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Spinal Cord Infarction Caused by Non-dissected and Unruptured Thoracoabdominal Aortic Aneurysm with Intraluminal Thrombus.

Young Jin KI ; Byoung Hyun JEON ; Heui Je BANG

Annals of Rehabilitation Medicine.2012;36(2):297-302. doi:10.5535/arm.2012.36.2.297

Spinal cord infarction, especially anterior spinal artery syndrome, is a relatively rare disease. We report a case of spinal cord infarction caused by thoracoabdominal aortic aneurysm with intraluminal thrombus. A 52-year-old man presented with sudden onset paraplegia. At first, he was diagnosed with cervical myelopathy due to a C6-7 herniated intervertebral disc, and had an operation for C6-7 discetomy and anterior interbody fusion. Approximately 1 month after the operation, he was transferred to the department of rehabilitation in our hospital. Thoracoabdominal aortic aneurysm with intraluminal thrombus was found incidentally on an enhanced computed tomography scan, and high signal intensities were detected at the anterior horns of gray matter from the T8 to cauda equina level on T2-weighted magnetic resonance imaging. There was no evidence of aortic rupture, dissection, or complete occlusion of the aorta. We diagnosed his case as a spinal cord infarction caused by thoracoabdominal aortic aneurysm with intraluminal thrombus.
Animals ; Anterior Spinal Artery Syndrome ; Aorta ; Aortic Aneurysm ; Aortic Aneurysm, Thoracic ; Aortic Rupture ; Cauda Equina ; Horns ; Humans ; Infarction ; Intervertebral Disc ; Magnetic Resonance Imaging ; Middle Aged ; Paraplegia ; Rare Diseases ; Spinal Cord ; Spinal Cord Diseases ; Thrombosis

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Ulnar Neuropathy at the Wrist in a Patient with Carpal Tunnel Syndrome after Open Carpal Tunnel Release.

Nack Hwan KIM ; Dong Hwee KIM

Annals of Rehabilitation Medicine.2012;36(2):291-296. doi:10.5535/arm.2012.36.2.291

Ulnar neuropathy at the wrist is rarely reported as complications of carpal tunnel release. Since it can sometimes be confused with recurrent median neuropathy at the wrist or ulnar neuropathy at the elbow, an electrodiagnostic study is useful for detecting the lesion in detail. We present a case of a 51-year-old woman with a two-week history of right ulnar palm and 5th digit tingling sensation that began 3 months after open carpal tunnel release surgery of the right hand. Electrodiagnostic tests such as segmental nerve conduction studies of the ulnar nerve at the wrist were useful for localization of the lesion, and ultrasonography helped to confirm the presence of the lesion. After conservative management, patient symptoms were progressively relieved. Combined electrodiagnostic studies and ultrasonography may be helpful for diagnosing and detecting ulnar neuropathies of the wrist following carpal tunnel release surgery.
Carpal Tunnel Syndrome ; Elbow ; Female ; Hand ; Humans ; Median Neuropathy ; Middle Aged ; Neural Conduction ; Sensation ; Ulnar Nerve ; Ulnar Neuropathies ; Wrist

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Arteriovenous Malformation Incidentally Found by Ultrasonography in a Thigh Hematoma after Contusion.

Ho Jun LEE ; Bum Sun KWON ; Jae Hyun KWON ; Jin Woo PARK ; Ki Hyung RYU ; Dong Youn CHA ; Jae Hoon SHIM ; Woo Hyun LIM

Annals of Rehabilitation Medicine.2012;36(2):287-290. doi:10.5535/arm.2012.36.2.287

Vascular malformations in extremities are difficult to detect in cases of minor trauma. The authors report a case of an arteriovenous malformation (AVM) incidentally found by ultrasonography in a contusion. After a slip down, a 52-year-old man who had undergone total arthroplasty in both hips 10 years earlier complained of an ovoid right hip swelling that had gradually increased in size. Suspecting a simple cyst or hematoma, the swelling was examined by ultrasonography, which revealed a subcutaneous hematoma with arterial flow connected to muscle. Arteriography revealed an AVM around the right hip joint. Due to the presence of multiple arteriovenous shunts, a conservative treatment course was adopted and after 3 weeks of treatment the swelling almost completely resolved. It appears that the small AVM may have existed congenitally before hip surgery and the contusion over the AVM had led to hematoma rather than an arteriovenous fistula. The authors emphasize the usefulness of ultrasonography for the diagnosis of posttraumatic swelling.
Angiography ; Arteriovenous Fistula ; Arteriovenous Malformations ; Arthroplasty ; Contusions ; Extremities ; Hematoma ; Hip ; Hip Joint ; Humans ; Middle Aged ; Muscles ; Thigh ; Vascular Malformations

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Back Pain Secondary to Brucella Spondylitis in the Lumbar Region.

Kil Byung LIM ; Yee Gyung KWAK ; Dug Young KIM ; Young Sup KIM ; Jeong A KIM

Annals of Rehabilitation Medicine.2012;36(2):282-286. doi:10.5535/arm.2012.36.2.282

Brucellosis is a systemic, infectious disease caused by the bacterial genus Brucella and a common zoonosis that still remains a major health problem in certain parts of the world such as the Mediterranean region, the Middle East, and Latin America. It may involve multiple organs and tissues. Osteoarticular involvement is the most frequent complication of brucellosis, in which the diagnosis of brucellar spondylitis is often difficult since the clinical presentation may be obscured by many other conditions. There are only a few reports on brucellar spondylitis in Korea. Here, we report a case of spondylitis due to brucella in an elderly male.
Aged ; Back Pain ; Brucella ; Brucellosis ; Communicable Diseases ; Humans ; Korea ; Latin America ; Lumbosacral Region ; Male ; Mediterranean Region ; Middle East ; Spondylitis

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Occurrence of Intestinal Pseudo-obstruction in a Brainstem Hemorrhage Patient.

Sang jee LEE ; In hun NA ; Eun seok CHOI ; Sung hee JUNG ; Jong soo YOON

Annals of Rehabilitation Medicine.2012;36(2):278-281. doi:10.5535/arm.2012.36.2.278

Intestinal pseudo-obstruction is a massive colonic dilation with signs and symptoms of colonic obstruction, but without a mechanical cause. A 49-year-old female patient complained of nausea, vomiting, and abdominal distension 1 month after a massive brainstem hemorrhage. No improvement was seen with conservative treatments. An extended-length rectal tube was inserted to perform glycerin enema. In addition, bethanechol (35 mg per day) was administered to stimulate colonic motility. The patient's condition gradually improved over a 2-month period without any surgical intervention. Extended length rectal tube enema and bethanechol can be used to improve intestinal pseudo-obstruction in stroke patients.
Bethanechol ; Brain Stem ; Colon ; Enema ; Female ; Glycerol ; Hemorrhage ; Humans ; Intestinal Pseudo-Obstruction ; Middle Aged ; Nausea ; Stroke ; Vomiting

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Femoral Neuropathy and Meralgia Paresthetica Secondary to an Iliacus Hematoma.

Tae Im YI ; Tae Hee YOON ; Joo Sup KIM ; Ga Eun LEE ; Bo Ra KIM

Annals of Rehabilitation Medicine.2012;36(2):273-277. doi:10.5535/arm.2012.36.2.273

Compressive femoral and lateral femoral cutaneous neuropathies from an iliacus hematoma are unusual presentation. We report a case of a 16-year-old boy who developed right femoral and lateral femoral cutaneous neuropathies as a complication of traumatic ipsilateral iliacus hematoma formation. The patient complained of numbness in the right thigh and calf as well as right leg weakness, and pain in the right inguinal area. Nerve conduction study and needle electromyography identified the neuropathies. After the electrodiagnostic studies, the pelvic bone MRI revealed a large, 9x5x4.5 cm right iliacus hematoma. As a result, diagnosis of a right iliacus hematoma compressing the femoral and lateral femoral cutaneous nerves was made, and the patient underwent an operation to remove the hematoma. Symptoms and neurological signs showed notable improvement after surgical decompression. Subsequent follow-up electrodiagnostic studies after 11 weeks demonstrated regeneration evidence.
Adolescent ; Decompression, Surgical ; Electromyography ; Femoral Neuropathy ; Follow-Up Studies ; Hematoma ; Humans ; Hypesthesia ; Leg ; Needles ; Nerve Compression Syndromes ; Neural Conduction ; Pelvic Bones ; Regeneration ; Thigh

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Augmentative and Alternative Communication Training Using Eye Blink Switch for Locked-in Syndrome Patient.

Si Woon PARK ; You lim YIM ; Sook hee YI ; Hyun young KIM ; Seung min JUNG

Annals of Rehabilitation Medicine.2012;36(2):268-272. doi:10.5535/arm.2012.36.2.268

Locked-in Syndrome is a severe pontine stroke causing quadriplegia, lower cranial nerve paralysis, and mutism with preservation of only vertical gaze and upper eyelid movement in a conscious patient. We present a case of a Locked-in Syndrome patient who received communication training with augmentative and alternative communication equipment by using eye blinks. After 3 weeks of training, the patient was able to make an attempt to interact with other people, and associate a new word by Korean alphabet selection. Augmentative and alternative communication equipment which uses eye blinks might be considered to be beneficial in improving the communication skills of locked-in syndrome patients.
Communication Aids for Disabled ; Cranial Nerves ; Eye ; Eyelids ; Humans ; Mutism ; Paralysis ; Quadriplegia ; Stroke

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Safety of Monitoring Exercise for Early Hospital-based Cardiac Rehabilitation.

Chul KIM ; Chang Jin MOON ; Min Ho LIM

Annals of Rehabilitation Medicine.2012;36(2):262-267. doi:10.5535/arm.2012.36.2.262

OBJECTIVE: To survey the cardiovascular complications induced by cardiac monitoring exercise during 10 years of our cardiac rehabilitation (CR) clinic and report on the safety of monitoring exercise training for early hospital-based CR. METHOD: All cardiac patients who participated in our exercise program from January 2000 through December 2009 were recruited as study subjects. We stratified the exercise risks of cardiac events and conducted the monitoring exercise with individualized prescriptions. We measured all cardiac complications, including death, symptoms, abnormal hemodynamic responses, and electrocardiogram (ECG) abnormality during exercise training, for 10 years. A total of 975 patients (68% male; mean age, 58.9+/-10.6) were included in this study. Initial indications for CR were recent percutaneous transluminal coronary angioplasty (PTCA) (75%), post-cardiac surgery (coronary bypass graft, 13.2%), valvular surgery and other cardiac surgery (4.2%), and others (7.6%). RESULTS: The study population underwent 13,934 patient-hours of monitoring exercise. No death, cardiac arrest or acute myocardial infarction (AMI) occurred during exercise (0/13,934 exercise-hours). Fifty-nine patients experienced 70 cardiovascular events during the 13,934 exercise-hours (1/199 exercise-hours); there were 17 cases of angina only (1/820 exercise-hours), 31 cases of ECG abnormalities only (1/449 exercise-hours), 12 cases of angina with ECG abnormalities (1/1,161 exercise-hours), and 10 cases of abnormal hemodynamic responses (1/1,393 exercise-hours). CONCLUSION: Early hospital-based CR is safe enough that no death, cardiac arrest or AMI occurred during the 13,934 patient-hours of monitoring exercise. However, risk stratification for exercise-induced cardiovascular events, proper exercise prescriptions, and intensive ECG monitoring are required prior to initiation of the monitoring exercise.
Angioplasty, Balloon, Coronary ; Cardiovascular Diseases ; Death ; Electrocardiography ; Hemodynamics ; Humans ; Myocardial Infarction ; Prescriptions ; Thoracic Surgery ; Transplants

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Impact of Exercise-based Cardiac Rehabilitation on In-stent Restenosis with Different Generations of Drug Eluting Stent.

Chul KIM ; Hee Eun CHOI ; Byung Ok KIM ; Min Ho LIM

Annals of Rehabilitation Medicine.2012;36(2):254-261. doi:10.5535/arm.2012.36.2.254

OBJECTIVE: To compare the rate of restenosis between a cardiac rehabilitation (CR) group and a control group within three different generations of drug eluting stents (DES). METHOD: Patients who received DES due to an acute coronary syndrome were included. They were divided into a CR group and a control group. The CR group received six to eight weeks of early cardiac rehabilitation program in a hospital setting, and sustained a self-exercise program for six months in a community. The control group was instructed to exercise by themselves after leaving the hospital. Nine months after the first onset of disease, we implemented a coronary angiography and compared the two groups. In addition, we divided the patients into three subgroups according to the generation of DES, and compared the rate of restenosis between the CR group and control group within these three subgroups. RESULTS: At 9 months, in-stent restenosis, measured as an in-segment late luminal loss (LLL) of the stented coronary area, was smaller in the CR group (n=52) 0.16+/-0.42 mm compared to the control group (n=51) 0.39+/-0.78 mm (p<0.05). A reduction of LLL in the CR group compared to the control group was consistent among the three different generations of DES. CONCLUSION: The CR program is strongly associated with a significant reduction in LLL in the stented coronary segments, regardless of the generation of DES.
Acute Coronary Syndrome ; Coronary Angiography ; Coronary Restenosis ; Drug-Eluting Stents ; Family Characteristics ; Humans ; Phenobarbital ; Stents

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The Relation between Postvoid Residual and Occurrence of Urinary Tract Infection after Stroke in Rehabilitation Unit.

Bo Ram KIM ; Jeong Hoon LIM ; Seung Ah LEE ; Jin Hyun KIM ; Seong Eun KOH ; In Sik LEE ; Heeyoune JUNG ; Jongmin LEE

Annals of Rehabilitation Medicine.2012;36(2):248-253. doi:10.5535/arm.2012.36.2.248

OBJECTIVE: To determine the relation between postvoid residual (PVR) and the occurrence of urinary tract infection (UTI) in stroke patients. METHOD: One hundred and eighty-eight stroke patients who were admitted to an inpatient rehabilitation unit and who did not have UTI on admission (105 males, 83 females, mean age 67.1 years) were included in this study. The PVR was measured 3 times within 72 hours after admission. Mean PVR, demographic variables, K-MMSE (Korean Mini-Mental State Examination), initial K-MBI (Korean Modified Barthel Index), Foley catheter indwelling time and stroke type were defined and the relation to the occurrence of UTI was analyzed. RESULTS: UTI occurred in 74 patients (39.4%) during admission to the rehabilitation unit. There were significant differences between the UTI and non-UTI groups in K-MMSE, K-MBI, Foley catheter indwelling time (p<0.01). However, age, gender, stroke location and type were not associated. The occurrence of UTI was 4.87 times higher in the patients with a mean PVR over 100 ml than in those with a mean PVR <100 ml. The mean PVR was 106.5 ml in the UTI group, while it was 62.7 ml in the non-UTI group (p<0.01). PVR was not associated with age. CONCLUSION: The UTI rate is higher when the mean PVR is over 100 ml irrespective of gender and age. Close monitoring of PVR and appropriate intervention is needed to reduce the occurrence of UTI in stroke patients.
Catheters ; Female ; Humans ; Inpatients ; Male ; Stroke ; Urinary Tract ; Urinary Tract Infections

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