Influence of the Initial Readings of Blood Pressure Components on Functional Outcome in Acute Ischemic Stroke Patients

BACKGROUND: To investigate the influence of the initial readings of blood pressure (BP) components on functional outcome in acute ischemic stroke patients stratified by age. METHODS: We reviewed the medical records of 54 first-ever hemiplegic MCA ischemic stroke patients (age 61.6+/-9.6 years; 37men, 17 women). Subjects were stratified by age, and BP was measured six times within the initial 24 hours after stroke onset. The maximal systolic BP (MSBP), minimal diastolic BP (mDBP), and maximal pulse pressure (MPP) were selected for analysis. Functional outcomes were evaluated with the korean-modified Barthel index (K-MBI) and functional independence measure (FIM) at 3 months after stroke onset in all subjects. RESULTS: The amount of MSBP and MPP elevation was significantly higher in patients with diabetes mellitus and smoking history, respectively (p<0.05). In regards to age groups, MPP was inversely correlated with FIM (r= -0.727, p=0.027) in subjects in their 40s. Each of MSBP and MPP were inversely correlated with FIM in the 50s age group (r= -0.666, -0.761; p=0.013, 0.002). MPP was inversely correlated with each of K-MBI and FIM in the 60s age group (r= -0.659, -0.786; p=0.002, 0.000). MPP was inversely correlated with K-MBI, and MSBP was inversely correlated with FIM in the 70s age group (r= -0.787, -0.651; p=0.002, 0.022). CONCLUSION: In elderly patients with ischemic stroke, MPP was significantly correlated with functional outcome. Therefore, the tight control and management of pulse pressure from the acute stage of stroke should be seriously considered.

The Correlations between Pulse Pressure and Functional Outcomein Acute Middle Cerebral Arterial Ischemic Stroke

OBJECTIVE: To investigate the correlation between the pulse pressure (PP) and functional outcome in acute middle cerebral arterial (MCA) ischemic stroke. METHOD: We reviewed the medical records of 52 first-ever hemiplegic MCA ischemic stroke patients (age 61.5+/-9.7 years; 35 men, 17 women). Functional outcomes were evaluated with Korean-modified Barthel index (K-MBI), functional independence measure (FIM), Korean-national institutes of health stroke scale (K-NIHSS), and Korean-mini mental state examination (K-MMSE) on 3 days and 3 months after the onset of stroke in all the subjects. The PP was measured six times within initial 24 hours after stroke onset and then the highest PP was selected for the analysis. RESULTS: The degree of PP elevation revealed the significant correlations with male gender, over the age of 55 years, diabetes mellitus, and current smoking history, respectively (p<0.05). In TOAST (Trial Org 10172 in Acute Stroke Treatment) classification, the large artery atherosclerosis group showed significantly the higher PP rather than the other groups (p<0.05). There were inverse correlations between the PP and each of FIM and K-MBI scores on 3 months after stroke onset (p=0.000, 0.009; r=- 0.479, -0.358). There was an inverse correlation between the PP and the change of FIM (p=0.000, r=-0.532). CONCLUSION: The PP within initial 24 hours after stroke onset revealed significant correlation with functional outcome. The management for the proper PP gives the favorable effect on the functional outcome in acute MCA territory ischemic stroke.

Correlation between Functional Evaluation Scales and Cognitive Evoked Potentials in Patients with Chronic Stroke

OBJECTIVE: To investigate the correlation between functional evaluation scales and cognitive evoked potentials (CEPs) in chronic stroke patients. METHOD: Ten chronic stroke patients with middle cerebral arterial infarction (age 53.6+/-15.7 years, 5 men, 5 women, duration 210.5+/-143.2 days) were recruited. Korean mini-mental status examination (K-MMSE) scores of the subjects were ranked between 15~24 points and the grades of Rancho Los Amigos level of cognitive function of the subjects were VI or VII. They received physical therapy using neuro-developmental technique and cognitive rehabilitation twice a day, 5 times a week, for total 4 weeks. Before and after the treatment, cognitive function tests including K-MMSE, Loewenstein occupational therapy cognitive assessment (LOTCA) and motor-free visual perception test (MVPT) and functional ability tests including functional independence measure (FIM) and Korean version of National Institutes of Health stroke scale (K-NIHSS) were done and CEPs were recorded. RESULTS: The scores of K-MMSE, LOTCA, MVPT, FIM and K-NIHSS showed significant improvement, respectively (p<0.05). The P300 latencies significantly decreased from 420.2+/-34.8 msec to 391.5+/-36.4 msec (p<0.05). There were significant correlations between the percentage of change of P300 latencies and each percentage of change of K-MMSE, LOTCA and MVPT (r=0.863, p=0.001; r=0.745, p=0.013; r=0.806, p=0.005). There were significant correlations between the percentage of change of P300 latencies and each percentage of change of FIM and K-NIHSS (r=0.758, p=0.011; r=0.743, p=0.014). CONCLUSION: The CEPs would be a useful method for reflecting the effect of neuro-cognitive rehabilitation treatment and predicting the functional recovery in chronic stroke patients.

Pain Evaluation with Surface Electromyography in Temporomandibular Myofascial Pain Dysfunction Syndrome

OBJECTIVE: To investigate usefulness of surface electromyography (sEMG) for the pain evaluation in the patients with temporomandibular myofascial pain dysfunction syndrome (TM-MPDS). METHOD: Twenty unilateral TM-MPDS patients (10 males, 10 females, duration of disease 6.6+/-5.6 months, age 28.5+/-3.0 years) and twenty healthy controls (10 males, 10 females, age 30.1+/-6.2 years) were recruited for this study. The patients were treated with trigger point injection therapy and cryotherapy once a week, and ultrasound thermotherapy four times a week for 2 weeks. Active electrodes were attached on temporalis and masseter muscles with reference electrode on chin and ground electrode on forehead. All of subjects were instructed to clench teeth for 5 seconds after full relaxation. For temporalis and masseter muscles, the amplitudes of clenching-EMG activities were obtained and the mean value of five biting cycles was calculated on both sides. sEMG, visual analog scale (VAS) and asymmetry index (AI) were assessed before and 2 weeks after treatment. RESULTS: For temporalis and masseter muscles, the amplitudes of affected side-EMG activity significantly decreased, and the AI of the patient group significantly increased compared with those of the control group (p<0.05, p< 0.05). The AI of the patient group significantly decreased after treatment (p<0.05, p<0.05). Higher AI in masseter muscle before treatment was significantly correlated with lower VAS after treatment (r=-0.487, p<0.05). CONCLUSION: It is suggested that sEMG would be useful for diagnosing and evaluating the pain in TM-MPDS.