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.
Drug Therapy* ; Humans ; Retreatment*

No abstract available.
Mass Screening*

No abstract available.
Atrophy* ; Brain*

To define the effectiveness of C-reactive protein (CRP) as indicator for early detection of the post-operative infection, it is essential to exclude possible normal changes of CRP influenced by surgery itself. We analyzed 44 patients who had done orthopaedic surgeries without any evidence of infection preoperative and postoperatively from May to Aug. 1995 at Dongsan medical center, Keimyung University. We checked the levels of Erythrocyte sedimentation rate (ESR) and CRP levels at preoperative and postoperative 1, 3, 5, 7, 9, 11, 13, 15, 17, 19 and 21st day in all cases. In all cases, ESR increased up to 60mm/hr maximally and CRP increased to more than 10mg/dl at least one occasion within the first 3 weeks postoperatively. However CRP showed more rapid changes than ESR. The mean value of the CRP was increased maximally (7.2mg/dl) at 3 day after operation and then decreased rapid until 11 day. ESR was also increased at 3 day after operation, but it sustained high level until 21 day after operation. CRP appears to be more sensitive and rapid indicator as an acute phase reactant for the operation itself because CRP revealed more earlier and accentuated change after the operation. The changes of CRP showed same pattern regardless of operation time, use of tourniquet, use of transfusion and gender. In conclusion, within 3 day after operation, the high titer of CRP can not to be an indicator for early detection of the infection, because normal high titer can be developed by surgery itself. If there notes persistent high titer or more increasing pattern of CRP after postoperative 3 day or abnormal high titer of CRP after 11 day postoperatively, infection may be highly suspicious.
Blood Sedimentation ; C-Reactive Protein ; Humans ; Tourniquets

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

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

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.

A 28-yr-old woman presented with both hip pain that started sequentially during the peripartum period. Diagnosis of transient osteoporosis of the hip (TOH) was made based on typical findings of plain radiographs and magnetic resonance images. The subchondral trabeculae of the femoral head were evaluated on serially taken coronal multiplanar reformation computerized tomogram images. At 4 weeks after pain onset, marked decrease in the sclerotic density with irregular discontinuation was observed in the primary compression trabeculae. At 12 weeks, a focal area of irregular thickening of trabeculae was observed. At 20 weeks, sclerotic density of trabeculae recovered markedly and the focal area of irregular trabecular thickening disappeared. At 1 yr, subchondral trabeculae recovered almost completely. The evidence of subchondral trabecular injury was observed in the femoral heads of TOH.
Adult ; Female ; Femur Head/*injuries/radionuclide imaging ; Humans ; Osteoporosis/*diagnosis/radiography ; Pregnancy ; Tomography, X-Ray Computed