Hemiplegic stroke patients may have abnormal awareness or perception of the affected limb (s). For example, patients may experience their limb as not belonging to them (asomatognosia) or attribute their own body parts to other persons (somatoparaphrenia). Disturbed sensation of limb ownership (asomatognosia, somatoparaphrenia) for the hemiplegic limb has been reported in patients with right insula lesion. We report a case of a 70-year-old right handed female who had somatoparaphrenia and neglect dyslexia after right posterior cerebral artery and posterior corpus callosal infarction. Additionally, she showed visual defect, dyschromatopsia, and hemispatial neglect
Aged ; Dyslexia ; Extremities ; Female ; Hand ; Human Body ; Humans ; Infarction ; Infarction, Posterior Cerebral Artery ; Ownership ; Perceptual Disorders ; Posterior Cerebral Artery ; Sensation ; Stroke

Phantom limbs are usually observed after amputation of extremities. In patients after a stroke, a similar but rarely occurring phenomenon consisting of the patient experiencing the presence of an additional limb has been described. This phenomenon, generally called supernumerary phantom limb (SPL), may be caused by lesions in the right or left cerebral hemisphere, but has been predominantly reported in patients who have had a right hemispheric stroke. We report two cases of atypical SPL and phantom limb pain (PLP) after pontine hemorrhage. The patients were treated conservatively and their symptoms lasted more than 1 month. This is the first report of SPLs after left pontine hemorrhage, and phantom perception and pain lasted longer than those in previously observed cases. Our results indicate that SPL may be more common than reported; therefore, thorough examinations are essential for the care of stroke patients.
Cerebral Hemorrhage/*complications ; Cerebral Infarction/complications ; Female ; Humans ; Male ; Middle Aged ; Pain/etiology ; Phantom Limb/*diagnosis/etiology/therapy ; Psychomotor Performance/physiology ; Stroke/complications ; Tomography, X-Ray Computed

Schwannomas are benign, usually slow-growing tumors that originate from Schwann cells surrounding peripheral, cranial, or autonomic nerves. The most common form of these tumors is acoustic neuroma. Schwannomas of the brachial plexus are quite rare, and symptomatic schwannomas of the brachial plexus are even rarer. A 47-year-old woman presented with a 1-year history of dysesthesia, neuropathic pain, and mild weakness of the right upper limb. Results of physical examination and electrodiagnostic studies supported a diagnosis as thoracic outlet syndrome. Conservative treatment did not relieve her symptoms. After 9 months, a soft mass was found at the upper margin of the right clavicle. Magnetic resonance imaging showed a 3.0x1.8x1.7 cm ovoid mass between the inferior trunk and the anterior division of the brachial plexus. Surgical mass excision and biopsy were performed. Pathological findings revealed the presence of schwannoma. After schwannoma removal, the right hand weakness did not progress any further and neuropathic pain gradually reduced. However, dysesthesia at the right C8 and T1 dermatome did not improve.
Autonomic Pathways ; Biopsy ; Brachial Plexus* ; Clavicle ; Diagnosis ; Female ; Hand ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neuralgia ; Neurilemmoma* ; Neuroma, Acoustic ; Paresthesia ; Physical Examination ; Schwann Cells ; Thoracic Outlet Syndrome* ; Upper Extremity

OBJECTIVE: To compare the efficacy of ultrasonography guided stellate ganglion block (US-SGB) with that of blind SGB in management of the stroke patients with complex regional pain syndrome (CRPS) type 1. METHOD: Forty-two patients with post-stroke CRPS were randomly assigned to either US-guided SGB (22 patients) or blind SGB group (20 patients). The mean age of US-guided SGB and blind SGB groups was 61.3+/-5.6 years and 59.1+/-4.5 years. We performed two blockades at 7-day intervals on the affected side of patients with CRPS. Pain intensity, using a visual analog score (VAS), score of CRPS clinical severity, and the amounts of affected hand swelling with a hand volumeter were assessed before, 2 weeks and 4 weeks after treatment. RESULTS: In both groups, VAS and the amount of hand swelling were significantly decreased after 2 weeks and after 4 weeks. Between two groups, VAS difference of US-guided SGB group and that of blind SGB group were 2.61+/-1.09, 1.88+/-0.62 at 2 weeks and 3.67+/-1.03, 3.13+/-0.62 at 4 weeks, respectively. US-guided SGB group showed more significant improvement in mean change of VAS compared to the blind SGB group (p-value<0.05). CONCLUSION: Both US-guided SGB and blind SGB techniques were effective in relieving pain in subacute stroke patients with CRPS. US-guided SGB was better in pain relief but has no advantages in reduction of hand swelling in this study.
Hand ; Humans ; Stellate Ganglion ; Stroke

Dystonia is a movement disorder characterized by involuntary muscle contractions. Patients with dystonia may experience uncontrollable twisting, repetitive movements, or abnormal posture. A 55-year-old man presented with an involuntary left forearm supination, which he had experienced for five years. There was no history of antecedent trauma to the wrist or elbow. Although conventional therapeutic modalities had been performed, the symptoms persisted. When he visited our hospital, electromyography was performed. Reduced conduction velocity was evident at the elbow-axilla segment of the left median nerve. We suspected that there was a problem on the median nerve between the elbow and the axilla. For this reason, we performed an ultrasonography and magnetic resonance imaging study. A spindle-shaped soft tissue mass was observed at the left median nerve that suggested the possibility of neurofibroma. Dystonia caused by traumatic or compressive peripheral nerve injury has often been reported, but focal dystonia due to a neurogenic tumor is extremely rare. Here, we report our case with a review of the literature.
Axilla ; Dystonia ; Dystonic Disorders* ; Elbow ; Electromyography ; Forearm ; Humans ; Magnetic Resonance Imaging ; Median Nerve ; Median Neuropathy ; Middle Aged ; Movement Disorders ; Muscle, Smooth ; Neurofibroma ; Peripheral Nerve Injuries ; Posture ; Supination ; Ultrasonography ; Wrist

Giant cell tumor (GCT) is a relatively rare neoplasm. In GCT, the bone affection of the axial skeleton is extremely rare. Most GCT arises in the meta-epiphyseal ends of the long bones. Its peak incidence is between 30 to 40 years of age. GCT is usually classified as benign, but shows locally aggressive behavior and may occasionally undergo a malignant transformation. The patients with GCT in the spine often complain of the lower back pains, as the tumors primarily involve the sacrum. We report a case of an adolescent female complaining of the upper back pain with a sudden weakness of the lower extremities, later diagnosed with the GCT of the T2 vertebra. The present patient showed American Spinal Injury Association Impairment Scale (AIS) D before the surgery, which changed to AIS E after the treatments including the surgery, radiation therapy and rehabilitation.
Adolescent ; Back Pain ; Female ; Giant Cell Tumors ; Giant Cells ; Humans ; Incidence ; Low Back Pain ; Lower Extremity ; Sacrum ; Skeleton ; Spinal Cord ; Spinal Cord Injuries ; Spinal Injuries ; Spine

Guillain-Barre syndrome (GBS) and syringomyelia are diseases of different entities. GBS is an acute post-infectious autoimmune disease which is mediated by autoantibodies against the myelin of peripheral nerves. Syringomyelia is a chronic disease characterized by a cavity extending longitudinally inside the spinal cord. A 67-year-old man is being hospitalized due to severe numbness and ascending weakness in all limbs. On neurological examination, the motor power of all limbs are decreased and show absence of deep tendon reflexes (DTRs). The patient is being diagnosed with GBS on the basis of the acute clinical course, nerve conduction studies of segmental demyelinating polyneuropathy, and a finding of albuminocytologic dissociation in the cerebrospinal fluid. The patient is presented with a new set of symptoms thereafter, which composes of sensory changes in the upper extremities, the urinary dysfunction including frequency and residual urine, spastic bilateral lower extremities, and increased reflexes of the knee and the biceps at follow-up examinations. The spinal magnetic resonance imaging in the sagittal section revealed a syrinx cavity between the fifth cervical and the first thoracic vertebral segment in the cord. The somatosensory evoked potential show sensory pathway defects between both the brachial plexus and the brain stem. Thus, this patient is being diagnosed with both GBS and syringomyelia. We report a case of symptomatic syringomyelia coexisting with GBS. Since the GBS is presented with a progressive muscle weakness and reduced DTRs, the muscle weakness and stiffness in the extremities suggests a concurrent syringomyelia might be easily overlooked.
Aged ; Autoantibodies ; Autoimmune Diseases ; Brachial Plexus ; Brain Stem ; Chronic Disease ; Dissociative Disorders ; Evoked Potentials, Somatosensory ; Extremities ; Follow-Up Studies ; Guillain-Barre Syndrome* ; Humans ; Hypesthesia ; Knee ; Lower Extremity ; Magnetic Resonance Imaging ; Muscle Spasticity ; Muscle Weakness ; Myelin Sheath ; Neural Conduction ; Neurologic Examination ; Peripheral Nerves ; Polyneuropathies ; Reflex ; Reflex, Stretch ; Spinal Cord ; Syringomyelia* ; Upper Extremity

OBJECTIVE: To investigate the relationship between the shoulder gradient and acromiohumeral interval of both shoulders in patients with unilateral shoulder impingement syndrome. METHOD: Using the angulometer, we measured the shoulder gradient in patients with unilateral shoulder impingement syndrome in a standing position. Using the radiography, we measured the acromiohumeral interval and the angle between a vertical line and a line connecting a superior angle with an inferior angle of the scapula. RESULTS: In patients with unilateral shoulder impingement syndrome, the frequency of shoulder impingement syndrome was 76.2% (16 of 21) on the side of the relatively lower shoulder. The mean acromiohumeral interval on the side of the lower shoulder was 10.03+/-1.28 mm, compared with 10.46+/-1.50 mm for the higher shoulder. The angle between a vertical line and a line connecting a superior angle with an inferior angle of the scapular of the side of the lower shoulder was -0.31+/-3.73 degrees, compared with 3.85+/-4.42 degrees for the higher shoulder. CONCLUSION: The frequency of shoulder impingement syndrome was significantly higher on the side of the relatively lower shoulder, and there is no significant difference in the acromiohumeral interval between the side of the lower shoulder and that of the higher shoulder. In patients with unilateral shoulder impingement syndrome, the scapular on the side of lower shoulder was more rotated downward than on the side of the higher shoulder.
Humans ; Shoulder ; Shoulder Impingement Syndrome

Monomelic amyotrophy (MMA), also known as Hirayama disease, is a sporadic juvenile muscular atrophy in the distal upper extremities. This disorder rarely involves proximal upper extremities and presents minimal sensory symptoms with no upper motor neuron (UMN) signs. It is caused by anterior displacement of the posterior dural sac and compression of the cervical cord during neck flexion. An 18-year-old boy visited our clinic with a 5-year history of left upper extremity pain and slowly progressive weakness affecting the left shoulder. Atrophy was present in the left supraspinatus and infraspinatus. On neurological examination, positive UMN signs were evident in both upper and lower extremities. Electrodiagnostic study showed root lesion involving the fifth to seventh cervical segment of the cord with chronic and ongoing denervation in the fifth and sixth cervical segment innervated muscles. Cervical magnetic resonance imaging (MRI) showed asymmetric cord atrophy apparent in the left side and intramedullary high signal intensity along the fourth to sixth cervical vertebral levels. With neck flexion, cervical MRI revealed anterior displacement of posterior dural sac, which results in the cord compression of those segments. The mechanisms of myelopathy in our patient seem to be same as that of MMA. We report a MMA patient involving proximal limb with UMN signs in biomechanical concerns and discuss clinical importance of cervical MRI with neck flexion. The case highlights that clinical variation might cause misdiagnosis.
Adolescent ; Atrophy ; Biological Assay ; Denervation ; Diagnostic Errors ; Extremities ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Motor Neurons* ; Muscles ; Neck ; Neurologic Examination ; Shoulder ; Spinal Cord Diseases ; Spinal Muscular Atrophies of Childhood ; Upper Extremity

The aim of the study is to investigate the association between cerebral white matter hyperintensity (WMH) and the functional improvement using the Korean version of Modified Barthel Index (K-MBI) score during inpatient stroke rehabilitation. One hundred sixty participants were divided into 2 groups based on the severity of WMH according to Fazekas scale: Mild WMH group was defined as patients with Fazekas scale 0 and 1, and severe WMH group was defined as Fazekas scale 2 and 3. Functional status was assessed using the K-MBI score, and functional gains were calculated from the K-MBI score. The absolute functional gain in mild WMH group was significantly higher compared to severe WMH group (p < 0.05). In addition, patients in mild WMH had higher absolute functional efficiency, rehabilitation effectiveness, and relative functional efficiency. In the generalized linear model analyses, there was an association between functional outcomes and severity of WMH. In this study, the severity and extent of WMH are significantly correlated with poor functional improvement in patients with ischemic stroke. The WMH could be considered as one of many factors that can influence functional recovery during rehabilitation of stroke.
Humans ; Inpatients ; Linear Models ; Recovery of Function ; Rehabilitation ; Stroke ; White Matter