No Response Rates of Sensory Nerve Conduction Studies and Late Responses in Lower Limbs of Heathy Adults

OBJECTIVE: The purpose of this study was to determine no response rates of sensory nerve conduction studies and late responses in the lower limbs of healthy adults. METHOD: The subjects were 50 healthy adults (mean age, 45.6 years) without the clinical signs and symptoms of peripheral neuropathy. All subjects underwent electrodiagnostic evaluation of the following sensory nerves in lower limbs: superficial peroneal, sural, proximal sural, lateral dorsal cutaneous branch of sural nerve (LDSN), and medial plantar. Examined late responses included: tibial F-wave, peroneal F-wave, and H-reflex recorded from the soleus muscle. RESULT: No response rates of sensory nerve conduction studies such as superficial peroneal, sural, proximal sural, LDSN, and medial plantar nerves were 2%, 0%, 0%, 24%, and 18%, respectively. No response rates of late responses such as tibial F-wave, peroneal F-wave, and H-reflex were 0%, 2%, and 8%, respectively. And no response rates were significantly correlated with age (p<0.05). CONCLUSION: No response rate of sensory and late responses of lower limbs are relevant to age increments, the results should be considered for an early diagnosis of peripheral neuropathy in the lower limbs of old population.

Patterns of Voiding Dysfunction of Stroke Patients during Rehabilitation

OBJECTIVE: The purpose of this study is to evaluate the patterns of voiding dysfunction of stroke patients during rehabilitation. METHOD: We evaluated 53 patients with complaints of voiding dysfunction following the strokes. After the comprehensive history and physical examination, all patients underwent cystometric study and males underwent the transrectal ultrasound. RESULTS: The incidences of detrusor hyperreflexia, detrusor areflexia, and normal finding on the cystometry were 50.9%, 32.1%, and 17.0%, respectively (p<0.05). There was a significantly high incidence of detrusor hyperreflexia in the groups of subcortical lesion, large lesion, and the over 3 months after stroke (p<0.05). However, there was no statistical difference on cystometric findings according to the other characteristics of the stroke such as the age, sex, type of stroke, cognition, aphasia, and diabetes mellitus. The incidences of irritative, obstructive, and mixed symptoms according to the presenting voiding complaints were 49.1%, 32.1%, and 18.9%, respectively (p<0.05). There was no significant statistical difference on the cystometric findings according to the 3 voiding symptom groups as well as none of significant statistical difference on prostate enlargement in males in according to the 3 voiding symptom groups. CONCLUSION: Only with the pattern of voiding, we could not predict the cystometric finding or the presence of bladder outlet obstruction. Thus, we recommend the further studies including cystometry and evaluation of the bladder outlet obstruction for the treatment of voiding dysfunction of stroke patients during rehabilitation.

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.

Risk Factors Associated with Stroke Recurrence

OBJECTIVE: This study was done to evaluate the risk factors associated with recurrence after first-ever stroke. METHOD: We retrospectively studied 256 first-ever stroke patients treated in Dong-Eui hospital from March 1997 to February 1998. Telephone or out-patient interviews were performed with these patients regarding stroke recurrence and treatment for hypertension and diabetes mellitus. These were divided into two groups, those with recurrence and those without. Evaluated risk factors for stroke recurrence were the following: history of diabetes mellitus, hypertension, heart disease, smoking, alcohol drinking, and transient ischemic attack; clinical findings at admission of hypertension, diabetes mellitus, hyperlipidemia, heart disease, type and location of stroke; treatment compliance for diabetes mellitus and hypertension after discharge. RESULTS: The recurrence rate after first-ever stroke was 12.9%. In univariate analysis, significant risk factors for stroke recurrence were history of smoking, clinical findings at admission of diabetes mellitus, atrial fibrillation, ischemic heart disease, and non-compliance with therapy for diabetes mellitus and hypertension after discharge (p<0.05). In multivariate analysis, significant risk factors for stroke recurrence were atrial fibrillation at admission (odds ratio=3.43) and non-compliance with therapy for hypertension after discharge (odds ratio=7.51)(p<0.05). CONCLUSION: History of smoking, clinical findings at admission of diabetes mellitus, atrial fibrillation, ischemic heart disease, and non-compliance with therapy for diabetes mellitus and hypertension after discharge are considered to be important factors for recurrence of stroke. So treatment and education for those factors associated with stroke recurrence are needed during rehabilitation program.