ABSTRACT
BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) and Repetitive facilitative exercise (RFE) improves motor impairment after stroke. OBJECTIVE: To investigate whether neuromuscular electrical stimulation (NMES) can facilitate the effects of rTMS and RFE on the function of the hemiparetic hand in stroke patients. METHODS: This randomized double-blinded crossover study divided 20 patients with hemiparesis into two groups and provided treatment for 4 weeks at 5 days/week. NMES-before-sham group and NMES-following-sham group performed NMES sessions and sham NMES sessions for each 2 weeks. Patients received NMES or sham NMES for the affected extensor muscle concurrently with 1âHz rTMS for the unaffected motor cortex for 10âmin and performed RFE for 60âmin. The Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), Box and Block Test (BBT) and Modified Ashworth Scale (MAS) were used for evaluation. RESULTS: FMA and ARAT improved significantly during both sessions. The gains in the BBT during an NMES session were significantly greater than those during a sham NMES session. MAS for the wrist and finger significantly decreased only during an NMES session. CONCLUSIONS: NMES combined with rTMS might facilitate, at least in part, the beneficial effects of RFE on motor function and spasticity of the affected upper limb.
Subject(s)
Exercise Therapy/methods , Hand , Paresis/rehabilitation , Stroke Rehabilitation/methods , Transcranial Direct Current Stimulation/methods , Transcranial Magnetic Stimulation/methods , Adult , Aged , Combined Modality Therapy/methods , Combined Modality Therapy/trends , Cross-Over Studies , Double-Blind Method , Electric Stimulation Therapy/methods , Electric Stimulation Therapy/trends , Exercise Therapy/trends , Female , Hand/physiopathology , Humans , Male , Middle Aged , Paresis/physiopathology , Random Allocation , Stroke/complications , Stroke Rehabilitation/trends , Transcranial Direct Current Stimulation/trends , Transcranial Magnetic Stimulation/trends , Treatment OutcomeABSTRACT
A 45-year-old woman was admitted with headache following sudden disturbance of consciousness that occurred two hours beforehand. A neurological examination identified disorientation, left homonymous hemianopia, left hemiplegia, and sensory disturbance in the left limbs. Brain MRI DWI showed acute infarcts in the right occipital lobe and bilateral thalami, and MRA poorly depicted right vertebral artery and right posterior cerebral artery. Anticoagulation was started to treat acute ischemic stroke, but her consciousness level deteriorated at 12 hours after onset. MRI revealed a double lumen in the basilar artery, indicating a diagnosis of vertebrobasilar artery dissection. Serial MRA findings showed that images of the basilar artery and posterior cerebral artery changed over time, suggesting vertebral artery dissection extension to the posterior cerebral artery.
Subject(s)
Basilar Artery/diagnostic imaging , Stroke/diagnostic imaging , Stroke/etiology , Vertebral Artery Dissection/complications , Vertebral Artery Dissection/diagnostic imaging , Vertebral Artery/diagnostic imaging , Diffusion Magnetic Resonance Imaging , Female , Humans , Magnetic Resonance Angiography , Middle AgedABSTRACT
Hereditary diffuse leukoencephalopathy with spheroids (HDLS) is a young-adult-onset autosomal dominant white matter disease characterized by progressive cognitive dysfunction. We herein report the case of a 20-year-old woman who developed spastic hemiplegia. Brain magnetic resonance imaging revealed increased bilateral T2 signal intensity and bright diffusion-weighted imaging signals with a low apparent diffusion coefficient within the frontoparietal white matter. The lesion gradually expanded for over one year. The patient was initially diagnosed with multiple sclerosis (MS); however, she did not respond to immunosuppressive therapy. DNA sequencing showed a heterozygous c.2381T>C mutation in colony-stimulating factor 1 receptor. HDLS with a pure motor phenotype is sometimes difficult to differentiate from MS.