Postoperative Medial Plantar and Sural Neuropathy With Complex Regional Pain Syndrome.

This case illustrates a distinct presentation of coexistent medial plantar and sural neuropathy leading to the development of complex regional pain syndrome (CRPS) in a 49-year-old male patient. CRPS is a broad medical diagnosis describing prolonged and excessive pain that is out of proportion to exam and has historically been diagnosed according to the Budapest criteria. To our knowledge, this is a rare report of a case of medial plantar and sural neuropathy further complicated with CRPS, status-post calcaneal fracture, surgery, and post-surgical boot placement. The case highlights the complexity of diagnosing and managing multiple concurrent neuropathies and underscores the need for interdisciplinary approaches in treating CRPS to improve patient outcomes.

Diagnostic Accuracy of the Yale Swallow Protocol in Moderate-to-Severe Traumatic Brain Injury: A Prospective Blinded Videofluoroscopic Investigation.

OBJECTIVE: The study aimed to assess the accuracy of the Yale Swallow Protocol (YSP) in screening aspiration in adults with acute moderate-to-severe traumatic brain injury (TBI) by comparing the YSP with a videofluoroscopic swallow study (VFSS). SETTING: Level 1 academic trauma center. PARTICIPANTS: The study involved a cohort of 50 consecutive adults with a history of acute moderate-to-severe TBI. DESIGN: The prospective cohort study was conducted between July 2020 and June 2021. Participants underwent the YSP to assess aspiration risk, followed by a VFSS within 5 to 10 minutes after the YSP, to assess the accuracy of the YSP compared with the VFSS. MAIN MEASURE: The accuracy of the YSP in identifying aspiration in adults with acute moderate-to-severe TBI. RESULTS: The interrater agreement for identifying aspiration on the VFSS and the YSP was excellent, as well as 100% agreement between the speech-language pathologists and the radiologist and between the 2 speech-language pathologists, respectively. Of the 50 participants, 16 passed the YSP, while 34 failed. Among those who failed, 30 were confirmed to have aspirated on the VFSS (true-positives) and 4 did not show aspiration on the VFSS (false-positives). The YSP demonstrated a high sensitivity of 96.8%, a specificity of 78.9%, a positive predictive value of 88.2%, and a negative predictive value of 93.8% in identification of aspiration in this cohort. CONCLUSIONS: To date, no dedicated prospective studies have been conducted to assess the utility of the YSP as a screening tool for identifying aspiration risk in persons with moderate-to-severe TBI. The results of this study conclude that the YSP is an effective screening tool for prediction of aspiration in acute care patients with moderate-to-severe TBI due to its high sensitivity and negative predictive value. These factors aid in identification of individuals at risk for aspiration and facilitate timely interventions to prevent complications.