Collet-Sicard syndrome is a rare condition characterized by the unilateral paralysis of the 9th through 12th cranial nerves. We describe a case of a 46-year-old man who presented with dysphagia after a falling down injury. Computed tomography demonstrated burst fracture of the atlas. Physical examination revealed decreased gag reflex on the left side, decreased laryngeal elevation, tongue deviation to the left side, and atrophy of the left trapezius muscle. Videofluoroscopic swallowing study (VFSS) revealed frequent aspirations of a massive amount of thick liquid and incomplete opening of the upper esophageal sphincter during the pharyngeal phase. We report a rare case of Collet-Sicard syndrome caused by Jefferson fracture.
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Method: From July, 2001 to June, 2002, twelve patients who had calcaneal fractures with persistent foot pain and paresthesia were included in our study. We examined electromyography for medial and lateral plantar nerve, inferior calcaneal nerve, also evaluated types of calcaneal fracture and severity of pain and disability with nerve injury.
Results: The intraarticular types were 13 cases, extraarticular type was 1 case and communited types were 2 cases. In the electromyographic findings, the 9 cases were diagnosed as neuropathy. In a cases with neuropathy, 8 persons complained over moderate degree of pain and all persons complained over moderate degree of walking disability. However one of three persons without neuropathy complained over moderate degree of walking disability. So disability tended to be more severe in cases with neuropathy.
Conclusion: We think that neuropathy associated with calcaneal fracture is a cause of aggravation of pain and walking disability, and electromyography for nerves of foot will be needed in the calcaneal fracture. (J Korean Acad Rehab Med 2003; 27: 928-934)
Method: Thirty eight complete peripheral nerve injuries, diagnosed by motor and sensory nerve conduction studies (NCS) and needle electromyography (nEMG), were studied. Nerve injuries were grouped into two groups with and without SEP recorded at the time of initial evaluation. Outcome of nerve injuries was graded from 0 to 3 based on the results of NCSs and nEMG, followed up for more than six months. Grade 0 was designated for those with no evidence of recovery, and grade 3 for those with recovery in nEMG and both motor and sensory NCSs.
Results: At the time of initial electrodiagnosis, SEP study showed no response in 25 cases, but SEP could be observed in 13 cases, although they were attenuated or delayed. Recovery of nerve injury was observed in 22 cases, despite the findings compatible with complete injury in initial NCSs and nEMG. The group in which SEPs were recorded showed significantly higher grades of recovery, compared to no re sponse group.
Conclusion: In predicting the prognosis of complete peripheral nerve injuries, SEP study could be useful as a supplementary electrodiagnostic method.
Objective: To determine the effect of exercise in the early phase of reinnervation after sciatic nerve injuries in the rat.
Method: Thirty six rats, Sprague-Dawley (weight, 200 to 220 g), were divided into the normal control and experimental groups. Using a haemostatic forceps, crushing injuries to the bilateral sciatic nerves were induced in the experimental group. The experimental group was further divided into exercise groups by the duration of daily swimming and initiation (duration since injury) of exercise after nerve injury (A, 2 hours/day and day 1; B, 30 minutes/day and day 1; C, 2 hours/day and week 2; D, 30 minutes/day and week 2) and non-exercise group (E). After completion of 5-week program the test results were evaluated by 1) sciatic nerve motor conduction study recorded at the gastro-soleus muscles, 2) measurement of soleus muscle tension, and 3) hematoxylin-eosin stain & alkaline ATPase stain (pH 9.4) of the soleus muscles.
Results: Nerve conduction study revealed significantly prolonged latency in group C and decreased amplitude in the group C, D. Peak twich tension decreased significantly in group C, D & E. Maximal tetanic tension was increased significantly in the group A compared to C. Both type I and II muscle fibers atrophied significantly in all the experimental groups compared to the normal control group with no changes of the composition of two muscle fibers.
Conclusion: Swimming applied from the early phase after sciatic nerve injury may be beneficial in early recovery of muscle tension. Overexercise in the early stage of reinnervation, however, may hamper the functional return of the damaged muscle by nerve injury.
Objective: To evaluate the efficacy of direct current electrical fields and peripheral external electrical stimulation to promote regeneration of the transected rat sciatic nerve.
Method: Four groups were studied: three experimental groups and one control group. Cathod distal (CD) group; nerves were treated with 1.0 μA direct current with the cathode oriented distally to the lesion, anode distal (AD) group; nerves were treated with the anode oriented distally to the lesion, external stimulation (ES) group; nerves were treated with 3 mA, 60 Hz, galvanic current, using a ring electrode at ankle joint 3 times per day. No current was delivered in control group. Electrophysiologic and functional assessments were conducted at 3 weeks postoperatively.
Results: All experimental groups showed significantly higher electrophysiologic and functional improvement than the control group. However, there is no significant differece in improvement among experimental groups.
Conclusion: Both direct current electrical field and peripheral external electrical stimulation can effectively promote peripheral nerve regeneration.
Objective: To show the prevalence of the dorsomedial cutaneous nerve (DMCN) injury in the hallux valgus and to evaluate whether the sensory nerve damage contributes to pain and sensory impairment in the great toe.
Method: Sixty feet of healthy adults (normal group) and 26 feet of patients with hallux valgus (hallux valgus group) were evaluated with sensory nerve conduction study of DMCN. The prevalence of the nerve injury was compared between the two groups. Sensory nerve action potentials of DMCN in hallux valgus feet were analyzed and compared according to the patient's symptom and the severity of the radiographic measurements of the feet.
Results: The prevalence of DMCN injury was 42.3% of the hallux valgus group. The peak latency of the DMCN sensory action potential of the symptomatic feet showed statistically significant delay compared to the asymptomatic group (p＜0.05). Delay of the peak latency and decrement of the amplitude of the DMCN were statistically significant among the three groups as the valgus deformity worsened (p＜0.05).
Conclusion: DMCN injury should be considered in addition to soft tissue injury or arthritis in the differential diagnosis of the pain, burning sensation or numbness associated with hallux valgus.
Objective: To evaluate the changes of motor unit number estimation (MUNE) and the amplitude of compound muscle action potential (CMAP) according to severity of nerve injury in rat.
Method: The sciatic nerve was compressed with two different severity (mild, severe) in 20 rats each. MUNE was performed in gastrocnemius of rat using the Poisson statistics. MUNE and amplitude of CMAP were compared according to severity of injury at two and four weeks after injury.
Results: The MUNE and amplitude of CMAP were significantly diminished at two and four weeks after nerve injury in severely injured rat. Both values were also diminished at two weeks after injury in mildly injured rat. The amplitude of CMAP was slightly increased at four weeks after mild injury despite of further decrement of MUNE.
Conclusion: The MUNE and amplitude of CMAP changed differently according to severity of nerve injury in rat, which might represent different denervation and reinnervation process.
The evaluation of peripheral nerve disorders has traditionally relied on clinical history, physical examination, and electrodiagnostic studies. The electrodiagnostic study is currently most popular procedure. The purpose of this study is to assess the significance of the changes of amplitude and area of compound muscle action potentials(CMAPs) in peripheral nerve injury. After compression of sciatic nerve in 65 Korean house rabbits, the amplitude and the area of CMAPs were compared to each other before and after compression injury.
The correlation coefficients between the changes of the parameters, amplitude and area, were obtained at a scheduled interval, and the parameters were also assessed when the evidence of denervation and regeneration was seen. In addition, the relationship between the degree of abonormal spontaneous activities and each parameter was assessed.
At preinjury state, there was a significantly high correlationship between two parameters. The correlation coefficients were 0.764 and 0.756 with distal and proximal stimulations respectively in abductor hallucis recordings, and 0.649 in gastrocnemius recording. At postinjury, there was more significant high correlationship between two parameters. The correlation coefficients were 0.955 and 0.962 with distal and proximal stimulations respectively in abductor hallucis recordings, and 0.930 in gastrocnemius recording. Nineteen cases showed denervation activities at postinjury 4th day. Of those cases, the amplitude was decreased earlier in 2 cases and the area in 3 cases at the same day. Of 10 cases regenerated, the amplitude was normalized earlier than the area in 2 cases. There was a significant decrement tendency in both amplitude and area with the degree of abnormal spontaneous activities.
Therefore, both the amplitude and the area of CMAPs are good quantitative indices of peripheral neuropathy and useful parameters in long-term follow up study.
The evaluation of peripheral nerve disorders has traditionally relied on clinical history, physical examination and electrodiagnostic studies. The electrodiagnostic study is currently the most popular procedure to analyse the nerve lesion, but it is painful and its result is operator dependent. The purpose of this study is to evaluate the significance of MRI signal change of denervated muscle in peripheral nerve as an adjuvant study of electrodiagnostic study. After the compression of sciatic nerves in 20 rabbits and severance of scitic nerve in 10 rabbits, the signal change of both T1WI(TR; 450 msec, TE; 15 msec) and T2WI(TR; 3,000 msec TE; 90 msec) of calf muscles were compared with EMG findings of the same muscles. Signal intensity ratio(SIR) of calf muscles was measured and compaired with the grade of abnormal spontaneous activity in the same muscles in needle EMG study. Serial studies were done on 4th day, 1 week, 2 weeks, 3 weeks, 4 weeks, 6 weeks, 8 weeks, 10 weeks after sciatic nerve injury. Among 25 rabbits showing abnormal spontaneous activity in needle EMG, the signal intensity of both T1WI and T2WI was increased in 13 rabbits. The signal intensity began to increase at 1 week in 10 rabbits and 2 weeks in 3 rabbits following nerve injury which was about 1 week later than appearance of abnormal spontaneous activity in needle EMG study. There were no signal intensity increase in rabbits which showed no abnormal spontaneous activity in needle EMG study. The signal intensity ratio and grade of abnormal spontaneous activity had a good correlation(Spearman's correlation coefficiency : 0.635). The signal intensity of 3 rabbits which showed regeneration evidence in needle EMG study returned to normal. These findings suggest that MRI study of denervated muscle can be used as an evaluation method for severe peripheral nerve injury, howeverits value is doubtful in mild peripheral nerve injury.
Quantitative analysis of abnormal spontaneous activities, motor unit action potentials and interference patterns were recorded in 55 subjects with traumatic peripheral nerve injury to understand the changes of electromyographic signals.
We analyzed amplitudes of fibrillation potentials and positive sharp waves at rest, amplitude, duration, spike duration and polyphasicity of motor unit action potentials at minimal contraction, and the root mean square(RMS), and mean rectified voltage (MRV) at maximal contraction.
The amplitudes of fibrillation potentials and positive sharp waves had negative correlations with the duration of peripheral nerve injury but the amplitudes of motor unit action potentials, RMS, and MRV had positive correlations.
Therefore electromyographic evaluation could be used for the estimation of the duration of peripheral nerve injury.
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