Prevalence, etiology, and biopsychosocial risk factors of cervicogenic dizziness in patients with neck pain: A multi-center, cross-sectional study.

OBJECTIVES: This study aims to investigate the prevalence, etiology, and risk factors of cervicogenic dizziness in patients with neck pain. PATIENTS AND METHODS: Between June 2016 and April 2018, a total of 2,361 patients (526 males, 1,835 females; mean age: 45.0±13.3 years; range, 18 to 75 years) who presented with the complaint of neck pain lasting for at least one month were included in this prospective, cross-sectional study. Data including concomitant dizziness, severity, and quality of life (QoL) impact of vertigo (via Numeric Dizziness Scale [NDS]), QoL (via Dizziness Handicap Inventory [DHI]), mobility (via Timed Up-and-Go [TUG] test), balance performance [via Berg Balance Scale [BBS]), and emotional status (via Hospital Anxiety- Depression Scale [HADS]) were recorded. RESULTS: Dizziness was evident in 40.1% of the patients. Myofascial pain syndrome (MPS) was the most common etiology for neck pain (58.5%) and accompanied with cervicogenic dizziness in 59.7% of the patients. Female versus male sex (odds ratio [OR]: 1.641, 95% CI: 1.241 to 2.171, p=0.001), housewifery versus other occupations (OR: 1.285, 95% CI: 1.006 to 1.642, p=0.045), and lower versus higher education (OR: 1.649-2.564, p<0.001) significantly predicted the increased risk of dizziness in neck pain patients. Patient with dizziness due to MPS had lower dizziness severity scores (p=0.034) and milder impact of dizziness on QoL (p=0.005), lower DHI scores (p=0.004), shorter time to complete the TUG test (p=0.001) and higher BBS scores (p=0.001). CONCLUSION: Our findings suggest a significant impact of biopsychosocial factors on the likelihood and severity of dizziness and association of dizziness due to MPS with better clinical status.

P-wave and QT dispersion in spinal cord injury.

OBJECTIVE: Spinal cord injury (SCI) can lead to significant cardiac arrhythmia. However, P-wave, QT dispersion, and risk factors in these patients have not been widely investigated. In this study, we assessed whether there is a relationship between electrocardiogram (ECG) parameters and risk factors in SCI patients. METHODS: The study population consisted of 85 SCI patients and 38 control subjects. P-wave durations were measured using 12 leads of the surface ECG. P-wave dispersion was defined as the difference between the P-wave maximum and P-wave minimum duration. QT dispersion was defined as the difference between the largest and smallest QT interval for any of the 12 leads (QTmax-QT-min). QT intervals were also corrected (QTc) in accordance with the heart rate using Bazett's formula (QT Interval/√[RR interval]). We also evaluated the independent risk factors for P-wave dispersion and QT dispersion in SCI patients. RESULTS: The P-wave minimum, P-wave maximum, QT minimum, and dispersion were significantly different between the control and SCI groups. There was no significant difference in P-wave dispersion, QT maximum, or QTc. Multivariate regression analysis showed that disease duration, glucose and high-density lipoprotein cholesterol (HDL-C) levels, and systolic tension were independent risk factors for P-wave dispersion. CONCLUSION: Our results demonstrate that QT dispersion is related to SCI and that P-wave dispersion was linked to the duration of SCI, HDL-C and glucose levels, and arterial tension in SCI patients.

Carpal tunnel syndrome and metabolic syndrome co-occurrence.

We aimed to evaluate the relation between the severity of carpal tunnel syndrome and metabolic syndrome. One hundred and fifty patients who had a clinical and electrophysiologically confirmed diagnosis of carpal tunnel syndrome (CTS), were included in this study. The patients were divided into two groups (with or without metabolic syndrome) according to the criteria of National Cholesterol Education Program. Eighty one (73.5 %) of the patients with CTS had metabolic syndrome. The patients with metabolic syndrome the severity of CTS was found 22.2 % had mild CTS, 56.8 % had moderate CTS, and 21 % had severe CTS. The patients without metabolic syndrome the severity of CTS was found 44.9 % had mild CTS, 40.6 % had moderate CTS, and 14.5 % had severe CTS. The severity of CTS between both groups was found to be statistically significant (p = 0.0009). While a correlation was found between the severity of CTS and high level of LDL with the presence of metabolic syndrome (correlation coefficient 0.209). In conclusion metabolic syndrome that appears to be a risk factor for CTS. At the same time, the presence of metabolic syndrome increases the severity of the disease.

Position sense of the hemiparetic and non-hemiparetic ankle after stroke: is the non-hemiparetic ankle also affected?

BACKGROUND AND PURPOSE: Researchers have shown an increased interest in proprioception deficits of the paretic side in hemiplegic patients. However, far too little attention has been paid to the proprioception sense of the non-hemiparetic side. The objective of this research was to determine whether the position sense of the ankles, especially of the non-paretic side, is affected in stroke patients. METHODS: 20 inpatients with stroke and 10 healthy control subjects were evaluated using an isokinetic dynamometer. Proprioceptive error scores (in degrees) for passive reproduction of joint position tests (PRJPTs) were measured. RESULTS: Error values of PRJPT for 5° plantarflexion, 10° plantarflexion, and 15° dorsiflexion were significantly higher in patients on both the paretic and non-paretic side compared with the control group dominant side. CONCLUSION: The impaired results of PRJPT in both the paretic and non-paretic ankles of stroke patients are surprising when one expects that the non-paretic side would be preserved under the control of the healthy hemisphere.

How does metabolic syndrome affect the functional ambulation in stroke patients?

BACKGROUND/AIMS: Metabolic syndrome (MetS) is a risk factor for stroke. However, the role of MetS in stroke rehabilitation has not been assessed. The aim of this study was to evaluate the impact of MetS on rehabilitation from stroke. MATERIALS AND METHODS: A total of 337 consecutive patients with subacute stroke and 220 age-matched healthy controls were studied. The diagnosis of MetS was based on the criteria of the National Cholesterol Education Program Adult Treatment Panel III. Ambulation levels were evaluated using the Functional Ambulation Classification (FAC) measure. The correlation between MetS and FAC was investigated. The regression analysis included presence of hypertriglyceridemia, high fasting glucose, low high-density lipoprotein cholesterol, hypertension, abdominal obesity, MetS, and age ≯65 years. RESULTS: The prevalence of MetS in the control group and the ischemic and hemorrhagic stroke groups was 33.2% (n = 73), 59.8% (n = 156), and 68.4% (n = 52), respectively. MetS prevalence was significantly higher in stroke groups compared with the control group (P < .001). FAC and MetS were significantly and negatively correlated in the stroke groups (P < .001, rho = -0.387, for hemorrhagic stroke;P < .001, rho = -0.379, for ischemic stroke). Multivariable logistic regression analysis demonstrated that diastolic tension, MetS presence, and age were found to be independent risk factors for FAC in ischemic stroke groups. CONCLUSIONS: MetS is associated with worse functional ambulation for both ischemic and hemorrhagic stroke patients. Aggressive rehabilitation can be advocated in the presence of MetS in ischemic stroke patients.

Isolated fibrosis/contracture of the rectus femoris muscle: diagnosis and follow-up with sonography.

Reported here is a 21-year-old female with isolated contracture of the rectus femoris muscle. Its possible relation to breech positioning, and the role of sonography for its diagnosis and close follow-up are discussed in the light of the relevant literature.

A rarely seen syndrome in rehabilitation of hemiplegia: antiphospholipid antibody-negative Sneddon's syndrome.

Sneddon's syndrome is a rarely seen disorder and it is characterized by livedo reticularis (LR) and neurologic findings. Some systematic findings may also be seen with neurologic and cutaneous findings. In this case, we aimed to present a 28-year-old female patient with diffuse LR, cardiac valve disease and migraine-type headache who had a right hemiplegic attack.

Association of anti-CCP positivity with serum ferritin and DAS-28.

Antibodies to cyclic citrullinated peptides (anti-CCP) are highly specific for the diagnosis of rheumatoid arthritis (RA) with a marginal increased prediction of the disease. In this study, we aimed to investigate the relation of the presence of anti-CCP with clinical manifestations and disease activity in a cohort of RA patients. A total of 61 RA patients were included in this study. Data of disease-related parameters such as duration of disease, medications, degree of pain (visual analog scale, VAS), disease activity score 28 (DAS-28) and health assessment questionnaire (HAQ) were recorded. Laboratory workup included erythrocyte sedimentation rate (ESR), plasma C-reactive protein (CRP), rheumatoid factor (RF), anti-CCP, complete blood count and anemia parameters. Anti-CCP positivity was associated with higher scores of DAS-28, longer duration of morning stiffness, serum RF positivity and low levels of serum ferritin, while it was not associated with disease duration, VAS, HAQ, ESR, CRP and hemoglobin.

The development of dysphagia and dysphonia due to anterior cervical osteophytes.

Cervical osteophytes may cause dysphagia by compressing the esophagus and may cause dysphonia by compressing the larynx and inferior laryngeal nerve. The occurrence of dysphagia and dysphonia due to cervical osteophytes has rarely been reported in literature. In this article, a case, in which the multiple cervical osteophytes were found to be the cause of dysphagia and dysphonia, was evaluated by imaging methods and electrophysiological evaluation of swallowing and the case was discussed in the light of relevant literatures.

The risk factors related to falling in elderly females.

The purpose of this study was to explore the relationship between muscle strength and functional mobility and falls in women aged 65 and over. Thirty-one female subjects with a mean age of 69.57 +/- 4.89 years (65-78) were enrolled in the study. Demographic properties, body mass index, comorbid medical conditions, smoking, the number of medications taken, and fall characteristics were recorded. Knee flexor and extensor strength of the dominant extremity was measured by Biodex isokinetic system, and physical capacity was assessed with a 6-minute walk test. Cognitive status was evaluated by the Mini-Mental State Examination, and disability in daily activities was determined with the Barthel Index. Twelve subjects (38.7%) reported experiencing a fall in the previous year. Eight (25.8%) had experienced a fall outside the home and 4 (12.9%) inside the home. Nine subjects had fallen once, 2 subjects twice, and 1 subject had fallen 3 times. Six (19.4%) subjects reported a fracture after falling. Muscle strength of the knee extensors and flexors and work capacity was similar between those who had fallen and those who had not. The risk factors related to falling were evaluated, but no related factor was determined. Fear of falling was found to be high in patients who had fallen in the previous year. In conclusion, knee extensor and flexor strength are not significant factors in falls or the risk of falling for elderly women, particularly those who are able to function independently. Balance tests in current use are not effective predictors of falls in older adults who live independently and who do not have any significant health problem. These results suggest that there may be a significant interactive effect of the many causal factors that we need to address. Further study is needed to develop new assessment tools for active elderly people to help prevent falls and fall-related injuries.

Sympathetic skin responses in hemiplegic patients with and without complex regional pain syndrome.

BACKGROUND AND AIMS: To investigate whether there were changes in the sympathetic skin responses (SSR) in the limbs with complex regional pain syndrome (CRPS) type I in hemiplegic patients. SETTING: A physical medicine and rehabilitation center in Turkey. MATERIALS AND METHODS: Sympathetic skin responses were evaluated in 69 stroke patients (41 with CRPS and 28 without CRPS) and 20 healthy volunteers. SSR were recorded on the paretic and healthy hands after stimulation of the ipsilateral median nerve. Patients' ages ranged from 33 to 77 years, with a mean of 60.0+/-12.9 years. RESULTS: The SSR were obtained in all patients with CRPS, whereas SSR was absent in 9 of 28 patients with hemiplegia who did not have CRPS after stimulation of the plegic side and the difference was statistically significant (P=0.023). SSR amplitudes were increased at the hemiplegic limbs in patients affected by CRPS compared to individuals unaffected; this group difference was statistically significant (P=0.014). The mean amplitude of the SSR in the advanced stage of CRPS was greater than lower stage and the difference was statistically significant (P=0.035). CONCLUSION: Our results suggest that SSR can be obtained in stroke patients with CRPS even in the early stages of CRPS. SSR acquirability and amplitude increase as the stage of the disease advances. As an electrophysiologic technique, SSR may be used in the evaluation of the sympathetic function in hemiplegic patients and also in the diagnosis of CRPS and in monitoring of its treatment.

Decreased chest mobility in children with spastic cerebral palsy.

Consequences of neuromuscular impairment may lead to lung damage and reduced lung function in children with cerebral palsy (CP). The purpose of this study was to evaluate chest mobility by means of chest expansion (CE) measurements in patients with spastic CP. Chest circumference at maximal voluntary inspiration (Cinsp) and at maximal voluntary expiration (Cexpir) and CE (the difference between Cinsp and Cexpir) were measured in 56 consecutive inpatients with spastic CP and in 40 healthy children. CE was significantly decreased (p < 0.001) and Cexpir was increased (p < 0.02) in the CP group, while mean Cinsp values were not statistically different (p > 0.05). The difference between CP patients and controls with respect to CE was becoming more prominent in older children. As chest mobility is decreased in spastic CP patients, early initiation of pulmonary rehabilitation, which may improve and maintain chest mobility and respiratory function, seems reasonable in this patient group.

Autonomic dysreflexia after intramuscular injection in traumatic tetraplegia: a case report.

Autonomic dysreflexia is a syndrome of massive imbalance of reflex sympathetic discharge occurring in patients with spinal cord lesion above the splanchnic outflow (T6). It is characterized by a sudden onset and severe increase in blood pressure and is potentially life threatening. The most common causes are bladder and rectum distention. In this case study, we report an autonomic dysreflexia case that developed after intramuscular injection in a 29-yr-old tetraplegic patient with C5 American Spinal Injury Association grade A lesion. After careful scrutiny of English literature, this clinical manifestation seems to be an unusual event.