OBJECTIVE: This study was designed to evaluate the usefulness of stretch reflex threshold speed (SRTS) in biomechanical assesment of spasticity of hemiplegic patients. METHOD: Thirty-eight hemiplegic patients and twenty-seven control subjects were studied. The spasticity of ankle plantar flexor muscles were assessed both clinically and biomechanically. Modified Ashworth scale (MAS) and Brunnstrom stage were used in clinical assessment. For biomechanical assessment, ankle plantar flexor muscles were stretched isokinetically while EMG signals were recorded simultaneously. SRTS was defined as a minimum angular velocity in which EMG signals evoked by stretch reflex were recorded. RESULTS: SRTSs of ankle plantar flexors were 128.1 47.1o/sec in control group, 163.7 79.7o/sec in intact legs, and 83.4 69.1o/sec in involved legs of hemiplegic group. STRS was significantly lower in involved legs of hemiplegic group than in intact legs of hemiplegic group and control group. Significant reverse correlation was observed between SRTS and MAS. There was significant difference in SRTS between MAS 0 group and other groups. The patients with Brunnstrom stage 3 and 4 groups showed decreased SRTS compared to the patients with other groups. CONCLUSION: SRTS is thought to reflect increased excitability of stretch reflex and seems to be one of useful parameters in quantitative assessment of spasticity.
Ankle ; Equidae ; Hemiplegia ; Humans ; Leg ; Muscle Spasticity* ; Muscles ; Reflex, Stretch*

Cavernous angiomas are considered to be congenital in origin. Patients under age of 14 years usually does not require imaging because they are likely to have a benign abducens nerve palsy, unless they develop additional signs or symptoms of neurologic disease during observation. Here we report a case of an isolated abducens nerve palsy caused by overt hemorrhage from de novo formation of cavernous angioma in the pons. Cavernous angiomas of the brain stem should be considered as a possible cause of isolated abducens nerve palsy in young adult and MRI, including gradient-echo sequences should be performed.
Abducens Nerve Diseases* ; Abducens Nerve* ; Brain Stem ; Hemangioma, Cavernous* ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Pons ; Young Adult

Cavernous angiomas are considered to be congenital in origin. Patients under age of 14 years usually does not require imaging because they are likely to have a benign abducens nerve palsy, unless they develop additional signs or symptoms of neurologic disease during observation. Here we report a case of an isolated abducens nerve palsy caused by overt hemorrhage from de novo formation of cavernous angioma in the pons. Cavernous angiomas of the brain stem should be considered as a possible cause of isolated abducens nerve palsy in young adult and MRI, including gradient-echo sequences should be performed.
Abducens Nerve Diseases* ; Abducens Nerve* ; Brain Stem ; Hemangioma, Cavernous* ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Pons ; Young Adult

Collet-Sicard syndrome is one of the syndromes of the multiple lower cranial nerve palsies, characterized by unilateral paralysis of 9th through 12th cranial nerves. The present report describes a 34-year-old woman who had hoarseness, dysarthria, and loss of taste developed after febrile illness. Brain MRI, both T1WI and T2WI, showed high signal intensity in the left jugular foramen. Gd-GTPA contrast injection revealed thickening and enhancement of the left tentorium. Angiography disclosed nonvisualization of the left transverse and sigmoid sinus, and reconstruction of the left internal and external jugular vein by collaterals from the angular, facial, and posterior fossa veins. The patient improved spontaneously two months later. This is the first report of Collet-Sicard syndrome resulting from jugular vein thrombosis.
Adult ; Angiography ; Brain ; Colon, Sigmoid ; Cranial Nerve Diseases ; Cranial Nerves ; Dysarthria ; Female ; Hoarseness ; Humans ; Jugular Veins* ; Magnetic Resonance Imaging ; Paralysis ; Thrombosis* ; Veins

No abstract available.
Spinal Cord* ; Urinary Bladder, Neurogenic*

Epidural and intrathecal injection of narcotics for postoperative pain relief have been well reported. In an attempt to assess the postoperative analgesic effect of demerol in anal surgery, caudal block was carried out with 1.5% lidocaine mixed with demerol 5 mg(Group II) in 15 patients and demerol 1 0 mg(Group II) in 15 patients. As a control group(Group I), 16 patients were injected with 1.5% lidocaine alone in the epidural space for caudal anesthesia. The incidence of postoperative injection of demerol as needed by the patients for pain control were recorded and compared. As a result of this study, the 3rd group in which 10 mg of demerol were used, appeared to have a significantly prolonged analgesic effect and there were no serious complications observed in our experience such as nausea, vomiting or respiratory depression.
Anesthesia, Caudal ; Epidural Space ; Humans ; Incidence ; Injections, Spinal ; Lidocaine ; Meperidine* ; Narcotics ; Nausea ; Pain, Postoperative ; Respiratory Insufficiency ; Vomiting

Vascular injuries in lumbar disc surgery are serious complications which may be overlooked due to a broad range of clinical manifestations. It is important to be aware of the perioperative implications of this rare occurrence to lower mortality risk. A 20-yr-old man with a right L4-5 lumbar disc protrusion was operated on routinely under a surgical microscope. A bloody surgical field was noted temporarily during a discectomy along with a decreased blood pressure. After fluid resuscitation with an ephedrine injection, the bleeding soon stopped spontaneously and his vital signs were stabilized. Fifty hours after the operation, the patient showed signs of hypovolemic hypotension with abdominal distension. The right femoral artery pulsation was absent on palpation. An enhanced CT angiography revealed a retroperitoneal hematoma and obstruction of the left common iliac artery. An urgent laparotomy was done to repair the injured vessel by excision and interposition of a graft. The patient had an uneventful recovery.The subacute course of deterioration might have been due to intermittent blood leakage from the lacerated common iliac artery, which was sealed spontaneously. It is very important to pay close attention to post-surgical clinical manifestations to avoid a potentially fatal outcome in lumbar disc surgery.
Angiography ; Diskectomy/*adverse effects ; Hematoma/etiology ; Humans ; Iliac Artery/*injuries ; Intervertebral Disc ; Lacerations/*etiology ; Lumbar Vertebrae/*surgery ; Male ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVE: It is a widely accepted belief that paraspinal muscles tend to show spontaneous activity on needle electromyography early on in a radiculopathy and distal muscles become abnormal later on. But most studies have shown the limitations of using symptom duration when interpreting electrodiagnostic findings in radiculopathy. The purpose of this study was to determine the relationship between symptom duration and abnormal spontaneous activity in S1 radiculopathy confined to abnormal H-reflex. METHOD: A retrospective study that collected the informations on symptom duration and spontaneous activity in paraspinal muscle and gastrocnemius for 112 patients with S1 radiculopathy diagnosed by unilateral H-reflex abnormality was undertaken. RESULTS: Abnormal spontaneous activity in paraspinal muscle had shown a significant negative correlation with symptom duration, that is a tendency to decrease its expression over symptom duration. On the contrary abnormal spontaneous activity in gastrocnemius muscle was rare at first a few weeks and became to show after 7 weeks. Patients with symptom duration over 1 year had higher incidence of having no abnormal spontaneous activities both in paraspinal and gastrocnemius muscle. CONCLUSION: These results suggested that symptom duration had a potential role in the diagnosis of S1 radiculopathy when H-reflex were abnormal unilaterally.
Diagnosis ; Electromyography ; H-Reflex ; Humans ; Incidence ; Muscle, Skeletal ; Muscles ; Needles ; Paraspinal Muscles ; Radiculopathy* ; Retrospective Studies

OBJECTIVE: To investigate the clinical usefulness of scintigraphy for the evaluation of dysphagia in patients with brain lesion and to clarify the most useful quantitative parameter for detection of aspiration using scintigraphy. METHOD: For 42 patients with dysphagia, swallowing evaluations were done by videofluoroscopy and scintigraphy. According to videofluoroscopic findings these patients were grouped into three; aspiration, laryngeal penetration and no penetration group. Quantitative parameters from scintigraphy were measured and compared among three patients groups and normal control; these parameters were oral discharge time (ODT), pharyngeal transit time (PTT), oral residue (OR), pharyngeal residue (PR), pharyngeal swallowing efficiency (PSE) and oro-pharyngeal swallowing efficiency (OPSE). Sensitivity and specificity of these parameters detecting aspiration were also evaluated according to the videofluoroscopic findings. RESULTS: In aspiration group ODT, PTT, PSE and OPSE were 1.18+/-1.14 sec, 1.80+/-1.49 sec, 86.05+/-61.42%/sec and 38.21+/- 28.65%/sec respectively, all of which were significantly different from the other groups, but OR and PR were not different statistically. According to the ROC (Relative Operating Characteristic) table, sensitivity and specificity of OPSE were 72.7 and 80.7% respectively, which were the highest among the parameters. CONCLUSION: Scintigraphy was useful to quantitative dysphagia in patients with brain lesion. Sensitivity and specificity of swallowing efficiency was higher than time and residue parameters. OPSE was considered to be the most useful quantitative parameter for detecting aspiration.
Brain ; Deglutition ; Deglutition Disorders* ; Evaluation Studies as Topic* ; Humans ; Radionuclide Imaging* ; Sensitivity and Specificity ; Stroke

OBJECTIVE: To measure lumbar multifidus muscles by ultrasonography and to study its correlation with the isometric peak touque of back. METHOD: Bilateral L5 and S1 multifidus muscle sizes of 18 healthy volunteers were measured in prone position by ultrasonography with 7.5 MHz, 40 mm-length probe. Multifidus muscles were identified using anatomic landmark-spinous process and lamina and vertical and horizontal diameter were measured. Boundary of muscle was traced and cross sectional area was measured. Lumbar spinal range of motion (ROM) and isometric peak torque of three axes-flexion/ extension, rotation and lateral flexion-were measured by Isostation B-200R back muscle tester. RESULTS: Multifidus muscle cross sectional areas were well correlated with isometric peak torque in all direction of movements. Muscle size and lumbar spine ROM showed no correlation. CONCLUSION: Ultrasonographic measure of lumbar multifidus muscles could be a useful tool to estimate back muscle function.
Back Muscles ; Healthy Volunteers ; Muscles* ; Paraspinal Muscles* ; Prone Position ; Range of Motion, Articular ; Spine ; Torque* ; Ultrasonography