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Sample records for paresis

  1. Monocular elevator paresis in neurofibromatosis type 2.

    PubMed

    Egan, R A; Thompson, C R; MacCollin, M; Lessell, S

    2001-05-08

    A retrospective review of 29 consecutive unselected patients referred for neuro-ophthalmic evaluation after the diagnosis of neurofibromatosis type 2 (NF2) showed that four of them had a monocular elevator paresis. In two of the four MRI demonstrated lesions, presumed to be schwannomas, of the third nerve. These findings indicate that monocular elevator paresis is a common neuro-ophthalmic finding in NF2, which the authors suspect is probably a sign of third nerve infiltration or compression by a schwannoma.

  2. Abnormal Parietal Function in Conversion Paresis

    PubMed Central

    van Beilen, Marije; de Jong, Bauke M.; Gieteling, Esther W.; Renken, Remco; Leenders, Klaus L.

    2011-01-01

    The etiology of medically unexplained symptoms such as conversion disorder is poorly understood. This is partly because the interpretation of neuroimaging results in conversion paresis has been complicated by the use of different control groups, tasks and statistical comparisons. The present study includes these different aspects in a single data set. In our study we included both normal controls and feigners to control for conversion paresis. We studied both movement execution and imagery, and we contrasted both within-group and between-group activation. Moreover, to reveal hemisphere-specific effects that have not been reported before, we performed these analyses using both flipped and unflipped data. This approach resulted in the identification of abnormal parietal activation which was specific for conversion paresis patients. Patients also showed reduced activity in the prefrontal cortex, supramarginal gyrus and precuneus, including hemisphere-specific activation that is lateralized in the same hemisphere, regardless of right- or left-sided paresis. We propose that these regions are candidates for an interface between psychological mechanisms and disturbed higher-order motor control. Our study presents an integrative neurophysiological view of the mechanisms that contribute to the etiology of this puzzling psychological disorder, which can be further investigated with other types of conversion symptoms. PMID:22039428

  3. Diagnosing limb paresis and paralysis in sheep

    PubMed Central

    Crilly, James Patrick; Rzechorzek, Nina; Scott, Philip

    2015-01-01

    Paresis and paralysis are uncommon problems in sheep but are likely to prompt farmers to seek veterinary advice. A thorough and logical approach can aid in determining the cause of the problem and highlighting the benefit of veterinary involvement. While this may not necessarily alter the prognosis for an individual animal, it can help in formulating preventive measures and avoid the costs – both in economic and in welfare terms – of misdirected treatment. Distinguishing between central and peripheral lesions is most important, as the relative prognoses are markedly different, and this can often be achieved with minimal equipment. This article describes an approach to performing a neurological examination of the ovine trunk and limbs, the ancillary tests available and the common and important causes of paresis and paralysis in sheep. PMID:26752801

  4. [Antioxidant therapy in combined treatment of postoperative intestinal paresis].

    PubMed

    Magomedov, M A

    2004-01-01

    Method of treatment of postoperative intestinal paresis with antioxidant emoxipin in experiment demonstrated that stabilization of redox processes and antioxidant systems in intestinal tissues leads to compensation of energy deficiency and recovery of intestinal peristalsis. Clinical use of this method in combined treatment of patients with postoperative intestinal paresis in acute generalized peritonitis reduces time of postoperative intestinal paresis and intoxication, lethality reduced 1,7-fold.

  5. Voice range in superior laryngeal nerve paresis and paralysis.

    PubMed

    Eckley, C A; Sataloff, R T; Hawkshaw, M; Spiegel, J R; Mandel, S

    1998-09-01

    Evaluation of Physiologic Frequency Range (PFR) and Musical Frequency Range (MRP) of Phonation was performed on 56 adults (singers and nonsingers) presenting with superior laryngeal nerve (SLN) paresis or paralysis confirmed by laryngeal electromyography. The most common etiology was neuritis (69.7%), followed by iatrogenic and unknown causes,each accounting for 10.2% of cases, and finally trauma (8.9%). Both female and male singers with SLN paresis or paralysis had significantly higher PFR and MPR than nonsingers. Female classical singers presented PFR and MPR of up to 10 semitones (ST) higher than nonclassical singers and nonsingers. The lowest PFR and musical ranges were found in patients with SLN paresis associated with recurrent laryngeal nerve paresis or paralysis. The authors suggest that voice range measurement is a useful parameter for analyzing the effects of SLN paresis or paralysis on voice and that it may also assist in measuring outcome following voice therapy.

  6. [Intensity in the neurorehabilitation of spastic paresis].

    PubMed

    Meimoun, M; Bayle, N; Baude, M; Gracies, J-M

    2015-02-01

    Neurorestoration of motor command in spastic paresis requires a double action of stimulation and guidance of central nervous system plasticity. Beyond drug therapies, electrical stimulation and cell therapies, which may stimulate plasticity without precisely guiding it, two interventions seem capable of driving plasticity with a double stimulation and guidance component: the lesion itself (lesion-induced plasticity) and durable behavior modifications (behavior-induced plasticity). Modern literature makes it clear that the intensity of the neuronal and physical training is a primary condition to foster behavior-induced plasticity. When it comes to working on movement, intensity can be achieved by the combination of two key components, one is the difficulty of the trained movement, the other is the number of repetitions or the daily duration of the practice. A number of recent studies shed light on promising recovery prospects, particularly using the emergence of new technologies such as robot-assisted therapy and concepts such as guided self-rehabilitation contracts. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  7. Is cold paresis related to axonal depolarization?

    PubMed

    Franssen, Hessel; Gebbink, Tineke A; Wokke, John H J; van den Berg, Leonard H; van Schelven, Leonard J

    2010-09-01

    Cold paresis may occur in multifocal motor neuropathy and lower motor neuron disease. It was proposed to reflect nerve lesions where axons are depolarized due to loss of Na/K-pump activity. In those circumstances, a further decrease in pump activity by cooling may induce extra depolarization, conduction block, and weakness. Evidence for this hypothesis is incomplete because it is unknown if cold induces depolarization in human motor axons and other factors may contribute to the symptoms. To solve these questions, we examined 10 normal subjects. At 37, 25, 20, and 15°C we assessed: excitability in the median nerve, decrement on 3-Hz stimulation, pulsed Doppler of a wrist artery, and thenar muscle strength. Cooling induced: (1) findings compatible with axonal depolarization on excitability testing (fanning-in of threshold electrotonus, steepened current threshold relation, increased refractory period, decreased super- and subexcitability), (2) decreased Doppler peak systolic velocity without causing ischemia, (3) decreased muscle strength and impaired muscle relaxation. Decrement tests and compound muscle action potential amplitude remained normal. The excitability findings induced by cooling were best explained by axonal depolarization due to the effect of temperature on Na/K-pump activity. The induced weakness may be explained not only by this mechanism but also by impaired muscle contraction. © 2010 Peripheral Nerve Society.

  8. Bell's palsy: symptoms preceding and accompanying the facial paresis.

    PubMed

    De Seta, Daniele; Mancini, Patrizia; Minni, Antonio; Prosperini, Luca; De Seta, Elio; Attanasio, Giuseppe; Covelli, Edoardo; De Carlo, Andrea; Filipo, Roberto

    2014-01-01

    This individual prospective cohort study aims to report and analyze the symptoms preceding and accompanying the facial paresis in Bell's palsy (BP). Two hundred sixty-nine patients affected by BP with a maximum delay of 48 hours from the onset were enrolled in the study. The evolution of the facial paresis expressed as House-Brackmann grade in the first 10 days and its correlation with symptoms were analyzed. At the onset, 136 patients presented postauricular pain, 114 were affected by dry eye, and 94 reported dysgeusia. Dry mouth was present in 54 patients (19.7%), facial pain, hyperlacrimation, aural fullness, and hyperacusis represented a smaller percentage of the reported symptoms. After 10 days, 39.9% of the group had a severe paresis while 10.2% reached a complete recovery. Dry mouth at the onset was correlated with severe grade of palsy and was prognostic for poor recovery in the early period. These outcomes lead to the deduction that the nervus intermedius plays an important role in the presentation of the BP and it might be responsible for most of the accompanying symptomatology of the paresis. Our findings could be of important interest to early address a BP patient to further examinations and subsequent therapy.

  9. Bell's Palsy: Symptoms Preceding and Accompanying the Facial Paresis

    PubMed Central

    Mancini, Patrizia; Minni, Antonio; Prosperini, Luca; De Seta, Elio; Attanasio, Giuseppe; Covelli, Edoardo; De Carlo, Andrea; Filipo, Roberto

    2014-01-01

    This individual prospective cohort study aims to report and analyze the symptoms preceding and accompanying the facial paresis in Bell's palsy (BP). Two hundred sixty-nine patients affected by BP with a maximum delay of 48 hours from the onset were enrolled in the study. The evolution of the facial paresis expressed as House-Brackmann grade in the first 10 days and its correlation with symptoms were analyzed. At the onset, 136 patients presented postauricular pain, 114 were affected by dry eye, and 94 reported dysgeusia. Dry mouth was present in 54 patients (19.7%), facial pain, hyperlacrimation, aural fullness, and hyperacusis represented a smaller percentage of the reported symptoms. After 10 days, 39.9% of the group had a severe paresis while 10.2% reached a complete recovery. Dry mouth at the onset was correlated with severe grade of palsy and was prognostic for poor recovery in the early period. These outcomes lead to the deduction that the nervus intermedius plays an important role in the presentation of the BP and it might be responsible for most of the accompanying symptomatology of the paresis. Our findings could be of important interest to early address a BP patient to further examinations and subsequent therapy. PMID:25544960

  10. Isolated marginal facial nerve paresis after TMJ discopexy: a case report.

    PubMed

    Reychler, H; Mahy, P

    2011-01-01

    Isolated marginal facial nerve paresis after TMJ discopexy: a case report. This is the first report of a transient, isolated marginal facial nerve paresis after temporomandibular joint arthrotomy. The paresis seems to have resulted from a crush lesion by Backhaus forceps, placed transcutaneously during the operation to distract the intra-articular space.

  11. Isolated unilateral oculomotor paresis in pure midbrain stroke.

    PubMed

    Amano, Yu; Kudo, Yosuke; Kikyo, Hideyuki; Imazeki, Ryoko; Yamamoto, Masahiro; Amari, Kazumitsu; Tanaka, Fumiaki; Johkura, Ken

    2015-04-15

    Pure midbrain stroke can cause isolated unilateral oculomotor paresis. We attempted to determine whether there is a difference in the oculomotor paresis pattern between pure midbrain infarction and midbrain hemorrhage. Pure midbrain stroke patients who presented with isolated unilateral oculomotor paresis were identified from a group of 2447 consecutive patients hospitalized for acute cerebral infarction or hemorrhage during the period May 2008 through April 2014. Detailed oculomotor findings were evaluated in the identified patients per the cause of the stroke. Five patients with infarct and 1 with hemorrhage became our study subjects. Lesions were located in the paramedian area of the midbrain involving the oculomotor fascicles. The pupillary sphincter and inferior rectus muscles were selectively spared in the infarct patients, whereas these muscles were selectively affected in the hemorrhage patient. Fibers in the oculomotor fascicle that innervate the levator palpebrae, superior rectus, and inferior oblique muscles appear to be more susceptible to ischemic damage than those that innervate the pupillary sphincter and inferior rectus muscles. Isolated impairment of the pupillary sphincter and inferior rectus muscles may be suggestive of a non-ischemic process. Copyright © 2015 Elsevier B.V. All rights reserved.

  12. Laryngoscopic and stroboscopic signs in the diagnosis of vocal fold paresis.

    PubMed

    Estes, Christine; Sadoughi, Babak; Mauer, Elizabeth; Christos, Paul; Sulica, Lucian

    2017-09-01

    To identify strobolaryngoscopic findings significant in the diagnosis of paresis. Retrospective cohort study. Fellowship-trained laryngologists reviewed 34 videostroboscopic examinations (24 with paresis, eight without paresis, two repeat). They indicated presence or absence of paresis, including side and type, degree of confidence in diagnosis, and ranked clinical findings that influenced diagnosis by order of importance. Fleiss's κ was used to assess inter-rater agreement for paresis presence, side, and type. Clinical findings compelling in diagnosis were tabulated and described. Confidence levels for side and type were compared by analysis of variance/Kruskal-Wallis tests and post hoc pairwise comparisons. Thirty-one laryngologists completed the review. Inter-rater agreement on presence or absence of paresis was fair at 0.334 (Fleiss's κ). Fourteen examinations were diagnosed with paresis by >70% of raters and considered strong paresis-candidate exams. Diagnosis of paresis side and type were inconsistent, although with statistically significant differences in confidence ratings (unilateral vs. bilateral, recurrent laryngeal nerve [RLN] vs. superior laryngeal nerve [SLN], RLN vs. mixed RLN/SLN). Laryngoscopic and stroboscopic findings with the strongest association with paresis were vocal fold motion anomalies, vocal fold degeneration, glottic insufficiency, and mucosal wave anomalies. Most laryngologists use strobolaryngoscopy for diagnosis of paresis. Although certain clinical findings were found to be associated with diagnosis, most commonly vocal fold motion anomalies, these varied among raters, especially when determining sidedness and nerve involvement. Future studies should expand the discussion and consideration of strobolaryngoscopic factors and adjunct functional and objective measures to develop a heuristic algorithm for diagnosis of paresis. 4. Laryngoscope, 127:2100-2105, 2017. © 2017 The American Laryngological, Rhinological and Otological

  13. A Rare Complication of Herpes Zoster: Segmental Zoster Paresis

    PubMed Central

    Teo, Hooi Khee; Chawla, Mayank; Kaushik, Manish

    2016-01-01

    Herpes zoster is a common presentation in both the community and emergency department; however segmental zoster paresis is a rare complication that can lead to misdiagnosis. We present a case of a 74-year-old Indian gentleman with a background of well controlled diabetes mellitus, hypertension, and ischaemic heart disease who presented with sudden right lower limb weakness. This was preceded by a 5-day history of paraesthesia starting in the right foot and ascending up the right lower limb. On examination, there was a characteristic vesicular rash in the L2/3 region with MRC grading 3/5 in the right hip flexors. The rest of the neurological examination was unremarkable. MRI of the spine did not show any evidence of spinal disease. The patient was initiated on IV acyclovir with improvement of the lower limb weakness to MRC grading 5/5 as the vesicles improved. This is an interesting case as it highlights a rare presentation of zoster: segmental motor paresis that recovered fully with resolution of the rash. It shows the importance of recognizing motor neuropathy as a complication of shingles as it has a very good prognosis with most patients regaining full motor function of the affected limb with treatment. PMID:27313622

  14. Stretch-sensitive paresis and effort perception in hemiparesis.

    PubMed

    Vinti, Maria; Bayle, Nicolas; Hutin, Emilie; Burke, David; Gracies, Jean-Michel

    2015-08-01

    In spastic paresis, stretch applied to the antagonist increases its inappropriate recruitment during agonist command (spastic co-contraction). It is unknown whether antagonist stretch: (1) also affects agonist recruitment; (2) alters effort perception. We quantified voluntary activation of ankle dorsiflexors, effort perception, and plantar flexor co-contraction during graded dorsiflexion efforts at two gastrocnemius lengths. Eighteen healthy (age 41 ± 13) and 18 hemiparetic (age 54 ± 12) subjects performed light, medium and maximal isometric dorsiflexion efforts with the knee flexed or extended. We determined dorsiflexor torque, Root Mean Square EMG and Agonist Recruitment/Co-contraction Indices (ARI/CCI) from the 500 ms peak voluntary agonist recruitment in a 5-s maximal isometric effort in tibialis anterior, soleus and medial gastrocnemius. Subjects retrospectively reported effort perception on a 10-point visual analog scale. During gastrocnemius stretch in hemiparetic subjects, we observed: (1) a 25 ± 7 % reduction of tibialis anterior voluntary activation (maximum reduction 98 %; knee extended vs knee flexed; p = 0.007, ANOVA); (2) an increase in dorsiflexion effort perception (p = 0.03, ANCOVA). Such changes did not occur in healthy subjects. Effort perception depended on tibialis anterior recruitment only (βARI(TA) = 0.61, p < 0.01) in healthy subjects (not on gastrocnemius medialis co-contraction) while it depended on both tibialis anterior agonist recruitment (βARI(TA) = 0.41, p < 0.001) and gastrocnemius medialis co-contraction (βCCI(MG) = 0.43, p < 0.001) in hemiparetic subjects. In hemiparesis, voluntary ability to recruit agonist motoneurones is impaired--sometimes abolished--by antagonist stretch, a phenomenon defined here as stretch-sensitive paresis. In addition, spastic co-contraction increases effort perception, an additional incentive to evaluate and treat this phenomenon.

  15. Prediction and Outcome of Intensive Care Unit-Acquired Paresis.

    PubMed

    Peñuelas, Oscar; Muriel, Alfonso; Frutos-Vivar, Fernando; Fan, Eddy; Raymondos, Konstantinos; Rios, Fernando; Nin, Nicolás; Thille, Arnaud W; González, Marco; Villagomez, Asisclo J; Davies, Andrew R; Du, Bin; Maggiore, Salvatore M; Matamis, Dimitrios; Abroug, Fekri; Moreno, Rui P; Kuiper, Michael A; Anzueto, Antonio; Ferguson, Niall D; Esteban, Andrés

    2016-04-13

    Intensive care unit-acquired paresis (ICUAP) is associated with poor outcomes. Our objective was to evaluate predictors for ICUAP and the short-term outcomes associated with this condition. A secondary analysis of a prospective study including 4157 mechanically ventilated adults in 494 intensive care units from 39 countries. After sedative interruption, patients were screened for ICUAP daily, which was defined as the presence of symmetric and flaccid quadriparesis associated with decreased or absent deep tendon reflexes. A multinomial logistic regression was used to create a predictive model for ICUAP. Propensity score matching was used to estimate the relationship between ICUAP and short-term outcomes (ie, weaning failure and intensive care unit [ICU] mortality). Overall, 114 (3%) patients had ICUAP. Variables associated with ICUAP were duration of mechanical ventilation (relative risk ratio [RRR] per day, 1.10; 95% confidence interval [CI] 1.08-1.12), steroid therapy (RRR 1.8; 95% CI, 1.2-2.8), insulin therapy (RRR 1.8; 95% CI 1.2-2.7), sepsis (RRR 1.9; 95% CI: 1.2 to 2.9), acute renal failure (RRR 2.2; 95% CI 1.5-3.3), and hematological failure (RRR 1.9; 95% CI: 1.2-2.9). Coefficients were used to generate a weighted scoring system to predict ICUAP. ICUAP was significantly associated with both weaning failure (paired rate difference of 22.1%; 95% CI 9.8-31.6%) and ICU mortality (paired rate difference 10.5%; 95% CI 0.1-24.0%). Intensive care unit-acquired paresis is relatively uncommon but is significantly associated with weaning failure and ICU mortality. We constructed a weighted scoring system, with good discrimination, to predict ICUAP in mechanically ventilated patients at the time of awakening. © The Author(s) 2016.

  16. Acute onset of trigeminal neuralgia, facial paresis and dysphagia after mild head injury.

    PubMed

    Gkekas, Nikolaos; Primikiris, Panagiotis; Georgakoulias, Nikolaos

    2014-01-01

    The authors report the rare and first documented case of concomitant microvascular decompression of trigeminal, facial and glossopharyngeal nerves for the management of intractable to medical therapy acute onset of trigeminal neuralgia, facial paresis and dysphagia after mild head injury.

  17. The sensitivity of the bielschowsky head-tilt test in diagnosing acquired bilateral superior oblique paresis.

    PubMed

    Muthusamy, Brinda; Irsch, Kristina; Peggy Chang, Han-Ying; Guyton, David L

    2014-04-01

    To determine the sensitivity of the Bielschowsky head-tilt test and other commonly used criteria in identifying patients with true bilateral superior oblique paresis. A retrospective chart review was performed to identify patients seen between 1978 and 2009 who were diagnosed with acquired bilateral superior oblique paresis. All patients had a confirmed history of head trauma or brain surgery with altered consciousness followed by symptomatic diplopia. Bilateral superior oblique paresis was defined and diagnosed by the above history, including the presence of greater extorsion in downgaze than upgaze on Lancaster red-green testing, a V-pattern strabismus, and bilateral fundus extorsion. We analyzed findings of the Bielschowsky head-tilt test, the Parks 3-step test, and reversal of the hypertropia from straight-ahead gaze to the other 8 diagnostic positions of gaze to determine these tests' sensitivity in identifying true bilateral superior oblique paresis. Twenty-five patients were identified with the diagnosis of true bilateral superior oblique paresis. The Bielschowsky head-tilt test had a 40% sensitivity, the Parks 3-step test had a sensitivity of 24%, and reversal of the hypertropia had a sensitivity of 60% in making the diagnosis of true bilateral superior oblique paresis. What previously has been described as masked bilateral superior oblique paresis simply may be a reflection of inherent poor sensitivity of the Bielschowsky head-tilt test, the Parks 3-step test, and reversal of the hypertropia in diagnosing bilateral superior oblique paresis. Hence, none of these tests should be relied on exclusively to make this diagnosis. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Inferior oblique muscle paresis as a sign of myasthenia gravis.

    PubMed

    Almog, Yehoshua; Ben-David, Merav; Nemet, Arie Y

    2016-03-01

    Myasthenia gravis may affect any of the six extra-ocular muscles, masquerading as any type of ocular motor pathology. The frequency of involvement of each muscle is not well established in the medical literature. This study was designed to determine whether a specific muscle or combination of muscles tends to be predominantly affected. This retrospective review included 30 patients with a clinical diagnosis of myasthenia gravis who had extra-ocular muscle involvement with diplopia at presentation. The diagnosis was confirmed by at least one of the following tests: Tensilon test, acetylcholine receptor antibodies, thymoma on chest CT scan, or suggestive electromyography. Frequency of involvement of each muscle in this cohort was inferior oblique 19 (63.3%), lateral rectus nine (30%), superior rectus four (13.3%), inferior rectus six (20%), medial rectus four (13.3%), and superior oblique three (10%). The inferior oblique was involved more often than any other muscle (p<0.01). Eighteen (60%) patients had ptosis, six (20%) of whom had bilateral ptosis. Diagnosing myasthenia gravis can be difficult, because the disease may mimic every pupil-sparing pattern of ocular misalignment. In addition diplopia caused by paresis of the inferior oblique muscle is rarely encountered (other than as a part of oculomotor nerve palsy). Hence, when a patient presents with vertical diplopia resulting from an isolated inferior oblique palsy, myasthenic etiology should be highly suspected.

  19. Differentiating bilateral superior oblique paresis from sensory extorsion.

    PubMed

    Muthusamy, Brinda; Peggy Chang, Han-Ying; Irsch, Kristina; Ying, Howard S; Muthusamy, Kirithika; Anwar, Didar; Guyton, David L

    2013-10-01

    To determine whether patients historically diagnosed with bilateral superior oblique paresis (BSOP) categorized into (1) immediate-onset and (2) gradual-onset torsional diplopia groups are also distinguishable on the basis of patterns of subjective misalignment in various directions of gaze, consistent with the gradual-onset group being caused by sensory extorsion rather than by BSOP. The medical records of all patients diagnosed with BSOP, V-pattern esotropia, or V-pattern exotropia between 1978 and 2009 were retrospectively reviewed. Those patients with torsional diplopia were classified into immediate- or gradual-onset diplopia groups. The torsional misalignments measured by Lancaster red-green plots were compared, and the surgical outcomes were evaluated. Of 38 patients identified, 27 had immediate-onset and 11 gradual-onset diplopia. There was a statistically significant difference in the increase in extorsion from up- to downgaze between the immediate- versus gradual-onset group (17.8° versus -1.5°, P < 0.001). Patients in the immediate-onset group fared significantly better with bilateral Harada-Ito procedures than with bilateral inferior oblique-weakening procedures (P = 0.02), whereas patients in the gradual-onset group fared equally well with either procedure (P = 0.72). Extorsion in upgaze is largely absent in patients with immediate-onset BSOP but is present in both up- and downgaze in patients with gradual-onset sensory extorsion. Lancaster red-green testing aids in distinguishing these two groups. The bilateral Harada-Ito procedure is a better procedure for true BSOP, whereas a bilateral inferior oblique-weakening procedure may be preferred for patients with sensory extorsion. Copyright © 2013 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.

  20. Literature review of evidence based physiotherapy in patients with facial nerve paresis.

    PubMed

    Hg Beurskens, Carien; Al Burgers-Bots, Ingrid; W Kroon, Dineke; Ab Oostendorp, Rob

    2004-01-01

    A variety of physiotherapeutic approaches have been tried out during the past 25 years to alleviate the plight of patients with peripheral facial nerve paresis. The objective of this review was to assess the effectiveness of physiotherapy in patients with facial nerve paresis. Trials were identified by computerised searches of biomedical databases, reference lists, and by contacting investigators. Selection criteria were randomised controlled trials of physiotherapy for the improvement of sequelae of facial nerve paresis, comparing the treatment with either another intervention or no intervention. Two reviewers independently assessed the trials using the PEDro scale. Two physiotherapy randomised controlled studies were identified. Interventions used for treatment of patients with facial nerve paresis in the included studies were relaxation, biofeedback and exercise therapy. Neither of the two randomised controlled studies showed scientific evidence of a physiotherapeutic approach in comparison with a control group. Both studies described benefits of the interventions. Further randomised controlled studies are required to determine the effectiveness of physiotherapy in patients with facial nerve paresis.

  1. Adjustable superior oblique tendon spacer with application of nonabsorbable suture for treatment of isolated inferior oblique paresis.

    PubMed

    Fard, Masoud A; Ameri, Ahmad; Anvari, Faramaz; Jafari, Alireza K; Yazdian, Ziaeddin

    2010-01-01

    To evaluate and report the outcomes of a superior oblique tendon spacer procedure using nonabsorbable adjustable sutures in patients with inferior oblique (10) paresis. This interventional case series included 6 eyes of 6 patients with 10 paresis. All met Bielschowsky/Parks Three-step Test criteria to identify an isolated 10 paresis. In all patients, the superior oblique tendon was exposed; 2 nonabsorbable polyester sutures were placed 3 mm apart, and the tendon was cut. With the use of a slipknot, the cut ends of the tendon were separated 5 to 7 mm. Tendon separation was adjusted intraoperatively according to the fundus torsion and exaggerated traction test. The mean duration of follow-up was 8.1 months (range, 5-12 [corrected] months). Four patients had congenital 10 paresis and 2 had iatrogenic 10 paresis following denervation/myectomy of 10. Mean primary position hypotropia improved from 15.2 prism diopters (PD) before surgery to 2.7 PD in congenital 10 paresis and from 11.5 PD to 2.5 PD in iatrogenic 10 paresis. In congenital 10 paresis, mean preoperative superior oblique overaction and 10 underaction was +2 and -2, which decreased to 0 and -1.25 respectively; fundus incyclotorsion resolved in all patients. Superior oblique overaction and 10 underaction improved in iatrogenic 10 paresis as well. In no patient did an overcorrection develop. The adjustable superior oblique tendon suture spacer procedure is an effective and safe option for correcting 10 paresis without developing iatrogenic superior oblique paresis.

  2. Recurrent Patent Foramen Ovale-Related Cerebral Infarcts Alternately Causing Bilateral Hand Paresis.

    PubMed

    Lee, Seung-Jae

    2017-01-01

    Isolated hand paresis is a rare presentation of stroke, which mostly results from a lesion in the cortical hand motor area, a knob-like area within the precentral gyrus. I report the case of a patient who experienced recurrent ischemic stroke alternately involving bilateral hand knob areas, causing isolated hand paresis. There was no abnormal finding on brain and neck magnetic resonance angiography, transthoracic echocardiography, and 48-h Holter monitoring, and there were no abnormal immunologic and coagulation laboratory findings. The only embolic source was found to be a patent foramen ovale, which was proven on transesophageal echocardiography. The patient underwent percutaneous device closure of patent foramen ovale after alternately repeated paresis of both hands despite antiplatelet treatment. This case suggests that ischemic stroke affecting the cortical knob area, albeit extremely rare, may recur due to a patent foramen ovale, and it necessitates complete investigation, including transesophageal echocardiography, to identify possible embolic sources.

  3. Natural history of idiopathic abducens nerve paresis in a young adult.

    PubMed

    Hussaindeen, Jameel Rizwana; Mani, Revathy; Rakshit, Archayeeta; Ramasubramanian, Srikanth; Vittal Praveen, Smitha

    2016-01-01

    The natural history of idiopathic abducens nerve paresis and the role of conservative management such as vision training during the recovery process is not well documented in the literature to the best of our knowledge. This case report presents the natural recovery process of idiopathic abducens nerve paresis in a young adult and the role of vision therapy in the recovery process. Copyright © 2016 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.

  4. Tabes dorsalis progressing to general paresis after 20 years despite routine penicillin therapy.

    PubMed Central

    Giles, A J

    1980-01-01

    A man with a history of treatment for early syphilis presented with tabes dorsalis. Despite receiving a course of penicillin accepted as adequate by the World Health Organisation the illness progressed to tabo-paresis after 20 years. Reinfection cannot be excluded. PMID:7448579

  5. Temporary hindlimb paresis following dystocia due to foetal macrosomia in a Celebes crested macaque (Macaca nigra).

    PubMed

    Debenham, John James; Bettembourg, Vanessa; Østevik, Liv; Modig, Michaela; Jâderlund, Karin Hultin; Lervik, Andreas

    2017-04-01

    A multiparous Celebes crested macaque presented with dystocia due to foetal macrosomia, causing foetal mortality and hindlimb paresis. After emergency caesarean section, recovery of motor function took 1 month before hindlimbs were weight bearing and 2 months before re-integration with the troop. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. Influence of facial paresis on ocular vestibular-evoked myogenic potentials.

    PubMed

    Huang, Yen-Chieh; Young, Yi-Ho

    2013-06-01

    The ocular vestibular-evoked myogenic potential (oVEMP) test with eyes up condition may help differentiate facial paresis with and without vestibular nerve deficit, while the oVEMP test with the eyes closed condition is not reliable for testing patients with facial paresis. This study investigated the influence of facial paresis on oVEMPs via the eyes up versus eyes closed conditions. Twenty patients with unilateral facial paresis underwent a battery of audiovestibular function tests. The oVEMP test was performed via bone-conducted vibration stimuli with the eyes up and eyes closed conditions used in a randomized order. Under the eyes up condition, the rate of abnormal oVEMP tests in the lesion ear was 30%, significantly higher than the 0% in the opposite healthy ear, indicating that the lesion ear not the recorded eye is responsible for abnormal oVEMPs. However, abnormal oVEMP test results of lesion ears under the eyes closed condition did not significantly differ from those of opposite healthy ears. Analysis of caloric and oVEMP test results indicated that both tests obtained normal responses from 10 ears, and abnormal responses from 5 ears. The caloric and oVEMP test results were significantly correlated.

  7. Risks of postoperative paresis in motor eloquently and non-eloquently located brain metastases

    PubMed Central

    2014-01-01

    Background When treating cerebral metastases all involved multidisciplinary oncological specialists have to cooperate closely to provide the best care for these patients. For the resection of brain metastasis several studies reported a considerable risk of new postoperative paresis. Pre- and perioperative chemotherapy (Ctx) or radiotherapy (Rtx) alter vasculature and adjacent fiber tracts on the one hand, and many patients already present with paresis prior to surgery on the other hand. As such factors were repeatedly considered risk factors for perioperative complications, we designed this study to also identify risk factors for brain metastases resection. Methods Between 2006 and 2011, we resected 206 brain metastases consecutively, 56 in eloquent motor areas and 150 in non-eloquent ones. We evaluated the influences of preoperative paresis, previous Rtx or Ctx as well as recursive partitioning analysis (RPA) class on postoperative outcome. Results In general, 8.7% of all patients postoperatively developed a new permanent paresis. In contrast to preoperative Ctx, previous Rtx as a single or combined treatment strategy was a significant risk factor for postoperative motor weakness. This risk was even increased in perirolandic and rolandic lesions. Our data show significantly increased risk of new deficits for patients assigned to RPA class 3. Even in non-eloquently located brain metastases the risk of new postoperative paresis has not to be underestimated. Despite the microsurgical approach, our cohort shows a high rate of unexpected residual tumors in postoperative MRI, which supports recent data on brain metastases’ infiltrative nature but might also be the result of our strict study protocol. Conclusions Surgical resection is a safe treatment of brain metastases. However, preoperative Rtx and RPA score 3 have to be taken into account when surgical resection is considered. PMID:24422871

  8. Risks of postoperative paresis in motor eloquently and non-eloquently located brain metastases.

    PubMed

    Obermueller, Thomas; Schaeffner, Michael; Gerhardt, Julia; Meyer, Bernhard; Ringel, Florian; Krieg, Sandro M

    2014-01-14

    When treating cerebral metastases all involved multidisciplinary oncological specialists have to cooperate closely to provide the best care for these patients. For the resection of brain metastasis several studies reported a considerable risk of new postoperative paresis. Pre- and perioperative chemotherapy (Ctx) or radiotherapy (Rtx) alter vasculature and adjacent fiber tracts on the one hand, and many patients already present with paresis prior to surgery on the other hand. As such factors were repeatedly considered risk factors for perioperative complications, we designed this study to also identify risk factors for brain metastases resection. Between 2006 and 2011, we resected 206 brain metastases consecutively, 56 in eloquent motor areas and 150 in non-eloquent ones. We evaluated the influences of preoperative paresis, previous Rtx or Ctx as well as recursive partitioning analysis (RPA) class on postoperative outcome. In general, 8.7% of all patients postoperatively developed a new permanent paresis. In contrast to preoperative Ctx, previous Rtx as a single or combined treatment strategy was a significant risk factor for postoperative motor weakness. This risk was even increased in perirolandic and rolandic lesions. Our data show significantly increased risk of new deficits for patients assigned to RPA class 3. Even in non-eloquently located brain metastases the risk of new postoperative paresis has not to be underestimated. Despite the microsurgical approach, our cohort shows a high rate of unexpected residual tumors in postoperative MRI, which supports recent data on brain metastases' infiltrative nature but might also be the result of our strict study protocol. Surgical resection is a safe treatment of brain metastases. However, preoperative Rtx and RPA score 3 have to be taken into account when surgical resection is considered.

  9. Topical distribution of initial paresis of the limbs to predict clinically relevant spasticity after ischemic stroke: a retrospective cohort study.

    PubMed

    Picelli, A; Tamburin, S; Dambruoso, F; Midiri, A; Girardi, P; Santamato, A; Fiore, P; Smania, N

    2014-10-01

    The degree of initial paresis relates to spasticity development in stroke patients. However, the importance of proximal and distal paresis in predicting spasticity after stroke is unclear. To investigate the role of topical distribution of initial limb paresis to predict clinically relevant spasticity in adults with stroke. Retrospective cohort study Seventy-two first-ever ischemic stroke patients were examined. At the acute phase of illness, demographics and the European Stroke Scale motor items (maintenance of outstretched arm position, arm raising, wrist extension, grip strength, maintenance of outstretched leg position, leg flexion, foot dorsiflexion) were evaluated. At six months after the stroke onset, spasticity was assessed at the upper and lower limb with the modified Ashworth Scale. Clinically relevant spasticity was defined as modified Ashworth Scale ≥3 (0-5). The degree of initial paresis of the proximal muscles of the upper limb and the distal muscles of the lower limb showed the strongest association and the best profile of sensitivity-specificity in predicting clinically relevant spasticity at the upper and lower limb, respectively. Younger age showed higher risk for developing clinically relevant spasticity in the upper limb. Our findings support the hypothesis that the initial degree of proximal paresis of the upper limb and distal paresis of the lower limb as well as age may be considered early predictors of clinically relevant spasticity in adults with ischemic stroke. Our findings further improve the role of initial paresis as predictor of spasticity after stroke.

  10. Ataxia and paresis with equine herpesvirus type 1 infection in a herd of riding school horses.

    PubMed

    Friday, P A; Scarratt, W K; Elvinger, F; Timoney, P J; Bonda, A

    2000-01-01

    An outbreak of neurologic disease associated with serologic evidence of equine herpesvirus type 1 (EHV-1) infection occurred in a herd of 46 riding school horses. Ataxia and paresis were observed in 14 geldings and 5 barren mares. Eight affected horses had distal limb edema, 1 horse had a head tilt, and 3 others had urinary incontinence. Other clinical signs included fever, depression, and inappetance in 30 horses. Seven horses with neurologic signs were treated with acyclovir. Serum neutralizing antibody titers against EHV-1 increased 4-fold between acute and convalescent samples or exceeded 1:256 in 19 of 44 horses, confirming recent infection. A significantly greater proportion of horses that seroconverted were mares (P = .014). Of the 19 horses exhibiting ataxia and paresis, 17 made a complete recovery, 1 made a partial recovery, and 1 was euthanized.

  11. Transient unilateral combined paresis of the hypoglossal nerve and lingual nerve following intubation anesthesia.

    PubMed

    Ulusoy, Hulya; Besir, Ahmet; Cekic, Bahanur; Kosucu, Muge; Geze, Sukran

    2014-01-01

    Nerve damage may occur in the pharyngolaryngeal region during general anesthesia. The most frequently injured nerves are the hypoglossal, lingual and recurrent laryngeal. These injuries may arise in association with several factors, such as laryngoscopy, endotracheal intubation and tube insertion, cuff pressure, mask ventilation, the triple airway maneuver, the oropharyngeal airway, manner of intubation tube insertion, head and neck position and aspiration. Nerve injuries in this region may take the form of an isolated single nerve or of paresis of two nerves together in the form of hypoglossal and recurrent laryngeal nerve palsy (Tapia's syndrome). However, combined injury of the lingual and hypoglossal nerves following intubation anesthesia is a much rarer condition. The risk of this damage can be reduced with precautionary measures. We describe a case of combined unilateral nervus hypoglossus and nervus lingualis paresis developing after intubation anesthesia.

  12. Predicting recovery of voluntary upper extremity movement in subacute stroke patients with severe upper extremity paresis.

    PubMed

    Koh, Chia-Lin; Pan, Shin-Liang; Jeng, Jiann-Shing; Chen, Bang-Bin; Wang, Yen-Ho; Hsueh, I-Ping; Hsieh, Ching-Lin

    2015-01-01

    Prediction of voluntary upper extremity (UE) movement recovery is largely unknown in patients with little voluntary UE movement at admission. The present study aimed to investigate (1) the extent and variation of voluntary UE movement recovery, and (2) the best predictive model of the recovery of voluntary UE movement by clinical variables in patients with severe UE paresis. Prospective cohort study. 140 (out of 590) stroke patients with severe UE paresis completed all assessments. Voluntary UE movement was assessed using the UE subscale of the Stroke Rehabilitation Assessment of Movement (STREAM-UE). Two outcome measures, STREAM-UE scores at discharge (DC(STREAM-UE)) and changes between admission and discharge (Δ(STREAM-UE)), were investigated to represent the final states and improvement of the recovery of voluntary UE movement. Stepwise regression analyses were used to investigate 19 clinical variables and to find the best predictive models of the two outcome measures. The participants showed wide variation in both DC(STREAM-UE) and Δ(STREAM-UE). 3.6% of the participants almost fully recovered at discharge (DC(STREAM-UE) > 15). A large improvement (Δ(STREAM-UE) >= 10) occurred in 16.4% of the participants, while 32.9% of the participants did not have any improvement. The four predictors for the DC(STREAM-UE) (R(2) = 35.0%) were 'baseline STREAM-UE score', 'hemorrhagic stroke', 'baseline National Institutes of Health Stroke Scale (NIHSS) score', and 'cortical lesion excluding primary motor cortex'. The three predictors for the Δ(STREAM-UE) (R(2) = 22.0%) were 'hemorrhagic stroke', 'baseline NIHSS score', and 'cortical lesion excluding primary motor cortex'. Recovery of voluntary UE movement varied widely in patients with severe UE paresis after stroke. The predictive power of clinical variables was poor. Both results indicate the complex nature of voluntary UE movement recovery in patients with severe UE paresis after stroke.

  13. Community-based exercise for upper limb paresis: a controlled trial with telerehabilitation.

    PubMed

    Benvenuti, Francesco; Stuart, Mary; Cappena, Veruska; Gabella, Sara; Corsi, Sara; Taviani, Antonio; Albino, Antonio; Scattareggia Marchese, Sandro; Weinrich, Michael

    2014-09-01

    Arm paresis remains a major impairment after stroke despite the best conventional rehabilitation. Randomized, controlled trials of intensive exercise programs have demonstrated improvements in arm function for patients with chronic stroke. However, the gains achieved have been relatively modest for the large investments in patient and therapist time. To evaluate the safety, acceptance, adherence, and effectiveness of a community-based exercise program for upper limb paresis in patients with chronic stroke and the effects of telerehabilitation monitoring in kiosks distributed through the community. Longitudinal cohort with geographic control group. The experimental group received devices needed for a home exercise program based on the Carr and Shepherd "Motor Learning Program" and were instructed to practice the exercises at least twice a week at the kiosk and at least 3 more days a week at home. The control group received usual care. Compared with the control group, patients in the experimental group demonstrated significant gains in arm function as measured by the Wolf Motor Function Test, 9-Hole Peg Test, Motricity Index, and Nottingham Extended Activities of Daily Living Questionnaire. The intervention received high satisfaction ratings and produced no adverse events. Only 30% of the subjects attended kiosks regularly. Outcomes for this group did not differ significantly from those who only practiced at home. Home- and community-based exercise for arm paresis is safe and effective. Telerehabilitation interventions will need additional enhancements to improve effectiveness. The optimal upper extremity exercise prescription poststroke remains to be established. © The Author(s) 2014.

  14. Ipsilateral hemiparesis and contralateral lower limb paresis caused by anterior cerebral artery territory infarct.

    PubMed

    Xu, Yongfeng; Liu, Lan

    2016-07-01

    Ipsilateral hemiparesis is rare after a supratentorial stroke, and the role of reorganization in the motor areas of unaffected hemisphere is important for the rehabilitation of the stroke patients. In this study, we present a patient who had a subclinical remote infarct in the right pons developed ipsilateral hemiparesis and contralateral lower limb paresis caused by a new infarct in the left anterior cerebral artery territory. Our case suggests that the motor areas of the unaffected hemisphere might be reorganized after stroke, which is important for the rehabilitation of stroke patients.

  15. Ipsilateral hemiparesis and contralateral lower limb paresis caused by anterior cerebral artery territory infarct

    PubMed Central

    Xu, Yongfeng; Liu, Lan

    2016-01-01

    Ipsilateral hemiparesis is rare after a supratentorial stroke, and the role of reorganization in the motor areas of unaffected hemisphere is important for the rehabilitation of the stroke patients. In this study, we present a patient who had a subclinical remote infarct in the right pons developed ipsilateral hemiparesis and contralateral lower limb paresis caused by a new infarct in the left anterior cerebral artery territory. Our case suggests that the motor areas of the unaffected hemisphere might be reorganized after stroke, which is important for the rehabilitation of stroke patients. PMID:27356659

  16. Predicting Recovery of Voluntary Upper Extremity Movement in Subacute Stroke Patients with Severe Upper Extremity Paresis

    PubMed Central

    Koh, Chia-Lin; Pan, Shin-Liang; Jeng, Jiann-Shing; Chen, Bang-Bin; Wang, Yen-Ho; Hsueh, I-Ping; Hsieh, Ching-Lin

    2015-01-01

    Background and Objective Prediction of voluntary upper extremity (UE) movement recovery is largely unknown in patients with little voluntary UE movement at admission. The present study aimed to investigate (1) the extent and variation of voluntary UE movement recovery, and (2) the best predictive model of the recovery of voluntary UE movement by clinical variables in patients with severe UE paresis. Design Prospective cohort study. Methods 140 (out of 590) stroke patients with severe UE paresis completed all assessments. Voluntary UE movement was assessed using the UE subscale of the Stroke Rehabilitation Assessment of Movement (STREAM-UE). Two outcome measures, STREAM-UE scores at discharge (DCSTREAM-UE) and changes between admission and discharge (ΔSTREAM-UE), were investigated to represent the final states and improvement of the recovery of voluntary UE movement. Stepwise regression analyses were used to investigate 19 clinical variables and to find the best predictive models of the two outcome measures. Results The participants showed wide variation in both DCSTREAM-UE and ΔSTREAM-UE. 3.6% of the participants almost fully recovered at discharge (DCSTREAM-UE > 15). A large improvement (ΔSTREAM-UE >= 10) occurred in 16.4% of the participants, while 32.9% of the participants did not have any improvement. The four predictors for the DCSTREAM-UE (R2 = 35.0%) were ‘baseline STREAM-UE score’, ‘hemorrhagic stroke’, ‘baseline National Institutes of Health Stroke Scale (NIHSS) score’, and ‘cortical lesion excluding primary motor cortex’. The three predictors for the ΔSTREAM-UE (R2 = 22.0%) were ‘hemorrhagic stroke’, ‘baseline NIHSS score’, and ‘cortical lesion excluding primary motor cortex’. Conclusions Recovery of voluntary UE movement varied widely in patients with severe UE paresis after stroke. The predictive power of clinical variables was poor. Both results indicate the complex nature of voluntary UE movement recovery in patients

  17. General paresis

    MedlinePlus

    ... Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases . 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 239. Review Date 2/27/2016 Updated by: Amit M. Shelat, DO, FACP, Attending ...

  18. Effects of Mirror Therapy Using a Tablet PC on Central Facial Paresis in Stroke Patients

    PubMed Central

    2017-01-01

    Objective To investigate the effects of mirror therapy using a tablet PC for post-stroke central facial paresis. Methods A prospective, randomized controlled study was performed. Twenty-one post-stroke patients were enrolled. All patients performed 15 minutes of orofacial exercise twice daily for 14 days. The mirror group (n=10) underwent mirror therapy using a tablet PC while exercising, whereas the control group (n=11) did not. All patients were evaluated using the Regional House–Brackmann Grading Scale (R-HBGS), and the length between the corner of the mouth and the ipsilateral earlobe during rest and smiling before and after therapy were measured bilaterally. We calculated facial movement by subtracting the smile length from resting length. Differences and ratios between bilateral sides of facial movement were evaluated as the final outcome measure. Results Baseline characteristics were similar for the two groups. There were no differences in the scores for the basal Modified Barthel Index, the Korean version of Mini-Mental State Examination, National Institutes of Health Stroke Scale, R-HBGS, and bilateral differences and ratios of facial movements. The R-HBGS as well as the bilateral differences and ratios of facial movement showed significant improvement after therapy in both groups. The degree of improvement of facial movement was significantly larger in the mirror group than in the control group. Conclusion Mirror therapy using a tablet PC might be an effective tool for treating central facial paresis after stroke. PMID:28758071

  19. Effects of Mirror Therapy Using a Tablet PC on Central Facial Paresis in Stroke Patients.

    PubMed

    Kang, Jung-A; Chun, Min Ho; Choi, Su Jin; Chang, Min Cheol; Yi, You Gyoung

    2017-06-01

    To investigate the effects of mirror therapy using a tablet PC for post-stroke central facial paresis. A prospective, randomized controlled study was performed. Twenty-one post-stroke patients were enrolled. All patients performed 15 minutes of orofacial exercise twice daily for 14 days. The mirror group (n=10) underwent mirror therapy using a tablet PC while exercising, whereas the control group (n=11) did not. All patients were evaluated using the Regional House-Brackmann Grading Scale (R-HBGS), and the length between the corner of the mouth and the ipsilateral earlobe during rest and smiling before and after therapy were measured bilaterally. We calculated facial movement by subtracting the smile length from resting length. Differences and ratios between bilateral sides of facial movement were evaluated as the final outcome measure. Baseline characteristics were similar for the two groups. There were no differences in the scores for the basal Modified Barthel Index, the Korean version of Mini-Mental State Examination, National Institutes of Health Stroke Scale, R-HBGS, and bilateral differences and ratios of facial movements. The R-HBGS as well as the bilateral differences and ratios of facial movement showed significant improvement after therapy in both groups. The degree of improvement of facial movement was significantly larger in the mirror group than in the control group. Mirror therapy using a tablet PC might be an effective tool for treating central facial paresis after stroke.

  20. Isolated double herpes zoster paresis involving the left facial nerve and the right peroneal nerve following disseminated herpes zoster.

    PubMed

    Takahama, Hideto; Tsukahara, Nanako; Hirayama, Masatoshi; Ito, Satoshi; Sakuramoto, Chieko

    2007-05-01

    A 72-year-old Japanese male developed disseminated herpes zoster and could not easily walk due to right drop foot and pain. He soon developed numbness and pain on the left side of his face, and noticed difficulty closing his left eye. The left angle of his mouth dropped. The patient was diagnosed as having a double mononeuropathy (a left facial nerve paresis and a right peroneal nerve paresis) following disseminated herpes zoster. Given that the patient was elderly and had diabetes mellitus, the patient appeared to be an immunocompromised host. We also describe other rare complications of herpes zoster from the published work.

  1. Post-traumatic Vertical Gaze Paresis in Nine Patients: Special Vulnerability of the Artery of Percheron in Trauma?

    PubMed

    Galvez-Ruiz, Alberto

    2015-01-01

    The purpose was to present a case series of vertical gaze paresis in patients with a history of cranioencephalic trauma (CET). The clinical characteristics and management are presented of nine patients with a history of CET secondary to motor vehicle accidents with associated vertical gaze paresis. Neuroimaging studies indicated posttraumatic contusion of the thalamic-mesencephalic region in all nine patients who corresponded to the artery of Percheron region; four patients had signs of hemorrhagic transformation. Vertical gaze paresis was present in all patients, ranging from complete paralysis of the upward and downward gaze to a slight limitation of upward gaze. Posttraumatic vertical gaze paresis is a rare phenomenon that can occur in isolation or in association with other neurological deficits and can cause a significant limitation in the quality-of-life. Studies in the literature have postulated that the unique anatomy of the angle of penetration of the thalamoperforating and lenticulostriate arteries makes these vessels more vulnerable to isolated selective damage in certain individuals and can cause-specific patterns of CET.

  2. Post-traumatic Vertical Gaze Paresis in Nine Patients: Special Vulnerability of the Artery of Percheron in Trauma?

    PubMed Central

    Galvez-Ruiz, Alberto

    2015-01-01

    Purpose: The purpose was to present a case series of vertical gaze paresis in patients with a history of cranioencephalic trauma (CET). Methods: The clinical characteristics and management are presented of nine patients with a history of CET secondary to motor vehicle accidents with associated vertical gaze paresis. Results: Neuroimaging studies indicated posttraumatic contusion of the thalamic-mesencephalic region in all nine patients who corresponded to the artery of Percheron region; four patients had signs of hemorrhagic transformation. Vertical gaze paresis was present in all patients, ranging from complete paralysis of the upward and downward gaze to a slight limitation of upward gaze. Discussion: Posttraumatic vertical gaze paresis is a rare phenomenon that can occur in isolation or in association with other neurological deficits and can cause a significant limitation in the quality-of-life. Studies in the literature have postulated that the unique anatomy of the angle of penetration of the thalamoperforating and lenticulostriate arteries makes these vessels more vulnerable to isolated selective damage in certain individuals and can cause-specific patterns of CET. PMID:26180479

  3. CMT2C with vocal cord paresis associated with short stature and mutations in the TRPV4 gene.

    PubMed

    Chen, D-H; Sul, Y; Weiss, M; Hillel, A; Lipe, H; Wolff, J; Matsushita, M; Raskind, W; Bird, T

    2010-11-30

    Recently, mutations in the transient receptor potential cation channel, subfamily V, member 4 gene (TRPV4) have been reported in Charcot-Marie-Tooth Type 2C (CMT2C) with vocal cord paresis. Other mutations in this same gene have been described in separate families with various skeletal dysplasias. Further clarification is needed of the different phenotypes associated with this gene. We performed clinical evaluation, electrophysiology, and genetic analysis of the TRPV4 gene in 2 families with CMT2C. Two multigenerational families had a motor greater than sensory axonal neuropathy associated with variable vocal cord paresis. The vocal cord paresis varied from absent to severe, requiring permanent tracheotomy in 2 subjects. One family with mild neuropathy also manifested pronounced short stature, more than 2 SD below the average height for white Americans. There was one instance of dolichocephaly. A novel S542Y mutation in the TRPV4 gene was identified in this family. The other family had a more severe, progressive, motor neuropathy with sensory loss, but less remarkable short stature and an R315W mutation in TRPV4. Third cranial nerve involvement and sleep apnea occurred in one subject in each family. CMT2C with axonal neuropathy, vocal cord paresis, and short stature is a unique syndrome associated with mutations in the TRPV4 gene. Mutations in TRPV4 can cause abnormalities in bone, peripheral nerve, or both and may result in highly variable orthopedic and neurologic phenotypes.

  4. Combination of cyclosporin A and prednisolone for juvenile cellulitis concurrent with hindlimb paresis in 3 English cocker spaniel puppies

    PubMed Central

    Park, Chul; Yoo, Jong-Hyun; Kim, Ha-Jung; Kang, Byeong-Teck; Park, Hee-Myung

    2010-01-01

    Three 7-week-old, English cocker spaniel littermates were diagnosed as having juvenile cellulitis with concurrent neurologic signs based on history, histopathology, and therapeutic response. The puppies were treated with cyclosporin A and prednisolone. Skin lesions and hindlimb paresis improved following treatment. PMID:21286328

  5. Feasibility of High-Repetition, Task-Specific Training for Individuals With Upper-Extremity Paresis

    PubMed Central

    Waddell, Kimberly J.; Birkenmeier, Rebecca L.; Moore, Jennifer L.; Hornby, T. George

    2014-01-01

    OBJECTIVE. We investigated the feasibility of delivering an individualized, progressive, high-repetition upper-extremity (UE) task-specific training protocol for people with stroke in the inpatient rehabilitation setting. METHOD. Fifteen patients with UE paresis participated in this study. Task-specific UE training was scheduled for 60 min/day, 4 days/wk, during occupational therapy for the duration of a participant’s inpatient stay. During each session, participants were challenged to complete ≥300 repetitions of various tasks. RESULTS. Participants averaged 289 repetitions/session, spending 47 of 60 min in active training. Participants improved on impairment and activity level outcome measures. CONCLUSION. People with stroke in an inpatient setting can achieve hundreds of repetitions of task-specific training in 1-hr sessions. As expected, all participants improved on functional outcome measures. Future studies are needed to determine whether this high-repetition training program results in better outcomes than current UE interventions. PMID:25005508

  6. [Clinical course and serial brain MRI findings in a patient with Lissauer form of general paresis].

    PubMed

    Ishihara, Tomohiko; Ishihara, Ayako; Ozawa, Tetutaro; Sanpei, Kazuhiro; Shimohata, Takayoshi; Nishizawa, Masatoyo

    2015-01-01

    A 60-year-old man presented with progressive dementia and generalized convulsions. An initial MRI revealed a widespread high-intensity area with a mass effect in the right frontal and temporal lobes on T2-weighted images. Findings on digital subtraction angiography were normal. Serum and CSF tests showed high titers of antibodies to Treponema pallidum, which helped to distinguish neurosyphilis from glioma. He was initially treated with penicillin injection; however, it caused liver dysfunction and penicillin was switched to erythromycin. Even after antibiotic therapy for 2 months, his dementia did not improve. He underwent brain MRI four times during the treatment course, and they showed steady progression of brain atrophy in the right hemisphere. Taking these findings together, we diagnosed Lissauer form of general paresis. To the best of our knowledge, this is the first case of Lissauer form of paretic neurosyphilis, in which the progression of brain atrophy was clearly demonstrated on MRI.

  7. A novel homozygous HOXB1 mutation in a Turkish family with hereditary congenital facial paresis.

    PubMed

    Sahin, Yavuz; Güngör, Olcay; Ayaz, Akif; Güngör, Gülay; Sahin, Bedia; Yaykasli, Kursad; Ceylaner, Serdar

    2017-02-01

    Hereditary congenital facial paresis (HCFP) is characterized by isolated dysfunction of the facial nerve (CN VII) due to congenital cranial dysinnervation disorders. HCFP has genetic heterogeneity and HOXB1 is the first identified gene. We report the clinical, radiologic and molecular investigations of three patients admitted for HCFP in a large consanguineous Turkish family. High-throughput sequencing and Sanger sequencing of all patients revealed a novel homozygous mutation p.Arg230Trp (c.688C>T) within the HOXB1 gene. The report of the mutation brings the total number of HOXB1 mutations identified in HCFP to four. The results of this study emphasize that in individuals with congenital facial palsy accompanied by hearing loss and dysmorphic facial features, HOXB1 mutation causing HCFP should be kept in mind. Copyright © 2016 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  8. Ascending paresis as presentation of an unusual association between necrotizing autoimmune myopathy and systemic lupus erythematosus.

    PubMed

    García-Reynoso, Marco Julio; Veramendi-Espinoza, Liz Eliana; Ruiz-Garcia, Henry Jeison

    2014-01-01

    A 45 year-old man went to the emergency room due to disease duration of 15 days of insidious onset and progressive course. It began with symmetrical weakness and pain in feet and ankles that extends upward to the knees. Later, this progressed to paraparesis with Creatine phosphokinase levels of 44,270 U/L and respiratory failure that required mechanical ventilation. Electromyography and muscle biopsy of quadriceps were made. The patient responded to corticotherapy in pulses and supporting management. The presentation of ascending paresis suggested the diagnosis of Guillain-Barré syndrome. However, the degree of muscle involvement with rhabdomyolysis explains the neurological damage by itself. The biopsy revealed pathological criteria for necrotizing autoimmune myopathy (NAM), as well as other clinical and laboratory evidence. Patient disease continued and reached criteria for systemic lupus erythematosus (SLE). To our best knowledge, this is the first report of the NAM and SLE association.

  9. Mirror therapy for patients with severe arm paresis after stroke--a randomized controlled trial.

    PubMed

    Thieme, Holm; Bayn, Maria; Wurg, Marco; Zange, Christian; Pohl, Marcus; Behrens, Johann

    2013-04-01

    To evaluate the effects of individual or group mirror therapy on sensorimotor function, activities of daily living, quality of life and visuospatial neglect in patients with a severe arm paresis after stroke. Randomized controlled trial. Inpatient rehabilitation centre. Sixty patients with a severe paresis of the arm within three months after stroke. Three groups: (1) individual mirror therapy, (2) group mirror therapy and (3) control intervention with restricted view on the affected arm. Motor function on impairment (Fugl-Meyer Test) and activity level (Action Research Arm Test), independence in activities of daily living (Barthel Index), quality of life (Stroke Impact Scale) and visuospatial neglect (Star Cancellation Test). After five weeks, no significant group differences for motor function were found (P > 0.05). Pre-post differences for the Action Research Arm Test and Fugl-Meyer Test: individual mirror therapy: 3.4 (7.1) and 3.2 (3.8), group mirror therapy: 1.1 (3.1) and 5.1 (10.0) and control therapy: 2.8 (6.7) and 5.2 (8.7). However, a significant effect on visuospatial neglect for patients in the individual mirror therapy compared to control group could be shown (P < 0.01). Furthermore, it was possible to integrate a mirror therapy group intervention for severely affected patients after stroke. This study showed no effect on sensorimotor function of the arm, activities of daily living and quality of life of mirror therapy compared to a control intervention after stroke. However, a positive effect on visuospatial neglect was indicated.

  10. Bovine spastic paresis: A review of the genetic background and perspectives for the future.

    PubMed

    Goeckmann, Victoria; Rothammer, Sophie; Medugorac, Ivica

    2016-10-01

    Bovine spastic paresis (BSP) is a sporadic, progressive neuromuscular disease that is thought to affect all breeds of cattle. The disease manifests as a unilateral or bilateral hyperextension of the hind limb due to increased muscle tone or permanent spasm of mainly the gastrocnemius and/or the quadriceps muscle. Clinical signs only appear in rising, standing and moving animals, which is an important diagnostic feature. Although several medical treatments have been described, surgical procedures such as neurectomy or tenectomy are generally indicated. Even though complete recovery can be achieved, BSP-affected animals should not be used for breeding, since BSP is commonly considered a hereditary disease. The condition therefore negatively affects animal welfare, economics and breeding. When first described in 1922, BSP was already assumed to be heritable, and this assumption has been perpetuated by subsequent authors who have only discussed its possible modes of inheritance, which included monogenetic and polygenetic modes and gene-environment interactions. Besides some clinical aspects and the consideration of the tarsal joint angle as a BSP-correlated trait, this review mainly focuses on the assumed genetic aspects of BSP. Evaluation of the published literature demonstrates that to date, irrevocable proof for the assumed heritability of BSP is still missing. The assumption of heredity is further contradicted by known allele frequencies and incidences of proven hereditary diseases in cattle, such as arachnomelia or bovine spinal muscular atrophy. Consequently, future research is needed to determine the cause of spastic paresis. Procedures that will help test the null-hypothesis ('BSP is not hereditary') and possible modes of inheritance are discussed in this review. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Early hemi-diaphragmatic plication through a video assisted mini-thoracotomy in postcardiotomy phrenic nerve paresis

    PubMed Central

    Tsakiridis, Kosmas; Visouli, Aikaterini N.; Machairiotis, Nikolaos; Christofis, Christos; Stylianaki, Aikaterini; Katsikogiannis, Nikolaos; Mpakas, Andreas; Courcoutsakis, Nicolaos; Zarogoulidis, Konstantinos

    2012-01-01

    New symptom onset of respiratory distress without other cause, and new hemi-diaphragmatic elevation on chest radiography postcardiotomy, are usually adequate for the diagnosis of phrenic nerve paresis. The symptom severity varies (asymptomatic state to severe respiratory failure) depending on the degree of the lesion (paresis vs. paralysis), the laterality (unilateral or bilateral), the age, and the co-morbidity (respiratory, cardiac disease, morbid obesity, etc). Surgical treatment (hemi-diaphragmatic plication) is indicated only in the presence of symptoms. The established surgical treatment is plication of the affected hemidiaphragm which is generally considered safe and effective. Several techniques and approaches are employed for diaphragmatic plication (thoracotomy, video-assisted thoracoscopic surgery, video-assisted mini-thoracotomy, laparoscopic surgery). The timing of surgery depends on the severity and the progression of symptoms. In infants and young children with postcardiotomy phrenic nerve paresis the clinical status is usually severe (failure to wean from mechanical ventilation), and early plication is indicated. Adults with postcardiotomy phrenic nerve paresis usually suffer from chronic dyspnoea, and, in the absence of respiratory distress, conservative treatment is recommended for 6 months -2 years, since improvement is often observed. Nevertheless, earlier surgical treatment may be indicated in non-resolving respiratory failure. We present early (25th day postcardiotomy) right hemi-diaphragm plication, through a video assisted mini-thoracotomy in a high risk patient with postcardiotomy phrenic nerve paresis and respiratory distress. Early surgery with minimal surgical trauma, short operative time, minimal blood loss and postoperative pain, led to fast rehabilitation and avoidance of prolonged hospitalization complications. The relevant literature is discussed. PMID:23304442

  12. Bridle transfer for paresis of the anterior and lateral compartment musculature.

    PubMed

    Prahinski, J R; McHale, K A; Temple, H T; Jackson, J P

    1996-10-01

    In the Riordan (bridle) transfer, the posterior tibialis muscle as motor is routed through the interosseous membrane and anastomosed into a "bridle" formed by the distal tibialis anterior and peroneus longus muscles. In theory, the bridle provides inversion/eversion balance even if the transfer effects only tenodesis. However, the procedure has been criticized because its insertion is not into bone. This review analyzes the use of bridle transfer in flaccid paresis involving musculature innervated by the peroneal nerve. Surgery was performed 1 to 3 years after injury for patients with traumatic etiology. Ten patients are reviewed at 61 months' mean follow-up. Eight patients had traumatic peroneal nerve loss. Two had neuromuscular etiology. Evaluation included review of records, telephone interviews, and physical examinations. Data on functional status included walking barefoot running, need for bracing, return to duty, and patient satisfaction. Physical examination recorded ankle position and motions, gait findings, and results of static electromyograms. All patients were able to walk barefoot, but 6 of 10 had a mild to moderate limp. Five patients returned to running initially; only two were able to keep running. Nine patients were brace-free initially (polio sequela required bracing initially), and four others returned to bracing. Of these, two experienced an acute "tearing" and dorsiflexion loss, one sustained a prolonged gradual loss of dorsiflexion, and one sustained a contralateral cerebrovascular accident. Only three of seven patients returned to active duty, and one is on jump status. All patients were satisfied with their initial result. Only two patients had no detectable swing phase problems (both returned to active duty). Five patients had peroneal nerve exploration with repair or neurolysis; two of them sustained complete transections. Postoperative electromyograms showed insignificant, if any, nerve return. The Riordan transfer works well for

  13. Stance control is not affected by paresis and reflex hyperexcitability: the case of spastic patients

    PubMed Central

    Nardone, A; Galante, M; Lucas, B; Schieppati, M

    2001-01-01

    OBJECTIVES—Spastic patients were studied to understand whether stance unsteadiness is associated with changes in the control of voluntary force, muscle tone, or reflex excitability, rather than to abnormal posture connected to the motor deficit itself.
METHODS—Twenty four normal subjects, 12 patients affected by amyotrophic lateral sclerosis (ALS), seven by spastic paraparesis, and 14 by hemiparesis were studied. All patients featured various degrees of spasticity and paresis but were free from clinically evident sensory deficits. Body sway during quiet upright stance was assessed through a stabilometric platform under both eyes open (EO) and eyes closed (EC) conditions. The sudden rotation of a supporting platform, in a toe up and toe down direction respectively, evoked short (SLR) and medium latency (MLR) reflex responses to stretch of the soleus or the tibialis anterior (TA) muscle.
RESULTS—No relation was found between clinical findings (tone, muscle strength, tendon reflexes, plantar response, and duration of disease) and body sway. On average, all patient groups exhibited a forward shift of the centre of foot pressure (CFP) with respect to normal subjects; in addition, paraparetic and to a much larger extent hemiparetic patients showed a lateral shift of CFP. Body sway area was significantly increased only in the hemiparetic patients. No relation was found between position of the CFP and sway within any patient group. Soleus SLR was increased in all patients with respect to normal subjects. TA SLR was often seen in both patients with ALS and paraparetic patients, but only rarely in normal subjects and hemiparetic patients. However, no relation was found between amplitude of soleus or TA SLRs and stabilometric variables. The frequency and size of soleus MLR and TA MLR were decreased in all patients. These responses were decreased in size and not modulated by background EMG in the affected leg of hemiparetic patients, suggesting a disturbed control of

  14. Deficit in late-stage contingent negative variation provides evidence for disrupted movement preparation in patients with conversion paresis.

    PubMed

    Blakemore, Rebekah L; Hyland, Brian I; Hammond-Tooke, Graeme D; Anson, J Greg

    2015-07-01

    Conversion paresis is the presence of unexplained weakness without detectable neuropathology that is not feigned. To examine the 'abnormal preparation' and 'disrupted execution' hypotheses proposed to explain the movement deficits in conversion paresis, electroencephalographic, electromyographic and kinematic measures were recorded during motor preparation and execution. Six patients with unilateral upper limb conversion weakness, 24 participants feigning weakness and 12 control participants performed a 2-choice precued reaction time task. Precues provided advance information about the responding hand or finger. Patients and feigners demonstrated similar diminished force, longer movement time and extended duration of muscle activity in their symptomatic limb. Patients showed significantly suppressed contingent negative variation (CNV) amplitudes, but only when the symptomatic limb was precued. Despite the similarity in performance measures, this CNV suppression was not seen in feigners. Diminished CNV for symptomatic hand precues may reflect engagement of an inhibitory mechanism suppressing cortical activity related to preparatory processes. Copyright © 2015 Elsevier B.V. All rights reserved.

  15. [Autopsy case of Lissauer's general paresis with rapidly progressive left hemiparesis].

    PubMed

    Kato, Hiroko; Yoshida, Mari; Ando, Tetsuo; Sugiura, Makoto; Hashizume, Yoshio

    2009-06-01

    A 48-years-old man presented with slowly progressive bradykinesia, personality change and rapidly progressive left hemiparesis. On admission, he presented dementia, poor judgment, left hemiparesis. MRI revealed a widespread high intensity area in right hemisphere and MRA was almost normal. Serological tests of serum and CSF demonstrated high titers of antibodies to Treponema pallidum. He was treated for syphilis with daily penicillin injections without improvement. He died of sepsis eight months after admission. At autopsy, the brain weighed 1,100 g and the right cerebral hemisphere was atrophic, especially in frontal base, temporal, parietal, angular, and posterior regions covered by thickened, fibrotic leptomeninges. Microscopically, chronic meningoencephalitis was observed. Severe neuronal loss with gliosis was seen in the right cerebral cortices. Scattered rod-shaped microglia and inflammatory cell infiltration were visible in the cerebral parenchyma. The dorsal column of the spinal cord was not involved and meningovascular syphilis was unclear. The distribution of the encephalitic lesions was well correlated with the clinical and neuroradiological findings. This was a rare autopsy case presenting Lissauer's general paresis, clinically manifesting as rapidly progressive stroke-like episode.

  16. Role of vitamin D in calcium homeostasis and its use in prevention of bovine periparturient paresis.

    PubMed

    Horst, R L; Goff, J P; Reinhardt, T A

    2003-01-01

    Calcium (Ca) is essential for life in higher animals. It is involved in the normal functioning of a wide variety of tissues and physiologic processes which include bone formation, muscle contraction, nerve transmission, blood clotting and as a second messenger regulating the actions of many hormones. In order for these functions to be carried out properly, blood Ca concentrations must be monitored and regulated within strict limitations. The discovery of the vitamin D endocrine system has resulted in the realization that Ca regulation in mammals and birds involves a coordinated effort between the hormones parathyroid hormone (PTH), calcitonin and the hormonally-active form of vitamin D3, 1,25-dihydroxyvitamin D3 [1,25(OH)2D3]. Failure of this system to maintain normal blood Ca concentrations at parturition is a common occurrence in ruminants leading to clinical (periparturient paresis, milk fever) and subclinical hypocalcemia. Vitamin D sterols have played a significant role in efforts to avoid parturient hypocalcemia and this report will summarize advantages and disadvantages associated with their use.

  17. Effect of intravenous calcium borogluconate and sodium phosphate in cows with parturient paresis.

    PubMed

    Braun, U; Zulliger, P; Liesegang, A; Bleul, U; Hässig, M

    2009-03-07

    Thirty cows with parturient paresis were divided into three groups of 10. All the cows were given 500 ml of a 40 per cent calcium borogluconate solution intravenously over a period of 10 minutes, and 20 were also given 500 ml of a 10 per cent solution of sodium phosphate intravenously; in 10 of the cows this solution was administered over a period of 10 minutes immediately after the calcium borogluconate solution, and in the other 10 cows 200 ml of the solution was administered rapidly and the remaining 300 ml was added to 10 litres of sodium chloride and glucose solution and infused slowly over six hours. There were no significant differences between the groups with respect to the outcome of the treatments; six or seven of the cows in each group stood within eight hours of the treatment. There were no significant differences between the changes in serum calcium concentrations among the groups. The mean concentrations of inorganic phosphorus in the groups given sodium phosphate were increased above the normal range initially, but after eight hours there were no significant differences between the groups in terms of the numbers of cows that were hypophosphataemic. There were no significant differences between the three groups with respect to changes after treatment in the serum concentrations of magnesium or parathyroid hormone.

  18. Interlimb coordination of posture in patients with spastic paresis. Impaired function of spinal reflexes.

    PubMed

    Dietz, V; Berger, W

    1984-09-01

    Activation of leg musculature on both sides following a unilateral displacement was studied during stance on separate see-saws, or on stable force-measuring platforms, in patients with spastic hemiparesis and paraparesis. During balancing the movements on the spastic side were damped and the degree of muscle activation reduced. Whereas in healthy subjects the tibialis anterior muscles of both sides were activated, following a unilateral displacement, with the same strength and latency (see-saws 55 ms, platforms 85 ms), in hemispastic patients the EMG responses were delayed (by about 20 to 30 ms) and of reduced strength on the spastic leg, irrespective of whether the unaffected or the spastic side was displaced. In addition, the compensatory movements on the spastic side were damped in both conditions, although the amplitude of displacement was the same bilaterally. Although there was no correlation between the delay and the reduction in EMG response, the latter was correlated with the severity of paresis. In patients with spastic paraparesis quite similar results were obtained with delayed and reduced EMG responses on both sides. It is concluded that in spasticity the impaired regulation of quick compensatory movements is due to a dysfunction of a spinal interneuronal system by which the early EMG responses are mediated. This could be explained by loss of supraspinal control. In addition to the impaired neural activation of leg muscles, changes in the mechanical properties of muscle can be assumed to contribute to the damped movements on the spastic side.

  19. Ultrasound-guided femoral nerve block as a diagnostic aid in demonstrating quadriceps involvement in bovine spastic paresis.

    PubMed

    De Vlamynck, Caroline; Vlaminck, Lieven; Hauspie, Stijn; Saunders, Jimmy; Gasthuys, Frank

    2013-06-01

    The aim of this study was to evaluate the clinical effects of a femoral nerve block via a dorsal paralumbar injection in healthy calves and calves suffering from spastic paresis. Based on bony landmarks and using ultrasound guidance, the femoral nerves of eight healthy calves were blocked bilaterally with a 4% procaine solution containing blue dye. In 11/16 nerve blocks, paralysis of the quadriceps muscle was obtained after dorsal paralumbar injection. Paralysis was total in 8/16 cases. The injection site was confirmed by post mortem dissection, and in 12/16 cases, the blue dye was found <2mm from the nerve. Clinical use of the technique was then demonstrated in two cases of atypical bovine spastic paresis. In such calves an objective diagnostic tool is required to identify those calves which are suitable for partial tibial neurectomy. The femoral nerve block used in this study has the potential to be such a method and can be used to establish the involvement of the quadriceps femoris in calves suffering from the quadriceps or mixed presentation form of spastic paresis. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. Treatment of cows with parturient paresis using intravenous calcium and oral sodium phosphate.

    PubMed

    Braun, U; Grob, D; Hässig, M

    2016-09-01

    The goal of this study was to investigate whether intravenous infusion of 1000 ml 40% calcium borogluconate combined with the oral adminstration of 500 g sodium phosphate leads to a better cure rate and longer-lasting normocalcaemia and normophosphataemia than standard intravenous treatment with 500 ml calcium borogluconate in cows with parturient paresis. Forty recumbent cows with hypocalcaemia and hypophosphataemia were alternately allocated to group A or B. Cows of both groups were treated intravenously with 500 ml 40% calcium borogluconate, and cows of group B additionally received another 500 ml calcium borogluconate via slow intravenous infusion and 500 g sodium phosphate administered via an orogastric tube. Thirty-two cows stood within 8 hours after the start of treatment and 8 did not; of the 32 cows that stood, 18 belonged to group A and 14 to group B (90% of group A vs. 70% of group B; P = 0.23). Seven cows relapsed; of these and the 8 that did not respond to initial treatment, 10 stood after two standard intravenous treatments. Downer cow syndrome occurred in 5 cows, 3 of which recovered after aggressive therapy. The overall cure rate did not differ significantly between groups A and B. Twelve (60%) cows of group A and 14 (70%) cows of group B were cured after a single treatment and of the remaining 14, 11 were cured after two or more treatments. Two downer cows were euthanized and one other died of heart failure during treatment. Serum calcium concentrations during the first eight hours after the start of treatment were significantly higher in group B than in group A, and oral sodium phosphate caused a significant and lasting increase in inorganic phosphate. More cows of group B than group A were cured after a single treatment (P > 0.05). These findings, although not statistically significant, are promising and should be verified using a larger number of cows.

  1. The management of peripheral facial nerve palsy: "paresis" versus "paralysis" and sources of ambiguity in study designs.

    PubMed

    Linder, Thomas E; Abdelkafy, Wael; Cavero-Vanek, Sandra

    2010-02-01

    Conservative management of idiopathic or herpetic acute peripheral facial palsy (herpes zoster oticus, HZO) often leads to a favorable outcome. However, recent multicenter studies have challenged the necessity of antivirals. Whereas large numbers of patients are required to reveal statistical differences in a disease with an overall positive outcome, surprisingly few studies differentiate between patients with paresis and paralysis. Analyzing our own prospective cohort of patients and reviewing the current literature on conservative treatment of Bell's palsy and HZO, we reveal the importance of initial baseline assessment of the disease course to predict the outcome and to validate the impact of medical treatment options. STUDY DESIGN AND DATA SOURCE: Prospective analysis of consecutive patients referred to 2 tertiary referral centers and research on the Cochrane Library for current updates of their previous reviews and search of MEDLINE (1976-2009) for randomized trials on conservative treatment of acute facial palsy were conducted. One hundred ninety-six patients with Bell's palsy or HZO were followed up prospectively until complete recovery or at least for 12 months. The numeric Fisch score (FS) was used to classify facial function, and patients were separated between incomplete palsy (=paresis) and complete paralysis. Electroneuronography (ENoG) was used to further subdivide patients with paralysis. The treatment protocol was independent of the ongoing investigation including prednisone and valacyclovir in most patients. A total of 250 previous studies on facial palsy outcome were evaluated regarding their distinction between different severity scores at baseline and its impact on treatment outcome. Trials not making the distinction between paresis and paralysis at baseline and with an insufficient follow-up of less than 12 months were excluded. In the Bell's and HZO paresis group, all except 1 patient recovered completely, most of them within 3 months

  2. Role of contralesional hemisphere in paretic arm reaching in patients with severe arm paresis due to stroke: A preliminary report.

    PubMed

    Mohapatra, Sambit; Harrington, Rachael; Chan, Evan; Dromerick, Alexander W; Breceda, Erika Y; Harris-Love, Michelle

    2016-03-23

    Stroke is highly prevalent and a leading cause of serious, long-term disability among American adults. Impaired movement (i.e. paresis) of the stroke-affected arm is a major contributor to post-stroke disability, yet the mechanisms of upper extremity motor recovery are poorly understood, particularly in severely impaired patients who lack hand function. To address this problem, we examined the functional relevance of the contralesional hemisphere in paretic arm motor performance in individuals with severe arm paresis. Twelve individuals with severe stroke-induced arm paresis (Upper Extremity Fugl-Meyer Assessment=17.1 ± 8.5; maximum score=66) participated in the study. Participants performed a reaching response time task with their paretic arm. At varying time intervals following a 'Go' cue, a pair of transcranial magnetic stimulation (TMS) pulses were delivered to contralesional hemisphere primary motor (M1) or dorsal pre-motor cortex (PMd) to momentarily disrupt the pattern of neural firing. Response time components and hand-path characteristics were compared across the 2 sites for trials with and without TMS disruption. There was no significant effect of TMS disruption on overall Response time or Reaction time, but Movement time was significantly longer (i.e. slower) with disruption of the contralesional hemisphere (p=0.015), regardless of which area was stimulated. Peak hand-path velocity and hand-path smoothness were also significantly lower (p=0.005 and p<0.0001, respectively) with TMS disruption of the contralesional hemisphere. The data from this study provide evidence supporting a functionally relevant role of contralesional hemisphere motor areas in paretic arm reaching movements in individuals with severe post-stroke arm impairment. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. An exploratory analysis of the self-reported goals of individuals with chronic upper-extremity paresis following stroke.

    PubMed

    Waddell, Kimberly J; Birkenmeier, Rebecca L; Bland, Marghuretta D; Lang, Catherine E

    2016-01-01

    To classify the self-identified goals of individuals post-stroke with chronic upper extremity (UE) paresis, and determine if age, UE functional capacity and pre-stroke hand dominance influence overall goal selection. Sixty-five subjects participated. Using the Canadian Occupational Performance Measure (COPM) to establish treatment goals, the top five goals were categorized using the Occupational Therapy Practice Framework into five categories: activities of daily living (ADLs), instrumental activities of daily living (IADLs), leisure, work and general UE movement. A Chi-square analysis determined if age, UE functional capacity (measured by the Action Research Arm Test) and UE hand dominance influenced individual goal selection. The majority of goals were in the ADL (37%) and IADL (40%) categories. A small percentage (12%) was related to general UE movement. Individuals with moderate UE functional capacity identified more ADL goals than those with higher UE functional capacity. There was not a difference between age and UE dominance across all five goal areas. Individuals with chronic UE paresis had specific goals that were not influenced by age or hand dominance, but partially influenced by severity. General UE movement goals were identified less than goals related to specific activities. Considering the specificity of individual goals following stroke, it is recommended that clinicians regularly utilize a goal setting tool to help establish client goals. It is recommended that clinicians further inquire about general goals in order to link upper extremity deficits to functional activity limitations. Age, upper extremity functional capacity and hand dominance have little influence on the rehabilitation goals for individuals with chronic paresis after stroke.

  4. A hybrid BMI-based exoskeleton for paresis: EMG control for assisting arm movements.

    PubMed

    Kawase, Toshihiro; Sakurada, Takeshi; Koike, Yasuharu; Kansaku, Kenji

    2017-02-01

    Brain-machine interface (BMI) technologies have succeeded in controlling robotic exoskeletons, enabling some paralyzed people to control their own arms and hands. We have developed an exoskeleton asynchronously controlled by EEG signals. In this study, to enable real-time control of the exoskeleton for paresis, we developed a hybrid system with EEG and EMG signals, and the EMG signals were used to estimate its joint angles. Eleven able-bodied subjects and two patients with upper cervical spinal cord injuries (SCIs) performed hand and arm movements, and the angles of the metacarpophalangeal (MP) joint of the index finger, wrist, and elbow were estimated from EMG signals using a formula that we derived to calculate joint angles from EMG signals, based on a musculoskeletal model. The formula was exploited to control the elbow of the exoskeleton after automatic adjustments. Four able-bodied subjects and a patient with upper cervical SCI wore an exoskeleton controlled using EMG signals and were required to perform hand and arm movements to carry and release a ball. Estimated angles of the MP joints of index fingers, wrists, and elbows were correlated well with the measured angles in 11 able-bodied subjects (correlation coefficients were 0.81  ±  0.09, 0.85  ±  0.09, and 0.76  ±  0.13, respectively) and the patients (e.g. 0.91  ±  0.01 in the elbow of a patient). Four able-bodied subjects successfully positioned their arms to adequate angles by extending their elbows and a joint of the exoskeleton, with root-mean-square errors  <6°. An upper cervical SCI patient, empowered by the exoskeleton, successfully carried a ball to a goal in all 10 trials. A BMI-based exoskeleton for paralyzed arms and hands using real-time control was realized by designing a new method to estimate joint angles based on EMG signals, and these may be useful for practical rehabilitation and the support of daily actions.

  5. A hybrid BMI-based exoskeleton for paresis: EMG control for assisting arm movements

    NASA Astrophysics Data System (ADS)

    Kawase, Toshihiro; Sakurada, Takeshi; Koike, Yasuharu; Kansaku, Kenji

    2017-02-01

    Objective. Brain-machine interface (BMI) technologies have succeeded in controlling robotic exoskeletons, enabling some paralyzed people to control their own arms and hands. We have developed an exoskeleton asynchronously controlled by EEG signals. In this study, to enable real-time control of the exoskeleton for paresis, we developed a hybrid system with EEG and EMG signals, and the EMG signals were used to estimate its joint angles. Approach. Eleven able-bodied subjects and two patients with upper cervical spinal cord injuries (SCIs) performed hand and arm movements, and the angles of the metacarpophalangeal (MP) joint of the index finger, wrist, and elbow were estimated from EMG signals using a formula that we derived to calculate joint angles from EMG signals, based on a musculoskeletal model. The formula was exploited to control the elbow of the exoskeleton after automatic adjustments. Four able-bodied subjects and a patient with upper cervical SCI wore an exoskeleton controlled using EMG signals and were required to perform hand and arm movements to carry and release a ball. Main results. Estimated angles of the MP joints of index fingers, wrists, and elbows were correlated well with the measured angles in 11 able-bodied subjects (correlation coefficients were 0.81  ±  0.09, 0.85  ±  0.09, and 0.76  ±  0.13, respectively) and the patients (e.g. 0.91  ±  0.01 in the elbow of a patient). Four able-bodied subjects successfully positioned their arms to adequate angles by extending their elbows and a joint of the exoskeleton, with root-mean-square errors  <6°. An upper cervical SCI patient, empowered by the exoskeleton, successfully carried a ball to a goal in all 10 trials. Significance. A BMI-based exoskeleton for paralyzed arms and hands using real-time control was realized by designing a new method to estimate joint angles based on EMG signals, and these may be useful for practical rehabilitation and the support of

  6. An exploratory analysis of the self-reported goals of individuals with chronic upper-extremity paresis following stroke

    PubMed Central

    Waddell, Kimberly J.; Birkenmeier, Rebecca L.; Bland, Marghuretta D.; Lang, Catherine E.

    2016-01-01

    Purpose To classify the self-identified goals of individuals post-stroke with chronic upper extremity (UE) paresis, and determine if age, UE functional capacity, and pre-stroke hand dominance influence overall goal selection. Method Sixty five subjects participated. Using the Canadian Occupational Performance Measure (COPM) to establish treatment goals, the top five goals were categorized using the Occupational Therapy Practice Framework into five categories: activities of daily living (ADL), instrumental activities of daily living (IADL), leisure, work, and general UE movement. A chi-square analysis determined if age, UE functional capacity (measured by the Action Research Arm Test), and UE hand dominance influenced individual goal selection. Results The majority of goals were in the ADL (37%) and IADL (40%) categories. A small percentage (12%) was related to general UE movement. Individuals with moderate UE functional capacity identified more ADL goals than those with higher UE functional capacity. There was not a difference between age and UE dominance across all five goal areas. Conclusions Individuals with chronic UE paresis had specific goals that were not influenced by age or hand dominance, but partially influenced by severity. General UE movement goals were identified less than goals related to specific activities. PMID:26146964

  7. Postherpetic pseudohernia: delayed onset of paresis of abdominal muscles due to herpes zoster causing an ipsilateral abdominal bulge.

    PubMed

    Ohno, Shunsuke; Togawa, Yasuhiro; Chiku, Tsuyoshi; Sano, Wataru

    2016-05-26

    Postherpetic pseudohernia causes an abdominal bulge as well as an abdominal wall herniation. This disease is one of the neurological complications of herpes zoster and essentially consists of paresis of ipsilateral abdominal muscles. Postherpetic pseudohernia may be mistaken for abdominal wall herniation because it is not well known. We describe two cases presenting an abdominal bulge. The ipsilateral abdominal bulge appeared after recovery from abdominal zoster. Abdominal CT showed no evidence of a herniation or mass. We diagnosed a postherpetic pseudohernia. One of the patients recovered spontaneously 4 months after the onset, and the other partially recovered after 2 months. This disease can be expected to disappear spontaneously, unlike abdominal herniation requiring surgery. It has been reported that 79.3% of patients eventually recovered spontaneously. For surgeons and general practitioners, it is beneficial to keep this disease in mind when examining a patient presenting an abdominal bulge. 2016 BMJ Publishing Group Ltd.

  8. Julius Wagner-Jauregg and the Legacy of Malarial Therapy for the Treatment of General Paresis of the Insane

    PubMed Central

    Tsay, Cynthia J.

    2013-01-01

    Julius Wagner-Jauregg, a preeminent Austrian psychiatrist was awarded the Nobel Prize in Medicine in 1927 for the development of malaria therapy for the treatment of neurosyphilis, or general paresis of the insane. Despite being only one of three psychiatrists to win a Nobel Prize, he has faded from public consciousness and his name recognition pales in comparison to his contemporary and fellow Austrian, Sigmund Freud. This paper explores his contributions to the field of biological psychiatry and also touches upon reasons, such as the growing bioethics movement, his controversial affiliation with the Nazi Party, and the evolution of neurosyphilis, that explain why Wagner-Jauregg is not more widely celebrated for his contributions to the field of psychiatry, even though his malarial treatment could be considered the earliest triumph of biological psychiatry over psychoanalysis. PMID:23766744

  9. Neck abscess and vocal cord paresis: delayed complications of a self-extruded long fishbone stuck in throat.

    PubMed

    Vallamkondu, V; Carlile, S; Shakeel, M; Ah-See, K W

    2013-11-18

    A 57-year-old Caucasian man, otherwise fit and well, presented with a 2-week history of dysphagia, odynophagia. Two weeks prior to the presentation, he had felt a fishbone stuck in his throat which was self-extruded after 3 days. Subsequently he developed a right anterior neck swelling and hoarseness. Transnasal endoscopic examination of larynx revealed an injected and oedematous right hemilarynx with right vocal cord paresis. An ultrasound examination of the neck confirmed a collection in the neck on the right side, and frank pus was aspirated from the neck abscess and he responded well to conservative management. Subsequent examination in follow-up had shown complete recovery of vocal cord movement. The patient did not seek medical attention immediately after getting a 5 cm fishbone extruded from the throat which resulted in significant morbidity. All patients should be alerted to the possibility of delayed complications and they should be encouraged to seek urgent medical attention.

  10. Paresis in an Asian small clawed otter (Aonyx cinereus) associated with vertebral and ischial osteolysis caused by a malignant lymphangiosarcoma.

    PubMed

    Swenson, Julie; Carpenter, James W; Janardhan, Kyathanahalli S; Ketz-Riley, Cornelia; Brinkman, Erin

    2008-06-01

    A 10-yr-old male intact Asian small clawed otter (Aonyx cinerus) was presumptively diagnosed by histopathology and immunohistochemistry with lymphangiosarcoma after bony destruction of the ischium and spinal column from local tumor invasion had caused progressive signs of hind limb lameness and paresis/paralysis, which led to humane euthanasia. At necropsy, the primary tumor was identified as a flocculent mass present under the caudal lumbar vertebrae. Multiple nerves were seen to run from the spinal cord into the wall of the mass. This mass had locally invaded the surrounding muscle, vertebral column, and spinal cord, which led to the clinical signs noted at presentation. Bony destruction was severe with almost complete obliteration of the right ischium and osteolysis of L6, exposing the spinal cord beneath. The tumor had metastasized to at least two different sites within the spleen. The abdominal tumor was confirmed to be of endothelial origin by the use of immunohistochemical staining for factor VIII-related antigen and was confirmed as lymphatic origin versus vascular origin because of the lack of red blood cells within the vessels. The length of time from initial presentation with hind limb lameness to euthanasia because of hind limb paralysis was 4 mo. This is the first report of lymphangiosarcoma, an uncommon malignant neoplasm of lymphatic origin, in a mustelid and the first report of neoplastic disease in an Asian small clawed otter. In addition, the presentation of hind limb paresis associated with bony lysis because of local tumor invasion has not been previously reported with lymphangiosarcoma in humans, domestic animals, or nondomestic animals.

  11. Training of reaching in stroke survivors with severe and chronic upper limb paresis using a novel nonrobotic device: a randomized clinical trial.

    PubMed

    Barker, Ruth N; Brauer, Sandra G; Carson, Richard G

    2008-06-01

    Severe upper limb paresis is a major contributor to disability after stroke. This study investigated the efficacy of a new nonrobotic training device, the Sensorimotor Active Rehabilitation Training (SMART) Arm, that was used with or without electromyography-triggered electrical stimulation of triceps brachii to augment elbow extension, permitting stroke survivors with severe paresis to practice a constrained reaching task. A single-blind, randomized clinical trial was conducted with 42 stroke survivors with severe and chronic paresis. Thirty-three participants completed the study, of whom 10 received training using the SMART Arm with electromyography-triggered electrical stimulation, 13 received training using the SMART Arm alone, and 10 received no intervention (control). Training consisted of 12 1-hour sessions over 4 weeks. The primary outcome measure was "upper arm function," item 6 of the Motor Assessment Scale. Secondary outcome measures included impairment measures; triceps muscle strength, reaching force, modified Ashworth scale; and activity measures: reaching distance and Motor Assessment Scale. Assessments were administered before (0 weeks) and after training (4 weeks) and at 2 months follow-up (12 weeks). Both SMART Arm groups demonstrated significant improvements in all impairment and activity measures after training and at follow-up. There was no significant difference between these 2 groups. There was no change in the control group. Our findings indicate that training of reaching using the SMART Arm can reduce impairment and improve activity in stroke survivors with severe and chronic upper limb paresis, highlighting the benefits of intensive task-oriented practice, even in the context of severe paresis.

  12. Synergy effects of combined multichannel EMG-triggered electrical stimulation and mirror therapy in subacute stroke patients with severe or very severe arm/hand paresis.

    PubMed

    Schick, Thomas; Schlake, Hans-Peter; Kallusky, Juliane; Hohlfeld, Günter; Steinmetz, Maria; Tripp, Florian; Krakow, Karsten; Pinter, Michaela; Dohle, Christian

    2017-01-01

    Neurorehabilitation requires the development of severity-dependent and successful therapies for arm/hand rehabilitation in stroke patients. To evaluate the effectiveness of adding mirror therapy to bilateral EMG-triggered multi-channel electrostimulation for the treatment of severe arm/hand paresis in stroke patients. The subjects of this randomized, controlled, multicentre study were stroke patients who had suffered their first insult between 1 and 6 months before study start and had severe or very severe arm/hand paresis, as classified by Fugl-Meyer-Assessment. Subjects were randomly allocated to an intervention group (n = 16) or control group (n = 17). Both groups were treated for 3 weeks (5x week, 30 minutes) with bilateral EMG-triggered multi-channel electrostimulation. The intervention group additionally received mirror feedback of the unaffected limb. The primary outcome measure was motor recovery of the upper extremities, as measured by the Fugl-Meyer Assessment. The Intervention Group with very severe paresis had significantly better motor recovery in total Fugl-Meyer Assessment (p = 0.017) at a medium effect size (Cohen) of d = 0.7, due to a significant recovery of shoulder and elbow function (p = 0.003) in the Fugl-Meyer Assessment Part A subtest. For subjects with severe paresis, additional mirror therapy did not significantly influence outcome. Additional mirror therapy in combination with EMG-triggered multi-channel electrostimulation is therapeutically beneficial for post-acute stroke patients with very severe arm/hand paresis.

  13. Ruptured vertebral artery-posterior inferior cerebellar artery aneurysm associated with facial nerve paresis successfully treated with interlocking detachable coils--case report.

    PubMed

    Kurokawa, R; Saito, R; Nakamura, Y; Kagami, H; Ichikizaki, K

    1999-11-01

    An 81-year-old female presented with severe headache. Computed tomography revealed subarachnoid hemorrhage. She developed right facial nerve paresis on the next day. Angiography revealed a right vertebral artery-posterior inferior cerebellar artery aneurysm. The aneurysm was successfully occluded with interlocking detachable coils (IDCs) on the 7th day. Magnetic resonance (MR) imaging 1 month after IDC placement showed partially thrombosed aneurysm near the internal acoustic meatus. Ten months after the ictus, MR imaging revealed marked resolution of the intra-aneurysmal thrombus and reduction of the aneurysm size. Her facial nerve function gradually recovered during this period. Her facial nerve paresis was probably caused by acute stretching of the facial nerve by the ruptured aneurysm that was in direct contact with the nerve. Intra-aneurysmal thrombosis using coils can reduce aneurysm size and alleviate cranial nerve symptoms.

  14. The energy cost of level walking before and after hydro-kinesi therapy in patients with spastic paresis.

    PubMed

    Zamparo, P; Pagliaro, P

    1998-08-01

    In this study the energy cost of level walking was measured in 23 patients with stationary spastic paresis before and after a two-week treatment (45 min daily) of hydro-kinesi therapy, the latter consisting of passive and active movements in warm (32 degrees C) sea water, free swimming and water immersion walking. Among the subjects (80.2 +/- 13.2 kg body mass; 56.0 +/- 14.6 years of age; 10.7 +/- 6.6 years of duration of spasticity), 12 were affected by hemiparesis, 4 by multiple sclerosis and 7 by spinal cord injury. The energy cost of level walking (Cw) was measured before and after therapy from the ratio of the overall steady-state oxygen consumption to the effective speed of progression. The differences in Cw due to the treatment, at matched speeds, were found to be negligible at speeds higher than 0.75 m.s-1 (less than 5%) but to increase, with decreasing speed, up to about 17% at 0.1 m.s-1. The treatment was therefore effective in improving the gait characteristics of the subjects, through a decrease of their Cw, mainly at low speeds of progression.

  15. [Delayed paresis of the femoral nerve after total hip arthroplasty associated with hereditary neuropathy with liability to pressure palsies (HNPP)].

    PubMed

    Schuh, A; Dürr, V; Weier, H; Zeiler, G; Winterholler, M

    2004-07-01

    Delayed lesions of the femoral or sciatic nerve are a rare complication after total hip arthroplasty. Several cases in association with cement edges, scar tissue, broken cerclages, deep hematoma, or reinforcement rings have been published. We report about a 62-year-old female who developed a pure motor paresis of the quadriceps muscle 2 weeks after total hip arthroplasty. After electrophysiological evaluation had revealed an isolated femoral nerve lesion, revision of the femoral nerve was performed. During operative revision no pathologic findings could be seen. One week later the patient developed paralysis of the left wrist and finger extensors after using crutches. Electrophysiological evaluation revealed several nerve conduction blocks in physiological entrapments and the diagnosis of hereditary neuropathy with liability to pressure palsies (HNPP) was established. Hereditary neuropathy with liability to pressure palsies (HNPP) is a rare disease with increased vulnerability of the peripheral nerve system with mostly reversible sensorimotor deficits. It should be taken into consideration in cases of atypical findings of compression syndromes of peripheral nerves or delayed neuropathy, e. g., after total hip arthroplasty.

  16. Knee Moment-Angle Characteristics and Semitendinosus Muscle Morphology in Children with Spastic Paresis Selected for Medial Hamstring Lengthening.

    PubMed

    Haberfehlner, Helga; Jaspers, Richard T; Rutz, Erich; Becher, Jules G; Harlaar, Jaap; van der Sluijs, Johannes A; Witbreuk, Melinda M; Romkes, Jacqueline; Freslier, Marie; Brunner, Reinald; Maas, Huub; Buizer, Annemieke I

    2016-01-01

    To increase knee range of motion and improve gait in children with spastic paresis (SP), the semitendinosus muscle (ST) amongst other hamstring muscles is frequently lengthened by surgery, but with variable success. Little is known about how the pre-surgical mechanical and morphological characteristics of ST muscle differ between children with SP and typically developing children (TD). The aims of this study were to assess (1) how knee moment-angle characteristics and ST morphology in children with SP selected for medial hamstring lengthening differ from TD children, as well as (2) how knee moment-angle characteristics and ST morphology are related. In nine SP and nine TD children, passive knee moment-angle characteristics and morphology of ST (i.e. fascicle length, muscle belly length, tendon length, physiological cross-sectional area, and volume) were assessed by hand-held dynamometry and freehand 3D ultrasound, respectively. At net knee flexion moments above 0.5 Nm, more flexed knee angles were found for SP compared to TD children. The measured knee angle range between 0 and 4 Nm was 30% smaller in children with SP. Muscle volume, physiological cross-sectional area, and fascicle length normalized to femur length were smaller in SP compared to TD children (62%, 48%, and 18%, respectively). Sixty percent of the variation in knee angles at 4 Nm net knee moment was explained by ST fascicle length. Altered knee moment-angle characteristics indicate an increased ST stiffness in SP children. Morphological observations indicate that in SP children planned for medial hamstring lengthening, the longitudinal and cross-sectional growth of ST muscle fibers is reduced. The reduced fascicle length can partly explain the increased ST stiffness and, hence, a more flexed knee joint in these SP children.

  17. Knee Moment-Angle Characteristics and Semitendinosus Muscle Morphology in Children with Spastic Paresis Selected for Medial Hamstring Lengthening

    PubMed Central

    Haberfehlner, Helga; Jaspers, Richard T.; Rutz, Erich; Becher, Jules G.; Harlaar, Jaap; van der Sluijs, Johannes A.; Witbreuk, Melinda M.; Romkes, Jacqueline; Freslier, Marie; Brunner, Reinald

    2016-01-01

    To increase knee range of motion and improve gait in children with spastic paresis (SP), the semitendinosus muscle (ST) amongst other hamstring muscles is frequently lengthened by surgery, but with variable success. Little is known about how the pre-surgical mechanical and morphological characteristics of ST muscle differ between children with SP and typically developing children (TD). The aims of this study were to assess (1) how knee moment-angle characteristics and ST morphology in children with SP selected for medial hamstring lengthening differ from TD children, as well as (2) how knee moment-angle characteristics and ST morphology are related. In nine SP and nine TD children, passive knee moment-angle characteristics and morphology of ST (i.e. fascicle length, muscle belly length, tendon length, physiological cross-sectional area, and volume) were assessed by hand-held dynamometry and freehand 3D ultrasound, respectively. At net knee flexion moments above 0.5 Nm, more flexed knee angles were found for SP compared to TD children. The measured knee angle range between 0 and 4 Nm was 30% smaller in children with SP. Muscle volume, physiological cross-sectional area, and fascicle length normalized to femur length were smaller in SP compared to TD children (62%, 48%, and 18%, respectively). Sixty percent of the variation in knee angles at 4 Nm net knee moment was explained by ST fascicle length. Altered knee moment-angle characteristics indicate an increased ST stiffness in SP children. Morphological observations indicate that in SP children planned for medial hamstring lengthening, the longitudinal and cross-sectional growth of ST muscle fibers is reduced. The reduced fascicle length can partly explain the increased ST stiffness and, hence, a more flexed knee joint in these SP children. PMID:27861523

  18. How muscles recover from paresis and atrophy after intramuscular injection of botulinum toxin A: Study in juvenile rats.

    PubMed

    Shen, Jian; Ma, Jianjun; Lee, Cassandra; Smith, Beth P; Smith, Thomas L; Tan, Kim H; Koman, L Andrew

    2006-05-01

    Botulinum toxin A (BoNT-A) is a potent biological toxin widely used for the management of skeletal muscle spasticity or dynamic joint contracture. Intramuscular injection of BoNT-A causes muscle denervation, paresis, and atrophy. This clinical effect of botulinum toxin A lasts 3 to 6 months, and injected muscle eventually regains muscle mass and recovers muscle function. The goal of the present study was to characterize the molecular and cellular mechanisms leading to neuromuscular junction (NMJ) regeneration and skeletal muscle functional recovery after BoNT-A injection. Fifty-six 1-month-old Sprague-Dawley rats were used. Botulinum toxin A was injected into the left gastrocnemius muscle at a dosage of 6 units/kg body weight. An equivalent volume of saline was injected into the right gastrocnemius muscle to serve as control. The gastrocnemius muscle samples were harvested from both hind limbs at 3 days, 7 days, 15 days, 30 days, 60 days, 90 days, 180 days, and 360 days after administration of toxin. In addition, the gastrocnemius muscles from 1-month-old rats with no injections were harvested to serve as uninjected control group. Muscle samples were processed and mRNA was extracted. Real-time polymerase chain reaction (PCR) and gene microarray technology were used to identify key molecules involved in NMJ stabilization and muscle functional recovery. More than 28,000 rat genes were analyzed and approximately 9000 genes are expressed in the rat gastrocnemius muscle. Seven days following BoNT-A injection, 105 genes were upregulated and 59 genes were downregulated. Key molecules involved in neuromuscular junction (NMJ) stabilization and muscle functional recovery were identified and their time course of gene expression following BoNT-A injection were characterized. This animal study demonstrates that following intramuscular injection of BoNT-A, there is a sequence of cellular events that eventually leads to NMJ stabilization, remodeling, and myogenesis and muscle

  19. [The Mysterious Paresis].

    PubMed

    Biskup, Ewelina; Necek, Magdalena; Changjin, Qu; Xue, Guanhua

    2016-04-27

    Internal jugular central venous line placement is a standardized and common clinical procedure. However, even the most skillful physician may face complications. Careful patient evaluation and detailed vascular anatomical knowledge can minimize the risk of iatrogenic injuries. Following a strict protocol in case of unsuccessful attempts of venous puncture helps to improve patient outcome. In this case report, we present a patient who suffered an unusual injury. Further, we discuss current treatment options for pseudoaneurysms.

  20. Partially irreversible paresis of the deep peroneal nerve caused by osteocartilaginous exostosis of the fibula without affecting the tibialis anterior muscle.

    PubMed

    Paprottka, Felix Julian; Machens, Hans-Günther; Lohmeyer, Jörn Andreas

    2012-08-01

    Dysfunction of the lower limb's muscles can cause severe impairment and immobilisation of the patient. As one of the leg's major motor and sensory nerves, the deep peroneal nerve (synonym: deep fibular nerve) plays a very important role in muscle innervation in the lower extremities. We report the case of a 19-year-old female patient, who suffered from a brace-like exostosis 6-cm underneath her left fibular head causing a partially irreversible paresis of her deep peroneal nerve. This nerve damage resulted in complete atrophy of her extensor digitorum longus and extensor hallucis longus muscle, and in painful sensory disturbance at her left shin and first web space. The tibialis anterior muscle stayed intact because its motor branch left the deep peroneal nerve proximal to the nerve lesion. Diagnosis was first verified 6 years after the onset of symptoms by a magnetic resonance imaging (MRI) scan of her complete left lower leg. Subsequently, the patient was operated on in our clinic, where a neurolysis was performed and the 4-cm-long osteocartilaginous exostosis was removed. Paralysis was already irreversible but sensibility returned completely after neurolysis. The presented case shows that an osteocartilaginous exostosis can be the cause for partial deep peroneal nerve paresis. If this disorder is diagnosed at an early stage, nerve damage is reversible. Typical for an exostosis is its first appearance during the juvenile growth phase. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  1. Stationary facial nerve paresis after surgery for recurrent parotid pleomorphic adenoma: a follow-up study of 219 cases in Denmark in the period 1985-2012.

    PubMed

    Nøhr, Anders; Andreasen, Simon; Therkildsen, Marianne Hamilton; Homøe, Preben

    2016-10-01

    The purpose was to assess degree of permanent facial nerve dysfunction after surgery for recurrent pleomorphic adenoma (RPA) of the parotid gland, including variables that might influence re-operation outcomes. Nationwide retrospective longitudinal cohort study including a questionnaire survey of patients undergoing surgery for RPA. Of 219 living patients, 198 (92 %) responded and 127 (63 %) reported no facial dysfunction. Statistically significant associations were found between number of surgeries and permanent facial nerve dysfunction of all degrees (OR 1.43, 95 % CI 1.16-1.78, p = 0.001). A not significant tendency for females to be associated with worse outcome was found (p = 0.073). Risks of different degrees of paresis after the second-fourth surgeries were found (OR 1.86-2.19, p < 0.05). Our study demonstrates a significant correlation between number of surgeries for RPA of the parotid and severity of facial nerve paresis. This is important when informing and planning treatment of these patients.

  2. A petrogenetic study of anorogenic felsic magmatism in the Cretaceous Paresis ring complex, Namibia: evidence for mixing of crust and mantle-derived components

    NASA Astrophysics Data System (ADS)

    Mingram, B.; Trumbull, R. B.; Littman, S.; Gerstenberger, H.

    2000-10-01

    Paresis is one of a group of Cretaceous ring complexes extending from the coast some 350 km NE across the Damara Belt. It consists of over 90% rhyolites and comendites, with subordinate intrusions of quartz syenite and alkali-feldspar syenite. These felsic units are accompanied by very minor amounts of silica-undersaturated basalt, phonolite and lamprophyre. Located near the edge of the Congo Craton, Paresis is the farthest inland of any felsic complex in the Cretaceous ring complex group. The other ring complexes in the vicinity consist of carbonatites and undersaturated alkaline rocks (e.g., Okorusu, Kalkfeld, Etaneno, Ondurakorume). Geochemical and isotopic data provide evidence for both mantle and crustal components in the sources of the Paresis magmas. The alkaline basalts, phonolite and lamprophyre have overlapping Sr and Nd isotopic initial ratios which plot within the mantle array close to bulk-earth values ( ɛNd=-0.9 to -2.8 and 87Sr/ 86Sr(i)=0.7042-0.7054) and may indicate a mantle plume component. The rhyolite units comprise metaluminous feldspar rhyolites and peraluminous, more differentiated quartz-feldspar rhyolites. Both units show prominent negative Nb and Ta anomalies on mantle-normalized multielement diagrams and have extremely nonradiogenic Nd ratios ( ɛNd=-21) and Sr initial ratios of 0.7117-0.7138. These isotopic values suggest a crustal origin from pre-Damara (Early Precambrian) gneisses and granitoids, which are exposed in the Congo craton and related inliers in northern Namibia. The comendites are peralkaline, highly differentiated rocks. In contrast to the rhyolites, comendites lack mantle-normalized Nb and Ta anomalies, have higher HFSE and LREE contents, extreme negative Eu anomalies and ɛNd values of -11. Like the comendites, alkali-feldspar syenites are peralkaline, lack Nb and Ta anomalies, have negative Eu anomalies and high HFSE concentrations. Their ɛNd values are -6.5 to -8. The quartz syenites overlap with the peralkaline

  3. Electrical stimulation-supported voice exercises are superior to voice exercise therapy alone in patients with unilateral recurrent laryngeal nerve paresis: results from a prospective, randomized clinical trial.

    PubMed

    Ptok, Martin; Strack, Daniela

    2008-08-01

    For more than 40 years, electrical stimulation procedures for unilateral recurrent laryngeal nerve paresis (URLNP) therapy have been proposed. However, it is unclear whether electrical stimulation therapy is effective for URLNP patients. In this study we compare the outcome of traditional voice exercise treatment (VE) with electrical stimulation-supported voice exercise (ES). A total of 90 URLNP patients were recruited to participate in a prospective, randomized trial. The decrease in vocal fold irregularity (CFx) and increase in maximum phonation time (MPT) after a 3-month therapy period were the dependent variables. In the ES group, CFx improved to a significantly greater extent than in the VE group. MPT increased similarly in both groups. Our data indicate that ES is superior to VE for patients with URLNP. Because no further data exist, it can be assumed that improvement following VE only reflects spontaneous recovery. However ES appears to be an effective non-surgical therapeutic procedure.

  4. Depiction of facial nerve paresis in the gallery of portraits carved in stone by George Matthew the Dalmatian on the Sibenik Cathedral dating from the 15th century.

    PubMed

    Skrobonja, Ante; Culina, Tatjana

    2011-06-01

    The introductory segment of this paper briefly describes George Matthew the Dalmatian, the architect who, between 1441 and 1473, oversaw the construction of the Cathedral of St. James in Sibenik, a city on the Croatian side of the Adriatic coast. Of the most impressive details included in this monumental construction and sculptural flamboyant gothic production infused with distinctive Dalmatian spirit is a frieze of 71 stone and three lion portraits encircling the outer apse wall. From the intriguing amalgamation of portraits of anonymous people this master came across in his surrounding, the fiftieth head in the row has been selected for this occasion. On the face of a younger man the authors have recognized and described pathognomonic right-sided facial nerve paresis. The question posed here is whether this is coincidental or it represents the master's courage, given that instead of famous people in the cathedral he situated not only ordinary people but also those "labelled" and traditionally marginalized, thus, in the most beautiful manner, foreshadowing the forthcoming spirit of Humanism and Renaissance in Croatian and European art.

  5. Use of a Robotic Device for the Rehabilitation of Severe Upper Limb Paresis in Subacute Stroke: Exploration of Patient/Robot Interactions and the Motor Recovery Process

    PubMed Central

    Courtial, Ophélie; Grosmaire, Anne-Gaëlle; Hutin, Emilie

    2015-01-01

    This pioneering observational study explored the interaction between subacute stroke inpatients and a rehabilitation robot during upper limb training. 25 stroke survivors (age 55 ± 17 years; time since stroke, 52 ± 21 days) with severe upper limb paresis carried out 16 sessions of robot-assisted shoulder/elbow training (InMotion 2.0, IMT, Inc., MA, USA) combined with standard therapy. The values of 3 patient/robot interaction parameters (a guidance parameter: Stiffness, a velocity-related parameter: Slottime, and Robotic Power) were compared between sessions 1 (S1), 4 (S4), 8 (S8), 12 (S12), and 16 (S16). Pre/post Fugl-Meyer Assessment (FMA) scores were compared in 18 patients. Correlations between interaction parameters and clinical and kinematic outcome measures were evaluated. Slottime decreased at S8 (P = 0.003), while Guidance decreased at S12 (P = 0.008). Robotic Power tended to decrease until S16. FMA scores improved from S1 to S16 (+49%, P = 0.002). Changes in FMA score were correlated with the Stiffness parameter (R = 0.4, P = 0.003). Slottime was correlated with movement velocity. This novel approach demonstrated that a robotic device is a useful and reliable tool for the quantification of interaction parameters. Moreover, changes in these parameters were correlated with clinical and kinematic changes. These results suggested that robot-based recordings can provide new insights into the motor recovery process. PMID:25821804

  6. Use of a robotic device for the rehabilitation of severe upper limb paresis in subacute stroke: exploration of patient/robot interactions and the motor recovery process.

    PubMed

    Duret, Christophe; Courtial, Ophélie; Grosmaire, Anne-Gaëlle; Hutin, Emilie

    2015-01-01

    This pioneering observational study explored the interaction between subacute stroke inpatients and a rehabilitation robot during upper limb training. 25 stroke survivors (age 55 ± 17 years; time since stroke, 52 ± 21 days) with severe upper limb paresis carried out 16 sessions of robot-assisted shoulder/elbow training (InMotion 2.0, IMT, Inc., MA, USA) combined with standard therapy. The values of 3 patient/robot interaction parameters (a guidance parameter: Stiffness, a velocity-related parameter: Slottime, and Robotic Power) were compared between sessions 1 (S1), 4 (S4), 8 (S8), 12 (S12), and 16 (S16). Pre/post Fugl-Meyer Assessment (FMA) scores were compared in 18 patients. Correlations between interaction parameters and clinical and kinematic outcome measures were evaluated. Slottime decreased at S8 (P = 0.003), while Guidance decreased at S12 (P = 0.008). Robotic Power tended to decrease until S16. FMA scores improved from S1 to S16 (+49%, P = 0.002). Changes in FMA score were correlated with the Stiffness parameter (R = 0.4, P = 0.003). Slottime was correlated with movement velocity. This novel approach demonstrated that a robotic device is a useful and reliable tool for the quantification of interaction parameters. Moreover, changes in these parameters were correlated with clinical and kinematic changes. These results suggested that robot-based recordings can provide new insights into the motor recovery process.

  7. Therapeutic synergism in the treatment of post-stroke arm paresis utilizing botulinum toxin, robotic therapy, and constraint-induced movement therapy.

    PubMed

    Takebayashi, Takashi; Amano, Satoru; Hanada, Keisuke; Umeji, Atsushi; Takahashi, Kayoko; Koyama, Tetsuo; Domen, Kazuhisa

    2014-11-01

    Botulinum toxin type A (BtxA) injection, constraint-induced movement therapy (CIMT), and robotic therapy (RT) each represent promising approaches to enhance arm motor recovery after stroke. To provide more effective treatment for a 50-year-old man with severe left spastic hemiparesis, we attempted to facilitate CIMT with adaptive approaches to extend the wrist and fingers using RT for 10 consecutive weeks after BtxA injection. This combined treatment resulted in substantial improvements in arm function and the amount of arm use in activities of daily living, and may be effective for stroke patients with severe arm paresis. However, we were unable to sufficiently prove the efficacy of combined treatment based only on a single case. To fully elucidate the efficacy of the combined approach for patients with severe hemiparesis after stroke, future studies of a larger number of patients are needed. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  8. Impairment-oriented training or Bobath therapy for severe arm paresis after stroke: a single-blind, multicentre randomized controlled trial.

    PubMed

    Platz, T; Eickhof, C; van Kaick, S; Engel, U; Pinkowski, C; Kalok, S; Pause, M

    2005-10-01

    To study the effects of augmented exercise therapy time for arm rehabilitation as either Bobath therapy or the impairment-oriented training (Arm BASIS training) in stroke patients with arm severe paresis. Single blind, multicentre randomized control trial. Three inpatient neurorehabilitation centres. Sixty-two anterior circulation ischaemic stroke patients. Random assignment to three group: (A) no augmented exercise therapy time, (B) augmented exercise therapy time as Bobath therapy and (C) augmented exercise therapy time as Arm BASIS training. Fugl-Meyer arm motor score. Secondary measure: Action Research Arm Test (ARA). Ancillary measures: Fugl-Meyer arm sensation and joint motion/pain scores and the Ashworth Scale (elbow flexors). An overall effect of augmented exercise therapy time on Fugl-Meyer scores after four weeks was not corroborated (mean and 95% confidence interval (CI) of change scores: no augmented exercise therapy time (n=20) 8.8, 5.2-12.3; augmented exercise therapy time (n=40) 9.9, 6.8-13.9; p = 0.2657). The group who received the augmented exercise therapy time as Arm BASIS training (n=20) had, however, higher gains than the group receiving the augmented exercise therapy time as Bobath therapy (n=20) (mean and 95% CI of change scores: Bobath 7.2, 2.6-11.8; BASIS 12.6, 8.4-16.8; p = 0.0432). Passive joint motion/pain deteriorated less in the group who received BASIS training (mean and 95% CI of change scores: Bobath -3.2, -5.2 to -1.1; BASIS 0.1, -1.8-2.0; p = 0.0090). ARA, Fugl-Meyer arm sensation, and Ashworth Scale scores were not differentially affected. The augmented exercise therapy time as Arm BASIS training enhanced selective motor control. Type of training was more relevant for recovery of motor control than therapeutic time spent.

  9. Effects of orthotic therapeutic electrical stimulation in the treatment of patients with paresis associated with acute cervical spinal cord injury: a randomized control trial.

    PubMed

    Iwahashi, K; Hayashi, T; Watanabe, R; Nishimura, A; Ueta, T; Maeda, T; Shiba, K

    2017-06-27

    A randomized controlled trial. To determine the effects of orthotic therapeutic electrical stimulation (TES) on the hand in patients with paresis associated with acute cervical spinal cord injury. Spinal Injuries Center, Fukuoka, Japan. The study included patients treated for spinal cord injuries (Frankel classification, grades B and C) at our institution within 1 week post injury between May 2011 and December 2014. The patients were allocated randomly to TES and control groups at the time of admission and underwent TES+conventional training or conventional training alone, respectively. Both hands of each patient were treated in the same way. The primary outcome was total passive motion (TPM) of the fingers (degrees). The secondary outcomes were edema (cm) and the upper-extremity motor scores of the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI). After randomization, outcomes were assessed at 1 week, 1 month and 3 months post injury in both groups. Twenty-nine individuals were assessed at 3 months (15, TES; 14, control). There were no significant between-group differences for TPM of the fingers, edema and upper-extremity motor scores at 1 week, 1 month and 3 months after injury, although TPM of the fingers tended to be lower in the control group. It is unclear from the results of this study whether TES has a therapeutic effect on TPM, edema or the upper-extremity motor score of the ISNCSCI. The results of this study provide useful data for future meta-analyses.Spinal Cord advance online publication, 27 June 2017; doi:10.1038/sc.2017.74.

  10. Electrically Assisted Movement Therapy in Chronic Stroke Patients With Severe Upper Limb Paresis: A Pilot, Single-Blind, Randomized Crossover Study.

    PubMed

    Carda, Stefano; Biasiucci, Andrea; Maesani, Andrea; Ionta, Silvio; Moncharmont, Julien; Clarke, Stephanie; Murray, Micah M; Millán, José Del R

    2017-08-01

    To evaluate the effects of electrically assisted movement therapy (EAMT) in which patients use functional electrical stimulation, modulated by a custom device controlled through the patient's unaffected hand, to produce or assist task-specific upper limb movements, which enables them to engage in intensive goal-oriented training. Randomized, crossover, assessor-blinded, 5-week trial with follow-up at 18 weeks. Rehabilitation university hospital. Patients with chronic, severe stroke (N=11; mean age, 47.9y) more than 6 months poststroke (mean time since event, 46.3mo). Both EAMT and the control intervention (dose-matched, goal-oriented standard care) consisted of 10 sessions of 90 minutes per day, 5 sessions per week, for 2 weeks. After the first 10 sessions, group allocation was crossed over, and patients received a 1-week therapy break before receiving the new treatment. Fugl-Meyer Motor Assessment for the Upper Extremity, Wolf Motor Function Test, spasticity, and 28-item Motor Activity Log. Forty-four individuals were recruited, of whom 11 were eligible and participated. Five patients received the experimental treatment before standard care, and 6 received standard care before the experimental treatment. EAMT produced higher improvements in the Fugl-Meyer scale than standard care (P<.05). Median improvements were 6.5 Fugl-Meyer points and 1 Fugl-Meyer point after the experimental treatment and standard care, respectively. The improvement was also significant in subjective reports of quality of movement and amount of use of the affected limb during activities of daily living (P<.05). EAMT produces a clinically important impairment reduction in stroke patients with chronic, severe upper limb paresis. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  11. Charcot–Marie–Tooth disease type 1A duplication with severe paresis of the proximal lower limb muscles: a long‐term follow‐up study

    PubMed Central

    Berciano, J; Gallardo, E; García, A; Infante, J; Mateo, I; Combarros, O

    2006-01-01

    Objective To describe a large pedigree with Charcot–Marie–Tooth disease type 1A (CMT1A) duplication in which severe pelvic and thigh musculature weakness occurred in two patients, detected by analysing the leg muscle atrophy pattern on magnetic resonance imaging (MRI). Methods The pedigree comprised 18 patients, aged between 15 and 85 (median 46) years, who were serially evaluated for up to three decades. All 18 patients and 13 non‐affected at‐risk people underwent electrophysiological examination. An MRI study of lower limb musculature was carried out in four patients. Three patients underwent sural‐nerve biopsy. Genetic testing was carried out in 17 patients and in all 13 at‐risk normal people. Results Fourteen patients were asymptomatic or slightly disabled. The two oldest patients, aged 84 and 80, showed a moderate phenotype. Two other patients, aged 70 and 53, showed late‐onset and gradually progressive peroneal paresis extending up to the thigh and pelvic musculature, resulting in waddling gait. MRI scans of all three patients with a mild phenotype showed subtle and subclinical fatty infiltration of calf anterolateral muscle compartments, with thigh muscle involvement in one patient, and extensive atrophy of intrinsic foot muscles. In the youngest patient with proximal leg weakness, the MRI scan showed massive fatty atrophy of all the calf muscles, posteromedial thigh muscle compartments, and internal and external hip rotator muscles. Sural‐nerve biopsy specimens showed hypertrophic neuropathy with no superimposed inflammation. Good correlation was seen between electrophysiological and genetic testing. Conclusions Late in the clinical course, a small proportion of patients with CMT1A develop severe proximal leg weakness, and long‐term follow‐up is essential for its detection. MRI scans may show subclinical involvement of the thigh musculature. PMID:16788010

  12. Swallowing therapy--a prospective study on patients with neurogenic dysphagia due to unilateral paresis of the vagal nerve, Avellis' syndrome, Wallenberg's syndrome, posterior fossa tumours and cerebellar hemorrhage.

    PubMed

    Prosiegel, M; Höling, R; Heintze, M; Wagner-Sonntag, E; Wiseman, K

    2005-01-01

    No studies exist dealing with the outcome of dysphagic patients with posterior fossa (IV. ventricle) tumours (PFT) or cerebellar hemorrhage (CH), and the outcome of patients with Wallenberg's syndrome (WS) after functional swallowing therapy (FST) has so far not been studied in detail. Patients and methods. 208 patients with neurogenic dysphagia (ND) who were consecutively admitted for functional swallowing therapy (FST) over a 3 year period to our hospital were examined clinically, by use of a videofluoroscopic swallowing study (VFSS) and/or fibreoptic evaluation of swallowing (FEES). The most frequent etiology was stroke (48%), followed by CNS tumours (13%). In the present study we defined three groups. Group 1 comprised 8 patients with PFT or CH. Group 2 consisted of 27 patients with WS, which was the leading cause among patients with non-hemispheric stroke. Since in WS a vagal nerve paresis due to affection of the Nucleus ambiguus occurs, 8 patients with Avellis' syndrome or unilateral paresis of the vagal nerve served as controls and were defined as group 3. Findings. In the three groups, functional feeding status showed significant improvement after FST comprising methods of restitution, compensation and adaptation, each of which were applied in more than 80% of patients. Outcome was, however, significantly worse in group 1 as compared to group 2 and in group 2 as compared to group 3. Dysfunction of the upper esophageal sphincter and reflex triggering were significantly more severely disturbed in groups 1 and 2 as compared to group 3. Group 1 showed significantly more severe disturbances of the oral phase as compared to groups 2 and 3. After FST, more than 50% (5/8) of group 1 and 30% (8/27) of WS patients (group 2) were dependent on tube feeding, whereas all patients of group 3 were full-oral feeders. Interpretation. This is the first study dealing with the outcome of dysphagic patients with PFT or CH. Based on our results it can be assumed that in these

  13. Could local dynamic stability serve as an early predictor of falls in patients with moderate neurological gait disorders? A reliability and comparison study in healthy individuals and in patients with paresis of the lower extremities.

    PubMed

    Reynard, Fabienne; Vuadens, Philippe; Deriaz, Olivier; Terrier, Philippe

    2014-01-01

    Falls while walking are frequent in patients with muscular dysfunction resulting from neurological disorders. Falls induce injuries that may lead to deconditioning and disabilities, which further increase the risk of falling. Therefore, an early gait stability index would be useful to evaluate patients in order to prevent the occurrence of future falls. Derived from chaos theory, local dynamic stability (LDS), defined by the maximal Lyapunov exponent, assesses the sensitivity of a dynamic system to small perturbations. LDS has already been used for fall risk prediction in elderly people. The aim of the present study was to provide information to facilitate future researches regarding gait stability in patients with neurological gait disorders. The main objectives were 1) to evaluate the intra-session repeatability of LDS in patients and 2) to assess the discriminative power of LDS to differentiate between healthy individuals and neurological patients. Eighty-three patients with mild to moderate neurological disorders associated with paresis of the lower extremities and 40 healthy controls participated in the study. The participants performed 2×30 s walking wearing a 3D accelerometer attached to the lower back, from which 2×35 steps were extracted. LDS was defined as the average exponential rate of divergence among trajectories in a reconstructed state-space that reflected the gait dynamics. LDS assessed along the medio-lateral axis offered the highest repeatability and discriminative power. Intra-session repeatability (intraclass correlation coefficient between the two repetitions) in the patients was 0.89 and the smallest detectable difference was 16%. LDS was substantially lower in the patients than in the controls (33% relative difference, standardized effect size 2.3). LDS measured in short over-ground walking tests seems sufficiently reliable. LDS exhibits good discriminative power to differentiate fall-prone individuals and opens up the possibility of

  14. From Paresis to PANDAS and PANS

    MedlinePlus

    ... years later led to the virtual eradication of neuro-syphilis, as the disorder came to be called, ... MRI scans of a PANDAS patient, showing reduced inflammation in the caudate nucleus(area circled just to ...

  15. [Facial paresis in children; consider Lyme disease].

    PubMed

    Dorresteijn, E M; Kouwenberg, J M

    2001-05-26

    Three girls, aged 3, 7 and 13 years, developed acute peripheral facial palsy. The first patient was initially diagnosed as having Bell's palsy. The third patient had negative serology at first assessment, on the basis of which the diagnosis of Lyme disease was temporarily rejected. Ultimately, all three appeared to have neuroborreliosis. They were treated with intravenous ceftriaxone and recovered well. Facial palsy in childhood is frequently caused by Lyme borreliosis and infection with Borrelia burgdorferi should therefore be investigated, even if there are no signs of a tick bite or erythema migrans. Diagnosis is made by serology, followed by immunoblotting to confirm a positive result. In case of strong suspicion based on the patient's history or physical examination or a positive serology, lumbar puncture should be carried out. Antibiotic treatment facilitates recovery and prevents complications.

  16. [What does conservative therapy of "idiopathic" facial paresis accomplish?].

    PubMed

    Oeken, F W; Görisch, I; Weilepp, M

    1978-09-01

    The results of conservative therapy in 160 patients with so-called idiopathic facial paralysis are reported. In 94.2% of the patients a complete or far extending normalisation took place. In incomplete paralysis the number of patients restored to health was about 96.1%, and 93.3% incomplete paralysis. We treated with salicyl-pyrazon-dervatives or combined with corticosteroids and with antibiotics resp. sulfonamids combined with corticosteroids. Physical therapy was applicated additionally in every case. Recovery did not depend from the sort of medicaments which were chosen.

  17. Using Laryngeal Electromyography to Differentiate Presbylarynges from Paresis

    ERIC Educational Resources Information Center

    Stager, Sheila V.; Bielamowicz, Steven A.

    2010-01-01

    Purpose: Differential diagnosis of patients over 64 years of age reporting hoarseness is challenging. Laryngeal electromyography (LEMG) was used to determine the status of the recurrent and superior laryngeal nerves. The authors hypothesized that individuals with hoarseness but normal LEMG would have measures similar to those of patients from…

  18. Unilateral diaphragmatic paralysis and segmental motor paresis following herpes zoster.

    PubMed

    Bahadir, Cengiz; Kalpakcioglu, Ayşe Banu; Kurtulus, Duygu

    2008-08-01

    We report the case of a 73-year-old woman who complained of acute onset of pain and weakness of her left shoulder and proximal arm muscles 3 weeks after a diagnosis of herpes zoster. Electromyography revealed involvement of the C5-6 myotomes and the upper trunk of the brachial plexus. Chest X-ray and electromyographic studies documented paralysis of the left diaphragm. One year after onset, muscle strength returned to normal, but radiographic and electrophysiologic findings of diaphragm paralysis were unchanged.

  19. Vestibular system paresis due to emergency endovascular catheterization

    PubMed Central

    Simoceli, Lucinda; Sguillar, Danilo Anunciatto; Santos, Henrique Mendes Paiva; Caputti, Camilla

    2012-01-01

    Summary Objective: The objective of this story of case is to describe an uncommon cause of associated peripheral Vestibulopathy to the unilateral auditory loss in aged patient after catheterization of urgency. Story of case: Patient of the masculine sort, 82 years, submitted to the correction of abdominal ragged aneurism of aorta, in the intra-operative suffered heart attack acute from the myocardium needing primary angioplasty. High after hospital it relates to complaint of accented hearing loss to the right and crippling vertigo, without focal neurological signals. To the otorhinolaryngological clinical examination it presented: Test of Weber lateralized for the left, spontaneous nystagmus for the left, marches rocking, has taken normal disbasia and ataxia, index-nose and diadochokinesia, Test of Romberg with oscillation without fall and Fukuda with lateral shunting line for the right. The audiometric examination evidenced deafness to the right and sensorineural loss to the left in sharps, areflexia initial to the right in caloric test e, the computerized tomography of the secular bones and brainstem, presence of metallic connecting rod crossing the right secular bone, from the vein internal jugular vein and bulb jugular vein, crossing the posterior, superior and vestibule semicircular canals, projecting itself in temporal lobe. The radiological diagnoses was traumatic injury for guide to endovascular metallic during catheterization of urgency and the behavior, considering that the patient had not compensated the balance, it was vestibular rehabilitation. Conclusion: Complaints of giddiness in the aged patient must be closely evaluated of its pathological clinical description because the antecedents of illnesses and previous treatments, in general, direct the diagnostic hypotheses however they can bring unexpected alterations. PMID:25991947

  20. Using Laryngeal Electromyography to Differentiate Presbylarynges from Paresis

    ERIC Educational Resources Information Center

    Stager, Sheila V.; Bielamowicz, Steven A.

    2010-01-01

    Purpose: Differential diagnosis of patients over 64 years of age reporting hoarseness is challenging. Laryngeal electromyography (LEMG) was used to determine the status of the recurrent and superior laryngeal nerves. The authors hypothesized that individuals with hoarseness but normal LEMG would have measures similar to those of patients from…

  1. Vestibular system paresis due to emergency endovascular catheterization.

    PubMed

    Simoceli, Lucinda; Sguillar, Danilo Anunciatto; Santos, Henrique Mendes Paiva; Caputti, Camilla

    2012-04-01

    Objetivo: O objetivo deste relato de caso é descrever uma causa incomum de vestibulopatia periférica associada à perda auditiva unilateral em paciente idoso pós- cateterismo de urgência.Relato de caso: Paciente do gênero masculino, 82 anos, submetido à correção de aneurisma roto de aorta abdominal, no intra-operatório sofreu infarto agudo do miocárdio necessitando de angioplastia primária. Após alta hospitalar refere queixa de hipoacusia acentuada à direita e vertigem incapacitante, sem sinais neurológicos focais. Ao exame clínico otorrinolaringológico apresentava: Teste de Weber lateralizado para a esquerda, nistagmo espontâneo para a esquerda , marcha oscilante, leve disbasia e ataxia, índex-nariz e diadococinesia normais, Teste de Romberg com oscilação sem queda e Fukuda com desvio lateral para a direita. O exame audiométrico evidenciava anacusia à direita e perda neurossensorial à esquerda em agudos, arreflexia vestibular à direita na prova calórica e, na tomografia computadorizada dos ossos temporais e tronco-encefálico, presença de haste metálica atravessando o osso temporal direito, a partir da veia jugular interna e bulbo jugular, atravessando os canais semicirculares posterior, superior e vestíbulo, projetando-se em lobo temporal. O diagnóstico radiológico foi lesão traumática por guia endovascular metálico durante cateterismo de urgência e a conduta, considerando que o paciente não havia compensado o equilíbrio, foi reabilitação vestibular.Conclusão: Queixas de tontura no paciente idoso devem ser criteriosamente avaliadas diante do seu histórico clínico patológico pois os antecedentes de doenças e tratamentos prévios, em geral, direcionam as hipóteses diagnósticas porém podem trazer alterações inesperadas.

  2. Lesions to Primary Sensory and Posterior Parietal Cortices Impair Recovery from Hand Paresis after Stroke

    PubMed Central

    Abela, Eugenio; Missimer, John; Wiest, Roland; Federspiel, Andrea; Hess, Christian; Sturzenegger, Matthias; Weder, Bruno

    2012-01-01

    Background Neuroanatomical determinants of motor skill recovery after stroke are still poorly understood. Although lesion load onto the corticospinal tract is known to affect recovery, less is known about the effect of lesions to cortical sensorimotor areas. Here, we test the hypothesis that lesions of somatosensory cortices interfere with the capacity to recover motor skills after stroke. Methods Standardized tests of motor skill and somatosensory functions were acquired longitudinally over nine months in 29 patients with stroke to the pre- and postcentral gyrus, including adjacent areas of the frontal, parietal and insular cortices. We derived the recovery trajectories of each patient for five motor subtest using least-squares curve fitting and objective model selection procedures for linear and exponential models. Patients were classified into subgroups based on their motor recovery models. Lesions were mapped onto diffusion weighted imaging scans and normalized into stereotaxic space using cost-function masking. To identify critical neuranatomical regions, voxel-wise subtractions were calculated between subgroup lesion maps. A probabilistic cytoarchitectonic atlas was used to quantify of lesion extent and location. Results Twenty-three patients with moderate to severe initial deficits showed exponential recovery trajectories for motor subtests that relied on precise distal movements. Those that retained a chronic motor deficit had lesions that extended to the center of the somatosensory cortex (area 2) and the intraparietal sulcus (areas hIP1, hIP2). Impaired recovery outcome correlated with lesion extent on this areas and somatosensory performance. The rate of recovery, however, depended on the lesion load onto the primary motor cortex (areas 4a, 4p). Conclusions Our findings support a critical role of uni-and multimodal somatosensory cortices in motor skill recovery. Whereas lesions to these areas influence recovery outcome, lesions to the primary motor cortex affect recovery dynamics. This points to a possible dissociation of neural substrates for different aspects of post-stroke recovery. PMID:22363604

  3. Homolateral ataxia and crural paresis: a crossed cerebral-cerebellar diaschisis.

    PubMed Central

    Giroud, M; Creisson, E; Fayolle, H; Gras, P; Vion, P; Brunotte, F; Dumas, R

    1994-01-01

    A patient developed weakness of the right leg and homolateral ataxia of the arm, caused by a subcortical infarct in the area supplied by the anterior cerebral artery in the left paracentral region, demonstrated by CT and MRI. Cerebral blood flow studied by technetium-labelled hexamethyl-propylene-amine oxime using single photon emission computed tomography showed decreased blood flow in the left lateral frontal cortex and in the right cerebellar hemisphere ("crossed cerebral-cerebellar diaschisis"). The homolateral ataxia of the arm may be caused by decreased function of the right cerebellar hemisphere, because of a lesion of the corticopontine-cerebellar tracts, whereas crural hemiparesis is caused by a lesion of the upper part of the corona radiata. Images PMID:8126511

  4. Superficial peroneal nerve paresis in a dancer caused by a midfoot ganglion: case report.

    PubMed

    Martin, Darrell; Dowling, Jamie; Rowan, Fiachra; Casey, Mary; O'Grady, Paul

    2015-06-01

    Ganglion cysts are common benign masses, usually occurring in the hands and feet. This report describes the case of a young female Irish dancer who presented with paresthesia of her foot due to a ganglion in near proximity to the superficial peroneal nerve. Midfoot ganglia in young girls engaged in Irish dance can limit their ability to participate. This pathology requires further epidemiological studies to investigate its prevalence. In the event of failed conservative management, surgical intervention to excise the cyst and decompress the nerve is an effective treatment to facilitate return to dancing.

  5. Hind-limb paresis in a dog with paralumbar solitary T-cell lymphoma.

    PubMed

    Ortega, Maria; Castillo-Alcala, Fernanda

    2010-05-01

    A 2-year-old, neutered, male golden retriever was referred to the Ontario Veterinary College, with a 6-week history of hind limb weakness and back pain. Magnetic resonance imaging of the lumbar vertebral column, and histopathology and immunohistochemistry following euthanasia identified an uncommon solitary T-cell lymphoma in the paralumbar area.

  6. Brain regions important for recovery after severe post-stroke upper limb paresis.

    PubMed

    Rondina, Jane M; Park, Chang-Hyun; Ward, Nick S

    2017-09-01

    Background The ability to predict outcome after stroke is clinically important for planning treatment and for stratification in restorative clinical trials. In relation to the upper limbs, the main predictor of outcome is initial severity, with patients who present with mild to moderate impairment regaining about 70% of their initial impairment by 3 months post-stroke. However, in those with severe presentations, this proportional recovery applies in only about half, with the other half experiencing poor recovery. The reasons for this failure to recover are not established although the extent of corticospinal tract damage is suggested to be a contributory factor. In this study, we investigated 30 patients with chronic stroke who had presented with severe upper limb impairment and asked whether it was possible to differentiate those with a subsequent good or poor recovery of the upper limb based solely on a T1-weighted structural brain scan. Methods A support vector machine approach using voxel-wise lesion likelihood values was used to show that it was possible to classify patients as good or poor recoverers with variable accuracy depending on which brain regions were used to perform the classification. Results While considering damage within a corticospinal tract mask resulted in 73% classification accuracy, using other (non-corticospinal tract) motor areas provided 87% accuracy, and combining both resulted in 90% accuracy. Conclusion This proof of concept approach highlights the relative importance of different anatomical structures in supporting post-stroke upper limb motor recovery and points towards methodologies that might be used to stratify patients in future restorative clinical trials. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. Pneumorrhachis Resulting in Transient Paresis after PICC Line Insertion into the Ascending Lumbar Vein

    PubMed Central

    Sieg, Emily P; Choudhary, Arabinda; Iantosca, Mark

    2016-01-01

    Obtaining intravascular access in the neonatal intensive care unit (NICU) is not only critical but also technically challenging. Malposition of the catheter tip is a known and well-documented complication. Specifically, peripherally inserted central venous catheter (PICC) line insertion into the ascending lumbar vein can lead to neurological dysfunction and, in some cases, even death. We present the first reported case of pneumorrhachis (PR) following PICC line insertion into the ascending lumbar vein. Our patient presented with lower extremity weakness and imaging confirmed the presence of air within the spinal canal. After conservative treatment, the strength deficit resolved and subsequent imaging revealed resolution of the air within the spinal canal. Insertion of central venous catheters into the ascending lumbar vein is a well-documented complication that can lead to neurologic injury and even death. This should be considered in the evaluation of any neonate presenting with an abnormal neurological examination or unexplained change in exam after line insertion. PMID:27904815

  8. Pneumorrhachis Resulting in Transient Paresis after PICC Line Insertion into the Ascending Lumbar Vein.

    PubMed

    Payne, Russell; Sieg, Emily P; Choudhary, Arabinda; Iantosca, Mark

    2016-10-17

    Obtaining intravascular access in the neonatal intensive care unit (NICU) is not only critical but also technically challenging. Malposition of the catheter tip is a known and well-documented complication. Specifically, peripherally inserted central venous catheter (PICC) line insertion into the ascending lumbar vein can lead to neurological dysfunction and, in some cases, even death. We present the first reported case of pneumorrhachis (PR) following PICC line insertion into the ascending lumbar vein. Our patient presented with lower extremity weakness and imaging confirmed the presence of air within the spinal canal. After conservative treatment, the strength deficit resolved and subsequent imaging revealed resolution of the air within the spinal canal. Insertion of central venous catheters into the ascending lumbar vein is a well-documented complication that can lead to neurologic injury and even death. This should be considered in the evaluation of any neonate presenting with an abnormal neurological examination or unexplained change in exam after line insertion.

  9. Efficacy of brain-computer interface-driven neuromuscular electrical stimulation for chronic paresis after stroke.

    PubMed

    Mukaino, Masahiko; Ono, Takashi; Shindo, Keiichiro; Fujiwara, Toshiyuki; Ota, Tetsuo; Kimura, Akio; Liu, Meigen; Ushiba, Junichi

    2014-04-01

    Brain computer interface technology is of great interest to researchers as a potential therapeutic measure for people with severe neurological disorders. The aim of this study was to examine the efficacy of brain computer interface, by comparing conventional neuromuscular electrical stimulation and brain computer interface-driven neuromuscular electrical stimulation, using an A-B-A-B withdrawal single-subject design. A 38-year-old male with severe hemiplegia due to a putaminal haemorrhage participated in this study. The design involved 2 epochs. In epoch A, the patient attempted to open his fingers during the application of neuromuscular electrical stimulation, irrespective of his actual brain activity. In epoch B, neuromuscular electrical stimulation was applied only when a significant motor-related cortical potential was observed in the electroencephalogram. The subject initially showed diffuse functional magnetic resonance imaging activation and small electro-encephalogram responses while attempting finger movement. Epoch A was associated with few neurological or clinical signs of improvement. Epoch B, with a brain computer interface, was associated with marked lateralization of electroencephalogram (EEG) and blood oxygenation level dependent responses. Voluntary electromyogram (EMG) activity, with significant EEG-EMG coherence, was also prompted. Clinical improvement in upper-extremity function and muscle tone was observed. These results indicate that self-directed training with a brain computer interface may induce activity- dependent cortical plasticity and promote functional recovery. This preliminary clinical investigation encourages further research using a controlled design.

  10. Vestibular perceptual thresholds to angular rotation in acute unilateral vestibular paresis and with galvanic stimulation.

    PubMed

    Cutfield, Nicholas J; Cousins, Sian; Seemungal, Barry M; Gresty, Michael A; Bronstein, Adolfo M

    2011-09-01

    Studies of compensation of injury to the human vestibular system have, in the main, focused on the vestibular-ocular reflex. Probing vestibular perception allows more of the sensory pathway to be assessed. We present a novel paradigm for simultaneously testing vestibular perceptual and nystagmic thresholds to angular acceleration around an earth vertical axis. The perceptual thresholds can be modulated asymmetrically in normal subjects by DC galvanic stimulation with the head flexed in the roll plane, as expected from the main torsional plane of action of the galvanic stimulus. The perceptual and nystagmic thresholds were bilaterally elevated in acute vestibular neuritis, a unilateral condition, possibly due to central suppression of vestibular input. The degree of asymmetry in thresholds was small in comparison with the large caloric asymmetry present in the patients, indicating a relatively preserved capacity for near-threshold performance of the non-damaged labyrinth both in the "on" and "off" directions.

  11. Peripheral paresis of upper extremity nerves following supracondylar fracture of the humerus in children.

    PubMed

    Havránek, P; Véle, F; Hájková, H; Zwingerová, H

    1989-01-01

    The authors observed a lesion of the peripheral nerves in 13 of 401 children with supracondylar humerus fractures (3.2%). Most frequently, the radial nerve was injured. All patients with neural lesions healed spontaneously, a surgical revision of the nerve was not necessary. The authors' opinion is that neural lesions accompanying supracondylar fractures can be treated conservatively. Exceptions are clear indications for surgical revision, as persisting ischaemia of the forearm or extensive open fractures. When treating conservatively, it is necessary to make a thorough clinical and EMG investigation to set exactly the diagnosis of the neural lesion immediately after removing the plaster cast (mostly 3 weeks after the injury). This investigation is to be repeated regularly, as the reinervation dynamics of the affected region is to be followed up. At the same time it is advantageous to perform electrostimulation until reinervation potentials appear, vitaminotherapy and intensive active exercise with the involved extremity. If no signs of reinvertion in the affected area appear within 6 months, a surgical revision of the nerve is to be considered.

  12. A Symptomatic Case of Thoracic Vertebral Hemangioma Causing Lower Limb Spastic Paresis.

    PubMed

    Alfawareh, Mohammad; Alotaibi, Tariq; Labeeb, Abdallah; Audat, Ziad

    2016-10-31

    BACKGROUND Despite being the most common tumor of the spine, vertebral hemangioma is rarely symptomatic in adults. In fact, only 0.9-1.2% of all vertebral hemangiomas may be symptomatic. When hemangiomas occur in the thoracic vertebrae, they are more likely to be symptomatic due to the narrow vertebral canal dimensions that mandate more aggressive management prior to the onset of severe neurological sequelae. CASE REPORT An 18-year-old male presented to the emergency room with a one-month history of mild to moderate mid-thoracic back pain, radiating to both lower limbs. It was associated with both lower limb weakness and decreased sensation. There was no history of bowel or bladder incontinence. Neurological examination revealed lower limb weakness with power 3/5, exaggerated deep tendon reflexes, bilateral sustained clonus, impaired sensation below the umbilicus, spasticity, and a positive Babinski sign. A CT scan showed a diffuse body lesion at the 8th thoracic vertebra with coarse trabeculations, corduroy appearance, or jail-bar sign. The patient underwent decompression and fixation. Biopsy of permanent samples showed proliferation of blood vessels with dilated spaces and no malignant cells, consistent with hemangioma. Postoperatively, spasticity improved, and the patient regained normal power. CONCLUSIONS Symptomatic vertebral hemangiomas are rare but should be considered as a differential diagnosis. They can present with severe neurological symptoms. When managed appropriately, patients regain full motor and sensory function. Decompression resulted in quick relief of symptoms, which was followed by an extensive rehabilitation program.

  13. [On the problem of voice rehabilitation in the case of unilateral vocal fold paresis].

    PubMed

    Shilenkova, V V

    Односторонний парез голосовых складок (ОПГС) значительно снижает качество жизни пациента. Ведущая роль в реабилитации пациентов с ОПГС принадлежит стимулирующей терапии, которая заключается в активации реиннервации мышц гортани и компенсаторных механизмов, позволяющих достичь наиболее полного смыкания голосовых складок при фонации. Цель исследования — оптимизация консервативного лечения больных с ОПГС. 50 пациентам с ОПГС в возрасте 18—70 лет и давностью заболевания не более 6 мес было проведено комплексное лечение, включающее электростимуляцию гортани, витаминотерапию, фонопедию. Пациенты были объединены в две группы — А и Б по 25 человек. В группе А в комплекс лечения был добавлен нейромидин курсом 1,5 мес. Результаты оценивались с использованием ларингостробоскопии, флоуметрии, шкалы GRBAS, акустического анализа голоса (lingWaves), опросника VHI. В группе А восстановление подвижности голосовой складки наступило в 20% случаев, в группе Б — в 8%. Отсутствие эффекта имело место в 12% случаев в группе А и в 28% в группе Б. Различия между группами статистически достоверны, р<0,05. В остальных случаях отмечалась положительная динамика флоуметрии, GRBAS, VHI, времени максимальной фонации, Jitter, DSI, частотного и динамического диапазонов, интенсивности голоса (68% пациентов группы А и 64% больных группы Б). Полученные данные подтверждают целесообразность проведения при ОПГС комплексной терапии, представляющей сочетание электростимуляции гортани, фонопедии и применения холинергических препаратов. Добавление нейромидина в общепринятую схему консервативного лечения позволяет повысить его результативность с 72 до 88%.

  14. A Symptomatic Case of Thoracic Vertebral Hemangioma Causing Lower Limb Spastic Paresis

    PubMed Central

    Alfawareh, Mohammad; Alotaibi, Tariq; Labeeb, Abdallah; Audat, Ziad

    2016-01-01

    Patient: Male, 18 Final Diagnosis: Hemangioma Symptoms: Pain • weaknes of lower limbs Medication: — Clinical Procedure: Decompression and fixation Specialty: Neurosurgery Objective: Unusual clinical course Background: Despite being the most common tumor of the spine, vertebral hemangioma is rarely symptomatic in adults. In fact, only 0.9–1.2% of all vertebral hemangiomas may be symptomatic. When hemangiomas occur in the thoracic vertebrae, they are more likely to be symptomatic due to the narrow vertebral canal dimensions that mandate more aggressive management prior to the onset of severe neurological sequelae. Case Report: An 18-year-old male presented to the emergency room with a one-month history of mild to moderate midthoracic back pain, radiating to both lower limbs. It was associated with both lower limb weakness and decreased sensation. There was no history of bowel or bladder incontinence. Neurological examination revealed lower limb weakness with power 3/5, exaggerated deep tendon reflexes, bilateral sustained clonus, impaired sensation below the umbilicus, spasticity, and a positive Babinski sign. A CT scan showed a diffuse body lesion at the 8th thoracic vertebra with coarse trabeculations, corduroy appearance, or jail-bar sign. The patient underwent decompression and fixation. Biopsy of permanent samples showed proliferation of blood vessels with dilated spaces and no malignant cells, consistent with hemangioma. Postoperatively, spasticity improved, and the patient regained normal power. Conclusions: Symptomatic vertebral hemangiomas are rare but should be considered as a differential diagnosis. They can present with severe neurological symptoms. When managed appropriately, patients regain full motor and sensory function. Decompression resulted in quick relief of symptoms, which was followed by an extensive rehabilitation program. PMID:27795545

  15. [Experimental studies on the suppression of the stapedius reflex in comparison with EMG-results in idiopathic facial paresis].

    PubMed

    Javor, P; Bernath, O; Ludin, H P

    1976-01-01

    The recording of intra-aural muscle reflexes elicited by acoustic stimulation is a routine method in clinical audiology. The most important quantitative examinations of the reflex dynamic, i.e. Metz recruitment and reflex decay in low frequencies, allow the judgement of function of the afferent pathway in the stimulated inner ear and acoustic nerve. Quantitative determinations of the efferent branch were carried out by several authors in a few normal subjects and in several patients with multiple sclerosis or facial palsy. Absolute acoustic impedance - a method yielding wide scattering - was used in order to determine changes in reflex activity in pathological conditions. In the first part of our investigations we tried to find a parameter or reflex dynamic allowing to characterize the functional capacity in the efferent part of the reflex arch in the facial nerve. We examined particularly the steepness of the onset of recorded reflex. Statistical analysis showed an extraordinary stability of this parameter in normal and pathological conditions. Measurements in normal subjects yielded very small intra- and inter-individual variability. In the second part of our experiments we studied normal-hearing patients with unilateral Bells palsy. In the early phase of the lesion we found a significant decrease of the onset steepness in the reflex diagram recorded on the paralyzed side. The greatest reduction of this parameter was seen with a 1,000-Hz stimulus. The time course of the alteration of the onset steepness also seems to have a characteristis pattern. In a further investigation we compared the variations of this reflex parameter with findings in stimultaneously recorded electroneuronograms.

  16. Hot topic: prevention of parturient paresis and subclinical hypocalcemia in dairy cows by zeolite A administration in the dry period.

    PubMed

    Thilsing-Hansen, T; Jørgensen, R J

    2001-03-01

    To test the effects of a zeolite feed supplement on parturient calcium status and milk fever, two groups of dry cows were treated with either 1 kg of zeolite/d or none for 4 wk prepartum. At calving and d 1 and 2 after calving all cows were given 250 g of calcium carbonate as a drench, and a blood sample was taken. Serum calcium analysis revealed a greater calcium concentration in zeolite-treated cows. While three control cows contracted milk fever, necessitating intravenous calcium therapy, and six out of eight control cows experienced serum calcium levels below 2 mmol/L in one or more samples taken, none of the zeolite-treated cows contracted milk fever or experienced subclinical hypocalcemia.

  17. Identification of a novel mutation in the spastin gene (SPG4) in an Italian family with hereditary spastic paresis.

    PubMed

    Bertelli, M; Cecchin, S; Lorusso, L; Sidoti, V; Fabbri, A; Lapucci, C; Buda, A; Pandolfo, M

    2006-09-01

    Hereditary spastic paraparesis (HSP) includes a heterogeneous group of neurodegenerative diseases characterised by progressive spasticity and hyper-reflexia of the lower limbs. Autosomal dominant HSP type 4 is the most common clinical form, accounting for about 40-50% of autosomal dominant HSP families. This form is due to mutation of the gene encoding spastin (SPG4), an ATP-ase associated with a variety of cellular function (AAA). Here we describe a novel missense mutation (1297T>C; 391L>P) in exon 8 of SPG4 gene, identified in 2 members (mother and son) of an Italian family with autosomal dominant HSP, clinically pure in the mother and complicated in the son. The mutation lies in a highly conserved AAA box domain between amino acids 342 and 599 in spastin sequence. In both patients, this novel mutation was associated with the absence of relatively common clinical characteristics, such as vibratory sensory deficit and loss of sphincter control, and partial temporal epilepsy, particularly in the son, with infantile onset, secondarily generalised and moderately severe neuropsychiatric symptoms.

  18. [Depressor anguli oris sign (DAO) in facial paresis. How to search it and release the smile (technical note)].

    PubMed

    Labbé, D; Bénichou, L; Iodice, A; Giot, J-P

    2012-06-01

    After facial paralysis recovery, it is common to note a co-contraction between depressor anguli oris (DAO) muscle and zygomatic muscles. This DAO co-contraction will "obstruct" the patient's smile. The purpose of this technical note is to show how to find the DAO sign and how to free up the smile. TECHNICAL: This co-contraction between the zygomatic muscles and DAO research is placing a finger on marionette line, asking the patient to smile: we perceive a rope under the skin corresponding to the abnormal contraction and powerful DAO. A diagnostic test with lidocaine injection into the DAO can be performed to confirm the diagnosis. The treatment of pathological DAO's contraction can be by injection of botulinum toxin in the DAO, or by surgical myectomy. In all cases, a speech therapy complete the treatment. The DAO sign is a semiological entity easy to find. His treatment releases smile without negative effect on the facial expression as the DAO is especially useful in the expression of disgust. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  19. Distal hereditary motor neuropathy with vocal cord paresis: from difficulty in choral singing to a molecular genetic diagnosis.

    PubMed

    Ingram, Gillian; Barwick, Katy E S; Hartley, Louise; McEntagart, Meriel; Crosby, Andrew H; Llewelyn, Gareth; Morris, Huw R

    2016-06-01

    Patients presenting with distal weakness can be a diagnostic challenge; the eventual diagnosis often depends upon accurate clinical phenotyping. We present a mother and daughter with a rare form of distal hereditary motor neuropathy type 7 in whom the diagnosis became apparent by initial difficulty in singing, from early vocal cord dysfunction. This rare neuropathy has now been identified in two apparently unrelated families in Wales. This family's clinical presentation is typical of distal hereditary motor neuropathy type 7, and they have the common truncating mutation in the SLC5A7 gene. Advances in genetic analysis of these rare conditions broaden our understanding of their potential molecular mechanisms and may allow more directed therapy.

  20. Facilitating robot-assisted training in MS patients with arm paresis: a procedure to individually determine gravity compensation.

    PubMed

    Bastiaens, H; Alders, G; Feys, P; Notelaers, S; Coninx, K; Kerkhofs, L; Truyens, V; Geers, R; Goedhart, A

    2011-01-01

    Gravity compensation (GC) of the arm is used to facilitate arm movements in conventional therapy as well as in robot-assisted rehabilitation of neurologically impaired persons. Positive effects of GC on Range of Motion (ROM) have been demonstrated in stroke. In Multiple Sclerosis (MS), research regarding this topic is lacking. Since an active participation of the patient is required for effective training, full support of the arm might not be advisable. The present study reports on the development of a procedure to measure actively the individual need for GC and to estimate the influence of GC on ROM during reaching, lifting and transporting in severely affected Persons with MS (PwMS). Ten PwMS were tested with the procedure for determination of GC. Maximal reaching movements were performed in a 3D space in three conditions: No support (NS), with GC by the HapticMaster (GC-HM) and with GC by the HapticMaster combined with a sling suspension system (GC-HMS). For the total sample, significant correlations were found between the amount of GC and clinical tests for upper limb function. In four subjects with severe arm dysfunction it was found that mean ROM is larger in the GC-HMS condition compared to the GC-HM condition, and in the GC-HM condition compared to the NS condition, suggesting positive effects of GC on active ROM in PwMS. Therefore, GC could have a positive effect on arm rehabilitation by enabling the PwMS to actively reach a larger ROM during training.

  1. A Thalamic-Fronto-Parietal Structural Covariance Network Emerging in the Course of Recovery from Hand Paresis after Ischemic Stroke.

    PubMed

    Abela, Eugenio; Missimer, John H; Federspiel, Andrea; Seiler, Andrea; Hess, Christian Walter; Sturzenegger, Matthias; Wiest, Roland; Weder, Bruno J

    2015-01-01

    To describe structural covariance networks of gray matter volume (GMV) change in 28 patients with first-ever stroke to the primary sensorimotor cortices, and to investigate their relationship to hand function recovery and local GMV change. Tensor-based morphometry maps derived from high-resolution structural images were subject to principal component analyses to identify the networks. We calculated correlations between network expression and local GMV change, sensorimotor hand function and lesion volume. To verify which of the structural covariance networks of GMV change have a significant relationship to hand function, we performed an additional multivariate regression approach. Expression of the second network, explaining 9.1% of variance, correlated with GMV increase in the medio-dorsal (md) thalamus and hand motor skill. Patients with positive expression coefficients were distinguished by significantly higher GMV increase of this structure during stroke recovery. Significant nodes of this network were located in md thalamus, dorsolateral prefrontal cortex, and higher order sensorimotor cortices. Parameter of hand function had a unique relationship to the network and depended on an interaction between network expression and lesion volume. Inversely, network expression is limited in patients with large lesion volumes. Chronic phase of sensorimotor cortical stroke has been characterized by a large scale co-varying structural network in the ipsilesional hemisphere associated specifically with sensorimotor hand skill. Its expression is related to GMV increase of md thalamus, one constituent of the network, and correlated with the cortico-striato-thalamic loop involved in control of motor execution and higher order sensorimotor cortices. A close relation between expression of this network with degree of recovery might indicate reduced compensatory resources in the impaired subgroup.

  2. Resting Energy Expenditure in Patients with Stroke during the Subacute Phases - Relationships with Stroke Types, Location, Severity of Paresis, and Activities of Daily Living.

    PubMed

    Kawakami, Michiyuki; Liu, Meigen; Wada, Ayako; Otsuka, Tomoyoshi; Nishimura, Atsuko

    2015-01-01

    The energy demands in patients with stroke during the subacute phases are unclear. However, this information is essential for appropriate clinical and nutritional management. The aims of this study were to determine the resting energy expenditure (REE) during the subacute phases, examine its relationships with stroke types, location, severity of hemiparesis, and activities of daily living (ADL), and evaluate whether estimation of REE from the Harris-Benedict equation (HB) requires the addition of a 'stress factor' to capture possible additional REE imposed by stroke. We measured REE in 95 patients with subacute stroke (53.5 ± 16.6 days post-stroke) with indirect calorimetry, and compared it with predicted values of energy expenditure estimated from the HB (expressed as percentage). Patients were admitted for rehabilitation of their first ischemic or nonsurgical hemorrhagic stroke. The severity of hemiparesis was assessed with the motor items of the Stroke Impairment Assessment Set (SIAS). The ADL was assessed with the Functional Independence Measure (FIM). We compared REE and %HB of the two groups divided by hemiparesis severity and ADL limitation using the Student's t-test, and those of the five groups divided by stroke location. The correlations between REE and the motor items of the SIAS and the FIM score were assessed with the Spearman rank correlation test. A multiple regression analysis for REE was conducted. The average body weight (BW) was 57.1 ± 11.3 kg. The average body mass index (BMI) was 22.5 ± 4.0. The mean REE (%HB) was 1,271 ± 284 kcal/day (106.0 ± 17.3%). REE and %HB of the low ADL group was less than that of the high ADL group (p < 0.05). The REE had a positive correlation with the FIM score (rs = 0.51, p < 0.01). The motor items of the SIAS were not significantly correlated with REE. BW, FIM, and stroke location were independent predictors of REE. Analysis of energy expenditure suggests that stroke patients are not hypermetabolic during the subacute phase. The 'stress factor' in stroke patients during the subacute phase was 1.0-1.1. This finding provides important information for improving nutritional management during the subacute phase in patients with stroke. © 2015 S. Karger AG, Basel.

  3. [Specific features of the clinical picture and difficulties of diagnostics of laryngeal paresis and paralysis in the newborn babies, during breast feeding and early infancy].

    PubMed

    Vasina, A A; Radtsig, E Iu

    2014-01-01

    The objective of the present study was to compare different methods for the endoscopic examination of the larynx in the newborn babies, during the period of breast feeding and early infancy. Special attention was given to differential diagnostics and the cases of the asymptomatic clinical curse of the disease. Case reports are presented, and the relevant literature data are analysed.

  4. The Efficacy of Intraoperative Neurophysiological Monitoring Using Transcranial Electrically Stimulated Muscle-evoked Potentials (TcE-MsEPs) for Predicting Postoperative Segmental Upper Extremity Motor Paresis After Cervical Laminoplasty

    PubMed Central

    Manabe, Hideki; Izumi, Bunichiro; Tanaka, Hiroyuki; Kawai, Kazumi; Tanaka, Nobuhiro

    2016-01-01

    Study Design: Prospective study. Objective: To investigate the efficacy of transcranial electrically stimulated muscle-evoked potentials (TcE-MsEPs) for predicting postoperative segmental upper extremity palsy following cervical laminoplasty. Summary of Background Data: Postoperative segmental upper extremity palsy, especially in the deltoid and biceps (so-called C5 palsy), is the most common complication following cervical laminoplasty. Some papers have reported that postoperative C5 palsy cannot be predicted by TcE-MsEPs, although others have reported that it can be predicted. Methods: This study included 160 consecutive cases that underwent open-door laminoplasty, and TcE-MsEP monitoring was performed in the biceps brachii, triceps brachii, abductor digiti minimi, tibialis anterior, and abductor hallucis. A >50% decrease in the wave amplitude was defined as an alarm point. According to the monitoring alarm, interventions were performed, which include steroid administration, foraminotomies, etc. Results: Postoperative deltoid and biceps palsy occurred in 5 cases. Among the 155 cases without segmental upper extremity palsy, there were no monitoring alarms. Among the 5 deltoid and biceps palsy cases, 3 had significant wave amplitude decreases in the biceps during surgery, and palsy occurred when the patients awoke from anesthesia (acute type). In the other 2 cases in which the palsy occurred 2 days after the operation (delayed type), there were no significant wave decreases. In all of the cases, the palsy was completely resolved within 6 months. Discussion: The majority of C5 palsies have been reported to occur several days after surgery, but some of them have been reported to occur immediately after surgery. Our results demonstrated that TcE-MsEPs can predict the acute type, whereas the delayed type cannot be predicted. Conclusions: A >50% wave amplitude decrease in the biceps is useful to predict acute-type segmental upper extremity palsy. Further examination about the interventions for monitoring alarm will be essential for preventing palsy. PMID:26147699

  5. Neurosyphilis

    MedlinePlus

    ... getting syphilis. People with general paresis can have personality or mood changes. Tabes dorsalis is characterized by ... getting syphilis. People with general paresis can have personality or mood changes. Tabes dorsalis is characterized by ...

  6. [Peripheral paralysis of facial nerve in children].

    PubMed

    Steczkowska-Klucznik, Małgorzata; Kaciński, Marek

    2006-01-01

    Peripheral facial paresis is one of the most common diagnosed neuropathies in adults and also in children. Many factors can trigger facial paresis and most frequent are infectious, carcinoma and demyelinisation diseases. Very important and interesting problem is an idiopathic facial paresis (Bell's palsy). Actually the main target of scientific research is to assess the etiology (infectious, genetic, immunologic) and to find the most appropriate treatment.

  7. Isolated Shoulder Weakness due to a Small Cortical Infarction

    PubMed Central

    Nah, Hyeon-Uk; Park, Hee Kyung

    2006-01-01

    Small cortical infarctions can produce isolated motor paresis in the upper extremities. Several cases of isolated hand or finger paresis have been reported, but isolated shoulder weakness is extremely rare. We report here a patient who developed isolated shoulder weakness due to a small cortical infarction in the medial precentral gyrus. PMID:20396510

  8. [Vocal cord paralysis--analysis of a cohort of 400 patients].

    PubMed

    Reiter, R; Pickhard, A; Smith, E; Hansch, K; Weber, T; Hoffmann, T K; Brosch, S

    2015-02-01

    Vocal cord paralysis has diverse etiologies. In the present study, vocal chord paralysis caused by surgery/trauma was present in more than two thirds of the cases, followed by primary malignancy-associated paralysis. Thyroidectomy was the most common cause in bilateral paresis, especially if performed in recurrent or malignant disease. Voice therapy was promising in pa-tients with unilateral paresis and hoarseness as main symptom. Persistent dysphonia due to insufficiency of the glottic closure led to an operative glottis restricting procedure in only 6% of cases. In almost half the patients with dyspnea as the main symp-tom of bilateral vocal cord paresis, temporary tracheotomy or surgical glottis widening procedures had to be performed. The group of idiopathic and traumatic paresis patients showed the best spontaneous recovery within the first 12 months in comparison to primary malignancy-associated paralysis, which showed no recovery of the recurrens nerve.

  9. [A man with a crooked smile].

    PubMed

    Bechan, M A H Afzal; van Dortmont, Laura M C; Claes, J Franka H M

    2013-01-01

    A 51-year-old man had a paresis of the right side of the lower lip after carotic endarterectomy. The diagnosis was 'pressure neuropathy of the right ramus marginalis mandibulae' caused by the operation. This neuropathy is self limiting.

  10. Neurological Principles and Rehabilitation of Action Disorders: Common Clinical Deficits

    PubMed Central

    Sathian, K.; Buxbaum, Laurel J.; Cohen, Leonardo G.; Krakauer, John W.; Lang, Catherine E.; Corbetta, Maurizio; Fitzpatrick, Susan M.

    2014-01-01

    In this paper we use the CAP principles to consider the impact of common clinical problems on action. We focus on three major syndromes: paresis, apraxia and ataxia. We also review mechanisms that could account for spontaneous recovery, using what is known about the best studied clinical dysfunction, paresis, and also ataxia. Together, this and the previous paper lay the groundwork for the third paper in this series, which reviews the relevant rehabilitative interventions. PMID:21613535

  11. Relation between symptoms and pathophysiology in inflammatory neuropathies: Controversies and hypotheses.

    PubMed

    Franssen, Hessel

    2015-06-02

    This review attempts to explain the symptoms experienced by patients with inflammatory neuropathies by pathophysiological events. The emphasis is not on the primary events that may cause a particular illness but on downstream events taking place in peripheral nerves or muscles. Symptoms that will be discussed include sensory predominance, motor predominance, activity-induced weakness, heat paresis, and cold paresis. Each symptom is associated with, but not limited to, particular neuropathies.

  12. [Hemiparesis and facial palsy caused by methotrexate].

    PubMed

    Rueda Arenas, E; García Corzo, J; Franco Ospina, L

    2013-12-01

    Methotrexate used in the treatment of acute lymphocytic leukemia, can cause neurotoxicity, including a rare presentation with hemiparesis. We describe two teenagers, who during the implementation of the M phase of the protocol, suffered hemiparesis, facial paresis and dysarthria which quickly reversed. Leukemia involvement of the central nervous system and stroke, were ruled out. We briefly review the pathophysiology of methotrexate neurotoxicity, the characteristics of the focal paresis presentation and magnetic resonance image findings.

  13. Isolated pyocele of anterior clinoid process presenting as a cavernous sinus syndrome.

    PubMed

    O'Donnell, Thomas J; Michael, L Madison; Laster, Robert; Fleming, James C

    2013-05-01

    A 37-year-old man presented with fever, decreased vision in the left eye, a partial left cranial nerve III paresis, and a left cranial nerve VI paresis. Neuro-imaging showed an opacification of a left pneumatised anterior clinoid process. After failing a course of intravenous antibiotics, a craniotomy was performed with exenteration of the cavity and resolution of symptoms. Although rare, a pyocele of a pneumatised anterior clinoid process may cause ocular morbidity and require surgical intervention.

  14. Management of paretic vertical deviations.

    PubMed

    Archer, Steven M

    2011-01-01

    Paretic vertical deviations are characterized by complex patterns of incomitance that make them some of the most challenging strabismus problems to treat. Optimum results are obtained by performing surgery on those muscles, selected from among the eight cyclovertical muscles in the two eyes, that minimize the incomitance. In superior oblique paresis the additional factors of torticollis and torsion need to be addressed and aberrant regeneration can alter the surgical plan in third nerve paresis.

  15. Effects of ankle foot orthoses on body functions and activities in people with floppy paretic ankle muscles: a systematic review.

    PubMed

    van der Wilk, Dymphy; Dijkstra, Pieter Ubele; Postema, Klaas; Verkerke, Gijsbertus Jacob; Hijmans, Juha Markus

    2015-12-01

    People with floppy ankle muscles paresis use ankle foot orthoses to improve their walking ability. Ankle foot orthoses also limit ankle range of motion thereby introducing additional problems. Insight in effects of ankle foot orthoses on body functions and activities in people with floppy paretic ankle muscles aids in clinical decision making and may improve adherence. Studies published before October 27th, 2014, were searched in Pubmed, Embase, Cinahl, and Cochrane Library. Studies evaluating effects of ankle foot orthoses on body functions and/or activities in people with floppy paretic ankle muscles were included. Studies solely focusing on people with spastic paretic ankle muscles were excluded. Study quality was assessed using a custom-made scale. Body functions and activities were defined according to the International Classification of Functioning, Disability and Health. Twenty-four studies were included, evaluating 394 participants. Participants were grouped according to paresis type (i) dorsiflexor paresis, (ii) plantar flexor paresis, (iii) both dorsiflexor and plantar flexor paresis. Dorsal, circular, and elastic ankle foot orthoses increased dorsiflexion during swing (by 4-6°, group i). Physical comfort with dorsal ankle foot orthoses was lower than that with circular ankle foot orthoses (groups i and iii). Dorsal ankle foot orthoses increased push-off moment (by 0.2-0.5 Nm/kg), increased walking efficiency, and decreased ankle range of motion (by 12-30°, groups ii and iii). People with dorsiflexor paresis benefit more from circular and elastic ankle foot orthoses while people with plantar flexor paresis (and dorsiflexor paresis) benefit more from dorsal ankle foot orthoses. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. [Erysipel at the lower leg combined with a peripheral peroneus nerve palsy--an unusual occurrence].

    PubMed

    Röllinghoff, M; Delank, K-S; Haupt, W F; Eysel, P

    2006-01-01

    We present the clinical case of a fifty-year-old man who presented two times with a foot elevator paresis and an erysipel first on the right and after two months on the left side. Afterwards, we carried out a thorough case history with the help of clinical, radiological and magnetic resonance imaging. Even so the clinical pathology of the foot elevator paresis could not be manifested. A compartment syndrome could be discounted. In the context of the second stay during a neurology examination on both legs electromyography was performed and the nerve speed was tested. A peripheral peroneus paresis of unknown level and of unknown aetiology was demonstrated. The erysipel regressed rapidly under intravenous ampicillin antibiotics while the peroneus paresis was unchanged. The patent was released with a peroneus splint on both sides. With this case report we would like to point out the causes of peripheral peroneus paresis with regard to an additional erysipel. This case report is discussed regarding the possible aetiopathology and the current literature.

  17. [Disorders of muscle tonus and their treatment with sirdalud in patients in the early recovery period of ischemic stroke].

    PubMed

    Gekht, A B; Burd, G S; Selikhova, M V; Iaish, F; Beliakov, V V

    1998-01-01

    The paper presents the results of clinical and neurophysiologic study of muscular tonus in 94 patients aged 42-70 years in early recovery after ischemic stroke. Selective role of spasticity was estimated in clinical pattern of motor disorders in groups of the patients with different disorders of muscular tonus with the same degree of paresis. Efficiency of antispastic preparation sirdalud was analyzed in 28 patients from this group. Sirdalud in daily dose of 6-12 mg in patients with prevalence of a spasticity in a clinical picture of the paresis and with either moderate or manifested degree of paresis of the extremities has significant antispastic effect without any decrease of muscular strength, which, in turn, increases the degree of restoration of motor functions.

  18. Herpetic Brachial Plexopathy: Application of Brachial Plexus Magnetic Resonance Imaging and Ultrasound-Guided Corticosteroid Injection.

    PubMed

    Kim, Jeong-Gil; Chung, Sun G

    2016-05-01

    Herpes zoster, commonly known as shingles, is an infectious viral disease characterized by painful, unilateral skin blisters occurring in specific sensory dermatomes. Motor paresis is reported in 0.5% to 5% of patients. Although the mechanism of zoster paresis is still unclear, the virus can spread from the dorsal root ganglia to the anterior horn cell or anterior spinal nerve roots. It rarely involves the brachial plexus. We report a case of brachial plexitis following herpes zoster infection in which pathological lesions were diagnosed using brachial plexus magnetic resonance imaging and treated with ultrasound-guided perineural corticosteroid injection.

  19. Ophthalmoplegia in tiger snake envenomation.

    PubMed

    Ferdinands, Mervyn; Seneviratne, Janaka; O'Brien, Terry; White, Owen

    2006-04-01

    Herein, we present the case of a 67-year-old grazier who was bitten by a tiger snake and developed coagulopathy and respiratory distress. The patient required intubation and ventilation in intensive care. There was delayed detection of snake envenomation and administration of antivenom. On extubation several days later, gross external ocular paresis was noted. Clinical testing indicated that the ocular pathology was secondary to neurotoxin-mediated presynaptic blockade. The paresis was partially resolved by the time of discharge one week later. The present case report discusses the possible mechanisms for the delayed development of ophthalmoplegia.

  20. Air as the caloric stimulus.

    PubMed

    O'Neill, G O

    1978-05-01

    The use of air as the caloric medium was investigated and compared to that of water. The ability of air and water to generate surface temperatures close to the fluid outlet temperature was studied by irrigation onto a thermocouple. Results of caloric tests performed with air and water are compared by calculating the average nystagmus response for the hot and cold stimuli for two groups of sixty patients. Also, the number of canal paresis, directional preponderance, mixed, bi-lateral canal paresis and normal responses are compared for each group. Finally, the effect of performing a bi-thermal air caloric on a patient having a unilateral drum perforation is discussed.

  1. [The head-up-orthosis - a good solution for ambulant patients with Dropped-head-syndrome].

    PubMed

    Czell, D; Weber, M

    2012-11-14

    Severe paresis of the neck muscles, dystonia or an increased activation of the head flexor can lead to dropped-head syndrome. It can be based on various neurological diseases. We present a patient with amyotrophic lateral sclerosis with severe paresis of the head extensor muscles, which led to a dropped-head syndrome. Usual advices did not permit an adequate swallowing and breathing. The new developed device (head-up) can be adjusted on the individual needs which lead to a marked improvement in quality of life of the patient. Especially for ambulatory patients with Dropped-head syndrome is the «head-up» a very good solution.

  2. A thymic carcinoid in a Bengal tiger (Panthera tigris).

    PubMed

    Powe, Joshua; Castleman, William; Fiorello, Christine

    2005-09-01

    An 18-yr-old Bengal tiger (Panthera tigris) presented with acute onset hind limb paresis. Radiographic and ultrasonographic imaging revealed a caudal abdominal aortic thrombus and a cranial mediastinal mass. Necropsy confirmed aortic thrombosis. Necrotizing enteritis and multifocal renal thrombosis were also noted. The cranial mediastinum contained a bilobed mass that histologically and ultrastructurally was consistent with a carcinoid.

  3. Mutism following left hemisphere infarction.

    PubMed Central

    David, A S; Bone, I

    1984-01-01

    A case of mutism due to left hemisphere infarction is described. Recovery revealed mild motor dysphasia. Review of the literature showed that the case resembles aphemia but is unique by virtue of its duration, and the absence of associated apraxia and paresis. Images PMID:6210346

  4. Comparative imaging of spinal extradural lymphoma in a Bordeaux dog.

    PubMed

    Veraa, Stefanie; Dijkman, Reinie; Meij, Björn P; Voorhout, George

    2010-05-01

    A lumbar extradural lymphoma compressing the spinal cord was identified on contrast enhanced computed tomography (CT) and magnetic resonance imaging (MRI) images in a 4-year-old Bordeaux dog presented with posterior paresis. A significant paravertebral extension was only clearly defined on contrast MRI images; therefore, MRI was more useful than CT in imaging of spinal extradural lymphoma in this dog.

  5. [Arguments against the pharmacotherapy of Bells' palsy].

    PubMed

    Portegies, P

    2005-06-25

    Bell's palsy is the most frequent type of peripheral facial paresis. Its cause is unknown. The prognosis is good in 85% of patients. Based on theories about its pathogenesis, antivirals and corticosteroids have been tried. In 6 studies with antivirals and 9 with corticosteroids (most ofthe studies were methodologically flawed), the efficacy of these treatments was not demonstrated.

  6. Retroperitoneal abscesses in two western lowland gorillas (Gorilla gorilla gorilla).

    PubMed

    Hahn, Alicia; D'Agostino, Jennifer; Cole, Gretchen A; Raines, Jan

    2014-03-01

    This report describes two cases of retroperitoneal abscesses in female western lowland gorillas (Gorilla gorilla gorilla). Clinical symptoms included perivulvar discharge, lameness, hindlimb paresis, and general malaise. Retroperitoneal abscesses should be considered as part of a complete differential list in female gorillas with similar clinical signs.

  7. Tick paralysis in a red wolf.

    PubMed

    Beyer, A B; Grossman, M

    1997-10-01

    A free-ranging male red wolf (Canis rufus) in North Carolina (USA), exhibiting paresis, anorexia and heavy tick infection was diagnosed with tick paralysis. The wolf recovered completely following the removal of all ticks. This is the first record of tick paralysis in the red wolf.

  8. Horner’s syndrome with an ipsilateral X nerve palsy following presumed shingles

    PubMed Central

    Sedehizadeh, Saam; Bowen, John

    2010-01-01

    Herpes zoster is a common clinical problem but its complications, apart from post-herpetic neuralgia, are comparatively rare. We describe a case of Horner’s syndrome and ipsilateral vagal paresis following likely herpes zoster of the third and fourth cervical roots. This unusual combination has not, to our knowledge, been previously described. PMID:22736602

  9. Identifying Concussion / Mild TBI in Service Members

    DTIC Science & Technology

    2012-03-22

    paresis/plegia, sensory loss, aphasia , etc.) that may or may not be transient o Intracranial lesion DoD Definition of TBI 8  External forces may...mild TBI including: o Evidence-based recommendations o ICD-9 coding guidance o Clinical recommendations for cognitive rehabilitation o Clinical

  10. Bacterial diskospondylitis in juvenile mink from 2 Ontario mink farms

    PubMed Central

    Martínez, Jorge; Vidaña, Beatriz; Cruz-Arambulo, Robert; Slavic, Durda; Tapscott, Brian; Brash, Marina L.

    2013-01-01

    Nine juvenile mink with hind-limb paresis/paralysis from 2 Ontario farms were submitted for necropsy. Diagnostic tests revealed spinal compression and severe thoracic diskospondylitis with intralesional Gram-positive coccoid bacterial colonies. Streptococcus canis, Streptococcus dysgalactiae subsp. equisimilis, and hemolytic Staphylococcus spp. were isolated from vertebral lesions. PMID:24155490

  11. Intoxication of sheep exposed to ozark milkweed (Asclepias viridis Walter).

    PubMed

    Smith, R A; Scharko, P; Bolin, D; Hong, C B

    2000-12-01

    Some 20 sheep died 1 at a time on a farm in Fleming County, KY, in late July of 1999 after consumption of Asclepias viridis Walter. Major histological lesions were mild multifocal nonsuppurative myocarditis. Gross pathology revealed wet and heavy lungs. Many affected animals had a hunched appearance, and marked posterior paresis was also observed.

  12. Motor-evoked potentials (MEP) during brainstem surgery to preserve corticospinal function.

    PubMed

    Sarnthein, Johannes; Bozinov, Oliver; Melone, Angelina Graziella; Bertalanffy, Helmut

    2011-09-01

    Brainstem surgery bears a risk of damage to the corticospinal tract (CST). Motor-evoked potentials (MEPs) are used intraoperatively to monitor CST function in order to detect CST damage at a reversible stage and thus impede permanent neurological deficits. While the method of MEP is generally accepted, warning criteria in the context of brainstem surgery still have to be agreed on. We analyzed 104 consecutive patients who underwent microsurgical resection of lesions affecting the brainstem. Motor grade was documented prior to surgery, early postoperatively and at discharge. A baseline MEP stimulation intensity threshold was defined and intraoperative testing aimed to keep MEP response amplitude constant. MEPs were considered deteriorated and the surgical team was notified whenever the threshold was elevated by ≥20 mA or MEP response fell under 50%. On the first postoperative day, 18 patients experienced new paresis that resolved by discharge in 11. MEPs deteriorated in 39 patients, and 16 of these showed new postoperative paresis, indicating a 41% risk of new paresis. In the remaining 2/18 patients, intraoperative MEPs were stable, although new paresis appeared postoperatively. In one of these patients, intraoperative hemorrhage caused postoperative swelling, and the new motor deficit persisted until discharge. Of all 104 patients, 7 deteriorated in motor grade at discharge, 92 remained unchanged, and 5 patients have improved. Adjustment of surgical strategy contributed to good motor outcome in 33/39 patients. MEP monitoring may help significantly to prevent motor deficits during demanding neurosurgical procedures on the brainstem.

  13. Periorbital scleroderma associated with heterochromia iridis.

    PubMed

    Stone, R A; Scheie, H G

    1980-12-01

    Two patients had biopsy-proven linear scleroderma, associated with a pigmentary abnormality of the anterior segment of the eye. One patient had heterochromia iridis, atrophy of the upper eyelid, a typical coup de sabre lesion, and a markedly asymmetric pigmentary glaucoma. The second patient had bilateral scalp involvement, paresis of the extraocular muscles, blepharoptosis, and heterochromia iridis.

  14. The effects of mirror therapy on arm and hand function in subacute stroke in patients.

    PubMed

    Radajewska, Alina; Opara, Józef A; Kucio, Cezary; Błaszczyszyn, Monika; Mehlich, Krzysztof; Szczygiel, Jarosław

    2013-09-01

    The aim of this study was to evaluate the effect of mirror therapy on arm and hand function in subacute stroke in patients. The study included 60 hemiparetic right-handed patients after ischemic stroke 8-10 weeks after onset. They underwent stationary comprehensive rehabilitation in the rehabilitation centre. They were divided into two randomly assigned groups: mirror (n=30) and control (n=30). For both groups, two subgroups were created: one that included patients with right arm paresis (n=15) and the other that included patients with left arm paresis (n=15). The mirror group received an additional intervention: training with a mirror for 5 days/week, 2 sessions/day, for 21 days. Each single session lasted for 15 min. The control group (n=30) underwent a conventional rehabilitation program without mirror therapy. To evaluate self-care in performing activities of daily living, the Functional Index 'Repty' was used. To evaluate hand and arm function, the Frenchay Arm Test and the Motor Status Score were used. Measurements were performed twice: before and after 21 days of applied rehabilitation. No significant improvement in hand and arm function in both subgroups in Frenchay Arm Test and Motor Status Score scales was observed. However, there was a significant improvement in self-care of activities of daily living in the right arm paresis subgroup in the mirror group measured using the Functional Index 'Repty'. Mirror therapy improves self-care of activities of daily living for patients with right arm paresis after stroke.

  15. Bacterial diskospondylitis in juvenile mink from 2 Ontario mink farms.

    PubMed

    Martínez, Jorge; Vidaña, Beatriz; Cruz-Arambulo, Robert; Slavic, Durda; Tapscott, Brian; Brash, Marina L

    2013-09-01

    Nine juvenile mink with hind-limb paresis/paralysis from 2 Ontario farms were submitted for necropsy. Diagnostic tests revealed spinal compression and severe thoracic diskospondylitis with intralesional Gram-positive coccoid bacterial colonies. Streptococcus canis, Streptococcus dysgalactiae subsp. equisimilis, and hemolytic Staphylococcus spp. were isolated from vertebral lesions.

  16. Impairment-oriented training (IOT)--scientific concept and evidence-based treatment strategies.

    PubMed

    Platz, T

    2004-01-01

    Everyday activities can be affected by many different body dysfunctions (impairments). A multi-modal analysis of electric brain activity revealed that movement-related brain activity is differentially altered in patients with different impairments, i.e. paresis, somatosensory deficits, and apraxia. Each body dysfunction has its own characteristics in terms of the resulting sensorimotor control deficits. The Impairment-oriented Training concept intends to characterise the resulting sensorimotor control deficits for each impairment. Based on such analyses two specific training techniques have been developed for stroke patients with mild and severe arm paresis: (1.) The Arm Ability training for mild arm paresis trains different sensorimotor abilities such as dexterity, speed of isolated hand and finger movements, steadiness, aiming, or tracking under visual guidance. Improvement of these motor abilities leads to improved motor performance in every day life circumstances. (2.) The Arm BASI S training for severe arm paresis intends to restore more basic motor control, i.e. the full range of active non-segmented motion of all limb segments, both postural activities and dynamic motion control, interjoint-coordination, and adequate motor control when external forces are applied. Clinical trials with representative study populations supported both techniques' clinical efficacy.

  17. Worster-Drought Syndrome: Poorly Recognized despite Severe and Persistent Difficulties with Feeding and Speech

    ERIC Educational Resources Information Center

    Clark, Maria; Harris, Rebecca; Jolleff, Nicola; Price, Katie; Neville, Brian G. R.

    2010-01-01

    Aim: Worster-Drought syndrome (WDS), or congenital suprabulbar paresis, is a permanent movement disorder of the bulbar muscles causing persistent difficulties with swallowing, feeding, speech, and saliva control owing to a non-progressive disturbance in early brain development. As such, it falls within the cerebral palsies. The aim of this study…

  18. Perceived health in a population based sample of victims of the 1956 polio epidemic in the Netherlands

    PubMed Central

    Nollet, F; Ivanyi, B; Beelen, A; de Haan, R J; Lankhorst, G; de Visser, M

    2002-01-01

    Objective: To investigate perceived health and its relation to residual paresis from polio, late onset neuromuscular symptoms following poliomyelitis (LSP), and sex, in a population based sample of polio survivors. Methods: 350 subjects traced from the notification records of the Dutch 1956 polio epidemic received a mailed questionnaire on residual polio paresis and new neuromuscular symptoms. Perceived health was measured using the Nottingham health profile. Respondents with new muscle weakness and new neuromuscular symptoms were considered as cases with LSP. Results: Health problems were perceived by 151 of the 260 respondents. Respondents with residual paresis had significantly more health problems than clinically recovered respondents for the Nottingham health profile category of physical mobility. The perceived health of respondents with LSP (45.5%) was significantly worse than that of respondents without LSP for all the health profile categories. Among the respondents with LSP, health status did not differ between those with residual paresis and those who had recovered, except for physical mobility. Female respondents with LSP reported worse health status than male respondents with regard to physical mobility and social isolation. Conclusions: In this population based sample, health problems were frequently reported. They were mainly related to late onset neuromuscular symptoms following poliomyelitis, which were perceived by a substantial proportion of all polio survivors—not only subjects with polio residuals but also individuals who (subjectively) had recovered from polio. PMID:12438472

  19. Worster-Drought Syndrome: Poorly Recognized despite Severe and Persistent Difficulties with Feeding and Speech

    ERIC Educational Resources Information Center

    Clark, Maria; Harris, Rebecca; Jolleff, Nicola; Price, Katie; Neville, Brian G. R.

    2010-01-01

    Aim: Worster-Drought syndrome (WDS), or congenital suprabulbar paresis, is a permanent movement disorder of the bulbar muscles causing persistent difficulties with swallowing, feeding, speech, and saliva control owing to a non-progressive disturbance in early brain development. As such, it falls within the cerebral palsies. The aim of this study…

  20. Dysphonia and dysphagia after anterior cervical decompression.

    PubMed

    Tervonen, Hanna; Niemelä, Mika; Lauri, Eija-Riitta; Back, Leif; Juvas, Anja; Räsänen, Pirjo; Roine, Risto P; Sintonen, Harri; Salmi, Tapani; Vilkman, S Erkki; Aaltonen, Leena-Maija

    2007-08-01

    In this paper, the authors investigate the effects of anterior cervical decompression (ACD) on swallowing and vocal function. The study comprised 114 patients who underwent ACD. The early group (50 patients) was examined immediately pre- and postoperatively, and the late group (64 patients) was examined at only 3 to 9 months postoperatively. Fifty age- and sex-matched patients from the Department of Otorhinolaryngology-Head and Neck Surgery who had not been intubated in the previous 5 years were used as a control group. All patients in the early and control groups were examined by a laryngologist; patients in the late group were examined by a laryngologist and a neurosurgeon. Videolaryngostroboscopy was performed in all members of the patient and control groups, and the function of the ninth through 12th cranial nerves were clinically evaluated. Data were collected concerning swallowing, voice quality, surgery results, and health-related quality of life. Patients with persistent dysphonia were referred for phoniatric evaluation and laryngeal electromyography (EMG). Those with persistent dysphagia underwent transoral endoscopic evaluation of swallowing function and videofluorography. Sixty percent of patients in the early group reported dysphonia and 69% reported dysphagia at the immediate postoperative visit. Unilateral vocal fold paresis occurred in 12%. The prevalence of both dysphonia and dysphagia decreased in both groups 3 to 9 months postoperatively. All six patients with vocal fold paresis in the early group recovered, and in the late group there were two cases of vocal fold paresis. The results of laryngeal EMG were abnormal in 14 of 16 patients with persistent dysphonia. Neither intraoperative factors nor age or sex had any effect on the occurrence of dysphonia, dysphagia, or vocal fold paresis. Most patients were satisfied with the surgical outcome. Dysphonia, dysphagia, and vocal fold paresis are common but usually transient complications of ACD

  1. Cutaneous and neurologic disease associated with HTLV-I infection.

    PubMed

    Sharata, H H; Colvin, J H; Fujiwara, K; Goldman, B; Hashimoto, K

    1997-05-01

    Human T-lymphotropic virus type I (HTLV-I) is the etiologic agent of HTLV-I associated myelopathy (HAM)/tropical spastic paresis (TSP), and adult T-cell leukemia/lymphoma (ATLL). ATLL has been associated with HTLV-I in the southeastern United States. However, to our knowledge, no case reports of HAM/TSP in association with ATLL occurring in the United States have been described. We describe a 40-year-old black woman with a 10-year history of recalcitrant psoriasiform eruption and erythrodermic flares. Medical history is additionally significant for a 2-year history of HTLV-I-associated myelopathy and lower extremity spastic paresis. Polymerase chain reaction with Southern blot analysis was used to detect HTLV-I proviral genome from frozen skin biopsy specimens and peripheral blood mononuclear cells.

  2. [Neuromuscular electric stimulation therapy in otorhinolaryngology].

    PubMed

    Miller, S; Kühn, D; Jungheim, M; Schwemmle, C; Ptok, M

    2014-02-01

    Animal experiments have shown that after specific nerve traumatization, neuromuscular electrostimulation (NMES) can promote nerve regeneration and reduce synkinesia without negatively interfering with normal regeneration processes. NMES is used routinely in physical rehabilitation medicine. This systematic literature search in the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, the DAHTA database, the Health Technology Assessment Database and MEDLINE or PubMed considered studies on the use of NMES in otorhinolaryngology that have been published in German or English. The search identified 180 studies. These were evaluated and relevant studies were included in the further evaluation. In the fields of otorhinolaryngology and phoniatry/paediatric audiology, clinical studies investigating the effects of NMES on facial and laryngeal paresis, as well as dysphonia and dysphagia have been carried out. The evidence collected to date is encouraging; particularly for the treatment of certain forms of dysphagia and laryngeal paresis.

  3. Surgery for a giant arteriovenous malformation without motor deterioration: preoperative transcranial magnetic stimulation in a non-cooperative patient.

    PubMed

    Kronenburg, Annick; van Doormaal, Tristan; van Eijsden, Pieter; van der Zwan, Albert; Leijten, Frans; Han, Kuo Sen

    2014-07-01

    Transcranial magnetic stimulation (TMS) is a noninvasive activation method that is increasingly used for motor mapping. Preoperative functional mapping in vascular surgery is not routinely performed; however, in cases of high-grade arteriovenous malformations (AVMs), it could play a role in preoperative decision making. A 16-year-old male was suffering from a giant, right-sided insular, Spetzler-Martin Grade V AVM. This patient's history included 3 hemorrhagic strokes in the past 3 years, resulting in Medical Research Council Grade 2-3 (proximal) and 2-4 (distal) paresis of the left side of the body and hydrocephalus requiring a ventriculoperitoneal shunt. Preoperative TMS showed absent contralateral innervation of the remaining left-sided motor functions. Subsequently, the AVM was completely resected without any postoperative increase of the left-sided paresis. This case shows that TMS can support decision making in AVM treatment by mapping motor functions.

  4. Nomenclature proposal to describe vocal fold motion impairment.

    PubMed

    Rosen, Clark A; Mau, Ted; Remacle, Marc; Hess, Markus; Eckel, Hans E; Young, VyVy N; Hantzakos, Anastasios; Yung, Katherine C; Dikkers, Frederik G

    2016-08-01

    The terms used to describe vocal fold motion impairment are confusing and not standardized. This results in a failure to communicate accurately and to major limitations of interpreting research studies involving vocal fold impairment. We propose standard nomenclature for reporting vocal fold impairment. Overarching terms of vocal fold immobility and hypomobility are rigorously defined. This includes assessment techniques and inclusion and exclusion criteria for determining vocal fold immobility and hypomobility. In addition, criteria for use of the following terms have been outlined in detail: vocal fold paralysis, vocal fold paresis, vocal fold immobility/hypomobility associated with mechanical impairment of the crico-arytenoid joint and vocal fold immobility/hypomobility related to laryngeal malignant disease. This represents the first rigorously defined vocal fold motion impairment nomenclature system. This provides detailed definitions to the terms vocal fold paralysis and vocal fold paresis.

  5. Unruptured internal carotid-posterior communicating artery aneurysm splitting the oculomotor nerve: a case report and literature review.

    PubMed

    Toyota, Shingo; Taki, Takuyu; Wakayama, Akatsuki; Yoshimine, Toshiki

    2014-08-01

    Objective To report a rare case of unruptured internal carotid-posterior communicating artery (IC-PC) aneurysm splitting the oculomotor nerve treated by clipping and to review the previously published cases. Case Presentation A 42-year-old man suddenly presented with left oculomotor paresis. Three-dimensional digital subtraction angiography (3D DSA) demonstrated a left IC-PC aneurysm with a bulging part. During surgery, it was confirmed that the bulging part split the oculomotor nerve. After the fenestrated oculomotor nerve was dissected from the bulging part with a careful microsurgical technique, neck clipping was performed. After the operation, the symptoms of oculomotor nerve paresis disappeared within 2 weeks. Conclusions We must keep in mind the possibility of an anomaly of the oculomotor nerve, including fenestration, and careful observation and manipulation should be performed to preserve the nerve function during surgery, even though it is very rare.

  6. A pilot study of robotic-assisted exercise for hand weakness after stroke.

    PubMed

    Stein, Joel; Bishop, Joel; Gillen, Glen; Helbok, Raimund

    2011-01-01

    Upper limb paresis is a major source of disability in stroke survivors, and robotic aided exercise therapy is a promising approach to enhance motor abilities. Few devices have been available to provide robotic therapy to the fingers and hand. We report an open-label pilot study of 12 individuals with chronic moderate hemiparesis after stroke who underwent a six-week training program using a hand robotic device. Participants received a total of 18 hours of robotic therapy. Improvements were found in multiple measures of motor performance, including the Upper Extremity Fugl-Meyer, the Motor Activity Log, the Manual Ability Measure-36, and the Jebsen Hand Function Test. All subjects tolerated the treatment well and no complications were observed. We conclude that robotic therapy for hand paresis after stroke is safe and feasible, and that further studies of efficacy are justified by these preliminary results. © 2011 IEEE

  7. [Post-polio syndrome - a case report].

    PubMed

    Pastuszak, Żanna; Tomczykiewicz, Kazimierz; Stępień, Adam

    2015-07-01

    Post-polio syndrome occurs 30-40 years after polio virus infection. The main symptoms of PPS are slowly progressive muscle limbs paresis with muscle atrophy, joints pain, paresthesia. In 90% of patients the main symptom is fatigue that leads to physical and mental activity deterioration. The cause of disease remains unknown. Probably it is an effect of motoneurons damage during acute virus polio infection, their overloading and degeneration of remaining ones. In this study we described a case of man who developed PPS 36 years after Heine-Medin disease. The main symptom was intensification of right limb paresis and muscle atrophy. In electromyography there were damage features of muscle clinically affected and unaffected. Changes in lifestyle made possible to continue occupational activity.

  8. [Evaluation of the vocal tract during Japanese vowel production in myasthenia gravis using magnetic resonance imaging].

    PubMed

    Kinoshita, Yoshimasa; Yasukouchi, Hideoki; Tsuru, Eichi; Tanaka, Ryuji; Matsushima, Yasuyuki

    2004-10-01

    We report a 65-year-old Japanese female whose primary symptom of myasthenia gravis was related to rhinolalia aperta. The vocal tract during vowel production was evaluated using two-dimensional fast advanced spin echo (2D-FASE) MR images on supine and prone position. Before treatment, MRI on prone position demonstrated anterior shift of the palatine uvula and the tongue during Japanese "a", "u" and "o" production following the gravity, the former suggested the paresis of the sphenosalpingostaphylinus and elevator veli palatini muscle and the latter the paresis of the styloglossal and hypoglossal muscles. After treatment of steroid pulse and immune absorption, 2D-FASE images on prone position revealed the normalized configuration of the tongue and the soft palate during the Japanese five-vowel production. Kinetic MRI may be useful for evaluation of dynamics of the tongue and the soft palate.

  9. Jugular foramen meningiomas: review of the major surgical series.

    PubMed

    Bakar, Bulent

    2010-01-01

    Primary jugular foramen meningiomas are uncommon, with 96 previous cases published between 1992 and 2007. Exact location and extent of tumor were determined on the basis of radiologic and operative findings and used to develop a staging system. The mean age of patients was 39.4 years. The lesion was located on the right in 14 patients and on the left in 11 patients. The series identified 23 males and 58 females. The most common presenting clinical symptoms were hearing loss and tinnitus. Most clinical findings were middle ear mass and neck mass. Most meningiomas were World Health Organization grade I. The most common postoperative complications were lower cranial nerve paresis and facial nerve paresis. Surgical planning should consider that meningiomas usually invade the dura mater, cranial nerves, and surrounding bone. The surgeon should carefully collect detailed data about the tumor, and consult an otolaryngologist preoperatively for lower cranial nerve functions and hearing levels.

  10. Paroxysmal hemipareses in childhood.

    PubMed

    Dittrich, J; Havlová, M; Nevsímalová, S

    1979-12-01

    The authors report three patients suffering since infancy from transient attacks of paresis. The flaccid pareses most frequently affect the extremities in a hemiplegic fashion, but occasionally there is monoparesis or quadriparesis. The laterality and degree of the paresis are variable. Conciousness is always preserved, and in two cases attacks were preceded by ocular motor disturbances (skew deviation, nystagmoid jerks and conjugate deviations). Exceptionally, the transient hemiparesis may be preceded by a grand mal epileptic fit, though they are more likely to appear sporadically and independently of the paretic changes. In the interparoxysmal periods the children showed pronounced hypotonia, hyperkinetic extrapyramidal features and oligophrenia. Neuroradiological procedures have excluded brain anomalies of vascular or other aetiology and simple biochemical analyses were negative. EMG during paretic periods have revealed central motor neuron lesions, while EEG demonstrated non-specific paroxysmal features. A brain-stem dysfunction in the aetiology is postulated.

  11. Pituitary adenoma apoplexy with initial presentation mimicking bacterial meningoencephalitis: a case report.

    PubMed

    Huang, Wen-Yi; Chien, Yu-Yi; Wu, Chia-Lun; Weng, Wei-Chieh; Peng, Tsung-I; Chen, Hsien-Chih

    2009-05-01

    Pituitary apoplexy is a rare but life-threatening disorder. Clinical presentation of this condition includes severe headache, impaired consciousness, fever, visual disturbance, and variable ocular paresis. Signs of meningeal irritation are very rare. However, if present and associated with headache, fever, and pleocytosis, meningeal irritation may lead to misinterpretation as infectious meningoencephalitis. To the best of our knowledge, pituitary apoplexy with an initial presentation mimicking infectious meningoencephalitis had rarely been reported in the literature. Here, we report a 57-year-old man who had acute severe headache, high fever, neck stiffness, disturbance in consciousness, and left ocular paresis. Laboratory data showed leukocytosis, an elevated C-reactive protein level, and neutrophilic pleocytosis in the cerebrospinal fluid. Because bacterial meningoencephalitis was suspected, empiric antibiotic therapy was administered but in vain. Further examinations indicated a diagnosis of pituitary adenoma with apoplexy. After the immediate administration of intravenous corticosteroid supplement and surgical decompression, the patient recovered.

  12. [Advances in diagnosis of facial nerve paralysis: pathophysiology and clinical symptoms].

    PubMed

    Krukowska, Jolanta; Czernicki, Jan

    2003-09-01

    Facial palsy is important clinical and social problem because of frequently appearance and to cause facial symmetry troubles which are visible for surroundings. Clinical picture of facial palsy, independently of its reason, contains a lot of symptoms depending on degree and place of nerve damage. The most visible and unpleasant for sick person unpleasant symptoms are abolition (in palsy) or considerably handicap (in paresis) function of facial countenance muscles which are hard to endure for patients. In special accidents patients demand psychology consultation and antidepression treatment to modify imagination about role of appearance in shape social relation. In place of damage nerve for particular attention deserve objective treatment the stapedius muscle reflex. It allows to objective estimation the facial nerve damage. Regress in paresis of this nerve decides on treatment. This treatment has a prognostic sense too--return of the stapedius muscle reflex announces return the function of damage nerve.

  13. Unruptured Internal Carotid-Posterior Communicating Artery Aneurysm Splitting the Oculomotor Nerve: A Case Report and Literature Review

    PubMed Central

    Toyota, Shingo; Taki, Takuyu; Wakayama, Akatsuki; Yoshimine, Toshiki

    2014-01-01

    Objective To report a rare case of unruptured internal carotid-posterior communicating artery (IC-PC) aneurysm splitting the oculomotor nerve treated by clipping and to review the previously published cases. Case Presentation A 42-year-old man suddenly presented with left oculomotor paresis. Three-dimensional digital subtraction angiography (3D DSA) demonstrated a left IC-PC aneurysm with a bulging part. During surgery, it was confirmed that the bulging part split the oculomotor nerve. After the fenestrated oculomotor nerve was dissected from the bulging part with a careful microsurgical technique, neck clipping was performed. After the operation, the symptoms of oculomotor nerve paresis disappeared within 2 weeks. Conclusions We must keep in mind the possibility of an anomaly of the oculomotor nerve, including fenestration, and careful observation and manipulation should be performed to preserve the nerve function during surgery, even though it is very rare. PMID:25083381

  14. "Fou rire prodromique" as the presentation of pontine ischaemia secondary to vertebrobasilar stenosis

    PubMed Central

    Gondim, F; Parks, B; Cruz-Flores, S

    2001-01-01

    "Fou rire prodromique" (prodrome of crazy laughter) is a rare form of pathological laughter of uncertain pathophysiology. A patient is presented with pathological laughter as the first manifestation of pontine ischaemia due to vertebrobasilar stenosis. A 65 year old man developed uncontrollable and unemotional laughter for almost an hour followed by transient right facial-brachial paresis. He had fluctuation of laughter, right facial brachial paresis, and occasional crying. Magnetic resonance imaging, magnetic resonance angiogram (MRA), and an angiogram showed small left pontine and cerebellar infarcts, left vertebral artery occlusion, and right vertebral and basilar artery stenosis. His condition deteriorated to bilateral brain stem infarction and he died. Necropsy confirmed the extensive brain stem infarction. Pathological laughter can be the very first presenting manifestation of ischaemia of the ventrotegmental junction of the upper pons. It is hypothesised that the pathological laughter in this patient was secondary to ischaemic ephaptic stimulation of the descending corticopontine/ bulbar pathways.

 PMID:11723208

  15. Focal thoracolumbar spinal cord lymphosarcoma in a ferret (Mustela putorius furo)

    PubMed Central

    Ingrao, Joelle C.; Eshar, David; Vince, Andrew; Lee-Chow, Bridget; Nykamp, Stephanie; DeLay, Josepha; Smith, Dale

    2014-01-01

    A 6-year-old, castrated male domestic ferret (Mustela putorius furo) was euthanized following progressive hind limb paresis and atonia of the bladder of 1-year duration. Neurological evaluation localized the lesion to the thoracolumbar spinal region, and magnetic resonance imaging showed a focal intramedullary spinal cord lesion. Histopathology revealed an extensive, unencapsulated, poorly demarcated mass within the thoracolumbar spinal cord, diagnosed as lymphosarcoma. PMID:24982519

  16. Diagnostic and therapeutic pitfalls in benign vocal fold diseases

    PubMed Central

    Bohlender, Jörg

    2013-01-01

    More than half of patients presenting with hoarseness show benign vocal fold changes. The clinician should be familiar with the anatomy, physiology and functional aspects of voice disorders and also the modern diagnostic and therapeutic possibilities in order to ensure an optimal and patient specific management. This review article focuses on the diagnostic and therapeutic limitations and difficulties of treatment of benign vocal fold tumors, the management and prevention of scarred vocal folds and the issue of unilateral vocal fold paresis. PMID:24403969

  17. Resection of Navigated Transcranial Magnetic Stimulation-Positive Prerolandic Motor Areas Causes Permanent Impairment of Motor Function.

    PubMed

    Moser, Tobias; Bulubas, Lucia; Sabih, Jamil; Conway, Neal; Wildschutz, Noémie; Sollmann, Nico; Meyer, Bernhard; Ringel, Florian; Krieg, Sandro M

    2017-07-01

    Navigated transcranial magnetic stimulation (nTMS) helps to determine the distribution of motor eloquent areas prior to brain surgery. Yet, the eloquence of primary motor areas frontal to the precentral gyrus identified via nTMS is unclear. To investigate the resection of nTMS-positive prerolandic motor areas and its correlation with postsurgical impairment of motor function. Forty-three patients with rolandic or prerolandic gliomas (WHO grade I-IV) underwent nTMS prior to surgery. Only patients without ischemia within the motor system in postoperative MRI diffusion sequences were enrolled. Based on the 3-dimensional fusion of preoperative nTMS motor mapping data with postsurgical MRI scans, we identified nTMS points that were resected in the infiltration zone of the tumor. We then classified the resected points according to the localization and latency of their motor evoked potentials. Surgery-related paresis was graded as transient (≤6 weeks) or permanent (>6 weeks). Out of 43, 31 patients (72%) showed nTMS-positive motor points in the prerolandic gyri. In general, 13 out of 43 patients (30%) underwent resection of nTMS points. Ten out of these patients showed postoperative paresis. There were 2 (15%) patients with a transient and 8 (62%) with a permanent surgery-related paresis. In 3 cases (23%), motor function remained unimpaired. After resection of nTMS-positive motor points, 62% of patients suffered from a new permanent paresis. Thus, even though they are located in the superior or middle frontal gyrus, these cortical areas must undergo intraoperative mapping.

  18. Burn Resuscitation

    DTIC Science & Technology

    2009-01-01

    areas involving large areas of skin the patient is exposed to death first from shock . . .’’ [10]. In describing the pathophysiology leading to the shock...state seen in burns he postulated that various irritants , mental and physical, caused vasomotor paresis leading to accumulation of blood in the...resuscitation volumes. Subsequent studies suggested a decrease in abdominal compartment syndrome (ACS). Oda et al., in 2006, published their experience

  19. Long-Term outcome of neonatal Citrobacter koseri (diversus) meningitis treated with imipenem/meropenem and surgical drainage.

    PubMed

    Straussberg, R; Harel, L; Amir, J

    2001-10-01

    Neonatal Citrobacter koseri (diversus) meningitis is often complicated by the formation of brain abscesses and has a poor neurological outcome with seizures, mental retardation and paresis as sequelae in 50% of the cases. As there is emerging resistance to ampicillin, gentamicin and third-generation cephalosporins, we attempted to treat this infection with carbapenems. Carbapenems in combination with cefotaxime and surgical drainage may play an important role in treating C. koseri meningitis.

  20. Monoparesis in association with feline pulmonary carcinoma: A literature review with 3 new cases

    PubMed Central

    van Stee, Lucinda; Boston, Sarah; Singh, Ameet; Park, Fiona; Richardson, Danielle; Abrams-Ogg, Anthony; Vince, Andrew

    2014-01-01

    We describe 3 cases of cats that were presented with a sudden onset of monoparesis as a result of arterial thromboembolism without evidence of cardiovascular disease that were subsequently diagnosed with a primary pulmonary carcinoma. Arterial tumor thromboemboli due to pulmonary carcinoma should be considered as a differential diagnosis in cases of lameness or paresis in older cats. We theorize that large tumor emboli may obstruct peripheral arteries leading to acute monoparesis. PMID:25183892

  1. Dysphagia and dysphonia in a patient with cancer.

    PubMed

    Schattner, Ami; Mate, Andras; Lahav, Gil; Adi, Meital

    2009-09-01

    A patient with cancer undergoing chemotherapy via Portacath presented with severe progressive dysphagia and dysphonia. Unilateral paresis of the 9, 10, 11, and 12th cranial nerves was found (Collet-Sicard's syndrome or Villaret's syndrome), associated with ipsilateral jugular vein thrombosis identified by imaging. The use of central venous catheters is increasing, and even rare, hitherto unreported, complications need to be recognized. After catheter removal, the patient slowly improved with low-molecular weight heparin treatment and time.

  2. Control of robot assistant for rehabilitation of upper extremities.

    PubMed

    Kostić, Miloš D; Popović, Mirjana B; Popović, Dejan B

    2012-01-01

    The assisted movement in humans with paresis of upper extremities is becoming popular for neurorehabilitation. We propose a novel method for trajectory selection and assistance control. This paper presents simulation of a planar two degrees of freedom robot that assists horizontal movement of the hand. The control assumes that during the exercise the hand needs to follow healthy alike trajectories. The robot is assumed to provide minimal assistance and operate as a teacher of the movement.

  3. Motor affliction of the L5 nerve root in lumbar nerve root compression syndromes.

    PubMed

    Jönsson, B; Strömqvist, B

    1995-09-15

    From a prospective and consecutive study on degenerative lumbar spine disorders containing 416 patients, all patients with a severely reduced or absent strength of the extensor hallucis longus muscle (n = 35) before surgery were identified. The incidence, diagnosis, and recovery after surgery of patients with L5 root compression syndromes and a severely reduced or absent power before surgery of the big toe extensor was evaluated. The L5 root is commonly involved in disc herniation and central and lateral spinal stenosis. Whether motor recovery occurs after root decompression is not fully known. All patients underwent a conventional radiologic evaluation before surgery including one or more myelography, computed tomography scan, and magnetic resonance imaging. At examination before surgery, extensor hallucis longus-power was graded as normal, reduced, or severely reduced/absent, and the latter group is presented here. Surgical findings were registered. Clinical investigation was performed after 4, 12-, and 24-month follow-up periods. A pronounced extensor hallucis longus paresis was seen in disc herniation in 20 of 187 patients, in lateral spinal stenosis in 10 of 122 patients, and central spinal stenosis 5 of 107 patients. Improvement of the paresis after surgery was equally common in disc herniation (15 of 20 patients) and lateral spinal stenosis (7 of 10 patients). Complete restitution was more common in disc herniation. None of the five patients with central spinal stenosis improved concerning paresis at the follow-up period. Improvement was most common during the first 4 months after surgery. No correlation between age or preoperative symptom duration and recovery was noted in either group. The incidence of pronounced extensor hallucis longus paresis in lumbar nerve root compression varied between 5-11%. Recovery after surgery was common in disc herniation and lateral spinal stenosis but did not occur in central stenosis. Complete recovery was most common in

  4. Familial long thoracic nerve palsy: a manifestation of brachial plexus neuropathy.

    PubMed

    Phillips, L H

    1986-09-01

    Long thoracic nerve palsy causes weakness of the serratus anterior muscle and winging of the scapula. It is usually traumatic in origin. Isolated long thoracic nerve palsy has not been recognized as the major manifestation of familial brachial plexus neuropathy, but I have studied the syndrome in four members of three generations of one family. One individual suffered an episode of facial paresis. The inheritance pattern was autosomal dominant.

  5. [Idiopathic facial paralysis].

    PubMed

    Wolf, S R

    1998-09-01

    Although acute idiopathic facial paresis is often labelled "Bell's palsy", historical studies show that Nicolaus Anton Friedreich (1761-1836) from Würzburg was the first physician to describe the typical symptoms of the disorder in 1797, approximately 24 years prior to the paper published by Sir Charles Bell. Diagnostics has now improved to the extent that acute idiopathic facial palsy can more frequently be assigned to etiologies caused by inflammatory disorders. Herpes simplex virus type I and Borrelia burgdorferi are particularly relevant. Underestimation of the degree of paresis is, particularly in children, a drawback of the clinical examination. "Incomplete eyelid closure" is not a reliable indicator of remaining nerve function. For this reason complete electromyography (EMG) is recommended in all cases of severe facial paresis. Since electroneurography does not reliably reflect the degree of denervation present, needle EMG is preferred. The therapy of the facial palsy of unclear etiology is still not well defined. Nevertheless, we recommend that a combined treatment should be used early, at least in patients with disfiguring pareses. Combinations may consist of cortisone, virostatic agents and hemorrheologic substances and possibly antibiotics. Surgical decompression of the facial nerve remains controversial, since positive surgical results lack statistical support. Individual instructions for facial exercises, massage and muscle relaxation can support rehabilitation and possibly reduce the production of pathological synkinesia. Electrical stimulation should not be used. There are a number of possibilities available to reduce the effects of misdirected reinnervation, especially the use of botulinum-A-toxin. However, intensive diagnosis and therapy in the early phase of paresis are decisive in obtaining a favorable outcome. Further refinements in rehabilitation and comparative multicenter controlled studies are still required for future improvements in

  6. Design and development of a hand robotic rehabilitation device for post stroke patients.

    PubMed

    Rashedi, E; Mirbagheri, A; Taheri, B; Farahmand, F; Vossoughi, G R; Parnianpour, M

    2009-01-01

    Robot-mediated rehabilitation is a rapidly advancing discipline that seeks to develop improved treatment procedures using new technologies, e.g., robotics, coupled with modern theories in neuroscience and rehabilitation. A robotic device was designed and developed for rehabilitation of upper limbs of post stroke patients. A novel force feedback bimanual working mode provided real-time dynamic sensation of the paretic hand. Results of the preliminary clinical tests revealed a quantitative evaluation of the patient's level of paresis and disability.

  7. Spinal Dural Arteriovenous Fistula and Cecal Arteriovenous Malformation in a Boy

    PubMed Central

    Soni, Vimlesh; Vaidya, Pankaj C; Sahu, Jitendra Kumar; Yadav, Mukesh

    2017-01-01

    Concurrent spinal dural arteriovenous fistula (AVF) and cecal arteriovenous malformation (AVM) are very rare. A 6-year old boy presented with lower limb paresis after trauma. On imaging work-up spinal dural AVF was found. It was managed with endovascular glue embolization. After two years, the boy presented with severe anemia and occult gastrointestinal tract (GIT) bleed. Cecal AVM was diagnosed and managed with embolization. PMID:28164000

  8. Verminous myelitis in a pit bull puppy.

    PubMed

    Snook, Eric R; Baker, David G; Bauer, Rudy W

    2009-05-01

    A 10-week-old, male pit bull dog presented to the referring veterinarian with hind limb paresis and epaxial muscle atrophy. No spinal lesions were identified at gross necropsy; however, histologically there was marked granulomatous myelitis in the spinal cord between T13 and L2 with occasional, intralesional nematode larvae. Based on morphologic characteristics, the nematode larvae were identified as Strongyloides spp., possibly Strongyloides stercoralis.

  9. Facial palsy, an unusual presenting feature of childhood leukemia.

    PubMed

    Krishnamurthy, Shedthikere; Weinstock, Arie L; Smith, Sharon H; Duffner, Patricia K

    2002-07-01

    Facial paralysis is not a well-recognized presenting feature of leukemia in children. We present two infants and one older child in whom the initial manifestation of their leukemia was lower motor neuron facial paresis. Initial diagnosis in all the patients was Bell's palsy. The presence of Bell's palsy in young children requires a complete evaluation, including consideration of leptomeningeal disease. Leukemic children presenting with cranial neuropathy require intensive central nervous system therapy.

  10. Effect of auditory constraints on motor performance depends on stage of recovery post-stroke.

    PubMed

    Aluru, Viswanath; Lu, Ying; Leung, Alan; Verghese, Joe; Raghavan, Preeti

    2014-01-01

    In order to develop evidence-based rehabilitation protocols post-stroke, one must first reconcile the vast heterogeneity in the post-stroke population and develop protocols to facilitate motor learning in the various subgroups. The main purpose of this study is to show that auditory constraints interact with the stage of recovery post-stroke to influence motor learning. We characterized the stages of upper limb recovery using task-based kinematic measures in 20 subjects with chronic hemiparesis. We used a bimanual wrist extension task, performed with a custom-made wrist trainer, to facilitate learning of wrist extension in the paretic hand under four auditory conditions: (1) without auditory cueing; (2) to non-musical happy sounds; (3) to self-selected music; and (4) to a metronome beat set at a comfortable tempo. Two bimanual trials (15 s each) were followed by one unimanual trial with the paretic hand over six cycles under each condition. Clinical metrics, wrist and arm kinematics, and electromyographic activity were recorded. Hierarchical cluster analysis with the Mahalanobis metric based on baseline speed and extent of wrist movement stratified subjects into three distinct groups, which reflected their stage of recovery: spastic paresis, spastic co-contraction, and minimal paresis. In spastic paresis, the metronome beat increased wrist extension, but also increased muscle co-activation across the wrist. In contrast, in spastic co-contraction, no auditory stimulation increased wrist extension and reduced co-activation. In minimal paresis, wrist extension did not improve under any condition. The results suggest that auditory task constraints interact with stage of recovery during motor learning after stroke, perhaps due to recruitment of distinct neural substrates over the course of recovery. The findings advance our understanding of the mechanisms of progression of motor recovery and lay the foundation for personalized treatment algorithms post-stroke.

  11. [Brown syndrome. General considerations. Case report].

    PubMed

    Pop, Ana-Maria

    2011-01-01

    This is an overview of a few general aspects of Brown's syndrome followed by a case report of a three year old girl suffering from congenital Brown's syndrome, astigmatism and amblyopia, which was detected by an ophthalmological screening at her kindergarten. The main differential diagnosis is ipsilateral inferior oblique paresis/paralysis. Since this was a mild-degree syndrome, it didn't require surgery only optical treatement and follow-up.

  12. Domperidone induced galactorrhea: An unusual presentation of a common drug

    PubMed Central

    Poovathingal, Mary Anne; Bhat, Rama; Ramamoorthi

    2013-01-01

    Domperidone is a prokinetic drug used for diabetic gastro paresis, hiccoughs, and vomiting. It is a peripheral D2 receptor antagonist with selective peripheral activity restricted to the upper gastro intestinal tract. It is not known to cross the blood brain barrier and hence, lacks neurological side effects. We would like to report a case of domperidone induced galactorrhea in a young female who presented with galactorrhea and other symptoms suggestive of prolactinoma. PMID:23833383

  13. Domperidone induced galactorrhea: an unusual presentation of a common drug.

    PubMed

    Poovathingal, Mary Anne; Bhat, Rama; Ramamoorthi

    2013-01-01

    Domperidone is a prokinetic drug used for diabetic gastro paresis, hiccoughs, and vomiting. It is a peripheral D2 receptor antagonist with selective peripheral activity restricted to the upper gastro intestinal tract. It is not known to cross the blood brain barrier and hence, lacks neurological side effects. We would like to report a case of domperidone induced galactorrhea in a young female who presented with galactorrhea and other symptoms suggestive of prolactinoma.

  14. Effect of Auditory Constraints on Motor Performance Depends on Stage of Recovery Post-Stroke

    PubMed Central

    Aluru, Viswanath; Lu, Ying; Leung, Alan; Verghese, Joe; Raghavan, Preeti

    2014-01-01

    In order to develop evidence-based rehabilitation protocols post-stroke, one must first reconcile the vast heterogeneity in the post-stroke population and develop protocols to facilitate motor learning in the various subgroups. The main purpose of this study is to show that auditory constraints interact with the stage of recovery post-stroke to influence motor learning. We characterized the stages of upper limb recovery using task-based kinematic measures in 20 subjects with chronic hemiparesis. We used a bimanual wrist extension task, performed with a custom-made wrist trainer, to facilitate learning of wrist extension in the paretic hand under four auditory conditions: (1) without auditory cueing; (2) to non-musical happy sounds; (3) to self-selected music; and (4) to a metronome beat set at a comfortable tempo. Two bimanual trials (15 s each) were followed by one unimanual trial with the paretic hand over six cycles under each condition. Clinical metrics, wrist and arm kinematics, and electromyographic activity were recorded. Hierarchical cluster analysis with the Mahalanobis metric based on baseline speed and extent of wrist movement stratified subjects into three distinct groups, which reflected their stage of recovery: spastic paresis, spastic co-contraction, and minimal paresis. In spastic paresis, the metronome beat increased wrist extension, but also increased muscle co-activation across the wrist. In contrast, in spastic co-contraction, no auditory stimulation increased wrist extension and reduced co-activation. In minimal paresis, wrist extension did not improve under any condition. The results suggest that auditory task constraints interact with stage of recovery during motor learning after stroke, perhaps due to recruitment of distinct neural substrates over the course of recovery. The findings advance our understanding of the mechanisms of progression of motor recovery and lay the foundation for personalized treatment algorithms post-stroke. PMID

  15. Iatrogenic salt poisoning in captive sandhill cranes

    USGS Publications Warehouse

    Franson, J.C.; Sileo, L.; Fleming, W.J.

    1981-01-01

    Salt poisoning developed in captive sandhill cranes (Grus canadensis) when sea salt was added to normal drinking water to produce a sodium chloride concentration of 1%. Two of 18 cranes died and 2 were euthanatized when moribund. Muscle weakness, paresis, dyspnea, and depression were observed. Brain and serum sodium, serum uric acid,:and plasma osmolality values were abnormally high. Lesions were those of visceral gout, renal tubular necrosis, nephrosis, and skeletal muscle.necrosis.

  16. Focal thoracolumbar spinal cord lymphosarcoma in a ferret (Mustela putorius furo).

    PubMed

    Ingrao, Joelle C; Eshar, David; Vince, Andrew; Lee-Chow, Bridget; Nykamp, Stephanie; DeLay, Josepha; Smith, Dale

    2014-07-01

    A 6-year-old, castrated male domestic ferret (Mustela putorius furo) was euthanized following progressive hind limb paresis and atonia of the bladder of 1-year duration. Neurological evaluation localized the lesion to the thoracolumbar spinal region, and magnetic resonance imaging showed a focal intramedullary spinal cord lesion. Histopathology revealed an extensive, unencapsulated, poorly demarcated mass within the thoracolumbar spinal cord, diagnosed as lymphosarcoma.

  17. [Liquorice-induced hypertension and hypokalaemia].

    PubMed

    Nielsen, Mette Lundgren; Pareek, Manan; Andersen, Inger

    2012-04-09

    Consumption of large amounts of liquorice can cause hypertension and hypokalaemia. Liquorice contains glycyrrhetinic acid, which inhibits the enzyme 11 beta-hydroxysteroid dehydrogenase type 2, and ultimately leads to an apparent mineralocorticoid excess syndrome. This case report describes a 50 year-old woman presenting with hypertension and hypokalaemia-induced limb paresis due to chronic liquorice ingestion. The patient was treated with potassium supplementation and spironolactone. Her blood pressure and electrolyte status normalised within a month after cessation of liquorice intake.

  18. Design and performance characterization of a hand orthosis prototype to aid activities of daily living in a post-stroke population.

    PubMed

    Gasser, Benjamin W; Goldfarb, Michael

    2015-01-01

    This paper presents the design of a hand orthosis prototype intended to assist persons with hand paresis, as a result of stroke, perform activities of daily living. Among its attributes, the orthosis is characterized by a low mass and small profile, while still offering the power assistance of a robotic exoskeleton. Experimental characterization of the orthosis is presented, including its mass, envelope dimensions, motion bandwidth, and joint torque characteristics.

  19. [Moyamoya disease as a cause of ischemic cerebral stroke in young people].

    PubMed

    Borowik, Helena; Pogorzelski, Robert; Drozdowski, Wiesław

    2006-01-01

    35-year old patient was admitted to the Department of Neurology, Medical University of Bialystok because of paresis of his left upper limb, progressing over last 10 months and right facial nerve paresis, which started a month ago. During neurological examination he presented with right facial and arm paresis, dysarthric speech, obesity and hypertension. The patient was previously hospitalized in regional hospital, where a lumbar puncture was done revealing normal composition of cerebrospinal fluid. His brain CT revealed bilateral hypodensive areas in frontal and parietal regions of vasogenic character. Doppler ultrasound showed significant slowing of blood flow velocity in both internal carotid arteries. Brain angiography presented with very weak contrast filling of intracranial branches of carotid and vertebral arteries and showed stenosis at the terminal portion of the internal carotid arteries and at the proximal portion of the anterior and middle cerebral arteries. The patient had transthoracic and transesophageal echocardiography, Holter ECG, lab tests (routine lab tests plus coagulation system evaluation with C protein resistance test, anticardiolipne antibodies, antinuclear antibodies, anticytoplasmatic antibodies and thyroid hormones) checked--all tests were within normal range. Based on cerebral angiography and clinical symptoms, after excluding any other reasons of cerebral ischemia, the patient was diagnosed with moyamoya disease and arterial hypertension. The patient was treated pharmacologically with improvement--regression of face assymetry and dysarthria and diminishing of his right arm paresis. The authors of this paper pay attention to moyamoya disease as a rare reason of ischemic strokes in the young in our geographic region. They remind moyamoya disease diagnostic criteria, its etiology and treatment.

  20. Genetic Studies of Strabismus, Congenital Cranial Dysinnervation Disorders (CCDDs), and Their Associated Anomalies

    ClinicalTrials.gov

    2017-02-16

    Congenital Fibrosis of Extraocular Muscles; Duane Retraction Syndrome; Duane Radial Ray Syndrome; Mobius Syndrome; Brown Syndrome; Marcus Gunn Syndrome; Strabismus Congenital; Horizontal Gaze Palsy; Horizontal Gaze Palsy With Progressive Scoliosis; Facial Palsy; Facial Paresis, Hereditary, Congenital; Third Nerve Palsy; Fourth Nerve Palsy; Sixth Nerve Palsy; Synkinesis; Ocular Motility Disorders; Levator-Medial Rectus Synkinesis; Athabaskan Brainstem Dysgenesis; Tongue Paralysis; Ninth Nerve Disorder; Fifth Nerve Palsy; Seventh Nerve Palsy; Eleventh Nerve Disorder; Twelfth Nerve Disorder; Vagus Nerve Paralysis; Moebius Sequence

  1. Normal Caloric Responses during Acute Phase of Vestibular Neuritis

    PubMed Central

    Lee, Sun-Uk; Park, Seong-Ho; Kim, Hyo-Jung; Koo, Ja-Won

    2016-01-01

    Background and Purpose We report a novel finding of caloric conversion from normal responses into unilateral paresis during the acute phase of vestibular neuritis (VN). Methods We recruited 893 patients with a diagnosis of VN at Dizziness Clinic of Seoul National University Bundang Hospital from 2003 to 2014 after excluding 28 patients with isolated inferior divisional VN (n=14) and those without follow-up tests despite normal caloric responses initially (n=14). We retrospectively analyzed the neurotological findings in four (0.5%) of the patients who showed a conversion from initially normal caloric responses into unilateral paresis during the acute phase. Results In those four patients, the initial caloric tests were performed within 2 days of symptom onset, and conversion into unilateral caloric paresis was documented 1–4 days later. The clinical and laboratory findings during the initial evaluation were consistent with VN in all four patients except for normal findings in bedside head impulse tests in one of them. Conclusions Normal findings in caloric tests should be interpreted with caution during the acute phase of suspected VN. Follow-up evaluation should be considered when the findings of the initial caloric test are normal, but VN remains the most plausible diagnosis. PMID:26932259

  2. Hearing loss and vestibular function correlation in Menière's disease patients.

    PubMed

    Boleas-Aguirre, M S; Palomar-Asenjo, V; Sánchez-Ferrándiz, N; Pérez, N

    2008-01-01

    To analyse the correlation between vestibular dysfunction and hearing level of patients diagnosed with Menière's disease. Retrospective study on the correlation between hearing level and unilateral weakness in 100 Menière's disease patients. In order assess the effect of disease severity in such correlation, the study group included 50 patients who subsequently were treated with oral medication and 50 who later received intratympanic gentamicin to control their symptoms. Audiogram and caloric tests were performed before beginning both of the treatments. Patients were classified according to the AAO-HNS guidelines. Handicap was assessed with the Functional Level of the AAO-HNS and the Dizziness Handicap Inventory. No correlation was found between pure tone average and canal paresis neither when patients were analysed as a whole nor when correlation was controlled for the treatment installed afterwards. Nevertheless, when they were grouped by hearing loss AAO-HNS stages, we found a greater canal paresis in those with a higher hearing loss (groups 3 and 4). No correlation was found between hearing loss and canal paresis of patients diagnosed with Menière's disease. However patients with a higher amount of hearing damage have a tendency to abnormal caloric results.

  3. Focal inhibitory seizure with prolonged deficit in adult Sturge-Weber syndrome.

    PubMed

    Aupy, Jerome; Bonnet, Charlotte; Arnould, Jean-Simon; Fernandez, Philippe; Marchal, Cecile; Zanotti-Fregonara, Paolo

    2015-09-01

    Sturge-Weber syndrome is a sporadic congenital neurocutaneous disorder often related to varying degrees of motor impairment. The phenomenon of prolonged ictal paresis is a rare seizure sign that can be due to lesions affecting the centro-parietal lobe. Focal inhibitory motor seizures can be difficult to differentiate from other clinical entities such as stroke, migraine or postictal paresis. We describe the case of a 40-year-old patient suffering from Sturge-Weber syndrome, admitted due to prolonged right-sided hemiparesis following a usual seizure. Repeated EEGs during the prolonged deficit showed only intermittent left fronto-parietal sharp waves. (99m)Tc HMPAO-brain SPECT performed seven days after the last seizure showed a vast area of parieto-occipital hyperperfusion in the left hemisphere. Aggressive antiepileptic therapy dramatically improved the clinical symptoms and scintigraphic images, which corroborated the diagnosis of ictal paresis. This case highlights the role of SPECT in the evaluation of Sturge-Weber syndrome, not only to investigate progressive neurological deterioration, but also exacerbation of seizures or prolonged neurological deficits. In fact, it may be possible to document ongoing epileptic activity using SPECT, despite a non-contributory EEG, which may be of help in adapting a therapeutic strategy.

  4. Surgical approaches to pathological lesions of the middle cerebellar peduncle and the lateral part of the pons - clinical observation.

    PubMed

    Majchrzak, Henryk; Tymowski, Michał; Majchrzak, Krzysztof; Stepień, Tomasz

    2007-01-01

    Pathological lesions of the middle cerebellar peduncle include tumours, arteriovenous malformations, cavernous angiomas and spontaneous haematomas. Because of the very low incidence of these lesions, surgical approaches to the middle cerebellar peduncle are not commonly known. The authors decided to present their own experience based on five cases operated on at the authors' institution. Five patients were operated on, four with tumours and one with spontaneous haematoma of the middle cerebellar peduncle. In three patients the cerebellomedullary fissure approach was used, in one patient the paramedian supracerebellar approach, and in one patient the retrosigmoid approach. In all cases neoplastic lesions and haematoma were totally removed. In each case, balance disturbances and ataxia of extremities increased or occurred as a new sign. These disturbances diminished within several weeks after the procedure. In the case of location of the lesion also in the lateral part of the pons, the authors observed peripheral paresis of the seventh cranial nerve and paresis of the sixth cranial nerve, which tended to resolve. Pathological lesions of the middle cerebellar peduncle can be effectively treated surgically. The cerebellomedullary fissure approach has been found to be the best because it provides greater access to the dorsal surface of the middle cerebellar peduncle and to the lateral part of the pons. The most frequent complications of the procedure were instability and ataxia as well as paresis of the sixth and seventh cranial nerve when the lesion was found in the lateral part of the pons.

  5. [A winged scapula].

    PubMed

    Faber, C G; Klaver, M M; Wokke, J H J

    2002-09-14

    Three patients, one woman aged 22 and two men aged 54 and 28, presented with scapular winging. In the first patient amyotrophic plexus neuralgia was diagnosed. The second patient most probably suffered from a stretch injury of the long thoracic nerve. The third patient had scapular winging due to an isolated paresis of the trapezius muscle, which was caused by an idiopathic lesion of the accessory nerve. In the first and second patient an improvement was noticeable after 9 months and 1.5 years respectively. There was no improvement in the third patient after 11 years. Paresis of the M. serratus anterior occurs due to paralysis of the N. thoracicus longus, as a result of direct compression, stump trauma, interventions such as thoracic operations, (repeated) stretch injuries or neuralgic brachial plexus amyotrophy; in these cases the scapular winging increases as the arm is lifted forwards. Paresis of the M. trapezius occurs due to the paralysis of the N. accessorius, due to trauma, interventions such as in the neck area, a space-occupying abnormality or an idiopathic abnormality; in these cases the scapular winging increases upon the arm being lifted sideways. Another possible cause of scapular winging is muscular dystrophy, especially fascioscapulohumeral muscular dystrophy (FSHD). Usually the prognosis for recovery from a neuropraxia and an idiopathic lesion of the N. thoracicus longus within a two-year period is good. The prognosis for an isolated lesion of the N. accessorius is much less favourable. An EMG is essential for establishing a diagnosis.

  6. Incidence and diagnosis of anosognosia for hemiparesis revisited

    PubMed Central

    Baier, B; Karnath, H

    2005-01-01

    Background: In previous studies, the incidence of anosognosia for hemiparesis has varied between 17% and 58% in samples of brain damaged patients with hemiparesis. Objective: To determine whether this wide variation might be explained by the different criteria used for diagnosing anosognosia. Methods: 128 acute stroke patients with hemiparesis or hemiplegia were tested for anosognosia for hemiparesis using the anosognosia scale of Bisiach et al. Results: 94% of the patients who were rated as having "mild anosognosia"—that is, they did not acknowledge their hemiparesis spontaneously following a general question about their complaints—suffered from, and mentioned, other neurological deficits such as dysarthria, ptosis, or headache. However, they immediately acknowledged their paresis when they were asked about the strength of their limbs. Their other deficits clearly had a greater impact. These patients had significantly milder paresis than those who denied their disorder even when asked directly about their limbs. Conclusions: Patients who do not mention their paresis spontaneously but do so when questioned about it directly should not be diagnosed having "anosognosia." If this more conservative cut off criterion is applied to the data of the present as well as previous studies, a frequency of between 10% and 18% for anosognosia for hemiparesis is obtained in unselected samples of acute hemiparetic stroke patients. The incidence thus seems smaller than previously assumed. PMID:15716526

  7. Medialization thyroplasty in glottis insufficiency due to unilateral vocal fold paralysis and after laser cordectomies - preliminary report.

    PubMed

    Rzepakowska, Anna; Osuch-Wójcikiewicz, Ewa; Sielska-Badurek, Ewelina; Niemczyk, Kazimierz

    2017-02-28

    Medialization thyroplasty (type I) is surgical procedure performed on the thyroid cartilage. The major indication for this surgery is significant glottis insufficiency due to unilateral vocal fold paresis. However the proce¬dure is also performed after vocal fold resections during cordectomy. The evaluation of voice results in patients after medialisation throplasty. In Otolaryngology Department of Medical University of Warsaw there were performed so far 8 thyroplasty procedures under local anaesthesia with implantation of medical silicon protesis. 6 patients had unilat¬eral vocal fold paresis and the rest two underwent in the past laser cordectomy due to T1a vocal carcinoma. There were no complications during and post the surgery. The follow up examination in 1st , 3rd, 6th i 12th months postoperatively revealed for all patients significant improvement of glottal closure in laryngeal videostrobos¬copy. The voice quality improved both in perceptual evaluation (GRBAS scale) and acoustic analysis (F0, jitter, shim¬mer, NHR) in both patients groups. However the rate of improvement was much more significant in group with uni¬lateral vocal fold paresis. In all patients the maximum phonation time (MPT) increased. The self-evaluation of voice quality with Voice Handicap Index questionnaire confirmed also individual improvement. The speech rehabilitations is not successful in each patient with glottis insufficiency. The medialisation thyroplasty remains the standard procedure for permanent improvement of voice quality in those cases.

  8. Influence of Asymmetric Recurrent Laryngeal Nerve Stimulation on Vibration, Acoustics, and Aerodynamics

    PubMed Central

    Chhetri, Dinesh K.; Neubauer, Juergen; Sofer, Elazar

    2015-01-01

    Objectives/Hypothesis Evaluate the influence of asymmetric recurrent laryngeal nerve (RLN) stimulation on the vibratory phase, acoustics and aerodynamics of phonation. Study Design Basic science study using an in vivo canine model. Methods The RLNs were symmetrically and asymmetrically stimulated over eight graded levels to test a range of vocal fold activation conditions from subtle paresis to paralysis. Vibratory phase, fundamental frequency (F0), subglottal pressure, and airflow were noted at phonation onset. The evaluations were repeated for three levels of symmetric superior laryngeal nerve (SLN) stimulation. Results Asymmetric laryngeal adductor activation from asymmetric left-right RLN stimulation led to a consistent pattern of vibratory phase asymmetry, with the more activated vocal fold leading in the opening phase of the glottal cycle and in mucosal wave amplitude. Vibratory amplitude asymmetry was also observed, with more lateral excursion of the glottis of the less activated side. Onset fundamental frequency was higher with asymmetric activation because the two RLNs were synergistic in decreasing F0, glottal width, and strain. Phonation onset pressure increased and airflow decreased with symmetric RLN activation. Conclusion Asymmetric laryngeal activation from RLN paresis and paralysis has consistent effects on vocal fold vibration, acoustics, and aerodynamics. This information may be useful in diagnosis and management of vocal fold paresis. PMID:24913182

  9. Effects of Asymmetric Superior Laryngeal Nerve Stimulation on Glottic Posture, Acoustics, Vibration

    PubMed Central

    Chhetri, Dinesh K.; Neubauer, Juergen; Bergeron, Jennifer L.; Sofer, Elazar; Peng, Kevin A.; Jamal, Nausheen

    2013-01-01

    Objectives Evaluate the effects of asymmetric superior laryngeal nerve stimulation on the vibratory phase, laryngeal posture, and acoustics. Study Design Basic science study using an in vivo canine model. Methods The superior laryngeal nerves were symmetrically and asymmetrically stimulated over eight activation levels to mimic laryngeal asymmetries representing various levels of superior laryngeal nerve paresis and paralysis conditions. Glottal posture change, vocal fold speed, and vibration of these 64 distinct laryngeal activation conditions were evaluated by high speed video and concurrent acoustic and aerodynamic recordings. Assessments were made at phonation onset. Results Vibratory phase was symmetric in all symmetric activation conditions but consistent phase asymmetry towards the vocal fold with higher superior laryngeal nerve activation was observed. Superior laryngeal nerve paresis and paralysis conditions had reduced vocal fold strain and fundamental frequency. Superior laryngeal nerve activation increased vocal fold closure speed, but this effect was more pronounced for the ipsilateral vocal fold. Increasing asymmetry led to aperiodic and chaotic vibration. Conclusions This study directly links vocal fold tension asymmetry with vibratory phase asymmetry; in particular the side with greater tension leads in the opening phase. The clinical observations of vocal fold lag, reduced vocal range, and aperiodic voice in superior laryngeal paresis and paralysis is also supported. PMID:23712542

  10. Testing a Protocol for a Randomized Controlled Trial of Therapeutic versus Placebo Shoulder Strapping as an Adjuvant Intervention Early after Stroke.

    PubMed

    Appel, Caroline; Perry, Lin; Jones, Fiona

    2015-06-01

    This study tested a protocol for a randomized controlled trial of therapeutic versus placebo shoulder strapping as an adjuvant intervention early after stroke. Despite widespread use, there is little evidence of the efficacy or acceptability of shoulder strapping to improve arm function in patients with shoulder paresis following stroke. This study tested a protocol designed to trial shoulder strapping as an adjuvant therapy in patients with shoulder paresis after stroke and tested its acceptability for patients and clinical staff. A multiple-method design comprised one quantitative randomized, double-blind, placebo-controlled study and two qualitative exploratory investigations entailing patient interviews and staff surveys. Seventeen sub-acute stroke patients with shoulder paresis were recruited in London stroke service settings between November 2007 and December 2009. Outcomes from a 4-week therapeutic strapping protocol were compared with those of placebo strapping as an adjunct to conventional rehabilitation. Minimal adverse events and greater improvement in arm function (Action Research Arm Test) were seen with therapeutic compared with placebo strapping (effect size 0.34). Patients and staff found the strapping acceptable with minimal adverse effects. This study provided data for sample size calculation and demonstrated a workable research protocol to investigate the efficacy of shoulder strapping as an adjuvant intervention to routine rehabilitation for stroke patients. Small-scale findings continue to flag the importance of investigating this topic. The protocol is recommended for a definitive trial of shoulder strapping as an adjuvant intervention.

  11. Train time as a quantitative electromyographic parameter for facial nerve function in patients undergoing surgery for vestibular schwannoma.

    PubMed

    Prell, Julian; Rampp, Stefan; Romstöck, Johann; Fahlbusch, Rudolf; Strauss, Christian

    2007-05-01

    The authors describe a quantitative electromyographic (EMG) parameter for intraoperative monitoring of facial nerve function during vestibular schwannoma removal. This parameter is based on the automated detection of A trains, an EMG pattern that is known to be associated with postoperative facial nerve paresis. For this study, 40 patients were examined. During the entire operative procedure, free-running EMG signals were recorded in muscles targeted by the facial nerve. A software program specifically designed for this purpose was used to analyze these continuous recordings offline. By automatically adding up time intervals during which A trains occurred, a quantitative parameter was calculated, which was named "train time." A strong correlation between the length of train time (measured in seconds) and deterioration of postoperative facial nerve function was demonstrated. Certain consecutive safety thresholds at 0.5 and 10 seconds were defined. Their transgression reliably indicated postoperative facial nerve paresis. At less than a 10-second train time, discrete worsening, and at more than 10 seconds, profound deterioration of facial nerve function can be anticipated. Train time as a quantitative parameter was shown to be a reliable indicator of facial nerve paresis after surgery for vestibular schwannoma.

  12. [A case of brachial plexus neuropathy who presented with acute paralysis of the hand after sleep].

    PubMed

    Iijima, Makiko; Okuma, Yasuyuki; Ohizumi, Hideki; Fujishima, Kenji; Goto, Keigo; Mizuno, Yoshikuni

    2002-09-01

    We report a 46-year-old woman who presented with acute paresis of the right hand and arm. She was well until when she noted a paresis and dysesthesia in her right hand in the morning. Neurological examination revealed weakness in the muscles which were supplied by lower cervical segments, with increased deep tendon reflexes in the right arm. Allen's test and Wright's test were positive. The nerve conduction studies disclosed a reduced CMAPs more severely by right median than ulnar nerve stimulation. The frequency and amplitude of the F waves was also reduced. Needle electromyogram showed a mild neurogenic pattern in the right hand muscles. Digital subtraction angiography revealed a tapering of the subclavian artery when the right arm was abducted. She underwent decompression surgery. A remarkable improvement of the symptoms was observed after surgery. Our patient suggests that brachial plexus neuropathy should be considered in the acute paresis of the hand after sleep, and that surgical procedure would lead to a successful outcome.

  13. Influence of asymmetric recurrent laryngeal nerve stimulation on vibration, acoustics, and aerodynamics.

    PubMed

    Chhetri, Dinesh K; Neubauer, Juergen; Sofer, Elazar

    2014-11-01

    Evaluate the influence of asymmetric recurrent laryngeal nerve (RLN) stimulation on the vibratory phase, acoustics and aerodynamics of phonation. Basic science study using an in vivo canine model. The RLNs were symmetrically and asymmetrically stimulated over eight graded levels to test a range of vocal fold activation conditions from subtle paresis to paralysis. Vibratory phase, fundamental frequency (F0 ), subglottal pressure, and airflow were noted at phonation onset. The evaluations were repeated for three levels of symmetric superior laryngeal nerve (SLN) stimulation. Asymmetric laryngeal adductor activation from asymmetric left-right RLN stimulation led to a consistent pattern of vibratory phase asymmetry, with the more activated vocal fold leading in the opening phase of the glottal cycle and in mucosal wave amplitude. Vibratory amplitude asymmetry was also observed, with more lateral excursion of the glottis of the less activated side. Onset fundamental frequency was higher with asymmetric activation because the two RLNs were synergistic in decreasing F0 , glottal width, and strain. Phonation onset pressure increased and airflow decreased with symmetric RLN activation. Asymmetric laryngeal activation from RLN paresis and paralysis has consistent effects on vocal fold vibration, acoustics, and aerodynamics. This information may be useful in diagnosis and management of vocal fold paresis. N/A. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  14. Toxicity and efficacy of ivermectin in chelonians.

    PubMed

    Teare, J A; Bush, M

    1983-12-01

    Five red-footed tortoises (Geochelone carbonaria) treated for intestinal nematode parasitism with a single IM injection of ivermectin (0.4 mg/kg) were found in a state of extreme paresis or flaccid paralysis. One tortoise recovered normal motor function over the next 7 to 10 days. The remaining tortoises died within 3 days of receiving the ivermectin. The only consistent postmortem finding was a marked fatty change in the liver. Studies in the red-footed tortoise showed that some paresis will occur with dosages as low as 0.05 mg/kg. At least 3 other species of chelonians were found to be susceptible to ivermectin toxicosis at similar dosages (0.1 mg/kg or less). The leopard tortoise (Geochelone pardalis) appeared to be the most susceptible of the species tested, consistently developing mild paresis with a dosage of 0.025 mg/kg. Death occurred with dosages as low as 0.3 mg/kg. A dosage of 0.05 mg/kg was found to be safe in red-footed tortoises, provided that treatment was not repeated at intervals of less than 7 days. Shedding of nematode larvae and eggs in the feces of parasitized red-footed tortoises was prevented with 2 to 6 weekly IM injections of ivermectin at a dosage of 0.05 mg/kg, but limited necropsy findings indicated that elimination of adult nematodes from the intestines was incomplete.

  15. Effects of asymmetric superior laryngeal nerve stimulation on glottic posture, acoustics, vibration.

    PubMed

    Chhetri, Dinesh K; Neubauer, Juergen; Bergeron, Jennifer L; Sofer, Elazar; Peng, Kevin A; Jamal, Nausheen

    2013-12-01

    Evaluate the effects of asymmetric superior laryngeal nerve stimulation on the vibratory phase, laryngeal posture, and acoustics. Basic science study using an in vivo canine model. The superior laryngeal nerves were symmetrically and asymmetrically stimulated over eight activation levels to mimic laryngeal asymmetries representing various levels of superior laryngeal nerve paresis and paralysis conditions. Glottal posture change, vocal fold speed, and vibration of these 64 distinct laryngeal-activation conditions were evaluated by high speed video and concurrent acoustic and aerodynamic recordings. Assessments were made at phonation onset. Vibratory phase was symmetric in all symmetric activation conditions, but consistent phase asymmetry toward the vocal fold with higher superior laryngeal-nerve activation was observed. Superior laryngeal nerve paresis and paralysis conditions had reduced vocal fold strain and fundamental frequency. Superior laryngeal nerve activation increased vocal fold closure speed, but this effect was more pronounced for the ipsilateral vocal fold. Increasing asymmetry led to aperiodic and chaotic vibration. This study directly links vocal-fold tension asymmetry with vibratory phase asymmetry, in particular the side with greater tension leads in the opening phase. The clinical observations of vocal fold lag, reduced vocal range, and aperiodic voice in superior laryngeal paresis and paralysis is also supported. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  16. [Rehabilitation of post stroke patients using a bioengineering system "brain-computer interface + exoskeleton"].

    PubMed

    Kotov, S V; Turbina, L G; Bobrov, P D; Frolov, A A; Pavlova, O G; Kurganskaia, M E; Biriukova, E V

    2014-01-01

    Objective. To investigate the possibility of using a bioengineering system, which includes an electroencephalograph and a personal computer with a software for synchronous data transmission, recognition and classification of EEG signals, development of directions for intended actions in real time in the combination with the hand exoskeleton (the bioengineering system "brain-computer interface + exoskeleton"), in motor rehabilitation of post stroke patients with paresis of the upper extremity. Material and methods. Brain-computer interface is a promising field of neurorehabilitation. Rehabilitation treatment, including 8-10 sessions, was conducted in 5 patients with paresis of the upper extremity. All patients had large MRI lesions in cortical/subcortical areas. Results. Positive changes in neurological status measured with the NIHSS, a significant increase in the volume and power of movements in the paretic hand, improvement of coordination and slight decrease in the level of spasticity were found after the treatment. There was an increase in daily activities measured with the Barthel index, mostly due to the improvement of fine motor skills. The level of disability assessed by the modified Rankin scale was changed significantly. Conclusion. The use of "brain-computer interface + exoskeleton" in the rehabilitation of post stroke patients with hand paresis provided positive results that would need to be verified in further studies.

  17. [Adenoid cystic carcinoma of the lacrimal gland].

    PubMed

    Holz, F G; Tetz, M; Born, I A; Völcker, H E

    1992-07-01

    A 38-year-old female presented with a left-sided peripheral N. VI-paresis and negative neuroradiologic work-up. After one year she developed an incomplete N. III paresis, numbness of her face correlating to N. V1 and V2, reduced lacrimal secretion as well as a palpable mass at the lateral orbital rim. Magnetic resonance imaging revealed an orbital tumor extending into the cavernous sinus. Biopsy disclosed an adenoid cystic carcinoma of the lacrimal gland with basaloid, cribriform and tubular pattern. Therefore, an exenteration with postoperative radiation therapy was performed. Immunohistochemical findings included positive reactions for keratin (KL-1 and AE 1 + 3), Vimentin and Egp 34. By determination of Ki 67 the proliferative activity of the tumor was found to be 15%. Our case report demonstrates that even in absence of an exophthalmus or pain a malignant orbital tumor may be assumed as the underlying cause for a combined monolateral oculomotor and trigeminal paresis. Immunohistochemical results support the notion, that the adenoid cystic carcinoma of the lacrimal gland may arise from precursor cells of the terminal duct system.

  18. Extrafascial injection for interscalene brachial plexus block reduces respiratory complications compared with a conventional intrafascial injection: a randomized, controlled, double-blind trial.

    PubMed

    Palhais, N; Brull, R; Kern, C; Jacot-Guillarmod, A; Charmoy, A; Farron, A; Albrecht, E

    2016-04-01

    Hemidiaphragmatic paresis after ultrasound-guided interscalene brachial plexus block is reported to occur in up to 100% of patients. We tested the hypothesis that an injection lateral to the brachial plexus sheath reduces the incidence of hemidiaphragmatic paresis compared with a conventional intrafascial injection, while providing similar analgesia. Forty ASA I-III patients undergoing elective shoulder and clavicle surgery under general anaesthesia were randomized to receive an ultrasound-guided interscalene brachial plexus block for analgesia, using 20 ml bupivacaine 0.5% with epinephrine 1:200 000 injected either between C5 and C6 within the interscalene groove (conventional intrafascial injection), or 4 mm lateral to the brachial plexus sheath (extrafascial injection). The primary outcome was incidence of hemidiaphragmatic paresis (diaphragmatic excursion reduction >75%), measured by M-mode ultrasonography, before and 30 min after the procedure. Secondary outcomes were forced vital capacity, forced expiratory volume in 1 s, and peak expiratory flow. Additional outcomes included time to first opioid request and pain scores at 24 h postoperatively (numeric rating scale, 0-10). The incidences of hemidiaphragmatic paresis were 90% (95% CI: 68-99%) and 21% (95% CI: 6-46%) in the conventional and extrafascial injection groups, respectively (P<0.0001). Other respiratory outcomes were significantly better preserved in the extrafascial injection group. The mean time to first opioid request was similar between groups (conventional: 802 min [95% CI: 620-984 min]; extrafascial: 973 min [95% CI: 791-1155 min]; P=0.19) as were pain scores at 24 h postoperatively (conventional: 1.6 [95% CI: 0.9-2.2]; extrafascial: 1.6 [95% CI: 0.8-2.4]; P=0.97). Ultrasound-guided interscalene brachial plexus block with an extrafascial injection reduces the incidence of hemidiaphragmatic paresis and impact on respiratory function while providing similar analgesia, when compared with a

  19. SMART Arm with outcome-triggered electrical stimulation: a pilot randomized clinical trial.

    PubMed

    Hayward, Kathryn S; Barker, Ruth N; Brauer, Sandra G; Lloyd, David; Horsley, Sally A; Carson, Richard G

    2013-01-01

    The SMART (SensoriMotor Active Rehabilitation Training) Arm is a nonrobotic device designed to allow stroke survivors with severe paresis to practice reaching. It can be used with or without outcome-triggered electrical stimulation (OT-stim) to augment movement. The aim of this study was to evaluate the efficacy of SMART Arm training when used with or without OT-stim, in addition to usual care, as compared with usual care alone during inpatient rehabilitation. Eight stroke survivors received 20 hours of SMART Arm training over 4 weeks; they were randomly assigned to either (1) SMART Arm training with OT-stim or (2) SMART Arm training alone. Usual therapy was also provided. A historical cohort of 20 stroke survivors formed the control group and received only usual therapy. The primary outcome was Motor Assessment Scale Item 6, Upper Arm Function. Findings for all participants were comparable at baseline. SMART Arm training, with or without OT-stim, led to a significantly greater improvement in upper arm function than usual therapy alone (P = .024). There was no difference in improvement between training with or without OT-stim. Initial motor severity and presence of OT-stim influenced the number of repetitions performed and the progression of SMART Arm training practice conditions. Usual therapy in combination with SMART Arm training, with or without OT-stim, appears to be more effective than usual therapy alone for stroke survivors with severe paresis. These findings warrant further investigation into the benefits of SMART Arm training for stroke survivors with severe paresis undergoing inpatient rehabilitation during the subacute phase of recovery.

  20. Radiation response of the rat cervical spinal cord after irradiation at different ages: Tolerance, latency and pathology

    SciTech Connect

    Ruifrok, A.C.C.; Van Der Kogel, A.J. ); Stephens, L.C. )

    1994-04-30

    Investigation of the age dependent single-dose radiation tolerance, latency to radiation myelopathy, and the histopathological changes after irradiation of the rat cervical spinal cord is presented. Rats were irradiated with graded single doses of 4 MV photons to the cervical spinal cord. When the rats showed definite signs of paresis of the forelegs, they were killed and processed for histological examination. The radiation dose resulting in paresis due to white matter damage in 50% of the animals (ED[sub 50]) after single dose irradiation was about 21.5 Gy at all ages [ge] 2 weeks. Only the Ed[sub 50] at 1 week was significantly lower. The latency to the development of paresis clearly changed with the age at irradiation, from about 2 weeks after irradiation at 1 week to 6-8 months after irradiation at age [ge] 8 weeks. The white matter damage was similar in all symptomatic animals studied. The most prominent were areas with diffuse demyelination and swollen axons, often with focal necrosis, accompanied by glial reaction. This was observed in all symptomatic animals, irrespective of the age at irradiation. Expression of vascular damage appeared to depend on the age at irradiation. Although the latency to myelopathy is clearly age dependent, single dose tolerance is not age dependent at age [ge] 2 weeks in the rat cervical spinal cord. The white matter damage is similar in all symptomatic animals studied, but the vasculopathies appear to be influenced by the age at irradiation. It is concluded that white matter damage and vascular damage are separate phenomena contributing to the development of radiation myelopathy, expression of which may depend on the radiation dose applied and the age at irradiation. 28 refs., 5 figs., 3 tabs.

  1. [Midbrain arteriovenous malformation causing bilateral total ophthalmoplegia as an initial ocular symptom--a case report].

    PubMed

    Kawamura, S; Suzuki, A; Yasui, N

    1988-02-01

    A 61-year-old woman is presented with a bilateral total ophthalmoplegia as an initial ocular symptom, caused by a midbrain hematoma. She complained of acute headache, nausea, vomiting and bilateral closure of her eyelids. Examination on admission showed meningeal irritation; mild consciousness disturbance; bilateral total ophthalmoplegia; left hemiparesis; ataxia in all extremities, more marked to the left. Computed tomography demonstrated a small hematoma in the midbrain tegmentum. Angiography demonstrated midbrain arteriovenous malformation, and she was treated conservatively. Abduction of both eyes and adduction of the left eye appeared on the next day of the ictus, and after that, improved gradually. Left ptosis had improved since one week after the ictus. Light reflex of the left pupil had seen 5 days after the ictus. At the same time, the left pupil revealed an oval-shape. Right internal ophthalmoplegia continued to exist. One year later, the right eye deviated externally, and the left deviated inferio-medially. Abduction of both eyes was normal. Infraduction of both eyes was seen, but limited on the left. Upgaze paresis remained unchanged, and adduction of the right eye was absent. Adduction of the left eye showed almost full recovery. There was right complete ptosis, but left ptosis became indefinite. These ocular findings indicated typical right oculomotor paresis plus superior rectus paresis of the left eye, which suggested a destructive lesion in the right oculomotor nucleus. Also, her left extremities showed a hemiparesis as a pyramidal tract sign (Weber's syndrome) and an ataxia as a cerebellar sign (Claude's syndrome).(ABSTRACT TRUNCATED AT 250 WORDS)

  2. Longitudinal Voice Outcomes After Type I Gore-tex Thyroplasty for Nonparalytic Glottic Incompetence.

    PubMed

    Overton, Lewis; Adams, Katherine; Shah, Rupali N; Buckmire, Robert A

    2017-01-01

    Type I Gore-tex thyroplasty (GTP) for nonparalytic glottic incompetence (GI) results in significantly improved subjective and perceptual voice outcomes. We endeavored to investigate the longitudinal course of voice outcomes measuring the same patients across time points stratified by diagnostic subgroup. Seventy-five patients with nonparalytic GI treated with GTP in the past 9 years were retrospectively reviewed and grouped according to their primary diagnoses (atrophy, scar, hypomobility, and paresis). Voice outcome measures, Voice-Related Quality of Life (VRQOL), Glottal Function Index (GFI), and GRBAS (grade, roughness, breathiness, asthenia, and strain) for each individual patient and diagnostic subgroup were grouped by time interval following surgery: 0 to 90 days, 3 to 9 months, 9 to 18 months, 18 to 36 months, 3 to 5 years, and 5 to 10 years. Across all diagnoses, statistically significant improvement in VRQOL was maintained at 3 to 5 years (P = .03) and GFI at 5 to 10 years (P = .02). The GRBAS showed statistically significant improvements out to 18 to 36 months (P = .02). In the subgroup analysis, hypomobility/paresis patients maintained significant improvement voice measures longer than patients with other diagnoses. As a group, scar patients did not show statistically significant postoperative improvement in VRQOL or GFI at any of the tested time points. Gore-tex thyroplasty provides durable improvement in subjective and perceptual voice outcomes for patients with nonparalytic GI. Patients treated for hypomobility/paresis have the most durable vocal outcomes followed by atrophy and lastly, scar. © The Author(s) 2016.

  3. Combined whole body vibration and balance training using Vibrosphere®: improvement of trunk stability, muscle tone, and postural control in stroke patients during early geriatric rehabilitation.

    PubMed

    Merkert, J; Butz, S; Nieczaj, R; Steinhagen-Thiessen, E; Eckardt, R

    2011-08-01

    Strokes are a leading cause of disability, immobility, and reduced ability to perform activities of daily living (ADLs) among the elderly. Balance and postural control are often affected in stroke patients. Physical therapy for the lower back to improve posture, mobility, and ADLs can be very time consuming. In this randomized, controlled study of 66 geriatric patients (mean age 74.5 years) with stroke-related paresis or hemiplegia, it was demonstrated that stroke patients may benefit more from 3 additional weeks of combined whole body vibration and balance training than from a comprehensive inpatient geriatric rehabilitation program in terms of trunk stability, postural control, and muscle tone.

  4. Astrocytoma in an African hedgehog (Atelerix albiventris) suspected wobbly hedgehog syndrome.

    PubMed

    Nakata, Makoto; Miwa, Yasutsugu; Itou, Takuya; Uchida, Kazuyuki; Nakayama, Hiroyuki; Sakai, Takeo

    2011-10-01

    A 28-month-old African hedgehog was referred to our hospital with progressive tetraparesis. On the first presentation, the hedgehog was suspected as having wobbly hedgehog syndrome (WHS) and the animal was treated with medication and rehabilitation. The animal died 22 days after onset. Pathological examination revealed that the animal was involved in astrocytoma between the medulla oblongata and the spinal cord (C1). This report indicates that a primary central nervous system tumor should be considered as one of the differential diagnoses for hedgehogs presenting with progressive paresis, together with WHS.

  5. Pineal cyst apoplexy: report of an unusual case managed conservatively.

    PubMed

    Ayhan, Selim; Bal, Ercan; Palaoglu, Selcuk; Cila, Aysenur

    2011-01-01

    Pineal cyst apoplexy is a very rare entity with previously reported symptoms of severe frontal or occipital headache, gaze paresis and visual field defects, nausea or vomiting, syncope, ataxia, hearing loss and sudden death. The treatment options for symptomatic pineal cysts are observation, shunting, aspiration via stereotactic guidance or endoscopy, third ventriculostomy, ventriculocysternostomy, and/or surgical resection by craniotomy and microsurgery. Here, the authors report an unusual case of a 28-year-old male patient with pineal cyst apoplexy, presenting with headache, insomnia, and sexual dysfunction symptoms who is being managed conservatively and observed for two years by an academic tertiary care unit.

  6. Central nervous system dysfunction associated with Rocky Mountain spotted fever infection in five dogs.

    PubMed

    Mikszewski, Jessica S; Vite, Charles H

    2005-01-01

    Five dogs from the northeastern United States were presented with clinical signs of neurological disease associated with Rocky Mountain spotted fever (RMSF) infection. Four of the five dogs had vestibular system dysfunction. Other neurological signs included paresis, tremors, and changes in mentation. All of the dogs had an elevated indirect fluorescent antibody titer or a positive semiquantitative enzyme screening immunoassay titer for Rickettsia rickettsii at the time of presentation. Although a higher mortality rate has been reported for dogs with neurological symptoms and RMSF infection, all of the dogs in this study improved with appropriate medical therapy and supportive care.

  7. Unusual skeletal deformities in calves in a Saskatchewan beef herd.

    PubMed

    Orr, J P; McKenzie, G C

    1981-05-01

    A very high incidence of posterior paresis in growing calves was casued by abnormal development of the vertebral column. The pathological changes were focal premature synostoses of vertebral growth plates with resulting reduction in size of the vertebral canal. Malacic changes were seen in sections from all areas of the spinal cord. Abnormalities in growth of the cranium and appendicular skeleton were also present. The growth plates in the cranial base were prematurely closed and the cranial cavity was shortened. Long bones were shortened and distorted. Possible causes include teratogenic plants or chemicals, mineral deficiencies, and hypervitaminosis A.

  8. Severe ischemic colitis following olanzapine use - A case report.

    PubMed

    Fernandes, Samuel R; Alves, Rosa; Araújo Correia, Luís; Rita Gonçalves, Ana; Malaquias, João; Oliveira, Emilia; Velosa, José

    2016-09-01

    Ischemic colitis is the most common subtype of intestinal ischemia usually resulting from vasospasm, vessel occlusion or mesenteric hypoperfusion. Neuroleptics have seldom been linked to ischemic colitis by blocking peripheral anticholinergic and antiserotonergic receptors inducing severe gastrointestinal paresis. We report a young patient with severe ischemic colitis requiring surgery due to necrosis of the bowel. After exclusion of other potential causes, olanzapine was admitted as the cause of ischemia. Clinicians should be aware of how to recognize and treat the potentially life-threatening effects of neuroleptics.

  9. Unusual Skeletal Deformities in Calves in a Saskatchewan Beef Herd

    PubMed Central

    Orr, J. P.; McKenzie, G. C.

    1981-01-01

    A very high incidence of posterior paresis in growing calves was casued by abnormal development of the vertebral column. The pathological changes were focal premature synostoses of vertebral growth plates with resulting reduction in size of the vertebral canal. Malacic changes were seen in sections from all areas of the spinal cord. Abnormalities in growth of the cranium and appendicular skeleton were also present. The growth plates in the cranial base were prematurely closed and the cranial cavity was shortened. Long bones were shortened and distorted. Possible causes include teratogenic plants or chemicals, mineral deficiencies, and hypervitaminosis A. ImagesFigure 1.Figure 2.Figure 3.Figure 4. PMID:7248886

  10. [Postero-medial bulbar hematoma with a favorable outcome. Study of dysautonomia].

    PubMed

    Rousseaux, M; Griffie, G; Dhellemmes, P; Dupard, T; Caron, J

    1988-01-01

    A case of postero-medial medullary hematoma in a 21 year-old woman is reported. An initial neurovegetative severe disregulation had a favorable outcome after surgery. Late deficits, characterizing the postero-medial medullary syndrome have been studied: paresis of the tongue, suppression of the nauseous reflex, instability with retropulsion, and downbeating nystagmus in primary position of the eyes were noted. Heart rate and arterial blood pressure analysis showed explosive tachycardic reactions and transitory disappearance of oculo-cardiac reflexes, suggesting the involvement of the efferent parasympathetic system coming from the dorsal motor nucleus of the vagus nerve.

  11. Lumbo-sacral radiculopathy referral decision-making and primary care management. A case report.

    PubMed

    Haswell, Kate; Gilmour, John Martin; Moore, Barbara Joyce

    2015-04-01

    Low back pain guideline recommendations can inform a decision in primary care to refer for surgical assessment. The purpose of this report is to present a patient with clinical signs and symptoms of lumbo-sacral radiculopathy who experienced pain of high intensity, severe paresis and depression. The guideline informed decision-making process resulted in a decision not to refer. This case report aims to increase awareness of referral guidelines and to demonstrate radicular pain and weakness, disability and depression outcomes subsequent to primary care management.

  12. [Foix-Chavany-Marie syndrome: anarthria and severe dyphagia after sequential bilateral infarction of the middle cerebral artery].

    PubMed

    Guhra, M; Poppenborg, M; Hagemeister, C

    2008-02-01

    Bilateral lesions of the opercula frontoparietalia are uncommon and cause a symptom cluster including anarthria, severe dysphagia, inability to chew and sometimes facial paresis. At the same time there is an automatic-voluntary dissociation, meaning that the affected muscles are functional within the scope of involuntary movements. This syndrome is known as Foix-Chavany-Marie syndrome (FCMS), (bilateral) anterior operculum syndrome or facio-pharyngo-glosso-masticatory diplegia. We report the case of a patient who suffered from FCMS after having infarctions in the territory of the middle cerebral artery on each side 4 years apart.

  13. How Does Ankle-foot Orthosis Stiffness Affect Gait in Patients With Lower Limb Salvage?

    DTIC Science & Technology

    2014-05-10

    noninjured control subjects? Methods Thirteen patients with lower limb salvage (ankle arthrodesis, neuropathy , foot/ankle reconstruction, etc) after major...characteristics Group Age (years) Height Mass Months of IDEO use Diagnosis IDEO 1 28 1.92 96.4 3.9 R LE neuropathy 2 21 1.79 95.7 11.3 R paresis 3 30...11.0 L LE neuropathy , crushed tibia/fibula 7 36 1.78 75.5 4.4 L LE talar fracture, multiple fractures 8 22 1.64 80.3 9.0 R LE tissue loss/trauma 9 27

  14. [Multifocal polyneuropathy with persistent conduction blockage. A new subset of chronic inflammatory polyneuropathies].

    PubMed

    Alvarez Vadillo, E; Ferrer Gila, M T; Amer Ferrer, G; Anciones Rodríguez, B; Pérez Conde, M C; Gutiérrez Molina, M; Cruz Martínez, A

    1989-09-09

    Recently a subset of chronic demyelinating inflammatory polyneuropathies with asymmetrical involvement limited to upper limbs, at least at the onset, resembling a multifocal mononeuropathy has been described. Electrodiagnostic testing disclosed multifocal CB outside the common entrapment sites has been described. We report a 55 years old man with a 4 years history of paresis, numbness, fasciculations, myokymia, cramps and mild amyotrophy. Electrophysiological evaluation showed proximal multifocal conduction block and abundant spontaneous activity as fasciculations, myokymia and scarce denervation activity. The importance of taking into account this entity in the differential diagnosis of patients with suspected mononeuritis multiplex or motoneuron disease is emphasized. The nosologic place of this entity is also discussed.

  15. Study of Preoperative Predictive Signs in Management of Facial Nerve in Parotid Tumors

    PubMed Central

    CHIRILA, Magdalena; MURESAN, Mihaela; BOLBOACA, Sorana D.

    2014-01-01

    Objectives: To find preoperative predictive signs for better surgical planning of the facial nerve in parotid tumors. Methods: Prospective study in patients with primary parotid malignancies. Patients with primary parotid malignant tumor were investigated for preoperative clinical signs in correlation with histological findings and surgical management of the facial nerve. Outcomes: The study included 47 patients. Several clinical findings as facial pain, paresthesia, and rapid growth of tumor might suggest the risk of malignancy. Paresis/palsy of the facial nerve was correlates with direct neural involvement. Conclusion: There are several predictive clinical signs that might suggest malignancy of a parotid tumor. PMID:25553124

  16. Skull Base Clear Cell Carcinoma, Metastasis of Renal Primary Tumor: A Case Report and Literature Review

    PubMed Central

    Sepúlveda, Ilson; Platin, Enrique; Klaassen, Rodrigo; Spencer, M. Loreto; García, Cesar; Alarcón, Ricardo; Ulloa, David

    2013-01-01

    We report on a patient who presented with cranial nerve VI bilateral paresis, absence of pharyngeal reflex, dysarthria, right tongue deviation, and right facial paralysis. Imaging studies showed an expansive process in the cranial base with clivus and petrous apex osteolysis. A biopsy confirmed the presence of clear cell adenocarcinoma and suspicion of renal tumor metastases. Abdominal imaging studies revealed a mass in the right kidney. Consequently, radiotherapy was performed, and the patient was enrolled in a palliative care and pain control program. PMID:24019781

  17. [A relapse of multiple sclerosis manifesting as acute delirium].

    PubMed

    Castellanos-Pinedo, F; Galindo, R; Adeva-Bartolomé, M T; Zurdo, M

    2004-01-01

    Psychotic symptoms are infrequent in multiple sclerosis (MS) and their relationship to cerebral lesions has not been clearly documented. The case of a 58 year old woman with secondary progressive MS is presented. She had acute delirium with persecutory delusions associated to paresis of her left leg. Magnetic resonance imaging of the brain disclosed an active lesion in the left hippocampus. The patient was treated with risperidone and megadoses of methylprednisolone, with dramatic improvement. Clinical and radiological data in this patient suggest that psychotic disorders can be symptomatic of a relapse in MS and, therefore, susceptible to be treated with steroids.

  18. Spasticity Management After Stroke.

    PubMed

    Bethoux, Francois

    2015-11-01

    Many poststroke survivors develop spasticity. Spasticity is usually associated with other neurologic impairments, in particular paresis, which complicate the evaluation of its consequences and of treatment outcomes. The diagnosis and the assessment of spasticity are based on clinical examination, in particular resistance to passive movement and abnormal involuntary muscle contraction. Nonpharmacologic and pharmacologic treatments are commonly combined to manage spasticity, based on prespecified goals. There is evidence supporting the effectiveness and safety of most medications commonly used to treat spasticity; however, more evidence is needed regarding functional outcomes and the impact of combining treatment modalities.

  19. Horner's syndrome after neck surgery.

    PubMed

    González-Aguado, Rocío; Morales-Angulo, Carmelo; Obeso-Agüera, Sergio; Longarela-Herrero, Yolanda; García-Zornoza, Roberto; Acle Cervera, Leticia

    2012-01-01

    Horner's syndrome (oculosympathetic paresis) is characterised by the classic triad of ipsilateral palpebral ptosis, pupillary miosis and facial anhidrosis. The syndrome arises from the interruption of sympathetic innervation to the eye and adnexa at varying levels. It is a rare complication of neck surgery.We describe 6 patients who presented with Horner's syndrome after a neck procedure in our department during the last 5 years and review the different neck procedures that can cause it. Copyright © 2011 Elsevier España, S.L. All rights reserved.

  20. [Incomplete Horner's syndrome as a presenting sign of fourth ventricle ependymoma].

    PubMed

    Escrivá, E; Martínez-Costa, L

    2013-09-01

    The case of 44 year old male patient with palpebral ptosis and trigeminal neuralgia as presenting sign of fourth ventricle ependymoma is reported. After surgical treatment, the patient developed a residual paresis of the sixth cranial nerve. Horner's syndrome occurs due to an alteration of the sympathetic innervations of the eye and adnexa. Some tumours may be the cause, in our case an ependymoma of the fourth ventricle, which onset exceptionally with blepharoptosis and involvement of the ophthalmic division of trigeminal nerve, due to the proximity of these nerve fibres at the brainstem. Copyright © 2011 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  1. Caudal cervical disc protrusion in a Bengal tiger (Panthera tigris tigris).

    PubMed

    Lambrechts, N E; Berry, W L

    2000-09-01

    A young adult male white Bengal tiger (Panthera tigris tigris) presented with hindlimb ataxia. Cervical and lumbar myelography revealed a compressive lesion of the cord at C(6-7). Corticosteroid therapy and confinement failed to provide lasting remission of signs. A modified, inverted cone ventral slot decompression was used to remove the fibrous material causing cord compression at C(6-7). Temporary Horner's syndrome and laryngeal paresis developed postsurgically because of excessive tissue retraction. The animal recovered normal ambulatory function 6 wk after surgery.

  2. The Triple Forced Duction Test(s) for diagnosis and treatment of superior oblique palsy -- with an updated flow chart for unilateral superior oblique palsy.

    PubMed

    Mims, James L

    2003-01-01

    To review and update the management of superior oblique extraocular muscle clinical paresis and palsy, (SOP) employing and applying recent advances in the diagnosis and surgical methods. These include three recently introduced forced duction tests, respectively for laxity of the SO tendon, absence of the SO tendon, and contracture of the ipsilateral superior rectus muscle. Also discussed are the pathophysiologic mechanisms behind various modes of clinical presentation of SOP, older concepts requiring scrutiny, and prior surgical methods which should no longer be employed due to advances in our knowledge. These newer aspects of SOP management are organized and displayed in a revised Plager flow sheet to facilitate their application.

  3. Prolonged ictal monoparesis with parietal Periodic Lateralised Epileptiform Discharges (PLEDs).

    PubMed

    Murahara, Takashi; Kinoshita, Masako; Usami, Kiyohide; Matsui, Masashi; Yamashita, Kouhei; Takahashi, Ryosuke; Ikeda, Akio

    2013-06-01

    We report a patient with prolonged monoparesis and parietal periodic lateralised epileptiform discharges (PLEDs). The patient was a 73-year-old man with chronic myelomonocytic leukaemia who developed persisting monoparesis of the right arm, sensory aphasia, and finger agnosia, initially associated with focal clonic seizures. These neurological deficits remained for seven days without subsequent focal clonic seizures. The EEG showed left-sided PLEDs, maximal in the left occipito-parietal area. Ten days later, following phenytoin treatment, these symptoms suddenly improved and parietal PLEDs disappeared. Sustained PLEDs in the left parietal region may have been causally associated with ictal paresis in this patient.

  4. Classic Raymond Syndrome.

    PubMed

    Khan, Majid; Naveed, Sadaf; Haider, Iqbal; Humayun, Mohammad; Khan, Abidullah

    2017-03-01

    Classic Raymond syndrome presents with abducens nerve palsy on the ipsilateral side with contralateral hemiparesis and facial nerve paralysis. A 60-year gentleman presented with deviation of left angle of mouth and right sided weakness. Examination showed that he had left sided abducens nerve palsy, with contralateral central facial paralysis and paresis. MRI of brain confirmed left pontine infarct. These findings were consistent with classic Raymond syndrome. Till now, only a few cases have been reported worldwide, this being the first case reported in South Asia. This case confirms that classic Raymond syndrome is different from the common type of Raymond syndrome in terms of sparing of coritcofacial fibers in the latter type.

  5. Diseases of the tendons and tendon sheaths.

    PubMed

    Steiner, Adrian; Anderson, David E; Desrochers, André

    2014-03-01

    Contracted flexor tendon leading to flexural deformity is a common congenital defect in cattle. Arthrogryposis is a congenital syndrome of persistent joint contracture that occurs frequently in Europe as a consequence of Schmallenberg virus infection of the dam. Spastic paresis has a hereditary component, and affected cattle should not be used for breeding purposes. The most common tendon avulsion involves the deep digital flexor tendon. Tendon disruptions may be successfully managed by tenorrhaphy and external coaptation or by external coaptation alone. Medical management alone is unlikely to be effective for purulent tenosynovitis.

  6. Benign monomelic amyotrophy with proximal upper limb involvement: case report.

    PubMed

    Neves, Marco Antonio Orsini; Freitas, Marcos R G de; Mello, Mariana Pimentel de; Dumard, Carlos Henrique; Freitas, Gabriel R de; Nascimento, Osvaldo J M

    2007-06-01

    Monomelic amyotrophy (MA) is a rare condition in which neurogenic amyotrophy is restricted to an upper or lower limb. Usually sporadic, it usually has an insidious onset with a mean evolution of 2 to 4 years following first clinical manifestations, which is, in turned, followed by stabilization. We report a case of 20-years-old man who presented slowly progressive amyotrophy associated with proximal paresis of the right upper limb, which was followed by clinical stabilization 4 years later. Eletroneuromyography revealed denervation along with myofasciculations in various muscle groups of the right upper limb. We call attention to this rare location of MA, as well as describe some theories concerning its pathophysiology .

  7. [Venomous and poisonous animals. III. Elapidae snake envenomation].

    PubMed

    Chippaux, J P

    2007-02-01

    Envenomation by Elapidae snakes is less frequent than by Viperidae snakes but represents a true medical emergency due to rapid progression of cobra syndrome. Elapidae venom contains neurotoxins that paralyze striated muscles especially in the thoracic cavity. Respiratory paralysis can occur within a few hours and is preceded by neurological symptoms (local paresthesia and paresis progressing to the cranial nerves). When cobra envenomation is suspected, antivenom administration by the direct venous route must be undertaken as quickly as possible to stop the envenomation process. Artificial ventilation is necessary in case of dyspnea.

  8. [Thyrotoxic hypokalemic periodic paralysis in patients of African descent].

    PubMed

    Maia, Morgana Lima e; Trevisam, Paula Grasiele Carvalho; Minicucci, Marcos; Mazeto, Glaucia M F S; Azevedo, Paula S

    2014-10-01

    Thyrotoxic hypokalemic periodic paralysis (THPP) is an endocrine emergency marked by recurrent attacks of muscle weakness associated with hypokalemia and thyrotoxicosis. Asiatic male patients are most often affected. On the other hand, African descents rarely present this disease. The case described shows an afrodescendant patient with hypokalemia and tetraparesis, whose diagnosis of hyperthyroidism was considered during this crisis. The THPP, although rare, is potentially lethal. Therefore, in cases of flaccid paresis crisis this diagnosis should always be considered, especially if associated with hypokalemia. In this situation, if no previous diagnosis of hyperthyroidism, this should also be regarded.

  9. An unusual presentation of spinal dural arteriovenous fistula: A case report

    PubMed Central

    Saadat, Payam; Adabi, Marzie

    2016-01-01

    Background: Spinal dural AVF is the most common type of spinal vascular malformation. However, presenting symptoms differ according to site of spinal involvement. This study described a case of arteriovenous malformation with paraparesis and incontinence. Case Presentation: Diagnosis of patient was confirmed by clinical and imaging examination using magnetic resonance image and ruling out other possibilities Result: A definitive diagnosis of arterio venous fistula was confirmed by clinical and MRI examination and demonstrated abnormalities compatible with dural arteriovenous fistula. Conclusion: Dural arteriovenous fistula should be considered in patients with paresis in both lower extremities. PMID:27757211

  10. Neuralgic Amyotrophy Manifesting as Mimicking Posterior Interosseous Nerve Palsy

    PubMed Central

    Yang, Jin Seo; Kang, Suk Hyung; Choi, Eun Hi

    2015-01-01

    The upper trunk of the brachial plexus is the most common area affected by neuralgic amyotrophy (NA), and paresis of the shoulder girdle muscle is the most prevalent manifestation. Posterior interosseous nerve palsy is a rare presentation in patients with NA. It results in dropped finger on the affected side and may be misdiagnosed as entrapment syndrome or compressive neuropathy. We report an unusual case of NA manifested as PIN palsy and suggest that knowledge of clinical NA phenotypes is crucial for early diagnosis of peripheral nerve palsies. PMID:26713154

  11. Unilateral facial paralysis after treatment of secondary syphilis.

    PubMed

    Berger, Emily M; Galadari, Hassan I; Gottlieb, Alice B

    2008-06-01

    Bell's palsy is an acute facial paralysis of unknown etiology. Infections including syphilis have been implicated as causes for peripheral facial paresis. The Jarisch-Herxheimer reaction is an acute worsening of skin manifestations and systemic symptoms occurring after administration of antimicrobial therapy for spirochetal infections. Although rare, neurological signs can present as part of the Jarisch-Herxheimer reaction. The authors report a case of Bell's palsy experienced by a patient shortly after treatment with penicillin for secondary syphilis and propose that this acute unilateral peripheral facial paralysis was a Jarisch-Herxheimer reaction in response to therapy.

  12. [Social medicine assessment after surgical and targeted treatment of renal cell cancer].

    PubMed

    Vahlensieck, W; Hoffmann, W; Zermann, D-H

    2016-12-01

    In Germany, renal cell cancer counts for 2.5 % of all carcinomas in women and 3.5 % in men. Curative therapy ensures good chances of recovery. But there might be permanent complications like renal insufficiency, pain, incisional hernia, flank muscle relaxation, and paresis. In addition, targeted therapy is associated with several potential side effects. In both therapy groups, severe psychological problems may occur. Still employed patients with these problems must be examined by an expert to estimate the possibilities of returning to working (positive scope of work) and occupations which can not be performed anymore (negative scope of work).

  13. Virtual reality system in conjunction with neurorobotics and neuroprosthetics for rehabilitation of motor disorders.

    PubMed

    De Mauro, Alessandro; Carrasco, Eduardo; Oyarzun, David; Ardanza, Aitor; Frizera Neto, Anselmo; Torricelli, Diego; Pons, José Luis; Gil, Angel; Florez, Julian

    2011-01-01

    Cerebrovascular accidents (CVA) and spinal cord injuries (SCI) are the most common causes of paralysis and paresis with reported prevalence of 12,000 cases per million and 800 cases per million, respectively. Disabilities that follow CVA (hemiplegia) or SCI (paraplegia, tetraplegia) severely impair motor functions (e.g., standing, walking, reaching and grasping) and prevent the affected individuals from healthy-like, full and autonomous participation in daily activities. Our research focuses on the development of a new virtual reality (VR) system combined with wearable neurorobotics (NR), motor-neuroprosthetics (MNP) and brain neuro-machine interface (BNMI) to overcome the major limitations of current rehabilitation solutions.

  14. [Non-Hodgkin's lymphoma: a differential diagnosis of otogenic facial paralysis].

    PubMed

    Laubert, A; Mausolf, A; Bernhards, J; Le Blanc, S; Werner, M

    1991-03-01

    Of all the neoplastic conditions of the lymphatic system, Non-Hodgkin's lymphoma (NHL) represents a heterogenous group. As well as lymph nodes NHL can involve extranodal sites, including regions in head and neck. The mouth and oropharynx are typical extranodal sites, and the ENT surgeon should be aware of this possibility of the swift diagnosis of NHL is to be made. We report two patients with rare invasion of the middle ear, facial nerve paresis, and asymptomatic cerebral involvement by Non-Hodgkin's lymphoma.

  15. Diplopia as the primary presentation of foodborne botulism

    PubMed Central

    Khakshoor, Hamid; Moghaddam, Ali Akbar Saber; Vejdani, Amir Hossein; Armstrong, Blair K.; Moshirfar, Majid

    2012-01-01

    Foodborne botulism is a serious condition caused by Clostridium botulinum neurotoxin. Clinically, botulism presents as bilateral cranial nerve neuropathy and descending paralysis. We report a unique presentation of botulism to remind clinicians of this potentially fatal condition. In this observational case report initial evaluation showed only esodeviation. This progressed to unilateral cranial nerve six (CN VI) paresis along with systemic signs. Clinical diagnosis was made based on in-depth history and concurrent symptoms in three other patients. Foodborne botulism presenting as diplopia and unilateral motility deficits is rare and can represent a diagnostic and therapeutic challenge to the ophthalmologist. PMID:22993467

  16. [Neurological complication after a vertical infraclavicular brachial plexus block. Case report of possible differential diagnoses of a neurological deficit].

    PubMed

    Ehrenberg, R; Bucher, M; Graf, B

    2009-08-01

    A 72-year-old man with an obliteration of the brachial artery received a vertical infraclavicular block (VIP) for vascular surgery but 20 h after the operation a complete paresis of the affected extremity occurred. A new vascular obliteration could be excluded. During the diagnostic examination the patient noticed a snapping noise in the cervical column when moving his head and an abrupt recovery of the neurological deficits occurred. The radiological diagnostic provided no indication of cerebral ischemia or lesions of the brachial plexus. An additional diagnostic finding was a profound herniated vertebral disc with compression of the myelon. Fortunately, the neurological deficits completely returned to normal.

  17. Augmentation of lateral tarsorrhaphy in lagophthalmos.

    PubMed

    Nemet, Arie Y

    2014-08-01

    Lagophthalmos, the inability to close the eyelids completely, is a serious condition caused by orbicularis oculi muscle paresis or paralysis. The standard lateral tarsorrhaphy may leave the eye open with corneal exposure. In those cases, we suggest that better approximation of the upper and lower eyelids will be achieved when the lower lid is retracted laterally and the upper lid medially. This yields satisfactory closure of the eyelids. I report herein four patients who were successfully treated with permanent lateral tarsorrhaphy with this approximation of the upper and lower eyelids with effective, satisfactory outcomes.

  18. A Rare Case of Ocular Myositis

    PubMed Central

    ALBU, CARMEN VALERIA; CĂTĂLIN, B.; ZAHARIA, CORNELIA

    2014-01-01

    We report the case of a 43 year old man who presented recurrent left abducens palsy. His medical history included arterial hypertension, ischemic cardiomiopathy, dyslipidemia, rhinitis, maxillary sinusitis. Physical examination revealed a overweight patient, horizontal gaze diplopia, left nerve VI paresis, mild left retro-orbital pain. The orbital MRI also didn’t offer new information: mild external edema on the left eye, with normal tendon aspect, no thickening or enhancement of the muscle belly and also normal aspect of the bony orbit. Recurrent palsy of EOMs can be caused in rare cases by ocular myositis. PMID:24791211

  19. Sport Injuries of the Ear and Temporal Bone.

    PubMed

    Osetinsky, L Mariel; Hamilton, Grant S; Carlson, Matthew L

    2017-04-01

    In cases of head trauma, the ear should be evaluated in all of its components. A good understanding of otologic and skull base anatomy enables a thorough trauma assessment of this complex anatomic region. Auricular laceration, abrasion, avulsion, hematoma, frostbite, otitis externa, exostosis, tympanic membrane perforation, ossicular discontinuity, perilymphatic fistula, labyrinthine concussion, temporal bone fracture, facial nerve paresis, and sensorineural hearing loss are a few of the more common otologic injuries seen in active patients. Prevention of otologic trauma by wearing protective equipment during activity is the best way of maintaining the long-term health of the ear and audiovestibular function. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. [Personage-Turner syndrome--case report].

    PubMed

    Tomczykiewicz, Kazimierz; Stepień, Adam; Staszewski, Jacek

    2011-08-01

    Personage-Turner syndrome or acute brachial radiculitis is rare syndrome. In typical cases it was manifested by strong pain of shoulder region and the weakness of muscles which are supplies by individual nerves or part of brachial plexus and in longer time with atrophy. Aetiology of this disease is unknown, probably on the autoimmuno-inflammatory background. Diagnosis is made on the typical clinical picture and in exclusion many illness with impairment brachial plexus. In presented case the course of disease as well as executed investigations suggested that discopathy could be the reason of paresis, however renewed estimation caused the change of the diagnosis.

  1. Muscle Paralysis in Herpes Zoster

    PubMed Central

    Rubin, David; Fusfeld, Robert D.

    1965-01-01

    Herpes zoster may, in some instances, cause motor paralysis as well as the usual sensory and cutaneous manifestations. It is suggested that the presence of electromyographic denervation potentials be used as the criterion of muscle paresis in order to avoid mistaking atrophy of disuse for true lower motor neuron disease. Use of the proper physical therapy procedures hastens the recovery of function and may serve to retard denervation atrophy and fibrosis in patients with muscle paralysis. ImagesFigure 1 (Case 1).Figure 1 (Case 1). PMID:5828175

  2. Post-cataract surgery diplopia: aetiology, management and prevention.

    PubMed

    Kalantzis, George; Papaconstantinou, Dimitris; Karagiannis, Dimitris; Koutsandrea, Chryssanthi; Stavropoulou, Dora; Georgalas, Ilias

    2014-09-01

    Diplopia is an infrequent but distressing adverse outcome after uncomplicated cataract surgery. Many factors may contribute to the occurrence of this problem, including prolonged sensory deprivation resulting in disruption of sensory fusion, paresis of one or more extraocular muscles, myotoxic effects of local anaesthesia, optical aberrations (for example, aniseikonia) and pre-existing disorders (for example, thyroid orbitopathy). The purpose of this review is to present the aetiology and clinical features of diplopia after cataract surgery and to discuss the possible modalities for the prevention and treatment of this frustrating complication.

  3. Aldosterone and cortisol co-secreting bifunctional adrenal cortical carcinoma: A rare event.

    PubMed

    Chowdhury, Puskar Shyam; Nayak, Prasant; Gurumurthy, Srinivasan; David, Deepak

    2014-07-01

    Adrenocortical carcinoma (ACC) co-secreting aldosterone and cortisol is extremely rare. We report the case of a 37-yearold female who presented with paresis and facial puffiness. Evaluation revealed hypertension, hyperglycemia, severe hypokalemia and hyperaldosteronemia with elevated plasma aldosterone to renin ratio (ARR). Urinary free cortisol estimation showed elevated levels. Computed tomography scan revealed a right adrenal mass. Radical adrenalectomy specimen revealed ACC (T3N1). Post-operatively, the patient became normotensive and euglycemic with normalization of urinary cortisol and ARR. This case highlights the need for a complete evaluation in patients of hyperaldosteronism if overlapping symptoms of hypercortisolism are encountered, to avoid post-operative adrenal crisis.

  4. Comparison between caloric and canal impulse rotatory test.

    PubMed

    Cohen, B; Dobler, S; Sauron, B; Hazan, A; Peytral, C; Fombeur, J P

    2002-01-01

    It has been suggested that the rotatory test using videosnystagmoscopy can also be applied for identification of vestibular canal paresis. In this study, we test this hypothesis by comparing the results of a canal impulse rotatory test with those of the caloric test using the method described by Freyss. Our study indicates that only in 38% of all tested patients, the same results between the two tests have been obtained. Furthermore, which the group with abnormal findings is observed separately, in 24% patients only these two test methods lead to the same results. Consequently, the canal impulse rotatory test cannot replace the caloric test.

  5. Comparison between caloric and canal impulse rotatory test.

    PubMed

    Cohen, B; Dobler, S; Sauron, B; Hazan, A; Peytral, C; Fombeur, J P

    2002-01-01

    It has been suggested that the rotatory test using videonystagmoscopy can also be applied for identification of vestibular canal paresis. In this study, we test this hypothesis by comparing the results of a canal impulse rotatory test with those of the caloric test using the method described by Freyss. Our study indicates that only in 38% of all tested patients, the same results between the two tests have been obtained. Furthermore, when the group with abnormal findings is observed separately, in 24% patients only these two test methods lead to the same results. Consequently, the canal impulse rotatory test cannot replace the caloric test.

  6. Losing Your Voice: Etiologies and Imaging Features of Vocal Fold Paralysis

    PubMed Central

    Vachha, Behroze; Cunnane, Mary Beth; Mallur, Pavan; Moonis, Gul

    2013-01-01

    Neurogenic compromise of vocal fold function exists along a continuum encompassing vocal cord hypomobility (paresis) to vocal fold immobility (paralysis) with varying degrees and patterns of reinnervation. Vocal fold paralysis (VFP) may result from injury to the vagus or the recurrent laryngeal nerves anywhere along their course from the brainstem to the larynx. In this article, we review the anatomy of the vagus and recurrent laryngeal nerves and examine the various etiologies of VFP. Selected cases are presented with discussion of key imaging features of VFP including radiologic findings specific to central vagal neuropathy and peripheral recurrent nerve paralysis. PMID:23814687

  7. [Botulism in infancy].

    PubMed

    Gautier, E; Gallusser, A; Despland, P A

    1989-06-01

    The authors describe a case of botulism in a 3-month-old infant infected with Clostridium botulinum type A. Symptomatology developed within four days, persisted for two weeks, then regressed. Symptoms were paresis of face muscles, hyporeactive pupils, loss of succion and deglutition, axial hypotonia, weakness of peripheral muscles, lability of the autonomic nervous system with acute episodes of bradycardia and constipation. Anomalies of the electroen-cephalogram and of the auditory evoked responses suggest that the toxin penetrated the central nervous system. Treatment was symptomatic, without need for assisted ventilation. It was not possible to detect the source of infection.

  8. Facial nerve rerouting in skull base surgery.

    PubMed

    Parhizkar, Nooshin; Hiltzik, David H; Selesnick, Samuel H

    2005-08-01

    Facial nerve rerouting techniques were developed to facilitate re-section of extensive tumors occupying the skull base. Facial nerve rerouting has its own limitations and risks, requiring microsurgical expertise, additional surgical time, and often some degree of facial nerve paresis. This article presents different degrees of anterior and posterior facial nerve rerouting, techniques of facial nerve rerouting, and a comprehensive review of outcomes. It then reviews anatomic and functional preservation of the facial nerve in acoustic neuroma resection, technical aspects of facial nerve dissection, intracranial facial nerve repair options, and outcomes for successful acoustic neuroma surgery.

  9. Neural Reanimation Advances and New Technologies.

    PubMed

    Kim, Jennifer

    2016-02-01

    Facial paralysis can have a profound effect on the patient from both an aesthetic and functional point of view. Just as there are numerous etiologies of facial paresis, there are as many therapeutic options and variations of these options. The purpose of this article was to review the most current surgical options for neural reanimation of a damaged facial nerve, including recent advances in nerve repair, conduit technology, and nerve transfers, as well as emerging technology in translational research with biomedical engineering and tissue engineering.

  10. Strabismus complications from local anesthetics.

    PubMed

    Guyton, David L

    2008-01-01

    Strabismus developing after retrobulbar or peribulbar anesthesia for both anterior and posterior segment eye surgery may be due to myotoxicity to an extraocular muscle from the local anesthetic agent. Initial paresis often causes diplopia immediately after surgery, but later progressive segmental fibrosis occurs, and/or hypertrophy of the muscle, producing diplopia in the opposite direction from the direction of the initial diplopia. The inferior rectus muscle is most commonly affected. Usually a large recession on an adjustable suture of the involved muscle(s) yields good alignment. Using topical anesthesia or sub-Tenon's anesthesia can avoid this complication.

  11. Time-course and determinants of spasticity during the first six months following first-ever stroke.

    PubMed

    Lundström, Erik; Smits, Anja; Terént, Andreas; Borg, Jörgen

    2010-04-01

    To explore the occurrence of, and risk factors for, spasticity until 6 months after first-ever stroke. Forty-nine patients were examined at day 2-10, at 1 month, and at 6 months. The modified Ashworth Scale was used to assess resistance to passive movements. A comprehensive clinical examination was performed to identify other positive signs of upper motor neurone syndrome, in accordance with a broader definition of spasticity, and to evaluate whether spasticity was disabling. Neurological impairments were determined by use of the National Institutes of Health Stroke Scale and global disability by use of the modified Rankin Scale. Spasticity was present in 2 patients (4%) at day 2-10, in 13 patients (27%) at 1 month, and in 11 patients (23%) at 6 months. Severe paresis of the arm at day 2-10 was associated with a higher risk for spasticity at 1 month (odds ratio = 10, 95% confidence interval 2.1-48.4). Disabling spasticity was present in one patient at 1 month and in 6 patients (13%) at 6 months. Spasticity according to the modified Ashworth Scale usually occurs within 1 month and disabling spasticity later in a subgroup. Severe paresis of the arm is a risk factor for spasticity.

  12. IVIG treatment in post-polio patients: evaluation of responders.

    PubMed

    Ostlund, Gunilla; Broman, Lisbet; Werhagen, Lars; Borg, Kristian

    2012-12-01

    The aim of this work is to evaluate the outcome of IVIG treatment in patients with post-polio syndrome (PPS) and to identify responders. The study included 113 PPS patients who had received one IVIG treatment in an open trial, prospective follow-up study. Clinical examination was performed and clinical data were retrieved from medical records. The short form 36 (SF-36), physical activity scale for the elderly (PASE), and the visual analogue scale (VAS) were used as measurements of quality of life, physical activity, and the intensity of pain. Data before treatment and at 6-month follow-up were collected. Analysis was performed in subgroups based on demographic and medical parameters. A statistically significant increase of the SF-36 sub domains bodily pain, vitality, social function, role emotional, and the mental compound score (MCS) was found at the 6-month follow-up. A significant decrease of pain was found in patients who reported pain intensity over VAS of 20 mm, in patients younger than 65 years of age and in patients who had paresis in the lower extremities. A trend was found in patients with PPS as the only diagnosis. IVIG leads to increase of quality of life at 6-month follow-up for SF-36 regarding sub domains of bodily pain, vitality, social function, role emotional, as well as for pain. Age below 65 years, paresis in the lower extremities, and lack of concomitant disorders may be the main indicators for a future identification of responders.

  13. Aneurysmal Bone Cyst of the Temporal Bone Presenting with Headache and Partial Facial Palsy

    PubMed Central

    Kletke, Stephanie N.; Popovic, Snezana; Algird, Almunder; Alobaid, Abdullah; Reddy, Kesava K. V.

    2015-01-01

    Background Aneurysmal bone cysts (ABCs) are benign bony lesions that rarely affect the skull base. Very few cases of temporal bone ABCs have been reported. We describe the first case of a temporal bone ABC that was thought to be consistent with a meningioma based on preoperative magnetic resonance imaging (MRI) findings. Clinical Presentation An otherwise healthy 23-year-old woman presented with a pulsatile noise in her left ear and a 4-week history of throbbing headache with nausea. There was no associated emesis, visual or auditory changes, or other neurologic features. Neurologic examination revealed a left lower motor neuron facial paresis. Computed tomography and MRI studies demonstrated a large lesion in the left middle cranial fossa skull base with erosion of the petrous temporal bone. Based on the presence of a “dural tail” on preoperative contrast-enhanced T1-weighted imaging, the lesion was interpreted to likely be consistent with a meningioma. An orbitozygomatic approach was utilized for surgical excision. Histopathologic evaluation was consistent with an ABC. Conclusion Postoperatively the patient had improvement in the lower motor neuron facial paresis. It is important to consider ABC in the differential diagnosis of intracranial lesions accompanied by the dural tail sign on MRI. PMID:26251800

  14. Occam's razor in the management of ventriculoperitoneal shunt dysfunction: Diagnosis and management of an unusual pediatric case.

    PubMed

    Dadlani, Ravi; Dadlani, Reena; Ghosal, Nandita; Hegde, Alangar

    2015-01-01

    Ventriculoperitoneal (VP) shunt surgery is probably the commonest surgical procedure in neurosurgery. Belying its technical simplicity is the myriad complications associated with it. Shunt malfunction is a common complication associated with this surgery, second only to shunt related infections, which may be associated with it. Sterile cerebrospinal fluid (CSF) eosinophilia (CE) has been reported with VP shunts, which may or may not be related to the dysfunction. Eosinophilia in the CSF has also been associated with a number of other conditions including parasitic infestations in the brain. This may be unrelated to the shunt surgery. We present a case of a child, operated earlier for hydrocephalus, who presented with sub-acute loss of vision and bilateral oculomotor paresis. CSF from a chamber tap revealed eosinophilia. The commonest presenting symptom of shunt malfunction is raised intracranial pressure. There are no reports in the literature of VP shunt malfunction presenting with bilateral oculomotor paresis and decreased visual acuity. The associated CE complicated the clinical picture, especially since the initial brain radiology was normal. We discuss the clinical differential diagnosis of this very interesting presentation, management dilemmas and outcome in this child. This rare clinical presentation was found to be the result of a shunt malfunction and not due to any rare parasitic infestation of the brain. Occam's razor dictates that the simplest explanation in a given situation is usually the most accurate, as is seen in this case.

  15. Drooling in children with cerebral palsy: effect of salivary flow reduction on daily life and care.

    PubMed

    Van der Burg, Jan J W; Jongerius, Peter H; Van Hulst, Karen; Van Limbeek, Jacques; Rotteveel, Jan J

    2006-02-01

    The purpose of this study was to investigate the effect of salivary flow reduction on daily life and provision of care in children with cerebral palsy (CP). Parents of children with CP were asked to fill in a questionnaire on the impact of drooling on the daily life of their children and their families and the data were then analyzed. Forty-five children with severe drooling (28 males, 17 females; mean age 9y 5mo [SD 3y 7mo]; range 3 to 16y) were monitored before and after receiving medication (scopolamine and botulinum toxin) to reduce salivary flow. Type of CP included hypotonia (n = 1), spastic paresis (n = 27), and mixed motor disorders with spastic and dyskinetic paresis (n = 17). Eight children were independently ambulant and 37 children were wheelchair users. Thirty-four children had learning disability with a developmental age of below 6 years. Six participants dropped out of the study; data on 39 children were analyzed. Results showed that anticholinergic agents effectively reduced salivary flow. Drooling diminished substantially and this was accompanied by a significant reduction in care needs, making daily care less demanding. The amount of reported damage to communication devices and computers decreased. In addition to the evaluation of primary variables, such as the salivary flow rate, investigation of impact of drooling on daily life provides useful information about the outcome of treatment for reduction in drooling.

  16. Acute paretic syndrome in juvenile White Leghorn chickens resembles late stages of acute inflammatory demyelinating polyneuropathies in humans

    PubMed Central

    2010-01-01

    Background Sudden limb paresis is a common problem in White Leghorn flocks, affecting about 1% of the chicken population before achievement of sexual maturity. Previously, a similar clinical syndrome has been reported as being caused by inflammatory demyelination of peripheral nerve fibres. Here, we investigated in detail the immunopathology of this paretic syndrome and its possible resemblance to human neuropathies. Methods Neurologically affected chickens and control animals from one single flock underwent clinical and neuropathological examination. Peripheral nervous system (PNS) alterations were characterised using standard morphological techniques, including nerve fibre teasing and transmission electron microscopy. Infiltrating cells were phenotyped immunohistologically and quantified by flow cytometry. The cytokine expression pattern was assessed by quantitative real-time PCR (qRT-PCR). These investigations were accomplished by MHC genotyping and a PCR screen for Marek's disease virus (MDV). Results Spontaneous paresis of White Leghorns is caused by cell-mediated, inflammatory demyelination affecting multiple cranial and spinal nerves and nerve roots with a proximodistal tapering. Clinical manifestation coincides with the employment of humoral immune mechanisms, enrolling plasma cell recruitment, deposition of myelin-bound IgG and antibody-dependent macrophageal myelin-stripping. Disease development was significantly linked to a 539 bp microsatellite in MHC locus LEI0258. An aetiological role for MDV was excluded. Conclusions The paretic phase of avian inflammatory demyelinating polyradiculoneuritis immunobiologically resembles the late-acute disease stages of human acute inflammatory demyelinating polyneuropathy, and is characterised by a Th1-to-Th2 shift. PMID:20109187

  17. [Neurology of hysteria (conversion disorder)].

    PubMed

    Sonoo, Masahiro

    2014-07-01

    Hysteria has served as an important driving force in the development of both neurology and psychiatry. Jean Martin Charcot's devotion to mesmerism for treating hysterical patients evoked the invention of psychoanalysis by Sigmund Freud. Meanwhile, Joseph Babinski took over the challenge to discriminate between organic and hysterical patients from Charcot and found Babinski's sign, the greatest milestone in modern neurological symptomatology. Nowadays, the usage of the term hysteria is avoided. However, new terms and new classifications are complicated and inconsistent between the two representative taxonomies, the DSM-IV and ICD-10. In the ICD-10, even the alternative term conversion disorder, which was becoming familiar to neurologists, has also disappeared as a group name. The diagnosis of hysteria remains important in clinical neurology. Extensive exclusive diagnoses and over investigation, including various imaging studies, should be avoided because they may prolong the disease course and fix their symptoms. Psychological reasons that seem to explain the conversion are not considered reliable. Positive neurological signs suggesting nonorganic etiologies are the most reliable measures for diagnosing hysteria, as Babinski first argued. Hysterical paresis has several characteristics, such as giving-way weakness or peculiar distributions of weakness. Signs to uncover nonorganic paresis utilizing synergy include Hoover's test and the Sonoo abductor test.

  18. Mirror therapy activates outside of cerebellum and ipsilateral M1.

    PubMed

    Shinoura, Nobusada; Suzuki, Yuichi; Watanabe, Yasuko; Yamada, Ryozi; Tabei, Yusuke; Saito, Kuniaki; Yagi, Kazuo

    2008-01-01

    Mirror therapy is effective in the rehabilitation of patients with hemiparesis, but its mechanism is not clear. In this study, a patient with brain tumor (patient 1) who underwent mirror therapy after surgery and showed drastic recovery of hand paresis, a patient with visual memory disturbance (patient 2), and five normal volunteers performed tasks related to mirror therapy in fMRI study. In patient 1 and all normal volunteers, right and left hand clenching with looking at a mirror (eye open) activated outside of cerebellum, while right and left hands clenching with eye closed activated inside of cerebellum. In patient 2, mirror therapy did not activate outside of cerebellum. In patient 1, and 3 out of 5 normal volunteers, the area of right (affected) M1 activated by right and left hands clenching with eye open was more than that by right and left hands clenching with eye closed, and that right M1 was activated by right hand clenching with eye open. In conclusion, mirror therapy facilitate the paresis of patients by activating ipsilateral M1 and outside of cerebellum, which is possibly related to visual memory function.

  19. Bald Eagle nestling mortality associated with Argas radiatus and Argas ricei tick infestation and successful management with nest removal in Arizona, USA

    USGS Publications Warehouse

    Justice-Allen, Anne; Orr, Kathy; Schuler, Krysten L.; McCarty, Kyle; Jacobson, Kenneth; Meteyer, Carol

    2016-01-01

    Eight Bald Eagle (Haliaeetus leucocephalus) nestlings heavily infested with larval ticks were found in or under a nest near the confluence of the Verde and Salt rivers in Arizona in 2009-11. The 8-12-wk-old nestlings were slow to respond to stimuli and exhibited generalized muscle weakness or paresis of the pelvic limbs. Numerous cutaneous and subcutaneous hemorrhages were associated with sites of tick attachment. Ticks were identified as Argas radiatus and Argas ricei. Treatment with acaricides and infection with West Nile virus (WNV) may have confounded the clinical presentation in 2009 and 2010. However, WNV-negative birds exhibited similar signs in 2011. One nestling recovered from paresis within 36 h after the removal of all adult and larval ticks (>350) and was released within 3 wk. The signs present in the heavily infested Bald Eagle nestlings resembled signs associated with tick paralysis, a neurotoxin-mediated paralytic syndrome described in mammals, reptiles, and wild birds (though not eagles). Removal of the infested nest and construction of a nest platform in a different tree was necessary to break the cycle of infection. The original nesting pair constructed a new nest on the man-made platform and successfully fledged two Bald Eagles in 2012.

  20. Laryngeal structure and function in dogs with cough.

    PubMed

    Johnson, Lynelle R

    2016-07-15

    OBJECTIVE To investigate the prevalence and type of laryngeal abnormalities in dogs examined because of cough that did not have signs of upper airway disease and to compare the prevalence of those abnormalities among dogs with various respiratory tract diseases. DESIGN Prospective study. ANIMALS 138 dogs with cough that did not have signs of upper airway disease. PROCEDURES The study was conducted between July 2001 and October 2014 and included dogs examined for cough that had laryngoscopic and bronchoscopic examinations performed by 1 examiner. Laryngeal hyperemia and swelling were recorded, and laryngeal function was assessed before and after doxapram stimulation when indicated. Results were compared among dogs on the basis of cough duration (acute [< 2 weeks], subacute [2 weeks to 2 months], and chronic [> 2 months]) and disease diagnosed (inflammatory airway disease, airway collapse, lower respiratory tract infection, and eosinophilic bronchopneumopathy). RESULTS Laryngeal hyperemia was detected in 73 of 134 (54%) dogs with cough of subacute or chronic duration, and its prevalence did not vary significantly among dogs with various diseases. Thirteen dogs had laryngeal paresis, and 13 dogs had laryngeal paralysis; dysphonia (n = 2) and stridor (1) were uncommon findings in those dogs. The prevalence of laryngeal dysfunction (paresis or paralysis) did not differ significantly among diseases. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that 26 of 138 (19%) dogs examined because of cough alone had laryngeal dysfunction, which suggested that a complete laryngoscopic examination should be included in the diagnostic evaluation of dogs with cough.

  1. Acute venous thromboembolic disease and paradoxical embolism.

    PubMed

    Pérez R, Diego; Maldonado J, Daniela; Andresen H, Max

    2015-04-01

    We report two cases of paradoxical cerebral embolism associated with acute venous thromboembolic disease. The first case corresponds to a 49-year-old woman with sudden onset of dyspnea and syncope, followed by right upper extremity paresis, aphasia and dysarthria. The admission brain computed tomography (CT) was unremarkable, but lung CT showed multilobar and multisegmentary pulmonary embolism. Echocardiography showed dilated right ventricle with impaired systolic function, moderate tricuspid regurgitation, moderate pulmonary hypertension and positive bubble test, suggestive of a patent foramen ovale (PFO) which was successfully closed by endovascular Amplatzer device placement. The patient was discharged with anticoagulation therapy and permanent antiplatelet aggregation therapy. The second case is a 60-year-old woman found unconscious. Neurological examination revealed expressive aphasia, right hemianopsia, right central facial paralysis and right-sided paresis with a National institute of Health Stroke Scale of 19. Brain CT showed signs of acute left middle cerebral artery infarction. Later, she developed greater impairment of consciousness. A new brain CT showed significant edema with mass effect requiring a decompressive craniotomy. Echocardiography showed PFO and lower extremities' Doppler ultrasound showed a left infrapopliteal posterior tibial right deep venous thrombosis. An inferior vena cava filter was placed and two days after surgery, anticoagulation was started.

  2. Surgical management of a recurrent spinal meningioma in a cat.

    PubMed

    Sumner, J P; Simpson, D J

    2007-07-01

    A 13-year-old male neutered Persian crossbred cat was evaluated for hindlimb paresis, ataxia and urinary incontinence that had been progressing over the previous 3 months. Neurologically, the cat had thoracolumbar spinal cord deficits and a myelogram detected the presence of a mass compressing the thoracic spinal cord. A hemilaminectomy was performed to excise the soft tissue mass, subsequently identified histologically as a psammomatous meningioma. The cat regained ambulatory function and continence following surgery until a recurrence of paresis and ataxia 36 months later. A second myelogram suggested local recurrence of the tumour, which was confirmed by histological examination of the tumour after its removal at a second laminectomy. The cat again regained normal neurological function, until a further recurrence 16 months after the second surgery. The meningioma was surgically debulked a third time and the cat regained ambulation and continence postoperatively. This case demonstrates the successful use of repeated surgical resection in the management of a recurrent spinal meningioma in a cat. The cat was ambulatory and continent at a follow-up examination 63 months after the initial presentation.

  3. Imatinib Mesylate plus Hydroxyurea Chemotherapy for Cerebellar Meningioma in a Belgian Malinois Dog

    PubMed Central

    JUNG, Hae-Won; LEE, Hee-Chun; KIM, Ji-Hyun; JANG, Hyo-Mi; MOON, Jong-Hyun; SUR, Jung-Hyang; HA, Jeongim; JUNG, Dong-In

    2014-01-01

    ABSTRACT An 8-year-old intact male Belgian Malinois, weighing 37.2 kg, was referred for evaluation due to right side facial paresis, ataxia and a 2-month history of decreased cognitive ability. Physical and neurological examinations revealed mild depression, left-sided head tilt, right-sided facial paresis and ataxia. A well-demarcated, broad-based cerebellar mass and hyperostosis were found on CT imaging of the brain. Based on these CT findings, a cerebellar meningioma was strongly suspected. Hydroxyurea and prednisolone were administered; after 4 weeks, there was reduction in mass size as compared to initial CT results. However, the mass size was found to have grown 6 weeks after hydroxyurea treatment. We then prescribed a combination of imatinib mesylate and hydroxyurea. Two weeks following combination treatment, the mass size had reduced significantly. The mass continuously decreased in size until the patient died during anesthesia. Cerebellar transitional meningioma was confirmed by histopathologic examination. To the author’s knowledge, this is the first reported case of imatinib mesylate plus hydroxyurea therapy for the treatment of meningioma in veterinary medicine. PMID:25131949

  4. Neurovascular complications due to the Hippocrates method for reducing anterior shoulder dislocations.

    PubMed

    Regauer, Markus; Polzer, Hans; Mutschler, Wolf

    2014-01-18

    In spite of the fact that the Hippocrates method hardly has been evaluated in a scientific manner and numerous associated iatrogenic complications have been reported, this method remains to be one of the most common techniques for reducing anterior shoulder dislocations. We report the case of a 69-year-old farmer under coumarin anticoagulant therapy who sustained acute first time anterior dislocation of his dominant right shoulder. By using the Hippocrates method with the patient under general anaesthesia, the brachial vein was injured and an increasing hematoma subsequently caused brachial plexus paresis by pressure. After surgery for decompression and vascular suturing, symptoms declined rapidly, but brachial plexus paresis still was not fully reversible after 3 mo of follow-up. The hazardousness of using the Hippocrates method can be explained by traction on the outstretched arm with force of the operator's body weight, direct trauma to the axillary region by the physician's heel, and the topographic relations of neurovascular structures and the dislocated humeral head. As there is a variety of alternative reduction techniques which have been evaluated scientifically and proofed to be safe, we strongly caution against the use of the Hippocrates method as a first line technique for reducing anterior shoulder dislocations, especially in elder patients with fragile vessels or under anticoagulant therapy, and recommend the scapular manipulation technique or the Milch technique, for example, as a first choice.

  5. Arytenoid Dislocation as a Cause of Prolonged Hoarseness after Cervical Discectomy and Fusion

    PubMed Central

    Goz, Vadim; Qureshi, Sheeraz; Hecht, Andrew C.

    2012-01-01

    Study Design Case series of two arytenoid dislocations after anterior cervical discectomy. Objective To recognize arytenoid dislocation as a possible cause of prolonged hoarseness in patients after anterior cervical discectomies. Summary of Background Data Prolonged hoarseness is a common postoperative complication after anterior cervical spine surgery. The etiology of prolonged postoperative hoarseness is usually related to a paresis of the recurrent laryngeal nerve. However, other causes of postoperative hoarseness may be overlooked in this clinical scenario. Other possible etiologies include pharyngeal and laryngeal trauma, hematoma and edema, injury of the superior laryngeal nerve, as well as arytenoid cartilage dislocation. Arytenoid dislocation is often misdiagnosed as vocal fold paresis due to recurrent or laryngeal nerve injury. Methods We report two cases of arytenoid dislocation and review the literature on this pathology. Results Two patients treated with anterior cervical discectomy and fusion experienced prolonged postoperative hoarseness. Arytenoid dislocation was confirmed by flexible fiber-optic laryngoscopy in both cases. The dislocations experienced spontaneous reduction at 6 weeks and 3 months postsurgery. Conclusions Arytenoid dislocation must be considered in the differential diagnosis of prolonged postoperative hoarseness and evaluated for using direct laryngoscopy, computed tomography, or a laryngeal electromyography. Upon diagnosis, treatment must be considered immediately. Slight dislocations can reduce spontaneously without surgical intervention; however, operative intervention may be required at times. PMID:24436851

  6. Arytenoid dislocation as a cause of prolonged hoarseness after cervical discectomy and fusion.

    PubMed

    Goz, Vadim; Qureshi, Sheeraz; Hecht, Andrew C

    2013-03-01

    Study Design Case series of two arytenoid dislocations after anterior cervical discectomy. Objective To recognize arytenoid dislocation as a possible cause of prolonged hoarseness in patients after anterior cervical discectomies. Summary of Background Data Prolonged hoarseness is a common postoperative complication after anterior cervical spine surgery. The etiology of prolonged postoperative hoarseness is usually related to a paresis of the recurrent laryngeal nerve. However, other causes of postoperative hoarseness may be overlooked in this clinical scenario. Other possible etiologies include pharyngeal and laryngeal trauma, hematoma and edema, injury of the superior laryngeal nerve, as well as arytenoid cartilage dislocation. Arytenoid dislocation is often misdiagnosed as vocal fold paresis due to recurrent or laryngeal nerve injury. Methods We report two cases of arytenoid dislocation and review the literature on this pathology. Results Two patients treated with anterior cervical discectomy and fusion experienced prolonged postoperative hoarseness. Arytenoid dislocation was confirmed by flexible fiber-optic laryngoscopy in both cases. The dislocations experienced spontaneous reduction at 6 weeks and 3 months postsurgery. Conclusions Arytenoid dislocation must be considered in the differential diagnosis of prolonged postoperative hoarseness and evaluated for using direct laryngoscopy, computed tomography, or a laryngeal electromyography. Upon diagnosis, treatment must be considered immediately. Slight dislocations can reduce spontaneously without surgical intervention; however, operative intervention may be required at times.

  7. [A case of Lissauer form of paretic neurosyphilis with drop attacks and dementia].

    PubMed

    Syouzaki, Taisaku; Arahata, Sou; Araki, Eiichi; Furuya, Hirokazu; Fujii, Naoki

    2010-07-01

    A 52-year-old man was admitted to our hospital due to drop attack accompanied with progressive right hand's clumsiness and recent memory impairment. Neurological examination revealed postural involuntary movement of the right hand, and impaired finger fine movements. He showed mild mental deterioration with lower MMSE score. Toreponema Pallidum Latex immuno Assay (TPLA) titers in serum and cerebrospinal fluid (CSF) were remarkably elevated. MRI revealed cerebral atrophy in the left hemisphere. The 99mTc-ECD SPECT analysis showed reduced cerebral blood flow in the left hemisphere. EEG showed slow background activity in the left hemisphere. Drop attacks and involuntary movement were diminished by the administration of the valproate. We diagnosed this case as Lissauer's general paresis and treated with intravenous benzylpenicillin potassium 24 million units per day for 2 weeks. After this treatment, the titer of TPLA in the serum and CSF decreased. The clinical symptoms and signs, the score of MMSE, findings of SPECT and EEG also improved. Although Lissauer's general paresis is a rare form of neurosyphilis, it is important to distinguish this disease in case of progressive dementia and focal neurological signs. Early diagnosis and treatment are the only way to prevent irreversible neurological damage in this disease.

  8. Historic evidence to support a causal relationship between spirochetal infections and Alzheimer’s disease

    PubMed Central

    Miklossy, Judith

    2015-01-01

    Following previous observations a statistically significant association between various types of spirochetes and Alzheimer’s disease (AD) fulfilled Hill’s criteria in favor of a causal relationship. If spirochetal infections can indeed cause AD, the pathological and biological hallmarks of AD should also occur in syphilitic dementia. To answer this question, observations and illustrations on the detection of spirochetes in the atrophic form of general paresis, which is known to be associated with slowly progressive dementia, were reviewed and compared with the characteristic pathology of AD. Historic observations and illustrations published in the first half of the 20th Century indeed confirm that the pathological hallmarks, which define AD, are also present in syphilitic dementia. Cortical spirochetal colonies are made up by innumerable tightly spiraled Treponema pallidum spirochetes, which are morphologically indistinguishable from senile plaques, using conventional light microscopy. Local brain amyloidosis also occurs in general paresis and, as in AD, corresponds to amyloid beta. These historic observations enable us to conclude that chronic spirochetal infections can cause dementia and reproduce the defining hallmarks of AD. They represent further evidence in support a causal relationship between various spirochetal infections and AD. They also indicate that local invasion of the brain by these helically shaped bacteria reproduce the filamentous pathology characteristic of AD. Chronic infection by spirochetes, and co-infection with other bacteria and viruses should be included in our current view on the etiology of AD. Prompt action is needed as AD might be prevented. PMID:25932012

  9. A clinical study of new cases of parenchymal neurosyphilis: has tabes dorsalis disappeared or been missed?

    PubMed

    Zhang, Yong-Qing; Huang, Ming; Jia, Xiao-Yan; Zou, Ya-Fen; Chen, Dan

    2015-01-01

    Tabes dorsalis (TD) was documented as the most common parenchymal neurosyphilis, but its incidence dramatically declined in the antibiotic era. Syphilis has resurged on the China mainland since the 1980s. In recent years, physicians have been reporting parenchymal neurosyphilis, and the overwhelming majority was general paresis, but this was not the case in the authors' hospital. To make clear the real situation of parenchymal neurosyphilis in the authors' hospital, a retrospective review was carried out of the records of patients during 2009-2012. Overrepresented clinical new cases of tabetic and paretic parenchymal neurosyphilis were collected. Clinical characteristics, neuroimaging, laboratory data, and responses to penicillin were analyzed in two groups. The efficiency of two current criteria based on CSF antibodies tests was inspected. In the 43 cases with positive serum rapid plasma reagin (RPR) and TPPA tests, 18 patients met the criteria of this study: 11 presented with symptoms of general paresis, and seven had typical presentations of TD. There were statistical differences in serum RPR titers, CSF RPR, white blood cell count, and TP between the paretic and tabetic groups. The response to penicillin was relatively poor in TD. The efficiency of two current criteria was lower in the diagnosis of TD. TD was not uncommon in our area. Its clinical features remained typical, but underdiagnosis with CSF-based criteria and a decreased response to penicillin were prominent issues.

  10. Recurrent Laryngeal Edema Imitating Angioedema Caused by Dislocated Screw after Anterior Spine Surgery

    PubMed Central

    Wójtowicz, Piotr; Szafarowski, Tomasz; Migacz, Ewa; Krzeski, Antoni

    2015-01-01

    The anterior cervical spine surgery is a common procedure to stabilize vertebrae damaged by various diseases. The plates and screws are usually used in the spine fixation. This kind of instrumentation may detach from the bones which is a rare but well-known complication. A 77-year-old male presented to the otorhinolaryngology department with throat pain, choking, and dysphagia. At first the angioedema was diagnosed and he was treated conservatively. The endoscopy revealed laryngeal edema, being more defined on the right side with right vocal fold paresis. CT scans showed the stabilizing plate with two screws attached tightly and the back-out of the third screw toward soft tissue of the neck. In the meantime, his condition deteriorated and he needed tracheotomy. In few days the surgical removal of the dislocated screw was performed successfully. Although two-month follow-up reported no obstruction of the larynx, the vocal folds paresis with gradual functional improvement was observed. Long-term complication of anterior spine surgery sometimes may suggest laryngeal angioedema at first. If the conservative treatment is ineffective and there is a history of anterior spine surgery, the clinicians should consider the displacement of the plate or screws in differential diagnosis. PMID:25755901

  11. Assessment of 3-nitropropionic acid-evoked peripheral neuropathy in rats: neuroprotective effects of acetyl-l-carnitine and resveratrol.

    PubMed

    Binienda, Zbigniew K; Beaudoin, Micheal A; Gough, Bobby; Ali, Syed F; Virmani, Ashraf

    2010-08-16

    Oxidative stress and secondary excitotoxicity, due to cellular energy deficit, are major factors playing roles in 3-nitropropionic acid (3-NPA) induced mitochondrial dysfunction. Acute or chronic exposure to 3-NPA also leads to neuronal degeneration in different brain regions. The present study quantitatively assessed peripheral neuropathy induced by chronic exposure to 3-NPA in rats. The neuroprotective abilities of two antioxidants, acetyl-l-carnitine and resveratrol, were investigated as well. Rats were exposed for up to four weeks to 3-NPA alone or 3-NPA combined with acetyl-l-carnitine or resveratrol, administered peripherally. The experimental outcome was evaluated by neurophysiological, histological, and morphometric analyses. Rats exposed to 3-NPA developed hind limb paresis. Furthermore, a significant decrease in motor nerve conduction velocity (MCV) was detected in tail nerves and axonal degeneration in sciatic nerves (p<0.05). Treatment with resveratrol prevented the functional effects of 3-NPA exposure, whereas treatment with acetyl-l-carnitine, preventing paresis, was not effective to MCV and morphological changes. These data suggest that resveratrol is a good candidate for treatment of metabolic neuropathy. The experimental outcome of this study shows that chronic treatment with 3-NPA in rats is relevant in development of an experimental model of toxic neuropathy.

  12. Somatotopic organization of the corticospinal tract in the human brainstem: a MRI-based mapping analysis.

    PubMed

    Marx, Juergen J; Iannetti, Gian D; Thömke, Frank; Fitzek, Sabine; Urban, Peter P; Stoeter, Peter; Cruccu, Giorgio; Dieterich, Marianne; Hopf, Hanns C

    2005-06-01

    To investigate the incompletely understood somatotopical organization of the corticospinal tract in the human brainstem, we performed a voxel-based statistical analysis of standardized magnetic resonance scans of 41 prospectively recruited patients with pyramidal tract dysfunction caused by acute brainstem infarction. Motor hemiparesis was rated clinically and by the investigation of motor evoked potentials to arms and legs. Infarction affected the pons in 85% of cases. We found the greatest level of significance of affected brainstem areas between the pontomesencephalic junction and the mid pons. Lesion location was significantly more dorsal in patients with hemiparesis affecting more proximal muscles and was significantly more ventral in patients with predominantly distal limb paresis. Comparison of magnetic resonance lesion from patients with paresis predominantly affecting arm or leg did not show significant topographical differences. We conclude that a topographical arm/leg distribution of corticospinal fibers is abruptly broken down as the descending corticospinal tract traverses the pons. Corticospinal fibers, however, follow a somatotopical order in the pons with fibers controlling proximal muscles being located close to the reticular formation in the dorsal pontine base, and thus more dorsal than the fibers controlling further distal muscle groups.

  13. Ipsilesional trajectory control is related to contralesional arm paralysis after left hemisphere damage.

    PubMed

    Haaland, Kathleen Y; Schaefer, Sydney Y; Knight, Robert T; Adair, John; Magalhaes, Alvaro; Sadek, Joseph; Sainburg, Robert L

    2009-06-01

    We have recently shown ipsilateral dynamic deficits in trajectory control are present in left hemisphere damaged (LHD) patients with paresis, as evidenced by impaired modulation of torque amplitude as response amplitude increases. The purpose of the current study is to determine if these ipsilateral deficits are more common with contralateral hemiparesis and greater damage to the motor system, as evidenced by structural imaging. Three groups of right-handed subjects (healthy controls, LHD stroke patients with and without upper extremity paresis) performed single-joint elbow movements of varying amplitudes with their left arm in the left hemispace. Only the paretic group demonstrated dynamic deficits characterized by decreased modulation of peak torque (reflected by peak acceleration changes) as response amplitude increased. These results could not be attributed to lesion volume or peak velocity as neither variable differed across the groups. However, the paretic group had damage to a larger number of areas within the motor system than the non-paretic group suggesting that such damage increases the probability of ipsilesional deficits in dynamic control for modulating torque amplitude after left hemisphere damage.

  14. A magnetic resonance imaging study of double elevator palsy.

    PubMed

    Cadera, W; Bloom, J N; Karlik, S; Viirre, E

    1997-06-01

    The pathophysiology of double elevator palsy is poorly understood. We assessed two patients with this condition using magnetic resonance imaging (MRI) to evaluate the appearance of the extraocular muscles. Cross-sectional study. Radiology department of a university-affiliated hospital in London, Ont. Two patients from a private ophthalmology practice who had undergone complete transpositions of the horizontal rectus muscles to treat hypotropia associated with double elevator palsy. MRI. A volume scanning technique was used to obtain maximum information about the muscles. Appearance of the extraocular muscles. In both patients MRI showed decreased volume of the superior rectus muscle on the affected side. The other rectus muscles were normal. This suggested either congenital hypoplasia or paresis of the involved superior rectus muscle. In addition, the full tendon transpositions of the medial and lateral recti did not appreciably change the middle and deep orbital pathways of the transposed horizontal rectus muscles. MRI may be a useful adjunct to saccadic velocity assessments in differentiating between primary inferior rectus restriction, primary superior rectus paresis and congenital supranuclear elevator deficiency.

  15. High risk of cerebrospinal fluid leakage in surgery of a rare primary intraosseous cavernous hemangioma of the clivus showing meningeal infiltration: A case report and review of the literature

    PubMed Central

    Serrano, Lucas; Archavlis, Eleftherios; Januschek, Elke; Ulrich, Peter T.

    2015-01-01

    Background: Primary intraosseous cavernous hemangiomas (PICH) of the skull represent an infrequent bone tumor. Although some rare cases of PICHs located in the skull base have been published, to our concern only three cases have been reported in the English literature of PICHs arising within the clivus. Case Description: We present the case of a patient presenting an isolated abducens paresis due to a rare PICH of the clivus showing also an unusual destruction of the inner table as well as infiltration of the dura mater. Due to this uncommon infiltrative pattern of an otherwise expected intraosseous tumor, a cerebrospinal fluid (CSF)-fistula occurred while performing a transnasal biopsy. The patient recovered successfully without need of lumbar drainage or re-surgery. Additionally, intratumoral decompression was sufficient to relief the abducens paresis. Conclusions: Our case provides new and meaningful information about clinical features as well as growth pattern of these rare clival tumors. We also discuss the importance of knowing these peculiarities before surgery in order to plan the optimal operative management as well as to avoid complications while approaching PICHs localized in such a delicate cranial region. PMID:25949853

  16. Stance limb ground reaction forces in high functioning stroke and healthy subjects during gait initiation.

    PubMed

    Sharma, Sheena; McMorland, Angus J C; Stinear, James W

    2015-08-01

    Following stroke, little is known about ground reaction forces during gait initiation. To compare stroke patients' with healthy subjects' anterior, medial, and lateral ground reaction forces generated during gait initiation. Patients with left paresis, right paresis, and age-similar healthy subjects were recruited. During gait initiation the average peak anterior, medial, and lateral ground reaction forces acting on each lower limb were calculated when it was the stance limb. Anterior ground reaction forces acting on the right and left stance limbs of healthy subjects were greater than anterior forces acting on the nonparetic and paretic limbs of stroke patients. Medial ground reaction forces for the nonparetic and paretic limbs of stroke patients and for the right and left stance limbs of healthy subjects were equivalent. While lateral ground reaction forces acting on the nonparetic and paretic limbs were equivalent for left paretic patients, for right paretic patients lateral forces acting on the nonparetic limb were greater compared to the paretic limb and also greater compared to the left limb of healthy subjects. An effect of side-of-lesion was revealed in average peak lateral ground reaction force data. Larger lateral ground reaction forces acting on the left nonparetic stance limb of right paretic patients compared to the right nonparetic stance limb of left paretic patients during gait initiation may be an indication of differing adaptations that depend on the side-of-lesion. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Swallowing disturbance pattern relates to brain lesion location in acute stroke patients.

    PubMed

    Steinhagen, Volker; Grossmann, Annette; Benecke, Reiner; Walter, Uwe

    2009-05-01

    The relationship of brain lesion location and swallowing disturbance pattern has been poorly studied in acute stroke patients. Sixty patients with first-ever acute ischemic stroke at clearly assessed location and clinical signs of dysphagia were studied. Swallowing-related parameters rated clinically and fiberendoscopically were attention deficit, buccofacial apraxia, orofacial paresis, gag reflex, delay of pharyngeal swallow, pharyngeal contraction, larynx elevation, function of upper esophageal sphincter (UES), and aspiration severity. Attention deficit was independently predicted only by parietotemporal infarction, buccofacial apraxia by left-sided parietotemporal infarction, orofacial paresis by infarction encompassing upper motor neuron of cranial nerves, and impaired UES opening by lateral medullary infarction. Other swallowing parameters were not related to lesion topology. On posthoc analysis, pneumonia within 21 days after stroke was predicted only by insular lesion. Distinct acute brain lesion locations result in characteristic swallowing disturbance patterns. Dysphagic patients with insular stroke appear to have even higher risk of pneumonia suggesting a further associated factor promoting infection in these subjects.

  18. The influence of functional electrical stimulation on hand motor recovery in stroke patients: a review.

    PubMed

    Quandt, Fanny; Hummel, Friedhelm C

    2014-01-01

    Neuromuscular stimulation has been used as one potential rehabilitative treatment option to restore motor function and improve recovery in patients with paresis. Especially stroke patients who often regain only limited hand function would greatly benefit from a therapy that enhances recovery and restores movement. Multiple studies investigated the effect of functional electrical stimulation on hand paresis, the results however are inconsistent. Here we review the current literature on functional electrical stimulation on hand motor recovery in stroke patients. We discuss the impact of different parameters such as stage after stoke, degree of impairment, spasticity and treatment protocols on the functional outcome. Importantly, we outline the results from recent studies investigating the cortical effects elicited by functional electrical stimulation giving insights into the underlying mechanisms responsible for long-term treatment effects. Bringing together the findings from present research it becomes clear that both, treatment outcomes as well as the neurophysiologic mechanisms causing functional recovery, vary depending on patient characteristics. In order to develop unified treatment guidelines it is essential to conduct homogenous studies assessing the impact of different parameters on rehabilitative success.

  19. Bald Eagle Nestling Mortality Associated with Argas radiatus and Argas ricei Tick Infestation and Successful Management with Nest Removal in Arizona, USA.

    PubMed

    Justice-Allen, Anne; Orr, Kathy; Schuler, Krysten; McCarty, Kyle; Jacobson, Kenneth; Meteyer, Carol

    2016-10-01

    Eight Bald Eagle ( Haliaeetus leucocephalus ) nestlings heavily infested with larval ticks were found in or under a nest near the confluence of the Verde and Salt rivers in Arizona in 2009-11. The 8-12-wk-old nestlings were slow to respond to stimuli and exhibited generalized muscle weakness or paresis of the pelvic limbs. Numerous cutaneous and subcutaneous hemorrhages were associated with sites of tick attachment. Ticks were identified as Argas radiatus and Argas ricei. Treatment with acaricides and infection with West Nile virus (WNV) may have confounded the clinical presentation in 2009 and 2010. However, WNV-negative birds exhibited similar signs in 2011. One nestling recovered from paresis within 36 h after the removal of all adult and larval ticks (>350) and was released within 3 wk. The signs present in the heavily infested Bald Eagle nestlings resembled signs associated with tick paralysis, a neurotoxin-mediated paralytic syndrome described in mammals, reptiles, and wild birds (though not eagles). Removal of the infested nest and construction of a nest platform in a different tree was necessary to break the cycle of infection. The original nesting pair constructed a new nest on the man-made platform and successfully fledged two Bald Eagles in 2012.

  20. Localized diseases of the bovine brain and spinal cord.

    PubMed

    Sherman, D M

    1987-03-01

    Localized lesions of the central nervous system do occur in cattle. Those affecting the cranial nerves and focal lesions of the spinal cord are most easily recognized by careful neurologic examination. Once the lesion has been anatomically localized, likely etiologic causes can be pursued. Probably the most common cause of cranial nerve deficits in cattle is listeriosis. Important differential diagnoses include brain and pituitary abscesses and extensions of ear infections. Other possible causes include PEM, TEME, hypovitaminosis A, and several rare, sporadic causes. In young cattle, spinal trauma and vertebral body abscesses are the most common causes of progressive paresis resulting from spinal cord lesions. Congenital abnormalities must be considered in the differential diagnoses for very young calves. Non-neurologic conditions, including fractures of the limbs and especially nutritional muscular dystrophy, must be ruled out. In older cattle, compressive neoplasms, most notably lymphosarcoma, are primarily responsible for progressive paresis. Differential diagnosis should include other neurologic conditions such as delayed organophosphate neurotoxicity; early progressive diffuse neurologic diseases such as rabies, pseudorabies, and botulism; plant toxicities; and non-neurologic conditions resulting in recumbency, such as hypocalcemia and musculoskeletal trauma.

  1. Clinical practice guideline: Bell's Palsy executive summary.

    PubMed

    Baugh, Reginald F; Basura, Gregory J; Ishii, Lisa E; Schwartz, Seth R; Drumheller, Caitlin Murray; Burkholder, Rebecca; Deckard, Nathan A; Dawson, Cindy; Driscoll, Colin; Gillespie, M Boyd; Gurgel, Richard K; Halperin, John; Khalid, Ayesha N; Kumar, Kaparaboyna Ashok; Micco, Alan; Munsell, Debra; Rosenbaum, Steven; Vaughan, William

    2013-11-01

    The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the new Clinical Practice Guideline: Bell's Palsy. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 11 recommendations developed encourage accurate and efficient diagnosis and treatment and, when applicable, facilitate patient follow-up to address the management of long-term sequelae or evaluation of new or worsening symptoms not indicative of Bell's palsy. There are myriad treatment options for Bell's palsy; some controversy exists regarding the effectiveness of several of these options, and there are consequent variations in care. In addition, there are numerous diagnostic tests available that are used in the evaluation of patients with Bell's palsy. Many of these tests are of questionable benefit in Bell's palsy. Furthermore, while patients with Bell's palsy enter the health care system with facial paresis/paralysis as a primary complaint, not all patients with facial paresis/paralysis have Bell's palsy. It is a concern that patients with alternative underlying etiologies may be misdiagnosed or have an unnecessary delay in diagnosis. All of these quality concerns provide an important opportunity for improvement in the diagnosis and management of patients with Bell's palsy.

  2. [Thyrotoxic periodic paralysis: a case series of four patients and literature review].

    PubMed

    Boissier, E; Georgin-Lavialle, S; Cochereau, D; Ducloux, R; Ranque, B; Aslangul, E; Pouchot, J

    2013-09-01

    Periodic thyrotoxic hypokalemic paralysis (TPP) is a neuromuscular complication of hyperthyroidism. It is more common in young Asian males than in Caucasian and African patients. We report four new cases and review the literature. Four consecutive patients were diagnosed with TPP. They were all men with a median age of 34.5 years at presentation. Two patients originated from the Philippines, one was African and one was Caucasian ethnic background. They all presented with a paresis or flaccid paralysis, without respiratory failure. Previous similar episodes in their past medical history, the presence of profound hypokalemia (mean serum potassium level of 2 mmol/L) and the presence of clinical and biological signs of hyperthyroidism led to the diagnosis of TPP. All four patients were diagnosed with Graves' disease. Outcome was favourable in all four patients with the symptomatic treatment of TPP and treatment of Graves' disease. TPP is a severe condition, due to a dysfunction of the Na(+)-K(+) ATPase pump. Initial management relies on β-blocker treatment and careful potassium supplementation. Then, medical or surgical etiological treatment of the thyrotoxicosis is essential to prevent a recurrence. The disease is probably underdiagnosed: it must be suspected when a profound hypokaliema resolves very quickly (<12hours); hyperthyroidism should always be included in the differential diagnosis of a paresis associated with hypokalemia. Copyright © 2013 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  3. Neurovascular complications due to the Hippocrates method for reducing anterior shoulder dislocations

    PubMed Central

    Regauer, Markus; Polzer, Hans; Mutschler, Wolf

    2014-01-01

    In spite of the fact that the Hippocrates method hardly has been evaluated in a scientific manner and numerous associated iatrogenic complications have been reported, this method remains to be one of the most common techniques for reducing anterior shoulder dislocations. We report the case of a 69-year-old farmer under coumarin anticoagulant therapy who sustained acute first time anterior dislocation of his dominant right shoulder. By using the Hippocrates method with the patient under general anaesthesia, the brachial vein was injured and an increasing hematoma subsequently caused brachial plexus paresis by pressure. After surgery for decompression and vascular suturing, symptoms declined rapidly, but brachial plexus paresis still was not fully reversible after 3 mo of follow-up. The hazardousness of using the Hippocrates method can be explained by traction on the outstretched arm with force of the operator’s body weight, direct trauma to the axillary region by the physician’s heel, and the topographic relations of neurovascular structures and the dislocated humeral head. As there is a variety of alternative reduction techniques which have been evaluated scientifically and proofed to be safe, we strongly caution against the use of the Hippocrates method as a first line technique for reducing anterior shoulder dislocations, especially in elder patients with fragile vessels or under anticoagulant therapy, and recommend the scapular manipulation technique or the Milch technique, for example, as a first choice. PMID:24649415

  4. Potential determinants of efficacy of mirror therapy in stroke patients – A pilot study

    PubMed Central

    Brunetti, Maddalena; Morkisch, Nadine; Fritzsch, Claire; Mehnert, Jan; Steinbrink, Jens; Niedeggen, Michael; Dohle, Christian

    2015-01-01

    Abstract Background: Mirror therapy (MT) was found to improve motor function after stroke. However, there is high variability between patients regarding motor recovery. Objectives: The following pilot study was designed to identify potential factors determining this variability between patients with severe upper limb paresis, receiving MT. Methods: Eleven sub-acute stroke patients with severe upper limb paresis participated, receiving in-patient rehabilitation. After a set of pre-assessments (including measurement of brain activity at the primary motor cortex and precuneus during the mirror illusion, using near-infrared spectroscopy as described previously), four weeks of MT were applied, followed by a set of post-assessments. Discriminant group analysis for MT responders and non-responders was performed. Results: Six out of eleven patients were defined as responders and five as non-responders on the basis of their functional motor improvement. The initial motor function and the activity shift in both precunei (mirror index) were found to discriminate significantly between responders and non-responders. Conclusions: In line with earlier results, initial motor function was confirmed as crucial determinant of motor recovery. Additionally, activity response to the mirror illusion in both precunei was found to be a candidate for determination of the efficacy of MT. PMID:26409402

  5. [A case of Cogan's syndrome associated with multiple cranial neuropathy].

    PubMed

    Yamamoto, K; Takase, Y; Nogaki, H; Fukusako, T; Morimatus, M

    1990-06-01

    A 52-year-old woman was admitted to our hospital because of disturbance of right visual acuity and double vision. At 38-year-old she became deaf bilaterally and experienced many vertigo attacks. She was diagnosed as Ménière disease. At 45-year-old vertigo attacks disappeared. At 47-year-old right peripheral facial nerve palsy developed transiently with interstitial keratitis and episcleritis of the both eyes. Oral adrenocorticosteroid therapy produced an improvement of interstitial keratitis and episcleritis. On admission, ophthalmological examination revealed bilateral interstitial keratitis and episcleritis, right retrobulbar optic neuritis and she was proven to have bilateral sensorineural deafness by otologist. Neurological examination revealed right abducens nerve paresis. Laboratory examinations revealed slightly increased erythrocyte sedimentation rate. CRP was positive. Serological tests for syphilis were negative. CSF showed mildly elevated protein level. Orbital CT scans revealed the swelling of right optic nerve. Cerebral MRI showed multiple high spotty areas in left thalamus, bilateral basal ganglia and deep white matter in T2 weighted images. After treatment with adrenocorticosteroid, right optic neuritis and abducens nerve paresis improved together with bilateral interstitial keratitis and episcleritis. Multiple cranial neuropathy may develop with Cogan's syndrome.

  6. Metabolic disorders of cattle.

    PubMed

    Reid, G

    1993-05-01

    Goldberger discovered human pellagra was a non-infectious disease, affecting mostly the small and the timid in overcrowded institutions. Symptoms were diarrhoea, dermatitis and dementia. The staff and older children escaped the disease. They ate the meat and left the small and timid with the gravy. The 'Goldberger syndrome' is observed during competitive feeding of livestock, in ketotic animals and in the zinc depleted which are lethargic and pick all day at their feed. The pellagra preventative factor was later found to be nicotinic acid, derived from the amino acid tryptophan. Deficiencies of copper, magnesium, vitamin B6 (activated by a zinc kinase) inhibit the conversion of tryptophan to nicotinic acid. Stresses, including liver diseases, malabsorption, iron overload, porphyria, marasmus, cold stress, pregnancy, lactation, antibiotics and sulfa drugs, all increase dietary needs of nicotinic acid. Elevated free fatty acids and ketone bodies in the blood are associated with ketosis, zinc depletion and the pre-diabetic state. There is a diminished uptake of glucose by the tissues, a condition also found in parturient paresis of dairy cows when elevated hydrocortisone promotes insulin resistance and hyperglycaemia. This defect in insulin response leads to a diabetic-like state. The major predisposing factor in parturient paresis of dairy cows is hypocalcaemia. Gut absorption of dietary calcium may not meet the primary demands of lactation initiation until bone calcium mobilisation is established.

  7. Pattern of ocular involvement in myasthenia gravis with MuSK antibodies.

    PubMed

    Evoli, Amelia; Alboini, Paolo E; Iorio, Raffaele; Damato, Valentina; Bartoccioni, Emanuela

    2017-09-01

    Myasthenia gravis (MG) with antibodies to the muscle-specific kinase (MuSK) has a characteristic phenotype. Ocular manifestations have not been systematically evaluated. To investigate the features of extrinsic ocular muscle involvement in patients with MuSK-MG. We retrospectively evaluated the prevalence, time of onset, clinical pattern and outcome of ocular symptoms in 82 patients with a clinical follow-up ≥2 years. Ocular manifestations were observed in 79 patients (96.4%) and were the presenting symptoms in 48 (58.5%). Intermittent diplopia with subtle ophthalmoparesis was the most common complaint, ptosis was generally symmetrical and conjugated gaze paresis occurred in 35% of the patients. Ocular manifestations responded well to prednisone and partially to symptomatic treatment. A few patients developed chronic symmetrical ophthalmoparesis, associated with persistent weakness in other muscle groups. All patients with ocular presentation progressed to generalised disease, though weakness spread to other muscle groups was considerably delayed in a few cases. In MG with antibodies to MuSK, ocular manifestations were as frequent as in other disease subtypes. Symmetrical ophthalmoparesis with conjugated gaze limitation was rather common and associated with low functional disability. A proportion of these patients developed chronic eye muscle paresis. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  8. Anatomical facial nerve findings in 209 consecutive atresia cases.

    PubMed

    Goldsztein, Hernan; Roberson, Joseph B

    2013-04-01

    Describe intraoperative facial nerve findings in 209 consecutive atresia cases. Identify preoperative and intraoperative anatomical variants that should alert the surgeon to potential high-risk facial nerve anatomy. Case series with chart review. Tertiary care subspecialty private practice. Retrospective review of 209 consecutive atresia cases treated between 2007 and 2011. Descriptive analysis of intraoperative findings. Logistical regression models with generalized estimating equations were used to examine the effect of preoperative variables over the operative findings. Two hundred and nine consecutive patients (ages 2-48) underwent atresia repair between 2007 and 2011. Preoperative Jahrsdoerfer Scale was 9 (23%), 8 (42%), 7 (19%), 6 (2%), 5 or less (2%). The facial nerve was found to have an abnormal course in 39% of the cases and not identified in 1%. It was congenitally dehiscent in 53% of cases and was surgically exposed in 10%. The most common site of congenital dehiscence was in the tympanic segment (57%). Facial-stapes contact was found in 11% of cases. The stapedius tendon was absent in 30% of cases. A single patient had a mild transient postoperative paresis (House-Brackmann 2). Atresia repair remains one of the most challenging procedures in otology. In spite of modern preoperative imaging, the facial nerve remains at risk. When performing surgery on patients with preoperative facial nerve paresis and/or lower Jahrsdoerfer scores, the surgeon should be aware of a higher incidence of facial nerve abnormalities. Thorough knowledge of anatomical variations and meticulous surgical technique are mandatory to safely perform these surgeries.

  9. Potential determinants of efficacy of mirror therapy in stroke patients--A pilot study.

    PubMed

    Brunetti, Maddalena; Morkisch, Nadine; Fritzsch, Claire; Mehnert, Jan; Steinbrink, Jens; Niedeggen, Michael; Dohle, Christian

    2015-01-01

    Mirror therapy (MT) was found to improve motor function after stroke. However, there is high variability between patients regarding motor recovery. The following pilot study was designed to identify potential factors determining this variability between patients with severe upper limb paresis, receiving MT. Eleven sub-acute stroke patients with severe upper limb paresis participated, receiving in-patient rehabilitation. After a set of pre-assessments (including measurement of brain activity at the primary motor cortex and precuneus during the mirror illusion, using near-infrared spectroscopy as described previously), four weeks of MT were applied, followed by a set of post-assessments. Discriminant group analysis for MT responders and non-responders was performed. Six out of eleven patients were defined as responders and five as non-responders on the basis of their functional motor improvement. The initial motor function and the activity shift in both precunei (mirror index) were found to discriminate significantly between responders and non-responders. In line with earlier results, initial motor function was confirmed as crucial determinant of motor recovery. Additionally, activity response to the mirror illusion in both precunei was found to be a candidate for determination of the efficacy of MT.

  10. Skeletal muscle lesions in turkeys associated with the feeding of monensin.

    PubMed

    Wages, D P; Ficken, M D

    1988-01-01

    The feeding of monensin as a coccidiostat in three separate flocks of turkeys was associated with increased mortality, posterior paresis, and a skeletal muscle myopathy. Mortality attributed to the disease was 1.65%, 1.86%, and 4.80% in the three flocks. Samples of monensin-supplemented feed fed to the flocks when showing clinical signs contained 88, 85, and 106 g/ton of complete feed, respectively. Clinically, the turkeys showed posterior paresis, inability to rise, incoordination, reluctance to move, and leg trembling and weakness. Necropsy findings included consistent lesions of pallor within the type I muscles of the legs, wings, and backs. Microscopic lesions included myofiber degeneration and necrosis with massive cellular proliferation interpreted as sarcolemmal nuclei proliferation. Occasional axonal degeneration with loss of axons was present in peripheral nerves embedded in the damaged musculature. In the youngest flock, multifocal areas of acute coagulation necrosis of the myocardium were also present. These outbreaks occurred following intake of monensin in the complete feed at levels considered therapeutic; however, no associated predisposing clinical condition, drug/toxin interaction, or excessive monensin levels in the feed could be demonstrated.

  11. Sudden falls as a persistent complication of selective dorsal rhizotomy surgery in children with bilateral spasticity: report of 3 cases.

    PubMed

    Grootveld, Laura R; van Schie, Petra E M; Buizer, Annemieke I; Jeroen Vermeulen, R; van Ouwerkerk, Willem J R; Strijers, Rob L M; Becher, Jules J G

    2016-08-01

    Selective dorsal rhizotomy (SDR) surgery is a well-established treatment for ambulatory children with bilateral spastic paresis and is performed to eliminate spasticity and improve walking. The objective of this case report is to describe sudden falls as a persistent complication of SDR. The authors report on 3 patients with bilateral spastic paresis, aged 12, 6, and 7 years at the time of surgery. The percentage of transected dorsal rootlets was around 40% at the L2-S1 levels. Sudden falls were reported with a frequency of several a day, continuing for years after SDR. The falls were often triggered by performing dual tasks as well as occurring in the transition from sitting to standing, during running, after strenuous exercise, or following a fright. Patients also had residual hyperesthesia and dysesthesia of the foot sole. The authors hypothesize that the sudden falls are caused by a muscle inhibition reflex of the muscles in the legs, as an abnormal reaction to a sensory stimulus that is perceived with increased intensity by a patient with hyperesthesia. A favorable effect of gabapentin medication supports this hypothesis.

  12. [A case of multiple myeloma (biclonal type) associated with an intracranial mass invading the skull base and oculomotor palsy].

    PubMed

    Takano, K; Ohgami, S; Yonemasu, Y; Fukuda, H; Nakai, H; Tomabechi, M; Kawata, M; Takemori, N

    1991-12-01

    A case of multiple myeloma forming an intracranial mass which invaded the skull base was reported. A 72-year-old woman was admitted to the hospital because of left oculomotor paresis. Plain craniograms showed multiple punched out lesions. A CT scan demonstrated a mass lesion, which was homogeneously slightly enhanced with contrast medium, in the middle cranial fossa. MRI, both T1 and T2 weighted images, showed an isodensity mass. In the carotid angiograms the tumor was fed by the right branches of the cavernous portion of the internal carotid artery and the maxillary artery. Laboratory data were as follows: ESR: 132mm/30min, serum TP: 9.0g/dl, IgG: 4670mg/dl, IgA: 430mg/dl, and urinary Bence-Jones protein was detected. Bone marrow biopsy of the illiac bone demonstrated myeloma cells. During hospitalization oculomotor paresis disappeared, and the patient was treated with intramuscular interferon-alpha. Multiple myeloma which invades the skull base is rare, and only 10 cases have been reported since 1977. Moreover, the biclonal type is only 0.5% of all multiple myelomas.

  13. Outbreak of Beriberi in an Indian Population of the Upper Amazon Region, Roraima State, Brazil, 2008

    PubMed Central

    Cerroni, Matheus P.; Barrado, Jean C. S.; Nobrega, Aglaer A.; Lins, Alysson B. M.; da Silva, Iolanda P.; Mangueira, Robson R.; da Cruz, Rômulo H.; Mendes, Sandra M. F.; Sobel, Jeremy

    2010-01-01

    Edema, parasthesias, and paresis affected 10 residents of an Indian community in Roraima state; three died. Mining with mercury occurs locally; caxirí, a traditional alcoholic drink, is consumed daily. We conducted a 1:2 unmatched case-control study; a case was an Indian from Uiramutã county (population of 9,127) who presented ≥ 1 of lower extremity edema, paresthesias, paresis, or weakness. Controls were asymptomatic Indians randomly selected from the population. We identified 90 cases (prevalence of 1%) and 180 controls; all were enrolled. Among cases, 79% were male, and the median age was 31 years. Ethnicity was Macuxí, and 49% had income. Cases had lower extremity edema (85%), upper extremity paresthesias (84%), and lower extremity weakness and pain (78%). Risk factors were male sex (odds ratio [OR] = 6.8; P < 0.001), age 31–40 years (OR = 5.63; P < 0.001), and consumption of caxirí (OR = 2.7; P < 0.003). Mercury exposure was not a risk. Thiamine therapy produced complete rapid clinical recovery in all cases, confirming the diagnosis of beriberi. We recommend surveillance, thiamine supplementation, and nutritional intervention. PMID:21036843

  14. Implementation, testing and pilot clinical evaluation of superelastic splints that decrease joint stiffness.

    PubMed

    Pittaccio, Simone; Garavaglia, L; Viscuso, S; Beretta, E; Strazzer, S

    2013-09-01

    The present work aims at demonstrating that a customised choice of shape memory alloy (SMA) composition, thermo-mechanical treatment and shaping can lead to effective rehabilitation devices applicable to sub-acute and chronic spastic paresis in paediatric patients. SMA pseudoelasticity is regarded as a means to implement a corrective action on posture without hindering residual voluntary or reflex mobility of the affected limb. Specific hinges containing NiTi or NiTiNb elements were designed and constructed to transfer pseudoelastic recovery force to fitted splints for the elbow or the ankle joint. The devices were mechanically tested and showed complete stability after 20-100 cycles, and unchanged characteristics after 1000 full-range deflections. Repositioning splints equipped with patient-specific pseudoelastic hinges were prescribed to 25 individuals (aged 7.75 ± 5.40 years) with mild to severe spastic tetraparesis. Clinical and instrumental evaluations were carried out during crossover trials with traditional and pseudoelastic splints. The sequence of treatment steps was randomized for each subject. The results show that, compared to fixed-angle braces, pseudoelastic devices decrease passive joint stiffness while providing the same control on limb posture. Dynamic pseudoelastic braces are therefore an innovative treatment for spastic paresis, which may reduce joint stiffness.

  15. Triple test as predictive screen for unilateral weakness on caloric testing in routine practice.

    PubMed

    Rohrmeier, Christian; Richter, Otto; Schneider, Michael; Wirsching, Kornelia; Fiedler, Isabella; Haubner, Frank; Strutz, Jürgen; Kühnel, Thomas S

    2013-02-01

    To investigate in vertigo patients in routine practice to what extent a rapid and straightforward triple bedside test (spontaneous nystagmus, head-shaking nystagmus, and the head impulse test) can predict a normal result on caloric testing. Prospective, single-blind, diagnostic study. Tertiary referral center. 151 patients (78 male and 73 female subjects; mean age, 52.5 +/- 16.4 yr) presenting with acute or recent symptoms of vertigo. Diagnostic evaluation. The negative predictive value (NPV) of the triple test in relation to a normal caloric test response. In unilateral weakness (UW) on caloric testing (UW, >=25%), the triple test had sensitivity of 63.6%, specificity of 85.4%, a positive predictive value (PPV) of 71.4%, and an NPV of 80.4%. In other words, 80.4% of patients with a negative triple test also had a normal response on caloric testing. In pronounced canal paresis (UW, >=50%), the triple test had sensitivity of 81.8%, specificity of 81.4%, a PPV of 55.1%, and an NPV of 94.1%. Significant differences were found between 2 subgroups assessed by examiners with differing levels of experience (p < 0.05). The triple test represents a good screening tool that quickly and reliably excludes unilateral weakness and in particular pronounced canal paresis on caloric testing. (C) 2013 Otology & Neurotology, Inc.

  16. Multifocal motor neuropathy: update on clinical characteristics, pathophysiological concepts and therapeutic options.

    PubMed

    Meuth, Sven G; Kleinschnitz, Christoph

    2010-01-01

    Multifocal motor neuropathy (MMN) is an acquired immune-mediated neuropathy characterized by chronic or stepwise progressive asymmetrical limb weakness without sensory deficits. The upper extremities are more often affected than the lower extremities with distal paresis dominating over proximal paresis. Important diagnostic features are persistent multifocal partial conduction blocks (CBs) and the presence of high-titer anti-GM1 serum antibodies. Motor neuron disease, other chronic dysimmune neuropathies, such as chronic inflammatory demyelinating polyneuropathy and the Lewis-Sumner syndrome (MADSAM neuropathy), are important differential diagnoses. While corticosteroids and plasma exchange are largely ineffective, high-dose intravenous immunoglobulins are regarded as first-line treatment. In spite of significant success in elucidating the underlying disease mechanisms in MMN during the past few years, important pathophysiological issues and the optimum long-term therapy remain to be clarified. The present review summarizes the clinical picture and current pathophysiological concepts of MMN with a special focus on the molecular and electrophysiological basis of CBs and highlights established therapies as well as possible novel treatment options.

  17. The influence of NDT-Bobath and PNF methods on the field support and total path length measure foot pressure (COP) in patients after stroke.

    PubMed

    Krukowska, Jolanta; Bugajski, Marcin; Sienkiewicz, Monika; Czernicki, Jan

    In stroke patients, the NDT - (Bobath - Neurodevelopmental Treatment) and PNF (Proprioceptive Neuromuscular Facilitation) methods are used to achieve the main objective of rehabilitation, which aims at the restoration of maximum patient independence in the shortest possible period of time (especially the balance of the body). The aim of the study is to evaluate the effect of the NDT-Bobath and PNF methods on the field support and total path length measure foot pressure (COP) in patients after stroke. The study included 72 patients aged from 20 to 69 years after ischemic stroke with Hemiparesis. The patients were divided into 4 groups by a simple randomization. The criteria for this division were: the body side (right or left) affected by paresis and the applied rehabilitation methods. All the patients were applied the recommended kinesitherapeutic method (randomized), 35 therapy sessions, every day for a period of six weeks. Before initiation of therapy and after 6 weeks was measured the total area of the support and path length (COP (Center Of Pressure) measure foot pressure) using stabilometer platform - alpha. The results were statistically analyzed. After treatment studied traits decreased in all groups. The greatest improvement was obtained in groups with NDT-Bobath therapy. NDT-Bobath method for improving the balance of the body is a more effective method of treatment in comparison with of the PNF method. In stroke patients, the effectiveness of NDT-Bobath method does not depend on hand paresis.

  18. Treatment of lateral epicondylitis with botulinum toxin: a randomized, double-blind, placebo-controlled trial.

    PubMed

    Wong, Shiu Man; Hui, Andrew C F; Tong, Po-Yee; Poon, Dawn W F; Yu, Evelyn; Wong, Lawrence K S

    2005-12-06

    Lateral epicondylitis is a common condition for which botulinum toxin has been reported to have a therapeutic role in uncontrolled studies. To determine if an injection of botulinum toxin is more effective than placebo for reducing pain in adults with lateral epicondylitis. Randomized, double-blind, placebo-controlled trial conducted from September 2002 to December 2004. Outpatient clinics at a university hospital and a district hospital in Hong Kong. 60 patients with lateral epicondylitis. The primary outcome was change in subjective pain as measured by a 100-mm visual analogue scale (VAS) ranging from 0 (no pain) to 10 (worst pain ever) at 4 weeks and 12 weeks. All patients completed post-treatment follow-up. A single injection of 60 units of botulinum toxin type A or normal saline placebo. Mean VAS scores for the botulinum group at baseline and at 4 weeks were 65.5 mm and 25.3 mm, respectively; respective scores for the placebo group were 66.2 mm and 50.5 mm (between-group difference of changes, 24.4 mm [95% CI, 13.0 to 35.8 mm]; P < 0.001). At week 12, mean VAS scores were 23.5 mm for the botulinum group and 43.5 mm for the placebo group (between-group difference of changes, 19.3 mm [CI, 5.6 to 32.9 mm]; P = 0.006). Grip strength was not statistically significantly different between groups at any time. Mild paresis of the fingers occurred in 4 patients in the botulinum group at 4 weeks. One patient's symptoms persisted until week 12, whereas none of the patients receiving placebo had the same complaint. At 4 weeks, 10 patients in the botulinum group and 6 patients in the placebo group experienced weak finger extension on the same side as the injection site. The trial was small, and most participants were women. The blinding protocol may have been ineffective because the 4 participants who experienced paresis of the fingers could have correctly assumed that they received an active treatment. Botulinum toxin injection may improve pain over a 3-month period in

  19. In-vivo comparison of the neurotoxic potencies of incobotulinumtoxinA, onabotulinumtoxinA, and abobotulinumtoxinA.

    PubMed

    Kutschenko, Anna; Manig, Anja; Reinert, Marie-Christine; Mönnich, Angelika; Liebetanz, David

    2016-08-03

    Three botulinum neurotoxin type A (BoNT/A) products, incobotulinumtoxinA, onabotulinumtoxinA, and abobotulinumtoxinA, all manufactured by different methods, are employed in clinical practice. Comparing the three BoNT/A products is difficult because their concentrations and volumes differ and the precise dose equivalence ratio is not known. We aimed to compare the neurotoxic potencies by a systematic analysis of injected volume and dose. The potency of BoNT in inducing hind limb paresis was assessed by analyzing the wheel-running performance of mice. To standardize the volume, the effect of an identical dose of incobotulinumtoxinA dissolved in different volumes of saline (15, 10, 5, and 2μl) was studied in four groups of mice (n=13-15). The potencies of the BoNT products were then compared by injecting identical volumes (10μl) containing different doses into both hind leg muscles. Mice injected with incobotulinumtoxinA showed a volume-dependent reduction in wheel-running, with larger volumes inducing more intense paresis. A standardized volume containing the same number of mouse units of the BoNT/A products produced different degrees of paresis. The conversion ratio of incobotulinumtoxinA and onabotulinumtoxinA is estimated to be between 1:0.75 and 1:0.5. OnabotulinumtoxinA displayed a two-fold greater potency than abobotulinumtoxinA. Doses of onabotulinumtoxinA and abobotulinumtoxinA that produce an identical severity of pareses even result in the same duration of pareses. This wheel-running assay allows one to compare the neurotoxic potency of different volumes and doses of the BoNT products in vivo. Our results argue against common clinical practice because incobotulinumtoxinA and onabotulinumtoxinA are not readily interchangeable and a two-fold dose of abobotulinumtoxinA is needed to induce an effect identical to onabotulinumtoxinA. In addition, this emphasizes that the duration of BoNT-induced effect is the same as long as equipotent doses of BoNT are

  20. Associations between clinical outcome and navigated transcranial magnetic stimulation characteristics in patients with motor-eloquent brain lesions: a combined navigated transcranial magnetic stimulation-diffusion tensor imaging fiber tracking approach.

    PubMed

    Sollmann, Nico; Wildschuetz, Noémie; Kelm, Anna; Conway, Neal; Moser, Tobias; Bulubas, Lucia; Kirschke, Jan S; Meyer, Bernhard; Krieg, Sandro M

    2017-03-31

    OBJECTIVE Navigated transcranial magnetic stimulation (nTMS) and diffusion tensor imaging fiber tracking (DTI FT) based on nTMS data are increasingly used for preoperative planning and resection guidance in patients suffering from motor-eloquent brain tumors. The present study explores whether nTMS-based DTI FT can also be used for individual preoperative risk assessment regarding surgery-related motor impairment. METHODS Data derived from preoperative nTMS motor mapping and subsequent nTMS-based tractography in 86 patients were analyzed. All patients suffered from high-grade glioma (HGG), low-grade glioma (LGG), or intracranial metastasis (MET). In this context, nTMS-based DTI FT of the corticospinal tract (CST) was performed at a range of fractional anisotropy (FA) levels based on an individualized FA threshold ([FAT]; tracking with 50%, 75%, and 100% FAT), which was defined as the highest FA value allowing for visualization of fibers (100% FAT). Minimum lesion-to-CST distances were measured, and fiber numbers of the reconstructed CST were assessed. These data were then correlated with the preoperative, postoperative, and follow-up status of motor function and the resting motor threshold (rMT). RESULTS At certain FA levels, a statistically significant difference in lesion-to-CST distances was observed between patients with HGG who had no impairment and those who developed surgery-related transient or permanent motor deficits (75% FAT: p = 0.0149; 100% FAT: p = 0.0233). In this context, no patient with a lesion-to-CST distance ≥ 12 mm suffered from any new surgery-related permanent paresis (50% FAT and 75% FAT). Furthermore, comparatively strong negative correlations were observed between the rMT and lesion-to-CST distances of patients with surgery-related transient paresis (Spearman correlation coefficient [rs]; 50% FAT: rs = -0.8660; 75% FAT: rs = -0.8660) or surgery-related permanent paresis (50% FAT: rs = -0.7656; 75% FAT: rs = -0.6763). CONCLUSIONS This is

  1. Characterization of incident stroke signs and symptoms: findings from the atherosclerosis risk in communities study.

    PubMed

    Rathore, Saif S; Hinn, Albert R; Cooper, Lawton S; Tyroler, Herman A; Rosamond, Wayne D

    2002-11-01

    Although patterns of stroke occurrence and mortality have been well studied, few epidemiological data are available regarding the clinical characteristics of stroke events. We evaluated hospitalized stroke events reported in the Atherosclerosis Risk in Communities (ARIC) Study to describe the clinical characteristics of incident stroke. Confirmed stroke cases (n=474) were evaluated for stroke symptoms (headache, vertigo, gait disturbance, convulsions) and stroke signs (hemianopia, diplopia, speech deficits, paresis, paresthesia/sensory deficits) and their univariate associations with race, sex, and stroke subtype. Over 9.2 years of follow-up, 402 (85%) ischemic and 72 (15%) hemorrhagic strokes occurred. Frequency of stroke symptoms (95% CIs) were as follows: headache (27.4%; 23.4% to 31.4%), gait disturbance (10.8%; 7.9% to 13.6%), convulsions (4.4%; 2.6% to 6.3%), and vertigo (2.1%; 0.8% to 3.4%). Speech deficits occurred in 24.0% (20.2% to 27.9%), hemianopia in 14.6% (11.4% to 17.7%), and diplopia in 5.5% (3.4% to 7.5%) of cases. Most cases involved paresis (81.6%; 78.1% to 85.1%), while fewer cases experienced sensory deficits (44.5%; 40.0% to 49.0%). Blacks were more likely than whites to experience paresis (85.4% versus 78.2%; P=0.044). Men were more likely than women to experience a gait disturbance (14.4% versus 6.7%; P=0.007). Persons with hemorrhagic strokes had a higher proportion of headaches (55.6% versus 22.4%; P=0.001) and convulsions (11.1% versus 3.2%; P=0.003) than those with ischemic events, while speech and sensory deficits were more common in ischemic strokes (26.1% versus 12.5%, P=0.013, and 49.0% versus 19.4%, P=0.001, respectively). We present epidemiological data concerning the clinical characteristics of incident stroke in a population-based cohort. Although minor differences by race, sex, and stroke subtype were observed, data from additional follow-up are required to confirm observed variations.

  2. Incidence estimate and guideline-oriented treatment for post-stroke spasticity: an analysis based on German statutory health insurance data

    PubMed Central

    Egen-Lappe, Veronika; Köster, Ingrid; Schubert, Ingrid

    2013-01-01

    Background Spasticity after stroke has been internationally recognized as an important health problem causing impairment of mobility, deformity, and pain. The aim of this study was to assess the frequency of first-ever and recurrent stroke and of subsequent spastic and flaccid paresis. Factors influencing the development of spasticity were analyzed. A further major aim was to provide a “real-life” assessment of the treatment of spasticity in Germany and to discuss this in view of the treatment recommended by German and international clinical guidelines. Methods The database used in this study comprised a cohort of 242,090 insurants from a large statutory health insurance fund in the federal state of Hesse, Germany. A first hospital discharge diagnosis in 2009 with any of the International Classification of Diseases, Tenth Revision (ICD-10) codes I60–I64 was used to identify patients with acute stroke (hemorrhage and ischemic). These patients were followed up six months after stroke to monitor whether they developed spastic or flaccid paresis (hospital or ambulatory care diagnoses ICD-10 code G81–G83 [excluding G82.6/G83.4/G83.8]). For patients with spastic paresis after stroke the spasticity treatment was analyzed for a six-month period (physiotherapy, oral muscle relaxants, intrathecal baclofen, and botulinum toxin). Results Standardized to the population of Germany, 3.7 per 1000 persons suffered a stroke in 2009 (raw 5.2/1000). Of all surviving patients, 10.2% developed spasticity within 6 months. Cox regression revealed no significant influence of patient age, gender, morbidity (diabetes, hypertensive diseases, ischemic heart diseases) or type of stroke on development of spasticity. 97% of surviving patients with spasticity received physiotherapy (inpatient care 89%, ambulatory care 48%). Oral muscle relaxants were prescribed to 13% of the patients. No patient received intrathecal baclofen or botulinum toxin. Conclusion Claims data enabled analysis of

  3. A 12-year-old African American girl with subacute bilateral ophthalmoplegia.

    PubMed

    Bar, Amir; Urbine, Jacqueline; Bahora, Yasmine; Berkenstock, Meghan; Vodzak, Jennifer; Guruprasad, Hamalatha; Sinha, Manisha; Abed, Thair; Legido, Agustín

    2014-06-01

    A twelve-year-old African-American female presented with two week history of progressively worsening headache and fatigue, and vision difficulties for the past week. The physical examination was normal. The neurological evaluation was normal, except for cranial nerves (CN) testing, which showed bilateral restriction of adduction (CN III) and up gaze (CN IV) motions, vertical nystagmus, and left side facial paresis of central origin (CN VII). The bilateral exotropia and ophthalmoplegia are characteristics of WEBINO (Wall-Eyed Bilateral Intranuclear Ophthalmoplegia) syndrome, associated to a brain stem structural lesion. The following causes were evaluated and ruled out: tumor, infection, ischemic stroke, non-infectious inflammation. Pediatric Acquired Demyelinating Syndromes were then considered. Neuromyelitis Optica was ruled out in the absence of neuritis and normal spinal cord MRI. The differential diagnosis between Clinically Isolated Syndrome and Acute Demyelinating Encephalomyelitis, causing an isolated brain stem syndrome, is discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Brachioradial pruritus in a patient with cervical disc herniation and Parsonage-Turner syndrome*

    PubMed Central

    Carvalho, Sandrina; Sanches, Madalena; Alves, Rosário; Selores, Manuela

    2015-01-01

    Brachioradial pruritus is a chronic sensory neuropathy of unknown etiology which affects the skin of the shoulders, arms and forearms on the insertion of the brachioradialis muscle. We describe the case of a 60-yearold woman recently diagnosed with multiple myeloma who refers paresis, severe pruritus and itching lesions on the right arm with 6 months of evolution. Investigation led to a diagnosis of Brachioradial pruritus consequent to the presence of cervical disc herniation and Parsonage-Turner syndrome. The patient started gabapentin 900mg/day with good control of itching. Corticosteroids and antihistamines are often ineffective in the treatment of BP. Gabapentin has been used with encouraging results. All patients with Brachioradial pruritus should be evaluated for cervical spine injuries. PMID:26131874

  5. USSR Report, Life Sciences, Biomedical and Behavioral Sciences

    DTIC Science & Technology

    2007-11-02

    biological membranes was reactivated by unithiol and nicotinamide in dynamics of intoxication. The toxin was shown to activate Mg2+-ATPase in brain...0.001 29.8 Px < P* < ± 0.42 0.001 0.001 0.36 Px < Pa > ± 0.03 0.001 0.05 Same with nicotinamide 11.7 ± 0.24 Px < 0.001 P2 < 0.001...paresis 7.1 ± 0.17 Px < 0.001 1.1 ± 0.10 Px ɘ.02 24.8 Px < ± 0.31 0.001 0.70 Px < ± 0.04 0.01 Same with nicotinamide 8.1 ± 0.38 Px

  6. [Diagnostic-therapeutic Algorithm in a Blunt Injury of the Thorax.].

    PubMed

    Vyhnánek, F; Fanta, J; Lisý, P; Vojtísek, O; Cáp, F

    2000-01-01

    Based on the group of 22 patients operated on for a blunt injury of the thorax a diagnostic-therapeutic algorithm was evaluated in the procedure of the treatment of a severe trauma of the thorax. Acute thoracotomy or laparotomy was performed in 17 patients and in 5 of them thoracotomy was indicated only after some time interval. In the patients with acute surgery the indication was a rupture of diaphragm, massive hemotorax in case of lung laceration of bleeding from thoracic wall, rupture of bronchus and an associated injury of intra-abdominal parenchymal organs. Thoracotomy was after some time interval performed in case of empyema of thorax, post-injury paresis of diaphragm and residual hematoma in the lung parenchyma. Key words: blunt injury of thorax, diagnostic-therapeutic algorithm, indication to an acute or postponed operation.

  7. Dorello's Canal and Gruber's Ligament: Historical Perspective

    PubMed Central

    Ambekar, Sudheer; Sonig, Ashish; Nanda, Anil

    2012-01-01

    Wenzel Leopold Gruber and Primo Dorello were great anatomists and researchers during the 19th and 20th centuries. Their contributions to neuroanatomy—namely the Gruber's (petrosphenoidal) ligament and Dorello's canal, respectively—have come to be important structures in various approaches through the middle fossa. These structures have also helped provide us with an understanding of the mechanism of sixth nerve paresis in various pathological conditions, such as raised intracranial pressure and Gradenigo syndrome. Their numerous publications have stood as a reference to anatomical researchers. Gruber's description of internal mesogastric hernia and the Meckel-Gruber anastomosis are also widely known in medical literature. The following article is an attempt to reflect upon the life and works of Gruber and Dorello and the importance of their research. PMID:24294562

  8. Sarcocystis neurona encephalitis in a dog.

    PubMed

    Cooley, A J; Barr, B; Rejmanek, D

    2007-11-01

    A 1.5-year-old male Feist dog was presented to a veterinarian for reluctance to stand on the hind legs. Treatment included dexamethasone and resulted in a favorable initial response, but posterior paresis returned and progressed to recumbency, hyperesthesia, and attempts to bite the owner. The dog was euthanized. The brain was negative for rabies by fluorescent antibody analysis. Multiple foci of encephalitis were found in the cerebrum and particularly in the cerebellum. Protozoa morphologically consistent with Sarcocystis sp. were identified at sites of intense inflammation and malacia. Additionally, multiple schizonts were identified in areas without inflammation. Immunohistochemistry using both polyclonal and monoclonal antibodies specific for Sarcocystis neurona was strongly positive. No reaction to polyclonal antisera for Toxoplasma gondii or Neospora caninum was found. Polymerase chain reaction confirmed that the protozoa were S. neurona. Additional aberrant hosts for S. neurona other than horses have been identified, but S. neurona encephalitis has not been documented previously in the dog.

  9. [The intermediate syndrome during organophosphorus pesticide poisoning].

    PubMed

    Benslama, A; Moutaouakkil, S; Charra, B; Menebhi, L

    2004-04-01

    Acute intoxication by organophosphate pesticides is frequent in Morocco. We report two cases of malathion poisoning complicated by intermediate syndrome. The purpose of this work is to describe distinctive features of this syndrome, it arises 48-96 h after the cholinergic crisis and it is characterized by respiratory paresis with difficulties of weaning from the assisted respiratory, deficit of proximal limbs, neck flexors, and cranial nerves. This syndrome coincides with the prolonged inhibition of the acetylcholinesterase, and is not due to the necrosis of muscular fiber's necrosis. Both clinical and electromyographic features are explained by a combined pre- and postsynaptic dysfunction of the neuromuscular transmission. The difficulty of this syndrome lies in its rarity and also its severity, because of the respiratory failure, which justifies medical supervision in intensive care unit, for at least 96 h, in expectation for the respiratory distress, all the more cholinergic syndrome is intense.

  10. Myobiofeedback in motor reeducation of wrist and fingers after hemispherial stroke.

    PubMed

    Rathkolb, O; Baykoushev, S; Baykousheva, V

    1990-01-01

    32 patients with different grade of hemiparesis, were in the first weeks after a cerebral vascular accident treated by means of EMG-feedback in respect to volar and dorsal flexion of the wrist, flexion and extension of the fingers, and opposition of thumb to the second ev. other fingers. EMG was registered from suitable muscles of the paretic limb. The attempt of volitional movement at the paretic side was conditioned with a reinforced mirror synergia of the same type from the healthy to the damaged side. The patient observed the effect on the EMG screen. After 3-6 conditionings the patient performed the volitional movement alone. In 25 of patients (e.g. 78.1%) improvement was obtained, at least in EMG. A good correlation was found between effect of the procedures and severity of paresis (p less than 0.05; chi 2 = 7.35).

  11. Spontaneous iliopsoas muscle haematoma as a complication of anticoagulation in acute cerebral venous thrombosis: to stop or not to stop (the anticoagulation)?

    PubMed

    Fernandes, Carina; Pereira, Pedro; Rodrigues, Miguel

    2015-03-06

    Spontaneous iliopsoas muscle haematoma is an infrequent complication of anticoagulation, potentially causing neurological dysfunction through compression of the femoral nerve or lumbar plexus. The authors report the case of a puerperal woman admitted for an extensive cerebral venous thrombosis. Anticoagulation was started, with clinical improvement. The patient later reported low back pain irradiating to the right thigh and developed neurological impairment consistent with lumbar plexus dysfunction. A pelvic CT scan revealed a right iliopsoas muscle haematoma. Considering the risk of anticoagulation suspension, a conservative approach was chosen, with maintenance of anticoagulation. Clinical and functional improvement occurred, with mild right hip and knee flexion paresis as sequelae. Anticoagulation complications are challenging, especially when interruption of anticoagulation may threaten vital and functional outcomes. Therefore, a careful evaluation is essential, since no clinical guidelines are available. In this case, continuing anticoagulation provided a good functional outcome.

  12. Neurogenic cough.

    PubMed

    Altman, Kenneth W; Noordzij, J Pieter; Rosen, Clark A; Cohen, Seth; Sulica, Lucian

    2015-07-01

    We review contemporary concepts of the pathophysiology of neurogenic cough, and its evaluation and treatment based on scientific publications addressing neurogenic cough. Neurogenic cough is thought to be the result of sensory neuropathy, most commonly idiopathic. Because it is principally a sensory phenomenon, clinical evaluation is challenging, the diagnosis most often being made by exclusion. Identification of motor paresis, either by laryngoscopy or laryngeal electromyography, may suggest the presence of sensory neuropathy. The utility of amitriptyline and gabapentin has been demonstrated in randomized clinical trials, and retrospective series and case reports have suggested efficacy of pregabalin, baclofen, and botulinum toxin. Sensory neuropathy appears to be an important cause of chronic refractory cough, and appears amenable to treatment with a variety of pharmacologic agents.

  13. Idiopathic acute onset myelopathy in cheetah (Acinonyx jubatus) cubs.

    PubMed

    Walzer, Christian; Url, Angelika; Robert, Nadia; Kübber-Heiss, Anna; Nowotny, Norbert; Schmidt, Peter

    2003-03-01

    Numerous cases of ataxia, hind limb paresis, and paralysis have occurred in cheetah (Acinonyx jubatus) cubs over the past 10 yr within the European Endangered Species Program population, including 12 in mainland Europe, two in the British Isles, one in Namibia, and one in Dubai. The condition is the most important medical factor limiting European cheetah population growth. Eight cubs at the Salzburg Zoo, Austria, were affected. They demonstrated upper motor neuron lesions when alive and bilateral, symmetrical myelin degeneration of the spinal cord on necropsy. Ballooning of myelin sheaths surrounded mostly preserved axons, and no spheroids, characteristic of acute axonal degeneration, were found. Myelin loss markedly exceeded axonal degeneration. The syndrome's etiology is unclear, although viral, bacterial, parasitic, genetic, nutritional-metabolic, toxic, and physical causes have been considered.

  14. Interactive visuo-motor therapy system for stroke rehabilitation.

    PubMed

    Eng, Kynan; Siekierka, Ewa; Pyk, Pawel; Chevrier, Edith; Hauser, Yves; Cameirao, Monica; Holper, Lisa; Hägni, Karin; Zimmerli, Lukas; Duff, Armin; Schuster, Corina; Bassetti, Claudio; Verschure, Paul; Kiper, Daniel

    2007-09-01

    We present a virtual reality (VR)-based motor neurorehabilitation system for stroke patients with upper limb paresis. It is based on two hypotheses: (1) observed actions correlated with self-generated or intended actions engage cortical motor observation, planning and execution areas ("mirror neurons"); (2) activation in damaged parts of motor cortex can be enhanced by viewing mirrored movements of non-paretic limbs. We postulate that our approach, applied during the acute post-stroke phase, facilitates motor re-learning and improves functional recovery. The patient controls a first-person view of virtual arms in tasks varying from simple (hitting objects) to complex (grasping and moving objects). The therapist adjusts weighting factors in the non-paretic limb to move the paretic virtual limb, thereby stimulating the mirror neuron system and optimizing patient motivation through graded task success. We present the system's neuroscientific background, technical details and preliminary results.

  15. Isolated thalamic tuberculoma presenting as ataxic hemiparesis

    PubMed Central

    Sahu, Ritesh; Patil, Tushar B; Kori, Prakash; Shukla, Rakesh

    2013-01-01

    Lacunar syndrome is a neurodeficit secondary to a deep cerebral lesion, usually because of microatheroma of small arteries. Ataxic hemiparesis (AH) is a lacunar syndrome with unilateral pyramidal weakness and ipsilateral ataxia. Thalamic tuberculoma, as a cause of AH, has not been previously described in the literature. We describe an elderly man who presented with left hemiparesis and ipsilateral ataxia. Clinical examination revealed upper motor neuron left facial paresis and left-sided hemiparesis. The patient had incoordination in left upper and lower limbs. Mantoux test was positive and erythrocyte sedimentation rate was elevated. MRI of brain showed a conglomerated hypointense lesion in the right thalamus with a peripheral hyperintensity on T1-weighted imaging and a hyperintense lesion in T2-weighted imaging with significant perilesional oedema, suggesting a tuberculoma. The patient was treated with antitubercular therapy and was symptomatically better at the 9 months follow-up. PMID:23580686

  16. Bronchogenic adenocarcinoma in a hyacinth macaw (Anodorhynchus hyacinthinus).

    PubMed

    Baumgartner, Wes A; Guzman, David Sanchez-Migallon; Hollibush, Shawn; Gaschen, Lorrie; Hodgin, E Clay; Mitchell, Mark A

    2008-09-01

    An adult female hyacinth macaw (Anodorhynchus hyacinthinus) was presented for sudden onset of severe weakness in the legs. Neurologic examination revealed bilateral paresis of the pelvic limbs and decreased proprioception. Results of radiographs and computed tomography (CT) revealed variably sized soft tissue nodules throughout the lungs and invading into the spine and vertebral canal. Soon after the CT scan, the bird went into cardiorespiratory arrest and died. At necropsy, several yellow, coalescing nodules that were firm with a caseous component were present in the lungs, and a focus of similar tissue was attached to the vertebrae and invaded the spinal canal. On histologic examination, the diagnosis was primary pulmonary bronchial adenocarcinoma with spinal invasion.

  17. Drop attacks in elderly patients secondary to otologic causes with Meniere's syndrome or non-Meniere peripheral vestibulopathy.

    PubMed

    Lee, Hyung; Yi, Hyon-Ah; Lee, Seong-Ryong; Ahn, Byung-Hoon; Park, Byung-Rim

    2005-05-15

    Many neurologists are unaware of the drop attack that may occur from an inner ear dysfunction especially in elderly. We studied the clinical features and results of quantitative audiovestibular tests in six elderly patients (> or =65 years of age) who presented with drop attacks attributable to an inner ear pathology. Group was divided into Meniere's syndrome (4) or non-Meniere peripheral vestibulopathy (2). Standard dizziness questionnaire and quantitative audiovestibular function testing were performed. Episodes were described as a sudden push to the ground in four or a violent illusionary movement of environment leading to a fall in two. All cases gave a history of prior vertiginous episodes and vestibular testing revealed unilateral caloric paresis. Ipsilateral hearing loss was documented in four cases. Our results suggest that otologic causes should be considered in the differential diagnosis of the drop attack in elderly, even if the symptoms and signs were not consistent with Meniere's syndrome.

  18. Changes in Upper-Extremity Functional Capacity and Daily Performance During Outpatient Occupational Therapy for People With Stroke

    PubMed Central

    Doman, Caitlin A.; Waddell, Kimberly J.; Bailey, Ryan R.; Moore, Jennifer L.

    2016-01-01

    OBJECTIVE. This study explored how upper-extremity (UE) functional capacity and daily performance change during the course of outpatient rehabilitation in people with stroke. METHOD. Fifteen participants receiving outpatient occupational therapy services for UE paresis poststroke were enrolled. UE motor capacity was measured with the Action Research Arm Test (ARAT), and UE performance was measured using bilateral, wrist-worn accelerometers. Measurements were taken at or near the start of therapy, at every 10th visit or every 30 days throughout the duration of services, and at discharge. RESULTS. Three patterns were observed: (1) increase in ARAT scores and more normalized accelerometry profiles, (2) increase in ARAT scores but no change in accelerometry profiles, and (3) no change in ARAT scores or in accelerometry profiles. CONCLUSION. UE performance in daily life was highly variable, with inconsistencies between change in UE capacity and change in UE performance. UE capacity and performance are important constructs to assess separately during rehabilitation. PMID:27089298

  19. Diaphragm paralysis from cervical disc lesions.

    PubMed

    Cloward, R B

    1988-01-01

    An opera singer, who "made her living with her diaphragm", developed a post-traumatic unilateral radiculopathy due to cervical disc lesions, C3 to C6. During one year of severe neck and left arm pain she gradually lost the ability to sing difficult operatic passages which brought an end to her music career. Following a three level anterior cervical decompression and fusion, the neck and arm pain was immediately relieved. One week later her voice and singing ability returned to its full strength and power permitting her to resume her activities as a vocalist. The diagnosis of paresis of the left hemi-diaphragm as part of the cervical disc syndrome was implied by postoperative retrospective inference.

  20. Clinical and diagnostic imaging findings in an Italian wolf (Canis lupus italicus) with discospondylitis.

    PubMed

    Zeira, Offer; Briola, Chiara; Konar, Martin; Plonek, Marta; Papa, Valentina

    2013-12-01

    An adult male Italian wolf (Canis lupus italicus) was presented with an abnormal gait. Neurologic examination showed thoracic kyphosis, paraparesis, decreased proprioception in the pelvic limbs, and normal spinal reflexes. Neurologic symptoms suggested a thoracolumbar spinal cord lesion. Pathologic findings included leukocytosis. Spinal radiographs revealed ventral spondylosis of T4/T5/T6, a poorly defined intervertebral disc space, and mild lysis of the vertebral margins. Multiple metallic foreign bodies were seen in the thoracic wall. Magnetic resonance imaging of the spine detected increased signal intensity on fluid sensitive sequences of the vertebral bodies, the intervertebral disc, and surrounding soft tissues. These findings were interpreted as active discospondylitis at T4/T5. Medical therapy included antibiotic and analgesic treatment as well as movement restriction. Follow-up at 4 wk showed significant clinical and radiologic improvement. Discospondylitis should be included in the differential diagnosis in wolves with paresis.

  1. Optic neuropathy secondary to a sphenoid-ethmoidal mucocele: Case report.

    PubMed

    Mora-Horna, E R; López, V G; Anaya-Alaminos, R; Ceriotto, A; Salcedo, G

    2015-12-01

    The case is presented of a 51-year old male patient with a history of blunt trauma in the frontal region and a one-year history of vision loss, proptosis and paresis of the lateral rectus muscle of the right eye. A right ethmoid and bilateral sphenoid mucocele was diagnosed. Drainage was performed using an external and endoscopic approach with improvement in symptoms without recurrence at 10 months. Sphenoid mucoceles represent 1% of all mucoceles and may present with different clinical manifestations. Surgical excision is the treatment of choice, and early intervention is indicated to prevent complications. Copyright © 2014 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  2. [Differential diagnostics of diseases of the brachial plexus].

    PubMed

    Ritter, C; Wunderlich, G; Macht, S; Schroeter, M; Fink, G R; Lehmann, H C

    2014-02-01

    Progressive, atrophic, asymmetrically distributed flaccid paresis of arm and hand muscles represents a frequent symptom of neuromuscular diseases that can be attributed to injury of the arm nerves, the plexus or the cervical roots. A timely and exact diagnosis is mandatory; however, the broad spectrum of differential diagnoses often represents a diagnostic challenge. A large variety of neuromuscular disorders need to be considered, encompassing autoimmune mediated inflammatory neuropathic conditions, such as multifocal motor neuropathy, as well as chronic degenerative and nerve compression disorders. This review provides an overview of the most frequent disorders of the upper plexus and cervical roots and summarizes the characteristic clinical features as well as electrodiagnostic and laboratory test results. In addition the diagnostic value of magnetic resonance imaging and sonography is discussed.

  3. Bilateral paramedian thalamic artery infarcts: report of eight cases.

    PubMed Central

    Gentilini, M; De Renzi, E; Crisi, G

    1987-01-01

    Eight consecutive patients with CT scan evidence of a bilateral infarct in the territory of the paramedian thalamic artery are reported. In seven cases the infarct also extended to the territory of the polar artery. The main symptoms were: disorder of vigilance which cleared in a few days, and hypersomnolence which lasted longer and in two patients was still present a year later; amnesia, detectable clinically in four patients and only with tests in two patients, which persisted in one patient for three years; changes of mood and bulimia present in five and four patients respectively; and vertical gaze paresis in five patients. Only one patient died, and in the remainder the symptoms tended to subside, but none of the patients who could be followed-up for a year returned to normal behaviour. Clinical and CT scan correlations pointed to the mammillo-thalamic tract as the structure whose damage was responsible for the memory disorders. Images PMID:3625213

  4. An unusual case of orbito-frontal rod fence stab injury with a good outcome.

    PubMed

    Miscusi, Massimo; Arangio, Paolo; De Martino, Luca; De-Giorgio, Fabio; Cascone, Piero; Raco, Antonino

    2013-08-13

    High-energy non-missile penetrating injuries (stab injuries) account for a small percentage of penetrating head injuries and they present a series of special features. A 35-year-old man suffered orbito-frontal? and trans-cranial injuries after falling five meters from a terrace onto a rod iron fence. The removal of the metal rod was performed outside the operating room. The orbital roof was exposed and repaired through a bifrontal craniotomy and the frontal sinuses were cranialised. The orbital floor and zygoma were plated with micro-screws. The patient recovered without significant complications, apart from a slight paresis of the right superior rectus; the ocular globe remained intact.The positive outcome obtained in this very challenging case is attributable to the competency of the Neurotrauma Unit and to the use of a synergistic approach which involved the contribution of neurosurgeons, maxillo-facial surgeons, radiologists and anaesthesiologists.

  5. Chondrosarcoma metastasis in the thyroid gland: a case report

    PubMed Central

    2014-01-01

    Introduction Chondrosarcoma metastases in the thyroid gland are exceptional. To the best of our knowledge, only two cases have been previously reported in the literature. Here we report the third case. Case presentation We report the case of a 51-year-old Arab woman who presented in 2011 with a diaphyseal chondrosarcoma of her right tibia treated by surgery. In the last quarter of 2013, she presented a hard mass in her thyroid gland with dyspnea and a right laryngeal paresis. She underwent a debulking surgery with tracheostomy in order to prevent difficulty in respiration. The final pathology revealed the diagnosis of a chondrosarcoma metastasis within her thyroid gland. She died several days later. Conclusions Even if primary and metastatic chondrosarcomas of the thyroid gland are exceptional, they should be considered in the differential diagnosis of thyroid gland masses. The prognosis is poor but surgery may help preserve quality of life. PMID:24886665

  6. Mislaid dentures: a cause for unusual presentation of bilateral vocal cord palsy

    PubMed Central

    Vallamkondu, Vamsidhar; Gatenby, Andrew; Shakeel, Muhammad; Hussain, Akhtar

    2014-01-01

    An 81-year-old man was referred urgently to the head and neck clinic with symptoms of worsening dysphagia, dysphonia and weight loss. He had a history of chronic lymphocytic leukaemia. On full ear, nose and throat examination, he was found to have fixed vocal cords with pooling of saliva in the bilateral pyriform fossa. Hypopharyngeal malignancy was suspected and further imaging was performed. Imaging also raised the suspicion of malignancy in the hypopharynx. Rigid endoscopic examination under general anaesthesia was carried out which revealed an impacted denture in the cricopharynx and upper oesophagus. The patient was aware of his loss of dentures 3 months ago (corresponds to the onset of his symptoms) but felt that he had mislaid them and had never mentioned this to anyone. We present a case highlighting a delay in diagnosis, a missed diagnosis on CT scan and an unusual presentation leading to bilateral vocal cord paresis. PMID:25139929

  7. Friedrich Nietzsche: the wandering and learned neuropath under Dionisius.

    PubMed

    Gomes, Marleide da Mota

    2015-08-18

    Friedrich Nietzsche (1844-1900) was a remarkable philologist-philosopher while remaining in a condition of ill-health. Issues about his wandering/disruptive behavior that might be a consequence and/or protection against his cognitive decline and multifaceted disease are presented. The life complex that raises speculations about its etiology is constituted by: insight, creativity and wandering behavior besides several symptoms and signs of disease(s), mainly neurological one. The most important issue to be considered at the moment is not the disease diagnosis (Lissauer's general paresis or CADASIL, e.g.), but the probable Nietzsche's great cognitive reserve linked to the multifactorial etiology (genetic and environmental), and shared characteristics both to creativity and psychopathology. This makes any disease seems especial regarding Nietzsche, and whichever the diagnostic hypothesis has to consider the Nietzsche's unique background to express any disease(s).

  8. [Philosophy, psychiatry and psychoanalysis: the case of Nietzsche].

    PubMed

    Wolf, M A

    1995-05-01

    In this work dedicated to Frederic Nietzsche, we were first interested by the philosopher's personal psychopathology. Biographic and personality factors, the physical and moral pain, the mood variations, hypersensitivity, solitude and finally megalomanic traits have probably contributed to the development of his thought. Nietzsche gave personal interpretations of his own suffering. Freud himself recognized the organic component of the philosopher's illness. We reviewed the different symptoms in favor of a progressive general paresis. Philologist and moralist, Nietzsche was also a "psychologist". His intuitions in this area often preceded and prepared those of Freud. The relationship is surprising on certain points such as love and sexuality, the unconscious, the interpretation of dreams. We wish to remind readers that a prepsychoanalytic stream of thought, at the end of the 19th century, preceded the teaching now ascribed to Freud and his followers.

  9. Friedrich Nietzsche: the wandering and learned neuropath under Dionisius.

    PubMed

    Gomes, Marleide da Mota

    2015-11-01

    Friedrich Nietzsche (1844-1900) was a remarkable philologist-philosopher while remaining in a condition of ill-health. Issues about his wandering/disruptive behavior that might be a consequence and/or protection against his cognitive decline and multifaceted disease are presented. The life complex that raises speculations about its etiology is constituted by: insight, creativity and wandering behavior besides several symptoms and signs of disease(s), mainly neurological one. The most important issue to be considered at the moment is not the disease diagnosis (Lissauer's general paresis or CADASIL, e.g.), but the probable Nietzsche's great cognitive reserve linked to the multifactorial etiology (genetic and environmental), and shared characteristics both to creativity and psychopathology. This makes any disease seems especial regarding Nietzsche, and whichever the diagnostic hypothesis has to consider the Nietzsche's unique background to express any disease(s).

  10. Suspected natural lysosomal storage disease from ingestion of pink morning glory (Ipomoea carnea) in goats in northern Argentina.

    PubMed

    Ríos, Elvio E; Cholich, Luciana A; Chileski, Gabriela; García, Enrique N; Lértora, Javier; Gimeno, Eduardo J; Guidi, María G; Mussart, Norma; Teibler, Gladys P

    2015-07-01

    This study describes an occurrence of pink morning glory (Ipomoea carnea) intoxication in goats in northern Argentina. The clinical signs displayed by the affected animals were ataxia, lethargy, emaciation, hypertonia of the neck muscles, spastic paresis in the hind legs, abnormal postural reactions and death. The clinico-pathologic examination revealed that the affected animals were anemic and their serum level of aspartate aminotransferase was significantly increased. Cytoplasmic vacuolation in the Purkinje cells and pancreatic acinar cells was observed by histological examination. The neuronal lectin binding pattern showed a strong positive reaction to WGA (Triticum vulgaris), sWGA (succinylated T. vulgaris) and LCA (Lens culinaris). Although I. carnea is common in tropical regions, this is the first report of spontaneous poisoning in goats in Argentina.

  11. Epidemiology of venous thromboembolism

    PubMed Central

    Heit, John A.

    2015-01-01

    Thrombosis can affect any venous circulation. Venous thromboembolism (VTE) includes deep-vein thrombosis of the leg or pelvis, and its complication, pulmonary embolism. VTE is a fairly common disease, particularly in older age, and is associated with reduced survival, substantial health-care costs, and a high rate of recurrence. VTE is a complex (multifactorial) disease, involving interactions between acquired or inherited predispositions to thrombosis and various risk factors. Major risk factors for incident VTE include hospitalization for surgery or acute illness, active cancer, neurological disease with leg paresis, nursing-home confinement, trauma or fracture, superficial vein thrombosis, and—in women—pregnancy and puerperium, oral contraception, and hormone therapy. Although independent risk factors for incident VTE and predictors of VTE recurrence have been identified, and effective primary and secondary prophylaxis is available, the occurrence of VTE seems to be fairly constant, or even increasing. PMID:26076949

  12. [The features of botulinum therapy for different patterns of poststroke spasticity].

    PubMed

    Krylova, L V; Khasanova, D R

    To assess the efficacy of botulinum toxin therapy for different patterns of poststroke spasticity. Thirty-nine patients with poststroke spasticity were examined. Rehabilitation included 4 treatment courses of inpatient rehabilitation during 9 month usinga multidisciplinary team approach. Botulinum toxin therapy was included in the program. The individual program was developed taking into account the dynamics of a pathological spastic pattern. The transformation of the pathological movement pattern was observed during the rehabilitation using botulinum toxin. The best positive changes, including an improvement of the upper extremity function, walk and a decrease in the degree of paresis, was identified when botulinum toxin therapy was used in early stages of neurorehabilitation (1-3 month after stroke).

  13. Effectiveness of botulinum toxin A in the treatment of spasticity of the lower extremities in adults - preliminary report.

    PubMed

    Opara, Józef; Hordyńska, Ewa; Swoboda, Anna

    2007-01-01

    Botulinum toxin (BTX is currently a recognised treatment for local spasticity, especially in children with cerebral palsy. The following paper presents the early result of BTX treatment for adult patients with spastic paresis of the lower limbs. Twenty adult paraplegic patients (mean age 42 years) following cervical or thoracic SCI or suffering from MS, with moderate-to-severe spasticity in the lower extremities received BTX for the first time in life into the thigh adductor, knee flexor and foot flexor muscle groups. Results were evaluated using Modified Ashworth's Scale, Visual (Analogue) Scale for Pain Assessment, Modified Rivermead Mobility Index and Repty Functional Index prior to and three weeks after the administration of the toxin. Improvement was observed in most patients, usually manifesting as reductions or resolution of pain. Mild side effects (low-grade fever and flu-like symptoms) occurred in only one patient. Our study confirmed the efficacy and safety of BTX for focal lower limb spasticity in adults.

  14. Naturally occurring Parelaphostrongylus tenuis-associated choriomeningitis in a guinea pig with neurologic signs.

    PubMed

    Southard, T; Bender, H; Wade, S E; Grunenwald, C; Gerhold, R W

    2013-05-01

    An adult male guinea pig (Cavia porcellus) with a 1-month history of hind limb paresis, torticollis, and seizures was euthanized and submitted for necropsy. Gross examination was unremarkable, but histologic examination revealed multifocal eosinophilic and lymphoplasmacytic choriomeningitis and cross sections of nematode parasites within the leptomeninges of the midbrain and diencephalon. Morphologic features of the nematode were consistent with a metastrongyle, and the parasite was identified as Parelaphostrongylus tenuis by polymerase chain reaction testing and nucleotide sequencing. Further questioning of the owner revealed that the guinea pig was fed grass from a yard often grazed by white-tailed deer (Odocoileus virginianus). To the authors' knowledge, this is the first report of a naturally occurring P. tenuis infection in a guinea pig.

  15. [Arguments favouring the pharmacotherapy of Bells' palsy].

    PubMed

    de Ru, J A; van Benthem, P P G; Hordijk, G J

    2005-06-25

    Some clinicians claim a spontaneous complete recovery of facial nerve function after Bell's palsy in more than 80% of patients. However, for elderly patients and patients with a severe paresis/paralysis this is not the case. The main cause of Bell's palsy is probably reactivation of latent herpes viruses. Recent literature supports treatment with corticosteroids and antiviral medication, inhibiting viral replication and reducing oedema in the bony canal of the facial nerve. Using this medication in the first days of the disease provides a further 15% of patients with a good outcome in addition to the ones that improve spontaneously. Therefore, prednisone and valacyclovir are recommended for all patients with Bell's palsy and severe dysfunction, i.e. House-Brackmann facial grading scale IV, V and VI.

  16. Immunohistochemical screening for viral agents in cheetahs (Acinonyx jubatus) with myelopathy.

    PubMed

    Shibly, S; Schmidt, P; Robert, N; Walzer, C; Url, A

    2006-10-21

    Numerous cases of acute-onset progressive ataxia, hindlimb paresis and paralysis of unknown aetiology occurred during 1993 to 2003 in cheetahs (Acinonyx jubatus) within the European Endangered Species Programme (eep). This study describes the immunohistochemical investigation of a possible viral aetiology of the "cheetah myelopathy". Antibodies to feline herpesvirus type 1, canine distemper virus, canine parvovirus and Borna disease virus were applied to formalin-fixed and paraffin-embedded brain and spinal cord sections from 25 affected cheetahs aged between three-and-a-half months and 13 years. Using the avidin-biotin complex technique, none of the antibodies gave positive immunosignals in either the brain or the spinal cord tissue.

  17. Paraneoplastic limbic encephalitis presenting as acute viral encephalitis.

    PubMed

    Kararizou, E; Markou, I; Zalonis, I; Gkiatas, K; Triantafyllou, N; Kararizos, G; Likomanos, D; Zambelis, T; Vassilopoulos, D

    2005-11-01

    To describe a case of limbic encephalitis which initially presented as viral limbic encephalitis and during the clinical evaluation a renal carcinoma was diagnosed. Patient with history of peripheral paresis of right facial nerve, 1 month after symptoms appearance and treatment, developed fever, vomiting, grand mal seizure, decreased level of consciousness, confusion, hallucinations and agitation. The patient initially presented a clinical picture of viral LE. which confirmed by CSF. MRI brain showed areas with pathological intensity signal in the region of limbic system unilateral. During the clinical evaluation a renal carcinoma was discovered and a nephrectomy has been performed. Although PLE typically presents as a chronic or subacute disease, it may be fulminant and clinically indistinguishable from an acute HSVE. This association pose the problem of a possible relation between this two syndromes and the correct diagnosis is very important, because there are effective treatments.

  18. Pituitary Apoplexy Mimicking Meningitis

    PubMed Central

    Oh, Keun; Kim, Jang-Hee; Choi, Jin-Wook; Kang, Jae-Kyu

    2013-01-01

    Pituitary apoplexy is a rare but life-threatening disorder. Clinical presentation of this condition includes severe headaches, impaired consciousness, fever, visual disturbance, and variable ocular paresis. The clinical presentation of meningeal irritation is very rare. Nonetheless, if present and associated with fever, pituitary apoplexy may be misdiagnosed as a meningitis. We experienced a case of pituitary apoplexy masquerading as a meningitis. A 42-year-old man presented with meningitis associated symptoms and initial imaging studies did not show evidence of intra-lesional hemorrhage in the pituitary mass. However, a follow-up imaging after neurological deterioration revealed pituitary apoplexy. Hereby, we report our case with a review of literatures. PMID:24904903

  19. [A case of medial medullary infarction with persistent primitive hypoglossal artery].

    PubMed

    Jin, Kazutaka; Aihara, Naoto; Tsukamoto, Tetsuro

    2002-04-01

    A 66-year-old woman was admitted to our hospital because of vomiting, dizziness and vertigo. Neurological examination on admission revealed only upbeat nystagmus without cranial nerve symptoms, paresis, cerebellar signs or sensory disturbances. Magnetic resonance(MR) images demonstrated a new T 2 high intensity and T 1 iso-intensity signal lesion in the right upper medial medulla. This medial medullary infarction caused central vestibular dysfunction. MR angiography and digital subtraction angiography demonstrated a persistent primitive hypoglossal artery (PPHA) originating from the right internal carotid artery to the vertebrobasilar artery associated with the stenosis of the right internal carotid artery at the level of the cervical bifurcation. This is the first report of medullary infarction with persistent carotid-basilar anastomosis. We suspected this medullary infarction was caused by artery to artery embolism in the branch of the right vertebral artery through the PPHA distal originated from the stenosis of the right internal carotid artery.

  20. Administration of recombinant human granulocyte colony-stimulating factor (rhG-CSF) for the intracranial hemorrhage in two dogs: a case report

    PubMed Central

    Kang, M. H.; Park, H. M.

    2016-01-01

    Two dogs with generalized seizures were evaluated. The dogs were diagnosed with traumatic intracranial hemorrhages based on the history, neurological examinations, and magnetic resonance imaging (MRI) of the brain. Treatment was started with oxygen, prednisolone and anticonvulsant agents. No further seizure activity was observed after treatment in both dogs, however cushing reflex was detected in case 1 and a left-sided hemi-paresis was detected in case 2. Further supportive treatment with recombinant human granulocyte colony-stimulating factor (rhG-CSF) was attempted. No abnormal signs were noted in either of the dogs and no recurrence was noted 16 and 14 months later, in case 1 and 2, respectively. These cases indicate that a combination of rhG-CSF treatment with previous therapy could be used in dogs with traumatic brain injury. PMID:27656233

  1. Otopathology of Vasculitis in Granulomatosis With Polyangitis.

    PubMed

    Santos, Felipe; Salviz, Mehti; Domond, Haris; Nadol, Joseph B

    2015-12-01

    To describe the temporal bone histopathology of vasculitis in granulomatosis with polyangitis. Granulomatosis with polyangitis is an autoimmune disease that presents as granulomatosis and vasculitis. Otologic findings, including otitis media, hearing loss, vertigo, and facial paralysis are common in this condition. The temporal bones of four subjects with manifestations of vasculitis attributed to granulomatosis with polyangitis were studied under light microscopy. The four subjects had manifestations of vasculitis including hemorrhage within the cochlea and vestibule, and inflammation and occlusion of vessels in the lateral cochlear wall and the vasa nervorum of the facial nerve. We infer that sensorineural hearing loss, vestibulopathy, and facial nerve paresis in granulomatosis with polyangitis can be the results of vasculitis.

  2. Painful Spastic Hip Dislocation: Proximal Femoral Resection

    PubMed Central

    Albiñana, Javier; Gonzalez-Moran, Gaspar

    2002-01-01

    The dislocated hip in a non-ambulatory child with spastic paresis tends to be a painful interference to sleep, sitting upright, and perineal care. Proximal femoral resection-interposition arthroplasty is one method of treatment for this condition. We reviewed eight hips, two bilateral cases, with a mean follow-up of 30 months. Clinical improvement was observed in all except one case, with respect to pain relief and sitting tolerance. Some proximal migration was observed in three cases, despite routine post-operative skeletal traction in all cases and careful soft tissue interposition. One case showed significant heterotopic ossification which restricted prolonged sitting. This patient needed some occasional medication for pain. PMID:12180614

  3. Transient unilateral oculomotor palsy and severe headache in childhood Kawasaki disease.

    PubMed

    Thapa, Rajoo; Mallick, Debkrishna; Biswas, Biswajit; Chakrabartty, Subroto

    2011-01-01

    Transient affliction of the cranial nerves may at times be either the presenting feature or complication of otherwise uncomplicated Kawasaki disease (KD) in infants and children. The present report describes a 6 year 9 month old boy with classical KD who developed right-sided oculomotor nerve palsy (manifested by ipsilateral ptosis and medial rectus palsy) resulting in symptoms like severe nausea, intense frontal headache and double vision. The palsy resolved within 5 days of intravenous immunoglobulin therapy, with no residual ophthalmological abnormality at 6 weeks. Besides increased intracranial pressure, which commonly occurs during the course of KD in children, secondary to aseptic meningitis, intense headache in such children may have cranial nerve paresis as accentuating factors.

  4. Lumbosacral intervertebral disk disease in six cats.

    PubMed

    Harris, Jennipher E; Dhupa, Sarit

    2008-01-01

    Medical records of six cats diagnosed with lumbosacral intervertebral disk disease were reviewed. Clinical signs included reluctance to jump, low tail carriage, elimination outside the litter box, reluctance to ambulate, pelvic-limb paresis, urinary incontinence, and constipation. All cats had lumbosacral hyperpathia on palpation. Computed tomography in four cats revealed evidence of extradural spinal cord compression at the seventh lumbar (L(7)) to first sacral (S(1)) vertebral interspace. Compression was confirmed via myelography in three of these four cats, with confirmation in the fourth cat at the time of decompressive laminectomy. Each of the six cats underwent dorsal decompressive laminectomy at the L(7) to S(1) interspace. Postoperative clinical follow-up lasted 3 to 35 months, with most cats having excellent outcomes.

  5. Pediatric pseudotumor cerebri (idiopathic intracranial hypertension).

    PubMed

    Lessell, S

    1992-01-01

    This review focuses on the features of pseudotumor cerebri in the pediatric age group. There is no sex predilection in children, and obesity does not appear to be an important factor. Infants and young children may present with irritability, apathy, or somnolence, rather than headache. Dizziness and ataxia may also occur. Papilledema is infrequently noted in pediatric patients if the fontanelles are open or the sutures are split. Pre-adolescents appear more likely than adults or adolescents to have manifestations of their pseudotumor cerebri other than headache and papilledema, including lateral rectus pareses, vertical strabismus, facial paresis, back and neck pain. Among the etiologies that are particularly pertinent to children are tetracycline therapy, malnutrition or renutrition, and the correction of hypothyroidism. Children with pseudotumor cerebri are at risk for visual loss and their visual function must be closely monitored. Surgical intervention is imperative when vision is threatened.

  6. Debilitating clinical disease in a wild-born captive western lowland gorilla (Gorilla gorilla gorilla) co-infected with varicella zoster virus (VZV) and simian T-lymphotropic virus (STLV).

    PubMed

    Masters, Nicholas; Niphuis, Henk; Verschoor, Ernst; Breuer, Judith; Quinlivan, Mark; Wawrzynczyk, Teresa; Stidworthy, Mark

    2010-12-01

    A wild-born, 34-yr-old female western lowland gorilla (Gorilla gorilla gorilla) was transferred between zoologic collections in the United Kingdom. Adjustment to its new environment was difficult and a series of health problems ensued. Progressive severe illness of multiple etiologies, and a failure to respond to multiple therapies, led to its euthanasia 5 mo later. Disease processes included severe thoracic and axillary cutaneous ulceration of T2-3 dermatome distribution, gastroenteritis, ulcerative stomatitis, emaciation, hind limb weakness or paresis, and decubitus ulcers of the ankles and elbows. Ante- and postmortem infectious disease screening revealed that this animal was not infected with Mycobacterium tuberculosis, simian varicella virus (SVV), simian immunodeficiency virus (SIV), or hepatitis B virus; but was infected with varicella-zoster virus (VZV) and simian T-lymphotropic virus (STLV). It is hypothesized that recrudescence of VZV and other disease processes described were associated with chronic STLV infection and the end of a characteristically long incubation period.

  7. The Variegate Neurological Manifestations of Varicella Zoster Virus Infection

    PubMed Central

    Nagel, Maria A.; Cohrs, Randall J.; Mahalingam, Ravi

    2014-01-01

    Varicella zoster virus (VZV) is an exclusively human neurotropic alphaherpesvirus. Primary infection causes varicella (chickenpox), after which the virus becomes latent in ganglionic neurons along the entire neuraxis. With advancing age or immunosuppression, cell-mediated immunity to VZV declines, and the virus reactivates to cause zoster (shingles), dermatomal distribution, pain, and rash. Zoster is often followed by chronic pain (postherpetic neuralgia), cranial nerve palsies, zoster paresis, vasculopathy, meningoencephalitis, and multiple ocular disorders. This review covers clinical, laboratory, and pathological features of neurological complications of VZV reactivation, including diagnostic testing to verify active VZV infection in the nervous system. Additional perspectives are provided by discussions of VZV latency, animal models to study varicella pathogenesis and immunity, and of the value of vaccination of elderly individuals to boost cell-mediated immunity to VZV and prevent VZV reactivation. PMID:23884722

  8. Suspected cervical spinal cord vascular anomaly in an African warthog (Phacochoerus africanus).

    PubMed

    Whiteside, Douglas P; Shury, Todd K; Black, Sandra R; Raverty, Stephen

    2006-09-01

    Vascular myelopathies of the spinal cord have not been described in Suidae, and are a rare finding in companion animals. An 8.5-yr female African warthog (Phacochoerus africanus) presented with an acute onset of tetraparesis. Based on neurologic findings, a cervical spinal cord lesion between C7-T2 was suspected. Magnetic resonance imaging revealed severe intramedullary hemorrhage with suspected abnormal vessels in the spinal cord at the level of the seventh cervical vertebrae. The acute onset of clinical signs and rapid deterioration of neurological status precluded surgical managements. A vascular anomaly was suspected on gross pathology and histology. Immunohistochemistry identified the lesion as a spontaneous intramedullary hematoma. Spontaneous intramedullary hematomyelia should be considered as a differential for acute onset of paresis in suid species.

  9. Percutaneous CT-guided treatment of recurrent spinal cyst hydatid.

    PubMed

    Ozdemir, Ozgur; Calisaneller, Tarkan; Yildirim, Erkan; Altinors, Nur

    2011-01-01

    The involvement of spinal column in cyst hydatid disease is rare and hard to treat. The gold standard treatment is total removal of the cysts without rupture. However, recurrence after surgery is almost inevitable and reoperations carries technical difficulties and higher morbidity. We present a 69-year-old woman with two cystic masses at the T12 level, which compress the spinal cord causing severe paresis in her left leg. Under local anestesia, the cysts were aspirated and irrigated with 20% hypertonic saline solution via bilateral T12 transpedicular route. We aimed to report that percutaneous CT guided treatment should be considered as an alternative therapeutic option in case of recurrent spinal cyst hydatid.

  10. [Acquired inflammatory neuropathies in children and their therapy].

    PubMed

    Kaciński, M

    2001-01-01

    Neuropathies where there is an association with acquired peripheral nerves dysfunction and inflammation include inflammatory neuropathies (IN), as well as sequelae of vaccinations involving peripheral nerves. In a small portion of these diseases central nervous system is involved. In the years 1996-2000, among 22 children with acute flaccid paresis who were hospitalized in the Kraków Department of Paediatric Neurology, there were 16 patients with IN, including 13 with Guillain-Barré syndrome, single cases of Miller-Fisher syndrome, chronic inflammatory demyelinating polyneuropathy involving central nervous system and neuroborreliosis. Additionally, four children were hospitalized for optic neuritis. The author presents data on aetiology, electrophysiology and follow-up of these patients, as well as describes the management and outcome. Apart from their cognitive and practical value, these data significantly correspond with the currently implemented program of poliomyelitis eradication.

  11. Mislaid dentures: a cause for unusual presentation of bilateral vocal cord palsy.

    PubMed

    Vallamkondu, Vamsidhar; Gatenby, Andrew; Shakeel, Muhammad; Hussain, Akhtar

    2014-08-19

    An 81-year-old man was referred urgently to the head and neck clinic with symptoms of worsening dysphagia, dysphonia and weight loss. He had a history of chronic lymphocytic leukaemia. On full ear, nose and throat examination, he was found to have fixed vocal cords with pooling of saliva in the bilateral pyriform fossa. Hypopharyngeal malignancy was suspected and further imaging was performed. Imaging also raised the suspicion of malignancy in the hypopharynx. Rigid endoscopic examination under general anaesthesia was carried out which revealed an impacted denture in the cricopharynx and upper oesophagus. The patient was aware of his loss of dentures 3 months ago (corresponds to the onset of his symptoms) but felt that he had mislaid them and had never mentioned this to anyone. We present a case highlighting a delay in diagnosis, a missed diagnosis on CT scan and an unusual presentation leading to bilateral vocal cord paresis. 2014 BMJ Publishing Group Ltd.

  12. Patulin produced by an Aspergillus clavatus isolated from feed containing malting residues associated with a lethal neurotoxicosis in cattle.

    PubMed

    Sabater-Vilar, Monica; Maas, Roel F M; De Bosschere, Hendrik; Ducatelle, Richard; Fink-Gremmels, Johanna

    2004-11-01

    A severe neurotoxicosis, comprising tremors, ataxia, paresis, recumbency and death, occurred simultaneously among several herds of beef cattle in the region of Flanders (Belgium). After a first multi-toxin screening of some suspected diet elements, verruculogen was detected in a sample of a common feed ingredient. However, when the first animal necropsies revealed serious nervous lesions, including neuronal degeneration of the central nervous system and axonal degeneration in the peripheral nervous system, further investigations focused on fungal isolation. As expected from the pathological lesions, Aspergillus clavatus was found to be the dominant fungal species in a sample of compacted fodder, containing malting residues, consumed by all the affected herds. The isolated fungus appeared to produce patulin in culture medium. Traces of patulin were also detected in the fodder. These findings and their possible role in the intoxication are discussed.

  13. Unsuccessful cyclosporine plus prednisolone therapy for autoimmune meningoencephalitis in three dogs.

    PubMed

    Jung, Dong-In; Lee, Hee-Chun; Ha, Jeongim; Jung, Hae-Won; Jeon, Joon-Hyeok; Moon, Jong-Hyun; Lee, Jae-Hoon; Kim, Na-Hyun; Sur, Jung-Hyang; Kang, Byeong-Teck; Cho, Kyu-Woan

    2013-12-30

    A 4-year-old female Maltese (case 1), a 9-year-old castrated male shih tzu (case 2) and 2-year-old female Pomeranian (case 3) presented with neurological signs, such as head tilt, ataxia, circling and paresis. The three cases were tentatively diagnosed as having meningoencephalitis of unknown etiology based on computed tomography scan and cerebrospinal fluid analysis. All patients were managed with cyclosporine plus prednisolone therapy. The survival times of the three patients were 170, 70 and 21 days, respectively. After the cases died, we performed necropsy and histopathological examination for definitive diagnosis. Based on the necropsy, histopathological and immunohistochemical examinations, cases 1, 2 and 3 were definitely diagnosed as having necrotizing meningoencephalitis, necrotizing leukoencephalitis and granulomatous meningoencephalitis, respectively. This case report demonstrated the clinical findings, brain CT characteristics and histopathological and immunohistochemical features of NME, NLE and GME in dogs and discussed the reason for the relatively short survival times under cyclosporine plus prednisolone therapy.

  14. An autopsy case of sudden unexpected death due to a glial cyst of the pineal gland.

    PubMed

    Na, Joo-Young; Lee, Kyung-Hwa; Kim, Hyung-Seok; Park, Jong-Tae

    2014-09-01

    Pineal cysts are usually asymptomatic; however, they may rarely cause symptoms such as chronic headache, paroxysmal headache with gaze paresis, postural syncope, loss of consciousness, and sudden death. A 30-year-old woman with no specific medical history except chronic headache was found collapsed in a public toilet per se. Postmortem examination revealed no external injuries or internal diseases except a cystic lesion of the pineal gland. Histologic examination showed an internal cyst surrounded by glial tissues and pineal parenchyma that was diagnosed as a glial cyst of the pineal gland. Although the pineal cyst cannot be confirmed as the cause of death, it was considered, as no other cause was evident. Herein, we report a pineal cyst considered as an assumed cause of death.

  15. [Calcification of the cervical ligamentum flavum. Case report and review of the literature].

    PubMed

    Guesmi, H; Lamouchi, T; Mlaiki, A; Ksira, I; Tlili, K; Krifa, H

    2005-12-01

    Calcification of the cervical ligamentum flavum is a rare entity observed exclusively in Japanese people. We report a new case in a 65-year-old man from Tunisia who presented with symptoms of cervical myelopathy with mild tetra paresis, sensory abnormalities and dysuria. Magnetic resonance imaging (MRI) showed a posterior compression of the spinal cord at C3-C4. CT-scan showed a calcification of the ligamentum flavum at level C3-C4, compressing the left postero-lateral aspect of the spinal cord. C3-C4 laminectomy was performed with removal of abnormal ligamentum flavum tissue. The postoperative course was uneventful and all symptoms resolved. Calcification of the cervical ligamentum flavum is a rare entity; the diagnosis is easy but the pathogenesis remains unclear. Literature regarding this pathology is reviewed.

  16. Distinguishing postganglionic from preganglionic lesions. Studies in rabbits with surgically produced Horner's syndrome.

    PubMed

    Skarf, B; Czarnecki, J S

    1982-08-01

    It has been suggested that the pupillary response to hydroxyamphetamine hydrobromide eyedrops will separate distal from proximal lesions of the sympathetic pathway from the brain to the eye (the pupil fails to dilate in postganglionic lesions). We studied the pupillary response to hydroxyamphetamine in two groups of rabbits with surgically produced Horner's syndrome. Rabbits in one group had postganglionic lesions. In all animals, a miotic pupil developed ipsilateral to the surgical lesion, and oculosympathetic paresis was confirmed in each by testing pupillary response to topically applied cocaine. In rabbits with postganglionic lesions, hydroxyamphetamine failed to dilate the miotic (Horner's) pupils as well as it dilated the normal pupils, while in rabbits with preganglionic lesions both miotic and normal pupils dilated equally. Hydroxyamphetamine appears to be a diagnostically useful drug in Horner's syndrome.

  17. Bilateral perisylvian infarct: a rare cause and a rare occurrence.

    PubMed

    Singh, A; Kate, M P; Nair, M D; Kesavadas, C; Kapilamoorthy, T R

    2011-04-01

    Foix-Chavany-Marie opercular syndrome is a severe form of pseudobulbar palsy occurring due to bilateral anterior opercular lesions. We report a case of a 51-year-old man with sudden onset of inability to speak and dysphagia, and a history of synovial sarcoma of the right hand. Detailed language evaluation was normal. The patient had right upper motor neuron facial paresis and absent gag reflex bilaterally. Magnetic resonance (MR) imaging revealed acute and subacute infarcts involving the bilateral insular cortex. Two-dimensional echocardiography and cardiac MR imaging showed a mobile mass in the left atrium attached to the interatrial septum, which was likely a myxoma. Chest radiograph and computed tomography imaging of the chest revealed multiple cannonball shadows that were suggestive of secondaries in the lung. The probable cause of the cerebral lesions was the mass lesion in the heart or metastatic lesions from the synovial sarcoma. The cardiac surgeon and surgical oncologist recommended palliative care.

  18. ASSESSMENT OF UPPER EXTREMITY IMPAIRMENT, FUNCTION, AND ACTIVITY FOLLOWING STROKE: FOUNDATIONS FOR CLINICAL DECISION MAKING

    PubMed Central

    Lang, Catherine E.; Bland, Marghuretta D.; Bailey, Ryan R.; Schaefer, Sydney Y.; Birkenmeier, Rebecca L.

    2012-01-01

    The purpose of this review is to provide a comprehensive approach for assessing the upper extremity (UE) after stroke. First, common upper extremity impairments and how to assess them are briefly discussed. While multiple UE impairments are typically present after stroke, the severity of one impairment, paresis, is the primary determinant of UE functional loss. Second, UE function is operationally defined and a number of clinical measures are discussed. It is important to consider how impairment and loss of function affect UE activity outside of the clinical environment. Thus, this review also identifies accelerometry as an objective method for assessing UE activity in daily life. Finally, the role that each of these levels of assessment should play in clinical decision making is discussed in order to optimize the provision of stroke rehabilitation services. PMID:22975740

  19. Spontaneous iliopsoas muscle haematoma as a complication of anticoagulation in acute cerebral venous thrombosis: to stop or not to stop (the anticoagulation)?

    PubMed Central

    Fernandes, Carina; Pereira, Pedro; Rodrigues, Miguel

    2015-01-01

    Spontaneous iliopsoas muscle haematoma is an infrequent complication of anticoagulation, potentially causing neurological dysfunction through compression of the femoral nerve or lumbar plexus. The authors report the case of a puerperal woman admitted for an extensive cerebral venous thrombosis. Anticoagulation was started, with clinical improvement. The patient later reported low back pain irradiating to the right thigh and developed neurological impairment consistent with lumbar plexus dysfunction. A pelvic CT scan revealed a right iliopsoas muscle haematoma. Considering the risk of anticoagulation suspension, a conservative approach was chosen, with maintenance of anticoagulation. Clinical and functional improvement occurred, with mild right hip and knee flexion paresis as sequelae. Anticoagulation complications are challenging, especially when interruption of anticoagulation may threaten vital and functional outcomes. Therefore, a careful evaluation is essential, since no clinical guidelines are available. In this case, continuing anticoagulation provided a good functional outcome. PMID:25750219

  20. Direct approach to the ventrolateral medulla for cavernous malformation--case report.

    PubMed

    Oshiro, Shinya; Yamamoto, Masaaki; Fukushima, Takeo

    2002-10-01

    A 49-year-old man presented with symptomatic cavernous malformation in the ventrolateral portion of the medulla oblongata manifesting as left-sided numbness and gait disturbance. Neurological examination disclosed sensory disturbance on the left, cerebellar ataxia, nystagmus, dysphagia, and right hypoglossal nerve paresis. Magnetic resonance imaging revealed a cavernous malformation with hemorrhage occupying the right paramedian field of the medulla oblongata. The patient underwent complete removal of the lesion through vertical incision of the bulging surface of the ventrolateral medulla, anatomically coinciding with the inferior olive. The neurological deficits improved without additional postoperative deficits. This unusual microsurgical approach through a ventrolateral medullary incision permits direct resection of a subpial intrinsic lesion, even on the ventral medulla.

  1. [Effects of steroid therapy on long-term canal prognosis and activity in the daily life of vestibular neuronitis patients].

    PubMed

    Kitahara, T; Okumura, S; Takeda, N; Nishiike, S; Uno, A; Fukushima, M; Kubo, T

    2001-11-01

    We studied 28 patients with vestibular neuronitis treated at our hospital between 1997 and 1999. To determine the effects of steroid therapy on long-term canal prognosis and daily activity, we examined caloric tests and gave questionnaires to 12 steroid-treated and 16 nonsteroid-treated patients 2 years after onset. We found that canal improvement was 50% in the nonsteroid-treated group and 75% in the steroid-treated one. In cases with severe canal paresis (CP > or = 60%), canal improvement was 33% in the nonsteroid-treated group and 67% in the steroid-treated one. Steroid therapy at the acute stage of this disease significantly reduced the duration of spontaneous nystagmus and handicap in daily life due to dizziness induced by head and body movement, decreasing mood disturbance.

  2. Does C5 or C6 Radiculopathy Affect the Signal Intensity of the Brachial Plexus on Magnetic Resonance Neurography?

    PubMed Central

    Seo, Tae Gyu; Kim, In-Soo; Son, Eun Seok

    2016-01-01

    Patients with C5 or C6 radiculopathy complain of shoulder area pain or shoulder girdle weakness. Typical idiopathic neuralgic amyotrophy (INA) is also characterized by severe shoulder pain, followed by paresis of shoulder girdle muscles. Recent studies have demonstrated that magnetic resonance neurography (MRN) of the brachial plexus and magnetic resonance imaging (MRI) of the shoulder in patients with INA show high signal intensity (HSI) or thickening of the brachial plexus and changes in intramuscular denervation of the shoulder girdle. We evaluated the value of brachial plexus MRN and shoulder MRI in four patients with typical C5 or C6 radiculopathy. HSI of the brachial plexus was noted in all patients and intramuscular changes were observed in two patients who had symptoms over 4 weeks. Our results suggest that HSI or thickening of the brachial plexus and changes in intramuscular denervation of the shoulder girdle on MRN and MRI may not be specific for INA. PMID:27152289

  3. Guillain-Barré Syndrome After Zika Virus Infection in Brazil.

    PubMed

    do Rosário, Mateus Santana; de Jesus, Pedro Antonio Pereira; Vasilakis, Nikos; Farias, Daniel Santana; Novaes, Marco Antônio Caires; Rodrigues, Sueli Guerreiro; Martins, Lívia Caricio; Vasconcelos, Pedro Fernando da Costa; Ko, Albert Icksang; Alcântara, Luiz Carlos Junior; de Siqueira, Isadora Cristina

    2016-11-02

    Zika virus (ZIKV) is an emerging flavivirus, which has caused a widespread outbreak in the Americas. Shortly after its introduction in 2015, a cluster of cases with Guillain-Barré syndrome was detected in Brazil. Herein, we describe two cases from the city of Salvador, who developed ascending paresis after an acute exanthematous illness. The patients were admitted to the intensive care unit with tetraparesis and cranial nerve palsy, which resolved after intravenous administration of human immunoglobulin. Serological evaluation detected IgM-specific ZIKV antibodies. In regions of Zika virus transmission, health-care workers must be aware of the potential severe neurological complications associated with ZIKV infection and be prepared to provide prompt diagnosis, treatment, and supportive care. © The American Society of Tropical Medicine and Hygiene.

  4. [Clinical problems in medical mycology: Problem number 47].

    PubMed

    Corti, Marcelo; Muzzio, Estela; Villafañe, María Florencia; Priarone, María Marta; Messina, Fernando; Arechavala, Alicia; Maiolo, Elena; Negroni, Ricardo; Franze, Oscar

    2013-01-01

    A 66 year-old man, who had lived in Paraguay and was a rural worker, was admitted to Infectious Diseases Hospital F. J. Muñiz in Buenos Aires. He presented fever, loss of body weight, cough, mucopurulent expectoration, wide perianal ulceration, paresthesia and paresis of both legs as well as vesical and anal sphincter dysfunction. He was a heavy smoker and drinker. Thorax X-ray examination showed bilateral micronodular interstitial lesions. With a NMR of the dorsolumbar spine region a nodular lesion outside the spinal cord (which produced compression of this organ) was shown. The diagnosis of disseminated paracoccidiodomycosis was based on the finding of Paracoccidioides brasiliensis in the skin ulcer in histopathology and mycology studies, and on the positive results of serologic tests with paracoccidioidin antigen. The patient was treated with trimethoprim-sulfamethoxazole with good clinical outcome.

  5. A woman with forearm amyotrophy

    PubMed Central

    Sagui, Emmanuel; Correa, Éléonore; Ricobono, Diane; Bregigeon, Michel; Brosset, Christian

    2009-01-01

    We present the case of a 33-year-old woman with benign sporadic monomelic amyotrophy of the distal part of the arm, called Hirayama disease. Clinical features included forearm amyotrophy sparing the brachioradialis muscle, cold paresis and causalgia. Neck magnetic resonance imaging was normal in neutral and flexion position. Electromyography showed denervated patterns in the extensor digitorum communis, and conduction studies ruled out multifocal motor neuropathy. Motor evoked potentials were normal. Serum IgG anti-GM1 antibodies were moderately raised but were negative 8 months later. Outcome was favourable within 15 months, with partial motor recovery. Pathogenesis remains controversial: neck flexion induced myelopathy via chronic anterior horn ischaemia due to forward displacement of the posterior wall of the dura mater, or benign variant of lower motor neuron disease? Whatever the pathomechanism is, the clinical features and outcome are the same. PMID:22171230

  6. A woman with forearm amyotrophy.

    PubMed

    Sagui, Emmanuel; Correa, Eléonore; Ricobono, Diane; Bregigeon, Michel; Brosset, Christian

    2009-01-01

    We present the case of a 33-year-old woman with benign sporadic monomelic amyotrophy of the distal part of the arm, called Hirayama disease. Clinical features included forearm amyotrophy sparing the brachioradialis muscle, cold paresis and causalgia. Neck magnetic resonance imaging was normal in neutral and flexion position. Electromyography showed denervated patterns in the extensor digitorum communis, and conduction studies ruled out multifocal motor neuropathy. Motor evoked potentials were normal. Serum IgG anti-GM1 antibodies were moderately raised but were negative 8 months later. Outcome was favourable within 15 months, with partial motor recovery. Pathogenesis remains controversial: neck flexion induced myelopathy via chronic anterior horn ischaemia due to forward displacement of the posterior wall of the dura mater, or benign variant of lower motor neuron disease? Whatever the pathomechanism is, the clinical features and outcome are the same.

  7. Nonlinear dynamic mechanism of vocal tremor from voice analysis and model simulations

    NASA Astrophysics Data System (ADS)

    Zhang, Yu; Jiang, Jack J.

    2008-09-01

    Nonlinear dynamic analysis and model simulations are used to study the nonlinear dynamic characteristics of vocal folds with vocal tremor, which can typically be characterized by low-frequency modulation and aperiodicity. Tremor voices from patients with disorders such as paresis, Parkinson's disease, hyperfunction, and adductor spasmodic dysphonia show low-dimensional characteristics, differing from random noise. Correlation dimension analysis statistically distinguishes tremor voices from normal voices. Furthermore, a nonlinear tremor model is proposed to study the vibrations of the vocal folds with vocal tremor. Fractal dimensions and positive Lyapunov exponents demonstrate the evidence of chaos in the tremor model, where amplitude and frequency play important roles in governing vocal fold dynamics. Nonlinear dynamic voice analysis and vocal fold modeling may provide a useful set of tools for understanding the dynamic mechanism of vocal tremor in patients with laryngeal diseases.

  8. Electrophysiologic nerve stimulation for identifying the recurrent laryngeal nerve in thyroid surgery: review of 70 consecutive thyroid surgeries.

    PubMed

    Echeverri, A; Flexon, P B

    1998-04-01

    To describe a simple technique for identifying the recurrent laryngeal nerve (RLN) with a nerve stimulator to prevent damage to the nerve during thyroid surgery. A retrospective review of 70 thyroidectomies performed from October 1989 to January 1995 by one surgeon using electrophysiologic nerve stimulation to identify the RLN was conducted. The technique is described. Outpatient flexible fiberoptic laryngoscopy was performed preoperatively and postoperatively in all patients. From 70 thyroidectomies, 80 RLNs were identified to be at risk for injury. Five patients had transient unilateral vocal cord paresis postoperatively. No RLN transection or permanent vocal cord paralysis occurred. This is the first large series of patients undergoing the use of electrophysiologic nerve stimulation for identifying the RLN during thyroid surgery. We found the technique to be useful and safe for identifying the RLN. We present this technique as a less costly and time-consuming alternative to intraoperative RLN monitoring.

  9. Gait apraxia after bilateral supplementary motor area lesion

    PubMed Central

    Della, S; Francescani, A; Spinnler, H

    2002-01-01

    Objectives: The study aimed at addressing the issue of the precise nature of gait apraxia and the cerebral dysfunction responsible for it. Methods: The case of a patient, affected by a bilateral infarction limited to a portion of the anterior cerebral artery territory is reported. The patient's ability to walk was formally assessed by means of a new standardised test. Results: Due to an anomaly within the anterior cerebral artery system, the patient's lesion was centred on the supplementary motor regions of both hemispheres. He presented with clear signs of gait apraxia that could not be accounted for by paresis or other neurological deficits. No signs of any other form of apraxia were detected. Conclusions: The clinical profile of the patient and the analysis of 49 cases from previous literature suggest that gait apraxia should be considered a clinical entity in its own right and lesions to the supplementary motor areas are responsible for it. PMID:11784830

  10. Staged endoscopic ventricular foreign body removal in a gyr falcon (Falco rusticolus).

    PubMed

    Lloyd, Christopher

    2009-12-01

    A large ventricular foreign body was identified on radiographs in a captive-bred gyr falcon (Falco rusticolus) that was presented for paresis and swollen abdomen. On endoscopic examination, a large shiny mass was visible in the ventriculus. An ingluviotomy was done, and pieces of the mass, which consisted of a ball of artificial grass fibers, were removed by using a rigid endoscope and grasping forceps. Subsequently, 4 more ingluviotomies were required to gain endoscopic access to the ventriculus and to allow staged removal of the mass in a piecemeal fashion. Feeding the falcon a feathered quail and allowing it to cast naturally removed the remaining fibers of the mass. No deleterious effects were observed in the bird.

  11. [Transient Horner's syndrome after single shot paravertebral block].

    PubMed

    Gölboyu, Birzat Emre; Ekinci, Mürsel; Baysal, Pınar Karaca; Yeksan, Ayşe Nur; Çelik, Erkan Cem; Bilgi, Zeynep; Aksun, Murat

    2017-05-17

    Thoracic paravertebral block can provide analgesia for unilateral chest surgery and is associated with a low complication rate. Horner syndrome also referred to as oculosympathetic paresis, is a classic neurologic constellation of ipsilateral blepharoptosis, pupillary miosis, and facial anhidrosis resulting from disruption of the sympathetic pathway supplying the head, eye, and neck. We present a patient with an ipsilateral transient Horner syndrome after ultrasound guided single shot of 15mL 0.25% levobupivacaine for thoracic paravertebral block at T5-6 level. It should be kept in mind that even a successful ultrasound guided single shot thoracic paravertebral block can be complicated with Horner syndrome due to unpredictable distribution of the local anesthetic. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  12. Sarcopenia or muscle modifications in neurologic diseases: a lexical or patophysiological difference?

    PubMed

    Carda, S; Cisari, C; Invernizzi, M

    2013-02-01

    Sarcopenia is a condition characterized by a decrease in muscle mass and function (strength and mobility) that is frequently observed in the elderly. In people with paresis and altered mobility due to central nervous system (CNS) diseases, this definition then may not be applicable. In CNS diseases, mainly stroke and spinal cord injury, different and specific patterns of muscle loss and muscle changes have been described, due to denervation, disuse atrophy, spasticity and myosteatosis. The main observations available about these phenomena in CNS diseases are reviewed, and a broad view on the specific physiopathological mechanisms is also described. Moreover, a description of the potential pharmacological targets and treatment strategies (physical and nutritional) is provided. Since sarcopenia of the elderly and muscle modifications and muscle atrophy in CNS diseases have different mechanisms, it is probable that they do not respond equally to the same treatments.

  13. Modern Neurosyphilis: A Partially Treated Chronic Meningitis

    PubMed Central

    Hotson, John R.

    1981-01-01

    Approximately 5,000 new cases of neurosyphilis may occur in the United States each year. General paresis and tabes dorsalis, however, have become relatively rare since the introduction of penicillin. Seizures, neuro-ophthalmologic symptoms, stroke and acute meningoencephalitis are currently the most common manifestations of neurosyphilis. In more than a third of patients with neurosyphilis, nontreponemal tests for syphilis (such as VDRL) are negative and should not be used to exclude the diagnosis. Specific treponemal tests are more sensitive and more specific. Examination of the cerebrospinal fluid may show no abnormalities in neurosyphilis and is not an infallible guide to the activity of the infection. Penicillin is the only proven antibiotic treatment of neurosyphilis. However, low-dose regimens do not produce spirocheticidal concentrations in the brain, and high-dose penicillin therapy is recommended to insure eradication of the spirochetes. Doxycycline, a tetracycline derivation that achieves relatively high concentration in the brain, may also be effective. PMID:7340118

  14. Evaluation of a physiotherapeutic treatment intervention in "Bell's" facial palsy.

    PubMed

    Cederwall, Elisabet; Olsén, Monika Fagevik; Hanner, Per; Fogdestam, Ingemar

    2006-01-01

    The aim of this study was to evaluate a physiotherapeutic treatment intervention in Bell's palsy. A consecutive series of nine patients with Bell's palsy participated in the study. The subjects were enrolled 4-21 weeks after the onset of facial paralysis. The study had a single subject experimental design with a baseline period of 2-6 weeks and a treatment period of 26-42 weeks. The patients were evaluated using a facial grading score, a paresis index and a written questionnaire created for this study. Every patient was taught to perform an exercise program twice daily, including movements of the muscles surrounding the mouth, nose, eyes and forehead. All the patients improved in terms of symmetry at rest, movement and function. In conclusion, patients with remaining symptoms of Bell's palsy appear to experience positive effects from a specific training program. A larger study, however, is needed to fully evaluate the treatment.

  15. Spondylitis in broiler breeder farms in West-Azerbaijan province, Iran: Clinical Report

    PubMed Central

    Talebi, Alireza; Taifebagherlu, Jafar; Sharifi, Arian; Delkhosh-Kasmaie, Fatemeh

    2016-01-01

    Spondylitis is a reemerging epidemic spinal infection in male broiler chickens (5 to 7 weeks of age) as well as broiler breeder roosters (15 to 18 weeks of age). Among various causative agents, Enterococcus species and in particular E. cecorum, a gram-positive bacterium as a gastrointestinal flora of birds, have mostly been isolated. On late September 2015, a number of 10 weeks old roosters with characteristic clinical signs of lameness and hock-sitting posture were autopsied. During thorough general routine post-mortem examinations, abnormalities like nodular masses correlated well with the hock-sitting posture and posterior paresis/paralysis were observed in joint spaces on the caudal thoracic vertebral column (T6-T7) immediately anterior to the kidneys in all affected birds. At histopathological examinations, osteomyelitis with limited pathological lesions including mononuclear inflammatory cells infiltration and edema in spinal cord were seen and the infection was diagnosed as an acute spondylosis. PMID:28144429

  16. [Herpes zoster and postherpetic neuralgia].

    PubMed

    Wollina, U; Machetanz, J

    2016-08-01

    Herpes zoster develops by endogenous reactivation of varizella zoster virus (VZV). Incidence increases with age. Females are more frequently affected than males. The reactivation rate in seropositive individuals is about 20 %. After a short prodromal stage, herpetiform-grouped vesicles appear in segmental arrangement. Pain and paresthesia are typical zoster symptoms. Complications like bacterial superinfections, vasculopathy, paresis, and oculopathy may occur. During pregnancy herpes zoster is a threat for mother and child. Among elderly patients, cardiovascular risk is increased during the first week of herpes zoster infection. Postherpetic neuropathy is feared. Diagnosis can be made clinically and by the use of polymerase chain reaction. First-line treatment is systemic antiviral drug therapy with either acyclovir or brivudine. Adjuvant therapies consist of pain management and topical treatment.

  17. Pseudodementia and competency.

    PubMed

    Good, M I

    1993-01-01

    An increase in the number of challenges to competency determinations in probate cases parallels an increasingly aging population. In the literature on competency determination, there is little if any discussion of the implications of pseudodementing conditions, which can quite readily be misdiagnosed as true dementias, especially in the elderly. This case report describes a patient thought to have had a stroke with dementia and paresis who turned out to have had a pseudodementia. She later made a dramatic and somewhat surprising recovery. It subsequently came to light that a nearly successful attempt had been made to defraud her of her estate during her presumed dementia, which was thought to have been irreversible. The case underscores issues in competency determination, including matters of diagnosis, prognosis, and undue influence.

  18. [30-year-old Patient with suspected Marfan Syndrome and Progressive Gait disturbance].

    PubMed

    Balke, Maryam; Lehmann, Helmar C; Fink, Gereon R; Wunderlich, Gilbert

    2017-07-01

    History A 30-year-old man presented with a history of progressive muscle weakness, difficulty in concentrating, and a slender habitus since early childhood. Marfan syndrome was suspected since the age of 14. Examinations 13 years later he was examined by Marfan experts and by genetic testing and Marfan syndrome could not be confirmed. Further neurological examination revealed the suspected diagnosis of myotonic dystrophy type 1, which was confirmed by genetic testing. Treatment and course Similar to Marfan syndrome, myotonic dystrophy is a multisystemic disorder with the risk of cardiac arrythmias. It is necessary to provide an interdisciplinary care by neurologists, internists, ophthalmologists, speech therapists, and physiotherapists. Conclusion It is not enough to take the habitus as the principle sign to diagnose Marfan syndrome. Furthermore, it is essential to consider symptoms that are not typical for Marfan syndrome, such as cognitive deficiencies or progressive paresis. © Georg Thieme Verlag KG Stuttgart · New York.

  19. Fibular nerve palsy after hip replacement: Not only surgeon responsibility. Hereditary neuropathy with liability to pressure palsies (HNPP) a rare cause of nerve liability.

    PubMed

    Logroscino, G; Del Tedesco, F; Cambise, C; Coraci, D; Donati, F; Santilli, V; Padua, L

    2016-06-01

    Mononeuropathy after surgery may occur and hereditary neuropathy with liability to pressure palsies is a possible pathological condition related to paresis after hip surgery. We present a case of 66-year-old man presenting severe weakness at inferior limb muscles after hip prosthesis revision. Clinic and electrophysiology showed severe right fibular nerve damage and ultrasound found a marked enlargement of the same nerve, associated with focal enlargements in other nerves. A diagnosis of hereditary neuropathy with liability to pressure palsies was suspected and confirmed by genetic test. The patient gradually recovered returning to a normal daily active life. Ultrasound was crucial for diagnosis. The suspicion and diagnosis of latent neuropathy, which can occur after surgical intervention, may lead to a better understand of the risks of the surgery, specific for the patient, and avoid the wrong attribution to surgical malpractice.

  20. Respiratory Management in the Patient with Spinal Cord Injury

    PubMed Central

    Galeiras Vázquez, Rita; Rascado Sedes, Pedro; Montoto Marqués, Antonio; Ferreiro Velasco, M. Elena

    2013-01-01

    Spinal cord injuries (SCIs) often lead to impairment of the respiratory system and, consequently, restrictive respiratory changes. Paresis or paralysis of the respiratory muscles can lead to respiratory insufficiency, which is dependent on the level and completeness of the injury. Respiratory complications include hypoventilation, a reduction in surfactant production, mucus plugging, atelectasis, and pneumonia. Vital capacity (VC) is an indicator of overall pulmonary function; patients with severely impaired VC may require assisted ventilation. It is best to proceed with intubation under controlled circumstances rather than waiting until the condition becomes an emergency. Mechanical ventilation can adversely affect the structure and function of the diaphragm. Early tracheostomy following short orotracheal intubation is probably beneficial in selected patients. Weaning should start as soon as possible, and the best modality is progressive ventilator-free breathing (PVFB). Appropriate candidates can sometimes be freed from mechanical ventilation by electrical stimulation. Respiratory muscle training regimens may improve patients' inspiratory function following a SCI. PMID:24089664

  1. [Surgical treatment of paralytic lagophthalmos].

    PubMed

    Schrom, T; Bast, F

    2010-03-01

    Impairment of the peripheral or central part of the facial nerve causes an ipsilateral peripheral facial nerve paresis. It is quite a common syndrome and affects 20-35 persons per 100,000 per year in Western Europe and the United States. A possible complication of facial palsy is paralytic lagophthalmos with aesthetic and functional impairment for the patient. Beside primary nerve reconstructive procedures plastic-reconstructive procedures play a major role in correcting paralytic lagophthalmos. The eyebrow, upper and lower lids, medial and lateral lid angle as well as the lacrimal system need to be seen as functional units and can be corrected with local surgical procedures. Restoration of eye closure is the most important goal in treating the affected eye. Due to the significant aesthetic limitations and resultant psychological stress for the patient cosmetic aspects must be included in the surgical concept.

  2. Nonlinear dynamic mechanism of vocal tremor from voice analysis and model simulations

    PubMed Central

    Zhang, Yu; Jiang, Jack J.

    2009-01-01

    Nonlinear dynamic analysis and model simulations are used to study the nonlinear dynamic characteristics of vocal folds with vocal tremor, which can typically be characterized by low frequency modulation and aperiodicity. Tremor voices from patients with disorders such as paresis, Parkinson's disease, hyperfunction, and adductor spasmodic dysphonia show low-dimensional characteristics, differing from random noise. Correlation dimension analysis statistically distinguishes tremor voices from normal voices. Furthermore, a nonlinear tremor model is proposed to study the vibrations of the vocal folds with vocal tremor. Fractal dimensions and positive Lyapunov exponents demonstrate the evidence of chaos in the tremor model, where amplitude and frequency play important roles in governing vocal fold dynamics. Nonlinear dynamic voice analysis and vocal fold modeling may provide a useful set of tools for understanding the dynamic mechanism of vocal tremor in patients with laryngeal diseases. PMID:22505778

  3. Transient paralysis of the bladder due to wound botulism.

    PubMed

    Sautter, T; Herzog, A; Hauri, D; Schurch, B

    2001-05-01

    In the last 10 years, wound botulism has increasingly been reported and nearly all of these new cases have occurred in injecting-drug abusers. After absorption into the bloodstream, botulinum toxin binds irreversibly to the presynaptic nerve endings, where it inhibits the release of acetylcholine. Diplopia, blurred vision, dysarthria, dysphagia, respiratory failure and paresis of the limbs are common symptoms of this intoxication. Surprisingly and despite the well-known blocking action of the botulinum toxin on the autonomic nerve system, little attention has been paid to changes in the lower urinary tract following acute botulinum toxin poisoning. Here we report a case of bladder paralysis following wound botulism. Early diagnosis and adequate management of bladder paralysis following botulism is mandatory to avoid urologic complications. Accordingly, the prognosis is usually favorable and the bladder recovery complete.

  4. Genetic connections between neurological disorders and cholesterol metabolism

    PubMed Central

    Björkhem, Ingemar; Leoni, Valerio; Meaney, Steve

    2010-01-01

    Cholesterol is an essential component of both the peripheral and central nervous systems of mammals. Over the last decade, evidence has accumulated that disturbances in cholesterol metabolism are associated with the development of various neurological conditions. In addition to genetically defined defects in cholesterol synthesis, which will be covered in another review in this Thematic Series, defects in cholesterol metabolism (cerebrotendinous xanthomatosis) and intracellular transport (Niemann Pick Syndrome) lead to neurological disease. A subform of hereditary spastic paresis (type SPG5) and Huntington's disease are neurological diseases with mutations in genes that are of importance for cholesterol metabolism. Neurodegeneration is generally associated with disturbances in cholesterol metabolism, and presence of the E4 isoform of the cholesterol transporter apolipoprotein E as well as hypercholesterolemia are important risk factors for development of Alzheimer's disease. In the present review, we discuss the links between genetic disturbances in cholesterol metabolism and the above neurological disorders. PMID:20466796

  5. Infant brachial neuritis following a viral prodrome: a case in a 6-month old child and review of the literature.

    PubMed

    Mrowczynski, Oliver D; Langan, Sara T; Rizk, Elias B

    2017-09-07

    Brachial neuritis, commonly known as Parsonage-Turner syndrome, affects two to three people per 100,000 and presents with pain and weakness of the arm and shoulder. Brachial neuritis is uncommon in infants. Here, we present the case of a 6-month old female, who presented with right upper extremity weakness and paresis following a viral prodrome. We also present a summary of all reported cases of brachial neuritis in infants. This is the youngest case of brachial neuritis diagnosed at our institution. The child was treated with prednisolone and physical therapy. The patient is now 16 months old and her symptoms have significantly improved. Brachial neuritis should be considered in the differential when an infant presents with sudden onset of upper limb weakness, following a viral prodrome. Finally, a genetic workup is suggested for patients with recurring episodes.

  6. Rare cause of bilateral sudden deafness.

    PubMed

    Vos, F I; Merkus, P; van Nieuwkerk, E B J; Hensen, E F

    2016-10-08

    In this paper, we describe the case of a 62-year-old female with recurring episodes of sudden deafness with vertigo and facial paresis. Within a month's time, this resulted in bilateral deafness and vestibular areflexia. Erroneously, the patient was diagnosed with sudden deafness of unknown origin and subsequently with neuroborreliosis (Lyme disease). The true diagnosis of relapsing polychondritis (RP) was revealed 9 months after initial presentation. The diagnostic delay is in part explained by the fact that, by definition, the disease has to relapse before the diagnosis can be made, but also by its pluriform clinical presentation. Timely identification of RP as the cause of this profound sensorineural hearing loss proved to be important. It was key in instigating adequate follow-up, and allowed for cochlear implantation before total cochlear obliteration, which might have hampered optimal hearing rehabilitation. 2016 BMJ Publishing Group Ltd.

  7. Two cases of acute toluene intoxication.

    PubMed Central

    Meulenbelt, J; de Groot, G; Savelkoul, T J

    1990-01-01

    Two patients exposed to high concentrations of toluene in air (greater than 7000 mg/m3) were found at the bottom of a small swimming pool under construction. Their symptoms were stupefaction, paresis, and amnesia. Patient A had been exposed for three hours and patient B for two hours. Ninety minutes after the exposure, the toluene blood concentration in patient A was 4.1 mg/l and in patient B 2.2 mg/l. Urinary ortho-cresol secretion was shown to be a good index of exposure to toluene. After high level exposure, urinary meta-cresol excretion may also be used to monitor toluene exposure. PMID:2378819

  8. Brachioradial pruritus in a patient with cervical disc herniation and Parsonage-Turner syndrome.

    PubMed

    Carvalho, Sandrina; Sanches, Madalena; Alves, Rosário; Selores, Manuela

    2015-01-01

    Brachioradial pruritus is a chronic sensory neuropathy of unknown etiology which affects the skin of the shoulders, arms and forearms on the insertion of the brachioradialis muscle. We describe the case of a 60-year old woman recently diagnosed with multiple myeloma who refers paresis, severe pruritus and itching lesions on the right arm with 6 months of evolution. Investigation led to a diagnosis of Brachioradial pruritus consequent to the presence of cervical disc herniation and Parsonage-Turner syndrome. The patient started gabapentin 900 mg/day with good control of itching. Corticosteroids and antihistamines are often ineffective in the treatment of BP. Gabapentin has been used with encouraging results. All patients with Brachioradial pruritus should be evaluated for cervical spine injuries.

  9. Ductus arteriosus aneurysm with community-acquired methicillin-resistant Staphylococcus aureus infection and spontaneous rupture: a potentially fatal quandary.

    PubMed

    Stewart, Audra; Dyamenahalli, Umesh; Greenberg, S Bruce; Drummond-Webb, Jonathan

    2006-06-01

    We present the case of a 6-month-old previously healthy girl who presented with high fever, labored breathing, and an enlarged cardiac silhouette on her chest radiograph. Comprehensive evaluation discovered a ductus arteriosus aneurysm and pericardial effusion with methicillin-resistant Staphylococcus aureus bacteremia. Despite pericardiocentesis and appropriate intravenous antibiotics, there was rapid enlargement of the aneurysm and accumulation of echogenic material within the ductus arteriosus aneurysm. Infected aneurysm rupture was identified during emergency surgery. This infant also had vocal cord paresis, a likely complication of the surgery. The clinical course, diagnosis, and treatment of this patient are discussed. Infection of a ductus arteriosus or an infected ductal arteriosus aneurysm is a rare and potentially fatal clinical entity. In the era of increasing community-acquired methicillin-resistant S aureus infections, this is a diagnosis that requires a high index of suspicion.

  10. Computed tomography-guided bone biopsies for evaluation of proliferative vertebral lesions in two boa constrictors (Boa constrictor imperator).

    PubMed

    Di Girolamo, Nicola; Selleri, Paolo; Nardini, Giordano; Corlazzoli, Daniele; Fonti, Paolo; Rossier, Christophe; Della Salda, Leonardo; Schilliger, Lionel; Vignoli, Massimo; Bongiovanni, Laura

    2014-12-01

    Two boa constrictors (Boa constrictor imperator) presented with paresis of the trunk originating cranial to the cloaca. Radiographs were consistent with proliferative bone lesions involving several vertebrae. Computed tomography (CT) demonstrated the presence of lytic/expansile lesions. Computed tomography-guided biopsies of the lesions were performed without complications. Histology was consistent with bacterial osteomyelitis and osteoarthritis. Gram-negative bacteria (Salmonella sp. and Pseudomonas sp.) were isolated from cultures of the biopsies. Medical treatment with specific antibiotics was attempted for several weeks in both cases without clinical or radiographic improvements. The animals were euthanized, and necropsy confirmed the findings observed upon CT. To the authors' knowledge, this is the first report of the use of CT-guided biopsies to evaluate proliferative vertebral lesions in snakes. In the present report, CT-guided biopsies were easily performed, and both histologic and microbiologic results were consistent with the final diagnosis.

  11. Madurella mycetoma--a rare case with cranial extension.

    PubMed

    Maheshwari, Shradha; Figueiredo, Antonio; Narurkar, Swati; Goel, Atul

    2010-01-01

    Madurella species of fungus causes chronic subcutaneous infection of lower extremities; the infection is commonly labeled as Madura foot. We report a case of Madurella infection involving the cranial cavity. Such an involvement by Madurella fungal infection is not recorded in the literature. A 31-year-old non-immunocompromised male patient presented with complaints of left hemifacial pain for 1 year and diplopia on looking toward left side for a period of 2 weeks. On examination, he had ipsilateral sixth nerve paresis. Investigations revealed a large paranasal sinus lesion that extended in the cavernous sinus. The lesion was partially resected. Histologic examination revealed that the lesion was a fungus Madurella mycetomi. A rare cranial extension of Madurella fungal infection is reported. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  12. Spondylitis in broiler breeder farms in West-Azerbaijan province, Iran: Clinical Report.

    PubMed

    Talebi, Alireza; Taifebagherlu, Jafar; Sharifi, Arian; Delkhosh-Kasmaie, Fatemeh

    2016-01-01

    Spondylitis is a reemerging epidemic spinal infection in male broiler chickens (5 to 7 weeks of age) as well as broiler breeder roosters (15 to 18 weeks of age). Among various causative agents, Enterococcus species and in particular E. cecorum, a gram-positive bacterium as a gastrointestinal flora of birds, have mostly been isolated. On late September 2015, a number of 10 weeks old roosters with characteristic clinical signs of lameness and hock-sitting posture were autopsied. During thorough general routine post-mortem examinations, abnormalities like nodular masses correlated well with the hock-sitting posture and posterior paresis/paralysis were observed in joint spaces on the caudal thoracic vertebral column (T6-T7) immediately anterior to the kidneys in all affected birds. At histopathological examinations, osteomyelitis with limited pathological lesions including mononuclear inflammatory cells infiltration and edema in spinal cord were seen and the infection was diagnosed as an acute spondylosis.

  13. Monensin toxicity in turkey breeder hens.

    PubMed

    Ficken, M D; Wages, D P; Gonder, E

    1989-01-01

    High mortality in two flocks of 1900 turkey breeder hens accidentally fed 280 g monensin/ton of complete feed is described. Mortality attributed to the poisoning was 76% in flock 1 and 18% in flock 2. Clinically, turkeys were found dead, exhibited respiratory distress with wings extended laterally, had fine tremors, or showed posterior paresis and inability to rise. The most striking finding at necropsy was the almost complete absence of gross lesions. Some turkeys had severely congested lungs; however, many did not. A few birds had pale streaks within the adductor muscles of the legs. Microscopic lesions included myofiber degeneration and necrosis of skeletal and myocardial muscle. Serum phosphorus, lactate dehydrogenase, and creatine phosphokinase were markedly elevated, whereas potassium, chloride, and calcium values were lowered.

  14. Disappearance of spasticity after selective dorsal rhizotomy does not prevent muscle shortening in children with cerebral palsy: a case report.

    PubMed

    Spijker, Margje; Strijers, Rob L M; van Ouwerkerk, Willem J R; Becher, Jules G

    2009-05-01

    Selective dorsal rhizotomy is an effective treatment for spasticity in children with cerebral palsy who have a spastic motor disorder. It is hypothesized that muscle shortening is related to spasticity; the lack of stretch of a muscle is thought to be the cause of muscle shortening. If this is true, the treatment for spasticity should prevent the occurrence of muscle shortening during growth. We present the case of 1 child with cerebral palsy and spastic diplegia, for whom the treatment with selective dorsal rhizotomy was successful in improving the walking abilities. She did, however, develop muscle shortening during growth. In conclusion, the development of muscle shortening during growth in children with cerebral palsy and spastic paresis cannot be prevented by treatment for the spasticity alone.

  15. How do periodontal infections affect the onset and progression of Alzheimer's disease?

    PubMed

    Shaik, Munvar M; Ahmad, Sultan; Gan, Siew H; Abuzenadah, Adel M; Ahmad, Ejaz; Tabrez, Shams; Ahmed, Farid; Kamal, Mohammad A

    2014-04-01

    Chronic infection can cause slow progressive dementia, cortical atrophy and amyloid deposition in the atrophic form of general paresis. Due to the fact that specific bacterial ligands can increase the expression of proinflammatory molecules that can activate innate and adaptive immune systems, inflammation may play a significant role in the pathogenesis of Alzheimer's disease (AD). Furthermore, there is a significant association between AD and various types of spirochete. Periodontitis is a prevalent and persistent peripheral infection that is associated with gram-negative anaerobic bacteria and is capable of showing localized and systemic infections in the host. Periodontal disease related pathogens and their inflammatory products contribute to systemic inflammation and the pathogenesis of AD. In this minireview, we propose a hypothetical link between periodontitis, type 2 diabetes and AD. We also present the possible mechanistic links between periodontitis-related inflammation, type 2 diabetes and AD. Since this condition is treatable, periodontitis may be a readily-modifiable risk factor for AD.

  16. Effectiveness of Botulinum Toxin Administered to Abolish Acquired Nystagmus

    NASA Technical Reports Server (NTRS)

    Leigh, R. John; Tomsak, Robert L.; Grant, Michael P.; Remler, Bernd F.; Yaniglos, Stacy S.; Lystad, Lisa; Dell'Osso, Louis F.

    1992-01-01

    We injected botulinum toxin into the horizontal rectus muscles of the right eyes of two patients who had acquired pendular nystagmus with horizontal, vertical, and torsional components. This treatment successfully abolished the horizontal component of the nystagmus in the injected eye in both patients for approximately 2 months. Both patients showed a small but measurable improvement of vision in the injected eye that may have been limited by coexistent disease of the visual pathways. The vertical and torsional components of the nystagmus persisted in both patients. In one patient, the horizontal component of nystagmus in the noninjected eye increased; we ascribe this finding to plastic-adaptive changes in response to paresis caused by the botulinum toxin. Such plastic-adaptive changes and direct side effects of the injections - such as diplopia and ptosis - may limit the effectiveness of botulinum toxin in the treatment of acquired nystagmus. Neither patient elected to repeat the botulinum treatment.

  17. Not all cases of nyctalopia are benign: Unusual and serendipitous presentation of Arnold–Chiari Type 1 malformation at a Pediatric Tertiary Care Center

    PubMed Central

    Patra, Kailash Chandra; Kirtane, Abhijeet Prakash

    2016-01-01

    The Arnold–Chiari Type 1 malformation (CM1) is a rare congenital abnormality characterized by ectopia or caudal herniation of the cerebellar tonsils through the foramen magnum into the cervical spine, resulting in crowding at the craniocervical junction. It seldom presents in childhood with symptoms and a normal neurological examination. More typically, CM1 presents in young adult women with neurological symptoms including a headache, cervical pain, cranial nerve palsies, neurosensory deficit, and ataxia. Ocular manifestations associated with Chiari I include third and sixth cranial nerve paresis and convergence/divergence abnormalities. Papilledema is a rare manifestation of Chiari I with a clinical presentation often similar to that of idiopathic intracranial hypertension. To underscore this noteworthy complication, the authors report a case of an 8-year-old boy who presented with nyctalopia and suboccipital headaches, but was diagnosed serendipitously as a case of papilledema due to Chiari I malformation. PMID:27857798

  18. Not all cases of nyctalopia are benign: Unusual and serendipitous presentation of Arnold-Chiari Type 1 malformation at a Pediatric Tertiary Care Center.

    PubMed

    Patra, Kailash Chandra; Kirtane, Abhijeet Prakash

    2016-01-01

    The Arnold-Chiari Type 1 malformation (CM1) is a rare congenital abnormality characterized by ectopia or caudal herniation of the cerebellar tonsils through the foramen magnum into the cervical spine, resulting in crowding at the craniocervical junction. It seldom presents in childhood with symptoms and a normal neurological examination. More typically, CM1 presents in young adult women with neurological symptoms including a headache, cervical pain, cranial nerve palsies, neurosensory deficit, and ataxia. Ocular manifestations associated with Chiari I include third and sixth cranial nerve paresis and convergence/divergence abnormalities. Papilledema is a rare manifestation of Chiari I with a clinical presentation often similar to that of idiopathic intracranial hypertension. To underscore this noteworthy complication, the authors report a case of an 8-year-old boy who presented with nyctalopia and suboccipital headaches, but was diagnosed serendipitously as a case of papilledema due to Chiari I malformation.

  19. Concomitant amyotrophic lateral sclerosis and paraclinical laboratory features of multiple sclerosis: coincidence or causal relationship?

    PubMed

    Borisow, Nadja; Meyer, Thomas; Paul, Friedemann

    2013-01-23

    We report a 55-year-old patient, presenting with paresis, muscle atrophy and dysarthria, all symptoms accordable to definite amyotrophic lateral sclerosis (ALS). However, MRI and cerebrospinal fluid show abnormalities typical of multiple sclerosis (MS). On the basis of this case report, we discuss possible overlaps between both diseases by comparing clinical and paraclinical features including laboratory, radiological and electrophysiological diagnostics. As genetic, as well as environmental, factors are assumed to be involved in the development of both the diseases, literature is reviewed according to similar cases, results of autopsies and possible parallels in pathogenesis. In summary, based on the data currently available, the hypothesis of ALS being a neurodegenerative multisystem disorder, a common pathophysiological pathway or, alternatively, a random comorbidity of ALS and MS in this patient has to be discussed.

  20. Concomitant amyotrophic lateral sclerosis and paraclinical laboratory features of multiple sclerosis: coincidence or causal relationship?

    PubMed Central

    Borisow, Nadja; Meyer, Thomas; Paul, Friedemann

    2013-01-01

    We report a 55-year-old patient, presenting with paresis, muscle atrophy and dysarthria, all symptoms accordable to definite amyotrophic lateral sclerosis (ALS). However, MRI and cerebrospinal fluid show abnormalities typical of multiple sclerosis (MS). On the basis of this case report, we discuss possible overlaps between both diseases by comparing clinical and paraclinical features including laboratory, radiological and electrophysiological diagnostics. As genetic, as well as environmental, factors are assumed to be involved in the development of both the diseases, literature is reviewed according to similar cases, results of autopsies and possible parallels in pathogenesis. In summary, based on the data currently available, the hypothesis of ALS being a neurodegenerative multisystem disorder, a common pathophysiological pathway or, alternatively, a random comorbidity of ALS and MS in this patient has to be discussed. PMID:23349176

  1. Diplopia as an initial manifestation of disseminated non-hodgkin's lymphoma.

    PubMed

    Claeys, A; Trullemans, F; Maes, J; Hennekes, R; Salu, P

    2002-01-01

    A 37-year-old male presented a sudden diplopia. Ocular examination showed a partial paresis of the left eye (LE) on the left gaze, progressing in a few days towards a total ophthalmoplegia. Further investigation revealed an intra-orbital mass, immunohistologically diagnosed as a Diffuse Large B-cell Lymphoma (DLBCL), according to the WHO classification. Since the patient was in an advanced, disseminated stage of the disease (IVA-E), treatment was based on systemic and intrathecal chemotherapy with a pancranial radiotherapy. The clinical course was poor with only a 10-month survival. We wish to stress that the possibility of orbital malignancy in young adults with acute onset of ophthalmoplegia should be included in the differential diagnosis.

  2. [Brachial plexus compression from supraclavicular encapsulated fat necrosis. A case report].

    PubMed

    Domínguez-Páez, Miguel; de Miguel-Pueyo, Luis; Marín-Salido, Esteban José; Carrasco-Brenes, Antonio; Martín-Gallego, Alvaro; Arráez-Sánchez, Miguel Ángel

    2014-01-01

    We report the case of a 44-year-old male, lacking clinical history of previous illness, who had surgery at our hospital to treat a mass in the supraclavicular space. The patient presented with a 1-month progressive distal paresis of the left arm. The histo-pathological examination of the mass revealed an encapsulated fat necrosis. Fat necrosis is characterised by cystic architecture, encapsulation with fat necrosis within, and inflammatory infiltration of its walls. Neural structure compression secondary to this tumour mass is very rare. Fat necrosis is more frequent in the lower limbs, in areas exposed to trauma. This article is the first report of brachial plexus compression due to supraclavicular fat necrosis.

  3. Coccidioidomycosis in the llama: case report and epidemiologic survey.

    PubMed

    Muir, S; Pappagianis, D

    1982-12-01

    An 8-year-old nongravid female llama with a 1-month history of progressive posterior paresis was referred because of suspected degenerative myelopathy secondary to copper deficiency or plant poisoning. Neurologic examination revealed loss of conscious proprioception and slightly depressed bilateral patellar reflexes. Electromyographic examination of hindlimb flexors and extensors did not elicit evidence of lower motor neuron disease. Possible fragmentation and mottling of the 10th thoracic vertebral body were noted radiographically. Results of a lumbar CSF tap, complete blood count, and fecal flotation were not diagnostic. In the face of poor prognosis, the llama was euthanatized. Postmortem and histologic evaluation revealed, in addition to disseminated visceral granulomas, an extradural pyogranulomatous mass compressing the cord laterally at the level of T-10. Large numbers of Coccidioides immitis were dispersed throughout the granulomas. Complement fixing antibody tests in 11 other herd members showed evidence of C immitis infection in three.

  4. Treatment of temporomandibular joint ankylosis by gap arthroplasty.

    PubMed

    Vasconcelos, Belmiro Cavalcanti do Egito; Bessa-Nogueira, Ricardo Viana; Cypriano, Rafael Vago

    2006-01-01

    The purpose of this paper is to show that gap arthroplasty improve mouth opening when treating TMJ ankylosis. Eight patients with TMJ ankylosis were treated by gap arthroplasty. The patients were evaluated by at least twenty-four months (minimum 24 and maximum 48 months). Of the eight patients (eleven joints), five (62.5%) had unilateral involvement and three patients (37.5%) had bilateral involvement. The mean age was 20 years -/+ 9 (range 3 to 30 years). The mean maximal incisal opening (MIO) in the preoperative period was 9.25 -/+ 6.41 mm and in the postoperative period it was 29.88 -/+ 4.16 mm. The complication of temporary facial nerve paresis was encountered in two patients (25%). No recurrence was observed in our series. Trauma was the major cause of tempomandibular joint ankylosis in our sample. Gap arthroplasty showed good results when treating TMJ ankylosis.

  5. EEG findings during "paroxysmal hemiplegia" in a patient with GLUT1-deficiency.

    PubMed

    Pellegrin, S; Cantalupo, G; Opri, R; Dalla Bernardina, B; Darra, F

    2017-05-01

    A growing number of studies have disclosed the myriad of features that can suggest the diagnosis of a Glucose-transporter-1 deficiency (GLUT1D). The occurrence of paroxysmal movement disorders such as exercise-induced dystonia and non-kinesigenic dyskinesia, received considerable emphasis, while limited attention has been paid to other paroxysmal phenomena, as transitory neurological disorders. These paroxysmal events are roughly and variably described as limb weakness, hemiparesis or ataxia. Their EEG correlate has been never documented. We report the EEG pattern characterizing two acute episodes of paroxysmal paresis with confusion and aphasia, in a girl with GLUT1D. The EEG picture is characterized by a clear-cut contralateral EEG slowing, similar to what is observed in Alternating Hemiplegia of Childhood and Hemiplegic Migraine attacks. In our patient the paroxysmal events were responsive to a ketogenic diet. Copyright © 2017 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  6. Effectiveness of Botulinum Toxin Administered to Abolish Acquired Nystagmus

    NASA Technical Reports Server (NTRS)

    Leigh, R. John; Tomsak, Robert L.; Grant, Michael P.; Remler, Bernd F.; Yaniglos, Stacy S.; Lystad, Lisa; Dell'Osso, Louis F.

    1992-01-01

    We injected botulinum toxin into the horizontal rectus muscles of the right eyes of two patients who had acquired pendular nystagmus with horizontal, vertical, and torsional components. This treatment successfully abolished the horizontal component of the nystagmus in the injected eye in both patients for approximately 2 months. Both patients showed a small but measurable improvement of vision in the injected eye that may have been limited by coexistent disease of the visual pathways. The vertical and torsional components of the nystagmus persisted in both patients. In one patient, the horizontal component of nystagmus in the noninjected eye increased; we ascribe this finding to plastic-adaptive changes in response to paresis caused by the botulinum toxin. Such plastic-adaptive changes and direct side effects of the injections - such as diplopia and ptosis - may limit the effectiveness of botulinum toxin in the treatment of acquired nystagmus. Neither patient elected to repeat the botulinum treatment.

  7. [Experiences with the augmentation of vocal cords].

    PubMed

    Berghaus, A

    1987-06-01

    Augmentation of a vocal fold serves to improve glottic closure and may be indicated for paresis of the recurrent nerve and after tumor resection. Methods include injection of viscous fluids (paraffin, liquid silicone, polyvinyl alcohol, gelatin, sesame oil, collagen and particularly teflon paste) and operations to tighten the vocal cord or displace it medially. The disadvantages of the former include the danger of overcorrection, tissue irritation and possible systemic absorption of the material. As an alternative, solid material such as cartilage or synthetics may be used for augmentation. Experience obtained so far has shown that chips of porous polyethylene (PHDPE) are particularly suitable: they are easy to use, show good tissue tolerance and are anchored by ingrowth of connective tissue. The value of photokymography of the larynx in the assessment of therapeutic results after vocal-fold augmentation is discussed.

  8. Force regulation is deficient in patients with parietal lesions: a system-analytic approach.

    PubMed

    Scholle, H C; Bradl, U; Hefter, H; Dohle, C; Freund, H J

    1998-06-01

    By means of a quantitative system-analytic investigation strategy, the postural motor control of the fingers was evaluated, to characterise the possible deficit of force regulation in patients with parietal lesions. In spite of a normal response to short torque pulses, the parietal-lesion patients had difficulties in returning to the preload level after the application of an additional step torque load to fingers II-IV of their left or right hands. The control offset (measured 500 ms after step torque application) was significantly larger in the patient group. This deficit in the investigated patients with parietal lesions to compensate for step torque loads was not due to a paresis, but rather resulted from a disturbance in the generation of a sufficient counterforce against the applied step torque within an adequate time window and motor pattern. This distinct force-regulation deficit was found in patients with left- and right-sided parietal lesions.

  9. Giant Dural Supratentorial Chondroma Generating the Question of How Large Can a Tumor Become Without Revealing Itself.

    PubMed

    Doukas, Alexandros; Tallo, Annamarie; Parvin, Richard; Hans, Volkmar; Daemi, Pooya; Cheko, Azad; Scholz, Martin; Petridis, Athanasios K

    2015-11-05

    Chondromas usually affect the small bones of hand and feet and account for only 0.5% of all intracranial tumors. We present a case of a giant, supratentorial meningeal chondroma in a 19-year old male patient and discuss the preoperative diagnostic findings as well as the appropriate treatment options. A 19-old male presented with headache, new onset of focal seizures and paresis of left upper extremity. Magnetic resonance imaging revealed a large right parietal tumor in the precentral region with local mass effect. The patient underwent right parietal craniotomy and gross total resection of the tumor. The histopathological report revealed a chondroma. Intradural supratentorial chondromas are extremely rare. As with other slow growing intracranial masses, they often reach a relatively large size before generating symptoms. Maximal surgical resection is the treatment of choice and if this is achieved no adjuvant therapy is necessary.

  10. Giant Dural Supratentorial Chondroma Generating the Question of How Large Can a Tumor Become Without Revealing Itself

    PubMed Central

    Doukas, Alexandros; Tallo, Annamarie; Parvin, Richard; Hans, Volkmar; Daemi, Pooya; Cheko, Azad; Scholz, Martin

    2015-01-01

    Chondromas usually affect the small bones of hand and feet and account for only 0.5% of all intracranial tumors. We present a case of a giant, supratentorial meningeal chondroma in a 19-year old male patient and discuss the preoperative diagnostic findings as well as the appropriate treatment options. A 19-old male presented with headache, new onset of focal seizures and paresis of left upper extremity. Magnetic resonance imaging revealed a large right parietal tumor in the precentral region with local mass effect. The patient underwent right parietal craniotomy and gross total resection of the tumor. The histopathological report revealed a chondroma. Intradural supratentorial chondromas are extremely rare. As with other slow growing intracranial masses, they often reach a relatively large size before generating symptoms. Maximal surgical resection is the treatment of choice and if this is achieved no adjuvant therapy is necessary. PMID:26918096

  11. Suspected natural lysosomal storage disease from ingestion of pink morning glory (Ipomoea carnea) in goats in northern Argentina

    PubMed Central

    RÍOS, Elvio E.; CHOLICH, Luciana A.; CHILESKI, Gabriela; GARCÍA, Enrique N.; LÉRTORA, Javier; GIMENO, Eduardo J.; GUIDI, María G.; MUSSART, Norma; TEIBLER, Gladys P.

    2015-01-01

    This study describes an occurrence of pink morning glory (Ipomoea carnea) intoxication in goats in northern Argentina. The clinical signs displayed by the affected animals were ataxia, lethargy, emaciation, hypertonia of the neck muscles, spastic paresis in the hind legs, abnormal postural reactions and death. The clinico-pathologic examination revealed that the affected animals were anemic and their serum level of aspartate aminotransferase was significantly increased. Cytoplasmic vacuolation in the Purkinje cells and pancreatic acinar cells was observed by histological examination. The neuronal lectin binding pattern showed a strong positive reaction to WGA (Triticum vulgaris), sWGA (succinylated T. vulgaris) and LCA (Lens culinaris). Although I. carnea is common in tropical regions, this is the first report of spontaneous poisoning in goats in Argentina. PMID:25728544

  12. Transtympanic Facial Nerve Paralysis: A Review of the Literature

    PubMed Central

    Schaefer, Nathan; O’Donohue, Peter; French, Heath; Griffin, Aaron; Gochee, Peter

    2015-01-01

    Summary: Facial nerve paralysis because of penetrating trauma through the external auditory canal is extremely rare, with a paucity of published literature. The objective of this study is to review the literature on transtympanic facial nerve paralysis and increase physician awareness of this uncommon injury through discussion of its clinical presentation, management and prognosis. We also aim to improve patient outcomes in those that have sustained this type of injury by suggesting an optimal management plan. In this case report, we present the case of a 46-year-old white woman who sustained a unilateral facial nerve paresis because of a garfish penetrating her tympanic membrane and causing direct damage to the tympanic portion of her facial nerve. On follow-up after 12 months, her facial nerve function has largely returned to normal. Transtympanic facial nerve paralysis is a rare injury but can have a favorable prognosis if managed effectively. PMID:26090278

  13. Burkitt Lymphoma with Initial Clinical Presentation due to Infiltration of the Central Nervous System and Eye Orbits

    PubMed Central

    Camilo, Gustavo Bittencourt; Machado, Dequitier Carvalho; de Oliveira, Celso Estevão; Lacerda, Letícia da Silva; de Oliveira, Romulo Varella; de França Silva, Monique; Lopes, Agnaldo José

    2014-01-01

    Patient: Male, 17 Final Diagnosis: Burkitt lymphoma Symptoms: Anisocoria, ipsilateral ptosis, opthalmoparesis, paresis Medication: — Clinical Procedure: — Specialty: Oncology Objective: Unusual clinical course Background: Burkitt lymphoma rarely affects the central nervous system and ocular region. Under these conditions, computed tomography and (particularly) magnetic resonance imaging of the skull increase the diagnostic accuracy, as they objectively show the topography of lesions and the effect of neoplasia on structures. Case Report: We report here the case of a 17-year-old male whose initial clinical manifestations were related to neurological impairment and to the ocular musculature and ocular innervation. The diagnosis of Burkitt lymphoma with leukemization and infiltration of the central nervous system was confirmed. Conclusions: In this case, it is important to recognize that the neuroimaging findings were fundamentally important in indicating the initial form of the disease and in directing the appropriate clinical management. PMID:25243420

  14. [Disturbance of jaw-opening due to extension of syringobulbia to the pons--a case report].

    PubMed

    Mitani, Kotoe; Toyooka, Keiko; Kaido, Misako; Yuasa, Ryoichi; Hamada, Suguru; Tachimura, Takashi

    2002-06-01

    We report a patient with syringobulbia extending to the pons, who could not open his mouth widely. He had been involved in the traffic accident at 16 years of age. Since them he had suffered numbness in the left neck and arm. At age 30, he became unable to open the mouth widely with pain in the left jaw joint. He also noted dysphagia and tinnitus. Neurologically, there were vocal cord paresis, dysesthesia of the face, ageusia and cerebellar ataxia all on the left side. Brain MRI revealed syringobulbia which extended to the pons. Spinal MRI revealed syringomyelia through the entire spinal cord. The syrinx of the spinal cord seemed to connect with the brainstem lesion. EMG of the masticatory muscles revealed paradoxical activity in the left masticatory muscles. We concluded that disturbance of jaw-opening in this case was caused by syringobulbia, the lesion of which could involve masticatory central pattern generator in the brainstem.

  15. An unusual case of orbito-frontal rod fence stab injury with a good outcome

    PubMed Central

    2013-01-01

    Background High-energy non-missile penetrating injuries (stab injuries) account for a small percentage of penetrating head injuries and they present a series of special features. Case presentation A 35-year-old man suffered orbito-frontal? and trans-cranial injuries after falling five meters from a terrace onto a rod iron fence. The removal of the metal rod was performed outside the operating room. The orbital roof was exposed and repaired through a bifrontal craniotomy and the frontal sinuses were cranialised. The orbital floor and zygoma were plated with micro-screws. Conclusion The patient recovered without significant complications, apart from a slight paresis of the right superior rectus; the ocular globe remained intact. The positive outcome obtained in this very challenging case is attributable to the competency of the Neurotrauma Unit and to the use of a synergistic approach which involved the contribution of neurosurgeons, maxillo-facial surgeons, radiologists and anaesthesiologists. PMID:23941677

  16. Electromyographic (EMG) neuromonitoring in otolaryngology-head and neck surgery.

    PubMed

    Dillon, Francis X

    2010-09-01

    Intraoperative neuromonitoring (IONM) is a relatively recent advance in electromyography (EMG) applied to otolaryngology-head and neck surgery. Its purpose is to allow real-time identification and functional assessment of vulnerable nerves during surgery. The nerves most often monitored in head and neck surgery are the motor branch of the facial nerve (VII), the recurrent or inferior laryngeal nerves (X), the vagus nerve (X), and the spinal accessory nerve (XI), with other cranial lower nerves monitored less frequently. Morbidity from trauma to these nerves is significant and obvious, such as unilateral facial paresis. Although functional restorative surgery is usually considered to repair the effects of such an insult, the importance of preventing nerve injury in head and neck surgery is obvious. This article focuses on the anesthetic considerations pertinent to IONM of peripheral cranial nerves during otolaryngologic-head and neck surgery. The specific modality of IONM is EMG, both spontaneous and evoked.

  17. [Palsy of the upper limb: Obstetrical brachial plexus palsy, arthrogryposis, cerebral palsy].

    PubMed

    Salazard, B; Philandrianos, C; Tekpa, B

    2016-10-01

    "Palsy of the upper limb" in children includes various diseases which leads to hypomobility of the member: cerebral palsy, arthrogryposis and obstetrical brachial plexus palsy. These pathologies which differ on brain damage or not, have the same consequences due to the early achievement: negligence, stiffness and deformities. Regular entire clinical examination of the member, an assessment of needs in daily life, knowledge of the social and family environment, are key points for management. In these pathologies, the rehabilitation is an emergency, which began at birth and intensively. Splints and physiotherapy are part of the treatment. Surgery may have a functional goal, hygienic or aesthetic in different situations. The main goals of surgery are to treat: joints stiffness, bones deformities, muscles contractures and spasticity, paresis, ligamentous laxity. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  18. The 10th Bielschowsky Lecture. Changes in strabismus over time: the roles of vergence tonus and muscle length adaptation.

    PubMed

    Guyton, David L

    2006-01-01

    Patients with long-standing unilateral strabismus, such as "sensory" exotropia in the absence of fusion, or esotropia with unilateral amblyopia, typically show bilateral deviations under anesthesia, often symmetric. Forced ductions usually show symmetric muscle tightness. Changes in extraocular muscle lengths thus appear to occur primarily bilaterally, whether fusion is present or not. With skeletal muscles responding to changes in stimulation by the gain or loss of sarcomeres, it is likely that abnormal or unguided vergence tonus, which changes the lengths of the extraocular muscles bilaterally, is largely responsible for changes in the angle of strabismus over time. This mechanism helps explain the development of [1] increasing "basic" deviations in accommodative esotropia; [2] torsional deviations with apparent oblique muscle "overaction/underaction" and A and V patterns; [3] recurrent esotropia with early presbyopia; [4] occasional divergence insufficiency in presbyopes; and [5] basic cyclovertical deviations that mimic superior oblique muscle paresis.

  19. Robotic arm skate for stroke rehabilitation.

    PubMed

    Wong, Chee Kit; Jordan, Kimberlee; King, Marcus

    2011-01-01

    Upper limb paresis after stroke greatly affects the performance of Activities of Daily Living (ADL). Unfortunately, rehabilitation for upper limb impairment can have poor results. The current robot-assisted devices are expensive and not readily accessible for homecare. This paper presents the development of a low-cost tabletop robotic device for upper limb rehabilitation. Conceptually, patients perform computer-based goal-directed tasks using the robotic platform. Their progress is monitored and intervention, in the form of assistance or resistance, is introduced accordingly. A prototype platform is described. Experiments demonstrate the ability of the device to provide the necessary forces during movement exercises, in relation to task completion progress, device and target location. Appropriate exercises need to be developed before clinical trials can proceed. © 2011 CROWN

  20. Survey of young patients with polio and a foreign background at a Swedish post-polio outpatient clinic.

    PubMed

    Werhagen, Lars; Borg, Kristian

    2016-10-01

    Nowadays, polio survivors aged under 60 years are non-native Swedes which pose new aspects and challenges to a post-polio outpatient clinic. To analyze the medical data, walking aids, occupational, and family situation in non-native polio survivors aged less than 60 years at a Swedish post-polio outpatient clinic. Retrospective data analysis. Data were retrieved from medical records at the post-polio outpatient clinic. Actual age, age at acute polio infection, walking capacity, pain, concomitant diseases, working and family situation, and ethnical origin were analyzed. Data are presented in numbers and percentage. 153 patients were included. Mean age was 45 (17-60) years, and mean age at acute polio infection was 2 (0-12) years. Paresis of the lower extremities was the most common disability. 10 % were wheelchair dependent. Pain occurred in 70 % with a mean intensity of 55 measured with the visual analog scale. Hypertension was the most common concomitant disease. Half of the polio survivors were working at least part time, and roughly half were singles. Data were comparable with data earlier published in Swedish native polio survivors. Non-native polio survivors aged under 60 years showed similarities in age at acute polio infection, paresis, prevalence, and intensity of pain when compared with native Swedish polio survivors. They were, however, younger, and were less often working and married/cohabitants than native Swedish polio survivors. The results of this study underline the importance of social and vocational rehabilitation tailoring rehabilitation suitable for polio survivors with a foreign background.

  1. An imaging informatics-based ePR (electronic patient record) system for providing decision support in evaluating dose optimization in stroke rehabilitation

    NASA Astrophysics Data System (ADS)

    Liu, Brent J.; Winstein, Carolee; Wang, Ximing; Konersman, Matt; Martinez, Clarisa; Schweighofer, Nicolas

    2012-02-01

    Stroke is one of the major causes of death and disability in America. After stroke, about 65% of survivors still suffer from severe paresis, while rehabilitation treatment strategy after stroke plays an essential role in recovery. Currently, there is a clinical trial (NIH award #HD065438) to determine the optimal dose of rehabilitation for persistent recovery of arm and hand paresis. For DOSE (Dose Optimization Stroke Evaluation), laboratory-based measurements, such as the Wolf Motor Function test, behavioral questionnaires (e.g. Motor Activity Log-MAL), and MR, DTI, and Transcranial Magnetic Stimulation (TMS) imaging studies are planned. Current data collection processes are tedious and reside in various standalone systems including hardcopy forms. In order to improve the efficiency of this clinical trial and facilitate decision support, a web-based imaging informatics system has been implemented together with utilizing mobile devices (eg, iPAD, tablet PC's, laptops) for collecting input data and integrating all multi-media data into a single system. The system aims to provide clinical imaging informatics management and a platform to develop tools to predict the treatment effect based on the imaging studies and the treatment dosage with mathematical models. Since there is a large amount of information to be recorded within the DOSE project, the system provides clinical data entry through mobile device applications thus allowing users to collect data at the point of patient interaction without typing into a desktop computer, which is inconvenient. Imaging analysis tools will also be developed for structural MRI, DTI, and TMS imaging studies that will be integrated within the system and correlated with the clinical and behavioral data. This system provides a research platform for future development of mathematical models to evaluate the differences between prediction and reality and thus improve and refine the models rapidly and efficiently.

  2. Early Controversies Over Athetosis: II. Treatment

    PubMed Central

    Lanska, Douglas J.

    2013-01-01

    Background Athetosis has been controversial since it was first described by William Hammond in 1871; many aspects of Hammond’s career were equally controversial. Methods Primary sources have been used to review treatment controversies in the 50-year period following the initial description of athetosis. Results The treatments used most commonly employed available pharmaceutical agents and modalities (e.g., galvanism). Initial anecdotal reports of success were seldom confirmed with subsequent experience. Several novel invasive therapies were also developed and promoted, all of which damaged or destroyed either upper or lower motor neuron pathways, and were also often associated with high mortality rates. In general, these therapies substituted paresis for abnormal spontaneous movements. These included peripheral nerve stretching, excision of a portion of the precentral gyrus, rhizotomy, nerve “transplantation” (i.e., neurotomy and nerve-to-nerve anastomoses), and “muscle group isolation” (i.e., alcohol neurolysis). There was no agreement on the appropriateness of such high-risk procedures, particularly given the intentional generation of further neurological morbidity. Discussion Pharmaceutical agents and modalities initially employed for athetosis had little a priori evidence-based justification and no biologically plausible theoretical framework to guide empiric treatment selection. Subsequently, all the invasive procedures employed were directed at lessening or removing the manifestations, rather than the underlying cause, of the abnormal central nervous system “irritation,” usually by imposing paresis or paralysis. Factors contributing to the disparity in outcomes between favorable initial reports and the often-disappointing results of later studies included reliance on anecdotal reports or small uncontrolled case series, placebo effects, biased observation, misdiagnosis, and biased reporting. PMID:23450199

  3. Is upper limb virtual reality training more intensive than conventional training for patients in the subacute phase after stroke? An analysis of treatment intensity and content.

    PubMed

    Brunner, Iris; Skouen, Jan Sture; Hofstad, Håkon; Aßmuss, Jörg; Becker, Frank; Pallesen, Hanne; Thijs, Liselot; Verheyden, Geert

    2016-11-11

    Virtual reality (VR) training is thought to improve upper limb (UL) motor function after stroke when utilizing intensive training with many repetitions. The purpose of this study was to compare intensity and content of a VR training intervention to a conventional task-oriented intervention (CT). A random sample of 50 video recordings was analyzed of patients with a broad range of UL motor impairments (mean age 61y, 22 women). Patients took part in the VIRTUES trial and were randomized to either VR or CT and stratified according to severity of paresis. A standardized scoring form was used to analyze intensity, i.e. active use of the affected UL expressed in % of total time, total active time and total duration of a training session in minutes, content of training and feedback. Two raters collected data independently. Linear regression models as well as descriptive and graphical methods were used. Patients in the VR group spent significantly more time actively practicing with an activity rate of 77.6 (8.9) % than patients in the CT 67.3 (13.9) %, (p = .003). This difference was attributed to the subgroup of patients with initially severe paresis (n = 22). While in VR severely impaired patients spent 80.7 % (4.4 %) of the session time actively; they reached 60.6 (12.1) % in CT. VR and CT also differed in terms of tasks and feedback provided. Our results indicate that patients with severely impaired UL motor function spent more time actively in VR training, which may influence recovery. The upcoming results of the VIRTUES trial will show whether this is correlated with an increased effect of VR compared to CT. ClinicalTrials.gov NCT02079103 , February 27, 2014.

  4. Parsonage-Turner syndrome following post-exposure prophylaxis

    PubMed Central

    2014-01-01

    Background The ‘Parsonage-Turner syndrome’ (PTS) is a rare but distinct disorder with an abrupt onset of shoulder pain, followed by weakness and atrophy of the upper extremity musculature, and a slow recovery requiring months to years. To our best knowledge, this is the first case describing symptoms and signs of PTS following the administration of a post-exposure prophylaxis (PEP) regimen against possible human immunodeficiency virus (HIV) and hepatitis B virus (HBV) infection. Case presentation A 25-year-old Caucasian man presented with pain and unilateral scapular winging following PEP against possible HIV and HBV infection. Although atrophy and weakness were observed for the right supraspinatus muscle, a full range of motion was achievable. Neurological examination, plain radiography of the right shoulder and electromyography showed no additional abnormalities. The patient was diagnosed with post-vaccination PTS and treated non-operatively. During the following 15 months the scapular winging receded and full muscle strength was regained. Conclusion Parsonage-Turner syndrome is a rare clinical diagnosis. The precise pathophysiological mechanism of PTS remains unclear, but it seems to involve an interaction between genetic predisposition, mechanical vulnerability and an autoimmune trigger. An immunological event, such as – in this case – a vaccination as part of PEP treatment, can trigger the onset of PTS. The clinical presentation is distinctive with acute severe pain followed by patchy paresis, atrophy and sensory symptoms that persist for months to years. No currently available tests can provide a definite confirmation or exclusion of PTS. Routine blood examination, electromyography (EMG), and computed tomography (CT) or magnetic resonance imaging (MRI) serve mainly to exclude other disorders. The recovery can be quite lengthy, non-operative treatment is the accepted practice. Supplementary administration of oral prednisolone could shorten the

  5. Spinal cord compression in two related Ursus arctos horribilis.

    PubMed

    Thomovsky, Stephanie A; Chen, Annie V; Roberts, Greg R; Schmidt, Carrie E; Layton, Arthur W

    2012-09-01

    Two 15-yr-old grizzly bear littermates were evaluated within 9 mo of each other with the symptom of acute onset of progressive paraparesis and proprioceptive ataxia. The most significant clinical examination finding was pelvic limb paresis in both bears. Magnetic resonance examinations of both bears showed cranial thoracic spinal cord compression. The first bear had left-sided extradural, dorsolateral spinal cord compression at T3-T4. Vertebral canal stenosis was also observed at T2-T3. Images of the second bear showed lateral spinal cord compression from T2-T3 to T4-T5. Intervertebral disk disease and associated spinal cord compression was also observed at T2-T3 and T3-T4. One grizzly bear continued to deteriorate despite reduced exercise, steroid, and antibiotic therapy. The bear was euthanized, and a necropsy was performed. The postmortem showed a spinal ganglion cyst that caused spinal cord compression at the level of T3-T4. Wallerian-like degeneration was observed from C3-T6. The second bear was prescribed treatment that consisted of a combination of reduced exercise and steroid therapy. He continued to deteriorate with these medical therapies and was euthanized 4 mo after diagnosis. A necropsy showed hypertrophy and protrusion of the dorsal longitudinal ligament at T2-T3 and T3-T4, with resulting spinal cord compression in this region. Wallerian-like degeneration was observed from C2-L1. This is one of few case reports that describes paresis in bears. It is the only case report, to the authors' knowledge, that describes spinal magnetic resonance imaging findings in a grizzly bear and also the only report that describes a cranial thoracic myelopathy in two related grizzly bears with neurologic signs.

  6. VORICONAZOLE TOXICITY IN MULTIPLE PENGUIN SPECIES.

    PubMed

    Hyatt, Michael W; Georoff, Timothy A; Nollens, Hendrik H; Wells, Rebecca L; Clauss, Tonya M; Ialeggio, Donna M; Harms, Craig A; Wack, Allison N

    2015-12-01

    Aspergillosis is a common respiratory fungal disease in penguins managed under human care. Triazole antifungal drugs, including itraconazole, are most commonly used for treatment; however, itraconazole treatment failures from drug resistance are becoming more common, requiring newer treatment options. Voriconazole, a newer triazole, is being used more often. Until recently, no voriconazole pharmacokinetic studies had been performed in penguins, leading to empiric dosing based on other avian studies. This has led to increased anecdotal reporting of apparent voriconazole toxicity in penguins. This report describes 18 probable and 6 suspected cases of voriconazole toxicity in six penguin species from nine institutions: 12 African penguins (Spheniscus demersus), 5 Humboldt penguins (Spheniscus humboldti), 3 Magellanic penguins (Spheniscus magellanicus), 2 gentoo penguins (Pygoscelis papua papua), 1 macaroni penguin (Eudyptes chrysolophus), and 1 emperor penguin (Aptenodytes forsteri). Observed clinical signs of toxicity included anorexia, lethargy, weakness, ataxia, paresis, apparent vision changes, seizure-like activity, and generalized seizures. Similar signs of toxicity have also been reported in humans, in whom voriconazole therapeutic plasma concentration for Aspergillus spp. infections is 2-6 μg/ml. Plasma voriconazole concentrations were measured in 18 samples from penguins showing clinical signs suggestive of voriconazole toxicity. The concentrations ranged from 8.12 to 64.17 μg/ml, with penguins having plasma concentrations above 30 μg/ml exhibiting moderate to severe neurologic signs, including ataxia, paresis, and seizures. These concentrations were well above those known to result in central nervous system toxicity, including encephalopathy, in humans. This case series highlights the importance of species-specific dosing of voriconazole in penguins and plasma therapeutic drug monitoring. Further investigation, including pharmacokinetic studies, is

  7. Threshold dose for peripheral neuropathy following intraoperative radiotherapy (IORT) in a large animal model

    SciTech Connect

    Kinsella, T.J.; DeLuca, A.M.; Barnes, M.; Anderson, W.; Terrill, R.; Sindelar, W.F. )

    1991-04-01

    Radiation injury to peripheral nerve is a dose-limiting toxicity in the clinical application of intraoperative radiotherapy, particularly for pelvic and retroperitoneal tumors. Intraoperative radiotherapy-related peripheral neuropathy in humans receiving doses of 20-25 Gy is manifested as a mixed motor-sensory deficit beginning 6-9 months following treatment. In a previous experimental study of intraoperative radiotherapy-related neuropathy of the lumbro-sacral plexus, an approximate inverse linear relationship was reported between the intraoperative dose (20-75 Gy range) and the time to onset of hind limb paresis (1-12 mos following intraoperative radiotherapy). The principal histological lesion in irradiated nerve was loss of large nerve fibers and perineural fibrosis without significant vascular injury. Similar histological changes in irradiated nerves were found in humans. To assess peripheral nerve injury to lower doses of intraoperative radiotherapy in this same large animal model, groups of four adult American Foxhounds received doses of 10, 15, or 20 Gy to the right lumbro-sacral plexus and sciatic nerve using 9 MeV electrons. The left lumbro-sacral plexus and sciatic nerve were excluded from the intraoperative field to allow each animal to serve as its own control. Following treatment, a complete neurological exam, electromyogram, and nerve conduction studies were performed monthly for 1 year. Monthly neurological exams were performed in years 2 and 3 whereas electromyogram and nerve conduction studies were performed every 3 months during this follow-up period. With follow-up of greater than or equal to 42 months, no dog receiving 10 or 15 Gy IORT shows any clinical or laboratory evidence of peripheral nerve injury. However, all four dogs receiving 20 Gy developed right hind limb paresis at 8, 9, 9, and 12 mos following intraoperative radiotherapy.

  8. Cholestenoic acids regulate motor neuron survival via liver X receptors

    PubMed Central

    Theofilopoulos, Spyridon; Griffiths, William J.; Crick, Peter J.; Yang, Shanzheng; Meljon, Anna; Ogundare, Michael; Kitambi, Satish Srinivas; Lockhart, Andrew; Tuschl, Karin; Clayton, Peter T.; Morris, Andrew A.; Martinez, Adelaida; Reddy, M. Ashwin; Martinuzzi, Andrea; Bassi, Maria T.; Honda, Akira; Mizuochi, Tatsuki; Kimura, Akihiko; Nittono, Hiroshi; De Michele, Giuseppe; Carbone, Rosa; Criscuolo, Chiara; Yau, Joyce L.; Seckl, Jonathan R.; Schüle, Rebecca; Schöls, Ludger; Sailer, Andreas W.; Kuhle, Jens; Fraidakis, Matthew J.; Gustafsson, Jan-Åke; Steffensen, Knut R.; Björkhem, Ingemar; Ernfors, Patrik; Sjövall, Jan; Arenas, Ernest; Wang, Yuqin

    2014-01-01

    Cholestenoic acids are formed as intermediates in metabolism of cholesterol to bile acids, and the biosynthetic enzymes that generate cholestenoic acids are expressed in the mammalian CNS. Here, we evaluated the cholestenoic acid profile of mammalian cerebrospinal fluid (CSF) and determined that specific cholestenoic acids activate the liver X receptors (LXRs), enhance islet-1 expression in zebrafish, and increase the number of oculomotor neurons in the developing mouse in vitro and in vivo. While 3β,7α-dihydroxycholest-5-en-26-oic acid (3β,7α-diHCA) promoted motor neuron survival in an LXR-dependent manner, 3β-hydroxy-7-oxocholest-5-en-26-oic acid (3βH,7O-CA) promoted maturation of precursors into islet-1+ cells. Unlike 3β,7α-diHCA and 3βH,7O-CA, 3β-hydroxycholest-5-en-26-oic acid (3β-HCA) caused motor neuron cell loss in mice. Mutations in CYP7B1 or CYP27A1, which encode enzymes involved in cholestenoic acid metabolism, result in different neurological diseases, hereditary spastic paresis type 5 (SPG5) and cerebrotendinous xanthomatosis (CTX), respectively. SPG5 is characterized by spastic paresis, and similar symptoms may occur in CTX. Analysis of CSF and plasma from patients with SPG5 revealed an excess of the toxic LXR ligand, 3β-HCA, while patients with CTX and SPG5 exhibited low levels of the survival-promoting LXR ligand 3β,7α-diHCA. Moreover, 3β,7α-diHCA prevented the loss of motor neurons induced by 3β-HCA in the developing mouse midbrain in vivo.Our results indicate that specific cholestenoic acids selectively work on motor neurons, via LXR, to regulate the balance between survival and death. PMID:25271621

  9. Endoscopic aqueductoplasty and interventriculostomy for the treatment of isolated fourth ventricle in children.

    PubMed

    Fritsch, Michael J; Kienke, Sven; Manwaring, Kim H; Mehdorn, H Maximilian

    2004-08-01

    There are different approaches for the treatment of isolated fourth ventricle in children, including a suboccipital ventriculoperitoneal shunt, suboccipital craniotomy with microsurgical fenestration, and endoscopic fenestration. We discuss the indications, surgical methods, and outcome of 18 patients who underwent endoscopic treatment for isolated fourth ventricle. We retrospectively reviewed the medical histories of 18 patients with an isolated fourth ventricle. Surgical procedures included endoscopic aqueductoplasty, endoscopic aqueductoplasty with a stent, endoscopic interventriculostomy (lateral ventricle or third ventricle to fourth ventricle), and endoscopic interventriculostomy with a stent. Operations were performed between July 1997 and June 2002. The mean age of the patients at the time of surgery was 3 years. The mean follow-up was 29 months. All patients had a supratentorial ventriculoperitoneal shunt. Clinical symptoms (impairment of consciousness, tetraparesis, and ataxia) improved in all patients. Reduction of the size of the fourth ventricle was observed in all patients. Seven patients required reoperation because of restenosis (39% revision rate). Restenosis occurred between 2 weeks and 7 months after surgery (average, 3 mo). Four patients underwent reoperation with stent placement, and three patients underwent reaqueductoplasty. We had the following complications: one infection, one asymptomatic subdural hygroma, one transient oculomotor paresis, and one permanent oculomotor paresis (4 [22%] of 18 patients). The significant failure rate of fourth ventricle shunts has led to the development of alternative treatment methods. Endoscopic aqueductoplasty or interventriculostomy presents an effective, minimally invasive, and safe procedure for the treatment of isolated fourth ventricle in pediatric patients. Compared with suboccipital craniotomy and microsurgical fenestration, endoscopic aqueductoplasty is less invasive, and compared with fourth

  10. Preoperative navigated transcranial magnetic stimulation in patients with motor eloquent lesions with emphasis on metastasis.

    PubMed

    Hendrix, Philipp; Senger, Sebastian; Griessenauer, Christoph J; Simgen, Andreas; Schwerdtfeger, Karsten; Oertel, Joachim

    2016-10-01

    Navigated transcranial magnetic stimulation (nTMS) is a frequently used, non-invasive method to map the motor cortex. It is of great value in the preoperative workup of patients that suffer from motor eloquent brain lesions. Here, we present a single-center experience using preoperative nTMS in cortical motor eloquent lesions with emphasis on metastasis. All patients that underwent preoperative nTMS between June 2013 and January 2016 were evaluated. A total of 61 patients underwent nTMS before undergoing surgery for a motor eloquent brain lesion. Patients suffered from cerebral metastasis (23), glioblastoma (16), high grade glioma WHO III (4), low grade glioma WHO II (4), lymphoma (2), meningioma (8), cavernous hemangioma (3), or arteriovenous malformation (1). Thirty patients (49.2%) presented with a preoperative motor deficit. One week after surgery, paresis had resolved or improved in 56.7% of the patients. Out of the patients with postoperative paresis, 89.5% experienced an improvement of motor status at follow-up. All metastatic lesions were completely resected compared to 78.9% of non-metastatic lesions (P = 0.02). Only 4.3% of patients with a metastatic lesion, but 26.3% of patients with a non-metastatic lesion experienced deterioration of motor function after surgery (P = 0.04). Preoperative nTMS is suitable for mapping of a variety of motor eloquent brain lesions resulting in favorable neurological outcome. Particularly in metastatic motor eloquent lesion, motor function appears to be preserved after surgery. Clin. Anat. 29:925-931, 2016. © 2016 Wiley Periodicals, Inc.

  11. The Effects of Stroke Type, Locus, and Extent on Long-Term Outcome of Gait Rehabilitation: The LEAPS Experience.

    PubMed

    Nadeau, Stephen E; Dobkin, Bruce; Wu, Samuel S; Pei, Qinglin; Duncan, Pamela W

    2016-08-01

    Background Paresis in stroke is largely a result of damage to descending corticospinal and corticobulbar pathways. Recovery of paresis predominantly reflects the impact on the neural consequences of this white matter lesion by reactive neuroplasticity (mechanisms involved in spontaneous recovery) and experience-dependent neuroplasticity, driven by therapy and daily experience. However, both theoretical considerations and empirical data suggest that type of stroke (large vessel distribution/lacunar infarction, hemorrhage), locus and extent of infarction (basal ganglia, right-hemisphere cerebral cortex), and the presence of leukoaraiosis or prior stroke might influence long-term recovery of walking ability. In this secondary analysis based on the 408 participants in the Locomotor Experience Applied Post-Stroke (LEAPS) study database, we seek to address these possibilities. Methods Lesion type, locus, and extent were characterized by the 2 neurologists in the LEAPS trial on the basis of clinical computed tomography and magnetic resonance imaging scans. A series of regression models was used to test our hypotheses regarding the effects of lesion type, locus, extent, and laterality on 2- to 12-month change in gait speed, controlling for baseline gait speed, age, and Berg Balance Scale score. Results Gait speed change at 1 year was significantly reduced in participants with basal ganglia involvement and prior stroke. There was a trend toward reduction of gait speed change in participants with lacunar infarctions. The presence of right-hemisphere cortical involvement had no significant impact on outcome. Conclusions Type, locus, and extent of lesion, and the loss of substrate for neuroplastic effect as a result of prior stroke may affect long-term outcome of rehabilitation of hemiparetic gait. © The Author(s) 2015.

  12. Facial disability index (FDI): Adaptation to Spanish, reliability and validity

    PubMed Central

    Gonzalez-Cardero, Eduardo; Cayuela, Aurelio; Acosta-Feria, Manuel; Gutierrez-Perez, Jose-Luis

    2012-01-01

    Objectives: To adapt to Spanish the facial disability index (FDI) described by VanSwearingen and Brach in 1995 and to assess its reliability and validity in patients with facial nerve paresis after parotidectomy. Study Design: The present study was conducted in two different stages: a) cross-cultural adaptation of the questionnaire and b) cross-sectional study of a control group of 79 Spanish-speaking patients who suffered facial paresis after superficial parotidectomy with facial nerve preservation. The cross-cultural adaptation process comprised the following stages: (I) initial translation, (II) synthesis of the translated document, (III) retro-translation, (IV) review by a board of experts, (V) pilot study of the pre-final draft and (VI) analysis of the pilot study and final draft. Results: The reliability and internal consistency of every one of the rating scales included in the FDI (Cronbach’s alpha coefficient) was 0.83 for the complete scale and 0.77 and 0.82 for the physical and the social well-being subscales. The analysis of the factorial validity of the main components of the adapted FDI yielded similar results to the original questionnaire. Bivariate correlations between FDI and House-Brackmann scale were positive. The variance percentage was calculated for all FDI components. Conclusions: The FDI questionnaire is a specific instrument for assessing facial neuromuscular dysfunction which becomes a useful tool in order to determine quality of life in patients with facial nerve paralysis. Spanish adapted FDI is equivalent to the original questionnaire and shows similar reliability and validity. The proven reproducibi-lity, reliability and validity of this questionnaire make it a useful additional tool for evaluating the impact of facial nerve paralysis in Spanish-speaking patients. Key words:Parotidectomy, facial nerve paralysis, facial disability. PMID:22926474

  13. Calculated globulin (CG) as a screening test for antibody deficiency.

    PubMed

    Jolles, S; Borrell, R; Zouwail, S; Heaps, A; Sharp, H; Moody, M; Selwood, C; Williams, P; Phillips, C; Hood, K; Holding, S; El Shanawany, T

    2014-09-01

    Calculated globulin (total protein - albumin) is usually tested as part of a liver function test profile in both primary and secondary care and determines the serum globulin concentration, of which immunoglobulins are a major component. The main use hitherto of calculated globulin is to detect paraproteins when the level is high. This study investigated the potential to use low levels of calculated globulin to detect antibody deficiency. Serum samples with calculated globulin cut-off < 18 g/l based on results of a pilot study were collected from nine hospitals in Wales over a 12-month period. Anonymized request information was obtained and the samples tested for immunoglobulin levels, serum electrophoresis and, if appropriate, immunofixation. A method comparison for albumin measurement using bromocresol green and bromocresol purple was undertaken. Eighty-nine per cent (737 of 826) samples had an immunoglobulin (Ig)G level of < 6 g/l using the bromocresol green methodology with a cut-off of < 18 g/l, and 56% (459) had an IgG of < 4 g/l. Patients with both secondary and primary antibody deficiency were discovered and serum electrophoresis and immunofixation showed that 1·2% (10) had previously undetected small paraproteins associated with immune-paresis. Using bromocresol purple, 74% of samples had an IgG of < 6 g/l using a cut-off of < 23 g/l. Screening using calculated globulin with defined cut-off values detects both primary and secondary antibody deficiency and new paraproteins associated with immune-paresis. It is cheap, widely available and under-utilized. Antibody-deficient patients have been discovered using information from calculated globulin values, shortening diagnostic delay and time to treatment with immunoglobulin replacement therapy.

  14. Treatment of cows with milk fever using intravenous and oral calcium and phosphorus.

    PubMed

    Braun, U; Blatter, M; Büchi, R; Hässig, M

    2012-09-01

    Fifteen cows with milk fever were treated with 500ml of 40 % calcium borogluconate (group A) administered intravenously. Fifteen other cows with milk fever received the same treatment, supplemented with 500ml of 10 % sodium phosphate administered intravenously, and 80g calcium as calcium lactate and 70g inorganic phosphorus as sodium phosphate administered orally in drinking water. The cows were monitored and blood samples collected for 3 days to measure the concentrations of total and ionized calcium, inorganic phosphorus and magnesium and the activity of creatine kinase. The two groups did not differ significantly with respect to the course of the disease. In each group 14 cows were cured. A rapid and significant increase in serum calcium concentration from the hypo- to the hypercalcaemic range occurred in both groups within 10min of the start of treatment, followed by a slow and steady decrease to the hypocalcaemic range. Calcium lactate did not prevent the calcium concentration from returning to the hypocalcaemic range, and the calcium profiles of the two groups did not differ significantly. As expected, treatment had little effect on the concentration of inorganic phosphorus in group A. In group B, treatment caused a rapid increase in the concentration of inorganic phosphorus to a maximum 20min after the start of treatment. This was followed by a slow decrease in the phosphorus concentration to the normophosphataemic range. Our findings confirmed that combined intravenous and oral administration of sodium phosphate in cows with periparturient paresis attributable to hypocalcaemia and hypophosphataemia results in a rapid and sustained increase in serum phosphorus, but not in serum calcium concentration. This modified therapy did not improve the success rate of milk fever treatment and further studies are needed to improve treatment of periparturient paresis.

  15. Intraoperative acceleromyography monitoring reduces symptoms of muscle weakness and improves quality of recovery in the early postoperative period.

    PubMed

    Murphy, Glenn S; Szokol, Joseph W; Avram, Michael J; Greenberg, Steven B; Marymont, Jesse H; Vender, Jeffery S; Gray, Jayla; Landry, Elizabeth; Gupta, Dhanesh K

    2011-11-01

    The subjective experience of residual neuromuscular blockade after emergence from anesthesia has not been examined systematically during postanesthesia care unit (PACU) stays. The authors hypothesized that acceleromyography monitoring would diminish unpleasant symptoms of residual paresis during recovery from anesthesia by reducing the percentage of patients with train-of-four ratios less than 0.9. One hundred fifty-five patients were randomized to receive intraoperative acceleromyography monitoring (acceleromyography group) or conventional qualitative train-of-four monitoring (control group). Neuromuscular management was standardized, and extubation was performed when defined criteria were achieved. Immediately upon a patient's arrival to the PACU, the patient's train-of-four ratios were measured using acceleromyography, and a standardized examination was used to assess 16 symptoms and 11 signs of residual paresis. This examination was repeated 20, 40, and 60 min after PACU admission. The incidence of residual blockade (train-of-four ratios less than 0.9) was reduced in the acceleromyography group (14.5% vs. 50.0% control group, with the 99% confidence interval for this 35.5% difference being 16.4-52.6%, P < 0.0001). Generalized linear models revealed the acceleromyography group had less overall weakness (graded on a 0-10 scale) and fewer symptoms of muscle weakness across all time points (P < 0.0001 for both analyses), but the number of signs of muscle weakness was small from the time of arrival in the PACU and did not differ between the groups at any time. Acceleromyography monitoring reduces the incidence of residual blockade and associated unpleasant symptoms of muscle weakness in the PACU and improves the overall quality of recovery.

  16. A case of possible paraneoplastic neurological syndrome presenting as multiple cranial nerve palsies associated with gallbladder cancer.

    PubMed

    Kaido, Misako; Yuasa, Yoshihito; Yamamoto, Tameyoshi; Munakata, Satoru; Tagawa, Naohiro; Tanaka, Keiko

    2016-09-29

    We report the case of a patient who had developed multiple cranial nerve palsies in the course of possible paraneoplastic neurological syndrome (PNS) associated with gallbladder cancer. Twelve days prior to visiting our hospital, a 69-year-old man began experiencing neurological symptoms, beginning with diplopia and progressing to ptosis of the left palpebra and subsequent complete closure of the eye within 8 days. Results of the initial medical examination indicated paresis of left oculomotor (III) and abducens (VI) nerves. MRI of the brain revealed no focal lesion that could have resulted in compression of the affected nerves, while further examination ruled out diabetes mellitus, infection, vasculitis, and other systemic autoimmune diseases as potential causes. Gadolinium-enhanced MRI revealed high intensity located in the oculomotor nerves, and steroid pulse therapy was performed based on the assumption of inflammatory diseases. Although slight improvement was observed with respect to the left extraocular paresis, subsequent emergence of bilateral facial nerve (VII) palsy, right abducens nerve palsy, and right oculomotor nerve palsy occurred in succession. PET/CT performed under suspicion of PNS, confirmed the presence of gallbladder cancer. Surgical extirpation of the cancer occurred 3 months following the appearance of left oculomotor paralysis, after which the patient underwent postoperative chemotherapy. All cranial nerve palsies resolved within 2 months after the operation, and both cancer and PNS have shown no recurrence for over 5 years. Pathological examination of the resected tumor revealed well-differentiated tubular adenocarcinoma showing some signs of epithelial-mesenchymal transition, typically an indicator of a poor prognosis. Nevertheless, lymph node metastasis did not progress beyond N2, and the cancer was completely removed by lymph node dissection. Therefore, the presence of multiple cranial palsies in this patient led to early detection of

  17. [Reconstruction of quadriceps femoris muscle function with muscle transfer].

    PubMed

    Fansa, H; Meric, C

    2010-08-01

    Femoral nerve palsy, mostly of iatrogen cause, leads to paresis of quadriceps muscle with complete loss of knee extension. Therapeutical options include neurolysis, nerve reconstruction or functional muscle transplantations. Another concept is the transfer of hamstring muscles as described in post polio surgery. We describe our experience of biceps femoris and semitendinosus muscle transfer for reconstruction of knee extension. From 2003 to 2007 seven patients (mean age 43) with complete loss of knee extension after femoral nerve lesion were treated. Nerve palsy was caused by direct lesion, traction, hematoma after collapse, lesion of lumbosacral plexus and an unclear muscle dystrophy. Indication for muscle transfer was due to long standing muscle paresis. All patients received a transfer of biceps femoris and semitendinosus muscle/tendon into the quadriceps tendon. Patients were immobilised in a cast for 6 weeks in extended knee position. Weight bearing started after 8 weeks. Operations went uneventfully. All patients were able to extend the knee postoperatively against gravity and were able to climb stairs without help. 4 Patients had complete knee extension, 2 had a lack of 20 degrees , one of 30 degrees. Daily routine was possible in all cases. No instability of knee joints occurred postoperatively. In a nerve lesion close to the muscle a nerve reconstruction should be aimed. If not performed or with unsuccessful outcome, muscle transfer is a good option to restore function. All recent studies describe good to excellent results with stable knees, allowing the patient to manage daily routine without assistance and to climb stairs up and down. Long term complications such as dislocation of patella or genu recurvatum were not observed in our patients. The latter results as typical complication in polio from weakening knee flexion through biceps femoris transfer, if the gastrocnemius muscle is not forceful enough. However in an isolated femoral nerve lesion this

  18. The Effects of Stroke Type, Locus, and Extent on Long-Term Outcome of Gait Rehabilitation: The LEAPS Experience

    PubMed Central

    Nadeau, Stephen E.; Dobkin, Bruce; Wu, Samuel S.; Pei, Qinglin; Duncan, Pamela W

    2015-01-01

    Background Paresis in stroke is largely due to damage to descending corticospinal and corticobulbar pathways. Recovery of paresis predominantly reflects the impact on the neural consequences of this white matter lesion by reactive neuroplasticity (mechanisms involved in spontaneous recovery) and experience-dependent neuroplasticity, driven by therapy and daily experience. However, both theoretical considerations and empirical data suggest that type of stroke (large vessel distribution/lacunar infarction, hemorrhage), locus and extent of infarction (basal ganglia, right hemisphere cerebral cortex), and the presence of leukoaraiosis or prior stroke might influence long-term recovery of walking ability. In this secondary analysis based on the 408 participants in the Locomotor Experience Applied Post-Stroke (LEAPS) study database, we seek to address these possibilities. Methods Lesion type, locus, and extent were characterized by the two neurologists in the LEAPS trial on the basis of clinical CT and MRI scans. A series of regression models was employed to test our hypotheses regarding the effects of lesion type, locus, extent, and laterality on 2–12 month change in gait speed, controlling for baseline gait speed, age, and Berg Balance Scale score. Results Gait speed change at 1-year was significantly reduced in participants with basal ganglia involvement and prior stroke. There was a trend toward reduction of gait speed change in participants with lacunar infarctions. The presence of right hemisphere cortical involvement had no significant impact on outcome. Conclusions Type, locus, and extent of lesion, and the loss of substrate for neuroplastic effect due to prior stroke may impact long-term outcome of rehabilitation of hemiparetic gait. PMID:26498434

  19. Reduction in memory in passive avoidance learning, exploratory behaviour and synaptic plasticity in mice with a spontaneous deletion in the ubiquitin C-terminal hydrolase L1 gene.

    PubMed

    Sakurai, Mikako; Sekiguchi, Masayuki; Zushida, Ko; Yamada, Kazuyuki; Nagamine, Satoshi; Kabuta, Tomohiro; Wada, Keiji

    2008-02-01

    Overexpression of ubiquitin C-terminal hydrolase L1 (UCH-L1) in mice rescues amyloid beta-protein-induced decreases in synaptic plasticity and memory. However, the physiological role of UCH-L1 in the brain is not fully understood. In the present study, we investigated the role of UCH-L1 in the brain by utilizing gracile axonal dystrophy (gad) mice with a spontaneous deletion in the gene Uch-l1 as a loss-of-function model. Although gad mice exhibit motor paresis beginning at approximately 12 weeks of age, it is possible to analyse their brain phenotypes at a younger age when no motor paresis is evident. Maintenance of memory in a passive avoidance test and exploratory behaviour in an open field test were reduced in 6-week-old gad mice. The maintenance of theta-burst stimulation-induced long-term potentiation (LTP) of field synaptic responses from Schaffer collaterals to CA1 pyramidal cells in hippocampal slices was also impaired in gad mice. The LTP in gad mice was insensitive to actinomycin D, suggesting that a transcription-dependent component of the LTP is impaired. Phosphorylation of cyclic AMP response element binding protein (CREB) in the CA1 region of hippocampal slices from gad mice occurred earlier than in the slices from wild-type mice and was transient, suggesting that CREB phosphorylation is altered in gad mice. These results suggest that memory in passive avoidance learning, exploratory behaviour and hippocampal CA1 LTP are reduced in gad mice. We propose that UCH-L1-mediated maintenance of the temporal integrity and persistence of CREB phosphorylation underlies these impairments.

  20. The reconstructive strategy for improving elbow function in late obstetric brachial plexus palsy.

    PubMed

    Chuang, David Chwei-Chin; Hattori, Yasunori; Ma And, Hae-Shya; Chen, Hung-Chi

    2002-01-01

    Children with previously untreated obstetric brachial plexus palsy frequently have abnormal elbow function because of motor recovery with aberrant reinnervation, or because of paresis or paralysis. From 1988 to 1997 (9-year period), 62 children with obstetric brachial plexus palsy with resulting elbow deformity underwent various methods of palliative reconstruction to improve elbow function. For motor recovery with aberrant reinnervation, release of aberrantly reinnervated antagonistic muscles and augmentation of paretic muscles form the basis of surgical intervention. The surgical procedures included triceps-to-biceps transfer, biceps-to-triceps transfer, brachialis-to-triceps transfer, or combined biceps- and brachialis-to-triceps transfer. Choice of procedures was individualized and randomly determined on the basis of the degree and pattern of aberrant reinnervation between elbow flexors and extensors. In patients' motor recovery with paresis or paralysis, persistently weak elbow flexion was salvaged with a functioning free muscle transplantation or Steindler's flexorplasty, or regional shoulder muscle transfer. In addition, patients with aberrant reinnervation between shoulder abductors and elbow flexors underwent anterior deltoid-to-biceps transfer with a fascia lata graft. All patients had a minimum follow-up of 2 years. Results are assessed and discussed and a reconstructive algorithm is recommended. In general, reconstruction of elbow extension should precede that of elbow flexion. Biceps-to-triceps transfer with preservation of an intact brachialis muscle, or brachialis-to-triceps transfer with preservation of an intact biceps, allows 50 percent of these patients to achieve acceptable elbow flexion and extension in a single-stage procedure.

  1. Toxicological studies of shale oils, some of their components, and commercial products.

    PubMed Central

    Veldre, I A; Jänes, H J

    1979-01-01

    Estonian shale oil contains about 25--30% phenols, and their action determines the toxicity of shale oils. The clinical symptoms of intoxication are rather similar, regardless of route of administration. Due to neurotropic action, the coordination of movements is impaired, and clonic and tetanic convulsions, paresis and paralysis of extremities, and narcosis are observed. In subacute and chronic toxicity tests, dysfunction of the central nervous system was found. In long-term (4--6 month) experiments, changes in liver and kidney function were found. Shale oil has gonadotropic activity and causes changes in the sexual cycle as well as diminution of the number of primordial folicles in the ovaries or a decrease in the quantity of normal spermatogonia in testicular germinal epithelium. Shale oils produce local irritation of skin and mucous membranes. Shale oil can induce sensitization of the organism after repeated administration. The results of acute intoxication tests have proved that volatile and nonvolatile phenol fractions, isomeric dimethylphenols, and 5-methylresorcinol, must be characterized as moderately toxic substances; the LD50 ranges from 501 to 1500 mg/kg. The clinical symptoms of acute toxication are similar for all studied phenols (restlessness, unsteadiness, clonic tremor, paresis and paralysis of extremities, and death). In spite of the moderate toxicity of phenols in acute experiments, repeated administration of small doses can cause different changes in the nervous system and internal organs of experimental animals. For all the phenols studied, the maximum allowable concentration in water was limited by their effect on the organoleptic properties of water. The nonactive dose for warm-blooded animals is from 100 to 3000 times the threshold limit value of phenols on the basis of their organoleptic properties. The effect of commercial products of oil shale industry is generally determined by the toxicity of the main components: water-soluble oil shale

  2. Experimental lead toxicosis in ponies: comparison of the effects of smelter effluent-contaminated hay and lead acetate

    SciTech Connect

    Burrows, G.E.; Borchard, R.E.

    1982-12-01

    Grass hay produced in the Coeur d'Alene River Basin of northern Idaho was fed to a group of 4 ponies. The hay contained Pb in concentration of 423 +/- 82 mg/kg and Cd in concentration of 10.8 +/- 1.4 mg/kg, resulting in daily exposures of the ponies to approximately 7.4 mg of Pb/kg and 0.19 mg of Cd/kg/day. The results in this group of ponies were compared with those from a group fed noncontaminated grass hay and given a daily dose of 10 mg of Pb/kg of body weight, in the form of lead acetate. Clinical toxicologic signs, hematologic changes, and blood and tissue Pb concentrations were similar in the 2 groups. However, the severity of the disease process appeared to be greater in the ponies fed the Pb- and Cd-contaminated hay. This was shown clearly by the shorter interval between onset of clinical changes and death in the ponies fed contaminated hay. The possibility of multiple heavy metal effects is discussed. Clinical toxicologic signs observed include incoordination, labial paresis, pharyngeal paresis, CNS depression, anorexia, and body weight loss. Anemia or marginal anemia was common and was often accompanied by the appearance of nucleated RBC and Howell-Jolly bodies in peripheral blood. Neither the hematologic response nor the blood Pb concentrations were reflective of the severity of poisoning, although blood Pb concentrations were greater than 0.35 micrograms/ml once clinical signs of toxicity were observed. Liver, kidney, spleen, brain, and bone Pb concentrations and liver, kidney, and brain Cd concentrations were increased in both the ponies fed contaminated hay and the ponies given lead acetate.

  3. Toxicological studies of shale oils, some of their components, and commercial products.

    PubMed

    Veldre, I A; Jänes, H J

    1979-06-01

    Estonian shale oil contains about 25--30% phenols, and their action determines the toxicity of shale oils. The clinical symptoms of intoxication are rather similar, regardless of route of administration. Due to neurotropic action, the coordination of movements is impaired, and clonic and tetanic convulsions, paresis and paralysis of extremities, and narcosis are observed. In subacute and chronic toxicity tests, dysfunction of the central nervous system was found. In long-term (4--6 month) experiments, changes in liver and kidney function were found. Shale oil has gonadotropic activity and causes changes in the sexual cycle as well as diminution of the number of primordial folicles in the ovaries or a decrease in the quantity of normal spermatogonia in testicular germinal epithelium. Shale oils produce local irritation of skin and mucous membranes. Shale oil can induce sensitization of the organism after repeated administration. The results of acute intoxication tests have proved that volatile and nonvolatile phenol fractions, isomeric dimethylphenols, and 5-methylresorcinol, must be characterized as moderately toxic substances; the LD50 ranges from 501 to 1500 mg/kg. The clinical symptoms of acute toxication are similar for all studied phenols (restlessness, unsteadiness, clonic tremor, paresis and paralysis of extremities, and death). In spite of the moderate toxicity of phenols in acute experiments, repeated administration of small doses can cause different changes in the nervous system and internal organs of experimental animals. For all the phenols studied, the maximum allowable concentration in water was limited by their effect on the organoleptic properties of water. The nonactive dose for warm-blooded animals is from 100 to 3000 times the threshold limit value of phenols on the basis of their organoleptic properties. The effect of commercial products of oil shale industry is generally determined by the toxicity of the main components: water-soluble oil shale

  4. Corpectomy of three cervical vertebral bodies for malignant tumours--a study of two cases.

    PubMed

    Guzik, Grzegorz

    2013-01-01

    The increased detection rate of spinal tumours is due to more precise methods used for imaging the spinal column and better survival of cancer patients. It is therefore associated with greater incidence of metastatic complications. Primary tumours of the spine, both malignant and benign, are very rare. Histopathological confirmation is a prerequisite of correct treatment. Two patients with pain in the neck area, progressive paresis, breathing disorders and dysphagia were admitted to our hospital. In the first patient, a 78-year-old woman, imaging examinations revealed a large exophytic tumour originating from C5-C7 vertebrae and compressing other neck structures. In view of the progressive paresis and dyspnoea, we decided to perform surgical resection of the tumour without a prior biopsy. We used the Southwick and Robinson approach on the right side and the tumour was removed together with damaged vertebral bodies, which were replaced by an implant. The next stage of the treatment involved stabilisation of the spine from C3 to Th2. Histopathological evaluation confirmed a diagnosis of chordoma. The second patient was a 73-year-old man. Imaging examinations revealed destruction of the C6 to Th1 vertebral bodies by a tumour with pathological fractures and compression of the spinal canal. The tumour was approached from the left side and removed according to the method presented by Southwick and Robinson. The removed vertebral bodies were replaced with implants. The spine was stabilised in the second stage of treatment. A diagnosis of metastatic adenocarcinoma was confirmed by a histopathological examination. Tumours located in the cervical spine, especially at the C7-Th1 level, cause considerable diagnostic and therapeutic problems. Southwick and Robinson's anterior approach allows for good exposure of vertebral bodies down to the Th2 level.

  5. Deficiency of depression in adduction: clinical characteristics and surgical management of the "inverted Brown pattern".

    PubMed

    Marsh, Justin D; Yilmaz, Pinar Topcu; Guyton, David L

    2016-02-01

    To evaluate the clinical characteristics and surgical management of patients with an "inverted Brown pattern," which is defined clinically as a hypertropia with greatest deviation in down-and-in gaze of the higher eye, having the appearance of superior oblique muscle underaction but without significant inferior oblique muscle overaction. The medical records of patients with this misalignment pattern who had cyclovertical muscle surgery at our institution from 2003 through 2015 were retrospectively reviewed; medical records were analyzed for pre- and postoperative motility patterns, fundus torsion, intraoperative findings, and type of strabismus surgery. A total of 45 patients presenting with a hyperdeviation worse in down-and-in gaze of the higher eye were included in the study. Of these, 25 (56%) had previously had inferior oblique-weakening procedures. The remainder included those with untreated superior oblique paresis (22%), previous orbital trauma (18%), or other ocular surgery (4%). The mean preoperative hyperdeviation in straight-ahead gaze was 8.7(Δ), compared with 0.9(Δ) postoperatively. Surgical success, defined as the absence of diplopia in straight-ahead gaze and not requiring further cyclovertical surgery, was achieved in 78% of patients. The motility pattern referred to as the "inverted Brown pattern" can develop in patients with orbital trauma, as previously described, or in association with superior oblique muscle paresis, most commonly after prior surgery to weaken the inferior oblique muscle. Weakening or reweakening of the inferior oblique muscle appears to correct this misalignment pattern, despite the absence of significant inferior oblique overaction preoperatively. Copyright © 2016 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

  6. Clinical features and surgical outcomes of isolated inferior rectus muscle paralysis.

    PubMed

    Akbari, Mohammad Reza; Ameri, Ahmad; Keshtkar Jaafari, Alireza; Fard, Masoud Aghsaei; Eshraghi, Bahram; Mirmohammadsadeghi, Arash

    2014-06-01

    To describe clinical features of patients with unilateral isolated inferior rectus (IR) muscle paralysis along with type of surgical treatment and results after surgery. Patients diagnosed with unilateral isolated IR muscle palsy between 2009 and 2012 that required surgical treatment were included in the study. Diagnosis of IR muscle palsy was done by hypertropia with the largest angle in depression and abduction and inferior rectus muscle underaction. Twenty-two patients remained in the study; 17 patients (77.3%) had left eye involvement. IR muscle paresis was traumatic in 12 patients (54.5%), congenital in 9 patients (40.9%), and vascular in 1 patient (4.5%). Limitation of duction in the gaze of IR muscle was -2 to -3 in all cases. 3 patients, paradoxically, had contralateral compensatory head tilt (compensatory head tilt to the opposite side of IR muscle palsy). Intraoperatively, we did not detect any gross abnormalities in the IR muscles. The surgical plan at the first operation was IR muscle resection alone in 13 patients (59.1%). At the last follow-up visit, 15 patients (68%) had no deviations in primary position and downgaze. Three cases needed reoperation. The presence of both ipsilateral and contralateral compensatory head postures in our patients showed that three-step or head-tilt test is not helpful in the diagnosis of IR muscle palsy. In comparison with other studies, more patients in our study were treated with IR muscle resection alone. Also, our reoperation rate was lower than other studies. Absence of gross abnormality in the IR muscles at the operation and partial nature of the paresis may explain these good results. Thus, a considerable number of IR muscle palsy cases with the above characteristics may be treated successfully by one muscle surgery (IR muscle resection).

  7. Peripheral Neuropathies in Nonparetic Upper Extremities of Stroke Patients Induced by Excessive Use of a Walking Device.

    PubMed

    Dozono, Koichiro; Hachisuka, Akiko; Wada, Futoshi; Hachisuka, Kenji

    2015-08-01

    Poststroke patients reportedly experience entrapment neuropathies in the nonparetic upper extremities, and the use of an assistive device for long periods may increase this risk. We examined nerve conduction velocities in hemiparetic patients and investigated the relationship between abnormal measurements and duration of walking. Twenty-eight male hemiparetic outpatients who used a cane or a crutch participated in this study. Clinical characteristics such as age, period of time from stroke onset, side and severity of paresis, activities of daily living, and basic ability to walk, as well as each patient's approximate number of hours walking per day, were collected. Electrophysiological evaluation was performed via nerve conduction studies of the median, ulnar, and radial nerves. The clinical features were compared between patients with and without peripheral neuropathies. Twelve patients (43%) had peripheral neuropathies involving a total of 15 nerves. There was no difference in age, duration of hemiparesis, side and severity of paresis, Barthel index, and Functional Ambulation Classification between the 2 groups. Abnormalities were absent in the patients who walked at or less than an hour but were present in 50% and 63.4% of patients with walking times of 1-2 hours and more than 2 hours, respectively. Excessive use of a T-cane or a Lofstrand crutch was hypothesized to induce entrapment neuropathies in the nonparetic upper extremity. To prevent these injuries, a well-balanced gait should be established to reduce the load on the walking device. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  8. Subluxation of the shoulder joint in stroke patients and the influence of selected factors on the incidence of instability.

    PubMed

    Pop, Teresa

    2013-06-28

    The aim of the study was to evaluate the incidence of shoulder subluxation in stroke patients and the impact of rehabilitation and presence/absence of fluid in the subhumeral and subdeltoid bursae on the occurrence of instability. The study group was composed of 182 patients after stroke, with 108 men and 74 women. 156 of the patients had suffered an ischemic stroke whereas 26 had experienced a hemorrhagic stroke; 90 patients had right-sided paresis and 92 left-sided paresis. The study variables were evaluated by performing, on two occasions, an ultrasound examination of the shoulder and an assessment of upper limb functional capacity using the Brunnström scale. 182 patients of the study group participated in an exercise programme according tothe PNF concept. There was no subluxation of the shoulder on the healthy side, while on the paretic side, subluxation occurred in 25.3% of the patients. Bursal fluid was seen more frequently on the paretic side (12.6%). A statistically significant reduction of the subluxation and bursal fluid was achieved after the rehabilitation. Subluxation occurred more frequently in patients with a known presence of fluid in the bursae and in those with poorer functional capacity of the upper limb. 1. The clinical symptoms of stroke are the cause of subluxation in the shoulder joint. 2. Subluxation occurs more frequently in patients with a known presence of fluid in the subhumeral and subdeltoid bursae and in patients with reduced functional capacity. 3. The reduction of subluxation and bursal fluid was influenced by the exercise program and improved functional capacity.

  9. Prediction of ischemic stroke in patients with tissue-defined transient ischemic attack.

    PubMed

    Hayashi, Takeshi; Kato, Yuji; Nagoya, Harumitsu; Ohe, Yasuko; Deguchi, Ichiro; Fukuoka, Takuya; Maruyama, Hajime; Horiuchi, Yohsuke; Nagamine, Yuito; Sano, Hiroyasu; Tanahashi, Norio

    2014-07-01

    The risk of future stroke after transient ischemic attack (TIA) has been widely studied, but most findings were obtained for classically defined TIA (time-defined TIA). A new definition of TIA, that is, tissue-defined TIA, which requires the absence of fresh brain infarction on magnetic resonance imaging, could change stroke risk assessments. We, therefore, aimed to evaluate the risk of future stroke in patients with tissue-defined TIA. We retrospectively reviewed 74 patients with tissue-defined TIA, who could be followed for 2 years. Clinical, laboratory, and radiological data were collected and compared between groups that did and did not develop ischemic stroke within the 2-year period. Ischemic stroke occurred in 11 patients (14.9%). Increased age, hemiparesis, and/or dysarthria during the TIA, old cerebral infarction revealed by magnetic resonance imaging, and large-artery stenosis detected by magnetic resonance angiography and/or ultrasonography tended to increase the risk of future stroke, but no individual factor showed statistically significant effect. TIA etiology did not significantly affect the risk. ABCD2 score, an established score for predicting stroke after time-defined TIA, showed only a weak association with future stroke. In contrast, new scores that we created reliably predicted future stroke; these included the APO (age, paresis, and old cerebral infarction) and APOL (age, paresis, old cerebral infarction, and large-artery stenosis) scores. The areas under the receiver operating characteristic curves were .662, .737, and .807 for ABCD2, APO, and APOL, respectively. Compared with the established measures, our newly created scores could predict future stroke for tissue-defined TIA more reliably. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  10. Equine degenerative myeloencephalopathy in Lusitano horses.

    PubMed

    Finno, C J; Higgins, R J; Aleman, M; Ofri, R; Hollingsworth, S R; Bannasch, D L; Reilly, C M; Madigan, J E

    2011-01-01

    Equine degenerative myeloencephalopathy (EDM) is a neurodegenerative disorder that has been previously associated with low vitamin E concentrations. To describe the clinical, electrophysiologic, and pathologic features of EDM in a group of related Lusitano horses. Fifteen Lusitano horses. Neurologic examinations were conducted, and serum vitamin E concentrations were measured. Three neurologically abnormal horses were further evaluated by ophthalmologic examination, electroretinography, electroencephalography, muscle and nerve biopsies, and post-mortem examination. Six horses appeared neurologically normal, 6 were neurologically abnormal, and 3 had equivocal gait abnormalities. Abnormal horses demonstrated ataxia and paresis. An inconsistent menace response was noted in 4 neurologically abnormal horses and in 1 horse with equivocal findings. All horses had low serum vitamin E concentrations (<1.5 ppm). Ophthalmologic examinations, electroretinograms, electroencephalograms, and muscle and peripheral nerve biopsies were unremarkable in 3 neurologically abnormal horses. At necropsy, major neuropathological findings in these horses were bilaterally symmetric, severe, neuro axonal degeneration in the gracilis, cuneatus medialis, cuneatus lateralis, and thoracicus nuclei and bilaterally symmetric axonal loss and demyelination mainly in the dorsolateral and ventromedial tracts of the spinal cord. A diagnosis of EDM was made based on these findings. Pedigree analysis identified 2 sires among the affected horses. Equine degenerative myeloencephalopathy is a neurodegenerative disorder that causes ataxia and, in severe cases, paresis, in young Lusitano horses. The disease appears to have a genetic basis, and although vitamin E deficiency is a common finding, low serum vitamin E concentrations also may occur in apparently unaffected related individuals. Copyright © 2011 by the American College of Veterinary Internal Medicine.

  11. Evolution of Neurological Impairment in Pediatric Infratentorial Ependymoma Patients

    PubMed Central

    Morris, E. Brannon; Li, Chenghong; Khan, Raja B.; Sanford, Robert A; Boop, Frederick; Pinlac, Renee; Xiong, Xiaoping; Merchant, Thomas E.

    2009-01-01

    Background Infratentorial ependymoma is a common central nervous system tumor of childhood and in patients > 1 year of age is treated with maximally feasible surgical resection and radiotherapy. Because of this tumor typically arises within the 4th ventricle and can invade the brainstem, patients are at risk for significant neurological impairment. Purpose To characterize the incidence, evolution, and persistence of neurologic impairment in children with infratentorial ependymoma following maximal safe surgery and conformal or intensity-modulated radiation therapy (CRT/IMRT). Patients and Methods After surgical resection, 96 children with non-metastatic infratentorial ependymoma were enrolled on a phase II study of image-guided radiation therapy and were prospectively followed with interval comprehensive neurological examinations. Late adverse neurological severity was graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE), version 3.0. Results The most common deficits detected at baseline examination were limb dysmetria, cranial nerve VI/VII palsy, limb paresis, dysphagia, and truncal ataxia/hypotonia. When present, gait dysfunction and dysphagia were often severe. Oculomotor dysfunction, facial paresis, dysphagia, and gait impairment improved over time. With the exception of hearing loss, in the survivor cohort, very few severe late effects (CTCAE Grade 3/4/5) were present at 60 month survival. Conclusion In general, neurological deficits were maximal in the post-operative period and either remained stable or improved during radiation and the post-treatment evaluation period. With the exception of hearing, the majority of chronic residual neurological deficits in this at-risk population are mild and only minimally intrude upon daily life. PMID:19330288

  12. Outcome of hemiplegic cerebral palsy born at term depends on its etiology.

    PubMed

    Kitai, Yukihiro; Haginoya, Kazuhiro; Hirai, Satori; Ohmura, Kayo; Ogura, Kaeko; Inui, Takehiko; Endo, Wakaba; Okubo, Yukimune; Anzai, Mai; Takezawa, Yusuke; Arai, Hiroshi

    2016-03-01

    To elucidate the etiology and its relationship to the outcomes of hemiplegic cerebral palsy (HCP). MR images and outcomes of 156 children with HCP born at term and older than three years were investigated in two major centers for cerebral palsy in Japan. Etiologies were classified into perinatal ischemic stroke (PIS), cerebral dysgenesis (CD), and others. PIS was divided into periventricular venous infarction (PVI) and two types of arterial infarction; middle cerebral artery infarction (MCAI) and deep gray matter infarction (DGMI). Initial signs and the time of presentation were investigated among the three types of PIS. As functional outcomes, laterality of paresis, age at initial walk, affected hand's function, intellectual development, and occurrence of epilepsy were compared among all the four types. PIS was found in 106 children (68%), while CD accounted for 28 (18%). Among PIS, venous infarction was more common than arterial infarction (62:44). PVI revealed later presentation of motor asymmetry and more involvement of lower extremity as the initial sign among PIS groups. Only MCAI showed right-side predominance in laterality of paresis. DGMI related to better intellectual development and PVI showed lower occurrence of epilepsy, while there was no significant difference in affected hand's function among the four groups. PIS groups showed significantly earlier attainment of independent walk, better intellectual development, and lower occurrence of epilepsy than CD. PVI was the most common cause of HCP born at term, and the etiology closely related to the initial signs of hemiplegia and overall outcomes. Copyright © 2015 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  13. Value of measuring serum vascular endothelial growth factor levels in diagnosing acute ischemic stroke.

    PubMed

    Dassan, Pooja; Keir, Geoffrey; Jäger, Hans Rolf; Brown, Martin M

    2012-08-01

    It has previously been reported that serum levels of vascular endothelial growth factor are raised after acute ischemic stroke compared to healthy controls. The aim of this prospective study was to ascertain whether serum vascular endothelial growth factor measurements could be used to distinguish between acute ischemic stroke and common stroke mimics in the emergency room. Blood samples were taken on arrival to hospital and daily for six-days, in 44 patients with suspected ischemic stroke (29 acute infarcts and 15 stroke mimics), arriving within 24 h of symptom onset. Vascular endothelial growth factor levels were measured by enzyme-linked immunoassay. The neurological deficit was recorded daily using the National Institute of Health Stroke Scale. Evaluation of infarct volumes was based on diffusion-weighted magnetic resonance imaging. Serum vascular endothelial growth factor levels were significantly raised in acute ischemic stroke patients on the day of symptom onset and at all other time points, compared to healthy controls (P < 0·01). The sensitivity and specificity of vascular endothelial growth factor for diagnosing acute ischemic stroke on admission to hospital were only 69% and 73%, respectively. Vascular endothelial growth factor levels were also elevated in four out of 15 stroke mimics, including three patients presenting with postictal paresis. Vascular endothelial growth factor has limited clinical utility in the diagnosis of acute ischemic stroke in the emergency room because levels are also raised in common stroke mimics. Further studies are required to establish the mechanism of vascular endothelial growth factor elevation in postictal paresis. © 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.

  14. Concentrated tea tree oil toxicosis in dogs and cats: 443 cases (2002-2012).

    PubMed

    Khan, Safdar A; McLean, Mary Kay; Slater, Margaret R

    2014-01-01

    To determine the frequency, types, and severity of clinical signs; geographic distribution; and treatment information associated with toxicosis caused by 100% tea tree oil (TTO) in dogs and cats in the United States and Canada. Retrospective case series. 337 dogs and 106 cats with evidence of exposure to 100% TTO. 10-year incident data were retrieved from the ASPCA Animal Poison Control Center database from January 2002 to December 2012. Only evidenced or witnessed incidents assessed as toxicosis or suspected toxicosis were included. Signalment, amount of TTO used, intention of use, and outcome information were evaluated. Severity of illness and correlations with breed, sex, age, and weight were determined. TTO was intentionally used in 395 of 443 (89%) animals. The amount used ranged from 0.1 to 85 mL. Incidents were reported from 41 states, the District of Columbia, and 4 Canadian provinces. Exposure route was cutaneous in 221 (50%) animals, cutaneous and oral in 133 (30%), and oral in 67 (15%). Clinical signs developed within 2 to 12 hours and lasted up to 72 hours. The most common signs were increased salivation or drooling, signs of CNS depression or lethargy, paresis, ataxia, and tremors. A significant association with severity of illness was found for age and weight, with higher prevalence of major illness in younger and smaller cats. Intentional or accidental use of 100% TTO in dogs or cats caused serious signs of CNS depression, paresis, ataxia, or tremors within hours after exposure and lasting up to 3 days. Younger cats and those with lighter body weight were at greater risk of developing major illness.

  15. Clinical practice guideline: Bell's palsy.

    PubMed

    Baugh, Reginald F; Basura, Gregory J; Ishii, Lisa E; Schwartz, Seth R; Drumheller, Caitlin Murray; Burkholder, Rebecca; Deckard, Nathan A; Dawson, Cindy; Driscoll, Colin; Gillespie, M Boyd; Gurgel, Richard K; Halperin, John; Khalid, Ayesha N; Kumar, Kaparaboyna Ashok; Micco, Alan; Munsell, Debra; Rosenbaum, Steven; Vaughan, William

    2013-11-01

    Bell's palsy, named after the Scottish anatomist, Sir Charles Bell, is the most common acute mono-neuropathy, or disorder affecting a single nerve, and is the most common diagnosis associated with facial nerve weakness/paralysis. Bell's palsy is a rapid unilateral facial nerve paresis (weakness) or paralysis (complete loss of movement) of unknown cause. The condition leads to the partial or complete inability to voluntarily move facial muscles on the affected side of the face. Although typically self-limited, the facial paresis/paralysis that occurs in Bell's palsy may cause significant temporary oral incompetence and an inability to close the eyelid, leading to potential eye injury. Additional long-term poor outcomes do occur and can be devastating to the patient. Treatments are generally designed to improve facial function and facilitate recovery. There are myriad treatment options for Bell's palsy, and some controversy exists regarding the effectiveness of several of these options, and there are consequent variations in care. In addition, numerous diagnostic tests available are used in the evaluation of patients with Bell's palsy. Many of these tests are of questionable benefit in Bell's palsy. Furthermore, while patients with Bell's palsy enter the health care system with facial paresis/paralysis as a primary complaint, not all patients with facial paresis/paralysis have Bell's palsy. It is a concern that patients with alternative underlying etiologies may be misdiagnosed or have unnecessary delay in diagnosis. All of these quality concerns provide an important opportunity for improvement in the diagnosis and management of patients with Bell's palsy. The primary purpose of this guideline is to improve the accuracy of diagnosis for Bell's palsy, to improve the quality of care and outcomes for patients with Bell's palsy, and to decrease harmful variations in the evaluation and management of Bell's palsy. This guideline addresses these needs by encouraging

  16. Effects of Stroke on Ipsilesional End-Effector Kinematics in a Multi-Step Activity of Daily Living

    PubMed Central

    Gulde, Philipp; Hughes, Charmayne Mary Lee; Hermsdörfer, Joachim

    2017-01-01

    Background: Stroke frequently impairs activities of daily living (ADL) and deteriorates the function of the contra- as well as the ipsilesional limbs. In order to analyze alterations of higher motor control unaffected by paresis or sensory loss, the kinematics of ipsilesional upper limb movements in patients with stroke has previously been analyzed during prehensile movements and simple tool use actions. By contrast, motion recording of multi-step ADL is rare and patient-control comparisons for movement kinematics are largely lacking. Especially in clinical research, objective quantification of complex externally valid tasks can improve the assessment of neurological impairments. Methods: In this preliminary study we employed three-dimensional motion recording and applied kinematic analysis in a multi-step ADL (tea-making). The trials were examined with respect to errors and sub-action structure, durations, path lengths (PLs), peak velocities, relative activity (RA) and smoothness. In order to check for specific burdens the sub-actions of the task were extracted and compared. To examine the feasibility of the approach, we determined the behavioral and kinematic metrics of the (ipsilesional) unimanual performance of seven chronic stroke patients (64a ± 11a, 3 with right/4 with left brain damage (LBD), 2 with signs of apraxia, variable severity of paresis) and compared the results with data of 14 neurologically healthy age-matched control participants (70a ± 7a). Results: T-tests revealed that while the quantity and structure of sub-actions of the task were similar. The analysis of end-effector kinematics was able to detect clear group differences in the associated parameters. Specifically, trial duration (TD) was increased (Cohen’s d = 1.77); the RA (Cohen’s d = 1.72) and the parameters of peak velocities (Cohen’s d = 1.49/1.97) were decreased in the patient group. Analysis of the task’s sub-actions repeated measures analysis of variance (rmANOVA) revealed

  17. Outcomes of endovascular occlusion and stenting in the treatment of carotid blowout.

    PubMed

    Brinjikji, Waleed; Cloft, Harry J

    2015-08-01

    Carotid blowout is a life threatening complication of invasive head and neck cancers and their treatments. This is commonly treated with endovascular embolization and carotid stenting. Using the Nationwide Inpatient Sample, we report the immediate clinical results of patients receiving embolization and/or stenting for treatment of carotid blowout associated with head and neck cancer. Using the Nationwide Inpatient Sample from the period 2003-2011, we defined carotid blowout patients as those with head and neck malignancies receiving carotid stenting and/or endovascular embolization without open surgery. Outcomes studied included mortality, acute ischemic stroke, hemiplegia/paresis, and other post-operative neurologic complications. Outcomes for the endovascular embolization and carotid stenting group were compared. A total of 1218 patients underwent endovascular treatment for carotid blowout. Of these, 1080 patients (88.6%) underwent embolization procedures and 138 patients (11.4%) underwent carotid stenting. The mortality rate of endovascular embolization patients was similar to that of carotid stenting patients (8.0%, 95% confidence interval (CI) = 6.5%-9.7% versus 10.2%, 95% CI=6.0%-16.4%, p = 0.36). Stroke rate was similar between embolization patients and stenting patients (2.3%, 95% CI=1.6%-3.4% vs. 3.4%, 95% CI=1.3%-8.4%, p = 0.43). Hemiplegia rates were significantly higher rate in stenting patients compared with endovascular occlusion patients (3.8%, 95% CI=1.3%-8.4% vs. 1.4%, 95% CI=1.4%-2.4%, p = 0.05). The rate of post-operative neurologic complications was higher in stenting patients compared with embolization patients (6.5%, 95% CI=3.3%-12.1% vs. 1.4%, 95% CI=0.9%-2.4%, p < 0.0001). Given the natural history of carotid blowout, carotid stenting and endovascular embolization are acceptable means of treating this disease. Endovascular embolization remains the most common treatment among patients with head and neck cancers with lower

  18. Carbon Ion Irradiation of the Rat Spinal Cord: Dependence of the Relative Biological Effectiveness on Linear Energy Transfer

    SciTech Connect

    Saager, Maria; Glowa, Christin; Peschke, Peter; Brons, Stephan; Scholz, Michael; Huber, Peter E.; Debus, Jürgen; Karger, Christian P.

    2014-09-01

    Purpose: To measure the relative biological effectiveness (RBE) of carbon ions in the rat spinal cord as a function of linear energy transfer (LET). Methods and Materials: As an extension of a previous study, the cervical spinal cord of rats was irradiated with single doses of carbon ions at 6 positions of a 6-cm spread-out Bragg peak (16-99 keV/μm). The TD{sub 50} values (dose at 50% complication probability) were determined according to dose-response curves for the development of paresis grade 2 within an observation time of 300 days. The RBEs were calculated using TD{sub 50} for photons of our previous study. Results: Minimum latency time was found to be dose-dependent, but not significantly LET-dependent. The TD{sub 50} values for the onset of paresis grade 2 within 300 days were 19.5 ± 0.4 Gy (16 keV/μm), 18.4 ± 0.4 Gy (21 keV/μm), 17.7 ± 0.3 Gy (36 keV/μm), 16.1 ± 1.2 Gy (45 keV/μm), 14.6 ± 0.5 Gy (66 keV/μm), and 14.8 ± 0.5 Gy (99 keV/μm). The corresponding RBEs increased from 1.26 ± 0.05 (16 keV/μm) up to 1.68 ± 0.08 at 66 keV/μm. Unexpectedly, the RBE at 99 keV/μm was comparable to that at 66 keV/μm. Conclusions: The data suggest a linear relation between RBE and LET at high doses for late effects in the spinal cord. Together with additional data from ongoing fractionated irradiation experiments, these data will provide an extended database to systematically benchmark RBE models for further improvements of carbon ion treatment planning.

  19. Recovery of motor disability and spasticity in post-stroke after repetitive transcranial magnetic stimulation (rTMS).

    PubMed

    Málly, J; Dinya, E

    2008-07-01

    Lately it has been indicated that the stimulation of both sides of the motor cortices with different frequencies of rTMS can improve the behaviour of a paretic arm. We studied the effect of rTMS in severe cases of post-stroke after nearly 10 years. They had wide hemispheric lesion and their paresis had not changed for more than 5 years. The majority of patients could not move their fingers on the affected side. In our study we examined whether the active movement could be induced by rTMS even several years after stroke and which hemisphere (affected or unaffected) stimulated by rTMS would be the best location for attenuating the spasticity and for developing movement in the paretic arm. Sixty-four patients (more than 5 years after stroke in a stable state) were followed for 3 months. They were treated with rTMS with 1 Hz at 30% of 2.3T 100 stimuli per session twice a day for a week. The area to be stimulated was chosen according to the evoked movement by TMS in the paretic arm. That way, four groups were created and compared. In group A, where both hemispheres were stimulated (because of the single stimulation of TMS could induce movement from both sides of hemispheres) the spasticity decreased but the movement could not be influenced. A highly significant improvement in spasticity, in movement induction and in the behaviour of paresis was observed in group B, where before treatment, there was no evoked movement in the paretic arm from stimulating either hemispheres of the brain. For treatment we stimulated the unaffected hemisphere from where the intact arm is moved (ipsilateral to the paretic side). In both groups C (contralateral hemisphere to the paretic arm) and D (ipsilaterally evoked movement in the paretic arm), the spasticity decreased during the first week, but the movement of the paretic arm improved only in group C. It seems that spasticity can be modified by the stimulation either the affected or the unaffected hemisphere, but the induction of movement

  20. Diagnostic assessment of central and peripheral lesions by means of audiomotor reflex.

    PubMed

    Ljubin, C

    1989-01-01

    Audiomotor reflex is defined as an exteroceptive reflex evoked by a strong sound impulse, occurring on skeletal muscles, where it can be electromyographically registered. It is visually best noted on the facial and eyelid muscles. The physiological basis is the reflex arch consisted of receptor-cohlea, the afferent part, the primary reflex audiotory centre, the efferent part and the muscle-effector. The main physiological characteristic of the audiomotor reflex (AMR) in all healthy people is the symmetry of contractions of the same muscles on the left and the right side of the body. This symmetry occurs because of the crossed afferent connections. The symmetry of contraction was examined on the m.orbicularis oculi and also m.tibialis anterior utq. and it was found that the differences in the contraction of the pair of muscles (the same muscles on the left and on the right side of the body) are minimal and negligible. This fact makes us possible to propose the analysis of symmetry of the AMR contractions, measured on the same muscles on the left and right side of the body, as a diagnostic method for estimating the central and peripheral disorders. In order to evaluate the AMR method for the purpose, two investigations were conducted. The first investigation was conducted for the purpose of evaluating the diagnostic value of the AMR method at patients with central disorders. Eight hemiparetic children and nine healthy children were examined by means of routine stimulation (110 dB, 1 kHZ, 100 ms). The monitoring of the reflex contraction was on the m.tibialis anterior utq. It was evident that all parameters of the AMR m.tibialis anterior (amplitude, latency and duration of reflex contraction) in hemiparetic children were changed on the affected hemiparetic side, in terms of increased excitability of motoneurons. In order to evaluate the AMR method in peripheral disorders, i.e. paresis of the n.facialis, the examining of patients with paresis of n.facialis of varied

  1. Ultrasound-Guided Regional Anesthesia and Patient Safety: Update of an Evidence-Based Analysis.

    PubMed

    Neal, Joseph M

    2016-01-01

    In 2010, the American Society of Regional Anesthesia and Pain Medicine's evidence-based medicine assessment of ultrasound (US)-guided regional anesthesia (UGRA) analyzed the effect of this nerve localization technology on patient safety. That analysis focused on 4 important regional anesthesia complications: peripheral nerve injury, local anesthetic systemic toxicity (LAST), hemidiaphragmatic paresis (HDP), and pneumothorax. In the intervening 5 years, further research has allowed us to refine our original conclusions. This update reviews previous findings and critically evaluates new literature published since late 2009 that compares the patient safety attributes of UGRA with those of traditional nerve localization methods. As with the previous version of this exercise, analysis focused on randomized controlled trials that compared UGRA with an alternative neural localization method and case series of more than 500 patients. The Jadad score was used to grade individual study quality, and conclusions were graded as to strength of evidence. Of those randomized controlled trials identified by our search techniques, 28 compared the incidence of postoperative nerve symptoms, 27 assessed LAST parameters, 7 studied HDP, and 9 reported the incidence of pneumothorax. The current analysis strengthens our original conclusions that US guidance has no significant effect on the incidence of postoperative neurologic symptoms and that UGRA reduces the incidence and intensity of HDP but does so in an unpredictable manner. Conversely, emerging evidence supports the effectiveness of US guidance for reducing LAST across its clinical presentation continuum. The predicted frequency of pneumothorax has grown smaller in tandem with increased experience with US-guided supraclavicular block. This evidence-based review summarizes both the power and the limitations of UGRA as a tool for improving patient safety. Since the original 2010 publication of this analysis, evidence has continued to

  2. "Double elevator palsy" eye supraducts during stage II general anesthesia supporting hypothesis of (supra)nuclear etiology.

    PubMed

    Mims, James L

    2005-01-01

    Double Elevator Palsy (DEP) was originally given its name because the assumption was, that because the affected eye could not elevate in adduction or in abduction, there must be a paresis of both the Superior Rectus (SR) and the Inferior Oblique (IO). Later, it was thought that DEP was due to a paresis of the ipsilateral SR, since the SR is the main elevator of the eye in both adduction and abduction. Gradually, a group of observations accumulated that indicated that the SR was not paretic at all in DEP, leading to the concept that DEP is due to a unilateral deficit in a nucleus that functions to elevate one eye only, a unilateral center for upgaze. The purpose of this paper is to report a clinical case with findings that further support this last hypothesis. A 15 month old girl presenting with classical signs of DEP of the left eye received a 6 mm recession of the left Inferior Rectus (IR). This was insufficient to eliminate a large chin elevation and a 9 prism diopter left hypotropia in the primary position. At the beginning of the second surgery, at which a vertical transposition of the horizontal muscles of the left eye after the technique of Knapp was planned, it was noticed during anesthesia induction that, as the child passed through stage II of the general anesthesia, both eyes briefly elevated, the DEP affected left eye (post 6 mm IR recession) more than the right. A photograph was taken to record this phenomenon. As of this report, there are now at least 4 distinct circumstances under which distinct elevation of eyes diagnosed with DEP have been observed. These 4 include Bell's phenomenon, Dissociated Vertical Deviation of the affected DEP eye, normal upgaze saccades recorded moving from the downgaze position into the primary position, and now elevation during Stage II of a general anesthetic induction. Further, there is no abnormal head posture (head tilt) in patients with DEP, no Bielschowsky phenomenon. All of these pieces of clinical evidence confirm

  3. Pharmacological treatment of vertigo.

    PubMed

    Hain, Timothy C; Uddin, Mohammed

    2003-01-01

    This review discusses the physiology and pharmacological treatment of vertigo and related disorders. Classes of medications useful in the treatment of vertigo include anticholinergics, antihistamines, benzodiazepines, calcium channel antagonists and dopamine receptor antagonists. These medications often have multiple actions. They may modify the intensity of symptoms (e.g. vestibular suppressants) or they may affect the underlying disease process (e.g. calcium channel antagonists in the case of vestibular migraine). Most of these agents, particularly those that are sedating, also have a potential to modulate the rate of compensation for vestibular damage. This consideration has become more relevant in recent years, as vestibular rehabilitation physical therapy is now often recommended in an attempt to promote compensation. Accordingly, therapy of vertigo is optimised when the prescriber has detailed knowledge of the pharmacology of medications being administered as well as the precise actions being sought. There are four broad causes of vertigo, for which specific regimens of drug therapy can be tailored. Otological vertigo includes disorders of the inner ear such as Ménière's disease, vestibular neuritis, benign paroxysmal positional vertigo (BPPV) and bilateral vestibular paresis. In both Ménière's disease and vestibular neuritis, vestibular suppressants such as anticholinergics and benzodiazepines are used. In Ménière's disease, salt restriction and diuretics are used in an attempt to prevent flare-ups. In vestibular neuritis, only brief use of vestibular suppressants is now recommended. Drug treatments are not presently recommended for BPPV and bilateral vestibular paresis, but physical therapy treatment can be very useful in both. Central vertigo includes entities such as vertigo associated with migraine and certain strokes. Prophylactic agents (L-channel calcium channel antagonists, tricyclic antidepressants, beta-blockers) are the mainstay of treatment

  4. Differing prevalence and diversity of bacterial species in fetal membranes from very preterm and term labor.

    PubMed

    Jones, Hannah E; Harris, Kathryn A; Azizia, Malika; Bank, Lindsay; Carpenter, Bernadette; Hartley, John C; Klein, Nigel; Peebles, Donald

    2009-12-08

    Intrauterine infection may play a role in preterm delivery due to spontaneous preterm labor (PTL) and preterm prolonged rupture of membranes (PPROM). Because bacteria previously associated with preterm delivery are often difficult to culture, a molecular biology approach was used to identify bacterial DNA in placenta and fetal membranes. We used broad-range 16S rDNA PCR and species-specific, real-time assays to amplify bacterial DNA from fetal membranes and placenta. 74 women were recruited to the following groups: PPROM <32 weeks (n = 26; 11 caesarean); PTL with intact membranes <32 weeks (n = 19; all vaginal birth); indicated preterm delivery <32 weeks (n = 8; all caesarean); term (n = 21; 11 caesarean). 50% (5/10) of term vaginal deliveries were positive for bacterial DNA. However, little spread was observed through tissues and species diversity was restricted. Minimal bacteria were detected in term elective section or indicated preterm deliveries. Bacterial prevalence was significantly increased in samples from PTL with intact membranes [89% (17/19) versus 50% (5/10) in term vaginal delivery p = 0.03] and PPROM (CS) [55% (6/11) versus 0% (0/11) in term elective CS, p = 0.01]. In addition, bacterial spread and diversity was greater in the preterm groups with 68% (13/19) PTL group having 3 or more positive samples and over 60% (12/19) showing two or more bacterial species (versus 20% (2/10) in term vaginal deliveries). Blood monocytes from women with PTL with intact membranes and PPROM who were 16S bacterial positive showed greater level of immune paresis (p = 0.03). A positive PCR result was associated with histological chorioamnionitis in preterm deliveries. Bacteria are found in both preterm and term fetal membranes. A greater spread and diversity of bacterial species were found in tissues of women who had very preterm births. It is unclear to what extent the greater bacterial prevalence observed in all vaginal delivery groups reflects bacterial contamination

  5. Predictive properties of the video head impulse test: measures of caloric symmetry and self-report dizziness handicap.

    PubMed

    McCaslin, Devin L; Jacobson, Gary P; Bennett, Marc L; Gruenwald, Jill M; Green, Andrea P

    2014-01-01

    The purpose of this investigation was to determine whether a predictable relationship existed between self-reported dizziness handicap and video Head Impulse Test (vHIT) results in a large sample of patients reporting to a dizziness clinic. Secondary objectives included describing the characteristics of the vHIT ipsilesional and contralesional vestibulo-ocular reflex slow-phase velocity in patients with varying levels of canal paresis. Finally, the authors calculated the sensitivity and specificity of the vHIT for detecting horizontal semicircular canal impairment using the caloric test as the "gold standard." Participants were 115 adults presenting to a tertiary medical care center with symptoms of dizziness. Participants were administered a measure of self-report dizziness handicap (i.e., Dizziness Handicap Inventory) and underwent caloric testing and vHIT at the same appointment. Results showed that (1) there were no significant group differences (i.e., vHIT normal versus vHIT abnormal) in the Dizziness Handicap Inventory total score, (2) both ipsilesional and contralateral velocity gain decreased with increases in caloric paresis, and (3) a caloric asymmetry of 39.5% was determined to be the cutoff that maximized discrimination of vHIT outcome. The level of self-reported dizziness handicap is not predicted by the outcome of the vHIT, which is consistent with the majority of published reports describing the poor relationship between quantitative tests of vestibular function and dizziness handicap. Further, the study findings have demonstrated that vHIT and caloric data are not redundant, and each test provides unique information regarding the functional integrity of the horizontal semicircular canal at different points on the frequency spectrum. The vHIT does offer some advantages over caloric testing, but at the expense of sensitivity. The vHIT can be completed in less time, is not noxious to the patient, and requires very little laboratory space. However, the

  6. Mental practice-based rehabilitation training to improve arm function and daily activity performance in stroke patients: a randomized clinical trial

    PubMed Central

    Verbunt, Jeanine A; Seelen, Henk AM; Ramos, Feljandro P; Michielsen, Bernard HM; Wetzelaer, Wim L; Moennekens, Martine

    2008-01-01

    Background Over 50% of patients with upper limb paresis resulting from stroke face long-term impaired arm function and ensuing disability in daily life. Unfortunately, the number of effective treatments aimed at improving arm function due to stroke is still low. This study aims to evaluate a new therapy for improving arm function in sub-acute stroke patients based on mental practice theories and functional task-oriented training, and to study the predictors for a positive treatment result. It is hypothesized that a six-week, mental practice-based training program (additional to regular therapy) targeting the specific upper extremity skills important to the individual patient will significantly improve both arm function and daily activity performance, as well as being cost effective. Methods/design One hundred and sixty sub-acute stroke patients with upper limb paresis (MRC grade 1–3) will participate in a single-blinded, multi-centre RCT. The experimental group will undertake a six-week, individually tailored therapy regime focused on improving arm function using mental practice. The control group will perform bimanual upper extremity exercises in addition to regular therapy. Total contact time and training intensity will be similar for both groups. Measurements will be taken at therapy onset, after its cessation and during the follow-up period (after 6 and 12 months). Primary outcome measures will assess upper extremity functioning on the ICF level of daily life activity (Wolf Motor Function Test, Frenchay Arm Test, accelerometry), while secondary outcome measures cover the ICF impairment level (Brunnstrom-Fu-Meyer test). Level of societal participation (IPA) and quality of life (EuroQol; SS-Qol) will also be tested. Costs will be based on a cost questionnaire, and statistical analyses on MAN(C)OVA and GEE (generalized estimated equations). Discussion The results of this study will provide evidence on the effectiveness of this mental practice

  7. Prediction of gait outcome with the knee-ankle-foot orthosis with medial hip joint in patients with spinal cord injuries: a study using recursive partitioning analysis.

    PubMed

    Suzuki, T; Sonoda, S; Saitoh, E; Onogi, K; Fujino, H; Teranishi, T; Oyobe, T; Katoh, M; Ohtsuka, K

    2007-01-01

    Retrospective study of the degree of gait independence achieved by persons with spinal cord injury (SCI) using knee-ankle-foot orthosis with a medial single hip joint (MSH-KAFO). To examine the effects of the neurological level, degree of paresis, age, and inhibitory physical/other factors on the gait with a MSH-KAFO in patients with SCIs. Three university hospitals and two rehabilitation hospitals in Japan. The 45 patients (36 men, nine women) examined included 10 with injuries in the cervical cord between C6 and C8 (group C), 20 with injuries in the upper-middle thoracic cord between T4 and T10 (group UT), and 15 with injuries in the lower thoracic-lumbar cord between T12 and L1 (group TL). Mean age was 34.0 years (range 16-68 years). Of these patients, 13 used the Walkabout, four used the gear joint, and 28 used the Primewalk as the medial hip joint. Recursive partitioning, which predicted the final status of gait from the level, degree of paresis, age, and inhibitory factors, was performed, and a decision tree for gait was constructed. Inhibitory factors were spasticity, involuntary spasms or muscle contractions, pain, contracture, weakness of the upper extremities, and decreased motivation to perform gait exercise. The degree of gait independence was rated on the following five-point scale: outdoor independent gait (5 points), indoor independent gait (4 points), indoor supervised gait (3 points), indoor assisted gait (2 points), and gait within parallel bars (1 point). New branches were added to the decision tree for gait based on the clinical experience, thereby constructing a new decision tree. The coincident ratio between the value predicted on the basis of the decision tree of gait and the value actually observed was 53.3%. The coincident ratio between the value predicted on the basis of the modified decision tree of gait and the actually observed value was 68.9%. The results provide valuable information to medical teams that may assist prescription of

  8. A Low-cost Adaptive Balance Training Platform for Stroke Patients: A Usability Study.

    PubMed

    Verma, Sunny; Kumar, Deepesh; Kumawat, Animesh; Dutta, Anirban; Lahiri, Uttama

    2017-02-09

    Stroke patients usually suffer from asymmetric posture due to hemi-paresis that can result in reduced postural controllability leading to a balance deficit. This deficit increases the risk of falls, which often makes them dependent on caregivers for community ambulation, thus deteriorating their quality of life. Conventional balance training involves rehabilitation exercises performed under physiotherapist's supervision where the scarcity of trained professionals as well as the cost of clinic-based rehabilitation programs can deter stroke survivors from undergoing regular balance training. Thus, researchers have been exploring technology-assisted solutions, e.g. home-based Virtual Reality (VR) setup. In this study, we developed a VBaT (VR-based Balance Training) platform where VR-augmented user-interface using Nintendo Wii Balance Board was tested in a laboratory setting for its feasibility. The VBaT offered tasks of varying difficulties to the participants that adapted to individual performance capability during balance training. We performed a preliminary usability study with 7 stroke survivors (post-stroke period>6 months). Preliminary results indicate the potential of the VBaT system to cause improvement in overall average task performance over the course of training while using the VBaT. Thus the VBaT system is proposed to be a step towards an effective balance training platform for people with balance disorder.

  9. Motor exam of patients with spinal cord injury: a terminological imbroglio.

    PubMed

    Figueiredo, Nicandro

    2017-07-01

    The description of the motor deficit of patients with spinal cord injury (SCI) varies significantly, leading to confusion within the neurological terminology. This paper proposes a concise and easy to use terminology to describe the motor deficit of patients with SCI. A broad review of the origin of the nomenclature used to describe the motor deficit of patients with SCI was performed and discussed. The prefix: "hemi" should be used to describe paralysis of one half of the body; "mono" for one limb; "para" for lower limbs, di" for two symmetrical segments and/or parts in both sides of the body; "tri" for three limbs, or two limbs and one side of the face; and "tetra" for four limbs. The suffix: "plegia" should be used for total paralysis of a limb or part of the body, and "paresis" for partial paralysis. The term "brachial" refers to the upper limbs; and "podal" to the lower limbs. According to the spinal cord origin of the main key muscles for the limbs, patients with complete injury affecting spinal cord segments C1-5 usually presents with "tetraplegia"; C6-T1 presents with "paraplegia and brachial diparesis"; T2-L2 with "paraplegia"; and L3-S1 with "paraparesis".

  10. Complex neurological symptoms in bilateral thalamic stroke due to Percheron artery occlusion

    PubMed Central

    Caruso, Paola; Manganotti, Paolo; Moretti, Rita

    2017-01-01

    The artery of Percheron is a rare anatomical variant where a single thalamic perforating artery arises from the proximal posterior cerebral artery (P1 segment) between the basilar artery and the posterior communicating artery and supplies the rostral mesencephalon and both paramedian territories of the thalami. Almost one-third of human brains present this variant. Occlusion of the artery of Percheron mostly results in a bilateral medial thalamic infarction, which usually manifests with altered consciousness (including coma), vertical gaze paresis, and cognitive disturbance. The presentation is similar to the “top of the basilar syndrome”, and early recognition should be prompted. We describe the case of a young female with this vessel variant who experienced a bilateral thalamic stroke. Magnetic resonance angiography demonstrated bilateral thalamic infarcts and a truncated artery of Percheron. Occlusion of the vessel was presumably due to embolism from a patent foramen ovale. Thrombolysis was performed, with incomplete symptom remission, cognitive impairment, and persistence of speech disorders. Early recognition and treatment of posterior circulation strokes is mandatory, and further investigation for underlying stroke etiologies is needed. PMID:28053539

  11. Novel SLC16A2 mutations in patients with Allan-Herndon-Dudley syndrome

    PubMed Central

    Shimojima, Keiko; Maruyama, Koichi; Kikuchi, Masahiro; Imai, Ayako; Inoue, Ken; Yamamoto, Toshiyuki

    2016-01-01

    Summary Allan-Herndon-Dudley syndrome (AHDS) is an X-linked disorder caused by impaired thyroid hormone transporter. Patients with AHDS usually exhibit severe motor developmental delay, delayed myelination of the brain white matter, and elevated T3 levels in thyroid tests. Neurological examination of two patients with neurodevelopmental delay revealed generalized hypotonia, and not paresis, as the main neurological finding. Nystagmus and dyskinesia were not observed. Brain magnetic resonance imaging demonstrated delayed myelination in early childhood in both patients. Nevertheless, matured myelination was observed at 6 years of age in one patient. Although the key finding for AHDS is elevated free T3, one of the patients showed a normal T3 level in childhood, misleading the diagnosis of AHDS. Genetic analysis revealed two novel SLC16A2 mutations, p.(Gly122Val) and p.(Gly221Ser), confirming the AHDS diagnosis. These results indicate that AHDS diagnosis is sometimes challenging owing to clinical variability among patients. PMID:27672545

  12. Desmoplastic ganglioglioma of the spinal cord in a western European hedgehog (Erinaceus europaeus).

    PubMed

    Ulrich, Reiner; Stan, Alexandru C; Fehr, Michael; Mallig, Carolin; Puff, Christina

    2010-11-01

    Gangliogliomas are composed of neoplastic glial and neuronal cells and are extremely rare tumors of the central nervous system of domestic animals. The present report describes the clinical presentation and the pathomorphological and immunophenotypical characteristics of a desmoplastic ganglioglioma in the spinal cord of a 3-year-old male western European hedgehog (Erinaceus europaeus). Clinically, the hedgehog exhibited a skin wound and therapy-resistant paresis of the left hind limb. Necropsy showed dilatation of the urinary bladder. Histologic examination of the thoracic spinal cord revealed a focally extensive infiltrative mass, which consisted of multiple nodules of smaller bipolar or oligopolar glial cells and variably sized polygonal, ganglionic, neuron-like cells embedded in variable amounts of microcystic neuropilic matrix. An area of spindle-shaped cells arranged in interwoven fascicles and surrounded by a prominent network of reticulin fibers was interpreted as desmoplastic leptomeningeal stroma. Immunohistochemistry revealed a moderate number of glial fibrillary acidic protein and S-100-positive cells and processes. In addition, the ganglionic neuron-like cells expressed neurofilament, microtubule-associated protein-2, and neuron-specific enolase. In summary, this spinal cord tumor was composed of astroglial and neuronal cellular elements, justifying the diagnosis of a desmoplastic ganglioglioma.

  13. A fronto-parietal network is mediating improvement of motor function related to repetitive peripheral magnetic stimulation: A PET-H2O15 study.

    PubMed

    Struppler, Albrecht; Binkofski, Ferdinand; Angerer, Bernhard; Bernhardt, Michael; Spiegel, Sabine; Drzezga, Alexander; Bartenstein, Peter

    2007-01-01

    Repetitive peripheral magnetic stimulation (RPMS) is a focused and painless stimulation method, in which muscle contractions are elicited by depolarization of the terminal motor branches. Clinical-experimental investigations on different disorders of sensorimotor integration in the last decade have shown that RPMS can be used for the rehabilitation of motor functions after stroke. It is supposed that this therapeutic effect is based on the RPMS-induced proprioceptive inflow to the CNS. To analyze the conditioning effects of RPMS on reorganization of the motor system on cortical level positron emission tomography (PET) is used. Regional cerebral blood flow (rCBF) has been measured using H(2)O(15)-PET in eight patients with arm paresis following focal cerebral ischemic infarction before and after treatment using RPMS on upper arm flexor muscles. Behavioral measures showed a significant improvement of kinematics of finger movements and a reduction of spasticity in the affected arm following RPMS treatment. The recovery was associated with significant increase of neural activation within the superior posterior parietal lobe and the premotor cortex (PM) areas. The increase of activation of the parieto-premotor network following RPMS treatment indicates a significant conditioning effect of RPMS on the cortical level. These results emphasize the positive therapeutic effect of RPMS and describe the physiological bases of its function on the central level.

  14. [Neuroprotector effect of human recombinant erythropoietin sorbed on polymer nanoparticles studied on model of intracerebral post-traumatic hematoma (hemorrhagic stroke)].

    PubMed

    Balaban'ian, V Iu; Solev, I N; Elizarova, O S; Garibova, T L; Litvinova, S A; Voronina, T A

    2011-01-01

    The neuroprotective activity of recombinant human erythropoietin (r-HuEpo) sorbed on poly(butyl)cyanoacrilate nanoparticles (EPO-PBCA) and on polylactic-co-glycolic acid nanoparticles (EPO-PLGA) has been studied on Wistar rats with intracerebral post-traumatic hematoma (model of hemorrhagic stroke) (IPH-HS) in comparison to native r-HuEpo. It is established that EPO-PBCA produced a protective effect in rats after IPH-HS that was manifested by a decrease in the number of animals with neurological disorders such as circus movement, paresis, and paralysis of hind limbs; the drug also improved coordination (rotating rod test), reduced the number of lost animals, and decreased the loss weight among survived rats. In addition, EPO-PBCA optimized the research behavior of rats with IPH-HS in the open field test and prevented amnesia of passive avoidance reflex (PAR), which was caused by the IPH-HS. These effects were manifested during a two-week observation period. EPO-PLGA has a similar but much less pronounced effect on the major disorders caused by IPH-HS. The efficiency of native r-HuEpo as a neuropotective agent was insignificant and only manifested by decrease in the number of lost animals with IPH-HS.

  15. CNS-accessible Inhibitor of Glucosylceramide Synthase for Substrate Reduction Therapy of Neuronopathic Gaucher Disease

    PubMed Central

    Marshall, John; Sun, Ying; Bangari, Dinesh S; Budman, Eva; Park, Hyejung; Nietupski, Jennifer B; Allaire, Amy; Cromwell, Mary A; Wang, Bing; Grabowski, Gregory A; Leonard, John P; Cheng, Seng H

    2016-01-01

    Gaucher disease (GD) is caused by a deficiency of glucocerebrosidase and the consequent lysosomal accumulation of unmetabolized glycolipid substrates. Enzyme-replacement therapy adequately manages the visceral manifestations of nonneuronopathic type-1 Gaucher patients, but not the brain disease in neuronopathic types 2 and 3 GD. Substrate reduction therapy through inhibition of glucosylceramide synthase (GCS) has also been shown to effectively treat the visceral disease. Here, we evaluated the efficacy of a novel small molecule inhibitor of GCS with central nervous system (CNS) access (Genz-682452) to treat the brain disease. Treatment of the conduritol β epoxide-induced mouse model of neuronopathic GD with Genz-682452 reduced the accumulation of liver and brain glycolipids (>70% and >20% respectively), extent of gliosis, and severity of ataxia. In the genetic 4L;C* mouse model, Genz-682452 reduced the levels of substrate in the brain by >40%, the extent of gliosis, and paresis. Importantly, Genz-682452-treated 4L;C* mice also exhibited an ~30% increase in lifespan. Together, these data indicate that an orally available antagonist of GCS that has CNS access is effective at attenuating several of the neuropathologic and behavioral manifestations associated with mouse models of neuronopathic GD. Therefore, Genz-682452 holds promise as a potential therapeutic approach for patients with type-3 GD. PMID:26948439

  16. Improvement of gait following functional electrical stimulation. I. Investigations on changes in voluntary strength and proprioceptive reflexes.

    PubMed

    Carnstam, B; Larsson, L E; Prevec, T S

    1977-01-01

    Patients with central spastic paresis and equipped with peroneal stimulators sometimes experience an improvement in their gait, even when the stimulator has been switched off. The object of the present investigation was to reach a better understanding of the mechanisms operating in such cases. 7 patients were investigated on repeated occasions. It was found that some of these patients got a clear increase in isometric strength of foot dorsiflexion following 10 min of peroneal stimulation. In other cases the increase was only slight. There was an inverse relation between the increase and the strength before stimulation. The increase of strength was due, at least partly, to an increased ability to activate the foot dorsiflectors, since there was a simultaneous increase in the EMG from the anterior tibial muscle. Evidence was also obtained suggesting that the increase in strength involved not only foot dorsiflexion but also plantarflexion of the foot end extension of the knee. Following peroneal stimulation there was also a decrease of the achilles reflex and in some cases possibly also the patellar reflex. There was an inverse relation between the decrease in the achilles reflex and its strength before stimulation. It is probable that the changes in voluntary strength and reflex activity reflect conditions which can be of importance in explaining the gait improvement which is sometimes observed in patients equippped with peroneal stimulators.

  17. Motor rehabilitation after traumatic brain injury and stroke - Advances in assessment and therapy.

    PubMed

    Platz, T; Hesse, S; Mauritz, K H

    1999-01-01

    A long-term goal in motor rehabilitation is that treatment is not selected on the basis of 'schools of thought', but rather, based on knowledge about efficacy and effectiveness of specific interventions for specific situations (e.g. functional syndromes). Motor dysfunction after stroke or TBI can be caused by many different functional syndromes such as paresis, ataxia, deafferentaion, visuo-perceptual deficits, or apraxia. Examples are provided showing that theory-based analysis of motor behavior makes it possible to describe 'syndrome-specific motor deficits'. Its potential implications for motor rehabilitation are that our understanding of altered motor behavior as well as specific therapeutic approaches might be promoted. A methodological prerequisite for clinical trials in rehabilitation is knowledge about test properties of assessment tools in follow-up situations such as test-retest reliability and responsiveness to change. Test-retest reliability assesses whether a test can produce stable measures with test repetition, while sensitivity to change reflects whether a test detects changes that occur over time. Exemplifying these considerations, a reliability and validity study of a kinematic arm movement analysis is summarized. In terms of new therapeutic developments, two examples of clinical therapeutic studies are provided assessing the efficacy of specific inter-ventions for specific situations in arm and gait rehabilitation: the Arm Ability Training for high functioning hemiparetic stroke and TBI patients, and the treadmill training for non-ambulatory hemiparetic patients. In addition, a new technical development, a machine-controlled gait trainer ist introduced.

  18. [Clinical application of functional MRI for chronic epilepsy].

    PubMed

    Woermann, F G; Labudda, K

    2010-02-01

    Functional magnetic resonance imaging (fMRI) is frequently used in the presurgical diagnostic procedure of epilepsy patients, in particular for lateralization of speech and memory and for localization of the primary motor cortex to delineate the epileptogenic lesion from eloquent brain areas. fMRI is one of the non-invasive procedures in the presurgical diagnostic process, together with medical history, seizure semiology, neurological examination, interictal and ictal EEG, structural MRI, video EEG monitoring and neuropsychology. This diagnostic sequence leads either to the decision for or against elective epilepsy surgery or to the decision to proceed with invasive diagnostic techniques (Wada test, intra-operative or extra-operative cortical stimulation). It is difficult to evaluate the contribution of the fMRI test in isolation to the validity of the entire diagnostic sequence. Complications such as memory loss and aphasia in temporal lobe resections or paresis after frontal lobe resections are rare and rarely of disastrous extent. This further complicates the evaluation of the clinical relevance of fMRI as a predictive tool. In this article studies which investigated the concordance between fMRI and other diagnostic gold standards will be presented as well as the association between presurgical fMRI and postsurgical morbidity.

  19. Guideline for the diagnosis, treatment and response criteria for Bing-Neel syndrome

    PubMed Central

    Minnema, Monique C.; Kimby, Eva; D’Sa, Shirley; Fornecker, Luc-Matthieu; Poulain, Stéphanie; Snijders, Tom J.; Kastritis, Efstathios; Kremer, Stéphane; Fitsiori, Aikaterini; Simon, Laurence; Davi, Frédéric; Lunn, Michael; Castillo, Jorge J.; Patterson, Christopher J.; Le Garff-Tavernier, Magali; Costopoulos, Myrto; Leblond, Véronique; Kersten, Marie-José; Dimopoulos, Meletios A.; Treon, Steven P.

    2017-01-01

    Bing Neel syndrome is a rare disease manifestation of Waldenström’s macroglobulinemia that results from infiltration of the central nervous system by malignant lymphoplasmacytic cells. In this guideline we describe the clinical symptoms, as well as the appropriate laboratory and radiological studies, that can aid in the diagnosis. The presentation of Bing Neel syndrome may be very diverse, and includes headaches, cognitive deficits, paresis, and psychiatric symptoms. The syndrome can present in patients with known Waldenström’s macroglobulinemia, even in the absence of systemic progression, but also in previously undiagnosed patients. Diagnostic work-up should include cerebral spinal fluid analysis with multiparameter flow cytometry to establish B-cell clonality, protein electrophoresis and immunofixation for the detection and classification of a monoclonal protein as well as molecular diagnostic testing for immunoglobulin gene rearrangement and mutated MYD88. MRI of the brain and spinal cord is also essential. The second challenge is to expand our knowledge of prognosis and treatment outcome. Prospective clinical trials on Bing Neel syndrome patients that employ uniform treatment along with appropriate laboratory cerebral spinal fluid assessments and standardized MRI protocols will be invaluable, constituting a significant step forward in delineating treatment outcome for this intriguing disease manifestation. PMID:27758817

  20. Guideline for the diagnosis, treatment and response criteria for Bing-Neel syndrome.

    PubMed

    Minnema, Monique C; Kimby, Eva; D'Sa, Shirley; Fornecker, Luc-Matthieu; Poulain, Stéphanie; Snijders, Tom J; Kastritis, Efstathios; Kremer, Stéphane; Fitsiori, Aikaterini; Simon, Laurence; Davi, Frédéric; Lunn, Michael; Castillo, Jorge J; Patterson, Christopher J; Le Garff-Tavernier, Magali; Costopoulos, Myrto; Leblond, Véronique; Kersten, Marie-José; Dimopoulos, Meletios A; Treon, Steven P

    2017-01-01

    Bing Neel syndrome is a rare disease manifestation of Waldenström's macroglobulinemia that results from infiltration of the central nervous system by malignant lymphoplasmacytic cells. In this guideline we describe the clinical symptoms, as well as the appropriate laboratory and radiological studies, that can aid in the diagnosis. The presentation of Bing Neel syndrome may be very diverse, and includes headaches, cognitive deficits, paresis, and psychiatric symptoms. The syndrome can present in patients with known Waldenström's macroglobulinemia, even in the absence of systemic progression, but also in previously undiagnosed patients. Diagnostic work-up should include cerebral spinal fluid analysis with multiparameter flow cytometry to establish B-cell clonality, protein electrophoresis and immunofixation for the detection and classification of a monoclonal protein as well as molecular diagnostic testing for immunoglobulin gene rearrangement and mutated MYD88. MRI of the brain and spinal cord is also essential. The second challenge is to expand our knowledge of prognosis and treatment outcome. Prospective clinical trials on Bing Neel syndrome patients that employ uniform treatment along with appropriate laboratory cerebral spinal fluid assessments and standardized MRI protocols will be invaluable, constituting a significant step forward in delineating treatment outcome for this intriguing disease manifestation. Copyright© Ferrata Storti Foundation.