Osmolar relation between cerebrospinal fluid and serum in hyperosmolar hypernatraemic dehydration. (65/797)

The relation between cerebrospinal fluid (CSF) and serum osmolality was studied in 16 patients with hyperosmolar hypernatraemic dehydration before treatment. After correcting shock and acidosis, 0-45% saline in 2-5 or 5% dextrose was infused in each patient over a 48- to 72-hour period. During rehydration, serum osmolality, electrolyte concentrations, urea nitrogen, and blood pH were measured sequentially. Five patients developed severe neurological abnormalities within 48 hours of addmission (convulsions 2, convulsions with hemiplegia 2, hemiplegia 1). Of these, 3 had residual defects on follow-up at least one year later. This group was indistinguishable from the 11 without significant neurological abnormality, both on clinical grounds before rehydration, and after analysis of admission and subsequent serum biochemical variables. A significant osmolar gap (greater than 4 mmol/kg H2O) between serum and CSF was found in 13 patients. Severe neurological disturbance only occurred when CSF osmolality exceeded that of serum by 7 or more mmol/kg H2O. Discriminant analysis of the paired osmolar data showed that D = -117+1-74 X(CSF osmolality) -1-41 X (serum osmolality), and that severe neurological abnormality was predicted when D was positive.  (+info)

Reliability of measurements obtained with the modified Ashworth scale in the lower extremities of people with stroke. (66/797)

BACKGROUND AND PURPOSE: Abnormal muscle tone is a common motor disorder following stroke, which may require rehabilitation. The Modified Ashworth Scale is a 6-point rating scale that is used to measure muscle tone. The interrater and intrarater reliability of measurements obtained with the scale remain equivocal. The purpose of this study was to investigate the reliability of measurements obtained with the scale in the lower limb of patients with stroke. SUBJECTS: Twenty patients were tested 2 weeks after their stroke, and 12 patients were tested 12 weeks after their stroke. METHODS: Gastrocnemius, soleus, and quadriceps femoris muscles on the hemiplegic side were tested. RESULTS: Interrater reliability for 2 raters was poor, with a Kendall tau-b correlation for the combined muscle group of.062 (P=.461). For intrarater reliability, the Kendall tau-b correlation was.567 (P<.001). The agreement within one rater occurred mostly on the grade of 0. DISCUSSION AND CONCLUSION: The Modified Ashworth Scale yielded reliable measurements in the lower limb for a single examiner, and agreement was best on the grade of 0. The reliability between examiners was not good, which may bring into question the validity of measurements obtained with the scale.  (+info)

Hemiplegic/monoplegic presentation of cervical spine (C1-C2) tuberculosis. (67/797)

Tuberculosis of the craniovertebral region is very rare. Neural deficit in this region is reported in between 24% and 64% of cases, and mainly takes the form of quadriparesis. Hemiplegic and monoplegic presentation among this set of patients is rarer. Out of 32 patients treated at our institution between May 1989 and February 2001, only one had hemiplegia, while two had monoplegia. These three cases are discussed. Case 1 involved a 45-year-old woman who presented with hemiplegia following a trivial fall. Plain radiographs and computed tomographic (CT) scans of the skull appeared normal, but CT scans of C1-C2 and the craniovertebral junction revealed destruction of the dens and atlantoaxial subluxation. The patients in cases 2 and 3 had monoplegia. Plain radiographs in both cases showed an increased prevertebral soft tissue shadow in front of C1-C2. CT in case 2 and magnetic resonance imaging (MRI) in case 3 revealed destruction of the arch of C1 and the dens, with subluxation. All three patients were successfully treated with rest, skull traction, anti-tubercular drugs and suitable braces. Case 3 required stabilization. All three patients achieved complete neural recovery. Patients 1, 2 and 3 had 22, 48 and 4 months' follow-up respectively. Patient 3 was subsequently transferred to a neurosurgery ward for stabilization of the occipito-C3 vertebrae. Hemi/monoplegic presentation is extremely rare; no author in the literature is able to give reason for the rarity or the pathomechanics of the condition. We believe that if medullary cervical junctional involvement extends slightly higher (in rare circumstances), with involvement of one of the branches of the vertebral or lower basilar artery, medial medullary syndrome will occur, sparing medial lemniscus and emerging hypoglossal nerve fibres. Thus the pyramids will be involved, causing contralateral hemiparesis, and if the pyramids are selectively involved, it will cause contralateral monoparesis.  (+info)

Chorea, polycythaemis, and cyanotic heart disease. (68/797)

Two cases of polycythaemic chorea are described, both of which were complicated by severe heart disease. The first was a child with patent ductus arteriosus and coarctation of the aorta causing severe cyanosis and secondary polycythaemia. Chorea began intermittently at an early age, becoming continuous by his fifth birthday. The second was a middle-aged male with tight mitral stenosis and a story of paralytic chorea in his teens. Polycythaemia rubra vera was eventually diagnosed two years after mitral valvotomy, some seven years after the onset of chorea.  (+info)

"Pure" motor hemiplegia. (69/797)

Attenuation of cerebral evoked responses after stimulation of the median nerve in the hemiplegic limbs suggested that an apparently pure motor hemiplegia in some patients may not have pure involvement of the corticospinal system. Frontoparietal metastasis, infarction in basis pontis and medullary pyramid, and occlusion of internal carotid artery in the neck resulted in pure motor hemiplegia in some individuals.  (+info)

Mobility status during inpatient rehabilitation: a comparison of patients with stroke and traumatic brain injury. (70/797)

OBJECTIVES: To compare the mobility status (admission and discharge status, change in status) between patients with stroke and traumatic brain injury (TBI) during inpatient rehabilitation and to determine the relationship between mobility status and outcome variables including length of stay (LOS). DESIGN: Prospective study. SETTING: Free-standing tertiary rehabilitation center. PARTICIPANTS: A total of 210 patients with stroke (n = 136) and TBI (n = 74) consecutively admitted for inpatient rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Clinical Outcome Variable Scale (COVS), a 13-item scale of mobility status (measured on admission and discharge from inpatient rehabilitation), and rehabilitation LOS. RESULTS: With age and time since injury controlled in the model, the TBI group showed a significantly higher mobility status on admission and discharge over the stroke group, but the change (improvement) in mobility status did not differ. The admission mobility status accounted for 61% and 60% of variability of the discharge mobility status for the stroke and TBI groups, respectively. The admission mobility status accounted for 40% and 50% of the variability in rehabilitation LOS for the stroke and TBI groups, respectively. Either the admission mobility status or the physical therapist's prediction of the discharge status could be used to determine the actual discharge mobility status, although the physical therapist's predictions were more accurate than using a statistical model. CONCLUSIONS: The TBI group showed a higher mobility status at admission and discharge from inpatient rehabilitation than the stroke group; however, the rate of improvement (improvement in mobility status per day) did not differ between groups. Admission mobility status using the COVS was an excellent predictor of discharge mobility status and rehabilitation LOS in stroke and TBI patients.  (+info)

Kinks, coils, and carotids: a review. (71/797)

Kinking and coiling of the internal carotid artery (ICA) sometimes may result in symptomatic cerebrovascular disease, but indisputable evidence linking the two conditions is lacking. However, there is enough evidence to warrant careful consideration of surgical correction in patients who have features of the carotid artery syndrome and kinking of the ICA as shown on angiography. Kinking or buckling of the artery is due to atherosclerosis and is to be distinguished from coiling, which is ascribed to embryological causes. Definite recommendations regarding the advisability of surgery for infants who are discovered to have coils cannot be made, but coiling is generally asymptomatic. Adults with kinks in their carotid arteries who have recurrent transient ischemic attacks (TIAs) benefit most from surgical correction, particularly if symptoms are aggravated on head rotation, which may cause the kink to obstruct.  (+info)

Effect of duration of upper- and lower-extremity rehabilitation sessions and walking speed on recovery of interlimb coordination in hemiplegic gait. (72/797)

BACKGROUND AND PURPOSE: The effects of different durations of rehabilitation sessions for the upper extremities (UEs) and lower extremities (LEs) on the recovery of interlimb coordination in hemiplegic gait in patients who have had a stroke were investigated. SUBJECTS AND METHODS: Fifty-three subjects who had strokes involving their middle cerebral arteries were assigned to rehabilitation programs with (1) an emphasis on the LEs, (2) an emphasis on the paretic UE, or (3) a condition in which the paretic arm (UE) and leg (LE) were immobilized with an inflatable pressure splint (control treatment). The 3 treatment regimens were applied for 30 minutes, 5 days a week, during the first 20 weeks after onset of stroke. All subjects also participated in a rehabilitation program 5 days a week that consisted of 15 minutes of UE exercises and 15 minutes of LE exercises in addition to a weekly 11/2-hour session of training in activities of daily living. A repeated-measures design was used. Differences among the 3 treatment regimens were evaluated in terms of comfortable and maximal walking speeds. In addition, mean continuous relative phase (CRP) between paretic arm and leg (PAL) movements and nonparetic arm and leg (NAL) movements and standard deviations of CRP of both limb pairs as a measurement of stability (variability) were evaluated. RESULTS: Comfortable walking speed improved in the group that received interventions involving the LEs compared with the group that received interventions involving the UEs and the group that received the control treatment. No differences among the 3 treatment conditions were found for the mean CRP of NAL and PAL as well as the standard deviation of CRP of both limb pairs. DISCUSSION AND CONCLUSION: With the exception of an improved comfortable walking speed as a result of a longer duration of rehabilitation sessions, no differential effects of duration of rehabilitation sessions for the LEs and UEs on the variable we measured related to hemiplegic gait were found. Increasing walking speed, however, resulted in a larger mean CRP for both limb pairs, with increased stability and asymmetry of walking, indicating that walking speed influences interlimb coordination in hemiplegic gait.  (+info)