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Korean Medicine Treatment with Scalp Acupuncture for Diplopia and Lateropulsion in a Patient with Lateral Medullary Infarction: A Case Report

Article information

J Korean Med. 2024;45(3):211-223
Publication date (electronic) : 2024 September 1
doi : https://doi.org/10.13048/jkm.24050
Yeong-Sang Kim1orcid_icon, Hyeonjun Woo1orcid_icon, Jin-Ah Oh2orcid_icon, Su-Hyeon Jeong1,orcid_icon
1Department of Rehabilitation Medicine of Korean Medicine, Se-Myung University Chungju Korean Medicine Hospital
2Department of Sasang Constitutional Medicine, Se-Myung University Chungju Korean Medicine Hospital
Correspondence to: Su-Hyeon Jeong, Department of Rehabilitation Medicine of Korean Medicine, Se-Myung University Chungju Korean Medicine Hospital, 63 Sangbang 4-gil, Chungju-si, Chungcheongbuk-do 27429, Republic of Korea, Tel: +82-43-841-1737, E-mail: js365a@hanmail.net
Received 2024 July 15; Revised 2024 August 20; Accepted 2024 August 23.

Abstract

Background

This case study aimed to report the efficacy of scalp acupuncture in a patient with diplopia or lateropulsion and lateral medullary infarction.

Case report

A 41-year-old woman with lateral medullary infarctions presented with symptoms of left-sided diplopia, left lateropulsion, headache, dizziness, and right-sided dysesthesia for 8 months. She received daily Korean medicine treatments, including scalp acupuncture. During the treatment period, various assessments were conducted, including the symptom score, visual analog scale (VAS), diplopia questionnaire (DQ), eyeball movement, dizziness handicap inventory (DHI), Korean version of the berg balance scale (K-BBS), activities-specific balance confidence scale (ABC), vestibular disorders activities of daily living scale (VADL), and the EuroQol five-dimension index (EQ-5D index). The patient’s symptom score, VAS, DQ, DHI, and VADL scores decreased, while K-BBS, ABC, and EQ-5D scores increased. Additionally, eyeball movements improved after Korean medicine treatment including scalp acupuncture.

Conclusions

The observed improvements suggest that Korean medicine treatment including scalp acupuncture can effectively alleviate diplopia and lateropulsion in patients with lateral medullary infarction.

Keywords: lateral medullary infarction; scalp acupuncture; diplopia; lateropulsion; Korean traditional medicine
Fig. 1

The patient’s brain magnetic resonance imaging apparent diffusion co-efficient (left) and diffusion weighted image (right).

Fig. 2

Picture of the patient who treated with scalp acupuncture. balance area, vision area (left), vertigo and hearing area (right).

Fig. 3

The change of diplopia questionnaire.

Fig. 4

Eyeball movement of patient on day of admission (October 4, 2023). (A) At rest. (B) The eyes open widely. (C) Frontal gaze. (D) Upward gaze. (E) Downward gaze. (F) Left lateral gaze. (G) Right lateral gaze.

Fig. 5

Eyeball movement of patient on day of two days before the discharge (December 6, 2023). (A) At rest. (B) The eyes open widely. (C) Frontal gaze. (D) Upward gaze. (E) Downward gaze. (F) Left lateral gaze. (G) Right lateral gaze.

Fig. 6

The change of eye movement ranges (At rest, The eyes open widely, Frontal gaze, Upward gaze, Downward gaze, Left lateral gaze, Right lateral gaze).

Fig. 7

The diplopia symptom score change before and after scalp acupuncture.

Fig. 8

The lateropulsion symptom score change before and after scalp acupuncture.

The Composition of Herbal medicine

The Changes of Evaluation method.

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Article information Continued

Fig. 1

Fig. 1

The patient’s brain magnetic resonance imaging apparent diffusion co-efficient (left) and diffusion weighted image (right).

Fig. 2

Fig. 2

Picture of the patient who treated with scalp acupuncture. balance area, vision area (left), vertigo and hearing area (right).

Fig. 3

Fig. 3

The change of diplopia questionnaire.

Fig. 4

Fig. 4

Eyeball movement of patient on day of admission (October 4, 2023). (A) At rest. (B) The eyes open widely. (C) Frontal gaze. (D) Upward gaze. (E) Downward gaze. (F) Left lateral gaze. (G) Right lateral gaze.

Fig. 5

Fig. 5

Eyeball movement of patient on day of two days before the discharge (December 6, 2023). (A) At rest. (B) The eyes open widely. (C) Frontal gaze. (D) Upward gaze. (E) Downward gaze. (F) Left lateral gaze. (G) Right lateral gaze.

Fig. 6

Fig. 6

The change of eye movement ranges (At rest, The eyes open widely, Frontal gaze, Upward gaze, Downward gaze, Left lateral gaze, Right lateral gaze).

Fig. 7

Fig. 7

The diplopia symptom score change before and after scalp acupuncture.

Fig. 8

Fig. 8

The lateropulsion symptom score change before and after scalp acupuncture.

Table 1

The Composition of Herbal medicine

Name Botanic name Amount(g) Name Botanic name Amount(g)
Cheonghunhwadam-tang
生薑 Zingiber officinale Roscoe 6 半夏 Pinellia ternata (Thunb.) Breitenbach 4
陳皮 Citrus unshiu Markovich 4 白茯苓 Poria cocos Wolf 4
枳實 Poncirus trifoliata Rafin. 2.8 白朮 Atractylodes japonica Koidz. 2.8
白芷 Angelica dahurica Bentham et Hooker 2 黃芩 Scutellaria baicalensis Georgi 2
羌活 Ostericum koreanum Maximowicz 2 川芎 Cnidium officinale Makino 2
人蔘 Panax ginseng C.A Mey 2 南星 Arisaema amurense Maximowicz 2
防風 Saposhnikovia divaricata Schischkin 2 細辛 Asarum sieboldi Miq. 1.2
黃連 C. chinensis Franch 1.2 甘草 Glycyrrhiza uralensis Fisch. 1.2

Table 2

The Changes of Evaluation method.

Day 10.04 10.11 10.18 10.26 11.02 11.09 11.15 11.23 11.30 12.07
Dizziness symptom score 7 3 0 0 0 0 0 2 0 0
Headache VAS 7 5.5 0 0 0 0 2 0 0 0
Dysaesthesia symptom score 7 6.5 5 3.5 3 3 5.5 2 1.5 1.5
DHI 21 16 12 2 4 0
K-BBS 43 53 53 54 55 56
VADL 51 43 37 31 32 32 31 32 31 31
ABC 1320 1440 1500 1500 1550 1550 1540 1530 1530 1530
EQ-5D index 0.738 0.805 0.871 0.862 0.871

VAS: visual analog scale, DHI: Dizziness Handicap Inventory, K-BBS: Korean version of Berg Balance Scale, VADL: Vestibular Disorders Activities of Daily Living Scale, ABC: Activities-specific Balance Confidence Scale, EQ-5D index: EuroQol five dimension index.