A Electrodiagnostic Study on Relationship of the Double Crush Syndrome to Carpal Tunnel Syndrome: a Preliminary Study

BACKGROUND: The concept of "double crush syndrome (DCS)"-a proximal compressive lesion making the distal nerve more vulnerable to injury-is an intriguing hypothesis. However, recent studies did not show unitary results. This study was preliminarily undertaken in order to clarify the causal relationship of proximal compressive lesion and carpal tunnel syndrome (CTS) in an electrophysiologic aspect. METHODS: In the period between June 1998 and June 1999 there were 24 patients with CTS(33 limbs with CTS). With these CTS patients, thorough electrodiagnostic studies were performed to discover coexisting proximal compressive lesions along the median nerve and its corresponding cervical root lesions. RESULTS: In 10 of these limbs (30%), there was a electrodiagnostically-proven coexisting proximal compressive lesion(all cervical radiculopathies). But only 1 limb (3%) had an anatomically responsible association. Finally only 1 limb (3%) with CTS had a possibility of DCS. CONCLUSIONS: CTS and cervical radiculopathy are common disorders, so there is a high possibility of coexisting as a double primary lesion without a pathophysiological relationship. Our results do not support the double crush hypothesis. However, the possibility of a reversed double crush syndrome is suggested.

A clinical study on headache in the elderly

It has been known that the prevalence and the etiology of headache in the elderly are different from these in the general population. Nevertheless studies of headache in the elderly have been rare. Under these backgrounds, prospective study was performed to find the clinical characteristics of headache in the Korean elderly. The subjects consisted of 237 patients (male:femal = l.0:1.7). A detailed and relevant history was gathered by headache history force, and specific headache diagnosis was based on diagnostic criteria of the International Headache Society (1988). This study revealed that episodic/chronic tension-type headache (43%) was the meet common diagnosis, followed by headache not classifiable (8%), headache from substance withdrawal (6%), occipital neuralgia (5%), idiopathic stabbing headache (4%), and migraine(40%). Relatively because many patients with tension type headache had oromandibular dysfunctions, somewhat high proportion of the patients reported unilateral predominance in the location of pain. The proportion of symptomatic headache that start in the elderly were higher than that of idiopathic headache. When comparing with the general population, the importance of migraine and cluster headache declined, while the important of symptomatic headaches increased. Idiopathic headache was more common in woman than in men, but symptomatic headache had no definite sex difference. In conclusion, the etiologies and types of headache in the elderly are more complex and diverse, so that thorough diagnostic workups are needed.

Studies on Amino Acids Pattern in Amyotrophic Lateral Sclerosis

Recent researches on ALS pathogenesis are focusing on abnormal immunological factors, excitotoxic substances, neurotrophic factors, and oxidative stress. It is well known that glutamate and aspartate are major putative excitatory neurotransmitters and possess excitotoxic properties that lead to neuronal death. In this study the authors checked the plasma level of amino acids in ALS and control groups and tried to understand any association between excitotoxic amino acids and sporadic ALS. The concentration of amino acids was measured by the HPLC method in the fasting plasma of fifteen ALS and nine control subjects. When we evaluated 19 amino acids or their metabolites, none showed significant difference between ALS and control groups. The mean concentrations of glutamic acid in ALS and control groups were 42.3+26.7 mmol/L and 57.4+17.0 mmol/L respectively, which showed no significant difference (p>O. 05). It was not possible to compare the level of aspartic acid in ALS and control groups as the levels were very low in individuals of both groups. In conclusion, authors could not note any significant correlations between sporadic ALS and excitotoxic substances, such as glutamate and aspartate. However, further studies m the excitotoxic levels in cerebrospinal fluid, spinal cord and brain, could be helpful to understand the overexcitation character of motor neuron by excitatory amino acids.

Top of the Basilar Syndrome: Clinical and Radiological Characteristics

Clinical and radiological characteristics were studied in twenty-six patients with MRI-supported "top of the basilar" syndrome. Transient symptoms of vertebrobasilar artery insufficiency often preceded the eventual stroke in 46% of the patients. By the arbitrary clinical criteria, the patients were divided into embolic (n=16) or nonembolic (n=10) group of the syndrome. The proportion of embolic etiology was roughly higher than that of non-embolic etiology. The clinical manifestations were similar in both goup except fitting the criterial. Final outcomes were as follows: clear consciousness and normal intelligence in 4 (15%), dementia in 7 (27%), locked-in state in 2 (8%), persistent vegetative state in 9 (35%), and death in 4 patients (15%). By the MRI findings, all the patients had the thalamic infarction: bilateral in 24 (92%) and unilateral in 2 (8%). Variable combinations of infratentorial infarction in the midbrain, pons, and cerebellum were seen in most of them (24 cases), while supratentorial infarction in the terrritory of posterior cerebral artery, I.e. in the inferior temporal and/or occipital lobes, was less frequent (58%). The hemorrhagic infarction was very rare (12%). Infarcted areas in the tentative embolic group have more confluent and large infarction whereas those in the non-embolic group (most of them are tentatively thrombotic) show multiple discrete infarctions in the carotid them are tentatively thrombotic) show multiple discrete infarctions in the carotid territories as well as vertebrobasilar territory. The fact that the pattern of infarction in the paramedian thalamus and midbrain is not so different in both group suggests that this territory may be an end artery zone from the branches of basilar top, and that collaterals from the anterior circulation through the posterior communicating arteries usually do not supply this end artery zone.

Clinical Analysis of 26 Patients with Alcoholic Pellagra Encephalopathy

We analyzed 26 cases of probable alcoholic pellagra encephalopathy (APE) in the chronic heavy alcoholics, associated in 18 cases (69%( with Wernicke's disease and in 15 cases (58%) with alcoholic peripheral neuropathy. They were all males and their average age was 46 years. Daily average amount of drinking was 220gm and average period of drinking was 21.8 years. Clinical manifestations were dermatitis in 23 cases (88%), dementia in 22 (85%) and diarrhea in 12 (46%), but only 7 case (27%) had full triad. Most striking features of the APE were fluctuating confusion and/or clouding of consciousness, marked oppositional hypertonus, myoclonic jerks, severe muscle guarding or tenderness in the abdomen and long-lasting (2 weeks or more) delirious behavior. Twelve patients died of sepsis or pneumonia (3 untreated, 9 of 23 treated with nicotinamide). In conclusion, APE seems to be a fatal disease if untreated. Therefore, even in absence of dermatitis or diarrhea, APE should be considered in heavy chronic alcoholics who develop the deterioration of mentality, associated with above-mentioned clinical features, and they should be treated with multivitamins including nicotinamide.

Sturge-Weber Syndrome without Facial Nevus

This is a case report of a sixteen-year-old boy who has been suffering from throbbing headache since thirteen years of age. Neuroimaging investigations including brain CT and MRI demonstrated the characteristic features of Sturge-Weber syndrome: intracranial calcification, enlarged choroid plexus. And gyral enhancement. However, there was no facial nevus or focal neurological abnorrnality.

Combined Paraneoplastic Phenomena of Lambert-Eaton syndrome and Subacute Sensory Neuronopathy

No abstract available.