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1.
Orthop Clin North Am ; 51(2): 279-291, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32138865

RESUMO

Hansen disease remains a common problem worldwide with 750,000 new cases diagnosed each year. Nerve injury is a central feature of the pathogenesis because of the unique tendency of Mycobacterium leprae to invade Schwann cells and the peripheral nervous system, that can be permanent and develop into disabilities. The orthopedic surgeon has an important role in the management of neuropathy, performing surgical release of the tibial and common peroneal nerves in potentially constricting areas, thus providing a better environment for nerve function. In cases of permanent loss of nerve function with drop foot, specific tendon transfers can be used.


Assuntos
Doenças do Pé/cirurgia , Hanseníase/cirurgia , Doenças do Sistema Nervoso Periférico/cirurgia , Doenças do Pé/diagnóstico , Doenças do Pé/tratamento farmacológico , Doenças do Pé/microbiologia , Humanos , Hanseníase/diagnóstico , Hanseníase/tratamento farmacológico , Hanseníase/microbiologia , Transferência de Nervo , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/etiologia
2.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(2): 126-131, 2020 Feb 12.
Artigo em Chinês | MEDLINE | ID: mdl-32062882

RESUMO

Objective: To summarize the clinical course, neuroimaging and cerebrospinal fluid (CSF) analyses of cerebellar dysfunction in Legionnaires' disease. Methods: A case of Legionnaires' disease with pronounced cerebellar involvement was reported. The related literatures published up to February 2019 were reviewed with "Legionella, legionellosis, legionnaires' disease, cerebellum, cerebellar" as the keywords in CNKI, Wanfang and PubMed databases. Results: A 69-year-old man complained of anorexia and diarrhea for several days. He was subsequently admitted to the hospital after he had fever, ataxia, dysarthria and involuntary tremor. Chest CT revealed right lower lobe pneumonia. Routine urinalysis showed hematuria and proteinuria. Serum alanine transaminase was 52 U/L, creatinine 137 µmol/L, sodium 128 mmol/L, and creatine kinase 6 893 U/L. Cranial CT was normal. Analysis of CSF showed mildly elevated total protein. Legionella colonies isolated from bronchoalveolar lavage fluid was positive by PCR. After initial treatment with moxifloxacin and azithromycin for 7 days, the fever and neurological symptoms persisted. Corticosteroid therapy was administered for 3 days, the fever resolved, whereas the neurological symptoms improved gradually and slowly by 4 weeks of antibiotic therapy. Finally, successive serological test confirmed Legionella pneumophila serogroups 6 and 7 by indirect immunofluorescence. Twenty-one literatures with 23 cases were reviewed, and plus our case, there were a total of 24 cases for analysis. There were 16 males and 8 females, aged from 22 to 71 years. Ataxia and dysarthria were the cerebellar symptoms most frequently reported, occurring in 22 and 18 cases, respectively. All patients had various central and peripheral neuropathies during their illness. Neuroimaging and analysis of CSF was reported in 21 cases. There were no abnormalities in 18 cases of cranial imaging, 1 case with slight hydrocephalus on cranial CT, and 3 cases with hyperintensity in the splenium of corpus callosum on cranial MRI. Eighteen cases of CSF analyses were normal, whereas 1 case with elevated lymphocytes and 3 cases with elevated proteins. Nine cases were eventually identified as Legionella pneumophila serotype 1 by urinary antigen detection, 1 case as Legionella pneumophila serogroups 6 and 7, while the remaining 14 were unknown serotype. Long-term neurologic follow-up showed that 3 cases recovered completely in the first week, while 19 cases improved slowly in the following 3 weeks, and 13 cases had persistent deficits of gait or speech after 3 months. Conclusions: Legionellosis with cerebellar insufficiency is rare. It may be misdiagnosed in the onset of illness. After treatment, there is a trend of slow recovery and neurological symptoms may persist in long-term follow-up.


Assuntos
Doenças Cerebelares/etiologia , Cerebelo/diagnóstico por imagem , Líquido Cefalorraquidiano/química , Doença dos Legionários/complicações , Doenças do Sistema Nervoso Periférico/etiologia , Adulto , Idoso , Doenças Cerebelares/líquido cefalorraquidiano , Doenças Cerebelares/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroimagem , Pneumonia , Adulto Jovem
3.
World Neurosurg ; 133: 271-274, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31639501

RESUMO

BACKGROUND: Epidermoid cysts (ECs) account for 0.5% to 1% of all spinal tumors. They can be congenital or acquired. Acquired spinal ECs are extremely rare and are mostly caused by trauma, or secondary to iatrogenic procedure such as lumbar punctures or surgery for spina bifida. As far as we know, this is the first report of a spinal EC complicating surgery for a lumbar disc herniation. CASE DESCRIPTION: A 69-year-old woman, with a history of L3-L4 lumbar disc herniation surgery 30 years earlier, presented because of low back pain, weakness of her lower limbs, and bladder dysfunction evolving for 2 years. Magnetic resonance imaging identified an intradural cystic lesion extending from the medullary cone to the L4 level, evoking an EC. The diagnosis was confirmed peroperatively. Neurologic motor signs improved postoperatively but not the sphincter disorders. CONCLUSIONS: Despite the extreme rarity of this event, we should be aware of the potential de novo development of epidermoid tumors in patients who undergo surgery for lumbar disc herniation. Concerns must be given to persistent low back pain and delayed neurologic symptoms in these patients.


Assuntos
Cauda Equina/diagnóstico por imagem , Cisto Epidérmico/etiologia , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Procedimentos Ortopédicos/efeitos adversos , Doenças do Sistema Nervoso Periférico/etiologia , Idoso , Cauda Equina/cirurgia , Cisto Epidérmico/diagnóstico por imagem , Cisto Epidérmico/cirurgia , Feminino , Humanos , Laminectomia , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Doenças do Sistema Nervoso Periférico/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Resultado do Tratamento
4.
Medicine (Baltimore) ; 98(48): e18118, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770239

RESUMO

BACKGROUND: Vitamin D is a fat-soluble vitamin that is related to the health of the human body and is an indispensable nutrient for human beings. Some studies indicated that type 2 diabetes mellitus (T2DM) with diabetic peripheral neuropathy (DPN) may be associated with vitamin D deficiency, but the current understanding of this point of view remains controversial. This study aimed to evaluate the correlation between serum 25-hydroxyl vitamin D (25 [OH] D) concentration and DPN in patients with T2DM by a meta-analysis, and to provide a reference for doctors. METHODS: Relevant studies were selected from the PubMed, Cochrane Library, China National Knowledge Infrastructure, VIP databases, and Wanfang Data Knowledge Service Platform databases dating from 2000 to December 2017. A total of 75 articles related to serum 25 (OH) D and DPN were selected from 2000 to December 2017. Based on the inclusion and exclusion criteria of the literature, a quality assessment was conducted using the Newcastle-Ottawa scale, and a meta-analysis was performed by RevMan5.3 statistical software. RESULTS: Thirteen studies that involved a total of 2814 type 2 diabetic patients were finally included into the meta-analysis. Meta-analysis results, heterogeneity test showed that, P < .000 01, I = 92%, calculation by random effect model revealed that, the serum concentration of 25 (OH) D in T2DM combined with DPN group was lower than that in the group without DPN (weighted mean difference = -0.74, 95% confidence interval: -1.03 to -0.46) CONCLUSIONS:: Vitamin D is associated with type 2 DPN (DPN), and vitamin D deficiency can lead to an increased risk of type 2 DPN. However, more high-quality research is needed.


Assuntos
Diabetes Mellitus Tipo 2/sangue , Neuropatias Diabéticas/sangue , Doenças do Sistema Nervoso Periférico/sangue , Deficiência de Vitamina D/etiologia , Vitamina D/análogos & derivados , Adulto , Idoso , Diabetes Mellitus Tipo 2/complicações , Neuropatias Diabéticas/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/etiologia , Fatores de Risco , Vitamina D/sangue , Deficiência de Vitamina D/sangue
5.
Fisioter. Pesqui. (Online) ; 26(3): 247-257, jul.-set. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1039888

RESUMO

ABSTRACT The purpose of this study is to analyze the effects of using customized insoles and leg and foot exercises on the feet of patients with neuropathy caused by leprosy. Thirty volunteers diagnosed with leprosy were assigned to one of three groups: (1) Exercise group (n=10): performed exercises for the intrinsic muscles of the foot; (2) Insole group (n=10): used insoles to correct foot positioning; (3) Insole and Exercise group (n=10): used insoles and performed an exercise routine. The results of the treatments were analyzed with photogrammetry using the Alcimagem® and AutoCAD® programs. Left hindfoot posture changed after treatment in the Exercise and Insole groups (hindfoot, pre versus post <0.001). We also found that combining exercise and insoles did not alter the alignment of the feet during the study's evaluation period (customized insoles and exercises, pre versus post <0.05), which suggests that follow-up for more than four months may be needed. The left hindfoot's alignment can be changed with supervised exercises and the use of insoles.


RESUMO O objetivo deste estudo é analisar a influência do uso de palmilhas personalizadas e exercícios para perna e pés nos ângulos do antepé, retropé e arco plantar de pacientes com neuropatia causada por hanseníase. Trinta voluntários diagnosticados com hanseníase foram designados para um dos três grupos: (1) grupo exercício (n=10): realização de exercícios para pernas e pés; (2) grupo palmilha (n=10): utilização de palmilhas para corrigir o posicionamento do pé; (3) grupo palmilha e exercícios (n=10): uso de palmilhas associado a uma rotina de exercícios. O resultado dos tratamentos foi analisado por meio de fotogrametria, com os softwares Alcimagem e AutoCAD. A postura do retropé esquerdo foi modificada após o tratamento no "grupo exercício" e "grupo palmilha" (retropé, pré versus pós<0,001). Também foi observado que a combinação entre exercícios e palmilhas não alterou o alinhamento dos pés durante o período de avaliação do estudo (palmilha e exercícios, pré versus pós>0,05), o que sugere que o acompanhamento por mais de quatro meses pode ser necessário. Assim, o uso isolado de exercícios supervisionados ou de palmilhas altera o alinhamento do retropé, como aferido por fotogrametria.


RESUMEN El presente estudio tiene como objetivo analizar la influencia del uso de plantillas personalizadas y la práctica ejercicios de piernas y pies en los ángulos del antepié, del retropié y del arco plantar de pacientes con neuropatía debido a lepra. Treinta voluntarios diagnosticados con lepra fueron asignados a uno de estos tres grupos: (1) grupo de ejercicios (n=10): hacer ejercicios de piernas y pies; (2) grupo de plantillas (n=10): utilizar plantillas para corregir la posición del pie; (3) grupo de plantillas y ejercicios (n=10): utilizar plantillas asociadas con una rutina de ejercicios. Los resultados de los tratamientos se analizaron mediante fotogrametría, con los softwares Alcimagem y AutoCAD. La postura del retropié izquierdo se modificó tras el tratamiento en el "grupo de ejercicios" y en el "grupo de plantillas" (retropié, pre versus pos <0,001). También se observó que la combinación de ejercicios y plantillas no alteró la alineación del pie durante el período de evaluación del estudio (plantilla y ejercicios, pre versus pos >0,05), lo que sugiere que puede requerirse seguimiento durante más de cuatro meses. Por lo tanto, la práctica aislada de ejercicios supervisados o el uso de plantillas altera la alineación del retropié, medido por fotogrametría.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Aparelhos Ortopédicos , Doenças do Sistema Nervoso Periférico/reabilitação , Terapia por Exercício , Fotogrametria , Doenças do Sistema Nervoso Periférico/etiologia , Doenças do Pé/etiologia , Doenças do Pé/reabilitação , Hanseníase/complicações
6.
Zhonghua Yi Xue Yi Chuan Xue Za Zhi ; 36(8): 821-825, 2019 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-31400137

RESUMO

OBJECTIVE: To explore the clinical, electrophysiological and imaging features of a patient with Krabbe disease caused by GALC mutation. METHODS: A comprehensive analysis including clinical investigation and genetic testing was carried out. RESULTS: The patient presented with peripheral neuropathy with electrophysiological anomaly suggestive of asymmetric demyelinating neuropathy. Brain imaging revealed leukoencephalopathy. Genetic analysis has identified compound heterozygous mutations in exons 5 and 11 of the GALC gene, namely c.461C>A and c.1244G>A. CONCLUSION: Krabbe disease is a group of disorders featuring substantial phenotypic heterogeneity. Genetic and enzyme testing has become indispensable for accurate diagnosis for this disease.


Assuntos
Galactosilceramidase/genética , Leucodistrofia de Células Globoides/genética , Doenças do Sistema Nervoso Periférico/etiologia , Análise Mutacional de DNA , Testes Genéticos , Humanos , Leucodistrofia de Células Globoides/complicações , Mutação
7.
Minerva Med ; 110(5): 455-463, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31368292

RESUMO

Peripheral neuropathies are frequently encountered in clinical practice and are associated with a major impairment in quality of life. However, their management remains poor, and current therapies are often burdened with major side effects and can present poor efficacy on pain and functionality. Therefore, it has been suggested that the combination of two or more different drugs may improve analgesic efficacy and reduce side effects. Tricortin® 1000 is formulated with 12 mg of Brain cortex phospholipid liposomes + 1000 µg of Cyanocobalamin injectable solution (PL+CNCbl) for intramuscular use and is indicated in the treatment of poly-algo-neuropathic syndromes. This combination exerts a marked neurotrophic action by promoting the synthesis of endogenous phospholipids; moreover, the peculiar formulation optimizes the delivery of CNCbl which has analgesic and neurotrophic action. This paper discusses the pharmacotherapy of peripheral neuropathies, including low-back pain, neck pain, postherpetic neuropathy (PHN) and focuses on the fixed dose combination PL+CNCbl clinical efficacy in association with other treatments or in monotherapy.


Assuntos
Analgésicos/uso terapêutico , Fármacos Neuroprotetores/uso terapêutico , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Fosfolipídeos/uso terapêutico , Vitamina B 12/uso terapêutico , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , Córtex Cerebral/química , Ensaios Clínicos como Assunto , Combinação de Medicamentos , Humanos , Injeções Intramusculares , Lipossomos , Fármacos Neuroprotetores/administração & dosagem , Fármacos Neuroprotetores/efeitos adversos , Doenças do Sistema Nervoso Periférico/etiologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Fosfolipídeos/administração & dosagem , Fosfolipídeos/efeitos adversos , Vitamina B 12/administração & dosagem , Vitamina B 12/efeitos adversos
8.
Int J Neurosci ; 129(12): 1226-1233, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31402774

RESUMO

Porphyrias are inherited disorders of the heme biosynthetic pathway, usually characterized by dermatological changes due to the accumulation of byproducts in the pathway. Select porphyrias also affect the nervous system, namely hereditary coproporphyria, acute intermittent porphyria and variegate porphyria. Complications include paralysis, hyponatremia which can risk central pontine myelinolysis, seizures and coma. Neurological complications usually result from severe episodes of acute attacks. Acute attacks may also elicit neuropsychiatric symptoms such as confusion, hallucinations, anxiety and psychosis. However, these manifestations are generally self-limiting. Due to the generally low incidence of porphyria and full knowledge the associated neurological and psychiatric manifestations, we review the relevant porphyrias along with their clinical manifestations, evaluation, and management to raise its awareness in the clinical picture and to prevent misdiagnosis. Porphyria should be considered within the differential diagnosis for unexplained neurological symptoms.


Assuntos
Transtornos Mentais/etiologia , Doenças do Sistema Nervoso/etiologia , Porfirias/complicações , Heme/biossíntese , Humanos , Doenças do Sistema Nervoso Periférico/etiologia , Porfirias/diagnóstico , Porfirias/terapia
9.
Cir Cir ; 87(5): 501-507, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31448795

RESUMO

Objective: To study the incidence of cerebrovascular (transient ischemic attacks and stroke) and myocardial events (myocardial infarction) as well as early survival related to carotid endarterectomy. Our secondary aim is to establish possible risk factors associated with complications. Method: Retrospective observational case-control study within a cohort. All patients who underwent carotid endarterectomy by the angiology and vascular surgery service at the Hospital Universitario La Paz, in Madrid (Spain), in the period between January 2011 and December 2017 were included. Chi square was used to calculate differences. Kaplan-Meier and Cox regression was used for the survival analysis and patency. Results: 111 procedures were performed on 108 patients, 95 (87,9%) male with an average age of 68.5 ± 8.75. The mean time of follow-up was 2.9 years. There was no 30-day post-surgical mortality, with a 30-day postoperative cerebral vascular event rate of 2.7%. Statistically significant correlation was found between the presence of 30-day postoperative cerebral vascular event and primary closure (p = 0.005) as well as between the smoking habit and 30-day postoperative myocardial infarction (p = 0.036) and restenosis (p = 0.008). In mid-term follow-up, the event rate for cerebral vascular events and myocardial infarction was 1.8%. Conclusion: carotid endarterectomy is the procedure of choice in carotid stenosis. The low rates of perioperative mortality, morbidity and complications have been demonstrated.


Assuntos
Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas , Infarto do Miocárdio/etiologia , Complicações Pós-Operatórias/etiologia , Acidente Vascular Cerebral/etiologia , Idoso , Idoso de 80 Anos ou mais , Estenose das Carótidas/complicações , Estudos de Casos e Controles , Endarterectomia das Carótidas/efeitos adversos , Feminino , Seguimentos , Hospitais Universitários , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Doenças do Sistema Nervoso Periférico/epidemiologia , Doenças do Sistema Nervoso Periférico/etiologia , Complicações Pós-Operatórias/epidemiologia , Modelos de Riscos Proporcionais , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/etiologia , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia
10.
Clin Exp Rheumatol ; 37 Suppl 118(3): 192-198, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31464676

RESUMO

Neurologic involvement is a common extraglandular manifestation of primary Sjögren's syndrome (pSS), is varied and can be divided anatomically into 3 categories: central nervous system, peripheral neuropathies and autonomous nervous system manifestations. According to different study cohorts, neurological manifestations can occur in 18-45% of pSS patients, with the peripheral nervous system being the most frequent site of involvement compared to the central nervous system and autonomic system. Some neurologic complications share convergent pathophysiology, although the pathological basis of other conditions, namely cognitive impairment in pSS, is less clear. The heterogeneity of neurologic manifestations in pSS complicates the diagnosis and approach to treatment, which should be directed toward the underlying neuro-pathologic mechanism. The diagnosis and treatment of these manifestations must be optimised in order to avoid severe disability. However, for the majority of the complications, evidence for treatment efficacy is limited and requires further investigation.


Assuntos
Doenças Autoimunes do Sistema Nervoso/etiologia , Síndrome de Sjogren , Doenças Autoimunes do Sistema Nervoso/patologia , Doenças do Sistema Nervoso Central/etiologia , Humanos , Doenças do Sistema Nervoso Periférico/etiologia , Síndrome de Sjogren/complicações
11.
Diabetes Metab Syndr ; 13(3): 2075-2079, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31235139

RESUMO

Uncontrolled high blood sugar levels leads to diabetic neuropathy, which is usually develops slowly. Damaged nerves stop sending messages or may send message slowly at the wrong times. The propsed model is an insole for individuals with peripheral neuropathy conditions, where the peak plantar pressure value is measured at specified locations of the foot by means of a pressure sensor, which can be accessed via  a mobile applications; Simultaneously, a stimulation is given at acupressure points of the foot to relieve pain at definite intervals of time, based on the signals from the controller. A controller is being used to perform these operations which will be transmitted to the mobile application via Bluetooth terminal.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Pé Diabético/reabilitação , Neuropatias Diabéticas/reabilitação , Órtoses do Pé/normas , Dor/prevenção & controle , Doenças do Sistema Nervoso Periférico/reabilitação , Sapatos/normas , Adulto , Idoso , Pé Diabético/etiologia , Neuropatias Diabéticas/etiologia , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/etiologia , Prognóstico , Dispositivos Eletrônicos Vestíveis
12.
Curr Pain Headache Rep ; 23(6): 43, 2019 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-31123919

RESUMO

PURPOSE OF REVIEW: Understanding the etiologies of the complications associated with regional anesthesia and implementing methods to reduce their occurrence provides an opportunity to foster safer practices in the delivery of regional anesthesia. RECENT FINDINGS: Neurologic injuries following peripheral nerve block (PNB) and neuraxial blocks are rare, with most being transient. However, long-lasting and devastating sequelae can occur with regional anesthesia. Risk factors for neurologic injury following PNB include type of block, injection in the presence of deep sedation or general anesthesia, presence of existing neuropathy, mechanical trauma from the needle, pressure injury, intraneural injection, neuronal ischemia, iatrogenic injury related to surgery, and local anesthetic neurotoxicity. The present investigation discusses regional blocks, complications of regional blocks, risk factors, site-specific limitations, specific complications and how to prevent them from happening, avoiding complications in regional anesthesia, and the future of regional anesthesia.


Assuntos
Anestesia por Condução/normas , Anestésicos Locais/administração & dosagem , Bloqueio Nervoso/normas , Doenças do Sistema Nervoso Periférico/prevenção & controle , Guias de Prática Clínica como Assunto/normas , Anestesia por Condução/efeitos adversos , Anestésicos Locais/efeitos adversos , Humanos , Bloqueio Nervoso/efeitos adversos , Dor/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Doenças do Sistema Nervoso Periférico/etiologia
13.
Eur J Phys Rehabil Med ; 55(4): 519-521, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31058474

RESUMO

BACKGROUND: Neuralgic amyotrophy (NA) is a relatively uncommon syndrome causing brachial nerves dysfunction. However, it can also affect other nerves including phrenic nerve, which is often misdiagnosed. CASE REPORT: To determine the incidence and characteristics of phrenic nerve palsy in patients with NA in our population, we analyzed the records of all patients with phrenic nerve palsy and/or NA at the University Hospital and the county hospital within the last 10 years. We found that totally, seven patients were confirmed to have NA and phrenic nerve palsy. All of them are male of average age 51.9 years old (51.9±7.4) and had shortness of breath following shoulder and/or neck pain. All of them had elevated diaphragm found in SNIFF test and/or on chest X-ray. Pulmonary function test done in 6 patients demonstrated restrictive lung disease. Six patients needed long-term bi-level positive airway pressure (BiPAP) treatment but mechanic ventilation was not needed. CLINICAL REHABILITATION IMPACT: Our cohort represents one of the largest case series yet reported for phrenic nerve involvement in NA. Most of these patients have had significant pulmonary compromise in the early stage of onset of shoulder/neck pain requiring ongoing BiPAP and specialist monitoring. Recognition of this subset of patients may further require nerve conduction studies/electromyography and respiratory testing.


Assuntos
Neurite do Plexo Braquial/complicações , Paralisia/etiologia , Doenças do Sistema Nervoso Periférico/etiologia , Nervo Frênico , Adulto , Estudos de Coortes , Humanos , Masculino , Pessoa de Meia-Idade
14.
Int J Infect Dis ; 85: 74-79, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31100421

RESUMO

BACKGROUND: Treatment outcomes of patients with extensively drug-resistant tuberculosis (XDR-TB) are suboptimal and treatment options remain limited. Linezolid is associated with improved outcomes but also substantial toxicity, and details about the relationship between these are lacking from resource-poor HIV-endemic settings. METHODS: This was a prospective follow-up study of 63 South African XDR-TB patients (58.7% HIV-infected; median CD4 131 cells/µl) between 2014 and 2018. The frequency and severity of linezolid-associated adverse events and the impact on treatment outcomes were compared between linezolid interrupters and non-interrupters. RESULTS: Twenty-two patients (34.9%) discontinued or underwent dose reduction due to presumed linezolid-associated toxicity. Anaemia (77.3% vs. 7.3%; p< 0.001), peripheral neuropathy (63.6% vs. 14.6%; p= 0.003), and optic neuritis (18.2% vs. 9.8%; p= 0.34) occurred more frequently in linezolid interrupters than in non-interrupters. Anaemia, peripheral neuropathy, and optic neuritis occurred at a median of 5, 18, and 23 weeks, respectively, after treatment initiation. Linezolid interruption was not associated with unfavourable outcomes but was strongly associated with HIV co-infection (adjusted hazard ratio 4.831, 95% confidence interval 1.526-15.297; p= 0.007) and bacterial load (culture days to positivity; adjusted hazard ratio 0.824, 95% confidence interval 0.732- 0.927; p= 0.001). CONCLUSIONS: Linezolid-related treatment interruption is common, is strongly associated with HIV co-infection, and system-specific toxicity occurs within predictable time frames. These data inform the clinical management of patients with drug-resistant TB.


Assuntos
Antituberculosos/uso terapêutico , Tuberculose Extensivamente Resistente a Medicamentos/tratamento farmacológico , Linezolida/uso terapêutico , Adulto , Anemia/epidemiologia , Anemia/etiologia , Antituberculosos/efeitos adversos , Coinfecção , Diarilquinolinas/uso terapêutico , Farmacorresistência Bacteriana , Quimioterapia Combinada , Tuberculose Extensivamente Resistente a Medicamentos/complicações , Feminino , Fluoroquinolonas/farmacologia , Seguimentos , Infecções por HIV/complicações , Humanos , Linezolida/efeitos adversos , Masculino , Neurite Óptica/epidemiologia , Neurite Óptica/etiologia , Doenças do Sistema Nervoso Periférico/epidemiologia , Doenças do Sistema Nervoso Periférico/etiologia , Estudos Prospectivos , Resultado do Tratamento
15.
Med Sante Trop ; 29(1): 68-70, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31031251

RESUMO

OBJECTIVE: The aim of this study was to describe the epidemiological, clinical, and therapeutic profile as well as the outcome and to document the causes of pellagra and pellagra-like erythema in a hospital setting in Lomé, Togo. METHODS: This retrospective study examined the records of patients seen for outpatient consultation and/or hospitalization in the three public dermatology departments of Lomé from January 1997 to September 2017. RESULTS: During the study period, 178 (0.4%) of 47,219 patients seen in these dermatology departments consulted for pellagra or pellagra-like erythema; 159 (89.3%) had pellagra-like erythema. The patients' mean age was 45.8±16 years, and the sex ratio (M/F) 1.8. All patients had at least one site of cutaneous involvement, nearly always erythematous or pigmented lesions in the photo-exposed areas (99.4% of cases). Gastrointestinal and neurological signs were dominated respectively by diarrhea (12.4 % of cases), peripheral neuropathies (8.4% of cases) and insomnia (8.4% of cases). The main causes identified were alcoholism (42.1% of cases) and nutritional deficiency (6.7% of cases). Five of 178 patients were infected with HIV. All patients were treated with nicotinamide and multivitamin supplementation. No deaths were recorded during follow-up. CONCLUSION: Our results document the extreme rarity of pellagra-like erythema/pellagra. Its two main causes remain alcoholism and nutritional deficiency. Moreover, its prognosis is good when treated quickly and adequately.


Assuntos
Alcoolismo/complicações , Eritema/epidemiologia , Desnutrição/complicações , Pelagra/epidemiologia , Alcoolismo/epidemiologia , Diarreia/epidemiologia , Diarreia/etiologia , Eritema/etiologia , Feminino , Humanos , Masculino , Desnutrição/epidemiologia , Pessoa de Meia-Idade , Niacinamida/uso terapêutico , Pelagra/terapia , Doenças do Sistema Nervoso Periférico/epidemiologia , Doenças do Sistema Nervoso Periférico/etiologia , Estudos Retrospectivos , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/etiologia , Togo/epidemiologia , Complexo Vitamínico B/uso terapêutico
16.
Z Rheumatol ; 78(4): 339-351, 2019 May.
Artigo em Alemão | MEDLINE | ID: mdl-30944998

RESUMO

Peripheral neuropathies are probably an under-diagnosed complication of many rheumatic diseases. In some cases they take a mild clinical course, in others they cause severe impairment of patients' quality of life. A precise diagnosis and etiological classification are of major importance for successful treatment and prognosis of peripheral neuropathies. A detailed patient history and physical examination are the foundation of every diagnostic approach. Electrophysiological studies are obligatory when peripheral neuropathy is suspected, whereas nerve or nerve-muscle biopsies are indicated only in selected cases. Therapeutic approaches are often complicated by a lack of evidence. They correspond to frequently tested immunosuppressive treatment of the underlying disease, such as glucocorticoids, cyclophosphamide, mycophenolate mofetil and intravenous immunoglobulins and are based on the symptomatic pain treatment of other neuropathies. As first-line treatment gabapentin, pregabalin, duloxetine, venlafaxine and tricyclic antidepressants are frequently used.


Assuntos
Doenças do Sistema Nervoso Periférico , Doenças Reumáticas , Cloridrato de Duloxetina , Humanos , Manejo da Dor , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/etiologia , Qualidade de Vida , Doenças Reumáticas/complicações
17.
Int J Radiat Oncol Biol Phys ; 104(4): 845-851, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-30953713

RESUMO

PURPOSE: This study was performed to determine the dose-related incidence of neuropathy from single-session irradiation of the C6-C8 spinal nerves using a pig model and to test the hypothesis that the spinal nerves and spinal cord have the same tolerance to full cross-sectional irradiation. METHODS AND MATERIALS: Twenty-five Yucatan minipigs received study treatment. Each animal underwent computed tomography and magnetic resonance imaging for treatment planning, followed by single-session stereotactic ablative radiation therapy. A 1.5-cm length of the left-sided C6, C7, and C8 spinal nerves was targeted. Pigs were distributed into 5 groups with prescription doses of 16 (n = 7), 18 (5), 20 (5), 22 (5), or 24 (3) Gy with corresponding maximum nerve doses of 17.3, 19.5, 21.6, 24.1, and 26.2 Gy. The neurologic status of all animals was followed for approximately 52 weeks by serial electrodiagnostic examination and daily observation of gait. Histopathologic examination of paraffin-embedded sections with Luxol fast blue/periodic acid-Schiff staining was performed on bilateral spinal nerves and the spinal cord. RESULTS: Marked gait change was observed in 15 of the 25 irradiated pigs. Affected animals presented with a limp in their left front limb, and electromyography demonstrated evidence of denervation in C6 and C7 innervated muscles. Probit analysis showed the ED50 for gait change after irradiation of the spinal nerves to be 19.7 Gy (95% confidence interval, 18.5-21.1). The latency for all responding pigs was 9 to 15 weeks after irradiation. All symptomatic pigs had demyelination and fibrosis in their irradiated nerves, whereas contralateral nerves and spinal cord were normal. CONCLUSIONS: The ED50 for symptomatic neuropathy after full cross-sectional irradiation of the spinal nerves was found to be 19.7 Gy. The dose response of the C6-C8 spinal nerves is not significantly different from that of full cross-sectional irradiation of the spinal cord as observed in companion studies.


Assuntos
Tolerância a Radiação , Radiocirurgia/métodos , Medula Espinal/efeitos da radiação , Nervos Espinhais/efeitos da radiação , Animais , Relação Dose-Resposta à Radiação , Feminino , Doenças do Sistema Nervoso Periférico/etiologia , Doses de Radiação , Medula Espinal/patologia , Nervos Espinhais/patologia , Suínos , Porco Miniatura
18.
Neurol Sci ; 40(8): 1611-1617, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31001716

RESUMO

OBJECTIVES: Chronic neuropathies are a common cause of neurological disability worldwide. However, few reports have evaluated, in real life, the prevalence of the several conditions which can cause it. PATIENTS AND METHODS: The authors reviewed informatic database for outpatient office to confirm identification of chronic neuropathy in a 3-year interval period. RESULTS: Among the 100 selected patients with chronic neuropathies, almost one fifth (19%) remained idiopathic. The most common etiologies were diabetes (17%), dysimmune neuropathies (38%), and vitamin B12 deficiency (9%). In the "dysimmune neuropathies" group, we distinguished various etiologies, including dysimmune neuropathies associated or not with systemic autoimmune diseases (7 and 3%, respectively), chronic inflammatory polyneuropathy (CIDP) (8%), multifocal motor neuropathy (MMN) (3%), paraproteinemic (8%), celiac disease-related (6%), and paraneoplastic (3%) neuropathies. CONCLUSIONS: In this report from a single neurological center, treatable causes of chronic neuropathies, such as dysimmune neuropathies, including CIDP, and celiac disease-associated neuropathy, were common. These findings suggest the utility of routine screening with blood testing for dysimmune neuropathy and celiac disease for all patients presenting with idiopathic chronic polyneuropathy in whom primary diagnostic testings had failed to identify an etiology for the disease. SIGNIFICANCE: Our results indicate that patients with peripheral neuropathy could receive a benefit from being evaluated routinely in a specialized neurological center, as many of the conditions that were discovered represented potentially treatable causes of neuropathy.


Assuntos
Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/etiologia , Doença Crônica , Complicações do Diabetes/epidemiologia , Feminino , Humanos , Doenças do Sistema Imunitário/complicações , Doenças do Sistema Imunitário/epidemiologia , Masculino , Prevalência , Estudos Retrospectivos , Deficiência de Vitamina B 12/complicações , Deficiência de Vitamina B 12/epidemiologia
19.
Molecules ; 24(6)2019 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-30934631

RESUMO

The dried fruits of Forsythia viridissima have been prescribed to relive fever, pain, vomiting, and nausea in traditional medicine. Oxaliplatin (LOHP) is used to treat advanced colorectal cancer; however, it frequently induces peripheral neuropathies. This study was done to evaluate the neuroprotective effects of an aqueous extract of Forsythia viridissima fruits (EFVF) and its major constituents. Chemical constituents from EFVF were characterized and quantified with the UHPLC-diode array detector method, and three major constituents were identified as arctiin, matairesinol, and arctigenin. The in vitro cytotoxicity was measured by the Ez-cytox viability assay, and the in vivo neuroprotection activity was evaluated by a von Frey test in two rodent animal models that were administered LOHP. EFVF significantly alleviated the LOHP-induced mechanical hypersensitivity in the induction model. EFVF also prevented the induction of mechanical hyperalgesia by LOHP in the pre- and co-treatment of LOHP and EFVF. Consistently, EFVF exerted protective effects against LOHP-induced neurotoxicity as well as inhibited neurite outgrowths in PC12 and dorsal root ganglion cells. Among the major components of EFVF, arctigenin and matairesinol exerted protective effects against LOHP-induced neurotoxicity. Therefore, EFVF may be useful for relieving or preventing LOHP-induced peripheral neuropathy in cancer patients undergoing chemotherapy with LOHP.


Assuntos
Forsythia/química , Fármacos Neuroprotetores/química , Fármacos Neuroprotetores/farmacologia , Oxaliplatina/efeitos adversos , Doenças do Sistema Nervoso Periférico/etiologia , Compostos Fitoquímicos/química , Extratos Vegetais/química , Extratos Vegetais/farmacologia , Animais , Apoptose/efeitos dos fármacos , Linhagem Celular , Cromatografia Líquida de Alta Pressão , Modelos Animais de Doenças , Humanos , Masculino , Potencial da Membrana Mitocondrial/efeitos dos fármacos , Camundongos , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/patologia , Ratos , Espécies Reativas de Oxigênio/metabolismo
20.
Brain Nerve ; 71(4): 364-367, 2019 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-30988222

RESUMO

Vitamin B12 deficiency is associated with mucocutaneous symptoms, such as glossitis and hyperpigmentation, as well as megaloblastic anemia and neuropathy. These are reversible conditions, and the symptoms improve with early detection and treatment. Whenever anemia is encountered in routine practice, vitamin B12 deficiency should be considered and the presence of skin symptoms should be investigated.


Assuntos
Hiperpigmentação/etiologia , Deficiência de Vitamina B 12/complicações , Anemia Megaloblástica/etiologia , Humanos , Doenças do Sistema Nervoso Periférico/etiologia
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