, Ha Suk Bae, Tae Sik Yoon Post stroke dysphagia is a common disorder presented in 30-65% of stroke patients. It can result in severe complication such as aspiration pneumonia. Thus nutritional support with nasogastric(NG) feeding tube is needed in these patients. But this method is not recommended more than 4 weeks. In the patients with severe dysphagia, the percutaneous endoscopic gastrostomy(PEG) is recommended in respective with the complication and prognosis.
We experienced a case of 46 year-old-male with esophagogastric ulcer because of remnant NG feeding tube on stomach. He had not a special past history until admission. He was bedridden and quadriplegic state due to spontaneous intracranial hemorrhage on both fronto-parietal lobe and subdural hemorrhage. NG feeding tube(polyvinyl chloride, 16 French) was inserted because of severe dysphagia and the clinicians attempted the PEG tube insertion but removed the PEG tube due to the sepsis with wound infection and reinserted NG feeding tube. After transfer into our hospital, a sudden blood clot from NG feeding tube was drained. We performed gastrofibroscopic examination and found NG feeding tube remnant (23cm) on stomach. It was removed and multiple esophagogastric linear ulcer with hemorrhage due to exposed vessel was observed. He obtained nutrition by total parenteral nutrition for 4 weeks after that. On follow up gastrofibroscopic examination, esophagogastric ulcers were being healing. So we tried PEG tube insertion again but failed because of granulation tissue on previous PEG tube insertion site and inserted NG feeding tube. After 3 months, he was inserted PEG tube and being supported sufficient nutrition.
Many complications are associated with the prolonged NG feeding tube insertion. So recent studies showed alternative method in case of prolonged dysphagia. We report a case with esophagogastric ulcer associated with remnant NG feeding tube on stomach.
, Myung Shin Kim, Ju Young Lee, Jin Won Whang, Tae Sik Yoon The Arnold-Chiari Malformation is a cognenital disorder with symptoms such as ataxia, dissociated sensory loss, extremity pain, and frequently associated with other malformations of the same kind, including syringomyelia, basilar impression, atlantoaxial instability. The options for managements of the Chiari malformation have been under considerable debate, especially for case with syringomyelia. Presence of syrinx with evidence of motor weakness, sensory loss and ataxia has been reported as poor prognostic factor and may results in functional disability and dependency in activities of daily living and transfer. We report a case of Arnold-Chiari Malformation type I associated with syringomyelia and atlantoaxial instavility.
A 46 year-old man admitted to neurosurgery department with complaints of ataxic gait and decreased sensation in left extremities which were developed when he was 34 years old and aggravated slowly. 25 years ago he developed progressive weakness of intrinsic muscles of right hand. He was diagnosed as Arnold-Chiari Malformation type I. Under the diagnosis of atlantoaxial instability, the patient was treated with operation of craniocervical fusion and laminectomy at C2-C3 level. Despite these treatment, ataxic gait, motor weakness and sensory dissociation was not improved. After the patient was transferred to rehabilitation department, he received comprehensive rehabilitation program. The patient's functional independence measurement(FIM) score at admission was 72 and improved to 104 discharge. The patient was discharged with the state of the monocane ambulation. Like this case, Arnold-Chiari malformation associated with syringomyelia with the evidence of muscle atrophy, ataxia have poor prognosis, therefore early diagnosis and proper managements along with comprehensive rehabilitation is critical in obtaining the best outcome.
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