Sonographic assessment of carpal tunnel syndrome in rheumatoid arthritis: prevalence and correlation with disease activity.

Carpal tunnel syndrome (CTS) is one of the most frequent extra-articular manifestations of rheumatoid arthritis (RA). High frequency ultrasonography (US) is a sensitive and specific method in diagnosis of CTS. This study is aimed to: firstly assess diameter frequency of CTS in RA with US and compare with a control group; secondly, investigate relationship of CTS with disease activity. One hundred consecutive RA patients (women/men: 78/22) fulfilling ACR 1987 RA criteria and 45 healthy controls (women/control: 34/11) were enrolled into study. Disease activity parameters, RA and CTS patient global assessment and health assessment questionnaire (HAQ-DI) were recorded. Both patient and control group were questioned about secondary causes of CTS, and Katz hand diagram, Boston CTS questionnaire and Phalen ve Tinel tests were applied once for each hand. Wrist joint and carpal tunnel were assessed with US grey scale and power Doppler US, then cross-sectional area of median nerve (CSA) was calculated. Patients with median nerve CSA between 10.0 and 13.0 mm(2) were evaluated with electromyography (EMG). CTS was diagnosed if CSA of median nerve >13.0 mm(2) or CTS was shown with NCS. Although there was no difference between RA patients and controls in age, sex, history of DM (+) and goitre, CTS was more frequent in RA group (respectively, 17.0% vs. 4.4%, P = 0.038). In RA group with CTS, age, history of DM, disease duration, HAQ-DI score, CTS patient global score, Boston symptom severity and functional status scores were elevated compared to without CTS [respectively, 57 (36-73) vs. 50 (24-76), P = 0.041; 35.3% vs. 6.0%, P < 0.001; 108 (12-396) months vs. 72 (6-360) months, P = 0.036; 1.93 (0.75-2.87) vs. 1.125 (0-2.75), P = 0.013; 52 (1-97) vs. 25 (0-91), P = 0.001; 2.81 (1.18-4.17) vs. 2.0 (1.0-4.01), P = 0.01; 3.37 (1.37-5.0) vs. 2.25 (1.0-5.0), P = 0.008]. No difference was found between CTS (+) and (-) RA patients in acute phase reactants, disease activity and US findings (P > 0.05). Sensitivity of Katz hand diagram was higher than Tinel and Phalen tests (respectively, 100, 60.0, 66.7%). Boston symptom and functional scores of RA patients with CTS diagnosed by EMG were increased than patients CTS (-) by EMG [respectively, 3.05 (1.90-4.27) vs. 1.55 (1.0-2.90), P = 0.002; 3.25 (1.73-3.82) vs. 1.12 (1.0-2.10), P = 0.008]. CTS frequency in RA was found higher than normal population, especially in patients with additional risk factors of CTS. There was no relationship between CTS and disease activity. CTS group had long disease duration and worse functional status. CTS could be a result of the chronic course in RA. In patient with CSA between 10 and 13 mm(2), Boston CTS questionnaire might give additional idea about CTS.

Severity of Carpal tunnel syndrome assessed with high frequency ultrasonography.

Although nerve conduction study (NCS) is the method most frequently used in daily clinical practice to confirm clinical diagnosis of Carpal tunnel syndrome (CTS), ultrasonographic (US) measurement of the median nerve cross-sectional area is both sensitive and specific for the diagnosis of CTS. Moreover, an algorithm evaluating CTS severity based on CSA of median nerve was suggested. This study is aimed to investigate the clinical usefulness of this algorithm in assessing CTS severity. The patients underwent a full clinical examination, including Tinel and Phalen test, and questioned about symptoms and the secondary causes of CTS. All of the patients refilled a Turkish version Levine Boston Carpal tunnel syndrome questionnaire (BQ) and the visual analog scale for pain (VAS 0-100 mm) A MyLab 70 US system (Esaote Biomedica, Genoa, Italy) equipped with a broadband 6-18 MHz linear transducer was used for US examination. The cross-sectional area of the median nerve was measured at the proximal inlet of the carpal tunnel (US cut-off points that discriminate between different grades of CTS severity as 10.0-13.0 mm(2) for mild symptoms, 13.0-15.0 mm(2) moderate symptoms and >15.0 mm(2) for severe patients). Nerve conduction studies were carried out, and severity of electrophysiological CTS impairment was reported as normal, mild, moderate, severe and extreme. The agreement between NCS and US in showing CTS severity (normal, mild, moderate and severe) was calculated with Cohen's kappa coefficient. Ninety-nine wrists of 54 patients (male/female: 4/50) were included in the study. Mean ages of patients were (+/-SD) 43.3 +/- 11 years. Forty-nine patients had idiopathic CTS, whereas five had secondary CTS (4 had diabetes mellitus and 1 had hypothyroidism). Symptoms were bilateral in 45 patients (83.3%). There were statistical differences between the groups according to electrophysiologic severity scale in terms of age (P < 0.001), body-mass index (P = 0.034), VAS (P = 0.014), Boston symptom severity (P = 0.013) and CSA of median nerve (P < 0.001). The identification of CTS severity showed substantial agreement (Cohen's kappa coefficient = 0.619) between the US and NCS. Also the four groups based on US CTS severity classification were significantly different in VAS (P = 0.017) and Boston symptom severity (P = 0.021). The median nerve swelling detected by calculation of the CSA reflects in itself the degree of nerve damage as expressed by the clinical picture. In addition to CTS diagnosis, sonographic measurement of CSA could also give additional information about severity of median nerve involvement. Using of US may cost-effectively reduce the number of NCS in patients with suspected CTS.

Evaluation of language functions in acute cerebellar vascular diseases.

BACKGROUND: The principal features of the cerebellar infarcts are ataxia, failure of coordination, gait instability, and articulation and eye movement disabilities. Language disabilities are also seen with cerebellar lesions, but there are difficulties in diagnosis. This study was planned to evaluate the effects of cerebellar lesions on language functions and the relation between these functions and lesion type, age, and education level. METHODS: A total of 20 patients, 13 male (65%) and 7 female (35%), were included in this study. Twenty control subjects with similar demographic characteristics were also included. The mean age of the patient group was not statistically different. RESULTS: Patients with vermal lesions had significantly higher performance than patients with paravermal lesions when evaluating the understanding of hearing and total aphasia score. Understanding of reading function was significantly better in the patients with small lesions compared with those with large lesions. When the aphasia parameters were compared between the patient and control groups, significant differences were found for all parameters, which reflected the language abilities understanding, naming, true-wrong questions, complex questions, comparing, repeating, and total aphasia score. Reading and writing functions were also significantly different between the patients and the control subjects. CONCLUSION: We found that the cerebellum contributes in several language parameters. These functions show difference according to localization and lesion volume of cerebellar disease. Aphasia should be explored as an important parameter when evaluating the loss of function in patients with cerebellar lesions.

Serum magnesium level and clinical deterioration in Alzheimer's disease.

BACKGROUND: Recent studies suggest that magnesium, which specially affects the N-methyl-D-aspartate receptor response to excitatory amino acids, may be a supportive therapeutic agent in Alzheimer's disease. OBJECTIVE: To investigate the relationship between magnesium levels and the cognitive test results and clinical stages of the patients. METHODS: Thirty-seven patients (20 women, 17 men) and 34 controls were included in the study. The patients were staged according to Global Deterioration Scale (GDS) and Clinical Dementia Rating (CDR). RESULTS: There was a significant difference for Mg levels according to GDS (p = 0.030). Similarly, Mg levels were different between patients with low and high CDR stages (p = 0.003). Mg levels were lower in the group whose MMSE scores were <20 than in those whose MMSE scores were >/=20. A negative correlation was found between Mg levels and GDS and CDR (respectively: r = -0.35, p = 0.033; r = -0.360, p = 0.029). CONCLUSION: Our data suggest that there is a relationship between serum Mg levels and the degree of Alzheimer's disease and that the determination of the Mg level at various stages may provide valuable information in further understanding the progression and treatment of Alzheimer's disease.