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Cureus Apr 2024A 59-year-old male patient came to the outpatient department with complaints of left-sided hemicranial headache with drooping of the left upper eyelid (UL) for three...
A 59-year-old male patient came to the outpatient department with complaints of left-sided hemicranial headache with drooping of the left upper eyelid (UL) for three days associated with difficulty in swallowing and deviation of the tongue. The patient had a history of vigorous coughing for the past 15 days for which he did not take any medications. He was thoroughly evaluated in the outpatient department and diagnosed with Horner's syndrome. Acute Horner's syndrome with pain is nearly a hallmark of carotid dissection, and MRI of the brain and orbit was thus advised. On MRI, a hyperdense area was noted around the left internal carotid artery for which he was advised magnetic resonance angiography, which revealed internal carotid artery dissection (ICAD) of the left side. The patient was diagnosed with left-sided Horner's syndrome following left ICAD with involvement of the left hypoglossal nerve. He was started on antiplatelets and anticoagulants and closely followed up. Early diagnosis and prompt treatment were lifesaving for this patient.
PubMed: 38756256
DOI: 10.7759/cureus.58367 -
Journal of Neuroengineering and... May 2024Gait disorder remains a major challenge for individuals with stroke, affecting their quality of life and increasing the risk of secondary complications. Robot-assisted... (Randomized Controlled Trial)
Randomized Controlled Trial
Effects of robot-assisted gait training using the Welwalk on gait independence for individuals with hemiparetic stroke: an assessor-blinded, multicenter randomized controlled trial.
BACKGROUND
Gait disorder remains a major challenge for individuals with stroke, affecting their quality of life and increasing the risk of secondary complications. Robot-assisted gait training (RAGT) has emerged as a promising approach for improving gait independence in individuals with stroke. This study aimed to evaluate the effect of RAGT in individuals with subacute hemiparetic stroke using a one-leg assisted gait robot called Welwalk WW-1000.
METHODS
An assessor-blinded, multicenter randomized controlled trial was conducted in the convalescent rehabilitation wards of eight hospitals in Japan. Participants with first-ever hemiparetic stroke who could not walk at pre-intervention assessment were randomized to either the Welwalk group, which underwent RAGT with conventional physical therapy, or the control group, which underwent conventional physical therapy alone. Both groups received 80 min of physical therapy per day, 7 days per week, while the Welwalk group received 40 min of RAGT per day, 6 days per week, as part of their physical therapy. The primary outcome was gait independence, as assessed using the Functional Independence Measure Walk Score.
RESULTS
A total of 91 participants were enrolled, 85 of whom completed the intervention. As a result, 91 participants, as a full analysis set, and 85, as a per-protocol set, were analyzed. The primary outcome, the cumulative incidence of gait-independent events, was not significantly different between the groups. Subgroup analysis revealed that the interaction between the intervention group and stroke type did not yield significant differences in either the full analysis or per-protocol set. However, although not statistically significant, a discernible trend toward improvement with Welwalk was observed in cases of cerebral infarction for the full analysis and per-protocol sets (HR 4.167 [95%CI 0.914-18.995], p = 0.065, HR 4.443 [95%CI 0.973-20.279], p = 0.054, respectively).
CONCLUSIONS
The combination of RAGT using Welwalk and conventional physical therapy was not significantly more effective than conventional physical therapy alone in promoting gait independence in individuals with subacute hemiparetic stroke, although a trend toward earlier gait independence was observed in individuals with cerebral infarction.
TRIAL REGISTRATION
This study was registered with the Japan Registry of Clinical Trials ( https://jrct.niph.go.jp ; jRCT 042180078) on March 3, 2019.
Topics: Humans; Male; Stroke Rehabilitation; Female; Aged; Robotics; Middle Aged; Gait Disorders, Neurologic; Paresis; Stroke; Gait; Exercise Therapy; Single-Blind Method; Physical Therapy Modalities; Treatment Outcome
PubMed: 38745235
DOI: 10.1186/s12984-024-01370-5 -
Sensors (Basel, Switzerland) Apr 2024Thanks to medical advances, life expectancy is increasing. With it comes an increased incidence of diseases, of which age is a risk factor. Stroke is among these...
Thanks to medical advances, life expectancy is increasing. With it comes an increased incidence of diseases, of which age is a risk factor. Stroke is among these diseases, and is one of the causes of long-term disability. The opportunity to treat these patients is via rehabilitation. A promising new technology that can enhance rehabilitation is virtual reality (VR). However, this technology is not widely used by elderly patients, and, moreover, the elderly often do not use modern technology at all. It therefore becomes a legitimate question whether elderly people will be able to use virtual reality in rehabilitation. This article presents a rehabilitation application dedicated to patients with upper limb paresis and unilateral spatial neglect (USN). The application was tested on a group of 60 individuals including 30 post-stroke patients with an average age of 72.83 years. The results of the conducted study include a self-assessment by the patients, the physiotherapist's evaluation, as well as the patients' performance of the exercise in VR. The study showed that elderly post-stroke patients are able to use virtual reality applications, but the ability to correctly and fully perform an exercise in VR depends on several factors. One of them is the ability to make logical contact ( = 0.0001 < 0.05). However, the study presented here shows that the ability to use VR applications does not depend on age but on mental and physical condition, which gives hope that virtual reality applications can be used in post-stroke rehabilitation among patients of all ages.
Topics: Humans; Stroke Rehabilitation; Aged; Virtual Reality; Male; Female; Stroke; Aged, 80 and over; Middle Aged; Paresis
PubMed: 38732851
DOI: 10.3390/s24092745 -
Annals of Cardiac Anaesthesia Jan 2024Paraparesis following cardiac surgery is a manifestation of spinal cord injury (SCI). It can occur in any aortic surgery from the aneurysm to the coarctation of the...
Paraparesis following cardiac surgery is a manifestation of spinal cord injury (SCI). It can occur in any aortic surgery from the aneurysm to the coarctation of the aorta (CoA) where the cross-clamp of the aorta is applied. Though the incidence of paraplegia is low, its occurrence affects the morbidity and mortality of the patient. There are only sporadic case reports on the development of paraplegia following recurrent and technically challenging repair of CoA. However, the spontaneous development of paraplegia has also been reported in cases of unoperated CoA. The present report describes the case of delayed SCI in which paraparesis developed 5 days post a coarctation repair. The risk factors and strategies to protect the spinal cord during aortic surgeries are emphasized.
Topics: Humans; Aortic Coarctation; Paraparesis; Postoperative Complications; Male; Spinal Cord Injuries
PubMed: 38722130
DOI: 10.4103/aca.aca_98_23 -
Journal of Central Nervous System... 2024After standard care, 55%-75% of patients after stroke show a persistent paresis of the upper limb (UL). Assistive devices are developed to increase the patients' level...
The assistive potential of functional electrical stimulation to support object manipulation in functional upper extremity movements after stroke: A randomized cross-over study.
BACKGROUND
After standard care, 55%-75% of patients after stroke show a persistent paresis of the upper limb (UL). Assistive devices are developed to increase the patients' level of independence in daily life.
OBJECTIVES
To investigate the potential of Functional Electrical Stimulation (FES) to assist object manipulation in activities of daily life.
DESIGN
Seventeen patients after stroke were tested and analyzed in a randomized cross-over design.
METHODS
Functional grasping was assessed by means of the Action Research Arm Test (ARAT) and the modified Box and Block Test (mBBT), in one session with and another without FES assistance. The order of sessions was randomized. Patients' motivation was assessed after each session. Task performance and motivation were compared between conditions using the Wilcoxon test and subgroup analyses were performed for impairment severity by distribution-based mixed-factor analyses.
RESULTS
When analyzing the total ARAT, FES did not effectively assist the overall performance ( = .142), but did assist the performance of objects of the Grasp category ( = .020). Impairment severity showed an interaction with the orthotic effect ( = .012), as severely impaired patients profited from FES assistance and mild-moderately impaired did not. When focusing on the more functional items of the ARAT (i.e., excluding scores from thumb-middle and thumb-ring finger combinations), there was a significant orthotic effect of FES on task performance ( = .023). Further, there was an orthotic effect for the number of transported blocks in the mBBT ( = .033), exclusively prominent in the group of severely impaired patients. Functional Electrical Stimulation did not increase the patients' motivation ( = .959), which was high after both conditions.
CONCLUSION
Functional Electrical Stimulation has the potential to support object manipulation, but is dependent on impairment severity and object type. To observe a consistent orthotic effect, features of the stimulator should be further developed to generate appropriate grasps and forces across subjects and objects.
TRIAL REGISTRATION
The trial was registered with the German Clinical Trials Register (DRKS00025889).
PubMed: 38715966
DOI: 10.1177/11795735241247812 -
Scientific Reports May 2024A wide variety of treatments have been developed to improve respiratory function and quality of life in patients with bilateral vocal fold paresis (BVFP). One...
A wide variety of treatments have been developed to improve respiratory function and quality of life in patients with bilateral vocal fold paresis (BVFP). One experimental method is the electrical activation of the posterior cricoarytenoid (PCA) muscle with a laryngeal pacemaker (LP) to open the vocal folds. We used an ovine (sheep) model of unilateral VFP to study the long-term effects of functional electrical stimulation on the PCA muscles. The left recurrent laryngeal nerve was cryo-damaged in all animals and an LP was implanted except for the controls. After a reinnervation phase of six months, animals were pooled into groups that received either no treatment, implantation of an LP only, or implantation of an LP and six months of stimulation with different duty cycles. Automated image analysis of fluorescently stained PCA cross-sections was performed to assess relevant muscle characteristics. We observed a fast-to-slow fibre type shift in response to nerve damage and stimulation, but no complete conversion to a slow-twitch-muscle. Fibre size, proportion of hybrid fibres, and intramuscular collagen content were not substantially altered by the stimulation. These results demonstrate that 30 Hz burst stimulation with duty cycles of 40% and 70% did not induce PCA atrophy or fibrosis. Thus, long-term stimulation with an LP is a promising approach for treating BVFP in humans without compromising muscle conditions.
Topics: Animals; Sheep; Disease Models, Animal; Vocal Cord Paralysis; Electric Stimulation Therapy; Laryngeal Muscles; Humans; Pacemaker, Artificial; Vocal Cords; Female
PubMed: 38714750
DOI: 10.1038/s41598-024-60875-0 -
Physics and Imaging in Radiation... Apr 2024Ion beams exhibit an increased relative biological effectiveness (RBE) with respect to photons. This study determined the RBE of oxygen ion beams as a function of linear...
BACKGROUND AND PURPOSE
Ion beams exhibit an increased relative biological effectiveness (RBE) with respect to photons. This study determined the RBE of oxygen ion beams as a function of linear energy transfer (LET) and dose in the rat spinal cord.
MATERIALS AND METHODS
The spinal cord of rats was irradiated at four different positions of a 6 cm spread-out Bragg-peak (LET: 26, 66, 98 and 141 keV/µm) using increasing levels of single and split oxygen ion doses. Dose-response curves were established for the endpoint paresis grade II and based on ED (dose at 50 % effect probability), the RBE was determined and compared to model predictions.
RESULTS
When LET increased from 26 to 98 keV/µm, ED decreased from 17.2 ± 0.3 Gy to 13.5 ± 0.4 Gy for single and from 21.7 ± 0.4 Gy to 15.5 ± 0.5 Gy for split doses, however, at 141 keV/µm, ED rose again to 15.8 ± 0.4 Gy and 17.2 ± 0.4 Gy, respectively. As a result, the RBE increased from 1.43 ± 0.05 to 1.82 ± 0.08 (single dose) and from 1.58 ± 0.04 to 2.21 ± 0.08 (split dose), respectively, before declining again to 1.56 ± 0.06 for single and 1.99 ± 0.06 for split doses at the highest LET. Deviations from RBE-predictions were model-dependent.
CONCLUSION
This study established first RBE data for the late reacting central nervous system after single and split doses of oxygen ions. The data was used to validate the RBE-dependence on LET and dose of three RBE-models. This study extends the existing data base for protons, helium and carbon ions and provides important information for future patient treatments with oxygen ions.
PubMed: 38711920
DOI: 10.1016/j.phro.2024.100581 -
Cureus Apr 2024Thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism characterized by typical muscular symptoms, ranging from paresis to complete paralysis,...
Thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism characterized by typical muscular symptoms, ranging from paresis to complete paralysis, commonly associated with low potassium blood levels (<3 mmol/l). It is more commonly reported in adult Asian individuals and can lead to life-threatening situations. Therefore, early clinical diagnosis and targeted therapy are of crucial importance. In this article, we report the case of a 17-year-old adolescent with a Vietnamese background and known Graves' disease who was admitted with typical TPP-related symptoms but no hypokalemia. After treatment with an antithyroid medication and oral potassium supplementation, no new episode of TPP was observed. Using next-generation sequencing, a genetic analysis of TPP-related ion channel genes (KCNJ2, KCNJ18, KCNE3, SCN4A, and CACNA1S) found no known/likely pathogenic variants or variants of unknown significance. To the best of our knowledge, this is only the second reported case of quite normokalemic TPP in the pediatric population. Prompt diagnosis of TPP is essential to prevent harmful complications. Supplementation with potassium appears to be successful alongside non-selective beta-blockers. Normalization of thyroid function should be pursued to prevent new attacks, which is considered the best preventive measure.
PubMed: 38699133
DOI: 10.7759/cureus.57467 -
Frontiers in Pharmacology 2024This study utilizes Hydrogen proton magnetic resonance spectroscopy (H-MRS) to investigate metabolite concentrations in the bilateral hippocampus of general paresis (GP)...
BACKGROUND
This study utilizes Hydrogen proton magnetic resonance spectroscopy (H-MRS) to investigate metabolite concentrations in the bilateral hippocampus of general paresis (GP) patients.
METHODS
A total of 80 GP patients and 57 normal controls (NCs) were enrolled. Metabolite ratios in the bilateral hippocampus were measured using H-MRS. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Based on MMSE scores, participants were categorized into normal control, mild cognitive impairment, and moderate-severe dementia groups. Metabolite ratios (N-acetylaspartate (NAA)/creatine (Cr), choline (Cho)/creatine (Cr), N-acetylaspartate (NAA)/choline (Cho), myoinositol (MI)/creatine (Cr), choline (Cho)/N-acetylaspartate (NAA)) were compared between groups, and correlations between metabolite ratios and cognitive performance were examined.
RESULTS
MMSE scores progressively decreased in the normal, mild cognitive impairment, and moderate-severe dementia groups ( < 0.001). The moderate-severe dementia group showed significantly lower NAA/Cr ratios in the left hippocampus region (L-NAA/Cr ratios) ( < 0.001) and higher Cho/NAA ratios in the left hippocampus region (L-Cho/NAA ratios) ( < 0.05) compared to the other groups. However, differences in L-NAA/Cr and L-Cho/NAA ratios between the mild cognitive impairment group and the NC group were not significant in the hippocampus region ( > 0.05). NAA/Cho and NAA/Cr ratios in the right hippocampus region (R-NAA/Cho and R-NAA/Cr ratios) in the moderate-severe dementia group were lower than those in the control group ( < 0.05). No correlation was found between metabolite ratios and MMSE scores in bilateral hippocampus regions.
CONCLUSION
There are distinctive metabolic characteristics in the hippocampus of GP patients. GP patients exhibited lower NAA/Cr and NAA/Cho ratios in the bilateral hippocampus, indicating neuron loss in these areas, which may become more pronounced as the disease progresses.
PubMed: 38694926
DOI: 10.3389/fphar.2024.1382381 -
Therapeutic Advances in Infectious... 2024Powassan virus (POWV), a tick-borne flavivirus transmitted primarily by Ixodes ticks, poses a significant threat as it can lead to severe neuroinvasive illness. This... (Review)
Review
Powassan virus (POWV), a tick-borne flavivirus transmitted primarily by Ixodes ticks, poses a significant threat as it can lead to severe neuroinvasive illness. This review delves into the nuanced clinical presentation of Powassan infection, a challenge in diagnosis exacerbated by the absence of an available vaccine. Over the past decade, the prevalence of POWV has surged in North America, necessitating a thorough examination of its neurological manifestations alongside tick-borne encephalitis virus (TBEV). A comprehensive literature search conducted up to January 2024 revealed 135 cases of neurological symptoms associated with either Powassan or TBEV infection. Notably, severe occipital headache emerged as the most prevalent symptom (22.75%), followed by meningoencephalitis (10.34%), seizures (8.27%), and flaccid paresis (6.8%). Additional manifestations included poor balance, wide gait, dysarthria, facial nerve palsy, seizure, slurred speech, and absent deep tendon reflexes. Tragically, nine cases resulted in fatal outcomes attributed to POWV infection. This analysis highlights the intricate spectrum of neurological symptoms associated with Powassan infection and underscores the necessity for heightened awareness among medical practitioners, particularly in regions with a higher prevalence of the virus. The complexity of symptoms emphasizes the need for further research to unravel the factors contributing to this diversity. Additionally, exploring potential treatment avenues and vaccine development is crucial in addressing the rising threat posed by POWV, ultimately enhancing our ability to manage and prevent severe neurological outcomes.
PubMed: 38693969
DOI: 10.1177/20499361241247470