The Correlation of Motor Impairment and Fractional Anisotropy in Diffusion Tensor Imaging in Post-stroke Hemiplegic Patients

OBJECTIVE: Diffusion tensor imaging (DTI) fully characterizes water molecule mobility, allowing an exploration of fiber tract integrity and orientation in the human brain. The purpose of this study was to investigate the correlation between motor impairment and the changes of fractional anisotropy (FA) in the internal capsule in post-stroke hemiplegic patients. METHOD: Six normal subjects and 19 post-stroke hemiplegic patients who had a lesion in the internal capsule were included in this study. DTI was performed with a 3.0 Tesla MR at the mean interval of 28.2 days after stroke. Motor impairment was assessed with the Motricity Index and Trunk Control Test at the time of the imaging study. FA was measured in anterior limb and posterior limb of internal capsule. RESULTS: FA reduced significantly in the affected region compared with the other unaffected region in patients and normal region in controls. FA in the affected posterior limb of the internal capsule was correlated with the Motricity Index score of the affected upper limb (r=0.642, p<0.05). CONCLUSION: DTI can be helpful to evaluate motor impairment of the upper limb in post-stroke hemiplegic patients.

The Changes after Alcohol Neurolysis of the Tibial Nerve Motor Branches to Gastrocnemius Muscles in Poststroke Patients

OBJECTIVE: To evaluate the effectiveness and electrophysiological changes after alcohol neurolysis of the tibial nerve motor branches to gastrocnemius muscles on the treatment of ankle spasticity in stroke patients. METHOD: Fourteen poststroke hemiplegic patients who had an abnormal gait pattern due to the ankle spasticity participated. They were evaluated by modified Ashworth scale (MAS) score, passive range of motion (PROM) of ankle, and ankle clonus, and were studied using electrophysiological measurements such as amplitude and latency of H-reflex and M response, and H/M ratio. 50% alcohol was injected into the tibial nerve motor branches to the both gastrocnemius muscles with electromyography guidance. Follow-up evaluations were performed immediately, and then, at the one-week, one-month, and three-months following the neurolysis. RESULTS: The MAS scores significantly decreased and the PROM of the ankle significantly increased. The M response and H-reflex amplitude of gastrocnemius muscles significantly decreased after the neurolysis and they had a tendency to increase at the 3-months follow-up. Also, H/M ratio significantly decreased. There were no serious postinjection complications. CONCLUSION: Alcohol neurolysis of the tibial nerve motor branches was an effective and safe method for the treatment of the ankle spasticity in poststroke hemiplegic patients.

Intramedullary Cavernous Hemangioma as a Cause of Paraplegia: Two cases report

Cavernous hemangiomas occur throughout the central nervous system. Although they are most commonly found in the brain, the intraspinal lesion accounts for approximately 5% of all adult intramedullary lesions. Widespread use of MR imaging have led to an increase in the reported cases of intramedullary cavernous hamangiomas. Spinal intramedullary cavernomas are positioned in a particularly precarious location, and are more likely to cause clinically significant findings than cranial cavernomas. It is important to recognize cavernomas as a surgically manageable cause of myelopathy. Generally, surgery cannot cure the chronic myelopathy from cavernoma but can halt it's progression. These facts emphasize the need for early diagnosis. In our two cases, they developed initially low back pain and sensory changes of both legs and subsequently paraplegia. We report two cases of intramedullary cavernous hemangioma with the review of literatures.