Lower Limb Peripheral Neuropathy Research Articles

Plum-blossom needle combined with bloodletting therapy and nursing management for a patient with lower limb peripheral neuropathy caused by postoperative chemotherapy of colorectal cancer

Plum-blossom needle combined with bloodletting therapy and nursing management for a patient with lower limb peripheral neuropathy caused by postoperative chemotherapy of colorectal cancer

Peripheral neuropathy is associated with more frequent falls in Parkinson's disease

IntroductionPeripheral neuropathy is a common condition in the elderly that can affect balance and gait. Postural imbalance and gait difficulties in Parkinson's disease (PD), therefore, may stem not only from the primary neurodegenerative process but also from age-related medical comorbidities. Elucidation of the effects of peripheral neuropathy on these difficulties in PD is important to provide more targeted and effective therapy. The purpose of this study was to investigate the association between lower-limb peripheral neuropathy and falls and gait performance in PD while accounting for disease-specific factors. MethodsFrom a total of 140 individuals with PD, 14 male participants met the criteria for peripheral neuropathy and were matched 1:1 for Hoehn & Yahr stage and duration of disease with 14 male participants without peripheral neuropathy. All participants underwent fall (retrospectively) and gait assessment, a clinical evaluation, and [11C]dihydrotetrabenazine and [11C]methylpiperidin-4-yl propionate PET imaging to assess dopaminergic and cholinergic denervation, respectively. ResultsThe presence of peripheral neuropathy was significantly associated with more falls (50% vs. 14%, p = 0.043), as well as a shorter stride length (p = 0.011) and greater stride length variability (p = 0.004), which resulted in slower gait speed (p = 0.016) during level walking. There was no significant difference in nigrostriatal dopaminergic denervation, cortical and thalamic cholinergic denervation, and MDS-UPDRS motor examination scores between groups. ConclusionLower-limb peripheral neuropathy is significantly associated with more falls and gait difficulties in PD. Thus, treating such neuropathy may reduce falls and/or improve gait performance in PD.

Giant cell arteritis: Relapsing disease is a nightmare in diabetics

cyclophosphamide pulses. He developed solitary ileal perforation requiring surgery with ileostomy on follow up. Despite being on monthly CYC pulses for four months, along with steroids, he developed new vasculitic skin lesions along with new onset upper and lower limb peripheral neuropathy. He was given methylprednisolone pulses for three days along with hiking up of cyclophosphamide to biweekly with a plan to increase the interval to three weeks. He did not tolerate first session of plasmapheresis. Thecasehighlights the therapeutic challengeand lackof consensus guidelines in management of such cases of relapsing PAN.

Imaging of Peripheral Nerve Lesions in the Lower Limb

Lower limb peripheral neuropathy may have a variety of causes. This article focuses on focal neural lesions because of neural entrapment associated with static mechanical compression or dynamic compression/stretching. Mechanical compression may relate to direct blunt trauma, surgical injury, mass effect associated with adjacent mass lesions, and frictional effects associated with fibrous bands. Stretching neural injury may be associated with abnormalities in alignment such as plano-valgus hindfoot and hindfoot pronation. Recurrent inversion ankle injuries may also cause neural injury. Neural injury may be associated with denervation of the muscles supplied by the nerve. Electromyography (EMG) remains the gold standard for diagnosis of denervation. Diagnostic imaging plays a complementary role to EMG in difficult cases, the anticoagulated patient, and in clarifying the etiology of an EMG-demonstrated neuropathy. Magnetic resonance imaging and ultrasound can be used in peripheral nerve imaging to demonstrate extrinsic compressive lesions, focal neural lesions such as neural edema and swelling, focal neural scarring (posttraumatic neuroma in continuity) and intraneural ganglia. Imaging can also demonstrate the effects of muscle denervation. Focal areas of tenderness can be highlighted using skin markers for magnetic resonance imaging and by transducer palpation on ultrasound. Ultrasound can be particularly useful in assessing for intrinsic lesions in small peripheral nerves because of the superior spatial resolution of ultrasound in assessing superficial structures. Plain x-rays (and sometimes computed tomography scanning) may show significant bone changes and should be the initial imaging modality.