Objective: The aim of this study was to investigate the incidence of intrahemispheric diaschisis in subcortical lesions and relationships between involved structures and intrahemispheric diaschisis using positron emission tomography (PET).
Method: Thirty stroke patients with unilateral subcortical lesions without cortical structural abnormality were recruited. The findings of [18F]Fluoro-2-Deoxy-D-Glucose PET were interpretated by experienced radiologist.
Results: In the lesions around basal ganglia, hypometabolism of ipsilateral whole hemisphere was observed in 8 of 20 patients and ipsilateral parietal, frontal, temporal, occipital lobe was observed in order of incidence. Intrahemispheric diaschisis had a tendency to expand when the centrum semiovale was involved. Crossed cerebellar diaschisis was observed in 17 of 20 patients. In the lesions around thalamus, hypometabolism of ipsilateral whole hemisphere was observed in 6 of 8 patients, and ipsilateral frontal, temporal, parietal lobe was observed in order of incidence. Intrahemispheric diaschisis had a tendency to expand when the internal capsule was involved. Crossed cerebellar diaschisis was observed in 5 of 8 patients.
Conclusion: This study shows that intrahemispheric diaschisis was observed in all patients with subcortical lesions without cortical structural abnormality and had a tendency to expand to larger area of the cerebral cortex when the connecting fibers between cortical and subcortical structures were involved. (J Korean Acad Rehab Med 2002; 26: 495-501)
Objective: To evaluate effects of gabapentin in post-stroke reflex sympathetic dystrophy (RSD).
Method: To 20 RSD patients after stroke, gabapentin was administrated. We started medication with 300 mg per day and increased dosage by 300 mg per two days up to maximum 900∼1,200 mg. We evaluated RSD symptom severities with hand pain, hand swelling and shoulder pain before gabapentin administration. Severity of each symptoms was graded and scored (0: no pain/swelling, 1: mild, 2: moderate, 3: severe). Severities of RSD symptoms were reevaluated on every dose increasing and on 1 week, 2 weeks and 4 weeks later after administrating maximum dosage. We defined as no effect group didn't have any improvement in symptom severity score in comparison with baseline score. Medications other than gabapentin were administrated in no effect group.
Results: Among 19 subjects whom we could follow-up, 4 subjects were defined as no effect group. 15 (78.9%) subjects showed improvement in symptom severity score. Statistically significant symptom improvements were observed after 4 weeks in comparison with baseline in hand pain and shoulder pain (p=0.000). From gabapentin 300∼600 mg dosage, hand and shoulder pain showed significant pain decrease. Improvement of hand edema was observed after 4 weeks, but it was statistically insignificant.
Conclusion: We conclude the gabapentin is effective for RSD pain, however further control study is required. (Korean Acad Rehab Med 2002; 26: 502-507)
Objective: To estimate the probable cause and the time of cerebral insult in cerebral palsy (CP) based on MRI findings and risk factors.
Method: The subjects comprised all sixty-seven patients with CP showing abnormal MRI findings between March 1999 and September 2001 at the Catholic University of Korea, St. Mary's Hospital. A detailed medical history was available for all patients including those not born in our hospital. They ranged in age from two months to five years. We analyzed the brain magnetic resonance (MR) findings of patients with CP to correlate the probable cause and the time of cerebral insult through the consideration of medical histories including prenatal, perinatal and postnatal histories.
Results: Of the 67 MRIs, abnormalities were the followings; periventricular leukomalacias (PVLs) in 49 cases, cortical or subcortical infarction in 4 cases, brain atrophy in 7 cases, neuronal migration disorder in 4 cases, and delayed myelination in 3 cases. Among the patients with PVL, perinatal risk factors were responsible for cerebral insult in preterm, but pre- and perinatal contribution were similar in patients born at full term. Among the patients with cerebral infarction, only one case with meningitis at 11 months was suspected for cerebral insult. These patients had no risk factor as a peri- or post-natal etiology. Four patients with neuronal migration disorder had no risk factor for peri- or postnatal etiology except for the one who was a twin.
Conclusion: Review of brain MRI findings such as PVL, infarct, neuronal migration disorder and a detailed medical history including prenatal and perinatal etiology would be a useful method to estimate the probable cause and the time of cerebral insult in CP. (Korean Acad Rehab Med 2002; 26: 508-513)
Objective: Hip deformity is one of the common problems in children with cerebral palsy. And it is important to detect hip subluxation or dislocation as early as possible. The purpose of this study is to find the incidence of hip subluxation in early childhood in patients with cerebral palsy.
Method: We reviewed clinical and radiological records of children with cerebral palsy under 36 months of age. We measured migration index, acetabular index, center edge angle and neck shaft angle from hip X-ray of patients.
Results: Total 76 patients were included in this study. The mean of migration index was 4.5⁑7.5% at 8∼12 months, 10.9⁑11.9% at 13∼24 months, and 18.2⁑13.0% at 25∼36 months (p＜0.05). Twenty one patients (27.6%) were above 25% on the migration index. The neuromotor type of cerebral palsy in 21 patients with hip subluxation, were spastic in 20 (95.2%) except one child. The incidence of hip subluxation was 25.0% (8/32) for quadriplegia, 29.6% (8/27) for diplegia and 50.0% (4/8) for hemiplegia. The acetabular index was significantly higher and the center edge angle was lower in the subluxated hip group than in the non-subluxated hip group, though no significant difference in the neck shaft angle.
Conclusion: We concluded that the hip subluxation in cerebral palsy can occur under 36 months of age with a relatively high incidence. Therefore, it is recommended to evaluate the hip of cerebral palsy with radiological as well as clinical examination in early childhood. (J Korean Acad Rehab Med 2002; 26: 514-518)
Objective: To investigate current status of psychosexual function in adults with cerebral palsy (CP) by Derogatis Sexual Functioning Inventory (DSFI), which is a widely used multidimensional measure of sexual functioning.
Method: Forty-two adults with CP and 150 healthy controls participated in this study. All participants were interviewed with DSFI, which consisted of 10 domains such as sexual information, experience, drive, attitude, psychological symptoms, affect, gender role, fantasy, body image and satisfaction.
Results: Adults with CP showed significantly lower scores in sexual information, experience and satisfaction, and higher scores in psychological distress symptoms and conservative attitude, compared with controls (p＜0.05). Especially, unmarried men with CP had a significant sexual dysfunction in most substantive domains of DSFI (p＜0.05). However, there was no statistical difference in married men, unmarried women and married women, compared with normal controls. Sexual experience, drive, body image and satisfaction were significantly distressed in non-ambulatory CP, compared with functional ambulators (p＜0.05). The score of sexual satisfaction had a significant relationship with those of sexual experience, attitude, psychological symptoms and body image in adults with CP (p＜0.05).
Conclusion: Adults with CP showed a distress in psychosexual functioning, especially in unmarried men and non- ambulators. Therefore, active interventions of sexual counseling and education will be helpful for enhancing their sexual function. (Korean Acad Rehab Med 2002; 26: 519-525)
Objective: This study was designed to investigate the effect of the rectal electrical stimulation in patients with neurogenic bowel due to SCI.
Method: Twelve patients with SCI who have the symptoms of neurogenic bowel were recruited as subjects. Before and after electrical stimulation, anorectal angle and anal pressure was measured.
Results: 1. There was a reverse correlation between pre- electrical stimulation anorectal angle and colon transit time in rectosigmoid segment (p＜0.05). 2. Anal pressure of postelectrical stimulation was significantly decreased compared with that of pre-electrical stimulation (p＜0.05). 3. Anorectal angle of post-electrical stimulation was significantly increased compared with that of pre-electrical stimulation (p＜0.05).
Conclusion: This study suggested that rectal electrical stimulation for neurogenic bowel in patients with SCI could be helpful defecation method for bowel emptying. (J Korean Acad Rehab Med 2002; 26: 526-532)
Objective: The purposes were to determine the baseline colon transit time (CTT) and to assess the effect of dietary fiber (psyllium husk) on neurogenic bowel function in chronic spinal cord injured (SCI) persons.
Method: Eleven chronic spinal cord injured persons with upper motor neuron type neurogenic bowel were participated. Personal interview were carried out for all studied subjects at pre and post treatment period. The baseline colon transit time (CTT) were measured for the right (rCTT), left (lCTT), rectosigmoid (rsCTT) colons as well as for the entire colon using radio-opaque markers. After 4 weeks treatment of psyllium husk, the subjects were reevaluated for their CTTs and the results were compared to the pretreatment values.
Results: The mean age of the subjects was 33.9⁑11.0 years and the level of injury ranged from C3 to T10. The mean duration after SCI was 22.6 months (6∼47 months). The rCTT, lCTT, rsCTT and tCTT were not affected after the treatment of psyllium husk. Also their bowel care patterns and satisfaction were unaffected by the treatment.
Conclusion: The results of this study suggest that the use of psyllium husk in chronic spinal cord injured persons do not show the same effect on bowel function as has been previously reported in general population with idiopathic constipation. (J Korean Acad Rehab Med 2002; 26: 533- 538)
Objective: To compare the latency difference of median and ulnar sensory nerves through the wrist-palm short segment in patients with carpal tunnel syndrome (CTS).
Method: Subjects included 68 hands of 36 carpal tunnel syndrome patients and 97 hands of 53 healthy adults with no electrophysiologic evidence of CTS. The median and the ulnar sensory responses were recorded on the third and the fifth digit using bar recording electrode, respectively. Both nerves were stimulated just proximal to the distal wrist crease and 5 cm distal to the proximal stimulation point. The latency differences between the 2 stimulation points were obtained.
Results: The transcarpal short segment conduction times in the control group were 1.0⁑0.1 msec and 0.9⁑0.1 msec for the median and ulnar nerves, respectively. The transcarpal short segment conduction times in the patients with CTS were 1.9⁑0.5 msec and 1.0⁑0.3 msec for the median and ulnar nerves, respectively. The transcarpal short segment conduction time difference between the median and ulnar nerves were 0.13⁑0.12 msec in the control group and 0.88⁑0.50 msec in the CTS group. The difference of transcarpal conduction of two nerves was statistically significant in comparison with the two groups.
Conclusion: Wrist-palm short segment study of median and ulnar sensory nerve may be used adjunctively in diagnosis of mild CTS. (J Korean Acad Rehab Med 2002; 26: 539-542)
Objective: The purposes of these study were to evaluate the changes of temperature and sympathetic skin response (SSR) before and after sympathectomy in patients with palmar hyperhidrosis and to quantify long standing effect of sympathectomy.
Method: The SSR and skin temperature were measured before, one day and 30 days after thoracoscopic sympathectomy. SSR was recorded from palm and sole bilaterally. Temperature was recorded on 9 sites of each hand and 11 site of each sole. Patient's satisfaction with operation was assessed by 10-point scale.
Results: One day after sympathectomy, the amplitude of SSR was significantly decreased and latency of SSR was delayed in all cases on bilateral palm and sole. However, after sympathectomy 30 days, the amplitude of SSR was normalized in all cases on bilateral sole. All patients who had undergone sympathectomy showed significant clinical improvement. The temperature increased dramatically over 3oC on postoperation 1 day and maintained 1.72oC higher in post-operation 30 days than pre-operation on both hands. There was no significant difference of temperature among pre-operation and post-operation 1 day and post-operation 30 days on sole.
Conclusion: Our study proved effect of thoracoscopic sympathectomy to the patients with palmar hyperhidrosis objectively and quantified the decrement of sympathetic tone. Further study is needed for long term follow up over 2 months or more. (J Korean Acad Rehab Med 2002; 26: 543-549)
Objective: To evaluate long-term prognosis of postoperative femoral neuropathy.
Method: 15 patients who confirmed as femoral neuropathy by electrodiagnostic study after renal transplantation or abdominal hysterectomy were included in this study. Retrospective chart review and telephone interview of 12 available patients were performed at 36 months on average after operation. Second telephone interview were available in 4 out of 12 patients one year after first telephone interview. After the second telephone interview, we evaluated muscle strength and gait function of them in our labaratory.
Results: At immediate postoperative stage (average 16.8 days), knee extensor strength was less than grade III in 8 out of 12 patients. In gait function evaluation, six patients were unable to walk on flat surface. At first interveiw, recovery of muscle strength was excellent in five patients, good in five and fair in two. In gait function, all could walk without walking aids for more than 30 minutes and 9 could run and mount up the stairs. The second follow-up showed functional improvement even after 24 months of onset. The findings of physical examination correlated well with telephone interview.
Conclusion: Almost all patients who diagnosed as postoperative femoral neuropathy regained near normal motor strength and functional ambulation in the long-term follow- up. (J Korean Acad Rehab Med 2002; 26: 550-554)
Objective: Electrophysiologic study and 24 hours urine study were analysed in patients with diabetes mellitus in order to assess the correlation between the severity of the diabetic neuropathy and degree of microalbuminuria.
Method: Two hundreds forty one patients with diabetic neuropathy were included and divided into 3 groups - mild, moderate and severe groups. The latency and amplitude of the peroneal motor nerve, median and sural sensory nerves, F-wave of the peroneal nerve and H-reflexes were measured. Microalbuminuria and creatinine clearance with 24 hours urine were studied. The results of the nerve conduction study and the degree of microalbuminuria were evaluated for the correlation between the two signs.
Results: The degree of microalbuminuria significantly increased in accordance with the electrophysiologic severity of neuropathy (p＜0.05). The latencies and amplitudes of the peroneal motor, median and sural sensory nerves had significant correlation with the degree of microalbuminuria (p＜0.05).
Conclusion: The degree of microalbuminuria was significantly correlated with the electrophysiologic severity of diabetic neuropathy. The results suggest that pathogenesis of the neuropathy and nephropathy in patients with diabetes seem the same as microvascular and biochemical basis. (J Korean Acad Rehab Med 2002; 26: 555-561)
Objective: This study was conducted to assess the effect of intramuscular electrical stimulation (IMES) and compared it with that of transcutaneous electrical nerve stimulation (TENS) and dry needling in the patients with myofascial pain syndrome (MPS).
Method: Forty five patients with MPS was assigned randomly to TENS group (n=15), dry needling group (n=15) and IMES group (n=15). In TENS group, TENS was applied to the trigger point. In dry needling group, dry needling was applied to the trigger point. In IMES group, IMES was applied to the trigger point. Duration of treatment was 2 weeks. Effects were assessed before treatment, 1 day, 3 days, 7 days and 14 days after treatment by visual analogue scale (VAS) and McGill pain questionnaire (MPQ). Thermography was performed before treatment, 7 days and 14 days after treatment.
Results: Significant change of VAS improvement ratio was noticed in IMES group from the 1 day after treatment compared with other groups. Significant change of MPQ improvement ratio was noticed in IMES group from the 3 days after treatment compared with other groups. The skin temperature difference was significantly improved in IMES group at 14 days after treatment.
Conclusion: These results showed that IMES is effective treatment method for pain control in patients with MPS. (J Korean Acad Rehab Med 2002; 26: 562-566)
Objective: The purpose of this study is to evaluate the efficacy of stellate ganglion block for the patients with cervical Herniated Intervertebral Disc (HIVD).
Method: Forty patients with cervical HIVD were selected for the study. Patients were randomly assigned to one of two groups: Group 1, stellate ganglion block of 1% lidocaine and physical modalities (n=20); Group 2, only physical modalities as a control group (n=20). Group 1 patients were treated with the stellate ganglion block of 1% lidocaine three times over two-week period. The efficacy of stellate ganglion block was assessed with Visual Analog Scale (VAS) on pre- and post-stellate ganglion blocks and with Rubin scale (success rate).
Results: The VAS scores of post-block were significantly lower than pre-score (p＜0.05) in both groups, but there was no statistically significance between the two groups. After treatment, Rubin scale was with excellent or good in 75% in group 1 and in 50% in group 2, but there was no statistically significance.
Conclusion: The stellate ganglion block may be effective therapeutic method for patient with cervical HIVD. But the efficacy of additional stellate ganglion block for cervical HIVD remains controversial. (J Korean Acad Rehab Med 2002; 26: 567-570)
Objective: To investigate the efficacy of commonly available analgesics in the management of delayed-onset muscle soreness (DOMS) over an 8-day period, and to compare the efficacy between aspirin and acetaminophen.
Method: Forty-two subjects were recruited. DOMS was induced by using the isokinetic dynamometer (KinComⰒ) in standardized fashion in the nondominant knee extensor with subjects seated at 30 degree-angle velocity. Subjects were asked to extend their non-dominant knee with concentric method and to hold the knee with eccentric flexion force at 30 degree-angle velocity, with maximal efforts. On this way, they did 10 repetitions, and then 3 cycles. We categorized four groups (n=10, for each group), that were control group with no medication, placebo group with placebo medication (antacid tablets), aspirin group with medication of 900 mg of aspirin, and acetaminophen group with medication with 3,900 mg of acetaminophen. Visual Analogue Scale (VAS: twice a day, until on day 8). and McGill Pain Questionnaire (MPQ: on day 1 and 3) were measured.
Results: We didn't find any significant difference of peak VAS score and relief time between four groups (P＞0.05), The score of MPQ was not different between four groups (P＞0.05).
Conclusion: We concluded that the medication may not be beneficial, at least at the doses stated, in the management of DOMS. (Korean Acad Rehab Med 2002; 26: 571-575)
Objective: To evaluate the effects of back extensor strengthening exercise on improving the pain, activities of daily living (ADL) and bone mineral density in the chronic low back pain patients.
Method: 21 patients with chronic low back pain participated in back school program. Before program, measurement of lumbar extensor strength with MedXⰒ (Ocala, USA), visual analogue scale (VAS) for pain, level of ADL and bone mineral density (BMD) with DEXA (LunarⰒ, GE, USA) were done. For 12 weeks subjects had received the training for strengthening of back extensor and then, checked up with the above variables again.
Results: The results were as follows: 1) After 12 weeks of lumbar extensor strengthening program, isometric lumbar extensor strength was increased significantly (p＜0.01), 2) VAS and ADL were significantly improved from 5.1 to 3.3, and 8.1 to 9.9, respectively (p＜0.01), 3) BMD of lumbar spine were significantly improved from 1.1 to 0.8 (p＜0.05)
Conclusion: Twelve weeks lumbar extensor strengthening program with pelvic stabilization may be the effective therapeutic program for patients with chronic low back pain. (J Korean Acad Rehab Med 2002; 26: 576-580)
Objectives: To evaluate changes of the gait pattern and the clinical improvement in patients with degenerative arthritis of the knee after total knee arthroplasty (TKA).
Method: Gait analysis was performed in 64 patients with degenerative arthritis of the knee at pre- and post-surgery 1 year, also Hospital for Special Surgery (HSS) knee score and Visual analogue scale (VAS) for clinical assessment were investigated.
Results: 1) In the HSS knee score and VAS, there were statistically significant improvement after surgery (p＜0.05). 2) In the postoperative gait analysis, all the linear parameters except single limb support period were significantly improved (p＜0.05). Single limb support period was improved, but statistically insignificant. All the kinematic and kinetic parameters also were significantly improved (p＜0.05).
Conclusion: This study suggests that gait analysis can be used for quantitative evaluation of the effects of total knee arthroplasty in patients with degenerative arthritis of the knee. (J Korean Acad Rehab Med 2002; 26: 581-586)
Objective: To confirm the effect of calcitonin injection relieving pain in ovariectomized rats.
Method: Thirty five Sprague-Dawley rats were randomly divided into five groups (high dose calcitonin group (112 U/ Kg), low dose calcitonin group (56 U/Kg), free calcitonin group, ovariectomy group, control group). To assess the pain in ovariectomized rats, the tail of rats were dived in waters of 50⁑1oC. Then the tail withdrawal time was measured (tail withdrawal test). The tail withdrawal test was performed in once a week for eight weeks. Results: 1. At seven and eight weeks after injection, the tail withdrawal time of high and low dose calcitonin group compared with that of ovariectomy group were significantly prolonged (p＜0.05). 2. At eight weeks after injection, the tail withdrawal time of free calcitonin group compared with that of ovariectomy group was significantly prolonged (p＜0.05).
Conclusion: The effect of calcitonin injection relieving pain in ovariectomized rats was found. (Korean Acad Rehab Med 2002; 26: 587-590)
Objective: The purpose of this study was to know the correlation between resting calcaneal stance position (RCSP) and height-length (H/L) ratio of foot.
Method: Both feet of 173 persons who visited the Department of Rehabilitation Medicine, Chungnam National University Hospital were included in the study. Their mean age was 23.6 years old. H/L ratio, RCSP and navicular angle of 346 feet were measured. All people were divided into 3 groups, such as, normal foot (2o≤RCSP≤2o), rear foot valgus (RCSP＜2o) and rear foot varus (RCSP＞2o) according to the angle of RCSP. And the relationship between RCSP and H/L ratio were evaluated. Independent T-test, ANOVA and Pearson correlation of SPSS was used for statistical data processing.
Results: The mean H/L ratio of rear foot valgus was 0.2206, noraml foot 0.2440 and rearfoot varus 0.2625. H/L ratio and navicular angle showed significant increase in each RCSP groups in order of rear foot angle.
Conclusion: H/L ratio and RCSP showed strong positive correlation and the value of H/L ratio in normal group was 0.2440⁑0.0114 (Mean⁑S.D.). H/L ratio is easily acceptable parameter in human mechanics or orthotic field of rehabilitation. (J Korean Acad Rehab Med 2002; 26: 591-597)
Objective: To assess the proper type of outsole for the diabetic shoes according to the hardness of outsole in diabetic patients.
Method: Seventeen diabetic patients and 33 normal control volunteers in the 5∼6th decade were participated in this study. Walking exercise in the treadmill was performed in all subjects wearing the custom-made shoes with the two layers of hard outsole and one layer of soft outsole, respectively. Peak plantar pressures were measured after exercise by Pedar system with pressure sensitive insoles inserted in each shoes and compared with two types of outsoles. The degree of oxygen saturation was measured in the fourth toe by Oxysensor and the plantar thermography were measured by infrared thermometer before and after exercise, and compared with the two types of outsoles in diabetic and control groups, respectively.
Results: There were not significant differences of peak plantar pressures in all measuring points according to the type of outsole in diabetic group. The degree of oxygen saturation in the fourth toe was not significantly changed between the two types of outsoles before and after exercise in diabetic group. The plantar temperatures were significantly increased after exercise in all groups, but there was not significant difference according to the type of outsole.
Conclusion: There was not significant difference between hard and soft outsole with the custom-made shoes for diabetic patient applied in this study. But more advanced studies about the outsole of diabetic shoe should be needed. (Korean Acad Rehab Med 2002; 26: 598-605)
Objective: This study is designed to evaluate the relationship between bone mineral density (BMD) and life-style factors such as physical activity, smoking, and alcohol congumption and to offer the information for the modification of life-style.
Method: Eight hundred and sixty nine inhabitants (354 males and 515 females whose age was 55.0⁑13.9 years- old) were participated in this study. BMD was measured in the right calcaneus by quantitative ultrasound (Mark 6000Ⱂ, Medison). Amount of physical activity, smoking, and alcohol consumption were got through the closely designed interview. Independent sample T-test and simple regression were used for data analysis. Results: Amount of physical activities were 2656.8⁑732.3 cal/day, smokers were 329 persons (37.9% of inhabitants), and amount of alcohol consumption were 26.2⁑53.3 g/day. Increasing the amount of physical activity, BMD showed significantly higher T-score (p＜0.01). Increasing the amount of alcohol consumption, BMD showed significantly lower T-score (p＜0.01). BMD in smokers appeared significantly lower T-score than non-smokers (p＜0.01).
Conclusion: Life-style factors significantly effect on bone mineral density. Therefore prevention of osteoporosis through maintenance or augmentation of BMD needs proper physical activity, cessation of smoking, and no heavy drinking. (J Korean Acad of Rehab Med 2002; 26: 606-614)
Objective: The purposes of this study were to investigate the factors influencing life satisfaction and quality of life (QOL) of the disabled persons and to help the planning and evaluation of Community Based Rehabilitation (CBR).
Method: Data were collected through personal interviews of 503 registrated disabled persons in Uiwang City. Demographic variables and scores of modified Barthel index (MBI), modified Lambeth disability screening questionnaire (MLDSQ), Craig handicap assessment and reporting technique (CHART) and life domain satisfaction measure (LDSM) were obtained.
Results: The score of LDSM was 4.0⁑1.0. Life satisfaction was related to the age, sex, employment status, severity of disability, educational level, housing and residence, level of instrumental activities of daily living and social integration. MLDSQ score was the most strong predictor of life satisfaction (p=0.00) followed by social integration (p=0.001) and total CHART scores (p=0.017). And the factors influencing the handicap were monthly income, severity of disability, employment, level of education and age.
Conclusion: Based on our study, we suggest that the CBR program of Uiwang City need to focus on improving functional ability and social skill of disabled individual and housing, and also promoting their vocational and educational status. (J Korean Acad Rehab Med 2002; 26: 615-625)
X-linked recessive bulbospinal muscular atrophy (Kennedy's syndrome) is a variant of the spinal muscular atrophies caused by mutation of androgen receptor gene on X-chromosome. A 69-year-old man had suffered from slowly progressive lower extremity weakness and gynecomastia. Muscle weakness was more severe in proximal muscles and showed symmetrical features. He had fascicular contraction on his face and tongue. All tendon reflexes were absent and pyramidal signs were not detected. Nerve conduction studies were normal except low amplitude of sensory nerve action potential in median nerve. Needle electromyography revealed widespread chronic denervation potentials in all sampling muscles of extremities, facial and tongue muscles. Histopathologic findings showed chronic denervation atrophy. DNA analysis showed abnormal expansion of CAG repeats in the androgen receptor gene and we confirmed this case as Kennedy's syndrome. If an adult patient has slowly progressive muscle weakness, bulbar symptoms and signs of male genital failure, DNA analysis should be taken to differentiate Kennedy syndrome from other motor neuron disease or myopathy. (J Korean Acad Rehab Med 2002; 26: 626-630)
Ischemic myelopathy is a rare and uncommon disease than the cerebral ischemia. Ischemia of spinal cord usually occur in the midthoracic regions (T4-T8). The major arteries supplying spinal cord are anterior and posterior spinal arteries. Anterior spinal artery is more responsible for the ischemic change of the spinal cord. We report a 45 years old man with ischemia of the spinal cord and acute renal failure due to rhabdomyolysis following the heavy alcohol ingestion. (J Korean Acad Rehab Med 2002; 26: 631-634)
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