Sacral insufficiency fractures are not uncommon cause of low back pain in elderly women with osteoporosis. The characteristics of sacral insufficiency fractures may not be related with neurological compromise. Their associated rate of neurological complication has been reported approximately 2%. The neurological complication, which is due to stretching or compression of nerve roots, is related with bony displacement. We present the case of an elderly women who developed S1 radiculopathy secondary to sacral insufficiency fracture with no evidence of fracture line.
Aged ; Female ; Fractures, Stress* ; Humans ; Low Back Pain ; Osteoporosis ; Radiculopathy*

OBJECTIVE: To investigate the aspiration of saliva itself in bedridden patients with brain lesion using the response of radionuclide salivagram, and its association with patient characteristics and clinical factors. METHOD: Thirty two patients (21 men and 11 women) in bedridden state with brain lesion were performed the radionuclide salivagram. (99m)Tc sulfur colloid (1.0 mCi in a drop of saline) was instilled into patients' tongue with supine position. The sequential images were obtained at first 5 minutes and 10 minutes interval for 1 hour, and evaluated the presence of saliva aspiration as the entrance of tracer into major airways or lung parenchyma. The characteristics of patients and the states of cooperation, drooling, tracheostomy, and method of feed were also assessed. RESULTS: Seven out of 32 subjects exhibited positive response of saliva aspiration by radionuclide salivagram. Men, uncooperative, and anterior drooling was significantly associated with positive finding of salivagram (p<0.05). CONCLUSION: In bedridden patients with brain lesion, it seems that radionuclide salivagram may be one of methods for detection of the aspiration of saliva itself.
Brain ; Colloids ; Humans ; Lung ; Male ; Saliva ; Sialorrhea ; Sulfur ; Supine Position ; Tongue ; Tracheostomy

OBJECTIVE: The purpose of this study was to evaluate and compare the natural course of morphologic changes and clinical outcomes between large central extruded disc herniation and sequestration. METHOD: The study population consisted of 22 patients with sequestration and large central extrusion by an magnetic resonance (MR) imaging study. Seventeen (11 patients with sequestration, 6 patients with large central extrusion) patients underwent a follow-up MR imaging study. The size of herniated disc was measured on serial MR imaging studies and the change in size was classified into four categories. Clinical evaluations were also done using visual analogue scale (VAS), Oswestry low back pain disability questionnaire scoring, straight leg raising test (SLRT) and so forth. RESULTS: Successful clinical improvement was achieved in both groups. The VAS and Oswestry disability scoring established a greater change in the group with sequestration than in the group with large central extrusion. Greater morphologic decrease in the herniated discs occurred more frequently in sequestered disc herniation than large central extruded disc herniation. CONCLUSION: Both sequestered disc and large central extruded disc herniation could be treated successfully by conservative treatment.
Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; Leg ; Low Back Pain ; Magnetic Resonance Imaging ; Surveys and Questionnaires

Leigh syndrome is a subacute necrotizing encephalomyelopathy of infancy or early childhood. The clinical presentation can be highly variable. The classical presentations are central hypotonia, developmental regression or arrest, ataxia, ophthalmoplegia, and abnormal respiratory pattern. Diagnosis is usually confirmed by radiologic evidence of focal, bilateral and usually symmetric lesions of the both gray and white matter in the brain and the spinal cord. We experienced 2 cases of Leigh syndrome in a brother and sister.The first case, 4 year-old boy, was misdiagnosed as a cerebral palsy initially, but after acute infection, he revealed developmental regression and abnormal movement. His disease was confirmed by typical magnetic resonance imaging findings. The second case, 1 year-old girl with nystagmus, showed bilateral symmetric high signal intensity in globus pallidus on T2WI. We reported these cases with a brief review of the related literature.
Ataxia ; Brain ; Cerebral Palsy ; Child, Preschool ; Diagnosis ; Dyskinesias ; Female ; Globus Pallidus ; Humans ; Leigh Disease* ; Magnetic Resonance Imaging ; Male ; Muscle Hypotonia ; Ophthalmoplegia ; Siblings ; Spinal Cord

OBJECTIVE: To evaluate the efficacy of direct current electrical fields and peripheral external electrical stimulation to promote regeneration of the transected rat sciatic nerve. METHOD: Four groups were studied: three experimental groups and one control group. Cathod distal (CD) group; nerves were treated with 1.0 microampere direct current with the cathode oriented distally to the lesion, anode distal (AD) group; nerves were treated with the anode oriented distally to the lesion, external stimulation (ES) group; nerves were treated with 3 mA, 60 Hz, galvanic current, using a ring electrode at ankle joint 3 times per day. No current was delivered in control group. Electrophysiologic and functional assessments were conducted at 3 weeks postoperatively. RESULTS: All experimental groups showed significantly higher electrophysiologic and functional improvement than the control group. However, there is no significant differece in improvement among experimental groups. CONCLUSION: Both direct current electrical field and peripheral external electrical stimulation can effectively promote peripheral nerve regeneration.
Animals ; Ankle Joint ; Electric Stimulation* ; Electrodes ; Nerve Regeneration* ; Peripheral Nerves* ; Rats* ; Regeneration ; Sciatic Nerve

Several studies report varing incidence of spinal cord injury without radiologic abnormality (SCIWORA) from 21% to 66% in children. Fifty-five percentage of SCIWORA involves the cervical cord. The mechanisms of neural damage of SCIWORA include flexion, hyperextension, longitudinal distraction and ischemia. But spinal cord infarction related to vertebral arterial injury is rare. The authors report a case of selective spinal cord infarction on gray matter with unilateral vertebral artery injury after a minor trauma, in a 4-year-old boy. Neurological signs and symptoms developed 12 hours after the trauma. Initial postcontrast magnetic resonance imaging (MRI) showed an enhancement in the left vertebral artery. Follow up postcontrast MRI showed a selective signal change on the central gray matter and unilateral vertebral artery. We present this case with the review of literatures.
Child* ; Child, Preschool ; Follow-Up Studies ; Humans ; Incidence ; Infarction* ; Ischemia ; Magnetic Resonance Imaging ; Male ; Spinal Cord Injuries ; Spinal Cord* ; Vertebral Artery*

BACKGROUND: The purpose of this study is to investigate discharge destinations and outcomes of geriatric stroke patients in university hospitals, and to examine their correlates and variables. METHODS: A total of 24 subjects, who were admitted between January and June 2006 in two university hospitals in Daegu, were enrolled in this prospective study. Data on demographic factors, socioeconomic factors, clinical, functional status and discharge destinations of patients were documented. Pearson's chi square test and t-test were used for statistic analysis. RESULTS: Ten patients were discharged to the community(their own home: 7, offspring's home: 3) and 14 patients were discharged to other hospitals(rehabilitation hospitals or nursing home:12, oriental medicine hospitals: 2) Analysis revealed that discharge destinations had significant correlations with severity of cognitive function, severity of speech disturbance, admission FIM scores and discharge FIM scores(p<0.05). CONCLUSIONS: Large part(75%) of geriatric stroke patients could not return to pre-stroke living situations. Their discharge destinations were associated with cognitive function, speech disturbance, admission and discharge FIM scores. Recognizing these correlations could be helpful for appropriate intervention to geriatric stroke patients during admission for more comprehensive rehabilitational management.
Daegu ; Demography ; Geriatrics ; Hospitals, University* ; Humans ; Medicine, East Asian Traditional ; Nursing ; Prospective Studies ; Rehabilitation ; Socioeconomic Factors ; Stroke*

BACKGROUND: It is well documented that calcium ions perform a major role in neuronal degeneration in cerebrovascular disease and the other degenerative diseases, and that 1,25-dihydroxyvitamin D3 (D3) has the dose-dependent protective effects. This study was performed to examine the effects of different D3 dosages against delayed neuronal damage of the hippocampus. METHODS: Mature mongolian gerbils were injected with either 0.8 microgram/kg/day (group 2) for 5 days or 1.0 microgram/kg/day for 8 days (group 3) prior to the 10 min ligation of the bilateral common carotid arteries. Immunohistochemical expression for the glial cell line-derived neurotrophic factor (GDNF), the basic fibroblast growth factor (bFGF) and the platelet-derived neurotrophic factor (PDNF) was observed in the D3-injected (0.8 microgram/kg/day for 5 days) group. RESULTS: Group 2 showed a highly significant attenuation of delayed neuronal damage in the lateral CA1 region at 7 days after reperfusion. Group 3 showed unilateral or bilateral hemispheric infarcts 24 h after the onset of reperfusion. The D3-injected group showed a markedly increased bFGF expression level. CONCLUSION: The dose-dependent effect of D3 suggests the importance of determining the appropriate D3 dose for clinical applications. Although the mechanism(s) of neuroprotection by D3 remains unclear, D3 may facilitate a reduction in ischemia-induced oxidative stress via the activation of the neurotrophic factors, including bFGF and GDNF.
Calcitriol* ; Calcium ; Carotid Artery, Common ; Cerebrovascular Disorders ; Fibroblast Growth Factor 2 ; Gerbillinae* ; Glial Cell Line-Derived Neurotrophic Factor ; Hippocampus* ; Ions ; Ischemia* ; Ligation ; Nerve Growth Factors ; Neurons* ; Oxidative Stress ; Reperfusion

Spinal cord infarction is uncommon and accounts for only 1% of all strokes in comparison with cerebral infarction. Furthermore, posterior spinal cord infarction is particularly rare because of an anastomotic network of direct penetrating vessels and plexus of pial vessels fed by the paired posterior spinal arteries. We report a case of unilateral posterior spinal artery infarction on lower medulla and upper cervical spinal cord in a patient of 60-year-old woman. She complained of continuous headache for several weeks and suddenly presented right facial paresthesia, slow progression of motor weakness and proprioceptive sensory loss on right extremity, and voiding difficulty. Magnetic resonance and computed tomography imaging studies confirmed acute infarction at the right posterolateral aspect of the lower medulla and upper cervical cord (C1-2 level) with right vertebral artery hypoplasia. Transcranial doppler sonography also showed right vertebral artery hypoplasia rather than stenosis with atherosclerosis.
Arteries ; Atherosclerosis ; Cerebral Infarction ; Constriction, Pathologic ; Extremities ; Female ; Headache ; Humans ; Infarction ; Magnetic Resonance Spectroscopy ; Middle Aged ; Paresthesia ; Spinal Cord ; Stroke ; Ultrasonography, Doppler, Transcranial ; Vertebral Artery

Corynebacterium minutissimum is a non-spore forming, gram-positive, aerobic or facultative anaerobic bacillus. It is the causative organism of erythrasma, a common superficial infection of skin, which typically presents as reddish-brown macular patches. To date, it has rarely been found to cause invasive disease, although other non-diphtheria corynebacteria are becoming increasingly common as opportunistic pathogens. We report on a rare case of abdominal infection due to C. minutissimum in an immunocompetent adult who was successfully treated with intravenous amoxicillin/sulbactam.
Abdomen ; Adult ; Bacillus ; Corynebacterium* ; Erythrasma ; Humans ; Skin