The Pre-stroke Bone Mineral Density in First Stroke Patients

OBJECTIVE: To evaluate pre-stroke bone mineral density (BMD) of the patients with first stroke events. We previously reported that pre-stroke BMD of first stroke patients with severe immobility were relatively lower than those of normal population. In current study, we evaluated pre-stroke BMD of patients in first stroke patients regardless of severity or type of stroke. METHOD: The 121 patients with first stroke events were included. To reflect pre-stroke BMD, patients who had bone densitometry scans within the first thirty days from onset were chosen. The BMDs of the lumbar spine and both femurs (total hip and femoral neck) were examined. RESULTS: Among the 121 stroke patients, 56.2% were osteoporotic and 28.1% were osteopenic. In the female patients, 78.1% were osteoporotic and 20.5% were osteopenic. In the male patients, 22.9% were osteoporotic and 39.6% were osteopenic. CONCLUSION: Patients with first stroke events showed a high prevalence of pre-stroke low BMD. In the acute stages of stroke, bone loss progression is rapid. Therefore, such a high prevalence of pre-stroke low BMD can bring on a greater risk of fractures and additional functional loss. Early screening and active intervention of osteoporosis including patient education from the acute stages of stroke is crucial.

Wernicke's Encephalopathy Caused by Dysphagia in Down Syndrome: A case report

A subset of aged individuals with Down syndrome (DS) exhibits eating, drinking, and swallowing (EDS) difficulties, which have the potential to lead to life-threatening conditions such as malnutrition. We report a case of 37-year-old woman with DS, who developed Wernicke's encephalopathy related to malnutrition that was caused by EDS problems. The patient presented with a history of EDS problems for 2 years without treatment and had developed mental-status changes, unsteadiness of stance and gait with associated MRI findings, corresponding to Wernicke's encephalopathy. The patient was treated with nutritional support including thiamine replacement and dysphagia rehabilitation therapy. Our case highlights the importance of early and proper management of malnutrition associated with EDS problems in adult DS. The suspicion of Wernicke's encephalopathy must be considered when adult DS manifests as prolonged malnutrition, altered mentality and decreased mobility.