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Lee SM, Choi SY, Choi JH, Oh EH, Yoo D, Lee SU, Kim HJ, Choi JY, Kim JS, Choi KD. Ocular motor and vestibular dysfunction in central nervous system lymphoma. Eur J Neurol 2024; 31:e16242. [PMID: 38344918 DOI: 10.1111/ene.16242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/11/2024] [Accepted: 01/28/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND AND PURPOSE Diagnosis of lymphoma involving the central nervous system (CNS) is challenging. This study aimed to explore the abnormal vestibular and ocular motor findings in CNS lymphoma. METHODS A retrospective search of the medical records identified 30 patients with CNS lymphoma presenting ocular motor and vestibular abnormalities from four neurology clinics of university hospitals in South Korea (22 men, age range 14-81 years, mean 60.6 ± 15.2). The demographic and clinical features and the results of laboratory, radiological and pathological evaluation were analyzed. RESULTS Patients presented with diplopia (13/30, 43%), vestibular symptoms (15/30, 50%) or both (2/30, 7%). In 15 patients with diplopia, abnormal ocular motor findings included ocular motor nerve palsy (n = 10, 67%), internuclear ophthalmoplegia (n = 2, 13%), external ophthalmoplegia (n = 2, 13%) and exophoria (n = 1, 7%). The vestibular abnormalities were isolated in 14 (82%) of 17 patients with vestibular symptoms and included combined unilateral peripheral and central vestibulopathy in three from lesions involving the vestibular nuclei. CNS lymphoma involved the brainstem (53%), cerebellum (33%), leptomeninges (30%), deep gray nuclei (23%) or cranial nerves (17%). Two patients showed the "double-panda" sign by involving the midbrain. CONCLUSIONS This study expands the clinical and radiological spectra of CNS lymphoma. Neuro-ophthalmological and neuro-otological evaluation may guide the early diagnosis of CNS lymphoma.
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Affiliation(s)
- Suk-Min Lee
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, South Korea
| | - Seo Young Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, South Korea
| | - Jae-Hwan Choi
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Eun Hye Oh
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Dallah Yoo
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University, Seoul, South Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Hyo Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong-Yoon Choi
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ji-Soo Kim
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kwang-Dong Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, South Korea
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Zhao X, Ning H, Liu L, Zhu C, Zhang Y, Sun G, Ren H, Kong X. Genetic analysis of 37 cases with primary periodic paralysis in Chinese patients. Orphanet J Rare Dis 2024; 19:160. [PMID: 38609989 PMCID: PMC11015673 DOI: 10.1186/s13023-024-03170-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Primary periodic paralysis (PPP) is an inherited disorders of ion channel dysfunction characterized by recurrent episodes of flaccid muscle weakness, which can classified as hypokalemic (HypoPP), normokalemic (NormoPP), or hyperkalemic (HyperPP) according to the potassium level during the paralytic attacks. However, PPP is charactered by remarkable clinical and genetic heterogeneity, and the diagnosis of suspected patients is based on the characteristic clinical presentation then confirmed by genetic testing. At present, there are only limited cohort studies on PPP in the Chinese population. RESULTS We included 37 patients with a clinical diagnosis of PPP. Eleven (29.7%) patients were tested using a specific gene panel and 26 (70.3%) by the whole-exome sequencing (WES). Twenty-two cases had a genetic variant identified, representing a diagnostic rate of 59.5% (22/37). All the identified mutations were either in the SCN4A or the CACNA1S gene. The overall detection rate was comparable between the panel (54.5%: 6/11) and WES (61.5%: 16/26). The remaining patients unresolved through panel sequencing were further analyzed by WES, without the detection of any mutation. The novel atypical splicing variant c.2020-5G > A affects the normal splicing of the SCN4A mRNA, which was confirmed by minigene splicing assay. Among 21 patients with HypoPP, 15 patients were classified as HypoPP-2 with SCN4A variants, and 6 HypoPP-1 patients had CACNA1S variants. CONCLUSIONS Our results suggest that SCN4A alleles are the main cause in our cohort, with the remainder caused by CACNA1S alleles, which are the predominant cause in Europe and the United States. Additionally, this study identified 3 novel SCN4A and 2 novel CACNA1S variants, broadening the mutation spectrum of genes associated with PPP.
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Affiliation(s)
- Xuechao Zhao
- The Genetics and Prenatal Diagnosis Center, The Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Jianshe Rd, Erqi District, 450052, Zhengzhou, Henan, China
| | - Haofeng Ning
- Obstetrics and Gynaecology, The Seventh Affiliated Hospital, Sun Yat-Sen University, No 628 Zhenyuan Road Guangming District, 518107, Shenzhen, PR China
| | - Lina Liu
- The Genetics and Prenatal Diagnosis Center, The Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Jianshe Rd, Erqi District, 450052, Zhengzhou, Henan, China
| | - Chaofeng Zhu
- The Genetics and Prenatal Diagnosis Center, The Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Jianshe Rd, Erqi District, 450052, Zhengzhou, Henan, China
| | - Yinghui Zhang
- The Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Jianshe Rd, Erqi District, 450052, Zhengzhou, Henan, China
| | - Guifang Sun
- The Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Jianshe Rd, Erqi District, 450052, Zhengzhou, Henan, China
| | - Huanan Ren
- The Genetics and Prenatal Diagnosis Center, The Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Jianshe Rd, Erqi District, 450052, Zhengzhou, Henan, China
| | - Xiangdong Kong
- The Genetics and Prenatal Diagnosis Center, The Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Jianshe Rd, Erqi District, 450052, Zhengzhou, Henan, China.
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Soldado-Magraner J, Antonietti A, French J, Higgins N, Young MJ, Larrivee D, Monteleone R. Applying the IEEE BRAIN neuroethics framework to intra-cortical brain-computer interfaces. J Neural Eng 2024; 21:022001. [PMID: 38537269 DOI: 10.1088/1741-2552/ad3852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/27/2024] [Indexed: 04/05/2024]
Abstract
Objective. Brain-computer interfaces (BCIs) are neuroprosthetic devices that allow for direct interaction between brains and machines. These types of neurotechnologies have recently experienced a strong drive in research and development, given, in part, that they promise to restore motor and communication abilities in individuals experiencing severe paralysis. While a rich literature analyzes the ethical, legal, and sociocultural implications (ELSCI) of these novel neurotechnologies, engineers, clinicians and BCI practitioners often do not have enough exposure to these topics.Approach. Here, we present the IEEE Neuroethics Framework, an international, multiyear, iterative initiative aimed at developing a robust, accessible set of considerations for diverse stakeholders.Main results. Using the framework, we provide practical examples of ELSCI considerations for BCI neurotechnologies. We focus on invasive technologies, and in particular, devices that are implanted intra-cortically for medical research applications.Significance. We demonstrate the utility of our framework in exposing a wide range of implications across different intra-cortical BCI technology modalities and conclude with recommendations on how to utilize this knowledge in the development and application of ethical guidelines for BCI neurotechnologies.
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Affiliation(s)
- Joana Soldado-Magraner
- Department of Electrical and Computer Engineering and the Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, United States of America
| | - Alberto Antonietti
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano 20131, Italy
| | - Jennifer French
- Neurotech Network, St. Petersburg, FL 33733, United States of America
| | - Nathan Higgins
- School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia
| | - Michael J Young
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States of America
| | - Denis Larrivee
- Mind and Brain Institute, University of Navarra Medical School, Pamplona, Navarra 31008, Spain
- Loyola University, Chicago, IL 60611, United States of America
| | - Rebecca Monteleone
- Disability Studies Program, University of Toledo, Toledo, OH 43606, United States of America
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Mirsch D, Jelic T, Prats MI, Dreyfuss A, Yates E, Kummer T, Stenberg B, Vlasica K, Nagdev A. Just the facts: brachial plexus blocks for upper extremity injuries in the emergency department. CAN J EMERG MED 2024; 26:228-231. [PMID: 38060159 DOI: 10.1007/s43678-023-00628-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 11/23/2023] [Indexed: 12/08/2023]
Abstract
Ultrasound-guided nerve blocks (UGNBs) are becoming a more common method for pain control in the emergency department. Specifically, brachial plexus blocks have shown promise for acute upper extremity injuries as well as an alternative to procedural sedation for glenohumeral reductions. Unfortunately, there is minimal discussion in the EM literature regarding phrenic nerve paralysis (a well-known complication from brachial plexus blocks). The anatomy of the brachial plexus, its relationship to the phrenic nerve, and why ultrasound-guided brachial plexus blocks can cause phrenic nerve paralysis and resultant respiratory impairment will be discussed. The focus on patient safety is paramount, and those with preexisting respiratory conditions, extremes of age or weight, spinal deformities, previous neck injuries, and anatomical variations are at greater risk. We put forth different block strategies for risk mitigation, including patient selection, volume and type of anesthetic, block location, postprocedural monitoring, and specific discharge instructions. Understanding the benefits and risks of UGNBs is critical for emergency physicians to provide effective pain control while ensuring optimal patient safety.
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Affiliation(s)
| | - Tomislav Jelic
- Department of Emergency Medicine, Health Sciences Centre/St.Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada.
| | - Michael I Prats
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Andrea Dreyfuss
- Department at Hennepin Healthcare, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Evan Yates
- School of Medicine, Ronald O. Perelman Department of Emergency Medicine at NYU Grossman, NYU Langone Health, New York, NY, USA
| | | | - Bob Stenberg
- Northeast Ohio Medical School, Cleveland Clinic Akron General, Rootstown, OH, USA
| | | | - Arun Nagdev
- Highland Hospital/Alameda Health System, University of California, San Francisco, CA, USA
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Yang F, Chen L, Wang H, Zhang J, Shen Y, Qiu Y, Qu Z, Li J, Xu W. Combined contralateral C7 to C7 and L5 to S1 cross nerve transfer for treating limb hemiplegia after stroke. Br J Neurosurg 2024; 38:510-513. [PMID: 33843383 DOI: 10.1080/02688697.2021.1910764] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/20/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Contralateral C7 to C7 cross nerve transfer has been proved to be safe and effective for patients with spastic arm paralysis due to stroke and traumatic brain injury. For the lower limb, contralateral L5 to S1 cross nerve transfer serves as a novel surgical approach. In many cases, patients with hemiplegia have both upper and lower limb dysfunction and hope to restore all limb functions within one operation. To cope with this demand, we performed combined contralateral C7 to C7 and L5 to S1 cross nerve transfer in two cases successfully. CASE DESCRIPTION Two patients were enrolled in this study. The first patient is a 36-year-old woman who had spasticity and hemiplegia in both upper and lower limbs on the left side after a right cerebral hemorrhage 14 years prior. The second patient is a 64-year-old man who suffered from permanent muscle weakness in his right limbs, especially the leg, after a left cerebral hemorrhage 7 years prior. Both patients underwent the combined nerve transfer to improve upper and lower limb motor functions simultaneously. During the 10-month follow-up after surgery, the limb functions of both patients improved significantly. CONCLUSIONS This study demonstrates the safety and benefits of combined contralateral C7 to C7 and L5 to S1 cross nerve transfer for hemiplegic patients after stroke. This novel combined surgical approach could provide an optimal choice for patients suffering from both upper and lower limb dysfunction, to reduce hospital stay while reducing financial burden.
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Affiliation(s)
- Fangjing Yang
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Liwen Chen
- Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Shanghai, China
- Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
| | - Haipeng Wang
- Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
- Department of Orthopedics, Jing'an District Center Hospital, Shanghai, China
| | - Jionghao Zhang
- Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
- Department of Orthopedics, Jing'an District Center Hospital, Shanghai, China
| | - Yundong Shen
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Shanghai, China
- Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
| | - Yanqun Qiu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Shanghai, China
- Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
| | - Zhiwei Qu
- Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
- Department of Orthopedics, Jing'an District Center Hospital, Shanghai, China
| | - Jie Li
- Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Shanghai, China
- Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
| | - Wendong Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Shanghai, China
- Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, China, Shanghai
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de la Torre Laso J. The Reality of Tonic Immobility in Victims of Sexual Violence: "I was Paralyzed, I Couldn't Move". Trauma Violence Abuse 2024; 25:1630-1637. [PMID: 37555259 DOI: 10.1177/15248380231191232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Tonic immobility (TI) is a state of temporary, involuntary motor inhibition that occurs in states of intense fear and has been studied among victims of sexual violence. Studies on TI are scarce and mainly focus on rape victims. The present study is a literature review of research that has examined TI in women victims of sexual violence. A database search was carried out using the Preferred data elements for systematic reviews and meta-analyses (PRISMA) method. In order to be included in the analysis, the manuscripts had to deal exclusively with research involving samples of subjects and the study analyzed TI in victims of sexual violence. In all, 11 manuscripts met the above criteria and were included in the review. Research describes that TI is characterized by two factors: fear and immobility. Quantitative research was conclusive in affirming the presence of a state of paralysis and fear in TI. The immobility factor is the determining factor in explaining the victim's lack of defense or resistance and causes effects such as trembling, physical and mental paralysis, inability to vocalize, and eye closure. In addition, TI has been correlated with long-term negative clinical manifestations as victims are more likely to suffer from post-traumatic stress disorder. These findings contribute to an understanding of TI in victims of sexual violence. Therefore, legal and care practitioners must be able to recognize TI to understand the victim's behavior, differentiate it from consent, and to be able to assist in their recovery.
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Cooper LV, Erbeto TB, Danzomo AA, Abdullahi HW, Boateng K, Adamu US, Shuaib F, Modjirom N, Gray EJ, Bandyopadhyay AS, Zipursky S, Okiror SO, Grassly NC, Blake IM. Effectiveness of poliovirus vaccines against circulating vaccine-derived type 2 poliomyelitis in Nigeria between 2017 and 2022: a case-control study. Lancet Infect Dis 2024; 24:427-436. [PMID: 38246190 DOI: 10.1016/s1473-3099(23)00688-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Between 2018 and 2022, Nigeria experienced continuous transmission of circulating vaccine-derived type 2 poliovirus (cVDPV2), with 526 cases of cVDPV2 poliomyelitis detected in total and approximately 180 million doses of monovalent type 2 oral poliovirus vaccine (mOPV2) and 450 million doses of novel type 2 oral poliovirus vaccine (nOPV2) delivered in outbreak response campaigns. Inactivated poliovirus vaccine (IPV) was introduced into routine immunisation in 2015, with a second dose added in 2021. We aimed to estimate the effectiveness of nOPV2 against cVDPV2 paralysis and compare nOPV2 effectiveness with that of mOPV2 and IPV. METHODS In this retrospective case-control study, we used acute flaccid paralysis (AFP) surveillance data in Nigeria from Jan 1, 2017, to Dec 31, 2022, using age-matched, onset-matched, and location-matched cVDPV2-negative AFP cases as test-negative controls. We also did a parallel prospective study from March, 2021, using age-matched community controls from the same settlement as the cases. We included children born after May, 2016, younger than 60 months, for whom polio immunisation history (doses of OPV from campaigns and IPV) was reported. We estimated the per-dose effectiveness of nOPV2 against cVDPV2 paralysis using conditional logistic regression and compared nOPV2 effectiveness with that of mOPV2 and IPV. FINDINGS In the retrospective case-control study, we identified 509 cVDPV2 poliomyelitis cases in Nigeria with case verification and paralysis onset between Jan 1, 2017, and Dec 31, 2022. Of these, 82 children were excluded for not meeting inclusion criteria, and 363 (85%) of 427 eligible cases were matched to 1303 test-negative controls. Cases reported fewer OPV and IPV doses than test-negative controls (mean number of OPV doses 5·9 [SD 4·2] in cases vs 6·7 [4·3] in controls; one or more IPV doses reported in 95 [26%] of 363 cases vs 513 [39%] of 1303 controls). We found low per-dose effectiveness of nOPV2 (12%, 95% CI -2 to 25) and mOPV2 (17%, 3 to 29), but no significant difference between the two vaccines (p=0·67). The estimated effectiveness of one IPV dose was 43% (23 to 58). In the prospective study, 181 (46%) of 392 eligible cases were matched to 1557 community controls. Using community controls, we found a high effectiveness of IPV (89%, 95% CI 83 to 93, for one dose), a low per-dose effectiveness of nOPV2 (-23%, -45 to -5) and mOPV2 (1%, -23 to 20), and no significant difference between the per-dose effectiveness of nOPV2 and mOPV2 (p=0·12). INTERPRETATION We found no significant difference in estimated effectiveness of the two oral vaccines, supporting the recommendation that the more genetically stable nOPV2 should be preferred in cVDPV2 outbreak response. Our findings highlight the role of IPV and the necessity of strengthening routine immunisation, the primary route through which IPV is delivered. FUNDING Bill & Melinda Gates Foundation and UK Medical Research Council.
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Affiliation(s)
- Laura V Cooper
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK.
| | - Tesfaye B Erbeto
- World Health Organization Nigeria Country Office, Abuja, Nigeria
| | - Abba A Danzomo
- World Health Organization Nigeria Country Office, Abuja, Nigeria
| | - Hamisu W Abdullahi
- World Health Organization African Regional Office, Brazzaville, Republic of the Congo
| | - Kofi Boateng
- World Health Organization Nigeria Country Office, Abuja, Nigeria
| | - Usman S Adamu
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Ndoutabe Modjirom
- World Health Organization African Regional Office, Brazzaville, Republic of the Congo
| | - Elizabeth J Gray
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | | | - Simona Zipursky
- Polio Eradication, World Health Organization, Geneva, Switzerland
| | | | - Nicholas C Grassly
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Isobel M Blake
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
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Laferrière-Langlois P, Jeffries S, Harutyunyan R, Hemmerling TM. Epidural Catheterization in Cardiac Surgery: A Systematic Review and Risk Assessment of Epidural Hematoma. Ann Card Anaesth 2024; 27:111-120. [PMID: 38607874 PMCID: PMC11095789 DOI: 10.4103/aca.aca_160_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 04/14/2024] Open
Abstract
ABSTRACT The potential benefits of epidural anesthesia on mortality, atrial fibrillation, and pulmonary complications must be weighed against the risk of epidural hematoma associated with intraoperative heparinization. This study aims to provide an updated assessment of the clinical risks of epidural anesthesia in cardiac surgery, focusing on the occurrence of epidural hematomas and subsequent paralysis. A systematic search of Embase, Medline, Ovid Central, Web of Science, and PubMed was conducted to identify relevant publications between 1966 and 2022. Two independent reviewers assessed the eligibility of the retrieved manuscripts. Studies reporting adult patients undergoing cardiac surgery with epidural catheterization were included. The incidence of hematomas was calculated by dividing the number of hematomas by the total number of patients in the included studies. Risk calculations utilized various denominators based on the rigor of trial designs, and the risks of hematoma and paralysis were compared to other commonly encountered risks. The analysis included a total of 33,089 patients who underwent cardiac surgery with epidural catheterization. No epidural hematomas were reported across all published RCTs, prospective, and retrospective trials. Four case reports associated epidural hematoma with epidural catheterization and perioperative heparinization. The risks of epidural hematoma and subsequent paralysis were estimated at 1:7643 (95% CI 1:3860 to 380,916) and 1:10,190 (95% CI 1:4781 to 0:1), respectively. The risk of hematoma is similar to the non-obstetric population (1:5405; 95% CI 1:4784 to 6134). The risk of hematoma in cardiac surgery patients receiving epidural anesthesia is therefore similar to that observed in some other surgical non-obstetric populations commonly exposed to epidural catheterization.
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Affiliation(s)
- Pascal Laferrière-Langlois
- Department of Anaesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital, CIUSSS de l’Est de L’Ile de Montréal, Montréal, Québec, Canada
| | - Sean Jeffries
- Department of Experimental Surgery, McGill University Health Centre, Montréal, Canada
- Intelligent Technology Anaesthesia Group (ITAG) Laboratory, McGill University, Montréal, Canada
| | - Robert Harutyunyan
- Department of Experimental Surgery, McGill University Health Centre, Montréal, Canada
- Intelligent Technology Anaesthesia Group (ITAG) Laboratory, McGill University, Montréal, Canada
| | - Thomas M. Hemmerling
- Department of Experimental Surgery, McGill University Health Centre, Montréal, Canada
- Intelligent Technology Anaesthesia Group (ITAG) Laboratory, McGill University, Montréal, Canada
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Chen SX, Yang BB, Qian JH, Lu XX. [Repeated incomplete decompression of nucleus pulposus leads to paralysis:a case report]. Zhongguo Gu Shang 2024; 37:316-8. [PMID: 38515422 DOI: 10.12200/j.issn.1003-0034.20220523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Affiliation(s)
- Sheng-Xing Chen
- Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315000, Zhejiang, China
| | - Bin-Bin Yang
- Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315000, Zhejiang, China
| | - Jun-Hai Qian
- Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315000, Zhejiang, China
| | - Xiao-Xiao Lu
- Longshan Hospital Affiliated to Ningbo First Hospital, Ningbo 315000, Zhejiang, China
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Lallement P, Boussuges A, Habert P, Bermudez J, Reynaud-Gaubert M, Delliaux S, Bregeon F, Coiffard B. Evaluation of computed tomography in the diagnosis of ultrasound-proven diaphragm dysfunction. Respir Res 2024; 25:135. [PMID: 38509592 PMCID: PMC10956268 DOI: 10.1186/s12931-024-02770-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/13/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Computed tomography (CT) is routinely employed on the evaluation of dyspnea, yet limited data exist on its assessment of diaphragmatic muscle. This study aimed to determine the capability of CT in identifying structural changes in the diaphragm among patients with ultrasound-confirmed diaphragmatic dysfunction. METHODS Diaphragmatic ultrasounds conducted between 2018 and 2021 at our center in Marseille, France, were retrospectively collected. Diaphragmatic pillars were measured on CT scans at the L1 level and the celiac artery. Additionally, the difference in height between the two diaphragmatic domes in both diaphragmatic dysfunction cases and controls was measured and compared. RESULTS A total of 65 patients were included, comprising 24 with diaphragmatic paralysis, 13 with diaphragmatic weakness, and 28 controls. In the case group (paralysis and weakness) with left dysfunctions (n = 24), the CT thickness of the pillars at the level of L1 and the celiac artery was significantly thinner compared with controls (2.0 mm vs. 7.4 mm and 1.8 mm vs. 3.1 mm, p < 0.001 respectively). Significantly different values were observed for paralysis (but not weakness) in the right dysfunction subgroup (n = 15) (2.6 mm vs. 7.4 mm and 2.2 mm vs. 3.8 mm, p < 0.001 respectively, for paralysis vs. controls). Regardless of the side of dysfunction, a significant difference in diaphragmatic height was observed between cases and controls (7.70 cm vs. 1.16 cm and 5.51 cm vs. 1.16 cm, p < 0.001 for right and left dysfunctions, respectively). Threshold values determined through ROC curve analyses for height differences between the two diaphragmatic domes, indicative of paralysis or weakness in the right dysfunctions, were 4.44 cm and 3.51 cm, respectively. Similarly for left dysfunctions, the thresholds were 2.70 cm and 2.48 cm, respectively, demonstrating good performance (aera under the curve of 1.00, 1.00, 0.98, and 0.79, respectively). CONCLUSION In cases of left diaphragmatic dysfunction, as well as in paralysis associated with right diaphragmatic dysfunction, CT revealed thinner pillars. Additionally, a notable increase in the difference in diaphragmatic height demonstrated a strong potential to identify diaphragmatic dysfunction, with specific threshold values.
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Affiliation(s)
- Pauline Lallement
- Department of Respiratory Medicine and Lung Transplantation, Aix Marseille University, APHM, Chemin des Bourrely, 13015, Marseille, France
| | - Alain Boussuges
- Pulmonary Function Testing Laboratory, Aix-Marseille University, APHM, Marseille, France
| | - Paul Habert
- Department of Radiology, Aix-Marseille University, APHM, Marseille, France
- LIIE, Aix Marseille University, Marseille, France
- CERIMED, Aix Marseille University, Marseille, France
| | - Julien Bermudez
- Department of Respiratory Medicine and Lung Transplantation, Aix Marseille University, APHM, Chemin des Bourrely, 13015, Marseille, France
| | - Martine Reynaud-Gaubert
- Department of Respiratory Medicine and Lung Transplantation, Aix Marseille University, APHM, Chemin des Bourrely, 13015, Marseille, France
| | - Stéphane Delliaux
- Pulmonary Function Testing Laboratory, Aix-Marseille University, APHM, Marseille, France
| | - Fabienne Bregeon
- Pulmonary Function Testing Laboratory, Aix-Marseille University, APHM, Marseille, France
| | - Benjamin Coiffard
- Department of Respiratory Medicine and Lung Transplantation, Aix Marseille University, APHM, Chemin des Bourrely, 13015, Marseille, France.
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11
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Cheng L, Wang C, Sun Q. Teaching NeuroImage: Metastatic Urachal Carcinoma in the Extraocular Muscles Mimicking Oculomotor Paralysis. Neurology 2024; 102:e209191. [PMID: 38320227 DOI: 10.1212/wnl.0000000000209191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/11/2023] [Indexed: 02/08/2024] Open
Affiliation(s)
- Lu Cheng
- From the Department of Ophthalmology (L.C., Q.S.), Shanghai Aier Eye Hospital, Shanghai Aier Eye Institute; National Clinical Research Center for Eye Diseases (L.C.), Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine; and Department of Radiation Oncology (C.W.), Shanghai General Hospital, Shanghai Jiaotong University, China
| | - Chungang Wang
- From the Department of Ophthalmology (L.C., Q.S.), Shanghai Aier Eye Hospital, Shanghai Aier Eye Institute; National Clinical Research Center for Eye Diseases (L.C.), Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine; and Department of Radiation Oncology (C.W.), Shanghai General Hospital, Shanghai Jiaotong University, China
| | - Qiao Sun
- From the Department of Ophthalmology (L.C., Q.S.), Shanghai Aier Eye Hospital, Shanghai Aier Eye Institute; National Clinical Research Center for Eye Diseases (L.C.), Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine; and Department of Radiation Oncology (C.W.), Shanghai General Hospital, Shanghai Jiaotong University, China
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12
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Kwon H, Kim HJ, Kim JS. Teaching Video NeuroImage: Torsional Saccadic Palsy in Bilateral Thalamic Infarctions. Neurology 2024; 102:e209184. [PMID: 38315958 DOI: 10.1212/wnl.0000000000209184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/06/2023] [Indexed: 02/07/2024] Open
Affiliation(s)
- Hyesoo Kwon
- From the Dizziness Center (H.K., H.-J.K., J.-S.K.), Clinical Neuroscience Center, Department of Neurology, Biomedical Research Institute (H.-J.K.), Seoul National University Bundang Hospital, and Department of Neurology (J.-S.K.), Seoul National University College of Medicine, South Korea
| | - Hyo-Jung Kim
- From the Dizziness Center (H.K., H.-J.K., J.-S.K.), Clinical Neuroscience Center, Department of Neurology, Biomedical Research Institute (H.-J.K.), Seoul National University Bundang Hospital, and Department of Neurology (J.-S.K.), Seoul National University College of Medicine, South Korea
| | - Ji-Soo Kim
- From the Dizziness Center (H.K., H.-J.K., J.-S.K.), Clinical Neuroscience Center, Department of Neurology, Biomedical Research Institute (H.-J.K.), Seoul National University Bundang Hospital, and Department of Neurology (J.-S.K.), Seoul National University College of Medicine, South Korea
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13
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Iida K, Goseki T, Kunimi K, Hashimoto R. A Case of Superior Oblique Palsy without Brown Syndrome Induced by a Dog Bite. Am J Case Rep 2024; 25:e943299. [PMID: 38508873 PMCID: PMC10926234 DOI: 10.12659/ajcr.943299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/24/2024] [Accepted: 01/20/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Pseudo-Brown syndrome is characterized by dysfunction of the superior oblique tendon-trochlear complex. Canine tooth syndrome, which involves superior oblique palsy with pseudo-Brown syndrome, results from damage to the trochlear and superior oblique tendon from dog bites around the eye. This report describes a variant of canine tooth syndrome without pseudo-Brown syndrome following a dog bite around the left upper eyelid. In this case, magnetic resonance imaging (MRI) facilitated early diagnosis and therapeutic intervention. CASE REPORT A 19-year-old man presented with torsional diplopia following a dog bite around the left upper eyelid and forehead. Five days after the injury, an alternate prism cover test revealed 6 prism diopters (Δ) exotropia and 5Δ left hypertropia. Ocular motility showed no significant limitation in elevation or depression during adduction. MRI performed on the same day showed a high-signal area extending from the superior oblique tendon to the trochlear region and the superior oblique muscle belly of the left eye. A diagnosis of canine tooth syndrome without pseudo-Brown syndrome was made and oral steroids were administered. Ocular alignment did not improve, so left inferior oblique myotomy was performed 7 months after the injury. The patient's cyclovertical diplopia resolved postoperatively. CONCLUSIONS Dog bites around the eye can result in abnormalities of the extraocular muscles. Early MRI may be useful for diagnosis and determining treatment strategies. This report has highlighted the importance of rapid assessment and management of patients with dog bites involving the eye.
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Affiliation(s)
- Kie Iida
- Department of Ophthalmology, International University of Health and Welfare, Atami Hospital, Atami, Shizuoka, Japan
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshiaki Goseki
- Department of Ophthalmology, International University of Health and Welfare, Atami Hospital, Atami, Shizuoka, Japan
- Department of Ophthalmology, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Keiko Kunimi
- Department of Ophthalmology, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Ryuuya Hashimoto
- Department of Ophthalmology, Toho University Sakura Medical Center, Sakura, Chiba, Japan
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14
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Olivarez J, Gutovitz S, Arnold C. Cranial Nerve Six Palsy After Vaginal Delivery with Epidural Anesthesia: A Case Report. J Emerg Med 2024; 66:e338-e340. [PMID: 38413284 DOI: 10.1016/j.jemermed.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/17/2023] [Accepted: 11/06/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND This case report describes a 34-year-old woman who developed diplopia and strabismus 2 weeks after a vaginal delivery and epidural anesthesia. CASE REPORT A 34-year-old women presented to the emergency department (ED) with continued headache and new-onset diplopia after having undergone epidural anesthesia for a vaginal delivery 2 weeks prior. During that time, she underwent two blood patches, rested supine, drank additional fluids, and consumed caffeinated products for her spinal headache. When she developed double vision from a cranial nerve VI palsy, she returned to the ED. At that time, she had a third blood patch performed, and she was evaluated by a neurologist. The medical team felt the cranial nerve VI palsy was due to the downward pull of the brain and stretching of the nerve. Magnetic resonance imaging and neurosurgical closure of the dura were considered as the next steps in treatment; however, they were not performed after being declined by the patient. All symptoms were resolved over the next 3 weeks. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case illustrates the uncommon complication of a cranial nerve VI palsy from a persistent cerebrospinal fluid leak after a dural puncture. Emergency physicians must be aware that diplopia can be a rare presenting symptom after patients undergo a lumbar puncture. Furthermore, emergency physicians should be aware of the multiple treatment options available. Knowledge of the timeline of resolution of the diplopia is necessary to make shared decisions with our patients about escalating care.
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Affiliation(s)
- Jennifer Olivarez
- Department of Emergency Medicine, Grand Strand Regional Medical Center, Myrtle Beach, South Carolina
| | - Scott Gutovitz
- Department of Emergency Medicine, Grand Strand Regional Medical Center, Myrtle Beach, South Carolina
| | - Caylyne Arnold
- Department of Emergency Medicine, Grand Strand Regional Medical Center, Myrtle Beach, South Carolina
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15
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Yang ZM, Loh TH, Ross J, Dalal K, Meiler SE, Postma GN. Transnasal Humidified Rapid Insufflation Ventilatory Exchange in Endoscopic Esophageal Surgery. Ann Otol Rhinol Laryngol 2024; 133:325-329. [PMID: 38050852 PMCID: PMC10865761 DOI: 10.1177/00034894231216273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVES Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) describes apneic oxygenation using humidified high flow nasal-cannula oxygen. Although it has been described as a sole mode of oxygenation in endoscopic laryngotracheal surgery, its use in endoscopic esophageal surgery under general anesthesia with neuromuscular paralysis has not previously been described. The objective of this study is to assess the safety and efficacy of THRIVE in esophagology. METHODS We conducted a retrospective review of adult patients undergoing esophageal procedures under general anesthesia who were oxygenated using THRIVE at two academic institutions. Demographic, clinical, and anesthesiologic data were collected and analyzed. RESULTS 14 cases performed from March 2021 to March 2022 met inclusion criteria. 13/14 (92.9%) of patients were able to maintain oxygenation throughout the entirety of their procedure. The mean apneic time was 17.9 minutes with a maximum of 32 minutes. One patient required "rescue" intubation due to failure to maintain oxygenation. Excluding the sole THRIVE failure, the median SpO2 at the conclusion of surgery was 99% (range 94-100%). A linear regression model yielded an increase in EtCO2 of 0.95 mmHg/min or 0.127 kPa/min. SpO2 was negatively associated with both tobacco pack-year smoking history (R2 = 0.343, P = .014) and BMI (R2 = 0.238, P = .038). CONCLUSION THRIVE is a feasible, safe, and efficacious means of apneic oxygenation for patients undergoing esophageal endoscopic surgery under general anesthesia with neuromuscular paralysis, which may be particularly beneficial in patients with airway stenosis, as post-intubation changes can have severe clinical implications for this patient population. Obese patients and tobacco smokers may be at increased risk of oxygen desaturation when using THRIVE.
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Affiliation(s)
- Zao M. Yang
- Department of Otolaryngology, Head & Neck Surgery, UT Health San Antonio, San Antonio, TX, USA
- Department of Otolaryngology, Head & Neck Surgery, Augusta University Medical College of Georgia, Augusta, GA, USA
| | - Tuan-Hsing Loh
- Department of Anesthesiology, UT Health San Antonio, San Antonio, TX, USA
| | - Justin Ross
- Department of Otolaryngology, Head & Neck Surgery, Augusta University Medical College of Georgia, Augusta, GA, USA
| | - Kajal Dalal
- Department of Otolaryngology, Head & Neck Surgery, UT Health San Antonio, San Antonio, TX, USA
| | - Steffen E. Meiler
- Department of Anesthesiology, Augusta University Medical College of Georgia, Augusta, GA, USA
| | - Gregory N. Postma
- Department of Otolaryngology, Head & Neck Surgery, Augusta University Medical College of Georgia, Augusta, GA, USA
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16
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Sloof N, Hue CD, Campbell C, Barton MA, Nouri MN. Acute Flaccid Paralysis, Seizures, and Encephalopathy in a Pediatric Patient With Influenza A and Coronavirus Disease 2019 Infection. Pediatr Neurol 2024; 152:127-129. [PMID: 38262228 DOI: 10.1016/j.pediatrneurol.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/04/2023] [Accepted: 12/28/2023] [Indexed: 01/25/2024]
Affiliation(s)
- Natalie Sloof
- Department of Paediatrics, Western University, London, Ontario, Canada
| | - Christopher Donald Hue
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Craig Campbell
- Department of Paediatrics, Western University, London, Ontario, Canada
| | - Michelle A Barton
- Department of Paediatrics, Western University, London, Ontario, Canada
| | - Maryam Nabavi Nouri
- Department of Paediatrics, Western University, London, Ontario, Canada; Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
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17
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Luo W, Liu C, Zhong X, Wang Y, Qiu W. Hypothalamic Dysfunction, Bilateral Vertical Gaze Palsy, and Psychiatric Symptoms in Neuromyelitis Optica Spectrum Disorders: A Case Report. J Neuroophthalmol 2024; 44:e164-e166. [PMID: 36412924 DOI: 10.1097/wno.0000000000001752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Wenjing Luo
- Department of Neurology (WL, CL, XZ, YW, WQ), and Emergency (CL), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Geriatric Neurology (WL), The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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18
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Sorek G, Goudriaan M, Schurr I, Schless SH. Influence of musculoskeletal pain during gait on kinematics and selective motor control in individuals with spastic cerebral palsy: A pilot study. Clin Biomech (Bristol, Avon) 2024; 113:106219. [PMID: 38458003 DOI: 10.1016/j.clinbiomech.2024.106219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Individuals with cerebral-palsy commonly present with altered kinematics and selective-motor-control during gait, and may also experience musculoskeletal pain. This pilot study aims to investigate if the immediate experience of musculoskeletal pain during gait influences kinematics and selective-motor-control in individuals with spastic cerebral-palsy. METHODS Retrospective treadmill-based gait-analysis data for 145 individuals with spastic cerebral-palsy were screened. Participants were asked about experiencing lower-extremity musculoskeletal pain immediately during gait, with 26 individuals (18%) reporting this was the case (pain-group; mean 11.55 ± 3.15 years, Gross-Motor-Function-Classification-System levels I/II/III n = 5/13/8, Uni/bilateral involvement n = 11/15). Of the 77 individuals who did not report any pain, a no-pain group (n = 26) was individually matched. Kinematics were evaluated using the Gait-Profile-Score and spatiotemporal parameters (dimensionless-walking-speed, single-leg-support percentage and step-time). Selective-motor-control was assessed using the Walking-Dynamic-Motor-Control index. FINDINGS In the pain-group, 58% reported experiencing pain in their more-involved leg, 8% in the less-involved leg and 34% in both legs. Regarding the pain location, 38% of the pain-group reported experiencing pain in multiple locations. On a more specific level, 35%, 46% and 54% reported pain around the hip/thigh, knee/calf and ankle/ft, respectively. No significant differences were observed between the pain and no-pain groups for any of the outcome measures, in each leg or bilaterally. INTERPRETATION No significant differences in kinematics and selective-motor-control during gait were found between individuals with spastic cerebral-palsy, with and without musculoskeletal pain. This suggests that the individuals in this study may not present with obvious antalgic gait patterns, which may relate to the pre-existing altered kinematics and selective-motor-control.
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Affiliation(s)
- Gilad Sorek
- Laboratory for Pediatric Motion Analysis and Biofeedback Rehabilitation, ALYN Pediatric and Adolescent Rehabilitation Research Centre (Helmsley PARC), Jerusalem, Israel
| | - Marije Goudriaan
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam, the Netherlands; University corporate offices, student & academic affairs office, Utrecht university, Utrecht, the Netherlands
| | - Itai Schurr
- Clinical Motion Analysis Laboratory, ALYN Pediatric and Adolescent Rehabilitation Centre, Jerusalem, Israel
| | - Simon-Henri Schless
- Laboratory for Pediatric Motion Analysis and Biofeedback Rehabilitation, ALYN Pediatric and Adolescent Rehabilitation Research Centre (Helmsley PARC), Jerusalem, Israel; Clinical Motion Analysis Laboratory, ALYN Pediatric and Adolescent Rehabilitation Centre, Jerusalem, Israel.
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19
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Chen H, Subramanian PS. Conversion of Superior Oblique Myokymia to Superior Oblique Neuromyotonia in a Patient With History of Superior Oblique Palsy. J Neuroophthalmol 2024; 44:e190-e191. [PMID: 37389971 DOI: 10.1097/wno.0000000000001919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Affiliation(s)
- Hongan Chen
- Department of Ophthalmology and Sue Anschutz-Rodgers Eye Center (HC, PSS), Departments of Neurology (PSS) and Neurosurgery (PSS), University of Colorado School of Medicine, Aurora, Colorado; and Division of Ophthalmology (PSS), Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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20
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Srikanth UK, Marinaik CB, Rao S, Gomes AR, Rathnamma D, Isloor S, T. Lakshmikanth B, K. Siddaramegowda C, Rizwan A, Byregowda SM, Venkatesha MD, Munivenkatarayappa A, Hegde R. Studies on the sequential pathology of Kyasanur Forest Disease (KFD) in Mouse brain: KFD virus induces apoptosis of neurons in cerebrum and hippocampus. PLoS One 2024; 19:e0297143. [PMID: 38427645 PMCID: PMC10906829 DOI: 10.1371/journal.pone.0297143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/28/2023] [Indexed: 03/03/2024] Open
Abstract
The sequential pathology of Kyasanur forest disease (KFD) in mouse brain was assessed in this study. Kyasanur forest disease virus (KFDV) strain P9605 used in this study was confirmed by real-time reverse transcriptase-polymerase chain reaction targeting the NS5 gene. Mouse Lethal Dose 50 (MLD50) of the virus was determined by in-vivo mice inoculation test. One MLD50 of the KFDV was inoculated intra-cerebrally into 36 mice aged 2-3 weeks. Another group of 36 age-matched mice that served as control group were inoculated with plain media. Six mice each from infected and control groups were euthanized every 24 hrs intervals for six days. Brain tissues were collected in 10% NBF. The collected brain tissues were processed and subjected to histopathological studies by Hematoxylin and Eosin staining. Grossly, the infected mice showed symptoms of dullness, hunched back appearance, weakness, sluggish movements with indication of hind quarter paralysis on day four post-infection. These symptoms got aggravated with complete paralysis of the hind quarters, inability to move and death on 5th and 6th day post-infection. Microscopically, the brain showed apoptosis of neurons, perivascular cuffing, gliosis, congestion, neuropil vacuolation, meningitis, degeneration, and necrotic neurons. The real-time RT-PCR on hippocampus of the KFDV-infected mouse brain showed three-fold higher expression levels of Caspase 3, a crucial mediator of apoptosis. The cerebral cortex, cerebellum and hippocampus that control the motor neuron activities and muscle tone were primarily affected, possibly correlating with the gross symptoms of hind quarter paralysis, ataxia, and other motor neuron dysfunctions noticed. Taken together, these findings reveal that KFDV induces apoptosis of neurons in the cerebrum and hippocampus of KFDV infected mice. Further studies are needed to confirm if the lesions noticed in mice brain simulate the brain lesions in humans since gross motor-neuron symptoms are similar in mice as well as humans.
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Affiliation(s)
- Ullasgowda K. Srikanth
- Institute of Animal Health and Veterinary Biologicals, KVAFSU, Bangalore, India
- Veterinary College, KVAFSU, Bangalore, India
| | | | - Suguna Rao
- Veterinary College, KVAFSU, Bangalore, India
| | - Amitha Reena Gomes
- Institute of Animal Health and Veterinary Biologicals, KVAFSU, Bangalore, India
| | | | | | - Bharath T. Lakshmikanth
- Institute of Animal Health and Veterinary Biologicals, KVAFSU, Bangalore, India
- Veterinary College, KVAFSU, Bangalore, India
| | - Chinmayie K. Siddaramegowda
- Institute of Animal Health and Veterinary Biologicals, KVAFSU, Bangalore, India
- Veterinary College, KVAFSU, Bangalore, India
| | - Apsana Rizwan
- Institute of Animal Health and Veterinary Biologicals, KVAFSU, Bangalore, India
| | | | | | | | - Raveendra Hegde
- Institute of Animal Health and Veterinary Biologicals, KVAFSU, Bangalore, India
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Cho NY, Kim S, Tran Z, Hadaya J, Ali K, Kronen E, Burruss S, Benharash P. National Trends and Clinical Outcomes after Scooter Injury in the US: 2016 to 2020. J Am Coll Surg 2024; 238:254-260. [PMID: 38193571 DOI: 10.1097/xcs.0000000000000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
BACKGROUND In recent years, the adoption of electric scooters has been accompanied by a surge of scooter-related injuries in the US, raising concerns for their severity and associated healthcare costs. This study aimed to assess temporal trends and outcomes of scooter-related hospital admissions compared with bicycle-related hospitalizations. STUDY DESIGN This was a retrospective cohort study using the 2016 to 2020 National Inpatient Sample for patients younger than 65 years who were hospitalized after bicycle- and scooter-related injuries. The Trauma Mortality Prediction Model was used to quantify injury severity. The primary outcomes of interest were temporal trends of micromobility injuries. In-hospital mortality, rates of long bone fracture, traumatic brain injury, paralysis, length of stay, hospitalization costs, and nonhome discharge were secondarily assessed. RESULTS Among 92,815 patients included in the study, 6,125 (6.6%) had scooter-related injuries. Compared with patients with bicycle-related injuries, patients with scooter-related injuries were more commonly younger than 18 years (26.7% vs 16.4%, p < 0.001) and frequently underwent major operations (55.8% vs 48.1%, p < 0.001). After risk adjustment, scooter-related injuries were associated with greater risks of long bone fracture (adjusted odds ratio 1.40, 95% CI 1.15 to 1.70) and paralysis (adjusted odds ratio 2.06, 95% CI 1.16 to 3.69) compared with bicycle-related injuries. Additionally, patients with bicycle- or scooter-related injuries had comparable index hospitalization durations of stay and costs. CONCLUSIONS The prevalence and severity of scooter-related injuries have significantly increased in the US, thereby attributing to a substantial cost burden on the healthcare system. Multidisciplinary efforts to inform safety policies and enact targeted interventions are warranted to reduce scooter-related injuries.
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Affiliation(s)
- Nam Yong Cho
- From the Cardiovascular Outcomes Research Laboratories (CORELAB) (Cho, Kim, Tran, Hadaya, Ali, Kronen, Benharash), David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Shineui Kim
- From the Cardiovascular Outcomes Research Laboratories (CORELAB) (Cho, Kim, Tran, Hadaya, Ali, Kronen, Benharash), David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Zachary Tran
- From the Cardiovascular Outcomes Research Laboratories (CORELAB) (Cho, Kim, Tran, Hadaya, Ali, Kronen, Benharash), David Geffen School of Medicine, University of California, Los Angeles, CA
- Division of Acute Care Surgery, Department of Surgery, Loma Linda University Health, Loma Linda, CA (Tran, Burruss)
| | - Joseph Hadaya
- From the Cardiovascular Outcomes Research Laboratories (CORELAB) (Cho, Kim, Tran, Hadaya, Ali, Kronen, Benharash), David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Konmal Ali
- From the Cardiovascular Outcomes Research Laboratories (CORELAB) (Cho, Kim, Tran, Hadaya, Ali, Kronen, Benharash), David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Elsa Kronen
- From the Cardiovascular Outcomes Research Laboratories (CORELAB) (Cho, Kim, Tran, Hadaya, Ali, Kronen, Benharash), David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Sigrid Burruss
- From the Cardiovascular Outcomes Research Laboratories (CORELAB) (Cho, Kim, Tran, Hadaya, Ali, Kronen, Benharash), David Geffen School of Medicine, University of California, Los Angeles, CA
- Division of Acute Care Surgery, Department of Surgery, Loma Linda University Health, Loma Linda, CA (Tran, Burruss)
| | - Peyman Benharash
- Division of Cardiac Surgery, Department of Surgery (Benharash), David Geffen School of Medicine, University of California, Los Angeles, CA
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Zhang D, Zou W, Zhang B, Guo P. Scalp acupuncture for post-stroke spastic hemiparesis: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e37167. [PMID: 38428878 PMCID: PMC10906645 DOI: 10.1097/md.0000000000037167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/16/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Spastic paralysis is one of the most common sequelae of stroke, severely affecting patients' limb function and reducing their quality of life. Scalp acupuncture (SA) has been shown to significantly improve cerebral blood supply and reduce the severity of limb spasticity. This meta-analysis aims to systematically evaluate the clinical efficacy of SA in the treatment of post-stroke spastic paralysis, providing evidence-based medicine for clinical management of this condition. METHODS We comprehensively searched databases including China National Knowledge Infrastructure, Wanfang Data, VIP Chinese Science and Technology Periodical Database, China Biomedical Literature Database, PubMed, Embase, and Cochrane Library. Randomized controlled trials investigating the efficacy of SA in post-stroke spastic paralysis were identified until July 28, 2023. Meta-analysis was conducted using RevMan 5.4 and Stata17.0. RESULTS A total of 16 studies were included. Meta-analysis showed that the modified Ashworth spasticity assessment scale in the SA group was significantly higher than that in the rehabilitation group (mean difference [MD] = -0.56, 95% confidence interval [CI] [-0.75, -0.37], Z = 5.67, P < .00001). The simplified Fugl-Meyer motor function assessment scale in the SA group was significantly higher than that in the rehabilitation group (MD = 5.86, 95% CI [3.26, 8.46], Z = 4.41, P < .0001). The modified Barthel index assessment scale in the SA group was significantly higher than that in the rehabilitation group (MD = 5.79, 95% CI [4.73, 6.84], Z = 10.77, P < .00001). Additionally, the clinical effective rate in the SA group was significantly higher than that in the rehabilitation group (relative risk = 1.25, 95% CI [1.16, 1.36], Z = 5.42, P < .00001). CONCLUSION SA combined with rehabilitation therapy has certain advantages in reducing limb spasticity, improving limb function, and enhancing activities of daily living in patients with post-stroke spastic paralysis. This study provides reference and theoretical support for the promotion of SA in the treatment of this condition.
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Affiliation(s)
- Dongxue Zhang
- Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province, China
| | - Wei Zou
- Acupuncture and Moxibustion Department, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province, China
- Key Laboratory of Clinical Molecular Biology of Integrated Traditional Chinese and Western Medicine in Heilongjiang Province, Harbin, Heilongjiang Province, China
| | - Baiwen Zhang
- Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province, China
| | - Peixin Guo
- Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province, China
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23
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Patterson JMM, Medina MA, Yang A, Mackinnon SE. Posterior Interosseous Nerve Compression in the Forearm, AKA Radial Tunnel Syndrome: A Clinical Diagnosis. Hand (N Y) 2024; 19:228-235. [PMID: 36082441 PMCID: PMC10953526 DOI: 10.1177/15589447221122822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Posterior interosseous nerve (PIN) compression in the forearm without motor paralysis is a challenging clinical diagnosis. This retrospective study evaluated the clinical assessment, diagnostic studies, and outcomes following surgical decompression of the PIN in the forearm. METHODS This study reviewed 182 patients' medical charts following PIN decompression between 2000 and 2020 by a single surgeon. After exclusion of combined nerve entrapments, polyneuropathy, motor palsy, or lateral epicondylitis, the study included 14 patients. Data collected included: clinical presentation and pain drawings, provocative testing, functional outcomes, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. RESULTS There were 15 PIN decompressions (14 patients, mean follow-up = 11.9 months). Clinical presentation included pain (n = 14) (proximal dorsal forearm, n = 14; distal forearm over radial sensory nerve, n = 3) and positive clinical tests (sensory collapse test over the radial tunnel, n = 8; pain with forearm pronation and compression over the radial tunnel, n = 10; Tinel sign, n = 5). Postoperatively, there were significant improvements in Visual Analog Scale pain scores (6.7 to 3.3, P = .0006), quality-of-life scores (74.7 to 32.7, P = .0001), and DASH scores (46.3 to 33.6, P = .02). CONCLUSIONS The PIN compression in the forearm without motor paralysis is a clinical diagnosis supported by pain drawings, pain quality, and provocative tests. Patients with persistent, therapy-resistant dorsal forearm pain should be evaluated for PIN compression. Surgical decompression provides statistically significant quantifiable improvement in pain and quality of life.
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Affiliation(s)
| | | | - Alexander Yang
- Washington University School of Medicine, St. Louis, MO, USA
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24
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Cabrero-Rodríguez C, Mendoza-Barrios A, Redondo Torres E. Unilateral Phrenic Nerve Palsy in a Patient With a Giant Intrathoracic Goiter. Arch Bronconeumol 2024; 60:175-176. [PMID: 38160167 DOI: 10.1016/j.arbres.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024]
Affiliation(s)
| | | | - Enrique Redondo Torres
- Servicio de Endocrinología y Nutrición, Hospital Universitario Clínico San Cecilio, Granada, Spain
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25
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Yoon BA, Kim SY, Kim J, Seok JI, Seok JM, Lee S, Kim JK, Oh SI. Clinical and laboratory findings in scrub typhus associated Guillain-Barré syndrome in South Korea. J Peripher Nerv Syst 2024; 29:82-87. [PMID: 38286033 DOI: 10.1111/jns.12614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND AND AIMS Scrub typhus is an endemic disease in the fall season that occurs in a limited number of places known as the Tsutsugamushi Triangle. Peripheral neuropathy is a common complication of scrub typhus. Herein, we encountered several patients with ascending paralysis after scrub typhus infection, who were diagnosed with Guillain-Barré syndrome (GBS). We aimed to investigate the clinical and laboratory characteristics of patients who developed GBS after scrub typhus. METHODS Patients were retrospectively recruited from six nationwide tertiary centers in South Korea from January 2017 to December 2021. Patients who had been clinically diagnosed with GBS and confirmed to have scrub typhus via laboratory examination and/or the presence of an eschar before the onset of acute limb paralysis were included. The GBS-associated clinical and electrophysiological characteristics, outcomes, and scrub typhus-associated features were collected. RESULTS Of the seven enrolled patients, six were female and one was male. The median time from scrub typhus infection to the onset of limb weakness was 6 (range: 2-14) days. All patients had eschar on their bodies. Four patients (57.1%) were admitted to the intensive care unit and received artificial ventilation for respiratory distress. At 6 months, the median GBS disability score was 2 (range, 1-4) points. INTERPRETATION Patients with scrub typhus-associated GBS have a severe clinical presentation and require intensive treatment with additional immunotherapies. Therefore, GBS should be included in the differential diagnosis when peripheral neuropathies develop during scrub typhus treatment. Notably, scrub typhus is associated to GBS.
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Affiliation(s)
- Byeol-A Yoon
- Peripheral Neuropathy Research Center, Dong-A University College of Medicine, Busan, South Korea
- Department of Neurology, Dong-A University Medical Center, Busan, South Korea
| | - Sun-Young Kim
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Juhyeon Kim
- Department of Neurology, Gyeongsang National University Hospital, Jinju, South Korea
| | - Jung Im Seok
- Department of Neurology, School of Medicine, Catholic University of Daegu, Daegu, South Korea
| | - Jin Myoung Seok
- Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, South Korea
| | - Sukyoon Lee
- Department of Neurology, Inje University Busan Paik Hospital, Busan, South Korea
| | - Jong Kuk Kim
- Peripheral Neuropathy Research Center, Dong-A University College of Medicine, Busan, South Korea
- Department of Neurology, Dong-A University Medical Center, Busan, South Korea
| | - Seong-Il Oh
- Department of Neurology, Kyung Hee University Hospital, Seoul, South Korea
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26
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Ashayeripanah M, Vega-Ramos J, Fernandez-Ruiz D, Valikhani S, Lun ATL, White JT, Young LJ, Yaftiyan A, Zhan Y, Wakim L, Caminschi I, Lahoud MH, Lew AM, Shortman K, Smyth GK, Heath WR, Mintern JD, Roquilly A, Villadangos JA. Systemic inflammatory response syndrome triggered by blood-borne pathogens induces prolonged dendritic cell paralysis and immunosuppression. Cell Rep 2024; 43:113754. [PMID: 38354086 DOI: 10.1016/j.celrep.2024.113754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/01/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024] Open
Abstract
Blood-borne pathogens can cause systemic inflammatory response syndrome (SIRS) followed by protracted, potentially lethal immunosuppression. The mechanisms responsible for impaired immunity post-SIRS remain unclear. We show that SIRS triggered by pathogen mimics or malaria infection leads to functional paralysis of conventional dendritic cells (cDCs). Paralysis affects several generations of cDCs and impairs immunity for 3-4 weeks. Paralyzed cDCs display distinct transcriptomic and phenotypic signatures and show impaired capacity to capture and present antigens in vivo. They also display altered cytokine production patterns upon stimulation. The paralysis program is not initiated in the bone marrow but during final cDC differentiation in peripheral tissues under the influence of local secondary signals that persist after resolution of SIRS. Vaccination with monoclonal antibodies that target cDC receptors or blockade of transforming growth factor β partially overcomes paralysis and immunosuppression. This work provides insights into the mechanisms of paralysis and describes strategies to restore immunocompetence post-SIRS.
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Affiliation(s)
- Mitra Ashayeripanah
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Parkville, VIC 3000, Australia
| | - Javier Vega-Ramos
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Parkville, VIC 3000, Australia; The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
| | - Daniel Fernandez-Ruiz
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Parkville, VIC 3000, Australia; School of Biomedical Sciences, Faculty of Medicine & Health and the UNSW RNA Institute, The University of New South Wales, Kensington, NSW 2052, Australia
| | - Shirin Valikhani
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Parkville, VIC 3000, Australia
| | - Aaron T L Lun
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; Department of Medical Biology, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Jason T White
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Parkville, VIC 3000, Australia
| | - Louise J Young
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; Department of Medical Biology, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Atefeh Yaftiyan
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Parkville, VIC 3000, Australia
| | - Yifan Zhan
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; Department of Medical Biology, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Linda Wakim
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Parkville, VIC 3000, Australia
| | - Irina Caminschi
- Immunity Program, Monash Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Clayton, VIC 3800, Australia
| | - Mireille H Lahoud
- Immunity Program, Monash Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Clayton, VIC 3800, Australia
| | - Andrew M Lew
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; Department of Medical Biology, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Ken Shortman
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; Department of Medical Biology, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Gordon K Smyth
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; Department of Mathematics and Statistics, The University of Melbourne, Parkville, VIC 3010, Australia
| | - William R Heath
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Parkville, VIC 3000, Australia
| | - Justine D Mintern
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; Department of Biochemistry and Pharmacology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Antoine Roquilly
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Parkville, VIC 3000, Australia; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, 44000 Nantes, France; CHU Nantes, INSERM, Nantes Université, Anesthesie Reanimation, CIC 1413, 44000 Nantes, France.
| | - Jose A Villadangos
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Parkville, VIC 3000, Australia; Department of Biochemistry and Pharmacology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC 3010, Australia.
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27
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Skive AW, Tønnesen R. Disc herniation associated with butterfly vertebra anomaly. Ugeskr Laeger 2024; 186:V09230590. [PMID: 38445324 DOI: 10.61409/v09230590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Butterfly vertebra anomaly is a rare condition where the vertebral body fails to fuse during embryogenesis. In this case report, we present a 32-year-old male with progressive lower back pain and paralysis in both lower extremities. CT- and MR-scan showed an isolated L3 butterfly vertebra with a fusion of L2 and L3 discus through the defect and a discus prolapse compressing the spinal canal. The patient underwent successful decompressive surgery and experienced relief in symptoms post-operatively.
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Affiliation(s)
- Anders Weiland Skive
- Rygkirurgisk Afdeling, Københavns Universitetshospital - Rigshospitalet Glostrup
| | - Rune Tønnesen
- Rygkirurgisk Afdeling, Københavns Universitetshospital - Rigshospitalet Glostrup
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28
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Mizuta N, Hasui N, Kai T, Inui Y, Sato M, Ohnishi S, Taguchi J, Nakatani T. Characteristics of limb kinematics in the gait disorders of post-stroke patients. Sci Rep 2024; 14:3082. [PMID: 38321081 PMCID: PMC10847092 DOI: 10.1038/s41598-024-53616-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 02/02/2024] [Indexed: 02/08/2024] Open
Abstract
Post-stroke gait disorders involve altered lower limb kinematics. Recently, the endpoint of the lower limb has been used as a control variable to understand gait kinematics better. In a cross-sectional study of sixty-seven post-stroke patients, the limb extension angle and effective limb length during gait were used as input variables with a mixed Gaussian model-based probabilistic clustering approach to identify five distinct clusters. Each cluster had unique characteristics related to motor paralysis, spasticity, balance ability, and gait strategy. Cluster 1 exhibited high limb extension angle and length values, indicating increased spasticity. Cluster 2 had moderate extension angles and high limb lengths, indicating increased spasticity and reduced balance ability. Cluster 3 had low limb extension angles and high limb length, indicating reduced balance ability, more severe motor paralysis, and increased spasticity. Cluster 4 demonstrated high extension angles and short limb lengths, with a gait strategy that prioritized stride length in the component of gait speed. Cluster 5 had moderate extension angles and short limb lengths, with a gait strategy that prioritized cadence in the component of gait speed. These findings provide valuable insights into post-stroke gait impairment and can guide the development of personalized and effective rehabilitation strategies.
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Affiliation(s)
- Naomichi Mizuta
- Department of Rehabilitation, Faculty of Health Sciences, Nihon Fukushi University, 26-2 Higashihaemi-cho, Handa-shi, Aichi, 475-0012, Japan.
- Neurorehabilitation Research Center, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan.
- Department of Therapy, Takarazuka Rehabilitation Hospital, 22-2 Tsurunoso, Takarazuka-shi, Hyogo, 665-0833, Japan.
| | - Naruhito Hasui
- Department of Therapy, Takarazuka Rehabilitation Hospital, 22-2 Tsurunoso, Takarazuka-shi, Hyogo, 665-0833, Japan
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
| | - Takumi Kai
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
- Department of Rehabilitation Medicine, Hatsudai Rehabilitation Hospital, 3-53-3 Honmachi, Shibuya-ku, Tokyo, 151-0071, Japan
| | - Yasuhiro Inui
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
- Department of Rehabilitation, Nara Prefecture General Rehabilitation Center, 722 Oo, Tawaramoto, Shiki-gun, Nara, 636-0393, Japan
| | - Masahiro Sato
- Department of Rehabilitation, Nakazuyagi Hospital, 1-31, Nakazu, Tokushima-shi, Tokushima, 770-0856, Japan
| | - Sora Ohnishi
- Department of Therapy, Takarazuka Rehabilitation Hospital, 22-2 Tsurunoso, Takarazuka-shi, Hyogo, 665-0833, Japan
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
| | - Junji Taguchi
- Department of Medical, Takarazuka Rehabilitation Hospital, 22-2 Tsurunoso, Takarazuka-shi, Hyogo, 665-0833, Japan
| | - Tomoki Nakatani
- Department of Therapy, Takarazuka Rehabilitation Hospital, 22-2 Tsurunoso, Takarazuka-shi, Hyogo, 665-0833, Japan
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29
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Ahmed EY, Rawahi HA, Amrani FA, Masaoudi LA, Yazidi LA. Ramsay Hunt Syndrome Associated with Varicella-Zoster Virus Encephalitis in a Child. Sultan Qaboos Univ Med J 2024; 24:127-130. [PMID: 38434459 PMCID: PMC10906755 DOI: 10.18295/squmj.3.2023.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 02/16/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023] Open
Abstract
Ramsay Hunt syndrome (RHS) is a triad of peri-auricular pain, ipsilateral facial nerve palsy and vesicular rash around the ear pinna. It is caused by reactivation of varicella-zoster virus (VZV) that lies dormant in the geniculate ganglia. It can be complicated by VZV encephalitis rarely. We report the case of an 8-year-old previously healthy boy who presented to a tertiary care hospital in Muscat, Oman in 2021 with fever, progressive left ear pain, vesicular rash around his ear pinna and left-sided facial nerve palsy. His course was complicated by VZV encephalitis where he was managed with intravenous (IV) acyclovir and IV corticosteroids. He improved significantly and was asymptomatic with a normal neurology examination at the 6-months follow-up.
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Affiliation(s)
- Eman Y. Ahmed
- School Clinic, Ahlia School, Al Qurayya, Bahrain
- Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hatem Al Rawahi
- Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Fatema Al Amrani
- Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Laila Al Masaoudi
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Laila Al Yazidi
- Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
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30
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Jayavel P, Karthik V, Mathunny JJ, Jothi S, Devaraj A. Hand assistive device with suction cup (HADS) technology for poststroke patients. Proc Inst Mech Eng H 2024; 238:160-169. [PMID: 38189258 DOI: 10.1177/09544119231221190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
A stroke is a neurological disease that primarily causes paralysis. Besides paraplegia, all other types of paralysis affect the upper extremity. Advanced technologies, such as wearable devices and rehabilitation regimens, are also being developed to enhance the functional ability of a stroke person to grasp and release daily living objects. In this research, we developed a rehabilitation functional assist device combining a flexion and extension mechanism with suction cup technology (hybrid technology) to help post-stroke patients improve their hand grip strength in day-to-day grasping activities. Ten poststroke hemiplegia patients were studied to test the functional ability of the impaired hand by wearing and not wearing the device. The outcomes were validated by three standard clinical tests, such as the Toronto Rehabilitation Institute - Hand Functional Test (TRI-HFT), the Chedoke Arm Hand Activity Inventory (CAHAI-9), and the Fugl-Meyer Assessment (FMA) with overall score improvements of 14.5 ± 3.8-25 ± 2.2 (p = 0.005), 5.4 ± 2.8-10 ± 1.6 (p = 0.008), and 9.6 ± 2.6-17 ± 2.4 (p = 0.005) respectively. The p-value for each of the three evaluations was less than 0.05, indicating significantly improved results and the average feedback score of the participants was 3.8 out of 5. The proposed device significantly increased impaired hand functionality in post-stroke patients. The subjects could complete some of the grasping tasks that they could not grasp without the device.Clinical trial registrationThe Clinical Trial Registry of India approved the work CTRI/2022/02/040495 described in this manuscript.
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Affiliation(s)
- Porkodi Jayavel
- Department of Biomedical Engineering, College of Engineering and Technology, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu, India
| | - Varshini Karthik
- Department of Biomedical Engineering, College of Engineering and Technology, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu, India
| | - Jaison Jacob Mathunny
- Department of Biomedical Engineering, College of Engineering and Technology, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu, India
| | - Suresh Jothi
- SRM College of Physiotherapy, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu, India
| | - Ashokkumar Devaraj
- Department of Biomedical Engineering, College of Engineering and Technology, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu, India
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31
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Kim HJ, Lee SU, Lee ES, Choi JY, Kim JS. Recurrence and long-term outcomes of Tolosa-Hunt syndrome. J Neurol 2024; 271:935-943. [PMID: 37853245 DOI: 10.1007/s00415-023-12044-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND AND PURPOSE Tolosa-Hunt Syndrome (THS) is a rare disorder, and detailed clinical information and treatment outcomes have yet to be fully elucidated. This study aims to investigate the clinical features and factors associated with the treatment outcomes of THS, as defined by the established diagnostic criteria. METHODS This study retrospectively recruited 91 patients with a diagnosis of THS from 2003 to 2020. We analyzed the clinical features and outcomes, the initial treatment response, recurrences, and the final treatment response. RESULTS Isolated ocular motor nerve palsy was the most common (82.4%) finding of ophthalmoplegia, involving the oculomotor nerve in more than half of the cases (52.0%). The MRI lesions were mostly observed in the cavernous sinus (94.5%) with an extracavernous extension in about one-third of them. Five patients showed only extracavernous lesions. A total of 25 (27.5%) patients experienced recurrence. Recurrence occurred during steroid tapering as part of the initial treatment in seven, while in 18 patients, it happened after the successful termination of the initial treatment. However, all patients achieved complete remission at the final. Age was associated with a decrease in initial symptom duration (HR = 1.023, CI = 1.004-1.044) as well as an increase in recurrence-free duration (HR = 0.944, CI = 0.911-0.978). High-dose corticosteroid treatment was associated with a decrease in initial symptom duration (HR = 1.642, CI = 1.001-2.695) and total treatment duration (HR = 2.203 CI = 1.302-3.730). CONCLUSIONS THS can recur frequently especially in younger but have a favorable prognosis. High-dose corticosteroids can be an effective initial treatment and reduce the total treatment duration.
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Affiliation(s)
- Hyun-Jae Kim
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Sun-Uk Lee
- Neurotology Laboratory, Korea University Anam Hospital, Seoul, Republic of Korea
- Department of Neurology, Korea University Medical Center, Seoul, Republic of Korea
| | - Eek-Sung Lee
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Jeong-Yoon Choi
- Dizziness Center, Clinical Neuroscience Center and Department of Neurology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Ji-Soo Kim
- Dizziness Center, Clinical Neuroscience Center and Department of Neurology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
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Lu YT, Tseng WH, Chiu HL, Yang TL. Improvement in swallowing safety after injection laryngoplasty in patients with unilateral vocal paralysis complicated with aspiration. J Formos Med Assoc 2024; 123:179-187. [PMID: 37517935 DOI: 10.1016/j.jfma.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/22/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND The benefit of injection laryngoplasty (IL) on voice for unilateral vocal fold paralysis (UVFP) is supported increasingly in literatures, yet less is known for swallowing. Also, prevalence of patient-reported dysphagia is substantially higher than instrumental studies. This prospective study focused on swallowing outcomes, with predetermined flexible endoscopic evaluation of swallowing (FEES) protocol that simulates daily life situation. METHODS Adult patients with UVFP and aspiration receiving IL were recruited. Voice outcome measurements, as well as swallowing outcomes including Eating Assessment Tool (EAT-10) and FEES, which challenged patients with different fluid volumes: 10 mL, 20 mL, and 90 mL cup sipping were evaluated. RESULTS Significant improvements were demonstrated in all voice outcomes. Significant changes were also presented inEAT-10 (P < 0.01). Pre-operatively, penetration-aspiration scale (PAS) was 1.5 ± 1.3, 1.9 ± 1.7 and 2.3 ± 1.8 for 10 mL, 20 mL and 90 mL serial sipping, and improved to 1.1 ± 0.3, 1.1 ± 0.4 and 1.4 ± 0.7 post-operatively (P < 0.01). Safe swallowing (PAS ≤ 2) was achieved in all, except for one patient, who presented with a post-injection PAS of 4 (material enters the airway, contacts the vocal folds, and is ejected from the airway) on 90 mL cup sipping, whose pre-injection PAS was 7 (residue in trachea). CONCLUSION Maintaining swallowing function suitable for social environment is important. Our results demonstrated the feasibility of the predetermined FEES protocol, and positive effects of IL on both voice and swallowing outcomes.
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Affiliation(s)
- Yu-Tung Lu
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Hsuan Tseng
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Hsiang-Ling Chiu
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tsung-Lin Yang
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan
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Ward B. The Sub-Post-Tetanic "Bergin Zone" of Paralysis and its Impact on Neuromuscular Monitoring and Reversal. J Perianesth Nurs 2024; 39:161-164. [PMID: 38307696 DOI: 10.1016/j.jopan.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/28/2023] [Indexed: 02/04/2024]
Affiliation(s)
- Blake Ward
- Associate Chief CRNA - Quality and Education, Department of Anesthesiology, University of Mississippi Medical Center, Jackson, MS.
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François T, Davion JB, Deken-Delannoy V, Chantelot C, Saab M. Hereditary neuropathy associated with liability to pressure palsies: a 24-year experience with carpal and cubital tunnel surgery. J Hand Surg Eur Vol 2024; 49:257-263. [PMID: 37717179 DOI: 10.1177/17531934231199849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
The aim of this single-centre retrospective study was to evaluate the outcomes of carpal tunnel release surgery in patients with hereditary neuropathy with pressure palsies (HNPP). The secondary aims were to identify prognostic factors for the outcome of carpal tunnel release and to assess the outcome of cubital tunnel release. Our primary hypothesis was postoperative improvement. In total, 18 patients (26 carpal tunnel releases) with at least one symptomatic carpal tunnel syndrome were included. At a median follow-up of 8.5 years, more than 73% of the patients were satisfied with the results. The visual analogue scale (0 to 10) for discomfort decreased by 2.2 points (p < 0.001). The Boston Carpal Tunnel Questionnaire symptom severity scale decreased by 1.3 points (p < 0.001). The decrease in the Functional Status Scale was not significant. No significant prognostic factor for outcome was identified. A total of 12 patients also underwent cubital tunnel release, and three patients underwent just this procedure (23 procedures). Despite the lack of preoperative data, cubital tunnel release provided encouraging results. Level of evidence: III.
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Affiliation(s)
- Théo François
- CHU Lille, Service Orthopédie 1, Hôpital Roger Salengro, Lille, France
| | - Jean-Baptiste Davion
- CHU Lille, Clinique de Neurologie, Centre de Référence des Maladies Neuromusculaires de Lille, Hôpital Roger Salengro, Lille, France
| | - Valérie Deken-Delannoy
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Evaluation des technologies de santé et des pratiques médicales, Lille, France
| | | | - Marc Saab
- CHU Lille, Service Orthopédie 1, Hôpital Roger Salengro, Lille, France
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Kathari YK, Ahmad H, Kallen ME, Koka R, Omili D, Iraguha T, Clement J, Pham L, Khalid M, Fan X, Gebru E, Lesho P, Park E, Dishanthan N, Baker JM, Dietze KA, Hankey KG, Badros A, Yared JA, Dahiya S, Hardy NM, Kocoglu H, Luetkens T, Rapoport AP, Atanackovic D. Immune-mediated facial nerve paralysis in a myeloma patient post B-cell maturation antigen-targeted chimeric antigen receptor T cells. Haematologica 2024; 109:682-688. [PMID: 37675514 PMCID: PMC10828766 DOI: 10.3324/haematol.2023.283296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023] Open
Affiliation(s)
- Yamini K Kathari
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Haroon Ahmad
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA; Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Michael E Kallen
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD
| | - Rima Koka
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD
| | - Destiny Omili
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA; Transplant and Cellular Therapy Program, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Thierry Iraguha
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA; Transplant and Cellular Therapy Program, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Jean Clement
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Lily Pham
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA; Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Mazhar Khalid
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA; Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Xiaoxuan Fan
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA; Department of Microbiology and Immunology, University of Maryland, Baltimore, MD
| | - Etse Gebru
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA; Transplant and Cellular Therapy Program, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Patricia Lesho
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Esther Park
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Nishanthini Dishanthan
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA; Transplant and Cellular Therapy Program, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Jillian M Baker
- Department of Microbiology and Immunology, University of Maryland, Baltimore, MD
| | - Kenneth A Dietze
- Department of Microbiology and Immunology, University of Maryland, Baltimore, MD
| | - Kim G Hankey
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Ashraf Badros
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Transplant and Cellular Therapy Program, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Jean A Yared
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Transplant and Cellular Therapy Program, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Saurabh Dahiya
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Transplant and Cellular Therapy Program, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA; Stanford University, Stanford, CA
| | - Nancy M Hardy
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Transplant and Cellular Therapy Program, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Hakan Kocoglu
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Transplant and Cellular Therapy Program, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Tim Luetkens
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA; Transplant and Cellular Therapy Program, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA; Department of Microbiology and Immunology, University of Maryland, Baltimore, MD
| | - Aaron P Rapoport
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Transplant and Cellular Therapy Program, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Djordje Atanackovic
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Transplant and Cellular Therapy Program, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA; Department of Microbiology and Immunology, University of Maryland, Baltimore, MD.
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Whitehouse ER, Lopez A, English R, Getachew H, Ng TFF, Emery B, Rogers S, Kidd S. Surveillance for Acute Flaccid Myelitis - United States, 2018-2022. MMWR Morb Mortal Wkly Rep 2024; 73:70-76. [PMID: 38300829 PMCID: PMC10843070 DOI: 10.15585/mmwr.mm7304a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Acute flaccid myelitis (AFM) is a serious neurologic condition primarily affecting children; AFM can cause acute respiratory failure and permanent paralysis. AFM is a rare but known complication of various viral infections, particularly those of enteroviruses (EVs). Increases in AFM cases during 2014, 2016, and 2018 were associated with EV-D68 infection. This report examines trends in confirmed AFM cases during 2018-2022 and patients' clinical and laboratory characteristics. The number of AFM cases was low during 2019-2022 (28-47 cases per year); the number of cases remained low in 2022 despite evidence of increased EV-D68 circulation in the United States. Compared with cases during the most recent peak year (2018), fewer cases during 2019-2021 had upper limb involvement, prodromal respiratory or febrile illness, or cerebrospinal fluid pleocytosis, and more were associated with lower limb involvement. It is unclear why EV-D68 circulation in 2022 was not associated with an increase in AFM cases or when the next increase in AFM cases will occur. Nonetheless, clinicians should continue to suspect AFM in any child with acute flaccid limb weakness, especially those with a recent respiratory or febrile illness.
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Garg D, Kapoor H, Ahmad I, Goel D, Zahra S, Sharma P, Srivastava AK, Faruq M. Cognitive Impairment, Ataxia, Dystonia, and Gaze Palsy Due to a Novel Variant in SQSTM1: New Lessons. Mov Disord 2024; 39:445-447. [PMID: 38279634 DOI: 10.1002/mds.29684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 01/28/2024] Open
Affiliation(s)
- Divyani Garg
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Himanshi Kapoor
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), New Delhi, India
| | - Istaq Ahmad
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Divya Goel
- Division of Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology (IGIB), New Delhi, India
- Department of Pharmacology, School of Pharmaceutical Education & Research (SPER), New Delhi, India
| | - Sana Zahra
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), New Delhi, India
| | - Pooja Sharma
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), New Delhi, India
| | | | - Mohammed Faruq
- Division of Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology (IGIB), New Delhi, India
- Department of Pharmacology, School of Pharmaceutical Education & Research (SPER), New Delhi, India
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Kim CY, Choi SB, Lee ES. Prevalence and predisposing factors of post-stroke complex regional pain syndrome: Retrospective case-control study. J Stroke Cerebrovasc Dis 2024; 33:107522. [PMID: 38141321 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/05/2023] [Accepted: 11/28/2023] [Indexed: 12/25/2023] Open
Abstract
INTRODUCTION Poststroke complex regional pain syndrome (CRPS) is an important complication in stroke survivors. The identification of factors associated with post-stroke CRPS is important for preventive measures and early diagnosis. METHODS A total of 141 first-ever stroke survivors in the subacute stage were retrospectively analyzed. Demographic data, diagnosis time, duration of hospitalization, location of brain lesion, etiology, comorbidities, and blood test findings were investigated. Clinical data included Medical Research Council (MRC) grade, Fugl-Meyer assessment (FMA), National Institute for Health Stroke Scale (NIHSS), Berg Balance Scale (BBS). RESULTS Among 141 patients with subacute stroke, 22 were diagnosed with CRPS, with a prevalence of 15.6 %. The mean time to diagnosis was 38.6 (±16.5) days. The prevalence according to the degree of paralysis was 33.3 % in MRC grades 0 and 1, 8.6 % in grade 2, and 0 % in grade 3 or higher. The incidence rates within 1 month after stroke were 1.42 % and 22.47 % between 1 and 3 months after stroke, respectively. The independent risk factors for CRPS were hospitalization duration and FMA, NIHSS, and BBS scores. The sensitivity and specificity of the NIHSS score for predicting post-stroke CRPS were 86.4 % and 59.7 %, respectively, with an optimal cutoff value of 7.5. CONCLUSIONS CRPS of the affected upper limb in stroke patients is associated with stroke severity, including paralysis, and the incidence increases over time during the subacute phase. Additionally, having sufficient strength to move through a full range of motion against gravity had a protective effect against CRPS.
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Affiliation(s)
- Chan Yong Kim
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine Hospital, Republic of Korea
| | - Seong Bok Choi
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine Hospital, Republic of Korea
| | - Eun Sun Lee
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine Hospital, Republic of Korea.
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Bryson JB, Kourgiantaki A, Jiang D, Demosthenous A, Greensmith L. An optogenetic cell therapy to restore control of target muscles in an aggressive mouse model of amyotrophic lateral sclerosis. eLife 2024; 12:RP88250. [PMID: 38236205 PMCID: PMC10945574 DOI: 10.7554/elife.88250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Breakdown of neuromuscular junctions (NMJs) is an early pathological hallmark of amyotrophic lateral sclerosis (ALS) that blocks neuromuscular transmission, leading to muscle weakness, paralysis and, ultimately, premature death. Currently, no therapies exist that can prevent progressive motor neuron degeneration, muscle denervation, or paralysis in ALS. Here, we report important advances in the development of an optogenetic, neural replacement strategy that can effectively restore innervation of severely affected skeletal muscles in the aggressive SOD1G93A mouse model of ALS, thus providing an interface to selectively control the function of targeted muscles using optical stimulation. We also identify a specific approach to confer complete survival of allogeneic replacement motor neurons. Furthermore, we demonstrate that an optical stimulation training paradigm can prevent atrophy of reinnervated muscle fibers and results in a tenfold increase in optically evoked contractile force. Together, these advances pave the way for an assistive therapy that could benefit all ALS patients.
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Affiliation(s)
- J Barney Bryson
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- UCL Queen Square Motor Neuron Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Alexandra Kourgiantaki
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- UCL Queen Square Motor Neuron Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Dai Jiang
- Department of Electronic and Electrical Engineering, University College London, London, United Kingdom
| | - Andreas Demosthenous
- Department of Electronic and Electrical Engineering, University College London, London, United Kingdom
| | - Linda Greensmith
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- UCL Queen Square Motor Neuron Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
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Deo DR, Willett FR, Avansino DT, Hochberg LR, Henderson JM, Shenoy KV. Brain control of bimanual movement enabled by recurrent neural networks. Sci Rep 2024; 14:1598. [PMID: 38238386 PMCID: PMC10796685 DOI: 10.1038/s41598-024-51617-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/07/2024] [Indexed: 01/22/2024] Open
Abstract
Brain-computer interfaces have so far focused largely on enabling the control of a single effector, for example a single computer cursor or robotic arm. Restoring multi-effector motion could unlock greater functionality for people with paralysis (e.g., bimanual movement). However, it may prove challenging to decode the simultaneous motion of multiple effectors, as we recently found that a compositional neural code links movements across all limbs and that neural tuning changes nonlinearly during dual-effector motion. Here, we demonstrate the feasibility of high-quality bimanual control of two cursors via neural network (NN) decoders. Through simulations, we show that NNs leverage a neural 'laterality' dimension to distinguish between left and right-hand movements as neural tuning to both hands become increasingly correlated. In training recurrent neural networks (RNNs) for two-cursor control, we developed a method that alters the temporal structure of the training data by dilating/compressing it in time and re-ordering it, which we show helps RNNs successfully generalize to the online setting. With this method, we demonstrate that a person with paralysis can control two computer cursors simultaneously. Our results suggest that neural network decoders may be advantageous for multi-effector decoding, provided they are designed to transfer to the online setting.
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Affiliation(s)
- Darrel R Deo
- Department of Neurosurgery, Stanford University, Stanford, CA, USA.
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA.
| | - Francis R Willett
- Howard Hughes Medical Institute at Stanford University, Stanford, CA, USA
| | - Donald T Avansino
- Howard Hughes Medical Institute at Stanford University, Stanford, CA, USA
| | - Leigh R Hochberg
- School of Engineering, Brown University, Providence, RI, USA
- Carney Institute for Brain Science, Brown University, Providence, RI, USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Providence VA Medical Center, Providence, RI, USA
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jaimie M Henderson
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
- Bio-X Institute, Stanford University, Stanford, CA, USA
| | - Krishna V Shenoy
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
- Howard Hughes Medical Institute at Stanford University, Stanford, CA, USA
- Bio-X Institute, Stanford University, Stanford, CA, USA
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
- Department of Neurobiology, Stanford University, Stanford, CA, USA
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Zohdy YM, Laxpati NG, Rodas A, Howard BM, Pradilla G, Garzon-Muvdi T. Oculomotor nerve cavernous malformation: case report and operative video. Acta Neurochir (Wien) 2024; 166:16. [PMID: 38227056 DOI: 10.1007/s00701-024-05903-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/10/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Cavernous malformations (CMs) are clusters of thin-walled sinusoidal vessels without well-defined walls. Though they can occur anywhere in the neuroaxis, cranial nerve (CN) CMs are rare. METHOD We report a 47-year-old male with gradual CN III palsy. Initial imaging showed no significant findings, but a follow-up MRI revealed a growing lesion along CN III. Intraoperative findings confirmed a CN III CM. Diagnosing and treating CN III CM are complex. Radiological findings lack specificity, requiring consideration of various diagnoses for patients with isolated CN III palsy and abnormal radiological findings. CONCLUSION Surgery is the gold standard, aiming for complete lesion removal while minimizing neurological complications.
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Affiliation(s)
- Youssef M Zohdy
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Nealen G Laxpati
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Alejandra Rodas
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Brian M Howard
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Gustavo Pradilla
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Tomas Garzon-Muvdi
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, USA.
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Zhang W, Hao R. [Significance of accurately interpreting the Bielschowsky tilt test in the differential diagnosis of superior oblique muscle paralysis]. Zhonghua Yan Ke Za Zhi 2024; 60:3-7. [PMID: 38199763 DOI: 10.3760/cma.j.cn112142-20230917-00103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Superior oblique muscle paralysis is a common type of vertical rotatory strabismus with various subtypes. Regardless of the subtype, the Bielschowsky tilt test plays a crucial role in the diagnosis of superior oblique muscle paralysis and is often considered a significant criterion for diagnosis and differential diagnosis. However, the sensitivity and specificity of the Bielschowsky tilt test for diagnosing superior oblique muscle paralysis are not 100% due to the mechanism involved. The test is not solely based on extraocular muscle imbalance but also involves reflex pathways of the vestibular system and central nervous system. Consequently, lesions affecting corresponding areas may yield positive results in the Bielschowsky tilt test. Additionally, vestibular and central nervous system lesions can also cause strabismus, leading to a lack of one-to-one correspondence between a positive Bielschowsky tilt test and superior oblique muscle paralysis. Therefore, correctly interpreting the role of the Bielschowsky tilt test in superior oblique muscle paralysis is of paramount importance for the effective clinical management and treatment of associated conditions.
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Affiliation(s)
- W Zhang
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
| | - R Hao
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
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Deng Y, Yang S, Zhang L, Chen C, Cheng X, Hou C. Chronic bee paralysis virus exploits host antimicrobial peptides and alters gut microbiota composition to facilitate viral infection. ISME J 2024; 18:wrae051. [PMID: 38519112 PMCID: PMC11014883 DOI: 10.1093/ismejo/wrae051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/15/2024] [Accepted: 03/19/2024] [Indexed: 03/24/2024]
Abstract
The significance of gut microbiota in regulating animal immune response to viral infection is increasingly recognized. However, how chronic bee paralysis virus (CBPV) exploits host immune to disturb microbiota for its proliferation remains elusive. Through histopathological examination, we discovered that the hindgut harbored the highest level of CBPV, and displayed visible signs of damages. The metagenomic analysis showed that a notable reduction in the levels of Snodgrassella alvi and Lactobacillus apis, and a significant increase in the abundance of the opportunistic pathogens such as Enterobacter hormaechei and Enterobacter cloacae following CBPV infection. Subsequent co-inoculation experiments showed that these opportunistic pathogens facilitated the CBPV proliferation, leading to accelerated mortality in bees and exacerbation of bloated abdomen symptoms after CBPV infection. The expression level of antimicrobial peptide (AMP) was found to be significantly up-regulated by over 1000 times in response to CBPV infection, as demonstrated by subsequent transcriptome and quantitative real-time PCR investigations. In particular, through correlation analysis and a bacteriostatic test revealed that the AMPs did not exhibit any inhibitory effect against the two opportunistic pathogens. However, they did demonstrate inhibitory activity against S. alvi and L. apis. Our findings provide different evidence that the virus infection may stimulate and utilize the host's AMPs to eradicate probiotic species and facilitate the proliferation of opportunistic bacteria. This process weakens the intestinal barrier and ultimately resulting in the typical bloated abdomen.
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Affiliation(s)
- Yanchun Deng
- Institute of Bast Fiber Crops, Chinese Academy of Agricultural Sciences, Changsha 410205, China
| | - Sa Yang
- Institute of Apicultural Research, Chinese Academy of Agricultural Sciences, Beijing 100193, China
- Graduate School of Chinese Academy of Agricultural Sciences, Beijing 100081, China
| | - Li Zhang
- Institute of Apicultural Research, Chinese Academy of Agricultural Sciences, Beijing 100193, China
| | - Chenxiao Chen
- Institute of Bast Fiber Crops, Chinese Academy of Agricultural Sciences, Changsha 410205, China
| | - Xuefen Cheng
- Institute of Bast Fiber Crops, Chinese Academy of Agricultural Sciences, Changsha 410205, China
| | - Chunsheng Hou
- Institute of Bast Fiber Crops, Chinese Academy of Agricultural Sciences, Changsha 410205, China
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Zhao D, Li X, Carey AR, Henderson AD. Optic Neuritis and Cranial Neuropathies Diagnosis Rates before Coronavirus Disease 2019, in the Initial Pandemic Phase, and Post-Vaccine Introduction. Ophthalmology 2024; 131:78-86. [PMID: 37634758 DOI: 10.1016/j.ophtha.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/04/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023] Open
Abstract
PURPOSE To compare rates of diagnosis of neuro-ophthalmic conditions across the Coronavirus Disease 2019 (COVID-19) pandemic with pre-pandemic levels. DESIGN Multicenter, retrospective, observational study. PARTICIPANTS Patients seen for eye care between March 11, 2019, and December 31, 2021. METHODS A multicenter electronic health record database, Sight Outcomes Research Collaborative (SOURCE), was queried for new diagnoses of neuro-ophthalmic conditions (cranial nerve [CN] III, IV, VI, and VII palsy; diplopia; and optic neuritis) and new diagnoses of other ophthalmic conditions from January 1, 2016, to December 31, 2021. Data were divided into 3 periods (pre-COVID, pre-COVID vaccine, and after introduction of COVID vaccine), with a 3-year look-back period. Logistic regressions were used to compare diagnosis rates across periods. Two-sample z-test was used to compare the log odds ratio (OR) of the diagnosis in each period with emergent ocular conditions: retinal detachment (RD) and acute angle-closure glaucoma (AACG). MAIN OUTCOME MEASURES Diagnosis rate of neuro-ophthalmic conditions in each study period. RESULTS A total of 323 261 unique patients (median age 59 years [interquartile range, 43-70], 58% female, 68% White) across 5 academic centers were included, with 180 009 patients seen in the pre-COVID period, 149 835 patients seen in the pre-COVID vaccine period, and 164 778 patients seen in the COVID vaccine period. Diagnosis rates of CN VII palsy, diplopia, glaucoma, and cataract decreased from the pre-COVID period to the pre-vaccine period. However, the optic neuritis diagnoses increased, in contrast to a decrease in RD diagnoses (P = 0.021). By comparing the diagnosis rates before and after widespread vaccination, all eye conditions evaluated were diagnosed at higher rates in the COVID vaccination period compared with pre-COVID and pre-vaccine periods. The log OR of neuro-ophthalmic diagnosis rates across every period comparison were largely similar to emergency conditions (RD and AACG, P > 0.05). However, the log OR of cataract and glaucoma diagnoses were different to RD or AACG (P < 0.05) in each period comparison. CONCLUSIONS Neuro-ophthalmic diagnoses had a similar reduction in diagnosis rates as emergent eye conditions in the first part of the pandemic, except optic neuritis. After widespread COVID-19 vaccination, all ophthalmic diagnosis rates increased compared with pre-pandemic rates, and the increase in neuro-ophthalmic diagnosis rates did not exceed the increase in RD and AACG diagnosis rates. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- David Zhao
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland.
| | - Ximin Li
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Yan Z, Luo W, Liu H, Wang X, Wei M, Wang X, Wang Y, Gu J, Zhang H. Anatomical Study of Cross-Transfer of the Contralateral C7 Nerve Through the Posterior Epidural Pathway of the Cervical Spine for the Treatment of Spastic Paralysis of the Upper Limbs. World Neurosurg 2024; 181:e29-e34. [PMID: 36894004 DOI: 10.1016/j.wneu.2023.02.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND This study explored the safety and feasibility of surgical treatment of spastic paralysis of the central upper extremity by contralateral cervical 7 nerve transfer via the posterior epidural pathway of the cervical spine. METHODS Five fresh head and neck anatomical specimens were employed to simulate contralateral cervical 7 nerve transfer through the posterior epidural pathway of the cervical spine. The relevant anatomical landmarks and surrounding anatomical relationships were observed under a microscope, and the relevant anatomical data were measured and analysed. RESULTS The posterior cervical incision revealed the cervical 6 and 7 laminae, and lateral exploration revealed the cervical 7 nerve. The length of the cervical 7 nerve outside the intervertebral foramen was measured to be 6.4 ± 0.5 cm. The cervical 6 and cervical 7 laminae were opened with a milling cutter. The cervical 7 nerve was extracted from the inner mouth of the intervertebral foramen, and its length was 7.8 ± 0.3 cm. The shortest distance of the cervical 7 nerve transfer via the posterior epidural pathway of the cervical spine was 3.3 ± 0.3 cm. CONCLUSIONS Cross-transfer surgery of the contralateral cervical 7 nerve via the posterior epidural pathway of the cervical spine can effectively avoid the risk of nerve and blood vessel damage in anterior cervical nerve 7 transfer surgery; the nerve transfer distance is short, and nerve transplantation is not required. This approach may become a safe and effective procedure for the treatment of central upper limb spastic paralysis.
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Affiliation(s)
- Zhengcun Yan
- Department of Neurosurgery, Medical College of Yangzhou University, Yangzhou, China
| | - Wenmiao Luo
- Department of Neurosurgery, Medical College of Yangzhou University, Yangzhou, China
| | - Hongjun Liu
- Department of Hand Surgery, Medical College of Yangzhou University, Yangzhou, China
| | - Xiaodong Wang
- Department of Neurosurgery, Medical College of Yangzhou University, Yangzhou, China
| | - Min Wei
- Department of Neurosurgery, Medical College of Yangzhou University, Yangzhou, China
| | - Xingdong Wang
- Department of Neurosurgery, Medical College of Yangzhou University, Yangzhou, China
| | - Yongxiang Wang
- Department of Spinal Surgery, Medical College of Yangzhou University, Yangzhou, China
| | - Jiaxiang Gu
- Department of Hand Surgery, Medical College of Yangzhou University, Yangzhou, China
| | - Hengzhu Zhang
- Department of Neurosurgery, Medical College of Yangzhou University, Yangzhou, China.
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Gantiwala S, Hamidian Jahromi A, Konofaos P. A Historical Perspective on Brachial Plexus Palsy Management: From Ancient Civilizations to the Modern Era. J Craniofac Surg 2024; 35:33-38. [PMID: 37791800 DOI: 10.1097/scs.0000000000009669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/26/2023] [Indexed: 10/05/2023] Open
Abstract
Evidence of brachial plexus palsies and potential therapies have been identified by investigators across cultures and civilizations. It could be argued that there are early records of brachial plexus injuries in not only literary work but also paintings, sculptures, and ancient medical texts. The compiled ancient evidence in this review provides a historical framework of brachial plexus palsies and potential management techniques that have been utilized from ancient to modern time.
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Affiliation(s)
| | | | - Petros Konofaos
- Department of Plastic and Reconstructive Surgery, University of Texas Medical Branch (UTMB), Galveston, TX
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Protzuk O, Schmidt RC, Craig JM, Weber M, Isaacs J, O'Connell R. Reverse Shoulder Arthroplasty for Irreparable Rotator Cuff Tear After Radial to Axillary End-to-Side Transfer: A Case Report. JBJS Case Connect 2024; 14:01709767-202403000-00031. [PMID: 38363874 DOI: 10.2106/jbjs.cc.23.00526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
CASE A 60-year-old man sustained a massive irreparable rotator cuff tear and axillary nerve palsy with deltoid dysfunction after an anterior shoulder dislocation. He underwent staged reverse end-to-side radial-to-axillary nerve transfer with return of deltoid function allowing for subsequent reverse shoulder arthroplasty. At 1 year postoperatively, he returned to full activity. CONCLUSION Irreparable rotator cuff tears complicated by axillary nerve palsy can be effectively treated with a staged approach of nerve transfer followed by reverse shoulder arthroplasty.
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Affiliation(s)
- Omar Protzuk
- Division of Sports Medicine, Department of Orthopaedic Surgery, Virginia Commonwealth University Health Systems, Richmond, Virginia
| | - R Cole Schmidt
- Division of Sports Medicine, Department of Orthopaedic Surgery, Virginia Commonwealth University Health Systems, Richmond, Virginia
| | - Justin M Craig
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, Michigan
| | - Matt Weber
- Division of Sports Medicine, Department of Orthopaedic Surgery, Virginia Commonwealth University Health Systems, Richmond, Virginia
| | - Jonathan Isaacs
- Division of Hand Surgery, Department of Orthopaedic Surgery, Virginia Commonwealth University Health Systems, Richmond, Virginia
| | - Robert O'Connell
- Division of Sports Medicine, Department of Orthopaedic Surgery, Virginia Commonwealth University Health Systems, Richmond, Virginia
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Goonan R, Mohandoss E, Marston C, Kay J, De Silva AP, Maier AB, Reijnierse E, Klaic M. Is there a relationship between 'getting up and dressed' and functional and physical outcomes in geriatric rehabilitation inpatients? A quasi-experimental study. Clin Rehabil 2024; 38:119-129. [PMID: 37644886 DOI: 10.1177/02692155231197510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVES To evaluate the physical and functional outcomes of the 'Ending Pyjama Paralysis' intervention in an inpatient geriatric rehabilitation unit. DESIGN Quasi-experimental mixed-methods design nested within the 'REStORing health of acutely unwell adulTs' (RESORT) prospective, observational, longitudinal cohort of geriatric rehabilitation inpatients study. SETTING Geriatric rehabilitation wards in a major metropolitan public hospital between June 2019 and March 2020. INTERVENTION The 'Ending Pyjama Paralysis' movement originated in the UK. Its aim was to encourage patients to 'Get up, Get dressed and Get moving' to reduce hospital-associated functional decline. However, the physical and functional benefits of this campaign have not yet been evaluated. The 'Ending Pyjama Paralysis' was adopted as an integrated intervention on two out of four geriatric rehabilitation wards. The two control wards received usual care. MAIN MEASURES Physical measures included the Short Physical Performance Battery, and functional measures included the Katz Index of Independence in Activities of Daily Living and Lawton and Brody's Instrumental Activities of Daily Living, which were completed on admission and discharge. A linear mixed-effects model was used to analyse the results. RESULTS A total of 833 admissions were included in this study. Of these, 512 patients were in the control group, and 321 were in the intervention group. There were no significant differences in both physical and functional measures between the intervention and control groups. CONCLUSION The 'Ending Pyjama Paralysis' campaign did not result in enhanced functional or physical benefits in geriatric rehabilitation inpatients in this setting when applied in addition to usual care.
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Affiliation(s)
- Rose Goonan
- Allied Health, The Royal Melbourne Hospital, Melbourne, Australia
| | - Edward Mohandoss
- Allied Health, The Royal Melbourne Hospital, Melbourne, Australia
| | - Celia Marston
- Allied Health, The Royal Melbourne Hospital, Melbourne, Australia
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Jaqueline Kay
- Allied Health, The Royal Melbourne Hospital, Melbourne, Australia
| | - Anurika Priyanjali De Silva
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- MISCH (Methods and Implementation Support for Clinical and Health research Hub), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Department of Internal Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore, Singapore
| | - Esmee Reijnierse
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
| | - Marlena Klaic
- Allied Health, The Royal Melbourne Hospital, Melbourne, Australia
- Melbourne School of Health Science, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
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Gulati S, Tripathy S, Gupta T, Gaba S. Facial nerve communication with ansa cervicalis - An unusual anatomical variation. J Postgrad Med 2024; 70:60-63. [PMID: 38037772 PMCID: PMC10947731 DOI: 10.4103/jpgm.jpgm_454_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/03/2023] [Accepted: 08/14/2023] [Indexed: 12/02/2023] Open
Abstract
Neural connections of the seventh cranial nerve with its neighboring nerves are common and well documented; however, communication with ansa cervicalis is as yet unknown. We present a case with such a connection found during cadaveric dissection, with hitherto unknown consequences. In this specimen, after giving the marginal mandibular and cervical branches, the cervicofacial division continued distally to communicate with the distal loop of ansa cervicalis. Presence of such connection may result in facial muscle paralysis on injury to the ansa or strap muscle paralysis on injury to the facial nerve, depending on the direction of nerve fibers. Such unusual connections bring to light the need for extreme care during surgeries in the neck to safeguard any such connections and when using the ansa as donor.
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Affiliation(s)
- S Gulati
- Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Tripathy
- Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - T Gupta
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Gaba
- Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Taylor ZC, Nunna RS, Tran A, Costa M, Gruber M, Godolias P, Litvack Z. COVID-19 Vaccine Related Cervical Radiculitis and Parsonage-Turner Syndrome: Case Report and Review of the Literature. Turk Neurosurg 2024; 34:367-375. [PMID: 38497190 DOI: 10.5137/1019-5149.jtn.44533-23.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Parsonage-Turner Syndrome, or neuralgic amyotrophy, is an acute-onset upper limb and shoulder girdle palsy that can occur in a post-viral, post-surgical or idiopathic setting. There have also been some reported cases of the syndrome occurring following vaccinations. The pathophysiology of neuralgic amyotrophy is not completely understood and many of the commonly used diagnostic imaging modalities we use to try and diagnose this syndrome are inaccurate and misleading. We present the case of a 40-year-old gentleman who presented with acute onset burning pain and fasciculations in his right upper extremity following vaccination with the second dose of the Pfizer-BioNTech COVID-19 vaccine. His symptoms progressed to weakness in isolated muscle groups with electromyographic evidence of decreased nerve conduction. MRI of the cervical spine demonstrated multilevel central and foraminal stenosis, suggesting a diagnosis of cervical radiculopathy. The patient underwent a C4-5/C5-6 and C6-7 laminoforaminotomy and tolerated the procedure well. Post-operatively, the patient has experienced gradual symptom improvement with residual right triceps and pectoralis muscle weakness as well as paresthesias of the right elbow and forearm. Parsonage-Turner Syndrome is a brachial plexus palsy that can affect one or multiple branches of the brachial plexus. It causes acute-onset pain and weakness, and the diagnosis can be difficult to make with the commonly used diagnostic imaging methods. We reviewed other case reports about neuralgic amyotrophy following vaccinations as well as the current literature on more accurate diagnostic imaging modalities that may help our diagnosis and understanding of the pathophysiology of this condition.
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Affiliation(s)
- Zachary C Taylor
- Swedish Neuroscience Institute, Department of Neurosurgery, Seattle, WA, USA
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