scholarly journals A Case of Nivolumab-Induced Severe Mononeuropathy Multiplex and Rhabdomyolysis

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Katsuya Sakai ◽  
Hitoshi Mochizuki ◽  
Kosuke Mochida ◽  
Kazutaka Shiomi ◽  
Masahiro Amano ◽  
...  
Keyword(s):  
Nerve Conduction Study ◽  
Nerve Conduction ◽  
Immune Checkpoint Inhibitor ◽  
Checkpoint Inhibitor ◽  
Oral Prednisolone ◽  
Resonance Imaging ◽  
Intravenous Methylprednisolone ◽  
Limb Weakness ◽  
Muscle Impairment ◽  
Multiple Liver Metastases

We report an 81-year-old man with multiple liver metastases after tumorectomy for primary mediastinal malignant melanoma, who experienced limb weakness and sensory disturbance after nivolumab monotherapy. He was diagnosed with nivolumab-induced mononeuropathy multiplex and rhabdomyolysis based on serologic examination, muscle biopsy, magnetic resonance imaging of the limbs, and a nerve conduction study. A course of intravenous methylprednisolone (mPSL) was initiated at 1 g/day for 3 days. After that, oral prednisolone (PSL) was started at 1 mg/kg/day and gradually tapered. Limb muscle strength improved, but when PSL was reduced to 0.3 mg/kg/day, the weakness recurred, and a nerve conduction study showed exacerbation of mononeuropathy multiplex. The patient was again administered intravenous mPSL (0.5 g/day for 3 days) followed by oral PSL at 0.5 mg/kg/day, and his neurological symptoms improved. Nivolumab, an immune checkpoint inhibitor, is used for the treatment of advanced melanoma and other cancers and causes various immune-related adverse events (irAEs). However, neurological irAEs related to nivolumab are rare. Furthermore, there are no reports of simultaneous nerve and muscle impairment. Unexpected irAEs affecting various organs should be recognized and treated appropriately.

Acute Disseminated Encephalomyelitis in a 2-Year-Old Patient Following COVID-19

2021 ◽  
Author(s):  
Amy Robinson ◽  
Louise Chapman ◽  
Wendy Watts
Keyword(s):  
Oral Prednisolone ◽  
Acute Disseminated Encephalomyelitis ◽  
Neurological Complications ◽  
High Signal ◽  
Resonance Imaging ◽  
Intermittent Fever ◽  
Intravenous Methylprednisolone ◽  
Ataxic Gait ◽  
Truncal Ataxia ◽  
The Brain

AbstractThis report presents the case of acute disseminated encephalomyelitis in a 2-year-old patient following a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test. She presented with ataxic gait, truncal ataxia, and reduced coordination following 10 days of intermittent fever and lethargy. She did not have any respiratory symptoms. Magnetic resonance imaging of the brain and spine showed widespread T2 high signal within the gray and white matters and within the spinal cord. She was treated with intravenous methylprednisolone followed by tapering oral prednisolone; this led to resolution of her neurological symptoms. This case highlights that neurological complications can occur secondary to SARS-CoV-2 infection.

Diagnostic Ultrasound of the Soleal Sling

2016 ◽  
Vol 106 (2) ◽  
pp. 147-150
Author(s):  
Andrew J. Rader ◽  
Pasquale Cancelliere ◽  
Tyler Kelly
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Nerve Conduction Study ◽  
Nerve Conduction ◽  
Tibial Nerve ◽  
Diagnostic Ultrasound ◽  
Resonance Imaging ◽  
Study Techniques ◽  
A Site ◽  
Neurosensory Testing

The soleal sling may be a site of tibial nerve entrapment. Objective diagnosis of this syndrome is difficult with current nerve conduction study techniques, magnetic resonance imaging, and neurosensory testing. Diagnostic ultrasound is ideally suited to visualize the tibial nerve statically and dynamically as it enters the soleal sling, thus making an objective diagnosis of soleal sling impingement much easier.

scholarly journals Use of Magnetic Resonance Imaging to Identify Immune Checkpoint Inhibitor–Induced Inflammatory Arthritis

2020 ◽  
Vol 3 (2) ◽  
pp. e200032 ◽  
Author(s):  
Ananta Subedi ◽  
Sandra G. Williams ◽  
Lawrence Yao ◽  
Suresh Maharjan ◽  
Julius Strauss ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Immune Checkpoint ◽  
Inflammatory Arthritis ◽  
Immune Checkpoint Inhibitor ◽  
Checkpoint Inhibitor ◽  
Resonance Imaging

scholarly journals Outcome of Patients with Gullain Barre syndrome at Tertiary Care Hospital in Eastern Nepal

2018 ◽  
Vol 6 (2) ◽  
pp. 20-24
Author(s):  
Dilli Ram Kafle ◽  
Surendra Shah
Keyword(s):  
Early Diagnosis ◽  
Nerve Conduction Study ◽  
Nerve Conduction ◽  
Acute Flaccid Paralysis ◽  
Flaccid Paralysis ◽  
Care Hospital ◽  
Limb Weakness ◽  
Medical College ◽  
History Of ◽  
Tract Infections

Background: Gullain Barre syndrome is the most common cause of acute flaccid paralysis. Early diagnosis and treatment improves survival in patients with Gullain Barre Syndrome.Material and Methods: The purpose of the study was to note the common clinical features and identify predictors of outcome in Patients with Gullain Barre Syndrome. It is a prospective study which was conducted at Nobel Medical College Teaching Hospital from April 2015 to March 2016.Results: Time between onset of symptoms, presentation to hospital and admission was 5 ± 4 days. Four Patients (20%) gave history of upper respiratory tract infections and 12 (60%) had diarrhoea. Limb weakness was the most common symptom, which was documented in 20 (100%) patients. Other common symptoms were limb paresthesia, limb pain, and bladder dysfunction. Cerebrospinal Fluid protein was raised in 16(80%) patients to more than 45 mg/dl. All of our patients had CSF cell count less than 10. One (5%) patient had normal nerve conduction study initially. Eight (40%) patients had axonal (AMAN) variant of GBS, 3(15%) had AMSAN variant of GBS, while 8(40%) had demyelinating neuropathy (AIDP). The mean duration of hospital stay was7.4 ±2.7 days. Three months after hospital discharge 12(60%) patients achieved complete recovery. Eight (40%) patients still needed some support with ambulation. Predictors of worse outcome were old age, rapid progression of disease and AMSAN variant of GBS.Conclusion: Gullain Barre syndrome is an important cause of acute flaccid paralysis in children and adults. Early diagnosis is based on history of symmetrical limb weakness, CSF Findings and nerve conduction study. Majority of patients improve with supportive care while some develop respiratory failure and needs mechanical intubation. Journal of Nobel Medical College Volume 6, Number 2, Issue 11 (July-December, 2017) Page:20-24

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