Periodic limb movements in sleep (PLMS) is characterized by recurrent episodes of repetitive, stereotyped limb movements that occur during sleep. There have been a few reports on this condition developing after a stroke, but the movements in these reports were not prodromal stroke symptoms. We describe a case in which PLMS developed as a prodromal stroke symptom. A 78-year-old man experienced right hemiplegia and dysarthria following left striatocapsular infarct. After acute care, he was transferred to our center for rehabilitation. During rehabilitation, he complained of right-side involuntary leg movements during sleep. According to his history, it had been developed 10 days before the appearance of right hemiplegia. Polysomnography confi rmed the diagnosis of PLMS. We propose that PLMS can be a prodromal stroke symptom resulting from a pyramidal tract lesion without involvement of sensory components.

No abstract available.
Mass Screening*

No abstract available.
Drug Therapy* ; Humans ; Retreatment*

Pusher syndrome is a neurological disorder where the patient actively pushes away from the non-hemiparetic side following brain damage. We experienced a case in whom intractable pusher syndrome associated with thalamic hemorrhage improved following a newly developed pontine infarction. A 63-year-old man showed severe pusher syndrome after an initial thalamic hemorrhage. After approximately 2 years, a pontine infarction developed and improved the persistent pusher syndrome. We postulate that it resulted from involvement of the medial lemniscus with interruption of the distorted upward proprioceptive signal of body orientation.

Transient paralysis occasionally occurs after an epidural injection, but the reasons for this are still unknown. We present here a patient with transient paralysis following loculation of the injectant associated with the procedure. A 50-year-old woman with a history of two previous spinal operations complained of a burning sensation and radiating pain. A caudal block and right S1 transforaminal epidural block were performed. Loculation of the block injectant into the right L5 and S1 epidural space was confirmed through computed topographic imaging. She showed transient weakness of the right lower limb, which completely recovered after 1 day. This case shows that extra care should be taken when performing an epidural injection in a patient with adhesions around the injection site and appropriate adjustments should be made to the volume of the injectant.

Cyclic vomiting syndrome is characterized by recurrent episodes of stereotyped vomiting separated by regular symptom-free periods. We describe a case of cyclic vomiting syndrome developed after stroke, which has not been reported to date. A 69-year-old woman experienced recurrent vomiting following left cerebral infarct. The patient's vomiting pattern was consistent with cyclic vomiting syndrome, and the diagnosis of cyclic vomiting syndrome was established by exclusion of other known disorders which could have resulted in vomiting. She was treated with imipramine hydrochloride and her symptom was well controlled.
Aged ; Female ; Humans ; Imipramine ; Stroke ; Vomiting

BACKGROUND: Advanced age alone should not be a serious deterrent to surgery. Preoperative evaluation of concomitant illness, operation time, accurate and minimal, but adequate surgery will serve to minimize morbidity and mortality in elderly patients. METHODS: The total number of surgical patients admitted to Kwang Hye Hospital, Pusan, from March 1994 to August 1996 was 3211, and the number of surgical geriatric patients admitted during the same period was 214. Operations were performed on 139 patients. We recorded information about age, sex, anesthesia type, operation time, non malignancy vs malignancy, emergency vs elective "Surgery", coexisting disease, and APACHE II score, and we examined the patients for results affecting postoperative morbidity and mortality. RESULTS: Postoperative complications occured in 55 cases (39.6%), and the operative mortality was 2.2%. The significant factors affecting postoperative morbidity were emergency operation, malignancy and APACHE II score. The operation time and coexisting diseases were not significant. Age had little effect on the postoperative prognosis CONCLUSIONS: Performance of elective surgery and preoperative evaluation of the APACHE II score are important factors.
Aged ; Anesthesia ; APACHE ; Busan ; Emergencies ; Humans ; Mortality ; Postoperative Complications ; Prognosis

PURPOSE: To evaluate the result of percutaneous fixation with cannulated screws and Ilizarov external fixator in triplane fracture of the distal tibial epiphysis in children. MATERIALS AND METHODS: Between May 2004 and December 2007, 14 cases with triplane fractures were treated by percutaneous fixation with cannulated screws and Ilizarov external fixator after underwent CT imaging to assess the fracture pattern, articular disruption and to plan further management. Mean age and follow-up period were 14.1 years old and 15 months respectively. RESULTS: There were satisfactory results in all 14 cases that had excellent reduction and stable fixation. All cases regained full range of movement within 6 weeks. CONCLUSION: We obtained satisfactory result after percutaneous fixation with cannulated screws and Ilizarov external fixator in triplane fractures of the distal tibial epiphysis in children.
Child ; Epiphyses ; External Fixators ; Follow-Up Studies ; Humans

A 24-year-old male developed bulbar palsy, ophthalmoplegia, ptosis, and shoulder weakness bilaterally 2 weeks after he had experienced an upper respiratory infection. The electrodiagnostic study demonstrated axonal polyradiculoneuropathy. The repetitive nerve stimulation study (RNS) showed no significant decrement of the compound muscle action potentials (CMAPs). The videofluoroscopic swallowing study (VFSS) showed severe impairment of the pharyngeal phase of swallowing. He was diagnosed as having the pharyngeal-cervical-brachial variant of Guillain-Barre syndrome. The patient's dysphagia was not improved for 3 months. A follow up RNS showed a significant decrement of the CMAPs. Pyridostigmine bromide was tried to improve the dysphagia. The patient showed immediate improvement of his dysphagia on the VFSS after the trial with pyridostigmine bromide. Pyridostigmine bromide was given before each meal for 8 days and he showed continuous improvement of his dysphagia. The follow up VFSS after 3 months showed complete recovery of dysphagia.
Action Potentials ; Axons ; Bulbar Palsy, Progressive ; Deglutition ; Deglutition Disorders ; Follow-Up Studies ; Guillain-Barre Syndrome ; Humans ; Male ; Meals ; Muscles ; Ophthalmoplegia ; Polyradiculoneuropathy ; Pyridostigmine Bromide ; Shoulder ; Young Adult

OBJECTIVE: To evaluate the clinical usefulness of the subjective assessments of nutritional status (Mini-Nutritional Assessment [MNA] and scored patient-generated subjective global assessment [PG-SGA]), compared with the objective (hematological, biochemical, and anthropometric) assessments, and to identify the correlation between the MNA and the scored PG-SGA in elderly patients with stroke. METHODS: Thirty-five stroke patients, aged 60 to 89 years old, participated in our study. The MNA, the scored PG-SGA and objective factors were evaluated. The objective malnutrition state was defined based on laboratory outcomes. According to the MNA and the scored PG-SGA classifications, total patients were respectively divided into three groups; well-nourished (W), at risk of malnutrition (R), and malnourished (M), and into four groups; normally nourished (A), suspected or mildly malnourished (B), moderately malnourished (C), and severely malnourished (D). RESULTS: Mean age and body mass index of subjects were 70.6 years and 22.2 kg/m2, respectively. Twenty-six (74.3%) patients were identified to be at an objectively malnourished state. In MNA, 3 (8.6%) patients were classified as group W, 13 (37.1%) as R, and 19 (54.3%) as M. Total MNA scores and three categorization had mild correlation with objective grouping (r=0.383, r=0.350, p<0.05, respectively). Restructuring into two groups by combining group R and M made strong correlation (r=0.520, p<0.01). On the basis of scored PG-SGA, 6 (17.1%) patients were sorted as group A, 10 (28.6%) as B, 15 (42.9%) as C, and 4 (11.4%) as D, respectively. Total scores and the grouping into four indicated meaningful correlation with the objective distinction (r=-0.403, p<0.05, r=0.449, p<0.01, respectively). There was a significant correlation between the MNA scores and the PG-SGA scores (r=-0.651, p<0.01). CONCLUSION: It is proposed that the MNA and the scored PG-SGA would be useful in screening malnourished elderly patients with stroke.
Aged ; Body Mass Index ; Geriatrics ; Humans ; Malnutrition ; Mass Screening ; Nutrition Assessment ; Nutritional Status ; Stroke