ABSTRACT
Sciatic nerve injury after stretching exercise is uncommon. We report a case of an 18-year-old female trained dancer who developed sciatic neuropathy primarily involving the tibial division after routine stretching exercise. The patient presented with dysesthesia and weakness of the right foot during dorsiflexion and plantarflexion. The mechanism of sciatic nerve injury could be thought as hyperstretching alone, not caused by both hyperstretching and compression. Electrodiagnostic tests and magnetic resonance imaging revealed evidence of the right sciatic neuropathy from the gluteal fold to the distal tibial area, and partial tear of the left hamstring origin and fluid collection between the left hamstring and ischium without left sciatic nerve injury. Recovery of motor weakness was obtained by continuous rehabilitation therapy and some evidence of axonal regeneration was obtained by follow-up electrodiagnostic testing performed at 3, 5, and 12 months after injury.
Subject(s)
Adolescent , Female , Humans , Axons , Follow-Up Studies , Foot , Ischium , Lower Extremity , Magnetic Resonance Imaging , Muscle Stretching Exercises , Paresthesia , Regeneration , Rehabilitation , Sciatic Nerve , Sciatic NeuropathyABSTRACT
Epidural abscess and vertebral osteomyelitis induced by epidural injection is rare but one of the most serious complications. A 58-year old woman complained of aggrevating radicular pain to bilteral lower legs, tenderness on coccygeal area and claudication, after epidural injection for management of intractable sciatica. MRI and ultrasound revealed epidural abscess compressing dural sac at the level of L5-S1 vertebral body, sacrococcygeal abscess, and later S5- 1stcoccyx osteomyelitis. We report epidural abscess and vertebral osteomyelitis induced by caudal epidural injection.
Subject(s)
Female , Humans , Abscess , Epidural Abscess , Injections, Epidural , Leg , Osteomyelitis , SciaticaABSTRACT
Central pontine myelinolysis is a demyelinating disease of central pons. Nocturnal polyuria is defined as increased urination during nighttime with a nocturnal fraction exceeding from 20% to 33%. We have experienced nocturnal polyuria developed in two patients with central pontine myelinolysis. In these cases, serum antidiuretic hormone and urine osmolality were lower at nighttime than daytime. It suggests that nocturnal polyuria is caused by abnormal diurnal variation of antidiuretic hormone. In the first case, nocturnal polyuria was recovered spontaneously and also follow up brain MRI showed decreased signal intensity in pons. In the second case, nocturnal polyuria was improved after the treatment of intranasal desmopressin. It appeares that central pontine myelinolysis can cause nocturnal polyuria due to the interruption of antidiuretic hormone pathway. The symptom of nocturnal polyuria can be treated by desmopressin.
Subject(s)
Humans , Brain , Deamino Arginine Vasopressin , Demyelinating Diseases , Follow-Up Studies , Magnetic Resonance Imaging , Myelinolysis, Central Pontine , Osmolar Concentration , Polyuria , Pons , UrinationABSTRACT
OBJECTIVE: We investigated the usefulness of the scintigraphic swallowing study in selecting the patients with low risk of aspiration pneumonia among those who showed small amount of laryngeal aspiration in videofluoroscopy. METHOD: Scintigraphic swallowing study was performed in 22 patients with brain injury who showed small amount of laryngeal aspiration in videofluoroscopy. Oral feeding was tried in the patients who showed airway clearing function or no aspiration in scintigraphic swallowing study, and they were followed up for possible aspiration pneumonia. RESULTS: Total of sixteen patients showed no aspiration in scintigraphic swallowing study. Five patients showed laryngeal aspiration, but preserved airway clearing function. One patient showed impairment of airway clearing function. Oral feeding was tried in 21 patients. Oral feeding was successful in 18 of 21 patients but not in 3 patients because of dysphagia or cough. Only 1 patient developed pneumonia after 246 days of follow up. CONCLUSION: Scintigraphic swallowing study is useful to select the patients with low risk of aspiration pneumonia among the patients who showed small amount of laryngeal aspiration in videofluoroscopy.
Subject(s)
Humans , Brain Injuries , Brain , Cough , Deglutition Disorders , Deglutition , Follow-Up Studies , Pneumonia , Pneumonia, Aspiration , Radionuclide ImagingABSTRACT
Hemiplegic patients with an ankle foot orthosis (AFO) has a tendency to show external rotation of affected side foot. External rotation inhibiting shoes (ERIS) were designed to inhibit excessive rotation of hemiplegic foot. ERIS were applied to two hemiplegic patients who were able to walk independently with a plastic AFO. Both of them showed an excessive external rotation of hemiplegic foot after AFO apply. Each patient tried to walk with a pair of common shoes first and ERIS later. The external rotation angle, step length, stride length, cadence, speed were measured by footprint method. The external rotation angle of hemiplegic foot was significantly decreased with ERIS than with common shoes. However they did not show consistent improvement in the step length, stride length, cadence and speed. We reported that hemiplegic patients who walked with ERIS showed remarkable reduction in excessive external rotation of hemiplegic foot.