Ultrasound Imaging of the Trunk Muscles in Acute Stroke Patients and Relations With Balance Scales

Objective@#To examine the correlation between ultrasonographic trunk muscle parameters and balance scales in mild acute stroke patients. @*Methods@#A total of 55 stroke patients with hemiparesis and motor power grade ≥4 in the manual motor test were included. The Scale for the Assessment and Rating of Ataxia (SARA), Berg Balance Scale (BBS), Timed Up and Go Test (TUG), and Trunk Control Test (TCT) were used to evaluate patient balance function. Ultrasonographic parameters were measured on both non-paretic and paretic sides of the rectus abdominis, external oblique, internal oblique, transversus abdominis, and erector spinae muscles. Resting thickness and contraction thickness were measured in all muscles, and contractility and contractility ratio were calculated based on measured thicknesses. The differences between paretic and non-paretic muscle parameters, and the correlation between ultrasonographic parameters and balance scales were analyzed. Stroke patients were divided into two groups according to their fall risk. Ultrasonographic measurements between the two groups were compared. @*Results@#All muscles’ contraction thickness and contractility were significantly different between paretic and non-paretic sides (p<0.001). Contractility ratios of all trunk muscles showed a significant correlation with SARA, BBS, TUG, and TCT (p<0.05). Contractility ratios of all muscles were significantly different between high- and low-risk fall groups (p<0.05). @*Conclusion@#The contractility ratio in stroke patients reflects their balance disturbance and fall risk and it may serve as a new parameter for ultrasound imaging of trunk muscles.

Evaluation of Ataxia in Mild Ischemic Stroke Patients Using the Scale for the Assessment and Rating of Ataxia (SARA)

OBJECTIVE: To demonstrate the utility of Scale for the Assessment and Rating of Ataxia (SARA) for evaluation of posterior circulation-related features in patients with mild stroke. METHODS: Forty-five subjects, diagnosed with acute infarction in the cerebellum, basis pontis, thalamus, corona radiata, posterior limb of internal capsule, and their National Institutes of Health Stroke Scale (NIHSS) scores ≤5 were enrolled. SARA scores were graded by the cut-off value of severity in dependency of activities of daily living (ADL). SARA, Berg Balance Scale (BBS), Timed Up-and-Go (TUG), and Trunk Control Test (TCT) were correlated in regression analysis with the modified Rankin Scale (mRS) at discharge. Correlation between SARA and other tools was analyzed. Patients were divided based on mRS at admission (group A, mRS 0–2; group B, mRS 3–5). Scores between the two groups were compared. RESULTS: Among the subjects, 48.9% (22/45) scored above 5.5 on SARA, and even 11.1% (5/45) scored higher than 14.25, which is the cut-off value of ‘severe dependency’ in ADL. SARA showed significant value for prediction of mRS at discharge. SARA was correlated with BBS (r=-0.946, p < 0.001), TUG (r=-0.584, p < 0.001), and TCT (r=-0.799, p < 0.001). The SARA, BBS, TUG, and TCT scores between were lower in group B than in group A patients. SARA as well as BBS, TUG, and TCT reflect the functional severity of all patients. CONCLUSION: SARA is a complementary tool for evaluation of the severity of ataxia in mild stroke patients with features of posterior circulation.

Acute Cerebral Infarction as a Rare Thrombotic Event in Myelodysplastic Syndrome: A Case Report

Myelodysplastic syndrome (MDS) is a bone marrow failure syndrome characterized by cytopenia that results in high risks of infection and bleeding. However, there are few reports of cerebral infarction in MDS. We reported a 72-year-old female with MDS who developed acute cerebral infarction. Clinical history of the patient revealed no definite risk factors for stroke except diabetes mellitus and dyslipidemia that was well controlled. This case represented the rare occurrence of arterial thrombosis causing acute cerebral infarction in MDS, which may be due to complex chromosomal abnormality and inflammatory processes.

Acute Cerebral Infarction as a Rare Thrombotic Event in Myelodysplastic Syndrome: A Case Report

Myelodysplastic syndrome (MDS) is a bone marrow failure syndrome characterized by cytopenia that results in high risks of infection and bleeding. However, there are few reports of cerebral infarction in MDS. We reported a 72-year-old female with MDS who developed acute cerebral infarction. Clinical history of the patient revealed no definite risk factors for stroke except diabetes mellitus and dyslipidemia that was well controlled. This case represented the rare occurrence of arterial thrombosis causing acute cerebral infarction in MDS, which may be due to complex chromosomal abnormality and inflammatory processes.

Changes in Activation of Abdominal Muscles at Selected Angles During Trunk Exercise by Using Ultrasonography

OBJECTIVE: To investigate the changes of activation of the abdominal muscles depending on exercise angles and whether the activation of rectus abdominis differs according to the location, during curl up and leg raise exercises, by measuring the thickness ratio of abdominal muscles using ultrasonography. METHODS: We examined 30 normal adults without musculoskeletal problems. Muscle thickness was measured in the upper rectus abdominis (URA), lower rectus abdominis (LRA), obliquus externus (EO), obliquus internus (IO), and transversus abdominis (TrA), at pre-determined angles (30degrees, 60degrees, 90degrees) and additionally at the resting angle (0degrees). Muscle thickness ratio was calculated by dividing the resting (0degrees) thickness for each angle, and was used as reflection of muscle activity. RESULTS: The muscle thickness ratio was significantly different depending on the angles in URA and LRA. For curl up-URA p=0 (30degrees90degrees), p=0.44 (30degrees90degrees), p=0.44 (30degrees>90degrees), respectively, by one-way ANOVA test-and for leg raise-URA p=0 (30degrees<60degrees), p=0 (60degrees<90degrees), p=0 (30degrees<90degrees) and LRA p=0.01 (30degrees<60degrees), p=0 (60degrees<90degrees), p=0 (30degrees<90degrees), respectively, by one-way ANOVA test-exercises, but not in the lateral abdominal muscles (EO, IO, and TrA). Also, there was no significant difference in the muscle thickness ratio of URA and LRA during both exercises. In the aspect of muscle activity, there was significant difference in the activation of RA muscle by selected angles, but not according to location during both exercises. CONCLUSION: According to this study, exercise angle is thought to be an important contributing factor for strengthening of RA muscle; however, both the exercises are thought to have no property of strengthening RA muscle selectively based on the location.

Analysis of Vertical Ground Reaction Force Variables Using Foot Scans in Hemiplegic Patients

OBJECTIVE: To analyze the differences in the vertical ground reaction force (GRF) variables of hemiplegic patients compared with a control group, and between the affected and unaffected limbs of hemiplegic patients using foot scans. METHODS: Patients (n=20) with hemiplegia and healthy volunteers (n=20) underwent vertical force analysis. We measured the following: the first and second peak forces (F1, F2) and the percent stances at which they occurred (T1, T2); the vertical force impulse (VFI) and stance times. The GRF results were compared between the hemiplegic patients and control individuals, and between the affected and unaffected limbs of hemiplegic patients. Additionally, we analyzed the impulse of the unaffected limb according to the motor assessment scale (MAS), Brunnstrom stage, and a Timed Up and Go Test. RESULTS: The F1s and F2s of the affected and unaffected limbs were significantly less than those of the normal control individuals (p<0.05). The T1s of both the affected and unaffected limbs of the patients were greater than control individuals, whilst the T2s were lower (p<0.05). Greater impulses and stance times were recorded on both sides of the patients than in the limbs of the control individuals (p<0.05). The MAS, Brunnstrom stage and Timed Up and Go Test results were significantly correlated with the VFI of the unaffected limbs (p<0.05). CONCLUSION: The high impulse values of the unaffected limb were associated with complications during gait rehabilitation. Therefore, these results suggest that unaffected limbs should also be taken into consideration in these patients.

Ultrasonographic Measurement of Transverse Abdominis in Stroke Patients

OBJECTIVE: To compare transverse abdominis (TrA) contractility in stroke patients with hemiparesis and healthy adults using musculoskeletal ultrasonography. METHODS: Forty-seven stroke patients with hemiparesis and 25 age-matched healthy control subjects participated in this study. Stroke patients were divided into three groups on the basis of their degree of ambulation. Group A consisted of 9 patients with wheelchair ambulation, group B of 23 patients with assisted ambulation, and group C of 15 patients with independent ambulation. Inter-rater reliability regarding ultrasonographic measurement of abdominal muscle thickness in the control group was assessed by two examiners. The TrA contraction ratio (TrA contracted thickness/TrA resting thickness) was measured during abdominal drawing-in maneuver and was compared between the patients and the control group and between the ambulation groups. RESULTS: The inter-rater reliability ranged from 0.900 to 0.947. The TrA contraction ratio was higher in the non-paretic side than in the paretic side (1.40+/-0.62 vs. 1.14+/-0.35, p<0.01). The TrA contraction ratio of the patient group was lower in the non-paretic side as well as in the paretic side than that of the control group (right 1.85+/-0.29, left 1.92+/-0.42; p<0.001). No difference was found between the ambulation regarding the TrA contraction ratio. CONCLUSION: The TrA contractility in hemiparetic stroke patients is significantly decreased in the non-paretic side as well as in the paretic side compared with that of healthy adults. Ultrasonographic measurement can be clinically used in the evaluation of deep abdominal muscles in stroke patients.

Effect of silane activation on shear bond strength of fiber-reinforced composite post to resin cement

PURPOSE: Among the surface treatment methods suggested to enhance the adhesion of resin cement to fiber-reinforced composite posts, conflicting results have been obtained with silanization. In this study, the effects of silanization, heat activation after silanization, on the bond strength between fiber-reinforced composite post and resin cement were determined. MATERIALS AND METHODS: Six groups (n=7) were established to evaluate two types of fiber post (FRC Postec Plus, D.T. Light Post) and three surface treatments (no treatment; air drying; drying at 38degrees C). Every specimen were bonded with dual-curing resin cement (Variolink N) and stored in distilled water for 24 hours at 37degrees C. Shear-bond strength (MPa) between the fiber post and the resin cement were measured using universal testing device. The data were analyzed with 1-way ANOVA and by multiple comparisons according to Tukey's HSD (alpha=0.05). The effect of surface treatment, fiber post type, and the interactions between these two factors were analyzed using 2-way ANOVA and independent sample T-tests. RESULTS: Silanization of the FRC Postec Plus significantly increased bond strength compared with the respective non-treated control, whereas no effect was determined for the D.T. Light Post. Heat drying the silane coupling agent on to the fiber-reinforced post did not significantly improve bond strength compared to air-syringe drying. CONCLUSION: The bond strength between the fiber-reinforced post and the resin cement was significantly increased with silanization in regards to the FRC Postec Plus post. Bond strength was not significantly improved by heat activation of the silane coupling agent.

Proteomic Changes in Rat Gastrocnemius Muscle After Botulinum Toxin A Injection

OBJECTIVE: To observe the changes in protein expression induced by botulinum toxin A (BoNT-A) injection and to characterize the molecular and cellular action of mechanisms of BoNT-A injection on skeletal muscles using proteomic elements as biomarkers. METHODS: BoNT-A was injected into left gastrocnemius muscles of 12 Sprague-Dawley rats (2 months of age) at a dosage of 5 units/kg body weight. For the controls same volume of normal saline was injected to right gastrocnemius muscle of each rat. Muscle samples were obtained at 4 time points (3 rats per time point): 3, 7, 14, and 56 day post-injection. To reveal the alterations in muscle protein, we performed 2-dimensional electrophoresis (2DE) and compared Botox group and normal saline group at each time point. Altered protein spots in 2DE were identified using matrix-assisted laser desorption/ionization-time-of-flight mass spectrometer (MALDI-TOF MS) proteomics analysis. RESULTS: Compared with normal saline group, 46 protein spots showed changed protein expression. Twelve protein spots demonstrated increased volume and 34 protein spots demonstrated decreased volume. Among spots of decreased volume, 17 spots showed statistically significant differences. Thirty-eight identified proteins were associated with alterations in energy metabolism, muscle contractile function, transcription, translation, cell proliferation, and cellular stress response. CONCLUSION: BoNT-A gives influences on muscle contractile function and energy metabolism directly or indirectly besides neurotoxic effects. Proteomic expression provides better understanding about the effect of BoNT-A on skeletal muscle.

Identification of Alternatively Spliced Forms of human OSCAR in Osteoclasts

OBJECTIVES: Osteoclasts are multinucleated giant cells which can resorb bone and differentiated from hematopoietic cells. We have previously reported murine osteoclast-associated receptor (OSCAR) may be an important bone-specific regulator of osteoclast differentiation. We have cloned soluble form of human OSCAR (hOSCAR) and examined the role of hOSCAR on osteoclast differentiation. METHODS: Osteoclast differentiation was induced by treatment with macrophage colony-stimulating factor (M-CSF) and receptor activator of nuclear factor kappa B ligand (RANKL) and tartrate-resistant acid phosphatase (TRAP) staining and pit formation were performed. Expression was measured by flow cytometry analysis, Northern and Western blot analysis. RESULTS: hOSCAR is expressed in osteoclast cells and involved in the differentiation of osteoclasts from peripheral blood mononuclear cells (PBMC). Two alternatively spliced forms (soluble hOSCAR [hOSCAR-S]) of hOSCAR were identified from osteoclasts complementary deoxyribonucleic acid (cDNA) library derived from PBMC. Putative transmembrane domain was not found in hOSCAR-S forms and it suggested that these forms might be secreted from osteoclast cells. These secreted forms of hOSCAR attenuated RANKL-induced osteoclast formation and bone resorption. CONCLUSIONS: Human osteoclasts express at least five different OSCAR messenger ribonucleic acid (mRNA) isoforms which could play different regulatory roles for differentiation. The secreted forms of hOSCAR might be a negative regulator of membrane-bounded forms of OSCAR.

Identification of Alternatively Spliced Forms of human OSCAR in Osteoclasts

OBJECTIVES: Osteoclasts are multinucleated giant cells which can resorb bone and differentiated from hematopoietic cells. We have previously reported murine osteoclast-associated receptor (OSCAR) may be an important bone-specific regulator of osteoclast differentiation. We have cloned soluble form of human OSCAR (hOSCAR) and examined the role of hOSCAR on osteoclast differentiation. METHODS: Osteoclast differentiation was induced by treatment with macrophage colony-stimulating factor (M-CSF) and receptor activator of nuclear factor kappa B ligand (RANKL) and tartrate-resistant acid phosphatase (TRAP) staining and pit formation were performed. Expression was measured by flow cytometry analysis, Northern and Western blot analysis. RESULTS: hOSCAR is expressed in osteoclast cells and involved in the differentiation of osteoclasts from peripheral blood mononuclear cells (PBMC). Two alternatively spliced forms (soluble hOSCAR [hOSCAR-S]) of hOSCAR were identified from osteoclasts complementary deoxyribonucleic acid (cDNA) library derived from PBMC. Putative transmembrane domain was not found in hOSCAR-S forms and it suggested that these forms might be secreted from osteoclast cells. These secreted forms of hOSCAR attenuated RANKL-induced osteoclast formation and bone resorption. CONCLUSIONS: Human osteoclasts express at least five different OSCAR messenger ribonucleic acid (mRNA) isoforms which could play different regulatory roles for differentiation. The secreted forms of hOSCAR might be a negative regulator of membrane-bounded forms of OSCAR.

Usefulness of Ultrasound Examination in Evaluation of Breast Cancer-Related Lymphedema

OBJECTIVE: To evaluate the usefulness of ultrasound examination as an adjunctive measurement tool in breast cancer-related lymphedema. METHOD: Twenty healthy volunteers and 20 women who had been treated for unilateral breast cancer and had subsequently developed lymphedema were recruited. Examiners measured the volume of both arm with volumeter and the circumference of both forearm and upper arm with tape measure. Then the thickness of the skin and subcutis on the ventral aspect of forearm and upper arm were measured by ultrasonography. These results were compared with each other. RESULTS: The ICCs for interrater reliability of ultrasound examination was high (mostly>0.98). The volume of the swollen arm (2,308 ml) was larger than contralateral arm (1,873 ml). The circumference of swollen forearm (24.50 cm) and upper arm (30.81 cm) were larger than contralateral forearm (21.54 cm) and upper arm (27.60 cm). In the swollen side, average thickness of the forearm skin, forearm subcutis, upper arm skin and upper arm subcutis were 0.23 mm, 1.03 mm, 0.19 mm and 0.95 mm respectively. In the contralateral side, average thickness of the forearm skin, forearm subcutis, upper arm skin and upper arm subcutis were 0.12 mm, 0.69 mm, 0.13 mm, 0.73 mm respectively. The degree of increase in mid-forearm skin thickness were correlated with the degree of swelling calculated with volumeter (r=0.651, p=0.002). CONCLUSION: Ultrasonography is able to give valuable information on the extent of edema and fibrosis of skin and subcutis. It will be a useful tool to follow the results of lymphedema treatment and its progression over time.

Relationship between Physical Examinations and Two-Dimensional Computed Tomographic Findings in Children with Intoeing Gait

OBJECTIVE: To evaluate the validity of physical examinations by assessment of correlation between physical examinations and CT measurements in children with intoeing gait and the causes of intoeing gait by age using CT measurements. METHOD: Twenty-six children with intoeing gait participated in this study. The internal and external hip rotation, thigh-foot angle and transmalleolar angle were measured. In addition, femoral anteversion and tibial torsion of the subjects were assessed using a CT scan. The measurements of torsional angles were performed twice by two raters. The correlation coefficients between physical examinations and CT measurements were calculated using Pearson correlation. The data was analyzed statistically using SPSS v12.0. RESULTS: The correlation coefficients between physical examinations and CT measurements were not high. Before 5 years of age, intoeing gait was caused by femoral anteversion in 17.86%, tibial torsion in 32.29% and the combination of causes in 35.71% of cases. After 6 years of age, the contributions changed to 29.17%, 8.33% and 45.83%, respectively. CONCLUSION: Before 5 years of age, the common cause of an intoeing gait was tibial torsion, whereas after 6 years of age it was femoral anteversion. Regardless of age, the most common cause of intoeing gait was a combination of causes. This study shows poor correlation between physical examinations and CT. Therefore, it is limiting to use physical examination only for evaluating the cause of intoeing gait in clinical practice.

Percutaneous Endoscopic Gastrostomy Versus Percutaneous Radiologic Gastrostomy: A Comparison of Complications in Brain Injured Patients

OBJECTIVE: To compare complications of percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) in brain injured patients. METHOD: The records of brain injured patients who received either PEG or PRG between January 2001 and July 2008 in Busan paik hospital were reviewed retrospectively. Documented complications (infection, leakage, blockage/delayed feeding, aspiration pneumonia, tube displacement, pain, ileus, bleeding, tube fell/pulled out, bradycardia/hypotension) were recorded and compared. RESULTS: There were 44 brain injury patients with dysphagia. All patient received PEG or PRG successfully. (32 PEG, 12 PRG) The incidences of complications were 50% in both PEG group (16 in 32) and PRG group (6 in 12). In PEG group sixteen patients developed complications, 27 minor and two major. In PRG group six patients developed complications, 11 minor and one major. The most common complication of PEG was wound infection (37.9%). But there were no wound infection in PRG group. And there were no deaths in both PEG and PRG group. CONCLUSION: Both endoscopic and radiologic gastrostomy tube placements are safe and effective methods. But in high infection risk group such as old ages, DM or CRF patients who have brain injury with dysphagia, PRG is safer method than PEG.

Measurement of Proprioception of the Knee in Hemiplegic Patients Using an Isokinetic Dynamometer

OBJECTIVE: To measure knee joint proprioception quantitatively in hemiplegic patients after brain injury using an isokinetic dynamometer. METHOD: Thirty healthy subjects and 24 hemiplegic patients participated in this study. Joint position sense was evaluated with passive angle reproduction of 30degrees and 60degrees of knee flexion and kinesthesia was evaluated with the threshold for detection of passive movementfrom 45degrees of knee flexion. We used toe-"up or down"-test for conventional clinical method. RESULTS: Significant proprioceptive deficit was observed not only in paretic knees of both right and left hemiplegic patients (p0.05). CONCLUSION: The quantitative test using an isokinetic dynamometer is a reliable method to measure knee proprioception, and it is possible to detect proprioceptive deficit in hemiplegic patients. Conventional clinical assessments are poor for predicting the results of the quantitative measure in the nonparetic knee. This quantitative method may be useful in diagnosis and follow-up of knee proprioception of hemiplegic patients after brain injury.

Changes of Autonomic Nervous Function after Foot Bathing in Normal Adults

OBJECTIVE: To monitor the changes of autonomic nervous function before and after foot bathing through autonomic function tests using electrophysiological instrument. METHOD: Twenty five healthy adults took a foot bathing through popular 'foot bath' for 30 minutes at 43degrees C. Autonomic tests were performed three times before foot bathing, immediately and 15 minutes after foot bathing. Sympathetic skin response (SSR) and blood pressure after sustained grip for sympathetic tone, heart rate variation during deep breathing and Valsalva maneuver for parasympathetic tone (Expiratory/Inspiratory (E/I) ratio, Valsalva ratio) were measured. RESULTS: SSR amplitudes in one hand decreased significantly during foot bathing (p0.05). CONCLUSION: Heat therapy through foot bathing in normal adults reduced sudomotor response to electrical stimuli, which can be considered as reduction of specific sympathetic nervous function. We propose that foot bathing could be promising one of partial heat therapies for pain without cardiovascular complications unlike conventional whole body bathing.

A Case of Adult Acute Myeloid Leukemia Presenting with Musculoskeletal Manifestations / 대한류마티스학회지

Leukemia is a heterogenous group of neoplasms that arise from the malignant transformation of hematopoietic cells. The usual presentation is one of lethargy, pallor, fever, purpura, bleeding, etc, and all this is secondary to a decrease in the production of normal blood components. However, leukemia often manifests with musculoskeletal symptoms without a systemic presentation. Musculoskeletal symptoms that precede the recognition of leukemia are much less frequent in adults as compared to those in children, and this causes diagnostic confusion and a delayed diagnosis. We describe here a case of adult acute myeloid leukemia in which pain and weakness of the limbs were the main manifestations and these were suspected as being symptoms of musculoskeletal disease.

The Effect of Cognitive-behavioral Characteristics on Depression of Caregivers in Brain-injured Patients

OBJECTIVE: To evaluate the relationship between depression and cognitive-behavioral characteristics of caregivers using social problem solving inventory (SPSI), social support or conflict scale (SSS or SCS) and somatic symptoms (SS). METHOD: Fifty five couples of brain-injured patients and caregivers participated in this study. We conducted a questionnaire survey of caregivers with Beck depression index (BDI), SPSI, SSS, SCS and SS for cognitive-behavioral characteristics. And also we studied demographic factors of patients and caregivers, clinical features of brain-injured patients, care- giving duration and time per day through interview and review of medical records. The statistical analyses were performed by independent t-test, one-way ANOVA, Pearson correlation test and linear regression analysis-stepwise method. RESULTS: BDI of the caregivers showed a negative correlation with SPSI, SSS, patients' MMSE and caregivers' education level, also a positive correlation with SCS, SS and patients' GDS (p<0.05). And married caregivers showed more depressive mood (p<0.05). Of these factors, the most influencing factors on BDI were GDS and SCS through linear regression analysis (p<0.01). CONCLUSION: MMSE, GDS and education level as cognitive- mental factors rather than physical and economic strain had a statistical correlation with depression of caregivers. Especially, SPSI, SSS and SCS as cognitive-behavioral characteristics should be considered on evaluation of depression of caregivers and will be helpful for successful rehabilitation for patients and caregivers.

A Case of Growing Endobronchial Glandular Papilloma / 결핵및호흡기질환

Pulmonary papillomas are rare benign epithelial neoplasms arising in bronchial surface epithelium. They are categorized by a variety of cell types including squamous, glandular, and mixed squamous and glandular type. Among them, glandular papilloma is extremely rare and has not been reported in Korea. The patient was a 52 year-old man presenting with a 4-months' history of recurrent hemoptysis. Bronchofiberoscopy revealed a whitish, glistening, and polypoid mass lesion at the proximal bronchus in the basal segment of the left lower lung. Bronchoscopic biopsy was performed; papillary fronds lined by ciliated or nonciliated pseudostratified columnar epithelium were noted on histologic findings. We present the first case of glandular papilloma in Korea. Two years later, the patient visited our hospital again due to hemoptysis. On follow-up bronchoscopy, a mass that had been found previously showed an increase in size.

Striatal Hand in Traumatic Brain Injury: A case report

Striatal hand is characterized by flexion in metacarpopharyngeal (MCP) joints and hyperextension in proximal interphalangial (PIP) joints and flexion in distal interphalangeal (DIP) joint. In clinical practice, this problem is often overlooked or misdiagnosed as rheumatoid arthritis and the opportunity for an early diagnosis and a correct management of the patient's is missed. In this report, a case with striatal hand following traumatic brain injury (TBI) without cardinal Parkinsonian signs is presented, and the differential diagnosis of the disease is discussed. A-62-year-old man presented with hemiplegia subsequent to traumatic brain injury. During the last two years, "swan neck" deformity of the hands occurred. We could diagnose this case as striatial hand with exclusion of similar rheumatologic causes by careful study and its characteristic deformity pattern. Clinician should consider the possibility of striatal hand when the patient with TBI presents swan neck deformity for an early diagnosis and a correct management.