Cerebral venous sinus thrombosis (CVST) is an uncommon cause of cerebral infarction, compared to arterial diseases. It is often unrecognized at initial presentation due to the diversity of causes and clinical manifestations. A 29-year-old female patient complained of severe headache and presented at the emergency room with altered consciousness. Brain computed tomography and brain magnetic resonance image revealed the left sigmoid sinus thrombosis with venous hemorrhagic infarction (VHI) in the left temporal lobe. The patient had no past medical and family history of bleeding diathesis. The laboratory finding at the admission showed severe iron-deficiency anemia (IDA), and protein C and S activities were decreased. After the neurosurgery, iron replacement, and neurorehabilitation, the patient had a good recovery. There has been no known recurrence. We report our therapeutic intervention on a very rare case of CVST and VHI, with IDA as a probable cause of cerebral thrombosis.
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To investigate the correlation between visuospatial neglect and anemia in patients with right cerebral infarction, as well as to identify the risk factor of neglect and furnish preliminary data on rehabilitation management.
The line bisection test and Albert test were conducted on subjects with right cerebral infarction in order to analyze neglect severity. Multiple linear regression analysis was conducted to investigate correlation between neglect severity and hemoglobin and hematocrit level. Logistic regression analysis was applied to identify the risk factor of neglect.
Visuospatial neglect was observed in 33 subjects out of 124. Hemoglobin and hematocrit were not directly correlated with visuospatial neglect severity, whereas infarct size was directly correlated. Subjects with visuospatial neglect were characterized by a large infarct size, a low score in the Mini-Mental State Examination and long hospital stay.
In this study, visuospatial neglect was found to be uncorrelated with anemia. It implies that emphasis should be placed on the early detection of anemia and neglect in patients with left hemiplegia, the formulation of respective therapeutic plans and improvement of prognosis. The study found that the possibility of a visuospatial neglect occurrence increases with infarct size. In this regard, it is required that visuospatial neglect was detected and treated in the earliest possible stage, notwithstanding the difficulty that lies in the precise measurement of the severity.
Objective: Anemia had been reported to be one of the common complications in the spinal cord injured patients. The purposes of this study were to investigate the incidence of anemia, its relating factors and efficacy of rehabilitation therapy in the acute spinal cord injured patients.
Method: A retrospective study was performed in the 103 acute spinal cord injured patients. We monitored serum hemoglobin, serum hematocrit, serum albumin and protein and change of the weight in the acute spinal cord injured patients at our rehabilitation department.
Results: The incidence of anemia was 62.1% (64/103). According to the level of injury, the incidence of anemia was 65.2% in cervical cord injury, 62.5% in thoracic cord injury and 46.2% in lumbar cord injury. The incidence of anemia was not different significantly by the severity of injury. The relating factors of anemia were urinary tract infection, pressure sore, acute bleeding, pneumonia, hypoalbuminemia, hypoproteinemia. Among these, hypoproteinemia was statistically related to anemia. The efficacy of functional independence measure (FIM) was significantly lower in the anemic group.
Conclusion: Therefore we should concern about the prevention and treatment of anemia in the spinal cord injured patients.
목 적: 성인의 요추간 원판염은 대부분 수술이나 침습적 진단후 이차적으로 발생되는 반면, 일차적인 원판염은 매우 드물다. 때문에 일차적 원판염은 조기 진단과 적절한 항생제 치료가 중요함에도 불구하고 간과되기 쉽고, 골주사나 자기공명영상 검사상 원판염 소견을 얻기 전까지는 확진이 어려워 치료가 늦어질 가능성이 높다. 이에 저자들은 재생불량성빈혈 환자에게 발생한 자발적 일차적 요추간 원판염에 의한 요통의 진단이 지연되었던 증례를 고찰과 함께 보고한다.
증례요약: 재생불량성 빈혈과 항림프구글로불린 치료 과거력을 가진 19세 남자가 패렴 치료중 요통을 호소하였다. 의료진은 원인을 혈청병 혹은 장기간 침상생할에 의한 것으로 판단하고 보존적 치료후 퇴원시켰다. 이후 환자는 요통의 악화로 다시 입원하였으며 재활의학과 의사의 요추간 원판염의 진단하에 항생제 치료를 하여 요통은 완화되었으나 대퇴골두에 발생한 화농성 괴사로 고관절 치환술을 시행받았다.
결 론: 원판염은 항생제 치료에 빠른 효과를 볼 수 있는 질환이다. 그러므로 면역력이 저하된 환자나 침습적 시술을 받은 환자가 심한 요통을 호소하는 경우 원판염도 반드시 고려해야 한다.
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