Study of clinical profile and outcome of patients with acute non-traumatic paraparesis

Background: The following study is about the clinical profile and outcome of patients with acute non traumatic paraparesis. It includes the aetiology, clinical presentation and the outcome of various cases of acute non traumatic paraparesis. Paraplegia or paraparesis could be defined as loss of function of both legs as a result of disease or injury of the spinal cord, spinal roots, peripheral nerves or myopathies. Acute non-traumatic paraparesis is a neurological emergency. Reversible causes of acute paraplegia can be treated successfully if diagnosed early.Methods: The observational study was done in the department of general medicine at D. Y. Patil Hospital, Navi Mumbai with sample size of 75 patients over 1 year.Results: With early diagnosis prognosis of acute non traumatic paraparesis can be improved which was evaluated over period of 3 months.Conclusions: Acute non-traumatic paraparesis is a neurological emergency. Reversible causes of acute paraplegia can be treated successfully if diagnosed early. It is important to diagnose and classify all cases into compressive and non-compressive lesions based on presenting symptoms because the management of the two differs.

Complex Regional Pain Syndrome. A Comprehensive Review on Neuroplastic Changes Supporting the Use of Non-invasive Neurostimulation in Clinical Settings

Background: Complex regional pain syndrome (CRPS) is a rare debilitating disorder characterized by severe pain affecting one or more limbs. CRPS presents a complex multifactorial physiopathology. The peripheral and sensorimotor abnormalities reflect maladaptive changes of the central nervous system. These changes of volume, connectivity, activation, metabolism, etc., could be the keys to understand chronicization, refractoriness to conventional treatment, and developing more efficient treatments.Objective: This review discusses the use of non-pharmacological, non-invasive neurostimulation techniques in CRPS, with regard to the CRPS physiopathology, brain changes underlying chronicization, conventional approaches to treat CRPS, current evidence, and mechanisms of action of peripheral and brain stimulation.Conclusion: Future work is warranted to foster the evidence of the efficacy of non-invasive neurostimulation in CRPS. It seems that the approach has to be individualized owing to the integrity of the brain and corticospinal function. Non-invasive neurostimulation of the brain or of nerve/muscles/spinal roots, alone or in combination with conventional therapy, represents a fertile ground to develop more efficient approaches for pain management in CRPS.

Nerve transfer for restoration of lower motor neuron-lesioned bladder function. Part 3: Correlation between histological changes and nerve evoked contractions

We determined the effect of pelvic organ decentralization and reinnervation one year later on urinary bladder histology and function. Nineteen canines underwent decentralization by bilateral transection of all coccygeal and sacral (S) spinal roots, dorsal roots of lumbar (L)7 and hypogastric nerves. After exclusions, 8 were reinnervated 12 months post-decentralization with obturator-to-pelvic and sciatic-to-pudendal nerve transfers, then euthanized 8-12 months later; four served as long-term decentralized only animals. Before euthanasia, pelvic or transferred nerves and L1-S3 spinal roots were stimulated and maximum detrusor pressure (MDP) recorded. Bladder specimens were collected for histological and ex vivo smooth muscle contractility studies. Both reinnervated and decentralized animals showed less or denuded urothelium, fewer intramural ganglia, and more inflammation and collagen, than controls, although percent muscle was maintained. In reinnervated animals, pgp9.5+ axon density was higher, compared to decentralized animals. Ex vivo smooth muscle contractions in response to KCl correlated positively with submucosal inflammation, detrusor muscle thickness, pgp9.5+ axon density. In vivo, reinnervated animals showed higher MDP after stimulation of L1-L6 roots, compared to their transected L7-S3 roots, and reinnervated and decentralized animals showed lower MDP than controls after stimulation of nerves (due likely to fibrotic nerve encapsulation). MDP correlated negatively with detrusor collagen and inflammation, and positively with pgp9.5+ axon density and intramural ganglia numbers. These results demonstrate that bladder function can be improved by transfer of obturator nerves to pelvic nerves at one year after decentralization, although the fibrosis and inflammation that developed were associated with decreased contractile function.

Effectiveness of laser therapy for the treatment of lumbosacral radiculoischemias

Introduction.The study was devoted to assessing the effectiveness of laser therapy in the treatment of spondylogenic radiculoischemias. Low-intensity laser therapy and vaporization technology were used.Aim – to improve treatment and outcomes in patients with compression of the spinal roots in herniated intervertebral discs using various methods of laser therapy.Materials and methods. In two groups, the results of treatment of 225 patients with clinical manifestations of spondylogenic lumbosacral radiculoischemias were analyzed using laser therapy techniques. In 115 cases (group 1), laser treatment was performed using the method of puncture polychannel laser disk decompression. In 110 patients (group 2), low-intensity percutaneous laser therapy was used. The dynamics of the clinical and neurological manifestations of the disease was recorded: the time of pain syndrome reduction, the dynamics of motor and sensory disorders of the corresponding root, changes in parameters according to the Roland-Morris and Oswestry Disability questionnaire.Results. In both groups, an improvement in clinical and neurological manifestations was obtained: the intensity of pain syndrome according to VAS decreased in more than 70 % of the observed individuals. A significant improvement in the parameters of vital activity was revealed according to scales with a long-lasting effect (more than 12 months) with an improvement in the blood supply to the spinal roots.Conclusion. Laser radiation has significant clinical effectiveness; the important parameters are the wavelength and rate of the radiation. Structural-modifying action and improvement of microcirculation (of arterial and venous bed) are achieved. Evaluation of the effectiveness of polychannel laser puncture decompression is advisable using scales and questionnaires. Low-intensity percutaneous laser therapy and monochannel interstitial laser therapy provide a targeted antiedemic and neuroprotective effect with the possibility of dosing and control. The treatment is highly effective and improves the prognosis of the disease.

Rehabilitation challenges in COVID-19 induced acute polyradiculoneuropathies

Introduction. SARS-COV 2 infection causes damage of the peripheral nervous system: loss of smell loss of taste and demyelination or axonal injury in the spinal roots and motor and sensory nerves with acute polyradiculoneuritis. As many people are affected by COVID-19, the number of patients with secondary peripheral nervous system damage is increasing. Material and method. There are a significant number of Guillain Barre syndrome (GBS) cases reported in COVID-19 positive patients, leading to the recognition of GBS as one of the peripheral nervous system complications of SARS-COV 2 infection. We are trying to summarise the particularities of specific rehabilitation in post-COVID patients. Results and discussions. The rehabilitation of a COVID patients has particularities, first – because of infectious risk carried by the patient during the procedures, second by the patient’s pulmonary and physical impairments induced by the Coronavirus. Conclusions. There is scarce evidence for rehabilitation interventions, and many recommendations are based on methods developed in other viral infections or chronic pulmonary and neurologic conditions. There is a urgent need for studies regarding the efficacy of interventions in COVID rehabilitation, as the number of patients is constantly increasing. Keywords: therapeutic plasma exchange, plasmapheresis, neuroimmune disorders,rehabilitation,

On the question of the peripheral innervation of the rectum. Critical and experimental research

All experiments were made by you 56. Of these, 10 experiments with negative pressure, 8 experiments with double registration (according to Courtade and Guyon` y), 15 with simultaneous registration of three bowel sections (colonis, recti and sphinct. Inter.), 4 experiments with irritation spinal roots, 2 experiments for examining the external sphincter. The remaining 17 embrace the usual experiments of investigating the movements of the recti under the influence of the irritated intestinal nerves according to the method indicated by us in the beginning of our work; this also included 5 experiments with combined irritations n. erigentis and n. hypogastrici.

Use of low-intensity laser therapy for the treatment of lumbosacral radiculoischemia

The development of programs for the treatment of spondylogenic radiculoischemia is an urgent problem. The most significant mechanism of pathogenesis is due to impaired arterial and venous blood supply to the cerebrospinal root. The uniqueness of the use of preformed physical factors in dorsalgia has been proved. Low-intensity laser therapy improves blood supply and microcirculation in the irradiation zone. Clinically, a significant decrease in the intensity of pain syndrome is observed, and restoration of the function of the spinal roots is noted. The study analyzed the results of the treatment of patients using laser therapy technologies and its effect on segmental spinal hemodynamics. The effectiveness of low-intensity percutaneous laser therapy is demonstrated. Clinical evidence indicates improved microcirculation in the corresponding cerebrospinal root.

Intramasseteric Schwannoma Mimicking a Parotid Tumor: Case Report and Review of Literature

BackgroundSchwannoma is a benign neoplasm originating from Schwan cells of peripheral nerves as well as the cranial and spinal roots. It often occurred in head and neck region involving cranial nerves VII, VIII, and XII. However, schwannoma located in intramasseteric region is extremely uncommon. There have been only ten reported cases documented in English literatures to date. Case presentationHere, we report a rare intramasseteric schwannoma case, who presented a painless mass in the left cheek with 2 years evolution and was treated with surgical excision through trans-parotid approach. An uneventful recovery without salivary fistula or facial paralysis was recorded after the surgery. Due to its rarity and clinical significance, we also review intramasseteric schwannoma regarding its clinical characteristics and surgical managements.ConclusionIn a word, intramasseteric schwannoma is a benign lesion with favorable prognosis. MRI (magnetic resonance imaging) scanning is recommended for evaluation and differential diagnoses for this condition. Surgical excision of the tumor without parotidectomy is considered to be effective.