Traumatic Cauda Equina Syndrome Due to Spinal Stenosis in an Achondroplastic Patient: A Case Report

Achondroplasia is a congenital developmental condition characterized pathologically by defective enchondral ossification, affecting chiefly the long bones, and clinically by peculiar dwarfism with short extremities and normal trunk. One of the most common neurologic manifestation in achondroplastic patients in adulthood is spinal stenosis where the prominent characteristics of lumbar vertebrae structure are shortening of interpedicular distance and hypertrophy of vertebral pedicle. There has been no case report of traumatic cauda equina syndrome resulted in paraparesis among achondroplasic patients in Korea. We experienced a 30 year-old achondroplastic man sustained paraparesis as the result of an accidental slipping down. After the surgical decompression, the patient made slow recovery in all aspects of function via rehabilitation therapy.

Thoracic Arachnoiditis Following Surgical Lumbar Fixation: A case report

This 32 year-old man sustained crush injury and resultant in paraplegia. Lumbar MRI was taken and revealed fracture and dislocation between L2 and L3 vertebrae bodies. On the day of the injury, he underwent a surgical intervention of posterolateral fixation and bone graft from L1 to L4 vertebrae. He was transferred to Rehabilitation Medicine Department of Asan Medical Center where patient was subsequently found to have an unexpected neurologic finding of decreased sensation below T5 dermatome on right and below T6 on left. Accordingly we took a thoracic MRI which showed features consistent with arachnoiditis at thoracic and lumbar cord segment. A dermatomal somatosensory evoked potential study was performed with finding of abnormal somatosensory pathway below mid thoracic dermatome. We reported an unusual case of thoracic arachnoiditis occurred after the surgical fixation of the lumbar vertebral fracture and dislocation.

Causes and Types of Childhood Strokes

OBJECTIVE: We documented childhood strokes in this hospital to ascertain the causes of childhood strokes and the proportion of stroke types. METHOD: We reviewed the medical records and brain imaging studies of all children with possible strokes who were admitted to Asan Medical Center from 1990 to 1999. Our review of charts identified 131 acute childhood stroke patients aged from one to eighteen years old. RESULTS: Seventy boys (53.4%) and 61 girls (46.6%) were involved in this study. The predominant diagnoses responsible for the stroke were arteriovenous malformation (42.0%) and moyamoya disease (24.4%). The diagnoses of 30 stroke patients (22.9%) were undetermined, 16 of them were ischemic and 14 hemorrhagic. The total number of hemorrhagic stroke was almost twice as that of ischemic stroke. As patients aged, the incidence of ischemic stroke decreased while the opposite trend was observed in hemorrhagic stroke. There were 14 death (10.7%) consisting of 13 hemorrhagic stroke patients and 1 ischemic during the admission period. Relapse of stroke were noted in 19 of 131 patients (14.5%) with the main cause being arteriovenous malformation. CONCLUSION: Although the main diagnoses of childhood strokes were arteriovenous malformation and moyamoya disease, the cause of strokes in 23% could not be confirmed. The incidence of ischemia decreased while that of hemorrhage increased with the increase in age. Death, relapse, and complication occurred more frequently in hemorrhagic than ischemic stroke.

Changes of Nerve Conduction at High Temperature in Patients with Carpal Tunnel Syndrome

OBJECTIVE: High body temperature may alter nerve conduction in demyelinated neurons. This study was designed to investigate the changes in nerve conduction parameters in response to the heat applied over the wrist in the patients with carpal tunnel syndrome (CTS). METHOD: 16 hands of CTS patients and 16 hands of normal subjects were involved in this study. Motor and sensory nerve responses were measured at 32degrees C and 42degrees C in all the subjects. Infrared was applied on the wrist to warm the skin to 42degrees C. Changes of relative amplitude, duration, and latency of evoked potentials in median sensory and motor nerves of CTS patients were compared with those of the normal subjects. Correlation between the latency measured at 32degrees C and changes of amplitude of motor and sensory nerve responses after warming to 42degrees C was evaluated in CTS group. RESULTS: Relative reduction in duration of motor responses in CTS group was significantly greater than in normal group. Relative reduction of motor and sensory amplitude, and sensory latency were greater in CTS. There was no significant relation between motor and sensory latency at 32degrees C and relative amplitude reduction in motor and sensory responses at 42degrees C. CONCLUSION: Increase in temperature may increase the number of blocked nerve fibers in patients with CTS than in normal subjects.