scholarly journals The red flags of ulnar neuropathy in leprosy

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259804
Author(s):  
Márcia Jardim ◽  
Robson T. Vital ◽  
Ximena Illarramendi ◽  
Mariana Hacker ◽  
Beatriz Junqueira ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Ulnar Nerve ◽  
Clinical Signs ◽  
Nerve Biopsy ◽  
Ulnar Neuropathy ◽  
Sensory Impairment ◽  
Nerve Enlargement ◽  
Leprosy Patients ◽  
Demyelinating Lesions ◽  
Temporal Dispersion

The diagnosis of pure neural leprosy is more challenging because patients share characteristics with other common pathologies, such as ulnar compression, which should be taken into consideration for differential diagnosis. In this study, we identify ulnar nerve conduction characteristics to aid in the differential diagnosis of ulnar neuropathy (UN) in leprosy and that of non-leprosy etiology. In addition, we include putative markers to better understand the inflammatory process that may occur in the nerve. Data were extracted from a database of people affected by leprosy (leprosy group) diagnosed with UN at leprosy diagnosis. A non-leprosy group of patients diagnosed with mechanical neuropathy (compressive, traumatic) was also included. Both groups were submitted to clinical, neurological, neurophysiological and immunological studies. Nerve enlargement and sensory impairment were significantly higher in leprosy patients than in patients with compressive UN. Bilateral impairment was significantly higher in the leprosy group than in the non-leprosy group. Leprosy reactions were associated to focal demyelinating lesions at the elbow and to temporal dispersion (TD). Clinical signs such as sensory impairment, nerve enlargement and bilateral ulnar nerve injury associated with eletrodiagnostic criteria such as demyelinating finds, specifically temporal dispersion, could be tools to help us decided on the best conduct in patients with elbow ulnar neuropathy and specifically decide if we should perform a nerve biopsy for diagnosis of pure neural leprosy.

Diagnostic values of conventional conduction parameters in ulnar neuropathy at elbow

2021 ◽  
Vol 74 (11-12) ◽  
pp. 397-407
Author(s):  
Murat Alemdar
Keyword(s):  
Action Potential ◽  
Diagnostic Accuracy ◽  
Ulnar Nerve ◽  
Diagnostic Yield ◽  
Reduction Rate ◽  
Clinical Signs ◽  
Sensory Nerve ◽  
Nerve Fibers ◽  
Ulnar Neuropathy ◽  
The Absolute

Conventional parameters used in electrodiagnosis of ulnar neuropathy at elbow (UNE) are: (i) absolute across-elbow ulnar nerve motor conduction velocity (MCV), (ii) reduction rate of composed muscle action potential (CMAP) amplitude from above to below elbow stimulation, and (iii) MCV difference between forearm and across-elbow segment. We aimed to search the diagnostic accuracy values of these parameters on UNE, and their correlations with axonal dysfunction of ulnar nerve fibers. Arms with clinical signs of UNE and two-fold healthy controls were included. We detected the best cut off points of the measured parameters and their possible combinations. Their diagnostic accuracy values and correlations with parameters reflecting the axonal functions were analyzed, statistically. Totally, 118 arms with UNE and 236 controls were included. Absolute across-elbow MCV yielded a higher accuracy than MCV difference and reduction rate of CMAP amplitude (p = 0.010 and p˂0.001, respectively). Besides, combining it with other parameters did not increase the diagnostic yield. Correlation analyses revealed that the only parameter having positive linear correlations with sensory nerve action potential amplitudes both in the control and the disease groups is the absolute across-elbow MCV. The absolute across-elbow MCVs have also positive linear correlation with CMAP amplitudes in disease group. The absolute across-elbow MCV is the most valuable conventional parameter for the electrodiagnosis of UNE. It is also the most correlated parameter with the electrodiagnostic parameters reflecting the axonal functions of the ulnar nerve fibers.

COVID-19: how nuclear medicine can provide a differential diagnosis in very dubious case

Coronaviruses ◽  
2020 ◽  
Vol 01 ◽  
Author(s):  
Maria Silvia De Feo ◽  
Viviana Frantellizzi ◽  
Giuseppe De Vincentis
Keyword(s):  
Infectious Disease ◽  
Differential Diagnosis ◽  
Ct Scan ◽  
Imaging Technique ◽  
False Negative ◽  
Clinical Signs ◽  
Negative Results ◽  
Infectious Disease Department ◽  
False Negative Results ◽  
99Mtc Hmpao

Background: We present the case of a 55-year-old woman, admitted to the Infectious Disease Department of Policlinico Umberto I, Rome, in mid-March 2020, with suspicion of COVID-19 infection. Objective: The rRT-PCR was negative and the following CT scan, performed to exclude false-negative results and help diagnosis, was inconclusive. Methods: It was decided to submit the patient to 99mTc-HMPAO-labelled leukocyte scan. Results: This exam led to the diagnosis of infective endocarditis. Conclusion: In the present pandemic scenario, 99mTc-HMPAO-labelled leukocyte scan represents a reliable imaging technique for differential diagnosis with COVID-19 in patients with confusing clinical signs, possible false-negative rRT-PCR results and inconclusive CT scan.

scholarly journals Uptake of exogenous estrogen as a differential diagnosis of ovarian-remnant-syndrome in a bitch: a case report

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Sebastian Ganz ◽  
Axel Wehrend
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Luteinizing Hormone ◽  
Clinical Signs ◽  
Menopausal Symptoms ◽  
Case Presentation ◽  
Estrogen Exposure ◽  
Exogenous Estrogen ◽  
Endocrine Parameters

Abstract Background Clinical signs of heat in bitches that have been previously spayed are often associated with the presence of ovarian remnant syndrome. The inclusion of exogenous estrogens as a differential diagnosis in this regard is often ignored and may lead to misinterpretation of the case. Case presentation Herein, we report a case of exogenous estrogen exposure over several months to a 6.5-year-old spayed crossbred bitch, weighing 8.4 kg. The bitch presented in the clinic because of suspected ovarian remnant syndrome. Castration was performed within the first 6 months after birth. Important endocrine parameters measured at the first appointment were Anti-Müllerian hormone (< 0.01 ng/mL), progesterone (0.36 ng/mL), estradiol-17ß (20.7 pg/mL), and luteinizing hormone (< 0.1 ng/mL). After an extensive conversation with the owner, it was revealed that she was using an estrogen spray because of severe menopausal symptoms. After the owner stopped using this spray, the symptoms of the bitch disappeared. Conclusion Therefore, the uptake of estrogens should be a differential diagnosis for symptoms of the ovarian remnant syndrome. A detailed anamnesis is crucial to identify the source of estrogen in the environment of the affected bitch.

A CASE REPORT OF ACUTE CUBITAL TUNNEL SYNDROME CAUSED BY VENOUS THROMBOSIS

Hand Surgery ◽  
2015 ◽  
Vol 20 (01) ◽  
pp. 137-139 ◽  
Author(s):  
Yoshihiro Abe ◽  
Masahiko Saito
Keyword(s):  
Case Report ◽  
Venous Thrombosis ◽  
Ulnar Nerve ◽  
Cubital Tunnel Syndrome ◽  
Nerve Compression ◽  
Ulnar Neuropathy ◽  
Cubital Tunnel ◽  
Ulnar Nerve Compression ◽  
Compression Neuropathy ◽  
Tunnel Syndrome

Compression neuropathy of the ulnar nerve at the elbow is well-recognised as cubital tunnel syndrome (CuTS). Many causes of ulnar neuropathy at the elbow have been identified. A previously unreported finding of ulnar nerve compression in the cubital tunnel caused by a thrombosed proximal ulnar recurrent artery vena comitans is described.

scholarly journals A randomized clinical trial of oral steroids for ulnar neuropathy in type 1 and type 2 leprosy reactions

2008 ◽  
Vol 66 (4) ◽  
pp. 861-867 ◽  
Author(s):  
José Antonio Garbino ◽  
Marcos da Cunha Lopes Virmond ◽  
Somei Ura ◽  
Manoel Henrique Salgado ◽  
Bernard Naafs
Keyword(s):  
Motor Nerve ◽  
Clinical Score ◽  
Ulnar Neuropathy ◽  
Control Group ◽  
Spontaneous Pain ◽  
Oral Steroids ◽  
Leprosy Patients ◽  
Higher Doses

BACKGROUND: Steroids regimens in leprosy neuropathies are still controversial in botth types of reactions. METHOD: For this trial, 21 patients with ulnar neuropathy were selected from 163 leprosy patients, 12 with type 1 reaction (T1R) and nine with type 2 (T2R). One experimental group started with prednisone 2 mg/kg/day and the control group with 1 mg/kg/day. A clinical score based on tests for spontaneous pain, nerve palpation, sensory and muscle function was used. Neurophysiological evaluation consisted on the motor nerve conduction of the ulnar nerve in three segments. Student "t" test for statistical analysis was applied on the results: before treatment, first week, first month and sixth month, between each regimen and types of reaction. CONCLUSION: In both reactions during the first month higher doses of steroids produced better results but, earlier treatment with lower dose was as effective. Short periods of steroid, 1 mg/Kg/day at the beginning and,tapering to 0,5 mg/Kg/day or less in one month turned out to be efficient in T2R.

Functional Ulnar Nerve Paraganglioma: First Documented Occurrence in the Extremity With Hitherto Undescribed Associated Extensive Glomus Cell Hyperplasia and Tumorlet Formation

2017 ◽  
Vol 26 (1) ◽  
pp. 64-72 ◽  
Author(s):  
Louis Tsun Cheung Chow ◽  
Michael Ho Ming Chan ◽  
Simon Kwok Chuen Wong
Keyword(s):  
Ulnar Nerve ◽  
Nerve Biopsy ◽  
Vascular Tumor ◽  
The Body ◽  
Glomus Cell ◽  
Cell Hyperplasia ◽  
Chief Cells ◽  
Sustentacular Cells ◽  
History Of ◽  
The Right

Extra-adrenal paraganglioma has never been described in the extremities. A 34-year-old woman complained of an enlarging mass in the right forearm for 18 months. Imaging showed a circumscribed vascular tumor attached to the ulnar nerve; biopsy revealed features of paraganglioma. The resected tumor consisted of zellballen pattern of chief cells staining positively for chromogranin with surrounding S100-positive sustentacular cells. The chief cells contained many neurosecretory granules and mitochondria, whereas the sustentacular cells contained a large amount of rough endoplasmic reticulum and some microfilaments. There was adjacent extensive glomus cell hyperplasia and tumorlet formation. The intraoperative blood pressure dropped abruptly on tumor removal. The serum normetanephrine level decreased from a preoperative level of 1987 pg/mL (normal < 149 pg/mL) to normal after operation. The patient admitted on questioning to a history of paroxysmal attacks of transient palpitation, hand tremors, and sweating; imaging showed no evidence of tumor in other parts of the body, and there was no family history of similar tumor; she remained well 33 months after the operation. This occurrence of functional ulnar nerve paraganglioma with the hitherto undescribed associated glomus cell hyperplasia and tumorlet formation attests to the probable existence of normal sympathetic paraganglia in the extremity and their intimate functional relationship with glomus bodies.

scholarly journals ELBOW ULNAR NEUROPATHY: TREATMENT BY ANTERIOR TRANSPOSITION OF THE ULNAR NERVE

2016 ◽  
Vol 24 (4) ◽  
pp. 184-186
Author(s):  
Antonio Tufi Neder Filho ◽  
Regina de Azevedo Alves ◽  
Arlindo Gomes Pardini Júnior ◽  
Marcelo Riberto ◽  
Milton Mazer
Keyword(s):  
Ulnar Nerve ◽  
Ulnar Neuropathy ◽  
Anterior Transposition

scholarly journals Clinical Evidence of Lyme Disease in Dogs and Disease Awareness Among Students and Veterinarians in Veracruz, Mexico

2019 ◽  
Vol 1 (2) ◽  
Author(s):  
Blanca Paola Boria-Gamboa ◽  
José Alfredo Villagómez-Cortés ◽  
David Itzcoatl Martínez-Herrera
Keyword(s):  
Differential Diagnosis ◽  
Lyme Disease ◽  
Professional Practice ◽  
Clinical Evidence ◽  
Clinical Signs ◽  
Small Animal ◽  
Apparent Absence ◽  
Veterinary Students ◽  
Disease Awareness ◽  
Veterinary Curriculum

Background: Lyme disease is a relatively new and zoonotic canine pathology mostly unknown by people involved in the management and care of dogs.  Objective: to assess the knowledge about Lyme disease by veterinarians and veterinary students in Veracruz, Mexico. Methodology: three questionnaires were designed and applied to 290 individuals (40 small animal veterinarians, 50 in other professional practice and 200 veterinary students). Results and discussion: in general, the three groups were unaware about the disease, although there is a high interest in learning about this problem. Graduates from seven universities included in this study stated that Lyme disease was not part of the veterinary curriculum in their schools. Five clinical cases suggestive of Lyme disease occurring in dogs in the area were detected at the time of this research. Conclusion: although the presence of the agent causing Lyme disease has not been demonstrated in the studied area due to the lack of laboratory support and the apparent absence of the vector, it cannot be ruled out; furthermore, it is important that veterinary practitioners and student alike be aware of the potential presence of Lyme disease, paying particular attention to differential diagnosis when resembling clinical signs are observed.

scholarly journals Ulnar Nerve Enlargement at the Medial Epicondyle Negatively Correlates With Nerve Conduction Velocity in Cubital Tunnel Syndrome

Hand ◽  
2018 ◽  
Vol 15 (2) ◽  
pp. 165-169
Author(s):  
T. David Luo ◽  
Amy P. Trammell ◽  
Luke P. Hedrick ◽  
Ethan R. Wiesler ◽  
Francis O. Walker ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Nerve Conduction ◽  
Nerve Conduction Velocity ◽  
Motor Nerve ◽  
Cubital Tunnel Syndrome ◽  
Medial Epicondyle ◽  
Cubital Tunnel ◽  
Motor Nerve Conduction ◽  
Nerve Enlargement ◽  
Tunnel Syndrome

Background: In cubital tunnel syndrome (CuTS), chronic compression often occurs at the origin of the flexor carpi ulnaris at the medial epicondyle. Motor nerve conduction velocity (NCV) across the elbow is assessed preoperatively to corroborate the clinical impression of CuTS. The purpose of this study was to correlate preoperative NCV to the direct measurements of ulnar nerve size about the elbow at the time of surgery in patients with clinical and/or electrodiagnostic evidence of CuTS. Methods: Data from 51 consecutive patients who underwent cubital tunnel release over a 2-year period were reviewed. Intraoperative measurements of the decompressed nerve were taken at 3 locations: at 4 cm proximal to the medial epicondyle, at the medial epicondyle, and at the distal aspect of Osborne fascia at the flexor aponeurotic origin. Correlation analysis was performed comparing nerve size measurements to slowing of ulnar motor nerve conduction velocities (NCV) below the normal threshold of 49 m/s across the elbow. Results: Enlargement of the ulnar nerve at the medial epicondyle and nerve compression at the flexor aponeurotic origin was a consistent finding. The mean calculated cross-sectional area of the ulnar nerve was 0.21 cm2 above the medial epicondyle, 0.30 cm2 at the medial epicondyle, and 0.20 cm2 at the flexor aponeurotic origin ( P < .001). There was an inverse correlation between change in nerve diameter and NCV slowing ( r = −0.529, P < .001). Conclusions: For patients with significantly reduced preoperative NCV and clinical findings of advanced ulnar neuropathy, surgeons can expect nerve enlargement, all of which may affect their surgical decision-making.

The clinical course of bartonellosis in 24 cats

2021 ◽  
Vol 77 (04) ◽  
pp. 65146-2021
Author(s):  
ŁUKASZ MAZUREK ◽  
OLIWIER TEODOROWSKI ◽  
PIOTR DĘBIAK ◽  
KLAUDIUSZ SZCZEPANIAK ◽  
ANNA WILCZYŃSKA ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Medical Records ◽  
Clinical Course ◽  
Bartonella Henselae ◽  
Clinical Signs ◽  
Course Of Disease ◽  
Laboratory Abnormality ◽  
Allergic Dermatitis ◽  
Time Of Presentation ◽  
Common Laboratory

The aim of this study was to analyse clinical cases of bartonellosis. Medical records of cats naturally infected with Bartonella henselae were retrospectively evaluated with regard to clinical signs and laboratory abnormalities at the time of presentation, therapy and course of disease. The most common clinical abnormalities in B. henselae-positive cats included in the study were flea allergic dermatitis (29.5%), fever (25%) and diarrhoea (12.5%). Thrombocytopenia was the most common laboratory abnormality (50%).The results of the study indicate that B. henselae infection must be considered in differential diagnosis in patients with thrombocytopenia and flea invasion.

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