Effect of Repetitive Transcranial Magnetic Stimulation on Post-stroke Non-fluent Aphasia in Relation with Broca's Area

This study investigated the differences in the effect of repetitive transcranial magnetic stimulation (rTMS) between patients with and without the involvement of Broca's area (IBA).The medical records of 20 stroke patients treated with rTMS for non-fluent aphasia were reviewed. Patients completed the Korean version of the Western Aphasia Battery (K-WAB) pre- and post-rTMS. Magnetic resonance T1-weighted images of the brain were analyzed using SPM12 software. Montreal Neurological Institute templates and Talairach coordinates were used to determine Broca's area involvement and segregate patients into 2 groups: IBA and non-IBA (NBA) groups. All statistical analyses were performed using the SPSS software.Twenty subjects were included in the study. The K-WAB scores revealed improvements in the total subjects and IBA and NBA groups. There were no statistical differences between the IBA and NBA groups in the ΔK-WAB scores of aphasia quotient, fluency, comprehension, repetition, and naming. The rTMS was positive for non-fluent aphasia patients, but there was no significant difference in effectiveness depending on the IBA. Further research with a larger number of patients is needed to identify the differences in the effect of rTMS on the IBA.

Utilizing Pulmonary Function Parameters to Predict Dysphagia in Individuals With Cervical Spinal Cord Injuries

Objective@#To utilize pulmonary function parameters as predictive factors for dysphagia in individuals with cervical spinal cord injuries (CSCIs). @*Methods@#Medical records of 78 individuals with CSCIs were retrospectively reviewed. The pulmonary function was evaluated using spirometry and peak flow meter, whereas the swallowing function was assessed using a videofluoroscopic swallowing study. Participants were divided into the non-penetration-aspiration group (score 1 on the Penetration-Aspiration Scale [PAS]) and penetration-aspiration group (scores 2–8 on the PAS). Individuals with pharyngeal residue grade scores >1 were included in the pharyngeal residue group. @*Results@#The mean age was significantly higher in the penetration-aspiration and pharyngeal residue groups. In this study, individuals with clinical features, such as advanced age, history of tracheostomy, anterior surgical approach, and higher neurological level of injury, had significantly more penetration-aspiration or pharyngeal residue. Individuals in the penetration-aspiration group had significantly lower peak cough flow (PCF) levels. Individuals in the pharyngeal residue group had a significantly lower forced expiratory volume in 1 second (FEV1). According to the receiver operating characteristic curve analysis of PCF and FEV1 on the PAS, the cutoff value was 140 L/min and 37.5% of the predicted value, respectively. @*Conclusion@#Low PCF and FEV1 values may predict the risk of dysphagia in individuals with CSCIs. In these individuals, active evaluation of swallowing is recommended to confirm dysphagia.

Correlation between Dysarthria and Aspiration in Patients with Stroke / 대한연하장애학회지

Objective@#This study examined the correlation between dysarthria and aspiration to determine if dysarthria can predict aspiration in stroke patients. @*Methods@#The medical records of 176 patients with first stroke, who underwent a videofluoroscopic swallowing study (VFSS) and Urimal test of articulation and phonology (U-TAP) at the same time between January 2012 and December 2015 in the authors’ hospital, were reviewed retrospectively. The correlation between the penetration aspiration scale (PAS) score and U-TAP score was analyzed in all patients. The mean PAS score and frequency of each PAS score in the dysarthria group and non-dysarthria group were compared. In addition, the aspiration was analyzed based on the severity of dysarthria in the dysphagia group. All statistical analyses were performed using SPSS software. @*Results@#The correlation between the PAS score and U-TAP score was not statistically significant in all the subjects.The mean PAS score was 3.46±5.52 and 3.07±5.49 in the dysphagia and non-dysphagia group, respectively. The mean PAS score of the dysphagia group was higher than that of the non-dysphagia group. On the other hand, it was not statistically significant. In addition, there was no significant difference in the frequency of the PAS scores between the two groups. The aspiration was compared with the severity of dysarthria according to the U-TAP score; there was no statistically significant difference. @*Conclusion@#No correlation was observed between dysarthria and aspiration in stroke patients. In addition, there was no difference in the frequency of aspiration with or without dysarthria. According to the results of this study, aspiration cannot be predicted by dysarthria in stroke patients. Therefore, each diagnostic test and assessment should be performed for each symptom.

Unilateral Diaphragm Paralysis Associated With Neurosyphilis: A Case Report

Diaphragm dysfunction can originate from various etiologies, and bilaterality of the dysfunction depends on the cause. Symptoms of diaphragm dysfunction vary depending on the degree of phrenic nerve denervation, spinal cord lesion, and involvement of the diaphragm. Several infectious diaphragmatic dysfunctions have been reported, including the human immunodeficiency virus, poliovirus, West Nile virus, and dengue virus. Here, we report a case of unilateral diaphragm paralysis in a 34-year-old man with neurosyphilis.

Revisit Spinal Shock: Pattern of Reflex Evolution during Spinal Shock / 대한신경손상학회지

When the spinal cord is suddenly severed, all the fundamental functions of the spinal cord below the level of injury including the spinal cord reflexes are immediately depressed, which is referred to as spinal shock. The resolution of spinal shock occurs over a period of days to months, and spinal shock slowly transitions to spasticity. The definition of spinal shock and the pattern of reflex recovery or evolution remains as an issue of debate and controversy. The identification of clinical signs that determine the duration of spinal shock is controversial. The underlying mechanisms of spinal shock are also not clearly defined. Various authors have defined the termination of spinal shock as the appearance of the bulbocavernosus reflex, the recovery of deep tendon reflexes, or the return of reflexic detrusor activity. However, many questions remain to be answered, such as: When should we define spinal shock as the end? What types of reflexes appear first among polysynaptic cutaneous reflexes, monosynaptic deep tendon reflexes, and pathological reflexes? Should it include changes in autonomic reflexes such as a detrusor reflex?

Motor and Sensory Function as a Predictor of Respiratory Function Associated With Ventilator Weaning After High Cervical Cord Injury

OBJECTIVE: To analyze the respiratory function of high cervical cord injury according to ventilator dependence and to examine the correlations between diaphragm movement found on fluoroscopy and sensory and motor functions. METHODS: A total of 67 patients with high cervical spinal cord injury (SCI), admitted to our hospital were enrolled in the study. One rehabilitation physician performed sensory and motor examinations on all patients while each patient was in the supine position on the American Spinal Injury Association (ASIA) standard. In addition, fluoroscopic diaphragm movement studies and bedside spirometry were performed. RESULTS: Bedside spirometry and diaphragm fluoroscopic tests were analyzed according to ventilator dependence. Forced vital capacity and maximal inspiratory pressure were significantly higher in the ventilator weaned group. Natural breathing during the fluoroscopic diaphragm examinations and ventilator weaning showed statistical significance with the movement on the right, while deep breathing showed statistical significance with the movement on both sides. Deep breathing movement has correlation with the C5 key muscle. Diaphragm movement has correlation with right C3 and bilateral C4 sensory functions. CONCLUSION: The present expansion study showed that, through simple bedside physical examinations, rehabilitation physicians could relatively easily predict diaphragm movement and respiratory function recovery, which showed significance with ventilator weaning in patients with high cervical SCI.

Anorectal Manometric and Urodynamic Parameters According to the Spinal Cord Injury Lesion

OBJECTIVE: To assess the correlation between the anorectal function and bladder detrusor function in patients with complete spinal cord injury (SCI) according to the type of lesion. METHODS: Medical records of twenty-eight patients with SCI were included in this study. We compared the anorectal manometric and urodynamic (UD) parameters in total subjects. We analyzed the anorectal manometric and UD parameters between the two groups: upper motor neuron (UMN) lesion and lower motor neuron (LMN) lesion. In addition, we reclassified the total subjects into two groups according to the bladder detrusor function: overactive and non-overactive. RESULTS: In the group with LMN lesion, the mean value of maximal anal squeeze pressure (MSP) was slightly higher than that in the group with UMN lesion, and the ratio of MSP to maximal anal resting pressure (MRP) was statistically significant different between the two groups. In addition, although the mean value of MSP was slightly higher in the group with non-overactive detrusor function, there was no statistical correlation of anorectal manometric parameters between the groups with overactive and non-overactive detrusor function. CONCLUSION: The MSP and the ratio of MSP to MRP were higher in the group with LMN lesion. In this study, we could not identify the correlation between bladder and bowel function in total subjects. We conclude that the results of UD study alone cannot predict the outcome of anorectal manometry in patients with SCI. Therefore, it is recommended to perform assessment of anorectal function with anorectal manometry in patients with SCI.

Anorectal Manometric and Urodynamic Parameters According to the Spinal Cord Injury Lesion

OBJECTIVE: To assess the correlation between the anorectal function and bladder detrusor function in patients with complete spinal cord injury (SCI) according to the type of lesion. METHODS: Medical records of twenty-eight patients with SCI were included in this study. We compared the anorectal manometric and urodynamic (UD) parameters in total subjects. We analyzed the anorectal manometric and UD parameters between the two groups: upper motor neuron (UMN) lesion and lower motor neuron (LMN) lesion. In addition, we reclassified the total subjects into two groups according to the bladder detrusor function: overactive and non-overactive. RESULTS: In the group with LMN lesion, the mean value of maximal anal squeeze pressure (MSP) was slightly higher than that in the group with UMN lesion, and the ratio of MSP to maximal anal resting pressure (MRP) was statistically significant different between the two groups. In addition, although the mean value of MSP was slightly higher in the group with non-overactive detrusor function, there was no statistical correlation of anorectal manometric parameters between the groups with overactive and non-overactive detrusor function. CONCLUSION: The MSP and the ratio of MSP to MRP were higher in the group with LMN lesion. In this study, we could not identify the correlation between bladder and bowel function in total subjects. We conclude that the results of UD study alone cannot predict the outcome of anorectal manometry in patients with SCI. Therefore, it is recommended to perform assessment of anorectal function with anorectal manometry in patients with SCI.

Effect of Constraint-Induced Movement Therapy and Mirror Therapy for Patients With Subacute Stroke

OBJECTIVE: To evaluate the effectiveness of constraint-induced movement therapy (CIMT) and combined mirror therapy for inpatient rehabilitation of the patients with subacute stroke. METHODS: Twenty-six patients with subacute stroke were enrolled and randomly divided into three groups: CIMT combined with mirror therapy group, CIMT only group, and control group. Two weeks of CIMT for 6 hours a day with or without mirror therapy for 30 minutes a day were performed under supervision. All groups received conventional occupational therapy for 40 minutes a day for the same period. The CIMT only group and control group also received additional self-exercise to substitute for mirror therapy. The box and block test, 9-hole Pegboard test, grip strength, Brunnstrom stage, Wolf motor function test, Fugl-Meyer assessment, and the Korean version of Modified Barthel Index were performed prior to and two weeks after the treatment. RESULTS: After two weeks of treatment, the CIMT groups with and without mirror therapy showed higher improvement (p<0.05) than the control group, in most of functional assessments for hemiplegic upper extremity. The CIMT combined with mirror therapy group showed higher improvement than CIMT only group in box and block test, 9-hole Pegboard test, and grip strength, which represent fine motor functions of the upper extremity. CONCLUSION: The short-term CIMT combined with mirror therapy group showed more improvement compared to CIMT only group and control group, in the fine motor functions of hemiplegic upper extremity for the patients with subacute stroke.

Effects of Botulinum Toxin on Reducing the Co-contraction of Antagonists in Birth Brachial Plexus Palsy

Birth brachial plexus palsy (BBPP) is usually caused by plexus traction during difficult delivery. Although the possibility of complete recovery is relatively high, 5% to 25% of BBPP cases result in prolonged and persistent disability. In particular, muscle imbalance and co-contraction around the shoulder and elbow cause abnormal motor performance, osseous deformities, and joint contracture. Physical and occupational therapies have most commonly been used, but these conventional therapeutic strategies have often been inadequate, in managing the residual muscle imbalance and muscle co-contraction. Therefore, we attempted to improve the functional movements, by using botulinum toxin type A, to reduce the abnormal co-contraction of the antagonist muscles.

Phasic Changes in Bladder Compliance During Filling Cystometry of the Neurogenic Bladder

OBJECTIVE: To investigate phasic changes during filling cystometry that most accurately represent detrusor properties, regardless of other factors affecting detrusor contractility. METHODS: Seventy-eight patients (59 males, 19 females; mean age, 48.2 years) with spinal cord injuries were enrolled. Urodynamic studies were performed using a normal saline filling rate of 24 mL/min. We calculated bladder compliance values of the detrusor muscle in each of three filling phase intervals, which divided the filling cystometrogram into three phases referable to the cystometric capacity or maximum cystometric capacity. The three phases were sequentially delineated by reference to the pressure-volume curve reflecting bladder filling. RESULTS: Bladder compliance during the first and second phases of filling cystometry was significantly correlated with overall bladder compliance in overactive detrusors. The highest coefficient of determination (r2=0.329) was obtained during the first phase of the pressure-volume curve. Bladder compliance during all three phases was significantly correlated with overall bladder compliance of filling cystometry in underactive detrusors. However, the coefficient of determination was greatest (r2=0.529) during the first phase of filling cystometry. CONCLUSION: Phasic bladder compliance during the early filling phase (first filling phase) was the most representative assessment of overall bladder compliance during filling cystometry. Careful determination of early phase filling is important when seeking to acquire reliable urodynamic data on neurogenic bladders.

Differences in Urodynamic Variables for Vesicoureteral Reflux Depending on the Neurogenic Bladder Type

OBJECTIVE: To compare the urodynamic study variables at the onset of vesicoureteral reflux (VUR) between the overactive and underactive bladders in patients with spinal cord injury who presented with VUR. METHODS: A total of 28 (13 cases of detrusor overactivity and 15 detrusor underactivity) men were enrolled. We compared the urodynamic variables between the two groups; detrusor pressure and bladder compliance, the infused volume at the onset of VUR measured on a voiding cystourethrography and cystometric capacity, maximum detrusor pressure, and bladder compliance during filling cystometry were recorded. RESULTS: At the onset of VUR, the bladder volume and compliance, except for the detrusor pressure, showed a significant difference between the two groups. The detrusor pressure, bladder volume, and bladder compliance relative to the cystometric capacity showed a significant difference between the two groups. The detrusor pressure, bladder volume, and bladder compliance at the onset of VUR relative to the cystometric bladder capacity did not show any significant difference between the two groups. CONCLUSION: There were differences in some variables at the onset of VUR depending on the type of neurogenic bladder. The VUR occurred at a lower capacity in neurogenic bladder with detrusor overactivity than in neurogenic bladder with detrusor underactivity at the same pressure. VUR occurred at a lower intravesical pressure compared to that known as the critical detrusor pressure (> or =40 cm H2O) required for the development of VUR. The results of our study demonstrate that the detrusor pressure should be maintained lower than the well known effective critical detrusor pressure for the prevention and treatment of VUR.

Botulinum Toxin in the Treatment of Drooling in Tetraplegic Patients With Brain Injury

OBJECTIVE: To investigate the effect of botulinum toxin type A (BTA) injection into the salivary gland and to evaluate the changes of drooling in varied postures in tetraplegic patients with brain injury. METHODS: Eight tetraplegic patients with brain injury were enrolled. BTA was injected into each parotid and submandibular gland of both sides under ultrasonographic guidance. Drooling was measured by a questionnaire-based scoring system for drooling severity and frequency, and the sialorrhea was measured by a modified Schirmer test for the patients before the injection, 3 weeks and 3 months after the injection. Drooling was evaluated in each posture, such as supine, sitting, and tilt table standing, and during involuntary mastication, before and after the injection. RESULTS: The severity and frequency of drooling and the modified Schirmer test improved significantly at 3 weeks and 3 months after the injection (p<0.05). Drooling was more severe and frequent in tilt table standing than in the sitting position and in sitting versus supine position (p<0.05). The severity of drooling was significantly increased in the patients with involuntary mastication (p<0.05). CONCLUSION: Salivary gland injection of BTA in patients with tetraplegia resulting from brain injury who had drooling and sialorrhea could improve the symptoms for 3 months without complications. The severity and frequency of drooling were dependent on posture and involuntary mastication. Proper posture and involuntary mastication of the patients should be taken into account in planning drooling treatment.

The Correlation between Modified Ashworth Scale and Biceps T-reflex and Inter-rater and Intra-rater Reliability of Biceps T-reflex

OBJECTIVE: To establish a correlation between the modified Ashworth scale (MAS) and amplitude and latency of T-reflex and to demonstrate inter-rater and intra-rater reliability of the T-reflex of the biceps muscle for assessing spasticity after stroke. METHOD: A total of 21 patients with hemiplegia and spasticity after ischemic stroke were enrolled for this study. The spasticity of biceps muscle was evaluated by an occupational therapist using the MAS. The mean value of manual muscle test of biceps muscles was 2.3+/-0.79. Latency and amplitude of T-reflex were recorded from biceps muscles by two physicians. The onset latency and peak to peak amplitude of the mean of 5 big T-reflex were measured. The examinations were carried out by two physicians at the same time to evaluate the inter-rater reliability. Further, one of the physicians performed the examination again after one week to evaluate the intra-rater reliability. The correlations between MAS and T-reflex, and the intra- and inter-rater reliability of biceps T-reflex were established by calculating the Spearman correlation coefficients and the intra-class correlation coefficients (ICCs). RESULTS: Amplitude of the biceps T-reflex increased with increasing level of MAS (rs=0.464 and 0.573, respectively, p<0.01). ICCs of latency and amplitude of biceps T-reflex were 0.914 and 0.822. The Spearman correlation coefficients of latency and amplitude of biceps T-reflex were 0.937 and 0.635, respectively (p<0.01). CONCLUSION: Biceps T-reflex demonstrates a good quantitative measurement and correlation tool with MAS for spasticity, and also shows acceptable inter- and intra-rater reliability, which can be used for patients with spasticity after stroke.

A Case of Generalized Auditory Agnosia with Unilateral Subcortical Brain Lesion

The mechanisms and functional anatomy underlying the early stages of speech perception are still not well understood. Auditory agnosia is a deficit of auditory object processing defined as a disability to recognize spoken languages and/or nonverbal environmental sounds and music despite adequate hearing while spontaneous speech, reading and writing are preserved. Usually, either the bilateral or unilateral temporal lobe, especially the transverse gyral lesions, are responsible for auditory agnosia. Subcortical lesions without cortical damage rarely causes auditory agnosia. We present a 73-year-old right-handed male with generalized auditory agnosia caused by a unilateral subcortical lesion. He was not able to repeat or dictate but to perform fluent and comprehensible speech. He could understand and read written words and phrases. His auditory brainstem evoked potential and audiometry were intact. This case suggested that the subcortical lesion involving unilateral acoustic radiation could cause generalized auditory agnosia.

Screening for the Coexistence of Congenital Muscular Torticollis and Developmental Dysplasia of Hip

OBJECTIVE: To investigate the coexistence rate and related factors of developmental dysplasia of the hip (DDH) and congenital muscular torticollis (CMT), and to determine whether ultrasonography (US) gives good value for screening of DDH in CMT. METHOD: We prospectively examined 121 infants (73 males and 48 females) diagnosed with CMT to determine the incidence of DDH by US. We also assessed the relationship between neck US findings and DDH occurrence, and investigated the clinical features of CMT related to DDH. RESULTS: 18 patients (14.9%) were diagnosed as having DDH by US. However, most DDH was subclinical and spontaneously resolved. Only 2 patients (1.7%) needed to be treated with a harness. The positive predictive value of clinical examinations for DDH was 52.6% and patients treated by harness were all clinically positive. DDH was more common in the left side (13 left, 4 right, 1 both), but 6 out of 18 DDH (33.3%) cases presented on the contralateral side of CMT. Sex difference was not observed. Breech presentation and oligohydramnios were not related to DDH occurrence. Neck US findings did not correlate with DDH occurrence. CONCLUSION: The coexistence rate of CMT and DDH was concluded to be 14.9%. If only DDH cases that required treatment were included, the coexistence rate of these two disorders would be lowered to 1.7%. All of these patients showed positive findings in clinical examination. Therefore, hip US should not be recommended routinely for patients with CMT.

Effect on the Bone Mineral Density According to Weight-bearing Exercise in Children with Spastic Quadriplegic Cerebral Palsy: A Preliminary Study

OBJECTIVE: To evaluate the effect of weight-bearing exercise on the bone mineral density (BMD) in children with spastic quadriplegic cerebral palsy (CP). METHOD: A heterogeneous group of 18 prepubertal children with CP (age, 8.9+/-2.9 years; GMFCS level, IV and V) participated. Patients underwent a dual-energy X-ray absorptiometry scan of the lumbar spine (L1-L4) and proximal femur, and the Z scores were calculated by using data obtained from the control group who were normal children (age, 8.8+/-2.9 years). We divided the patients into 2 groups: group A standing for 2 hours a day, 5 days a week; group B standing for 30 minutes a day, 1 or 2 days a week. We measured BMD after 1 year and compared it to baseline measurements. RESULTS: BMD was significantly higher on L2-L4 vertebrae, femoral neck and trochanter area after exercise in group A (p0.05). BMD according to static weight-bearing exercise for 1 year were significantly different between groups A and B on the L1, L4 vertebrae, femoral neck and trochanter area (p<0.05). CONCLUSION: This study suggests that weight-bearing exercise may be an important part of a rehabilitation protocol to maintain and improve BMD in children with spastic quadriplegic CP.

Quantitative Analysis of Bulbocavernosus Reflex Activity in Patients with Spinal Cord Injury

OBJECTIVE: To quantify activities of bulbocavernosus reflex (BCR) using root mean square (RMS) value of motor unit action potentials in power spectrum analysis. METHOD: Twenty-six male patients with spinal cord injury were studied. The BCRs were evaluated by one examiner. The patients were assigned into absent, hypoactive and normal reflex groups according to the degree of BCR activity. The electrophysiological activities of the BCRs were evaluated by the RMS value of the motor unit action potentials in power spectrum analysis recorded from the bulbocavernosus muscle using concentric needle electrode. RESULTS: The BCR by clinical examination was absent in 6 patients, hypoactive in 10 patients and normal in 10 patients. RMS values of absent, hypoactive and normal BCR groups were 15.1+/-3.6 uV, 26.7+/-13.2 uV and 36.3+/-4.8 uV, respectively. RMS values of three groups were significant different (p=0.028) and showed significant correlation (r=0.714, p= 0.005). CONCLUSION: There was strong correlation between RMS value of motor unit action potentials of bulbocavernosus muscle and degree of BCR activities estimated by clinical examination in patients with spinal cord injury.

Compression Neuropathy of the Hypoglossal Nerve Following Orotracheal Intubation: A case report

Hypoglossal nerve injury is an uncommon complication following endotracheal intubation. A transoral procedure including endotracheal intubation may result in hypoglossal nerve compression at the lateral margin on the hyoid bone and inner mandibular margin at the tongue base. A 50-year-old patient undergoing rotator cuff repair developed a transient unilateral postoperative hypoglossal nerve injury following uncomplicated endotracheal intubation for general anesthesia. The following day the patient complained of difficulty with tongue movement and buccal manipulation of food, and had slurred speech. An electrophysiologic assessment confirmed a diagnosis of unilateral hypoglossal nerve palsy. The symptoms resolved spontaneously and completely by 6 weeks. The possible etiology of the injury is discussed, and related literatures are reviewed.

Urodynamic Findings and Voiding Symptoms according to LesionSites in Stroke

OBJECTIVE: To investigate urodynamic findings and voiding symptoms according to the location of brain lesion after stroke. METHOD: Twenty-six patients with stroke (19 infarction, 7 hemorrhage) who had complained of voiding dysfunction were studied. Brain MRI was performed to identify the suprapontine lesion or pontine lesion. Intravesical pressure and voiding control function of the external urethral sphincters were evaluated by urodynamic study with electromyographic study of the external urethral sphincter. Also voiding symptoms were evaluated. We classified voiding dysfunction into three subgroups by urodynamic findings as follows: detrusor hyperactivity, detrusor hypoactivity, and normal. Functions of the external urethral sphincters were divided into normal, impairment of external urethral sphincter volitional control (IEUS), and detrusor-sphincter dyssynergia (DSD). The symptoms of voiding dysfunction were categorized into three types as a irritative, obstructive or mixed type. RESULTS: In patients with suprapontine lesion (n=22), 11 (50%) showed hyperactive detrusor and 6 (27.3%) showed hypoactive detrusor. However, in the pontine lesion (n=4), one patient (25%) was normal and the others were hypoactive detrusor. Fourteen cases (64%) of the suprapontine lesion and 1 case (25%) of pontine lesion demonstrated normal external urethral volitional control. Seven of 11 patients with irritative symptoms showed detrusor overactivity. Five of 9 patients with obstructive symptoms showed hypoactive detrusor. CONCLUSION: We concluded that hyperactive detrusor in suprapontine lesion and hypoactive detrusor in pontine lesion were dominant. However, voiding symptoms in stroke patients were various according to the external urethral sphincter function as well as the detrusor activity.