scholarly journals Neuromyelitis Optica in a Nepalese Man

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Yogesh Subedi ◽  
Utsav Joshi ◽  
Sanjeeb Sudarshan Bhandari ◽  
Ashbina Pokharel ◽  
Ashbita Pokharel
Keyword(s):  
Spinal Cord ◽  
Neuromyelitis Optica ◽  
Immunoglobulin G ◽  
Cervical Spinal Cord ◽  
Immunosuppressive Treatment ◽  
Lower Limbs ◽  
Inflammatory Disorder ◽  
Hyperintense Signal ◽  
Muscle Groups ◽  
The Right

Background. Neuromyelitis optica is a severely disabling inflammatory disorder of the central nervous system of autoimmune etiology that mainly affects the optic nerves and spinal cord. Here, we present a case report detailing a patient with tingling and weakness of right upper and lower limbs who was neuromyelitis optica immunoglobulin G-positive. Case Presentation. A 46-year-old Nepalese man presented to the hospital with a history of tingling and weakness of right upper and lower limbs that developed over a period of two months. Clinical evaluation showed diminished power across all major muscle groups in the right upper and lower limbs. Magnetic resonance imaging of his cervical spine showed T1 iso- to hypointense signal and T2 hyperintense signal in central cervical spinal cord from first to sixth cervical level, probably suggestive of myelitis or demyelination. The patient was immediately started on intravenous methylprednisolone. The diagnosis of neuromyelitis optica was later confirmed with strongly positive neuromyelitis optica immunoglobulin G. Conclusion. In resource limited setting, in the absence of tests for neuromyelitis optica immunoglobulin G, treatment was started and the patient’s condition started to get better. Hence, early initiation of aggressive immunosuppressive treatment is essential in such cases.

scholarly journals Cervical Intramedullary Schwannoma with Syrinx: Case Report and Review of the Literature

2017 ◽  
Vol 07 (03) ◽  
pp. 239-248
Author(s):  
Abdulaziz AlQarni ◽  
A. AlArifi ◽  
Ali Alassiri ◽  
Amjed Kouli ◽  
M. Abbas
Keyword(s):  
Spinal Cord ◽  
Cervical Spinal Cord ◽  
Lower Limbs ◽  
Nerve Sheath Tumor ◽  
Resonance Imaging ◽  
Spinal Cord Tumors ◽  
Nerve Sheath ◽  
Spindle Cells ◽  
The Right ◽  
Intramedullary Schwannoma

AbstractSchwannoma is a nerve sheath tumor originating from the Schwann cell. It is benign in nature and it arises from anywhere where Schwann cells can be found. It is rarely found in the parenchyma of the spinal cord. Intramedullary schwannomas (or neurilemmomas) without evidence of neurofibromatosis are rare spinal cord tumors. Intramedullary schwannoma was first reported in 1932 by Penfield. Our patient presented with neck pain, gradually worsening, weakness in the right upper and lower limbs, numbness in both shoulders, and a decrease in the grasping strength of both hands over a 4-year period. A magnetic resonance imaging of the spine showed a heterogeneously enhancing mass in the cervical spinal cord extending from the C2 to T1 levels with associated hemorrhagic changes. Histologically, the tumor was found to be composed of bland spindle cells with blunt-ended and sometimes wavy nuclei admixed with hyalinized vasculature. Surrounding reactive spinal cord parenchyma with frequent Rosenthal fibers was also observed. Focal Verocay bodies were evident, and with immunohistochemistry, there was diffuse and strong positivity for S100, which is confirmatory for the diagnosis of schwannoma. We report a case of cervical intramedullary schwannoma presented with syringobulbia in a young adult.

scholarly journals Role of Plasma Exchange in Steroid Resistant Neuromyelitis Optica with Loss of Vision

2020 ◽  
Author(s):  
Ashish Maheshwari ◽  
Dnyaneshwar Shridharrao Patale ◽  
Trupti Lokhande ◽  
Smita Chouhan ◽  
Sana Mariyam
Keyword(s):  
Plasma Exchange ◽  
Neuromyelitis Optica ◽  
Vision Loss ◽  
Tertiary Care ◽  
Inflammatory Disorder ◽  
Steroid Resistant ◽  
Loss Of Vision ◽  
Effective Treatment Modality ◽  
American Society ◽  
The Right

Neuromyelitis Optica (NMO) is a demyelinating inflammatory disorder of the spinal cord and optic nerve. As per American Society For Apheresis (ASFA) guidelines, Therapeutic Plasma Exchange (TPE) is considered as a second-line treatment in patients with weak or no response to steroid therapy. A patient of NMO presented to the tertiary care institute with a sudden loss of vision in the right eye. The patient was resistant to steroid treatment and improved significantly with TPE. Hence, TPE may be an effective treatment modality in steroid-resistant NMO with vision loss.

scholarly journals Muscle strength and inflammatory response to the training load in rowers

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e10355
Author(s):  
Tomasz Podgórski ◽  
Alicja Nowak ◽  
Katarzyna Domaszewska ◽  
Jacek Mączyński ◽  
Magdalena Jabłońska ◽  
...  
Keyword(s):  
Muscle Metabolism ◽  
Creatine Kinase Activity ◽  
Lower Limbs ◽  
Total Testosterone ◽  
Blood Biochemical ◽  
Global Force ◽  
Significant Difference ◽  
Muscle Groups ◽  
Torque Values ◽  
The Right

Background Regular exercise leads to changes in muscle metabolism. The consequence of this is the adaptation to higher training loads.The aim of this study was to evaluate biomechanical and biochemical parameters describing the functions of skeletal muscles in periods when changes in training forms were introduced. Methods Seventeen male sweep-oar rowers, members of the Polish national rowing team, participated. The study was carried out at the beginning and at the end of the preparatory period. In the first and second examination measurements of torques of selected muscle groups and blood biochemical analysis were performed. Results There was observed a statistically significant decrease in the relative global force of the right lower limb between both terms of examination. A statistically significant increase in maximum torque was found for torso flexors. In the case of muscles responsible for torso rotation, a statistically significant decrease in the torque values of right torso rotators was observed. A significant difference was found with respect to creatine kinase activity, total testosterone concentration, total testosterone to cortisol ratio and total phenolics concentration (p < 0.05). Conclusion The study shows that the rowers’ training should be more focused on building the strength of lower limbs to prevent the overload of lumbar spine and that the amount of force developed may be significantly affected by the antioxidant potential of rowers.

Analgesic effect of paired associative stimulation in a tetraplegic patient with severe drug-resistant neuropathic pain: a case report

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Selja Vaalto ◽  
Anna-Lena Nyman ◽  
Anastasia Shulga
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Motor Function ◽  
Analgesic Effect ◽  
Lower Limbs ◽  
Drug Resistant ◽  
Motor Rehabilitation ◽  
Paired Associative Stimulation ◽  
Cord Injury ◽  
The Right

Abstract Objectives There is no effective evidence-based non-pharmacological treatment for severe neuropathic pain after spinal cord injury (SCI). Paired associative stimulation (PAS) has been used in motor rehabilitation of patients after SCI. In the SCI-PAS protocol for tetraplegic patients, peripheral and central nerve tracts are activated with subject-specific timing, such that ascending and descending signals appear simultaneously at the cervical level. The effect on motor rehabilitation is thought to arise via strengthening of cervical upper and lower motoneuron synapses. We have observed an analgesic effect of PAS on mild-to-moderate neuropathic pain in tetraplegic patients receiving PAS for motor rehabilitation. Here, we applied PAS to a patient with severe drug-resistant neuropathic pain. Methods The patient is a 50-year-old man who had a traumatic cervical SCI three years earlier. He has partial paresis in the upper limbs and completely plegic lower limbs. The most severe pain is located in the right upper limb and shoulder region. The pain has not responded to either pharmacological therapy or repetitive-TMS therapy targeted to either primary motor cortex or secondary somatosensory cortex. PAS was targeted to relieve pain in the right upper arm. Peripheral nerve stimulation targeted the median, ulnar, and radial nerves and was accompanied by TMS pulses to the motor representation area of abductor pollicis brevis, abductor digiti minimi, and extensor digitorum communis muscles, respectively. Results Hand motor function, especially finger abduction and extension, was already enhanced during the first therapy week. Pain decreased at the end of the second therapy week. Pain was milder especially in the evenings. Numerical rating scale scores (evening) decreased 44% and patient estimation of global impression of change was 1, subjectively indicating great benefit when compared to before therapy. Quality of sleep also improved. Conclusions The SCI-PAS protocol reduced neuropathic pain in our subject. The mechanism behind the analgesic effect may involve the modulation of nociceptive and sensory neuronal circuits at the spinal cord level. The possibility to use PAS as an adjunct treatment in drug-resistant post-SCI neuropathic pain warrants further investigation and sham-controlled studies. Patients with neuropathic pain due to SCI may benefit from PAS therapy in addition to PAS therapy-induced improvement in motor function.

scholarly journals Quantitative assessment of the cervical spinal cord damage in neuromyelitis optica using diffusion tensor imaging at 3 Tesla

2011 ◽  
Vol 33 (6) ◽  
pp. 1312-1320 ◽  
Author(s):  
Wenshu Qian ◽  
Queenie Chan ◽  
Henry Mak ◽  
Zhongping Zhang ◽  
Marina-Portia Anthony ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Diffusion Tensor Imaging ◽  
Neuromyelitis Optica ◽  
Quantitative Assessment ◽  
Diffusion Tensor ◽  
Cervical Spinal Cord ◽  
3 Tesla ◽  
Spinal Cord Damage

The cervical spinal cord in neuromyelitis optica patients: A comparative study with multiple sclerosis using diffusion tensor imaging

2012 ◽  
Vol 81 (10) ◽  
pp. 2697-2701 ◽  
Author(s):  
Fernanda Miraldi Clemente Pessôa ◽  
Fernanda Cristina Rueda Lopes ◽  
João Victor Altamiro Costa ◽  
Soniza Vieira Alves Leon ◽  
Romeu Côrtes Domingues ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Diffusion Tensor Imaging ◽  
Comparative Study ◽  
Neuromyelitis Optica ◽  
Diffusion Tensor ◽  
Cervical Spinal Cord

Neuromyelitis Optica

2017 ◽  
Author(s):  
Teri L. Schreiner ◽  
Jeffrey L. Bennett
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Central Nervous System ◽  
Nervous System ◽  
Optic Neuritis ◽  
Neuromyelitis Optica ◽  
Water Channel ◽  
Transverse Myelitis ◽  
Inflammatory Disorder ◽  
The Central Nervous System

Neuromyelitis optica (NMO), or Devic’s disease is an inflammatory disorder of the central nervous system that preferentially affects the optic nerves and spinal cord. Initially considered a variant of multiple sclerosis (MS), NMO is now clearly recognized to have distinct clinical, radiographic, and pathologic characteristics. Historically, the diagnosis of NMO required bilateral optic neuritis and transverse myelitis; however, the identification of a specific biomarker, NMO-IgG, an autoantibody against the aquaporin-4 (AQP4) water channel, has broadened NMO spectrum disease to include patients with diverse clinical and radiographic presentations. This chapter addresses the diagnosis, pathophysiology, and management of the disease.

Recurrent Hypothalamic Dysfunction in Seropositive Neuromyelitis Optica

2020 ◽  
pp. 10.1212/CPJ.0000000000001012
Author(s):  
Mary Clare McKenna ◽  
Nuala McNicholas ◽  
Conor Fearon ◽  
David Bradley
Keyword(s):  
Spinal Cord ◽  
Central Nervous System ◽  
Neuromyelitis Optica ◽  
Clinical Manifestations ◽  
Inflammatory Disorder ◽  
Diverse Range ◽  
Hypothalamic Dysfunction ◽  
Inappropriate Secretion ◽  
Clinical Presentations ◽  
The Central Nervous System

Background:Neuromyelitis optica (NMO) is a rare autoimmune inflammatory disorder of the central nervous system1. Pathogenic aquaporin 4 (AQP4) antibodies are present in 65-88% of cases1. The majority of cases follow a relapsing course preferentially involving the optic nerves, spinal cord, brainstem, diencephalon or cerebral regions1, 2. Within the acute diencephalic clinical presentations, symptomatic hypothalamic lesions may have a diverse range of clinical manifestations including homeostatic dysfunction of neuroendocrine systems2-4. We report a case of recurrent hypothalamic dysfunction secondary to NMO manifesting as syndrome of inappropriate secretion of antidiuretic hormone (SIADH), thermal dysregulation, dysautonomia and disorder of alertness.

Alternate Leg Movement Amplifies Locomotor-Like Muscle Activity in Spinal Cord Injured Persons

2005 ◽  
Vol 93 (2) ◽  
pp. 777-785 ◽  
Author(s):  
Noritaka Kawashima ◽  
Daichi Nozaki ◽  
Masaki O. Abe ◽  
Masami Akai ◽  
Kimitaka Nakazawa
Keyword(s):  
Spinal Cord ◽  
Muscle Activity ◽  
Lower Limbs ◽  
Emg Activity ◽  
Joint Movement ◽  
Experimental Conditions ◽  
Biceps Femoris Muscle ◽  
Cord Injury ◽  
Leg Movement ◽  
The Right

It is now well recognized that muscle activity can be induced even in the paralyzed lower limb muscles of persons with spinal cord injury (SCI) by imposing locomotion-like movements on both of their legs. Although the significant role of the afferent input related to hip joint movement and body load has been emphasized considerably in previous studies, the contribution of the “alternate” leg movement pattern has not been fully investigated. This study was designed to investigate to what extent the alternate leg movement influenced this “locomotor-like” muscle activity. The knee-locked leg swing movement was imposed on 10 complete SCI subjects using a gait training apparatus. The following three different experimental conditions were adopted: 1) bilateral alternate leg movement, 2) unilateral leg movement, and 3) bilateral synchronous (in-phase) leg movement. In all experimental conditions, the passive leg movement induced EMG activity in the soleus and medial head of the gastrocnemius muscles in all SCI subjects and in the biceps femoris muscle in 8 of 10 SCI subjects. On the other hand, the EMG activity was not observed in the tibialis anterior and rectus femoris muscles. The EMG level of these activated muscles, as quantified by integrating the rectified EMG activity recorded from the right leg, was significantly larger for bilateral alternate leg movement than for unilateral and bilateral synchronous movements, although the right hip and ankle joint movements were identical in all experimental conditions. In addition, the difference in the pattern of the load applied to the leg among conditions was unable to explain the enhancement of EMG activity in the bilateral alternate leg movement condition. These results suggest that the sensory information generated by alternate leg movements plays a substantial role in amplifying the induced locomotor-like muscle activity in the lower limbs.

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