Reflex sympathetic dystrophy syndrome in stroke patients with hemiplegia-three phase bone scintigraphy and clinical...

In an attempt to investigate the correlation between three phase bone scintigraphy (TPBS) and the clinical manifestation of reflex sympathetic dystrophy syndrome (RSDS) in the upper extremity of hemiplegia, we collected 30 patients with cerebral vascular accidents (CVA) confirmed by head computed tomography (infarction or hemorrhage) within 3 months of their CVA event. All patients received TPBS after admission. Clinical assessment for the development of the RSDS was done at least 3 months (268 +/- 120 days) after the stroke. The correlation between the development of RSD and certain clinical variables (including sex, age, side affected, caused of stroke, and motor stage) were analyzed. Twelve patients (40%) manifested definite or probable RSDS, as assessed by Tepperman's criteria, during the follow-up period. Nineteen patients (63%) exhibited radionuclide evidence of RSDS based on delayed bone scan criteria performed within 3 months (43 +/- 25 days) of the stroke. The positive delayed image of TPBS demonstrated a sensitivity = 92%; specificity = 56%; positive predictive value = 58%, and negative predictive value = 91%. The Kappa statistics for agreement between positive bone scan and RSDS development was 70% (Kappa = 0.43, p < 0.05). Neither sex, age, side affected, cause of stroke, or motor stage had a significant correlation with clinical RSDS. In conclusion, TPBS is a useful screening tool for the development of RSD in hemiplegic patients. However, the diagnosis of RSDS depends on the clinical evaluation and that TPBS as an adjunct assessment of RSDS must be interpreted with caution.