Acute Peripheral Nerve Research Articles

Diabetes Mellitus and Hypertension are Associated with Bell's Palsy

Background: Bell's palsy occurs in approximately 40-70% of all cases of acute peripheral facial nerve paralysis, and its cause is unknown. Bell's palsy has several risk factors, including diabetes mellitus and hypertension. Objective: This study aims to identify the association between diabetes mellitus and hypertension with the occurrence of Bell's palsy. Methods: This research was conducted at RSUD Tugurejo Semarang in March 2022 using a retrospective study design and purposive sampling technique. Data collected included the history of diabetes mellitus, hypertension, and the occurrence of Bell's palsy. Medical records were used as research instruments. Hypothesis testing was performed using the Fischer exact test. Results: A total of 32 samples were included in this study. There were 11 patients (34.4%) with a history of diabetes mellitus, 21 patients (65.6%) with a history of hypertension, 11 patients experienced acute Bell's palsy (34.4%), and 21 patients had subacute Bell's palsy (65.6%). The statistical analysis showed a significant association between diabetes mellitus (p=0.017) and hypertension (p=0.033) with the occurrence of Bell's palsy. Conclusion: This study reveals a significant correlation between diabetes mellitus and hypertension and the occurrence of Bell's palsy. Several studies also suggest that hypertension is linked to a poorer prognosis in patients with comorbidities and facial paralysis in Bell's palsy. However, there are also studies stating that age and gender are associated with the occurrence of Bell's palsy independently of diabetes and hypertension.

Fibrin Glue Acutely Blocks Distal Muscle Contraction after Confirmed Polyethylene Glycol Nerve Fusion: An Animal Study.

Polyethylene glycol (PEG) is a synthetic, biodegradable, and hyperosmotic material promising in the treatment of acute peripheral nerve injuries. Our team set out to investigate the impact of fibrin glue upon PEG fusion in a rat model. Eighteen rats underwent sciatic nerve transection and PEG fusion. Electrophysiologic testing was performed to measure nerve function and distal muscle twitch. Fibrin glue was applied and testing repeated. Due to preliminary findings, fibrin glue was applied to an uncut nerve in five rodents and testing was conducted before and after glue application. Mann-Whitney U tests were used to compare median values between outcome measures. A Shapiro-Wilk test was used to determine normality of data for each comparison, significance set at a P value less than 0.05. PEG fusion was confirmed in 13 nerves with no significant change in amplitude (P = 0.054), latency (P = 0.114), or conduction velocity (P = 0.114). Stimulation of nerves following PEG fusion produced distal muscle contraction in 100% of nerves. Following application of fibrin glue, there was a significant reduction in latency (P = 0.023), amplitude (P < 0.001), and conduction velocity (P = 0.023). Stimulation of the nerve after application of fibrin glue did not produce distal muscle twitch. Five uncut nerves with fibrin glue application blocked distal muscle contraction following stimulation. Our data suggest that fibrin glue alters the nerve's function. The immediate confirmation of PEG fusion via distal muscle twitch is blocked with application fibrin glue in this experimental model. Survival and functional outcome studies are necessary to understand if this has implications on the long-term functional outcomes.

Peripheral Facial Paralysis After COVID-19 BioNTech ® Vaccine

Bell's palsy, also known as acute peripheral facial nerve palsy of unknown cause, commonly manifests with sudden onset of unilateral facial paralysis. This case report describes two patients who has bell’s palsy after their first dose of the Pfizer-BioNTech vaccine.

Acute Peripheral Facial Nerve Palsy in Children and Adolescents: Clinical Aspects and Treatment Modalities.

Peripheral facial nerve palsy is a relatively frequent, rather idiopathic, and isolated nonprogressive disorder with a tendency toward spontaneous recovery in children. It is primarily characterized by unilateral paresis or paralysis of the mimic musculature affecting verbal communication, social interactions, and quality of life. This study aimed to evaluate the clinical aspects and efficacy of different therapeutic modalities in the population of children and adolescents with acute peripheral facial nerve palsy, the quality and recovery rate in comparison to different therapy modalities and etiological factors as well as to determine parameters of recovery according to the age of patients. The retrospective study included children and adolescents (n=129) with an acute onset of peripheral facial nerve palsy, diagnosed and treated in the Clinic of Neurology and Psychiatry for Children and Youth in Belgrade (2000-2018). The mean age of the patients was 11.53 years (SD±4.41). Gender distribution: 56.6% female and 43.4% male patients. There were 118 (91.5%) patients with partial and 11 (8.5%) patients with complete paralysis. Left-sided palsy occurred in 67 (51.9%) patients, right-sided in 58 (45.0%), while there were 4 (3.1%) bilateral paralyses. The most common etiological factor was idiopathic (Bell's palsy) - 74 (57.4%) patients followed by middle ear infections - 16 (12.4%). Regardless of etiology, age, and therapy protocols, there was a significant recovery in most of the patients (p<0.001), without significant differences in recovery rate. Comparison of inpatient and outpatient populations showed significant differences regarding the number of relapses, severity of clinical presentation, and recovery rate in relation to etiology. Bell's palsy is shown to be the most common cause of peripheral facial nerve palsy in children and adolescents, regardless of gender. It is followed by mid-ear infections, respiratory infections, and exposure to cold. Most children and adolescents recovered in three weeks after initial presentation, regardless of etiology, age, and therapy.

The outcome of polyethylene glycol fusion augmented by electrical stimulation in a delayed setting of nerve repair following neurotmesis in a rat model

PurposePolyethylene glycol is known to improve recovery following its use in repair of acute peripheral nerve injury. The duration till which PEG works remains a subject of intense research. We studied the effect of PEG with augmentation of 20Htz of electrical stimulation (ES) following neurorrhaphy at 48 h in a rodent sciatic nerve neurotmesis model.MethodTwenty-four Sprague Dawley rats were divided into 4 groups. In group I, the sciatic nerve was transected and repaired immediately. In group II, PEG fusion was done additionally after acute repair. In group III, repair and PEG fusion were done at 48 h. In group IV, ES of 20Htz at 2 mA for 1 h was added to the steps followed for group III. Weekly assessment of sciatic functional index (SFI), pinprick, and cold allodynia tests were done at 3 weeks and euthanized. Sciatic nerve axonal count and muscle weight were done.ResultsGroups II, III, and IV showed significantly better recovery of SFI (II: 70.10 ± 1.24/III: 84.00 ± 2.59/IV: 74.40 ± 1.71 vs I: 90.00 ± 1.38) (p < 0.001) and axonal counts (II: 4040 ± 270/III: 2121 ± 450/IV:2380 ± 158 vs I: 1024 ± 094) (p < 0.001) at 3 weeks. The experimental groups showed earlier recovery of sensation in comparison to the controls as demonstrated by pinprick and cold allodynia tests and improved muscle weights. Addition of electrical stimulation helped in better score with SFI (III: 84.00 ± 2.59 vs IV: 74.40 ± 1.71) (p < 0.001) and muscle weight (plantar flexors) (III: 0.49 ± 0.02 vs IV: 0.55 ± 0.01) (p < 0.001) in delayed repair and PEG fusions.ConclusionThis study shows that PEG fusion of peripheral nerve repair in augmentation with ES results in better outcomes, and this benefit can be demonstrated up to a window period of 48 h after injury.

BELL’S PALSY in a girl child: A rare case report with review of literature

Bell's Palsy is a unilateral acute peripheral facial nerve palsy of sudden onset and unknown aetiology. Bell's Palsy is common in adults but rarely seen in children. Inability to close the unilateral eye, drooping of corner of mouth, with drooling of saliva and unable to smile on affected side are few important clinical features of Bell's Palsy. Management of Bell's Palsy in children is basically symptomatic only. Multivitamins with light physiotherapy are all that are helpful to manage most of the Bell's Palsy cases in children. Overall, Bell's Palsy in children is self-limiting with early and complete recovery.

Orthopedic surgical procedures in people with hemophilia.

People with hemophilia tend to develop joint lesions secondary to the recurrent hemarthroses typical of their condition. These usually include chronic synovitis and arthropathy chiefly affecting their ankles, knees, and elbows. In addition, muscular hematomas, albeit less frequently, may also result in complications such as acute compartment syndrome, pseudotumors, bone cysts and peripheral nerve compression. Joint lesions may require some of the following surgical interventions: arthroscopic synovectomy (in cases of synovitis), arthroscopic joint debridement, radial head resection, opening-wedge tibial osteotomy, arthrodesis, arthrodiastasis (of the ankle), tendon lengthening (hamstrings, Achilles tendon), progressive extension of the knee by placing an external fixator in cases of flexion contracture of the knee, supracondylar femoral extension osteotomy in cases of knee flexion contracture and, eventually, a total joint arthroplasty when the affected joint has been destroyed and the patient experiences severe joint pain. Total knee arthroplasty in hemophilic patients is associated with a high infection risk (7% on average). As regards the complications following muscle hematomas, acute compartment syndrome requires urgent performance of a fasciotomy when hematological treatment is incapable of resolving the problem. Surgical resection of hemophilic pseudotumors is the best solution, with those affecting the pelvis (secondary to iliopsoas hematomas) being particularly difficult to resolve. Peripheral nerve lesions can often be effectively addressed with hematological treatment, although a surgical neurolysis of the ulnar nerve is indicated if nonoperative treatment fails.

Ramsay Hunt Syndrome with Pharyngolaryngeal Involvement Mimicking Acute Stroke: A Case Report.

Ramsay Hunt syndrome is a clinical manifestation of the reactivation of latent varicella zoster virus in the geniculate ganglion after acute infection. It is commonly associated with an acute peripheral facial nerve paralysis, auricular vesicular eruption and acute sensorineural hearing loss. However, in some rare cases the involvement of other cranial nerves, especially the glossopharyngeal and vagal is described. We present a 56-year-old male patient who was diagnosed with acute pharyngitis. Two days later, the patient developed dysarthria, hoarseness, and left side facial weakness. Considering a patient's history of cardiovascular events, the acute stroke was suspected. Magnetic resonance imaging ruled out an acute cerebrovascular accident. The patient's otalgia aggravated and he reported hearing loss. Clinical examination revealed facial paralysis affecting the left side of the face, erythematous rash on the left auricle, multiple vesicles present on patient's left tympanic membrane, ulcerous lesion on the left side of the soft palate and ipsilateral velopharyngeal palsy. Indirect laryngoscopy revealed ulcerous lesions in the left side of the epiglottis and left vocal cord paralysis. The patient was diagnosed with Ramsay Hunt syndrome with cranial polyneuropathy. Oral acyclovir and oral prednisolone were administered. Seven months after discharge, facial paralysis improved to lower grade and flexible laryngoscopy showed that the left vocal cord had resumed normal movement. Ramsay Hunt syndrome can be accompanied by involvement of other cranial nerves. Previous history of hypertensive crises and myocardial infarction may influence a diagnosis of Ramsay Hunt syndrome, especially when it has atypical presentation. However, this diagnosis should be considered in patients with unilateral multiple cranial nerve palsies.

Allogenic bone marrow-derived mesenchymal stem cells and its conditioned media for repairing acute and sub-acute peripheral nerve injuries in a rabbit model

The present study evaluated healing potential of bone marrow-derived mesenchymal stem cells (BM-MSCs) and BM-MSCs-conditioned medium (BM-MSCs-CM) for acute and subacute injuries in the rabbit peripheral nerve injury model. The regenerative capacity of MSCs was evaluated in 40 rabbits divided into eight groups, four groups each for acute and subacute injury models. BM-MSCs and BM-MSCS-CM were prepared by isolating allogenic bone marrow from the iliac crest. After inducing sciatic nerve crush injury, different treatments consisting of PBS, Laminin, BM-MSCs + laminin, and BM-MSCS-CM + laminin were used on the day of injury in the acute injury model and after ten days of crush injury in the subacute groups. The parameters studied included: pain, total neurological score, gastrocnemius muscle weight and volume ratio, histopathology of the sciatic nerve and gastrocnemius muscle, and scanning electron microscopy (SEM). Findings indicate that BM-MSCs and BM-MSCS-CM have augmented the regenerative capacity in acute and subacute injury groups with a slightly better improvement in the subacute groups than the animals in acute injury groups. Histopathology data revealed different levels of regenerative process undergoing in the nerve. Neurological observations, gastrocnemius muscle evaluation, muscle histopathology, and the SEM results depicted better healing in animals treated with BM-MSCs and BM-MSCS-CM. With this data, it could be concluded that BM-MSCs support the healing of injured peripheral nerves, and the BM-MSCS-CM does accelerate the healing of acute and subacute peripheral nerve injuries in rabbits. However, stem cell therapy may be indicated during the subacute phase for better results.

Physiotherapy Perspective in the Rehabilitation of Traumatic Brachial Plexus Injury in a Patient with Polytrauma: A Case Report Emphasising an Early Approach

Traumatic peripheral nerve damage from Road Traffic Accidents (RTA) can cause severe impairment and loss of function in the upper and lower limbs. A significant portion of acute peripheral nerve injuries affects the upper limb, particularly the brachial plexus. The treatment for complete brachial plexus injury may involve surgery and intensive physiotherapy to help the nerves regenerate and reinnervate the muscles. A 17-year-old male was referred to the Neurology department from a primary healthcare centre after being involved in RTA that resulted in a fall on the right-side. Investigatory findings revealed a head injury with Subarachnoid Haemorrhage (SAH), fractures of the right tibia shaft, right clavicle lateral shaft, and right lower limb. Following surgery, the patient experienced difficulty in performing movements with the right upper limb, along with pain and tingling sensations. As a result, the patient was referred to physiotherapy. During physiotherapy, the patient received sensory re-education sessions lasting 15-20 minutes each, as well as bilateral training sessions lasting 20 minutes each, for a total of four weeks. Over the course of the treatment, the patient demonstrated overall improvement in hand function, including proper grasp and opposition. This improvement was reflected in the brachial assessment tool, Upper Extremity (UE) functional index, and functional independence measure. These positive outcomes underscore the importance of early neuro-physiotherapeutic rehabilitation for patients with brachial plexus injuries, as it can significantly enhance their overall well-being and quality of life.

Magnetic resonance imaging assessment of the therapeutic effect of combined electroacupuncture and stem cells in acute peripheral nerve injury.

Objectives: This study aimed to evaluate the therapeutic effect of a combination of Bone Mesenchymal stem cells (BMSCs) transplantation and Electroacupuncture (EA) for acute sciatic nerve injury in rats using magnetic resonance. Methods: Ninety-two male adult healthy Sprague-Dawley rats were randomly divided into the EA+BMSCs group, EA group, MSCs group, and PBS group (control). Electroacupuncture was performed on a rat receiving EA treatment at Huantiao (GB30) and Zusanli (ST36). T2 values and diffusion tensor imaging (DTI) derived from multiparametric magnetic resonance imaging (MRI), histological assessments, and immunohistochemistry was used to monitor nerve regeneration. Walking track analysis was used to assess nerve functional recovery. Repeated-measures one-way analysis of variance was used to evaluate the significance of T2, DTI, and SFI values among the four groups. One-way analysis of variance was used for comparing the histological characteristics. Bonferroni test was used for multiple pairwise comparisons at each time point. Results: In terms of FA, the EA+BMSCs and EA groups had faster recovery than PBS (control) in all time points after surgery, and the EA+BMSCs group recovered better than the BMSCs group at 3 weeks (P ≤ 0.008). FA values were higher in the EA group than in the BMSCs group at 4 weeks (P ≤ 0.008). In terms of RD, the EA+BMSCs group recovered better than the BMSCs group at 2 and 4 weeks (P ≤ 0.008). Immunofluorescence staining for axon guidance molecule netrin-1 revealed that it was significantly higher in the EA+BMSCs subgroup and EA subgroup than it was in the control (PBS) subgroup at 1-3 weeks (P < 0.001). Immunofluorescence staining for S100 showed the continuity of nerve fibers recovered more quickly in the EA+BMSCs subgroup than in the BMSCs subgroup. Conclusion: Our research revealed that a combination of MSCs and EA can provide both topological and biomolecular guidance to promote axonal extension, myelin regeneration, and functional recovery after PNI. EA not only promotes nerve repair on its own, but also enhanced the beneficial effects of stem cell treatment and the secretion of netrin 1, a guidance regeneration factor, and promotes the orderly growth of nerve fibers. These PNI repairs could be monitored non-invasively and in situ by MRI. The FA and RD values derived from MRI could be sensitive biomarkers to reflect the PNI repair process.

Ramsay-Hunt syndrome in HIV patient

Introduction Ramsay-Hunt syndrome type (SRH) type II is defined by the combination of herpes zoster oticus to acute peripheral facial nerve paralysis, described in 1907 by James Ramsay Hunt. Reactivation of latent varicella-zoster virus in the geniculate ganglion of the facial nerve will cause SRH, resulting in inflammation, edema, and compression of the VII cranial pair. However, nerve involvement, and in turn the development of SRH, manifests in less than 1% of infected patients. It is the second most common cause of atraumatic peripheral facial palsy (PFP) and has an incidence of 5 cases/100,000 people, with no sex predilection. Currently, SRH is classically described as a triad of otalgia, ipsilateral facial paralysis, and vesicles near the ear and ear canal; however, motor, sensory, and autonomic impairment when combined result in diverse neurological damage and may cause different symptoms, its diagnosis is mainly clinical. Goal To report the case of an HIV patient associated with SHR, seen by IIER between May and June/2022. Case Report Male, 49 years old, sought care on 05/20/22 in a hospital with complaints of vertigo and intense headache, associated with nausea and vomiting with onset of symptoms one day ago. His personal history was HIV+, diagnosed in 2013 and under regular treatment. On 5/25/22 resurfaced with the same symptoms of vertigo in conjunction with the appearance of an erythematous and painful vesicle in the right auricular region with edema and flushing of the region in association with PFP symptoms. On 05/30/22 he returned to the clinic with the same symptoms as before, and a magnetic resonance imaging of the temporal bones was done, showing an inflammatory process through the contrast at the bottom of the internal auditory canal suggestive of Bell's Palsy. (To see the complet abstract, please, check out the PDF.)

Effect of Amniotic Membrane Nerve Wrapping in Final Results of Traumatic Peripheral Nerve Repair.

BACKGROUNDPreventing perineural adhesions and scars formation in the traumatic peripheral injuries is very important on the recovery process. We aimed to evaluate the effect of using the amniotic membrane wrapping on the results of surgical treatment of damaged peripheral nerves.METHODSThis cohort study included 30 patients with symptoms of acute peripheral nerve injuries due to penetrating trauma in the forearm or wrist in January 2019 to November 2020 referred to the Hand and Microsurgery Department, 15 Khordad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. In 15 patients, after nerve repair, amniotic membrane coverage was used around the nerve, all patients were followed for 12 months. Ultrasound study for neuroma formation and nerve regeneration was determined based on EMG and NCV findings. The modified Medical Research Councile classification (MRCC) was used to evaluate of motor and sensory recovery. RESULTSIn the amniotic membrane wrapping group, all patients had nerve regeneration and functional nerve recovery occurred after 12 months. In the control group, 5 patients (33.4%) did not have nerve recovery and had functional and sensory impairment. In terms of functional capabilities; there was a significant difference in pinch strength, grip power and MRCC scoring between the two groups. Moreover, the mean volume of neuroma in these patients who used amniotic membrane covering was 2.7 mm3 and in the control group, it was 3.9 mm3 (P=0.001). Five patients who did not have a damaged nerve, the neuroma volume was 4.8 ± 0.9 mm3.CONCLUSIONThe use of amniotic membrane covering is effective methods in the improve results of peripheral nerve repair and nerve function recovery.

282 Follow-up for Evaluation for Nerve Repair Surgery: The Role of Socioeconomic and Geographic Factors in Victims of Violent Nerve Injury

OBJECTIVES/GOALS: We have created the first-ever database for all patients who have acute peripheral nerve injuries. Our goal is to use this data to construct two clinical scoring systems to facilitate triaging by emergency room physicians by 1.) identifying patients who would likely benefit from a nerve surgery, and 2.) identify patients who are less likely to follow up. METHODS/STUDY POPULATION: Based on 2,606 consult emails from the Washington University in St. Louiss Division of Plastic and Reconstructive Surgery, from 2013 to 2019, we have identified more than 600 patient cases in which patients presented after an injury with any kind of nerve deficit. We have defined nerve deficits as any abnormality on motor or sensory exam of the extremities, excluding those younger than 18 years old and those with other disease processes that may affect function of the peripheral nervous system. Data for these patients was collected from electronic medical records and include handedness, nerve injured, operative details, area deprivation index decile, mechanism of injury, insurance and employment status, and whether injuries were a result of work or violence. RESULTS/ANTICIPATED RESULTS: Our plan is to provide the first descriptive statistics for such a population, as well as multiple regression analysis for our two endpoints, loss to follow up and need for surgery. Following regression analysis, we also look to perform cluster analysis to further study co-occurring clinical and social features that affect our endpoints. We are excitedly awaiting to perform the analysis after the final data has been collected. DISCUSSION/SIGNIFICANCE: Nerve injury is a common symptom of penetrating injuries. Many of the socioeconomic factors associated with increased risk for violent injury are also risk factors for decreased rates of follow up. This problem is particularly worrisome given that nerve repair surgery is only viable as an option to return function within the first year after injury.

Histological examination of the effects of epidermal growth factor on regeneration of acute peripheral nerve injuries on rabbit model.

Peripheral nerve injuries are one of the most common and costly injuries especially in the young population. In this study, it is aimed to determine the histological role of epidermal growth factor (EGF) in nerve regeneration with an acute damage made on sciatic nerve in the rabbit model. We used 18 New Zealand rabbits (nine in control group and nine in experimental group). Each group was divided into two groups consisting of five rabbits planned for diameter measurement and four rabbits planned for spatial measurement. The sciatic nerve exploration in the right flank of each animal, full-thickness nerve damage, and then epineural repair was made by a single researcher. 10 µg/kg EGF was given to the repair area of the experimental group and five more EGF injections were given to the experimental group every other day postoperatively. In the control group, we used saline solution. Rabbits were observed for 8 weeks. During follow-up, two rabbits died. At the end of 8 weeks, the nerve tissue of each animal was evaluated histologically and morphologically. In the experimental group consisting of five rabbits, the mean thickness of connective tissue (epineurium+ mesoneurium) was 156,867 µm; while, in the control group, the thickness was 25,170 µm. In the other groups, the numerical increase in epineurium and mesoneurium areas was detected in the EGF (+) group as a result of the comparative spatial measurements. Epineurium and mesoneurium enlargement was observed in the EGF-given group. Adipocyte and capillary increase was observed in connective tissue. EGF increases epineurium and mesoneurium diameters in peripheral connective tissue in acute peripheral nerve injury regeneration. However, further studies are needed to understand this effect clinically and physiologically.

Delivery of nitric oxide-releasing silica nanoparticles for in vivo revascularization and functional recovery after acute peripheral nerve crush injury

Nitric oxide (NO) has been shown to promote revascularization and nerve regeneration after peripheral nerve injury. However, in vivo application of NO remains challenging due to the lack of stable carrier materials capable of storing large amounts of NO molecules and releasing them on a clinically meaningful time scale. Recently, a silica nanoparticle system capable of reversible NO storage and release at a controlled and sustained rate was introduced. In this study, NO-releasing silica nanoparticles (NO-SNs) were delivered to the peripheral nerves in rats after acute crush injury, mixed with natural hydrogel, to ensure the effective application of NO to the lesion. Microangiography using a polymer dye and immunohistochemical staining for the detection of CD34 (a marker for revascularization) results showed that NO-releasing silica nanoparticles increased revascularization at the crush site of the sciatic nerve. The sciatic functional index revealed that there was a significant improvement in sciatic nerve function in NO-treated animals. Histological and anatomical analyses showed that the number of myelinated axons in the crushed sciatic nerve and wet muscle weight excised from NO-treated rats were increased. Moreover, muscle function recovery was improved in rats treated with NO-SNs. Taken together, our results suggest that NO delivered to the injured sciatic nerve triggers enhanced revascularization at the lesion in the early phase after crushing injury, thereby promoting axonal regeneration and improving functional recovery.

DTI and MTR Measures of Nerve Fiber Integrity in Pediatric Patients With Ankle Injury.

Acute peripheral nerve injury can lead to chronic neuropathic pain. Having a standardized, non-invasive method to evaluate pathological changes in a nerve following nerve injury would help with diagnostic and therapeutic assessments or interventions. The accurate evaluation of nerve fiber integrity after injury may provide insight into the extent of pathology and a patient's level of self-reported pain. The aim of this investigation was to evaluate the extent to which peripheral nerve integrity could be evaluated in an acute ankle injury cohort and how markers of nerve fiber integrity correlate with self-reported pain levels in afferent nerves. We recruited 39 pediatric participants with clinically defined neuropathic pain within 3 months of an ankle injury and 16 healthy controls. Participants underwent peripheral nerve MRI using diffusion tensor (DTI) and magnetization transfer imaging (MTI) of their injured and non-injured ankles. The imaging window was focused on the branching point of the sciatic nerve into the tibial and fibular division. Each participant completed the Pain Detection Questionnaire (PDQ). Findings demonstrated group differences in DTI and MTI in the sciatic, tibial and fibular nerve in the injured ankle relative to healthy control and contralateral non-injured nerve fibers. Only AD and RD from the injured fibular nerve correlated with PDQ scores which coincides with the inversion-dominant nature of this particular ankle injuruy cohort. Exploratory analyses highlight the potential remodeling stages of nerve injury from neuropathic pain. Future research should emphasize sub-acute time frames of injury to capture post-injury inflammation and nerve fiber recovery.

End-to-side neurorrhaphy in peripheral nerves: Does it work?

Acute peripheral nerve injuries are common and can cause physical disabilities with sensory and functional sequelae; they therefore require surgery. The aim of this study was to conduct a systematic review to assess the clinical applicability of end-to-side neurorrhaphy in peripheral nerve reconstruction, based on available evidence. We carried out a systematic review of the literature using MEDLINE/PubMed, EMBASE, Cochrane Library, Web of Science, Scielo and Scopus through March 16, 2021. Most of the selected studies were qualitative and employed nonrandomized groups of patients, without standardized scales for assessing outcomes, which made statistical analysis difficult. Efficacy varied from 24% to 81%. Factors for better outcome included the type of injury, type of injured nerve (sensory, motor or mixed), presence of an epineural window, topography, injury extension <1.3 cm, and intervention within 2 weeks of injury. Clinical studies so far lack scientific evidence on end-to-side neurorrhaphy in peripheral nerve lesions.

Evaluation of peripheral nerve acute crush injury in rabbits: comparison among diffusion kurtosis imaging, diffusion tensor imaging and electromyography.

Diffusion kurtosis imaging (DKI) has been proven to provide additional value for assessing many central nervous system diseases compared with conventional diffusion tensor imaging (DTI); however, whether it has the same value in peripheral nerve injury is unclear. This study aimed to investigate the performance of DKI, DTI, and electromyography (EMG) in evaluating peripheral nerve crush injury (PNCI) in rabbits. A total of 27 New Zealand white rabbits were selected to establish a PNCI model. Longitudinal DTI, DKI, and EMG were evaluated before surgery and 1day, 3days, 1week, 2weeks, 4weeks, 6weeks, and 8weeks after surgery. At each time point, two rabbits were randomly selected for pathological examination. The results showed that fractional anisotropy (FA) derived from both DKI and DTI demonstrated a significant difference between injured and control nerves at all time points (all P < 0.005) mean kurtosis of the injured nerve was lower than that on the control side after 2-8weeks (all P < 0.05). No statistically significant difference was found in radial kurtosis, axial kurtosis, and apparent diffusion coefficient at almost every time point. The difference in compound muscle action potential (CMAP) of the bilateral gastrocnemius at each time point was statistically significant (all P < 0.001). CMAP was a sensitive and reliable method to assess acute PNCI without being affected by perineural edema. DKI may not be superior to DTI in evaluating peripheral nerves, DTI with a shorter scanning time was preferred as an effective choice for evaluating acute peripheral nerve traumatic injury.

Influence of surface peripheral electrical stimulation on nerve regeneration after digital nerve neurorrhaphy: study protocol for a randomized clinical trial

We will study the influence of low intensity and frequency surface peripheral electrical stimulation (PES) on nerve regeneration of digital nerve injuries of the hand after its surgical repair in humans. Participants will be patients with acute traumatic peripheral nerve injury referred to the Hand Surgery Service of the General Hospital of the State of Bahia, a reference service in the state. These patients will undergo surgery followed by PES in the immediate postoperative period. After hospital discharge, they will be followed up on an outpatient basis by researchers, who will remotely supervise a physiotherapy program. Our hypothesis is that PES will positively influence the recovery of sensory function in patients undergoing neurorrhaphy of digital nerves of the hand. ReBEC registration: U1111-1259-1998 (12/18/2020)