Annals of Rehabilitation Medicine

Wernicke's Encephalopathy and Peripheral Polyneuropathy Developed during Long Term Metronidazole Therapy in a Patient with a Brain Abscess: A Case Report.: Park, Nyo Kyung , Kwon, Bum Sun , Park, Jin Woo , Lee, Ho Jun , Ryu, Gi Hyeong , Jeong, Sang Wuk , Noh, Sang Mi; J Korean Acad Rehabil Med 2011;35(1):122-128.

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Metronidazole can induce serious neurologic problems including peripheral neuropathy, seizures, and encephalopathy. We examined a patient with acute Wernicke's encephalopathy and peripheral polyneuropathy that had developed after prolonged metronidazole therapy without a history of chronic alcoholism or poor nutritional intake. The 68-year-old man had been hospitalized for a brain abscess and was treated for 10 weeks with metronidazole (2 grams per day). This patient, who showed symptoms of numbness and tingling in the legs, was referred for electromyography (EMG) and was diagnosed with peripheral polyneuropathy. A few days later, he developed sudden ataxia, dizziness, and diplopia. The neurologic examination revealed nystagmus and ophthalmoplegia, and the FLAIR brain MRI showed symmetrical high signal intensity lesions in the cerebellar dentate nucleus, midbrain, tegmentum around the periaqueductal gray matter, and tectum. After administering intravenous thiamine and stopping the metronidazole therapy, he recovered from the ophthalmoplegia and ataxia. Brain MR showed complete recovery within 3 weeks; however the EMG remained abnormal for a further 6 months, although the symptoms were almost completely resolved by this time.

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Multiple Symmetric Lipomatosis with Peripheral Neuropathy: A case report.: Lee, Joo Young , Park, Young Ok , Yang, Hee Seung , Kang, Eun Kyoung , Lim, Min Jeong; J Korean Acad Rehabil Med 2004;28(6):622-626.

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Multiple symmetric lipomatosis is a rare disorder characterized by massive fatty deposits arranged symmetrically around the neck, shoulder, abdomen and back. It is typically associated with high alcohol consumption and a high prevalence of peripheral neuropathy. The pathogenesis of the syndrome is still unknown, but mitochondrial abnormality or metabolic abnormalities are occasionally found in the affected patients. In our patient, clinical and electrophysiologic signs of a generalized peripheral sensorimotor neuropathy and a multiple bilateral lumbosacral radiculopathywere observed. Sural nerve biopsy demonstrated many small unmyelinated fibers with complete loss of axoplasm and a extensive loss of myelinated fibers. Lipoma biopsy demonstrated non-capsulated mature adipose cells in the subcutaneous tissue. Serum lipid studies were normal. MERRF point mutation of mitochondrial DNA were negative in blood. We reported a case of multiple symmetric lipomatosis and peripheral polyneuropathy with the review of literature. (J Korean Acad Rehab Med 2004; 28: 622-626)

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One Case of Peripheral Polyneuropathy Associated with Klippel-Trenaunay Syndrome: A case report.: Lee, Namju , Lee, Sanghyo , Kim, Hyundong; J Korean Acad Rehabil Med 2004;28(4):383-386.

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Klippel-Trenaunnay syndrome is characterized by three typical clinical manifestations; 1) Capillary malformations (port-wine stains), 2) bony and soft tissue hypertrophy, 3) varicosities or venous malforamation, but many other clinical manifestations can be presented. Although many associated clinical manifestations were reported in Klippel- Trenaunay syndrome, peripheral polyneuropathy or any other results of electrodiagonostic study were not reported previously. We experienced a 22 year old male who was transfered in rehabiliation program after surgical manage-ment of intra cerebral hemorrhage. During rehabilitation program we diagnosed him as Klippel-Trenaunay syndrome by three typical clinical manifestations associated with dilated cardiomyopathy. He also presented sensory impairment in distal part of all extremites. Electrodiagonostic study revealed peripheral polyneuropathy. We concluded that the possibility of peripheral polyneuropathy should be considered in Klippel-Trenaunnay syndrome. (J Korean Acad Rehab Med 2004; 28: 383-386)

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Arteiovenous Fistula Effects on Peripheral Nerve in Patients with Chronic Renal Failure.: Jung, Tae Du , Park, Chang Young , Lee, Yang Soo; J Korean Acad Rehabil Med 2003;27(1):85-89.

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Objective
The purpose of this study is to evaluate the arteiovenous fistula effects on peripheral nerve in patients with chronic renal failure by nerve conduction studies.

Method: Nerve conduction studies were performed in 23 patients with chronic renal failure. We not only measured distal latencies, amplitudes, and conduction velocities of median and ulnar motor nerves but also measured same parameters of radial sensory nerves at both upper limbs. In case of pateints with suspected peripheral polyneuropathy, we checked peripheral nerves at one lower limb. The results of nerve conduction studies and the frequency of cubital tunnel syndrome or carpal tunnel syndrome were compared between arteiovenous fistula side and non-arteiovenous fistula side.

Results: The amplitudes of median motor, ulnar motor nerves and radial sensory nerve in arteiovenous fisula side are statistically lower than those in non-arteiovenous fisula side (p＜0.05). In the 14 patients with peripheral polyneuropathy, the difference is also statistically significant between two sides (p＜0.05). Compared arteiovenous fisula side with non-arteiovenous fisula side, the frequency of cubital tunnel syndrome or carpal tunnel syndrome was not different between two sides.

Conclusion: Arteiovenous fisula may damage to the peripheral nerve in patients with chronic renal failure. (J Korean Acad Rehab Med 2003; 27: 85-89)

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Relations of Glycosylated Hemoglobin and Parameters of Nerve Conduction Study in Diabetic Peripheral Polyneuropathy.: Jeong, Tae Seok , Choi, Ki Sub , Kim, Hyun Jung , Park, Young Seok; J Korean Acad Rehabil Med 2003;27(1):80-84.

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Objective
This study was performed to determine the relations of glycosylated hemoglobin (HbA1c) and parameters of nerve conduction study (NCS) in diabetic peripheral polyneuropathy patients.

Method: Prospectively, total 40 patients with non-insulin dependent diabetes mellitus were included in the study. NCS was performed on median, ulnar, posterior tibial, deep peroneal, superficial peroneal, and sural nerves. Distal latency and conduction velocity (CV) of compound muscle action potential (CMAP), distal latency and amplitude of sensory nerve action potential (SNAP) were used as parameters of NCS. Multiple linear regression analysis were used to analyze the relations of HbA1c and parameters of NCS, after adjustment for age, height, weight, and disease duration of diabetes mellitus.

Results: HbA1c level had an inverse relation to CV of median motor nerve (β=⁣1.272, p＜0.01), ulnar motor nerve (β=⁣1.287, p＜0.01), posterior tibial nerve (β=⁣0.982, p＜0.05), and deep peroneal nerve (β=⁣1.449, p＜0.05).

Conclusion: This study indicates that HbA1c level was inversely related to motor nerve CV, and that sustained hyperglycemia may be involved in demyelination of motor nerves. Analysis of motor nerve CV related to HbA1c is expected to be useful in the follow-up or efficacy study of diabetes mellitus neuropathy as baseline data. (J Korean Acad Rehab Med 2003; 27: 80-84)

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Organophosphate Induced Peripheral Polyneuropathy with Delayed Myelopathy: A case report.: Shin, Hye Sung , Hwang, Jung Hye , Lee, Chyung Ki; J Korean Acad Rehabil Med 2002;26(1):113-116.

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Organophosphate is known to damage both the peripheral and central nervous system. We report a case of organophosphate-induced peripheral polyneuropathy with myelopathy. A 46 years old woman who had ingested a large amount of insecticide (organophosphate) was transported to our hospital. Following medical treatment, she was transferred to the Department of Rehabilitation Medicine 1 month later. Upon admission to rehabilitation medicine, the patient was quadriplegic with markedly decreased muscle tone and strength. Electrodiagnostic examination revealed low amplitude of sensory nerve action potential (SNAP), unevokable compound muscle action potential in distal muscles and abnormal spontaneous activities with needle

electromyography, which were compatible with peripheral polyneuropathy. Three months later, motor and sensory function of upper extremities were normalized. The muscle tone of lower extremity increased to Ashworth grade II. Follow-up electrodiagnostic examination revealed normalization of SNAP and disappearance of spontaneous activities, but somatosensory evoked potential which were initially normal, revealed prolonged P40 latencies in the lower extremities. These electrophysiological findings were thought to result from the spinal cord lesion and correlated with clinical findings. We diagnosed the patient as peripheral polyneuropathy with delayed myelopathy induced by organophosphate. (J Korean Acad Rehab Med 2002; 26: 113-116)

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Evaluation of Peripheral Polyneuropathy in Patients with Diabetes Mellitus Using Quantitative Sensory Test.: Park, Jeong Mee , Kang, Seok Jeong , Kim, Ki Wan , Kim, Jin Weon , Kim, Seong Hoon; J Korean Acad Rehabil Med 2001;25(1):102-109.

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Objective: The purpose of this study was to determine whether quantitative sensory test can be used as a screening test of peripheral polyneuropathy in patients with diabetes mellitus, and to evaluate the severity of peripheral polyneuropathy in patients with diabetes mellitus using quantitative sensory test.

Method: We performed nerve conduction study to right upper and left lower extremity of the patients. Quantitative sensory test was performed using TSA-2001 thermal sensory analyser on right thenar and left foot dorsum in both diabetic and control groups.

Results: 1) The warm sense and heat pain threshold were higher, the cold sense and cold pain threshold were lower in diabetic group than age-matched control group (p＜0.05). 2) The warm sense and heat pain threshold were higher, the cold sense and cold pain threshold were lower in diabetic group than young-aged control group (p＜0.05). 3) As nerve conduction study results were severe, the cold sense threshold in right thenar were decreased (p＜0.05).

Conclusion: Quantitative sensory study in patients with diabetes mellitus are sensitive to identify neuropathic change; thus, they would be used as the screening method of diabetic peripheral polyneuropathy.