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The authors' response
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DEPARTMENTS
Letters to the Editor H Wave Reflex In rereading the article by Braune and associates’ in the May 1997 issue, I noted that the H wave reflex was not done in the assessment of a first sacral nerve root lesion and am curious as to why it was not. This test, in clinical practice, is quite sensitive in assessing for a first sacral nerve root lesion. Vito J. Carabetta, MD Olatbe, KS 66061 Reference 1. Braune H-J, Wunderlich MT. Diagnostic value of different neurophysiological methods in the assessment of lumbar nerve root lesions. Arch Phys Med Rehabil 1997;78:518-21.
The authors’
response:
The H-wave reflex is indeed used in the assessment of first sacral nerve root impairments. Since we believed that in clinical practice it gave no more information than the loss of the Achilles tendon reflex, we decided to omit it in our testing battery. Hans-J. Braune, MD Marburg, Germany Cerebral Angioplasty in Vascular Dementia The case report by Maeshima et al’ is of great interest to those of us in the imaging community. There are, however, serious questions that arise about the quality of the images and
Arch
Phys Med
Rehabil
Vol78,
December
1997
their subsequent interpretation. The images in figure 3 are of questionable technical quality. They are suboptimal for interpretation. Further, the repeat images performed on days 12 and 14 using the tracer HMPAO can yield changes that are misleading. HMPAO during this time frame often shows “luxury perfusion.” This suggests improvement of perfusion; however, this is a misleading finding because what is represented in the images is not true return of perfusion to the area of decreased perfusion. It would have been more appropriate to image this patient at least 30 days after the initial scan, thus eliminating confusion over the reported improvement ascribed to these images. Insufficient data were provided to fully evaluate the SPECT procedure. It is important to know the manner in which the Diamox study was performed, what type of camera was used, and how the data were processed and reconstructed. Such information is essential in providing the reader with an understanding of the utility of SPECT in the evaluation of patients undergoing rehabilitation after PTA or other surgical interventions that result in either long- or short-term cognitive deficits.
College
Ronald S. Tikofsky, PbD Department of Radiology of Physicians and Surgeons Columbia University New York, NY 10037
Reference 1. Maeshima S, Terada T, Yoshida Cerebral angioplasty in a patient Med Rehabil 1997;78:666-9.
N, Nakai K, Itakura T, Komai N. with vascular dementia. Arch Phys
DEPARTMENTS
Letters to the Editor H Wave Reflex In rereading the article by Braune and associates’ in the May 1997 issue, I noted that the H wave reflex was not done in the assessment of a first sacral nerve root lesion and am curious as to why it was not. This test, in clinical practice, is quite sensitive in assessing for a first sacral nerve root lesion. Vito J. Carabetta, MD Olatbe, KS 66061 Reference 1. Braune H-J, Wunderlich MT. Diagnostic value of different neurophysiological methods in the assessment of lumbar nerve root lesions. Arch Phys Med Rehabil 1997;78:518-21.
The authors’
response:
The H-wave reflex is indeed used in the assessment of first sacral nerve root impairments. Since we believed that in clinical practice it gave no more information than the loss of the Achilles tendon reflex, we decided to omit it in our testing battery. Hans-J. Braune, MD Marburg, Germany Cerebral Angioplasty in Vascular Dementia The case report by Maeshima et al’ is of great interest to those of us in the imaging community. There are, however, serious questions that arise about the quality of the images and
Arch
Phys Med
Rehabil
Vol78,
December
1997
their subsequent interpretation. The images in figure 3 are of questionable technical quality. They are suboptimal for interpretation. Further, the repeat images performed on days 12 and 14 using the tracer HMPAO can yield changes that are misleading. HMPAO during this time frame often shows “luxury perfusion.” This suggests improvement of perfusion; however, this is a misleading finding because what is represented in the images is not true return of perfusion to the area of decreased perfusion. It would have been more appropriate to image this patient at least 30 days after the initial scan, thus eliminating confusion over the reported improvement ascribed to these images. Insufficient data were provided to fully evaluate the SPECT procedure. It is important to know the manner in which the Diamox study was performed, what type of camera was used, and how the data were processed and reconstructed. Such information is essential in providing the reader with an understanding of the utility of SPECT in the evaluation of patients undergoing rehabilitation after PTA or other surgical interventions that result in either long- or short-term cognitive deficits.
College
Ronald S. Tikofsky, PbD Department of Radiology of Physicians and Surgeons Columbia University New York, NY 10037
Reference 1. Maeshima S, Terada T, Yoshida Cerebral angioplasty in a patient Med Rehabil 1997;78:666-9.
N, Nakai K, Itakura T, Komai N. with vascular dementia. Arch Phys