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Pain Control and Sedation in Neuro Intensive Critical Unit 神经重症病房的疼痛控制与镇静
Pub Date : 2023-08-01 DOI: 10.17340/jkna.2023.3.1
Soo-Hyun Park, Yerim Kim, Yeojin Kim, J. Bae, Ju-Hun Lee, Wook-Sung Kim, Hong-Ki Song
Neurocritical patients who can self-report pain use the 0-10 numerical rating scale (NRS, verbal or visual form). However, critically ill patients whose nervous systems cannot express pain use the behavioral pain scale (BPS) and the critical care pain observation tool (CPOT) behavioral pain assessment tools. These tools reveal pain-related changes in movement, facial expression, posture, and physiological indicators such as heart rate, blood pressure, and respiratory rate. In pain control, it is first essential to reduce unnecessary painkillers through non-drug therapy and maximize the effect of the administered analgesics. For nonneuropathic pain, narcotic analgesics such as fentanyl, hydromorphone, morphine, and remifentanil are administered intravenously. Gabapentin, pregabalin, and carbamazepine are recommended along with narcotic analgesics for neuropathic pain control. In addition, nonnarcotic analgesics for multi-modal analgesia are used to reduce the use of narcotic analgesics or the side effects of narcotic analgesics. In the intensive care unit (ICU), the sedation-agitation scale (SAS) and the Richmond agitation-sedation scale (RASS) are used to determine the depth of sedation to be maintained during shallow or deep sedation, considering the condition of the critically ill patient. When selecting sedatives for critically ill patients, preferentially consider nonbenzodiazepines such as propofol or dexmedetomidine rather than benzodiazepines such as midazolam or lorazepam. In addition, patients use painkillers or sedatives for over a week, and neurological changes or physiological dependence may occur. Therefore, clinicians should evaluate the critically ill patient’s condition, and sedatives and painkillers should be reduced or discontinued.
能够自我报告疼痛的神经危重症患者使用0-10数值评定量表(NRS,口头或视觉形式)。而神经系统不能表达疼痛的危重患者则使用行为疼痛量表(behavioral pain scale, BPS)和重症疼痛观察工具(critical care pain observation tool, CPOT)行为疼痛评估工具。这些工具揭示了运动、面部表情、姿势以及心率、血压和呼吸频率等生理指标与疼痛相关的变化。在疼痛控制中,首先必须通过非药物治疗减少不必要的止痛药,并最大限度地发挥镇痛药的作用。对于非神经性疼痛,麻醉性镇痛药如芬太尼、氢吗啡酮、吗啡和瑞芬太尼可静脉注射。加巴喷丁、普瑞巴林和卡马西平建议与麻醉性镇痛药一起用于神经性疼痛控制。此外,采用非麻醉性镇痛药进行多模态镇痛,以减少麻醉性镇痛药的使用或麻醉性镇痛药的副作用。在重症监护室(ICU),考虑到危重患者的情况,采用镇静-躁动量表(SAS)和Richmond躁动-镇静量表(RASS)来确定浅镇静或深镇静期间维持的镇静深度。在为危重病人选择镇静剂时,优先考虑非苯二氮卓类药物,如异丙酚或右美托咪定,而不是苯二氮卓类药物,如咪达唑仑或劳拉西泮。此外,患者使用止痛药或镇静剂超过一周,可能出现神经变化或生理依赖。因此,临床医生应评估危重患者的病情,并应减少或停用镇静剂和止痛药。
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引用次数: 0
What Is an Independent Medical Examination? 什么是独立的身体检查?
Pub Date : 2023-08-01 DOI: 10.17340/jkna.2023.3.2
D. Jeong
An independent medical examination (IME) is a medical evaluation performed by a medical professional on a patient who was not previously involved in the treatment of that patient, to evaluate the patient’s course of prior treatment and current condition. IMEs are conducted by doctors, psychologists, and other licensed healthcare professionals in essentially all medical disciplines, depending on the purpose of the exam and the claimed injuries. Such examinations are generally conducted in the context of a legal or administrative proceeding, at the request of the party opposing the patient’s request for benefits. Conducting an independent medical examination does not establish a typical doctor-patient relationship as exists when a clinician treats a patient. Thus, a “limited doctor-patient relationship” exists when conducting independent medical examinations.
独立医疗检查(IME)是由医疗专业人员对以前未参与治疗的患者进行的医疗评估,以评估患者先前的治疗过程和当前状况。体检主要由医生、心理学家和其他持有执照的医疗保健专业人员在所有医学学科中进行,具体取决于考试的目的和声称的伤害。这种检查通常在法律或行政程序的背景下进行,应反对患者福利请求的一方的要求进行。进行独立的医学检查并不像临床医生治疗病人那样建立典型的医患关系。因此,在进行独立医疗检查时,存在着"有限的医患关系"。
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引用次数: 0
Lexical-semantic Deficit without Semantic Impairment in a Patient with Left Anterior Choroidal Artery Infarction: Neural Correlates Based on Diffusion-tensor Tractography 左前脉络膜动脉梗死患者的词汇语义缺陷无语义损害:基于弥散张量束造影的神经相关性
Pub Date : 2023-08-01 DOI: 10.17340/jkna.2023.3.6
Han Kyu Na, Y. Sun, Sangwon Joe, Chung-Seok Lee, Seok-joo Kim, Yunjung Choi, Haram Joo, Deog Young Kim, H. Nam
A 35-year-old male presented with atypical aphasia following left anterior choroidal artery infarction associated with distal internal carotid artery dissection. He presented with 1) lexical-semantic deficit without semantic impairment, 2) frequent surface errors (both surface dyslexia and dysgraphia), and 3) intact non-word reading/repetition (preserved sub-lexical route), suggesting deficit in the phonological output lexicon. Diffusion-tensor tractography analysis revealed disruption in the inferior fronto-occipital fasciculus and inferior longitudinal fasciculus, which might serve as potential subcortical neural correlates for phonological output lexicon.
一位35岁男性患者在左前脉络膜动脉梗死合并颈动脉远端夹层后出现非典型失语。他表现出1)词汇语义缺陷,但没有语义损伤;2)频繁的表面错误(包括表面阅读障碍和书写障碍);3)完整的非单词阅读/重复(保留亚词汇路径),表明语音输出词汇存在缺陷。弥散张量束造影显示额枕下束和纵向束的断裂可能是语音输出词汇的潜在皮层下神经关联。
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引用次数: 0
Posterior Reversible Encephalopathy after Quetiapine Overdose 喹硫平过量后后路可逆性脑病
Pub Date : 2023-08-01 DOI: 10.17340/jkna.2023.3.10
M. Kim, J. Jeon, Man Gyeong Han, D. Shin
Quetiapine is an atypical antipsychotic drug that can cause sinus tachycardia, hypotension, coma, etc. with overdose, and rarely convulsions, rhabdomyolysis and neuroleptic malignant syndrome. Posterior reversible encephalopathy syndrome usually occurs in association with hypertension, but can occur rarely in rhabdomyolysis accompanied by acute kidney injury and arginine vasopressin axis hyperstimulation. We report the experience of a patient hospitalized with a quetiapine overdose who developed drug-induced rhabdomyolysis and reversible encephalopathy without hypertension after acute renal injury.
喹硫平是一种非典型抗精神病药物,过量可引起窦性心动过速、低血压、昏迷等,很少发生惊厥、横纹肌溶解和抗精神病药恶性综合征。后部可逆性脑病综合征通常与高血压相关,但在横纹肌溶解合并急性肾损伤和精氨酸加压素轴过度刺激时很少发生。我们报告了一位因喹硫平过量而住院的患者,他在急性肾损伤后出现药物性横纹肌溶解和可逆性脑病,无高血压。
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引用次数: 0
Mnemonics for Key Phenomenology of Hyperkinetic Disorders 多动障碍关键现象学助记法
Pub Date : 2023-08-01 DOI: 10.17340/jkna.2023.3.17
Woong-Woo Lee
Received May 22, 2023 Revised June 13, 2023 Accepted June 13, 2023 이상운동 질환의 현상학(phenomenology)은 운동과다(hyperkinesia)와 운동 과소(hypokinesia)를 나누는 것으로부터 출발한다. 운동과소의 대표적인 것은 운 동완만(bradykinesia)으로, 이는 파킨슨증(Parkinsonism)의 핵심 증상이기도 하다. 운동과다는 운동과소보다 더 많은 표현형이 있어 모두 기억하기는 쉽지 않게 느껴진다. 하지만 대표적인 다섯 개의 표현형을 기억한다면 거의 대부분의 운동과 다 증상을 설명할 수 있다. 운동과다의 대표적인 표현형인 근긴장이상증(dystonia), 무도증(chorea), 실조 증(ataxia), 근간대경련(myoclonus), 떨림(tremor)의 앞 글자만 따면 “Dys-ChoAt-My-Trem”이라는 말로 축약할 수 있다. 다음 그림을 보면 “이상하게 열차에서 춤추고 있는 장면”, 즉 “디스-코-앳-마이-트렘”이므로 이상운동 질환 중에 운동과다 의 대표적인 현상학을 기억하기 위해 활용되기 좋다(Fig.). 물론 각각의 정의는 익숙 해지도록 숙지해야 한다.
Received May 22、2023 Revised June 13、2023 Accepted June 13、2023以上运动疾病的现态学(phenomenology)从区分运动过多(hyperkinesia)和运动过少(hypokinesia)开始。运动过少的代表性症状是运动完万(bradykinesia),这也是帕金森症(Parkinsonism)的核心症状。运动过多比运动过少有更多的表现型,所以很难全部记住。但是如果记住5个代表性的表现型,几乎可以说明大部分的运动和多症状。只要取运动过多的代表性表现型肌紧张异常症(dystonia)、无道症(chorea)、失调症(ataxia)、肌大痉挛(myoclonus)、抖动(tremor)的前一个字,就可以用“Dys-ChoAt-My-Trem”来简称。在下面的图片中,“奇怪地在列车上跳舞的场面”,即“disco - at - my - trem”,很好地用于记住异常运动疾病中运动过多的代表性现象学(Fig.)。当然,每个定义都要熟悉。
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引用次数: 0
Multifocal Peripheral Neuropathies, Rhabdomyolysis, and Dermal Change in Carbon Monoxide Intoxication 一氧化碳中毒的多灶性周围神经病变、横纹肌溶解和皮肤变化
Pub Date : 2023-08-01 DOI: 10.17340/jkna.2023.3.3
Dae Wang Jeong, Dasom Yoon, Jeong Kyu Lee, Kyoung Mi Lee, Y. Suh, Y. Jung
Carbon monoxide poisoning is common cause of fatal intoxication. When carbon monoxide is absorbed into the blood, it interferes with the oxygen supply to the cells, causing damage to tissues and organs. Delayed neuropsychiatric sequelae (DNS) manifested by cognitive dysfunction, motor disorder, micturition disorder are widely known complication of carbon monoxide intoxication. But neuromuscular complication is a rare DNS of carbon monoxide intoxication. We herein report a 42-year-old patient with multifocal neuropathies, rhabdomyolysis, and dermal change due to carbon monoxide intoxication.
一氧化碳中毒是致命中毒的常见原因。当一氧化碳被血液吸收时,它会干扰细胞的氧气供应,导致组织和器官受损。迟发性神经精神后遗症是一氧化碳中毒的常见并发症,主要表现为认知功能障碍、运动障碍、排尿障碍等。但神经肌肉并发症是一氧化碳中毒的一种罕见的DNS。我们在此报告一个42岁的病人,多局灶性神经病,横纹肌溶解,皮肤变化,由于一氧化碳中毒。
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引用次数: 0
TWNK Gene Associated Perrault Syndrome Patient with Neurological Features 与神经系统特征相关的TWNK基因佩诺特综合征患者
Pub Date : 2023-05-01 DOI: 10.17340/jkna.2023.2.6
Hyung Ki Kim, Jae Young Bae, J. Lim, J. Seok, Jongkyu Park
Perrault syndrome 5 is a rare autosomal recessive disorder that is characterized by the association of sensorineural hearing loss and ovarian dysgenesis in females with diversity of neurologic deficits due to variants of twinkle mtDNA helicase (TWNK) gene. Since neurologic deficits develop gradually, patient is often misdiagnosed with other neurological disease during early age. Herein, we report a case of genetically diagnosed Perrault syndrome 5.
Perrault综合征5是一种罕见的常染色体隐性遗传病,其特征是女性感音神经性听力损失和卵巢发育不良,并伴有由眨眼mtDNA解旋酶(TWNK)基因变异引起的多种神经功能缺陷。由于神经功能缺损是逐渐发生的,患者在早期常被误诊为其他神经系统疾病。在此,我们报告一例基因诊断的佩诺特综合征5。
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引用次数: 0
Development of Software Solutions for Stroke: A Personal Experience 中风软件解决方案的开发:个人经验
Pub Date : 2023-05-01 DOI: 10.17340/jkna.2023.2.1
Joonnyung Heo
Variety of software solutions are being used for clinical use. This special contribution focuses on the personal experience of developing several software solutions concerning stroke. Stroke119 application was developed to inform the patient of the closest hospital available for thrombolytic therapy and provides a simple three-step self-test for detection of acute stroke. A multi-center web-based registry solution named SMART DB was developed to facilitate multi-center studies. Over 650,000 records were created by 25 centers in SMART DB. An artificial intelligence-based web solution for prediction of coronary artery disease in stroke patients was developed named S2CAD. A clinical decision support platform for thrombi acquired from endovascular thrombectomy named ARIA Cloud was developed. Software for stroke is actively being developed in Korea. Software solutions are expected to increase efficiency by providing clinical decision support in the near future.
各种各样的软件解决方案被用于临床应用。这个特别的贡献集中在开发几个关于中风的软件解决方案的个人经验上。Stroke119应用程序的开发是为了告知患者最近的医院可以进行溶栓治疗,并提供一个简单的三步自检来检测急性中风。开发了一个基于web的多中心注册解决方案SMART DB,以促进多中心研究。在SMART数据库中,25个中心创建了超过65万条记录。开发了一种基于人工智能的预测中风患者冠状动脉疾病的网络解决方案,命名为S2CAD。开发了血管内取栓术后血栓的临床决策支持平台ARIA Cloud。目前,国内正在积极开发治疗中风的软件。在不久的将来,软件解决方案有望通过提供临床决策支持来提高效率。
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引用次数: 0
Muscle Biopsy 肌肉活检
Pub Date : 2023-05-01 DOI: 10.17340/jkna.2023.2.14
Jin-Hong Shin, Sang Jun Park, Dae-Seong Kim
{"title":"Muscle Biopsy","authors":"Jin-Hong Shin, Sang Jun Park, Dae-Seong Kim","doi":"10.17340/jkna.2023.2.14","DOIUrl":"https://doi.org/10.17340/jkna.2023.2.14","url":null,"abstract":"","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129511789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Sudden Sensorineural Hearing Loss due to Basilar Artery Atherosclerotic Plaque without Diffusion Restriction 无扩散限制的基底动脉粥样硬化斑块引起的突发性感音神经性听力损失
Pub Date : 2023-05-01 DOI: 10.17340/jkna.2023.2.10
Nak-In Kim, Young Seo Kim
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引用次数: 0
期刊
Journal of the Korean Neurological Association
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