Application of Segmental Phase Angle for Assessment of Post-Stroke Complex Regional Pain Syndrome

Our objective is to evaluate the applicability of segmental phase angle (PhA) via bioelectrical impedance analysis (BIA) for post-stroke complex regional pain syndrome (CRPS). Due to its noninvasiveness and convenience, various studies have used BIA in clinical conditions. We measured segmental PhA in 4 patients at the time of CRPS diagnosis and repeated 4 weeks after 2 weeks of steroid pulse therapy. In 3 cases, the affected-to-unaffected ratio of the upper limb PhA decreased at the time of diagnosis. In 2 cases with improvement of more than 5 points in the CRPS severity score (CSS), increased ratios were observed. In other 2 cases with improvement of less than 4 points in the CSS, no remarkable changes in the ratios were found. We suggest that the segmental PhA can be helpful in assessment of post-stroke CRPS and its recovery.

Application of Segmental Phase Angle for Assessment of Post-Stroke Complex Regional Pain Syndrome

Our objective is to evaluate the applicability of segmental phase angle (PhA) via bioelectrical impedance analysis (BIA) for post-stroke complex regional pain syndrome (CRPS). Due to its noninvasiveness and convenience, various studies have used BIA in clinical conditions. We measured segmental PhA in 4 patients at the time of CRPS diagnosis and repeated 4 weeks after 2 weeks of steroid pulse therapy. In 3 cases, the affected-to-unaffected ratio of the upper limb PhA decreased at the time of diagnosis. In 2 cases with improvement of more than 5 points in the CRPS severity score (CSS), increased ratios were observed. In other 2 cases with improvement of less than 4 points in the CSS, no remarkable changes in the ratios were found. We suggest that the segmental PhA can be helpful in assessment of post-stroke CRPS and its recovery.

Botulinum Toxin-A Injection in the Treatment of Spasticity in a Infantile-Onset Neurodegeneration With Brain Iron Accumulation: A Case Report

Pantothenate kinase-associated neurodegeneration (PKAN) is a neurodegenerative disorder characterized by iron accumulation in the globus pallidus (GP) of the brain (neurodegeneration with brain iron accumulation [NBIA]), which is characterized by dystonia and spasticity resulting in postural difficulties. A 33-month-old boy was admitted with a pronounced gait disturbance. Marked hypertonicity in the patient's both calf muscles was noted, resulting in waddling with repeated slip-falls. NBIA was suspected by high T2 intensity in the GP on brain MRI, then it was confirmed by detecting PANK2 mutation. Botulinum toxin-A injection was administered to both calf muscles. After 2 weeks, a decrease in spasticity and an increase in range of motion were observed, and consequently, an increase in the patient's gait stability with both heels touching the ground, enabling him to walk straight independently. A definitive treatment for NBIA has not been established, and a symptomatic therapy is currently the mainstay of treatment in this case. This is the first case report of botulinum toxin injection for treatment of gait disturbance caused by spasticity in an infantile-onset PKAN.

Efficacy of Aquatic Treadmill Training on Gait Symmetry and Balance in Subacute Stroke Patients

OBJECTIVE: To determine the efficacy of aquatic treadmill training (ATT) as a new modality for stroke rehabilitation, by assessing changes in gait symmetry, balance function, and subjective balance confidence for the paretic and non-paretic leg in stroke patients. METHODS: Twenty-one subacute stroke patients participated in 15 intervention sessions of aquatic treadmill training. The Comfortable 10-Meter Walk Test (CWT), spatiotemporal gait parameters, Berg Balance Scale (BBS), and Activities-specific Balance Confidence scale (ABC) were assessed pre- and post-interventions. RESULTS: From pre- to post-intervention, statistically significant improvements were observed in the CWT (0.471±0.21 to 0.558±0.23, p<0.001), BBS (39.66±8.63 to 43.80±5.21, p<0.001), and ABC (38.39±13.46 to 46.93±12.32, p<0.001). The step-length symmetry (1.017±0.25 to 0.990±0.19, p=0.720) and overall temporal symmetry (1.404±0.36 to 1.314±0.34, p=0.218) showed improvement without statistical significance. CONCLUSION: ATT improves the functional aspects of gait, including CWT, BBS and ABC, and spatiotemporal gait symmetry, though without statistical significance. Further studies are required to examine and compare the potential benefits of ATT as a new modality for stroke therapy, with other modalities.

Thoracic Radiculopathy due to Rare Causes

Thoracic radiculopathy represents an uncommon spinal disorder that is frequently overlooked in the evaluation of thoracic, or abdominal pain syndrome. The clinical representation of this uncommon disorder is often atypical. With many differential diagnoses to consider, it is not surprising that the cause of thoracic radiculopathy is often not discovered for months, or years, after the symptoms arise. We report two rare cases of thoracic radiculopathy; one case was caused by extraskeletal Ewing sarcoma (EES) along the thoracic paraspinal area, and the other by foraminal stenosis, due to a bony spur of the thoracic vertebra. As such, thoracic radiculopathy should be considered in the diagnosis of patients with thoracic and abdominal pain, especially if initial diagnostic studies are inconclusive.

Thoracic Radiculopathy due to Rare Causes

Thoracic radiculopathy represents an uncommon spinal disorder that is frequently overlooked in the evaluation of thoracic, or abdominal pain syndrome. The clinical representation of this uncommon disorder is often atypical. With many differential diagnoses to consider, it is not surprising that the cause of thoracic radiculopathy is often not discovered for months, or years, after the symptoms arise. We report two rare cases of thoracic radiculopathy; one case was caused by extraskeletal Ewing sarcoma (EES) along the thoracic paraspinal area, and the other by foraminal stenosis, due to a bony spur of the thoracic vertebra. As such, thoracic radiculopathy should be considered in the diagnosis of patients with thoracic and abdominal pain, especially if initial diagnostic studies are inconclusive.

Analysis of Vertical Ground Reaction Force Variables Using Foot Scans in Hemiplegic Patients

OBJECTIVE: To analyze the differences in the vertical ground reaction force (GRF) variables of hemiplegic patients compared with a control group, and between the affected and unaffected limbs of hemiplegic patients using foot scans. METHODS: Patients (n=20) with hemiplegia and healthy volunteers (n=20) underwent vertical force analysis. We measured the following: the first and second peak forces (F1, F2) and the percent stances at which they occurred (T1, T2); the vertical force impulse (VFI) and stance times. The GRF results were compared between the hemiplegic patients and control individuals, and between the affected and unaffected limbs of hemiplegic patients. Additionally, we analyzed the impulse of the unaffected limb according to the motor assessment scale (MAS), Brunnstrom stage, and a Timed Up and Go Test. RESULTS: The F1s and F2s of the affected and unaffected limbs were significantly less than those of the normal control individuals (p<0.05). The T1s of both the affected and unaffected limbs of the patients were greater than control individuals, whilst the T2s were lower (p<0.05). Greater impulses and stance times were recorded on both sides of the patients than in the limbs of the control individuals (p<0.05). The MAS, Brunnstrom stage and Timed Up and Go Test results were significantly correlated with the VFI of the unaffected limbs (p<0.05). CONCLUSION: The high impulse values of the unaffected limb were associated with complications during gait rehabilitation. Therefore, these results suggest that unaffected limbs should also be taken into consideration in these patients.

A Child of Palatal Myoclonus Tinnitus Treated with Intraoral Injection of Botulinum Toxin / 대한이비인후과학회지

Palatal myoclonus (palatal tremor) was reported to be presented with a sole symptom of objective pulsating tinnitus and could be controlled by botulinum toxin injection alone. However, there were 3 cases reported in Korea of palatal myoclonus tinnitus controlled with botulinum toxin injection through the dual administration route of the mouth and nasal cavity. We present an 11-year-old boy of essential palatal myoclonus tinnitus, which was controlled by intraoral botulinum toxin injection to the tensor veli palatini muscle alone. Intraoral injection of botulinum toxin to the anatomical location of tensor veli palatini muscle with the guidance of electromyography was effective and safe for the child of objective tinnitus caused by palatal myoclonus.

Relationship between Physical Examinations and Two-Dimensional Computed Tomographic Findings in Children with Intoeing Gait

OBJECTIVE: To evaluate the validity of physical examinations by assessment of correlation between physical examinations and CT measurements in children with intoeing gait and the causes of intoeing gait by age using CT measurements. METHOD: Twenty-six children with intoeing gait participated in this study. The internal and external hip rotation, thigh-foot angle and transmalleolar angle were measured. In addition, femoral anteversion and tibial torsion of the subjects were assessed using a CT scan. The measurements of torsional angles were performed twice by two raters. The correlation coefficients between physical examinations and CT measurements were calculated using Pearson correlation. The data was analyzed statistically using SPSS v12.0. RESULTS: The correlation coefficients between physical examinations and CT measurements were not high. Before 5 years of age, intoeing gait was caused by femoral anteversion in 17.86%, tibial torsion in 32.29% and the combination of causes in 35.71% of cases. After 6 years of age, the contributions changed to 29.17%, 8.33% and 45.83%, respectively. CONCLUSION: Before 5 years of age, the common cause of an intoeing gait was tibial torsion, whereas after 6 years of age it was femoral anteversion. Regardless of age, the most common cause of intoeing gait was a combination of causes. This study shows poor correlation between physical examinations and CT. Therefore, it is limiting to use physical examination only for evaluating the cause of intoeing gait in clinical practice.

Bilateral Femoral Neuropathy Secondary to Unilateral Retroperitoneal Hematoma

The location of pelvic portion of the femoral nerve between the iliacus and psoas muscles makes the nerve particularly vulnerable in hemorrhage within iliacus. We report a uncommon case of bilateral femoral neuropathy resulting from unilateral retroperitoneal hematoma. A 28-year-old man developed zero-trace grade of muscular weakness on both knee extensor muscles, numbness over bilateral anteromedial thighs and medial lower legs, tenderness of both hip adductor muscles after stab wound at left abdominal region. Abdominal computerized tomographic finding showed hematoma of left psoas muscles. Electromyographic examination revealed no motor unit action potentials in both iliopsoas, vastus medialis and adductor longus muscles. Nerve conduction study noted no compound motor action potentials of both femoral nerves. The fascial walls and laminae of the pouches in the lower abdominal wall tend to reinforce the rigidity of the fibrous arch over the femoral nerve in the intermuscular groove. This neuropathy is suggested, when the pouches are filled with blood, would further increase pressure on the subjacent nerves, especially bilateral femoral nerves.

Usefulness of Wrist Crease Stimulation Method in Diagnosis of Carpal Tunnel Syndrome

OBJECTIVE: The previously established method of carpal tunnel syndrome (CTS) diagnosis is relatively troublesome and risk of misleading due to uncertainty of exact distance measurement for stimulation. If we use the wrist crease, an anatomical landmark, there might not be error in length measurement for stimulation at any wrist position. This study was performed to evaluate the wrist stimulation method in the diagnosis of CTS for it's convenience and reducing the errors. METHOD: Seventy healthy adults and sixty-five patients with clinical and electrophysiologic evidence of CTS were studied. Sensory nerve action potentials (SNAPs) in second and fifth digit were recorded antidromically with stimulation at a distance of 14 cm from recording electrode and stimulation at wrist crease. The ratio and difference of distal latency and ratio of amplitude between median and ulnar SNAPs were assessed. RESULTS: The ratio and difference of distal latency and ratio of amplitude in the 14 cm stimulation method were 1.52+/-0.28, 1.59+/-0.91 msec, 1.26+/-0.27 in the right, 1.43+/-0.14, 1.29+/-0.42 msec, 1.18+/-0.20 in the left, respectively in the men patients, and those of women patients were 1.48+/-0.35, 1.43+/-1.04 msec, 1.18+/-0.30 in the right, 1.53+/-0.30, 1.46 0.80 msec, 0.75+/-0.36 in the left. In wrist crease stimulation, those of men patients were 1.72+/-0.39, 1.74+/-0.98 msec, 1.22+/-0.24 in the right, 1.53+/-0.21, 1.31+/-0.46 msec, 1.25+/-0.29 in the left, and those of women patients were 1.67+/-0.46, 1.56+/-1.01 msec, 0.63+/-0.32 in the right, 1.68+/-0.37, 1.56+/-0.82 msec, 0.68+/-0.30 in the left. These results showed a significant positive correlation between the patients group and the control group in two stimulation methods (p<0.001). CONCLUSION: Based on the result of this study, wrist crease stimulation method is a quick and easy procedure, which would be recommended in the early diagnosis of CTS.

Normative Data of Somatosensory Evoked Potentials of Posterior Femoral Cutaneous Nerve in Korean Adults

OBJECT: The isolated posterior femoral cutaneous nerve (PFCN) neuropathy has rarely been described in the literature and documented electrophysiologically, based on the paucity of published report. The purpose of this study was to assess the reference value of somatosensory evoked potentials (SSEP) in posterior femoral cutaneous nerve. METHOD: Both legs of twenty healthy adults were tested. Somatosensory evoked potentials were obtained with the active recording electrode placed at Cz', 2 cm posterior to CZ, and the reference electrode at FZ (international 10~20 system). The posterior femoral cutaneous nerve was excited 14 cm proximal to the midpopliteal fossa between the long head of the biceps femoris and the semitendinosus muscles. RESULTS: The mean latency of right P1 were 35.35+/-3.17 msec, N1 were 45.28+/-2.71 msec and mean peak amplitudes were 1.42+/-0.98 microvolt. In the left side, mean latency of P1 were 34.54+/-2.89 msec, N1 were 43.87+/-2.44 msec and mean peak amplitudes were 1.20+/-0.53 microvolt. CONCLUSION: Based on the result of this study, the reference values could be used to differentiate and detect the lesion in the case of isolated dysfunction of the posterior femoral cutaneous nerve.

Ultrastructural Changes in Rat Anterior Tibial and Soleus Muscles Following Graded Periods of Ischemia and Reperfusion / 체질인류학회지

Skeletal muscles are known to have tolerance to ischemia, but a prolonged ischemia can cause damage to muscular tissues. The ischemia-reperfusion injury results from the oxygen free radicals released by leucocytes and formed by the reaction of hypoxanthine and xanthine oxidase. Superoxide dismutase (SOD), one of major antioxidant enzymes ocurring in the various tissues of the body metabolizes or scarvanges the oxygen free radicals. Although many studies reported difference in tolerance to ischemia and reperfusion between white and red muscles, some other investigators failed in finding such difference. The present study was performed to examine effects of graded periods of ischemia and reperfusion on the cellular ultrastructure and activity of SOD in white and red muscles. The Sprague-Dawley rats (200~250 g) were used as experimental animals. Under pentobarbital (50 mg/kg IP) anesthesia, incision was made on lower abdomen and left common iliac artery was occluded by means of a vascular clamp for 2, 4 and 6 hour (hrs). Thereafter, the superficial portion of mid-belly of anterior tibial muscle and soleus muscles were excised at 0, 24 and 72 hrs after onset of reperfusion. The specimens were sectioned into slices, 2 mm in length, 1 mm in width and thickness. Some specimens were prepared for electron microscopic observation and others for determination of SOD activity by using antihuman Cu, Zn- and Mn-SOD antibodies. The results obtained were as follows. 1. In anterior tibial muscle, areas with loose electron-density and dilated cristae were observed in the mitochondria immediately after 2 hrs of ischemia, while widened intermyofibrillar spaces and dilated cisternae of sarcoplasmic reticulum were seen after 2 hrs and 24 hrs reperfusion. When subjected to 2 hrs ischemia and 72 hrs reperfusion, no significant change was found in the cellular ultrastructure. 2. In soleus muscle, electron density was loose in the matrix of mitochondria immediately after 2 hrs of ischemia, while cisternae of sarcoplasmic reticulum were dilalated after 2 hrs of ischemia and 24 hrs reperfusion. Following 2 hrs of ischemia and 72 hrs reperfusion, the electron microscopic findings were similar to those of normal rats. 3. The changes in cellular ultrastructure were more prominent in both the 4 hrs and 6 hrs ischemia groups, in which degree of ultrastructural changes were proportional to duration of reperfusion. 4. In anterior tibial muscle, trace or weak immunoreactivities of Cu, Zn- and Mn-SOD were seen, whereas trace immunoreactivity of Cu, Zn-SOD and trace or weak immunoreactivity of Mn-SOD were observed in soleus muscle. 5. The immunoreactivities of Cu, Zn- and Mn-SOD were not altered in 2 hrs ischemic and 72 hrs reperfused group, while they were increased slightly in 2 hrs ischemic and 24 hrs reperfused group. 6. In both muscles, the activity of SOD increased following 4 hrs or 6 hrs ischemia and 24 hrs or 72 hrs reperfusion. The changes in immunoreactivity of Mn-SOD were not different between two muscles, whereas immunoreactivity of Cu, Zn-SOD were higher in anterior tibial muscle. Consequently, it is suggested that significant ischemia reperfusion injuries are produced after 4~6 hrs ishemia followed by 24 hrs or 72 hrs reperfusion, that anterior tibial muscle is more susceptible to ischemic reperfusion injury and that the ischemic-reperfusion injury is closely related with activity of SOD.

Soleus Myopathy Induced by Passive Stretch in a Stroke Patient: A case report

We present a 50-year-old woman who sustained spastic left hemiplegia secondary to the right thalamic hemorrhage 6 years ago. She complained of persistent severe left calf pain after serial casting for the treatment of shortened plantar flexors of the left ankle. Two months later, magnetic resonance T1-weighted images showed diffuse high signal intensity involving the whole muscle bulk of the soleus and normal signal intensity of thin atrophied gastrocnemius. Needle electromyography of the soleus revealed myopathic patterns. Histologic findings of the soleus showed necrotic muscle fibers with phagocytosis, endomyseal collagen and fat deposition. We concluded that prolonged passive stretch of spastic plantar flexors of the ankle under serial casting induced soleus myopathy with segmental myonecrosis, and which developed left calf pain. Selective induction of soleus myopathy could be explained by the higher stretch tension produced by ankle dorsiflexion in the soleus compared to the gastrocnemius because of different proximal ends.

The Blink Reflex in Patients with Diffuse Axonal Injury

The study of blink reflexes was carried out to demonstrate the correlations, if there were, between the stage of diffuse axonal injury(DAI) and the abnormality of blink reflexes. The blink reflex was recorded in 20 healthy adult subjects and 22 patients with DAI who were classified according to Adams' classification(DAI I; 7, DAI II; 9 and DAI III; 6). The latencies and amplitudes of R1 and R2 in patients with DAI were compared with those of healthy subjects. The results were as follows; 1) In 20 subjects of patient group, the latencies of R1 were all within a normal range. In 2 subjects, the difference in latencies between the two sides was above 1.4 msec. 2) In 15 subjects, R2 was absent or delayed, and reduced in the size of amplitude in all. Nine were affected bilaterally, and 4 were unilaterally. 3) Seventy one percent of patients in each stage represented abnormal findings. 4) There were no correlations between the DAI stage and the blink reflex. This study demonstrated that the polysynaptic R2 was more profoundly suppressed than the oligosynaptic R1 in a diffuse axonal injury because of a loss or decrease of suprapontine facillitation, which influenced the trigeminal spinal complex and the interneuron of lateral reticular formation.

Anomalous muscle in hand:extensor digitorum brevis manus

No abstract available.

Techniques for studying the great auricular nerve conduction

No abstract available.