Transient median nerve palsy following ultrasound-guided subscapularis plane block: a case report

Abstract The subscapularis plane block is an effective approach to anesthetize axillary and upper subscapular nerves. There have been no reports regarding brachial plexus paralysis as a potential complication to date. Described here is a case of median nerve palsy following ultrasound-guided subscapularis plane block for awake frozen shoulder manipulation that was performed on a 52-year-old female diagnosed with adhesive capsulitis. The patient could not flex digits two and three, and ipsilateral inner palm numbness occurred shortly after the block commenced, with complete resolution in the next two hours. The local anesthetics spillage towards brachial plexus with possible partial paralysis should always be expected after subscapularis plane block.

Factors predisposing to post thyroidectomy vocal cord paralysis at Ospital ng Maynila Medical Center

Objective@#To determine the prevalence of vocal cord paralysis among post thyroidectomy patients based on severity and laterality, and explore possible associations with age, sex, diagnosis and type of thyroid lesion and surgical procedure.@*Methods@#Design: Cross-sectional study. Setting: Tertiary Government Training Hospital. Participants: Records of patients who underwent thyroidectomy under the Department of Otorhinolaryngology – Head and Neck Surgery of the Ospital ng Maynila Medical Center from January 1, 2014 to June 30, 2021. @*Results@#There were strong associations between the type of lesion and the presence of recurrent laryngeal nerve injury (V=.211, p=.001) and the diagnosis and the presence of RLNI (V=.245, p=.006). There were no significant associations between patient’s sex, age, diagnosis, type of thyroid lesion, surgical procedure with laterality and severity of RLNI. It was notable that all cases of bilateral recurrent laryngeal nerve injury were due to carcinoma only. Patients with malignant tumors were 2.8x (95% CI: 1.48-5.29) as likely to develop post surgical RLNI than those with benign tumors (p=.0015).@*Conclusion@#The factors that had a strong association with the presence of vocal cord paralysis among post-thyroidectomy patients were the diagnosis and type of thyroid lesion. Malignant thyroid lesions (specifically thyroid carcinoma) had a higher incidence of recurrent laryngeal nerve injury compared to benign thyroid lesions. More data from different institutions and including other predisposing factors may confirm our findings.

Isolated pupillary-sparing cranial nerve III palsy from a subgaleal abscess

@#Cranial nerve (CN) III palsy is rarely caused by intraorbital compression, let alone from a subgaleal abscess. We present a case of a hypertensive 55-year-old man with an acute isolated pupillary-sparing left CN III palsy from a left subgaleal abscess with associated pterional osteomyelitis and frontotemporal mass. This is the first reported such case and the third reported case of a chronic spontaneous subgaleal abscess. A seemingly routine case of an acute, pupillary-sparing, isolated CN III palsy from hypertension turned out to be a rare case in terms of etiology of the palsy and of the source of the abscess.

An alternative approach for blocking the superior trunk of the brachial plexus evaluated by a single arm clinical trial

Abstract Background Interscalene brachial plexus block is associated with phrenic nerve paralysis. The objective of this study was to evaluate an alternative approach to interscalene brachial plexus blocks in terms of efficacy, grade of motor and sensory blockade, and phrenic nerve blockade. Methods The study was prospective and interventional. The ten living patients studied were 18 to 65 years old, ASA physical status I or II, and submitted to correction of rotator cuff injury. A superior trunk blockade was performed at the superior trunk below the omohyoid muscle, without blocking the phrenic nerve. The needle was advanced below the prevertebral layer until contacting the superior trunk. In order to guarantee the correct positioning of the needle tip, an intracluster pattern of the spread was visualized. The block was performed with 5 mL of 0.5% bupivacaine in ten patients. In the six cadavers, 5 mL of methylene blue was injected. Diaphragmatic excursion was assessed by ultrasonography of the ipsilateral hemidiaphragm. In three patients, pulmonary ventilation was evaluated with impedance tomography. Pain scores and analgesic consumption were assessed in the recovery room for 6 hours after the blockade. Results In the six cadavers, methylene blue didn't reach the phrenic nerve. Ten patients underwent arthroscopic surgery, and no clinically phrenic nerve paralysis was observed. No patient reported pain during the first 6 hours. Conclusions This study suggests that this new superior trunk approach to block the superior trunk may be an alternative technique to promote analgesia for shoulder surgery in patients with impaired respiratory function.

Tiempo de evolución y eliminación de la diplopía binocular en pacientes con paresia o parálisis oculomotoras / Evolution Time and Elimination of Binocular Diplopia in Patients with Oculomotor Paresis or Paralysis

Objetivo: Determinar la relación existente entre tiempo de evolución y eliminación de la diplopía binocular en pacientes con paresia o parálisis oculomotoras. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo de una serie de casos que acudieron a la consulta del Servicio de Oftalmología Pediátrica del Instituto Cubano de Oftalmología Ramón Pando Ferrer y que cumplían con los criterios de inclusión en el periodo comprendido entre mayo del 2018 a junio del 2019. Se evaluaron las variables: sexo, tiempo de evolución, opciones de tratamiento, eliminación de diplopía, fusión y estereopsis. Resultados: El mayor número de casos acudieron a consulta entre una semana y menos de un mes de evolución de la enfermedad y más de seis meses. No resultó significativo la relación sexo, etiología y tiempo de evolución en acudir los pacientes a consulta externa. El 66,7 por ciento de la muestra estudiada resolvió solo con tratamiento médico, incluidos el 100 por ciento de los pacientes con menos de una semana de evolución. Todos los pacientes con tiempo de evolución menor de seis meses eliminaron la diplopía y se encontró diferencia estadística (p = 0,04) entre estas variables. El 76,7 por ciento logró fusión y el 56,7 por ciento estereopsis. Conclusiones: La mayor parte de los pacientes con tiempo de evolución menor de seis meses eliminaron la diplopía solo con tratamiento médico, incluidos el 100 por ciento de los pacientes con menos de una semana de evolución, observándose una relación entre la recuperación y la cronicidad de la diplopía(AU)

Objective: To determine the relationship between time of evolution and elimination of binocular diplopia in patients with oculomotor paresis or paralysis. Methods: A descriptive, longitudinal and prospective study was carried out, from May 2018 to June 2019, of a series of cases that were assisted in consultation of the Pediatric Ophthalmology Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology and that met the inclusion criteria. The variables evaluated were sex, evolution time, treatment options, elimination of diplopia, fusion and stereopsis. Results: The largest number of cases were assisted in consultation between one week and less than one month of evolution of the disease and more than six months. The relationship between sex, etiology and time of evolution in attending the outpatient clinic was not significant. 66.7 percent of the studied sample solved only with medical treatment, including 100 percent of patients with less than one week of evolution. All patients with evolution time of lesser than six months eliminated diplopia and a statistical difference was found (p = 0.04) between these variables. 76.7 percent achieved fusion and 56.7 percent stereopsis. Conclusions: Most of the patients with evolution time of lesser than six months eliminated diplopia only with medical treatment, including 100 percent of patients with less than one week of evolution, observing a relationship between recovery and chronicity of diplopia. Diplopia(AU)

Etiología y evolución de la diplopía binocular en pacientes con paresia o parálisis oculomotoras / Etiology and Course of Binocular Diplopia in Patients with Oculomotor Paresis or Paralysis

Objetivo: Determinar la etiología y evolución de la diplopía binocular en pacientes con paresia o parálisis oculomotoras. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo de una serie de casos que acudieron a la consulta del Servicio de Oftalmología Pediátrica del Instituto Cubano de Oftalmología Ramón Pando Ferrer y cumplían con los criterios de inclusión en el periodo comprendido entre mayo del 2018 a junio del 2019. Se evaluaron las variables: edad, sexo, factores de riesgo, etiología, opciones de tratamiento y eliminación de diplopía. Resultados: La edad media de la muestra estudiada fue de 56,8 años y predominó el sexo masculino (56,7 por ciento versus 43,3 por ciento). El factor de riesgo más frecuente fue el microvascular (86,7 por ciento), 14 pacientes con hipertensión arterial y 12 con diabetes mellitus. Predominó también la etiología microvascular en 18 pacientes de 30. El 66,7 por ciento de la muestra estudiada resolvió solo con tratamiento médico y el 86,7 por ciento de los casos eliminaron la diplopía en todas las posiciones diagnósticas de la mirada. Conclusiones: El nervio craneal más frecuente afectado es el sexto y prevaleció la etiología microvascular en el sexto y tercer nervio craneal, sin embargo, para el cuarto es la traumática la única causa encontrada, lo cual concuerdan con la literatura revisada(AU)

Objective: To determine the etiology and evolution of binocular diplopia in patients with oculomotor paresis or paralysis. Methods: A descriptive, longitudinal and prospective study was carried out, from May 2018 to June 2019, of a series of cases that were assisted in the consultation of the Pediatric Ophthalmology Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology and met the inclusion criteria. The variables evaluated were age, sex, risk factors, etiology, treatment options and elimination of diplopia. Results: The mean age of the studied sample was 56.8 years and the male sex predominated (56.7 percent versus 43.3 percent). The most frequent risk factor was microvascular (86.7 percent), fourteen patients with arterial hypertension and 12 with diabetes mellitus. Microvascular etiology also predominated in 18 patients out of 30. The medical treatment only solved 66.7 percent of the studied sample and 86.7 percent of cases eliminated diplopia in all diagnostic gaze positions. Conclusions: The most frequently affected cranial nerve is the sixth and microvascular etiology prevailed in the sixth and third cranial nerves, however, for the fourth traumatic is the only cause found, which is consistent with the literature reviewed(AU)

Diplopía binocular por paresia o parálisis oculomotoras: resultados de las opciones de tratamiento / Binocular Diplopia due to Oculomotor Paresis or Palsies: Outcomes of Treatment Options

Objetivo: Determinar resultados de las opciones de tratamiento para la diplopía binocular en pacientes con paresia o parálisis oculomotoras. Método: Se realizó un estudio descriptivo, longitudinal y prospectivo de una serie de casos que acudieron a la consulta del Servicio de Oftalmología Pediátrica del Instituto Cubano de Oftalmología Ramón Pando Ferrer. Se evaluaron las variables: edad, sexo, etiología, opciones de tratamiento, limitación de los movimientos oculares, eliminación de diplopía, fusión y estereopsis. Resultados: La etiología más frecuente fue la microvascular. El 66,7 por ciento de la muestra estudiada se resolvió solo con tratamiento médico, de ellos el 100,0 por ciento con diagnóstico de paresias o parálisis del tercer nervio craneal, seguido por el sexto y cuarto con 63,6 por ciento y 33,3 por ciento, respectivamente. Necesitaron tratamiento médico, quirúrgico y aplicación de toxina botulínica seis pacientes, el 33,3 por ciento del cuarto y el 22,7 por ciento del sexto nervio craneal. El resto de las opciones de tratamiento solo con un paciente. No se halló asociación significativa entre opciones de tratamiento y nervio craneal afectado. El 86,6 por ciento finalizó sin limitación de los movimientos oculares. El 86,7 por ciento de los casos eliminaron la diplopía en todas las posiciones diagnósticas de la mirada. El 76,7 por ciento logró fusión y el 56,7 por ciento estereopsis. Conclusiones: El tratamiento médico y el combinado de médico más inyección de toxina botulínica y cirugía de músculos extraoculares fueron las opciones más utilizadas y permitieron alineamiento ocular y eliminación de la diplopía binocular(AU)

Objective: To determine outcomes of treatment options for binocular diplopia in patients with oculomotor paresis or paralysis. Method: A descriptive, longitudinal and prospective study was carried out of a series of cases that were assisted at the consultation of the Pediatric Ophthalmology Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology. The variables evaluated were age, sex, etiology, treatment options, limitation of ocular movements, elimination of diplopia, fusion and stereopsis. Results: The microvascular etiology was the most frequent. 66.7 percent of the studied sample was resolved only with medical treatment, 100.0 percent of them had a diagnosis of paresis or paralysis of the third cranial nerve, followed by the sixth and fourth with 63.6 percent and 33.3 percent, respectively. Six patients required medical and surgical treatment and application of botulinum toxin, 33.3 percent of the fourth and 22.7 percent of the sixth cranial nerve. The rest of the treatment options with only one patient. No significant association was found between treatment options and affected cranial nerve. 86.6 percent finished without limitation of eye movements. 86.7 percent of cases eliminated diplopia in all diagnostic gaze positions. 76.7 percent achieved fusion and 56.7 percent stereopsis. Conclusions: Medical treatment and combined medical treatment plus botulinum toxin injection and extraocular muscle surgery were the most used options and allowed ocular alignment and elimination of binocular diplopia(AU)

Parálisis diafragmática asociada al bloqueo interescalénico en cirugía de hombro: la utilidad de la ecografía diafragmática como herramienta diagnóstica / Phrenic paresis associated with interscalene block in shoulder surgery. Utility of diaphragm ultrasound examination

Introducción: El bloqueo interescalénico se utiliza de forma estandarizada durante la cirugía mayor de hombro, sin embargo, ninguna técnica realizada por encima de la clavícula ha demostrado reducir la tasa de bloqueo del nervio frénico por debajo del 20%. El interés en buscar una prueba diagnóstica que permita identificar la afectación del nervio frénico ha ido en incremento en los últimos años y varias han sido las pruebas diagnósticas empleadas. El objetivo de este trabajo es evaluar la utilidad clínica del ultrasonido para identificar la parálisis hemidiafragmática posterior al bloqueo interescalénico para la cirugía de hombro.Materiales y métodos: estudio diagnóstico observacional prospectivo en treinta y tres pacientes programados para cirugía de hombro. Se les realizó una espirometría forzada y se evaluó el grosor del músculo diafragma. Estas determinaciones se realizaron antes y a los veinte minutos de realizar el bloqueo interescalénico.Resultados: el total de los pacientes estudiados (100%) presentó bloqueo del nervio frénico según uno o los dos métodos utilizados en este estudio para su diagnóstico. Todos los pacientes presentaron variaciones en la ratio del grosor diafragmático en el lado del bloqueo frénico por debajo de 1.2.Conclusión: la exploración ecográfica del diafragma es una gran herramienta para la examinación de una víscera cuya alteración implica graves trastornos en el paciente crítico, a su vez el índice del grosor diafragmático <1.2 puede ser de utilidad en el diagnóstico de paresia frénica asociada al bloqueo del plexo braquial a nivel interescalénico. Tipo de Estudio: Diagnóstico prospectivo. Nivel de Evidencia: II

Introduction: the interscalene block is used in a standardized way during major shoulder surgery, however, no technique performed above the clavicle has been shown to reduce the rate of phrenic nerve block below 20%. The interest for a diagnostic test to allows identifying the involvement of the phrenic nerve has been increasing in recent years and several diagnostic tests have been used. The purpose of this article is to evaluate the clinical utility of ultrasound to identify hemidiaphragmatic paralysis after interscalene block for shoulder surgery.Materials and methods: prospective observational diagnostic study in thirty-three patients scheduled for shoulder surgery. A forced spirometry was performed and the thickness of the diaphragm muscle was evaluated with ultrasound. These determinations were made before and twenty minutes after performing the interscalene block.Results: all the patients studied (100%) presented phrenic nerve block according to one or the two methods used in this study for its diagnosis. All patients presented variations in the diaphragm thickness ratio on the side of the phrenic block below 1.2.Conclusion: the ultrasound examination of the diaphragm is a great tool for the examination of a viscera whose alteration implies serious disorders in the critical patient, in turn, the diaphragm thickness index <1.2 can be useful in the diagnosis of phrenic paresis associated with interscalene brachial plexus block. Level of Evidence: II

Initial outcomes of endoscopic CO2 laser posterior cordectomy and partial arytenoidectomy among patients with bilateral vocal cord paralysis: A Case series

Objective@#To describe the initial outcomes of endoscopic CO2 laser posterior cordectomy and partial arytenoidectomy among patients with bilateral vocal cord paralysis in our institution.@*Methods@# Design: Case Series Setting: Tertiary National University Hospital Participants: 17 Patients @*Results@#Seventeen (17) patients who underwent transoral posterior cordectomy and partial arytenoidectomy using carbon dioxide laser were included in the study consisting of 14 females and 3 males. Iatrogenic injury was the most common cause of bilateral vocal cord paralysis in this subset of patients. Five patients who tolerated decannulation and another six who had no preoperative tracheostomy all reported subjective improvement in breathing. All of them were also observed to have resolution of stridor and increased respiratory comfort compared to their preoperative condition. The most common postoperative complication was granuloma formation at the medial arytenoidectomy site occurring only in 4 patients. None of the patients complained of aspiration episodes or dysphagia during the postoperative period. @*Conclusion@#Our initial experience with transoral endoscopic posterior cordectomy and partial arytenoidectomy using carbon dioxide laser has good postoperative outcomes among patients with bilateral vocal cord paralysis.

A inserção da realidade virtual aplicada na recuperação físico-funcional de membros superiores após acidente vascular encefálico: uma revisão sistemática / The insertion of virtual reality applied in the physical and functional recuperation of upper limbs after a stroke: a systematic review

Uma das principais causas de morte e limitação funcional em todo o mundo é o Acidente Vascular Encefálico (AVE), causando alterações significativas sobre as atividades de vida diária do indivíduo. O AVE ocorre a partir de comprometimentos vasculares, ocasionando danos cognitivos e musculares, sendo necessário o tratamento fisioterapêutico para a recuperação da função. A realidade virtual se tornou uma aliada da fisioterapia para a recuperação de pacientes pós-AVE, como forma de tornar o tratamento mais interativo e atraente para o paciente. O presente estudo teve como objetivo verificar a eficácia do uso da realidade virtual na recuperação funcional dos membros superiores em pacientes com sequelas de AVE, por meio de uma revisão sistemática. Os estudos utilizados foram buscados em duas bases de dados, onde aqueles selecionados deveriam obedecer aos critérios de inclusão e exclusão pré-determinados. Os resultados obtidos mostraram que a realidade virtual em conjunto com a fisioterapia pode proporcionar resultados significantes para a melhora funcional do membro superior afetado, o que acarreta melhora e bem estar geral do paciente. (AU)

One of the main causes of death and functional limitation worldwide is the stroke, causing significant changes in the individual's daily activities. Stroke occurs from vascular impairments, causing cognitive and muscle damage, requiring physiotherapeutic treatment to recover function. Virtual reality has become a complement of physiotherapy for the recovery of post-stroke patients, with a way of making treatment more interactive and attractive to the patient. The present study aimed to verify the effectiveness of the use of virtual reality in the functional recovery of the upper limbs in patients with stroke sequelae, through a systematic review. The studies used were searched on two scientific bases, where those selected should obey the predetermined inclusion and exclusion criteria. The results obtained showed that virtual reality in conjunction with physical therapy can provide significant results for the functional improvement of the upper limb affected, which leads to improvement and general well-being of the patient. (AU)

La enfermedad neurológica de Leonardo da Vinci / The neurological disease of Leonardo da Vinci

Introducción: el año 2019 se conmemoraron los 500 años de la muerte de Leonardo da Vinci en el Chateux du Cloux, Francia. Según registros históricos, Leonardo vivió los últimos años de su vida con una parálisis en su mano derecha, atribuida a un probable accidente cerebrovascular (ACV), lo cual afectó a su capacidad para emprender nuevos proyectos pictóricos. Este trabajo describe como fueron los últimos años de vida de Leonardo, revisa los antecedentes sobre salud y su probable enfermedad neurológica, sus eventuales etio-logías y sus consecuencias. Desarrollo: Leonardo llegó a Francia en 1516 por invitación del rey Francisco I para llevar el Renacimiento y completar su formación personal. En 1517 es visitado por el cardenal Luis de Aragón, y su secretario registra en su diario que Leonardo se encuentra afectado de una parálisis de la mano derecha. Algunos autores sugieren un ACV como causa probable, sobretodo porque según el historiador Vasari, Leonardo vivió sus últimos años en condición de discapacidad. Se llega a plantear que su condición de vege-tariano habría podido influir como factor de riesgo de ACV. Sin embargo, un dibujo no fechado de Figino muestra a Leonardo con una parálisis de tipo periférica de la mano derecha, abriendo el diagnóstico diferencial. Conclusiones: no hay información suficiente para valorar el tipo y la causa de enfermedad neurológica de Leonardo da Vinci, no obstante, está influyó significativamente en su interacción con su discípulo Francisco Melzi y su mecenas Francisco I, hecho que contribuyó a que su legado perdure hasta hoy.

Introduction: the year2019 marked the 500th anniversary of the death of Leonardo da Vinci at the Chateau du Cloux, France. According to historical records, Leonardo lived the last years of his life with palsy on his right hand, attributed to a probable stroke, which affected his ability to undertake new pictorial projects. This study describes how were the last years of Leonardo's life, reviews his medical history and his probable neurological disease, with its possible etiologies and its consequences. Discussion: Leonardo arrived in France in 1516 invited by King Francis I to lead the Renaissance and complete his education. In 1517, cardinal Luis de Aragón visited Leonardo, and his secretary recorded in his diary that he was affected by a palsy on his right hand. Some authors suggest that stroke could have been a probable cause, especially because according to the historian Vasari, Leonardo lived his last years in a condition of disability. His vegetarian food habit could have been a risk factor for his suspected stroke. However, an undated drawing by Figino shows Leonardo with a peripheral nerve palsy on his right hand, opening up the differential diagnosis. Conclusions:there is not enough information to assess the type and cause of Leonardo da Vinci's neurological disease. However, this condition significantly affected his interaction with his discipleFrancisco Melzi and his patron Francisco I, a fact that contributed to his legacy enduring until today.

Hipertensión intracraneal idiopática asociada a nitrofurantoína. Caso clínico / Idiopathic intracranial hypertension associated with nitrofurantoin. Case report

Resumen Introducción: La Hipertensión Intracraneal Idiopática (HICI) es un síndrome neurológico caracterizado por un aumento de la presión intracraneal en ausencia de lesión estructural o hidrocefalia. Los síntomas incluyen cefalea, tinnitus pulsátil, oscurecimientos visuales transitorios y pérdida visual. Dentro de los signos destacan diplopía por parálisis del VI par, edema de papila y disminución de la agudeza visual. Los pacientes no tienen compromiso de conciencia ni signos neurológicos focales. La principal complicación es la pérdida visual que puede ser irreversible. La asociación entre HICI y nitrofurantoína (NTF) se reportó en 1974. Caso clínico: Mujer de 42 años, con sobrepeso, que desarrolló una HICI aproximadamente 18 meses posterior al inicio de nitrofurantoína profiláctica. Consultó por cefalea frontal, opresiva que aumentaba con la maniobra de Valsalva, asociada a disminución fluctuante de la agudeza visual y episodios de oscurecimiento. Al examen destacó edema de papila bilateral, sin déficit neurológico focal. La presión del líquido cefalorraquídeo (LCR) fue de 25,5 cm de agua. La resonancia magnética mostró signos de aumento de la presión del LCR, sin lesiones estructurales ni hidrocefalia. El cuadro se recuperó concomitantemente a la suspensión de la NTF y el uso de topiramato. No se constató daño visual permanente. Conclusiones: Se debe sospechar la HICI en mujeres en edad fértil con sobrepeso. Dentro de los gatillantes del síndrome destacan varios fármacos, entre ellos la NTF. El principal objetivo del tratamiento de la HICI es preservar la función visual.

Abstract Introduction: Idiopathic intracranial hypertension (IIH) is a syndrome characterized by increased intracranial pressure without a space occupying lesion or hydrocephalus. The symptoms are headache, pulsatile tinnitus, transient visual obscurations, and visual loss. Signs are diplopia caused by sixth cranial nerve paresis and papilledema with its associated loss of sensory visual function. The patient maintains an alert and oriented mental state, but has no localizing neurologic findings. The only major morbidity with IIH is visual loss. The association between IIH and nitrofurantoin was reported in 1974. Case: A 42 years old female, overweighed, who developed IIH 18 months after the start of prophylactic nitrofurantoin. She had frontal oppressive headache that increased with the Valsalva maneuver, fluctuant visual loss and transient visual obscurations. She had bilateral papilledema without localizing neurologic findings. The cerebrospinal fluid (CSF) pressure was 25.5 cm H2O. Magnetic resonance imaging showed signs of increased CSF pressure without structural lesions or hydrocephalus. IIH recovered with the withdrawal of nitrofurantoin and the use of topiramate. There was not permanent visual loss. Conclusions: It is recommendable to suspect IIH in obese women in the childbearing years. There are several drugs associated with IIH including nitrofurantoin. The main objective of treatment is to prevent visual loss.

Melkersson-rosenthal: reporte de caso clínico de una neurodermatosis infrecuente / Melkersson-rosenthal syndrome: case report of an uncommon neurodermatosis

Resumen: El síndrome de Melkersson-Rosenthal (SMR) es una entidad clínica rara, de patogénesis desconocida. Se manifiesta característicamente por edema orofacial recidivante, lengua fisurada y parálisis recurrente del nervio facial. Representando así undesafío diagnóstico y terapéutico, además de generar importante compromiso social al individuo acometido. El presente artículo tiene como objetivo describir el caso de un paciente de 15años de edad que presentó: edema labial, lengua fisurada y queilitis granulomatosa al examen histopatológico, llevándose a consideración la hipótesis del síndrome citado, con resultados satisfactorios al tratamiento establecido.

Abstract: Melkersson-Rosenthal syndrome (MRS) is a rare clinical entity with an unknown pathogenesis. It clinically manifests in orofacial edema, plicated tongue and recurrent paralysis of the facial nerve. It represents a diagnostic and therapeutic challenge, and has an important psycosocial impact on the affected individual. This study describes the case of a 15-year-old patient who presented with labial edema, plicated tongue and granulomatous cheilitis on histopathological examination, for which a diagnosis of MRS was proposed. The patient showed a good response to treatment.

Análisis de las notificaciones obligatorias de las parálisis flácidas en el hospital clínico Herminda Martín en el periodo enero 2016 - diciembre 2018 / Analysis of the mandatory notifications of flaccid paralysis at the hospital clínico Herminda Martín in the period january 2016 - december 2018

Introducción: El síndrome de parálisis flácida (PFA) corresponde a la debilidad muscular de inicio brusco y progresión rápida, que comienza por las extremidades y puede llegar a comprometer los músculos de la respiración y/o estructuras anatómicas dependientes del tronco encefálico en un lapso de 1 a 10 días. Este síndrome debe ser notificado de forma inmediata al momento de la sospecha a la Autoridad Sanitaria Regional. Materiales y métodos: Se realizó un estudio observacional descriptivo, de cohorte transversal, para evaluar si los pacientes hospitalizados mayores de 15 años por sospecha de PFA en el Hospital Clínico Herminda Martin fueron oportunamente notificados a la Secretaria Regional Ministerial de salud. Luego se calculó el porcentaje de casos notificados con respecto al total de casos de sospecha, considerando estos como el 100%, aplicando una regla de tres simple para la determinación. Para la realización del estudio se utilizaron tablas de recolección de datos. Resultados: De un total de 82 pacientes analizados, 35 de estos cumplen con los criterios de inclusión y solo 11 pacientes fueron notificados, siendo uno notificado correctamente. Un total de 4 pacientes ingresados con la Clasificación Internacional de Enfermedades °10 (CIE-10) correspondiente no fue analizado por falta de información y 5 de los pacientes notificados no se obtuvo información sobre sus fichas clínicas. Discusión: El 31.42% de los pacientes con sospecha de PFA fueron notificados. Esto evidencia la urgencia de la regularización en el proceso de notificación obligatoria en este síndrome en particular, que localmente esta subnotificado. Durante el análisis de los datos, la mayor limitación fue la escasa información actualizada relevante para este estudio

Introduction: Acute flaccid paralysis syndrome (AFP) is characterized by a rapid onset weakness, that begins on the limbs and can include respiratory muscle and/or anatomic structures that depend on the brainstem in a period of time of 1 to 10 days. This syndrome must be notified immediately as soon as it is suspected to the Regional Sanitary Authority. Material and Methods: A descriptive, cross-sectional cohort observational study was performed to evaluate if hospitalized patients that were 15 years old or more for PFA in the Hospital Clínico Herminda Martin were duly notified to the "Secretaria Regional Ministerial de salud". Then the percentage of notified patients in comparison to suspected patients was calculated, considering this as the 100% to apply a simple rule of three to obtain the percentage. To elaborate the Investigation, records of data collection were used. Results: From a total of 82 patients analyzed, 35 of them met the inclusion criteria but only 11 of them were notified, being only 1 correctly notified. A total of 4 patients that were admitted with the corresponding "Clasificación Internacional de Enfermedades-10, were not analyzed because of lack of information and it was not obtained from the information from clinical records of 5 of the notified patients. Discussion: 31,42% of the AFP suspected patients were notified. This shows the urgency of regulating the process of obligatory notification for this particular syndrome, that are locally sub notified. During the analysis of the database, the major limitation was the little relevant and actualized information for this study.

Acute Vertical Pendular Nystagmus and Delayed Oculopalatal Tremor in a Patient with Bilateral Horizontal Gaze Palsy

No abstract available.

Surgical treatment of thoracolumbar fracture with incomplete lower limb paralysis in a patient with COVID-19 / 中华创伤杂志(英文版)

Since December 2019, COVID-19, an acute infectious disease, has gradually become a global threat. We report a case of thoracolumbar fractures (T and L) and incomplete lower limb paralysis in a patient with COVID-19. After a series of conservative treatment which did not work at all, posterior open reduction and pedicle screw internal fixation of the thoracolumbar fracture were performed in Wuhan Union Hospital. Three weeks later, the patient could stand up and the pneumonia is almost cured. We successfully performed a surgery in a COVID-19 patient, and to our knowledge it is the first operation for a COVID-19 patient ever reported.

Parálisis fláccida aguda por enterovirus con resolución completa del cuadro neurológico. A propósito de un caso pediátrico / Acute flaccid paralysis related to enterovirus with complete resolution of the neurological symptoms. A pediatric case report

Desde la eliminación de la circulación del virus polio salvaje, disminuyeron los casos de parálisis fláccida aguda. Sin embargo, continúan ocurriendo casos asociados a otros enterovirus no polio y virus neurotropos. Se presenta el caso de una paciente de 9 años con diagnóstico de meningitis y mielitis con compromiso motor en los miembros inferiores y vejiga neurogénica asociado a enterovirus, con resolución completa del cuadro neurológico posterior a la administración de gammaglobulina hiperinmune.

Since the wild poliovirus no longer circulates, the number of cases of acute flaccid paralysis decreased. However, cases related to non-polio enteroviruses and neurotrope viruses continue to occur. We present a nine-year-old patient with meningitis and myelitis with motor involvement in the lower limbs and neurogenic bladder associated with enterovirus, with complete resolution of the neurological symptoms following the administration of hyperimmune gammaglobulin.