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2.
Medicine (Baltimore) ; 99(31): e21298, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756110

RESUMO

Serums were collected from people to assess whether polio immunity level was high enough to satisfy the polio vaccine immunization switch in Chongqing.People in 7 age groups (<1 year, 1-2 years, 3-4 years, 5-6 years, 7-14 years, 15-19 years, ≧20 years) were randomly selected in 3 areas by different geographical features in 2015. Peripheral venous blood samples were obtained and assays to detect poliovirus (PV) -neutralizing antibodies were performed. Acute flaccid paralysis (AFP) data was collected from 2012 to 2016 in Chongqing to evaluate the performance of AFP surveillance system by indicator analysis.A total of 636 people were tested for PV neutralization antibodies (NA). Overall NA seroprevalence for PV1, PV2 and PV3 were 93.40%, 96.38% and 91.82%, and geometric mean titers (GMTs) were 61.14, 66.78 and 21.47, respectively. GMTs and NA seroprevalence for PV1, PV2 and PV3 in older people were lower than young people. There were significant differences in seroprevalences of PV1 and PV3 among geographic areas (P < .05) in Chongqing.High seroprevalence for PV1, PV2, and PV3 and qualified capability for monitoring AFP cases showed that the polio eradication program has made positive achievements in Chongqing and established a stable base for a polio vaccine immunization switch. Nevertheless, GMTs were negatively associated with age in the geographic districts with poor economical features, which will increase the risk of emergence of vaccine-derived PV after polio vaccine switch. More than 1 dose of inactivated polio vaccine should be introduced into the polio vaccine schedule, and the supplementary immunization of polio should still be annually carried out after polio vaccine switch, especially among elder children and the adults.


Assuntos
Anticorpos Antivirais/sangue , Paralisia/epidemiologia , Poliovirus/imunologia , Adolescente , Anticorpos Neutralizantes/sangue , Criança , Pré-Escolar , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Hipotonia Muscular , Paralisia/sangue , Paralisia/etiologia , Estudos Soroepidemiológicos , Adulto Jovem
3.
Rinsho Shinkeigaku ; 60(8): 549-553, 2020 Aug 07.
Artigo em Japonês | MEDLINE | ID: mdl-32641634

RESUMO

A 39-year-old man presented with an 8-month history of pain and paresthesia of the right foot sole and difficulty in the right toe dorsiflexion. A neurological examination revealed weakness in performing both the ankle and right foot toe dorsiflexion, reduced right planta pedis sensation, and absent right Achilles tendon reflex. Tinel's sign was present on the right popliteal fossa and medial part of the right ankle. MRI of the right knee showed multiple cystic lesions in his right tibial nerve. The cystic lesions extended from the popliteal fossa and were thought to be intraneural ganglion cysts. On MRI performed 4 months later, most of the cystic lesions spontaneously vanished. Therefore, intraneural ganglia should be considered when atypical mononeuropathy, such as tibial nerve palsy, is present.


Assuntos
Cistos Glanglionares/complicações , Paralisia/etiologia , Neuropatia Tibial/etiologia , Adulto , Cistos Glanglionares/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Nervo Tibial/diagnóstico por imagem
4.
Medicine (Baltimore) ; 99(27): e20974, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629711

RESUMO

BACKGROUND: Stroke is emerging as a significant health issue that threatens human health worldwide and as a common sequela of stroke spastic paralysis after stroke (SPAS) has received wide attention. Currently, several systematic reviews have suggested that the commonly used acupuncture therapy (electroacupuncture, fire acupuncture, warm acupuncture, and filiform needle acupuncture) has achieved significant efficacy in the treatment of SPAS. In this study, network meta-analysis will be used to analyze the results of different clinical trials and evaluate the differences in the efficacy of different acupuncture treatments for SPAS. METHODS: Only randomized controlled trials will be included and all patients were diagnosed as spastic paralysis after stroke. A computer-based retrieval will be conducted at CNKI, WanFang databases, VIP, Sinoed, Pubmed, Embase, Web of Science, and the Cochrane library. The search period limit is from the time the date of database establishment to April 17, 2020. To avoid omissions, we will manually retrieve relevant references and conference papers. The risk of bias in the final included studies will be evaluated based on the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. All data analysis will be conducted by Revman5.3, WinBUGS 1.4.3, and Stata14.2. RESULTS: This study quantified the effectiveness of each intervention for different outcome indicators. The primary outcomes include the Fugl-Meyer Assessment score, the modified Ashworth scale for the assessment of spasticity, and Barthel Index. The secondary outcomes include clinical effectiveness and adverse reactions. CONCLUSION: It will provide evidence-based medical evidence for clinicians to choose more effective acupuncture therapy for SPAS.


Assuntos
Terapia por Acupuntura/métodos , Paralisia/terapia , Acidente Vascular Cerebral/complicações , Humanos , Metanálise como Assunto , Espasticidade Muscular/etiologia , Paralisia/etiologia , Revisões Sistemáticas como Assunto
5.
Ann Afr Med ; 19(2): 147-149, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32499473

RESUMO

Sjogren syndrome (SS) is a systemic autoimmune disorder with predominant exocrine gland involvement leading to sicca symptoms. Among extraglandular manifestations, renal disease is the most common. Tubular interstitial nephritis and renal tubular acidosis (RTA) are the common presentations. Mild hypokalemia associated with distal RTA is common in SS, however, severe hypokalemia causing paralysis is unusual. We report the case of a 26-year-old female who presented with hypokalemic paralysis. On evaluation, distal RTA was diagnosed. Further evaluation showed positive SS-a/SS-b antibodies in high titer, which confirms the diagnosis of primary SS. Our report illustrates that SS is a rare but important cause of hypokalemic paralysis.


Assuntos
Acidose Tubular Renal/complicações , Hipopotassemia/diagnóstico , Paralisia/etiologia , Síndrome de Sjogren/diagnóstico , Administração Intravenosa , Administração Oral , Adulto , Anticorpos Antinucleares/sangue , Bicarbonatos/administração & dosagem , Bicarbonatos/uso terapêutico , Feminino , Humanos , Hipopotassemia/tratamento farmacológico , Paralisia Periódica Hiperpotassêmica , Cloreto de Potássio/administração & dosagem , Cloreto de Potássio/uso terapêutico , Citrato de Potássio/administração & dosagem , Citrato de Potássio/uso terapêutico , Compostos de Potássio/administração & dosagem , Compostos de Potássio/uso terapêutico , Síndrome de Sjogren/etiologia , Resultado do Tratamento
6.
Medicine (Baltimore) ; 99(26): e20929, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590805

RESUMO

Retrospective reviewThe degree of spinal cord compression and bony spinal canal stenosis are risk factors for the occurrence of spinal cord injury (SCI) without major fracture or dislocation, but they do not affect the severity of neurological symptoms. However, whether a relatively large spinal cord for the dural sac influences the severity of symptoms in SCI cases is unknown.The purpose of this study was to verify the influence of spinal cord size relative to dural sac on the severity of paralysis in elderly patients with cervical SCI caused by minor trauma.Subjects were 50 elderly patients with SCI caused by falls on flat ground. At 72 hours after injury, neurological assessment was performed using the Japanese Orthopaedic Association (JOA) scoring system. Bony canal anteroposterior diameters (APD) at mid C5 vertebral body were measured with computed tomography. We measured dural sac and spinal cord APD at the injured level and mid C5 with magnetic resonance imaging. Spinal cord compression ratio was calculated by dividing spinal cord at the injured level by spinal cord at mid C5. As the evaluation of spinal cord size relative to the dural sac, spinal cord/dural sac ratio was calculated at the injured level and mid C5. To clarify the factors influencing the severity of paralysis, the relationships between JOA score and those parameters were examined statistically.A significant negative correlation was observed between JOA score and spinal cord/dural sac ratio at mid C5. No clear relationship was observed between JOA score and bony canal APD or spinal cord compression ratio.In elderly patients with SCI caused by minor trauma, a relatively large spinal cord for the dural sac was shown to be a factor that influences the severity of paralysis. This result can be useful for the treatment and prevention of SCI in the elderly.


Assuntos
Vértebras Cervicais/lesões , Paralisia/etiologia , Canal Vertebral/anatomia & histologia , Traumatismos da Medula Espinal/etiologia , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/anatomia & histologia , Feminino , Geriatria/métodos , Humanos , Japão/epidemiologia , Imagem por Ressonância Magnética/métodos , Masculino , Paralisia/epidemiologia , Índice de Gravidade de Doença , Canal Vertebral/patologia , Medula Espinal/anormalidades , Medula Espinal/fisiologia , Traumatismos da Medula Espinal/classificação , Traumatismos da Medula Espinal/epidemiologia , Tomografia Computadorizada por Raios X/métodos , Ferimentos e Lesões/complicações , Ferimentos e Lesões/epidemiologia
7.
Int J Infect Dis ; 95: 157-159, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32220630

RESUMO

Botulism is a form of paralysis caused by a neurotoxin produced by the bacterium Clostridium botulinum. It is well known that natural honey contains Clostridium botulinum spores; controversy arises when a honey-related product is being used for wound care, where the possibility occurs of applying these spores to an open wound. To our knowledge, no reported cases of medical-grade honey have been associated with wound botulism. Given this fact, do we feel secure regarding the safety of this product, and will it be enough to alleviate our concern? We present a case of an infant with an infected umbilical stump, which required a surgical wound debridement. This infant developed a sudden progressive flaccid paralysis a few days after the application of topical medical grade honey for wound care. Even though suspicion of wound botulism is high, confirmation of the diagnosis, detection of neurotoxin, and isolating the organism remains a challenge.


Assuntos
Botulismo/diagnóstico , Botulismo/etiologia , Mel/efeitos adversos , Administração Tópica , Desbridamento , Feminino , Mel/microbiologia , Humanos , Lactente , Paralisia/etiologia , Ferimentos e Lesões/cirurgia
8.
Med Sci Monit ; 26: e920751, 2020 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-32134903

RESUMO

Todd's paralysis, a neurological abnormality characterized by temporary limb weakness or hemiplegia, typically occurs following a seizure, without enduring consequences. Since limb weakness or hemiplegia can also be a common symptom of an acute ischemic stroke, it is often difficult to diagnose Todd's paralysis in individuals experiencing an acute ischemic stroke if they do not have a pre-existing history of epilepsy. Given that there is a limited understanding of Todd's paralysis, this review discusses the history, prevalence, clinical manifestations, duration, etiology, and diagnosis of Todd's paralysis. A few factors that may help clinicians distinguish Todd's paralysis from other clinical indications are as follows: (1) Todd's paralysis is commonly observed after partial seizures or generalized tonic-clonic seizures. (2) The incidence of Todd's paralysis is greater if the epilepsy is associated with old age or stroke history. (3) The duration of Todd's paralysis can range from minutes to days, depending on the type of seizure or whether the patient has experienced cortical structural damage. (4) The etiology of Todd's paralysis is associated with cerebral perfusion abnormality after seizures. Further research is needed to explore factors that distinguish Todd's paralysis from other indications that may lead to limb weakness in order to improve the diagnosis of Todd's paralysis.


Assuntos
Paralisia/fisiopatologia , Convulsões/complicações , Epilepsia/complicações , Humanos , Paralisia/etiologia , Acidente Vascular Cerebral/complicações
9.
Medicine (Baltimore) ; 99(3): e18817, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011490

RESUMO

RATIONALE: Although C5 palsy is a common complication of cervical spine surgery, its cause has not been confirmed. There are various hypotheses for its mechanism, including spinal cord impairment and nerve involvement. Therefore, prophylactic foraminotomy is one of the methods recommended for preventing C5 palsy. However, we describe a patient who experienced C5 palsy after microendoscopic foraminotomy between the left C5/6 and C6/7 levels. PATIENT CONCERNS: A 43-year-old man presented with a 14-month history of progressive numbness in the left upper limb. We performed microendoscopic left foraminal decompressions at the C5/6/7 levels to treat the left C6 and C7 radiculopathy. On the postoperative day 1, we observed weak motor strength of the left deltoid, left biceps, and left forearm pronator, while the motor strength of the other muscles was normal. DIAGNOSES: C5 palsy following C5/6/7 left foraminotomy. INTERVENTION: Follow-up rehabilitation with muscle strength training and range of motion training. OUTCOME: The patient recovered his motor strength completely within 3 months postoperatively. LESSONS: In this case, the C5 palsy could not be adequately explained by the theory of nerve root impingement or disruption in blood circulation following spinal cord decompression. We hypothesized that the patient had drill heat-induced C5 palsy. Regarding the C5 palsy without C5 nerve root decompression, we hypothesize that the C5 palsy in C5/6/7 foraminotomy could be related to variations in the formation of the brachial plexus. Prophylactic foraminotomy for cervical posterior surgery should be performed with care, limiting its use in patients who are at a risk of developing C5 palsy because the prophylactic procedure can cause C5 palsy. We must also consider that even without decompression at the C4/5 level, there is a possibility of C5 palsy occurring.


Assuntos
Vértebras Cervicais/cirurgia , Foraminotomia , Paralisia/etiologia , Paralisia/reabilitação , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/reabilitação , Compressão da Medula Espinal/cirurgia , Adulto , Humanos , Masculino , Recuperação de Função Fisiológica
10.
World Neurosurg ; 136: e393-e397, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31931248

RESUMO

OBJECTIVE: During surgery, shoulder traction is often used for better fluoroscopic imaging of the lower cervical spine. Traction on the C5 root has been implicated as a potential cause of C5 palsy after cervical spine surgery. Using magnetic resonance imaging, this study was undertaken to determine the impact of upper extremity traction on the C5 root orientation. METHODS: In this study, 5 subjects underwent coronal magnetic resonance imaging of the cervical spine and left brachial plexus. Using a wrist restraint, sequential traction on the left arm with 10, 20, and 30 lb. was applied. Measurements of the angle between the spinal axis and C5 nerve root and the angle between the C5 nerve root and the upper trunk of the brachial plexus were obtained. The measurements were taken by a trained neuroradiologist and analyzed for significance. RESULTS: The angle between the C5 nerve root and the vertical spinal axis remained within 3 and 4 degrees of the mean and was not found to be associated with increased traction weight (P = 0.753). The angle between the C5 root and the upper trunk increased with increasing weight and was found to be statistically significant (P = 0.003). CONCLUSIONS: While the cause of C5 palsy is likely multifactorial, this study provides evidence that, in the awake volunteer, upper extremity traction leads to C5 root and upper trunk tension. These results suggest that shoulder traction in the anesthetized patient could lead to tension of the C5 nerve root and subsequent injury and palsy.


Assuntos
Cuidados Intraoperatórios/efeitos adversos , Paralisia/etiologia , Tração/efeitos adversos , Adulto , Idoso , Plexo Braquial/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Feminino , Fluoroscopia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Paralisia/patologia , Raízes Nervosas Espinhais/patologia
11.
Spine (Phila Pa 1976) ; 45(1): E10-E17, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31415464

RESUMO

STUDY DESIGN: Retrospective radiological analysis OBJECTIVE.: The aim of this study was to identify the effects of posterior cervical muscle swelling on C5 palsy (C5P) by evaluating early postoperative magnetic resonance (MR) images. SUMMARY OF BACKGROUND DATA: Cervical laminoplasty is an established technique, but the risk of C5P after surgery has not been fully resolved. Studies have reported that lateral stretching and postoperative swelling of the multifidus muscle may cause stretching of the medial branches and cervical nerves. METHODS: A total of 214 C5 nerves of 107 consecutive patients who underwent laminoplasty were examined. We reviewed their demographic and surgical data and radiographic and MR images as parameters, including the axial cross-sectional area (CSA) of the posterior muscles. The patients and C5 nerves were divided into C5P and non-C5P groups. The parameters and changes were compared between the two groups to examine correlations with C5P. RESULTS: In demographic data, age, sex, history of smoking, diabetes mellitus, and preoperative Japanese Orthopedic Association scores were not significantly different between the groups. Only body mass index (BMI) was significantly higher in the C5P group. Regarding the surgical and imaging data, the number of laminoplasty, operative time, decompression trough width, cervical sagittal alignment, preoperative spinal cord rotation, and posterior shift of the spinal cord were not significantly different, but the multifidus CSA change ratio was significantly higher in the C5P group. Multiple logistic regression analyses revealed that the multifidus CSA change ratio and BMI were significant independent factors. CONCLUSION: Multifidus swelling is associated with C5P, possibly through traction of the C5 nerve via the medial branches of the cervical dorsal rami. The medial branch is the shortest of the dorsal rami and may have the largest effect by traction force. Therefore, a gentle maneuver of the deep posterior muscles during surgery is a potential countermeasure to prevent C5P. LEVEL OF EVIDENCE: 3.


Assuntos
Laminoplastia/efeitos adversos , Doenças Musculares/complicações , Paralisia/etiologia , Adulto , Idoso , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica , Edema , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças Musculares/fisiopatologia , Paralisia/fisiopatologia , Músculos Paraespinais/fisiopatologia , Músculos Paraespinais/cirurgia , Radiografia , Estudos Retrospectivos , Fatores de Risco , Medula Espinal/cirurgia
12.
Ann R Coll Surg Engl ; 102(3): e70-e72, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31859522

RESUMO

Postoperative femoral nerve palsy with nerve division is a potentially devastating complication with a poor prognosis, especially when there is a delay in diagnosis. We present a novel 'belt and braces' approach for managing this unusual injury, using a modification of a nerve transfer, which has only been previously reported in the literature three times to our knowledge.


Assuntos
Nervo Femoral/lesões , Herniorrafia/efeitos adversos , Transferência de Nervo/métodos , Nervo Obturador/cirurgia , Feminino , Hérnia Inguinal/cirurgia , Humanos , Pessoa de Meia-Idade , Paralisia/etiologia , Paralisia/cirurgia
13.
Rinsho Shinkeigaku ; 60(1): 41-45, 2020 Jan 30.
Artigo em Japonês | MEDLINE | ID: mdl-31852870

RESUMO

A 66-year-old woman was admitted to our institution with sudden-onset weakness of her left upper limb. Neurological examination revealed monoplegia and sensory loss of the limb. A brain MRI did not find evidence of an acute ischemic stroke. Her medical history revealed that she had fallen and bruised her shoulder 3 days earlier. Detailed physiological examination revealed that there was a mild subcutaneous ecchymosis with tenderness in the left shoulder. An additional contrast-enhanced chest CT scan showed a fracture of the clavicle diaphysis and a pooling contrast agent demonstrating a 60*40 mm mass near the left subclavian artery (SUB-A) which suggested a pseudoaneurysm. We determined that her symptoms were due to compression of the brachial plexus by immediate growth of a traumatic SUB-A pseudoaneurysm (TSAP) due to her earlier fall. For reduction of pressure to the brachial plexus by the TSAP and prevention of rupture, an endovascular treatment team performed endovascular internal trapping of the left SUB-A just distal to the orifice of the left vertebral artery and a cardiovascular surgeon performed percutaneous drainage of the pseudoaneurysm. After the procedure, the palsy and sensory loss of the left hand gradually improved. A TSAP could be one of the causes of sudden-onset palsy of the upper limb within a few days after a fall.


Assuntos
Acidentes por Quedas , Aneurisma/etiologia , Paralisia/etiologia , Artéria Subclávia/cirurgia , Extremidade Superior/irrigação sanguínea , Extremidade Superior/inervação , Idoso , Aneurisma/diagnóstico , Aneurisma/cirurgia , Diagnóstico Diferencial , Drenagem/métodos , Feminino , Humanos , Fatores de Tempo
14.
Indian Pediatr ; 56(11): 976-977, 2019 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-31729333
15.
BMC Neurol ; 19(1): 279, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718589

RESUMO

BACKGROUND: Cerebral infarction occurs when the arteries to brain are obstructed, and motor impairment contralateral to responsible lesion is commonly recognized. Few studies have profiled the characteristics of cases with ipsilateral motor impairment. We sought to characterize clinical features of patients with motor dysfunction caused by ipsilateral ischemic stroke. METHODS: We retrieved and analyzed the medical data for patients with ipsilateral cerebral infarction. Patients were regarded as having ipsilateral cerebral infarction if motor impairment is ipsilateral to recent stroke lesions. RESULTS: Only 22 patients with unusual ipsilateral cerebral infarction were included in this study. Ipsilateral limb paralysis was observed in all cases, and one case showed central facioplegia. Majority of patients with limb paralysis (90.9%, 20/22) presented with mild muscle strength deficits (MRC grading of 4 or more). Most of the patients (72.7%, 16/22) had a past history of stroke, and previous strokes were contralateral to the side of the recent stroke in 14 out of 16 patients (87.5%). No history of stroke or cerebral injury was identified in seven patients. With aspect of MRI findings, recent infarct lesions of all cases were located along the corticospinal tract. CONCLUSIONS: History of stroke plays an important role in the pathogenesis of ipsilateral motor impairment, and cortical reorganization in the unaffected hemisphere may contribute to the compensation of motor function after stroke. Besides that, some cases with first stroke may be due to impairment of ipsilateral uncrossed corticospinal fibers.


Assuntos
Infarto Cerebral/complicações , Infarto Cerebral/patologia , Lateralidade Funcional/fisiologia , Paralisia/etiologia , Paralisia/fisiopatologia , Adulto , Idoso , Infarto Cerebral/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtornos Motores/etiologia , Transtornos Motores/fisiopatologia , Neuroimagem , Paralisia/diagnóstico por imagem , Acidente Vascular Cerebral/complicações
17.
J Orthop Surg Res ; 14(1): 291, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481077

RESUMO

BACKGROUND: Therapeutic intervention has recently been actively performed for metastatic spine tumor even though spinal cord paralysis is not clearly observed, but there has been no report in which the degree of spinal cord compression by tumor was taken into consideration for the paralysis-preventing effect of treatment. Thus, we investigated the neurological outcome after treatment of patients with spinal cord compression in a state of impending paralysis. METHODS: A retrospective cohort study. The subjects were 88 patients with epidural spinal cord compression (ESCC) scale 1b or severer compression with American Spinal Injury Association (ASIA) E spinal metastasis. The neurological outcome after the therapeutic intervention was investigated at regular intervals until death. The therapeutic intervention was posterior decompression and stabilization in 18 patients, stabilization without posterior decompression in 15, and radiotherapy in 55 patients (3 groups). RESULTS: The ASIA aggravation group was comprised of 15 patients, and the severity of paralysis was ASIA A in 3, B in 3, C in 6, and D in 3. Paralysis appeared in 16.7% in the posterior decompression and stabilization group, 13.3% in the posterior stabilization without decompression group, and 18.8% in the radiotherapy group. In the transverse view, the incidence was high in cases with advancement to the intervertebral foramen and circumferential-type advancement, and paralysis developed in more than 20% of ESCC 1c or severer cases. Factors influencing neurological aggravation were investigated, but there was no significant factor. CONCLUSION: In ESCC 1b or severer cases with ASIA E spinal metastasis, paralysis aggravated after therapeutic intervention in 16.7% in the posterior decompression and stabilization group, 13.3% in the stabilization without decompression group, and 16.7% in the radiotherapy group. There was no significant factor influencing the development of paralysis.


Assuntos
Descompressão Cirúrgica/tendências , Espaço Epidural/cirurgia , Paralisia/cirurgia , Compressão da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica/métodos , Espaço Epidural/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/tendências , Paralisia/diagnóstico por imagem , Paralisia/etiologia , Estudos Prospectivos , Estudos Retrospectivos , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento
18.
Ugeskr Laeger ; 181(36)2019 Sep 02.
Artigo em Dinamarquês | MEDLINE | ID: mdl-31538573

RESUMO

Chronic rhinosinusitis and nasal polyposis are common rhinological diagnoses. Left untreated both diseases can result in visual dysfunctions because of their close proximity to orbita. We report a rare case of an isolated trochlear nerve palsy caused by chronic sinusitis and nasal polyposis. The patient was a healthy 54-year-old woman. She was successfully managed with sinus surgery and recovered fully. Despite the rare aetiology, diseases in the sinuses should be considered in the differential diagnosis of trochlear nerve palsy.


Assuntos
Pólipos Nasais , Paralisia , Sinusite , Doença Crônica , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Paralisia/etiologia , Sinusite/complicações
19.
Am J Case Rep ; 20: 1356-1359, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31515465

RESUMO

BACKGROUND It is still challenging to remove an epidural catheter in a postoperative patient receiving urgent antiplatelet and anticoagulation therapy for acute coronary syndrome. CASE REPORT While under general anesthesia combined with thoracic epidural anesthesia, a 72-year-old male patient underwent right radical nephrectomy for renal cell carcinoma. On postoperative day 1 (POD1), the patient experienced bradycardia and a decrease in blood pressure, and he was diagnosed acute myocardial infarction. Intra-aortic balloon pumping (IABP) was induced for cardiogenic shock, and urgent thrombus aspiration and coronary balloon angioplasty were performed. On POD3, the surgeon removed the epidural catheter under both antiplatelet and anticoagulation therapy. At that time, the platelet count was 45×109/L and the activated partial thromboplastin time (APTT) was 72.2 seconds. Four hours after the epidural catheter was removed, the patient complained of bilateral fatigue in legs and developed a loss of sensation. Six hours after the epidural catheter was removed, he developed motor paralysis and became completely paralyzed in both limbs after 9 hours. At 19 hours after the epidural catheter was removed, emergency magnetic resonance imaging detected a spinal epidural hematoma at the level of Th9-11 with compression of the spinal cord. Emergency laminectomy was performed to decompress and remove the spinal epidural hematoma at 18 hours after the onset of sensorimotor symptoms. After surgery and rehabilitation, these symptoms had only slightly improved. CONCLUSIONS In patients with urgent antithrombotic therapy for urgent percutaneous coronary intervention (PCI) with an IABP for acute coronary syndrome, the epidural catheter should not be removed until the IABP and heparin are discontinued, and platelet counts have recovered.


Assuntos
Anestesia Epidural/efeitos adversos , Angioplastia Coronária com Balão , Anticoagulantes/efeitos adversos , Hematoma Epidural Espinal/etiologia , Balão Intra-Aórtico , Infarto do Miocárdio/terapia , Idoso , Anestesia Geral , Anticoagulantes/administração & dosagem , Bradicardia/etiologia , Bradicardia/terapia , Trombose Coronária/terapia , Hematoma Epidural Espinal/diagnóstico por imagem , Hematoma Epidural Espinal/terapia , Humanos , Laminectomia , Imagem por Ressonância Magnética , Masculino , Infarto do Miocárdio/etiologia , Paralisia/etiologia , Paralisia/terapia , Complicações Pós-Operatórias , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/terapia , Trombectomia
20.
Zhen Ci Yan Jiu ; 44(8): 589-93, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31475493

RESUMO

OBJECTIVE: To observe the clinical effect of early acupuncture treatment of limb paralysis in patients with traumatic brain injury (TBI) and changes of serum interleukin-6 (IL-6), brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) levels, so as to explore its mechanism underlying improvement of TBI. METHODS: A total of 70 TBI inpatients were equally divided into a medication group and an acupuncture plus medication group according to a random number table. The medication contained intravenous drip of Mannitol Injection (125 mL, once every 8 h ) and Oxiracetam Injection (4 g, once a day). Starting 72 h after TBI, acupuncture therapy was applied to main points as Fenglong (ST40), Zusanli (ST36), Guanyuan (CV4), Baihui (GV20), Shuigou (GV26) and Fengchi (GB20), etc. The treatment was given once a day for total 28 days. Before and after the treatment, plasma IL-6, BDNF and NGF contents were detected using radioimmunoassay, the volume of the injured brain tissue was detected by using CT scan. The neurological deficit severity was evaluated by using Glasgow Coma Scale (GCS), and the degree of activity of daily living (ADL) ability was assessed by using simplified Fugl-Meyer assessment (FMA) scale, and modified Barthel index (BI), separately. RESULTS: After the treatment, the GCS score on day 28, FMA and ADL-BI scores on day 28 and 60 were significantly increased in both medication and acupuncture plus medication groups in comparison with their own pre-treatment (P<0.05). The focal volume values of the injured brain were significantly decreased on day 14 and 28 in both groups compared with their own pre-treatment (P<0.05). The therapeutic effect of acupuncture plus medication was obviously superior to that of simple medication in lowering focal injured volume on day 14 and 28, and in increasing FMA and ADL-BI scores on day 28 and 60 (P<0.05). Compared with pre-treatment, the levels of plasma IL-6 on day 3, 7 and 14 were significant decreased, and those of plasma BDNF and NGF on day 3, 7 and 14 considerably increased in both groups in comparison with their own pre-treatment (P<0.05). The therapeutic effect of acupuncture plus medication was evidently superior to that of simple medication in lowering IL-6 on day 3 and 7, and in increasing BDNF and NGF levels on day 3, 7 and 14 (P<0.05). CONCLUSION: Early acupuncture treatment can significantly improve the TBI patient's limb motor function and daily life activities, which may be related with its effects in reducing the inflammation and increasing BDNF and NGF levels.


Assuntos
Terapia por Acupuntura , Lesões Encefálicas Traumáticas , Paralisia/terapia , Lesões Encefálicas Traumáticas/complicações , Fator Neurotrófico Derivado do Encéfalo , Humanos , Interleucina-6 , Paralisia/etiologia
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