{"title":"Cerebral Infarction and Recovery in a 12-Year-Old Child With Intracranial Fibromuscular Dysplasia.","authors":"Min Hwan Kim, Jae In Lee, Shin-Seung Yang","doi":"10.12786/bn.2023.16.e35","DOIUrl":"10.12786/bn.2023.16.e35","url":null,"abstract":"<p><p>Fibromuscular dysplasia (FMD) is a congenital vascular anomaly resulting in arterial stenosis and weakening of typically medium-sized arteries. It is a noninflammatory, nonatherosclerotic arterial disease that affects most commonly the renal and internal carotid arteries, but intracranial FMD in the pediatric population is very rare. We report a young age-onset ischemic stroke patient with FMD affecting the middle cerebral artery (MCA). A 14-year-old boy was admitted with left-side weakness during physical education at school. The brain magnetic resonance (MR) imaging revealed an acute ischemic stroke in the right basal ganglia and internal capsule, while the MR angiogram showed segmental intraluminal stenosis in the left proximal MCA. The transfemoral angiography revealed the pathognomonic sign of a \"string of beads\" at the proximal MCA area. The clinical course was stable, and the boy gradually recovered from the motor weakness of his arm and leg. FMD should be considered as a potential cause of pediatric stroke.</p>","PeriodicalId":72442,"journal":{"name":"Brain & NeuroRehabilitation","volume":"16 3","pages":"e35"},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138479682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jeongeun Lee, Eunjee Lee, Shahid Bashir, Gyu Jin Kim, Suk Hoon Ohn, Kwang-Ik Jung, Woo-Kyoung Yoo
{"title":"Compensatory Hyperactivity of the Ipsilesional Red Nucleus in a Patient With Somatosensory Cortex Damage: A Case Report.","authors":"Jeongeun Lee, Eunjee Lee, Shahid Bashir, Gyu Jin Kim, Suk Hoon Ohn, Kwang-Ik Jung, Woo-Kyoung Yoo","doi":"10.12786/bn.2023.16.e33","DOIUrl":"10.12786/bn.2023.16.e33","url":null,"abstract":"<p><p>This case study describes a patient who experienced motor recovery and involuntary movements following damage to the right primary somatosensory cortex caused by an intracranial hemorrhage. The patient initially suffered from paralysis in her left arm and leg, but exhibited significant motor recovery later, accompanied by multiple episodes of ballistic movement during the recovery process. A diffusion tensor imaging analysis was performed to investigate changes in sensorimotor-related brain areas in the patient. The patient had higher fractional anisotropy and lower mean diffusivity values in the ipsilesional red nucleus (RN) than age-matched controls. We assume that hyperactivity of the ipsilesional RN might play a role in motor recovery after damage to the primary somatosensory cortex, potentially through its involvement in sensorimotor integration. Our findings demonstrated the potential for adaptive changes in the ipsilesional RN following damage to the primary somatosensory cortex.</p>","PeriodicalId":72442,"journal":{"name":"Brain & NeuroRehabilitation","volume":"16 3","pages":"e33"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138479684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jeongeun Lee, Gyu Jin Kim, Shahid Bashir, Eunjee Lee, Suk Hoon Ohn, Kwang-Ik Jung, Woo-Kyoung Yoo
{"title":"Heterogeneous Diffusion Metrics Patterns in Delayed Encephalopathy After Acute Carbon Monoxide Poisoning: A Case Report.","authors":"Jeongeun Lee, Gyu Jin Kim, Shahid Bashir, Eunjee Lee, Suk Hoon Ohn, Kwang-Ik Jung, Woo-Kyoung Yoo","doi":"10.12786/bn.2023.16.e34","DOIUrl":"10.12786/bn.2023.16.e34","url":null,"abstract":"<p><p>Delayed encephalopathy (DE) following acute carbon monoxide (CO) poisoning is characterized by a wide range of neurological symptoms, including akinetic mutism, cognitive impairment, and gait disturbances. Herein, we reported the case of a 61-year-old patient with DE after acute CO poisoning, who displayed heterogeneous patterns of cortical and subcortical structural integrity on diffusion tensor imaging (DTI). Four distinct patterns of diffusion tensor metrics (fractional anisotropy [FA] and mean diffusivity [MD]) were observed in the patient compared to age-matched controls (a decrease in FA and an increase in MD, a decrease in FA only, an increase in MD only, and an increase in FA and MD). This study revealed heterogeneous patterns of cortical and subcortical damage associated with DE after CO poisoning, contributing to a deeper understanding of the diverse clinical symptoms observed in this patient.</p>","PeriodicalId":72442,"journal":{"name":"Brain & NeuroRehabilitation","volume":"16 3","pages":"e34"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138479686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marya Hameed, Fatima Siddiqui, Fahad Hassan Sheikh, Muhammad Khuzzaim Khan, Bushra Admani, Prasanna Kumar Gangishetti
{"title":"Borjeson-Forssman-Lehmann Syndrome: Clinical Features and Diagnostic Challenges.","authors":"Marya Hameed, Fatima Siddiqui, Fahad Hassan Sheikh, Muhammad Khuzzaim Khan, Bushra Admani, Prasanna Kumar Gangishetti","doi":"10.12786/bn.2023.16.e32","DOIUrl":"10.12786/bn.2023.16.e32","url":null,"abstract":"<p><p>Borjeson-Forssman-Lehmann syndrome (BFLS) is an X-linked recessive disorder resulting from mutations in the <i>PHF6</i> gene. The syndrome is characterized by short stature, obesity, hypogonadism, hypotonia, intellectual disability, distinctive facial features, fleshy ears, and finger and toe abnormalities. However, the diagnostic challenge in identifying BFLS remains a topic of interest. In this case report, we present the clinical characteristics of a proband with BFLS, highlighting the additional features of hypotonia, intellectual disability, and distinctive facial features. While no definitive treatment exists for BFLS, patients benefit from specialized education and ongoing supervision from early childhood through adulthood. Symptomatic treatment, including close follow-up, may be necessary for complications such as seizures and hearing problems. Mastectomy or testosterone replacement therapy may be considered on a case-by-case basis. Genetic counseling for X-linkage should be offered to affected families.</p>","PeriodicalId":72442,"journal":{"name":"Brain & NeuroRehabilitation","volume":"16 3","pages":"e32"},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138480029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Spontaneous Cortical Intracerebral Hemorrhage Causing Ipsilateral Hand and Oral Sensory Change Without Motor Deficit: A Case Report.","authors":"Minwoo Kim, Donghyun Shin, Songi Han, Jusun Oh","doi":"10.12786/bn.2023.16.e30","DOIUrl":"10.12786/bn.2023.16.e30","url":null,"abstract":"<p><p>Intracerebral hemorrhage (ICH) is the second most common stroke subtype associated with high morbidity and mortality rates. Although various brain regions are susceptible to ICH, putaminal hemorrhage is the most common, whereas cortical ICH is less common. Here, we report the case of a 69-year-old man who developed a parietal cortical ICH. The patient developed hypoesthesia and paresthesia in the right upper lip and hand; however, the weakness was not severe. Twenty-five days after the ICH onset, the manual muscle test results were normal, but he had difficulty eating and shaving because of decreased hand dexterity. The rehabilitation focused on improving fine hand motor function and endurance. On the 94th day after ICH onset, paresthesia remained only in the fingertips, and the upper lip sensory change disappeared. Patients with sensory symptoms in the perioral area, hands, and brain lesions were previously referred to as having cheiro-oral syndrome (COS). With the advancement of neuroimaging, the use of this term has decreased, as cerebrovascular events can explain patient symptoms in correlation with neuroanatomy, etiology, and pathogenesis. We report a patient with cortical ICH, also known as COS, which is a stroke syndrome with a good prognosis.</p>","PeriodicalId":72442,"journal":{"name":"Brain & NeuroRehabilitation","volume":"16 3","pages":"e30"},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138479688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Impact of Mental Practice on Motor Function in Patients With Stroke: A Systematic Review and Meta-analysis.","authors":"Hyun Seok, Yoon-Hee Choi","doi":"10.12786/bn.2023.16.e31","DOIUrl":"10.12786/bn.2023.16.e31","url":null,"abstract":"<p><p>Mental practice (MP), the cognitive rehearsal of physical activities without overt movements, has recently emerged as a promising rehabilitation method for patients with stroke. This paper presents a systematic review and meta-analysis critically evaluating the existing evidence to offer a comprehensive estimate of the overall effect of MP on motor function in stroke patients. A systematic search of 3 international databases (PubMed, Embase, and the Cochrane Library) was conducted for randomized controlled trials. We finally selected 31 randomized clinical trials and conducted meta-analysis to determine the effectiveness of MP on motor recovery of upper extremity, upper extremity function, activities of daily living, and gait velocity in stroke patients. The results of the systematic reviews showed that MP combined with conventional therapy has a positive impact on improving upper extremity motor function, with a moderate quality of evidence. However, the beneficial effect of MP on gait velocity was not demonstrated. It is recommended to treat with MP in addition to conventional rehabilitation therapy to improve the motor outcome of stroke depending on the patient's condition (Recommendation level: Conditional Recommend Evidence certainty: Moderate).</p>","PeriodicalId":72442,"journal":{"name":"Brain & NeuroRehabilitation","volume":"16 3","pages":"e31"},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138479696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Update of Rehabilitation in Huntington's Disease: Narrative Review.","authors":"Ki-Hong Kim, Min-Keun Song","doi":"10.12786/bn.2023.16.e28","DOIUrl":"10.12786/bn.2023.16.e28","url":null,"abstract":"<p><p>Huntington's disease (HD) is a neurodegenerative disease that has motor dysfunction, predominantly chorea, cognitive impairment, and psychiatric disturbances as symptoms. Treatment is directed to reduce the severity of symptoms, although there are few studies and no clinical guidelines for rehabilitation in HD. Therefore, this review aimed to establish an effective rehabilitation approach for HD according to the stage of the disease. In the early stage of HD, the motor symptoms are mild, and psychological symptoms occur. Treatment in this period should focus on aerobic and resistance exercises, task-specific training, secondary prevention education, cognitive training, and psychological management. In the middle stage of HD, the motor symptoms are more severe. Task-specific rehabilitation approaches, education for the patient and caregiver, functional respiratory exercises, activities of daily living training, multidisciplinary and multimodal daycare rehabilitation are helpful to patients in this stage. At the late stage of HD, most patients need complete support for activity of daily living. Mobility and balance evaluation and prevention strategies should be focused on for safety, and respiratory exercises and physical exercise to prevent complications in patients with severely impaired mobility should be considered based on the patient's condition. Programmed rehabilitation management based on the stage of the disease is effective for patients with HD.</p>","PeriodicalId":72442,"journal":{"name":"Brain & NeuroRehabilitation","volume":"16 3","pages":"e28"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138479699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Effect of Elastic Eyelid Band Application on Bilateral Severe Ptosis in a Patient With Bilateral Incomplete Claude's Syndrome: A Case Report.","authors":"Cho Rom Ham, Yong Wook Kim, Jong Mi Park","doi":"10.12786/bn.2023.16.e29","DOIUrl":"10.12786/bn.2023.16.e29","url":null,"abstract":"<p><p>Patients with brainstem stroke can present with various oculomotor disorders, including ptosis. Neurogenic ptosis, which results from total or partial dysfunction of the third cranial nerve and/or the Müller muscle, can significantly restrict activities of daily living and participation in rehabilitation. Therefore, surgical intervention is an effective therapeutic strategy. However, owing to complications associated with incomplete eyelid closure, such as exposure keratitis and corneal injury, patients with neurogenic ptosis should first be observed, as natural recovery without surgery can be expected despite a poor prognosis. We reported the case of a 66-year-old woman with bilateral Claude syndrome who presented with severe bilateral ptosis, quadriparesis, and cognitive impairment after a bilateral midbrain infarction. After 3 months of intensive rehabilitation using soft elastic eyelid bands, her ptosis improved without the need for eyelid bands and visual field significantly increased, with improved functional level to the point of walking independently without assistance. This report demonstrates the potential advantages of the simple yet effective nonsurgical intervention of a soft elastic eyelid band for ptosis to restore significant functional gains in patients with severe bilateral ptosis after acute stroke.</p>","PeriodicalId":72442,"journal":{"name":"Brain & NeuroRehabilitation","volume":"16 3","pages":"e29"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138479689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cervical Myelopathy Due to Epidural Hematoma at the Cervicomedullary Junction Associated With Ventriculoperitoneal Shunt Overdrainage: A Case Report.","authors":"Ji Woong Park, Junwon Park","doi":"10.12786/bn.2023.16.e27","DOIUrl":"10.12786/bn.2023.16.e27","url":null,"abstract":"<p><p>We present a case of cervical myelopathy caused by epidural hematoma formation due to chronic cerebrospinal fluid overdrainage. A 55-year-old man who underwent ventriculoperitoneal (V-P) shunt surgery for normal pressure hydrocephalus presented with progressive weakness of both the upper and lower extremities. Magnetic resonance imaging (MRI) revealed compressive myelopathy at the cervicomedullary junction at the C1-C2 level caused by epidural hematoma formation due to intracranial hypotension (IH) caused by a complication of V-P shunt. He underwent decompressive laminectomy and hematoma removal at C1-C2 and replacement of the V-P shunt valve. Follow-up cervical spine MRI showed an improved state of severe central spinal stenosis at the C1-C2 level and an improved state of compression-related cord signal intensity change in the spinal cord. After surgical intervention and intensive rehabilitation, the patient showed clinical improvement. If cervical myelopathy is suspected in patients with a shunt, cord compression due to venous engorgement or hematoma caused by over-shunting and IH should be considered.</p>","PeriodicalId":72442,"journal":{"name":"Brain & NeuroRehabilitation","volume":"16 3","pages":"e27"},"PeriodicalIF":0.0,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138479683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yuta Terasawa, Koki Ikuno, Shintaro Fujii, Yuki Nishi, Emi Tanizawa, Sachio Nabeshima, Yohei Okada
{"title":"Unveiling the Impact of Outpatient Physiotherapy on Specific Motor Symptoms in Parkinson's Disease: A Prospective Cohort Study.","authors":"Yuta Terasawa, Koki Ikuno, Shintaro Fujii, Yuki Nishi, Emi Tanizawa, Sachio Nabeshima, Yohei Okada","doi":"10.12786/bn.2023.16.e26","DOIUrl":"10.12786/bn.2023.16.e26","url":null,"abstract":"<p><p>Understanding how outpatient physiotherapy impacts on specific motor symptoms in Parkinson's disease (PD) is important for multidisciplinary care, but these points have not been clarified. We investigated the impact of outpatient physiotherapy on individual motor symptoms in PD patients. Fifty-five PD patients participated in the prospective cohort study, which examined the changes in motor symptoms after 90 min of outpatient physiotherapy program (1×/week for 10 weeks) and at 3 months follow-up. Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) motor score and tremor, rigidity, bradykinesia, and axial scores were assessed and compared pre-intervention, post-intervention, and at follow-up. Significant level was set at 0.05. Their MDS-UPDRS motor score and axial score significantly decreased post-intervention and at the follow-up. In the analysis differentiating effects based on the severity of motor symptoms according to the MDS-UPDRS motor score, only the moderate-severe group showed significant decreases in their MDS-UPDRS motor score, bradykinesia, and axial scores post-intervention, as well as in their MDS-UPDRS motor score, rigidity, bradykinesia, and axial scores at the follow-up. These findings suggest the outpatient physiotherapy might provide benefits, particularly in managing axial symptoms and bradykinesia, for community dwelling PD patients with moderate-severe motor symptoms within a multidisciplinary care framework.</p>","PeriodicalId":72442,"journal":{"name":"Brain & NeuroRehabilitation","volume":"16 3","pages":"e26"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138479698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}