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Cureus Jun 2024We present a case report of diagnosis of cervical spine multiple sclerosis by a chiropractic physician. This unique case contributes an account of a challenging...
We present a case report of diagnosis of cervical spine multiple sclerosis by a chiropractic physician. This unique case contributes an account of a challenging differential diagnosis to the literature. A 30-year-old male presented with a three-year history of diffuse left upper extremity motor strength deficits and paresthesia (numbness and tingling). The patient had seen multiple physicians for these symptoms with no diagnosis of multiple sclerosis and no advanced imaging. The differential diagnosis included lower cervical spine nerve root compression or neurological disorders such as amyotrophic lateral sclerosis, cerebral lesion, motor neuropathy, multiple sclerosis, or spinal cord lesion. MRI of the cervical spine with and without IV contrast revealed evidence of spinal cord multiple sclerosis. The patient was referred to a neurologist where the diagnosis of multiple sclerosis was confirmed. A 10-year follow-up showed the patient was controlling his condition with medications and had no disability. This case underscores the importance for physicians to consider neurological conditions and advanced imaging in the presence of diffuse motor strength deficits and paresthesia in the absence of injury, pain, or any other symptoms.
PubMed: 38894936
DOI: 10.7759/cureus.62618 -
Diagnostics (Basel, Switzerland) May 2024(1) Background: Neurologic and musculoskeletal diseases represent a considerable portion of the underlying etiologies responsible for the widely prevalent symptoms of... (Review)
Review
(1) Background: Neurologic and musculoskeletal diseases represent a considerable portion of the underlying etiologies responsible for the widely prevalent symptoms of pain, weakness, numbness, and paresthesia. Because of the subjective and often nonspecific nature of these symptoms, different diagnostic modalities have been explored and utilized. (2) Methods: Literature review. (3) Results: Nerve and muscle biopsy remains the gold standard for diagnosing many of the responsible neurological and musculoskeletal conditions. However, the need for invasive tissue sampling is diminishing as more investigations explore alternative diagnostic modalities. Because of this, it is important to explore the current role of neurosurgical intervention for nerve and muscle biopsies and its current relevance in the diagnostic landscape of neurological and musculoskeletal disorders. With consideration of the role of nerve and muscle biopsy, it is also important to explore innovations and emerging techniques for conducting these procedures. This review explores the indications and emerging techniques for neurological intervention for nerve and muscle biopsies. (4) Conclusions: The role of neurosurgical intervention for nerve and muscle biopsy remains relevant in diagnosing many neurological and musculoskeletal disorders. Biopsy is especially relevant as a supportive point of evidence for diagnosis in atypical cases. Additionally, emerging techniques have been explored to guide diagnostics and biopsy, conduct less invasive biopsies, and reduce risks of worsening neurologic function and other symptoms secondary to biopsy.
PubMed: 38893695
DOI: 10.3390/diagnostics14111169 -
Journal of Clinical Medicine May 2024: Patients with rheumatoid arthritis (RA) have an increased risk of infection. Their risk of presenting herpes zoster (HZ) is 1.5-2 times higher than immunocompetent...
: Patients with rheumatoid arthritis (RA) have an increased risk of infection. Their risk of presenting herpes zoster (HZ) is 1.5-2 times higher than immunocompetent individuals and disseminated presentation is more frequent. Our aim was to analyze the prevalence and general features of HZ in RA patients. : This was a prospective study of 392 RA patients included in the vaccination program of our hospital between 2011 and 2016, and follow-up continued until December 2020. A diagnosis of HZ was made according to clinical manifestations: skin rash, blisters, paresthesia, and local pain in one or more dermatomes. : We studied 392 participants (309 women/83 men), mean age 59 ± 13 years. Every patient was followed-up over a mean period of 137 ± 110 months (range: 42 months-42 years). HZ infection was observed in 30 of 392 (25 women/5 men) patients, age (mean ± SD) 64.7 ± 11.8 years. Prevalence was 7.65% in this period and the incidence rate was 13.22/1000 patients/year. Three patients had facial involvement, one had optic involvement, and one patient presented disseminated HZ. Seven patients presented post herpetic neuralgia treated with gabapentinoids. The main features of RA of these 30 patients were: positive RF (n = 17; 56.6%), positive anti-CCP (n = 13; 43.3%), and erosive disease (n = 10; 33.3%). At HZ infection, the treatments were glucocorticoids (n = 19; 63.3%), conventional DMARDs (n = 15; 50%), biological DMARDs (n = 15; 50%), tofacitinib (n = 2; 6.6%), and upadacitinib (n = 1; 3.3%). : HZ is a relatively frequent viral complication in RA patients. In our series, one patient presented disseminated HZ and nearly 25% of patients had post-herpetic neuralgia. Including a HZ vaccine in our vaccination program for RA patients may be beneficial.
PubMed: 38892832
DOI: 10.3390/jcm13113121 -
Reviews on Environmental Health Jun 2024The fifth generation, 5G, for wireless communication is currently deployed in Sweden since 2019/2020, as well as in many other countries. We have previously published... (Review)
Review
The fifth generation, 5G, for wireless communication is currently deployed in Sweden since 2019/2020, as well as in many other countries. We have previously published seven case reports that include a total of 16 persons aged between 4 and 83 years that developed the microwave syndrome within short time after being exposed to 5G base stations close to their dwellings. In all cases high radiofrequency (RF) radiation from 4G/5G was measured with a broadband meter. RF radiation reached >2,500,000 to >3,180,000 μW/m in peak maximum value in three of the studies. In total 41 different health issues were assessed for each person graded 0 (no complaint) to 10 (worst symptoms). Most prevalent and severe were sleeping difficultly (insomnia, waking night time, early wake-up), headache, fatique, irritability, concentration problems, loss of immediate memory, emotional distress, depression tendency, anxiety/panic, dysesthesia (unusual touched based sensations), burning and lancinating skin, cardiovascular symptoms (transitory high or irregular pulse), dyspnea, and pain in muscles and joints. Balance disorder and tinnitus were less prevalent. All these symptoms are included in the microwave syndrome. In most cases the symptoms declined and disappeared within a short time period after the studied persons had moved to a place with no 5G. These case histories are classical examples of provocation studies. They reinforce the urgency to inhibit the deployment of 5G until more safety studies have been performed.
PubMed: 38889394
DOI: 10.1515/reveh-2024-0017 -
Journal of the American College of... Jun 2024
PubMed: 38887227
DOI: 10.1002/emp2.13222 -
Journal of Bone Metabolism May 2024Hypoparathyroidism is characterized by chronic hypocalcemia with low or abnormal parathyroid hormone levels. Thyroid surgery remains a predominant cause of...
BACKGROUND
Hypoparathyroidism is characterized by chronic hypocalcemia with low or abnormal parathyroid hormone levels. Thyroid surgery remains a predominant cause of hypoparathyroidism, often preventable by partial thyroidectomy. Although hypoparathyroidism can impair quality of life (QOL), data remain limited for Latin America. We aimed to characterize clinical manifestations and QOL in patients with postsurgical hypoparathyroidism.
METHODS
This case-control study included patients (>18 years) who underwent total thyroidectomy (TT) for differentiated thyroid cancer (DTC) with postsurgical hypoparathyroidism (Group 1, Cases) and those with DTC who underwent TT without postsurgical hypoparathyroidism (Group 2, Controls). Clinical records were collected, and the SF-36v2 QOL survey and a structured symptom survey were applied. A logistic multivariate regression analysis was performed.
RESULTS
This study included 106 subjects (Group 1, N=41; Group 2, N=65). Group 1 patients were younger, had a higher frequency of lymph node resection, and more frequently received Ι-131 than Group 2 patients (p<0.05). In the SF-36v2 survey, Group 1 had fewer physical-functioning scores (odds ratio, 3.8; 95% confidence interval, 1.2-11.7) and lower scores in mental and physical components than Group 2 and national records. Commonly reported symptoms include paresthesia, daily fatigue, and memory alterations. Treatment adherence rates were 56% and 71% for calcium and calcitriol, respectively. Furthermore, 24% of patients experienced one or more hypoparathyroidism drug-related adverse effects.
CONCLUSIONS
Patients with postsurgical hypoparathyroidism had an impaired QOL, a high frequency of disease-associated symptoms, and limited treatment adherence. These results should be considered when deciding the best surgical alternative for DTC.
PubMed: 38886971
DOI: 10.11005/jbm.2024.31.2.140 -
BMJ Neurology Open 2024Recently, there have been a few reports of atypical post-coronavirus disease 2019 (COVID-19) myelopathy manifesting tract-specific lesions similar to those due to...
INTRODUCTION
Recently, there have been a few reports of atypical post-coronavirus disease 2019 (COVID-19) myelopathy manifesting tract-specific lesions similar to those due to vitamin B deficiency. However, the precise characteristics of imaging or clinical course remain not well understood.
METHODS
A retrospective analysis of the clinical and imaging characteristics of four patients who were referred to our hospital with a unique post-COVID-19 myelopathy was performed.
RESULTS
Four-to-six weeks following COVID-19 infection in the summer of 2023, four middle-aged men developed paraparesis, hypo/dysesthesia and bladder/bowel disturbance, suggesting myelopathy. Although spinal MRI showed no abnormalities in the early stages, tract-specific longitudinal lesions along the dorsal and lateral columns became apparent as the symptoms progressed. Owing to the lack of MRI findings at the early stage, all cases were challenging to diagnose. However, the patients remained partially responsive to aggressive immunosuppressive therapies, even in the advanced stage.
DISCUSSION
We termed these tract-specific longitudinal lesions in the presented case series 'Grasshopper sign' because brain coronal and spine axial MRI findings looked like a grasshopper's antennae and face. Early identification of the characteristic MRI abnormality could allow for early intervention using intensive immunosuppressive therapy, which could improve patient outcomes.
PubMed: 38884066
DOI: 10.1136/bmjno-2024-000730 -
Cureus May 2024Meralgia paresthetica (MP) is a painful condition caused by damage or constriction of the lateral femoral cutaneous nerve (LFCN). This entrapment condition typically...
Meralgia paresthetica (MP) is a painful condition caused by damage or constriction of the lateral femoral cutaneous nerve (LFCN). This entrapment condition typically arises due to various factors, including trauma, pelvic tumors, external compression from belts or snug attire, and weight gain. The prognosis is generally favorable since most cases are self-limiting or respond to conservative treatment. We present the case of a 53-year-old overweight man, with no relevant medical history, who was a victim of a traffic accident in October 2023 which resulted in polytrauma, according to the Case Reports (CARE) checklist. The main complaint of the patient was tingling of the left thigh, with dysesthesia to gentle rubbing along the anterolateral surface. After a diagnostic study, a diagnosis of post-trauma MP was thus established, probably due to seat-belt compression of the LFCN, and physiatric treatment was initiated. With the assistance of ultrasound, a large hematoma was seen, above the inguinal ligament with drainage of 140ccc of serosanguineous fluid with resolution of the symptoms. This case emphasizes the importance of a physiatry consultation for a correct diagnosis and focuses on the main complaint of a polytrauma patient.
PubMed: 38882964
DOI: 10.7759/cureus.60440 -
Cureus May 2024Background This study investigates the functional outcomes of single-bundle arthroscopic anterior cruciate ligament (ACL) reconstruction, comparing the use of two...
Functional Outcome of Single-Bundle Arthroscopic Anterior Cruciate Ligament Reconstruction using Peroneus Longus Graft and Hamstring Graft: An Open-Label, Randomized, Comparative Study.
Background This study investigates the functional outcomes of single-bundle arthroscopic anterior cruciate ligament (ACL) reconstruction, comparing the use of two distinct graft sources: peroneus longus (PL) graft and hamstring graft. The choice of graft material in ACL reconstruction is crucial for optimal postoperative results, and this study aims to contribute valuable insights into the comparative efficacy of these two graft types. Method This open-label randomized comparative study involved a carefully selected cohort of patients undergoing single-bundle arthroscopic ACL reconstruction. Participants were randomly assigned to either the PL graft group or the hamstring graft group. Surgical procedures were conducted using standardized techniques, and postoperative rehabilitation protocols were closely monitored. Functional outcomes, including range of motion, stability, and patient-reported measures, were assessed at predefined intervals to ensure comprehensive data collection. Results The study underscores significant demographic and clinical factors in ACL reconstruction outcomes. Participants were predominantly aged 17-30 years (58.33%) with a mean age of 29.27 years and exhibited a male predominance (80.56%). Common complaints included knee pain and instability, primarily due to falls from bikes (55.56%) or sports-related trauma (44.44%). Notably, PL grafts demonstrated advantages over hamstring grafts, with longer mean length (10.11 mm vs. 8.77 mm, p=0.0001) and shorter operation times. Visual analog scale (VAS), International Knee Documentation Committee (IKDC), and Tegner Lysholm scores show no significant differences between grafts over the period of time. There is no notable foot eversion weakness or significant donor site morbidity after the PL graft harvest. Hamstring graft cases exhibit a higher incidence of altered sensation and muscle atrophy, suggesting the potential benefits of PL grafts for improved surgical outcomes. Conclusions Graft comparisons favored PL grafts due to longer length, and functional outcome assessments between the two graft types. However, foot and ankle strength assessments revealed fluctuations in strength recovery with PL grafts, highlighting the need for tailored rehabilitation. Thigh circumference variations suggested potential muscle atrophy in the hamstring graft group, along with reported paresthesia in the ipsilateral proximal leg. In conclusion, PL grafts offer potential advantages for ACL surgery, but ongoing monitoring and specialized rehabilitation are crucial.
PubMed: 38872693
DOI: 10.7759/cureus.60239