We reported a case of rheumatoid arthritis (RA) with asymmetrical manifestation of wrist arthropathy in a hemiplegic stroke patient. The patient was a 61-year-old woman who had a left thalamic hemorrhage and now suffered right hemiplegia. Six months after her apoplectic stroke she complained of left wrist pain. X-ray examination indicated that her left wrist joint was destroyed. The sparing effect was observed in her paralyzed right wrist. The test for serum rheumatoid factor was positive and the patient's inflammatory signs were elevated. Consequently, she was administered anti-rheumatic drugs and fitted with a left wrist orthosis and her left wrist pain diminished. We also discuss the mechanism of unilateral RA.

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Decompressive craniectomy is occasionally performed for salvage in the acute phase of patients with increasing intracranial pressure. However, it causes various disorders in the chronic state, known as a “syndrome of the sinking skin flap” or “symptoms of the trephined” (ST). Atmospheric pressure on the brain, cerebral blood flow changes, or cerebrospinal fluid hydrodynamic changes have been postulated as possible reasons for these disorders, both of which can be improved by cranioplasty. We now report a case of facilitating rehabilitation, with improved ST, cognitive and motor functions, and activities of daily living (ADL) after cranioplasty. The patient was a 47-year-old man who underwent decompressive craniectomy for cerebral herniation following cardiogenic cerebral embolism. He suffered from persistent left hemiparesis, left spatial neglect and ST (headache and fatigability). His cognitive and motor functions had not been recovered through rehabilitation before the cranioplasty was performed. ST also prevented him from continuing rehabilitation. However, facilitating rehabilitation, with improved ST, cognitive and motor functions, and ADL was significantly shown after cranioplasty. These functional recoveries were postulated to correlate to an improved cerebral blood flow following cranioplasty, which was evaluated by ¹²³I-IMP SPECT. The present case suggests that cranioplasty would be a significant therapeutic strategy for facilitating rehabilitation and improving functional recovery in patients following decompressive craniectomy.

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