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1.
Magy Seb ; 73(4): 153-159, 2020 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-33310918

RESUMO

Összefoglaló. A thoracoabdominalis aorta kirekesztése a gerincvelo keringésének csökkenését okozza. Az ischemia klinikailag paraparesis, paraplegia formájában jelenik meg. Ez elsosorban nyitott mutétek során jelent aligha kiszámítható szövodményt, de a modern endovascularis technikák sem oldották meg teljes mértékben ennek biztonságos kivédését - bár arányát jelentosen mérsékelték. A javuló eredmények számos tényezore vezethetok vissza, mint a keringés kirekesztési idejének csökkentése, a gerincvelo-funkció és metabolismus ellenorzése. Mesterséges keringésjavító direkt és indirekt eljárások, liquor drainage, hutés mellett a collateralis keringés javítását szolgáló prekondicionáló módszerek kerültek bevezetésre. Kísérletes munkánkban 25-30 kg testsúlyú kutyákon vizsgáltuk - más paraméterek mellett - a distalis perfusio növelésének, a liquornyomás csökkentésének, illetve ezek kombinációjának protektív hatását egyórás thoracoabdominalis aortakirekesztés során. Dolgozatunkban a kísérleti állataink neurológiai végállapotát a keringési paraméterek és szöveti perfusio és a reperfusio változásainak összefüggésein keresztül tárgyaljuk. Megállapítottuk, hogy distalis gerincvelo reperfusiós hyperaemiája szorosan összefügg a neurológiai károsodás mértékével. Summary. Clamping of the thoracoabdominal aorta reduces perfusion of the spinal cord significantly, which clinically may present as paraparesis or paraplegia - devastating and unpredictable complications of open thoracoabdominal aortic surgery. Introduction of monitoring of evoked potentials and/or biochemical markers, methods increasing distal arterial pressure, indirect procedures enhancing residual flow (like liquor drainage), drugs, and use of hypothermia contributed to achieve better outcome. Preconditioning of spinal cord circulation is also a promising method. New endovascular techniques for thoracoabdominal aortic aneurysms and dissections reduced surgical trauma significantly. Despite all these progressions spinal cord ischemic damage is still a significant risk. To address this problem we carried out an experimental work using a canine model focusing on the protective effect of distal arterial perfusion, spinal fluid drainage, and their combination in a one hour setting of thoracoabdominal aortic clamping. In this paper we publish our data of circulatory and specific perfusion parameters of the spinal cord during and after declamping in correlation of final neurologic outcome.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Procedimentos Endovasculares/métodos , Isquemia/cirurgia , Paraplegia/complicações , Medula Espinal/cirurgia , Animais , Constrição , Cães , Perfusão , Medula Espinal/irrigação sanguínea
2.
PLoS Biol ; 18(11): e3000943, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33196637

RESUMO

In several neurodegenerative disorders, axonal pathology may originate from impaired oligodendrocyte-to-axon support of energy substrates. We previously established transgenic mice that allow measuring axonal ATP levels in electrically active optic nerves. Here, we utilize this technique to explore axonal ATP dynamics in the Plpnull/y mouse model of spastic paraplegia. Optic nerves from Plpnull/y mice exhibited lower and more variable basal axonal ATP levels and reduced compound action potential (CAP) amplitudes, providing a missing link between axonal pathology and a role of oligodendrocytes in brain energy metabolism. Surprisingly, when Plpnull/y optic nerves are challenged with transient glucose deprivation, both ATP levels and CAP decline slower, but recover faster upon reperfusion of glucose. Structurally, myelin sheaths display an increased frequency of cytosolic channels comprising glucose and monocarboxylate transporters, possibly facilitating accessibility of energy substrates to the axon. These data imply that complex metabolic alterations of the axon-myelin unit contribute to the phenotype of Plpnull/y mice.


Assuntos
Trifosfato de Adenosina/metabolismo , Bainha de Mielina/metabolismo , Paraplegia/metabolismo , Potenciais de Ação , Animais , Axônios/metabolismo , Modelos Animais de Doenças , Metabolismo Energético , Feminino , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Camundongos Transgênicos , Microscopia Eletrônica de Transmissão , Microscopia Imunoeletrônica , Proteína Proteolipídica de Mielina/deficiência , Proteína Proteolipídica de Mielina/genética , Bainha de Mielina/patologia , Nervo Óptico/metabolismo , Nervo Óptico/patologia , Paraplegia/genética , Paraplegia/patologia , Fenótipo
3.
Zhonghua Yi Xue Yi Chuan Xue Za Zhi ; 37(11): 1261-1264, 2020 Nov 10.
Artigo em Chinês | MEDLINE | ID: mdl-33179235

RESUMO

OBJECTIVE: To explore the genetic basis for a pedigree affected with hereditary spastic paraplegia type 4 (HSP4). METHODS: Peripheral venous blood samples were taken from members of the four-generation pedigree and 50 healthy controls for the extraction of genomic DNA. Genes associated with peripheral neuropathy and hereditary spastic paraplegia were captured and subjected to targeted capture and next-generation sequencing. The results were confirmed by Sanger sequencing. RESULTS: DNA sequencing suggested that the proband has carried a heterozygous c.1196C>G variant in exon 9 of the SPAST gene, which can cause substitution of serine by threonine at position 399 (p.Ser399Trp) and lead to change in the protein function. The same variant was also detected in other patients from the pedigree but not among unaffected individuals or the 50 healthy controls. Based on the ACMG 2015 guidelines, the variant was predicted to be possibly pathogenic. CONCLUSION: The c.1196C>G variant of the SPAST gene probably underlay the HSP4 in this pedigree.


Assuntos
Paraplegia/genética , Paraplegia Espástica Hereditária/genética , Espastina/genética , Sequência de Bases , Humanos , Mutação , Linhagem , Análise de Sequência de DNA
4.
Rinsho Shinkeigaku ; 60(11): 752-757, 2020 Nov 27.
Artigo em Japonês | MEDLINE | ID: mdl-33115989

RESUMO

Surfer's myelopathy is non-traumatic spinal cord injury which develops in beginner surfers. The patient was a 17-year-old female who developed severe paraplegia with bilateral sensory dysfunction below the groin and bladder/rectal dysfunctions after her first surfing lesson. A spinal-cord MRI performed six hours after onset revealed an intramedullary hyperintensity area from T8 to the conus medullaris on the T2 weighted images. Expansion of this hyperintensity area was observed on Day 3 and showed a reduction on Day 8. After providing intravenous methylpredonisolone, intravenous glycerol and intravenous edaravone, motor function and bladder/rectal functions began to improve after approximately three weeks. In this study, the expansion of the lesion in the early stages of the disease course was observed by sequential spinal MRI. Furthermore, a time lag between improvement according to imaging and improvement in symptoms was also observed.


Assuntos
Traumatismos em Atletas/diagnóstico por imagem , Imagem de Tensor de Difusão/métodos , Traumatismos da Medula Espinal/diagnóstico por imagem , Esportes Aquáticos , Adolescente , Traumatismos em Atletas/complicações , Traumatismos em Atletas/tratamento farmacológico , Edaravone/administração & dosagem , Feminino , Glicerol/administração & dosagem , Humanos , Infusões Intravenosas , Metilprednisolona/administração & dosagem , Paraplegia/tratamento farmacológico , Paraplegia/etiologia , Doenças Retais/tratamento farmacológico , Doenças Retais/etiologia , Doenças da Medula Espinal , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/tratamento farmacológico , Fatores de Tempo , Resultado do Tratamento , Doenças da Bexiga Urinária/tratamento farmacológico , Doenças da Bexiga Urinária/etiologia
6.
BMC Neurol ; 20(1): 290, 2020 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-32746806

RESUMO

BACKGROUND: Spastic paraplegia type 30 (SPG30) caused by KIF1A mutations was first reported in 2011 and was initially considered a very rare autosomal recessive (AR) form. In the last years, thanks to the development of massive parallel sequencing, SPG30 proved to be a rather common autosomal dominant (AD) form of familial or sporadic spastic paraplegia (SPG),, with a wide range of phenotypes: pure and complicated. The aim of our study is to detect AD SPG30 cases and to examine their molecular and clinical characteristics for the first time in the Russian population. METHODS: Clinical, genealogical and molecular methods were used. Molecular methods included massive parallel sequencing (MPS) of custom panel 'spastic paraplegias' with 62 target genes complemented by familial Sanger sequencing. One case was detected by the whole -exome sequencing. RESULTS: AD SPG30 was detected in 10 unrelated families, making it the 3rd (8.4%) most common SPG form in the cohort of 118 families. No AR SPG30 cases were detected. In total, 9 heterozygous KIF1A mutations were detected, with 4 novel and 5 known mutations. All the mutations were located within KIF1A motor domain. Six cases had pure phenotypes, of which 5 were familial, where 2 familial cases demonstrated incomplete penetrance, early onset and slow relatively benign SPG course. All 4 complicated cases were caused by novel mutations without familial history. The phenotypes varied from severe in two patients (e.g. lack of walking, pronounced mental retardation) to relatively mild non-disabling symptoms in two others. CONCLUSION: AD SPG30 is one of the most common forms of SPG in Russia, the disorder has pronounced clinical variability while pure familial cases represent a significant part.


Assuntos
Cinesina/genética , Paraplegia/congênito , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Heterozigoto , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Deficiência Intelectual/genética , Masculino , Pessoa de Meia-Idade , Mutação , Paraplegia/genética , Fenótipo , Federação Russa , Adulto Jovem
7.
Medicine (Baltimore) ; 99(30): e21346, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791734

RESUMO

RATIONALE: Papillary thyroid carcinoma (PTC) is the most common type of primary thyroid cancer with a low incidence of distant metastases. PTC represents more than 70% to -90% of thyroid malignancies. Distant metastases have only been observed in only 1% to 15% of patients with PTC. In this article, we reported the case of a patient with PTC and hyperthyroidism as well as simultaneous multiple metastases. PATIENT CONCERNS: A 47-year-old man was admitted to our hospital on February 22, 2019, with several neck masses that had been present for 12 months, low back pain for 9 months, and lower limb paraplegia for 3 months. DIAGNOSES: According to the patient physical examination, adjuvant examination (e.g., ultrasound, computed tomography, magnetic resonance imaging, blood test, and biopsy) and medical history, the clinical diagnosis was as follows: thyroid papillary carcinoma; cervical lymph node metastasis; multisite bone metastasis (6th and 7th cervical vertebrae, left clavicle proximal, right scapula bone, thoracic vertebrae, lumbar vertebrae, sacral vertebrae, bilateral ilium, and left pubic bone); muscular metastasis (the right medial femoral muscle, the vastus lateralis muscle, left thigh muscle, and the flexor superficialis of the left forearm); possible mediastinal lymph node metastasis; and paraplegia due to the soft-tissue metastasis around the 9th thoracic vertebral spine; and hyperthyroidism (free thyroxine: 36.59 pmol/L, free triiodothyronine: 9.58 pmol/L, thyroid-stimulating hormone: 0.005 µIU/mL, thyroid autoantibody: 2.53 IU/L). INTERVENTIONS AND OUTCOMES: The patient refused to undergo further intervention or follow-up. LESSONS: In summary, this is the 1st case of in which a patient with PTC and hyperthyroidism, as well as simultaneous multiple skeletal muscles and bone metastases, lymph node metastasis, and paraplegia was observed. In practice, in cases where patients have PTC and hyperthyroidism, practitioners should perform further examinations to rule out the presence of distant metastases. We believe that the use of ultrasound has a unique advantage in the diagnosis of PTC and skeletal muscle metastasis.


Assuntos
Carcinoma Papilar/patologia , Hipertireoidismo/diagnóstico , Paraplegia/etiologia , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Paraplegia/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Recusa do Paciente ao Tratamento , Ultrassonografia/métodos
8.
J Neuroeng Rehabil ; 17(1): 95, 2020 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-32664972

RESUMO

BACKGROUND: Peripheral nerve stimulation with implanted nerve cuff electrodes can restore standing, stepping and other functions to individuals with spinal cord injury (SCI). We performed the first study to evaluate the clinical electrodiagnostic changes due to electrode implantation acutely, chronic presence on the nerve peri- and post-operatively, and long-term delivery of electrical stimulation. METHODS: A man with bilateral lower extremity paralysis secondary to cervical SCI sustained 5 years prior to enrollment received an implanted standing neuroprosthesis including composite flat interface nerve electrodes (C-FINEs) electrodes implanted around the proximal femoral nerves near the inguinal ligaments. Electromyography quantified neurophysiology preoperatively, intraoperatively, and through 1 year postoperatively. Stimulation charge thresholds, evoked knee extension moments, and weight distribution during standing quantified neuroprosthesis function over the same interval. RESULTS: Femoral compound motor unit action potentials increased 31% in amplitude and 34% in area while evoked knee extension moments increased significantly (p < 0.01) by 79% over 1 year of rehabilitation with standing and quadriceps exercises. Charge thresholds were low and stable, averaging 19.7 nC ± 6.2 (SEM). Changes in saphenous nerve action potentials and needle electromyography suggested minor nerve irritation perioperatively. CONCLUSIONS: This is the first human trial reporting acute and chronic neurophysiologic changes due to application of and stimulation through nerve cuff electrodes. Electrodiagnostics indicated preserved nerve health with strengthened responses following stimulated exercise. Temporary electrodiagnostic changes suggest minor nerve irritation only intra- and peri-operatively, not continuing chronically nor impacting function. These outcomes follow implantation of a neuroprosthesis enabling standing and demonstrate the ability to safely implant electrodes on the proximal femoral nerve close to the inguinal ligament. We demonstrate the electrodiagnostic findings that can be expected from implanting nerve cuff electrodes and their time-course for resolution, potentially applicable to prostheses modulating other peripheral nerves and functions. TRIAL REGISTRATION: ClinicalTrials.gov NCT01923662 , retrospectively registered August 15, 2013.


Assuntos
Terapia por Estimulação Elétrica/métodos , Eletrodos Implantados/efeitos adversos , Nervo Femoral/fisiologia , Próteses Neurais/efeitos adversos , Potenciais de Ação , Adulto , Fenômenos Biomecânicos , Terapia por Estimulação Elétrica/efeitos adversos , Eletrodiagnóstico , Eletromiografia , Humanos , Joelho , Masculino , Força Muscular , Paralisia/reabilitação , Paraplegia/reabilitação , Complicações Pós-Operatórias/epidemiologia , Traumatismos da Medula Espinal/reabilitação
10.
Stud Health Technol Inform ; 270: 741-745, 2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-32570481

RESUMO

Sensors are used in many fields to measure physical phenomena, often on mobile persons. Paraplegia is a disease with a massive impact on the ability to move, so patients show changes in walking behaviour or are even wheelchair users. It is unclear how sensors can be used with paraplegics to generate valid data for research. In the ParaReg project, such data shall be integrated with a medical register. In this paper, we elaborate current approaches for sensor measurements that might serve as an additional data source for ParaReg with the help of a literature review. We queried IEEE Xplore and MEDLINE to find publications that describe the current use of sensors for patients with paraplegia. The retrieved publications were screened for eligibility by two reviewers independently. To ensure reproducibility, we conducted an initial alignment. All publications were assessed based on their abstract. Inclusions were analysed for their major topic, and we proposed categories, which were statistically described afterwards. We retrieved 685 publications in total and included 287 publications in our analysis. The categories we found are: "diagnostic sensor tools for clinical environments", "seating position analysis", "functional electrical stimulation (FES) / neuroprosthesis control", "seating position analysis", "control systems for devices" and "assessment of physical activity". "FES / neuroprosthesis control" shows most publications and the highest publication rate in history, followed by "assessment of physical activity".


Assuntos
Paraplegia , Traumatismos da Medula Espinal , Biometria , Humanos , Reprodutibilidade dos Testes
12.
Medicine (Baltimore) ; 99(19): e20032, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384463

RESUMO

RATIONALE: Spontaneous spinal subdural hematoma (SSDH) is a rare disease that can cause severe permanent neurological dysfunction. Here we present a case of spontaneous SSDH, in which a series of magnetic resonance images (MRIs) taken through the course of the disease facilitated understanding of the resolution process of the hematoma and the diagnosis of SSDH. PATIENT CONCERNS: A 59-year-old male presented with sudden severe back pain and rapid onset of paraplegia. This symptom had continued developing while he was transferred to the emergency department. Initial physical examination showed flaccid paralysis of both lower limbs with areflexia and loss of all sensation below T6 bilaterally. MRI images showed an anterior subdural hematoma from C7 to T7 with spinal cord compression. DIAGNOSIS: Based on MRI findings, the diagnosis was SSDH. INTERVENTIONS: We chose conservative treatment of 1-week bed rest and intensive rehabilitation for the patient due to the presence of sacral sparing and the slight motor recovery at 24 hours after the onset. OUTCOMES: Frequent MRI images demonstrated that the spinal cord compression was surprisingly mitigated only 2 days and mostly absorbed 4 days after the onset. The patient's motor function was recovered completely and he was discharged after 8 weeks of hospitalization. LESSONS: Our chronological MRI findings provide crucial information for diagnosing SSDH and also suggest that spinal surgeons should consider the potential option of a conservative approach for treating SSDH. Although prompt selection of a therapeutic strategy for SSDH could be challenging, the surgeons could observe the course of the patient's neurological status for a few days to detect signs of spontaneous recovery.


Assuntos
Tratamento Conservador/métodos , Hematoma Subdural Espinal , Imagem por Ressonância Magnética/métodos , Paraplegia , Canal Vertebral/diagnóstico por imagem , Hematoma Subdural Espinal/complicações , Hematoma Subdural Espinal/diagnóstico , Hematoma Subdural Espinal/fisiopatologia , Hematoma Subdural Espinal/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Exame Neurológico/métodos , Paraplegia/etiologia , Paraplegia/fisiopatologia , Paraplegia/reabilitação , Recuperação de Função Fisiológica , Remissão Espontânea , Resultado do Tratamento
13.
World Neurosurg ; 140: 162-165, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32389872

RESUMO

BACKGROUND: Paraplegia after lumbar spinal surgery has been previously described. It was generally provoked by a missed thoracic compression because of degenerative processes, arachnoid cyst, and spinal cord tumor such as meningioma. We describe here a case of a patient with neurofibromatosis type 2 (NF-2) with multiple spinal meningiomas that developed postoperative paraplegia because of decompensation of spinal cord compression below and far from the operated level. CASE DESCRIPTION: A 54-year-old woman with NF-2 was followed-up for multiple spinal meningiomas (C7-T1, T6-7, T9-10 levels). Surgery for the symptomatic and larger lesion (C7-T1) was scheduled. Postoperatively, the patient was found to have paraplegia with sensor anesthesia below the level of the T6 vertebra. An urgent spinal magnetic resonance imaging (MRI) scan was performed revealing the absence of complication at the operated level (C7-T1) but the appearance of a marked intramedullary hyperintensity at the T6-7 level. An urgent T6-7 laminectomy and removal of the meningioma was performed. The postoperative phase was marked by a poor recuperation. Spinal MRI scan at 3 months clearly showed a severely injured spinal cord at the T6-7 level consistent with the neurologic status of the patient. CONCLUSIONS: We report here the first case of acute neurologic deterioration after decompensation of a spinal cord compression below the operated level in spinal intradural surgery. Neurosurgeons must be aware of this possible complication when treating patients with multiple spinal meningiomas.


Assuntos
Meningioma/cirurgia , Neurofibromatose 2/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Paraplegia/etiologia , Compressão da Medula Espinal/etiologia , Neoplasias da Medula Espinal/cirurgia , Feminino , Humanos , Laminectomia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Paraplegia/diagnóstico por imagem , Paraplegia/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia
15.
World Neurosurg ; 140: 602-613, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32446984

RESUMO

Spinal cord injury (SCI) has no cure and individuals with SCI become dependent on others for life. After injury, the signals below the lesion are disrupted, but the brain still produces motor commands. Researchers have bypassed this obstacle, which has given rise to the brain-machine interface (BMI). BMI devices are implanted in the brain or spinal cord, where they decode and send signals beyond the injured segment. Experiments were initially conducted on animals, with favorable results. BMIs are classified according to their type, function, signal generation, and so on. Because of invasiveness, their long-term use is questionable, because of infections and complications. The use of an implantable epidural array in patients with chronic SCI showed that participants were able to walk with the help of a stimulator, and after months of training, they were able to walk with the stimulator turned off. Another innovation is a robotic suit for paraplegics and tetraplegics that supports the movement of limbs. The research on stem cells has not shown favorable results. In future, one of these cutting-edge technologies will prevail over the other, but BMI seems to have the upper hand. The future of BMI with fusion of robotics and artificial intelligence is promising for patients with chronic SCI. These modern devices need to be less invasive, biocompatible, easily programmable, portable, and cost-effective. After these hurdles are overcome, the devices may become the mainstay of potential rehabilitation therapy for partial recovery. The time may come when all patients with severe SCI are told "You will walk again."


Assuntos
Interfaces Cérebro-Computador , Exoesqueleto Energizado , Paraplegia/reabilitação , Quadriplegia/reabilitação , Traumatismos da Medula Espinal/reabilitação , Estimulação da Medula Espinal , Interfaces Cérebro-Computador/história , História do Século XX , História do Século XXI , Humanos , Reabilitação Neurológica , Paraplegia/etiologia , Quadriplegia/etiologia , Recuperação de Função Fisiológica , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/fisiopatologia
16.
Arch Phys Med Rehabil ; 101(11): 1898-1905, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32450062

RESUMO

OBJECTIVE: Individuals with spinal cord injury (SCI) often present signs and symptoms of median nerve (MN) pathology. Preclinical signs identification of MN pathology might facilitate early intervention to prevent or delay carpal tunnel syndrome in SCI. We assessed if ultrasound parameters changed in response to upper extremity (UE) circuit training exercise in individuals with paraplegia and able-bodied individuals. DESIGN: Case-control study. PARTICIPANTS: Adults (N=32) with paraplegia (n=16) and age- and sex-matched able-bodied controls (n=16). INTERVENTION: Circuit training exercise. MAIN OUTCOME MEASURES: MN ultrasound evaluation at the pisiform and radius before and after UE exercise. Ultrasound parameters included cross-sectional area (CSA), and gray scale (GS). Data presented as mean ± SD. RESULTS: Pre-exercise CSAs were larger in SCI at the radius (12.0±2.9 vs 9.0±2.1; P=.003), but not the pisiform (9.8±3.1 vs 9.1±1.7; P=.431). There were no statistical differences in MN response to exercise between groups (all P≥.293). Across participants, CSA changes were inversely associated with their pre-exercise values at the pisiform (r=-0.648; P<.001) and the radius (r=-0.366; P=.043). Participants with pre-exercise CSA values ≥10.00 mm2 at the pisiform responded to exercise with decreases in CSA (mean change ± SD, -2.0±1.5; P=.002) and GS (-2.8±6.2; P=.029). Participants with pre-exercise CSA ≤9.99 mm2 at the pisiform responded to exercise with no change in CSA (mean change ± SD, 0.7±2.5; P=.002) and increased GS (3.2±7.2; P=.029). CONCLUSIONS: CSA exercise response was more strongly related to pre-exercise MN values than presence or absence of SCI.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Nervo Mediano/diagnóstico por imagem , Paraplegia/diagnóstico por imagem , Traumatismos da Medula Espinal/diagnóstico por imagem , Ultrassonografia , Adulto , Síndrome do Túnel Carpal/etiologia , Síndrome do Túnel Carpal/prevenção & controle , Estudos de Casos e Controles , Exercícios em Circuitos , Feminino , Humanos , Masculino , Paraplegia/complicações , Paraplegia/reabilitação , Índice de Gravidade de Doença , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/reabilitação , Resultado do Tratamento , Extremidade Superior/inervação , Extremidade Superior/fisiopatologia , Adulto Jovem
17.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 28(2): 595-601, 2020 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-32319402

RESUMO

OBJECTIVE: To investigate the cause, diagnosis and therapeutic method of the neurological complication with the main manifestation of paraplegia after the hematopoietic stem cell transplantation (HSCT). METHODS: The clinical features, the process of diagnosis and treatment and the prognosis follow-up of 9 cases, who received HSCT in our department during January 2014 and January 2017 and had the neurological complication with the main symptom of paraplegia after the transplantation, were summarized. RESULTS: The incidence rate of paraplegia was 2.96% (9/304). The median onset time was 245 days (50 days-772 days) after transplantation. The cause of paraplegia determined by examination was extramedullary recurrence of leukemia in 3 cases, cyclosporin neurotoxicity in 1 case, GBS in 1 case, CIDP in 2 cases and autoimmune myeleterosis in 2 cases. One patient abandoned the treatment. The rest 8 patients received empirical or targeted treatment. The median follow-up period was 11 months. There were 5 dead cases and 4 survival cases. CONCLUSION: Paraplegia is a serious post-HSCT complication. The cause of paraplegia should be determined as early as possible to perform targeted treatment. Empirical preemptive treatment should be given if necessary, so as to improve the survival rate and the quality of life of HSCT patients.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Paraplegia/terapia , Humanos , Leucemia , Qualidade de Vida , Recidiva , Estudos Retrospectivos
18.
World Neurosurg ; 139: 151-157, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32305599

RESUMO

OBJECTIVE: Paralysis (paraplegia or quadriplegia) after posterior fossa surgery is a rare but devastating complication. We investigated previous reports of this complication to examine similarities among patients, risk factors, and methods by which it may be prevented. METHODS: A systematic review was completed according to PRISMA guidelines. Electronic databases were searched until November 2019 using keywords "paraplegia," "quadriplegia," or "spinal cord injury" added to "posterior fossa surgery." RESULTS: Thirteen case reports published between 1996 and 2019 were included. Five (38.5%) involved quadriplegia/quadriparesis and 8 (61.5%) involved paraplegia after surgery. Ten cases (76.9%) were tumor resections and 3 (23.1%) were posterior fossa decompressions (2 for Chiari malformations and 1 for Morquio syndrome). Seven surgeries (53.8%) were performed in the sitting position and 6 (46.2%) were prone. Proposed mechanisms of paralysis involved cervical hyperflexion yielding spinal cord ischemia in 8 patients (61.5%), arterial hypotension in 2 patients (15.4%), spinal cord compression from hematoma in 1 patient (7.7%), and decreased cardiac output in 1 patient (7.7%) (1 study did not propose a cause). Cervical hyperflexion was equally likely in the sitting and prone positions (4 patients each). Only 3 patients (23.1%) involved intraoperative complications (all cardiopulmonary in nature). CONCLUSIONS: Paralysis after posterior fossa surgery often involves spinal cord infarction apparently caused by cervical hyperflexion. Extreme care during patient positioning is needed in both the sitting or prone positions. Electrophysiologic monitoring might enable early identification of spinal cord dysfunction to minimize or avoid this complication.


Assuntos
Fossa Craniana Posterior/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Paraplegia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Quadriplegia/epidemiologia , Traumatismos da Medula Espinal/epidemiologia , Isquemia do Cordão Espinal/epidemiologia , Malformação de Arnold-Chiari/cirurgia , Neoplasias Encefálicas/cirurgia , Humanos , Neoplasias Infratentoriais/cirurgia , Monitorização Neurofisiológica Intraoperatória/métodos , Paraplegia/etiologia , Posicionamento do Paciente , Complicações Pós-Operatórias/etiologia , Decúbito Ventral , Quadriplegia/etiologia , Postura Sentada , Traumatismos da Medula Espinal/etiologia , Isquemia do Cordão Espinal/etiologia
19.
World Neurosurg ; 139: 175-178, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32311568

RESUMO

BACKGROUND: Guillain-Barré syndrome (GBS) is a rare but well-documented cause of paralysis, often occurring after infection. Few cases have been reported in association with spinal cord injury (SCI), which masks the characteristic ascending paralysis. To our knowledge, this is the first reported case of confirmed GBS during the clinical course of thoracic paraplegia due to a gunshot wound (GSW). CASE DESCRIPTION: A 23-year-old male presented with a GSW to the right axilla that lodged in the spinal canal at the level of T4, causing right hemothorax and American Spinal Injury Association A paraplegia. He had full strength in bilateral upper extremities until 2 weeks after the injury, at which time he developed progressive weakness in the arms with associated paresthesias and dyspnea. Within 5 days, he was intubated and nearly quadriplegic. Cerebrospinal fluid analysis and electromyography led to a diagnosis of GBS. He was treated with plasmapheresis and experienced rapid and marked recovery in respiratory and upper extremity motor function. CONCLUSIONS: The differential diagnosis for new-onset weakness in patients with GSW-induced SCI is complicated by the inability to obtain magnetic resonance imaging. This unique case of GBS in a patient with T4 paraplegia highlights the importance of obtaining a thorough history and using diagnostic tools to explore possibilities beyond surgery.


Assuntos
Síndrome de Guillain-Barré/complicações , Paraplegia/etiologia , Traumatismos da Medula Espinal/complicações , Vértebras Torácicas/lesões , Ferimentos por Arma de Fogo/complicações , Eletromiografia , Síndrome de Guillain-Barré/líquido cefalorraquidiano , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/terapia , Humanos , Masculino , Plasmaferese , Canal Vertebral , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Tomografia Computadorizada por Raios X , Adulto Jovem
20.
J Neuroeng Rehabil ; 17(1): 51, 2020 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-32299483

RESUMO

BACKGROUND: Participation in physical and therapeutic activities is usually severely restricted after a spinal cord injury (SCI). Reasons for this are the associated loss of voluntary motor function, inefficient temperature regulation of the affected extremities, and early muscle fatigue. Hydrotherapy or swim training offer an inherent weight relief, reduce spasticity and improve coordination, muscle strength and fitness. METHODS: We present a new hybrid exercise modality that combines functional electrical stimulation (FES) of the knee extensors and transcutaneous spinal cord stimulation (tSCS) with paraplegic front crawl swimming. tSCS is used to stimulate the afferent fibers of the L2-S2 posterior roots for spasticity reduction. By activating the tSCS, the trunk musculature is recruited at a motor level. This shall improve trunk stability and straighten the upper body. Within this feasibility study, two complete SCI subjects (both ASIA scale A, lesion level Th5/6), who have been proficient front crawl swimmers, conducted a 10-week swim training with stimulation support. In an additional assessment swim session nine months after the training, the knee extension, hip extension, and trunk roll angles where measured using waterproof inertial measurement units (IMUs) and compared for different swimming conditions (no stimulation, tSCS, FES, FES plus tSCS). RESULTS: For both subjects, a training effect over the 10-week swim training was observed in terms of measured lap times (16 m pool) for all swimming conditions. Swimming supported by FES reduced lap times by 15.4% and 8.7% on average for Subject A and Subject B, respectively. Adding tSCS support yielded even greater mean decreases of 19.3% and 20.9% for Subjects A and B, respectively. Additionally, both subjects individually reported that swimming with tSCS for 30-45 minutes eliminated spasticity in the lower extremities for up to 4 hours beyond the duration of the session. Comparing the median as well as the interquartile range of all different settings, the IMU-based motion analysis revealed that FES as well as FES+tSCS improve knee extension in both subjects, while hip extension was only increased in one subject. Trunk roll angles were similar for all swimming conditions. tSCS had no influence on the knee and hip joint angles. Both subjects reported that stimulation-assisted swimming is comfortable, enjoyable, and they would like to use such a device for recreational training and rehabilitation in the future. CONCLUSIONS: Stimulation-assisted swimming seems to be a promising new form of hybrid exercise for SCI people. It is safe to use with reusable silicone electrodes and can be performed independently by experienced paraplegic swimmers except for transfer to water. The study results indicate that swimming speed can be increased by the proposed methods and spasticity can be reduced by prolonged swim sessions with tSCS and FES. The combination of stimulation with hydrotherapy might be a promising therapy for neurologic rehabilitation in incomplete SCI, stroke or multiples sclerosis patients. Therefore, further studies shall incorporate other neurologic disorders and investigate the potential benefits of FES and tSCS therapy in the water for gait and balance.


Assuntos
Terapia por Estimulação Elétrica/métodos , Terapia por Exercício/métodos , Paraplegia/reabilitação , Traumatismos da Medula Espinal/reabilitação , Natação/fisiologia , Adulto , Terapia por Estimulação Elétrica/instrumentação , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Espasticidade Muscular/reabilitação , Paraplegia/etiologia , Projetos Piloto , Traumatismos da Medula Espinal/complicações
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