OBJECTIVE: To investigate the activation pattern of somatosensory cortex in subcortical stroke patients underlying recovered somatosensory capacity of hand, using functional MRI (fMRI). METHOD: Four patients with subcortical cerebral hemorrhage or infarction and five normal healthy volunteers were investigated. Sensory task was given on the palm of hand by brushing as a frequency of 1 Hz. In fMRI study, ten slices were obtained using the Echo Planar Imaging technique, data was statistically analyzed using SPM-99 software. RESULTS: During the tactile stimulation of affected hand, contralateral primary somatosensory cortex was activated in all the patients. In the two patients with full recovery of tactile sense, cortical activation for paretic hand was stronger than in nonparetic hand. On the other hand, the other two patients with incomplete recovery showed that cortical activation for nonparetic hand was stronger than in paretic hand and even normal control. CONCLUSION: Our result suggested that functional consequences of the somatosensory cortical area were not limited to the ipsilateral hemisphere to the lesion, but affect the contralateral, nonlesioned hemisphere, in subcortical stroke patients with recovered somatosensory capacity.
Cerebral Hemorrhage ; Echo-Planar Imaging ; Hand* ; Healthy Volunteers ; Humans ; Infarction ; Magnetic Resonance Imaging ; Somatosensory Cortex* ; Stroke*

We present four pediatric cases examined by diffusion tensor MRI (DTI) to investigate microstructural abnormalities of brain related to their neurologic disability and motor weakness, following absence of any remarkable lesion on the motor pathway in conventional MRI. DTI is a relatively novel MR technique that enables investigation of the orientation and integrity of white matter fiber tracts of the brain in vivo. Case 1, 2 and 3 had suffered from cerebral palsy and case 4 had developed left hemiparesis after a traumatic brain injury. Conventional brain MRI presented no specific abnormality in case 1 and 2, a focal encephalomalacia in the left anterior thalamus in case 3, and contusional hemorrhages in the left temporal and parietal lobes in case 4. But DTI disclosed microstructural abnormalities on descending motor pathway including the posterior limb of the internal capsule or the cerebral peduncle of the midbrain in all cases.
Brain Injuries* ; Brain* ; Cerebral Palsy ; Child* ; Contusions ; Diffusion* ; Encephalomalacia ; Extremities ; Hemorrhage ; Humans ; Internal Capsule ; Magnetic Resonance Imaging* ; Mesencephalon ; Paresis ; Parietal Lobe ; Rehabilitation ; Tegmentum Mesencephali ; Thalamus

Dyke-Davidoff-Masson Syndrome (DDMS) is a rare condition characterized by asymmetry of cerebral hemispheric growth with atrophy on one side, ipsilateral compensatory osseous hypertrophy, and contralateral hemiparesis. We experienced a 17 month-old male who presented with left focal clonic or tonic-clonic seizures accompanied by left hemiparesis and developmental delay. Brain MRIs demonstrated progressive atrophy of the right cerebral hemisphere with dilatation of the lateral ventricle, expansion of the ipsilateral frontal sinus with calvarial thickening, and elevation of the petrous pyramid and orbital roof. Brain SPECT showed a decreased volume of the right hemisphere with reduced blood flow. We therefore report a case of DDMS with a review of the literature.
Atrophy ; Brain ; Cerebrum ; Dilatation ; Frontal Sinus ; Hemiplegia ; Humans ; Hypertrophy ; Infant ; Korea* ; Lateral Ventricles ; Magnetic Resonance Imaging ; Male ; Orbit ; Paresis ; Petrous Bone ; Seizures ; Tomography, Emission-Computed, Single-Photon

Cervical dystonia is the most common form of local dystonia encountered in a movement disorders clinic. Rotatocollis is involuntary contraction of sternocleidomastoid and contralateral splenius muscles resulting in twisting of the head clockwise or counterclockwise on the axial plane. We injected phenol solution into the affeced muscle or nerve branch in two patients with rotatocollis. There was significant improvement in neck movement and position. Phenol block may offer an easy and inexpensive alternatives for patients with cervical dystonia.
Dystonia ; Head ; Humans ; Movement Disorders ; Muscles ; Neck ; Paraspinal Muscles ; Phenol* ; Torticollis*

Dysesthetic pain syndrome is a common disabling painful sequelae of spinal cord injury patients. The purposes of this study were to gather the general informations of pain in spinal cord injury patients and to investigate the correlation between the various factors affecting pain severity. Twenty-seven spinal cord injury patients with dysesthetic pain were evaluated by medical histories, physical and neurological examinations. The pain intensity was measured by a visual analogue scale. Twenty-one subjects were males and six were females. The mean age of patients was 35.1 years. The patients were classified into five pain categories : diffuse pain, segmental pain, root pain, visceral pain, and non-neurogenic pain. Nineteen patients (70.4%) were categorized into diffuse pain group, six patients (22.2%) into both diffuse and segmental pain group, two patients (7.4%) into root pain group and five patients (18.5%) into perianal pain group. According to this study, the only significant factor affecting the severity of dysesthetic pain in spinal cord injury patients was the severity of spinal cord injury. Pain appeared earlier and more intensely in the complete spinal cord injury patients. There was no correlation between the severity of pain and the level of lesion, age, or the posterior tibial nerve SEP response.
Female ; Humans ; Male ; Neurologic Examination ; Spinal Cord Injuries* ; Spinal Cord* ; Tibial Nerve ; Visceral Pain

Sixteen legs in eight cadavera were dissected to observe the anatomic course of the superficial peroneal nerve around the ankle and the superficial peroneal sensory conduction study was performed in twenty-eight normal subjects. The anatomic course of the superficial peroneal nerve around the ankle was in two types, type I and type II. Type I was 13 cases(81%) and type II was 3 cases(19%). In type I, the nerve penetrated the crural fascia and became subcutaneous at 8.8+/-1.1 cm proximal to the ankle joint and divided into two major branches at 2.6+/-1.1 cm proximal to the ankle. Medial and intermediate dorsal cutaneous nerves were located at 47%(+/-3.4%) and 35%(+/-4.9%) of the intermalleolar distance from lateral malleolus, respectively. In type II, the medial and intermediate dorsal cutaneous nerve arose seperately from the superficial peroneal nerve at 8.0+/-0.9 cm proximal to the ankle joint. Medial and intermediate dorsal cutaneous nerves were located at 49%(+/-5.6%) and 33%(+/-4.0%) of the intermalleolar distance from the lateral malleolus, respectively. Superficial peroneal sensory conduction study was performed based on the findings of type I. The mean distal latencies and amplitudes were 3.21+/-0.35 msec, 12.1+/-3.37 micronV and 3.17+/-0.37msec, 14.54+/-4.60 micronV in medial and intermediate dorsal cutaneous nerves, respectively.
Ankle ; Ankle Joint ; Fascia ; Leg ; Peroneal Nerve*

OBJECTIVE: Athetoid cerebral palsy is a nonprogressive disorder, due to hypoxic injury or jaundice in basal ganglia, characterized by impairment of postural reflexes, arrhythmical involuntary movements, and dysarthria. Dysarthria is a group of motor speech disorder resulting from a disturbance of motor control of the speech mechanism. The purpose of this study is to evaluate the acoustic characteristics of dysarthria in athetoid cerebral palsy. METHOD: We investigated the acoustic characteristics of dysarthria in 8 male patients with athetoid cerebral palsy and 6 males as a control group using Computerized Speech Laboratory (i.e., Multi-Dimensional Voice Program (MDVP), Visi-Pitch, and Electroglottography) and Nasometer. RESULTS: In the MDVP analysis, average fundamental frequency, jitter, and shimmer are significantly increased in patient group as compared to control group (p<0.05). In the Visi-Pitch analysis, maximal phonation and diadochokinetic rate are significantly decreased in patient group (p<0.05). The athetoid cerebral palsied patients have many pitch breaks. Nasalance is not significantly decreased in patient group in comparision with control group. CONCLUSION: We think that average fundamental frequency, jitter and shimmer are increased and maximal phonation time and diadochokinetic rate are decreased in athetoid cerebral palsied patients.
Acoustics* ; Basal Ganglia ; Cerebral Palsy* ; Dysarthria* ; Dyskinesias ; Humans ; Jaundice ; Male ; Phonation ; Reflex ; Voice

The causes of leg length discrepancy in childhood include neurologic, musculoskeletal, tumor and vascular diseases. It may contribute secondary complications such as gait disturbance, scoliosis, hip joint arthritis or cosmetic problem etc. Acquired arteriovenous fistula is a rare cause of leg length discrepancy. Multiple vascular punctures in the neonates, especially in prematures, can result in iatrogenic arteriovenous fistula formation. We report two cases of arteriovenous fistula secondary to vascular punctures, diagnosed by color doppler ultrasonography and CT angiography. The lesions were explored and treated surgically.
Angiography ; Arteriovenous Fistula ; Arthritis ; Cosmetics ; Fistula ; Gait ; Hip Joint ; Humans ; Infant, Newborn ; Leg ; Punctures ; Scoliosis ; Ultrasonography, Doppler, Color ; Vascular Diseases

OBJECTIVE: To investigate the effects of modified constraint- induced movement therapy (CIMT) on motor function and cortical activation in children with hemiplegic cerebral palsy (CP). METHOD: Five children with hemiplegic cerebral palsy were studied with Jebsen hand function test and quality of upper extremity skills test (QUEST), dynamic electromyography (EMG), and single photon emission computed tomography (SPECT) at rest before and after the CIMT period. Children were treated with a 4-week protocol of modified CIMT, consisting of twice-weekly 2-hour sessions of structured activities and a home program for non-treatment days. Children wore orthoses on their less affected upper extremities for 6 hours per day, during which time they were engaged in play, functional activities and 2-hour protocol of motor tasks. RESULTS: Improvements in upper-extremity function were found in Jebsen hand function test and QUEST. Increased muscle activities in elbow extensors were observed in dynamic EMG during affected hand grip. In right hemiplegic patients, regional cerebral perfusion increased in right Brodmann area (BA) 3 and lentiform nucleus. In left hemiplegic patients, regional cerebral perfusion increased in right BA 6, 9, 21, left BA 19 and left cerebellum, but decreased in left BA 11. CONCLUSION: Modified CIMT appears to change local cerebral perfusion in areas known to participate in movement planning and execution. These changes might be a sign of cortical activation after CIMT in the children with hemiplegic cerebral palsy. Results of this study suggest that modified CIMT may be an effective way of treating children with hemiplegic CP.
Cerebellum ; Cerebral Palsy ; Child ; Corpus Striatum ; Elbow ; Electromyography ; Hand ; Hand Strength ; Humans ; Muscles ; Orthotic Devices ; Perfusion ; Tomography, Emission-Computed, Single-Photon ; Upper Extremity

OBJECTIVE: The purpose of this study is to develop a new neuropathic pain model in the rat. METHOD: Each male adult rat was anesthetized and the sciatic nerve was exposed. Each exposed nerve was injected with 0.03 cc of 1% phenol solution. Normal saline 0.03 cc was injected to the placebo group. Rats were tested for the presence of mechanical allodynia by von Frey hair. Spontaneous pain behavior (paw shaking, paw elevation) was examined for 5 minutes in the cage. RESULTS: Phenol injected group developed allodynia after the second post-injection day for up to 1 month. Allodynia was also observed in the contralateral legs of phenol injected group. The control group did not develop allodynia. Spontaneous pain behavior was not observed in either group. CONCLUSION: Neuropathic pain model was developed by 1% phenol solution injection to the rat sciatic nerve. This study suggests an easier method for making the neuropathic pain model.
Adult ; Animals ; Hair ; Humans ; Hyperalgesia ; Leg ; Male ; Neuralgia* ; Phenol* ; Rats* ; Sciatic Nerve*