Infrared Thermal Imaging in Hemiplegic Patients of Upper Extremity by Stroke

OBJECTIVE: To investigate the usefulness of infrared thermal imaging for define the cause of shoulder pain on hemiplegic patients. METHOD: Subjects were 91 stroke patients who admitted to rehabilitation department from January 2002 to June 2003. Retrospective study was done by review of medical records. The subjects were divided into the control group (n=42) without shoulder pain and study group (n=49) who had the shoulder pain. The study group were also divided into subluxation, adhesive capsulitis, complex regional pain syndrome (CRPS) type I by main cause of pain. RESULTS: In the control group, the result revealed hypothermia on the involved upper extremity compared with the opposite intact side (p <0.05). In the study group, it revealed hyperthermia on the hand and forearm who diagnosed with CRPS type I. CONCLUSION: Distal infrared thermal imaging is considered to be useful diagnostic tool of CRPS type I in hemiplegic patient with shoulder pain.

Diffusion-Weighted MR Imaging of Spinal Cord Infarction

PURPOSE: To evaluate the usefulness of diffusion-weighted imaging(DWI) and quantitative apparent diffusion coefficient (ADC) maps in the patients with spinal cord infarction. MATERIALS AND METHODS: We studied 6 patients presented symptoms with spinal cord infarction, retrospectively(3 men and 3 women). We obtained multi-shot echo planar-based, DWI using 1.5T MR scanner at 5.4 mean days after the onset of ischemic symptoms. In six patients, signal intensity was acquired at conventional b value (1000s/mm2). The ADC value for the normal spinal cord and for infarcted lesions was measured from the trace ADC maps by using regions of interest positioned over the spinal cord. We analyzed signal intensity of lesion on MRI and DWI, and compared with ADC values in infarcted lesions and normal site. RESULTS: T1-weighted MR image showed iso-signal intensity in four of six patients and low signal intensity in two of six. T2-weighted MR image demonstrated high signal intensity in all of six. All DWI were considered to be diagnostic. All of six depicted a bright signal intensity on DWI. ADC values of infarcted lesion were measured lower than that of normal spinal cord on ADC map. The differences in ADC values between infarcted and normal spinal cord were significantly different (p<0.05). CONCLUSION: It is possible to obtain DWI and ADC map of the spinal cord and DWI may be useful in the early diagnosis and localization of lesion site in patients with spinal cord infarction.

Epidemiologic Study of Complications in Spinal Cord Injury Patients

OBJECTIVE: The patients with spinal cord injury (SCI) suffered by a lot of complications that influence the quality of life both physically and mentally. The purpose of this study was to evaluate the epidemiology of patients with spinal cord injury in incidence of the complication according to the injury level and period. METHOD: Retrospective study was done in 554 patients with SCI who discharged from Yonsei University Medical Center from January, 1987 to December, 1996. We investigated the incidence of each complication such as respiratory, cardiovascular, genitourinary, musculoskeletal, and dermatologic complications according to the neurologic level and each period (1987~1991, 1992~1996). RESULTS: Among the 554 cases, urologic complication (40.3%) was the most common complication followed by dermatologic (39.0%), musculoskeletal (33.6%), cardiovascular (27.1%) and so on. The most common complications of each system were autonomic dysreflexia (13.2%) in cardiovascular, pneumonia (9.6%) in respiratory, contracture (27.8%) in musculoskeletal, urinary tract infection (34.3%) in urologic, hemorrhoid in gastrointestinal, and central pain (24.0%) in neurogenic complications. The most common site of pressure sore was sacral area (58.9%). There was no significant difference in each complication according to the injury period. CONCLUSION: Urologic complication was the most prevalent in patients with SCI followed by dermatologic, musculoskeletal and so on. These basic results would be helpful for prevention and management of the complication of SCI.

Epidemiologic Study of Spinal Cord Injury

OBJECTIVE: The purpose of this study is to present epidemiological data on patients with spinal cord lesion admitted to the Rehabilitation Hospital, YUCM. METHOD: Review of medical records of 590 patients with spinal cord injury admitted to the Rehabilitation Hospital, YUCM from 1987 to 1996 retrospectively. RESULTS: 1) Sex: Males account for 79.6% of the SCI patients. 2) Age: The largest number of injuries occurs in the 20~29 years of age group (32.5% of patients). 3) Etiology: Trauma accounts for 91.2% of all spinal cord injuries. The leading causes of traumatic spinal cord injury are traffic accidents (57.6%) and falls (26.4%). 4) Level of injury: Complete tetraplegia accounts for 20.5% of all SCI patients, incomplete tetraplegia 23.9%, complete paraplegia 38.8% and incomplete paraplegia 16.5%. In tetraplegics, incomplete injuries increased from 40% in 1987~1991 to 56.7% in 1992~1996. 5) Methods of bladder management: 87% of patients voids by reflex. Intermittent catheterization is practiced by 8% of patients. CONCLUSION: Epidemiologic data of 590 patients admitted to the Rehabilitation Hospital, YUCM, from 1987 to 1996 is presented with changes of epidemiology in each period. The patients suffered SCI from trauma, and traffic accidents and sports as causes were increasing. Female patients and incomplete injuries were also increasing. Mean duration of hospitalization decreased.

Accuracy of a Portable Ultrasound Scanning in the Measurement of Post-void Residual Urine Volume in Patients with Spinal Cord Injury

As a standard method for the measurement of post-void residual urine volume, the urethral catheterization is commonly used. However, it is frequently associated with the discomfort of the patients, urethral trauma and urinary tract infection. A noninvasive method of determining the residual urine volume could minimize unnecessary catheterizations and be useful in the management of neurogenic bladder in the patient with spinal cord injury(SCI). This study was undertaken to evaluate the accuracy of a portable ultrasound scanner for measuring bladder volumes in SCI patients undergoing bladder training and to determine the factors affecting its accuracy. Sixty patients with SCI were included in this study. Two investigators performed the ultrasound measurement of the post-void residual urine volume alternately and the same procedures were repeated. After that, the urethral catheterization was done. In comparison of the residual volume measured by two different methods, the correlation coefficient(R2) of the two different methods was 0.996 and the mean value of difference between the residual volume measured by ulltrasound and by catheterization was 21.6 ml. The accuracy of the ultrasound measurements was not affected by gender, types of the neurogenic bladder, shape of the bladder, trabeculation of the bladder and central obesity. The results indicate that the portable ultrasound scanning method is a useful non-invasive method and can be substituted for the urethral catheterization in determination of bladder volumes in patients with SCI.