Clinical Evaluation of Stroke in Infants and Children

PURPOSE: The causes of stroke in children are varied and morbidity by stroke is significant, it needs further investigations to identify the underlying causes. Despite significant morbidity in childhood, only a few studies have been reported. So we reviewed retrospectively clinical records, diagnosed stroke in neuroradiologic study and analyzed sex, age, cause, clinical features, mortality, lesion of brain injury and residual deficits. METHODS: From January 1994 to July 1997, 67 patients diagnosed with stroke in neuroradiologic study were studied retrospectively. We described age, sex distribution, underlying causes, clinical features, mortality, lesion of brain injury and residual deficits. RESULTS: There were 50 cases(74.6%) of ischemic stroke and 14 cases(20.9%) of hemorrhagic stroke. The most common cause was moyamoya disease in ischemic stroke and hemato- oncologic disease in hemorrhagic stroke. The presenting features were seizure, 30 cases(44.8%) ; motor deficit, 27 cases(40.3%) ; mental change, 15 cases(22.4%) ; and headache, 11 cases(16.4%). Forty-five cases(67.1%) involved carotid system and 13 cases(19.5%) involved vertebrobasilar system. The mortality rate was 19.4% and the rate of residual deficit was 63.0%. CONCLUSION: Cerebrovascular disease in childhood is not an uncommon occurrence in Korea considering these results. As a consequence of medical progress, early mortality rate has decreased, but the rate of residual deficits tended to increase. So further studies on childhood stroke are required for early diagnosis and treatment which are important in decreasing mortality and morbidity.

Is Conventional Angiography Always Superior to MR Angiography in Evaluatin of Cerebral Aneurysm?

Conventional angiography still remains the procedure of choice in evaluation of cerebral aneurysm. However, MRI and MR angiography can play different roles in vizualizing cerebral aneurysm. A 43-year-old male was evaluated for recurrent seizure attacks. The brain MRI showed non-enhancing iso-signal mass on T1WI, signal voiding mass with stalk-like structure on coronal T2WI in the right temporal region. MRA also revealed dark round signal. However, the conventional cerebral angiography failed to visualize it. Finally, the mass was confirmed as a huge aneurysm filled with intraluminal thrombus on operation. It should seem that contrast media could not fill the aneurysmal sac because of intraluminal thrombus in conventional angiography. But aneurysmal sac seemed to be visible on MRA as paramagnetic artifact of thrombus. So, it can be assumed that MRA is superior to the conventional angiography in some cases of cerebral aneurysm, especially when it is associated with intraluminal thrombus.

A Review of 5 Patients with Pure Sensory Stroke Syndrome

Pure sensory stroke (PSS), first described by Fisher in 1965, is a clinical condition characterized by numbness and paresthesia of the face, arm and trunk on one side, in absence of other neurologic deficit. PSS could arise anywhere along the sensory system from the cerebral cortex to the medulla. The authors experienced 5 patients with PSS: one patient had a hemorrhage on the thalamocortical pathway including the internal capsule and the corona radiata. Two another had thalarnic lesions. The fourth had a pontine hemorrhage with perioral onionpeel distributed face sensor- involvement. And the last had a pontine lacune involving crossed trigeminothalamic tract and lateral spinothalamic tract.

Characteristics of Cognitive Evoked Potentials in Chronic Alcoholics

The cognive evoked potential has been used as an objective test of the human cognitive function. The most prominent component of cognitive evoked potential is P3 (also known as the P300) which has been linked in many studies with cognitive function. According to many studies. The latency of P3 corresponds to time involved in stimulus evaluation and categorization. 15 chronic alcoholics and 15 normal controls were studied on the cognitive evoked potential to evaluatt impairment of cognitive function using the auditory stimulus of odd-ball procedure. We measured latencies and arnplitudes of P3 on 20 sites according to the international 10-20 systern for electrode placement, and results were as follows: .1. All latencies of P3 were significantly longer for chronic alcoholics than in norrnal controls on 20 sites. 2. All amplitudes ot P3 were not significantly different between chronic alcoholics and normal controls on 20 sites. 3. P3 arnplitude of chronic alcoholics was highest on Pz, and P4. Fz, C4. F4, and Cz in order. But in normal controls. P3 amplitudes were highest on Fz. And Cz. Pz P4, F4, and C4 in order. With these results, it is suggested that the prolongation of P3 latencies of chronic alcoholics is related to their cognitive impairment.

The Response to Low Rate Stimulation of Repetitive Nerve Stimulation Test after Intravenous Tensilon Injection on Patients With Myasthenia Gravis

Repetitive nerve stimulation test(RNS) was performed on 32 patients with myasthenia gravis who showed positive response to the tensilon test. The result of the repetitive stimulation test before and after the tensilon injection was compared with the point of improvement of the CMAP and decremental response. The results were as follows: 1. All patients with myasthenis gravis showed decremental responses to the low rate of stimulation in RNS. 2. The results after tensilon injections showed significant improvements of the CMAP in ocularis oculi(OOC), flexor carpi ulnaris(FCU)(P <0.0005), deltoid and abductor digiti quinti muscles(ADQ)(P < 0.005). 3. There were improvements of decremental responses after tensilon injection. 1) At 2/sec, there were significant improvements in the muscles of ADQ(P <0.005), deltoidl OOC and FCU(P < 0.0005). 2) At 3/sec, there were significant improvements in the muscles of OOC(P <0.005), deltoid, FCU and ADQ(P < 0.0005). 3) At 5/sec, there were also significant improvements in all the muscles of OOC, deltoid, ADQ, FCU(P <0.0005). These results showed that tensilon improves the RNS abnorrnalities in myasthenic patients with positive tensilon test. We think these findings before and after the tensilon injection are helpful to diagnose and differentiate a patient with suspected myasthenia gravis who has a negative tensilon test or insignificant RNS findings.

The Response to Low Rate Stimulation of Repetitive Nerve Stimulation Test after Intravenous Tensilon Injection on Patients With Myasthenia Gravis

Repetitive nerve stimulation test(RNS) was performed on 32 patients with myasthenia gravis who showed positive response to the tensilon test. The result of the repetitive stimulation test before and after the tensilon injection was compared with the point of improvement of the CMAP and decremental response. The results were as follows: 1. All patients with myasthenis gravis showed decremental responses to the low rate of stimulation in RNS. 2. The results after tensilon injections showed significant improvements of the CMAP in ocularis oculi(OOC), flexor carpi ulnaris(FCU)(P <0.0005), deltoid and abductor digiti quinti muscles(ADQ)(P < 0.005). 3. There were improvements of decremental responses after tensilon injection. 1) At 2/sec, there were significant improvements in the muscles of ADQ(P <0.005), deltoidl OOC and FCU(P < 0.0005). 2) At 3/sec, there were significant improvements in the muscles of OOC(P <0.005), deltoid, FCU and ADQ(P < 0.0005). 3) At 5/sec, there were also significant improvements in all the muscles of OOC, deltoid, ADQ, FCU(P <0.0005). These results showed that tensilon improves the RNS abnorrnalities in myasthenic patients with positive tensilon test. We think these findings before and after the tensilon injection are helpful to diagnose and differentiate a patient with suspected myasthenia gravis who has a negative tensilon test or insignificant RNS findings.

A Case of Overlap Myasthenic Syndrome

Myasthenia gravis (MG) differs from the Lambert-Eaton syndrome (LES) clinically, electrophysiologically, and therapeutically. However. There had been a few reports documenting the coexistence of MG and LES in the same patient, which is termed as "overlap myasthenic syndrome". We had studied a patient who had showed all the clinical characteristics of MG including positive response to pyridostigmin. Unlike the usual response in MG, there had been an abnormal incremental responses at post-exercise and high rate stimulation with abnormal decremental responses at low-rate stimulation in repetitive nerve stimulation test, which satisfies the diagnostic criteria of both MG as LES.

The Diagnostic Value of Segmental Nerve Conduction Study in Diabetics

Nerve conduction study has been an important part of electrodiagnosis and has been utilized as a clinical diagnostic technique in diabetic neuropathy. But conduction study of the more proximal segment has been a few reports. This study demonstrated segmental method for obtaining orthodromic motor nerve conduction and mixed nerve conduction, and antidromic distal sensory nerve conduction in diabetic group and normal group. The purpose of the study was to determine diagnostic value of segmental nerve conduction in diabetic neuropathy. The results were as follows: 1. Significant difference at P0.05 between diabetic group and normal group; in ulnar motor terminal letency, ulnar sensory nerve conduction velocity at axilla-Erb's point segment and finger-wrist segment, peroneal motor terminal latency and peroneal motor nerve conduction velocity at popliteal fossa-fibula head segment, posterior tibial motor terminal latency, sural sensory nerve conduction velocity. 3. The nerve conduction of proximal segment is more statistically significant than that of distal segment.