Successful Management of Parsonage–Turner Syndrome with Steroids in the Post-acute Weakness Phase: A Case Report

Introduction: Parsonage–Turner Syndrome (PTS) is a rare disease of the brachial plexus of unclear aetiology. The limited data available typically describes involvement of branches of brachial nerves. The authors present a case of PTS with a rare combination of unilateral brachial plexus, phrenic nerve, and recurrent laryngeal nerve injuries. They also highlight successful treatment with pharmacological intervention despite several months’ delay in diagnosis. The 35-year-old female presented with acute onset of severe left shoulder pain followed by severe progressive weakness of the left shoulder muscles, progressive weakness of her voice, nasal regurgitation of fluids, paroxysmal bouts of coughing, and exertional dyspnoea at rest. The symptoms remained undiagnosed for about 10 months. A clinical diagnosis of exclusion of PTS was finally made, and treatment with steroids, neurotropic drugs, and physiotherapy was started. The patient has recovered significantly since then and continues to improve. Conclusion: The authors presented a case of PTS with a rare combination of brachial plexus, recurrent laryngeal nerve, and phrenic nerve injuries. This case was also remarkable for the significant improvement in her symptoms with treatment, despite the delay in diagnosis. This bears evidence that steroids and adjuvant therapy is useful even months after onset of the disease.

A Case Report: Internal Carotid Artery Dissection Presenting as Hoarseness Secondary to Vocal Cord Palsy

Internal carotid artery (ICA) dissection is a rare cause of a cranial nerve X palsy. Patients more commonly present with stroke or transient ischaemic attacks. An undetected and untreated ICA dissection can have serious consequences. Here, the authors present two cases of ICA dissection presenting with isolated vagal nerve palsy presenting with hoarseness. CT scans provided good evidence of ICA in both cases. The patients were treated with antiplatelet agents and made a good recovery with complete resolution of symptoms.

A Case of Subacute Combined Degeneration as a Manifestation of Pernicious Anaemia

Vitamin B12 deficiency affects multiple systems, including the central and peripheral nervous systems, producing a vast spectrum of neurological symptoms. It is particularly important due to its insidious presentation and because it can evolve to spastic paraplegia with permanent sequelae. The authors describe a case of a woman with asthenia, bilateral lower limb weakness, urinary retention, and faecal incontinence, with no structural cause on imaging studies. Blood tests showed anaemia (haemoglobin: 6.8 g/dL) and vitamin B12 deficiency (<100 pg/mL). After upper digestive endoscopy compatible with chronic atrophic gastritis and positive for anti-intrinsic factor antibodies was obtained, the diagnosis of subacute combined degeneration due to vitamin B12 deficiency in the context of pernicious anaemia was admitted. Although this entity is a rare cause of myelopathy, it is a frequent manifestation of vitamin B12 deficiency. Clinical suspicion is fundamental since the reversibility of the neurological lesion is dependent on early treatment.

Clarity on Cannabinoid-Based Products in Medicine

The perception of cannabis in society has changed over the last decades, leading to an increasing permissiveness about its use mainly across Western countries. This has happened in parallel to the growing study of the possible role of cannabinoid-based products in medicine. The cannabis plant contents comprise more than one hundred different cannabinoids, each binding differently to numerous human body targets. This cannabinoids administration, either isolated, combining some of them, or as a full plant extract can produce many different risk–benefit effects in humans depending on the product composition. Moreover, we have seen the appearance of synthetic cannabinoids. As expected, doses and different routes of administration introduce further variability. Cannabinoid-based pharmaceutical products authorised for medicinal use after comprehensive research and with approval by regulatory medicines agencies, such as the European Medicines Agency (EMA) and U.S. Food and Drug Administration (FDA), should be distinguished from cannabinoid-based products (whether standardised or not) that aimed for medicinal use but lack submitted efficacy, tolerability, and safety scientific evidence for regulatory approval. Distribution of some of the latter products are still allowed in certain geographical areas. There are also cannabinoid products used mainly recreationally or as food supplements and ruled separately. In a detailed white paper, this review describes the present situation, depicting the societal and medical state of the art, collecting the facts-based risk–benefit features of already available cannabinoid-based products, and also the future possibilities in medicine, which can be vast if proper research is developed

A Successful Treatment of Chronic Migraine With Hyperbaric Oxygen Therapy

The World Health Organization (WHO) ranks migraine as the most prevalent and disabling neurological condition. Management of migraines can be broadly divided into lifestyle and trigger management, acute treatments, and preventive treatments. Despite pharmacological advances, this medical problem has remained undertreated. A 40-year-old male presented to the authors’ hospital and complained of severe, constant, and throbbing pain over the right side of his head. There was occasional photophobia but no visual disturbances. Oral analgesics were not helpful. After careful evaluation, he was advised to receive hyperbaric oxygen therapy sessions. He underwent one session per day, 5 days per week for 4 weeks. At the end of the 20 sessions, the patient reported an improvement in his symptoms, and did not require any oral medication. The authors concluded that hyperbaric oxygen therapy should be explored further as a treatment for pharmacologically resistant migraine.

Conservative Approach of Spontaneous Spinal Epidural Haematomas in the Era of Anticoagulant Treatments

Anticoagulation and antiplatelet therapy is a widespread management option in various indications, especially in elderly patients who are at greater risk of complications related to any treatment. One of the important and rare complications of anticoagulation and antiplatelet therapy is spontaneous spinal epidural haematoma (SSEH).1,2 Surgery remains the gold standard treatment, especially in cases of progressive neurological deficit.3 In this study, a group of 14 patients with SSEH is presented. Additionally, the clinical symptoms of SSEH, diagnostic procedures, conservative and surgical treatments, and different risk factors are discussed.

Current Paradigms to Explore the Gut Microbiota Linkage to Neurological Disorders

It has been suggested that an intricate communication link exists between the gut microbiota and the brain and its ability to modulate behaviour of an individual governing homeostasis. Metabolic activity of the microbiota is considered to be relatively constant in healthy individuals, despite differences in the composition of microbiota. The metabolites produced by gut microbiota and their homeostatic balance is often perturbed as a result of neurological complications. Therefore, it is of paramount importance to explore the link between gut microbiota and brain function and behaviour through neural, endocrine, and immune pathways. This current review focusses on the impact of altered gut microbiota on brain functions and how microbiome modulation by use of probiotics, prebiotics, and synbiotics might prove beneficial in the prevention and/or treatment of neurological disorders. It is important to carefully understand the complex mechanisms underlying the gut–brain axis so as to use the gut microbiota as a therapeutic intervention strategy for neurological disorders.

Clinical Controversies in Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis is a devastating neurodegenerative condition with few effective treatments. Current research is gathering momentum into the underlying pathology of this condition and how components of these pathological mechanisms affect individuals differently, leading to the broad manifestations encountered in clinical practice. We are moving away from considering this condition as merely an anterior horn cell disorder into a framework of a multisystem neurodegenerative condition in which early cortical hyperexcitability is key. The deposition of TAR DNA-binding protein 43 is also a relevant finding given the overlap with frontotemporal dysfunction. New techniques have been developed to provide a more accurate diagnosis, earlier in the disease course. This goes beyond the traditional nerve conduction studies and needle electromyography, to cortical excitability studies using transcranial magnetic stimulation, and the use of ultrasound. These ancillary tests are proposed for consideration of future diagnostic paradigms. As we learn more about this disease, future treatments need to ensure efficacy, safety, and a suitable target population to improve outcomes for these patients. In this time of active research into this condition, this paper highlights some of the areas of controversy to induce discussion surrounding these topics.