The purpose of this study is to investigate predictors of crossed cerebellar diaschisis (CCD), and the effects of CCD on functional outcomes including motor function, activities of daily living, cognitive function, and ambulation 6 months after onset in patients with intracerebral hemorrhage (ICH).
A total of 74 patients experiencing their first ICH were recruited. If the asymmetric index was more than 10% using single photon emission computed tomography (SPECT), a diagnosis of CCD was confirmed. Clinical factors were retrospectively assessed by reviewing medical records. Radiologic factors encompassed the concomitance of intraventricular hemorrhage, side and location of the lesion, and hemorrhage volume. Functional outcomes were evaluated using the Fugl-Meyer Assessment, the Korean version of the Mini-Mental State Examination, the Korean version of the Modified Barthel Index, and measurement of the Functional Ambulatory Category at the time of SPECT measurement and 6 months post-ICH.
Lesion location, especially in the basal ganglia (odds ratio [OR]=6.138, p=0.011), and hemorrhagic volume (OR=1.055, p=0.046) were independent predictors for CCD according to multivariate logistic regression analysis. In addition, the presence of CCD was significantly related to the improvement in Fugl-Meyer Assessment score after 6 months (adjusted R2=0.152, p=0.036).
Lesion location and hemorrhagic volume were the predisposing factors for CCD, and the CCD was associated with poor motor recovery over 6 months in patients with hemorrhagic stroke.
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To investigate neural correlates associated with recovery of motor function over 6 months in patients with basal ganglia (BG) stroke using acetazolamide (ACZ) stress brain-perfusion single-photon emission computed tomography (SPECT).
Medical records of 22 patients presenting first-ever BG stroke were retrospectively reviewed. Regional cerebral blood flow (CBF) and cerebrovascular reserve (CVR) were measured for 9 regions in each cerebral hemisphere (primary motor cortex, supplementary motor area, premotor cortex, prefrontal cortex, temporal lobe, parietal lobe, occipital lobe, BG, and thalamus). The Fugl-Meyer Assessment (FMA) motor score was used to assess motor function.
After ACZ injection, CBF of all regions of interest (ROIs) increased compared with baseline. Baseline CBF of all ROIs was not significantly correlated with changes in FMA upper or lower motor score. However, multivariate analysis revealed CVR was significantly associated with change in FMA upper score in the ipsilateral primary motor cortex (R2=0.216, p=0.017), the ipsilateral parietal lobe (R2=0.135, p=0.029), and the contralateral primary motor cortex (R2=0.210, p=0.041).
CVR in the bilateral primary motor cortex and ipsilateral parietal lobe was associated with restoration of upper motor function 6 months after BG stroke. SPECT is a readily available imaging modality useful in studying brain residual function in patients with BG stroke.
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To evaluate the craniofacial asymmetry in adults with neglected congenital muscular torticollis (CMT) by quantitative assessment based on craniofacial three-dimensional computed tomography (3D-CT).
Preoperative craniofacial asymmetry was measured by 3D-CT for 31 CMT subjects ≥18 years of age who visited a tertiary medical center and underwent 3D-CT between January 2009 and December 2013. The relationship between the age and the severity of craniofacial asymmetry was analyzed in reference to anteroposterior length asymmetry of the frontal bone and zygomatic arch, vertical and lateral displacements of the facial landmarks, and mandibular axis rotation.
The age at CT was 27.71±7.02 years (range, 18-44 years). All intra-class correlation coefficients were higher than 0.7, suggesting good inter-rater reliability (p<0.05) of all the measurements. The frontal and the zygomatic length ratio (i.e., the anteroposterior length asymmetry on the axial plane) was 1.06±0.03 and 1.07±0.03, respectively, which was increased significantly with age in the linear regression analysis (r2=0.176, p=0.019 and r2=0.188, p=0.015, respectively). The vertical or lateral displacement of the facial landmarks and rotation of the mandibular axis did not significantly correlate with age (p>0.05).
Craniofacial asymmetry of neglected CMT became more severe with age in terms of anteroposterior length asymmetry of the ipsilateral frontal bone and zygomatic arch on the axial plane even after growth cessation. This finding may enhance the understanding of therapeutic strategies for craniofacial asymmetry in adults with neglected CMT.
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To investigate the correlation among age, disc morphology, positive discography, and prognosis in patients with chronic low back pain.
A total of 183 intervertebral discs in 72 patients with chronic low back pain were studied. Discography was performed using a pressure-controlled manometric technique. The pain reaction during discography at each level was recorded as follows: no pain, dissimilar pain, similar pain, or concordant pain. Discs with similar or concordant pain were classified as positive. All the examined discs were assessed morphologically using axial computed tomography imaging. The grade of general degeneration and annular disruption of the discs were assessed according to the Dallas discogram description (DDD). Intradiscal injection of steroid was tried for patients with symptomatic disc identified during provocative discography and who did not consent to surgical operation.
There was a higher correlation between general degeneration and age, as compared with annular disruption and age. Higher general degeneration and annular disruption grades had higher positive rates of discography. However, annular disruption alone was independently associated with positive discography. Age and grade of general degeneration did not affect the prognosis.
The grade of general degeneration was associated with age, but it was not correlated with positive discography and prognosis. In addition, high grade of annular disruption correlated with positive discography.
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To investigate the usefulness of computed tomography venography (CTV) for evaluation of leg swelling, especially deep vein thrombosis (DVT), in rehabilitation patients.
A hundred twenty-three patients, who had performed CTV performed because of suspected DVT in our clinic, were enrolled. We performed chart reviews retrospectively and categorized CTV findings as follows: DVT distal to inguinal ligament and no compression lesion; DVT proximal to inguinal ligament and no compression lesion; DVT distal to inguinal ligament and anatomical variant (for example, May-Thurner syndrome); DVT due to compression of mass (cancer or cyst); DVT and other incidental abnormal finding; and no DVT and other possible causes of leg swelling.
DVTs were found in 65 (53%) patients. DVTs were found at distal level (thigh or lower leg) to inguinal ligament in 47 patients. DVTs were found at proximal to inguinal ligament, usually undetectable with duplex ultrasonography, in 6 patients. DVTs caused by external compression, such as femoral vein and cancer mass, were found in 12 patients (10%), which are also not easily detected with duplex ultrasonography. Other various causes of leg edema without DVT were found in 22 (18%) patients.
CTV can evaluate more extensively venous problems in the pelvis and abdomen and detect other possible causes of leg swelling. Therefore, CTV can be a useful tool not only for easy detection of DVT but also for evaluating differential diagnosis of leg edema in rehabilitation patients.
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Occipital condyle fractures (OCFs) with selective involvement of the hypoglossal canal are rare. OCFs usually occur after major trauma and combine multiple fractures. We describe a 38-year-old man who presented with neck pain and a tongue deviation to the right side after a traffic accident. Severe limitations were detected during active and passive range of neck motion in all directions. A physical examination revealed a normal gag reflex and normal mobility of the palate, larynx, and shoulder girdle. He had normal taste and general sensation in his tongue. However, he presented with a tongue deviation to the right side on protrusion. A videofluoroscopic swallowing study revealed piecemeal deglutition due to decreased tongue mobility but no aspiration of food. Plain X-ray film findings were negative, but a computed tomography study with coronal reconstruction demonstrated a right OCF involving the hypoglossal canal. An electrodiagnostic study revealed evidence of right hypoglossal nerve palsy. We report a rare case of isolated hypoglossal nerve palsy caused by an OCF.
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Method: Fourty-one patients with CP underwent MRI and SPECT of the brain. The patients were divided into 5 groups. Group 1 was for the cases with normal findings on MRI and SPECT, group 2 for abnormal on MRI but normal on SPECT, group 3 for normal on MRI but abnormal on SPECT, group 4 for abnormal findings on both MRI and SPECT with same abnormal lesion and group 5 for abnormal findings on both MRI and SPECT but with different abnormal lesion.
Results: In group 2, periventricular leukomalacia (PVL) and cortical atrophy were shown on MRI. In group 3, decreased blood flow at cerebellum was shown on SPECT. In group 4, brain atrophy on MRI and the decreased blood flow at the same site on SPECT were shown. In group 5, 15 of 22 cases with PVL on MRI and decreased blood flow at cerebellum, thalamus, basal ganglia and the cortical areas were shown.
Conclusion: Brain SPECT was more sensitive in the detection of cerebellum, thalamus and cortical blood flow abnormality. MRI was more sensitive in demonstration of white matter lesion. (J Korean Acad Rehab Med 2003; 27: 868-874)
Objective: The purpose of this study is to identify how the isotonic and isometric mixed excercise training for 12 weeks take influence on the muscular strength, muscle size and foot pressure (by EMEDⰒ) in patients with degenerative knee joint disease.
Method: Seven patients with degenerative knee joint disease were chosen for the experimental objects and were trained isotonic exercise program for twelve weeks. Before and after exercise, CybexⰒ, Computed Tomography and EMEDⰒ were examined.
Results: After exercise program, peak torque, peak torque %Bwt and average power were significantly increased at 60o/sec and 180o/sec in both knee flexors and extensors. But peak torque ratio flexor/extensor were not significantly increased. Cross-sectional area of quadriceps and hamstrings were significantly increased. But there were no significant difference in the peak pressure at the heel and time (from initiation of initial contact to peak pressure at the heel).
Conclusion: We knew that isotonic and isometric mixed exercise training to the patients with degenerative knee joint disease for 12 weeks improved the muscular strength and muscle size, but this is not influenced on heel pressure. So, there may be needed to study with kinetic and kinematic analysis to more experimental patients.
Objective: The purposes of this study were to evaluate the causes of intoeing gait and to investigate the association between femoral anteversion and tibial torsion.
Methods: The subjects were 23 children with intoeing gait. The association between increased femoral anteversion and external torsion of the tibia was investigated by computed tomography and 3-dimensional computed tomography. The tibial torsion angle was measured by computed tomography. Femoral anteversion angle was measured by computed tomography and 3-dimensional computed tomography.
Results: The intoeing gait was caused by increased femoral anteversion in 67.4% of the cases, by internal tibial torsion in 21.7% and by other factors in 10.9%. There was a clear correlation between the degree of femoral anteversion and the degree of external torsion of the tibia.
Conclusion: The results of this study indicate that most common cause of intoeing gait is increased femoral anteversion and that in cases of increased femoral anteversion, compensatory external torsion of the tibia develops during growth.
Objective: To evaluate the clinical values of the DDST II (Denver Developmental Screening Test, 2nd revision), 99mTc HMPAO brain single photon emission computed tomography (SPECT) findings and brain magnetic resonance imaging (MRI) in the assessment of cerebral palsy children.
Method: Twenty-two children with cerebral palsy were investigated. Four profiles of DDST (II) were summated to a monthly age according to each developmental status. 99mTc HMPAO brain SPECT imagings were analyzed for the calculation of the perfusion defect indices. The clinical severities were scored as mild to severe, and were compared to a motor age of Maryland criteria. The presence of abnormal findings of brain MRI was also checked.
Results: (1) The gross and fine motor profiles of DDST (II) were significantly different between normal and abnormal findings of the brain SPECT in cerebral palsy children. (2) The region of interests ROIs in brain SPECT correlated with many profiles of DDST (II), 1) prefrontal area of the brain SPECT and language profile of DDST (II), 2) premotor area and gross motor/language profile, 3) thalamic area and social-personal profile, 4) basal ganglia area and gross motor/language proflie. respectively. (3) There was no relationship between each profile of DDST (II) and brain MRI findings.
Conclusion: The DDST (II) and Brain SPECT seemes to be more useful than the brain MRI for the functional assessment of cerebral palsy children.
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