A 53-year-old man abruptly developed headache and unconsciousness. Brain computed tomography (CT) and CT angiography showed subarachnoid hemorrhage, intraventricular hemorrhage, and multiple tortuous vascular structures on the brain stem and upper cervical spinal cord. Four-vessel angiography displayed intradural ventral arteriovenous fistula, supplied by the left vertebral and occipital arteries. Drainage was via both sigmoid sinus and cervical venous plexus. He had been treated with transarterial coil embolization of the left vertebral artery. Subsequently, he suffered from left hemiplegia and cognitive problem. Brain magnetic resonance (MR) and MR angiography performed 4 weeks later revealed multiple infarctions on the left cerebellum, left upper cervical spinal cord, and both medial thalamus, as well as occlusion of the left vertebral artery with reduction in varix size. After rehabilitative management, his muscle strength and cognitive function improved. We report a very rare case of dural arteriovenous fistula on the brain stem and upper cervical spinal cord.

Background: Age is one of the many factors that can influence functional improvement and activities of daily living (ADL) after a stroke. We looked at the effects of functional improvement of hemiplegic upper extremity (HUE) on ADL according to age in stroke patients. Methods: We recruited 46 stroke patients beginning acute or subacute rehabilitation. They were classified into two groups according to age, the elderly group (≥65 years, n=18) and the young group (<65 years, n=28). We performed the Pedretti clinical test for sensory evaluation of the upper extremity, the manual function test (MFT) to exam the motor function, and the functional independence measure (FIM) to assess ADL. Results: Sensory changes to HUE correlated significantly with eating, dressing-lower body, and toileting (self-care subitem) (p<0.05). Motor changes to HUE correlated significantly with dressing-upper body and toileting (self-care sub-item) (p<0.05). Prior to beginning rehabilitation, there were significant differences in sensory and motor functions of HUE between the two groups (p<0.05) but no significant difference in FIM (p>0.05). There were no significant differences in the changes to Pedretti clinical test, MFT, and FIM between the two groups before and after rehabilitation (p>0.05). In the young group, the motor improvement of HUE correlated significantly with FIM (p<0.05). In the elderly group, however, the sensory improvement and motor improvement of HUE were not correlated with FIM (p>0.05). Conclusion: In our study, elderly stroke patients showed improvement in function and ADL similar to young stroke patients. This potential should be maximized and elderly stroke patients should receive active rehabilitation.

A 49-year-old man received prolotherapy in the upper cervical region at a local medical clinic. Immediately after the procedure, he felt a sensation resembling an electric shock in his right upper and lower extremities, and continuously complained of numbness and discomfort in the right hemibody. He visited our clinic a week later. Upon physical examination, there were no significant abnormal findings. The visual analog scale was 60 points. T2-weight magnetic resonance images of the cervical spine showed a 0.7 cm sized bright oval spot on the right side of the spinal cord at the level of C4-C5 disc, suggesting spinal cord injury. There were no definite electrodiagnostic abnormalities. Digital infrared thermal images showed moderately decreased surface temperature on lateral aspect of the right forearm and dorsum of the right hand compared with the other side. Considering that very rare complications like spinal cord injury may develop after prolotherapy, we suggest that special interventions such as prolotherapy be performed by professional experts.

No abstract

Objective:To investigate the effect of regular exercise program on cognitive function in chronic cerebral hypoperfused rat. Method: Forty-eight male Sprague-Dawley rats were used. Chronic cerebral hypoperfusion was induced by bilateral common carotid arteries occlusion (BCCAO). All rats were randomly divided into 4 groups: normal rats (group A); normal rats with regular exercise program (group B); BCCAO rats (group C); BCCAO rats with regular exercise program (group D). Regular exercise program was composed of daily 30-minute treadmill exercise for 4 weeks. Cognitive function was evaluated by Morris water maze (MWM) test. The activities of superoxide dismutase (SOD) and the level of malondialdehyde (MDA) were checked. The neurons were microscopically analyzed on Hematoxylin-Eosin and Cresyl violet stains. Results: After regular exercise program, there was significant difference in the escape latency among 4 groups in hidden platform trial of MWM test (p＜0.05). There was significant difference in the number of crossings among 4 groups in probe trial of MWM test (p＜0.05). The activities of SOD of group A and group D were significantly higher than those of group C, respectively (p＜0.05). Histopathological study displayed the formation of apoptotic cell bodies and pyknotic cells in group C and group D. There were more normal neurons in group D than group C. Conclusion: Regular treadmill exercise was helpful in improving cognitive function in chronic cerebral hypoperfused rat. Therefore, regular exercise program would be one of the useful strategies for treating chronic neurodegenerative diseases. (Brain & NeuroRehabilitation 2011; 4: 95-102) 인구의 고령화와 함께 치매와 같은 퇴행성 뇌신경질환 의 발생률이 점차 증가하고 있으며, 2005년 기준 우리나 라의 치매 발생률은 6.3%에 해당한다. 1 혈관성 치매는 알 츠하이머 치매(Alzheimer's disease)에 이어 두 번째로 흔한 치매로, 2 혈관계가 막히거나 질환에 의해 뇌로 가는 혈류 가 감소되었을 때 발생하며, 3 기억과 인지기능의 점진적 인 퇴행을 초래한다. 4 만성 대뇌 저관류 백서 모델은 치매 연구를 위한 대표적 인 동물 실험 모델이다. 백서에서 만성 대뇌 저관류는 영 구적으로 양측 총경동맥을 결찰(bilateral common carotid arteries occlusion, BCCAO)함으로써 유발되며, 저명한 백 질 병변, 학습 및 기억 장애, 해마의 신경원 손상 등을 초 래한다. 5 이러한 양측 총경동맥 결찰 백서는 만성 대뇌혈 관 저관류의 병태생리를 이해하고, 혈관성 치매의 잠재적 치료제로 사용될 수 있는 약물을 선별하는데 유용하다. 6 신체 활동은 많은 다양한 자극을 제공함으로써 인체의