scholarly journals Median Nerve Neuritis after Infection by the SARS-CoV-2 Virus

2021 ◽  
Vol 6 (1) ◽  
pp. 1-4
Author(s):  
Marcelo de Pinho Teixeira Alves ◽  
João Pedro Gouveia Nóbrega
Keyword(s):  
Median Nerve ◽  
Metabolic Diseases ◽  
Severe Disease ◽  
Neurological Complications ◽  
Neurological Manifestations ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
First Case ◽  
Asymptomatic Patients ◽  
The Right

Background: The spectrum of neurological complications from SARS-CoV-2 infection is under constant investigation. According to numerous publications, occurrence of neurological complications can be about 36.4%. There are no reports to date of the occurrence of bilateral median nerve neuritis in the wrist after SARS-CoV-2 infection. Case: A previously healthy 24 years old female was observed in March 2021 due to dysesthesias in both hands, associated with nocturnal discomfort and decreased grip strength. The symptoms started a month earlier with acroparesthesias. SARS-CoV-2 virus infection was in January 2021 and evolved favorably, with progressive remission in about 10 days. Prior to the infection she didn’t have any of the hand symptoms; denied diabetes or metabolic diseases. Negative tests for SARS-CoV-2 infection since February. April 2021, the patient returned with persistent dysesthesias in her hands. Normal EMG, however with Sensitive Conduction Speed (SCS) of 50 m/sec on the right wrist; on the left SCS 55 m/sec. Sensitive latency 2.8 on the right and 2.6 on the left. Amplitude 17 on the right and 24 on the left. MRI detected an increase in signal in PDFS sequences in both median nerves, in the carpal tunnel, with no detected variations in cross-sectional areas or masses. The treatment was a 30 days 150 mg benfotiamine in two daily doses. Discussion: There is a wide variation in the clinical presentation of SARS-CoV-2 infection, ranging from asymptomatic patients to death. Most frequent symptoms are fever, dry cough, sore throat, dyspnea, myalgia, fatigue, chills, diarrhea, chest pain and vomiting, and the most common complications pneumonia and acute respiratory distress syndrome. Neurological manifestations of viral infection can occur in about 36.4% and in 45.5% in severe disease. They include Guillán-Barré and Miller Fischer syndrome; however, these conditions usually occur in more severe cases of the disease, but this patient hadn’t the typical picture of ataxia, ophthalmoplegia and areflexia. Benfotiamine is a synthetic derivative of thiamine with a multifaceted therapeutic profile, with a therapeutic role especially in diabetic neuropathy. Conclusion: Knowledge and recognition of neurological manifestations of SARS-CoV-2 infection and early detection of secondary peripheral neuropathies result in improvement of patients' clinical results and development of ideal ways of treatment. Although only a small percentage of patients develop peripheral neuropathy, in a pandemic this can result in a major social and health impact. The reported case is the first case of bilateral secondary median nerve neuritis in the literature. Level of evidence 4.

scholarly journals Use of monoclonal antibody therapy for nosocomial SARS-CoV-2 infection in patients at high risk for severe COVID-19: experience from a tertiary-care hospital in Germany

Infection ◽  
2021 ◽  
Author(s):  
Johanna Koehler ◽  
Barbara Ritzer ◽  
Simon Weidlich ◽  
Friedemann Gebhardt ◽  
Chlodwig Kirchhoff ◽  
...  
Keyword(s):  
High Risk ◽  
Tertiary Care Hospital ◽  
Severe Disease ◽  
Treatment Options ◽  
Tertiary Care ◽  
Antibody Therapy ◽  
Additional Treatment ◽  
Care Hospital ◽  
Cross Sectional ◽  
Asymptomatic Patients

AbstractAdditional treatment options for coronavirus disease (COVID-19) are urgently needed, particularly for populations at high risk of severe disease. This cross-sectional, retrospective study characterized the outcomes of 43 patients with nosocomial severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection with and without treatment using monoclonal SARS-CoV-2 spike antibodies (bamlanivimab or casirivimab/imdevimab). Our results indicate that treatment with monoclonal antibodies results in a significant decrease in disease progression and mortality when used for asymptomatic patients with early SARS-CoV-2 infection.

scholarly journals PROFILE OF PATIENTS RECEIVING TOTAL KNEE ARTHROPLASTY: A CROSS-SECTIONAL STUDY

2017 ◽  
Vol 25 (5) ◽  
pp. 202-205 ◽  
Author(s):  
MARCELO JOSÉ CORTEZ BEZERRA ◽  
IGOR MAGALHÃES BARBOSA ◽  
THALES GONÇALVES DE SOUSA ◽  
LARISSA MEIRELES FERNANDES ◽  
DIEGO LEONARDO MENEZES MAIA ◽  
...  
Keyword(s):  
Medical Records ◽  
Severe Disease ◽  
Functional Limitation ◽  
Cross Sectional Study ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Lequesne Index ◽  
Total Knee ◽  
Epidemiological Profile

ABSTRACT Objective: To describe the epidemiological profile, presented deformities, associated comorbidities, and impact on quality of life in patients with knee osteoarthritis. This study was conducted in a philanthropic hospital in Fortaleza from 2014 to 2015. Methods: Data were collected from medical records, epidemiological forms, and by applying the Lequesne index questionnaire, which contains several questions related to pain, discomfort and functional limitation to assess the severity of symptoms. Results: Females were more prevalent (76.7%), as were patients over 65 years of age (61.6%) and non-whites (81.6%). As for comorbidities, 83.3% had hypertension and 31.7% had diabetes. Of the total, 76.5% cases were genu varum, and 23.5% genu valgum. According to the Lequesne index findings, 61.6% cases were “extremely severe,” and women had higher scores. Conclusion: Females were more prevalent and whites were less prevalent. The most frequent comorbidity was hypertension. Female and elderly patients have more severe disease according to Lequesne index score, and these findings were statistically significant. Level of Evidence II, Prospective Study.

scholarly journals Sonographic Measurement of Cross-sectional Area of the Median Nerve in Academic Dentists Without Symptoms or Signs of Carpal Tunnel Syndrome

2018 ◽  
Vol 35 (2) ◽  
pp. 105-111
Author(s):  
Akram Asbeutah ◽  
Mohsen Dashti ◽  
Abdullah AlMajran ◽  
Aref Ghayyath
Keyword(s):  
Median Nerve ◽  
Statistical Significance ◽  
Working Hours ◽  
Cross Sectional Area ◽  
Dominant Hand ◽  
Sectional Area ◽  
Cross Sectional ◽  
Increased Risk ◽  
Bone Level ◽  
The Right

The objective was to evaluate the distribution of the cross-sectional area (CSA) and flattening ratio (FR) of the median nerve (MN) in asymptomatic academic dentists using ultrasonography (US). Fifty academic dentists underwent US of the MN in transverse section at the pisiform bone level and the CSA (mm2) and FR were measured bilaterally. A CSA of <10 mm2 was considered normal. Paired t-test showed no statistical significance between either hand for CSA and FR ( P> .05). Two independent t-tests showed significant statistical differences ( P= .023) between males and females in the right dominant hand for CSA. Linear correlation analysis showed no significant correlation between CSA and FR for number of years of experience or number of working hours per day in either hand ( P>.05). The CSA was abnormal in the right dominant hand in 20 (40%) of the subjects. These male academic dentists were at increased risk of having an enlarged MN without symptoms.

The sural nerve: Sonographic anatomy, variability and relation to the small saphenous vein in the setting of endovenous thermal ablation

2016 ◽  
Vol 32 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Omar Rodriguez-Acevedo ◽  
Kristen Elstner ◽  
Aaron Zea ◽  
Jenny Diaz ◽  
Kui Martinic ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Thermal Ablation ◽  
Sural Nerve ◽  
Duplex Ultrasound ◽  
Anatomical Variations ◽  
Neurological Complications ◽  
Reference Points ◽  
Deep Fascia ◽  
Cross Sectional ◽  
The Right

Background Neurological complications are well documented in association with both surgical stripping or disconnection and thermal ablation of the small saphenous vein. The sural nerve (medial sural cutaneous nerve) is most vulnerable due to its close relationship to the small saphenous vein. Objective This is a cross-sectional observational study of the sonographic anatomy of 115 Australian patients to determine the course of the sural nerve and its relationship to the small saphenous vein, and to identify its relevance in the thermal ablation of the small saphenous vein. Method Sonographic mapping of the right sural nerve was performed with a Philips L12.5 and Sonosite 10.5 MHz ultrasound machine on 115 patients. The sural nerve was traced proximally from the level of the lateral malleolus to the popliteal fossa in order to measure its distance from the small saphenous vein at four reference points in the lower leg. Results A total of 115 patients were studied (females 82, males 33). The sural nerve was identified in 100% of patients; 64 patients (55.7%) showed usual sural nerve anatomy, while 51 patients (44.3%) demonstrated a range of anatomical variations, including the sural nerve becoming epifascial at a higher point than usual. Conclusion The sural nerve was identifiable on duplex ultrasound in 100% of cases. Classic anatomical relations and the perceived protection of the sural nerve conferred by the deep fascia of the upper calf are unreliable. Preoperative strategies can help to approach and protect the sural nerve in the endovenous ablation setting.

scholarly journals PROFIL PASIEN SINDROM TEROWONGAN KARPAL DI POLIKLINIK SARAF RSUP SANGLAH DENPASAR

2018 ◽  
Vol 35 (3) ◽  
Author(s):  
I Komang Arimbawa ◽  
Ni Komang Dewi Mahayani ◽  
I Gusti Ngurah Purna Putra ◽  
Thomas Eko Purwata
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Working Hours ◽  
Cross Sectional Study ◽  
Study Data ◽  
Cross Sectional ◽  
Neurology Clinic ◽  
Tunnel Syndrome ◽  
The Right

PROFILE OF PATIENT CARPAL TUNNEL SYNDROME IN THE NEUROLOGY CLINIC SANGLAH GENERAL HOSPITAL IN DENPASARABSTRACTIntroduction: Carpal tunnel syndrome (CTS) is the entrapment of the median nerve at the carpal tunnel.Aims: To determine the profile of patients with carpal tunnel syndrome in the Neurology Clinic Sanglah GeneralHospital in Denpasar.Methods: This is a descriptive, cross sectional study. Data was collected during a6-month period from April 2016 to September 2016.Results: Among 25 subjects, 76% were female with mean age 48+10,133 years old, housewives (40%), with working hours of more than 8 hours per day. Most subjects had symptoms on the right hand 68% in the form of tingling sensation (96%), pain (36%), numbness (48%), and hand weakness (24%). Most subject has positive Phalen test (80%), Tinnel (80%), and Flick (76%) and small number had tenar muscle atrophy (28%), impaired sensibility (32%), and decrease in muscle strength (24%). As many as 68% of subjects had distal sensoric latency of median nerve recorded on the 4th digit>3.5msec, while 72% showed ≥0.5 difference of distal sensoric latency between the median nerve and ulnar nerve, while8% showed no response.Discussion: Most patients were female, with dominant complaint was tingling, positive Phalen and Tinnel test, and68% ENMG result shown CTS.Keywords: Carpal tunnel syndrome, electroneuromyography, patient profileABSTRAKPendahuluan: Sindrom terowongan karpal (STK) adalah penjepitan N. Medianus saat melewati terowongan karpal. Tujuan: Untuk mengetahui profil pasien sindrom terowongan karpal di poliklinik saraf RSUP Sanglah, Denpasar. Metode: Penelitian potong lintang terhadap pasien dengan STK yang berobat ke poliklinik saraf RSUP Sanglah,Denpasar secara konsekutif pada bulan April-September 2016.Hasil: Dari 25 subjek, 76% adalah perempuan dengan rerata usia 48+10,133 tahun, ibu rumah tangga (40%) dengan durasi kerja lebih dari 8 jam perhari. Mayoritas keluhan terjadi pada tangan kanan (68%), berupa kesemutan (96%), nyeri (36%), rasa tebal (48%), dan kelemahan otot  tangan (24%). Sebagian besar hasil positif pada tes Phalen (80%), Tinnel (80%), dan Flick (76%), serta sebagian kecil mengalami atrofi otot tenar (28%), gangguan sensibilitas (32%), dan kelemahan otot tangan (24%). Latensi distal sensorik N. Medianus pada perekaman jari IV terutama >3,5ms (68%), perbedaan latensi distal sensorik N. Medianus dan Ulnaris ≥0,5ms (72%), dan tidak ada respons 8%.Diskusi: Sebagian besar sampel adalah perempuan, gejala yang dominan berupa kesemutan, tes Phalen dan Tinnel yang positif, serta hasil ENMG 68% menderita STK.Kata kunci: Elektroneuromiografi, profil pasien, sindrom terowongan karpal

scholarly journals Anterior artery release, distraction and fusion (ARDF) for radiculopathy caused by a vertebral artery loop

2021 ◽  
Author(s):  
Mazda Farshad ◽  
José Miguel Spirig ◽  
Marco D. Burkhard
Keyword(s):  
Vertebral Artery ◽  
Nerve Root ◽  
Cervical Radiculopathy ◽  
Loop Formation ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Surgical Strategies ◽  
History Of ◽  
The Right ◽  
Neurovascular Decompression

Abstract Background Anomalous vertebral artery (VA) with loop formation is a rare cause of cervical nerve root compression. Various techniques with anterior and posterior approaches have been described for surgical treatment once conservative treatments fail. We herein present a case treated with the new technique of anterior release, distraction and fusion (ARDF) and further provide an updated review of surgically managed VA loops in the subaxial spine. Case description A 76-year-old female complained of a 6-year history of pulsating, shooting pain in her right arm to the thumb. After obtaining repeated MRI, the VA loop compressing the right-sided C6-nerve root was detected. A neurovascular decompression through ARDF which led to an indirect loop straightening was performed. The patient immediately improved after surgery and remained pain-free 1 year postoperative. Conclusion Neural irritation due to VA loop formation is a rare cause of cervical radiculopathy. While various surgical strategies have been described, we believe that anterior and anterolateral approaches are the safest to yield neurovascular decompression. We described and documented ARDF (anterior VA release, intervertebral distraction and fusion) on a patient case. Level of evidence II (Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding).

scholarly journals EVALUATION OF NEUROLOGICAL MANIFESTATIONS IN HUMAN IMMUNODEFICIENCY VIRUS-AIDS PATIENTS ADMITTED TO SOUTH INDIAN TERTIARY CARE HOSPITAL – A CROSS-SECTIONAL STUDY

2020 ◽  
pp. 86-90
Author(s):  
ARUN SINGH TEJAVATH ◽  
AMIT MATHUR ◽  
PRATIMA SINGH ◽  
SUPRIYA SUMAN ◽  
PREETI RAJ ◽  
...  
Keyword(s):  
Leukocyte Count ◽  
Tertiary Care ◽  
Neurological Complications ◽  
Cross Sectional Study ◽  
Neurological Manifestations ◽  
Sectional Study ◽  
Cross Sectional ◽  
Cd4 Counts ◽  
Immunodeficiency Virus ◽  
The Mean

Objective: The objective of the study was to describe, evaluate, and analyze neurological manifestation in human immunodeficiency virus HIV positive patients admitted to a tertiary care center. Methods: The study was a prospective cross-sectional study, in which 103 HIV patients were analyzed. All patients were interviewed face to face and evaluated by the investigator with particular reference to neurological manifestations. They were classified into various stages of HIV using the World Health Organization staging system. Results: The mean age in males was 37 (standard deviation [SD] 8.0) years and in females 35 (SD 7.0) years. A greater proportion of females were diagnosed in the asymptomatic state during screening, either during pregnancy or when the spouse was found to be positive. Headache was the most common neurologic symptom and fundus abnormalities were the most common neurological sign documented in patients. The mean CD4 counts in males are 156.5/mm3 and in females are 229.57/mm3 whereas the mean absolute leukocyte count in males is 1088.30/mm3 and in females is 1473.52/mm3. The CD4 counts showed a better correlation with the occurrence of neurological manifestations than absolute leukocyte count. Conclusion: Headache was a significant predictor of the occurrence of neurological complications (p=0.01). CD4 counts were significantly lower in patients with neurological complications and most of the neurological manifestations; on the contrary, all the opportunistic infections were documented in patients with CD4 counts below 200/mm3. Neurological complications did not show any correlation with the patient being on anti-retroviral therapy.

scholarly journals Multinational characterization of neurological phenotypes in patients hospitalized with COVID-19

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Trang T. Le ◽  
Alba Gutiérrez-Sacristán ◽  
Jiyeon Son ◽  
Chuan Hong ◽  
Andrew M. South ◽  
...  
Keyword(s):  
Severe Disease ◽  
Neurological Complications ◽  
Cerebrovascular Diseases ◽  
Hospitalized Patients ◽  
Disorders Of Consciousness ◽  
Polymerase Chain Reaction Test ◽  
Cross Sectional ◽  
Before And After ◽  
Neurological Conditions ◽  
Chain Reaction Test

AbstractNeurological complications worsen outcomes in COVID-19. To define the prevalence of neurological conditions among hospitalized patients with a positive SARS-CoV-2 reverse transcription polymerase chain reaction test in geographically diverse multinational populations during early pandemic, we used electronic health records (EHR) from 338 participating hospitals across 6 countries and 3 continents (January–September 2020) for a cross-sectional analysis. We assessed the frequency of International Classification of Disease code of neurological conditions by countries, healthcare systems, time before and after admission for COVID-19 and COVID-19 severity. Among 35,177 hospitalized patients with SARS-CoV-2 infection, there was an increase in the proportion with disorders of consciousness (5.8%, 95% confidence interval [CI] 3.7–7.8%, pFDR < 0.001) and unspecified disorders of the brain (8.1%, 5.7–10.5%, pFDR < 0.001) when compared to the pre-admission proportion. During hospitalization, the relative risk of disorders of consciousness (22%, 19–25%), cerebrovascular diseases (24%, 13–35%), nontraumatic intracranial hemorrhage (34%, 20–50%), encephalitis and/or myelitis (37%, 17–60%) and myopathy (72%, 67–77%) were higher for patients with severe COVID-19 when compared to those who never experienced severe COVID-19. Leveraging a multinational network to capture standardized EHR data, we highlighted the increased prevalence of central and peripheral neurological phenotypes in patients hospitalized with COVID-19, particularly among those with severe disease.

scholarly journals Chronic extensor hallucis longus tendon rupture treated with double-bundle autograft of extensor hallucis capsularis: A case report

2019 ◽  
Vol 7 ◽  
pp. 2050313X1984196 ◽  
Author(s):  
Toshinori Kurashige
Keyword(s):  
Tendon Rupture ◽  
Metatarsophalangeal Joint ◽  
Extensor Tendon ◽  
Double Bundle ◽  
Level Of Evidence ◽  
Longus Tendon ◽  
First Case ◽  
Extensor Hallucis Longus ◽  
The Right

The extensor hallucis capsularis is an accessory extensor tendon with varied occurrence. Here, we present the case of a 40-year-old man with chronic extensor hallucis longus tendon rupture treated using extensor hallucis capsularis tendon as a double-bundle autograft. He had dropped a knife proximal to the right hallux metatarsophalangeal joint 4 months ago. Computed tomography revealed the presence of extensor hallucis capsularis, with its width and thickness, and the point of divergence from the extensor hallucis longus tendon. Because direct suturing was considered difficult and the extensor hallucis capsularis tendon was sufficiently wide and long, double-bundle autograft transplantation of extensor hallucis capsularis was performed. At 1-year follow-up examination, the patient retained almost full function of his hallux. To the best of our knowledge, this is the first case to use this technique. Using the extensor hallucis capsularis tendon for grafting should be carefully considered because the variable width and length may limit the graft strength. Level of evidence: IV

High-resolution ultrasound in the diagnosis of failed carpal tunnel decompression: a study of 35 cases

2022 ◽  
pp. 175319342110686
Author(s):  
Enrico Carità ◽  
A. Donadelli ◽  
M. Laterza ◽  
P. Perazzini ◽  
S. Tamburin ◽  
...  
Keyword(s):  
High Resolution ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Giant Cell Tumour ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Ultrasound Findings ◽  
Cause Of Failure ◽  
Perineural Fibrosis ◽  
Median Nerve Injury

We used high-resolution ultrasound to examine 35 median nerves (35 patients) with failed carpal tunnel decompression to identify the cause of failure. The carpal tunnel was examined before revision surgery, and the results were correlated with surgical findings. The cross-sectional area was measured, and nerve morphology was analysed at the sites of compression. We found persistent median nerve compression in 30 out of 35 patients. In 20 patients, the compression was caused by a residual transverse carpal ligament, in four by perineural fibrosis, in five by both of these causes and in one by tenosynovitis. In four patients, evidence of median nerve injury with an epineural/fascicular lesion was detected; and in one, no abnormalities were found. Surgical findings were consistent with the ultrasound findings except in one patient where tenosynovitis was associated with a giant cell tumour, which was missed by ultrasound. High-resolution ultrasound can provide helpful information in preoperative diagnosis of failed carpal tunnel decompression with good correlation between the ultrasound and surgical findings. Level of evidence: IV

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