Peripheral Neurological Deficits Research Articles

Associations between acupuncture and uses of opioids and neuropsychiatric medication following chemotherapy-induced peripheral neuropathy among patients with breast cancer.

216 Background: Chemotherapy-induced peripheral neuropathy (CIPN) features debilitative neuropathic pain and neurologic deficits, commonly present in breast cancer population exposed to certain chemo-agents. Given suboptimal effects often rendered by limited therapeutic options, CIPN is associated to psychological distress and drug-seeking behaviors, which leads to heightened functional impairment and disease burden. Acupuncture has gained clinical recognitions for alleviating pain and mental distress, but its impact on medication uses for pain or psychiatric disorders in CIPN remains unclear. As such, this study aims to investigate the association between acupuncture and use of these medications among breast cancer patients experiencing CIPN. Methods: This survival analysis utilized data from the TriNetX Network comprising real-time electronic health records from over 60 healthcare organizations across the United States. Breast cancer patients over 18 at the index date within 01/01/1997 (inception of acupuncture practice in US) and 05/10/2023, diagnosed with CIPN after exposure to chemo-agents such as taxane, platinum, vinca alkaloids, thalidomide, or bortezomib, were identified as the baseline cohort. Patients who received at least three acupuncture sessions post CIPN diagnosis were compared to those without any acupuncture record. Endpoints included prescription of sedative/hypnotics, anti-depressants, anti-psychotics, anti-convulsant agents, and opioid analgesics, within a twelve-month follow-up period after index date. Antibiotics use was the negative control outcome. A 1:1 propensity-score-matching (PSM) method was applied for between-group balance of demographics, BMI, cancer treatment history, health comorbidities, and concurrent medications, followed by hazard ratios and 95% CI calculation using Cox regression model. Results: Among 398 PSM pairs, acupuncture group demonstrated significantly lower hazards of sedative/hypnotics (HR= 0.74, 95% CI 0.61-0.9), anti-depressants (HR= 0.75, 95% CI 0.61-0.93), anti-psychotics (HR= 0.74, 95% CI 0.58-0.96), anticonvulsants (HR= 0.48, 95% CI 0.27-0.87), and opioids (HR= 0.78, 95% CI 0.65-0.94) use, whereas antibiotics showed insignificant result (HR= 0.75, 95% CI 0.55-1.02). The significance sustained after sensitivity analyses, excluding patients with concurrent other cancers, and narrowing follow-up period down to the last nine months to concentrate on treatment effects. Conclusions: Our study suggests a decreased need of opioids and neuropsychiatric medication associated with acupuncture treatment among breast cancer patients endorsing CIPN. Rigorous clinical studies are warranted to validate the causal underpinnings.

The Long-Term Impact of COVID-19 on Disability after Post-Acute Rehabilitation: A Pilot Study.

Background: The long-term effect of the 2019 coronavirus (COVID-19) pandemic is not fully known. Severe cases of COVID-19 have resulted in disability that can be assessed in a biopsychosocial manner with the International Classification of Functioning, Disability and Health with the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire. This study aimed to evaluate the long-term effects on disability of COVID-19 three years after post-acute rehabilitation using WHODAS 2.0. Methods: This single-center cohort study included patients with severe COVID-19 who underwent immediate post-discharge post-acute rehabilitation intervention. Three years later, patients were assessed via telephone using the WHODAS 2.0 questionnaire. Results: Of the 69 patients identified in the hospital database, 27 responded. A total of 16 patients refused to respond due to emotional distress. The mean age was 63.4 ± 8.6 years, 81.5% were independent in the community, 55.3% had been previously admitted to the ICU, and the median rehabilitation hospitalization duration was 18 (11.5,24) days. Comorbidities included type 2 diabetes mellitus (DM) (55.5%), grade 2 high blood pressure (62.9%), pressure ulcers (37%), peripheral neurologic deficits (62.9%), and central neurological deficits (14.8%). ICU admission was significantly correlated with advanced rehabilitation needs (measured by the level of the rehabilitation (p < 0.01) and longer hospitalizations (measured by total days in the hospital (p < 0.001). The overall disability score was 35.09%, significantly influenced by DM and central neurological deficits. Conclusions: Central neurological deficits and DM are associated with higher disability scores. Tailored rehabilitation programs, ongoing medical assessment, integrated care models, and patient education are essential for improving long-term outcomes after COVID-19 disease.

Retrospective Evaluation of Clinical and Clinicopathologic Findings, Case Management, and Outcome for Dogs and Cats Exposed to Micrurus fulvius (Eastern Coral Snake): 92 Cases (2021-2022).

This retrospective, observational study describes the clinical findings, case management trends, and outcomes of 83 dogs and nine cats exposed to eastern coral snakes in a university teaching hospital setting. The medical records of dogs and cats that received antivenom following coral snake exposure were reviewed. Data collected included signalment, time to antivenom administration, physical and laboratory characteristics at presentation, clinical course during hospitalization, length of hospitalization, and survival to discharge. The mean time from presentation to coral snake antivenom administration was 2.26 ± 1.46 h. Excluding cases where the owner declined in-hospital care, the mean hospitalization time for dogs and cats was 50.8 h and 34 h, respectively. The mean number of antivenom vials was 1.29 (1-4). Gastrointestinal signs (vomiting and ptyalism) occurred in 42.2% (35/83) of dogs and 33.3% (3/9) of cats. Peripheral neurologic system deficits (ataxia, paresis to plegia, absent reflexes, and hypoventilation) were noted in 19.6% (18/92) of dogs and cats. Hemolysis was also common in 37.9% (25/66) of dogs but was not observed in cats. Mechanical ventilation (MV) was indicated in 12% (10/83) of dogs but no cats. Acute kidney injury (AKI), while rare, was a common cause of euthanasia at 20% (2/5) and was the most common complication during MV at 44.4% (4/9). Pigmenturia/hemolysis occurred in 88.9% (8/9) of MV cases and in all cases with AKI. Despite delays in antivenom administration by several hours, dogs and cats with coral snake exposure have low mortality rates (6% of dogs (5/83) and 0% of cats). Gastrointestinal signs were common but were not predictive of progression to neurological signs. Thus, differentiating between coral snake exposure and envenomation before the onset of neurological signs remains challenging.

Conservative treatment of spinal tuberculosis in a retrospective cohort study over 20-year period: high eradication rate and successful health status can be expected.

Tuberculosis (TB) which mainly cause lung primarily TB, can also affect the musculoskeletal system. Spine involvement occurs in 50% of the cases and neurologic deficit and kyphotic deformity may occur. The choice of conservative or surgical management of spinal TB in the absence of neurologic deficits remains controversial. The aim of the present study was to investigate the outcome and the success rate of conservative treatment and to provide evidence for the timing of treatment for spinal TB in adult patients. Consecutive enrolled adult patients were conservatively treated from January 2000 to January 2020 for spinal TB in a tertiary care Orthopedic and Trauma Center-Spine Surgery Unit in Turin. Patients were conservatively treated with antibiotics and orthoses and followed up for at least 12 months. Clinical, radiological, laboratory and microbiological tests were performed for all the patients and demographic data, risk factors, comorbidity, clinical symptoms such as peripheral neurological deficit, and vertebral level involved were recorded. Treatment success was considered as no disease recurrence after 1 year of follow-up. Patients underwent successful conservative treatment were also evaluated with the self-perceived quality of life [36-Item Short Form (SF-36)] survey. A total of 132 patients (59 women and 73 men) suffering from spinal TB with a mean age at presentation of 49 years (range, 32-68 years) were treated. The mean follow-up was 43 months (range, 12-82 months). In 80 cases, there was a single vertebra involvement while multiple levels were involved in 52 cases. Sixty-nine (52%) patients presented spondylitis without involvement of the disk and 63 (48%) patients presented a spondylitis with disk involvement. Conservative treatment was effective in 113 patients (86%) which showed inter-somatic fusion with stability of the spine. The mean period of antibiotic therapy was 12 months (range, 8-15 months). Patients wear spinal orthosis for at least 12 weeks. The physical component summary (PCS)-36 (48.9±10.0) and mental component summary (MCS) (46.5±7.0) summary scores at follow-up were comparable to the normative values (P=0.652 and P=0.862, respectively). Painful deformity occurred in 25 patients (19%). Conservative treatment is effective treatment for spinal TB and may avoid surgical intervention in the absence of neurologic deficits.

Association of blood neutrophil-lymphocyte ratio with short-term prognosis and severity of tuberculosis meningitis patients without HIV infection

BackgroundPredicting the short-term prognosis and severity of tuberculosis meningitis (TBM) patients without HIV infection can be challenging, and there have been no prior studies examining the neutrophil lymphocyte ratio (NLR) as a potential predictor of short-term prognosis or its relationship to TBM severity. We hypothesized that NLR might serve as an independent indicator of short-term prognostic significance and that there might be a correlation between NLR and severity. The aim of this study was to investigate the role of NLR as a predictor of short-term prognosis and its relationship to severity of tuberculosis meningitis patients without HIV infection.MethodsWe retrospectively collected data from patients diagnosed with TBM in the West China Hospital, Sichuan University, from the period between January 1st, 2018 and August 1st, 2019. Multivariable analysis was executed by the logistic regression model to verify the independence of the 28-day mortality, the discriminative power for predicting short-term prognosis was evaluated using a Receiver Operating Characteristic (ROC) curve, survival outcomes were analyzed using the Kaplan-Meier method and Pearson’s correlation analysis was performed to discuss correlation between NLR and the severity of TBM.ResultsWe collected data from 231 TBM patients without HIV infection. 68 (29.4%) patients are classified as stage (I) 138(59.8%) patients are stage (II) 25(10.8%) patients are stage (III) 16(6.9%) patients died during the follow-up period of 28 days. By multiple logistic regression analyses, the NLR (OR = 1.065, 95% CI = 1.001–1.133, P = 0.045), peripheral neurological deficit (OR 7.335, 95% CI 1.964–27.385, P = 0 0.003) and hydrocephalus (OR 11.338, 95% CI 2.397–53.633, P = 0 0.002) are independent risk factors of 28-day mortality. The area under the ROC curve (AUC) for predicting short prognosis using NLR is 0.683 (95% CI 0.540–0.826, P = 0.015), the optimal cutoff value is 9.99(sensitivity: 56.3%, specificity: 80.9%). The Kaplan-Meier analysis demonstrated that patients with higher NLR(>9.99) had significantly worse survival outcomes(P<0.01).Pearson’s correlation analysis presents a significant positive correlation between the severity of TBM and NLR (r = 0.234, P<0.01).ConclusionsNLR, peripheral neurological deficit, and hydrocephalus are independent risk factors of 28-day mortality, NLR can predict the short-term prognosis of TBM patients without HIV infection. NLR is also found to be significantly and positively correlated with the severity of TBM.

P 46. Assessment of individualized treatment decisions for intravenous immunoglobulin therapy in patients with chronic immune-mediated neuropathies: observational study design and progress

Introduction. Chronic immune-mediated neuropathies such as chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN) are associated with immune mediated peripheral nerve damage and neurological deficits. Randomized, controlled clinical trials have demonstrated the effectiveness of human intravenous immunoglobulin (IVIG) for these conditions. IVIG is considered a treatment of choice for both disorders. German and EFNS/PNS guidelines recommend individualization of IVIG therapy during treatment for CIDP and MMN. However, there is a lack of documentation of individualized dosing in real-world practice. Objective. This study is designed to determine the patterns of use of 10% IVIG in real-world clinical practice and identify the factors driving treatment decisions for patients with CIDP or MMN. Methods. The study is non-interventional, longitudinal, multicenter design. Primary data collected will be physicians“ practice patterns, demographics, treatment regimens and tolerability of 10% IVIG. Adult patients (n=150) diagnosed with CIDP or MMN and with current or prospective therapy with 10% IVIG will be eligible for the study. Approximately 40 sites in Germany will participate in the study. The planned recruitment period for the study is 18 months starting in first half of 2021. Results. According to the study protocol, patient demographics, medical and disease history and concomitant medication are to be assessed at baseline. Data will be collected at the baseline visit and at each infusion visit (approximately every 3 weeks as scheduled for routine care) for up to 18 months . In addition, the study will include an initial , cross-sectional, quantitative survey for participating physicians on their current practice patterns for CIDP and MMN. The survey will include assessment of initial therapy choices, IVIG dosing, outcome measures, dosing reductions and treatment schemes for relapses. The criteria used for decisions about initiation, continuation and individualization of IVIG treatment (dosing, intervals, co-medication) will be recorded at each visit. Physicians are also requested to provide the Inflammatory Neuropathy Cause and Treatment (INCAT) Disability Score at baseline and other study visits, if these scores are routinely determined. The physician-assessed Clinical Global Impression of Improvement (CGI-I) is to be performed at all visits. The potential impact of the COVID-19 pandemic on an individual subject“s treatment algorithm will also be captured in the electronic data capture system . To assess safety, serious adverse events and adverse drug reactions will be evaluated at each visit. Conclusions. Results from this clinical trial will allow identification of the factors driving treatment decisions by physicians utilizing 10% IVIG to treat patients with CIDP or MMN as part of their clinical routine and allow assessment of the influence of patient-reported outcomes and objective clinical measures.

COVID-19 and anosmia in Tehran, Iran

Patients with acute olfactory disorders typically present to the otolaryngologist with both acute hyposmia and less often with anosmia. With the onset of COVID-19 we have noticed an increase in the number of patients who have presented with new onset of complete smell loss to the senior author’s practice in Tehran, Iran. This anosmia and the frequency with which patients present is highly unusual. Coronaviruses have been known to cause common cold symptoms. COVID-19 infections have been described as causing more severe respiratory infections and the symptoms reported by authors from Wuhan, China have not specifically included anosmia. We describe patients who have presented during a two-week period of the COVID-19 pandemic with complete loss of sense of smell. Most had either no symptoms or mild respiratory symptoms. Many had a normal otolaryngologic exam. A relationship between COVID-19 and anosmia should be considered during the pandemic. We hypothesize that the mechanism of injury is similar to that of other coronavirus infections that cause central and peripheral neurologic deficits.

Validation of an helicoidal versus standard ankle-foot orthosis for patients with unilateral drop foot

Patients with drop foot commonly use ankle-foot orthosis (AFO) as walking aid, but the impact on gait abilities of the orthosis design is still unclear. The aim was to compare gait abilities and satisfaction of patients with drop foot wearing a helicoidal AFO (hAFO) versus a standard AFO (sAFO) or no AFO (noAFO). Twenty patients (12 females, age ranging from 29.5 to 79.4 years),with unilateral drop foot in relation with peripheral neurological deficit and myopathy ( n = 14 and n = 6, respectively; duration of disease ranging from 4 to 558 months) were included in a randomized cross-over study. Gait abilities were assessed with the 6-minute walk test (6MWT) and the Timed Up and Go (TUG) test in 3 conditions (noAFO, sAFO and hAFO) using identical shoes. The Quebec User Evaluation of Satisfaction with assistive Technology (QUEST) assessed the satisfaction while wearing sAFO and hAFO. Data were described with median ± IQR. Friedman and Wilcoxon tests were used to compare 6MWT, TUG and QUEST between conditions. There was a positive effect of wearing an AFO on the 6MWT (Chi 2 = 30.6, P < 0.001): the improvement from the noAFO condition (336.5 ± 110.3 m) was 15% with sAFO (388.5 ± 137.0 m; P = 0.079) and 32% with hAFO (443.5 ± 91.0 m; P < 0.001), with a difference of 14% ( P < 0.001) between hAFO and sAFO. The TUG was also improved by wearing an AFO (Chi 2 = 22.4, P < 0.001): the improvement from the noAFO condition (10.75 ± 3.36 s) was 7% with sAFO (10.04 ± 3.43 s; P = 0.334) and 21% with hAFO (8.48 ± 2.89 s; P < 0.001), with a difference of 15% ( P = 0.002) between hAFO and sAFO. The QUEST scores (from 0 to 5) were higher for hAFO than sAFO for device (4.63 ± 0.97 vs 3.25 ± 1.04; P < 0.001) and service (5 ± 0.25 vs 4.63 ± 1.25, P = 0.037) subscales. The use of hAFO for drop foot improves gait abilities in comparison with sAFO or noAFO, with a higher patient satisfaction.

A rare case of tuberculous spinal arachnoiditis

Central nervous system tuberculosis represents approximately 10% of extra pulmonary tuberculosis. However, spinal tuberculous arachnoiditis is a rare complication of CNS tuberculosis that can result in severe peripheral neurological deficit. We are reporting a case of 7-year-old male child of disseminated tuberculosis (pulmonary and spinal arachnoiditis) with nutritional anemia. We aim to illustrate the difficulties in the diagnosis and management of this potentially curable disease by reviewing the literature.

Optimization of Biodegradable Nerve Conduit Diameter for Nerve Regeneration

In the treatment of peripheral neurological deficits, autologous nerve grafting is the first choice...

A Case of Neurological Manifestations Accompanying Generalized Tuberculosis

Tuberculosis (TB), a multisystemic disease with variety presentations and manifestations, is the most common cause of infectious disease–related mortality worldwide [1]. A 23-year-old, male, is admitted to the Infectious diseases clinic “Mother Theresa” hospital in Tirana, after one year intermittent FUO and exudative pleural effusion treated first in Albania and then Italy. He had fever, back pain, muscular weakness, difficulty walking, urinary retention. In chest x ray radiological examination, CT scan of thorax and MRI of spinal cord are seen military form lesions, and vertebral destructions that raise suspicion of a possible pulmonary and extra pulmonary TB. The patient’s condition is randomly assigned to the beginning of antitubercular therapy (ATT), manifesting disturbance of conscience and coma. LCS results with 50 cells / mm3 and the CT scan of head detects hydrocephalus; funduscopia detected papilledema on 1st stage; which mean that the case is complicated with TB meningitis. The patient passes to the intensive care unit where ATT tapered cortisone, CNS diuretics and supportive therapy. After a week the patient comes out of the coma, begins his clinical improvement, but the neurological consequences of hydrocephaly and paraplegia become clearer. Two months later the patient was better clinically, walking with support .Peripheral neurological deficits persisted up to 10 months after leaving the hospital but with progressive improvement. The best ways to reduce mortality and morbidity associated with TBM are the timely diagnosis.

Typical Carpal Tunnel Syndrome or Something More? A Plastic Surgeon’s Experience With Chronic Inflammatory Demyelinating Polyneuropathy

Chronic inflammatory demyelinating polyneuropathy (CIDP) typically presents with widespread peripheral motor and sensory deficits that progress over a 2- to 3-month period. In this article, the authors report a case involving a 32-year-old pregnant woman presenting to hand clinic after a 3-month history of bilateral median nerve compression consistent with carpal tunnel syndrome. Carpal tunnel syndrome is a common complaint resulting from pregnancy-associated edema and is typically treated conservatively. However, upon follow-up, this patient displayed new signs of widespread peripheral neurological deficits, prompting a diagnosis of CIDP. In addition to this highly atypical presentation of CIDP, the patient’s symptoms spontaneously remitted throughout the pregnancy requiring no further treatment. This case highlights the heterogeneous nature of neurological disease presentation and the importance in considering alternative diagnosis in what may appear as clear-cut plastic surgery case.

Cranio-spinal Rosai Dorfman disease: case series and literature review

Rosai-Dorfman disease (RDD) is a rare condition similar to lymphomas, presenting with cervical lymphadenopathy in young adults. Extra-nodal involvement is relatively common but involvement of the central nervous system (CNS) is rare. Cranial RDD presents with symptoms of raised intracranial pressure, focal or generalised seizures, while spinal RDD presents with pain, peripheral neurological deficits and radiculopathy. In contrast to other similar neoplastic or degenerative conditions affecting the CNS, RDD is a benign, non-infective, granulomatous disorder. Radiologically cranio-spinal RDD often mimics commoner dural-based lesions like meningioma, with only subtle radiological differentiating findings on Magnetic Resonance Imaging (MRI). The histopathology of RDD is diagnostic. Surgical excision is preferred modality of treatment. However, adjuvant therapies like steroids and radiation may help controlling residual or recurrent disease. There are multiple sporadic reports and short case publications in the literature, often focusing on a particular aspect of RDD. In this study, authors aim to present five cases of craniospinal RDD, and comprehensive review of literature and highlight neurological complications of systemic RDD.

Definition and management of varicella zoster virus-associated meningoradiculitis: a case report.

BackgroundThe varicella zoster virus affects the central or peripheral nervous systems upon reactivation, especially when cell-mediated immunity is impaired. Among varicella zoster virus-related neurological syndromes, meningoradiculitis is an ill-defined condition for which clear management guidelines are still lacking. Zoster paresis is usually considered to be a varicella zoster virus-peripheral nervous system complication and treated with oral antiviral therapy. Yet in the literature, the few reported cases of herpes zoster with mild cerebral spinal fluid inflammation were all considered meningoradiculitis and treated using intravenous antiviral drugs, despite absence of systemic signs of meningitis. Nevertheless, these two clinical pictures are very similar.Case presentationWe report the case of an alcohol-dependent elderly Caucasian man presenting with left lower limb zoster paresis and mild cerebral spinal fluid inflammation, with favorable outcome upon IV antiviral treatment. We discuss interpretation of liquor inflammation in the absence of clinical meningitis and implications for the antiviral treatment route.ConclusionFrom this case report we suggest that varicella zoster virus-associated meningoradiculitis should necessarily include meningitis symptoms with the peripheral neurological deficits and cerebral spinal fluid inflammation, requiring intravenous antiviral treatment. In the absence of (cell-mediated) immunosuppression, isolated zoster paresis does not necessitate spinal tap or intravenous antiviral therapy.

Age-related differentiation of sensorimotor control strategies during pursuit and compensatory tracking.

Motor control deficits during aging have been well-documented. Various causes of neuromotor decline, including both peripheral and central neurological deficits, have been hypothesized. Here, we use a model of closed-loop sensorimotor control to examine the functional causes of motor control deficits during aging. We recruited 14 subjects aged 19-61 years old to participate in a study in which they performed single-joint compensatory and pursuit tracking tasks with their dominant hand. We found that visual response delay and visual noise increased with age, while reliance on visual feedback, especially during compensatory tracking decreased. Increases in visual noise were also positively correlated with increases in movement error during a reach and hold task. The results suggest an increase in noise within the visuomotor control system may contribute to the decline in motor performance during early aging.

Selective impact of Tau loss on nociceptive primary afferents and pain sensation

Tau protein hyperphosphorylation and consequent malfunction are hallmarks of Alzheimer's disease pathology; importantly, pain perception is diminished in these patients. In physiological conditions, Tau contributes to cytoskeletal dynamics and in this way, influences a number of cellular mechanisms including axonal trafficking, myelination and synaptic plasticity, processes that are also implicated in pain perception. However, there is no in vivo evidence clarifying the role of Tau in nociception. Thus, we tested Tau-null (Tau−/−) and Tau+/+ mice for acute thermal pain (Hargreaves' test), acute and tonic inflammatory pain (formalin test) and mechanical allodynia (Von Frey test). We report that Tau−/− animals presented a decreased response to acute noxious stimuli when compared to Tau+/+ while their pain-related behavior is augmented under tonic painful stimuli. This increased reactivity to tonic pain was accompanied by enhanced formalin-evoked c-fos staining of second order nociceptive neurons at Tau-null dorsal horn. In addition, we analyzed the primary afferents conveying nociceptive signals, estimating sciatic nerve fiber density, myelination and nerve conduction. Ultrastructural analysis revealed a decreased C-fiber density in the sciatic nerve of Tau-null mice and a hypomyelination of myelinated fibers (Aδ-fibers) – also confirmed by western blot analysis – followed by altered conduction properties of Tau-null sciatic nerves. To our knowledge, this is the first in vivo study that demonstrates that Tau depletion negatively affects the main systems conveying nociceptive information to the CNS, adding to our knowledge about Tau function(s) that might also be relevant for understanding peripheral neurological deficits in different Tauopathies.

35 m Vertical Free Fall: How Impact Surface Influences Survival.

We describe the accidental free fall of a 23-year-old construction worker, who fell 13 stories (approximately 35 meters) from a false work landing on a toilet container. On impact he broke through the roof of the container, which attenuated his fall and made his survival possible. The patient sustained a central spleen rupture, liver laceration, subdural hematoma, blunt thoracic trauma with a left-sided hematothorax and right-sided pneumothorax with serial bilateral rib fractures, and an unstable fracture of the 10th thoracic vertebra. Two thoracic drainages were inserted in the emergency department before the patient underwent emergency surgery for the management of his intra-abdominal injuries. On the third day after trauma the unstable fracture of the 10th thoracic vertebra was stabilized with an internal fixator. Following extubation on day 8 after trauma the patient did not show any peripheral neurological deficits but cerebral affection with a general slowdown. After only 21 days, the patient was discharged from the hospital to a rehabilitation center where work specific rehabilitation was started. Although the patient is not suffering from physical afflictions from the injury his daily life abilities are still limited due to cerebral damage.

Incidencia de complicaciones neurológicas y cefalea pospunción dural luego de anestesia regional en la práctica obstétrica: un estudio retrospectivo de 2399 pacientes

Introduction and objectivesRegional anesthesia provides excellent anesthesia and analgesia in obstetric patients, but has potential for complications such as post-dural puncture headache and permanent or transient nerve damage. This study aimed to describe the incidence of post-dural puncture headache and nerve damage in the obstetric population of auniversity hospital that was submitted to neuraxial blockades, comparing with the world literature, and identify risk factors. Materials and methodsA retrospective cohort was performed including data collected in the records of post-anesthetic consults conducted during the year 2010. The main analysis was performed on the complaints of peripheral neurological deficits and headaches reported by patients, type of anesthesia and performed surgical procedures. A multiple regression analysis was performed to investigate the association between the onset of lower limb paresthesias and the length of stay of these patients in the gynecological position and other variables. ResultsA total of 2399 pregnant patients who had undergone neuraxial blockade were evaluated. Neurologic complications that occurred in these patients were divided into lower limb paresthesias (0.3%), transient radicular irritation (0.1%), and post-dural puncture headache (3%). The patients who stayed more than 60 min in gynecological position showed an odds ratio of evolution with lower limb paresthesias of 1.75 and patients who stayed more than 120 min showed an odds ratio of 2.1, but without statistical significance. ConclusionsPatients submitted to neuraxial blockades and placed in gynecological position were more likely to evolve with lower limb paresthesias related to duration of this position.

Anorexie psychogène et carences vitaminiques sévères dans les suites d’une gastrectomie longitudinale

IntroductionMorbid obesity is an emerging condition in the general population. Bariatric surgery, which has demonstrated its effectiveness for weight loss, mortality and morbidity related to obesity, is required in some patients. However, it may be associated with various adverse effects, including vitamin deficiencies. Case reportWe report a 33-year old man who presented central and peripheral neurological deficits and cardiac manifestations related to multiple vitamin deficiencies, following “sleeve” gastrectomy. The vitamin deficiencies were related to insufficient ingesta secondary to psychogenic anorexia. The patient improved with vitamins, antidepressant drugs and atypical neuroleptics. ConclusionPost-operative complications of “sleeve” gastrectomy include vitamin deficiencies that can develop in the context of psychogenic anorexia and ingesta reduction, in the absence of any digestive malabsorption.

Incidence of neurological complications and post-dural puncture headache after regional anesthesia in obstetric practice: A retrospective study of 2399 patients

Introduction and objectivesRegional anesthesia provides excellent anesthesia and analgesia in obstetric patients, but has potential for complications such as post-dural puncture headache and permanent or transient nerve damage. This study aimed to describe the incidence of post-dural puncture headache and nerve damage in the obstetric population of a university hospital that was submitted to neuraxial blockades, comparing with the world literature, and identify risk factors. Materials and methodsA retrospective cohort was performed including data collected in the records of post-anesthetic consults conducted during the year 2010. The main analysis was performed on the complaints of peripheral neurological deficits and headaches reported by patients, type of anesthesia and performed surgical procedures. A multiple regression analysis was performed to investigate the association between the onset of lower limb paresthesias and the length of stay of these patients in the gynecological position and other variables. ResultsA total of 2399 pregnant patients who had undergone neuraxial blockade were evaluated. Neurologic complications that occurred in these patients were divided into lower limb paresthesias (0.3%), transient radicular irritation (0.1%), and post-dural puncture headache (3%). The patients who stayed more than 60min in gynecological position showed an odds ratio of evolution with lower limb paresthesias of 1.75 and patients who stayed more than 120min showed an odds ratio of 2.1, but without statistical significance. ConclusionsPatients submitted to neuraxial blockades and placed in gynecological position were more likely to evolve with lower limb paresthesias related to duration of this position.