ABSTRACT
OBJECTIVE: To evaluate the effects of orthostatic stress with a head-up tilt on the autonomic nervous system and to determine how a cerebral stroke influences the cardiac autonomic function, using the power spectral analysis(PSA) of heart rate variability(HRV). METHOD: We studied 11 stroke patients with a left hemiplegia and 14 patients with a right hemiplegia. Their hemispheric brain lesions were confirmed by the MRI. The ECG and respiration signals were recorded at the tilt angle of 0o and 70o for 5 minutes under the condition of frequency controlled respirtaion(0.25 Hz). Data were compared with the age- and sex-matched 12 healthy controls. RESULT: In a control group, the normalized high frequency power showed a significant decrease during the head-up tilt(p0.05). Compared with the right hemiplegia and control groups, the left hemiplegia group was associated more with a reduced low and high frequency power and showed no significant changes under the orthostatic stress. CONCLUSION: PSA of HRV can identify the reduced cardiac autonomic activity in stroke patients, with a greater reduction in the left hemiplegia group than in the right hemiplegia group, which may cause a high risk of cardiac arrhythmias and sudden death.
Subject(s)
Humans , Arrhythmias, Cardiac , Autonomic Nervous System , Brain , Death, Sudden , Electrocardiography , Heart Rate , Heart , Hemiplegia , Magnetic Resonance Imaging , Respiration , StrokeABSTRACT
OBJECTIVE: To find out the motor recovery in stroke patients according to the presence of diaschisis. METHOD: Computed tomography (CT) and/or magnetic resonance imaging (MRI) scan and single photon emission computed tomography (SPECT) study were performed on a consecutive series of 98 inpatients from July 1995 to August 1996. Among them 42 stroke patients were included in this study with cerebellar, pontine, and bilateral hemispheric lesions excluded. RESULTS: The types of diaschisis were crossed cerebellar diaschisis (CCD) (36 cases), thalamocortical diaschisis (6 cases), striatocortical diaschisis (5 cases), and capsulocortical diaschisis (1 case). And the functional recovery scale improved from 37.5 points to 53.0 points by the motricity index and from 41.2 points to 68.8 points by the MBI score. Only the motricity index showed a significant inverse correlation with the asymmetry index in CCD. CONCLUSION: Although other types of diaschisis were found, the most frequent type was CCD. The lower the asymmetry score was the lower motricity index. Therefore, CCD could be a prognostic factor for the motor recovery.
Subject(s)
Humans , Inpatients , Magnetic Resonance Imaging , Stroke , Tomography, Emission-Computed, Single-PhotonABSTRACT
The purpose of this study was to determine the factors which were responsible for delaying early diagnosis and optimal management of rheumatoid arthritis (RA) in Korea. We interviewed 109 outpatients diagnosed as RA being treated by rheumatologists, and we eventually analyzed 98 patients' data. The median length of time from symptom onset to the first visit to a medical doctor, to diagnosis, and visiting a rheumatologist were 8 weeks, 23 weeks, and 42 months respectively. The subspecialist with whom the patients consulted with for the longest time before visiting a rheumatologist were an orthopaedic surgeon for 51 patients, a Chinese herbal doctor for 19 patients, and a pharmacist for 16 patients. For early diagnosis and optimal management of RA in Korea, we believe that it is necessary to reduce the use of unconventional medical services such as Chinese herbal medicine and nonprescribed medication, and to emphasize rheumatologic and rehabilitative care in the early stage.