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Practical Neurology Jun 2023
Topics: Humans; Cerebral Infarction; Ataxia; Headache; Paresis
PubMed: 36450373
DOI: 10.1136/pn-2022-003555 -
The Israel Medical Association Journal... Aug 2021Cervical spinal surgery is considered safe and effective. One of the few specific complications of this procedure is C5 nerve root palsy. Expressed primarily by deltoid...
BACKGROUND
Cervical spinal surgery is considered safe and effective. One of the few specific complications of this procedure is C5 nerve root palsy. Expressed primarily by deltoid muscle and biceps brachii weakness, it is rare and has been related to nerve root traction or to ischemic spinal cord damage.
OBJECTIVES
To determine the clinical and epidemiological traits of C5 palsy. To determine whether C5 palsy occurs predominantly in one specific surgical approach compared to others.
METHODS
A retrospective study of patients who underwent cervical spine surgery at our medical center during a consecutive 8-year period was conducted. The patient data were analyzed for demographics, diagnosis, and surgery type and approach, as well as for complications, with emphasis on the C5 nerve root palsy.
RESULTS
The study group was comprised of 124 patients. Seven (5.6%) developed a C5 palsy following surgery. Interventions were either by anterior, by posterior or by a combined approach. Seven patients developed this complication. All of whom had myelopathy and were older males. A combined anteroposterior (5 patients) and posterior access (2 patients) were the only approaches that were associated with the C5 palsy. None of the patients who were operated via an anterior approach did develop this sequel.
CONCLUSIONS
The incidence of the C5 root palsy in our cohort reached 5.6%. Interventions performed through a combined anterior-posterior access in older myelopathic males, may carry the highest risk for this complication.
Topics: Cervical Plexus; Cervical Vertebrae; Decompression, Surgical; Deltoid Muscle; Female; Humans; Intraoperative Complications; Israel; Male; Middle Aged; Muscle Weakness; Outcome and Process Assessment, Health Care; Paresis; Postoperative Complications; Retrospective Studies; Risk Assessment; Spinal Cord Ischemia
PubMed: 34392627
DOI: No ID Found -
PloS One 2021Recent studies have suggested that people's intent and ability to act also can influence their perception of their bodies' peripersonal space. Vice versa one could...
Recent studies have suggested that people's intent and ability to act also can influence their perception of their bodies' peripersonal space. Vice versa one could assume that the inability to reach toward and grasp an object might have an impact on the subject's perception of reaching distance. Here we tested this prediction by investigating body size and action capability perception of neurological patients suffering from arm paresis after stroke, comparing 32 right-brain-damaged patients (13 with left-sided arm paresis without additional spatial neglect, 10 with left-sided arm paresis and additional spatial neglect, 9 patients had neither arm paresis nor neglect) and 27 healthy controls. Nineteen of the group of right hemisphere stroke patients could be re-examined about five months after initial injury. Arm length was estimated in three different methodological approaches: explicit visual, explicit tactile/proprioceptive, and implicit reaching. Results fulfilled the working hypothesis. Patients with an arm paresis indeed perceived their bodies differently. We found a transient overestimation of the length of the contralesional, paretic arm after stroke. Body size and action capability perception for the extremities thus indeed seem to be tightly linked in humans.
Topics: Aged; Arm; Body Size; Case-Control Studies; Female; Humans; Male; Middle Aged; Paresis; Proprioception; Size Perception; Stroke
PubMed: 34086777
DOI: 10.1371/journal.pone.0252596 -
Neurosciences (Riyadh, Saudi Arabia) Apr 2023Dyk-Davidoff-Masson Syndrome (DDMS) is one of the rare neurological conditions attributed to the development of drug-resistant epilepsy (DRE). The DDMS condition is... (Review)
Review
Dyk-Davidoff-Masson Syndrome (DDMS) is one of the rare neurological conditions attributed to the development of drug-resistant epilepsy (DRE). The DDMS condition is characterized by cerebral hemisphere asymmetry, where atrophy occurs on one side of the brain and clinically manifests as hemiparesis, seizure disorder, mental retardation, and facial asymmetry. In addition, the condition has various perinatal or postnatal etiologies. Herein, we report the case of a 29-year-old right-handed male with Dyke-Davidoff Masson syndrome and mild right-side weakness. The patient experiences attacks of seizures with stiffness in his right arm and right leg, sometimes experiencing agitation and abnormal movement of the body parts. The MRI of the brain showed asymmetry with atrophic changes involving the left hippocampus, consisting of mesial temporal sclerosis. Additionally, the results showed the presence of gyral hyperintensities over the left parietal region. Therefore, the patient's case is reported with a literature review to support it.
Topics: Humans; Male; Adult; Epilepsy; Brain; Brain Diseases; Magnetic Resonance Imaging; Neuromuscular Diseases; Paresis; Nervous System Malformations; Syndrome; Atrophy
PubMed: 37045464
DOI: 10.17712/nsj.2023.2.20220084 -
Journal of Neurology, Neurosurgery, and... Sep 2020
Topics: Amyotrophic Lateral Sclerosis; Humans; Muscles; Neural Pathways; Paresis
PubMed: 32665325
DOI: 10.1136/jnnp-2020-323729 -
The Journal of Neuropsychiatry and... 2021Functional neurological (conversion) disorder (FND) is a prevalent and disabling condition at the intersection of neurology and psychiatry. Advances have been made in... (Review)
Review
Functional neurological (conversion) disorder (FND) is a prevalent and disabling condition at the intersection of neurology and psychiatry. Advances have been made in elucidating an emerging pathophysiology for motor FND, as well as in identifying evidenced-based physiotherapy and psychotherapy treatments. Despite these gains, important elements of the initial neuropsychiatric assessment of functional movement disorders (FND-movt) and functional limb weakness/paresis (FND-par) have yet to be established. This is an important gap from both diagnostic and treatment planning perspectives. In this article, the authors performed a narrative review to characterize clinically relevant variables across FND-movt and FND-par cohorts, including time course and symptom evolution, precipitating factors, medical and family histories, psychiatric comorbidities, psychosocial factors, physical examination signs, and adjunctive diagnostic tests. Thereafter, the authors propose a preliminary set of clinical content that should be assessed during early-phase patient encounters, in addition to identifying physical signs informing diagnosis and potential use of adjunctive tests for challenging cases. Although clinical history should not be used to make a FND diagnosis, characteristics such as acute onset, precipitating events (e.g., injury and surgery), and a waxing and waning course (including spontaneous remissions) are commonly reported. Active psychiatric symptoms (e.g., depression and anxiety) and ongoing psychosocial stressors also warrant evaluation. Positive physical examination signs (e.g., Hoover's sign and tremor entrainment) are key findings, as one of the DSM-5 diagnostic criteria. The neuropsychiatric assessment proposed emphasizes diagnosing FND by using "rule-in" physical signs while also considering psychiatric and psychosocial factors to aid in the development of a patient-centered treatment plan.
Topics: Anxiety; Comorbidity; Conversion Disorder; Depression; Diagnostic Tests, Routine; Expert Testimony; Humans; Paresis
PubMed: 32778007
DOI: 10.1176/appi.neuropsych.19120357 -
Neurology Aug 2021To determine similarities and differences in key predictors of recovery of bimanual hand use and unimanual motor impairment after stroke. (Clinical Trial)
Clinical Trial Observational Study
OBJECTIVE
To determine similarities and differences in key predictors of recovery of bimanual hand use and unimanual motor impairment after stroke.
METHOD
In this prospective longitudinal study, 89 patients with first-ever stroke with arm paresis were assessed at 3 weeks and 3 and 6 months after stroke onset. Bimanual activity performance was assessed with the Adult Assisting Hand Assessment Stroke (Ad-AHA), and unimanual motor impairment was assessed with the Fugl-Meyer Assessment (FMA). Candidate predictors included shoulder abduction and finger extension measured by the corresponding FMA items (FMA-SAFE; range 0-4) and sensory and cognitive impairment. MRI was used to measure weighted corticospinal tract lesion load (wCST-LL) and resting-state interhemispheric functional connectivity (FC).
RESULTS
Initial Ad-AHA performance was poor but improved over time in all (mild-severe) impairment subgroups. Ad-AHA correlated with FMA at each time point ( > 0.88, < 0.001), and recovery trajectories were similar. In patients with moderate to severe initial FMA, FMA-SAFE score was the strongest predictor of Ad-AHA outcome ( = 0.81) and degree of recovery ( = 0.64). Two-point discrimination explained additional variance in Ad-AHA outcome ( = 0.05). Repeated analyses without FMA-SAFE score identified wCST-LL and cognitive impairment as additional predictors. A wCST-LL >5.5 cm strongly predicted low to minimal FMA/Ad-AHA recovery (≤10 and 20 points respectively, specificity = 0.91). FC explained some additional variance to FMA-SAFE score only in unimanual recovery.
CONCLUSION
Although recovery of bimanual activity depends on the extent of corticospinal tract injury and initial sensory and cognitive impairments, FMA-SAFE score captures most of the variance explained by these mechanisms. FMA-SAFE score, a straightforward clinical measure, strongly predicts bimanual recovery.
CLINICALTRIALSGOV IDENTIFIER
NCT02878304.
CLASSIFICATION OF EVIDENCE
This study provides Class I evidence that the FMA-SAFE score predicts bimanual recovery after stroke.
Topics: Adult; Aged; Cognitive Dysfunction; Connectome; Female; Hand; Humans; Longitudinal Studies; Magnetic Resonance Imaging; Male; Middle Aged; Outcome Assessment, Health Care; Paresis; Prognosis; Psychomotor Performance; Recovery of Function; Severity of Illness Index; Stroke
PubMed: 34400568
DOI: 10.1212/WNL.0000000000012366 -
Die Anaesthesiologie Jan 2024
Topics: Humans; Paresis; Psychophysiologic Disorders; Postoperative Period
PubMed: 37993726
DOI: 10.1007/s00101-023-01357-2 -
Folia Medica Jun 2023Acute hemiparesis is an emergency of various etiologies and possible fatal outcome.
Acute hemiparesis is an emergency of various etiologies and possible fatal outcome.
Topics: Humans; Paresis; Stroke
PubMed: 38351818
DOI: 10.3897/folmed.65.e81368 -
Journal of Speech, Language, and... Sep 2022The purposes of this study were to determine whether the acoustic measures from glottal stops distinguished between controls and patients with unilateral vocal fold...
PURPOSES
The purposes of this study were to determine whether the acoustic measures from glottal stops distinguished between controls and patients with unilateral vocal fold paresis/paralysis (UVFP) at initial evaluation and posttreatment/observation, to explore the types of false vocal fold (FVF) movement during glottal stop production in UVFP, and to assess the agreement between normalization of various measures and reported voice normalization.
METHOD
Patients with UVFP and controls were recorded acoustically and laryngoscopically speaking two sets of five repeated /i/s, controls once and patients with UVFP initially and posttreatment/observation. Averaged intensity differences and slopes for offsets (maximum voicing intensity to minimum glottal stop intensity) and onsets (minimum glottal stop intensity to maximum voicing intensity) were measured. FVF movements were rated separately for paretic and nonparetic sides. Patients were asked to report voice normalization posttreatment/observation. Cohen's kappas were calculated for agreements between patient-reported voice normalization and normalization of Voice-Related Quality of Life (V-RQOL), translaryngeal flow, four acoustic measures of glottal stop production, and FVF movement.
RESULTS
Significant differences (analysis of variance [ANOVA]; < .014) were found for all acoustic measures between controls and patients with UVFP and between patients with UVFP initially and posttreatment/observation (paired tests; < .05). In addition, 78% of UVFP patients had no FVF movement on the paretic side initially, and 42% had bilateral dynamic FVF movement posttreatment/observation. Cohen's kappa showed moderate agreement between voice normalization and V-RQOL, slight agreement with offset measures, and fair agreement with onset measures.
CONCLUSION
This study provided proof of concept for using acoustic measures of glottal stops to distinguish between controls and patients with UVFP, both initially and posttreatment/observation.
Topics: Humans; Paresis; Quality of Life; Vocal Cord Paralysis; Vocal Cords; Voice Training
PubMed: 36044894
DOI: 10.1044/2022_JSLHR-21-00599