OBJECTIVE: The present study evaluated the characteristics and natural history of stroke patients. METHOD: Seven hundred and sixty seven consecutive patients admitted through acute care facility were reviewed. All medical records including age, case fatality, risk factors and radiological findings including CT or MRI were reviewed. To investigate the activities of daily living (ADL) of stroke patients, follow-up study was done in 303 patients through telephone interview or direct contact. Stroke was subdivided into cerebral infarct, intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). RESULTS: The proportion of stroke subtypes were infarct (45.9%), ICH (34.7%) and SAH (19.4%). The recurrence rate of stroke was higher in the infarct patient. Higher percentage of fatality was noted in the SAH patient. Higher incidence of hemorrhage was still observed compared to western country. Hypertension is the major risk factors for all stroke subtypes. But among hypertensive individuals, only 29% patients controlled the hypertension. Fifty-eight percent of stroke patients regained independent ADL. CONCLUSION: The result of this study shows the clinical pictures of stroke patients. Further research was needed to investigate the trends of stroke and control of risk factors and attention must be paid to the patients who is dependent in ADL.
Activities of Daily Living ; Cerebral Hemorrhage ; Follow-Up Studies ; Hemorrhage ; Humans ; Hypertension ; Incidence ; Interviews as Topic ; Magnetic Resonance Imaging ; Medical Records ; Natural History ; Recurrence ; Risk Factors ; Stroke* ; Subarachnoid Hemorrhage

We report a case of the top of the basilar syndrome with peduncular hallucinosis in a 58 year old man who showed visual, oculomotor, and behaviorai symptoms and signs. Angiography revealed atherosclerotic stenosis at the junction of vertebral and basilar arteries. Mri showed high-signal lesions in various vertebrobasilar territories including thaiamus and midbrain.
Angiography ; Basilar Artery ; Brain Stem Infarctions ; Constriction, Pathologic ; Humans ; Magnetic Resonance Imaging ; Mesencephalon ; Middle Aged

We report a 60 year-old right-handed woman with left anterior cerebral artery territory infarction who showed the alien hand sign. The patient exhibited a severe disturbance of the right arm motor control characterized by forced grasping. Motor perseveration. And the presence of intermanual conflict that at times the right hand interfered with tasks performed by the left hand. Also, features of a transcortical motor aphasia signs of callosal interruption, urinary incontinence, and weakness of right leg were noted. MRI showed high signal areas in the left medial frontal cortex and anterior corpus callosum.
Anterior Cerebral Artery ; Aphasia, Broca ; Arm ; Corpus Callosum ; Emigrants and Immigrants* ; Female ; Hand Strength ; Hand* ; Humans ; Infarction ; Leg ; Magnetic Resonance Imaging ; Middle Aged ; Urinary Incontinence

No abstract available.
Appendicitis* ; Child* ; Humans

A 69-year-old man presented with annular lichen planus involving both forearms, hand dorsa, wrists, inner sides of the thighs, knees and ankles. He was treated initially with systemic corticosteroids and etretinate, but rernission and recurr ence of the skin lesions were observed. During the follow-up, we found erythrasma on all his toewebs and both soles. After administration of erythromycin for the treatment of erythrasma, lesions of the lichen planus rapidly improved. Five months later, some lesions of lihen planus and erythrasma had recurred. After administration of erythromycin, the lesions of lichen planus improved again. No recurrence was observed for the following 8 months. We suspect that eradication of the chronic focus of infection and the anti-inflammatory effect, of erythromycin may lead to supression of abnormal immunological reactions and resolution of lichen planus.
Acitretin ; Adrenal Cortex Hormones ; Aged ; Ankle ; Erythrasma ; Erythromycin* ; Etretinate ; Follow-Up Studies ; Forearm ; Hand ; Humans ; Knee ; Lichen Planus* ; Lichens* ; Recurrence ; Skin ; Thigh ; Wrist

OBJECTIVE: To evaluate the usability of near-nerve needle recording techniques in cases of unrecordable sensory nerve action potentials (SNAPs) with a surface electrode and to determine a proper alternative value of the missing latencies. METHOD: Twenty six hands of 23 patients with a carpal tunnel syndrome (CTS) and an unobtainable median SNAP by surface electrode were evaluated by the near-nerve needle recording of median SNAPs. Using the nerve conduction data of 113 patients with CTS, we have established 3 alternative values: maximal, 95 percentile and predictive latencies. The alternative values were compared with the mean onset latencies by the near-nerve needle recordings of median SNAPs. RESULTS: Median SNAPs were obtainable in the 22 out of 26 hands by the near-nerve recording technique. The mean onset latency was 5.51+/-0.36 ms. The alternative values from 113 patients with CTS were as follows: maximum latency, 6.9 ms; 95 percentile latency, 5.6 ms; and predictive latency, 5.52 ms (Y = 0.123x X 5.52491; Y, onset latency; X, amplitude; r2=0.564; p=0.00). The Predictive latency was nearest to the mean onset latency. CONCLUSION: To minimize the selection bias and statistical errors, the near nerve recording techniques proved to be a valuable method in cases of unrecordable SNAPs with surface electrode. For compensation of missing data, a proper alternative value can be obtained by the predictive latency calculated from a linear regression.
Action Potentials ; Carpal Tunnel Syndrome ; Compensation and Redress ; Electrodes ; Hand ; Humans ; Linear Models ; Needles ; Neural Conduction ; Selection Bias

OBJECTIVE: Carpal tunnel syndrome (CTS), a common entrapment neuropathy of the median nerve at the wrist, can be diagnosed clinically and electrophysiologically and treated successfully. The purpose of this study was to determine an association between clinical findings and the electrodiagnostic severity of this syndrome. METHOD: Medical records of 313 patients with CTS which was confirmed based on clinical and electrophysiological findings were reviewed. Clinical symptoms and signs (thenar atrophy, sensory change, positive Tinel sign and Phalen test) and electrodiagnostic values were recorded. CTS severity was determined according to the modified Stevens' criteria. The relationship between electrodiagnostic severity and clinical findings was investigated and statistically analyzed using the ANOVA and chi square tests. RESULTS: The median motor and sensory latencies became prolonged and amplitudes decreased with worsening electrophysiological severity of CTS, and the differences between severity groups were statistically significant. The frequency of symptoms and signs obtained was significantly greater in the more severe CTS groups. CONCLUSION: A positive correlation exists between the frequency of clinical findings and electrophysiological severity of CTS.
Atrophy ; Carpal Tunnel Syndrome* ; Electrodiagnosis ; Humans ; Median Nerve ; Medical Records ; Wrist

For the diagnosis of carpal tunnel syndrome (CTS), a sensory conduction study of median nerve is the most sensitive parameter, by either antidromic or orthodromic recording. Many different sensory recordings have been developed to detect the mild or early cases of carpal tunnel syndrome. A comparison of the median and ulnar sensory responses using the 4th digit either orthodromically or antidromically has been one of the methods. However, a simultaneous comparison of both antidromic and orthodromic methods on the 4th digit has not been documented. For the comparison between the median and the ulnar sensory nerve conduction of the 4th digit recorded antidromically or orthodromically, conduction studies of the median and ulnar sensory nerves were performed using standard methods in normal populations as well as in patients with carpal tunnel syndrome. We studied 31 CTS patients (46 hands) with mean age of 54 years old (range, 25~70). Also, 51 subjects (102 hands) with mean age of 48 years old were studied as control. The difference of antidromic latencies between the median and the ulnar nerves was less than or equal to 0.4 msec in the control subjects and greater than or equal to 0.5 msec in the patients with carpal tunnel syndrome. The difference of orthodromic latencies was less than or equal to 0.5 msec in the control subjects and greater than or equal to 0.5 msec in the patients with carpal tunnel syndrome. By the antidromic and orthodromic methods, the mean difference between latencies of the median or ulnar nerve was not statistically significant. However the amplitude of median or ulnar nerve was 2 times larger by the antidromic method than by the orthodromic. We concluded that the latency difference of 0.5 msec or greater between the median and ulnar nerve sensory conductions from the 4th digit would be valuable for the diagnosis of CTS. The antidromic methods with larger amplitude may be more technically convenient to determine CTS than the orthodromic methods.
Carpal Tunnel Syndrome* ; Diagnosis ; Fingers* ; Humans ; Median Nerve ; Middle Aged ; Neural Conduction ; Ulnar Nerve

OBJECTIVE: To establish the posterior cutaneous nerve of arm (PCNA) conduction technique and set up the reference values. METHOD: A PCNA conduction study was performed in 80 nerves of 40 neurologically healthy adult subjects with a mean age of 38 years (range, 20 to 56). Dantec Counterpoint MK2 machine was used. The recording bar electrodes were placed 10 cm distal to the axillary fold on a line connecting the posterior axillary fold and the olecranon. Supramaximal stimulation was applied to the axilla posterior to the brachial artery. Onset latency, baseline to peak amplitude and negative spike duration of sensory nerve action potentials were obtained. Skin temperature was measured in the posterior arm and maintained at 34 degrees C or above. RESULTS: Compound sensory action potential for the PCNA was recordable in all the subjects. The results were as follows: onset latency, 1.7+/-0.1 msec; baseline to peak amplitude, 4.6+/-1.4 microvolt; negative spike duration, 1.1+/-0.2 msec. CONCLUSION: PCNA response is readily obtainable. This study may help to assess the pain or paresthesia in the posterior aspect of the arm, although more studies are required for clinical application.
Action Potentials ; Adult* ; Arm* ; Axilla ; Brachial Artery ; Brachial Plexus ; Electrodes ; Humans ; Olecranon Process ; Paresthesia ; Proliferating Cell Nuclear Antigen ; Reference Values* ; Skin Temperature

OBJECTIVE: To investigate the clinical feature and quantitative electromyographic (QEMG) findings in the patients with post-polio syndrome (PPS). METHOD: Eleven patients who had clinical evidences of antecedent poliomyelitis were evaluated with standardized clinical history, physical examination and QEMG study. If a patient had fulfilled provisional criteria for PPS, he was regarded as PPS and six patients had fulfilled the criteria. Other patients were treated as control group with stable poliomyelitis. Manual muscle testing and needle EMG study including quantitative motor unit analysis was performed at the tibialis anterior and vastus medialis muscles. The existence of abnormal spontaneous activity and parameters of quantitative motor unit analysis, mean duration and amplitude of motor unit action potentials (MUAPs), were compared between PPS and control groups. The correlation between the muscle strength and parameters of QEMG was investigated. RESULTS: Abnormal spontaneous activities were noted in 4 out of 11 patients (36.4%) and three of these 4 patients were PPS. Mean duration and amplitude of MUAPs of tibialis anterior and vastus medialis muscles were not different significantly between the PPS and stable poliomyelitis group (p>0.05). The parameters of MUAPs were poorly correlated with muscle strength. CONCLUSION: Distribution of abnormal spontaneous activities and parameters of QEMG study were not different in PPS and stable poliomyelitis patients. QEMG study may not have additional benefit in differentiating PPS from stable poliomyelitis.
Action Potentials ; Humans ; Muscle Strength ; Muscles ; Needles ; Physical Examination ; Poliomyelitis ; Postpoliomyelitis Syndrome* ; Quadriceps Muscle