Motor polyradiculoneuropathy as an unusual presentation of neurobrucellosis: a case report and literature review.

Brucellosis, a zoonotic disease caused by Brucella species, poses a significant global health concern. Among its diverse clinical manifestations, neurobrucellosis remains an infrequent yet debilitating complication. Here, we present a rare case of neurobrucellosis with unusual presentations in a 45-year-old woman. The patient's clinical course included progressive lower extremity weakness, muscle wasting, and double vision, prompting a comprehensive diagnostic evaluation. Notable findings included polyneuropathy, elevated brucella agglutination titers in both cerebrospinal fluid and blood, abnormal EMG-NCV tests, and resolving symptoms with antibiotic therapy. The clinical presentation, diagnostic challenges, and differentiation from other neurological conditions are discussed. This case underscores the importance of considering neurobrucellosis in regions where brucellosis is prevalent and highlights this rare neurological complication's distinctive clinical and radiological features. Early recognition and appropriate treatment are crucial to mitigate the significant morbidity associated with neurobrucellosis.

Management of Brachioradial Pruritus With Cervical Epidural Steroid Injection: A Case Report.

Brachioradial pruritus (BRP) is a neuropathic dysesthesia described as itching over the dorsolateral forearm. The etiology of BRP has not been fully identified but is hypothesized to be multifactorial, including sun exposure and cervical spine disease. Management of BRP is challenging, and conservative measures often fail to provide notable improvement. We present a case of a 71-year-old woman with BRP refractory to topical and oral treatment, with radiographic evidence of cervical spinal canal and neuroforaminal stenosis. Two rounds of cervical epidural steroid injections (CESI) were performed at the C6-C7 epidural space resulting in a marked improvement of symptoms. With this case report, we would like to add to the current scientific knowledge of BRP management and the potential utilization of CESIs to provide symptomatic relief to patients suffering from refractory pruritus.

Postpartum Sciatic Neuropathy After Uncomplicated Vaginal Delivery.

Postpartum neuropathies are common, including femoral neuropathy, peroneal neuropathy, lumbosacral trunk plexopathy, and lateral femoral cutaneous neuropathy. Sciatic mononeuropathy in the peripartum period is rare. Postpartum sciatic neuropathy (PSN) in the setting of cesarean section has been reported before. We present a case series of 2 sciatic mononeuropathies after vaginal delivery. Case 1 is a 25-year-old woman who presented with a left foot drop after normal vaginal delivery after being in labor for 3 hours. Case 2 is a 24-year-old woman who presented with a right foot drop after normal vaginal delivery and being in labor for 31 hours. Both cases noted foot drops in the immediate postpartum period. Neurologic examinations revealed flail foot, 4/5 hamstring muscle strength on MRC scale and intact hip abduction. They had paresthesia on the posterolateral aspect of the leg, dorsal and plantar aspect of the foot with absent ankle reflex. MRI did not show evidence of spinal cord, nerve root or plexus involvement. Electrodiagnostic studies revealed evidence of sciatic mononeuropathy proximal to the short head of biceps femoris. They were discharged home with an ankle brace and therapy. At 3 months follow up, they had complete resolution of weakness. There have been a few reported cases of PSN secondary to cesarean section. Sciatic involvement after vaginal delivery is extremely rare. We report 2 cases of PSN after vaginal delivery to highlight that sciatic mononeuropathy can occur not only after cesarean section, but also after uncomplicated vaginal delivery and should raise awareness of this risk to clinicians.

Impact of Customized and Sustained Physiotherapy in Charcot-Marie-Tooth Disease.

Charcot-Marie-Tooth (CMT) disease is the most inherited form of peripheral neuropathy. This condition is also known as hereditary motor and sensory neuropathy (HMSN), which is a slowly progressive neuropathy affecting peripheral nerves and causes sensory loss, weakness and muscle wasting. This primarily involves distal muscles of feet, lower legs, hands and forearm. CMT is the most frequently inherited peripheral neuropathy known to affect 1 in 2500 individuals. There are four types: CMT1, CMT2, CMT3 and CMT4, depending upon the involvement of specific gene deficit, inheritance pattern, age of onset and whether the primary defect results in an abnormality of the myelin or axon of the nerve. Diagnosis of CMT is done based on physical examination, genetic testing, and electromyography (EMG) and nerve conduction velocity (NCV) test results. Symptoms of weakness progress from distal to proximal, i.e., it begins from feet and ankles. CMT is a known length dependent neuropathy which results in foot drop and later weakness of hands and forearm becomes evident. Due to the involvement of sensory nerve fibres, sensations like heat, touch, pain and most prominently vibration is also present distally. Long standing effects of CMT leads to the development of deformity and/or contractures which may involve forefoot, hindfoot, toes and/or long finger flexors. As physiotherapy is a means to maintain and/or gain maximum possible functional independence, consistency of the treatment becomes the most important factor. This case report intends to show that consistency in performing physiotherapeutic exercises helps in gaining maximum possible functional independence. This case report is a discussion of a 25-year-old male patient referred to the physiotherapy department with the polyneuropathy type symptoms with his history and investigation reports being consistent with that of Charcot-Marie-Tooth disease.

Do carpal Tunnel Hands Have Different Shape Compare to Normal Hands?

BACKGROUND: Given the fact that the carpal tunnel syndrome (CTS) happens as a consequence of the median nerve entrapment, besides other known factors, the shape and anthropometric characteristics of the carpal tunnel, wrist, and hand could be considered as a predisposing risk factor for idiopathic CTS. The aim of this study was to evaluate the morphology and radiologic scales in CTS hands. METHODS: In this prospective study, patients who underwent upper extremity electrodiagnostic studies were enrolled for hand morphologic and radiographic indexes. Patients were divided into CTS suffering and CTS symptom-free groups according to nerve conduction velocity (NCV) findings. A true posteroanterior radiograph of the hands was pas performed for each participant. Metacarpal length to wrist length index (carpal ratio), metacarpal length to metacarpal width index, third to first metacarpal length, hand length index, and hand volume index were measured in both groups. RESULTS: Significant differences were seen between the two groups regarding the body mass index (P< 0.001), metacarpal length divided by metacarpal width index (P=0.08), first metacarpal length divided by third metacarpal length (P=0.002), wrist circumference divided by distal flexor wrist crease to the tip of the third finger (P< 0.001), distal flexor wrist crease to the tip of the third finger divided by hand volume (P=0.05), and distal flexor wrist crease to the tip of the third finger divided by wrist circumference (P< 0.001). Multivariable analysis of hand indices were statically significant for the first metacarpal length divided by third metacarpal length (P=0.00), wrist circumference divided by distal flexor wrist crease to the tip of the third finger (P=0.138), and distal flexor wrist crease to the tip of the third finger divided by wrist circumference (P=0.117). However, first metacarpal length divided by third metacarpal length and third metacarpal length divided by palm height were associated with higher CTS occurrences. Receiver operating characteristic curve analysis demonstrated cutoff points which were possible to estimate only for first metacarpal length divided by third metacarpal length and wrist circumference divided by distal flexor wrist crease to the tip of the third finger. CONCLUSION: Based on our findings, CTS hand is characterized by shorter fingers compared to thumb and wrist (metacarpal length to wrist length and hand length indexes), wider (metacarpal length to metacarpal width index), and bulkier (hand volume index) compared to non-CTS hands. The severity of CTS was correlated with a higher carpal ratio. In conclusion, CTS hands are bulkier with wider palms and shorter fingers compared to thumb. In this study, the thumb to the third metacarpal length was proved to be the best index for diagnosis of "CTS hand".

Carpal Tunnel Release Surgery Plus Intraoperative Corticosteroid Injection versus Carpal Tunnel Release Surgery Alone: A Double Blinded Clinical Trial.

Background: Carpal tunnel syndrome is a prevalent disease with significant morbidity. The current treatments range from oral medication and local corticosteroid injection to surgical carpal tunnel release (CTR). In this study, we tried to assess the results of Carpal Tunnel Release surgery in combination with the anti-inflammatory effect of local corticosteroid injection. Methods: 65 patients were enrolled by clinical and electrodiagnostic tests and randomly divided into two groups, 32 in group one which underwent surgery with Dexamethasone injection and 33 in group 2 which intervened with carpal tunnel release surgery alone. Data on Boston questionnaire of patients were conducted before and two weeks after surgery. Distal motor and sensory latencies of patients were recorded before and two months after surgery. Mean values were compared between groups before and after surgery. Results: The mean preoperative Boston index was 35.83 in group one and 37.7 in group two, these data postoperative were 15.83 and 19.15 respectively. The mean preoperative distal sensory latency was 54.8 in group one and 47.6 in group two, these data postoperative were 34.1 and 35.1 respectively. The mean preoperative distal motor latency was 63.2 in group one and 62.3 in group two, these data postoperative were 44.5 and 46.55 respectively. Conclusions: CTR surgery plus local corticosteroid injection did not significantly change in results of Electrodiagnostic test or Boston index compared to the non-injection group.

Ultrasound and EMG-NCV study (electromyography and nerve conduction velocity) correlation in diagnosis of nerve pathologies.

PURPOSE: Nerve disorders are commonly encountered in clinical practice. Ultrasonography (USG) is a useful modality in the evaluation of most of the peripheral and superficial pathologies amenable to penetration by ultrasound. The primary objective is to study the USG findings of various peripheral nerve pathologies and to correlate them with electrophysiological (EMG-NCV) findings. METHOD: 42 patients referred with suspicion of peripheral nervous system affection were evaluated with USG along with EMG-NCV. After reviewing detailed anatomy of the region, the affected nerve was visualized along the major neurovascular bundle or at a known anatomical landmark with a high-frequency (9-20 MHz) linear/hockey stick transducer. RESULTS: The USG parameters, namely loss of fibrillary pattern, hypoechogenicity and nerve thickening, showed significant p value (p < 0.05) on the tests of significance, suggesting these parameters are significant predictors of nerve affection/pathology on USG. Each ultrasound parameter was correlated individually with SNAP and CMAP. The results revealed positive correlation of echogenicity (r = 0.210, p = 0.05), fibrillary pattern (r = 0.209, p = 0.05) and thickening (r = 0.387, p < 0.05) with sensory nerve action potential (SNAP) and compound muscle action potential (CMAP). CONCLUSION: USG can be used as corroborative investigation to strengthen the findings of EMG-NCV. This combination represents a powerful tool in enabling appropriate planning for treatment, preventing unnecessary intervention and thus improving overall outcomes in patients with peripheral neuropathy.

Review of Critical Illness Myopathy and Neuropathy.

Critical illness myopathy (CIM) and neuropathy are underdiagnosed conditions within the intensive care setting and contribute to prolonged mechanical ventilation and ventilator wean failure and ultimately lead to significant morbidity and mortality. These conditions are often further subdivided into CIM, critical illness polyneuropathy (CIP), or the combination-critical illness polyneuromyopathy (CIPNM). In this review, we discuss the epidemiology and pathophysiology of CIM, CIP, and CIPNM, along with diagnostic considerations such as detailed clinical examination, electrophysiological studies, and histopathological review of muscle biopsy specimens. We also review current available treatments and prognosis. Increased awareness and early recognition of CIM, CIP, and CIPNM in the intensive care unit setting may lead to earlier treatments and rehabilitation, improving patient outcomes.