Case Of Polyneuropathy Research Articles

CUIDADOS DE ENFERMAGEM AO PACIENTE COM POLINEUROPATIA DIABÉTICA

This article will focus on the investigation of nursing care provided to patients with diabetic polyneuropathy, with the aim of proposing strategies that contribute to the prevention and treatment of diabetic foot, a condition resulting from Diabetes Mellitus, which can often result in amputation. During the course of this study, we will highlight information about the evolution and stages of diabetic foot and its aggravating factors, as well as evaluate the prevalence of cases of diabetic polyneuropathy in Brazil, identifying the implications faced by the patient associated with diabetic foot, so that it is possible to report the methods of prevention and treatment of diabetic foot, according to its stages of clinical aggravation. The work will address the complications of diabetic foot, caused by non-healing lesions, which lead to infections and amputations in patients with poorly controlled diabetes. It highlights the importance of comprehensive nursing interventions to prevent and treat this a condition that has been increasingly frequent in patients with Diabetes Mellitus.

Neosporosis in 21 adult dogs, 2010-2023.

Limited information is available regarding the clinical features, treatment, and prognosis of neosporosis in adult dogs. Describe the clinical signs, laboratory findings, magnetic resonance imaging (MRI) findings, treatment and outcome in adult dogs (>6 months) diagnosed with neosporosis based on consistent clinical signs and positive serology (titer ≥1 : 800) at a referral hospital in Sydney, Australia. Twenty-one client-owned dogs. Retrospective case series of affected dogs between 2010 and 2023. Survival times were determined from onset of clinical signs to date of death or censoring. Clinical signs varied, and were indicative of generalized myopathy (6 dogs), multifocal intracranial disease (7 dogs), myelopathy (4 dogs), polyneuropathy (2 dogs) and single cases of focal myopathy and cerebellar disease. Serum creatine kinase activity was markedly increased (median, 3369 U/L) in most dogs. The most common MRI abnormalities were multifocal intracranial abnormalities (7/13 dogs) and muscle changes (5/13 dogs) whereas T2-weighted cerebellar abnormalities (2/13 dogs) and cerebellar atrophy (1/13) were less common. Treatment response was complete (resolution to normal) in 8 dogs, incomplete (persistent neurological deficits) in 6 dogs, but there was minimal response in 7 dogs. Thirteen dogs (62%) were alive after 6 months and 12 dogs (57%) alive after 1 year. Relapse was common, with 4 dogs experiencing at least 1 relapse event during the follow-up period. Adult-onset neosporosis is uncommon and has variable clinical presentations. Treatment response also is variable, and relapse can occur, even among patients that respond completely to initial treatment.

A clinical case of acute polyneuropathy, with the onset of bilateral facial nerve palsy in an early childhood

BACKGROUND: The differential diagnosis of peripheral nervous system damage depends on a thorough collection of history, comprehensive assessment of clinical manifestations, and dynamic examination of the patient. This article describes a clinical case of acute polyneuropathy in a young child, which began with gastrointestinal symptoms and bilateral facial neuropathy. CLINICAL CASE DESCRIPTION: The article presents a case of a child with an atypical course of acute polyneuropathy, which began with bilateral facial neuropathy combined with gastrointestinal complaints and pain syndrome. Features of the clinical presentation of the disease required extended laboratory and instrumental testing. Protocols for instrumental verification of diagnosis included nerve conduction studies examining neural conduction and axonal excitability of the affected facial nerve and the healthy side. Additionally, the functional status of the peripheral nerves in the upper and lower limbs was assessed. Polyneuropathic alterations revealed through nerve conduction studies confirmed diagnostic lumbar puncture to determine the presence of neuroinfectious processes. Magnetic resonance imaging of the brain, brachial, and lumbosacral plexuses using intravenous contrast showed the nature and prevalence of a lesion. Based on the overall clinical, laboratory, and instrumental examination data of the patient, “acute inflammatory demyelinating polyneuropathy” was diagnosed; timely etiopathogenetic treatment was initiated. CONCLUSION: In children, the course of a neuroinfection may be atypical. Sometimes, when dissociating the clinical manifestations of the disease from the results of a standard laboratory and instrumental test, expert diagnostic techniques should be used for differential diagnosis purposes.

The cytoplasmic tail of myelin protein zero induces morphological changes in lipid membranes

The major myelin protein expressed by the peripheral nervous system Schwann cells is protein zero (P0), which represents 50% of the total protein content in myelin. This 30-kDa integral membrane protein consists of an immunoglobulin (Ig)-like domain, a transmembrane helix, and a 69-residue C-terminal cytoplasmic tail (P0ct). The basic residues in P0ct contribute to the tight packing of myelin lipid bilayers, and alterations in the tail affect how P0 functions as an adhesion molecule necessary for the stability of compact myelin. Several neurodegenerative neuropathies are related to P0, including the more common Charcot-Marie-Tooth disease (CMT) and Dejerine-Sottas syndrome (DSS) as well as rare cases of motor and sensory polyneuropathy. We found that high P0ct concentrations affected the membrane properties of bicelles and induced a lamellar-to-inverted hexagonal phase transition, which caused bicelles to fuse into long, protein-containing filament-like structures. These structures likely reflect the formation of semicrystalline lipid domains with potential relevance for myelination. Not only is P0ct important for stacking lipid membranes, but time-lapse fluorescence microscopy also shows that it might affect membrane properties during myelination. We further describe recombinant production and low-resolution structural characterization of full-length human P0. Our findings shed light on P0ct effects on membrane properties, and with the successful purification of full-length P0, we have new tools to study the role of P0 in myelin formation and maintenance in vitro.

Requirement of Repeated Serum VEGF Measurements in POEMS Syndrome.

POEMS syndrome is often associated with a poor prognosis. Elevated serum vascular endothelial growth factor (sVEGF) is a useful diagnostic marker with high sensitivity and specificity. However, the relationship between sVEGF elevation and polyneuropathy in POEMS syndrome remains controversial. We herein report a case of polyneuropathy without sVEGF elevation at the first admission. However, at 21 months after the onset, the patient tested positive for sVEGF and was diagnosed with POEMS syndrome. Therefore, it is important to repeatedly measure sVEGF levels in patients with polyneuropathy with an atypical course when POEMS syndrome is suspected, even if the initial sVEGF level is normal.

Perception of vibration threshold potential with tuning fork and pure tone audiometry assessment for early detection of diabetic polyneuropathy

Background: Diabetes mellitus (DM), a multisystem disorder, is a known etiological entity, leading to several neurological disorders. Among them, nervous system is more commonly affected. In most of the diabetic polyneuropathy cases, sensory symptoms involving both general and special senses predominate. Due to gradual and non-homogenous manifestations, it is not easy to detect its onset. Till now no accepted gold standard has been available for its assessment and diagnosis. In this study, changes in vibration perception threshold (VPT) at different frequencies and auditory perception threshold have been investigated in diabetes patients and healthy controls. Aims and objectives: Determination of perception threshold of a general sense-vibration sense and a special sense-hearing in normal human subjects and patients of DM and evaluation of perception threshold of the human sensory system by VPT test and pure tone audiometry (PTA) as a diagnostic, prognostic and research tool for diabetic neuropathy. Materials and Methods: A case–control study, conducted in the department of physiology at medical college, Kolkata, after obtaining approval by the institutional research and ethics committee on 100 cases and 40 control subjects. Testing of vibration sensitivity was performed with the help of tuning forks of frequencies of 128 Hz, 256 Hz, and 512 Hz. Assessment of auditory perception threshold was done by Siemens SD 28 diagnostic audiometer. Results: All data obtained by the methods described here are tabulated. Graphs and charts are drawn and analyzed by standard statistical methods using Statistical Packages for the Social Sciences (version-16) and MATLAB (version-9). A P < 0.05 was considered as significant. A partial negative correlation was observed between the vibration sensitivity and fasting blood sugar and postprandial blood sugar level of the patient population of DM cases, with a “r” value (Pearson’s correlation coefficient was around −0.5. By PTA, it was found the percentage of rise in auditory threshold is around 92–93% in 8000 Hz frequency, and the results of the t-test yield a very highly significant difference (P < 0.0001) between cases and controls. It was found that 128 Hz and 256 Hz vibration stimuli applied over maxillary prominence are highly sensitive and efficient tools for perception analysis. Pure tone auditory threshold evaluation showed preservation of the right-sided advantage of auditory sensitivity and frequency-dependent loss of hearing in the diabetic study population. Conclusion: Determination of perception threshold of vibration sense by tuning fork and auditory perception by PTA may be used as an effective, easily performed, and low-cost bedside and also outpatient department-based diagnostic tool in patients with DM.

An Observational Study on Factors Causing Variable Response to Therapeutic Doses of Intravenous Immunoglobulin in Acute Immune-Mediated Polyneuropathy: A Tertiary Care Center Experience

Context: Immune-mediated neuropathies, notably Guillain–Barré syndrome (GBS) and its subtypes, exhibit diverse clinical presentations. Intravenous immunoglobulin (IVIG) is a standard treatment for these conditions, but the variable clinical course complicates outcome prediction. Despite standard IVIG dosing, some patients continue to deteriorate. Aim: The aim of this study was to assess the factors responsible for variable response to therapeutic doses of immunoglobulins in acute immune-mediated polyneuropathy. Settings and Design: This was a prospective, observational study. Materials and Methods: Acute immune-mediated polyneuropathy cases within 14 days of symptom onset and receiving IVIG were recruited. Hughes disability score (HDS), modified Erasmus GBS outcome score (mEGOS), and modified Rankin score (mRS) were assessed before IVIG, immediately after IVIG, and 4 weeks thereafter. Statistical Analysis Used: Categorical variables are expressed as percentages, and continuous variables are presented as mean ± standard deviation. Relationships between parameters were assessed using analysis of variance and multivariate analysis of covariance. Correlations were measured using Pearson’s correlation, and proportions were compared using the Chi-square test or Fisher’s exact test. Results: Among 60 GBS patients, the median age was 38 years, with upper respiratory tract infection as the most common antecedent infection (60%). The most common variant was pure motor type, while demyelinating (88.33%) was the most common electrophysiological subtype. Outcome correlated with post-IVIG scores of HDS and mRS. Linear regression analysis showed a positive correlation between onset-to-treatment duration and HDS and mEGOS scores after 4 weeks of IVIG, while mRS showed minimal correlation. No significant correlations were found between antecedent infection, gender, nerve conduction study pattern, GBS variant, and scores of HDS, mEGOS, and mRS. Conclusions: The study highlights the significance of onset-to-treatment duration. Factors with unfavorable course were age, delay in receiving IVIG, respiratory involvement, dysautonomia, cranial nerve involvement, and those with higher mEGOS scores at the 7th day of admission. Seasonal trends should not be overlooked. Serial evaluation of disability scores can predict the varying response to IVIG.

ID: 203843 A Rare Case of Ibrutinib-Induced Polyneuropathy

The B-cell-receptor (BCR) pathway, which includes Bruton’s-Tyrosine-Kinase (Btk) protein, regulates proliferation, differentiation, and apoptosis of B-cells. In B-cell malignancies such as chronic lymphocytic leukemia (CLL), aberrant BCR signaling plays critical role in pathogenesis of disease. Ibrutinab is irreversible Btk inhibitor that prevents downstream activation of the BCR pathway and subsequent proliferation of malignant B-cells. In this case report, patient with history of Ibrutinab use for several years for CLL treatment had rare adverse effect (AE) of Ibrutinib-inducted-polyneuropathy, which was only reported once in literature.

Myeloneuropathy with Bilateral Foot Pain after Scrub Typhus Infection: An Antibody-Proven Case Report

Scrub typhus is an acute febrile illness caused by <i>Orientia tsutsugamushi</i>. The most common neurological symptoms are headaches presenting with meningitis, meningoencephalitis, or encephalitis; however, transverse myelopathy and polyneuropathy are rare in typhoid infections. Herein, we report a laboratory and electrodiagnostically proven case of subacute myelopathy and polyneuropathy with slow progression after scrub typhus infection. A 64-year-old man complained of truncal numbness and a burning sensation in both feet. Magnetic resonance imaging did not reveal any definite changes in the spinal cord; however, serological tests showed immunoglobulin G antibodies against O. tsutsugamushi by enzyme-linked immunosorbent assay. An electrophysiological study showed myelopathy concurrent with polyneuropathy. To the best of our knowledge, this is the first immunochemical detection of antibodies in a patient with delayed neurological manifestations after scrub typhus infection.

Idiopathic progressive polyneuropathy presented with frequently acute pulmonary oedema: a case report

Neuropathy is when nerve damage interferes with the functioning of the peripheral nervous system (PNS). When the cause can’t be determined, it’s called idiopathic neuropathy(Idiopathic neuropathy, now designated as chronic idiopathic axonal polyneuropathy (CIAP). There are three kinds of nerves within the PNS. Sensory nerves relay messages from the sense organs to the brain. This allows sensations of temperature and touch. Motor nerves transmit signals from the brain to the muscles. This helps the brain control the muscles. Autonomic nerves control body functions like heart rate, breathing, and digestion. Damage to nerve cells can affect how the PNS communicates with the rest of the body. Symptoms can include numbness, pain, and balance issues. It’s called acute neuropathy when symptoms develop suddenly. Alternately, it’s called chronic neuropathy when symptoms start slowly and increase over time. Diagnosis involves physical examination and review of medical history. Diagnostic testing may include blood tests, nerve testing, and imaging tests. There is no cure for idiopathic neuropathy. Treatments including medication, physical therapy, and lifestyle modifications can help you function and feel better. We report a case of idiopathic polyneuropathy presented with frequent acute pulmonary edema for a year.

TH-261. A case of GBS-like polyneuropathy with unusual progression (Case Report)

TH-261. A case of GBS-like polyneuropathy with unusual progression (Case Report)

TH-259. Atypical chronic inflammatory demyelinating polyneuropathy cases, focal CIDP

TH-259. Atypical chronic inflammatory demyelinating polyneuropathy cases, focal CIDP

Varicella zoster-associated progressive lower cranial and upper cervical polyneuropathy: a case report

BackgroundMultiple cranial neuropathies carry a wide range of differential diagnoses, and when combined with cerebrospinal fluid monocytosis they often suggest an infective etiology. Reactivation of varicella zoster virus has been associated with a wide range of neurological complications. Among the cranial nerves, the upper cranial nerves (trigeminal and facial nerves) are more commonly affected; there have been some reports of lower cranial polyneuropathies resulting from varicella zoster virus reactivation. However, polyneuropathy involving both the cranial and cervical nerves is rarely reported.Case presentationThis report highlights the case of a 64-year-old Chinese man presenting with an acute, severe dysphagia and dysphonia secondary to herpes zoster-associated progressive polyneuropathy involving the lower cranial and upper cervical nerves, without any mucocutaneous manifestations.ConclusionsTo our knowledge, this is the first case of varicella zoster virus-associated cranial and cervical polyneuropathy in the literature. The report also highlights the poor sensitivity of varicella zoster virus DNA detection by polymerase chain reaction in the cerebrospinal fluid, and proposes that serology be routinely performed in such polymerase chain reaction-negative cases without a clear diagnosis.

Thymic plasmacytoma presenting as polyneuropathy and revealing multiple myeloma: a case report

BackgroundMultiple myeloma (MM) is the most frequent malignant plasma cell disorder with proliferation of neoplastic plasma cells in the bone marrow or other tissue, most commonly in the upper aerodigestive tract. The invasion of the thymus is exceptional. Neurological complications are usual, but represent exceptionally the revealing symptom.Case presentationWe report a case of polyneuropathy revealing a thymic plasmacytoma as a mediastinal invasion of MM in a 48-year-old woman. She was admitted after developing progressive ascending distal paresthesias and weakness in lower limbs. Examination showed symmetrical distal sensorimotor impairment with axillary and inguinal adenopathies. Electroneuromyography revealed a sensorimotor length-dependent neuropathy. Serum protein electrophoresis showed monoclonal protein peak in β-γ globulin region. Immunoelectrophoresis showed IgA lambda monoclonal gammapathy. Myelogram and bone marrow biopsy revealed plasmocytosis of 5%. Chest computed tomography showed a histologically confirmed thymic plasmacytoma associated with a lytic lesion of the 5th rib leading to the diagnosis of MM.ConclusionsThe association between a thymic plasmacytoma and peripheral neuropathy is rare and a workup for MM is necessary to guide therapeutic management.

Multifocal motor neuropathy after SARS-CoV-2 vaccination: a causal or coincidental association?

Multifocal motor neuropathy (MMN) is an immune-mediated and acquired demyelinating motor polyneuropathy. Several cases of polyneuropathy associated with severe acquired respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination have been reported. However, MMN has not been reported as a complication of SARS-CoV-2 vaccination. In this study, we report a case of MMN with progressive muscle weakness following the second dose of the Pfizer-BioNTech mRNA vaccine. It was diagnosed by clinical evaluation and electroneuromyography. SARS-CoV-2 vaccination is increasing rapidly all over the world. Some cases of polyneuropathy, especially Guillain–Barré syndrome, have been reported after vaccination. This is the first case report of MMN after SARS-CoV-2 vaccination.

Real-life trends of COVID-19 vaccination and outcomes among patients with cancer in Georgia: One center experience.

e18753 Background: Vaccination against COVID-19 decreases the risk of severe COVID 19 disease, hospitalization and death. Despite widespread recommendation from different cancer societies, vaccine hesitancy remains an issue in developing countries. Methods: Records of patients with cancer who received COVID-19 vaccination from March 1, 2021 and December 1, 2021, at Todua Clinic were analyzed retrospectively. Patient reported adverse effects (AE), vaccine related treatment interruptions, COVID -19 infection, and hospitalization rates were recorded. Results: A total of 1728 patients with cancer were treated at Todua Clinic during the study period. Of 177 (10%) patients who received Covid-19 vaccine, 63% were female and 34% were male. All patients were White. Mean age was 62 years. Majority of patients had solid cancer (93%) and only 7% had hematologic malignancies. A total of 76 (43%) patients had metastatic disease. Nearly half (47%) of patients were receiving cytotoxic chemotherapy, while others were receiving different treatment modalities (hormone therapy (33%), concurrent chemo-radiation (9%), chemo-immunotherapy (4%), targeted therapy (3%), immune therapy (2%), radiation therapy (2%)). Majority of the patients were vaccinated during the treatment process (61%), while 18% received covid-19 vaccine prior to treatment initiation and 21% patients received the vaccine after completion of treatment. A total of 124 patients (70%) were vaccinated with Pfizer-BioNTech, 33(19%) patients had received Sinopharm (Beijing), 14(8%) patients were vaccinated with The Oxford/AstraZeneca and 6 (3%) patients with Sinovac/CoronaVac. Only 13 (7%) patients received a booster dose (BD). Injection site pain was main AE for all vaccines (AstraZeneca 50%, Pfizer 33%, Sinopharm 45%, Sinovac 50%). Fever was reported in 14% of patients vaccinated with AstraZeneca, and 2% of those who received Pfizer vaccine. There were isolated cases of lymphadenopathy, fatigue, loss of appetite, joint and muscle pain after Pfizer vaccine and one case of polyneuropathy after a booster dose (Pfizer). No treatment interruptions were attributed to vaccination. Only 23 patients (13%) had confirmed COVID-19 infection (post AstraZeneca 1, Pfizer 13, Sinopharm 8, Sinovac 1). Only 1 case of hospitalization was reported after Sinopharm vaccine. No death was reported due to COVID-19 infection. Majority of patients (80%) were vaccinated following recommendation from their treating oncologist. Conclusions: In our study, COVID-19 vaccination was found to be safe for patients with cancer, and performed well with only one COVID-19 related hospitalization and no deaths. Vaccination rates among cancer patients are marginal in Georgia, and institutional and national policies are needed.

Increased Cases of Acute Polyneuropathy in COVID-19 Pandemic: What Awaits Neurologists?

The study consisted of patients with acute polyneuropathy that developed after the Covid-19 infection. All patients were confirmed serologically for PCR positivity and typical ground glass appearance in thorax tomography in case of respiratory involvement. In 16 patients, polyneuropathy was diagnosed with an electrophysiological and neurological examination. Etiological research was conducted for all patients to exclude any other causes of acute polyneuropathy.

Increased Cases of Acute Polyneuropathy in COVID-19 Pandemic; What Awaits Neurologists?

Increased Cases of Acute Polyneuropathy in COVID-19 Pandemic; What Awaits Neurologists?

The case of comorbidity of sinus node dysfunction and new coronavirus infection with Sjogren’s disease and Thompson’s myotonia

Coronavirus infection, according to modern data, poses a threat not only to the respiratory system, in more than 15% of patients it can lead to cardiovascular complications, including in young and middle-aged people. COVID-19 is probably the trigger of a detailed clinical picture of chronic diseases occurring in a latent form. The article considers the case of sinus node dysfunction and polyneuropathy in a young patient after coronavirus infection against the background of concomitant diseases such as Sjogrens disease and Thompsons myotonia. To observe the dynamics of the three diseases, the timely organization of a multidisciplinary approach is important. It is necessary to consider all three diseases in the paradigm of the main and concomitant in order to timely and adequate therapy. Further study of the clinical features, therapeutic approaches and complications in patients with COVID-19 is required.

A case of motor and sensory polyneuropathy induced by primary hyperparathyroidism

Primary hyperparathyroidism (PHP) is a disease in which excessive amounts of parathyroid hormone (PTH) are secreted and calcium levels in the blood increase. Hypercalcemia caused by PHP has a major influence on the peripheral nervous system and produces symptoms such as muscle cramps, paresthesia, and proximal muscle weakness. Here we report a rare case of sensory-dominant polyneuropathy caused by PHP, which improved after surgery.