of the modified model satisfied the recommended levels. Among the variables, ego-resilience (ß = 0.34, p < .001) and acculturative stress (ß = -0.65, p < .001) directly affected acculturation. Family environment (ß = 0. 35, p = .001) indirectly influenced acculturation through acculturative stress and stress-coping style. The explanatory power of the variables was 80.7%. DISCUSSION: The results confirmed the usefulness of the acculturation model that provides a theoretical basis for improving acculturation in married immigrant women.

[Validity and Reliability of Korean Version of Self-Care Chronic Obstructive Pulmonary Disease Inventory (SC-COPD) and Self-Care Self-Efficacy Scale (SCES-COPD)].

PURPOSE: This study examined the validity and reliability of the Korean version of the Self-Care in Chronic Obstructive Pulmonary Disease Inventory (SC-COPDI) and the Chronic Obstructive Pulmonary Disease Self-Care Self-Efficacy Scale (SCES-COPD). The SC-COPDI consists of the Self-Care Maintenance Scale (SCMES), Self-Care Monitoring Scale (SCMOS), and Self-Care Management Scale (SCMAS). METHODS: The original tool was translated using a back-translation process. Participants were 241 patients with COPD at the Chonnam National University Hospital in Korea. The construct validity was verified through confirmatory factor analysis, and reliability was verified using Cronbach's α. RESULTS: The SCMES consisted of 10 items of three factors-one of four factors was deleted from the original tool. In the SCMOS, there were six items of two factors after two items were deleted from the original tool. The SCMAS consisted of the original 10 items of three factors. The SCES-COPD consisted of six items of two factors, with one item removed from the original tool. The model fit indices of all tools were good, and the construct validity was confirmed. Cronbach's α of SCMES was .72, SCMOS was .90, SCMAS was .81, and SCES-COPD was .85. CONCLUSION: The Korean version of SC-COPDI and SCES-COPD are valid and reliable instruments for measuring selfcare in people with COPD. These instruments can be used in self-care studies of COPD patients in Korea.

Development of Self-Management Pictorial Health Information and Comparison of Korean Patients' With Chronic Obstructive Pulmonary Disease and Health Care Professionals' Perceptions.

The current study aimed to evaluate pictorial health information (HI) in chronic obstructive pulmonary disease (COPD) patient self-management. Each of 14 literal examples of COPD HI was transformed into three pictorials. The preliminary pictorial COPD HI was validated by 10 experts. In total, 60 patients with COPD and 50 health care professionals (HCPs) were selected to perceive the intended meanings in the pictorial HI. All 42 pictures scored ≥0.8 on the content validity index. Patients chose pictorial HI with descriptions of subjective expressions or those that reflected a patient's actual life, whereas HCPs selected HI that was described in simple, direct, and abstract expressions. Results indicate that HCPs are better suited to provide real life-friendly pictorial HI to patients with COPD. Therefore, it is expected that developing pictograms with patients with COPD could help convey intended meanings. [Journal of Gerontological Nursing, 48(10), 41-46.].

Development of a smartphone application for Korean patients with chronic obstructive pulmonary disease: Self-monitoring based action plans.

AIM: The purpose of this study was to develop and evaluate a smartphone application (app) of a COPD action plan (AP) based on symptom self-monitoring (SM) [AP-SM Sapp] to support the early detection of, and response to, symptoms. BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of the most prevalent respiratory diseases worldwide. Disease control is important to prevent progression of COPD caused by exacerbations; action plans are a successful strategy to prevent and manage COPD exacerbations. However, the digital literacy that COPD patients need to support technology-based COPD action plans is poorly understood. METHODS: A systematic literature review identified components for the app's development. Content validity testing with 12 clinical experts identified 35 critical components for inclusion in the app's development. The app was then submitted to user experience evaluation by thirteen technology experts and nine COPD patients. RESULTS: In user evaluation of the app, experts evaluated the AP-SM Sapp as a good quality app (57.37 ± 9.13) and COPD patients as an average quality app (44.44 ± 3.94) (range 0-69; higher scores indicating greater endorsement of app quality). Revisions based on these critiques produced a final version. CONCLUSION: The app was developed to support COPD patients in the early detection of symptoms so that exacerbations could be prevented or managed appropriately. Although the app used simple messages and pictographs to enhance digital literacy (thus narrowing the digital literacy gap), efficient onboarding will be important if barriers to app use are to be further reduced.

[Development and Evaluation of Resilience Enhancement Program Applying Mindfulness Meditation in Patients with Ileostomy].

PURPOSE: The purpose of this study was to develop a resilience enhancement program applying mindfulness meditation (REP-MM) and evaluate the effects of the program on post-traumatic stress (PTS), resilience, and health-related quality of life (HRQoL) in patients with ileostomy. METHODS: The REP-MM was developed by combining the resilience enhancement program with mindfulness meditation according to four patterns. The program was developed through identifying patients' needs, reviewing relevant literature, developing a preliminary program, and testing content validity and user evaluation. The participants were 55 patients with ileostomy. We conveniently assigned 27 patients to the experimental group and 28 to the control group. The study was conducted in conducted in a hospital from January 22 to May 30, 2019. The REPMM was provided to the experimental group, and conventional ileostomy care was provided to the control group using a nonequivalent control-group pretest-posttest design. RESULTS: ANCOVA revealed that the levels of PTS (F = 321.64, p < .001), resilience (F = 111.86, p < .001), and HRQoL (F = 31.08, p < .001) in the experimental group were higher than those in the control group when comparing pretest to posttest changes. CONCLUSION: The REP-MM is effective in PTS, resilience, and HRQoL in patients suffering from post-stoma creation crisis. The REP-MM can induce positive self-recognition changes in patients with ileostomy through dispositional, situational, relational, and philosophical interventions. We suggest nurses reduce PTS and improve resilience and HRQoL in patients with ileostomy.

Mediating effects of achievement emotions between peer support and learning satisfaction in graduate nursing students.

Graduate nursing students experience considerable stress due to their multiple responsibilities, including professional responsibilities, graduate coursework and family commitments. Peer support can help graduate students overcome stress and may heavily influence their learning satisfaction. However, the mechanisms underlying the influence of peer support on learning satisfaction in graduate students remain unclear. Thus, this cross-sectional study examined the relationship between peer support, achievement emotions (learner-specific emotions related to achievement activities) and learning satisfaction, as well as the mediating effects of achievement emotions among 225 graduate nursing students working in the Korean health care system. Participants completed a questionnaire assessing these variables. Pearson correlation was conducted to investigate the relationship between the variables and Baron and Kenny's regression analysis and Sobel test were conducted to examine the mediating effects of achievement emotions. Peer support correlated positively with positive achievement emotions and learning satisfaction and negatively with negative emotions. Positive emotions were positively and negative emotions were negatively, correlated with learning satisfaction. Achievement emotions mediated the relationship between peer support and learning satisfaction. Our findings indicate that peer support plays an important role in improving learning satisfaction, emphasizing the advantages of positive emotions and the disadvantages of negative emotions in graduate nursing students.

[Knowledge Structure of Chronic Obstructive Pulmonary Disease Health Information on Health-Related Websites and Patients' Needs in the Literature Using Text Network Analysis].

PURPOSE: The purpose of this study was to identify the knowledge structure of health information (HI) for chronic obstructive pulmonary disease (COPD). METHODS: Keywords or meaningful morphemes from HI presented on five health-related websites (HRWs) of one national HI institute and four hospitals, as well as HI needs among patients presented in nine literature, were reviewed, refined, and analyzed using text network analysis and their co-occurrence matrix was generated. Two networks of 61 and 35 keywords, respectively, were analyzed for degree, closeness, and betweenness centrality, as well as betweenness community analysis. RESULTS: The most common keywords pertaining to HI on HRWs were lung, inhaler, smoking, dyspnea, and infection, focusing COPD treatment. In contrast, HI needs among patients were lung, medication, support, symptom, and smoking cessation, expanding to disease management. Two common sub-topic groups in HI on HRWs were COPD overview and medication administration, whereas three common sub-topic groups in HI needs among patients in the literature were COPD overview, self-management, and emotional management. CONCLUSION: The knowledge structure of HI on HRWs is medically oriented, while patients need supportive information. Thus, the support system for self-management and emotional management on HRWs must be informed according to the structure of patients' needs for HI. Healthcare providers should consider presenting COPD patient-centered information on HRWs.

Quality of life in Korean tuberculosis patients: A longitudinal study.

OBJECTIVE: The purpose of this study was to examine health-related quality of life (HRQoL) in Korean tuberculosis (TB) patients and to identify factors associated with HRQoL. DESIGN: A longitudinal study design was employed with a six-month tracking period. SAMPLE: Fifty patients were enrolled from a single TB clinic. MEASUREMENTS: Data on physical and mental HRQoL domains, physical symptoms, self-esteem, stigma, treatment adherence and social support were collected on the day of TB diagnosis, and then again at 2- and 6-months' post-TB diagnosis. RESULTS: Mental HRQoL scores did not change over time (p = .500) although changes in the physical HRQoL significantly improved over 6 months (p < .001); these changes were small and not considered clinically meaningful. Worse physical symptoms (p < .001) but better treatment adherence (p = .006) were associated with lower physical HRQoL. Similarly, worse physical symptoms but better self-esteem (p < .001) and social support (p = .015) were associated with higher mental HRQoL. CONCLUSIONS: It is important that nurses caring for TB patients understand the physical and mental impact of TB and its treatment.

[A Comparative Study on Learning Outcomes according to the Integration Sequences of S-PBL in Nursing Students: Randomized Crossover Design].

PURPOSE: This study aimed to compare the effects of simulation integrated with problem based learning (S-PBL) according to the sequences of problem-based learning (PBL) and high fidelity simulation training (HFS) on knowledge, clinical performance, clinical judgment, self-confidence, and satisfaction in fourth-grade nursing students. METHODS: In this randomized crossover design study, four S-PBLs on medical-surgical nursing were applied alternatively to two randomly-assigned groups of 26 senior nursing students for 8 weeks. The collected data were analyzed using an independent t-test. RESULTS: The method of administering PBL prior to HFS led to significantly higher scores on knowledge (t=2.28, p=.025) as compared to the method of administering HFS prior to PBL. However, the latter method led to significantly higher scores on clinical performance (t=-6.49, p<.001) and clinical judgment (t=-4.71, p<.001) as compared to the method of administering PBL prior to HFS. There were no differences in the effect of the two methods on self-confidence (t=1.53, p=.128) and satisfaction (t=1.28, p=.202). CONCLUSION: The integration sequences of S-PBL was associated with different learning outcomes. Therefore, when implementing S-PBL, it is necessary to consider the educational goal to executes an appropriate sequence of integration.

Outcomes of patients treated with Sengstaken-Blakemore tube for uncontrolled variceal hemorrhage.

Background/Aims: The aim of this study was to investigate the mortality, bleeding control rate, and their associated predictors in patients treated with Sengstaken-Blakemore (SB) tube for uncontrolled variceal hemorrhage associated with hemodynamic instability or failure of endoscopic treatment. METHODS: The clinical data of 66 consecutive patients with uncontrolled variceal hemorrhage treated with SB tube at Gyeongsang National University Hospital from October 2010 to October 2015 were retrospectively analyzed. RESULTS: The overall success rate of initial hemostasis with SB tube was 75.8%, and the independent factors associated with hemostasis were non-intubated state before SB tube (odds ratio, 8.50; p = 0.007) and Child-Pugh score < 11 (odds ratio, 15.65; p = 0.022). Rebleeding rate after successful initial hemostasis with SB tube was 22.0%, and esophageal rupture occurred in 6.1%. Mortality within 30 days was 42.4%, and the related independent factors with mortality were failure of initial hemostasis with SB tube (hazard ratio, 6.24; p < 0.001) and endotracheal intubation before SB tube (hazard ratio, 2.81; p = 0.018). Conclusions: Since the era of endoscopic band ligation, SB tube might be a beneficial option as a temporary salvage treatment for uncontrolled variceal hemorrhage. However, rescue therapy had a high incidence of fatal complication and rebleeding.

[Effects of Education about Action Plans according to Self-Monitoring on Self-Management Adherence, Knowledge, Symptom Control, and Quality of Life among Adult Asthma Patients: A Randomized Controlled Trial].

PURPOSE: This study was conducted to identify the effects of education regarding action plans according to a self-monitoring program on self-management adherence, knowledge, symptom control, and health-related quality of life (HRQoL) among adults with asthma. METHODS: Thirty-four patients were randomly assigned to the intervention group and thirty-two to the control group in this study. A tailored 50-minute intervention based on the contents of self-monitoring and action plans developed by the National Heart Lung and Blood Institute was provided to the intervention group. Structured and well developed questionnaires were used to measure the dependent variables. RESULTS: There were no differences in all general and clinical characteristics, and the dependent variables between two groups in the pre-test. In the post-test, there were differences in the level of self-management adherence (t=4.41, p<.001), knowledge (t=2.26, p=.027), symptom control (t=-2.56, p=.013), and total HRQoL (t=2.14, p=.036) between the two groups, although there was a difference only in the sub-domain of emotion (t=2.03, p=.047) in HRQoL. CONCLUSION: This study found that action plans according to self-monitoring that enhance a participatory interaction in the treatment and care could help patients with moderate to severe asthma to engagead equately in self-care, to control their symptoms, and to improve their HRQoL. Further studies are still needed to identify longitudinal effects of this program.

[Effect of Debriefing Based on the Clinical Judgment Model on Simulation Based Learning Outcomes of End-of-Life Care for Nursing Students: A Non-Randomized Controlled Trial].

PURPOSE: This study was conducted to identify effects of debriefing based on the clinical judgment model for nursing students on their knowledge, skill performance, clinical judgment, self-confidence and learner satisfaction during simulation based end-of-life care (ELC) education. METHODS: Simulation based ELC education was developed in six steps as follows: selection of learning subjects and objects, development of learning tools, a trial run of simulation-based education, students' skill training, and evaluators' training. Forty-eight senior nursing students (25 in the experimental group and 23 in the control group) participated in the simulation-based ELC education using a high-fidelity simulator. Debriefing based on the clinical judgment was compared with the usual debriefing. RESULTS: ANCOVA showed that there were differences in knowledge (F=4.81, p=.034), skill performance (F=68.33, p<.001), clinical judgment (F=18.33, p<.001) and self-confidence (F=4.85, p=.033), but no difference in satisfaction (t=-0.38, p=.704) between the experimental and control groups. CONCLUSION: This study found that debriefing based on the clinical judgement model is effective for supporting nursing students for reflecting on clinical judgment and improving their diverse competencies in complex clinical settings such as ELC.

Usefulness of ascitic fluid lactoferrin levels in patients with liver cirrhosis.

BACKGROUND: Although elevated levels of lactoferrin provide a biomarker for inflammatory bowel diseases and colorectal cancer, the clinical significance of these elevated levels in ascitic fluid of patients with ascites caused by liver cirrhosis is limited. The aims of our study were to investigate the usefulness of ascitic fluid lactoferrin levels for the diagnosis of spontaneous bacterial peritonitis (SBP) in patients with cirrhosis and to evaluate the association between lactoferrin levels and the development of hepatocellular carcinoma (HCC). METHODS: A total of 102 patients with ascites caused by cirrhosis were consecutively enrolled into the study, from December 2008 to December 2011. Ascitic fluid lactoferrin levels were quantified using a human lactoferrin enzyme-linked immunosorbent assay kit. RESULTS: The median ascitic fluid lactoferrin levels were significantly higher in patients with SBP than in those without SBP (112.7 ng/mL vs. 0.6 ng/mL; p < 0.001). The area under the receiver operator characteristic curve for the diagnosis of SBP was 0.898 (95 % confidence interval, 0.839-0.957, p < 0.001), with a sensitivity and specificity for a cut-off level of 51.4 ng/mL of 95.8 % and 74.4 %, respectively. Moreover, the incidence of HCC in the 78 patients without SBP was significantly higher in patients with high ascitic fluid lactoferrin levels (≥35 ng/mL) than in those with low ascitic fluid lactoferrin level (<35 ng/mL). CONCLUSIONS: Ascitic fluid lactoferrin level can be a useful diagnostic tool to identify SBP in patients with ascites caused by cirrhosis. Elevated ascitic fluid lactoferrin level in patients without SBP may be indicative of a developing hepatocellular carcinoma.

[Effects of Dietary Program based on Self-efficacy Theory on Dietary Adherence, Physical Indices and Quality of Life for Hemodialysis Patients].

PURPOSE: The purpose of this study was to examine effects of a dietary program based on self-efficacy theory on dietary adherence, physical status and quality of life (QoL) in hemodialysis patients. METHODS: A non-equivalent control group pre-post test design was used. The intervention group received the dietary program for 8 weeks from August 4 to September 26, 2014. The control group received only usual care. RESULTS: ANCOVA showed that dietary adherence (F=64.75, p<.001) was significantly different between the two groups. Serum albumin (F=12.13, p =.001), interdialytic weight gain (F=56.97, p<.001), calories (F=15.80, p<.001) as physical status indices were significantly different, but serum potassium (F=2.69, p=.106) and serum phosphorus (F=1.08, p=.303) showed no significant difference between the two groups. In terms of health-related QoL, the physical component scale (F=10.05, p=.002) and the mental component scale (F=16.66, p<.001) were significantly different between the two groups. In addition, in terms of diet related QoL, diet level (F=35.33, p<.001) and satisfaction level (F=15.57, p<.001) were significantly different between the two groups, but dietary impact level (F=1.23, p =.271) was not significantly different. CONCLUSION: Findings show that the dietary program based on self-efficacy theory is an effective nursing intervention program to improve adherence to diet, and to maintain physical status and QoL for hemodialysis patients.

Patient outcomes according to COPD action plan adherence.

AIMS AND OBJECTIVES: To identify the level of pulmonary function, number of unplanned hospital visits, knowledge level of chronic obstructive pulmonary disease (COPD), level of anxiety and depression, and level of health-related quality of life (HRQoL) according to COPD action plan (AP) adherence in Korean patients with COPD. BACKGROUND: Previous studies reported conflicting results about the effect of COPD AP on patient outcomes, with little descriptive information. DESIGN: A cross-sectional descriptive study design was used. METHODS: A total of 126 patients with COPD were recruited from Chonnam National University Hospital in Gwangju city from September 2009 to March 2010. COPD action plan adherence and the levels of knowledge of COPD, anxiety and depression, and HRQoL were measured using a short COPD AP developed by the Family Physician Airway Group of Canada executive members, Bristol COPD Knowledge Questionnaire (BCKQ), the hospital anxiety and depression scale (HADS) and the St George's Respiratory Questionnaire (SGRQ), respectively. RESULTS: The score of COPD AP adherence was positively associated with the level of knowledge of COPD and negatively associated with the number of unplanned hospital visits and the level of anxiety and depression. CONCLUSION: Good adherence to COPD AP is likely related to better health outcomes in COPD. Healthcare providers may need to enhance COPD AP aspect in various COPD self-management programmes to improve the health status of patients with COPD. RELEVANCE TO CLINICAL PRACTICE: Chronic obstructive pulmonary disease AP aspect targeting frequent individual education with a written guideline would be helpful to enhance self-management in patients with COPD.

Psychosocial adjustment and quality of life of children after hematopoietic stem cell transplantation in South Korea.

The purpose of this study was to describe the psychosocial adjustment and health-related quality of life (HRQoL) in children who received hematopoietic stem cell transplantation (HSCT) and to examine the relationship of children's characteristics with psychosocial adjustment and HRQoL in South Korea. Participants were 53 children who survived at least 100 days after HSCT, whose current age ranged from 5 to 17 years and their primary caregivers, mostly mothers. Parents completed the Korean version of Child Behavior Check List and Child Health Questionnaire 50-item parent-report version. Children with HSCT had significantly lower scores on the total scale for behavior problems and on most subscales than a normative sample, t = 2.09 to -4.75, P = .043 to <.001. Compared with the Taiwanese sample, scores in physical and psychosocial QoL (except bodily pain, mental health, and behavior) were significantly lower in children with HSCT, t = -2.91 to -9.84, P =.005 to <.001. Time since HSCT seemed to influence the physical (F = 8.61, P = .001) and psychosocial QoL (F = 3.98, P = .025) subscales. Social competence (r = .48, P = .001) and behavioral problems (r = -.37, P = .006) were associated with psychosocial QoL but not with physical QoL. After HSCT, children could benefit from psychological support to promote their adaptation to daily life and improve their QoL.

Clinical characteristics of Kawasaki disease with sterile pyuria.

PURPOSE: Kawasaki disease (KD) is a systemic vasculitis and affects many organ systems. It often presents sterile pyuria, microscopic hematuria, and proteinuria due to renal involvement. The aims of this study were to define clinical characteristics of acute KD patients with pyuria and to analyze meaning of pyuria in KD. METHODS: The medical records and laboratory findings including serum and urine test of 133 patients with KD admitted to Yeungnam University Hospital from March 2006 to December 2010 were reviewed retrospectively. RESULTS: Forty patients had sterile pyuria and their clinical characteristics including age, gender and body weight were not significantly different with those who did not have pyuria. Fever duration after treatment was significantly longer in KD patients with pyuria. Erythrocyte sedimentation rate, C-reactive protein and serum concentration of alanine aminotransferase were significantly higher in patients with pyuria. Hyponatremia and coronary artery lesion were seen more often in patients with pyuria but there was no significant difference. Also serum blood urea nitrogen was significantly higher in KD patients with pyuria. Urine ß(2)-microglobulin was elevated in both patients groups and showed no difference between two groups. CONCLUSION: We found more severe inflammatory reaction in KD patients with pyuria. We also found elevation of some useful parameters like ß(2)-microglobulin that indicate renal involvement of KD through the urine test. Careful management and follow up will need for KD patients with pyuria and it is necessary in the future to study the specific parameters for renal involvement of KD.

Neuro-Behçet disease presented diplopia with hemiparesis following minor head trauma.

Behçet disease (BD) is rare in childhood. We report a 9-year-old boy with neuro-Behçet disease who presented diplopia and weakness on the left side after a cerebral concussion. Brain magnetic resonance imaging (MRI) revealed hyperintensity of the right mesodiencephalic junction on T2-weighted and fluid attenuated inversion recovery images. Prednisolone administration resulted in complete remission and normalization of abnormal MRI finding. Brain MRI is a useful diagnostic tool when the neurological sign is the first symptom of subclinical BD.