Brief Cognitive and Visuospatial Assessment for Patient with Stroke and Correlation of Cognitive Function and Functional Outcome

OBJECTIVE: To know the usefulness of the Modified Mini- Mental State Exam (3MS) as a screening test of cognitive function after stroke and the relationship between the 3MS with clock drawing task (CDT) and the 3MS with visual scan task (VST) in view of visual neglect and functional outcome. METHOD: We studied 17 patients with unilateral hemisphere stroke [7 right hemisphere stroke (RHS), 10 left hemisphere stroke (LHS)] who have a mean age of 59.4 years and a mean hospital stay of 34.3 days on final examination. None of them had the previous history of mental illness or the previous stroke attack. We performed the MMSE, 3MS, VST and CDT at the first week of onset of stroke and at discharge. RESULTS: 1) 3MS was a valuable screening test of cognitive function like MMSE (p<0.05) in both RHS and LHS groups. 2) VST was a valuable screening method of unilateral neglect in patients with normal 3MS (p<0.05). 3) CDT was also valuable screening method of unilateral neglect in patients with normal 3MS (p<0.05). 4) 3MS with CDT showed no significant correlation with FIM score (p<0.05). CONCLUSION: We think that 3MS is a valuable screening test of cognitive function after stroke. VST and CDTs are valuable screening tools in estimating unilateral neglect after stroke. But 3MS with CDT is not well correlated with functional outcome.

Diagnostic Value of Ultrasonography for Limited Finger Joint Mobility in Diabetes

OBJECTIVE: To investigate the diagnostic value of ultrasonography for limited finger joint mobility in diabetes and association between limited finger joint mobility and the presence of diabetic chronic complications. METHODS: Ultrasonography were performed in 13 non insulin-dependent diabetes with limited finger joint mobility and 15 non insulin-dependent diabetes without limited finger joint mobility matched for similar ages, sexes and durations of diabetes. Controls consisted of 12 healthy volunteers with no evidence of diabetes mellitus. Ultrasonography was used to measure flexor tendon and tendon sheath thickness of the third and fourth fingers in the volar aspect of both hands. We evaluated neuropathy, nephropathy and retinopathy in all diabetic patients and investigated association between limited finger joint mobility and the presence of diabetic chronic complications. RESULTS: Thickness of flexor tendon sheath of the third and fourth fingers were significantly increased in the diabetes with limited finger joint mobility compared to the diabetes without limited finger joint mobility (p<0.01). Also, flexor tendon thickness of the third finger was significantly increased in the diabetes with limited finger joint mobility compared to the diabetes without limited finger joint mobility (p<0.05). The diabetes with limited finger joint mobility had a significantly increased frequency of the diabetic chronic complications (p<0.05). CONCLUSION: In the diabetes with limited finger joint mobility, thickening of flexor tendon sheath and tendon were shown by ultrasonography. This finding suggests that ultrasonography can be used to diagnose limited finger joint mobility in the diabetes. Limited finger joint mobility is closely associated with diabetic chronic complications.

Paralytic Disease Related to Enterovirus 71 Infection: A report of 4 cases

Enterovirus 71 (E-71) infection was first described in 1974 after isolation studies of specimens from a series of patients who had severe neurological disease. One important feature of E-71 is its ability to cause paralytic disease. In the summer of 1997, we identified 4 children with E-71 infection. The striking feature of this outbreak is the occurrence of all cases with polio-like paralytic disease. Other disease associated with E-71 infection included aseptic meningitis, meningoencephalitis, respiratory disease, gastroenteritis, and hand-foot-mouth disease. The spectrum of illness observed in our cases was compared to that seen in other outbreaks. It is suggested that the significance of E-71 infection lies in its neuropathogenic potential. There is no specific, therapeutic modality of E-71 infection but its prognosis is good except some cases.