FOOT DROP AFTER SPINAL ANAESTHESIA FOLLOWING EMERGENCY APPENDECTOMY

Spinal anesthesia is the preferred anesthetic technique for cesarean section. Neurological complications are very rare and often transient after spinal anesthesia. A 11-year old male child present with pain abdomen in emergency department and underwent emergency appendectomy on 12-07-2019. During operation spinal anesthesia was induced. On 15-07-2019 patients was discharged from hospital. Patient revisited Neurology OPD with complaints of Foot Drop on 31-07-2019. Patient investigated with MRI and Nerve Conduction Studies. On MRI was found diffuse disc bulge at L3, L4, L5 level causing bilateral neural foramina narrowing and in nerve conduction study was found neuropathy of left peroneal and sural nerves. Patient was treated conservatively. Foot drop is a neurological disorder, which occurs following natural childbirth and spinal anesthesia due to direct needle trauma or local anesthetic toxicity. This complication is transient and usually resolves within a few days

Lower Limbs Axonal Neuropathy in Polyarteritis Nodosa with Onset of Neuropathic Symptoms

Objective The retrospective study aimed to investigate the most common electrophysiological changes in patients with polyarteritis nodosa (PAN) of peripheral neuropathy onset and supply some clinical data to neurologists to pay attention to PAN. Methods We reviewed the records of all PAN patients with peripheral neuropathy as the initial symptom who attended The Second Hospital of Hebei Medical University from December 2019 to December 2020. Finally, ten patients and thirteen healthy controls were clinical and electrophysiologically investigated in our study. Results Disease onset was subacute or acute style, with asymmetric clinical onset. Nine patients (90%) presented clinical onset from lower limbs, one (10%) from both lower and upper limbs. Symptoms of distal limbs were more severe than those of proximal ones in seven patients (70%). Nerve conduction studies revealed motor and sensory axonal neuropathy with a predilection for peroneal and sural nerves in the lower limbs. Conclusions Asymmetric motor and sensory axonal neuropathy, especially severe involvement of lower and distal limbs is the most electrophysiological changes in patients with PAN of peripheral neuropathy onset, which is consistent with clinical manifestation.

Normal neurophysiologic parameters of the sural nerve among adult healthy Sudanese population

Background: Nerve conduction studies (NCSs) are of central importance for the assessment of peripheral nervous system disorders. They help in the diagnosis, extent distribution of neural lesion as well as the prognosis of a disease process. The aim of this study is to establish normative NCS reference data of the sural nerve in Sudanese population for our EMG electrodiagnostic center; and to survey the effects of age, gender, height, weight and temperature on conduction Parameters. Methods: The study was conducted in Elmagzoub Neuroscience Electrodiagnostic Centre; supported by the Faculty of Medicine, National Ribat University, Khartoum, Sudan. NCSs were performed in 210 sural nerves of 105 adult healthy Sudanese subjects using standardized techniques. Results: The Right sural nerve SNAP parameters in the whole subjects were set as (mean ±standard deviation) for onset latency. peak latency, amplitude and conduction velocity. The values were 2.73±0.42 ms, 3.32±0.46 ms, 8.39±3.49 uV and 52.05±8.47 m/s, respectively. The Left sural nerve SNAP parameters in the whole study group were 2.71±0.50 ms, 3.29 ±0.52 ms, 8.54±4.56 uV and 52.66 ±8.95, respectively. Conclusion: The sural sensory nerve conduction parameters compared favorably with the existing literature. Age showed a positive correlation with latencies, and negative correlation with amplitude and velocity. Gender has conspicuous effect on all sural nerve conduction parameters. Height showed an effect on latency and conduction velocity whereas BMI revealed a negative correlation with amplitude and conduction velocity of sural nerve.

A Comparison of Neuropathy Quality of Life Tools: Norfolk QOL-DN, PN-QOL-97, and NeuroQOL-28

Aims To explore the effectiveness of the Norfolk QOL-DN (QOL-DN), PN-QOL-97, and NeuroQOL-28 as tools for early detection of diabetic peripheral neuropathy in overweight, obese, and inactive (OOI), prediabetes (PD), and type 2 diabetes (T2D) individuals. Methods Thirty-four adults were divided by A1C [(10 OOI, 13 PD, and 11 T2D] and the sural nerves were tested bilaterally via NC-Stat DPN Check, conducting a sural nerve conduction study (NCS). Participants were individually timed, filling out questionnaires (QOL-DN, NeuroQOL-28, and PN-QOL-97) at a self-selected pace. Data were analyzed and compared to NCS findings to determine the best instrument for early neuropathy detection, usability in screening settings, and application for individuals with OOI, PD, and T2D. Results Abnormal NCS results were obtained from 27 individuals, of which 25 were bilateral and symmetrical. Confirmed DSPN criteria were met for 24, and 1 case met criteria for subclinical neuropathy. Normal NCS findings, reported symptoms, and reduced bilateral sensation were found in 7 cases. The QOL-DN and NeuroQOL-28 significantly predict neuropathy criteria in OOI, PD, and T2D subjects. Analyses revealed the QOL-DN as the quickest for completion (M=5.17; SD=1.83), followed by the NeuroQOL-28 (M=5.58; SD=3.56), and the PN-QOL-97 (M=13.23; SD=3.606). Conclusions The QOL-DN and NeuroQOL-28 are valid early screening measures for DPN detection. Time completion studies revealed that the QOL-DN and NeuroQOL-28 may be used as excellent short screening measures, completed in approximately 6 minutes or less, with reasonable scoring for both. The NeuroQOL-28 is a better fit for immediate feedback, time constraints, or limited staff. Future investigations should evaluate these tools for detection in DPN-prone individuals and in subclinical populations screenings.

Post-COVID-19 multiple mononeuritis in a patient from a city in São Paulo

Context: COVID-19 is a disease capable of harming the entire organism, especially the lungs. It may lead to hospitalization in Intensive Care Units (ICU) and neurological conditions due to the possibility of development of myopathy in critically ill patients (MCIP) and even Multiple Mononeuritis (MM). That disorder presents itself with symmetrical lesions, significant disability, and no evidence of myopathy or demyelination in the electroneuromyography (ENM). Case report: We bring the case of a 57-year-old man with diabetes, systemic arterial hypertension, and dyslipidemia without previous neurological alterations. He was interned in ICU for 31 days because of a COVID-19 infection requiring mechanical ventilation and developed MM proven by ENM after hospital discharge. He presented as symptoms of incoordination, weakness, and gait ataxia. The patient’s ENM exam showed evidence of a reduction in the amplitude of the sensory potentials of all researched nerves and reductions in the values of sensitive nerve conduction on both median and sural nerves. It also exhibited an absence of sensitive response of the left superficial peroneal nerve, bilateral increase in the latency times of the H reflex, and absence of distal responses from both peroneal nerves. Conclusions: COVID-19 is a new entity, and it can cause neurological sequels. Even though MCIP is the primary neurological complication in ICU COVID patients, it is necessary to investigate the possibility of differentials like MM.

The effect of ozone injection within a common peroneal nerve schwannoma: A mistreatment due to a misdiagnosis

Background: Peripheral schwannomas can be misdiagnosed or mistreated as they can mimic other subcutaneous lesions, leading to wrong diagnosis and, therefore, to improper treatment. Case Description: A 23-years-old male presented a painful growing nodule at the left popliteal fossa, with distally irradiated pain. A first magnetic resonance imaging depicted a heterogeneous lesion between common peroneal and sural nerves but, surprisingly, the patient was submitted to perilesional injection of ozone-oxygen mixture, causing the onset of intense neuropathic pain. A second MRI showed a morphological change of tumor characteristics. He finally underwent surgery but, intraoperatively, inter-fascicular fibrous adherences were noticed, making the tumor removal more difficult and riskier. The histopathological diagnosis was of schwannoma with areas of foreign body reaction. Conclusion: The injection of ozone or other substances within a subcutaneous swelling should be avoided, before a complete imaging assessment; because of such swelling could be a peripheral nerve schwannoma. The correct assessment of a lesion of the limbs determining radiating pain should be carefully demanded to a thorough history, clinical examination, and appropriate imaging technique. To avoid incorrect management, the treatment of such tumors should be performed in the first place by dedicated equips with proven expertise in this field.

Clinical and Electrophysiological Aspects of Charcot – Marie Tooth Disease- A Case Report of Two Patients

Aims/ Objectives: To study the importance of electrophysiological tests in diagnosing hereditary motor sensory neuropathy in absence of genetic studies. Study Design: Cross-sectional study. Place and Duration of Study: Department of Physiology, Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India. Methodology: The patients were referred from the Department of Medicine to the Department of Physiology for nerve conduction, F-wave, EMG, VEP & BERA studies. Results: On electrophysiological examination, there was symmetrical decreased motor conduction velocity of median nerve (less than 38 m/sec), ulnar, tibial and peroneal nerves except in the first patient where the left peroneal nerve conduction velocity was not recordable with decreased amplitude and increased distal motor latencies. Sensory conduction velocities for bilateral median nerves were also decreased with increased latency and decreased amplitude in both the patients. Sensory conduction velocity and amplitudes of bilateral sural nerves were decreased in the first patient with increased latencies. However, sensory conduction velocity wasn’t recordable for bilateral sural nerves in the other patient. EMG shows decrease in recruitment of motor unit potentials, amplitude in bilateral tibial, peroneous, abductor digiti minimi & 1st dorsal interosseus muscle in the first patient. In proximal upper & lower limb muscles, EMG showed features of denervation. In the second patient, EMG was not advised. VEP in one patient had increased latency of P100 wave & other had normal VEP. Brainstem auditory evoked potential was normal in both patients. Conclusion: The paper highlights the importance of electrophysiological studies in diagnosis of motor sensory neuropathy in absence of genetic studies. Marked slowing of conduction velocity is the hallmark of CMDT1 [demylinating type].