Cervical epidural hematoma with Brown-Sequard syndrome caused by an epidural injection: a case report

Epidural hematoma with Brown-Sequard syndrome caused by an epidural injection is a rarely found condition in the emergency department (ED). We report an unusual case of Brown-Sequard syndrome in a 55-year-old man who presented at the ED with right-sided weakness and contralateral loss of pain and temperature sensation after a cervical epidural injection for shoulder pain. Cervicla spine magnetic resonance imaging showed an epidural hematoma from C4 to C6. After admission, his right hemiparesis and contralateral sensory loss improved within eight days, and surgical decompression was not required. Diagnosing spinal lesions in the ED is challenging, especially in patients with acute neurological signs requiring immediate evaluation for stroke. In this case, definite hemiparesis and some contralateral sensory loss were noted. Therefore, a potential spinal lesion was suspected rather than a stroke. This case emphasized the importance of conducting a focused neurological examination after history taking.

Analysis of Hot-Cold Confusion on Fingers

The thermosensory system may misidentify a temperature stimulus with different thermal properties. The mechanism of this hot-cold confusion has not been clarified; hence, it has not yet been applied. In this study, we created a wearable temperature presentation device that is closer to the application and analyzed the tendency and mechanism of temperature confusion by analyzing the hot-cold confusion of temperature sensation in the fingers, which are most frequently in contact with objects. Two experiments were performed. In the first experiment, we presented stimuli on the tips of three fingers (first, second, and third fingers). In the second experiment, we presented stimuli at the center of the distal phalanx, middle phalanx, and proximal phalanx of the first finger. The experimental results indicated the occurrence of hot-cold confusion. Domination, in which the center is dominated by both ends, and a mutual effect, in which the center interacts with both ends, were observed.

Anterior Spinal Artery Syndrome due to Intervertebral Disc Herniation: A systematic review

Objective: Anterior spinal artery syndrome (ASAS) has been rarely reported as a complication of intervertebral disc herniation (IVDH). Precipitation factors, presentation, evaluation, treatment strategy, and degrees of recovery have not yet been well documented. Methods: Systematic review was conducted according to PRISMA guidelines to review and summarize for the qualitative synthesis of the data from reported cases of anterior spinal artery syndrome due to intervertebral disc herniation from 1980 to February 2021. Results: A total of 12 cases were reviewed, the median age was 48.5 years. Motor weakness with or without pain was the most frequent presenting symptom accompanying bowel or bladder incontinence (25%) or diminished pain and temperature sensation with spared dorsal column sensation. 40% of conservatively treated patients had complete recovery without any residual deficit. Whereas all patients who managed surgically regained fully functional status with shorter recovery intervals. Conclusion: Abrupt onset of motor weakness is a potential warning symptom of spinal cord infarction, rarely attributed to ASA compression by a herniated disc. Moreover, an accompanying diminished pain and temperature sensation with spared dorsal column sensation is further intimation. Reestablishment of blood flow may bear a favorable outcome.

The physiological strain index does not reliably identify individuals at risk of reaching a thermal tolerance limit

Purpose The physiological strain index (PSI) was developed to assess individuals’ heat strain, yet evidence supporting its use to identify individuals at potential risk of reaching a thermal tolerance limit (TTL) is limited. The aim of this study was to assess whether PSI can identify individuals at risk of reaching a TTL. Methods Fifteen females and 21 males undertook a total of 136 trials, each consisting of two 40–60 minute periods of treadmill walking separated by ~ 15 minutes rest, wearing permeable or impermeable clothing, in a range of climatic conditions. Heart rate (HR), skin temperature (Tsk), rectal temperature (Tre), temperature sensation (TS) and thermal comfort (TC) were measured throughout. Various forms of the PSI-index were assessed including the original PSI, PSIfixed, adaptive-PSI (aPSI) and a version comprised of a measure of heat storage (PSIHS). Final physiological and PSI values and their rate of change (ROC) over a trial and in the last 10 minutes of a trial were compared between trials completed (C, 101 trials) and those terminated prematurely (TTL, 35 trials). Results Final PSIoriginal, PSIfixed, aPSI, PSIHS did not differ between TTL and C (p > 0.05). However, differences between TTL and C occurred in final Tsk, Tre–Tsk, TS, TC and ROC in PSIfixed, Tre, Tsk and HR (p < 0.05). Conclusion These results suggest the PSI, in the various forms, does not reliably identify individuals at imminent risk of reaching their TTL and its validity as a physiological safety index is therefore questionable. However, a physiological-perceptual strain index may provide a more valid measure.

Short-segment myelitis presenting as Brown-Séquard-plus syndrome as the initial attack of multiple sclerosis.

Brown-Séquard syndrome is an uncommon condition accounting incomplete spinal cord injury, manifesting as ipsilateral weakness and proprioception loss, associated with contralateral pain and temperature sensation loss. Brown-Séquard-plus syndrome (BSPS) has not quite a well-stablished definition, but usually is defined as a Brown-Séquard syndrome associated with clinical findings compatible with another spinal cord tract. We present a pearls & oysters article naming the most relevant findings and aspects to evaluate in this pathology, throughout a clinical case where a patient presents a Brown-Séquard-plus syndrome as the initial attack in multiple sclerosis.

Temperature Sensation in Parkinson’s Disease Measured by Quantitative Sensory Testing

BackgroundThe pathophysiology of abnormal temperature sensation in Parkinson’s disease (PD) remains unclear. Abnormal thermal detection does not seem to depend on the dopaminergic deficit, suggesting that other systems play a role in these changes, probably both central and peripheral.MethodsWe measured thermal detection thresholds (TDT) using quantitative sensory testing (QST) in 28 patients with PD and compared them with 15 healthy controls.ResultsOf 28 patients, 21 % had increased TDT according to the normative data. TDT were higher on the dominant side. No correlation between TDT and disease duration, severity of motor impairment, and dopaminergic therapy was observed. 50 % of the patients had difficulty differentiating between warm and cold stimuli, as TDT were within the normal range in most of these patients.ConclusionsThese results suggest that abnormal thermal detection may be present from early stages of the disease and is more pronounced on the dominant side. Abnormal differentiation between the thermal stimuli suggest impaired central processing of thermal information.

Temperature Sensation: From Molecular Thermosensors to Neural Circuits and Coding Principles

Temperature is a universal cue and regulates many essential processes ranging from enzymatic reactions to species migration. Due to the profound impact of temperature on physiology and behavior, animals and humans have evolved sophisticated mechanisms to detect temperature changes. Studies from animal models, such as mouse, Drosophila, and C. elegans, have revealed many exciting principles of thermosensation. For example, conserved molecular thermosensors, including thermosensitive channels and receptors, act as the initial detectors of temperature changes across taxa. Additionally, thermosensory neurons and circuits in different species appear to adopt similar logic to transduce and process temperature information. Here, we present the current understanding of thermosensation at the molecular and cellular levels. We also discuss the fundamental coding strategies of thermosensation at the circuit level. A thorough understanding of thermosensation not only provides key insights into sensory biology but also builds a foundation for developing better treatments for various sensory disorders. Expected final online publication date for the Annual Review of Physiology, Volume 83 is February 10, 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

A Review on the Pathophysiology and Management of Anterior Spinal Artery Syndrome

As an uncommon cause of spinal cord infarction, anterior spinal cord syndrome can manifest with motor paralysis, loss of pain, and temperature sensation distal to the site of the lesion. The main pathogenesis of this syndrome is the disruption of blood flow in the anterior spinal artery. Mortality and morbidity differ with the etiology of the syndrome. So knowing the etiology of blood flow disruption is essential for patient management. This review article highlights the important clinical manifestation of Anterior spinal artery syndrome. Also describes etiology, pathogenesis, diagnosis, prognosis, possible management, and complications.