Autonomic dysreflexia in a man with multiple sclerosis.

BACKGROUND/OBJECTIVE: To report manifestation of autonomic dysreflexia (AD) in a man with multiple sclerosis (MS). DESIGN: Case report. FINDINGS: A young man presented with a history of several admissions to the emergency department with complaints of hypertensive attacks, palpitations, difficulty in breathing, headaches, and flushing. The attacks were attributed to a previously diagnosed anxiety disorder. Onset of numbness of the left leg numbness prompted a more thorough study, which showed evidence of MS. AD was suspected as the cause of his recurrent attacks of hypertension. Bladder distension was identified as the cause of AD, and his hypertensive attacks were controlled by management of neurogenic bladder. CONCLUSIONS: This report emphasizes that AD can occur in MS. Somatic symptoms warrant thorough investigation before attributing them to psychosomatic causes.

The utility of high b-value DWI in evaluation of ischemic stroke at 3T.

PURPOSE: The utility of DWI with high b-value in ischemic stroke is still unsettled. The purpose of this study is to compare high b-value (3000) and standard b-value (1000) diffusion-weighted images in patients with ischemic stroke at 3T. MATERIALS AND METHODS: 27 patients with acute stroke who were admitted to the hospital during the first 24h after symptom onset were included in this study. All patients had a brain MRI study with stroke protocol including standard (b=1000) DWI and high b-value (b=3000) DWI sequences at 3T MR scanner. Number and localization of the lesions were assessed MR signal intensities (SI), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), contrast ratio (CR) and apparent diffusion coefficient (ADC) values of the lesions and normal parenchyma on DWI with b=1000 and b=3000 sequences were measured. RESULTS: All patients with acute stroke revealed hyperintense lesions due to restricted diffusion on DWI with both b-values. However, lesions of restricted diffusion were more conspicuous in b=3000 value DWI than b=1000, and additional 4 ischemic lesions were detected on b=3000 DWI. SNR, CNR, SI and also ADC values in both stroke area and normal parenchyma were lower at b=3000 than the value at b=1000. At b=3000, CR was significantly greater than b=1000 images. CONCLUSIONS: Although quantitative analysis shows higher SI, SNR and CNR values with standard b-value (b=1000) diffusion-weighted imaging, using higher b-value may still be beneficial in detecting additional subtle lesions in patients whose clinical findings are not correlated with standard b-value DWI in stroke.

Spinal accessory nerve monitoring in posterior fossa surgery.

The role of intraoperative monitoring of lower cranial nerves is not well established. In this study, the authors retrospectively analyzed the intraoperative monitoring data and the clinical outcome of the spinal accessory nerve (SAN) in patients who have undergone posterior fossa surgery. SAN was monitored in 19 patients. Subcutaneous needle electrodes were placed in the trapezius, and any abnormal spontaneous activity was documented for duration and amplitude. A bipolar stimulation probe was used for triggered electromyogram, with a maximum stimulation intensity of 3 mA. All patients were clinically evaluated for SAN dysfunction postoperatively 24 hours and 7 days. Neurotonic discharges, lasting between 3 and 90 minutes were seen in 84% of the patients. Continuous discharges lasting longer than 5 minutes were seen in 36% of the patients. The SAN was stimulated in 57.8% of the patients. With clinical examination, none of our patients had postoperative SAN dysfunction. Long lasting dense neurotonic discharges and high stimulation thresholds have been correlated with postoperative facial nerve injury; however, this does seem be true in the case of SAN monitoring. Neurotonic discharges are commonly false-positive and stimulation intensity up to 3 mA can be related with a good outcome. The intraoperative monitoring of SAN may not be valuable as much as facial nerve monitoring.