Prolotherapy-induced Cervical Spinal Cord Injury: A Case Report

A 49-year-old man received prolotherapy in the upper cervical region at a local medical clinic. Immediately after the procedure, he felt a sensation resembling an electric shock in his right upper and lower extremities, and continuously complained of numbness and discomfort in the right hemibody. He visited our clinic a week later. Upon physical examination, there were no significant abnormal findings. The visual analog scale was 60 points. T2-weight magnetic resonance images of the cervical spine showed a 0.7 cm sized bright oval spot on the right side of the spinal cord at the level of C4-C5 disc, suggesting spinal cord injury. There were no definite electrodiagnostic abnormalities. Digital infrared thermal images showed moderately decreased surface temperature on lateral aspect of the right forearm and dorsum of the right hand compared with the other side. Considering that very rare complications like spinal cord injury may develop after prolotherapy, we suggest that special interventions such as prolotherapy be performed by professional experts.

Dural Arteriovenous Fistula on the Brain Stem and Upper Cervical Spinal Cord: A Case Report

A 53-year-old man abruptly developed headache and unconsciousness. Brain computed tomography (CT) and CT angiography showed subarachnoid hemorrhage, intraventricular hemorrhage, and multiple tortuous vascular structures on the brain stem and upper cervical spinal cord. Four-vessel angiography displayed intradural ventral arteriovenous fistula, supplied by the left vertebral and occipital arteries. Drainage was via both sigmoid sinus and cervical venous plexus. He had been treated with transarterial coil embolization of the left vertebral artery. Subsequently, he suffered from left hemiplegia and cognitive problem. Brain magnetic resonance (MR) and MR angiography performed 4 weeks later revealed multiple infarctions on the left cerebellum, left upper cervical spinal cord, and both medial thalamus, as well as occlusion of the left vertebral artery with reduction in varix size. After rehabilitative management, his muscle strength and cognitive function improved. We report a very rare case of dural arteriovenous fistula on the brain stem and upper cervical spinal cord.

Rehabilitative Therapeutic Experience in a Juvenile Patient with Secondary Parkinsonism Related to Hypoparathyroidism: A case report

Secondary Parkinsonism caused by hypoparathyroidism in young patients has been rarely reported and the effectiveness of comprehensive rehabilitation management is widely varied. We experienced a case of 16 year old patient with secondary Parkinsonism caused by hypoparathyroidism, who has a chief complaint of progressive resting tremor and gait disturbance. At admission, the tremor subscore was 4 on the unified Parkinson's disease rating scale (UPDRS), the initial score of Korean-modified Barthel index (K-MBI) was 33 points and functional independence measure (FIM) was 52 points. Comprehensive rehabilitation consisted of oral antiparkinsonism drugs, range of motion exercise, motor control and coordination training, gait training with biofeedback, and activity daily living training were performed twice a day, 5 days a week. At one month after admission, she had more improved functional state. The tremor subscore was 2 on UPDRS, K-MBI was 72 points, and FIM was 89 points.

Pain Evaluation with Surface Electromyography in Temporomandibular Myofascial Pain Dysfunction Syndrome

OBJECTIVE: To investigate usefulness of surface electromyography (sEMG) for the pain evaluation in the patients with temporomandibular myofascial pain dysfunction syndrome (TM-MPDS). METHOD: Twenty unilateral TM-MPDS patients (10 males, 10 females, duration of disease 6.6+/-5.6 months, age 28.5+/-3.0 years) and twenty healthy controls (10 males, 10 females, age 30.1+/-6.2 years) were recruited for this study. The patients were treated with trigger point injection therapy and cryotherapy once a week, and ultrasound thermotherapy four times a week for 2 weeks. Active electrodes were attached on temporalis and masseter muscles with reference electrode on chin and ground electrode on forehead. All of subjects were instructed to clench teeth for 5 seconds after full relaxation. For temporalis and masseter muscles, the amplitudes of clenching-EMG activities were obtained and the mean value of five biting cycles was calculated on both sides. sEMG, visual analog scale (VAS) and asymmetry index (AI) were assessed before and 2 weeks after treatment. RESULTS: For temporalis and masseter muscles, the amplitudes of affected side-EMG activity significantly decreased, and the AI of the patient group significantly increased compared with those of the control group (p<0.05, p< 0.05). The AI of the patient group significantly decreased after treatment (p<0.05, p<0.05). Higher AI in masseter muscle before treatment was significantly correlated with lower VAS after treatment (r=-0.487, p<0.05). CONCLUSION: It is suggested that sEMG would be useful for diagnosing and evaluating the pain in TM-MPDS.

The Effect of Thermo-undulation Therapy on the Patients with Chronic Low Back Pain

OBJECTIVE: To verify the effect of thermo-undulation therapy on the patients with chronic low back pain. METHOD: 115 patients with back pain (mean age: 51.2 year-old; male, female: 46, 69) were recruited. Experimental group (n=85) was subjected to thermo-undulation therapy for 30 minutes, once a day, five days a week during eight weeks and control group (n=30) was administered with sham procedure. Before and after the therapy, range of motion (ROM) the spine and flexibility of lower extremity muscles were evaluated with goniometry. The functional status was measured by Roland Morris disability questionnaire and quality of life was measured by the SF-36 (36-Item Short Form Health Survey Instrument) and SF-12 scales. The STAI-6 (Spielberger State-Trait Anxiety Inventory) was used for anxiety. We checked the intensity of pain by visual analog scale (VAS) and evaluated the effect of far-infrared ray with Digital Infrared Thermographic Imaging (DITI) technique. RESULTS: After therapy, the scores of muscle flexibility, spine ROM, VAS, Roland Morris disability questionnaire, SF-36, SF-12 and STAI-6 showed a tendency to improve in experimental group (p0.05). Only the temperature differences of experimental group by DITI were significantly lower than those of control group (p<0.05). CONCLUSION: Thermo-undulation therapy may be an adjuvant therapy for chronic low back pain.

Therapeutic Experience in a Patient with Complex Regional Pain Syndrome Related to Brachial Plexitis: A case report

We report our therapeutic experience in a patient with complex regional pain syndrome (CRPS) related to brachial plexitis. A 16-year-old female suffered from excruciating burning pain and allodynia abruptly developed on left shoulder. Cervical MRI was normal. Electrodiagnostic findings were compatible with acute brachial plexopathy. Hand swelling, dystrophic color change, desquamation, and anhidrosis were displayed. Three-phase bone scan revealed increased radio-uptake on left upper extremity. The course of the disease was slowly progressive with wax and wane pattern. Pain became gradually intractable to all therapeutic modalities and medications. She gradually improved with long-term multimodal pain management. After 2 years of disease-free period, CRPS recurred and the extent was more severe than the first attack. We tried oral mexiletine, risedronate, high dose multi-vitamin, and leukotriene modulator which were effective in reducing pain and allodynia. Hand swelling gradually subsided and functional regain was obtained.

Adult-onset Still's Disease with Dysphagia: Case report

We experienced a case of adult-onset Still's disease with dysphagia of soft tissue origin. A 38-year-old woman was admitted for intermittent high spiking fever, diffuse pain and swelling on anterior neck with dysphagia. Physical examination revealed a thin woman with trismus, board-like hardness of anterior neck, hepatomegaly, and erythematous evanescent rash on leg. Neck CT displayed bilateral cervical lymphadenopathy with soft tissue swelling, and tonsilitis. Chest and abdomen CT showed the inflammatory changes of multiple organs. Laboratory evaluation revealed neutrophilic leukocytosis, slightly increased alanine transaminase, negative antinuclear antibody and rheumatoid factor, and increased inflammatory markers. Skin, liver, colon, and pleural biopsy demonstrated the chronic inflammation. Videofluoroscopic swallowing study revealed laryngeal penetration with large amount residue in vallecular space and pyriform sinus, and incomplete cricopharyngeal relaxation. Gradual improvement in anterior neck pain and pulmonary edema and the decrease of effortful and multiple swallowing were observed with high dose steroid therapy.

The Effect of Biofeedback Treatment in Children with Spastic-Diplegic Cerebral Palsy

OBJECTIVE: To investigate the effect of electromyography (EMG)-biofeedback treatment in children with spastic-diplegic cerebral palsy. METHOD: Twenty patients with spastic diplegia, who could recognize the auditory and visual stimulation, were recruited. Ten patients underwent EMG-biofeedback treatment with neurodevelopmental treatment (NDT) for 12 weeks, 3 times a week, total 1 hour a day, but age-, sex- and functional-matched ten controls underwent only NDT. Before and after the treatment, active range of motion, spasticity, muscle strength and Functional Independence Measure for Children (WeeFIM) and Gross Motor Function Measure (GMFM) were measured. RESULTS: In experimental group, there was a significant increase in active range of motion of hip and ankle joints (p0.05). Muscle strength of ankle dorsiflexor and hip extensor muscles was significantly improved (p<0.05). WeeFIM and GMFM scores significantly increased in an experimental group (p<0.05). CONCLUSION: EMG-biofeedback treatment in children with spastic-diplegic cerebral palsy might be an effective adjuvant to NDT through the muscle reeducation.

Joubert Syndrome with Severe Hypotonia: A case report

Joubert syndrome first described by Joubert et al. in 1969 is a very rare congenital disorder, characterized by episodic hyperpnea, abnormal eye movement, hypotonia, ataxia, and mental retardation. This syndrome generally represents as autosomal recessive inheritance and main neuropathological finding is agenesis or aplasia of the cerebellar vermis. This patient represents significant generalized muscle hypotonia which is not affected by any other tone-modifying maneuvers. And so there is no significant neuromotor improvement with neurodevelopmental treatment such as Bobath method, Vojta method, or proprioceptive nerve facilitation technique and so on. We report the Joubert syndrome showing typical features with delayed development.