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The purpose of this retrospective study was to define the accuracy of sonographic examination compared with magnetic resonance imaging (MRI) in detecting tears of the posterior cruciate ligament (PCL). Thirty-five patients with traumatic knee injuries fulfilling all the criteria were selected from 531 patients referred for sonographic examinations during 2003 to 2005 in the university hospital. The presence or absence of PCL injury was determined by MRI. Torn PCL was indicated when a PCL diameter (anterior-posterior dimension) greater than 10 mm, or a wavy or indistinct posterior PCL margin was found on sonographic examination. Among the 35 patients, 13 were found to have PCL tears on sonographic examination. Ten of these tears were also diagnosed by MRI. Two of 22 patients with normal PCL on sonographic examination were found to have PCL tears following MRI. There was significant agreement between MRI and sonography. We found that sonographic examination could accurately detect tears of the PCL and can be utilized as the first choice of imaging modality for patients with PCL injuries.

Bell's palsy (BP) has been related to inflammation and oedema of the facial nerve, leading to focal ischaemia and demyelination. Serological and PCR studies have suggested that BP is related to reactivation of herpes simplex virus type 1 (HSV-1) and varicella-zoster viruses (VZVs).1 2 Because the infectious burden of certain viruses of the herpes virus family has been associated with an increased risk of stroke,3 we sought to investigate whether there is an increased risk of stroke after BP. The data used in this study were taken from the complete National Health Insurance (NHI) claim database in Taiwan from 2000 to 2003. This study included a BP cohort and a non-BP cohort, both of which were selected from Taiwanese residents retrieved from the complete NHI claim database for 2001, in which more than 21.6 million persons were registered. To determine the date and cause of death, the claim database was linked to the national mortality registry. To keep individual information confidential in order to satisfy regulations regarding personal privacy in Taiwan, all personal identification numbers in the data were encrypted by converting them into scrambled numbers before data processing under the auspices of the Department of Health. The BP cohort consisted of subjects who had received a principal diagnosis of BP (ICD-9-CM code …

We report a 47-year-old male stroke patient with nasopharyngeal cancer (NPC) and protein C deficiency. The patient was diagnosed with NPC and received a complete course of radiotherapy. Infarction stroke occurred 28 months after radiotherapy and magnetic resonance imaging of the brain confirmed the diagnosis. Carotid duplex sonography showed 50–79% stenosis in his left internal carotid artery. Coagulation profiles indicated protein C deficiency. After medical treatment and rehabilitation, the patient regained the ability to walk and he could perform most of his daily activities. Radiotherapy-induced carotid stenosis is an exacerbating feature of stroke in patients with protein C deficiency. We suggest early carotid duplex sonography and survey of the coagulation profile to prevent a stroke in patients with NPC.

The strict definition of the Ramsay Hunt syndrome is peripheral facial nerve palsy accompanied by an erythematous vesicular rash on the ear (zoster oticus) or in the mouth. J Ramsay Hunt, who described various clinical presentations of facial paralysis and rash, also recognised other frequent symptoms and signs such as tinnitus, hearing loss, nausea, vomiting, vertigo, and nystagmus. He explained these eighth nerve features by the close proximity of the geniculate ganglion to the vestibulocochlear nerve within the bony facial canal. Hunt's analysis of clinical variations of the syndrome now bearing his name led to his recognition of the general somatic sensory function of the facial nerve and his defining of the geniculate zone of the ear. It is now known that varicella zoster virus (VZV) causes Ramsay Hunt syndrome. Compared with Bell's palsy (facial paralysis without rash), patients with Ramsay Hunt syndrome often have more severe paralysis at onset and are less likely to recover completely. Studies suggest that treatment with prednisone and acyclovir may improve outcome, although a prospective randomised treatment trial remains to be undertaken. In the only prospective study of patients with Ramsay Hunt syndrome, 14% developed vesicles after the onset of facial weakness. Thus, Ramsay Hunt syndrome may initially be indistinguishable from Bell's palsy. Further, Bell's palsy is significantly associated with herpes simplex virus (HSV) infection. In the light of the known safety and effectiveness of antiviral drugs against VZV or HSV, consideration should be given to early treatment of all patients with Ramsay Hunt syndrome or Bell's palsy with a 7-10 day course of famciclovir (500 mg, three times daily) or acyclovir (800 mg, five times daily), as well as oral prednisone (60 mg daily for 3-5 days). Finally, some patients develop peripheral facial paralysis without ear or mouth rash, associated with either a fourfold rise in antibody to VZV or the presence of VZV DNA in auricular skin, blood mononuclear cells, middle ear fluid, or saliva. This indicates that a proportion of patients with "Bell's palsy" have Ramsay Hunt syndrome zoster sine herpete. Treatment of these patients with acyclovir and prednisone within 7 days of onset has been shown to improve the outcome of recovery from facial palsy.

With the recent advances in equipment and software, ultrasonography (US) has been widely used in the diagnosis of muscle injury. We report a case of hamstring muscle tear initially diagnosed by US and subsequently confirmed by magnetic resonance imaging (MRI). The patient received conservative treatment and rehabilitation, after which the symptoms gradually subsided. US was used as the initial tool to identify the muscle injury and to assess the severity of the tear, as this technique has been proved to be equal in sensitivity to MRI by previous researchers. We conclude that US is a reliable and cost-effective tool in the detection of muscle injuries.

Rhabdomyolysis is the necrosis of skeletal muscle with the release of intracellular substances into the extracellular fluid and circulation, which may cause further life-threatening complications. Early diagnosis and prompt treatment are mandatory. However, the initial clinical manifestations of rhabdomyolysis may be subtle. High suspicion is crucial for early diagnosis. Although definite diagnosis depends on laboratory tests, imaging studies are usually the first modalities used to examine patients. Recently, sonography has been widely used in musculoskeletal disorders; however, few studies mention the sonographic findings of rhabdomyolysis. We report a case of rhabdomyolysis where the characteristic sonographic features are depicted. A 17-year-old male had swelling and pain over the medial side of his left foot after taking part in a 200-meter race. Sonographic examination showed decreased echogenicity, increased thickness, and disorganization of the left abductor hallucis muscle structure. Laboratory tests showed an elevated creatine kinase level of 1,314 U/L. Rhabdomyolysis was diagnosed and the symptoms improved after treatment. We conclude that sonographic examination was useful in diagnosing rhabdomyolysis, leading to further laboratory tests and the proper treatment of this disorder. Sonographic examination is recommended in patients who are clinically suspected of having rhabdomyolysis.