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One case of mirror writing after cerebral infarction
ELSEVIER
WorldJournal ofAcupuncture-Moxibustion(WJAM) Vol. 25, No.3, 30th Sep. 2015
• 59 •
Medical Record
One case of mirror writing after cerebral infarction Jmif!~JEfm1~~~~ WANG Run-sheng (.I.jM!t) Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China (1t~~*4*~~~~tJ?:~.Y! ~~, ~tJ?: 100029, 9='~)
ARTICLE INFO Author: WANG Run-sheng (1968-), male, attending physician. Research field: acupuncture therapy on mind cognition and postoperative complications. E-mail: [email protected]
The male patient is 70 years old, with the case No. of 00350405. He sought medical advices in acupuncture clinic of Beijing Anzhen Hospital on February 14,2011 with the chief complaints of dizziness and writing disorder for about one month. Medical history: five weeks ago, the patient was admitted to neurology department (emergency) of our hospital for suffering from dizziness and numbness and asthenia of unilateral limb. Cephalic NMR imaging diagnosis: lesions on left pedunculus cerebri, right thalamus and bilateral basal ganglia region, corona radiata region
and lacuna of centrum semiovale, and new cerebral infarction at left pedunculus cerebri. After treated at neurology department for three weeks, the patient got better and discharged from hospital. Current symptom: dizziness, discomfort and writing disorder. Physical examination: the mind was conscious with fluent language expression, the myodynamia of limbs was at grade V, and the limbs moved freely. But writing disorder was observed. His pulse was wiry, the tongue was light red and the costing was thin and white. Heart rate: 70 beats/min. Blood pressure: 120/80 mmHg (1 mmHg=0.133 kPa). TCM diagnosis: apoplexyapoplexy involving the meridians and collaterals, and the qi and blood stasis obstruction was formed in brain. Therapeutic method: invigorating blood and dissolving stasis, unblocking the meridians and quickening the collaterals, and opening the orifices and restoring consciousness. Point selection: Baihui ~ GV 20), bilateral Taiyang (*13B EX-HN 5), Fengchi ()5<\.rm GB 20) and Fengfii ()5<\.J# GV 16) were selected. Routine disinfection was conducted on the skin of acupoints first, and then continuous insertion was performed between GV 20 and EX-HN 5 for four times, with the needling depth of about 10 mm. The needling sensation of mellow should be the best. Oblique insertion was conducted at GB 20 and GV 16 for 10 mm with the method of even reinforcement and reduction, and the needle was retained for 60 min at each acupoint. The treatment was conducted once every other day, and two months were considered as one course of treatment. Before this time of attack,
eEf
the patient often transcribed the characters from newspapers and magazines as shown in Figure 1. After attack, his writing was unrecognized, as shown in Figure 2. After acupuncture treatment for three weeks (about ten times), his writing was cognizable but it was mirror writing, as shown in Figure 3. After treatment for another two weeks (eight times), mirror writing disappeared and the writing was normal, as shown in Figure 4. After acupuncture treatment, dizziness disappeared, the patient's writing was normal, and the efficacy was satisfying. The patient reserved his writing materials during the onset of cerebral infarction, so we can see the significant change of his writing after acupuncture treatment for approximate one month (eighteen times).
Note: mirror writing, a kind of special writing disorder, refers to a phenomenon of character reversal, which may occurs among both healthy people and patients with brain injury. In the perspective of the nature of mirror writing, it can be divided into two types, pathological mirror writing and conditional mirror writing. Pathological mirror writing derives from pathological reaction caused by neural mechanism injury. Mirror writing generated from brain injury belongs to pathological writing disorders. The patient may not be aware of the disorder during onset, and make no change after others point out the problem. The recovery of mirror writing depends on the rehabilitation of brain injury. It is believed in TCM that "the brain is the house of original spirit"
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WorldJournal ofAcupuncture-Moxibustion (WJAM) Vol. 25, No.3, 30th Sep.2015
"brainwave and memory are both in the brain" "the head is the house of bright essence", and "the head is the confluence of all yang-meridians". The head, closely related with zang-fu organs and meridians and collatera1s, is the location converging qi and blood. There are ten meridians directly connecting with the head among the twelve main meridians, and governor vessel, conception vessel, yang-link vessel, yin-link vessel, yangqiao vessel and yinqiao vessel also connect with the head among eight extraordinary vessels. If qi and blood stasis obstruction occurs in the head, the brain will be unblocked, and the cerebral function will be affected, with various kinds of sequela. With the effects of strengthening the brain and calming the mind, and dredging the joints and opening the orifices, GB 20 and GV 16 intersect with governor vessel, yang-link vessel and the footshaoyang, and several meridians enter the brain by way of the two points. GV 20, located in the top of the head, is also called "sanyang wuhui", It connects with the brain, and is the intersecting point of governor vessel, foot-taiyang, hand and foot-shaoyang and footjueyin liver meridian, with the functions of unblocking qi and blood of all meridians, up flourishing the brain, reaching house of original spirit, and strengthening the brain and reinforcing the intelligence. Continuous penetration needling from GV 20 to EX-HN 5 goes by the calvaria, frontal part and tempus, and runs through the governor vessel, taiyang bladder meridian and shaoyang gallbladder meridian, so as to inspire yang qi, unblock the meridians and quicken the collatera1s, and open the block and restore consciousness. Modem researches have shown that when scalp acupuncture is conducted on the cerebral cortex, the blood flow volume in cortical area will change, microcirculation and anaerobic condition of cerebral cortex will be improved, and the recovery of cortical function will be promoted. Thus it can be seen that scalp acupuncture
ELSEVIER
Figure 1 The patent's handwriting before attack
Figure 2 The patent's handwriting after attack
Figure 3 The patent's handwriting after 10 times of acupuncture
Figure 4
The patent's handwriting after 18 times of acupuncture
is significantly effective on the recovery of cerebral function injury.
REFERENCES [1]
[2]
[3]
Xie YX, Zhao ZH, Ao CL, Yang WL. Mirror writing and training outcome after hand-shift in patients with hemiplegia. Chin J Rehabil Med (Chin) 1995; 10(6): 245247+260. Wang K. Mirror writing of patients with cerebrovascular diseases. J Apoplexy Nerv Dis (Chin) 1994; 11(6): 347, 362. Wang XD. Relationship between mirror writing and cerebral function integration and degradation. J Clin Electroneurophysiol (Chin) 2003; 12(4): 195-197+224.
WorldJournal ofAcupuncture-Moxibustion(WJAM) Vol. 25, No.3, 30th Sep. 2015
• 59 •
Medical Record
One case of mirror writing after cerebral infarction Jmif!~JEfm1~~~~ WANG Run-sheng (.I.jM!t) Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China (1t~~*4*~~~~tJ?:~.Y! ~~, ~tJ?: 100029, 9='~)
ARTICLE INFO Author: WANG Run-sheng (1968-), male, attending physician. Research field: acupuncture therapy on mind cognition and postoperative complications. E-mail: [email protected]
The male patient is 70 years old, with the case No. of 00350405. He sought medical advices in acupuncture clinic of Beijing Anzhen Hospital on February 14,2011 with the chief complaints of dizziness and writing disorder for about one month. Medical history: five weeks ago, the patient was admitted to neurology department (emergency) of our hospital for suffering from dizziness and numbness and asthenia of unilateral limb. Cephalic NMR imaging diagnosis: lesions on left pedunculus cerebri, right thalamus and bilateral basal ganglia region, corona radiata region
and lacuna of centrum semiovale, and new cerebral infarction at left pedunculus cerebri. After treated at neurology department for three weeks, the patient got better and discharged from hospital. Current symptom: dizziness, discomfort and writing disorder. Physical examination: the mind was conscious with fluent language expression, the myodynamia of limbs was at grade V, and the limbs moved freely. But writing disorder was observed. His pulse was wiry, the tongue was light red and the costing was thin and white. Heart rate: 70 beats/min. Blood pressure: 120/80 mmHg (1 mmHg=0.133 kPa). TCM diagnosis: apoplexyapoplexy involving the meridians and collaterals, and the qi and blood stasis obstruction was formed in brain. Therapeutic method: invigorating blood and dissolving stasis, unblocking the meridians and quickening the collaterals, and opening the orifices and restoring consciousness. Point selection: Baihui ~ GV 20), bilateral Taiyang (*13B EX-HN 5), Fengchi ()5<\.rm GB 20) and Fengfii ()5<\.J# GV 16) were selected. Routine disinfection was conducted on the skin of acupoints first, and then continuous insertion was performed between GV 20 and EX-HN 5 for four times, with the needling depth of about 10 mm. The needling sensation of mellow should be the best. Oblique insertion was conducted at GB 20 and GV 16 for 10 mm with the method of even reinforcement and reduction, and the needle was retained for 60 min at each acupoint. The treatment was conducted once every other day, and two months were considered as one course of treatment. Before this time of attack,
eEf
the patient often transcribed the characters from newspapers and magazines as shown in Figure 1. After attack, his writing was unrecognized, as shown in Figure 2. After acupuncture treatment for three weeks (about ten times), his writing was cognizable but it was mirror writing, as shown in Figure 3. After treatment for another two weeks (eight times), mirror writing disappeared and the writing was normal, as shown in Figure 4. After acupuncture treatment, dizziness disappeared, the patient's writing was normal, and the efficacy was satisfying. The patient reserved his writing materials during the onset of cerebral infarction, so we can see the significant change of his writing after acupuncture treatment for approximate one month (eighteen times).
Note: mirror writing, a kind of special writing disorder, refers to a phenomenon of character reversal, which may occurs among both healthy people and patients with brain injury. In the perspective of the nature of mirror writing, it can be divided into two types, pathological mirror writing and conditional mirror writing. Pathological mirror writing derives from pathological reaction caused by neural mechanism injury. Mirror writing generated from brain injury belongs to pathological writing disorders. The patient may not be aware of the disorder during onset, and make no change after others point out the problem. The recovery of mirror writing depends on the rehabilitation of brain injury. It is believed in TCM that "the brain is the house of original spirit"
·60·
WorldJournal ofAcupuncture-Moxibustion (WJAM) Vol. 25, No.3, 30th Sep.2015
"brainwave and memory are both in the brain" "the head is the house of bright essence", and "the head is the confluence of all yang-meridians". The head, closely related with zang-fu organs and meridians and collatera1s, is the location converging qi and blood. There are ten meridians directly connecting with the head among the twelve main meridians, and governor vessel, conception vessel, yang-link vessel, yin-link vessel, yangqiao vessel and yinqiao vessel also connect with the head among eight extraordinary vessels. If qi and blood stasis obstruction occurs in the head, the brain will be unblocked, and the cerebral function will be affected, with various kinds of sequela. With the effects of strengthening the brain and calming the mind, and dredging the joints and opening the orifices, GB 20 and GV 16 intersect with governor vessel, yang-link vessel and the footshaoyang, and several meridians enter the brain by way of the two points. GV 20, located in the top of the head, is also called "sanyang wuhui", It connects with the brain, and is the intersecting point of governor vessel, foot-taiyang, hand and foot-shaoyang and footjueyin liver meridian, with the functions of unblocking qi and blood of all meridians, up flourishing the brain, reaching house of original spirit, and strengthening the brain and reinforcing the intelligence. Continuous penetration needling from GV 20 to EX-HN 5 goes by the calvaria, frontal part and tempus, and runs through the governor vessel, taiyang bladder meridian and shaoyang gallbladder meridian, so as to inspire yang qi, unblock the meridians and quicken the collatera1s, and open the block and restore consciousness. Modem researches have shown that when scalp acupuncture is conducted on the cerebral cortex, the blood flow volume in cortical area will change, microcirculation and anaerobic condition of cerebral cortex will be improved, and the recovery of cortical function will be promoted. Thus it can be seen that scalp acupuncture
ELSEVIER
Figure 1 The patent's handwriting before attack
Figure 2 The patent's handwriting after attack
Figure 3 The patent's handwriting after 10 times of acupuncture
Figure 4
The patent's handwriting after 18 times of acupuncture
is significantly effective on the recovery of cerebral function injury.
REFERENCES [1]
[2]
[3]
Xie YX, Zhao ZH, Ao CL, Yang WL. Mirror writing and training outcome after hand-shift in patients with hemiplegia. Chin J Rehabil Med (Chin) 1995; 10(6): 245247+260. Wang K. Mirror writing of patients with cerebrovascular diseases. J Apoplexy Nerv Dis (Chin) 1994; 11(6): 347, 362. Wang XD. Relationship between mirror writing and cerebral function integration and degradation. J Clin Electroneurophysiol (Chin) 2003; 12(4): 195-197+224.