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.
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To evaluate characteristics of cognitive impairments according to the location of aneurysmal subarachnoid hemorrhage (SAH) using a computerized neuropsychological test (CNT).
A total of 211 patients were transferred to our rehabilitation department after becoming neurologically stable following aneurysmal SAH. Twenty four of the 211 patients met the inclusion criteria and participated in a screening test using the mini-mental state examination (MMSE). Twenty patients with a MMSE score <26 were followed prospectively with a CNT and Beck depression inventory (BDI). Eleven patients had anterior communicating artery (ACoA) aneurysms and the other 9 had middle cerebral, internal carotid or posterior communicating artery aneurysms.
There were no differences in age, education, Hunt and Hess grade, or Fisher grade between the patients with ACoA aneurysmal SAH compared to patients with other aneurysmal SAH. In patients with ACoA aneurysmal SAH, scores of BDI (p=0.020), verbal learning test were lower than those of other aneurysmal SAH patients. In contrast, patients with non-ACoA aneurysmal SAH took significantly more time in auditory (p=0.025) and visual continuous performance tests (p=0.028). The cognitive deficit following aneurysmal SAH could be characterized by its location using CNT.
Using CNT in aneurysmal SAH patients could be a useful tool for evaluating the characteristics of cognitive impairment and planning rehabilitation programs according to each characteristic.
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Method: Subjects were 89 patients with aneurysmal SAH who were undergone craniotomy and clipping of aneurysm. We evaluated the relationship between the incidence of seizure and the use of antiepileptic drug. And we sought to identify putative risk factors associated with seizure after SAH.
Results: Ten patients (11.2%) had one or more epileptic seizures. One patient had only preoperative seizure and nine patients including four patients who had prehospital or preoperative seizure developed seizures during follow up after surgery. All but two of these nine patients were receiving an antiepileptic drug at the time of seizure. Blood samples for antiepileptic drug plasma levels were taken more than once in 81 patients. Of total blood samples, therapeutic serum levels were achieved in 73.5% of the seizure group and in 68.6% of the no-seizure group (p＞0.05). Drug- related side effects occurred in 22.5% (20/89). Significant risk factors for seizure included early seizure (4/5) and rebleeding after surgical clipping of aneurysm (2/3).
Conclusion: We think that the preventive effect of anticonvulsant drug on late seizure is unclear in patients with aneurysmal SAH. (J Korean Acad Rehab Med 2003; 27: 840-844)
Objective: To investigate the functional outcome with regard to cognitive deficits in patients with aneurysmal subarachnoid hemorrhage (SAH).
Method: Two hundred thirty-four patients who underwent surgical procedure for aneurysmal SAH were enrolled. Medical records of the patients were reviewed.
Results: Mental confusion (52.1%) was more common symptom than the motor (20.3%) and language (30.9%) impairment in patients with aneurysmal SAH. Neurological grade at admission (Hunt and Hess grade), cerebral vasospasm, and mental confusion were major prognostic factors. In terms of functional outcome, patients with mental confusion showed lower Functional Independence Measure (FIM) scores at admission and on discharge, lower FIM gain and FIM efficiency, and longer hospital stay with statistical significance than those without confusion.
Conclusion: The patients with cognitive deficits achieved poor functional outcome in the patients with aneurysmal SAH. More attention to cognitive impairment is necessary to achieve better rehabilitation goal.
Objective: Intraoperative somatosensory evoked potentials (SEPs) are widely used for the early detections of cerebral ischemia during temporary occlusive procedures of the parent vessels in aneurysm surgery. This study intended to evaluate the usefulness of median nerve SEPs during intracranial aneurysm surgery.
Method: Between September 1995 and June 1997, we monitored 42 aneurysm patients in Uijongbu St. Mary's hospital. Median nerve SEPs were detected on scalp and cervical spine during surgery. We measured latencies, amplitudes of N20 and N13 waveforms and central conduction time (CCT, N20-N13). We analyzed pre- and post-surgical radiologic findings and changes of neurologic signs.
Results: The delayed latencies, CCT, and reduced amplitudes of median nerve SEPs during intraoperative monitoring were closely related to neurological deficits after surgery.
Conclusion: Intraoperative SEPs are useful in preventing clinical neurological injury during surgery of intracranial aneurysm and in predicting which patients will have unfavourable outcomes.
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