A Cas e of Bilateral Lateral Medullary Syndrome due to Two Cons ecutive Medullary Infarcts

Lateral medullary syndrome is one of the most well known and best characterized vascular syndromes of the vertebrobasilar circulation. This syndrome is most often caused by unilateral occlusive disease of the ipsilateral vertebral artery or its posterior inferior cerebellar artery branch. Bilateral lateral medullary syndromes are rare and the prognosis of this condition is grave. A 70-year-old hypertensive, diabetic woman developed sudden dizziness and gait ataxia. On neurologic examination, she had dysarthria, hoarseness, nystagmus, absent gag reflex, sensory changes on the right hemibody, and left limb and gait ataxia. Brain MRI revealed left middle and inferior lateral medullar infarction. Brain MR angiography revealed occlusion of the right vertebral artery and mild stenosis at the origin of the left vertebral artery with distal occlusion. Seven months later, she developed right lateral medullary syndrome. Repeated brain MRI revealed right upper lateral medullar and cerebellar infarction. We report a case of bilateral lateral medullary syndromes due to two consecutive medullary infarcts.

How Many Hypertensive Patients Recognize the Name of Antihypertensive Drug That They Are Taking?

BACKGROUND: Doctor shopping is common in Korea. Therefore, if patients are not familiar with the name of the antihypertensive drug they are taking, they may end up taking a drug that previously caused them side effects and may have to start on a new antihypertensive drug. This study was to clarify the factors related to patients' recognition of the name of their antihypertensive medications. METHODS: A questionnaire survey was done in June 2002 targeting 607 outpatients who were on antihypertensive medication seeking care at Asan Medical Center, Ulsan University Hospital and a clinic in Gyungju. Out of the 607 patients, 293 patients responded to the questionnaire. RESULTS: Ninety six of the 293 patients (32.8%) were able to accurately name at least one of the antihypertensive drugs they were taking. Women were more familiar with names of antihypertensive drugs than men (39.4% vs 23.6%, odds ratio [O.R], 2.69; 95% confidence interval [CI], 1.39~5.22). The recognition of a drug was greater in subjects who had a higher education level (high school or university) compared to those with a lower education level (elementary school or less) by 4.2 fold (O.R, 4.20; CI, 1.64~10.69). The type of concomitant drug intake was lower in subjects who could name their antihypertensive drugs than for subjects who could not (O.R, 0.78; CI, 0.63~0.98). The patients who could name their antihypertensive drugs had both a lower mean systolic (133.2 11.6 mmHg: mean standard deviation [S.D] vs 141.3 15.5 mmHg: mean S.D) and diastolic blood pressure, compared to the patients who could not (84.5 7.2 mmHg: mean S.D vs 86.8 9.5 mmHg: mean S.D) when measured twice consecutively during a recent clinic visit. CONCLUSION: The recognition of a medication was associated with patient's sex, education level and the number of concomitant drug intake. The patients, who could name the antihypertensive drugs they were taking, had a lower mean systolic and diastolic blood pressure.

Knowledge and Skills in Blood Pressure Measurement Skills

BACKGROUND: Errors during measurement of blood pressure can cause over diagnosis or under diagnosis of hypertension, which can result in inappropriate management of hypertension and follow up consultation. The aim of this study was to investigate the factors affecting the accuracy of blood pressure measurement, which may serve as means to improve the accuracy of blood pressure measurements. METHODS: Among the 123 interns who work at Asan Medical Center, we selected 90 persons who agreed to join the study. Three interns were excluded because of their incomplete response to the questionnaire. Questionnaire for the survey concerning blood pressure measurement was created by selecting 5 case problems from a total of 34 cases provided within the blood pressure measurement CD ROM, which apply the Korotkoff sound technique. The factors that might affect the measurement were analyzed by multiple logistic regression. RESULTS: Fifteen (17.2%) interns failed to accurately measure blood pressure provided by the CD program. They showed a difference of greater than 10 mmHg between the actual and the measured systolic blood pressure. A discrepancy of greater than 5 mmHg was noted in the measurement of diastolic blood pressure. From the total sample of 87 interns, 15 (16.1%) interns showed digit preference (0 or 5), when measuring blood pressure. The discrepancy between the measured and the actual blood pressure was greater among those who had a digit preference (95% CI 1.055~17.770). CONCLUSION: Digit preference was the most important factor that affected the accuracy of blood pressure measurement taken by conventional sphygmomanometry. Effort to correct digit preference would improve the quality of blood pressure measurements.