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1.
PLoS One ; 17(8): e0266118, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36006991

RESUMEN

BACKGROUND: Immunization stress-related responses presenting as stroke-like symptoms could develop following COVID-19 vaccination. Therefore, this study aimed to describe the clinical characteristics of immunization stress-related responses causing stroke-like events following COVID-19 vaccination in Thailand. METHODS: We conducted a retrospective study of the secondary data of reported adverse events after COVID-19 immunization that presented with neurologic manifestations. Between March 1 and July 31, 2021, we collected and analyzed the medical records of 221 patients diagnosed with stroke-like symptoms following immunization. Two majority types of vaccines were used at the beginning of the vaccination campaign, including CoronaVac (Sinovac) or ChAdOx1 (AstraZeneca). Demographic and medical data included sex, age, vaccine type, sequence dose, time to event, laboratory data, and recovery status as defined by the modified Rankin score. The affected side was evaluated for associations with the injection site. RESULTS: Overall, 221 patients were diagnosed with immunization stress-related responses (stroke-like symptoms) following CoronaVac (Sinovac) or ChAdOx1 (AstraZeneca) vaccinations. Most patients (83.7%) were women. The median (interquartile range) age of onset was 34 (28-42) years in patients receiving CoronaVac and 46 (33.5-60) years in those receiving ChAdOx1. The median interval between vaccination and symptom onset for each vaccine type was 60 (16-960) min and 30 (8.8-750) min, respectively. Sensory symptoms were the most common symptomology. Most patients (68.9%) developed symptoms on the left side of the body; 99.5% of the patients receiving CoronaVac and 100% of those receiving ChAdOx1 had a good outcome (modified Rankin scores ≤2, indicating slight or no disability). CONCLUSIONS: Immunization stress-related responses presenting as stroke-like symptoms can develop after COVID-19 vaccination. Symptoms more likely to occur on the injection side are transient (i.e., without permanent pathological deficits). Public education and preparedness are important for administering successful COVID-19 vaccination programs.


Asunto(s)
Vacunas contra la COVID-19 , COVID-19 , Accidente Cerebrovascular , Adulto , COVID-19/prevención & control , Vacunas contra la COVID-19/efectos adversos , ChAdOx1 nCoV-19 , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Accidente Cerebrovascular/inducido químicamente , Tailandia , Vacunación/efectos adversos
2.
Asian J Neurosurg ; 14(3): 1021-1029, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31497157

RESUMEN

We describe a patient with acute calcific discitis following symptomatic Schmorl's node (SN) of upper thoracic spine. A 28-year-old female suffered from sudden severe pain in mid-thoracic, left scapular area, radiating to her chest. Plain radiography of the thoracic spine showed calcification in T3-4 intervertebral disc space. Computed tomography (CT) scan and magnetic resonance imaging (MRI) of the spine demonstrated calcification of the T3-T4 nucleus pulposus, migrating into the inferior of T3 vertebral body with reactive bone marrow edema. By conservative treatment with multidrug therapy, the pain subsided and disappeared in 3 months. Follow-up CT scan and MRI of the thoracic spine confirmed complete resolution of calcified SN and reactive bone marrow edema.

3.
Case Rep Neurol ; 11(1): 53-60, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31543786

RESUMEN

Prisoners are at risk for both physical and psychological diseases. Here, we report an outbreak of peripheral neuropathy in a prison in northeast Thailand. Between July and December 2014, there were 88 male prisoners at Bueng Kan Provincial Prison in Bueng Kan, Thailand suffering from peripheral neuropathy out of a total of 1,464 prisoners (6.01%). The common age range was 20-39 years (58 patients; 65.91%). The three most common features were hyporeflexia/areflexia of the lower extremities (36 patients; 83.72%). On laboratory vitamin B1 deficiency was detected in 4/5 patients, positive rhinovirus polymerase chain reaction in 3/4 patients, positive Mycoplasma pneumoniae IgM in 1/12 patients, and positive urinary arsenic in 4/7 patients. A dT vaccination was given on October 14 during the outbreak. This was a large outbreak of peripheral neuropathy in male prisoners. There are several possible causes of this outbreak including vitamin B1 deficiency, dT vaccination, arsenic toxicity, rhinovirus, and Mycoplasma infection.

4.
Mult Scler Relat Disord ; 30: 284-290, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30870805

RESUMEN

BACKGROUND: Polyneuropathies co-occurring with multiple sclerosis (MS) may be underdiagnosed while causing additional disability burden. OBJECTIVE: To determine polyneuropathy presence and type in MS and compare MS with chronic inflammatory demyelinating polyradiculoneuropathy (MS-CIDP) versus MS with other non-inflammatory polyneuropathies. METHODS: Retrospective chart review of Mayo Clinic cases diagnosed with MS and polyneuropathy. Serum from MS-CIDP for pan-IgG autoantibodies to neurofascin-155 were tested when available. RESULTS: From 1980-2013, 133 co-existing MS/ polyneuropathy cases were identified. Twenty-eight MS patients had inflammatory neuropathy (11 CIDP, 5 plexopathy, 2 vasculitis, 4 monoclonal gammopathy-associated, 6 other), 15 inherited neuropathy (8 axonal, 7 demyelinating), 32 diabetic sensorimotor polyneuropathy, and 58 other. 109 had neuropathy beginning simultaneous to or after MS diagnosis (82%). Compared to MS cases with other polyneuropathy subtypes, MS-CIDP cases had absent or reduced ankle reflexes (100 vs. 70%, p = 0.04), earlier age of neuropathy recognition (52 vs. 58 years, p = 0.048), worse impairment (NIS 27 vs. 22 points, p < 0.03), and more acquired demyelinating electrophysiology features (46% vs. 9%, p < 0.003). Of MS-CIDP cases with available serum, 1-in-3 had IgG4 autoantibodies to neurofascin-155. CONCLUSION: (1) Polyneuropathies occurring in MS contribute to neurological disability. (2) Diagnosing polyneuropathies in people with MS is challenging and, likely, under-diagnosed. Recognition is important as some polyneuropathies (e.g., CIDP) are treatable. (3) The probable over-representation of inflammatory neuropathy (especially CIDP) in MS suggests a shared dysimmune pathogenesis, supported by autoantibodies to neurofascin-155.


Asunto(s)
Esclerosis Múltiple/complicaciones , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/etiología , Adolescente , Adulto , Anciano , Moléculas de Adhesión Celular/sangre , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Esclerosis Múltiple/sangre , Esclerosis Múltiple/patología , Fibras Nerviosas/metabolismo , Fibras Nerviosas/patología , Factores de Crecimiento Nervioso/sangre , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/patología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Adulto Joven
5.
J Med Assoc Thai ; 100(3): 262-9, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29911781

RESUMEN

Background: The incidence, prevalence, clinical phenotypes, and treatment response of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) are varying in the world literature. There have been no epidemiologic studies of CIDP in Thai adult patients. Objective: To determine clinical characteristics, phenotypes, electrophysiological tests, and treatment response of CIDP in Thai adult patients and to find factors associated with disease outcome after treatment. Material and Method: Retrospective chart review of Prasat Neurological Institute patients diagnosed of CIDP between January 1, 2008 and December 31, 2014. Results: Sixty-three CIDP patients were identified. Patients were slightly male predominant (1.3:1), age at onset was 47.7 years, disease duration prior to first evaluation was 5.0 months, follow-up duration was 26.8 months, and 19% of patients had diabetes. Clinical phenotypes were classic CIDP (76.2%), 19% DADS, and 4.8% MADSAM. Fifteen point nine percent presented as AIDP and 12.7% as SIDP. Symmetrical, sensorimotor polyneuropathy with hyporeflexia were the common presentation. Autonomic symptoms, respiratory failure, bulbar involvement, ophthalmoparesis, ptosis, and muscle atrophy were rarely presented. The treatment response was generally favorable. Patients in disease relapsing group had shorter disease onset (2 vs. 6 months) and 40% had disease duration less than four weeks. Conclusion: Clinical characteristics, phenotypes, electrophysiological findings, and treatment response of CIPD in Thai patients were not different from previously published studies in western and oriental populations. Mode of disease onset may predict a response to immunosuppressive treatment in CIDP patients.


Asunto(s)
Inmunosupresores/uso terapéutico , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/diagnóstico , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/terapia , Adulto , Anciano , Azatioprina/uso terapéutico , Quimioterapia Combinada , Femenino , Humanos , Inmunización Pasiva , Masculino , Persona de Mediana Edad , Examen Neurológico , Plasmaféresis , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/fisiopatología , Prednisolona/uso terapéutico , Estudios Retrospectivos , Tailandia
6.
Neurology ; 85(8): 675-82, 2015 Aug 25.
Artículo en Inglés | MEDLINE | ID: mdl-26208957

RESUMEN

OBJECTIVES: To assess the association between severity of neuropathy and disease stage, and estimate the rate of neuropathy progression in a retrospective cross-sectional analysis of a multinational population of patients with familial amyloidotic polyneuropathy (FAP). METHODS: We characterize neuropathy severity and rate of progression in available patients with FAP in France, the United States, Portugal, and Italy. Neuropathy Impairment Scores (NIS), time from symptom onset to NIS measurement, polyneuropathy disability (PND) scores, FAP disease stage, and manual grip strength data were collected. We estimated neuropathy progression using Loess Fit and Gompertz Fit models. RESULTS: For the 283 patients studied (mean age, 56.4 years), intercountry genotypic variation in the transthyretin (TTR) mutation was observed, with the majority of patients in Portugal (92%) having early-onset Val30Met-FAP. There was also marked intercountry variation in PND score, FAP stage, and TTR stabilizer use. NIS was associated with PND score (NIS 10 and 99 for scores I and IV, respectively; p < 0.0001) and FAP stage (NIS 14 and 99 for stages 1 and 3, respectively; p < 0.0001). In addition, there was an association between NIS and TTR genotype. The estimated rate of NIS progression for a population with a median NIS of 32 was 14.3 points/year; the corresponding estimated rate for the modified NIS+7 is 17.8 points/year. CONCLUSIONS: In a multinational population of patients with FAP, rapid neuropathic progression is observed and the severity of neuropathy is associated with functional scales of locomotion.


Asunto(s)
Neuropatías Amiloides Familiares/diagnóstico , Neuropatías Amiloides Familiares/epidemiología , Progresión de la Enfermedad , Índice de Severidad de la Enfermedad , Adulto , Edad de Inicio , Anciano , Neuropatías Amiloides Familiares/genética , Estudios Transversales , Femenino , Francia/epidemiología , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Portugal/epidemiología , Estados Unidos/epidemiología
8.
Neurology ; 82(17): 1551-5, 2014 Apr 29.
Artículo en Inglés | MEDLINE | ID: mdl-24682967

RESUMEN

OBJECTIVE: To understand the pathologic and clinical correlates of patients with chronic meralgia paresthetica (MP) undergoing lateral femoral cutaneous nerve (LFCN) neurectomy. METHODS: A retrospective cohort approach was utilized to identify 7 patients undergoing LFCN neurectomy for intractable pain. Control autopsied LFCN was obtained. Clinical, radiologic, and electrophysiologic features were reviewed. RESULTS: In identified cases, preoperative symptoms included severe lateral thigh pain and numbness. The duration of symptoms prior to surgery ranged from 2 to 15 years. Body mass index (BMI) varied from 20 kg/m(2) to 44.8 kg/m(2) (normal-morbidly obese), with 6 out of 7 patients being obese. No patients were diabetic. Focal nerve indentation at the inguinal ligament was seen intraoperatively and on gross pathology in 4 of 7 cases. Multifocal fiber loss, selective loss of large myelinated fibers, thinly myelinated profiles, regenerating nerve clusters, perineurial thickening, and subperineurial edema were seen. None of these features were observed in control nerve. Morphometric analysis confirmed loss of large myelinated fibers with small and intermediate size fiber predominance. Five patients had varying degrees of intraneural and epineurial inflammation. Six of 7 reported improved pain after neurectomy, sometimes dramatic. CONCLUSIONS: Patients with chronic MP and intractable pain have an LFCN mononeuropathy with loss of nerve fibers. Pathologic and clinical study supports a compressive pathogenesis as the primary mechanism. Abnormal nerve inflammation coexists and may play a role in pathogenesis. These selected patients typically benefited from neurectomy at a site of inguinal ligament compression. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that patients with chronic MP LFCN neurectomy experience improvement in MP-related pain.


Asunto(s)
Nervio Femoral/cirugía , Síndromes de Compresión Nerviosa/cirugía , Procedimientos Neuroquirúrgicos/métodos , Piel/inervación , Adulto , Anciano , Enfermedad Crónica , Femenino , Neuropatía Femoral , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
10.
J Med Assoc Thai ; 96(5): 523-30, 2013 May.
Artículo en Inglés | MEDLINE | ID: mdl-23745305

RESUMEN

BACKGROUND: An important cause of recurrent ischemic stroke is failure to prevent secondary stroke due to poor control of important stroke risk factors. One of the proposed important risk factor is aspirin resistance. The prevalence of aspirin resistance varied widely. It depended on heterogeneity in studied populations and methods of platelet functional assessment. OBJECTIVE: To describe the prevalence of aspirin resistance based on optical platelet aggregometry in stroke patients who attended the Neurological Institute and investigate the clinical risk factors associated with aspirin resistance. MATERIAL AND METHOD: Three hundred stable ischemic stroke patients, whose aspirin dosage varied between 60 to 325 mg/day for at least 14 days before enrollment were recruited in the present study. Demographic data, modifiable risk factors, and treatment were collected by interview and from medical records. Aspirin resistance was determined by optical platelet aggregation technique, using arachidonicacid (AA) and adenosine diphosphate (ADP) as agonists. RESULTS: The patients were classified into two groups based on their platelet aggregatometry tests (PAT). The cases group (n = 40, 13.3%) included both patients with aspirin resistance (n = 2, 0.6%) and aspirin semi-responsiveness (n = 38, 12.7%). The control group was aspirin non-resistance (n = 260, 86.7%). The cases were older (64.8 year vs. 61.26 year, p = 0.049), higher proportion of females (60% vs. 41.5%, p = 0.029), and shorter in height (159.9 CM vs. 164.1 CM, p = 0.007) than the control group. Dosage and duration of the aspirin therapy were the same in both groups. The multivariate analysis showed old age was associated with aspirin resistance. CONCLUSION: The prevalence of aspirin resistance in the present study is 0.6% (95% CI, 0.18%-1.38%). The risk factor for aspirin resistance in post stroke patients is aging. No association between duration and aspirin dosage with aspirin resistance was found. The proportion of aspirin resistance was similar to a previous study done in post myocardial infarction patients.


Asunto(s)
Aspirina , Resistencia a Medicamentos , Agregación Plaquetaria/efectos de los fármacos , Accidente Cerebrovascular , Factores de Edad , Anciano , Aspirina/farmacocinética , Aspirina/uso terapéutico , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Masculino , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/farmacocinética , Inhibidores de Agregación Plaquetaria/uso terapéutico , Pruebas de Función Plaquetaria , Prevalencia , Factores de Riesgo , Prevención Secundaria , Factores Sexuales , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/prevención & control , Tailandia/epidemiología
11.
J Med Assoc Thai ; 94(9): 1035-43, 2011 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-21970191

RESUMEN

BACKGROUND: Recurrent strokes are more likely to be more disabling or fatal than first-even strokes. The high frequency of recurrences underscores the importance ofsecondary prevention. OBJECTIVE: Investigate risk factors of recurrent ischemic stroke and to compare the outcomes after treatment following the Thai stroke guideline between patients with recurrent ischemic stroke and patients without recurrent ischemic stroke. MATERIAL AND METHOD: Sixty-seven patients with recurrent ischemic stroke and 167 patients without recurrent ischemic stroke were included in the present study. All patients were evaluated for demographic data, modifiable risk factors, and treatment. RESULTS: Patients without recurrent ischemic stroke had better controlled level of systolic blood pressure, diastolic blood pressure, and higher high-density lipoprotein level than patients with recurrent ischemic stroke. Carotid stenosis was higher in patients with recurrent ischemic stroke (43.3% vs. 28.7%, p = 0.032). Patients with recurrent ischemic stroke received statin therapy (67.2% vs. 86.8%, p = 0.001) and folic acid (61.2% vs. 78.4%, p = 0.007) less than patients without recurrent ischemic stroke. The multivariate analysis showed that well controlled diastolic blood pressure (p = 0.014), higher level of high-density lipoprotein (p = 0. 010), and receiving of statin (p = 0.002) were associated with decreased incidence of recurrent ischemic stroke. CONCLUSION: Well-controlled risk factors including blood pressure, fasting blood sugar, high-density lipoprotein, and low-density lipoprotein were crucial for the protection of recurrent ischemic stroke. Furthermore, the benefits of statin and folic acid therapies for the protection of recurrent ischemic stroke were emphasized


Asunto(s)
Isquemia Encefálica/tratamiento farmacológico , Ácido Fólico/uso terapéutico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Accidente Cerebrovascular/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/epidemiología , Estenosis Carotídea/complicaciones , Estenosis Carotídea/epidemiología , Estudios de Casos y Controles , Femenino , Humanos , Incidencia , Lipoproteínas HDL/metabolismo , Lipoproteínas LDL/metabolismo , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Tailandia/epidemiología , Resultado del Tratamiento
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