Abstract
INTRODUCTION—This study was undertaken to evaluate the bone mineral density (BMD) in patients with complex regional pain syndrome type-I (CRPS-I) after stroke, and to correlate it with various clinical and neurophysiological parameters. PATIENTS AND METHODS—Twenty patients with CRPS-I after stroke were included and a detailed neurological evaluation was carried out. The severity of CRPS-I was graded on the basis of shoulder hand syndrome score. All the patients underwent bone mineral densitometry of paralysed and non-paralysed forearm by dual energy x ray absorptiometry. The BMD of paralysed forearm was also compared with that of age matched healthy controls. Neurophysiological tests included sympathetic skin response in both upper and lower limbs and median somatosensory evoked potentials. RESULTS—The mean age of patients was 57.2 (45-75) years and eight were females. Eight patients had severe weakness and 12 had moderate weakness of grade 2 on the hemiplegic side. There was significant reduction in BMD in the patients compared with controls (p<0.01). The bone density reduction correlated well with duration of illness (r = −0.673, p<0.01), shoulder hand syndrome score (r = −0.804, p<0.01), and Canadian neurological scale score (r = −0.738 p<0.01). Sympathetic skin response was not recordable bilaterally in all patients. Median somatosensory evoked potentials were not recordable in seven out of 20 patients who also had higher grade of CRPS-I. CONCLUSION—Our results show significant reduction of BMD in patients with CRPS-I after stroke. The reduction in BMD correlates with the severity of shoulder hand syndrome score, degree of weakness, duration of hemiplegia, and the severity of stroke. Keywords: stroke; complex regional pain syndrome type I; bone mineral density
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- Braus D. F., Krauss J. K., Strobel J. The shoulder-hand syndrome after stroke: a prospective clinical trial. Ann Neurol. 1994 Nov;36(5):728–733. doi: 10.1002/ana.410360507. [DOI] [PubMed] [Google Scholar]
- Chelimsky T. C., Low P. A., Naessens J. M., Wilson P. R., Amadio P. C., O'Brien P. C. Value of autonomic testing in reflex sympathetic dystrophy. Mayo Clin Proc. 1995 Nov;70(11):1029–1040. doi: 10.4065/70.11.1029. [DOI] [PubMed] [Google Scholar]
- Clinchot D. M., Lorch F. Sympathetic skin response in patients with reflex sympathetic dystrophy. Am J Phys Med Rehabil. 1996 Jul-Aug;75(4):252–256. doi: 10.1097/00002060-199607000-00002. [DOI] [PubMed] [Google Scholar]
- Côté R., Hachinski V. C., Shurvell B. L., Norris J. W., Wolfson C. The Canadian Neurological Scale: a preliminary study in acute stroke. Stroke. 1986 Jul-Aug;17(4):731–737. doi: 10.1161/01.str.17.4.731. [DOI] [PubMed] [Google Scholar]
- Drory V. E., Korczyn A. D. The sympathetic skin response in reflex sympathetic dystrophy. J Neurol Sci. 1995 Jan;128(1):92–95. doi: 10.1016/0022-510x(94)00210-f. [DOI] [PubMed] [Google Scholar]
- Goodman C. R. Osteoporosis as early complication of hemiplegia. N Y State J Med. 1971 Aug 15;71(16):1943–1945. [PubMed] [Google Scholar]
- Korpelainen J. T., Tolonen U., Sotaniemi K. A., Myllylä V. V. Suppressed sympathetic skin response in brain infarction. Stroke. 1993 Sep;24(9):1389–1392. doi: 10.1161/01.str.24.9.1389. [DOI] [PubMed] [Google Scholar]
- Larcos G., Wahner H. W. An evaluation of forearm bone mineral measurement with dual-energy X-ray absorptiometry. J Nucl Med. 1991 Nov;32(11):2101–2106. [PubMed] [Google Scholar]
- MAHONEY F. I., BARTHEL D. W. FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Md State Med J. 1965 Feb;14:61–65. [PubMed] [Google Scholar]
- Sato Y., Fujimatsu Y., Kikuyama M., Kaji M., Oizumic K. Influence of immobilization on bone mass and bone metabolism in hemiplegic elderly patients with a long-standing stroke. J Neurol Sci. 1998 Apr 1;156(2):205–210. doi: 10.1016/s0022-510x(98)00041-0. [DOI] [PubMed] [Google Scholar]
- Sato Y., Maruoka H., Oizumi K., Kikuyama M. Vitamin D deficiency and osteopenia in the hemiplegic limbs of stroke patients. Stroke. 1996 Dec;27(12):2183–2187. doi: 10.1161/01.str.27.12.2183. [DOI] [PubMed] [Google Scholar]
- Wasner G., Heckmann K., Maier C., Baron R. Vascular abnormalities in acute reflex sympathetic dystrophy (CRPS I): complete inhibition of sympathetic nerve activity with recovery. Arch Neurol. 1999 May;56(5):613–620. doi: 10.1001/archneur.56.5.613. [DOI] [PubMed] [Google Scholar]