Nephrogenic systemic fibrosis (NSF) is a rare fibrosing disorder of the skin and joints that occurs in patients with advanced renal insufficiency. This condition is progressive and can be seriously disabling. Gadolinium based contrast agent (GBCA) has been identified as a potential cause of this condition. A 56-years-old man in hemodialysis developed stiffness and contracture of the whole limbs eight years after frequent GBCA exposure for cervical magnetic resonance imaging. For the first time in Korea, we report late-onset nephrogenic systemic fibrosis after GBCA exposure and performed an electrophysiologic study of this condition.
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The changes of anterior horn cell excitability and conduction of the nervous system by the electrical stimulation of nerve have been reported in both vivo and vitro studies. Purpose of this study is to observe the neurophysiologic changes of nerves by 10 Hz electrical stimulation on polyneuropathic peripheral nerves. Subjects were 18 diabetic polyneuropathic patients diagnosed by the conduction studies. Electrophysiologic studies were performed in both right and left tibial nerves before and after conditioning of the right tibial nerve. Electrophysiologic studies included five tests which were the sural sensory and tibial motor conduction(abductor hallucis), F response(abductor hallucis), H reflex(gastrosoleus) and somatosensory evoked potential(ankle, SEP). Ten Hz rectangular electrical current was used for the conditioning stimulation. It was applied to the popliteal tibial nerve with the tolerable maximal intensity(10∼24 mA) for 5 minutes.
Following changes were statistically significant in statistics after the conditioning. Prolongation of F latency (p＜0.05), increases of F chronodispersion, duration and area(p＜0.05), prolongation of H latency(p＜0.05), increase of H amplitude(p＜0.05), decrease of P1 latency of SEP(p＜0.01) and increase of P1N1 amplitude of SEP(p＜0.01) were seen in both conditioned and unconditioned legs. Increase of F wave conduction time(FWCT) and decrease of F wave conduction velocity (FWCV) were seen in conditioned leg(p＜0.05).
Above findings suggest that certain electrical stimulation of polyneuropathic nerve may cause increase of the anterior horn cell excitability, fascilitation of the SEP conduction and slowness of alpha motor conduction to and from the spinal cord.
Electrophysiologic study including needle electromyograpy(EMG) was done in 66 patients with spina bifida who were referred to EMG laboratory. We have classified neurological impairments of spina bifida patients according to electrodiagnostic findings and the electrophysiologic study findings were compared with Magnetic Resonance Image(MRI) findings, and manual muscle test findings. Also electrophysiologic study findings were compared with urodynamic study(UDS) finding for the evaluation of neurogenic bladder in the same subjects.
55% of spina bifida patients had cauda equina lesions electrophysiologically and the most commonly involved, root was L5, and the next was S1. 42% of the subjects were normal electrophysiologically.
61% of patients with abnormal MRI findings had normal EMG findings. EMG findings did not correlated well with manual muscle tests in 44% of the subjects. Also in 44% of subjects, the electrophysiologic study was did not agree with urodynamic study findings.
In conclusion, we asserts that cauda equina lesion is a most common lesion in spina bifida patients and electrophysiologic study is superior than MRI or manual muscle test in detecting neurologic deficit of spina bifida patients. However, electrophysiologic study alone offers less accurate information than urodynamic study for the evaluation of neurogenic bladder in spina bifida patients.
Objective: The effect of the local steroid injection for the carpal tunnel syndrome (CTS) is well known, but there have been a few report of electrophysiologic evaluation for the effect of the local steroid injection. So this study was done to reveal the effect of local injection with triamcinolone acetonide (TA) into the carpal tunnel using the electrophysiologic changes and the improvement in symptoms.
Method: The triamcinolone acetonide (40 mg/ml) was injected to 43 patients (70 wrists) with the CTS diagnosed clinically and electrophysiologically. And the patients were reevaluated with the visual analogue scale and the electrophysiologic study every month. The mean duration of follow-up was 6 months, and the mean number of the injection was two times.
Results: The improvement of symptoms was noted in 90% of the cases, and most of the electrophysiologic parameters revealed significant improvement after the local injection of TA. The number of injection did not correlate with the visual analogue scale and the electrophysiologic parameters.
Conclusion: The local injection of TA into the carpal tunnel in the patients with CTS may be an effective therapeutic modality to improve the symptoms and the electrophysiologic parameters.
Objective: To investigate the ambulatory status and its contributing factors in eighty one patients with spina bifida, and to obtain informations about the actual state and the problems of their orthotic uses for the lower limbs.
Method: Eighty one spina bifida patients above thirty months of age who registered to the Myelomeningocele Clinic of Seoul National University Hospital were investigated through the telephone interviews and the retrospective reviews of the medical records by a physiatrist.
Results: About one half of 81 spina bifida patients had problems in their ambulation. It was significantly influenced by the neurological level, the type of spina bifida, the contractures and deformities of the lower limbs, and presence of hydrocephalus. The deformity of hip and the neurological level were revealed to be the most important factors contributing to their state of ambulation by the multiple linear logistic analysis(p＜0.01). Forty patients had used the lower limb orthoses of which the ankle-foot-orthosis was most frequently used. The satisfaction and compliance of the patients, however, were not high and the most common complaint of the parents was a skin wound from the use of orthoses.
Conclusion: The neurological level and the deformity of hip were the two most important contributing factors to the ambulation of the spina bifida patients. Early detection of the neurological level and an adequate prescription of the lower limb orthoses should be stressed for the management of ambulation in spina bifida patients.
The cranial nerve lesions can occur from a stroke, traumatic brain injury or direct cervical injury, and can produce various functional problems of the craniofacial structures. Usually the cranial nerve injury can be diagnosed by a simple clinical manifestation, and physical or neurological examination. Electrophysiologic study and imaging study such as MRI are frequently used as the sequential follow up studies for the objective evaluation of neurologic regeneration process.
We report a case of multiple cranial nerve injuries, of the fifth, seventh, tenth, eleventh and twelfth cranial nerves from a single deep cervical stab wound of 4 cm in length from 0.5 cm anterior of the tragus to 1 cm posterior to the mandibular angle.
Electrophysiologic study including an electromyography of tongue and vocal cord, blink reflex and facial nerve conduction study were used for the diagnosis and follow up.
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