Refractures after Operative Fixation in Severe Spastic Cerebral Palsy: A case report

Patients with severe cerebral palsy (CP) are susceptible to bone fractures due to low bone mineral density, deformity from contracture and developmental disability. We experienced a 12-year-old spastic CP female who sustained recurrent fracture of the right femur. The first episode occurred when she had been moved passively by another child in residential care. She underwent operative treatment with plate fixation, but seventeen days after operation, spasticity of legs aggravated and refracture happened at the fixation site. She underwent re-operative fixation, but at three days after the second operation, she sustained another fracture at the top of the plate, for which she underwent the third operation. She was then referred to our department for scissoring patterns of the lower extremities. We performed bilateral obturator nerve block which relieved patient's spasticity. We think that her recurrent fracture may be related with ignored risk factor of refracture such as uncontrolled spasticity.

The Assessment of Functional Change in Ischemic Stroke Rat

OBJECTIVE: To investigate and quantify functional deficit in ischemic stroke rat. METHOD: Male Sprague-Dawley rats were divided into sham group and stroke group. Permanent cerebral ischemia was inflicted on the stroke group by occluding the middle cerebral artery (MCAO). The proportion of hind limb weight bearing pressure was also measured. The withdrawal threshold values in the hindpaws were measured by using von-Frey hair for seven days from the day before ischemia. RESULTS: The proportion of paretic hind limb pressure to whole hind limb pressure in stroke group was significantly reduced than sham group (p0.05). Garcia motor score of stroke group was reduced significantly than sham group in whole experimental session after MCAO (p0.05). CONCLUSION: Ischemic stroke in rats can lead to the reduction of pressure at paretic hind limb. The motor test for pressure weight borne on the paretic leg may provide functional information in the future studies with ischemic stroke rat.

Anatomic Study of Injection Point of Piriformis Muscle on Cadaver Study

OBJECTIVE: To identify the optimal site for piriformis muscle injection, using easily detectable sacroiliac joint as a landmark, under fluoroscopic guidance. METHOD: We examined the anatomic relationships of the sciatic nerve, piriformis muscle and sacroiliac joint in 18 buttocks from 9 cadavers. The distance from the inferior margin of the sacroiliac joint to the piriformis muscle at the crossing point with the sciatic nerve, and the width of the sciatic nerve at that point were measured. We assessed the depth of the piriformis muscle and the sciatic nerve using ultrasonography in asymptomatic controls. RESULTS: The mean distance from the inferior margin of the sacroiliac joint to the piriformis muscle at the crossing point with the sciatic nerve was 15.7+/-3.4 (12~22) mm laterally and 16.5+/-4.1 (10~25) mm caudally. The mean width of the sciatic nerve at that point was 15.4+/-3.7 (12~22) mm. Ultrasonographic findings revealed the mean distance as 4.48+/-0.49 cm from the skin to the surface of the piriformis muscle and as 5.68+/-0.62 from the skin to the surface of the sciatic nerve. CONCLUSION: The most optimal injection site for piriformis syndrome was located 15.6+/-3.4 (12~22) mm laterally and 16.5+/-4.1 (10~25) mm caudally from the inferior margin of the sacroiliac joint.

Prevalence of Denervation Potentials from Foot Intrinsic and Lumbosacral Paraspinal Muscles in Asymptomatic Persons in Korea

OBJECTIVE: To determine the prevalence of denervation potentials from the foot intrinsic and the lumbosacral paraspinal muscles in asymptomatic persons in Korea. METHOD: Nerve conduction studies were performed in 80 asymptomatic persons at sural, peroneal and tibial nerves. We excluded 15 persons with abnormal values of nerve conduction studies. In our study, 36 males and 29 females participated and the mean age of subjects was 52.9 years. We checked denervation potentials from unilateral lumbosacral paraspinal (L4-S1) and foot intrinsic muscles (abductor hallucis and extensor digitorum brevis muscle) by needle EMG. RESULTS: The prevalence of denervation potentials from foot intrinsic muscles was 3% (2 cases out of 65 asymptomatic subjects). Denervation potentials consisting of a positive sharp wave were seen from the abductor hallucis muscle. No subjects showed any denervation potentials from the lumbosacral paraspinal muscles in our study. Abnormal X-ray findings were seen in subjects who had denervation potentials from the foot intrinsic muscles. CONCLUSION: The prevalence of denervation potentials from the foot intrinsic and the lumbosacral paraspinal muscles in asymptomatic person was not as high as previously reported

Comparison of Fixed Distance Stimulation and Distal Wrist Crease Stimulation in Median Motor Conduction Study

OBJECTIVE: To determine optimal stimulation site for median motor conduction study, we compared fixed distance (7 cm proximal to the recording electrode) stimulation method and distal wrist crease stimulation method. METHOD: Nerve conduction studies were performed in 65 hands of 36 healthy adults without neurologic abnormality. Median motor responses were recorded from abductor pollicis brevis (APB) with the stimulations at the point 7 cm proximal to the recording electrode and at the distal wrist crease. The distal latencies and onset-to-peak amplitudes were measured and compared between two techniques. The distal latencies were also compared to that of ulnar compound muscle action potential (CMAP) obtained with fixed distance stimulation (7 cm proximal to the recording electrode). And we measured median nerve actual length from distal wrist crease to APB muscle motor point by anatomic dissection of 12 hands. RESULTS: The distal latencies of median CMAP to APB with 7 cm fixed distance stimulation and distal wrist crease stimulation were 2.91+/-0.37 ms and, 2.75+/-0.41 ms respectively. The differences were statistically significant. The distal latency of ulnar CMAP was 2.50+/-0.32 ms. Differences in distal latencies between ulnar CMAPs and not only 7 cm fixed distance median stimulation but also distal wrist crease median stimulation were also statistically significant. The mean length of median nerve from distal wrist crease to APB motor point was 5.91+/-0.77 cm. CONCLUSION: We suggest that the median motor nerve conduction study using distal wrist crease stimulation was an easier and more rapid procedure than fixed distance median motor nerve conduction study.

Tc-99m-ECD Brain Single Photon Emission Computed Tomography Findings in Cerebral Palsy: Comparison with Magnetic Resonance Imaging Findings

OBJECTIVE: To investigate the correlation between magnetic resonance imaging (MRI) findings and single photon emission computed tomograpy (SPECT) in cerebral palsy (CP). METHOD: Fourty-one patients with CP underwent MRI and SPECT of the brain. The patients were divided into 5 groups. Group 1 was for the cases with normal findings on MRI and SPECT, group 2 for abnormal on MRI but normal on SPECT, group 3 for normal on MRI but abnormal on SPECT, group 4 for abnormal findings on both MRI and SPECT with same abnormal lesion and group 5 for abnormal findings on both MRI and SPECT but with different abnormal lesion. RESULTS: In group 2, periventricular leukomalacia (PVL) and cortical atrophy were shown on MRI. In group 3, decreased blood flow at cerebellum was shown on SPECT. In group 4, brain atrophy on MRI and the decreased blood flow at the same site on SPECT were shown. In group 5, 15 of 22 cases with PVL on MRI and decreased blood flow at cerebellum, thalamus, basal ganglia and the cortical areas were shown. CONCLUSION: Brain SPECT was more sensitive in the detection of cerebellum, thalamus and cortical blood flow abnormality. MRI was more sensitive in demonstration of white matter lesion.

The Resininferatoxin Therapy for the Hyperreflexive Neurogenic Bladder: Report of two cases of spinal cord injured patients

Resiniferatoxin, a substance isolated from some species of Euphorbia, a cactus-like plant, shows pharmacological effects similar to those of capsaicin. We administered resiniferatoxin for treating detrusor hyperreflexia to patient with chronic spinal cord injury. Resiniferatoxin solution (100 ml at a concentration of 10-7, 10-6 M) was instilled twice into the bladder of patient with detrusor hyperreflexia and left in place for 30 minutes. Effects on bladder function were monitored at 1 month later follow-up. One month after the last resiniferatoxin instillation, patients reported a significant symptomatic improvement of their incontinence and increased mean bladder capacity.

Depression and Anxiety in Mothers of Children with Cerebral Palsy

OBJECTIVE: To estimate the level of depression, anxiety and self consciousness in mothers of cerebral palsy (CP) children according to the clinical type and family type. METHOD: 39 mothers of CP children and 42 mothers of normal children (control) completed Beck Depression Inventory, State-Trait Anxiety Inventory, Ego strength scale and Family Adaptation and Cohesion Evaluation Scale. The data were tatistically analyzed. There were no significant differences in mother's age, children's age and monthly income between the CP mothers and control. RESULTS: Mothers of CP children showed significantly higher level of BDI and State anxiety(p<0.05), but there were no significant differences in the Trait anxiety. There were no differences in the BDI and State-Trait Anxiety Inventory according to the clinical severity and duration of CP children. There were no difference in BDI and State-Trait Anxiety Inventory according to the family adaptation and cohesion. CONCLUSION: It is necessary to consider emotional problem of mothers with cerebral palsy children and support psychologically in comprehensive rehabilitation.

Depression and Anxiety of Caregivers of Stroke Patient

OBJECTIVE: To evaluate the depression and anxiety level of caregivers of stroke patient according to the severity and duration of disability and family type. METHOD: The subjects were 38 caregivers of stroke patient, 39 mothers of cerebral palsy patient and 20 caregivers with nondisabled admission patient in general ward (control). The subjects completed Beck Depression Inventory (BDI), State-Trait Anxiety Inventory, Ego strength scale and Family Adaption and Cohesion Evaluation Scales. The data were statistically alalyzed. RESULTS: The caregivers of stroke patient showed significantly higher level of BDI and state anxiety inventory (p<0.01) than control group, but there were no significant difference in the trait-anxiety inventry. There were no significant differences in the BDI and State- Ttrait Anxiety inventory according to the severity and duration of disability and family type. There were no significant difference in the BDI and State-Ttrait Anxiety inventory between caregivers of stroke patient and mothers of cerebral palsy patient. CONCLUSION: It is necessary to consider depression and anxiety in caregivers with stroke patient and support their psychologic aspect for the comprehensive rehabilitation.