Epidemiologic Study of Fracture in Stroke Patients

OBJECTIVE: Fracture has been reported as one of complicated problems in stroke patients. The purpose of this study is to provide epidemiologic data on fractures in stroke patients and investigate the specific feature of these fractures. METHOD: Stroke patients treated in Dong-Eui hospital due to fracture after stroke from March 1990 to March 1999 were enrolled in this study, and the retrospective study of fracture was performed on these patients. RESULTS: Subjects were 73 fracture patients with history of previous stroke. There were 50 patients with ischemic stroke and 23 patients with hemorrhagic stroke. And 35 patients were right hemiplegia, 38 patients were left hemiplegia. In this study, the causes of fracture were slip (63 cases, 86.3%), fall (6 cases, 8.2%), range of motion exercise (3 cases, 4.1%), and crushing injury (1 case, 1.4%). The frequency of fracture in patients who walk independently or with minimal to moderate assist was higher than in patients who walk with maximal assist or were bed-ridden state. In 65 patients, the fracture occured on the same side of hemiplegia. The distribution of fracture site was femur (45 cases, 61.6%), humerus (12 cases, 16.4%), and radius (3 cases) in the order of frequency. The interval between stroke and occurrence of fracture were less than 6 months in 34 cases (46.6%), 6 months to 1 year in 10 cases (13.7%), 1 to 2 years in 13 cases (17.8%), and 2 to 20 years in 16 cases (21.9%). CONCLUSION: As with our study, the fracture in stroke patient tend to occur within the first year after a stroke as a result of slip and the most frequently affected site is femur of hemiplegic side.

Variations of End Level of the Dural Sac

OBJECTIVE: To determine the normal variations of end level of the dural sac in Korean subjects by magnetic resonance imaging (MRI). METHOD: The corresponding vertebral level of termination of the dural sac was evaluated by MRIs in two hundred adult Koreans (118 males, 82 females). We excluded the subjects with spine fracture, significant spinal deformity or spinal stenosis. End level of the dural sac was described in terms of their corresponding vertebral level. The vertebral levels were further divided into upper, middle, lower level, and intervertebral disc levels from the L5 to S3 vertebra. RESULTS: The most frequent end level of the dural sac was at the S1-S2 intervertebral disc level (22.5%) which was followed by the upper portion of S2 (21.5%) and the middle portion of S2 (17.0%). There was no significant difference in end level of the dural sac between male and female subjects. CONCLUSION: The dural sac most frequently ended at the S1-S2 intervertebral level and the end level of dural sac were located from the L5-S1 intervertebral level to the mid-point of S3. In a clinical setting, variable levels of the dural sac termination should be considered in an unexpected dural puncture during a caudal anesthesia or injection.

Normal Variations of the Spinal Cord Termination

OBJECTIVE: To determine the level of conus medullaris in normal subjects by the magnetic resonance imaging (MRI). METHODS: The corresponding vertebral level of tip of conus medullaris was evaluated in MRIs (sagittal T1 and T2-weighted imaging) of 226 subjects composed of Koreans (138 males, 88 females) with no spine fracture or significant spinal deformity. The termination of the spinal cord was determined by locating the corresponding vertebral point of the lowest end of the conus medullaris to the three-points (upper, middle, and lower) of the nearest vertebral body and intervertebral discs between the T11 and S3 vertebral bodies. RESULTS: If the male and female groups were combined, the most frequent level of cord termination was the mid-portion of L1 (24.5%) which was followed by the lower portion of L1 (22.1%) and the L1-L2 intervertebral disc level (20.8%). In a female group, the tip of conus was one third of vertebra lower than in a male group with a statistical significance (Mann- Whitney test, p=0.025). CONCLUSION: The spinal cord terminates at the mid-portion of L1 most frequently and the termination level distributes from the mid-portion of T12 to the intervertebral disc level of L1-L2. In a clinical setting, variable levels of the spinal cord termination should be considered in a diagnosis for the determination of the neurological level of the spinal cord associated with a vertebral injury and an unexpected neurological complication after a spinal anesthesia or injection.

Sensitivity of Clinical Parameters and Electrophysiological Findings in Diabetic Polyneuropathy

Recent studies for the diabetic polyneuropathy have quantified as well as compared the clinical and the electrophysiological findings. Thirty-one diabetic patients were examined with a conventional nerve conduction study, a late response, a somatosensory evoked potential (SEP), a sympathetic skin response (SSR), a R-R interval, and a needle electromyography (EMG) after the clinical examination. The purposes of this study were to evaluate the correlation of clinical features and electrophysiological findings and to provide reliable criteria for the diagnosis of diabetic polyneuropathy. Diabetic polyneuropathy was diagnosed when a nerve conduction study revealed abnormal findings in two or more peripheral nerves. The following parameters were highly correlated with a diabetic polyneuropathy; ankle jerks (Spearman's r=0.92), H reflexes (Spearman's r=0.92), F waves by the tibial nerve stimulation (Spearman's r=0.88), F waves by the peroneal nerve stimulations (Spearman's r=0.84), and amplitudes of a sensory nerve action potential (SNAP) in the sural nerve (Spearman's r=0.79), SEPs by the tibial nerve stimulation (Spearman's r=0.79). Motor nerve conduction of the upper limbs, R-R interval ratios, and blood pressure changes had no significant correlations with a diabetic polyneuropathy. We concluded that these clinical and electrophysiological findings with significantly high correlation values would be good parameters for the diagnosis of diabetic polyneuropathy.

Cervical Cord Injury due to Atlantoaxial Dislocation in Down's Syndrome: A Case Report

The children with Down's syndrome are predisposed to atlantoaxial instability due to ligamentous laxity of the atlantoaxial joint. That can lead to cervical spinal cord compression. A careful neurologic examination and pe riodic screening for atlantoaxial instability would be very important for early detection and prompt management. We report a child with Down's syndrome who was diagnosed as atlantoaxial dislocation. Long times after the showed progressive symptoms of cervical cord compression including respiratory distress.