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1.
Ann Otol Rhinol Laryngol ; 129(9): 849-855, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32312092

RESUMO

OBJECTIVE: Hemi-laryngopharyngeal spasm (HeLPS) has recently been described in the neurosurgical literature as a cause of intermittent laryngopharyngeal spasm and cough due to vascular compression of the vagus nerve at the cerebellopontine angle. We present the diagnostic criteria for this syndrome. METHODS: A retrospective chart review of six patients with HeLPS and three patients misdiagnosed with this condition are presented. All patients were diagnosed and treated at a tertiary care academic centre from July 2013 to July 2017. RESULTS: Patients with HeLPS had five defining characteristics: 1) All patients had symptoms of episodic laryngopharyngeal spasm and coughing. Patients were asymptomatic between episodes and were refractory to speech therapy and reflux management. 2) Laryngoscopy showed hyperactive twitching of the ipsilateral vocal fold in two of the six patients. No other inter-episodic abnormalities were seen. 3) Botulinum toxin A injections into the thyroarytenoid muscle on the affected ipsilateral side reduced laryngopharyngeal spasms. Botulinum toxin injection in the contralateral thyroarytenoid muscle did not improve laryngopharyngeal spasm. 4) Magnetic resonance imaging revealed ipsilateral neurovascular compression of the vagus nerve rootlets by the posterior inferior cerebellar artery. 5) Microvascular decompression (MVD) surgery of the ipsilateral vagus nerve resolved all symptoms (follow-up 2-4 years). CONCLUSION: The diagnostic criteria for hemi-laryngopharyngeal spasm (HeLPS) are proposed. Otolaryngology recognition of this new clinical entity may lead to a surgical cure and avoid the unnecessary therapies associated with misdiagnosis. LEVEL OF EVIDENCE: 4.


Assuntos
Laringismo/diagnóstico , Doenças Faríngeas/diagnóstico , Espasmo/diagnóstico , Adulto , Idoso , Feminino , Humanos , Laringoscopia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síndrome
3.
BMC Med Genet ; 21(1): 47, 2020 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-32131761

RESUMO

BACKGROUND: Choreoacanthocytosis (ChAc), is a rare neurodegenerative disease, characterized by movement disorders and acanthocytosis in the peripheral blood smears, and various neurological, neuropsychiatric and neuromuscular signs. It is caused by mutations in VPS13A gene with autosomal recessive pattern of inheritance. CASE PRESENTATION: Here we report two patients belonging to a consanguineous Moroccan family who present with movement disorder pathology. They were suspected to have choreoacanthocytosis according to biological, clinical and radiological finding. Thus, whole-exome sequencing was performed for precise diagnosis and identified a homozygous novel nonsense mutation c.337C > T (p.Gln113*) in exon 5 of VPS13A in the two affected siblings. CONCLUSION: Here, we report a novel nonsense p.Gln113* mutation in VPS13A identified by whole-exome sequencing, which caused ChAc in a Moroccan family. This is the first description of ChAc in Morocco with genetic confirmation, that expands the mutation diversity of VPS13A and provide clinical, neuroimaging and deep brain stimulation findings.


Assuntos
Neuroacantocitose/genética , Polimorfismo de Nucleotídeo Único , Proteínas de Transporte Vesicular/genética , Adulto , Códon sem Sentido , Consanguinidade , Feminino , Humanos , Marrocos , Neuroacantocitose/patologia , Linhagem , Convulsões/complicações , Convulsões/genética , Irmãos , Espasmo/complicações , Espasmo/genética
4.
Zhonghua Nei Ke Za Zhi ; 59(3): 253-256, 2020 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-32146759

RESUMO

Diarrhea is a common digestive symptom. Here, we reported a case of young patient admitted with diarrhea caused by lead poisoning and cytomegalovirus infection. Through informative medical history and multi-disciplinary team discussion, Satoyoshi syndrome was finally diagnosed.


Assuntos
Alopecia/diagnóstico , Osso e Ossos/anormalidades , Diarreia/diagnóstico , Espasmo/diagnóstico , Infecções por Citomegalovirus , Humanos , Intoxicação por Chumbo
5.
J Craniofac Surg ; 31(2): e205-e208, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31977713

RESUMO

Parry-Romberg syndrome is a rare craniofacial disorder characterized by progressive hemifacial atrophy with systematic manifestations. The combination with hemimasticatory spasm is rare, with only 9 patients reported before. In this study, a study of a young male patient with Parry-Romberg syndrome and hemimasticatory spasm on his left side was presented. Radiologic examinations showed severe atrophy limited to subcutaneous tissue and electromyography demonstrated as hemimasticatory spasm. Injection of botulinum toxin type A was applied for the treatment of hemimasticatory spasm and after 2 separated injections, the patient was significantly relieved from symptom. The theory of focal demyelination of the trigeminal nerve peripheral brunches is the possible link between hemifacial atrophy and hemimasticatory spasm, although the pathogenesis of both diseases requires further study and current therapeutic methods are still limited to symptomatic treatments. Injection of botulinum toxin type A is an effective way to treat hemimasticatory spasm and autologous fat transplant is a promising solution to correct facial asymmetry.


Assuntos
Hemiatrofia Facial/cirurgia , Espasmo/cirurgia , Adulto , Toxinas Botulínicas Tipo A/uso terapêutico , Eletromiografia , Hemiatrofia Facial/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Espasmo/diagnóstico por imagem
6.
Zhongguo Zhen Jiu ; 40(1): 21-5, 2020 Jan 12.
Artigo em Chinês | MEDLINE | ID: mdl-31930894

RESUMO

OBJECTIVE: To compare the differences in the clinical effect on post-stroke hand spasm among the combined treatment of penetrating acupuncture and kinesiotherapy, the simple application of penetrating acupuncture and the simple application of kinesiotherapy. METHODS: A total of 105 patients with post-stroke hand spasm were randomized into a penetrating acupuncture group, a kinesiotherapy group and a combined treatment group, 35 cases in each one, of which, 2 cases were dropped out in either the combined treatment group and the penetrating acupuncture group, and 1 case dropped out in the kinesiotherapy group. The routine rehabilitation training, e.g. occupational therapy and Bobath exercise and medication were adopted in all of the three groups. In the penetrating acupuncture group, the penetrating needling technique was exerted from Hegu (LI 4) to Houxi (SI 3) and from Waiguan (TE 5) to Sidu (TE 9) on the affected side. In the kinesiotherapy group, the persistent movement or passive movement was exerted on the wrist joint, the metacarpophalangeal joints and the interphalangeal joints. In the combined treatment group, the penetrating acupuncture (the same as the penetrating acupuncture group) was exerted combined with kinesiotherapy (the same as the kinesiotherapy group). In each group, the treatment was given once a day, 30 min in each time, 6 treatments a week in total, with the interval of 1 day between the courses. The treatment for 2 weeks was as one course and 2 courses were required totally. Before and after treatment, the scores of hand spasm index, hand-wrist motor function and the activity of daily living (ADL) were compared in each group. RESULTS: After treatment, the scores of hand spasm index were reduced as compared with those before treatment in each group (P<0.05) and the scores of hand-wrist motor function and ADL were increased significantly as compared with those before treatment in each group (P<0.05). After treatment, the reducing degree of the score of hand spasm index in the combined treatment group was greater than the penetrating acupuncture group and the kinesiotherapy group (P<0.01), and the increasing degree of the scores of hand-wrist motor function and ADL were higher than either the penetrating acupuncture group or the kinesiotherapy group (P<0.01). The improvements in each index were not different statistically between the kinesiotherapy group and the penetrating acupuncture group (P>0.05). CONCLUSION: Compared with the simple application of either penetrating acupuncture or kinesiotherapy, the combined treatment of them achieves the significant improvements in hand spasm degree, hand wrist motor function and ADL in patients with stroke.


Assuntos
Terapia por Acupuntura , Espasmo/terapia , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Pontos de Acupuntura , Humanos , Cinese , Espasmo/etiologia , Acidente Vascular Cerebral/complicações , Resultado do Tratamento
7.
World Neurosurg ; 136: 136-139, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31954899

RESUMO

BACKGROUND: Encephalopathy is reported to have affected 250,000 people in the United States over the last decade, with considerable morbidity and mortality. Baclofen, a gamma-aminobutyric acid-B agonist that acts on the central nervous system, is the drug most widely used to treat spasticity. Baclofen overdose is a potentially deadly condition that can cause encephalopathy and can result from multiple etiologies. Renal disease can contribute to baclofen overdose and encephalopathy, and there are currently no dosing recommendations for patient's on baclofen with renal impairment. CASE DESCRIPTION: We report an unusual case of a man aged 35 years who presented with persistent fevers, seizures, and normal mentation. The patient presented with intrathecal baclofen use and prior exposure to West Nile Virus. He developed acute kidney injury at hospital secondary to vancomycin use, and mental status declined. CONCLUSIONS: This case highlights that patients with baclofen overdose can initially appear to have serious brain injury, however, full patient recovery can occur in <72 hours. This case provides additional insight into the guidelines for the treatment and management for unknown cause encephalopathy. This case also highlights the link between renal disease, baclofen, and encephalopathy through a review of the literature.


Assuntos
Baclofeno/efeitos adversos , Encefalopatias/induzido quimicamente , Agonistas dos Receptores de GABA-B/efeitos adversos , Espasmo/tratamento farmacológico , Lesão Renal Aguda/induzido quimicamente , Adulto , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Baclofeno/administração & dosagem , Encefalopatias/complicações , Encefalopatias/fisiopatologia , Eletroencefalografia , Febre/etiologia , Febre/fisiopatologia , Agonistas dos Receptores de GABA-B/administração & dosagem , Humanos , Bombas de Infusão Implantáveis , Infusão Espinal , Masculino , Meropeném/uso terapêutico , Paraplegia/complicações , Convulsões/etiologia , Convulsões/fisiopatologia , Espasmo/etiologia , Traumatismos da Medula Espinal/complicações , Vancomicina/efeitos adversos
8.
World Neurosurg ; 136: e593-e600, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31958588

RESUMO

BACKGROUND: Despite the proven benefit of transradial access over transfemoral access in cardiac procedures, the transition for cerebrovascular procedures has only been slowly enforced. We present our experience with transradial access in cerebral diagnostic angiographies and neurointerventional procedures. METHODS: We performed a retrospective analysis of patients who underwent transradial access for cerebrovascular procedures in 3 German centers between February 2017 and May 2019. Demographics, technical features, and complications were evaluated. RESULTS: Transradial access was successful in 40/45 endovascular procedures (89%). Selected catheterization of the intended vessels was obtained in 95% of cases (40/42). The rate of procedure-related vascular complications was 2% (1/45). CONCLUSIONS: In this small retrospective series, transradial access proved to be safe and efficient. In the future, it is planned to further promote it as a standard access alternative for more patients.


Assuntos
Angiografia Cerebral/métodos , Procedimentos Endovasculares/métodos , Procedimentos Neurocirúrgicos/métodos , Artéria Radial , Adolescente , Idoso , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/etiologia , Angiografia Cerebral/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Segurança do Paciente , Estudos Retrospectivos , Espasmo/etiologia
9.
Acta Neurochir Suppl ; 127: 127-138, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31407073

RESUMO

BACKGROUND: Because treatments for cerebral arterial spasm-a delayed consequence of subarachnoid hemorrhage (SAH)-are clinically inconsistent, we describe here a new method for reversal of arterial spasm, possibly extensible to nitric oxide (NO)-sensitive microvasculature. METHODS: We subjected dogs to the intracisternal double-hemorrhage model of SAH (autologous blood injection on days 1 and 3) and began endovascular treatment of the spasmed basilar artery (BA) on Day 4. A conical-tip fused silica optical fiber was introduced via a microcatheter (inserted femorally) into the proximal vicinity of the spasmed BA. After local saline flushing of blood, an ultraviolet (UV) pulsed laser beam (355 nm Nd:YAG) was focused into the optical fiber and converted into a concentric ring beam, which facilitated endovascular irradiation for 30 s at intensities of 12-20 W/cm2. BA diameters were measured angiographically using a semiautomated routine over the entire BA length as well as the proximal, medial, and distal segments. RESULTS: On Day 4 the BAs had constricted by 21 ± 11%. After UV laser irradiation on Day 4, the constricted BAs dilated to 93 ± 15% of their normal diameters within minutes, and the dilation (91 ± 12%) persisted on Day 5. Most BA segments recovered to their respective baselines after UV irradiation, even when the UV beam was located considerably proximal to the BA origin. At days 4 and 5, the percent BA dilation normalized to Day 4 pre-treatment decreased linearly (by scatter plot, p < 0.02) over a range of about 60 mm from the UV irradiation site. CONCLUSIONS: We conjecture that the vasodilator nitric oxide, produced at high local concentration from its vascular storage forms (chiefly nitrites) by UV laser-induced photoscission, stimulates a wave of arterial dilation, possibly by longitudinal propagation of transnitrosation reactions in the arterial wall, which reverses cerebral vasospasm semi-locally and thus avoids the deleterious effects of systemic treatment.


Assuntos
Terapia a Laser , Hemorragia Subaracnóidea , Vasoespasmo Intracraniano , Animais , Artéria Basilar , Cães , Espasmo , Hemorragia Subaracnóidea/complicações , Raios Ultravioleta , Vasoconstrição , Vasoespasmo Intracraniano/etnologia , Vasoespasmo Intracraniano/terapia
10.
Arq Bras Cardiol ; 113(5): 960-968, 2019 11.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31800721

RESUMO

BACKGROUND: Coronary angiography with two catheters is the traditional strategy for diagnostic coronary procedures. TIG I catheter permits to cannulate both coronary arteries, avoiding exchanging catheters during coronary angiography by transradial access. OBJECTIVE: The aim of this study is to evaluate the impact of one-catheter strategy, by avoiding catheter exchange, on coronary catheterization performance and economic costs. METHODS: Transradial coronary diagnostic procedures conducted from January 2013 to June 2017 were collected. One-catheter strategy (TIG I catheter) and two-catheter strategy (left and right Judkins catheters) were compared. The volume of iodinated contrast administered was the primary endpoint. Secondary endpoints included radial spasm, procedural duration (fluoroscopy time) and exposure to ionizing radiation (dose-area product and air kerma). Direct economic costs were also evaluated. For statistical analyses, two-tailed p-values < 0.05 were considered statistically significant. RESULTS: From a total of 1,953 procedures in 1,829 patients, 252 procedures were assigned to one-catheter strategy and 1,701 procedures to two-catheter strategy. There were no differences in baseline characteristics between the groups. One-catheter strategy required less iodinated contrast [primary endpoint; (60-105)-mL vs. 92 (64-120)-mL; p < 0.001] than the two-catheter strategy. Also, the one-catheter group presented less radial spasm (5.2% vs. 9.3%, p = 0.022) and shorter fluoroscopy time [3.9 (2.2-8.0)-min vs. 4.8 (2.9-8.3)-min, p = 0.001] and saved costs [149 (140-160)-€/procedure vs. 171 (160-183)-€/procedure; p < 0.001]. No differences in dose-area product and air kerma were detected between the groups. CONCLUSIONS: One-catheter strategy, with TIG I catheter, improves coronary catheterization performance and reduces economic costs compared to traditional two-catheter strategy in patients referred for coronary angiography.


Assuntos
Cateteres Cardíacos/economia , Angiografia Coronária/métodos , Idoso , Cateterismo Cardíaco/economia , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/métodos , Meios de Contraste , Angiografia Coronária/economia , Angiografia Coronária/instrumentação , Redução de Custos/economia , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico por imagem , Artéria Radial/diagnóstico por imagem , Doses de Radiação , Radiação Ionizante , Estudos Retrospectivos , Espasmo , Fatores de Tempo
11.
Zhongguo Zhen Jiu ; 39(12): 1335-8, 2019 Dec 12.
Artigo em Chinês | MEDLINE | ID: mdl-31820611

RESUMO

The filiform needling technique is an important factor affecting the acupoint effect, and it is the key to option the needling technique corresponding to the disease so that the clinical curative effect can be improved. This paper systematically reviews the application of kinetic needling in the treatment of spasm, in order to provide some theoretical basis for the optimal acupuncture regimen of spasm. By summarizing and analyzing the similarities and differences of acupoint selection principle, needling characteristics, stimulation range, stimulation amount and indications in the treatment of spasm, it is found that kinetic needling emphasizes the effective combination of acupuncture and kinesis, which is an effective mean of treating spasm.


Assuntos
Pontos de Acupuntura , Humanos , Espasmo , Procedimentos Cirúrgicos Vasculares
13.
Neurol Res ; 41(12): 1075-1082, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31591945

RESUMO

Objectives: To explore the role of mTOR signaling pathway in modulating epileptogenesis in an N-methyl-D-aspartic acid (NMDA)-induced infant spasm (IS) rat model. Methods: After inducing IS successfully, the phosphorylation status of PI3K, Akt, mTOR and S6K of brain and hippocampus tissues was assessed using western blot and immunochemistry analysis, respectively. The possible mechanism of mTOR signaling pathway was evaluated by the, inhibitors for mTOR and PI3K, rapamycin and wortmannin, respectively. The inhibitors were injected into the intraperitoneal space of the rats to examine the effects of PI3K and mTOR in IS rat model. Results: The phosphorylated levels of mTOR and PI3K in hippocampus increased significantly (P < 0.05) 7 days after IS induction in rats. After administration of wortmannin, the phosphorylated levels of PI3K and mTOR decreased. However, only the phosphorylated level of mTOR decreased obviously after rapamycin administration. No obvious neurogenesis was found after IS induction. Discussion: Results of the present study suggest that hippocampal PI3K may be another potential target for IS treatment.


Assuntos
Hipocampo/enzimologia , Fosfatidilinositol 3-Quinase/metabolismo , Espasmo/enzimologia , Serina-Treonina Quinases TOR/metabolismo , Animais , Morte Celular , Modelos Animais de Doenças , Feminino , Hipocampo/efeitos dos fármacos , Hipocampo/patologia , N-Metilaspartato/administração & dosagem , Fosforilação , Inibidores de Proteínas Quinases/administração & dosagem , Ratos Sprague-Dawley , Transdução de Sinais , Sirolimo/administração & dosagem , Espasmo/induzido quimicamente , Espasmo/patologia , Wortmanina/administração & dosagem
14.
Kyobu Geka ; 72(11): 919-922, 2019 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-31588109

RESUMO

Coronary artery spasm after coronary artery bypass grafting(CABG) is rare and often fatal. There is no established treatment for perioperative coronary spasm because of the rare and not fully understood complications. We report a 67-year-old male, who experienced perioperative spasm of native coronary arteries and the left thoracic artery graft following CABG. Several transcatheter intracoronary injections of isosorbide sulfate failed to relieve the spasm completely. After 5 days' circulatory support with intra-aortic balloon pumping, the cardiac function improved and the patient recovered. Echocardiography performed before discharge showed decreased left ventricular systolic function with apical akinesis. Postoperative coronary angiography revealed 4 of the 5 grafts were patent.


Assuntos
Vasoespasmo Coronário , Vasos Coronários , Idoso , Angiografia Coronária , Ponte de Artéria Coronária , Humanos , Masculino , Espasmo
15.
J Anesth Hist ; 5(3): 65-84, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31570201

RESUMO

BACKGROUND: New therapies are created to address specific problems and enjoy popularity as they enter widespread clinical use. Broader use can reveal unknown adverse effects and impact the life cycle significantly. Succinylcholine, a depolarizing neuromuscular blocker, was the product of decades of research surrounding the ancient compound, curare. It was introduced into practice in the 1950s by Burroughs Wellcome and Company (BW Co) and was welcomed due to its rapidly acting muscle relaxation effects. Global clinical use revealed adverse effects, both minor and major, in particular, hyperkalemia and malignant hyperthermia. We investigated when practitioners and the manufacturer became aware of these adverse effects, how information about these side effects was disseminated, and whether the manufacturer met the regulatory requirements of the time, specifically regarding the timely reporting of adverse effects. SOURCES: Primary literature search using online and archived documents was conducted at the Wood Library-Museum of Anesthesiology, Schaumburg, IL. We consulted documents submitted by BW Co to federal authorities, through the Freedom of Information Act (FOIA), Food and Drug Administration (FDA) reports, promotional advertisements, package inserts, published articles, and textbooks. RESULTS: Initial clinical testing in humans in 1952 found no adverse effects on cardiovascular or respiratory systems. Fasciculations and myalgia were early side effects described in case reports in 1952. Large-scale clinical trials in 1953 found abnormally long recovery times among some patients; the discovery of abnormal pseudocholinesterase enzyme activity was not fully demonstrated until the early 1960s. Bradycardia was first reported in 1957 in children, and in 1959 in adults. In 1960, animal studies reported a transient increase in plasma potassium; further experiments in 1969 clearly demonstrated succinylcholine-induced hyperkalemia in burn patients. Malignant hyperthermia was first described in 1966. Similar cases of elevated temperatures and muscle rigidity were described globally but the underlying mechanism was not elucidated until the 1990s. Standard anesthesia textbooks did not report major side effects of succinylcholine until 1960 and included newly documented side effects with each edition. BW Co's packaging contained warnings as early as the 1950s but were later updated in 1962 and beyond to reflect the newly discovered hyperkalemia and malignant hyperthermia. CONCLUSION: Particularly given the regulatory environment of the time, BW Co appropriately reported the adverse effects of succinylcholine after market entry; it updated promotional and packaging material in a timely manner to reflect newly discovered adverse effects. The toxicity, though alarming and put clinicians on alert, did not seem to heavily impact succinylcholine's use, given its various desirable properties. It is still a choice muscle relaxant used today, although there are efforts to develop superior agents to replace succinylcholine.


Assuntos
Fármacos Neuromusculares Despolarizantes/história , Succinilcolina/história , Animais , Aprovação de Drogas/história , Aprovação de Drogas/legislação & jurisprudência , Desenvolvimento de Medicamentos/história , Indústria Farmacêutica/história , História do Século XX , Humanos , Hiperpotassemia/induzido quimicamente , Hiperpotassemia/história , Hipertermia Maligna/etiologia , Hipertermia Maligna/história , Fármacos Neuromusculares Despolarizantes/efeitos adversos , Fármacos Neuromusculares Despolarizantes/farmacologia , Vigilância de Produtos Comercializados , Espasmo/tratamento farmacológico , Espasmo/história , Succinilcolina/efeitos adversos , Succinilcolina/farmacologia , Estados Unidos , United States Food and Drug Administration/história
16.
Zhongguo Dang Dai Er Ke Za Zhi ; 21(9): 845-850, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31506140

RESUMO

OBJECTIVE: To investigate the factors in first-time adrenocorticotropic hormone (ACTH) therapy and their influence on spasm control time in infants with infantile spasms. METHODS: A total of 72 infants with infantile spasms who were admitted from January 2008 to October 2013 were enrolled. Their clinical data were collected, and the exposure factors for infantile spasms were selected. A Cox proportional-hazards regression model analysis was performed for these factors to analyze their influence on spasm control time. RESULTS: Clarification of the etiology (known or unexplained etiology), frequency of spasms before treatment, and presence or absence of combination therapy (ACTH used alone or in combination with magnesium sulfate) had a significant influence on spasm control time in infants with infantile spasms. The infants with a known etiology had a significantly shorter spasm control time than those with unexplained etiology, and the infants with a low frequency of spasms before treatment and receiving ACTH combined with magnesium sulfate early had a significantly longer spasm control time than their counterparts (P<0.05). CONCLUSIONS: For infants with infantile spasms at initial diagnosis, etiology should be clarified, which may helpful for evaluating prognosis. A combination of ACTH and magnesium sulfate should be given as soon as possible, which may improve their prognosis.


Assuntos
Hormônio Adrenocorticotrópico/uso terapêutico , Espasmos Infantis , Anticonvulsivantes , Humanos , Lactente , Modelos de Riscos Proporcionais , Espasmo , Espasmos Infantis/tratamento farmacológico
17.
Medicina (Kaunas) ; 55(9)2019 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-31450705

RESUMO

Background: Cycling is a popular source of recreation and physical activity for children and adults. With regard to the total number of sports injuries, cycling has the highest absolute number of injuries per year in the United States population. Cycling injuries can be classified into bicycle contact, traumatic, or overuse injuries. Aim of this study: The aims of this case report are to report a rare clinical complication of glenohumeral joint anterior dislocation that resulted in a patient experiencing continuous GHJ dislocations secondary to involuntary violent muscular spasms and emphasize the role of the physical therapist's differential diagnosis and clinical decision-making process in a patient following direct access referral. Case presentation: A professional 23-year-old cyclist presented to a physical therapist with spontaneous multidirectional dislocations to the right shoulder after the recurrence of trauma occurred during a recent cycling race. The dislocations do not occur at night, but occur during the day, randomly, and mostly associated with changes in the patient's psychological conditions. Directly from the clinical history, the physical therapist identified a neuro-physiological orange flag as well as an orthopedic red flag and, therefore, decided it was appropriate to refer the patient to a neurologist. It was determined by the physical therapist to be a priority to focus on the patient's neurologic status and then to evaluate the orthopedic problem. The neurological examination revealed a condition of spontaneous multidirectional dislocation associated with recurrent antero-posterior pain spasms of the shoulder joint. The neurologist prescribed medication. Following the second cycle of medication assumption, the patient was able to continue physiotherapy treatment and was referred to the orthopedic specialist to proceed with shoulder stabilization surgery. Discussion and conclusion: Currently, the diagnosis of this unusual clinical condition is still unclear. It is a shared opinion of the authors that the trauma during the past bicycle race awakened an underlying psychological problem of the patient that resulted in a clinical condition of weakness of all the structures of the shoulder, such that these spasms could result in multiple multidirectional dislocations.


Assuntos
Ciclismo/lesões , Luxação do Ombro/diagnóstico , Acidentes por Quedas , Atletas , Ciclismo/estatística & dados numéricos , Humanos , Itália , Imagem por Ressonância Magnética/métodos , Masculino , Luxação do Ombro/complicações , Luxação do Ombro/diagnóstico por imagem , Espasmo/etiologia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/fisiopatologia , Adulto Jovem
18.
Artigo em Russo | MEDLINE | ID: mdl-31407688

RESUMO

Stiff-person syndrome (SPS) is a rare chronic neurological disease characterized by progressing muscle rigidity and painful muscle spasms. The signs of SPS are pain and stiffness in spinal, abdominal and cervical muscles, increased muscle tonus in extensor muscles of extremities, constant stiffness of paravertebral and abdominal muscles and muscle spasms. A clinical case of a SPS patient T., aged 23 years, is presented. The peculiarity of this case is additional left-sided peripheral upper extremity monoparesis, which is most likely associated with the development of left-sided compression-ischemic brachial plexopathy resulted from profound muscular tonic syndrome in the neck and shoulder girdles.


Assuntos
Rigidez Muscular Espasmódica , Adulto , Humanos , Músculo Esquelético , Dor , Espasmo , Rigidez Muscular Espasmódica/complicações , Rigidez Muscular Espasmódica/diagnóstico , Adulto Jovem
19.
Pan Afr Med J ; 33: 43, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384358

RESUMO

Carpopedal spasm have various causes ranging from dsyselecrolytemia, syndromic, metabolic or endocrine causes. Any of these could cause a decrease in ionized calcium and tetany. Excessive vomiting leading to alkalosis, hypokaleamia and decreased ionised calcium should be kept in mind for early etiological diagnosis of carpopedal spasm. We report a case of 4-year-old boy presenting with a history of recurrent painful spasm and flexion of bilateral hands following excessive vomiting and electrolyte derangement.


Assuntos
Espasmo/etiologia , Vômito/complicações , Desequilíbrio Hidroeletrolítico/complicações , Cálcio/metabolismo , Pré-Escolar , Mãos , Humanos , Masculino , Desequilíbrio Hidroeletrolítico/etiologia
20.
BMJ Case Rep ; 12(7)2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31289167

RESUMO

We present the case of a 45-year-old healthy man who successfully completed three stages of the Bruce protocol but developed inferolateral ST segment elevation in the recovery phase. The ECG change was associated with a marked drop in blood pressure. He underwent emergency coronary angiography which revealed normal coronary arteries. It is likely that post-exercise hypotension triggered coronary spasm which caused the ST segment elevation. Alternatively, coronary spasm may have been the primary event, inducing sufficient myocardial ischaemia to cause a marked drop in blood pressure. Exercise tolerance testing is often a reliable test to rule out reversible myocardial ischaemia. While the physician is focused on ischaemic changes or rhythm abnormalities developing during the exercise phase, the recovery period is just as important and requires as much vigilance. Coronary vasospasm can result in significant ST changes and haemodynamic compromise at any point during the test, and the ECG traces can be indistinguishable from a classic ST elevation myocardial infarction, as in the present case.


Assuntos
Vasos Coronários/diagnóstico por imagem , Teste de Esforço/efeitos adversos , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Espasmo/tratamento farmacológico , Fármacos Cardiovasculares/administração & dosagem , Fármacos Cardiovasculares/uso terapêutico , Angiografia Coronária/métodos , Vasos Coronários/anatomia & histologia , Vasos Coronários/fisiopatologia , Diagnóstico Diferencial , Diltiazem/administração & dosagem , Diltiazem/uso terapêutico , Ecocardiografia , Eletrocardiografia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Hipotensão Pós-Exercício/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Espasmo/complicações , Espasmo/fisiopatologia , Resultado do Tratamento
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