Ischemic Lumbar Flexopainy: Caused by Obstruction of Iliolumbar Artery

We present a patient with ischemic lumbar plexopathy due to unilateral obstruction of iliolumbar artery, a branch of internal iliac artery. Although most parts of lumbar plexus and femoral nerve have rich vascularization and therefore are resistant to ischemic injury, but their poorly vascularized intrapelvic portions are vulnerable to ischeniic insults caused by stenosis or obstruction of internal iliac artery and/or its branch. So in lumbar plexopathy, angiograhpy with many other extensive examinations shoud be recommended for differentiation from various causes.

Pelizaeus-Merzbacher Disease: Two Cases in a Family Diagnosed by the Clinical Features and Magnetic Resonance Imaging

Pelizaeus-Merzbacher disease(PMD) is very rare x-liked recessive leukodystrophy, rather dysmyelinating d due to defect of biosynthesis of proteolipid protein, a component of myelin. Its usual clinical features are stridor, pendular nystagmus, extrapyramidal sign, pyramydal sign, developmental delay and cognition deterioration. Until now PMD has not been published in our country. A 4-year 3 month-old boy developed abnormal eye movement at 3 months of age. His psychomotor development was delayed. On our examination, definite horizontal pendular nystagmus was noted. He showed severe dysarthria, quadriparesis with generalized hyperreflexia, bilateral extensor plantar signs. All laboratory findings including cerebrospinal fluid study were normal. Brain magnetic resonance image (MRI) -revealed diffuse and symmetrical white matter changes in cerebrum and cerebellum. His 23-year-old younger maternal uncle also showed similar clinical history and brain MRI findings. Although the diagnosis of PMD depended on histopathologic investigation, recently MRI can make an important contribution to the diagnosis of PMD with characteristic clinical features. So we could diagnose him and his uncle as PMD.

Intrathecal Hyaluronidase in the Management of Spinal Block due to Tuberculous Spinal Arachnoiditis

Despite the appropriate chemotherapy and the use of steroids, spinal arachnoiditis, as a complication of tuberculous meningitis, is not uncommon in developing countries. The various methods of treatment previously undertaken have been unsatisfac.ory due to their serious side effects and/or doubtful therapeutic value. The proteolytic enzyme, hyaluronidase, by virtue of its action of hydrolysing the glucosaminidic bonds of hyaluronic acid and other mucopolysaccharides of the ground substance, offers a promising mode of treatment. This report describes the effectiveness of intrathecal injections of hyaluronidase in a patient with spinal block due to spinal tuberculous arachnoiditis. Despite the antituberculous regimen combined with steroid therapy, paraparesis and sensory changes developed in a 25-year-old female patient diagnosed with tuberculous meningitis. At that time, the CSF protein level was 6500mg%, and the myelogram and MRI showed a definite block of the CSF flow in the subarachnoid space from the second to the ninth thoracic level. After the 5 intrathecal hyaluronidase injections with the interval of two weeks(total 7500 unit), the neurological deficits were markedly improved to a nearly normal state and the CSF protein converted from 6500mg% to 128mg%. The thoracic myelogram showed improvement of passage of the contrast media through the right lateral column. Thus this case may provide the therapeutic role of hyalironidase as an adjunvant in the management of spinal arachnoiditis complicating Tb meningitis for which no satisfactory treatment exist.

Percutaneous biliary drainage

Percutaneous biliary drainage is an effective new nonsurgical method for combined external/internal catheterdecompression of obstructed extrahepatic bile ducts. Molnar and Stockum, and more recently others, have reportedsucdess utilizing this approach to establish biliary drainage in patients with obstructive jaundice. Percutaneousbiliary drainage was performed in 9 patients with obstructive jaundice. Internal drainage was accomplished in 4patients (44.4%), and external drainage in 5 patients (55.6%). Major complications occurred in 2 patients; bileleakage, one; sepsis, one. Minor complications occurred in 7 patients; mild or high fever, 5 cases; transienthemobilia, 2 cases. The catheter management problems encoutered including pain, catheter dislodgement ormigration, lumen occulusion, and external bile leakage.