Spinal MRI Abnormality in Zoster Sine Herpete / 대한임상신경생리학회지

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Clinical Significance of Paresthesia Distribution in Carpal Tunnel Syndrome

BACKGROUND: Carpal tunnel syndrome (CTS) is defined by symptoms associated with damage to the median nerve within the carpal tunnel. Abnormal sensation in the median nerve territory is one of the primary clinical diagnostic criteria for CTS. However, extramedian sensory abnormalities in CTS are common. The purpose of this study was to identify the clinical significance of the paresthesia distribution in CTS. METHODS: This was a cross-sectional retrospective study involving patients with CTS diagnosed based on the American Academy of Neurology criteria between January 2009 and January 2011. In total, 109 hands of 57 enrolled patients were analyzed. The participants were divided into two groups according to the distribution of sensory abnormalities: (1) sensory symptoms confined to the median nerve distribution (median group), and (2) sensory symptoms distributed diffusely over the entire hand (glove group). Clinical features and electrophysiological findings were investigated by thorough chart reviews. RESULTS: Forty-seven (43.1%) hands belonged to the glove group. The frequency of sensory abnormalities and motor weakness was higher in the median group (38.7 vs 9.7%) than in the glove group (12.8% vs. 0.0%) on neurological examination. The conduction velocities of sensory nerves of the wrist and finger were significantly slower in the median group than in the glove group. CONCLUSIONS: Evaluation of the sensory symptom distribution in CTS may predict the degree of nerve damage, with sensory abnormality restricted to the median nerve distribution reflecting more severe nerve damage in CTS.

Characteristics of Atopic Myelitis and its Relationship With Toxocara Canis Myelitis

BACKGROUND: It has recently been reported that atopic disorders are associated with various neurological diseases. Atopic myelitis (AM) has been defined as an idiopathic myelitis with either (1) an atopic disease such as atopic dermatitis, allergic rhinitis, or bronchial asthma, or (2) positive mite antigen-specific immunoglobulin E (IgE) with hyper-IgE-emia. The aim of this study was to characterize the clinical, radiological, and laboratory profiles of AM. METHODS: The characteristics of a group of patients with AM (n=18) were compared with those of a group of non-AM subjects (n=13). The history, clinical symptoms, serologic and cerebrospinal fluid (CSF) findings, and brain and spinal-cord magnetic resonance imaging (MRI) scans of all of the subjects were reviewed. RESULTS: Clinically, nonacute onset occurred more frequently in the AM group than in the non-AM group (72.2% vs. 30.8%, p=0.033). The positivity of specific IgG antibody to Toxocara canis was greater in the AM group than in the non-AM group (p=0.045). Swelling (p=0.001) and gadolinium enhancement (p=0.014) on MRI was also more prevalent in the AM group. There was tendency toward a greater proportion of males, purely sensory symptoms, a higher recurrence rate, and eosinophilia in the AM group than in the non-AM group. CONCLUSIONS: These findings suggest that AM is responsible for a considerable proportion of cases with idiopathic myelitis. It appears that the progression of symptom onset is slower, the positivity of specific IgG antibody to Toxocara canis higher, and the occurrence of swelling and enhancement of the lesion on spinal-cord MRI is more prevalent among those with AM than those without.