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Juvenile muscular atrophy of the distal upper extremity (Hirayama syndrome): a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3296-3307. [PMID: 35727373 DOI: 10.1007/s00586-022-07279-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Hirayama syndrome is likely caused by a forward displacement of the posterior dura during cervical flexion leading to changes in the muscles of the fingers and wrist. The aim of this systematic review was to document the number of reported cases, the necessity of dynamic MRI of the cervical spine and the subsequent treatment. METHODS AND MATERIALS A systematic review was conducted and the Pubmed/Medbase, Cochrane, Google, Embase and Ovid database were searched for (Hirayama) AND ((disease) OR (syndrome)). A total of 42 studies were included for analysis reporting 2311 patients. RESULTS The mean age was 20.2 ± 2.26 years and predominantly males (92.8%) were identified. On MRI the "snake eyes" appearance of the spinal cord was present in 27.8% and the typical time between onset of symptoms and diagnosis was 41.5 ± 16.4 months. A variety of different treatments have been reported, although there is no substantial evidence that any of them are superior to observation. CONCLUSION The delay in diagnosis from initial presentation of symptoms shows that this condition may be underdiagnosed in a variety of cases. Further, this study shows the necessity of either a dynamic MRI in flexion or a static MRI scan in neutral position and in flexion, to identify functional spinal and/or foraminal stenosis for a prompt diagnosis and subsequent treatment.
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Lu WZ, Lin HA, Hou SK, Lee CF, Bai CH, Lin SF. Split-hand index for amyotrophic lateral sclerosis diagnosis: A frequentist and Bayesian meta-analysis. Clin Neurophysiol 2022; 143:56-66. [PMID: 36116424 DOI: 10.1016/j.clinph.2022.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/02/2022] [Accepted: 08/21/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Preferential wasting of the thenar muscles, the split-hand sign, may be used for early diagnosis of amyotrophic lateral sclerosis (ALS). METHODS Electronic databases were searched for studies assessing the split-hand index (SHI) and the compound muscle action potential (CMAP) amplitudes of abductor pollicis brevis (APB), first dorsal interosseous (FDI), and abductor digiti minimi (ADM). The SHI was obtained by multiplying CMAP amplitudes of APB and FDI and dividing the product by the CMAP amplitude of ADM. The Bayesian analysis was used for validation. RESULTS In total, 17 studies and 1635 patients were included. Our meta-analysis revealed that ALS patients had significantly decreased SHI (standardized mean difference [SMD], -1.60, P < 0.001), CMAP of the APB (SMD, -1.67, P < 0.001), FDI (SMD, -1.12, P < 0.001), and ADM (SMD, -1.09, P < 0.001). The binormal receiver operating characteristic curve analysis showed a threshold of < 7.4 for SHI, and cutoff values of < 6.4 mV for APB and < 8.4 mV for FDI, respectively. The Bayesian analysis validated decreased SHI in ALS patients (posterior mean difference of - 5.91). CONCLUSIONS An SHI of < 7.4 can be used facilitating earlier diagnosis of ALS. SIGNIFICANCE SHI can be used as a standard neurophysiological biomarker for early diagnosis.
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Affiliation(s)
- Wei-Zhen Lu
- Department of Emergency Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Hui-An Lin
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sen-Kuang Hou
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Fan Lee
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Sheng-Feng Lin
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan; School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Reassessing the Diagnostic Utility of the Split Hand Index in Amyotrophic Lateral Sclerosis Patients-The Divide by Zero Problem. Neurol Int 2022; 14:707-715. [PMID: 36135994 PMCID: PMC9503317 DOI: 10.3390/neurolint14030059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/18/2022] [Accepted: 08/25/2022] [Indexed: 11/28/2022] Open
Abstract
We set out to assess the diagnostic utility of the split hand index (SHI) for amyotrophic lateral sclerosis (ALS) and also to see if and how it can be applied to severely atrophied muscles, a frequent finding in this setting. We enrolled 38 patients from our clinic, 19 diagnosed with ALS and 19 controls, matched for age and sex. The SHI was calculated, on both sides, for all the patients. We calculated a SHI of 0 when the abductor pollicis brevis muscle (ABD) or first dorsal interosseous muscle (FDI) compound muscle action potentials (CMAPs) were unobtainable, and we allotted a value of 0.1 mV to abductor digiti minimi muscle (ADM) CMAP, for mathematical purposes, when the value would have been 0. The means differences were large between groups, with a significant variance heterogeneity. We performed a ROC analysis and obtained an accuracy of 0.83 for a SHI of 7.2, p-value < 0.0001. In conclusion, we reaffirm the utility of the SHI in the diagnosis of ALS, especially in limb onset cases, and we think that it can be safely extended to severely atrophied muscles with absent or very low CMAP values, without endangering the sensitivity or specificity.
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Dang J, Chieng JSL, Dona NWDM, Geoiphy PG, Koh JS. Reverse split hand syndrome and distinctive spine imaging features in Hirayama disease. QJM 2022; 115:184-185. [PMID: 35150273 DOI: 10.1093/qjmed/hcac038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J Dang
- Department of Neurology, National Neuroscience Institute, 11 Jln Tan Tock Seng, Level 1, Singapore, Postal Code 308433
| | - J S L Chieng
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, Postal Code 768828
| | | | - P G Geoiphy
- Department of Diagnostic Radiology , Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, Postal Code 768828
| | - J S Koh
- Department of Neurology, National Neuroscience Institute, 11 Jln Tan Tock Seng, Level 1, Singapore, Postal Code 308433
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Wang H, Tian Y, Wu J, Luo S, Zheng C, Sun C, Nie C, Xia X, Ma X, Lyu F, Jiang J, Wang H. Update on the Pathogenesis, Clinical Diagnosis, and Treatment of Hirayama Disease. Front Neurol 2022; 12:811943. [PMID: 35178023 PMCID: PMC8844368 DOI: 10.3389/fneur.2021.811943] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/24/2021] [Indexed: 11/29/2022] Open
Abstract
Hirayama disease (HD) is characterized by the juvenile onset of unilateral or asymmetric weakness and amyotrophy of the hand and ulnar forearm and is most common in males in Asia. A perception of compliance with previous standards of diagnosis and treatment appears to be challenged, so the review is to update on HD. First, based on existing theory, the factors related to HD includes, (1) cervical cord compression during cervical flexion, (2) immunological factors, and (3) other musculoskeletal dynamic factors. Then, we review the clinical manifestations: typically, (1) distal weakness and wasting in one or both upper extremities, (2) insidious onset and initial progression for 3-5 years, (3) coarse tremors in the fingers, (4) cold paralysis, and (5) absence of objective sensory loss; and atypically, (1) positive pyramidal signs, (2) atrophy of the muscles of the proximal upper extremity, (3) long progression, and (4) sensory deficits. Next, updated manifestations of imaging are reviewed, (1) asymmetric spinal cord flattening, and localized lower cervical spinal cord atrophy, (2) loss of attachment between the posterior dural sac and the subjacent lamina, (3) forward displacement of the posterior wall of the cervical dural sac, (4) intramedullary high signal intensity in the anterior horn cells on T2-weighted imaging, and (5) straight alignment or kyphosis of cervical spine. Thus, the main manifestations of eletrophysiological examinations in HD include segmental neurogenic damages of anterior horn cells or anterior roots of the spinal nerve located in the lower cervical spinal cord, without disorder of the sensory nerves. In addition, definite HD needs three-dimensional diagnostic framework above, while probable HD needs to exclude other diseases via "clinical manifestations" and "electrophysiological examinations". Finally, the main purpose of treatment is to avoid neck flexion. Cervical collar is the first-line treatment for HD, while several surgical methods are available and have achieved satisfactory results. This review aimed to improve the awareness of HD in clinicians to enable early diagnosis and treatment, which will enable patients to achieve a better prognosis.
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Affiliation(s)
- Hongwei Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
- Spine Center Fudan University, Shanghai, China
| | - Ye Tian
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
- Spine Center Fudan University, Shanghai, China
| | - Jianwei Wu
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
- Spine Center Fudan University, Shanghai, China
| | - Sushan Luo
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chaojun Zheng
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
- Spine Center Fudan University, Shanghai, China
| | - Chi Sun
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
- Spine Center Fudan University, Shanghai, China
| | - Cong Nie
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
- Spine Center Fudan University, Shanghai, China
| | - Xinlei Xia
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
- Spine Center Fudan University, Shanghai, China
| | - Xiaosheng Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
- Spine Center Fudan University, Shanghai, China
| | - Feizhou Lyu
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
- Spine Center Fudan University, Shanghai, China
- Department of Orthopedics, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Jianyuan Jiang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
- Spine Center Fudan University, Shanghai, China
| | - Hongli Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
- Spine Center Fudan University, Shanghai, China
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Corcia P, Bede P, Pradat PF, Couratier P, Vucic S, de Carvalho M. Split-hand and split-limb phenomena in amyotrophic lateral sclerosis: pathophysiology, electrophysiology and clinical manifestations. J Neurol Neurosurg Psychiatry 2021; 92:1126-1130. [PMID: 34285065 DOI: 10.1136/jnnp-2021-326266] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/05/2021] [Indexed: 11/03/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder affecting the upper and lower motor neurons. A key clinical feature of ALS is the absence of accurate, early-stage diagnostic indicators. 'Split-hand syndrome' was first described in ALS at the end of the last century and a considerable body of literature suggests that the split-hand phenomenon may be an important clinical feature of ALS. Considering the published investigations, it is conceivable that the 'split-hand syndrome' results from the associated upper and lower motor neuron degeneration, whose interaction remains to be fully clarified. Additionally, other split syndromes have been described in ALS involving upper or lower limbs, with a nuanced description of clinical and neurophysiological manifestations that may further aid ALS diagnosis. In this review, we endeavour to systematically present the spectrum of the 'split syndromes' in ALS from a clinical and neurophysiology perspective and discuss their diagnostic and pathogenic utility.
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Affiliation(s)
- Philippe Corcia
- Centre Constitutif de Référence SLA, CHU Bretonneau, Tours, France
| | - Peter Bede
- Computational Neuroimaging Group, Trinity College Dublin, Ireland.,Pitié-Salpêtrière University Hospital, Sorbonne University, Paris, France
| | - Pierre-François Pradat
- Neurology, Hopital Pitie-Salpetriere, Paris, France.,LIB, Université Pierre et Marie Curie Faculté de Médecine, Paris, Île-de-France, France
| | | | - Steve Vucic
- Westmead Clinical School, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Mamede de Carvalho
- Instituto de Fisiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisbon, Lisbon, Portugal.,Department of Neurosciences and Mental Health, Hospital de Santa Maria, Lisboa, Portugal
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Hu N, Wang J, Liu M. Split hand in amyotrophic lateral sclerosis: A systematic review and meta-analysis. J Clin Neurosci 2021; 90:293-301. [PMID: 34275566 DOI: 10.1016/j.jocn.2021.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/05/2021] [Accepted: 06/06/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the frequency of split hand (SI) and its diagnostic performance in amyotrophic lateral sclerosis (ALS). METHODS PubMed, EMBASE, OVID and other databases were searched systematically up to March 2021 for relevant reports about the split hand syndrome. Two reviewers screened and selected the titles and abstracts of the studies independently during the database searches and performed full-text reviews and extracted available data. In our study, AACMAP was calculated by AACMAP = APBCMAP/ADMCMAP and split-hand index (SI) was calculated by SICMAP = (APBCMAP × FDICMAP)/ADMCMAP. The mean differences (MD) in APB/ADMCMAP and SICMAP between patients with ALS and control group were calculated (APB the abductor pollicis brevis muscle; ADM the abductor digiti minimi muscle; CMAP compound muscle action potentials). Meta-analysis was performed to determine summary sensitivity, specificity, and area under the curve (AUC) with 95% confidence intervals (CI) for SICMAP. RESULTS Pooled results of five studies including 339 patients showed that 50% (95%CI: 35%-65%) of patients with ALS presented split hand. APB/ADMCMAP in patients with ALS was significantly lower than healthy population (MD: -0.38, 95%CI: -0.48, -0.28). SICMAP in patients with ALS was significantly lower than healthy controls (MD: -5.87, 95%CI: -6.28, -5.46) and neuromuscular controls (MD: -5.60, 95%CI: -5.78, -5.42). Receiver operating characteristic curve analysis showed that the AUC was 0.860 [95%CI: 0.808, 0.911] for SICMAP. The sensitivity and specificity for SICMAP were 78% and 81% (cut-off value: 5.2-11.8), respectively. CONCLUSION Half of ALS patients might show split hand sign. SICMAP could be a potential biomarker in the diagnosis of ALS.
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Affiliation(s)
- Nan Hu
- Department of Neurology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Jingyi Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Beijing 100730, China.
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Al-Hashel JY, Abdelnabi EA, Ibrahim Ismail I. Monomelic Amyotrophy (Hirayama Disease): A Rare Case Report and Literature Review. Case Rep Neurol 2020; 12:291-298. [PMID: 33082767 PMCID: PMC7549014 DOI: 10.1159/000508994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/27/2020] [Indexed: 12/13/2022] Open
Abstract
Hirayama disease is a rare neurological entity that is characterized by initial progressive muscular wasting and weakness of the distal upper limb in young men, followed by a spontaneous arrest within several years. The disease is believed to be a result of forward displacement of the cervical dural sac and spinal cord induced by neck flexion. It is commonly seen in Asia and rarely encountered in the Middle East countries. We report a rare case of a 20-year-old Kuwaiti patient presenting with a 10-month duration of gradual left upper limb weakness and wasting. We describe his electrophysiological and radiological findings that confirmed the diagnosis, and conducted a literature review. Hirayama disease is rarely encountered in clinical settings and should be suspected in male patients presenting with unilateral or asymmetrical bilateral lower motor weakness of hands and forearms. It is a benign entity, and cervical collar is usually the only treatment needed in most cases.
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Affiliation(s)
- Jasem Y. Al-Hashel
- Department of Neurology, Ibn Sina Hospital, Safat, Kuwait
- Department of Medicine, Health Sciences Centre, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
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Preethish-Kumar V, Vengalil S, Tiwari S, Polavarapu K, Netravathi M, Ramalingaiah AH, Nalini A. Ventral longitudinal intraspinal fluid collection: Rare presentation as brachial amyotrophy and intracranial hypotension. J Spinal Cord Med 2019; 42:45-50. [PMID: 28402198 PMCID: PMC6340281 DOI: 10.1080/10790268.2017.1314901] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
CONTEXT Ventral longitudinal intraspinal fluid collection (VLISFC) presenting as hand amyotrophy has been described only in a few cases and there are no reports on associated intracranial CSF hypovolemia (ICH). We describe the clinical and imaging findings of a case with combined brachial amyotrophy and ICH secondary to VLISFC. FINDINGS A 31 year old man presented with severe positional neck discomfort, radiating pain, progressive asymmetrical wasting and weakness of distal upper limbs. Contrast Magnetic Resonance Imaging (MRI) of the spine demonstrated a ventral extradural intraspinal fluid collection extending from upper border of C6 to lower border of T3 vertebra with pockets of dorsal collection. Three-dimensional constructive interference in steady state (CISS 3D) used in spinal imaging for identification of CSF leak corroborated with the extent seen on T2 sagittal sections; however, the site of the leak was not identified. After a year he developed disturbing postural headache which was relieved in recumbent position. Follow up MRI of brain was normal while spine demonstrated significant cervical cord atrophy and bilateral cord white matter hyperintensities. Conclusion / Clinical Relevance: We report this unusual case where local compression by VLISFC located at the cervical and upper thoracic level not only caused distal bi-brachial amyotrophy mimicking Hirayama disease but also led to secondary intracranial hypotension. An early identification and intervention could possibly have prevented the onset of ICH.
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Affiliation(s)
- Veeramani Preethish-Kumar
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bangalore, India,Department of Clinical Neurosciences, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Sarbesh Tiwari
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bangalore, India,Department of Clinical Neurosciences, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - M Netravathi
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | | | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bangalore, India,Correspondence to: Dr. Atchayaram Nalini, Neuromuscular specialist & Professor, Department of Neurology, Neuroscience Faculty Center, National Institute of Mental Health and Neurosciences, Bangalore - 560029, India.
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Vachon C, Abu Libdeh A. Clinical Reasoning: A 17-year-old baseball player with right hand weakness. Neurology 2019; 92:e76-e80. [PMID: 30584084 DOI: 10.1212/wnl.0000000000006693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Christopher Vachon
- From the Departments of Neurology (C.V.) and Pediatric Neurology (A.A.L.), University of Virginia, Charlottesville.
| | - Amal Abu Libdeh
- From the Departments of Neurology (C.V.) and Pediatric Neurology (A.A.L.), University of Virginia, Charlottesville
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Rosliakova A, Zakroyshchikova I, Bakulin I, Konovalov R, Kremneva E, Krotenkova M, Suponeva N, Zakharova M. Hirayama disease: analysis of cases in Russia. Neurol Sci 2018; 40:105-112. [PMID: 30284056 DOI: 10.1007/s10072-018-3588-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 09/25/2018] [Indexed: 10/28/2022]
Abstract
The fourteen cases of Hirayama disease (HD) are presented in this article. HD is seldom disease characterized by juvenile muscular atrophy of upper extremities and benign course. All cases were diagnosed in the Research Center of Neurology (Moscow, Russia) during the year 2015-2017. Such methods as MRI (magnetic resonance imaging), EMG (electromyography), and NCS (nerve conduction studies) have been used to confirm diagnosis of HD. Transcranial magnetic stimulation was used to exclude upper motor neuron involvement in two cases. The original scale of neurological disturbances in HD has been proposed by authors to reveal correlations of HD severity with age of patients and duration of disease.Most of patients with HD are young males with common clinical signs. Detected MRI and EMG data were also comparable with previous publications. Independence of HD severity from age and duration of the disease may be the result of individual physical characteristics of dura mater and other structures of the cervical vertebra. In some our cases, amyotrophic lateral sclerosis and other neurological disorders were misdiagnosed before. In view of different prognosis in these pathologies and possible correction of HD, early diagnosis is very important.
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Bromberg MB. What is in the Literature? J Clin Neuromuscul Dis 2017; 19:89-95. [PMID: 29189555 DOI: 10.1097/cnd.0000000000000196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This edition of "What is in the Literature?" will focus on motor neuron disease (MND), including adult forms [amyotrophic lateral sclerosis (ALS), progressive muscular atrophy (PMA), primary lateral sclerosis (PLS), progressive bulbar palsy (PBA), and monomelic mononeuropathy (MMND)], and childhood forms [spinal muscle atrophy (SMA)].
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Affiliation(s)
- Mark B Bromberg
- Department of Neurology, University of Utah, Salt Lake City, UT
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Polavarapu K, Preethish-Kumar V, Nashi S, Vengalil S, Prasad C, Bhattacharya K, Verma A, Pruthi N, Bhat DI, Nalini A. Intrafamilial phenotypic variations in familial cases of cervical flexion induced myelopathy/Hirayama disease. Amyotroph Lateral Scler Frontotemporal Degener 2017; 19:38-49. [PMID: 28938856 DOI: 10.1080/21678421.2017.1374977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Hirayama disease is generally considered to be a sporadic disorder, except for a few reports of familial occurrence. In this study, we describe eight patients from four families with cervical flexion induced myelopathy (CFIM)/Hirayama disease (HD) and intra-familial phenotypic variations. All underwent clinical and electrophysiological evaluation, while seven of them had contrast MR imaging of cervical spine in flexion. There was significant intra-familial variability: distal bimelic form in four patients, classical monomelic form in three and proximo-distal form in one. Irrespective of the clinical phenotype, MRI showed characteristic dynamic changes of posterior dural detachment with prominent epidural enhancement extending variably from C3 vertebral level to dorsal spine in six patients. One patient with 28 years of illness, had only lower cervical cord atrophy without dynamic changes while another patient demonstrated forward dural displacement with epidural enhancement even after 38 years of disease duration.
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Affiliation(s)
- Kiran Polavarapu
- a Department of Neurology , National Institute of Mental Health and Neurosciences , Bengaluru , India.,b Department of Clinical Neurosciences , National Institute of Mental Health and Neurosciences , Bengaluru , India
| | - Veeramani Preethish-Kumar
- a Department of Neurology , National Institute of Mental Health and Neurosciences , Bengaluru , India.,b Department of Clinical Neurosciences , National Institute of Mental Health and Neurosciences , Bengaluru , India
| | - Saraswati Nashi
- a Department of Neurology , National Institute of Mental Health and Neurosciences , Bengaluru , India
| | - Seena Vengalil
- a Department of Neurology , National Institute of Mental Health and Neurosciences , Bengaluru , India
| | - Chandrajit Prasad
- c Department of Neuro Imaging and Interventional Radiology , National Institute of Mental Health and Neurosciences , Bengaluru , India , and
| | - Kajari Bhattacharya
- c Department of Neuro Imaging and Interventional Radiology , National Institute of Mental Health and Neurosciences , Bengaluru , India , and
| | - Abha Verma
- c Department of Neuro Imaging and Interventional Radiology , National Institute of Mental Health and Neurosciences , Bengaluru , India , and
| | - Nupur Pruthi
- d Department of Neurosurgery , National Institute of Mental Health and Neurosciences , Bengaluru , India
| | - Dhananjay I Bhat
- d Department of Neurosurgery , National Institute of Mental Health and Neurosciences , Bengaluru , India
| | - Atchayaram Nalini
- a Department of Neurology , National Institute of Mental Health and Neurosciences , Bengaluru , India
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Misirlioglu TO, Ozyemisci Taskiran O. Reliability of sonographic muscle thickness measurements of the thenar and hypothenar muscles. Muscle Nerve 2017; 57:E14-E17. [PMID: 28662294 DOI: 10.1002/mus.25735] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 06/12/2017] [Accepted: 06/24/2017] [Indexed: 12/13/2022]
Abstract
Introduction This study was undertaken to assess the intra- and interrater reliability of sonographic thickness measurements of the thenar and hypothenar muscles. METHODS The thickness of the thenar and hypothenar muscles of both hands of 15 volunteers (7 male, 8 female) were evaluated with a 4-13-MHz linear probe by 2 examiners who were blinded to each other's measurements. Interrater reliability was then evaluated. To assess intrarater reliability, the first examiner also performed a second measurement after an interval of at least 1 day. RESULTS Mean age of the subjects was 31.1 ± 9.0 years. Test-retest reliability showed excellent intrarater reliability (intraclass correlation coefficient range: 0.889-0.963) and substantial to excellent results for interrater reliability (intraclass correlation coefficient range: 0.692-0.937). DISCUSSION We found that ultrasound is a reliable method for thickness measurements of the thenar and hypothenar muscles. Muscle Nerve 57: E14-E17, 2018.
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Affiliation(s)
- Tugce Ozekli Misirlioglu
- Department of Physical Medicine and Rehabilitation, Koc University School of Medicine, Istanbul, Turkey
| | - Ozden Ozyemisci Taskiran
- Department of Physical Medicine and Rehabilitation, Koc University School of Medicine, Istanbul, Turkey
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Kalita J, Kumar S, Misra UK, Neyaz Z. Split hand index and ulnar to median ratio in Hirayama disease and amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:598-603. [DOI: 10.1080/21678421.2017.1336561] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Jayantee Kalita
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India and
| | - Surendra Kumar
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India and
| | - Usha K. Misra
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India and
| | - Zafar Neyaz
- Department of Radio diagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India
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Abstract
OBJECTIVE To evaluate corticomotoneuronal integrity in monomelic amyotrophy using threshold tracking transcranial magnetic stimulation (TT-TMS). METHODS Cortical excitability studies were prospectively performed in 8 monomelic amyotrophy patients and compared to 21 early-onset amyotrophic lateral sclerosis (ALS) patients and 40 healthy controls. Motor evoked potentials responses were recorded over abductor pollicis brevis. RESULTS Maximal motor evoked potential (MEP/CMAP ratio) was significantly increased in monomelic amyotrophy compared with controls (monomelic amyotrophy 51.2±12.4%; control 22.7±2.1%, p=0.04). Averaged short-interval intracortical inhibition (SICI, ISI 1-7ms) in monomelic amyotrophy patients was similar to controls (monomelic amyotrophy 9.6±2.1%; control 10.0±0.9%, p=0.98). However, it was significantly reduced in early-onset ALS in comparison with monomelic amyotrophy patients (monomelic amyotrophy 9.6±2.1%; ALS 2.3±1.7%, p<0.001). Averaged SICI is a good parameter (area under the curve 0.79, p=0.02) to discriminate between monomelic amyotrophy and early-onset ALS patients. CONCLUSIONS TT-TMS technique has identified normal cortical function in monomelic amyotrophy, a feature that distinguishes it from early-onset ALS. The greater corticomotoneuronal projections to spinal motoneurons may represent central nervous system adaptive change in monomelic amyotrophy. SIGNIFICANCE Corticomotoneuronal dysfunction does not drive the lower motor neurone loss presented in monomelic amyotrophy.
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