Evaluation of transcranial doppler in neuro-Behcet's disease patients

To study the value of transcranial Doppler [TCD] in patients with neuro-Behcet's disease [Neuro-BD] and to correlate the findings with the MRI results. This study included 15 patients fulfilling the diagnostic criteria of international study group for Behcet's disease. MRI brain was done and evaluated for the presence of parenchymal lesions. Bilateral transcranial Doppler ultrasound of the middle [MCA], anterior [ACA] and posterior [PCA] cerebral arteries were performed in patient and control groups. TCD parameters were compared between 15 patients and age and sex matched control subjects. We found 12 [80%] patients had single or multiple brain lesions on MRI. Most of these lesions were of high signal intensity on T2-weighted images and located in the brainstem, basal ganglia and deep white matter region. TCD findings were abnormal in 5 [33.3%] patients. Pulsatility and resistivity indices of the MCA were significantly higher in patients than in normal control [p<0.001]. The mean blood flow velocity of the MCA and ACA was marginally reduced in patients with neuro-BD than in healthy controls, but did not reach a statistical significance [p>0.05]. No significant relation was found between abnormal MRI lesions and TCD parameters. Cerebral hemodynamics might be affected in patients with Behcet's disease compared with healthy controls. TCD may be a useful tool in the evaluation of patients with neuro-Behcet's disease

Isokinetic muscle strength assessment of lower limbs in diabetic neuropathy

Motor dysfunction is a late and rare feature in diabetic distal sensory polyneuropathy. Early impairment of motor function in diabetic sensory neuropathy is largely unknown. We studied sixty patients with diabetic distal polyneuropathy, 30 patients with subclinical and 30 with clinical overt diabetic neuropathies. Thirty age and sex matched healthy subjects were used as a control group. Quantitative assessment of maximal muscle strength of extensors and flexors at knee and ankle was measured by isokinetic dynamometry in all patients and control subjects. The degree of neuropathy was determined by clinical and electrophysiological studies. Maximal isokinetic muscle strength in all patients was reduced by 14% for the ankle extensors [p<0.03] and by 17% for the ankle flexors [p<0.02]. At the knee, strength of extensors and flexors was reduced by 7% [NS] and 14% [p<0.05], respectively when compared with the control group. Muscle strength was significantly reduced in clinical diabetic neuropathy when compared with the control [p<0.05]. Impaired muscle strength was closely related to the severity of neuropathy. Amplitude of the compound muscle action potential was related to the strength at the ankle [r = -0.45, p< 0.01] and knee [r = -0.42, p< 0.02]. Diabetic patients may have early muscle weakness at the ankle and knee related to the presence and severity of diabetic neuropathy. Isokinetic dynamometry is a useful tool for evaluating muscle strength in early diabetic sensory neuropathy

Diagnostic value of ultrasonography in carpal tunnel syndrome

Objective: To evaluate the diagnostic value of ultrasonography in patients with clinically and electrophysiologically confirmed carpal tunnel syndrome [CTS]

Methodology: Seventy three wrists of 48 patients with clinically and electrophysiologically confirmed CTS and 60 wrists of 40 asymptomatic controls were included in the study. All of them underwent high resolution ultrasonography of the wrists. Cross sectional area and flattening ratio at the proximal carpal tunnel were measured in both groups

Results: There was a high degree of correlation between median nerve conduction abnormalities and the measurement of cross sectional area as measured by ultrasound [p<0.001]. The ultrasonographic measurements of median nerves were found to be increased significantly in patients with carpal tunnel syndrome when compared with controls, particularly in terms of cross sectional area [mean, 10.6 mm2 versus 6.1 mm2 p <0.001] and the flattening ratio [p<0.001]. A cut off value of cross sectional area larger than 9 mm2 at the level of proximal carpal tunnel provided a diagnostic sensitivity of 75.3% and specificity of 95 % and in 20.5 % of wrists, morphological changes suggested secondary causes

Conclusion: Additional diagnostic confirmation can be provided by ultrasonography, which is a sensitive, specific and useful non-invasive method for diagnosis of CTS and evaluation of the morphologic changes of the median nerve in CTS patients