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Frontiers in Neurology 2023
PubMed: 38053798
DOI: 10.3389/fneur.2023.1324882 -
Agri : Agri (Algoloji) Dernegi'nin... Jul 2023Herpes zoster (HZ) is a segmental vesicular eruption, pain, and sensorial symptoms. Segmental motor weakness can rarely be seen as a complication of HZ. Here, we present...
Herpes zoster (HZ) is a segmental vesicular eruption, pain, and sensorial symptoms. Segmental motor weakness can rarely be seen as a complication of HZ. Here, we present two cases of motor paresis associated with HZ, case 1 was L2 and L3 segmental motor paresis with femoral neuropathy and case 2 was L5 and S1 segmental motor paresis with sensorial ganglion involvement. In both cases after electrotherapy, exercise program, and medication for pain, there were no motor weakness and pain. Zoster motor paresis is a rare complication that responds to treatment and physicians should be careful about its presence in clinical follow-up.
Topics: Humans; Paresis; Herpes Zoster; Pain; Lower Extremity; Upper Extremity
PubMed: 37493485
DOI: 10.14744/agri.2021.70846 -
Medicina (Kaunas, Lithuania) Feb 2024The cortical hand knob region of the brain is a knob-like segment of the precentral gyrus, projecting into the middle genu of the central sulcus. This anatomic landmark... (Review)
Review
The cortical hand knob region of the brain is a knob-like segment of the precentral gyrus, projecting into the middle genu of the central sulcus. This anatomic landmark is responsible for intricate control of hand motor movements and has often been implicated in motor weakness following stroke. In some instances, damage to this area has been mistaken for peripheral causes of hand weakness. Our article aims to consolidate clinically relevant information on the cortical hand knob area in a comprehensive review to guide clinicians regarding diagnosis and treatment strategies. We conducted a systematic search within the Medline/PubMed database for reports of strokes in the cortical hand knob region. All studies were published electronically up until December 2023. The search was conducted using the keyword "hand knob". A total of 24 reports containing 150 patients were found. The mean and median ages were 65 and 67 years, respectively. Sixty-two percent of the individuals were male. According to the TOAST criteria for the classification of the stroke, 59 individuals had a stroke due to large-artery atherosclerosis, 8 had small-vessel occlusion, 20 had cardioembolism, 25 were determined, and 38 were undetermined. The most common etiologies for stroke in the hand knob area can be attributed to large vessel occlusions, small vessel occlusions, or cardioembolism. Presentations following damage to this area can mimic ulnar, median, or radial neuropathy as well. Our comprehensive review serves as a resource for recognizing and managing stroke in the cortical hand knob area.
Topics: Humans; Male; Aged; Female; Hand; Upper Extremity; Stroke; Muscle Weakness; Atherosclerosis; Magnetic Resonance Imaging
PubMed: 38399606
DOI: 10.3390/medicina60020318 -
BMJ Case Reports Nov 2023Uterine incarceration (UI) is a rare complication in non-pregnant women. A woman in her 50s presented to the emergency department with acute urinary retention and...
Uterine incarceration (UI) is a rare complication in non-pregnant women. A woman in her 50s presented to the emergency department with acute urinary retention and paresis of the right inferior limb. A neurological exam suggested a decrease in the right lower limb strength. On gynaecological exam, the cervix was displaced anteriorly and the cul de sac was obliterated with a pelvic mass. CA 19.9 and CA 125 levels were increased. The MRI of the pelvis confirmed an elongated and anteriorly displaced cervix compressing the urethra and the vesical neck due to a uterine mass. A diagnosis of UI was made and an abdominal hysterectomy with adhesiolysis was suggested as the treatment option. Six months after surgery the patient had no urinary complaints and the neurological exam was normal. UI should be considered in women with urinary and neurological symptoms. A delay in diagnosis may lead to significant morbidity.
Topics: Female; Humans; Hysterectomy; Pelvis; Urinary Bladder; Urinary Retention; Middle Aged; Uterine Neoplasms
PubMed: 38035678
DOI: 10.1136/bcr-2023-255799 -
Toxins Mar 2024Long-standing facial palsy sequelae cause functional, aesthetic, and psychological problems in patients. Botulinum toxin is an effective way to manage them, but no... (Review)
Review
Long-standing facial palsy sequelae cause functional, aesthetic, and psychological problems in patients. Botulinum toxin is an effective way to manage them, but no standardized recommendations exist. Through this non-systematic review, we aimed to guide any practitioner willing to master the ins and outs of this activity. We reviewed the existing literature and completed, with our experience as a reference center, different strategies of botulinum toxin injections used in facial palsy patients, including history, physiopathology, facial analysis, dosages, injection sites, and techniques, as well as time intervals between injections. The reader will find all the theorical information needed to best guide injections according to the patient's complaint, which is the most important information to consider.
Topics: Humans; Facial Paralysis; Bell Palsy; Face; Botulinum Toxins; Disease Progression
PubMed: 38535827
DOI: 10.3390/toxins16030161 -
Clinical Biomechanics (Bristol, Avon) Mar 2024Kinematic analysis has been recommended to quantify the upper limb motor function after stroke. However, previous studies have rarely reported the kinematic data of the...
BACKGROUND
Kinematic analysis has been recommended to quantify the upper limb motor function after stroke. However, previous studies have rarely reported the kinematic data of the post-stroke patients with moderate to severe upper limb paresis due to the poor accomplishment of the complex tasks.
METHODS
27 post-stroke individuals and 20 non-disabled people participated in the study. The trunk and upper limb movements during the Hand-to-mouth task were captured by the motion capture system and upper extremity kinematic analysis software automatically. The subgroup analysis within stroke group were conducted layering by the Fugl-Meyer Assessment for Upper Extremity scores (severe: 16-31; moderate: 32-50).
FINDINGS
The paretic upper limbs in the stroke group tended to use more trunk and shoulder compensatory strategies to offset the impact of spasticity and weakness compared with non-disabled controls. The less-affected limbs in the stroke group also showed abnormal kinematic data. There were significant differences between the kinematic metrics of severe and moderate subgroups.
INTERPRETATION
The Hand-to-mouth task is a good and feasible option for kinematic analysis of these patients. It is essential to layer the severity of the paresis and put more emphasis on trunk movements in the future kinematic studies.
Topics: Humans; Biomechanical Phenomena; Upper Extremity; Stroke; Stroke Rehabilitation; Paresis
PubMed: 38401320
DOI: 10.1016/j.clinbiomech.2024.106206 -
NeuroRehabilitation 2024Following a severe acquired brain injury, neuro-orthopaedic disorders are commonplace. While these disorders can impact patients' functional recovery and quality of... (Review)
Review
BACKGROUND
Following a severe acquired brain injury, neuro-orthopaedic disorders are commonplace. While these disorders can impact patients' functional recovery and quality of life, little is known regarding the assessment, management and treatment of neuro-orthopaedic disorders in patients with disorders of consciousness (DoC).
OBJECTIVE
To describe neuro-orthopaedic disorders in the context of DoC and provide insights on their management and treatment.
METHODS
A review of the literature was conducted focusing on neuro-orthopaedic disorders in patients with prolonged DoC.
RESULTS
Few studies have investigated the prevalence of spastic paresis in patients with prolonged DoC, which is extremely high, as well as its correlation with pain. Pilot studies exploring the effects of pharmacological treatments and physical therapy show encouraging results yet have limited efficacy. Other neuro-orthopaedic disorders, such as heterotopic ossification, are still poorly investigated.
CONCLUSION
The literature of neuro-orthopaedic disorders in patients with prolonged DoC remains scarce, mainly focusing on spastic paresis. We recommend treating neuro-orthopaedic disorders in their early phases to prevent complications such as pain and improve patients' recovery. Additionally, this approach could enhance patients' ability to behaviourally demonstrate signs of consciousness, especially in the context of covert awareness.
Topics: Humans; Consciousness Disorders; Muscle Spasticity; Quality of Life; Orthopedics; Consciousness; Paresis; Pain; Persistent Vegetative State
PubMed: 38251069
DOI: 10.3233/NRE-230137 -
Frontiers in Public Health 2023Dance can be an innovative, well-accepted, and effective therapy for stroke survivors. The present protocol aims to assess the feasibility of adapted Portuguese folk...
Dance can be an innovative, well-accepted, and effective therapy for stroke survivors. The present protocol aims to assess the feasibility of adapted Portuguese folk dance as a post stroke rehabilitative activity. We will use a mixed-methods pilot study convenience sampling to recruit 16 stroke survivors with mild-moderate lower limb paresis from a rehabilitation center in Lisbon and Tagus Valley. In addition to usual care, participants will attend 3 days per week 1-h dance exercise for 8 weeks. The dance style used for this intervention will be an adaptation of the Portuguese folk dance. Assessment will be conducted before and immediately after the program intervention. Acceptability will be assessed by four key domains (enrollment, retention, satisfaction, and recommendation to others). Safety will be assessed based on the number and type of adverse events. Feasibility will be assessed based on balance performance and functional mobility. Quantitative data will be analyzed through descriptive statistics for sample characterization, followed by inferential statistics to evaluate differences in the balance recovery and functional mobility scores between the initial and final assessment. Qualitative data will be analyzed using an inductive process of content analysis. The Portuguese folk dance program has the potential to improve balance outcomes and functional mobility. Our results will help validate Portuguese folk dance as a tool for rehabilitation settings for stroke survivors. The potential of our program to enhance balance outcomes and functional mobility among stroke survivors bears implications for aging and public health initiatives. Positive results from this study could pave the way for integrating dance-based rehabilitative activities into standard stroke rehabilitation protocols, catering to older stroke survivors' specific needs and preferences.
Topics: Humans; Pilot Projects; Portugal; Stroke; Public Health; Aging
PubMed: 37663853
DOI: 10.3389/fpubh.2023.1200093 -
Cureus May 2024The incidence of facial nerve paralysis is approximately 30 per 100,000 persons annually. Although it is often idiopathic, as in Bell's palsy, it can also result from... (Review)
Review
The incidence of facial nerve paralysis is approximately 30 per 100,000 persons annually. Although it is often idiopathic, as in Bell's palsy, it can also result from infections, trauma, or neoplasms. Facial nerve paralysis may present with partial or total facial paresis, lagophthalmos, denervation of the lacrimal gland, and other ocular abnormalities. While dry eye is a commonly expected outcome of facial nerve injury, some patients may paradoxically experience epiphora and hyperlacrimation. In this review, we examine this phenomenon and its mechanisms in facial nerve injury. Several mechanisms have been proposed for epiphora and hyperlacrimation, including aberrant axonal regeneration, which is known to cause crocodile tears syndrome; ocular irritation due to dry eye, resulting in increased reflex lacrimation due to disruption of the tear film; and impaired drainage of tears caused by paralysis of the orbicularis oculi muscle and malposition of the eyelids. Understanding the pathophysiology of these symptoms is crucial in guiding the management of patients with facial nerve injury. Further experimental and clinical studies focusing on the quantification of tear production and localization of nerve damage will help improve our understanding of the neuroanatomical correlates of this paradoxical manifestation.
PubMed: 38826950
DOI: 10.7759/cureus.59440 -
International Journal of Rehabilitation... Dec 2023Ankle-foot orthosis (AFO) is known to correct abnormal gait patterns and improve walking stability and speed in patients with hemiparesis. To quantify these benefits in...
Ankle-foot orthosis (AFO) is known to correct abnormal gait patterns and improve walking stability and speed in patients with hemiparesis. To quantify these benefits in post-stroke gait, a three-dimensional motion analysis of gait pattern was conducted. Forty patients with hemiparesis were enrolled. A three-dimensional motion analysis system was used to analyze patients' treadmill walking with/without an AFO. Outcome measures were 12 abnormal gait indices (forefoot contact, knee extensor thrust, retropulsion of the hip, flexed-knee gait, medial whip in the stance phase, circumduction gait, hip hiking, insufficient knee flexion during the swing phase, excessive lateral shifting of the trunk, contralateral vaulting, excessive hip external rotation, and posterior pelvic tilt), calculated using kinematic data and spatiotemporal indices, and the symmetry index of double-stance and single-stance time and step length. Forefoot contact (without AFO vs. with AFO: 71.0 vs. 65.8, P < 0.001), circumduction gait (65.0 vs. 57.9, P < 0.001), and contralateral vaulting (78.2 vs. 72.2, P = 0.003) were significantly reduced, whereas excessive hip external rotation (53.7 vs. 62.8, P = 0.003) significantly increased during walking with an AFO. Hip hiking (77.1 vs. 71.7) showed marginal reduction with the use of AFO ( P = 0.096). The absolute symmetry index of double-stance time (21.9 vs. 16.1, P = 0.014) significantly decreased during walking with an AFO. AFO effectively mitigates abnormal gait patterns typical of hemiparetic gait. A 3D motion analysis system with clinically oriented indices can help assess intervention efficacy for gait abnormalities.
Topics: Humans; Ankle; Foot Orthoses; Gait Disorders, Neurologic; Gait; Walking; Stroke; Ankle Joint; Stroke Rehabilitation; Biomechanical Phenomena; Paresis
PubMed: 37755385
DOI: 10.1097/MRR.0000000000000602