Evaluation of Vascular Response using Impedance Plethysmography in Patients with Spinal Cord Injury

OBJECTIVE: To determine abnormal vascular response to cuff ischemia in patients with spinal cord injury (SCI). METHOD: Ankle blood pressure (ABP) and ankle-brachial index (ABI) in 20 SCI patients (14 men, 6 women, mean age 39.8 years) and control group (14 men, 6 women, mean age 40.2 years) were measured using impedance plethysmography at rest and after distal thigh cuff compression for 5 and 10 minutes. The patients were divided into tetraplegia (10), paraplegia (10), complete injury (8) and incomplete injury (12). RESULTS: There was no significant difference in ABP and ABI at rest and 5 minutes of ischemic compression between the patients and control groups. However, ABP and ABI decreased more at 10 minutes of ischemic compression in SCI compared to control groups (p<0.001). Changes of ABP and ABI between tetraplegia and paraplegia were not different. Complete injury of SCI decreased more than incomplete injury at 10 minutes of ischemia in the APB and ABI (p<0.001). CONCLUSION: Vascular control was significantly impaired in patients with spinal cord injury. Impedance plethysmography can be a useful and objective tool in evaluation of vascular response for the patients with spinal cord injury.

Type A Botulinum Toxin Therapy on Thoracic Outlet Syndrome: A case report

The true neurogenic thoracic outlet syndrome (TOS), one type of the TOS, has vague and controversial clinical symptoms, so a variety of diseases can mimic the presentation of TOS, especially ulnar neuropathy or cervical root lesion. For most patients with TOS, common practice is to offer a course of conservative treatment, but its kinds are not enough and pain is too severe to do that in the chronic state. We experienced a case of true neurogenic thoracic outlet syndrome with distinctive clinical symptom and abnormal electrodiagnostic findings. The symptom was not controlled by conservative management including oral medication or physical therapy. So we injected type A botulinum toxin (Botox(R)) in the scalene and pectoralis minor muscles with ultrasonography guide. After 2 weeks, the pain decreased in visual analogue scale nine to four, and the compliance to physical therapy was improved. The result appeared to demonstrate that botulinum toxin injection may be helpful in controlling symptoms and making the patient adapt in physical therapy in the difficult case to management by any other methods.