The Correlation between Crossed Cerebellar Diaschisis and Motor Impairment of Hemiplegic Upper Extremity in Stroke Patients

OBJECTIVE: The aim of this study was to investigate the correlation between crossed cerebellar diaschisis (CCD) and motor evoked potentials (MEPs) and to study the relationship between CCD and the severity and prognosis of stroke. METHOD: 28 patients with first-ever unilateral stroke were recruited for this study. The central motor conduction times (CMCTs) were obtained from Abductor pollicis brevis (APB) and Abductor hallucis (AH) by recording MEPs. The existence of CCD was evaluated by single photon emission computed tomography (SPECT) of brain. The National Institutes of Health stroke scale (NIHSS), Motricity Index (MI), and functional outcome scales were measured. RESULTS: The presence of CCD correlated significantly with "not evoked" MEPs in upper extremity (p 0.05) and volume of brain lesion (p> 0.05). There was a significant correlation between the presence of CCD and lower MI score of upper extremity (p <0.05). CONCLUSION: The presence of CCD would indicate the damage on descending motor pathways and be associated with the severe motor impairment of upper extremity in stroke patients.

Graded Spinal Cord Contusive Rat Model by a Weight-drop Device

OBJECTIVE: To investigate the reproducibility of graded spinal cord contusion by a weight-drop device, and to establish a graded spinal cord contusive rat model based on the functional analysis and morphometric measurement. METHOD: The weight-drop device developed was composed of impactor with a guidance rod, stereotaxic frame and spine stabilizing device. We investigated the reproducibility of impact by reliability analysis two weeks later. Thirty Sprague-Dawley rats were injured by the weight-drop device from the height of 12.5, 25.0 and 50.0 mm. The three groups of each drop-height (n=10) as well as laminectomized sham group (n=10) were subjected to functional analysis by Basso Beattie Bresnahan Locomotor Scales (BBB scales) and inclined plane test after contusion for four weeks. The morphometric measurement was performed at regularly spaced intervals including the epicenter according to the graded drop-height. RESULTS: The impact of weight-drop was significantly increased according to the drop-height (p <0.05) and revealed high reproducibility. The changes of BBB scales and maximal angle of inclination had an inverse correlation with the contusion severity (p <0.05). There was an inverse correlation between the amount of residual white matter and drop-height (p <0.05). CONCLUSION: The weight-drop device newly developed provides a constant and reproducible spinal cord contusion model.

Effect of Passy-Muir Speaking Valve in Brain-injured Patients with Dysphagia: Two cases report

It is well known that the brain-injured patients with tracheostomy is prone to frequent tracheopulmonary aspiration and dysphagia problems. We experienced two brain-injured patients with dysphagia, who revealed the improvement of clinical and videofluoroscopic parameters after application of Passy-Muir speaking valve (PMV 2000(R), Passy-Muir Inc., USA). Two brain-injured patients had kept on nasogastiric and tracheostomy tubes. After PMV application for 2 weeks, the frequency of aspiration decreased, sleep hygiene and emotional lability improved, and also videofluoroscopic parameters such as pharyngeal delay time, pharyngeal transit time, and epiglottic closure were improved. Eventually, they could be free from tracheostomy tubes within 1 month after PMV application.

The Clinical Utility of Hand Sympathetic Skin Response in Bell's Palsy

OBJECTIVE: To investigate the correlation between the severity of paralysis and hand sympathetic skin response (SSR) in patients with Bell's palsy and to evaluate the clinical utility of hand SSR as a predicting factor of prognosis. METHOD: Twenty patients with Bell's palsy and twenty normal controls were recruited. The severity of paralysis was graded according to House-Brackmann Facial Grading Scale (H-B FGS), and percent degeneration of Nasalis was determined by Facial Nerve Conduction Study (FNCS). RESULTS: The difference of hand SSR amplitude between affected and unaffected side was significant (p<0.05). There was significant correlation between H-B FGS and the difference of hand SSR amplitude (p<0.05). There was significant correlation between percent degeneration and the difference of hand SSR amplitude (p<0.05). There were significant correlations between the difference of hand SSR amplitude at 5 days and percent degeneration at 9 and 14 days (p=0.026, p=0.001). CONCLUSION: The difference of hand SSR amplitude between affected and unaffected side was useful for the indication of the severity of paralysis. And, hand SSR would be useful for an early prognostic predictor in Bell's palsy.

Schwartz-Jampel Syndrome: A case report

Schwartz-Jampel syndrome is a rare autosomal recessive disorder characterized by clinical myotonia, persistent spontaneous activity, and skeletal dysplasia (short stature, pigeon breast, micrognathia etc.). We experienced an eleven- year-old girl complaining of gait disturbance and motor weakness of both legs. She was operated for umblical hernia at the age of two and for congenital hip dislocation at the age of six. She displayed short stature, short neck, microstomia, micrognathia, pigeon breast, and calf muscle hypertrophy. Her muscle strength was fair to good grade in both legs. Percussion- and exercise-induced myotonia was observed. Her cognitive function was below-average intelligence. Serum creatine kinase was elevated three to four times of normal level. Routine motor and sensory conduction studies were normal and continuous electrical myotonic discharges were detected in all examined muscles. Clinically, her symptom was non-progressive for three years.

Pattern of Exon Deletions of Dystrophin Gene in Korean Patients with Duchenne Muscular Dystrophy

OBJECTIVE: To investigate the pattern of exon deletions in Korean patients with Duchenne muscular dystrophy (DMD), and to find the correlation of the exon-deletion with clinical symptoms or laboratory findings. METHOD: Genomic DNA of the nine children with DMD were analyzed by the sets of multiplex PCR and one singlet PCR in total of fifteen primers of the dystrophin gene. The primers were made from the promotor, and the exons 3, 4, 6, 8, 12, 13, 43, 44, 47, 48, 50, 51, 52 and 60 of the dystrophin gene, respectively. RESULTS: Eight out of nine patients revealed exon deletions. The exon 3 was most commonly deleted (6 patients), and exon 48, 50 and 60 were second most common (2 patients). The exons 4, 6, 13, 44, 47 and 52 were not deleted in all patients. CONCLUSION: We found that the exons 3, 48, 50 and 60 are frequently deleted in Korean patients with DMD. The pattern of deletion was not correlate with clinical symptoms or laboratory findings.

Cystic Entrapment of Infraspinatus Branch of Suprascapular Nerve Confirmed by Ultrasonography: Case report

Cystic entrapment of infraspinatus branch of suprascapular nerve is a rare cause of shoulder pain with infraspinatus atrophy. We discuss the ultrasonographic diagnosis and ultrasonography- guided aspiration of the cyst as a treatment. Case: A 37-year-old, ship-yard laborer had experienced left shoulder discomfort and pain without trauma history. Physical examination showed profound selective atrophy of left infraspinatus muscle. Simple X-ray of shoulder showed normal findings. Electrodiagnostic examination revealed delayed motor latency of infraspinatus branch of suprascapular nerve and denervation potentials of infraspinatus muscle exclusively. Ultrasonographic finding showed 13.5X21.5 mm sized cystic mass around left infraspinatus notch. Ultrasonography-guided aspiration was done, and then electrical stimulation therapy and strengthening exercise of left shoulder were performed. Symptoms were improved. We report a rare case of cystic entrapment of infraspinatus branch of suprascapular nerve in a patient without traumatic insult.

Effect of Methylphenidate on Cognitive Function of Brain Injured Patient: Report of 5 cases

Outcome following brain injury is influenced by several factors, including on early medical and rehabilitative intervention, an integrated interdisciplinary team approach to treatment, and the patient's motivation and ablility to cooperate in rehabilitation efforts. Methylphenidate(MP) is a central stimulant that blocks the reuptake of serotonin and norepinephrine, and also it has a dopaminergic activity by releasing the dopamine from dopamine stored vesicles. Dopamine plays an important role in cognitive and affective brain functions. Methylphenidate has been used in an attention deficit disorder with hyperactivity in the pediatric clinic and for various types of depression and narcolepsy. Clinical research has not irreputably proved or disproved the effectiveness of MP for the improvement of cognitive function in brain injured patients. This report presents five cases who were treated by MP for the improvement of cognitive function in brain injured patients. Among five cases, 3 cases suffered from hemorrhagic strokes and 2 cases from tranmatic brain injuries. Three cases were in drowsy stateand 2 cases were semicomatous. After MP(10 mg) was ingested per oral route before breakfast, we evaluated patients' cognitive function by the Functional Independence Measure(FIM), Rappaport Disability Rating Scale(DRS), Mimi-mental State Examination(MMSE), Galveston Orientation and Amnesia Test(GOAT) and the clinical state as well as side effects. Based on the results from the study we suggest cautionally that MP would be useful for the treatment of brain injured pateints who had decreased cognitive function to induce an early participation of rehabilitation programs. Further prospective study is required with a large control group and affected group, to confirm our preliminary results.