Search Results (6)

Background: Hypertrophic olivary degeneration (HOD) is a rare neurological condition resulting from trans-synaptic degeneration of the inferior olivary nucleus (ION) following disruption of the dentato-rubro-olivary pathway, also known as the Guillain–Mollaret triangle (GMT). Although the clinical and radiologic features of HOD have been previously described, the precise temporal correlation between clinical symptom onset and manifestations on magnetic resonance imaging (MRI) remains difficult to establish, and the factors contributing to accelerated disease progression are poorly understood. Case Presentation: A 43-year-old male presented with intracerebral hemorrhage involving the left midbrain, bilateral pons, and cerebellum. Serial MRI was prospectively performed starting four weeks post-hemorrhage, at which time no signal abnormalities were detected in the ION. However, at 9 weeks, T2 hyperintensity first emerged in the bilateral ION. Approximately 2 weeks after this finding, the patient developed characteristic palatal and lingual tremors, accompanied by a dissociated vertical pendular nystagmus that was predominantly monocular (right eye). In addition, severe dysphagia was also noted, with videofluoroscopic swallowing study (VFSS) showing aspiration across all diets. A subsequent MRI obtained at 13 weeks post-insult (two weeks after tremor onset) revealed newly developed bilateral ION hypertrophy, with the maximal diameter increasing from a 5 mm baseline to 7 mm. Follow-up MRI at 17 weeks post-hemorrhage revealed further progression with increased hypertrophy and signal intensity. Dysphagia persisted throughout the clinical course, ultimately necessitating percutaneous endoscopic gastrostomy (PEG) tube insertion. Conclusions: This case provides rare, longitudinal documentation of the clinico-radiologic progression of HOD, facilitated by a pre-insult baseline MRI and prospective serial imaging. Our findings provide a detailed timeline of the transition from signal abnormality to hypertrophy in correlation with clinical symptom emergence. Full article

Mastication and swallowing are complex physiological processes involving the coordinated activity of multiple tissues in the oral cavity, facial region, and laryngeal system. Some detection methods suffer from limitations such as insufficient information acquisition and inadequate temporal feature analysis. To address these issues, this study proposes a conceptual method for analyzing the state of masticatory and swallowing movements. It integrates maxillofacial electromyographic (EMG) signals with laryngeal movement signals. The goal is to preliminarily explore state analysis of masticatory and swallowing movements over time. A designed gain-adjustable conditioning circuit processes and acquires these signals: maxillofacial EMG signals from EMG electrodes and laryngeal movement signals from flexible PVDF piezoelectric sensors. These two signal streams complement each other’s missing information, enabling comprehensive detection of the state of masticatory and swallowing movements. To address time-point labeling in mastication and swallowing, a sliding-window-based dispersion calculation method was employed to extract characteristic signal nodes, which were then accurately associated with their corresponding physiological motion states. We combined temporal features such as the zero point, onset of fluctuations, characteristic peaks, and baseline recovery from electromyographic (EMG) signals and laryngeal movement signals. This allowed us to establish a correspondence between key time points in the mastication and swallowing processes. The coefficient of determination (R²) for the pressure–voltage linear fit of the PVDF flexible piezoelectric sensor was 0.99446. The pressure resolution was approximately 0.08 kPa. Response times were no more than 15 ms for the EMG channel and no more than 10 ms for the PVDF pressure channel. These results indicate that this method is feasible for extracting oral movement time parameters in healthy subjects. Full article

Several studies support the benefits of biofeedback and Functional Electrical Stimulation (FES) in dysphagia therapy. Most commonly, adhesive electrodes are placed on the submental region of the neck to conduct Electromyography (EMG) measurements for controlling gamified biofeedback and functional electrical stimulation. Due to the diverse origin of EMG activity at the neck, it can be assumed that EMG measurements alone do not accurately reflect the onset of the pharyngeal swallowing phase (onset of swallowing). To date, no study has addressed the timing and detection performance of swallow onsets on a comprehensive database including dysphagia patients. This study includes EMG and BioImpedance (BI) measurements of 41 dysphagia patients to compare the timing and performance in the Detection of Swallow Onsets (DoSO) using EMG alone versus combined BI and EMG measurements. The latter approach employs a BI-based data segmentation of potential swallow onsets and a machine-learning-based classifier to distinguish swallow onsets from non-swallow events. Swallow onsets labeled by an expert serve as a reference. In addition to the F1 score, the mean and standard deviation of the detection delay regarding reference events have been determined. The EMG-based DoSO achieved an F1 score of 0.289 with a detection delay of 0.018 s ± 0.203 s. In comparison, the BI/EMG-based DoSO achieved an F1 score of 0.546 with a detection delay of 0.033 s ± 0.1 s. Therefore, the BI/EMG-based DoSO has better timing and detection performance compared to the EMG-based DoSO and potentially improves biofeedback and FES in dysphagia therapy. Full article

Cervicofacial subcutaneous emphysema (SE) is primarily caused by dental treatment introducing gas into the subcutaneous tissue. Air rapidly dissects into the subcutaneous tissue with face and neck swelling, leading to respiratory distress, patient discomfort, and chest pain. Computed tomography (CT) can detect spreading SE patterns. However, the true volume of SE and the degree of air changes in the body over time remain unknown. We evaluated the healing process of SE and the temporal changes in the volume of emphysema in three cases detected using our hospital’s electronic health record systems based on inclusion and exclusion criteria over the past 10 years, with CT and three-dimensional (3D) images. The first case was a 46-year-old woman who presented with complaints of swelling from her right eyelid to the neck and clavicles, pain on swallowing, respiratory distress, and hoarseness. The second case was a 35-year-old man who presented with complaints of swelling over the face. The third case was a 36-year-old man who presented with complaints of swelling from the left cheek to the neck. CT revealed SE and pneumomediastinum in all cases. All the patients were administered an antibacterial drug. The CT and 3D images showed an improvement in emphysema 3 days after the onset, with more than half of the volume reduction in emphysema. This made it possible to evaluate the changes in the air content of SE. Observation with CT until the healing process of SE is completed is crucial, and 3D images also help evaluate changes over time. Full article

Malnutrition and sarcopenia often coexist in rehabilitation patients, although they are often overlooked and undertreated in clinical practice. This cross-sectional study aimed to clarify the prevalence of the coexistence of malnutrition and sarcopenia (Co-MS) and its associated factors in convalescent rehabilitation wards in Japan. Consecutive patients aged ≥ 65 years in convalescent rehabilitation wards between November 2018 and October 2020 were included. Malnutrition and sarcopenia were determined by the Global Leadership Initiative on Malnutrition (GLIM) criteria and the Asian Working Group for Sarcopenia (AWGS 2019) criteria, respectively. Patients who presented both with malnutrition and sarcopenia were classified as Co-MS. Potentially associated factors included age, sex, days from onset to admission of rehabilitation wards, reason for admission, pre-morbid functional dependency, comorbidity, activities of daily living, swallowing ability, and oral function and hygiene. The prevalence of malnutrition, sarcopenia, and Co-MS was calculated. Binary logistic regression analyses were performed to compute odds ratios (ORs) and the 95% confidence interval (CI) of possible associated factors for each condition. Overall, 601 patients were eligible for the analysis (median 80 years old, 355 female patients, 70% cerebrovascular disease). Co-MS, malnutrition, and sarcopenia were found in 23.5%, 29.0%, and 62.4% of the enrolled patients, respectively. After adjustment, onset–admission interval (OR = 1.04; 95% CI = 1.02 to 1.06), hospital-associated deconditioning (OR = 4.62; 95% CI = 1.13 to 18.8), and swallowing ability (Food Intake LEVEL Scale) (OR = 0.83; 95% CI = 0.73 to 0.93) were identified as independent explanatory factors of Co-MS. In conclusion, Co-MS was prevalent in geriatric rehabilitation patients; thus, healthcare professionals should be aware of the associated factors to detect the geriatric rehabilitation patients who are at risk of both malnutrition and sarcopenia, and to provide appropriate treatments. Full article

To detect the variations of esophageal peristalsis in amyotrophic lateral sclerosis (ALS) patients with predominantly bulbar or predominantly pseudobulbar clinical presentation by using esophageal manometry (EM). Fifteen ALS patients with pseudobulbar clinical presentation (PBP) and 13 patients with bulbar presentation (BP), fulfilling WFN Criteria, were studied. EM was performed in all subjects using a flexible catheter with solid-state transducers. Swallowing was initiated with 5 to 10 mL of water (wet swallows) and saliva (dry swallows) and repeated at 30 s intervals. The manometric parameters were measured automatically and visualized by the computer system. The tracings were analyzed using Synectics software. In PBP patients, an increase of resting pressure value in the upper esophageal sphincter (UES) >45 mmHg, a wave-like course of resting pressure, and toothed peristaltic waves were observed. In BP patients, a low amplitude of peristaltic waves <30 mmHg (mean: 17 ± 5) was recorded, without signs of esophageal motility disturbance at onset or during progression. EM procedure allows objectively distinguishing dysphagia in ALS patients due to bulbar syndrome from the dysphagia due to pseudobulbar syndrome. It is important to identify PBP patients because of their high risk of aspiration. Full article