Asymptomatic electrophysiologic carpal tunnel syndrome in diabetics: entrapment or polyneuropathy

Electrophysiologic carpal tunnel syndrome (CTS) is common and is frequently asymptomatic in diabetics. In order to evaluate the clinical significance of asymptomatic electrophysiologic CTS, the nerve conduction studies (NCS) of 48 diabetics with asymptomatic electrophysiologic CTS were compared with those of 56 age and gender-matched controls, as well as 50 patients with symptomatic CTS without diabetes. Nerve conduction velocities of the ulnar, peroneal, and posterior tibial nerves were significantly slower in diabetics with asymptomatic electrophysiologic CTS than in normal controls. Compared to symptomatic non-diabetic CTS, there was also significant slowing of the median and ulnar nerve conduction velocities in asymptomatic diabetic CTS. However, in diabetics with asymptomatic CTS, abnormalities of the distal segment of the median NCS were more prominent compared with those of all the other tested nerves. These findings suggested that asymptomatic electrophysiologic CTS in diabetics is a manifestation of increased vulnerability to the entrapment of the peripheral nerve.

The usefulness of standardization of the nerve conduction study in the diagnosis and follow up of the demyelinating polyneuropathy

BACKGROUND: Nerve conduction study is an objective and quantitative diagnostic method for the diagnosis and follow-up study of polyneuropathy. Sometimes it is hard to interpret the nerve conduction study, because there are many segmental variables to test and uneven distribution of abnormalities in polyneuropathy. And there can be some interpersonal differences in the interpreting the results. It is obvious that one objective and quantitative value that represents the many segmental variables is helpful for the clinical interpretation and follow?up of polyneuropathy. METHODS: We evaluated 242 normal subjects and 71 patients with demyelinating polyneuropathy to find out a standardized representative value, distinguishing patients from normal subjects. The standardized representative value was made by combination of the some standardized segmental variables which showed marked differences between two groups. We evaluated the clinical usefulness of this value by comparing the sequential changes of this value with the clinical course. RESULTS: Statistically significant differences were present in each segmental value of the nerve conduction study between the groups of patients and normal persons. The diagnostic sensitivity of the segmental value was in range of 25.7%-81.8% in case of 2SD criteria. The diagnostic sensitivity of each functional standardized value - average of the segmental standardized values of same nature - was in range of 54.1%-89.9% in case of 2SD criteria. Using 3SD criteria the sensitivity was reduced to 20.9%-81.1%, more in sensory and mixed nerve than motor nerve. By combination of these functional standardized values, the diagnostic sensitivity could increase up to 79.1%-93.2% on 3SD criteria. CONCLUSION: The best combination which represents the NCV study is the average of the motor nerve terminal latency, the motor nerve conduction velocity, and the ratio of conduction block with 93.2% sensitivity and 100% specificity. This representative value well reflects the clinical course of patient in follow-up studies.

None uniformity of muscle pathology in Becker muscular dystrophy

Incontinentia pigmenti (IP) is a rare hereditary neurocutaneous syndrome characterized by typical linear hyperpigmentationed skin lesions, often associated with central nervous system (CNS) involvement, dysplasia in dental and skeletal system, and ocular abnormalities. Thirty to fifty percent of the patients suffer CNS complications such as mental retardation, seizures, spastic paralysis, microcephaly, and cerebellar ataxia. We experienced a case of incontinentia pigmenti in three-month-old female patient who had characteristic linear hyperpigmented skin lesion on both her thighs and partial seizure with secondary generalization. She had family history of typical skin lesions on her maternal relatives. She showed abnormal findings on EEG as well as multiple necrotic lesions on brain MRI. Confirm diagnosis of incontinentia pigmenti was made by skin biopsy.

A case of cervical discitis presenting as a acute bacterial meningitis after velopharyngoplasty

Infectious discitis(spondylitis) in adult is rare, accounting for only 5% of all cases Of pyogenic osteomyelitis. Because clinical picture is often nonspecific, diagnosis in early stage is difficult. Therefore, both radiographic and microbiological criteria are need to establish the diagnosis. We report a case of cervical discitis presenting as a acute bacterial meningitis after velopharyngoplasty. Cervical MRI showed C2 C3 disc space narrowing and inhomogenous signal intensity of C2 and C3 vertebral bodies which was compatible with pyogenic discitis. His initial presenting bacterial meningitis proved by CSF examination was secondary to cervical discitis and required prolonged antibiotic theraphy. To the best of our knowledge, this is the first case of primary cervical discitis with bacterial meningitis in Korea.

Therapeutic effects of thymectomy in patients with myasthenia gravis

Thymectomy is considered as one of the important therapy for patients with myasthenia gravis(MG) for reducing the symptoms and hasting the time of remission. However, the efficacy of thymectomy in previous studies were not in concordant with each others. This study was designed to assess the effects of thymectomy in 84 MG patients. The patients were divided into two groups according to their medications before thymectomy : the patients who had been treated with anticholinesterase(ACE group) and the others who had been treated with both anticholinesterase and steroid(steroid group). The outcomes of thymectomy were divided into two group : ""success"" and ""failure"". The ""success"" outcomes included the patients with remission or improvements and the ""failure"" outcomes included the patients with improvement by immunosuppressive agents, unimprovement, and death. To find factors which might influence on the prognosis after thymectomy, the following variables were considered for statistics; The onset age of MG, gender, myasthenic crisis before operation, the clinical symptoms at the time of operation, and the pathologic findings of thymus. The results were as follows. Sixty-six patients were included in ACE group and 18 in steroid group. The success were occurred in 37 patients among ACE group(56%) and in 8 patients among steroid group(44.4%). In ACE group, the success more frequently occurred in the patients with thymic follicular hyperplasia(79.3%) than in those with thymoma(36%), and normal or atrophic thymus(41.7%). The Patients who had mild clinical symptoms at the operation also showed higher success rate. However, gender, the age of onset, and the presence of myasthenic cirsis before the operation did not influences on the results of the operation. In steroid group, the success rate was higher in the patients with shorter duration of steroid treatment before thymectomy(< 6 month) and follicular hyperplasia. In addition, the immunosuppressive treatments also gave symptomatic improvements in most patients with failure outcomes after thymectomy. In conclusion, thymectomy demonstrated beneficial effects in about half of MG patients. Follicular hyperplasia and mild symptoms at the operation were considered to be factors for predicting better results after thymectomy. Our findings also suggest that the longstanding steroid treatment before thymectomy may negatively affect on the successful thymectomy, especially on remission.

Neurologic Complications of Herpes Zoster

Herpes zoster is an acute, self-limited disease of infectious origin. It is characterized by grouped vesicular lesions on an erythematous base distributed over several dermatomes as well as single. In some cases the patients can be found to have an identifiable risk factor such as old age, malignancy, irradiation, chemotherapy, immunosuppresive therapy and trauma. The majority of cases are self-limited and resolved completely. However it may have serious complication. We reviewed 369 cases of herpes zoster to determine the distribution of lesions, incidence of postherpetic neuralgia, associated disorders, and the age. 134 cases (36.1%) of 369 cases with herpes zoster were associated with chronic disorders. The complications of herpes zoster were developed in 71 cases (19.2%) and postherpetic neuralgia (PHN) was the most commom complication. The frequency and severity of postherpetic neuralgia were proportional to age. There was a predilection of the involvement in thoracic dermatomes, lumbar dermatomes and ophthalmic division of trigeminal nerve in decreasing order of frequency. The incidence and duration of postherpetic neuralgia are significantly related to age.

Eye movement changes in albinism : a case report with electronystagmographic findings

Albinism is associated with neural anomalies including foveal hypoplasia and aberrant optic pathway projection that result in a variety of oculomotor instability. We present a 38-years-old man with oculocutaneous albinism who had horizontal jerk-type nystagmus, which showed a reverse in direction by any extraneous light stimulation which was documented by electronystagmogram. The mechanism of the nystagmus in this case is uncertain. These findings in albinism have not been reported previously, to our knowledge, and suggest a defect in the visual pathway system.