Cerebellar Abscess Caused by Rare Bacteria: A Case Report.

This research was conducted to verify previously-developed equations analyzing musculoskeletal strain caused by uneven weight distribution inherent in a case of upper limb length discrepancy. The issue is an imbalance due to the growth of a shorter humerus in the individual’s right upper limb (RUL) as the result of a prior surgery affecting the individual’s right humeral growth plate. This shortened RUL weighs less than the left upper limb (LUL), lowering the balancing moment on the torso. When the individual sprints during physical exercise, there is an imbalance in rotational momentum created between the two arms in the sagittal plane. This imbalance in momentum compensation by one of the individual’s lower limbs. To solve this biomechanical problem, kinematic equations were developed to model the motion of a sprinter. In particular, the model defines the influence of the opposing upper limb motion on the lower limb motion that results in forward motion while sprinting. Furthermore, the equations incorporate the rotational motions of the upper and lower limbs. Trials were conducted with a test subject having a shorter RUL than LUL. In the trials, the subject initially started from rest before accelerating to a constant speed. Two Kistler force plates were used to generate force vectors of each of the subject’s feet once the constant speed was reached. Kistler force plates contain piezoelectric sensors which can be used to record ground force reaction. In this case, the Kistler force plates measured the horizontal, transverse, and longitudinal force vectors created when the subject’s foot contacted the plate. Additionally, the subject had several reflectors placed along his body. Using the Vicon three-dimensional (3D) optical motion analysis system, ten cameras in the laboratory captured the movement of the reflectors, generating vector motion for each limb during each trial run. To balance the rotational momentum of the upper limbs, a counteracting weight was attached to the wrist of the RUL in an attempt to minimize the effects on lower limb musculature. The difference in weight between each arm was determined, allowing a wearable device to be created which accounted for the difference. The device was attached to the subject’s right wrist to balance the weight of both arms. Hence, the left lower limb would not have to overcompensate for the shorter RUL’s lack of momentum. Similar running trials were conducted with the counterweight adjustment. The data from the trials, both with and without the counterweight, were compared to the theoretical equations determined from previous research.

Background. Follicular carcinoma thyroid usually metastasises to bone. Common sites of bone metastasis include skull and spine. Spinal metastasis are more common in the cervical region followed by dorsolumbar spine. Cervical extradural lesions present with progressive quadriparesis, sensory loss, dysautonomia, and respiratory distress. Typical Elsberg phenomenon in a cervical extradural lesion is rare. Elsberg phenomenon involves the involvement of ipsilateral upper limb, ipsilateral lower limb followed by contralateral lower limb and contralateral upper limb. Case presentation. We are reporting a case of 47-year-old lady presented with progressive quadriparesis of 1-month duration. Her weakness started in left upper limb followed by left lower limb, right lower limb and right upper limb weakness. She also had sensory loss below the level of C7. She had undergone near-total thyroidectomy for solitary thyroid nodule 14 years back and was on thyroid supplementation since then. Histopathology at that time was reported as follicular adenoma with Hashimoto thyroiditis. Her right upper limb power was grade 4- Left upper limb grade 1 right lower limb Grade 3, left lower limb grade 2 with hypertonia of both upper and lower limbs. She was evaluated with MRI Spine which showed a dumb bell-shaped extramedullary lesion involving the C5-C6 vertebra with significant cord compression and encasement of the left vertebral artery. USG neck showed left supraclavicular lymph node enlargement and small residual thyroid tissue in the left side of the thyroid. USG guided FNAC from the thyroid tissue and neck nodes were inconclusive. The patient underwent C4 and C5 laminectomy and subtotal excision from the cervical lesion. Histopathology was reported as metastasis from follicular carcinoma thyroid. Postoperatively patient limb power improved to grade 3 left upper and lower limbs and was discharged and later referred for radioiodine ablation Conclusion. Cervical extradural metastasis from follicular carcinoma thyroid can present with Elsberg syndrome even without any neck swelling even after decades of post thyroidectomy status for a benign aetiology. Laminectomy and decompression may lead to clinical improvement.

Monomelic amyotrophy (MMA) a variant of motor neuron disease, has the characteristic features of wasting and weakness usually confined to a single upper or lower limb occurring predominantly in young males and a benign outcome. Symptoms of increased sweating, coldness and cyanosis have been observed in a few patients. The objective was to evaluate the involvement of the sympathetic nervous system in MMA by measuring sympathetic skin response. Electromyography, motor and sensory nerve conduction studies were done in all the four limbs of 9 patients with atrophy of one upper limb. Stimulation at Erb's point, and above and below elbow was done to look for evidence of conduction block. The sympathetic skin response (SSR) was recorded in all the limbs of these patients. Wasting and weakness of right upper limb in 7 patients and left upper limb in 2 patients was seen. The mean age was 28.3+/-10.1 years. Twenty-five age matched (24.8+/-4.8 years) healthy subjects served as controls. The mean SSR latency in the affected upper limbs of 9 patients was prolonged compared to the 25 control subjects (1.51+/-0.07 s vs 1.42+/-0.19 s, P=0.03). The mean value of SSR latency in 18 upper limbs of the 9 patients which included atrophied and unatrophied limbs was also prolonged compared to the controls (1.50+/-0.08 s vs 1.42+/-0.19 s, P=0.05). There was no significant difference of the mean latency of SSR between the atrophied upper limbs and the clinically normal upper limbs (1.51+/-0.07 s vs 1.49+/-0.09 s, P=0.51). The mean SSR latency in the lower limbs of the patients (2.09+/-0.09 s) did not significantly differ from the control subjects (1.97+/-0.28 s, P=0.09). Motor and sensory nerve conduction was normal and there was no evidence of conduction block. In MMA the sympathetic nervous system is involved in the atrophic upper limb and also in the clinically unaffected upper limb but not in the lower limbs.

(The present study pursued the investigation of anthropometric asymmetries regarding the length of the upper and lower limbs and the indices of body proportionality and had the following ob-jectives: identifying the differences between the female and male groups, in the 4 age categories (7, 8, 9 and 10 years old), regarding anthropometric parameters and proportionality indicators; also tried to identify the differences in anthropometric parameters and proportionality indicators between the 4 age categories (7 - 10 years old) for each gender (female, respectively male). The study included 727 subjects with the age between 7-10 years, of which 383 (52.7%) female and 344 (47.3%) male, the subjects being divided into four groups according to age (7, 8, 9 and 10 years old groups). The measurements aimed at the following longitudinal anthropometric parameters and the calculation of proportionality ratios: height (cm); the length of the right upper limb (cm – LUL Right); the length of the left upper limb (cm – LUL Left); the length of the right lower limb (cm - LLL Right); the length of the left lower limb (cm - LLL Left); ratio of LUL Right X 100 / LLL Right; ratio of LUL Left x 100 / LLL Left; ratio of LUL Right x 100 / height; ratio of LUL Left x 100 / height; ratio of LLL Right x 100 / height; ratio of LLL_Left x 100/ height. Analyzing ccompara-tively the results recorded between the upper and lower right and left segments, we find asym-metry in all samples according to age and gender. The differences between the groups of girls and boys, in all age categories, were statistically significant. The ANOVA analysis reflects statis-tically significant differences between the 4 age groups (7 - 10 years) in all anthropometric evalu-ations. The largest asymmetries between the right and left upper limb were recorded in the age category of 7 years old group; respectively, the largest asymmetries between the lower limbs were recorded in the 10 year old groups depending on gender.

Effects of prism adaptation combined with electrical stimulation on cortical excitability of upper and lower limb muscles.

To compare walking speed in patients with spastic hemiparesis who received abobotulinumtoxinA either in the lower limb or simultaneously in both the lower and upper limbs. Post hoc analysis from a phase 3 study of abobotulinumtoxinA (Dysport®, NCT01251367). Adult patients with spastic hemiparesis causing gait dysfunction. Comfortable barefoot walking speed over 10 m was evaluated in patients receiving lower limb vs lower and upper limb injections over ≤4 treatment cycles; 1,000 U or 1,500 U in lower limb for cycle 1/2; optional upper limb injections from cycle 3 (500 U: upper limb, 1,000 U: lower limb). Mean (standard deviation; SD) lower limb cycle 3/4 doses were lower in the lower plus upper limb group vs lower limb only (1,000 U (SD 50), 1,000 U (SD 50) vs 1,380 U (SD 210), 1,360 U (SD 220). Baseline comfortable barefoot walking speed was similar between groups. Changes at cycle 3 week 4, in m/s, were: lower and upper limb: +0.063 (SD 0.131); lower limb only: +0.078 (SD 0.114), and cycle 4 week 4: lower and upper limb: +0.086 (SD 0.166); lower limb only: +0.086 (SD 0.123). Simultaneous lower and upper limb abobotulinumtoxinA treatment does not hamper improvement in walking speed compared with lower limb treatment alone. Thus, physicians may split the 1,500 U abobotulinumtoxinA dose as needed to best treat patients with spastic paresis.

Objective:The study aimed to assess the electrophysiological parameters (Hofmann reflex [H-reflex] and motor nerve conduction velocity [MNCV]) on children’s upper and lower limbs with lumbosacral meningomyelocele (MMC) and age-matched control to see the effect of the MMC on the cervical segment of the spinal cord.Materials and Methods:The present study was performed on infants with lumbosacral MMC. Twenty-five infants were examined with a mean age of 50 days of either sex. Out of them, 13 infants were in control and the remaining 12 were diagnosed with MMC. The H-reflex parameter and MNCV were recorded in these children’s right upper and lower limbs.Results:H-reflex was elicited in all the control group babies. In MMC, the H-reflex was elicited in the upper limbs. However, H-reflex was not elicited in the lower limbs of a few MMC babies. The upper limb’s H-reflex parameters and conduction velocity were significantly higher than those corresponding lower limbs in control babies. In MMC, where the H-reflex was elicited, such differences in the lower and upper limbs were not observed. However, the values of MNCV in the upper limb (right median nerve) were significantly less, and the values of Hmax in the lower limb (soleus muscle) were significantly more in MMC babies than in the control group.Conclusions:The values of electrophysiological parameters were higher in the upper limbs as compared to the corresponding lower limbs in control. These values were not altered in the upper limbs than those corresponding lower limbs of MMC, suggesting that motor function development was impaired/delayed in the spinal segment cranial to MMC lesion, and motor impairment in MMC children is mostly a result of upper motor neuron dysfunction.

Injuries to the growth plate of the humerus can occur in children during motor vehicle accidents. These injuries can then lead to growth abnormalities and musculoskeletal issues as the child develops. This research was conducted to analyze and develop a solution to musculoskeletal strain caused by uneven weight distribution inherent in a case of upper limb length discrepancy. The issue is an imbalance due to the growth of a shorter humerus in the individual’s right upper limb (RUL) as the result of a prior surgery on the individual’s right humeral growth plate. This shortened RUL weighs less than the left upper limb (LUL). This effectively lowers the mass moment of inertia of the RUL, thus lowering the balancing moment on the torso. When the individual sprints during physical exercise, there is an imbalance in rotational momentum that is created between the two arms. This imbalance in momentum requires that the opposing lower limb of the shorter RUL, the individual’s left lower limb, drives harder, leading to eventual failure in the hip flexor. In order to solve this biomechanical problem, kinematic equations were developed to model the motion of a sprinter. These equations model the motions of the hands, torso, and legs. In particular, the model defines the influence of the imbalance of the upper limbs’ motion on the lower limbs’ motion, which results in a forward rotation of the torso while sprinting. To balance the rotational momentum of the upper limbs, a counter-acting weight was attached to the wrist of the RUL, minimizing the effects on the lower limb musculature. Hence, the left lower limb would not have to overcompensate for the shorter RUL’s lack of momentum. The equations were then reconfigured to account for the counterweight, and the effect was observed and analyzed. A simulation predicted an angle of tilt of up to 5.7° in the sagittal plane from the vertical. The force required to rotate the body to the normal position was 18N. This force was determined to cause a twist of 10.0° in the transverse plane from the frontal plane. While this study was conducted on an individual with a shortened right upper limb secondary to a surgical procedure, study results can readily be generalized to individuals with shortening of either upper limb secondary to other traumatic events, such as motor vehicle accidents.

Efectos de un programa de ejercicio físico combinado sobre la capacidad funcional de mujeres mayores sanas en Atención Primaria de Salud

A 59-year-old man suffered numbness in his left upper limb for 4 years and weakness in his left upper and lower limb for 2 months. Physical examination showed his muscle...

Motor neuron disease (MND) can occur in patients with cancer, but there is minimal evidence that this is more than by chance. We contrast two cases of motor neuronopathies occurring in the context of systemic malignancy and argue that in one case the cause was most likely paraneoplastic, while in the other it was not. CASE 1: A 61-year-old woman developed progressive walking difficulties over 9months with weakness and stiffness in her legs. EMG showed fibrillations and positive sharp waves in multiple lower limb muscles bilaterally, with neurogenic units and a reduced recruitment pattern. An invasive ductal carcinoma of the breast was identified and she continued to deteriorate neurologically with worsening mobility, upper limb spasticity and fasciculations. She died approximately 26months after symptom onset. CASE 2: A 57-year-old woman developed weight loss and weakness of her right arm without any sensory symptoms. At presentation, she had wasting and fasciculations in her right upper limb muscles, with normal reflexes, normal left upper limb and lower limb examination. Over the following week, she developed left upper limb weakness and fasciculations, brisk knee reflexes, and flexor plantar responses. Her EMG showed upper and lower limb denervation. She was found to have anti-Hu and anti-CV2 antibodies present in serum. A PET-CT showed active uptake in lymph nodes in the right hilum. Biopsy confirmed a small cell lung cancer. She had chemoradiation therapy and the tumour went into remission. She has remained well on follow-up 24months later, regaining weight and strength after her chemotherapy. She continues to be monitored for cancer recurrence, but thus far appears to be in remission. In cases with rapidly progressive MND, particularly of upper limb onset, consideration should be given to testing anti-neuronal antibodies and searching for an occult tumour.

Objective: The aim of this study is to evaluate a novel composite measure of active range of motion (XA) and determine whether this measure correlates with active function. Design: Post hoc analysis of two randomized, placebo-controlled, double-blind studies with open-label extensions exploring changes in active function with abobotulinumtoxinA. Setting: Tertiary rehabilitation centers in Australia, Europe, and the United States. Subjects: Adults with upper (n = 254) or lower (n = 345) limb spastic paresis following stroke or brain trauma. Interventions: AbobotulinumtoxinA (⩽5 treatment cycles) in the upper or lower limb. Main measures: XA was used to calculate a novel composite measure (CXA), defined as the sum of XA against elbow, wrist, and extrinsic finger flexors (upper limb) or soleus and gastrocnemius muscles (lower limb). Active function was assessed by the Modified Frenchay Scale and 10-m comfortable barefoot walking speed in the upper limb and lower limb, respectively. Correlations between CXA and active function at Weeks 4 and 12 of open-label cycles were explored. Results: CXA and active function were moderately correlated in the upper limb (P < 0.0001–0.0004, r = 0.476–0.636) and weakly correlated in the lower limb (P < 0.0001–0.0284, r = 0.186–0.285) at Weeks 4 and 12 of each open-label cycle. Changes in CXA and active function were weakly correlated only in the upper limb (Cycle 2 Week 12, P = 0.0160, r = 0.213; Cycle 3 Week 4, P = 0.0031, r = 0.296). Across cycles, CXA improvements peaked at Week 4, while functional improvements peaked at Week 12. Conclusion: CXA is a valid measure for functional impairments in spastic paresis. CXA improvements following abobotulinumtoxinA injection correlated with and preceded active functional improvements.

Pedaling is a physical exercise practiced with either the upper or the lower limbs. Muscle coordination during these exercises has been previously studied using electromyography and synergy analysis, and three to four synergies have been identified for the lower and upper limbs. The question of synergy adaptabilities has not been investigated during pedaling with the upper limbs, and the impact of various modalities is yet not known. This study investigates the effect of pedal type (either clipped/gripped or flat) on the torque performance and the synergy in both upper and lower limbs. Torques applied by six participants while pedaling at 30% of their maximal power have been recorded for both upper and lower limbs. Electromyographic data of 11 muscles on the upper limbs and 11 muscles on the lower limbs have been recorded and synergies extracted and compared between pedal types. Results showed that the torques were not modified by the pedal types for the lower limbs while a deep adaptation is observable for the upper limbs. Participants indeed used the additional holding possibility by pulling the pedals on top of the pushing action. Synergies were accordingly modified for upper limbs while they remain stable for the lower limbs. In both limbs, the synergies showed a good reproducibility even if larger variabilities were observed for the upper limbs. This pilot study highlights the adaptability of muscle synergies according to the condition of movement execution, especially observed for the upper limbs, and can bring some new insights for the rehabilitation exercises.

Case presentation: A 67-year-old woman presented with intense pain and distal weakness of the lower limbs, associated with edema and arthralgia with difficulty walking for 2 months. He developed disproportionate and areflexic flaccid tetraparesis, weight loss and urinary retention. On examination, there was distal muscular atrophy of the four segments, disproportionate flaccid tetraparesis with muscle strength scores as follows: distal upper limbs -3 and distal lower limbs -2, according to the Medical Research Council Scale (MRC). Deep reflexes abolished (patellar, achilleus, biccipital and triccipital). Normal cranial nerves. He reported immunization against COVID-19 (Astrazeneca) 4 days before the onset of symptoms, with post-vaccination Guillain-Barré syndrome (GBS) as the diagnostic hypothesis. The electroneurographic study revealed a primarily axonal sensorimotor polyneuropathy, affecting nerves in the upper and lower limbs, compatible with the axonal variant of GBS. Human immunoglobulin 0.4g/kg/day was administered for 5 days, there was a slight improvement in muscle strength with muscle strength scores evolving to: distal upper limbs -4 and distal lower limbs -3 according to the Medical Research Council Scale (MRC). After 6 months, it progresses again insidiously with disabling pain, progressive, asymmetric quadriparesis, worse in the left upper limb and left lower limb, in addition to xerostomia, xerophthalmia, livedo reticularis in the lower limbs, scleritis of the right eye and oral ulcers. For investigation, serology was requested, resulting in positive ANCA, positive anti-Ro, positive anti-MPO, in addition to a ground-glass interstitial lung lesion. An evaluation was carried out in conjunction with rheumatology and ophthalmology, and, based on clinical characteristics and laboratory and imaging findings, she was diagnosed with Granulomatosis with Polyangiitis (GP) and Secondary Sjögren’s syndrome (SS), with sensory axonal polyneuropathy as the first symptom. engine. The patient continues to be treated with monthly cyclophosphamide, maintaining severe functional disability. Discussion: Early diagnosis of SS and GP remains a challenge given the complexity of clinical manifestations, in addition to the need for comprehensive immunobiological tests. In the case in question, it is worth highlighting that the neurological manifestations preceded the typical symptoms of the pathologies in question. This report allows us to discuss the clinical situation and immunological patterns of this condition and emphasizes the importance of comprehensive immunological testing for patients with GBS variants. Final comments: The association between GP and SS brings a high level of complexity to the clinical presentation and represents a challenging diagnosis. The specific temporal relationships and clinical presentation of this overlap syndrome can be difficult, and it is important to suspect this correlation given the early appearance of a polyneuropathy.

During gait rehabilitation, therapists or robotic devices often supply physical assistance to a patient's lower limbs to aid stepping. The expensive equipment and intensive manual labor required for these therapies limit their availability to patients. One alternative solution is to design devices where patients could use their upper limbs to provide physical assistance to their lower limbs (i.e., self-assistance). To explore potential neural effects of coupling upper and lower limbs, we investigated neuromuscular recruitment during self-driven and externally driven lower limb motion. Healthy subjects exercised on a recumbent stepper using different combinations of upper and lower limb exertions. The recumbent stepper mechanically coupled the upper and lower limbs, allowing users to drive the stepping motion with upper and/or lower limbs. We instructed subjects to step with 1) active upper and lower limbs at an easy resistance level (active arms and legs); 2) active upper limbs and relaxed lower limbs at easy, medium, and hard resistance levels (self-driven); and 3) relaxed upper and lower limbs while another person drove the stepping motion (externally driven). We recorded surface electromyography (EMG) from six lower limb muscles. Self-driven EMG amplitudes were always higher than externally driven EMG amplitudes (P < 0.05). As resistance and upper limb exertion increased, self-driven EMG amplitudes also increased. EMG bursts during self-driven and active arms and legs stepping occurred at similar times. These results indicate that active upper limb movement increases neuromuscular activation of the lower limbs during cyclic stepping motions. Neurologically impaired humans that actively engage their upper limbs during gait rehabilitation may increase neuromuscular activation and enhance activity-dependent plasticity.