Number Of Neurological Complications Research Articles

Polysegmental and multilevel lesions in hematogenous vertebral osteomyelitis: assessment of immediate and long-term results

Objective. To analyze the results of treatment of disseminated (polysegmental and multilevel) forms of hematogenous vertebral osteomyelitis (HVO) as compared with those of monosegmental and monovertebral lesions.Material and Methods. A retrospective analysis of a monocenter cohort of 266 patients with hematogenous osteomyelitis of the spine for 2006 to 2019 was carried out. Patients were divided into two groups: Group A (polysegmental and multilevel lesions) included 33 (12.4 %) patients and Group B (monosegmental and monovertebral lesions) – 233 (87.6 %) patients. The main examination methods were: clinical, radiological (standardized roentgenography, CT), MRI, microbiological, histological and statistical ones.Results. Comparison revealed that involvement of the cervical (p < 0.001) and thoracic (p = 0.014) spine was more typical for polysegmental and multilevel lesions. There was a tendency to the predominance of type A lesions according to the Pola classification in patients with local forms (p = 0.078) and to the increase in type C lesions in polysegmental and multilevel processes (p = 0.035). The number of neurological complications was higher in polysegmental and multilevel lesions (p = 0.003). There were no significant differences in the treatment results, the number of relapses and mortality rate between the compared groups.Conclusion. Lesions of the cervical and thoracic spine and the presence of a neurological deterioration are typical for multilevel and polysegmental HVO. The formation of a multilevel lesion in different regions of the spine with a gap of 2–4 weeks or more requires a separate implementation of the diagnostic algorithm, defining of classification criteria and differentiated treatment tactics for each focus.

Elongation of the brachial plexus after reverse shoulder arthroplasty: an anatomical study.

The use of reverse shoulder arthroplasty (RSA) is becoming more extended and its clinical results are good or excellent according to the literature. The main biomechanical characteristic of RSA is that it lowers and medializes the centre of rotation of the shoulder causing an arm lengthening. Although the number of neurological complications is low (5%), there are more neurophysiological changes in the brachial plexus with RSA than with the anatomic shoulder arthroplasty. The main goal of this study was to quantify the lengthening of the terminal branches of the brachial plexus suffered after RSA implantation. 20 Embalmed cadavers were analysed. Four distances using bone references were employed to measure the lengthening of the arm and subacromial space. The brachial plexus and its terminal branches (radial, axillary, ulnar, musculocutaneous and median nerves) and the axillary artery, were identified and marked. Measurements were made to determine the change of position of the neurovascular structures, the arm lengthening and the lengthening of each nerve before and after the implantation of RSA. Two models of RSA were used: SMR®(Lima) and Delta Xtend®(DePuy-Synthes). The mean arm elongation was 10.5mm. The subacromial space suffers an elongation of 20.5-29.8%. All the neurovascular structures suffered elongation: median nerve 23.1%, musculocutaneous nerve 22.1%, ulnar nerve 19%, radial nerve 17%, axillary nerve 12-14.5%, axillary artery 24.8%. There were no differences in the results between the types of prosthesis. Due to its design, the RSA causes an arm lengthening which is reflected by the elongation of the neurovascular structures of the arm.

CLINICAL CASE: CORONARY ARTERY BYPASS GRAFTING IN A PATIENT WITH CORONARY ARTERY DISEASE ACCORDING TO THE MIDCAB TECHNIQUE

Abstract: Today the main operations of myocardial revascularization are coronary artery bypass grafting (CABG) with artificial circulation (CI) and beating heart surgery, as well as balloon angioplasty and stenting. However, the modern standard for the provision of surgical care to patients with multivessel atherosclerotic coronary artery disease is CABG under cardiopulmonary bypass (IC), introduced into clinical practice in the 60s of the XX century. This approach is convenient for surgeons and allows for good visualization of all parts of the heart and the ascending aorta with a motionless bloodless surgical field in the area of formation of distal anastomoses. At the same time, the required amount of time for performing anastomoses is provided by a sufficient level of myocardial protection. This method has a statistically significant patency of shunts in the long-term period after the intervention [1,3]. On the basis of numerous studies of the classical method of CABG in conditions of IC, indications were developed, the basic principles and approaches were formulated in patients with coronary heart disease (IHD) [2]. The classical method of performing CABG always corresponds to the traumatic sternotomy approach, and also has a number of significant negative consequences caused by the use of the IC device: systemic inflammatory response, micro- and macroembolism of the brain, as well as other organs and systems, with which renal, respiratory and other complications of the postoperative period [2,3]. To prevent or reduce these negative effects on the body, especially in the presence of concomitant pathology, as well as in elderly patients, low-traumatic techniques are currently used without the use of an infrared device. These methods include the so-called Off-Pump Coronary Artery Bypass (OPCAB). Studies have shown that CABG surgery on a beating heart without the use of a heart-lung machine is safer, including the number of neurological complications is statistically significantly lower, and the rehabilitation process for such patients is shorter, which is reflected in the economic aspects [4, 5] ... All over the world, every year more and more direct myocardial revascularization operations are performed on a beating heart. So in large centers of the USA, Europe and Russia, according to the literature, up to 70% of cases are performed using the ORSAV technique [6]. We present a description of a clinical case of multiple beating heart bypass surgery using the MIDCAB mini access, performed in our center to a patient with concomitant pathology in the form of chronic heart failure and dyscirculatory encephalopathy. Good results were obtained, both intraoperatively and postoperatively. The results of such an intervention were analyzed in terms of the presence of pain in the postoperative period, the patient's quality of life, and from the point of view of economic feasibility. The method was adopted at the Republican Specialized Scientific and Practical Medical Center for Cardiology of the Karshi branch.

Neonatal neurology, a crucial discipline to enhance neurologic care of the newborn.

In the fetal and neonatal periods, a wide variety of primary neurological disorders occur, as well as a large number of neurological complications acquired during postnatal critical care. It is estimated that at least 30% of newborn infants admitted to neonatal intensive care will have neurological disorders or complications during their admission.(1-3) In addition, neonatal clinical practices, as well as the NICU environment, including sensory and emotional stimulation, can impact neurodevelopmental outcomes.(4).

Complications of the treatment of post-traumatic deformities of the thoracic and lumbar spine using staged surgical interventions

Objective . To analyze the results of surgical treatment of post-traumatic deformities of the thoracic and lumbar spine using staged surgical interventions from the point of view of surgical safety, and to study the structure, frequency and nature of intra- and postoperative complications and intraoperative blood loss. Material and Methods . A retrospective analysis of data of 212 patients for 2015–2018 was performed. Inclusion criteria were: age over 18 years, staged surgical interventions including anterior spinal fusion and posterior internal fixation performed in one surgical session for post-traumatic deformities of the thoracic and lumbar spine. Patient demographic data and surgical intervention protocols were studied taking into account surgical approaches, duration of operations and blood loss. Intraoperative and postoperative complications up to 6 weeks after surgery were taken into account. Intraoperative blood loss was studied both as the absolute volume and as the percentage of circulating blood volume (CBV). Results . Complications after staged surgical correction of post-traumatic deformities were recorded in 14.2 % of patients, including intraoperative complications in 3.3 % of cases, and postoperative complications in 10.9 %. The most common complications were surgical site infections, usually after posterior approach, and pneumonia. The number of neurological complications was 1.4 %. Complications were more frequent after three-stage surgical interventions than after two-stage ones. The lumbar spine deformity correction was associated with higher complication rate than that in the thoracic spine. Intraoperative blood loss in the study group was 562.2 ± 504.7 ml. The most significant blood loss, over 30 % of the СBV, was noted in 13 (6.1 %) patients. Using of minimally invasive transpedicular fixation during the staged surgical intervention provided the least number of infectious wound complications and the smallest amount of intraoperative blood loss. Conclusion . Staged surgical intervention for the correction of post-traumatic deformity of the thoracic and lumbar spine is a safe method of surgical treatment.

Imaging of cerebral complications of extracorporeal membrane oxygenation in infants with congenital heart disease \u2014 ultrasound with multimodality correlation

Cranial ultrasound on neonatal intensive care units is generally performed by intensive care physicians, but radiologists often provide this crucial bedside test to children on specialist paediatric cardiac intensive care units. On a paediatric cardiac intensive care unit, complex congenital cardiac conditions are commonly encountered in both pre- and postoperative scenarios, often with the use of extracorporeal membrane oxygenation (ECMO), which both increases the risks of a number of neurologic complications and results in significant changes in vascular physiology. The aim of this pictorial essay is to discuss cranial ultrasound technique, demonstrate the changes in Doppler flow profiles resulting from veno-arterial extracorporeal membrane oxygenation and congenital cardiac conditions, and illustrate commonly encountered intracranial complications of extracorporeal membrane oxygenation support in congenital cardiac care.

P92-T Acute motor and sensory axonal neuropathy followed bariatric surgery: Report of two cases

Background Bariatric surgery is an effective treatment for obesity. However, the number of neurological complications including polyneuropathies after bariatric surgery is increasingly reported. Case reports Case1. A 27-year-old female underwent a sleeve gastrectomy (SG) and was discharged on a special diet including parenteral B vitamins. Three months later she developed a weakness in both lower limbs progressively increased. The electro-neuromyography (ENMG) showed a severe amplitude reduction in both motor and sensory nerves. It was thought to be a case of AMSAN. Vitamin B1, B6, B12 levels and metabolic tests were normal. Intravenous immune globulin (IVIG) was started 0.4 g/kg/day for 5 days and 2 g/kg/month for 6 consecutive months. Her condition improved in 6 months. Case2. A 19-year-old male was submitted to a SG, 4 months before. He had numbness and pain in his legs and hands for 2 weeks. Weakness in the lower extremities started gradually ascended over the following days. Biochemical analyses were normal. His ENMG verified the diagnosis of AMSAN. IVIG was started at same dose for 5 days. However, his muscle strength reduced to distal part of the extremities. Plasma exchange (PE) started 5 times on alternate days. Physiotherapy was started after PE for 6 weeks. At his last examination his condition was nearly normal. Discussion Micronutational deficiencies which cannot be monitored can trigger processes of inflammatory neuropathy in SE cases. Our cases showed that IVIG and PE should be kept in mind as a reliable treatment option for subacute polyneuropathies caused by bariatric surgery.

Dual Antiplatelet Therapy Combining Aspirin and Ticagrelor for Intracranial Stenting Procedures: A Retrospective Single Center Study of 154 Consecutive Patients With Unruptured Aneurysms.

Dual antiplatelet therapy (DAPT) associating aspirin+clopidogrel is commonly utilized in neurovascular interventions despite unpredictable clopidogrel efficacy with 4% to 50% of patients considered nonresponders. Ticagrelor is an antiplatelet agent with low resistance rates but unknown efficacy and safety in neurovascular patients. To evaluate frequency of ischemic and hemorrhagic events in patients treated with aspirin and ticagrelor when associated with perioperative heparin bolus for unruptured aneurysms treated with intracranial stents. One hundred fifty-four consecutive patients with unruptured intracranial aneurysms treated by stent procedures (113=flow diverter stent [FDS], 41=stent-assisted coiling) were retrospectively analyzed. All patients received aspirin and ticagrelor without platelet function testing. Patients were separated in 2 groups following perioperative heparin dose: group I=70 U/kg; group II=50 U/kg. FDS versus stent-assisted coiling procedures were also separately analyzed. Nine patients (5.8%) presented symptomatic neurological complications poststenting (3 ischemic, 6 hemorrhagic): 8 patients received 70 U/kg of heparin (11.1%) and 1 patient received 50 U/kg (1.2%; P<.009). Four patients died (2.6%) during the 3-mo follow-up period-all deaths were correlated to intracranial hemorrhage: 3 at group I and 1 at group II (P<.251). No difference in complications or death was observed considering separately FDS and stent-assisted coiling procedures. This study did not find more neurological complications than in previous neurointerventional reports using DAPT with aspirin+ticagrelor or aspirin+clopidogrel. Overall number of neurological complications was lower when a lower dose of heparin was administered. Neurovascular studies comparing clopidogrel to ticagrelor and different doses of heparin are necessary to demonstrate which association is more efficient with lower complication rates.

Neurological Complications of Ebola Virus Infection.

Ebola virus disease is one of the deadliest pathogens known to man, with a mortality rate between 25-90% depending on the species and outbreak of Ebola. Typically, it presents with fever, headache, voluminous vomiting and diarrhea, and can progress to a hemorrhagic illness; neurologic symptoms, including meningoencephalitis, seizures, and coma, can also occur. Recently, an outbreak occurred in West Africa, affecting > 28,000 people, and killing > 11,000. Owing to the magnitude of this outbreak, and the large number (>17,000) of Ebola survivors, the medical and scientific communities are learning much more about the acute manifestations and sequelae of Ebola. A number of neurologic complications can occur after Ebola, such as seizures, memory loss, headaches, cranial nerve abnormalities, and tremor. Ebola may also persist in some immunologically privileged sites, including the central nervous system, and can rarely lead to relapse in disease. Owing to these findings, it is important that survivors are evaluated and monitored for neurologic symptoms. Much is unknown about this disease, and treatment remains largely supportive; however, with ongoing clinical and basic science, the mechanisms of how Ebola affects the central nervous system and how it persists after acute disease will hopefully become more clear, and better treatments and clinical practices for Ebola patients will be developed.

Tratamiento y control de los pacientes con fenilcetonuria: resultados del Grupo Colaborativo de Unidades de Seguimiento en España

Background and objectiveTo evaluate the management of phenylketonuria (PKU) in Spanish metabolic units and to develop a patients registry. Patients and methodsPKU patients diagnosed and/or followed up in Spain, with phenylalanine values before treatment > 360μmol/L. Registered anonimous data are those yielded by the units during 2010. ResultsData from the 18 Spanish Follow-up Units were collected. Eighty-three per cent of Units are multidisciplinary, all of them corresponding to control patients of all ages, with uniform management criteria. Data of 688 PKU patients were registered (median: 14 years [1 month-53 years], 41.5% are presently > 18-year-old. 71.8% patients came from neonatal screening; 15.8% have mild-PKU, 26% moderate-PKU and 51.5% classic-PKU. 78.6% patients are treated with protein-restricted diet, 9.3% with BH4 and free diet and 7.8% with BH4 and diet. Dietary control was good in 58.6% patients, intermediate in 26% and poor in 15.3%. Median (range) intellectual quotients was 97 (25-145). The number of neurological complications in late diagnosed patients was three-times higher than those of neonatal screening patients. 13.3% of adults had university studies and 37.5% had a stable couple. ConclusionsThis study allows for the first time the evaluation of the PKU management by Spanish PKU Follow-up Units, as well as the analysis and registry of controlled PKU patients. The study makes evident the need of adult Follow-up Units and the importance of neonatal screening for PKU patients prognosis.

Demyelinating Sensorimotor Polyneuropathy Associated With the Use of Sirolimus: A Case Report

Liver transplantation is associated with a number of neurological complications. We herein report a case of chronic inflammatory demyelinating polyneuropathy associated with the use of sirolimus-based immunosuppression. The patient was treated by converting the immunosuppression from sirolimus to cyclosporine and by a short course of oral steroids. Following this, we observed almost complete clinical and electrophysiologic resolution of this syndrome. We believe that this is the first described case of such a complication occurring in association with sirolimus. This immunosuppressive agent can, therefore, lead to neurological complications similar to the ones that have been observed with calcineurin inhibitors.

Neurological complications in obstetric regional anaesthesia

Neurological complications following regional anaesthesia in obstetrics are rare. The incidence is 0–36/10,000 epidural blocks and 0–35/10,000 spinal blocks; these are predominantly reversible neuropathies. As demand for regional anaesthesia increases so may the number of neurological complications. However, neurological deficits may also be secondary to labour and delivery or occur spontaneously. Any neurological deficit requires careful assessment and investigation. In most cases all that is required is reassurance and a simple explanation, but occasionally urgent treatment is required, in consultation with neurologists and surgeons.

Ultrastructural Localization of Monoclonal Antiphospholipid Antibody Binding to Rat Brain

Antiphospholipid antibodies (aPL), in the presence or absence of systemic lupus erythematosus, are associated with a number of neurologic complications. However, the role aPL play in pathology is unclear. A thrombotic etiology seems likely for many associated disorders, but not for others. Here we describe aPL-reactive sites in the central nervous system (CNS). Previously, using light microscopy, we showed direct binding of two monoclonal phosphatidylserine-reactive antibodies (aPS) to ependyma and myelin of fixed cat brain. In this study we determined the ultrastructural localization of their binding sites in rat CNS using immunogold electron microscopy techniques. Both monoclonal antibodies reacted strongly with myelin, preferentially with the major dense line formed by the cytoplasmic apposition of the oligodendrocyte plasma membrane. Both monoclonal antibodies also reacted with an antigen that appears associated with the axoneme in cilia of ependymal and choroid plexus epithelium. One monoclonal aPS also showed some reactivity with brain vascular endothelium and reacted slightly with mitochondria, while the other aPS did not react with these structures. While the etiology of aPL-associated neurologic disorders remains unclear, our data suggest possible target sites within the CNS with which aPL can react.

Cranial neuropathies and liver failure due to hepatitis A

Acute viral hepatitis may be associated with a number of neurologic complications, of which encephalitis and neuropathies are the most frequently reported. [1-4] Type A virus is rarely involved. Here we describe a case of cranial nerve palsies during severe hepatitis A infection with hepatic failure. A 15-year-old female student was admitted to our center with a 4-day history of dizziness, diplopia, and facial asymmetry. On examination, there was a complete right oculomotor palsy sparing the pupil, and a right facial nerve palsy with Bell's phenomenon. The remainder of the general physical and neurologic examination was unremarkable. Routine biochemical assays, …

Neurologic Complications of Renal Disease

Renal failure and its treatment are associated with a number of neurologic complications that must be differentiated from the nervous system complications of the disease leading to renal failure. Uremic encephalopathy is characterized by clinical signs of depressed brain function coexisting with excitation, often in the form of generalized epileptic seizures. Peripheral neuropathy, due to axonal involvement, is common and is characterized by ascending sensory and motor dysfunction. The treatment of renal failure also may lead to the development of neurologic abnormalities in the form of dialysis disequilibrium characterized by headache, nausea, irritability that may progress to seizures, coma, and death, which is caused by the entry of free water into the brain and swelling. Dialysis dementia, caused by the toxic effects of aluminum, is now rare. Renal transplant recipients may develop cerebrovascular disease, infections by opportunistic organisms, or malignant neoplasms, particularly primary lymphoma of the brain. As transplant recipients live longer and more operations are performed, additional complications may be seen in the future.

Auditory brainstem response study of alcoholic patients

Auditory brainstem responses were obtained from 52 alcoholic patients with or without neurological complications of alcoholism. Almost half of the patients had abnormal auditory brainstem responses manifested by a prolonged central conduction time (Wave I to V interval) without significant alterations in morphology. The incidence of abnormal auditory responses was related to the type and the number of neurological complications. Patients with Wernicke-Korsakoff syndrome, dementia or cerebellar degeneration had high incidence of brainstem abnormalities. All patients with 3 or more neurological complications had abnormal auditory brainstem responses.

Neurological Sequelae of Congenital Heart Surgery

The development of surgical treatment for certain types of congenital heart disease not only has resulted in a number of neurological complications but has also emphasized the frequency with which such disease is associated with cerebral lesions. In the past several years we have seen a number of neurological sequelae of cardiac surgery, and the difficulties in diagnosis and management of these cases have led us to consider them in some detail in an attempt to define the responsible factors. In this series preoperative neurological disturbance was present in only 14 of the 342 cases. The low incidence is related to the type of cardiac lesions seen (the majority being septal defects) and to the fact that, in the group selected, operation was considered to have a reasonable chance of success. Of these, 6 had the tetralogy of Fallot, 2 with episodic attacks of loss of consciousness, 1 with mental