Sensory Disturbances Research Articles

Neurological complications of influenza vaccination: navigating the spectrum with a focus on acute disseminated encephalomyelitis (ADEM)

Introduction: Acute disseminated encephalomyelitis (ADEM) is a rare neurological disorder characterized by inflammation in the brain and spinal cord. This systematic review aims to investigate the potential association between ADEM and influenza vaccination by analyzing relevant case reports. ADEM is traditionally thought to be a monophasic condition, predominantly affecting children, often following viral illnesses or immunizations. Recent attention has focused on a possible link between ADEM and influenza vaccination, prompting the need for a thorough investigation. Methods: The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the AMSTAR2 (A MeaSurement Tool to Assess systematic Reviews 2) guidelines. Electronic searches were conducted on PubMed, Cochrane Library, and clinicaltrials.gov databases, spanning up to August 2023. Inclusion criteria encompassed full-text articles in English, observational studies, case reports, and case series providing comprehensive details for confirming clinical diagnoses of ADEM following influenza vaccination. Data were extracted, including demographic information, vaccination details, clinical symptoms, diagnostic evaluations, treatment modalities, and outcomes. Quality assessment was performed using the Joanna Briggs Institute (JBI) Critical Appraisal tool. Results: A total of 23 cases of ADEM following influenza vaccination were identified from 19 included articles. The mean age of affected individuals was 40.2 years (±25.7) with 60.8% being male. Common presenting symptoms included muscle weakness (52.1%), urinary abnormalities (30.4%), altered consciousness (26%), and sensory disturbances (26%). Neurological examination revealed findings such as extensor plantar reflex (positive Babinski sign) in 26%, hyperreflexia in 30.4%, and generalized hyporeflexia in 13% of the cases. Diagnostic evaluations involved MRI, showing multiple hyperintense lesions in cerebral hemispheres (43.4%), subcortex (60.8%), and spinal cord (39.1%). Cerebrospinal fluid analysis indicated elevated white blood cell count in 69.5% of cases, with lymphocytic pleocytosis in 52.1%. Oligoclonal bands were reported positively in 8.6% of cases. Treatment approaches varied, with intravenous methylprednisolone being the most common (39.1%). Out of the 23 cases, two (8.6%) patients had a fatal outcome, while the rest showed clinical improvement with complete or partial resolution of symptoms. Persisting symptoms included numbness in the lower extremities (8.6%) and impaired ability to walk after 10 months (4.3%). Conclusion: While the association between ADEM and influenza vaccination is rare, healthcare professionals should remain vigilant and consider patients’ vaccination history, particularly following an influenza immunization. This systematic review highlights the clinical manifestations, diagnostic tools, treatment approaches, and outcomes of ADEM cases post-influenza vaccination. Further research is essential to understand this association and improve clinical decision-making, ensuring the safety and efficacy of immunization programs.

Clinical Approach to Myelopathy Diagnosis.

This article describes an integrative strategy to evaluate patients with suspected myelopathy, provides advice on diagnostic approach, and outlines the framework for the etiologic diagnosis of myelopathies. Advances in diagnostic neuroimaging techniques of the spinal cord and improved understanding of the immune pathogenic mechanisms associated with spinal cord disorders have expanded the knowledge of inflammatory and noninflammatory myelopathies. The discovery of biomarkers of disease, such as anti-aquaporin 4 and anti-myelin oligodendrocyte glycoprotein antibodies involved in myelitis and other immune-related mechanisms, the emergence and identification of infectious disorders that target the spinal cord, and better recognition of myelopathies associated with vascular pathologies have expanded our knowledge about the broad clinical spectrum of myelopathies. Myelopathies include a group of inflammatory and noninflammatory disorders of the spinal cord that exhibit a wide variety of motor, sensory, gait, and sensory disturbances and produce major neurologic disability. Both inflammatory and noninflammatory myelopathies comprise a broad spectrum of pathophysiologic mechanisms and etiologic factors that lead to specific clinical features and presentations. Knowledge of the clinical variety of myelopathies and understanding of strategies for the precise diagnosis, identification of etiologic factors, and implementation of therapies can help improve outcomes.

Occasional back pain in officers of the FFS of the EMERCOM of Russia depending on age, experience, professional workload and performance at work

Relevance: According to global studies, the prevalence of back pain in firefighters ranges from 30 to 71.1 %. Harsh working conditions lead to acute and chronic pain syndromes and limited range of motion in the spine, which can become critical in an emergency.The objective is to analyze the influence of age, length of service, professional workload, successful performance at work on the presence of pain and reduction of movements, as well as neurological vertebrogenic manifestations, taking into account the musculoskeletal system (MS) pathology (C13 IDC-10) in among fire service employees in general.Materials and methods: 117 subjects, aged 20 to 47 years, employed by the Federal Border Service of the State Fire Fighter Service of the EMERCOM of Russia, underwent traditional neurological examination, spine biomechanical testing, and pain syndrome assessment by the VAS scale. The results were split into groups and structured by age, length of service, professional workload, success at work, and pathology of the musculoskeletal system.Results: Occasional pain in the spine was observed in 59.2 % of firefighters, mostly in the subgroup with over 15 years of professional experience than in subgroups with 6 to 14 years and under 5 years (p < 0.05) of professional record. Musculartonic syndrome was detected in 34 % and was more pronounced in the subgroup with high professional workload, than in those with light and moderate (p < 0.05) workload and in workers aged 40 to 50 years, rather than in younger subgroups (p < 0.05). Static and static/dynamic disorders in the spine were detected in 45 % of employees and were prevalent mostly in the subgroup with a service record of over 15 years (p < 0.001), as well as in the subgroup with high professional load (p < 0.05). A decrease in reflexes was mostly observed in the subgroup aged 31 to 39 years old (p < 0.05) and in the ODS impairment subgroup (p < 0.001), while root tension symptoms dominated in the subgroup aged 40 to 50 years (p < 0.05). Sensitivity disorders (p < 0.005; p < 0.05) and root tension symptoms (p < 0.01; p < 0.005) were more often detected in subgroups with low and average professional success compared to the subgroup of successful performers. According to the regression analysis model that considered age, length of service, professional workload, successful performance at work, and ODS pathology, work experience was an only parameter showing a significant cause-and-effect correlation with static/ dynamic spine disorders: OR = 3.66; 95 % CI = 1.25–10.7 (p < 0.05).Conclusion: In firefighters, the major factors influencing pain and reduction of movements in the spine include work experience in extreme conditions and professional workload; transformed perception of painful stimuli and radicular sensory disturbances are more pronounced in employees with limited professional success. Ergonomic interventions and a biopsychosocial approach are key in the treatment and prevention of dorsopathy in fire service personnel.

The developmental timing of spinal touch processing alterations predicts behavioral changes in genetic mouse models of autism spectrum disorders

Altered somatosensory reactivity is frequently observed among individuals with autism spectrum disorders (ASDs). Here, we report that although multiple mouse models of ASD exhibit aberrant somatosensory behaviors in adulthood, some models exhibit altered tactile reactivity as early as embryonic development, whereas in others, altered reactivity emerges later in life. Additionally, tactile overreactivity during neonatal development is associated with anxiety-like behaviors and social behavior deficits in adulthood, whereas tactile overreactivity that emerges later in life is not. The locus of circuit disruption dictates the timing of aberrant tactile behaviors, as altered feedback or presynaptic inhibition of peripheral mechanosensory neurons leads to abnormal tactile reactivity during neonatal development, whereas disruptions in feedforward inhibition in the spinal cord lead to touch reactivity alterations that manifest later in life. Thus, the developmental timing of aberrant touch processing can predict the manifestation of ASD-associated behaviors in mouse models, and differential timing of sensory disturbance onset may contribute to phenotypic diversity across individuals with ASD.

Tumefactive demyelinating lesions: a retrospective cohort study in Thailand

Tumefactive demyelinating lesions (TDL), characterized by large (≥ 2 cm) demyelinating lesions mimicking tumors, are a rare manifestation of the central nervous system inflammatory demyelinating diseases (CNS-IDD). Distinguishing TDL from other brain lesions can be challenging, often necessitating biopsy or advanced diagnostics. The natural history of TDL varies among races. This study aimed to assess demographics, clinical and radiological features, laboratory findings, management, and outcomes of Thai patients with TDL. We retrospectively reviewed records of twenty-six patients with TDL from the Multiple Sclerosis and Related Disorders registry from two tertiary medical centers. Among 1102 CNS-IDD patients, 26 (2.4%) had TDL. The median age at TDLs onset was 34.5 years (range 17–75); 69.2% were female. Over 70% manifested TDL as their initial CNS-IDD presentation. Common presenting symptoms included motor deficits, sensory disturbances, and cognitive problems. About two-fifths exhibited multiple lesions, most frequently in the frontoparietal region (46.2%). Half of the patients showed an incomplete ring on post-contrast T1-weighted imaging, with peripheral diffusion-weighted imaging restriction in twenty-one patients. T2-hypointense rims were present in thirteen (56.5%) patients. Brain biopsy was performed in 12 cases (46.1%). Serum aquaporin-4 immunoglobulin was positive in 16.7% of tested (4/24) cases. Serum myelin oligodendrocyte glycoprotein immunoglobulin was negative in all thirteen patients tested. Twenty patients (76.9%) received intravenous corticosteroids for TDL attacks. After the median follow-up period of 48 months (range 6–300), 23.1% experienced CNS-IDD relapses. Median Expanded Disability Status Scale at TDL diagnosis was 4.3 (range 0.0–9.5), and improved to 3.0 (range 0.0–10.0) at the last follow-up. This study suggested that TDL were rare among Thai CNS-IDD patients, frequently presenting as a monophasic condition with a favorable outcome.

Repeat Gamma Knife radiosurgery for recurrent trigeminal neuralgia in patients with multiple sclerosis: a single-center retrospective study.

Gamma Knife radiosurgery (GKRS) has emerged as an effective treatment option for trigeminal neuralgia (TN) in patients with multiple sclerosis (MS). To date, the outcomes of repeat GKRS for patients with TN and MS with recurrent pain have been investigated in a few patients. This study aims to report the outcomes and predictive factors of pain reduction for MS patients undergoing repeat GKRS for recurrent TN. Eighteen patients with MS underwent repeat GKRS for recurrent TN. A retrospective chart review and telephone interviews were conducted to determine background medical history, dosimetric data, and outcomes of the procedure. Facial pain and sensory function were evaluated using the Barrow Neurological Institute (BNI) scales. Fifteen patients achieved a BNI pain score of IIIa or better, indicating pain reduction, within a median period of 21 days after repeat GKRS. The maximum dose for repeat GKRS ranged from 70 to 85 Gy. Pain recurred in 5 patients after a median period of 12 months after GKRS. Percentages of patients with pain reduction at 1, 2, 3, 5, and 7 years were 60%, 60%, 50%, 50%, and 50%, respectively. Older age at repeat GKRS predicted sustained pain reduction (P = 0.01). Seven patients developed facial sensory disturbances, which were bothersome in two patients. Repeat GKRS may be used as an effective treatment modality for prolonging the duration of pain reduction time in patients with MS and TN. After repeat GKRS, facial sensory disturbances are common; however, they are often not bothersome.

A case report of peroneal muscle atrophy type 2A2 with central nervous system involvement as initial presentation

BackgroundCharcot-Marie-Tooth disease (CMT) is a group of single-gene hereditary diseases of peripheral nerve with high clinical variability and genetic heterogeneity. The typical clinical manifestations include progressive muscle weakness and muscle atrophy in the distal extremities, accompanied by disappearance of tendon reflexes and distal sensory disturbances. CMT2A2 (OMIM: 609260) is caused by the mutation of MFN2 (OMIM: 608507), is the most common type of axonal pattern. Although a small number of patients with X-linked CMT1 (CMT1X) present with central nervous system involvement, including reversible white matter lesions, it is rarely in CMT2A2.Case presentationA 3-year and 5-month-old girl had experienced motor lag, muscle tension, and abnormal gait for over a year. A reexamination of cranial MRI revealed an anterior enlargement of the abnormal signal range in the lateral ventricles and bilateral frontal lobes. And the whole exon sequencing showed that this girl carried a heterozygous missense mutation c.314C > T of MNF2 gene, inherited from her mother.ConclusionsIn this study, we retrospectively analyzed the clinical and molecular genetic findings of a child with Charcot-Marie-Tooth disease A2 with central nervous system involvement as the initial presentation, and explored its pathogenic mechanism.

Bilateral lumbosacral plexopathy: A rare condition presenting as a diagnostic challenge

Lumbosacral plexopathy (LP) is an uncommon condition. Its diagnosis may be challenging especially in the absence of evident structural causes and should be supported by lumbosacral imaging and neurophysiologic studies. LP is considered idiopathic when no causal factor is identified and it is thought to be immune-mediated. The authors report the case of a male with priors of radical prostatectomy and pelvic radiotherapy who presented the nosological triad of LP: lower limb progressive muscle weakness, sensory disturbances, and pain. Extensive investigation excluded different etiologies but no undoubtful causal conclusions were reached, raising the exclusion diagnosis of idiopathic LP as most likely. The patient was started on a rehabilitation program and several therapies, including corticotherapy, tocopherol, pentoxifylline, and hyperbaric oxygen therapy (the latter three targeting a less likely hypothesis of post-radiation LP), showing progressive improvement. Early intervention by a multidisciplinary team may have facilitated this favorable outcome. Despite all questions, the authors hope this report alerts to this rare entity.

Surgical Management of Foramen Magnum Meningiomas: Clinical Insights and Outcomes

Objective: This retrospective study aimed to provide a comprehensive analysis of the surgical management of foramen magnum meningiomas (FMMs), focusing on patient characteristics, surgical approaches, complications, and postoperative outcomes. Materials and Methods: The study included 23 patients diagnosed with anterior or anterolateral FMMs who underwent surgical treatment between 2014 and 2022. The study encompassed clinical records, neurological assessments, radiological findings, and surgical approaches, with a focus on the far lateral approach (FLA). Evaluation of outcomes included Karnofsky Performance Scale (KPS) scores and The Neck Disability Index (NDI) scores. Surgical approaches and postoperative care strategies were detailed. The study also examined the relationship between tumor location and surgical techniques. Results: The analysis revealed that patients with FMMs presented with various clinical symptoms, including lower cranial nerve deficits, pyramidal tract syndrome, and sensory disturbances. The retrocondylar far lateral approach was predominantly utilized, resulting in various Simpson resection grades. Postoperative complications were observed, including cranial nerve deficits, cerebrospinal fluid leakage, and infections. Also, the study found patient KPS scores remained stable, and NDI scores showed no significant increases before and after surgery. Conclusion: Surgical management of FMMs is a complex task requiring meticulous planning, individualized approaches, and close attention to neurovascular structures. The study emphasized the diverse clinical presentations and surgical techniques associated with FMMs and highlighted the importance of ongoing research and collaborative efforts to enhance patient care in this challenging field.

Characteristics of Hirayama Disease in Young South Korean Soldiers.

The purpose of this study was to describe the clinical presentation and features in electrodiagnostic and imaging investigations of young South Korean males diagnosed with Hirayama disease (HD). We reviewed the electronic medical records of South Korean enlisted soldiers who were diagnosed with HD and discharged from military service during 2011-2021. We investigated the clinical characteristics and results of electrodiagnostic and magnetic resonance imaging (MRI) investigations. We analyzed laterality and identified the involved muscles using needle electromyography (EMG). Loss of lordosis, localized cervical cord atrophy, loss of attachment between the posterior dura and subjacent lamina, asymmetric flattening of the cord, crescent-shaped mass in the posterior epidural space, and noncompressive intramedullary T2-weighted high signal intensity were investigated using neutral- or flexion-position MRI. Forty-two male patients aged 20.2±0.8 years (mean±standard deviation) were identified. All patients complained of hand weakness, and 10 complained of hand tremor (23.8%). Four patients (9.5%) had symptoms in both upper limbs, and five (11.9%) had sensory disturbances. Needle EMG revealed that muscles in the C7-T1 myotome were commonly involved, and C5-C6 involvement of the deltoid (10.5%) and biceps brachii (12.5%) was also observed. In cervical MRI, localized cord atrophy (90.0%) was the most characteristic finding, and cord atrophy was most severe at the C5-C6 level (58.3%). This is the first description of a large number of patients with HD in South Korea. The clinical presentation and features found in electrodiagnostic and imaging investigations will improve the understanding of HD in the young South Korean male population.

A case of primary central nervous system post-transplant lymphoproliferative disease 14 years after living donor liver transplantation

The patient was a 51-year-old man who had undergone living donor liver transplantation for type B cirrhosis at the age of 37 years, and had a history of immunosuppressive drug use. He had developed focal seizures starting from his right upper limb, and MRI showed a lesion in the subcortical white matter of his left parietal lobe. Sensory disturbance and paralysis progressed in his right upper and lower limbs, and his brain lesion rapidly enlarged. A brain biopsy revealed diffuse large B-cell lymphoma, and Epstein-Barr virus-encoded small RNA in situ hybridization was positive. The patient was diagnosed with primary central nervous system post-transplant lymphoproliferative disorder (PCNS-PTLD) with no lesions in other organs. There are few reports of PCNS-PTLD cases after living donor liver transplantation in Japan. Although rare, it is nevertheless important to consider this disease in patients receiving immunosuppressive drugs after organ transplantation who develop brain lesions, regardless of which organ was transplanted.

Karakteristike i lečenje bola kod bolesnika sa Guillain-Barre sindromom

Immune-mediated neuropathies, including Guillain-Barré Syndrome (GBS), represent a heterogeneous group of disorders caused by a loss of immune tolerance to antigens of peripheral nerves or surrounding blood vessels. Clinically, GBS is characterized by the development of symmetrical muscle weakness over up to four weeks, accompanied by sensory disturbances and dysautonomia. Pain is a common symptom of GBS, but unfortunately, it is often overlooked. Pain should be viewed multidimensionally, and the biopsychosocial model is currently widely accepted. Pain assessment is conducted using various unidimensional, multidimensional, and specialized scales to detect the neuropathic component of pain. Regarding pain as the first symptom of the disease, previous studies have shown that this is the case in about 70% of patients. Pain in GBS patients has both neuropathic and nociceptive components. A previous study conducted on GBS patients in our population found that the prevalence of pain in the acute phase was 85.5%, and neuropathic pain was present in 26.4% of cases. Rare studies have shown that after the acute phase of the disease, pain decreases, but sensitive neuropathic elements such as paresthesias/dysesthesias often remain. It is also assumed that pain plays a significant role in worsening depression and anxiety, as well as negatively impacting the quality of life and sleep in GBS patients. Pain management in GBS involves both specific (Intravenous Immunoglobulin Therapy, IVIG, and/or Therapeutic Plasma Exchanges, TPE) and nonspecific treatment methods (supportive therapy), as well as the use of analgesics and co-analgesics based on the principles of treating pain syndromes, depending on the assumed pathophysiological mechanism. After the acute phase of the disease, special attention is given to physical rehabilitation treatment and psychosocial support for the patient. Therefore, the involvement of other specialists (physiatrist, psychiatrist, clinical psychologist, and pain medicine specialist) is of crucial importance for adequate pain management.

What matters to people and families affected by cerebral small vessel disease (SVD)? A qualitative grounded theory investigation

BackgroundCerebral small vessel disease (SVD) is a common neurological disorder contributing to stroke, dementia, and disability. No treatment options exist although clinical trials are ongoing. We aimed to understand what matters to people and families affected by SVD to inform future research. MethodsWe thematically analysed unsolicited correspondences from members of the public addressed to members of the Edinburgh SVD Research Group on a variety of subjects related to SVD. We used inductive thematic codes, categorised under concerns, requests, emotions, and contributions, to form a grounded theory that categorised and ranked concerns raised. Results101 correspondents expressed 346 concerns between August 2015 and February 2021, mostly via email. 60 correspondents (59.4 %) disclosed a SVD diagnosis, 39 (38.6 %) disclosed a previous stroke or TIA, and 40 (39.6 %) were family of people living with SVD. Primary concerns related to cognitive problems (number of correspondents (n)=43 (42.6 %)), lack of support or information from healthcare services (n = 41 (40.6 %)), prognosis (n = 37 (36.6 %)), sensory disturbances (n = 27 (26.7 %)), functional problems (n = 24, (23.8 %)), impact on daily life (n = 24 (23.8 %)), and causes of SVD (n = 19 (18.8 %)). 57 correspondents (56.4 %) expressed support for research, 43 (42.6 %) expressed an eagerness to understand SVD, 35 (34.7 %) expressed helplessness, and 19 (18.8 %) expressed frustration. ConclusionsCognitive decline was the main concern for people and families living with SVD who corresponded with the Edinburgh SVD research group. These findings also indicate a need for more accessible services and better information about SVD for patients and families.

Organophosphate-induced delayed neuropathy: A rare case presentation

Abstract: Organophosphate-induced delayed neuropathy (OPIDN) is a rare clinical condition. It occurs in association with ingestion of large amount of organophosphorus compound. The clinical picture is characterized by transient paraesthesia, tingling, and numbness usually confined to the distal parts of the limbs, describes as gloves and stockings pattern of sensory impairment, followed by symmetrical motor weakness, which is flaccid type, starts distally in the lower limbs first then ascends to involve upper limbs. The sensory and motor disturbances are usually mild and seen distally, but in more severe cases, it also effects proximal groups of muscles. Electrodiagnostic studies show a motor axonal neuropathy. Our case a 36-year-old female patient, who developed paraesthesia and weakness in all four limbs, 20 days after she had ingested a large amount of 50% chlorpyrifos. The electrophysiological Electromyography (EMG), Nerve conduction study (NCS), Evoked potential (EP) study was characterized by severe motor axonal polyneuropathy effecting both upper and lower limbs, considering the peripheral nerve involvement due to OP poisoning after a delay, so it can be named as OPIDN.

Health Services for Young Adults with Stroke: A Service Mapping Study over Two Australian States

Despite increased incidence of stroke in young adulthood across the world, young adults report significant difficulties finding services with the expertise and experience to meet their needs. This service mapping study sought to identify and characterise the availability, accessibility, and accommodation of services to meet the needs of young adults (aged 18–44 years) with stroke in two Australian states. Methods. Relevant clinical, rehabilitation, and allied health services were systematically identified from previous publications; the National Health Service Directory; professional association “find a provider” listings; and Stroke Foundation service lists. Desktop audit (n = 465 services) and key informant interviews (n = 321 services) were used to collect service design and delivery characteristics; level of experience, confidence, and willingness to work with young adults with stroke; and accommodation of communication impairments. Results. Most services (85%) were in major cities or inner regional areas. No services worked solely with young adults with stroke; however, several reported having relevant expertise, training, experience, and programmes to provide neurological rehabilitation to meet the needs of young adults with stroke. Reported willingness (91.0%) to work with young adults with stroke was high, but only 57.0% were very confident to do so. Most services with neurorehabilitation expertise addressed psychosocial recovery needs (e.g., emotional adjustment and relationships) as well as functional recovery, but few supported return‐to‐driving, peer support, and sensory processing disturbances. Further gaps were the use of accessible communication materials in only 50.2% of services, and staff had completed communication training at only 60.4% of services. Conclusion. Findings highlight that while expert neurorehabilitation services exist, they are not sufficiently available, accessible, or accommodating of the needs of young adults with stroke. There remains a need to improve access to services where clinicians have the skills to meet the rehabilitation needs of young adults with stroke in Australia.

Gabapentin improves neuropathic pain in Minamata disease model rats.

Methylmercury (MeHg), the causative agent of Minamata disease, damages the cranial nervous system and causes specific sensory disturbances, especially hypoesthesia, in the extremities. However, recent reports demonstrate that patients with chronic Minamata disease conversely develop neuropathic pain in the lower extremities. Studies on our established Minamata disease model rats showed that MeHg-mediated neurodegeneration might induce neuropathic pain by over time through inducing rewiring with neuronal activation in the somatosensory cortex via microglial activation in the spinal dorsal horn. In this study, the effects of gabapentin, a potentially effective treatment for neuropathic pain, was evaluated using this Minamata disease model rats. To further elucidate the mechanism of its medicinal effects, histochemical and biochemical analyses of the nervous system of Minamata disease model rats were conducted. Gabapentin treatment restored the reduction in the pain threshold caused by MeHg exposure in rats. Histochemical and biochemical analyses revealed that gabapentin showed no effect on MeHg-induced neurodegeneration in entire nervous system and microglial activation in the spinal dorsal horn. However, it was shown that gabapentin may reduce excessive synaptogenesis through its antagonist action on the alpha2-delta-1 subunit of calcium channels in the somatosensory cortex. These results indicate that gabapentin may alleviated neuropathic pain in MeHg poisoning, as typified by Minamata disease, by reversibly modulation synaptic rewiring in the somatosensory cortex.

Stereotactic Radiosurgery for Trigeminal Neuralgia

Stereotactic radiosurgery(SRS)performed with Gamma Knife or CyberKnife has been reported to be effective in treating trigeminal neuralgia(TN). Microvascular decompression is the first choice of treatment for patients with trigeminal neuralgia who are difficult to treat with drugs because of its high efficacy, with a pain relief rate of 70%-80% after 5 years. The pain relief rate of TN treated with SRS is approximately 50%-60% after 5 years, which is less than that of MVD. SRS is also inferior to surgery, causing more frequent sensory disturbances in the trigeminal nerve area(6%-20%). However, the serious complications, severe morbidity and mortality, associated with SRS are quite rare. SRS is an extremely minimally invasive treatment that does not require general anesthesia and can be used to treat TN with short-term hospitalization or outpatient visits.

Chapter 12 - Meralgia paresthetica

Meralgia paresthetica is a common but probably underrecognized syndrome caused by dysfunction of the lateral femoral cutaneous nerve. The diagnosis is based on the patient's description of sensory disturbance, often painful, on the anterolateral aspect of the thigh, with normal strength and reflexes. Sensory nerve conduction studies and somatosensory evoked potentials may be used to support the diagnosis, but both have technical limitations, with low specificity and sensitivity. Risk factors for meralgia paresthetica include obesity, tight clothing, and diabetes mellitus. Some cases are complications of hip or lumbar spine surgery. Most cases are self-limited, but a small proportion of patients remain with refractory and disabling symptoms. Treatment options include medications for neuropathic pain, neurolysis, neurectomy, and radioablation, but controlled trials to compare efficacy are lacking.

Unhappy Balloon, Nitrous Oxide-induced Subacute Combined Degeneration of the Spinal Cord: A Review of Case Series

Background: The younger generation in Korea easily exposed to nitrous oxide (N<sub>2</sub>O) under the name “Happy Balloon” may abuse it. N<sub>2</sub>O can irreversibly oxidize vitamin B<sub>12</sub> and cause abnormal hematopoiesis or nervous system toxicity such as subacute combined degeneration (SCD). The objective of this study was to assist in early diagnosis of N<sub>2</sub>O-induced SCD of spinal cord by characterizing its clinical manifestations.Methods: Four patients with myelopathy after abusing N<sub>2</sub>O were enrolled. To characterize N<sub>2</sub>O-induced myelopathy, previously reported cases of N<sub>2</sub>O-induced SCD were searched through PubMed and KoreaMed. Collected cases and our four patients were analyzed.Results: A total of 30 patients with N<sub>2</sub>O-induced myelopathy (26 males and 4 females with mean age of 24 years) were analyzed. These patients took a median dose of 650 canisters for a median duration of 3.5 months. All patients presented sensory disturbances, which involved the lower extremities more frequently (100%) than the upper extremities (63.3%). Gait ataxia (76.7%), weakness in the upper (23.3%) and lower (36.7%) extremities, bladder symptoms (26.7%), Rhomberg sign (43.3%), and Lhermitte’s phenomenon (10.0%) were observed. Serum vitamin B12 levels were decreased in many (63.3%) patients and homocysteine levels were elevated in all. Of 20 patients who underwent magnetic resonance imaging (MRI) of the spine, 19 had abnormal findings. Three patients presented with contrast enhancement in lesions.Conclusions: We strongly recommend that history of N<sub>2</sub>O abuse should be asked for young patients with suspected myelopathy, especially those presenting with gait ataxia and sensory disturbances suggesting posterior column dysfunction and those presenting long-segment lesion involving the upper cervical cord on MRI.

Early detection and rehabilitation in Erb-Duchenne paralysis before age 1 year: A Case Report From Lusaka Zambia

Erb-Duchenne paralysis is a neurological condition characterized by paralysis of the arm which occurs due to injury of the upper trunk of C5-C6 of the brachial plexus and can lead to disturbances in movement and sensation. Erb-Duchenne paralysis commonly presents with a “Waiter’s Tip” deformity characterized by elbow extension, medial rotation of the arm, forearm pronation, and wrist flexion. Management of Erb-Duchenne paralysis may involve strengthening exercises, range of motion exercises, manual therapy, and neuromuscular electrical stimulation. However, in most cases, the diagnosis of Erb-Duchenne paralysis is not detected early enough for rehabilitation outcomes to be maximized. We herein report a case of a 6-months old child who had Erb-Duchenne paralysis in the left upper limb. The aim of this case report is to highlight the importance of early detection and rehabilitation of Erb-Duchenne paralysis. Furthermore, the report also discusses the physiotherapy techniques that can be used to optimize outcomes.