scholarly journals Posterior Interosseous Fascicular Constriction Within the Radial Nerve in a Diabetic Patient With Bilateral Neuralgic Amyotrophy: A Case Report

2021 ◽  
Vol 12 ◽  
Author(s):  
Woojun Kim ◽  
Soo Hwan Kang ◽  
Jae Young An
Keyword(s):  
Upper Limb ◽  
Radial Nerve ◽  
Clinical Symptoms ◽  
Early Recognition ◽  
Shoulder Girdle ◽  
Sudden Onset ◽  
Left Forearm ◽  
Main Trunk ◽  
Neuralgic Amyotrophy

Background: Neuralgic amyotrophy (NA) is an acute, monophasic, painful inflammatory dysimmune focal, or multifocal mononeuropathy. The lesion in NA is not always restricted to the brachial plexus but also involves individual nerves or branches. The prognosis of NA is less favorable than previously assumed, but the reasons for poor recovery remain unknown. Nerve constriction may be one of the causes of poor prognosis in NA.Case Presentation: Herein, we described a 54-year-old male with a history of type 2 diabetes in whom bilateral neuralgic amyotrophy developed with constriction of the posterior interosseous fascicle within the radial nerve. The patient experienced sudden-onset severe pain in both shoulders followed, 2 days later, by weakness in bilateral shoulders and the left forearm extensors over the subsequent month. The left forearm extensors were more severely affected than both shoulder girdle muscles. He noted a 7-kg weight loss for 1 month before pain onset. After diagnosing diabetic NA based on the clinical symptoms, imaging, and electrophysiological studies, treatment with systemic steroids improved pain and weakness in both shoulder muscles. Weakness in the left forearm extensors persisted after 1 month of steroid treatment. Follow-up ultrasound revealed constriction of the posterior interosseous fascicle within the main trunk of the left radial nerve at the elbow. Surgical exploration at 6 months after onset identified fascicle constriction, for which neurolysis was performed. Weakness in the extensors of the wrist and fingers did not improve during the 16-month follow-up.Conclusion: A single constriction of the fascicle within a peripheral nerve may often be under-recognized if NA presents with variable degrees of weakness in bilateral upper limbs. Furthermore, fascicular constriction without edema of the parent nerve may be easily missed on the initial ultrasound. A lack of early recognition of nerve constriction and delay in surgical intervention can result in unfavorable outcomes. The physician should consider the possibility of the fascicular constriction when evaluating patients suspected of brachial NA with significant weakness in the distal upper limb compared to the proximal weakness or weakness of the distal upper limb that does not improve over time.

scholarly journals Tacrolimus-induced posterior reversible encephalopathy syndrome presenting as left upper limb monoplegia, convulsions, and sudden blindness: case report

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Mohamad-Sherif Mogawer ◽  
Mostafa EL-Shazly ◽  
Ayman Salah ◽  
Amany Abdel-Maqsod ◽  
Omar Abdelaziz ◽  
...  
Keyword(s):  
Upper Limb ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Early Recognition ◽  
Sudden Onset ◽  
Neurological Deficits ◽  
Posterior Reversible Encephalopathy ◽  
Donor Liver Transplantation ◽  
Uncommon Presentation ◽  
Reversible Encephalopathy

Abstract Background To report a case of sudden onset left upper limb monoplegia, convulsions, and bilateral blindness in a patient receiving tacrolimus for immunosuppression following living donor liver transplantation (LDLT) consistent with posterior reversible encephalopathy syndrome (PRES). Case presentation We report a case of a 64-year-old male patient on tacrolimus treatment following LDLT. On day 11, during his post-operative routine follow-up. The patient developed sudden onset of left upper limb monoplegia associated with attacks of convulsions and sudden bilateral blindness. MRI revealed multiple, bilateral cortical, and subcortical areas of high T2 and FLAIR signal intensity that did not show restricted diffusion. Findings were suggestive of posterior reversible encephalopathy syndrome (PRES). After the cessation of tacrolimus, vision was completely regained and all other neurologic symptoms were resolved, and follow-up MRI was normal. This case represents an uncommon presentation of tacrolimus toxicity. Conclusion Tacrolimus toxicity may present with PRES. Neurological deficits may be fully reversible with discontinuation of the drug; therefore, the early recognition and prompt management of this condition are of utmost importance.

scholarly journals Long-term Outcomes of Patients with Anti–Leucine-Rich Glioma-Inactivated 1 Encephalitis

2020 ◽  
Author(s):  
Shan Qiao ◽  
Huai-kuan Wu ◽  
Ling-ling Liu ◽  
Ke-jun Zang ◽  
Xuewu liu
Keyword(s):  
Clinical Symptoms ◽  
Early Recognition ◽  
Chinese Patients ◽  
Long Term Outcomes ◽  
Ancillary Test ◽  
Behavioral Abnormalities ◽  
Long Term Follow Up ◽  
And Behavior

Abstract Background: This report aims to provide a detailed description of the clinical manifestation, immunotherapy, and long-term outcomes of 117 Chinese patients with anti-leucine-rich glioma-inactivated 1 (LGI1) encephalitis. Methods: We retrospectively selected 117 patients diagnosed with anti-LGI1 encephalitis from the databases of multiple clinical centers from September 2014 to December 2019. The clinical features, ancillary test results, and details of long-term outcomes were analyzed.Results: Among the 117 anti-LGI1 encephalitis patients, 81 (69%) were male and 36 (31%) were female; the median onset age was 51 years (range: 30-77 years). The median time from symptom onset until diagnosis was 8.7 weeks (range: 2-49 weeks). The main features evaluated in our cohort were seizures, cognitive impairment, and mental and behavioral abnormalities. One hundred and nine patients were treated with immunotherapy, After 3-5 days of treatment, the clinical symptoms were somewhat alleviated in all the patients, and their memory, mental ability, and behavior improved. The median follow-up time was 33 months (range: 6-59 months). A total of 19 (16%) patients experienced a relapse; the median duration from onset to the first relapse was 5 (0.3-27) months. There were no mortalities during the follow-up period.Conclusions: The outcome of patients with anti-LGI1 encephalitis is mostly favorable, although some patients continue to suffer from cognitive dysfunction. Early recognition is of great significance for the treatment of anti-LGI1 encephalitis. Prompt adequate immunotherapy has positive implications for the improvement of clinical symptoms of anti-LGI1 encephalitis. Long-term follow-up is important for the assessment of LGI1 antibody-mediated encephalitis.

scholarly journals Atraumatic spontaneous swelling of sternoclavicular joint: a case report

2020 ◽  
Vol 8 (4) ◽  
pp. 1544
Author(s):  
Nazia E. Kottasseri ◽  
Mohammed A. Kalathingal ◽  
Shajitha T. Veettil
Keyword(s):  
Elderly Women ◽  
Shoulder Girdle ◽  
Axial Skeleton ◽  
Sudden Onset ◽  
Sternoclavicular Joint ◽  
Common Causes ◽  
The Common ◽  
Anterior Subluxation ◽  
Underlying Pathology

Atraumatic spontaneous swelling of the Sternoclavicular Joint (SCJ) is not very common in elderly women. The SCJ is an integral part of the shoulder girdle that connects the upper limb to the axial skeleton. Trauma, degeneration, infections and other disease processes that affect synovial joints are the common causes of swelling of the SCJ. Here authors report a case of nontraumatic spontaneous anterior subluxation of the sternoclavicular joint in 66-year-old women without any underlying pathology who presented with sudden onset of a nontender swelling in the suprasternal area. The patient was treated conservatively and remained asymptomatic throughout 6 months follow up.

scholarly journals A novel MAGED2 variant in a Chinese preterm newborn with transient antenatal Bartter’s syndrome with 4 years follow-up

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mingsheng Ma ◽  
Mengqi Zhang ◽  
Yu Zhou ◽  
Fengxia Yao ◽  
Min Wei ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Early Recognition ◽  
Male Infant ◽  
Bartter’S Syndrome ◽  
Bartter's Syndrome ◽  
Renal Tubular Disorder ◽  
Novel Variant ◽  
Renal Tubular ◽  
Antenatal Bartter’S Syndrome

Abstract Background Transient antenatal Bartter’s syndrome caused by MAGED2 mutation is a rare X-linked recessive renal tubular disorder. Cases reported are mostly infants, and the long-term prognosis of the disease is still under investigation. Case presentation We encountered a preterm male infant with polyhydramnios, polyuria, salt loss, hypercalciuria, nephrocalcinosis and alkalosis. Antenatal Bartter’s syndrome was suspected, but these clinical symptoms surprisingly disappeared after about 2 months. This led to the clinical diagnosis of transient antenatal Bartter’s syndrome. Gene analysis in this patient disclosed a novel variant (c.1598C > T, p.Ala533Val) in exon 12 of MAGED2 gene, and his mother was a heterozygous carrier. This patient was followed up in clinic for 4 years without recurrence of imbalance of potassium, sodium and chloride. His height and weight were in normal range, and all laboratory examinations and nephrotic ultrasound were also normal. Conclusions We reported the first Chinese case of transient antenatal Bartter’s syndrome caused by MAGED2 mutation. The 4-year follow-up of our case further demonstrates the benign prognosis of the disease and indicates that early recognition of this phenotype could avoid unnecessary treatments.

scholarly journals Upper limb phlegmasia cerulea dolens treated with single-session suction thrombectomy: a case report

2020 ◽  
Vol 2020 (10) ◽  
Author(s):  
Paul Ghaly ◽  
Glen Schlaphoff ◽  
John Crozier ◽  
Mehtab Ahmad
Keyword(s):  
Upper Limb ◽  
Rare Condition ◽  
Sudden Onset ◽  
Lower Limbs ◽  
Single Session ◽  
Vessel Patency ◽  
Clinical Triad ◽  
Phlegmasia Cerulea Dolens

Abstract Phlegmasia cerulea dolens (PCD) of the lower limbs is a rare condition. PCD of the upper limbs is extremely uncommon, with only a select few cases documented in the literature. A complication of severe deep venous thrombosis, PCD, is characterized by the clinical triad of oedema, pain and limb cyanosis. Delays in treatment are associated with high rates of morbidity and mortality. We present a case of sudden-onset upper limb PCD in a 68-year-old man following haemodialysis through a long-term arteriovenous fistula. Prompt diagnosis and rapid initiation of intravenous anticoagulation followed by urgent single-session suction thrombectomy resulted in the successful restoration of vessel patency without any significant adverse sequelae on 3-month follow-up.

scholarly journals Polymyalgia rheumatica update, 2015

2016 ◽  
Vol 157 (1) ◽  
pp. 2-12
Author(s):  
Zsuzsa Schmidt ◽  
Gyula Poór
Keyword(s):  
Side Effects ◽  
Polymyalgia Rheumatica ◽  
Clinical Symptoms ◽  
Late Onset ◽  
Early Recognition ◽  
Work Group ◽  
Shoulder Girdle ◽  
Medical Specialties ◽  
Family Doctors ◽  
Elderly Onset

Polymyalgia rheumatica is an inflammatory musculoskeletal disorder of people aged 50 years or over, characterised by pain, aching and morning stiffness in the shoulder girdle and often hip girdle and neck. Marked systemic inflammation and rapid response to corticosteroid therapy are characteristic features. Giant cell arteritis is a well-known association of polymyalgia rheumatica. Recent clinical evidence and scientific results in the field have provided new challenges for rheumatologists. Besides the aspecific – although characteristic – proximal syndrome, less well recognizable and more variable distal musculoskeletal manifestations were observed. Magnetic resonance and ultrasound studies showed mild, remitting and non-erosive synovitis, with dominating inflammation of the extraarticular synovial structures. As no pathognostic sign is known, the diagnosis of polymyalgia rheumatica is based on its differential diagnosis, differentiation from the polymyalgia mimics; particularly from elderly onset inflammatory arthritides, such as elderly onset rheumatoid arthritis and late onset seronegative spondylarthritis. In 2012 the international polymyalgia rheumatica work group under the guidance of the American College of Rheumatology and European League Against Rheumatism elaborated new classification criteria, the scoring algorythm of which is based on clinical symptoms, with ultrasonography increasing the specificity. Corticosteroids remain the cornerstone of the therapy of polymyalgia rheumatica. No effective steroid-sparing drug has been found to date. Corticosteroids are generally needed for 1–1.5 years, though some patients have a chronic-relapsing course and require corticosteroids for several years. Well known corticosteroid-related side effects (diabetes, hypertension, hyperlipidaemia and osteoporosis) cause significant morbidity and economic burden on the society. Novel therapeautic approaches are on trial. Early recognition of the disease, early start of corticosteroids and a well-defined course, prevention and management of side effects are everyday tasks for rheumatologists and family doctors. Knowledge of polymyalgia rheumatica is essential for all medical specialties. Orv. Hetil., 2016, 157(1), 2–12.

scholarly journals PROGNOSTIC FACTORS OF RELAPSE IN THE SURGICAL TREATMENT OF DESMOID FIBROIDS OF THE TRUNK AND EXTREMITIES

2019 ◽  
Vol 6 (1) ◽  
pp. 21-32
Author(s):  
A. V. Yadrina ◽  
V. Yu. Karpenko ◽  
O. V. Novikova ◽  
N. M. Bychkova ◽  
V. A. Derzhavin ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Surgical Treatment ◽  
Upper Limb ◽  
Soft Tissues ◽  
Histological Study ◽  
Shoulder Girdle ◽  
Resection Margins ◽  
Positive Resection Margins ◽  
Reconstructive Plastic Surgery

Purpose of the study. Evaluation of the results of surgical treatment of desmoid fibroids (DF) using reconstructive plastic surgery and determination of possible prognostic factors of relapses.Patients and methods. The results of surgical treatment of 40 patients with desmoid fibroids of extra abdominal local­ization were analyzed. In 45% of patients, the tumor was located in soft tissues of the shoulder girdle and upper limb, in 35% — on the trunk, in 20% — in soft tissues of the lower limb and in 7% of patients on the neck. The tumor size varied from 2 to 20 cm, the median was 8 ± 4.38 cm. Surgical treatment for newly diagnosed DF was performed in 22 (55%) patients, and for recurrent tumors — in 18 (45%) patients.Results. According to the planned histological study, negative resection boundaries were established in 24/40 patients (63%). In the remaining 16 cases (37%) positive resection margins were obtained: R1 in 14 patients and R2 in 2 patients. Adjuvant treatment is recommended for 14 patients with resection R1/R2. The duration of follow — up after treatment ranged from 6 to 107 months, median‑16.5 months. During follow-up, relapses were diagnosed in 14 patients (35%). No deaths have been reported.Conclusion. Surgical treatment of DF of extraabdominal localization is accompanied by a sufficiently high frequency of relapses. According to the results of the study, an unfavorable factor in the development of relapses is the location of the tumor in soft tissues of the shoulder girdle and upper limb.

TBE in Lithuania

2020 ◽  
Keyword(s):  
Viral Encephalitis ◽  
Clinical Symptoms ◽  
Shoulder Girdle ◽  
Muscle Paralysis ◽  
First Case ◽  
Tick Borne Encephalitis ◽  
Autopsy Data ◽  
Forest Worker ◽  
Girdle Muscle ◽  
Shoulder Girdle Muscle

The first case of tick-borne encephalitis (TBE) in Lithuania, diagnosed by clinical and epidemiologic criteria only, was reported in 1953. A forest worker became ill with the disease in April after a tick bite, had a typical clinical presentation with shoulder girdle muscle paralysis and bulbar syndrome, and died after 12 days from the start of clinical symptoms. Autopsy data were compatible with viral encephalitis.1 Serological diagnosis of TBE in Lithuania was started in 1970.2

Scoring System for the Diagnosis of COVID-19

2020 ◽  
Vol 13 (1) ◽  
pp. 413-414 ◽  
Author(s):  
Mohamed Farouk Allam
Keyword(s):  
Scoring System ◽  
Clinical Symptoms ◽  
False Negative ◽  
Nasopharyngeal Swab ◽  
Rt Pcr ◽  
Pcr Assay ◽  
Negative Results ◽  
False Negative Results ◽  
Symptoms And Signs

Due to the international spread of COVID-19, the difficulty of collecting nasopharyngeal swab specimen from all suspected patients, the costs of RT-PCR and CT, and the false negative results of RT-PCR assay in 41% of COVID-19 patients, a scoring system is needed to classify the suspected patients in order to determine the need for follow-up, home isolation, quarantine or the conduction of further investigations. A scoring system is proposed as a diagnostic tool for suspected patients. It includes Epidemiological Evidence of Exposure, Clinical Symptoms and Signs, and Investigations (if available). This scoring system is simple, could be calculated in a few minutes, and incorporates the main possible data/findings of any patient.

scholarly journals Chinese Herbal Medicine Dingji Fumai Decoction for Ventricular Premature Contraction: A Real-World Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Bo Liang ◽  
Fei-Hu Zou ◽  
Ling Fu ◽  
Hui-Ling Liao
Keyword(s):  
Herbal Medicine ◽  
Chinese Herbal Medicine ◽  
Clinical Symptoms ◽  
Medication Compliance ◽  
Controlled Trial ◽  
Ventricular Premature Contraction ◽  
Traditional Chinese Medicine Syndrome ◽  
Chinese Herbal ◽  
Double Blinded

Background. Chinese herbal medicine Dingji Fumai Decoction (DFD) is widely clinically used for ventricular premature contraction (VPC). This real-word trial was designed to assess the safety and effectiveness of DFD for VPC. Methods. This was a double-blinded, randomized placebo-controlled trial. Patients with VPC were randomized (1 : 1) to treatment with DFD combined with metoprolol (DFD arm) or metoprolol combined with placebo (MET arm). A primary end point was a composite of clinical symptoms and signs determined by the traditionalChinese medicine syndrome score and the number of VPC determined by the Holter examination. Second outcomes were adverse events, medication compliance, and laboratory examination. Results. 144 patients were randomized to DFD arm (76 patients) or MET arm (68 patients), and 136 cases (71 in DFD arm and 65 in MET arm) finally completed this trial. After a 12-week follow-up, DFD arm significantly decreased traditional Chinese medicine syndrome score and the number of VPC compared with MET arm (P=0.003 and 0.034, respectively). There was no adverse drug effect and patient medication compliance was good. Conclusions. Superiority with DFD arm for VPC was demonstrated over MET arm for both the safety and effectiveness end points.

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