A CASE STUDY OF ARNOLD-CHIARI MALFORMATION IN AN ADULT PRESENTING INITIALLY WITH RESPIRATORY FAILURE
Guthrie, Michael A. (The Graduate Hospital, Philadelphia, PA, USA)
Jacob, J (Mediplex Rehabilitation Hospital, Marlton, N J, USA)
Bonner, Francis J. (The Graduate Hospital, Philadelphia, PA, USA)
With Type 1 Arnold-Chiari malformations the patients are usually asymptomatic until late childhood or early adulthood. Symptoms may include increased intracranial pressure, progressive cerebellar ataxia, syringomyelia, frontal and occipital headaches, and downbeat nystagmus. Patients may also show a combination of disorders of the lower cranial nerves, cerebellum, medulla and spinal cord. Complicating presentations may include sleep apnea and even respiratory arrest or failure. We present a twenty-eight year old female who was admitted for respiratory and general rehabilitation status-post pneumonia and respiratory failure. Her medical history was remarkable for sleep apnea, headaches, vertigo, and progressive ataxia over four years. On admission she continued to complain of these symptoms, as well as left upper extremity tingling, and left lower extremity weakness with proprioceptive deficits. In therapy sessions she was easily fatigued, and exhibited severe ataxia. A sleep study documented severe sleep apnea. We also ordered a diagnostic magnetic resonance imaging (MRI) study of the brain which revealed an Arnold-Chiari Type 1 malformation with a syrinx of the cervical and the upper thoracic cord. While initial diagnosis of Arnold- Chiari Syndrome in a rehabilitation setting is rare, it should be considered in patients presenting with respiratory insufficiency, sleep apnea, in conjunction with ataxia of unknown etiology.
WALKING ABILITY IN ELDERLY PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
Haruki Musha (St. Marianna University, Kawasaki, Japan), Takehiko So, Yoshihiro Masui, Tomoyuki Kunishima, Fumihiko Eto, and Masahiro Murayama
Purpose: This study investigated the improvement of walking ability with cardiac rehabilitation in elderly patients with acute myocardial infarction.
Methods: Cardiopulmonary exercise testing and a 10m walking test were performed in 20 elderly patients at 1 month, 3 months, and 6 months after acute myocardial infarction.
Results: Peak Vo2 was 19.0±4.1 ml/min/kg at 1 month, 19.9±4.1 ml/min/kg at 3 months, and 23.7±3.5 ml/ min/kg at 6 months. Peak Vo2 increased significantly between 3 and 6 months. The 10m walking time did not change, being 6.4±1.5 sec at 1 month, 6.0±1.1 sec at 3 months, and 5.8±0.8 sec at 6 months. The walking time for patients in their 60s was 5.9±1.1 sec at 1 month, 5.9±0.8 sec at 3 months, and 5.7±0.9 sec at 6 months, while the times for patients in their 70s were 7.3±1.6 sec, 6.2±1.5 sec, and 6.1±0.6 sec, respectively. The time difference between the patients in their 60s and 70s was significant at I month, but decreased at 3 and 6 months.
Conclusion: Patients in their 70s with acute myocardial infarction showed improved walking ability after cardiac rehabilitation along with improving exercise tolerance.