Palsy Research Articles

Outcomes of Microneurolysis of Hourglass Constrictions in Chronic Neuralgic Amyotrophy

Wide variability in the recovery of patients affected by neuralgic amyotrophy (NA) is recognized, with up to 30% experiencing residual motor deficits. Using magnetic resonance imaging and ultrasound (US), we identified hourglass constrictions (HGCs) in all affected nerves of patients with chronic motor paralysis from NA. We hypothesized that chronic NA patients undergoing microsurgical epineurolysis and perineurolysis of constrictions would experience greater recovery compared with patients managed nonsurgically. We treated 24 patients with chronic motor palsy from NA and HGCs identified on magnetic resonance imaging and US either with microsurgical epineurolysis and perineurolysis of HGCs (11 of 24) or nonsurgically (13 of 24). Muscle strength (both groups) and electrodiagnostic testing (EDX) (operative group) was performed before and after surgery. Preoperative EDX confirmed muscle denervation in the distribution of affected nerve(s). All patients met criteria for microneurolysis: 12 months without improvement since onset or failure of clinical and EDX improvement after 6 months documented by 3 successive examinations, each at least 6 weeks apart. Mean time from onset to surgery was 12.5 ± 4.0 months. Average time to most recent post-onset follow-up occurred at 27.3 months (range, 18-42 months; 15 nerves). Average time to latest follow-up among nonsurgical patients was 33.6 months (range, 18-108 months; 16 nerves). Constrictions involved individual fascicular groups (FCs) of the median nerve and the suprascapular, axillary and radial nerves proper (HGCs). Nine of 11 operative patients experienced clinical recovery compared with 3 of 13 nonsurgical patients. EMG revealed significant motor unit recovery from axonal regeneration in the operative group. Microsurgical epineurolysis and perineurolysis of FCs and HGCs was associated with significantly improved clinical and nerve regeneration at an average follow-up of 14.8 months compared with nonsurgical management. We recommend microneurolysis of HGCs and FCs as a treatment option for patients with chronic NA who have failed to improve with nonsurgical treatment. Therapeutic IV.

Osmoregulatory profiles and gill histological changes in Nile tilapia (Oreochromis niloticus) exposed to lambda-cyhalothrin

Lambda-cyhalothrin is a synthetic pyrethroid that mimics the structure and insecticidal properties of pyrethrin, a natural insecticide derived from chrysanthemums. In fish, it disrupts the nervous system, causing motor paralysis and several other alterations associated with varying levels of mortality. This study aimed to evaluate osmoregulatory responses and histological changes in the gills of Oreochromis niloticus chronically exposed to a sublethal dosage (0.86 μg/L) of lambda-cyhalothrin. The mean serum values for Na2+, K+, Cl−, Ca2+, pH, lactate, H+, HCO3, and glucose along to degree of tissue change (DTC) at 24, 96, 168, and 240 h post-exposure (hpe) were evaluated. Lambda-cyhalothrin affected the neuronal motor function at 24 hpe, followed by the increase of the K+, Ca2+, H+, and glucose levels in the exposed group, compared to the control group. Lactate and H+ levels in the exposed group were higher than those in the control group at 168 and 240 hpe respectively. HCO3, and Cl- levels increased at 240 hpe, although there was no change in the pH values. DTC was higher in treated fish than in control fish, but there were no significant differences among time-exposure. The changes detected ranged from hyperemia of the branchial vasculature, eosinophilic granulocytic cell infiltration, mucous cell hyperplasia, and partial fusion of secondary lamellae at 24 hpe to vascular aneurysm formation, and necrosis of the lamellar epithelium at 240 hpe. Thus, a sublethal dosage of lambda-cyhalothrin in the long-term is toxic for Nile tilapia, characterized by hypokalemia, hypercalcemia, hyperglycemia, and respiratory alkalosis, followed by time-dependent histological changes.

Thyrotoxic Periodic Paralysis: An Update

Thyrotoxic periodic paralysis (TPP) is an endocrine emergency. In initial hours, it requires multidisciplinary care as it involves heart and nervous system. Early diagnosis demands highest clinical acumen as symptoms and signs of thyrotoxicosis are often subtle. TPP is not nowadays confined to particular ethnic groups. Different cellular ion channels have been identified in its etiopathogenesis. Definitive treatment of thyrotoxicosis is also important to prevent relapse. In all cases of hypokalemia in emergency room, TPP should be excluded. of hypokalemia should be rationalized to prevent rebound hyperkalemia as total body potassium loss is minimum or nil. Patients should be made euthyroid as soon as possible to prevent relapse of TPP. Future research on ethnic variation of Na + -K + ATPase activity may enlighten us the cause of higher prevalence in Asians. J Endocrinol Metab. 2020;10(3-4):60-62 doi: https://doi.org/10.14740/jem662

Lumbar Spinal Canal Stenosis from the Perspective of Locomotive Syndrome and Metabolic Syndrome: A Narrative Review

Patients with lumbar spinal canal stenosis (LSS) have impaired activities of daily living because of pain or motor paralysis, but no effective preventive treatment is currently available. The number of patients with LSS is predicted to continually increase as the average age of the global population increases. To provide a conceptual framework for improving healthy life expectancy, the Japanese Orthopaedic Association introduced the concept of locomotive syndrome, to which LSS is related. Ours and other studies have shown that LSS exacerbates locomotive syndrome and that surgical treatment is one method for improving it. Furthermore, we propose that the two-step test, a locomotive syndrome risk test, is effective for assessing the risk for falls and severity of LSS. Meanwhile, lumbar spinal epidural lipomatosis (LSEL), which is a manifestation of LSS, has been shown to be related to metabolic syndrome. Previous studies have suggested that the whole LSS can be also associated with metabolic syndrome. Although locomotive syndrome is very different from metabolic syndrome, which involves lipid metabolism, these two syndromes overlap, such as in LSS. Conducting research on LSS from the perspectives of both locomotive syndrome and metabolic syndrome may lead to novel methods for prevention and treatment of LSS and, conversely, may yield clues for resolving symptoms of the two syndromes. This review provides an overview of LSS from the perspective of locomotive syndrome and metabolic syndrome, along with findings from our research group.

Parâmetros lineares da marcha de crianças com paralisia cerebral do tipo espástica: estudo de caso

INTRODUÇÃO: A paralisia cerebral (PC) ocorre devido lesão no sistema nervoso central, resultando em comprometimento funcional e alterações na marcha. OBJETIVO: verificar e descrever as variáveis lineares da marcha de crianças com paralisia cerebral do tipo espástica. MATERIAIS E MÉTODOS: participaram do estudo três crianças com idade entre seis e sete anos com paralisia cerebral do tipo espástica, GMFCS nível I e II, onde foi realizada a identificação do desempenho da função motora grossa por meio do Sistema de Classificação da Função Motora Grossa (GMFSC) com grau 3 e 4 de espasticidade em membros inferiores segundo a Escala Modificada de Ashworth (MAS). Para registro dos parâmetros lineares e organização dos dados foram utilizados o software livre CVMob e o método de análise de movimento MED - Movement Element Decomposition. RESULTADOS: Os valores encontrados para velocidade foram (0,64; 0,58; 0,96 m/s) comprimento do passo (0,34;0,36; 0,36 m) cadência (127; 118; 130 p/min). CONCLUSÃO: Foi verificada a diminuição das variáveis lineares da marcha para velocidade, comprimento do passo e cadência nas três crianças estudas. Apesar da dificuldade em obter amostra maior, os dados sugerem a necessidade de maior controle das variáveis da marcha de crianças com Paralisia cerebral do tipo espástica.

Idiopathic spinal accessory nerve injury

Palsy of the eleventh cranial nerve – or spinal accessory nerve (SAN) − is a rare cause of scapular winging, leading to painful upper extremity disability due to weakness and atrophy of the trapezius muscle. Most SAN injuries are iatrogenic, and no specific pediatric epidemiology is known.Herein is described the case of a 17-year-old adolescent referred to Physical and Rehabilitation Medicine consultation due to insidious right shoulder pain with two years of evolution.Shoulder pain combined with muscular atrophy is suggestive of nerve lesion. Electromyography is the gold standard exam and showed segmental demyelination and axonotmesis in this case. After evaluation, the patient underwent physiotherapy, with excellent results.In conclusion, SAN injury treatment can be conservative or surgical and physiotherapy is the basis of early treatment in most cases. Recovery can occur even after a significant period of time.

Síndrome de Ramsay Hunt: uma revisão sistemática

Objetivo: Realizar revisão sistemática sobre a Síndrome de Ramsay Hunt, abordando seus aspectos etiológicos, os fatores de risco, as manifestações clínicas, o diagnóstico e o tratamento. Métodos: A pesquisa foi realizada a partir das bases de dados: SciELO, Medline, LILACS por meio dos descritores: Paralisia facial AND Herpes Zoster de Orelha Externa AND Síndrome Ramsay Hunt. No Pubmed, foram utilizados termos do MESH, Facial Paralisy AND Herpes Zoster Oticus. Foram incluídos artigos publicados entre 2017 e 2019 sobre o assunto e dois livros de otorrinolaringologia. Resultados: A busca produziu um total de 291 artigos, foram retirados 265 por não estarem no critério de tempo e 10 por estarem duplicados em bases de dados. Destes, 16 artigos atenderam aos critérios de inclusão previamente estabelecidos. A busca por livros em otorrinolaringologia resultou na inclusão de 2 livros que abordaram a temática de forma ampla e detalhada. Considerações Finais: Foi possível constatar a heterogeneidade nos estudos sobre a síndrome. Entretanto, todos apontam para a importância de seu reconhecimento, característica clínica e seguimento; uma vez que o rápido diagnóstico e tratamento diminuem o tempo de doença ativa, reduz o dano neural e possível neuralgia pós-herpética.

Acute Flaccid Myelitis Poised for a Comeback in Kids This Fall

Clinicians and parents should be alert this fall for symptoms of acute flaccid myelitis (AFM), which can cause paralysis and respiratory failure in

Short Communication on Narcolepsy

Narcolepsy is a sleep disorder and a neurological disorder. The condition stems from changes in your brain that affect your sleep wake cycles. The actual number of people who it affects may be higher. This is because the symptoms can be like other sleep disorders, such as obstructive sleep apnea. At first, narcolepsy often causes issues with sleeping at night, along with problems staying awake during the day. You may also d evelop other symptoms, such as sudden muscle paralysis. Symptoms like this can make it difficult to accomplish daily tasks. Like other neurological conditions, the brain’s role in narcolepsy is complex. Researchers are still learning more about it. But it is important to gain knowledge about how narcolepsy affects your brain so you can better understand the condition

Short Note on Crossed Eyes

Crossed eyes, also called strabismus, it is a condition in which your eyes do not line up. If you have crossed eyes, your eyes look in different directions. And each eye will focus on a two different object. The condition is usually common in children, but it can also occur later in life. In older people, children and adults, crossed e yes can be caused by a variety of underlying medical conditions, like cerebral palsy or stroke. Crossed eyes can usually be treated with corrective lenses, surgery, or a combination of both. If you have strabismus, your eyes might point inward or outward o r focus on different directions. You might also have impaired vision, double vision, decreased depth perception, eyestrain, or headache.

Bell's Palsy in Elderly Taiwanese Patients with a History of Peptic Ulcer Disease: A Correlation Study

Background: This nationwide, retrospective cohort study was initiated to investigate the correlation between Bell's palsy (BP) and peptic ulcer disease (PUD). Methods: The Taiwan National Health Insurance statistics were used in this large case-control study to investigate the correlation of BP in patients with a history of PUD. We included 69,340 patients in whom PUD was newly diagnosed between January 2000 and December 2005. The PUD patients were tracked until 31 December 2011 or when BP was first diagnosed. For comparison, 208,020 patients without PUD were randomly selected using a 1:3 case-control matching of age, gender and the year of diagnosis of PUD. The correlation of BP in patients with and without PUD was computed using Cox's proportional hazards model. The cumulative incidence of BP in both cohorts was estimated using the Kaplan-Meier method. Results: Elderly patients aged 65 years or older with a history of PUD had a higher incidence rate of BP (at 1.21 per 1000 persons/year) compared to those without PUD (0.96 per 1000 persons/year). A significantly higher adjusted hazard ratio of 2.5 (95% CI 2.13-2.93; p ＜ 0.0001) was found in this group as compared to patients aged 40-65 years. Conclusions: A significant positive correlation between BP and a history of PUD was observed in elderly patients.

Rehabilitation of patients with cerebral palsy using hand exoskeleton controlled by brain-computer interface

Detskiy tserebral'nyy paralich — odno iz tyazhelykh zabolevaniy tsentral'noy nervnoy sistemy u detey, soprovozhdayushcheyesya dvigatel'nymi narusheniyami. Tsel'yu raboty bylo opredelit' effektivnost' primeneniya kompleksa, ob"yedinyayushchego interfeys «mozg–komp'yuter» (IMK) i ekzoskelet kisti, v kachestve sredstva vosstanovleniya dvigatel'noy funktsii u patsiyentov s DTSP v dopolnenii k osnovnoy terapii. U 14 detey i podrostkov po shkalam ARAT, Fugl-Meyer, Jebsen–Taylor otsenivali izmeneniye dvigatel'noy funktsii v rezul'tate terapii, dopolnennoy 7–10 protsedurami s kompleksom IMK–ekzoskelet, a takzhe issledovali svoystva istochnikov m-ritma EEG pri voobrazhenii dvizheniy vo vremya upravleniya IMK. Posle protsedur byli vyyavleny dostoverno polozhitel'nyy prirost ballov po shkalam Fugl-Meyer (7 (2; 11) — dlya aktivnykh dvizheniy ruki; 4,5 (1; 6) — dlya proksimal'nykh otdelov i 2,5 (0; 5) — dlya kisti), ARAT (7,5 (1; 31) — dlya obshchey summy ballov, 1,5 (0; 12) — dlya sharovogo i 1,5 (0; 8) — dlya tsilindricheskogo zakhvata) i dostoverno otlichnoye ot nulya snizheniye vremeni vypolneniya trekh iz semi zadach testa Jabsen–Taylor (–1 (–4,13; 0,25) — dlya imitatsii kormleniya; –1 (–2; 0) — dlya perestanovki legkikh i tyazhelykh banok). Srednyaya veroyatnost' pravil'nogo raspoznavaniya IMK sostavila 0,51 (0,45; 0,54) (max = 0,70). V bol'shinstve zapisey EEG byli vydeleny istochniki m-ritma, kak v sokhrannom, tak i v porazhennom polusharii. Pokazano nalichiye desinkhronizatsii m-ritma pri voobrazhenii dvizheniy, ot stepeni kotoroy dostoverno zavisit tochnost' raboty IMK. Rezul'taty pokazyvayut, chto primeneniye kompleksa IMK–ekzoskelet effektivno dopolnyayet standartnuyu reabilitatsiyu detey s DTSP, a takzhe dayut osnovaniya predpolagat', chto yeye klinicheskaya effektivnost' v sluchaye DTSP mozhet byt' dokazana s privlecheniyem bol'shego chisla patsiyentov.

Hereditary Neuropathy with Liability to Pressure Palsies: A Case Report

Background: Hereditary neuropathy with liability to pressure palsies (HNPP) is an uncommon diagnosis that should be considered in patients with multiple compressive neuropathies. This case reports highlights a relatively rare neuropathy with genetic and occupational predisposition, probably first to be reported in the united arab emirates. Case Presentation: We present the case of a 41 years old male who presented with right hand numbness and weakness. Electrodiagnostic testing revealed multifocal neuropathy. Subsequent genetic testing identified heterogeneous deletion of the PMP22 gene to confirm the diagnosis of HNPP. Conclusions: Hereditary neuropathy with liability to pressure palsies can present as a multifocal neuropathy. Occupational history along with genetic testing plays a pivotal role to make the diagnosis.

Walking characteristics including mild motor paralysis and slow walking speed in post-stroke patients

Walking speed is strongly influenced by the severity of motor paralysis in post-stroke patients. Nevertheless, some patients with mild motor paralysis still walk slowly. Factors associated with this difference in walking speed have not been elucidated. To confirm walking characteristics of patients with mild motor paralysis and slow walking speed, this study identified patient subgroups based on the association between the severity of motor paralysis and walking speed. Fugl-Meyer assessment synergy score (FMS) and the walking speed were measured (n = 42), and cluster analysis was performed based on the association between FMS and walking speed to identify the subgroups. FMS and walking speed were associated (ρ = 0.50); however, some patients walked slowly despite only mild motor paralysis. Cluster analysis using FMS and walking speed as the main variables classified patients into subgroups. Patients with mild motor paralysis (FMS: 18.4 ± 2.09 points) and slow walking speed (0.28 ± 0.14 m/s) exhibited poorer trunk stability, increased co-contraction of the shank muscle, and increased intramuscular coherence in walking compared to other clusters. This group was identified by their inability to fully utilize the residual potential of motor function. In walking training, intervention in instability and excessive cortical control may be effective.

Transient receptor potential vanilloid 4 agonist GSK1016790A improves neurological outcomes after intracerebral hemorrhage in mice

Intracerebral hemorrhage (ICH) is one of the most severe subtypes of stroke with high morbidity and mortality. Although a lot of drug discovery studies have been conducted, the drugs with satisfactory therapeutic effects for motor paralysis after ICH have yet to reach clinical application. Transient receptor potential vanilloid 4 (TRPV4), a Ca2+-permeable cation channel and activated by hypoosmolarity and warm temperature, is expressed in various cell types. The present study investigated whether TRPV4 would participate in the brain damage in a mouse model of ICH. ICH was induced by intrastriatal treatment of collagenase. Administration of GSK1016790A, a selective TRPV4 agonist, attenuated neurological and motor deficits. The inhibitory effects of the TRPV4 agonist in collagenase-injected WT mice were completely disappeared in TRPV4-KO mice. The TRPV4 agonist did not alter brain injury volume and brain edema at 1 and 3 days after ICH induction. The TRPV4 agonist did not show any differences with respect to the increased number of Iba1-positive microglia/macrophages, GFAP-positive astrocytes, and Gr1-positive neutrophils at 1 and 3 days after ICH induction. Quantitative RT-PCR experiments revealed that the TRPV4 agonist significantly upregulated the expression level of c-fos, a marker of neuronal activity, while the agonist gave no effects on the expression level of cytokines/chemokines at 1 day after ICH induction, These results suggest that stimulation of TRPV4 would ameliorate ICH-induced brain injury, presumably by increased neuronal activity and TRPV4 provides a novel therapeutic target for the treatment for ICH.

Predictive factors for irreversible motor paralysis following cervical spinal cord injury.

A retrospective observational study. To elucidate predictive clinical factors associated with irreversible complete motor paralysis following traumatic cervical spinal cord injury (CSCI). Hokkaido Spinal Cord Injury Center, Japan. A consecutive series of 447 traumatic CSCI persons were eligible for this study. Individuals with complete motor paralysis at admission were selected and divided into two groups according to the motor functional outcomes at discharge. Initial findings in magnetic resonance imaging (MRI) and other clinical factors that could affect functional outcomes were compared between two groups of participants: those with and those without motor recovery below the level of injury at the time of discharge. Of the 73 consecutive participants with total motor paralysis at initial examination, 28 showed some recovery of motor function, whereas 45 remained complete motor paralysis at discharge, respectively. Multivariate logistic regression analysis showed that the presence of intramedullary hemorrhage manifested as a confined low intensity changes in diffuse high-intensity area and more than 50% of cord compression on MRI were significant predictors of irreversible complete motor paralysis (odds ratio [OR]: 8.4; 95% confidence interval [CI]: 1.2-58.2 and OR: 14.4; 95% CI: 2.5-82.8, respectively). The presence of intramedullary hemorrhage and/or severe cord compression on initial MRI were closely associated with irreversible paralysis in persons with motor complete paralysis following CSCI. Conversely, subjects with a negligible potential for recovery could be identified by referring to these negative findings.

Unilateral Oculomotor Nerve Dysfunction Induced by Ruptured Anterior Communicating Artery Aneurysm along with Isolated Intraventricular Hemorrhage in a Trauma Patient

Background: Many signs in relation to vascular events and consequent loss of consciousness could be easily incorrectly explained (unclear) in a setting of trauma, especially when these events are a result of the car accident. Third cranial nerve palsy widely occurs due to internal carotid and posterior communicating artery aneurysm. An anterior communicating(ACOM) aneurysm is a rare reason that could lead to oculomotor dysfunction. ACOM ruptured aneurysm may present with sub arachnoid hemorrhage (SAH) and intraventricular hemorrhage (IVH) but isolated IVH is a rare finding for ACOM ruptured aneurysm. Case Description: A 56-year-old male presented to the hospital emergency department because of trauma after a car accident. He was unconscious with left-sided dilated pupil and ptosis with a brain CT indicating IVH. Brain CT angiography that performed two weeks after the accident revealed ACOM aneurysm. The patient underwent craniotomy and clipping the aneurysm. He was discharged, after completing the period of the following treatmentA combination of neuropathic agents and opioids helped to control pain. These analgesic included amitriptyline, gabapentin, pregabalin, tramadol and morphine in various regimens. Paracetamol and ibuprofen were also used. Conclusion: This report is a unique case of synchronization of third cranial nerve palsy and isolated IVH without SAH due to ACOM aneurysm. In addition, it could be interesting to re-emphasize the need for a comprehensive assessment of traumatic patients for finding some primary pathologies, which could result in an accident.

Symmetric Hyper-acute Quadriplegia in a Previous Healthy Patient: NMO-Like

A 15-year-old previously healthy female presented to the emergency department with rapidly progressing ascending paralysis. Her symptoms began with right-sided flank pain which progressed to lower extremity weakness, followed by a “tingling” sensation in both upper extremities and difficulty breathing over the course of 1.5 hours. Physical exam revealed absent bilateral deep tendon reflexes and loss of sharp pain and temperature sensation below level of the neck with preserved vibration and position senses. IVIG therapy was initiated for suspected Guillain Barre Syndrome. CSF revealed protein 28 (reference: 15 - 45 …

Increased complications in pediatric patients with non-idiopathic scoliosis undergoing spinal instrumentation for neuromuscular scoliosis compared to syndromic and congenital scoliosis

Purpose: Non-idiopathic scoliosis encompasses a group of diagnoses including neuromuscular, syndromic, and congenital scoliosis. Neuromuscular scoliosis includes conditions such as cerebral palsy, muscular dystrophy, and spinal muscular atrophy. Syndromic scoliosis patients are those with Marfan’s Syndrome, Down Syndrome, and DiGeorge Syndrome. Congenital Scoliosis are patients with a congenitally malformed vertebra. It is known that those with neuromuscular scoliosis have increased complications in comparison to those with idiopathic scoliosis. However, patients diagnosed with syndromic …

Are the standard AP and lateral views enough to detect the rotational malalignment intraoperatively during CRPP of Gartland III pediatric supracondylar humerus fractures

Background: Displaced pediatric supracondylar humerus fractures (SCHF) can lead to residual deformity if not accurately reduced and stabilized. Most publications concerning SCHF reduction have focused on malalignment in the coronal and sagittal plane without considering the rotational malalignment. However, malrotation has been identified in 60% of patients with cubitus varus deformity following a SCHF. In addition, tardy ulnar nerve palsy has been correlated with the degree of internal rotation deformity in these patients. Intraoperatively, inability to restore anatomic rotation can narrow the corridor for intraosseous pinning and make it difficult to obtain a stable …