Childhood Poliomyelitis Research Articles

Does Childhood Poliomyelitis Increase the Risk of Adult Arterial Aneurysms?

Does Childhood Poliomyelitis Increase the Risk of Adult Arterial Aneurysms?

Crutch-induced acute arterial thrombosis.

A 61-year-old man was admitted to our institution with worsening numbness, pallor, and weakness in his left forearm for several days. His medical history indicated childhood poliomyelitis with shortening deformity of the left leg, and he has been utilizing one axillary crutch since his adolescence. No history of heart-related condition or diabetes was reported. Physical examinations showed a cold, pale left forearm, with diminished pulsations of the left radial and brachial arteries. Computed tomography angiography showed a distorted left subclavian artery with acute thrombosis that affected the left axillary artery and downstream vessels without collateral circulation (A / Cover).

Underdeveloped Left Upper Limb and Chest Wall Musculature Secondary to Childhood Poliomyelitis

Underdeveloped Left Upper Limb and Chest Wall Musculature Secondary to Childhood Poliomyelitis

The Association of Gélineau's Syndrome (Narcolepsy without Cataplexy) With Childhood Poliomyelitis: An Educational Mini-Review

The Association of Gélineau's Syndrome (Narcolepsy without Cataplexy) With Childhood Poliomyelitis: An Educational Mini-Review

Orthotics of Patient with Poliomyelitis and Power Lifting

A special category of Paralympian athletes can be attributed to people with disorders of the musculoskeletal system. In turn, among them a small group of athletes who had undergone the disease poliomyelitis, which are paralytic deformities of the spine and lower extremities. A clinical case is the result of orthotic fitting after surgery of a woman, of 30 years, who had childhood poliomyelitis, with severe consequences in the form of scoliosis of the spine 3 degrees and paralytic deformities of the feet. The patient traveled in a wheelchair or using crutches. It was manufactured orthopedic devices and spine orthosis. After the orthotics the patient was able to move independently and successfully engage in powerlifting.

Complex primary total hip replacement in a patient with sickle cell disease and contralateral poliomyelitis: A case report and review of literature

Sickle cell haemoglobinopathy (SCH) and neurological sequelae of childhood poliomyelitis are still relatively common in this environment. The non-paralytic limb in polio patients is subjected to abnormal stresses due to excessive weight-bearing load, leg length discrepancy, pelvic obliquity and abnormal gait mechanics. We present this case to highlight the challenges of managing such a case and present our experience. A 47-year-old female with SCH presented with left-sided avascular necrosis (AVN) of the head of the femur and right-sided post-polio paralysis. Limb length discrepancy was 1.5 cm with a longer left lower limb. Oxford hip score (OHS) = 25 and SF12 = 16. Packed cell volume (PCV) was 20%. Radiographs revealed a destroyed left hip with secondary osteoarthritis, partial collapse, lateral subluxation and metaphyseal sclerosis. She had non-cemented left total hip arthroplasty via Hardinge approach. One-month post-operative scores were OHS = 38, SF12 = 24. Three-month follow-up scores were OHS = 46 and SF12 = 30. AVN poses a major burden. Combination with post-polio paralysis and the risk of infection with encapsulated organisms create a complex interplay of challenges. Peri-operative management requires meticulous monitoring, care and prevention of sickling crisis. Uncemented implants gave better results with fewer complications. Limb shortening at arthroplasty increases dislocation risk; so, length should be maintained. Coexisting post-polio paralysis and SCH is rare but challenging. The non-paralytic limb is subjected to excessive abnormal forces. Excellent results and low complication rates are achievable if meticulous peri-operative management, appropriate choice of cementless implants and maintenance of length are done. Ensuring adequate fixation of implants at surgery reduces risk of loosening. Rehabilitation must take the risk of falls into account. Pre-operative planning and optimisation, meticulous surgical technique and cementless implants are keys to success.

Unusual MRI Findings in a Polio Survivor.

A 63-year-old male consulted our institution due to worsening of right hip pain for approximately one month. The patient had no apparent functional disorders besides rigidity of the right ankle secondary to childhood poliomyelitis. Plain radiographs demonstrated narrowing of the right hip joint space. Magnetic resonance imaging (MRI) showed unusual findings in the right gluteus medius muscle, suspecting a malignant musculoskeletal tumor. Further examinations clarified acute inflammation caused by Staphylococcus aureus with no atypia. After treatment, serum inflammatory markers normalized and MRI showed homogeneous fat signal intensity in the muscle, which was consistent with poliomyelitis. Total hip arthroplasty was performed due to progression of osteoarthritis. Intraoperative findings showed flaccidity of the gluteus medius muscle, and histological examination of the specimen also was compatible with poliomyelitis. Postoperatively there was no hip instability and the patient has been able to resume his previous physical activity. To our knowledge, this is the first report regarding polio survivors combined with septic arthritis, and sole MRI examination was unable to lead to the diagnosis. The current patient demonstrates the possibility that the involved muscles in poliomyelitis exist even in asymptomatic regions, which will be helpful for accurate diagnosis and life guidance in polio survivors.

Brave genius: a scientist, a philosopher, and their daring adventures from the French resistance to the Nobel Prize

I really thank Sean Carroll, himself a scientist and educator, for his accessible and scholarly book, dealing with an intellectually unique interaction of two exceptional individuals during 30 years of the 20th century: the philosopher and writer Albert Camus and the biologist Jacques Monod. All readers, whatever their main interest in politics, history, or contemporary evolution of metaphysical concepts and bioscience research, may learn a lot and enjoy this fascinating and passionate account of a critical period when ideologies, biological discoveries, and their occasional confrontations evolved so much. My invitation to review this book for The FASEB Journal is warmly appreciated. Perhaps I was asked, because when I was very young—before I became a research physician and biochemist —I was a member of the French Resistance in the Francs Tireurs et Partisans Francais (FTPF), a fighting organization. Therefore, I had the privilege to be directly in contact with several matters that Camus and Monod approached and greatly influenced but not to say decisively. As Monod and Camus were born in 1910 and 1913, respectively, the book deals with most important political and economical aspects of the 20th century: the development of Communism and Fascism, the second World War, and the following years, featuring the violent and complex relationship between the French and German people. After World War II, audacious French moralists and philosophers, such as Albert Camus, were at the forefront of their field, as were great scientists, particularly those who, like Jacques Monod, revolutionized the basic foundations of biology. They publicly elaborated and discussed revolutionary concepts. Each published a book, creating an intellectual breakthrough: Le mythe de Sisyphe (The Myth of Sisyphus) by Camus and Le hasard et la necessite (Chance and Necessity) by Monod; these books are introduced to us by Sean Carroll. Camus and Monod, both French and active resistants during the German occupation of France, met after the war; they became mutual admirers of each other and sincere friends. Monod had to work experimentally for many years before being able to speak openly on the significance of his biological discoveries with reference to questions and suggestions of Camus (such as “What is worth living for?”). Monod was the son of an American mother, and his father was a free-thinking painter. Jacques, a cellist and aspiring conductor, was encouraged to be a professional musician and did not make a definitive choice of career in biology until he completed his Ph.D., even though he had visited the laboratory of the pioneer geneticist Thomas Hunt Morgan. He married a specialist of Asian art, Odette Bruhland, and they had twin sons, born in 1939. Monod had not yet been conscripted into the army (a consequence of childhood poliomyelitis), but he managed to support the regular armed forces. After the Armistice, he was demobilized in July 1940, and in Paris with his family, he finished his doctorate on bacterial growth. Opportunities for obtaining food were difficult, but more importantly, the collaborationist French government of Vichy developed an antiSemitic policy (Statut des Juifs, or Status of Jews), and so, Monod sent his family to a suburban area. He himself became rapidly very active in the nascent Resistance, writing and distributing clandestine publications. Progressively, he played an important role in underground networks and was promoted to the

Free-flap harvesting from paralytic limbs of poliomyelitis patients – A safe and feasible option

Many patients who had childhood poliomyelitis are still suffering from the late sequalae of the condition. Free-flap harvesting from the paralytic limbs from these patients is a logical approach for functional preservation. However, concerns have been raised regarding its safety due to its hypoplastic vascular system and potential donor site healing problems. A 53-year-old man with known childhood poliomyelitis presented with left facial sarcoma. After wide excision, the defect was reconstructed with a dual-island fasciocutaneous-free anterolateral thigh flap harvested from his paralytic limb. The pedicle and perforators were found to be no different from those in normal limbs. His recovery was smooth without complications. On the basis of our experience and current evidence in the literature, we believe that free-flap harvesting from the paralytic lower limb in poliomyelitis patients is a safe option that incurs no additional risk and allows maximal function preservation.

Poliomyelitis and left ventricular hypertrabeculation (noncompaction)

Left ventricular hypertrabeculation (LVHT) is frequently associated with neuromuscular disorders (NMDs) but in the vast majority of the cases the NMD is hereditary [1]. Acquired NMDs which have been reported in association with LVHT include scleroderma [2], or mannose-binding lectin deficiency [3]. So far, LVHT has not been reported in a patient with poliomyelitis. The patient is a 77 years old, non-smoking male with a history of congenital epilepsymanifesting with generalized seizures, which disappeared at age 16 years, poliomyelitis in childhood, manifesting with quadruparesis, palpitations since age 40 years, paroxysmal atrial fibrillation documented at age 73 years forwhich he received oral anticoagulation since then, arterial hypertension, benign hypertrophy of the prostate gland, osteochondrosis of the cervical and thoracic spine, hyperlipidemia, chronic obstipation, and resection of a benign colon polyp at age 74 years. At age 69 years he underwent defecography for persisting diarrhea, which showed impaired evacuation. He was under a regular therapy with triazolam for insomnia. His antihypertensive therapy comprised bisoprolol, candesartan and hydrochlorothiazid. The family history was negative for cardiac or neurological disease. At age 75 years he was admitted for angina pectoris, vertigo and arterial hypertension. Clinical cardiologic examination was normal. Blood pressure was 125/80 mmHg. ECG revealed sinus-rhythm, absent Rprogression between V2 and V3, and negative T-waves in V5 and V6. OnX-ray of the lungs therewas atherosclerosis of the aorta and scoliosis of the thoracic spine. Echocardiography showed normal systolic function, diastolic dysfunction (E/A-ratio b1), thickening of the left

Concomitant CNS pathology in a patient with amyotropic lateral sclerosis following poliomyelitis in childhood

Post-polio syndrome (PPS) develops in approximately 30% of polio survivors several decades after the acute attack of paralytic poliomyelitis. Some of these patients develop post-poliomyelitis muscular atrophy (PPMA) which is characterized by a slowly progressive muscle weakness. Due to its clinicopathological features, investigators have often studied PPS and PPMA in association with amyotrophic lateral sclerosis (ALS), the underlying hypothesis being an increased risk of developing ALS from a prior acute paralytic poliomyelitis. Various studies, however, have indicated that de novo ALS cases in patients with prior acute paralytic poliomyelitis are rare. Herein, we describe a rare case of a 75-year-old woman who at post-mortem examination presented a combination of a PPS with proven histopathological sporadic ALS features. Furthermore, neuropathology of this case also revealed several other histopathological findings reminiscent of a tauopathy, synucleinopathy and amyloid angiopathy and a large pituitary cyst. To our knowledge, this is the first reported case of PPS with clear pathological hallmarks of sporadic ALS, including ubiquitin-, TDP-43, phosphorylated TDP-43- and p62-positive inclusions, with accompanying features compatible with Alzheimer's and Parkinson's disease.

Crutch-induced bilateral brachial artery aneurysms

A 57-year-old man, who was a chronic axillary crutch user as a result of childhood poliomyelitis, was referred to our hospital because of a sudden onset of right forearm ischemia. The right forearm had no pulse, and three-dimensional computed tomography (3DCT) showed an aneurysm of the right brachial artery associated with arterial occlusion. The thrombosed aneurysm of the brachial artery was resected and the brachial artery was successfully revascularized by interposing a saphenous vein graft. Postoperative 3DCT revealed an asymptomatic left brachial artery aneurysm. His postoperative course was uneventful under warfarin anticoagulation therapy.

SUPERFICIAL SIDEROSIS: SEALING THE DEFECT

Superficial siderosis (SS) of the CNS results from chronic hemorrhage into the subarachnoid space with hemosiderin deposition in the subpial layers.1,2 The clinical presentation includes progressive ataxia and deafness. Some patients have a history of trauma or intradural surgery. Despite extensive investigations, a cause of bleeding is frequently elusive. An extra-arachnoid, intraspinal, or intracranial CSF collection, often longitudinally extensive, is sometimes identified in spinal neuroimaging in SS.1–6 A dynamic CT myelogram can identify the dural defect connecting the intrathecal space with the fluid-filled collection.4 The precise mechanism of bleeding is unknown. Rarely CSF hypovolemia accompanies SS.6 Increased CSF RBC count may be seen in CSF hypovolemia.7 These observations have led to the suggestion that repairing the dural defect may halt bleeding and prevent deficit progression.6 Clinical confirmation of this hypothesis is lacking. We describe a patient with SS and CSF hypovolemia due to a CSF leak. Repair of the leak was accompanied by clinical improvement and resolution of neuroimaging and CSF abnormalities. ### Case report. A 64-year-old man was evaluated for a 3-year history of progressive imbalance and 10-year history of decreased hearing. His history was remarkable for childhood poliomyelitis. Over the years he had multiple horse riding-related falls. Twenty years earlier he had a C4-C7 laminectomy for right upper limb weakness. On examination, he had mild …

Multiple bilateral asymmetrical deficiency of trunk muscles

Trunk muscles are an important source for pedicled and free flaps in reconstructive surgery. Unilateral deficiencies of trunk muscles are well known, either isolated or as part of Poland’s syndrome. Bilateral muscular deficiencies and a “bilateral Poland anomaly” have also been sporadically reported, but this is rare. We report on an 82-year-old male cadaver with clinically obscure, asymmetric bilateral deficiencies of the majority of trunk muscles. There was a history of acute poliomyelitis in childhood. Histological examination of representative muscle samples of the trunk showed extensive muscle atrophy with fat and connective tissue replacement. This was compatible with the prior diagnosis of poliomyelitis. However, representative sections of the spinal cord failed to reveal the antecedent poliomyelitis. The possibility of subclinical bilateral deficiencies of trunk muscles has to be taken into account in patients with a history of poliomyelitis when planning reconstructions in cases of regional pedicled muscle transfers or free microvascular tissue transfers in reconstructive surgery.

Anesthesia for craniotomy in a patient with previous paralytic polio

Poliomyelitis remains endemic in many developing nations. Patients may develop residual muscle weakness in one or more limbs after an attack of poliomyelitis in childhood. We report an adult patient who presented for right temporal cortical grid placement. He had childhood poliomyelitis and, while showing no evidence of postpolio syndrome, demonstrated excessive sensitivity to nondepolarizing muscle relaxants and developed prolonged muscle weakness during the postoperative period.

Plexiform Neurofibroma of the Cauda Equina: A Case Report and Review of the Literature

Plexiform neurofibroma of the cauda equina is extremely rare. Herein, a case is reported in a 56-year-old man who also had muscle atrophy, severe motor disturbance, and mild sensory disturbance of the left leg due to childhood poliomyelitis. The clinical symptoms manifested insidiously until the patient developed cauda equina syndrome. At operation, the tumor mass was observed to engulf the nerve roots of the cauda equina. After pathological examination, the diagnosis of plexiform neurofibroma was made. Neither the patient described herein nor any previously reported patients had neurofibromatosis.

Respiratory failure in a patient with antecedent poliomyelitis: Amyotrophic lateral sclerosis or post-polio syndrome?

We report a 69-year-old man who developed paralytic poliomyelitis in childhood and then decades later suffered from fatal respiratory failure. Six months before this event, he had progressive weight loss and shortness of breath. He had severe muscular atrophy of the entire right leg as a sequela of the paralytic poliomyelitis. He showed mild weakness of the facial muscle and tongue, dysarthria, and severe muscle atrophy from the neck to proximal upper extremities and trunk, but no obvious pyramidal signs. Electromyogram revealed neurogenic changes in the right leg, and in the paraspinal, sternocleidomastoid, and lingual muscles. There was a slight increase in central motor conduction time from the motor cortex to the lumbar anterior horn. Pulmonary function showed restrictive ventilation dysfunction, which was the eventual cause of death. Some neuropathological features were suggestive of amyotrophic lateral sclerosis (ALS), namely Bunina bodies. In patients with a history of paralytic poliomyelitis who present after a long stable period with advanced fatal respiratory failure, one may consider not only respiratory impairment from post-polio syndrome but also the onset of ALS.

Evaluation of healthy and diseased muscle with magnetic resonance elastography

Basford JR, Jenkyn TR, An K-N, Ehman RL, Heers G, Kaufman KR. Evaluation of healthy and diseased muscle with magnetic resonance elastography. Arch Phys Med Rehabil 2002;83:1530-6. Objective: To investigate whether a new tissue-imaging technique, magnetic resonance elastography (MRE), offers a viable, noninvasive way to study healthy and diseased muscle. Design: Convenience sample. Setting: A magnetic resonance imaging (MRI) laboratory. Participants: Eight control subjects (4 men, 4 women), between the ages of 24 and 41 years, with normal neuromuscular examinations and histories, and 6 subjects (3 men, 3 women), ages 17 to 63 years, with lower-extremity neuromuscular dysfunction (1 with childhood poliomyelitis, 2 with flaccid, 3 with spastic paraplegia). Interventions: Subjects lay supine with their legs within the coils of a 1.5T MRI machine, with their feet strapped to a footplate positioned so that the axes of rotation of their ankles coincided with the apparatus. All subjects were tested in a no-load (0 torque) condition. Control subjects were also evaluated as they isometrically resisted ankle dorsi- (20.2Nm, 40.5Nm) and plantar- (8.2Nm, 16.4Nm) flexion moments. Subjects with neuromuscular dysfunction were evaluated in the same manner, except 1 individual with residual lower-extremity strength who could only be tested in the resting and passive ankle dorsiflexion modes. Shear waves were induced with a 150-Hz electromechanic transducer located over the belly tibialis anterior. MRE images were collected with a gradient-echo technique gated to the transducer's motion. Wave-phase propagation was visualized with 8 equally offset images across 1 vibration-cycle. Main Outcome Measures: Changes in shear-wave wavelength (λ) and muscle stiffness (as expressed by the shear modulus [G]) in the tibialis anterior and gastrocnemius muscles. Results: Wavelength and G differed between the groups in all the muscles studied, and increased as the load increased. Moreover, λ and G in the neuromuscular disease group at rest (eg, 3.88±0.48cm; range, 2.87–4.91cm; 38.40±00.77kPa; range, 22.35–59.67kPa) and in the lateral gastrocnemius were, respectively, more than 1.5 and 2.4 times larger than they were in the same muscle in the control group (2.56±0.28cm, 16.16±00.19kPa; P=.0002) (1Pa=1N/m2). Conclusions: Shear-wave wavelength and muscle stiffness increased with load in healthy muscle. In addition, at least for our sample, these quantities differed significantly between muscles with and without neuromuscular disease. In summary, MRE appears to provide in vivo physiologic information about the mechanical properties of muscle at rest and during contraction that is not otherwise available. The potential of this technique for monitoring the effects of treatment and exercise on both healthy and diseased muscle merits further research. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

An association between the flat back and postpolio syndromes: A report of three cases

The cases of three patients with a history of paralytic poliomyelitis in childhood who developed the flat back syndrome before or after spinal fusion for degenerative disease as adults were reviewed. The flat back syndrome, a combination of an inability to stand erect because of forward flexion of the trunk and pain in the low back and/or legs, typically occurs in the setting of decreased lumbar lordosis as a result of distraction instrumentation of the spine for scoliosis, vertebral fracture, or degenerative disease. Focus was placed on determining the factors responsible for the development and/or persistence of the flat back syndrome in these patients despite maintenance of, or partial operative restoration of, lumbar lordosis. Considering the essential role that the trunk extensor musculature plays in maintaining upright posture, it may be that a new onset of weakness (postpolio syndrome) in this musculature represents a major contributing factor to the flat back syndrome in these patients. Spine surgeons considering operative procedures in patients with a remote history of paralytic poliomyelitis should be aware of the possible increased risk of the flat back syndrome in this population of patients.

Faecal incontinence following childhood poliomyelitis

Faecal incontinence following childhood poliomyelitis