scholarly journals Rare Atypical Presentation of a Neuroblastoma of Posterior Mediastinum

2021 ◽  
Author(s):  
Vishal Singh ◽  
Lamkordor Tyngkan ◽  
Abdul Rashid Bhat
Keyword(s):  
Spinal Cord ◽  
Lower Limb ◽  
Mediastinal Tumor ◽  
English Literature ◽  
Posterior Mediastinum ◽  
Lower Limbs ◽  
Limb Weakness ◽  
Presenting Symptoms ◽  
Lower Limb Weakness ◽  
Posterior Mediastinal

Abstract Introduction Neuroblastoma is the third most common malignancy and one of the most common neurogenic tumors of posterior mediastinum in the pediatric age group. A posterior mediastinal tumor causing spinal cord compression is an important example of an oncologic emergency arising from a neurogenic tumor. We present a rare case of posterior mediastinum neuroblastoma, with exclusive lower limb weakness presenting at an unusually older age. Case Presentation A 6-year-old girl reported with upper back ache and sudden onset progressive bilateral lower limb weakness, with difficulty in urination for 10 days. The weakness had progressed to paraplegia on the day of presentation. On examination, the child was observed to have loss of tone and power in both lower limbs and bilateral extensor plantar reflex. Chest X-ray showed heterogeneous opacity involving most of the left lung. Contrast-enhanced MRI showed posterior mediastinal tumor, extending into spinal canal. Patient underwent D3 to D6 laminectomy with subtotal tumor excision and spinal decompression. Crush biopsy showed round cell tumor, and final histopathological examination revealed poorly differentiated neuroblastoma, which was strongly positive for neuron-specific enolase on immunohistochemistry. The surgery was followed by chemotherapy, and the patient remained symptom free on 2-year follow-up. Discussion The presenting symptoms in case of thoracic neuroblastoma may include airway obstruction and chronic cough. Sometimes, it may present with weakness, limping, paralysis, and bladder and bowel disturbances in case of spinal cord involvement. Posterior mediastinal neuroblastoma presenting with paraparesis is uncommon. In our case, the child presented with isolated lower limb flaccidity with no other classical symptoms. To the best of our knowledge and thorough study, only four cases of posterior mediastinum neuroblastoma presenting with lower limb paralysis has been published in the English literature to date. Conclusion Tumor usually presents with pressure symptoms, caused by the mass in the posterior mediastinum, but it’s almost exclusive occurrence in the pediatric population warrants a thorough investigation in patients presenting with not only a symptomatic mass but also exclusive lower limb neurological symptoms.

Improving sit-to-stand transition by the saddle-assistive device in the spinal cord injury: A case study

2021 ◽  
pp. 095441192110033
Author(s):  
Akbar Hojjati Najafabadi ◽  
Saeid Amini ◽  
Farzam Farahmand
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Lower Limb ◽  
Reaction Force ◽  
Assistive Device ◽  
Limb Weakness ◽  
Sit To Stand ◽  
Lower Limb Weakness ◽  
Wide Range ◽  
Cord Injury

Physical problems caused by fractures, aging, stroke, and accidents can reduce foot power; these, in the long term, can dwindle the muscles of the waist, thighs, and legs. These conditions provide the basis for the invalidism of the harmed people. In this study, a saddle-walker was designed and evaluated to help people suffering from spinal cord injury and patients with lower limb weakness. This S-AD works based on body weight support against the previously report designs. This saddle-walker consisted of a non-powered four-wheel walker helping to walk and a powered mechanism for the sit-to-stand (STS) transfer. A set of experiments were done on the STS in the use of the standard walker and the saddle-assistive device(S-AD). A comparison of the results showed that this device could reduce the vertical ground reaction force (GRF) of the legs up to 70%. Using this device could help a wide range of patients with lower limb weakness and SCI patients in changing from sitting to standing.

scholarly journals Neurologic melioidosis presented as encephalomyelitis and subdural collection in two male labourers in India

2015 ◽  
Vol 9 (11) ◽  
pp. 1289-1293 ◽  
Author(s):  
Kavitha Saravu ◽  
Rajagopal Kadavigere ◽  
Ananthakrishna Barkur Shastry ◽  
Rohit Pai ◽  
Chiranjay Mukhopadhyay
Keyword(s):  
Lower Limb ◽  
Corticosteroid Treatment ◽  
Conus Medullaris ◽  
Subdural Empyema ◽  
Lower Limbs ◽  
High Dose ◽  
Limb Weakness ◽  
Subdural Collection ◽  
Lower Limb Weakness ◽  
Left Lower Limb

Two distinct and potentially deceitful cases of neurologic melioidosis are reported. Case 1: A 39-year-old alcoholic and uncontrolled diabetic male presented with cough, fever, and left focal seizures with secondary generalization. An magnetic resonance imaging (MRI) brain scan revealed a small peripherally enhancing subdural collection along the interhemispheric fissure suggestive of minimal subdural empyema. Blood culture grew Burkholderia pseudomallei. Patient was diagnosed with disseminated bacteraemic melioidosis with subdural empyema. He was successfully treated with ceftazidime-cotrimoxazole-doxycycline. Case 2: A 45-year-old male presented with left lower limb weakness, difficulty in passing urine and stool, and back pain radiating to lower limbs. Neurological examination revealed flaccid left lower limb with absent deep tendon reflexes and plantar reflex. Spinal MRI showed T2 hyperintensity from D9 to L1 suggestive of demyelination. Patient was treated with high dose methylprednisolone. By day 3 of steroid treatment, lower limb weakness progressed. Subsequent MRI showed extensive cord hyperintensity on T2 weighted sequence extending from C5 to conus medullaris consistent with demyelination. Cerebrospinal fluid (CSF) culture grew B. pseudomallei, and the patient was given meropenem-cotrimoxazole. After three weeks of parenteral treatment, the lower limbs remained paralyzed. Patient was discharged on oral cotrimoxazole-doxycycline. Conclusions: Melioidosis should be considered as a differential in focal suppurative central nervous system (CNS) lesions, meningoencephalitis, or encephalomyelitis in endemic areas. CNS infections must be ruled out prior to steroid administration. The role of corticosteroids in demyelinating CNS melioidosis has been refuted. This is a rare documentation of effect of unintentional corticosteroid treatment in melioidosis.

ORGANOPHOSPHATE INDUCED DELAYED NEUROPATHY-A CASE REPORT

2021 ◽  
pp. 31-32
Author(s):  
Sarita J. Parmar ◽  
Harsh A. Patel ◽  
Vraj Rathod ◽  
Kapil Parmar ◽  
Minakshi Chauhan ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Lower Limb ◽  
Electrophysiological Study ◽  
Lower Limbs ◽  
Limb Weakness ◽  
Axonal Polyneuropathy ◽  
Lower Limb Weakness ◽  
Severe Motor ◽  
History Of ◽  
Indian Male

Organophoshate induced delayed polyneuropathy (OPIDP) is a rare clinical condition associated with ingestion of organophosphate. Clinically the patient presents with distal lower limb weakness mainly along with paraesthesia and other symptoms of neuropathy. Nerve conduction study shows motor axonal neuropathy.Here, we are presenting a case of 23 years old INDIAN male who presented with pain and tingling sensations in lower limbs along with bilateral upper limb and lower limb paresis with difculty in getting up and walking. He had history of Dichlorvos based organophosphate ingestion around 45 days before. Electrophysiological study suggestive of Severe motor axonal polyneuropathy affecting all four limbs. No central nervous system signs were present.

scholarly journals Spontaneous spinal epidural hematoma: a case report

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Ooi Chin Sheng ◽  
Ren-Chieh Wu ◽  
I-Hsin Chang
Keyword(s):  
Lower Limb ◽  
Epidural Hematoma ◽  
Lower Limbs ◽  
Spinal Epidural Hematoma ◽  
Limb Weakness ◽  
Female Ratio ◽  
Spontaneous Spinal Epidural Hematoma ◽  
Lower Limb Weakness ◽  
Bilateral Lower Limb ◽  
Spinal Epidural

Abstract Background Spinal epidural hematomas usually occur under certain conditions; they rarely occur spontaneously. The prevalence of spontaneous spinal epidural hematoma is ~ 0.1 per 100,000, and the male-to-female ratio is approximately 1.4 to 1. Herein, we describe a rare case of spontaneous spinal epidural hematoma. Case presentation A 63-year-old Taiwanese woman, with underlying hypertension, anemia, and a history of cardiovascular accident without sequela, was admitted to our emergency department with a chief complaint of sudden bilateral weakness in the lower limbs. Magnetic resonance imaging revealed a spontaneous epidural hematoma. The patient underwent emergency surgery to remove the epidural hematoma and laminectomy for decompression. The bilateral lower limb weakness was alleviated immediately after the surgery. Conclusion In patients with no risk factors related to spinal epidural hematoma, symptoms of bilateral lower limb weakness must be investigated carefully because this condition may occur spontaneously.

scholarly journals Postpartum femoral neuropathy: managing the next pregnancy

2019 ◽  
Vol 12 (12) ◽  
pp. e232967 ◽  
Author(s):  
Cathy Rowland ◽  
Daniel Kane ◽  
Maeve Eogan
Keyword(s):  
Caesarean Section ◽  
Motor Function ◽  
Lower Limb ◽  
Elective Caesarean Section ◽  
Mode Of Delivery ◽  
Primiparous Woman ◽  
Limb Weakness ◽  
Femoral Neuropathy ◽  
Lower Limb Weakness ◽  
Spontaneous Labour

A 34-year-old primiparous woman presented in spontaneous labour and had an unassisted vaginal birth of a 3.5 kg infant. Postnatally, the patient experienced lower limb weakness and was unable to mobilise unassisted. A diagnosis of postpartum femoral neuropathy was made. Full recovery of normal motor function was not achieved until 5 months postpartum. She returned in her next pregnancy, seeking advice on how to avoid this complication from reoccurring. It was decided that an elective caesarean section was an appropriate mode of delivery, which she underwent at 39 weeks without complication and without recurrence of the femoral neuropathy.

scholarly journals Massive Edema of the Lower Limbs in Patients after Spinal Cord Injury—One Picture, Different Diagnoses

2021 ◽  
Vol 18 (8) ◽  
pp. 4219
Author(s):  
Magdalena Mackiewicz-Milewska ◽  
Małgorzata Cisowska-Adamiak ◽  
Katarzyna Sakwińska ◽  
Iwona Szymkuć-Bukowska ◽  
Iwona Głowacka-Mrotek
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Heterotopic Ossification ◽  
Lower Limb ◽  
Bone Fractures ◽  
Lower Limbs ◽  
University Hospital ◽  
Pain Sensation ◽  
Vein Thrombosis ◽  
Cord Injury

Diagnosis of the cause of massive edema of the lower limbs in patients after spinal cord injury (SCI) can be difficult because of loss of pain sensation, commonly occurring in this group of patients. This paper reviews several different pathologies that can lead to lower-limb edema and the associated diagnostic difficulties. We present four cases of patients with massive edemas of lower limbs at different times after SCI undergoing treatment in the Department of Rehabilitation, University Hospital in Bydgoszcz, Poland. All patients had a lack of pain sensation in the lower limbs and significantly elevated levels of D-dimer. In two cases, deep vein thrombosis (DVT) and intramuscular hematomas (IHs) were diagnosed. IHs were probably a consequence of antithrombotic treatments implemented due to the occurrence of DVT. Heterotopic ossification (HO) was diagnosed in a third case, and, in another patient, who was hospitalized for the longest period after injury, we found humeral bone fractures. Heterotopic ossification, intramuscular haematomas, and bone fractures of the lower limb can mimic DVT. Careful observation of the edema evolution is recommended, as the onset of new symptoms may indicate a different cause of edema from that initially established.

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