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Annals of Medicine and Surgery (2012) Apr 2024Pseudoulnar palsy, characterized by weakness in the fourth and fifth digits, is a condition typically attributed to infarction of the medial aspect of the precentral...
INTRODUCTION AND IMPORTANCE
Pseudoulnar palsy, characterized by weakness in the fourth and fifth digits, is a condition typically attributed to infarction of the medial aspect of the precentral gyrus's "hand knob." This anatomical site is located in the primary motor cortex of the brain, in the posterior lobe of the frontal cortex. This report presents a novel case of pseudoulnar nerve palsy in conjunction with wrist drop stemming from an infarction of the hand knob gyrus.
CASE PRESENTATION
A 78-year-old female with hypertension and hyperlipidemia experienced sudden right wrist weakness and impaired mobility in her fourth and fifth digits. Clinical examinations, including neuroimaging, supported the diagnosis of an infarction in the medial precentral gyrus. Brain MRI confirmed the diagnosis of an acute infarction in the medial precentral gyrus. The patient was treated with enoxaparin, aspirin, and dexamethasone, and was discharged after symptom improvement.
CLINICAL DISCUSSION
Unlike the classical presentations, this case highlights the co-occurrence of ulnar and radial deficits following a unique infarction pattern. The distinct presentation of right pseudoulnar palsy with wrist drop was caused by an infarction at the level of the medial aspect of the hand knob.
CONCLUSION
This case underscores the importance of considering the central causes of peripheral-like deficits, especially in older individuals with vascular risk factors, emphasizing the significance of early intervention in mitigating potential long-term consequences. This report contributes to the evolving understanding of central neurological presentations, and serves as a reminder of the need for a comprehensive diagnostic approach.
PubMed: 38576987
DOI: 10.1097/MS9.0000000000001879 -
Frontiers in Medicine 2024As the most common acute optic neuropathy in older patients, nonarteritic anterior ischemic optic neuropathy (NAION) presents with varying degrees of visual acuity loss...
BACKGROUND
As the most common acute optic neuropathy in older patients, nonarteritic anterior ischemic optic neuropathy (NAION) presents with varying degrees of visual acuity loss and visual field defect. However, there is no generally accepted treatment for NAION.
OBJECTIVES
To evaluate the efficacy and safety of platelet-rich plasma (PRP) for patients with acute NAION within 2 months.
DESIGN
A prospective, nonrandomized controlled trial.
METHODS
Twenty-five eyes of 25 patients were enrolled. Of them, 13 received anisodine hydrobromide and butylphthalide-sodium chloride injection continuously for 10 days as basic treatment in the control group, and 12 received two tenon capsule injections of PRP on a 10 days interval as an additional treatment in the PRP group. We compared the best-corrected visual acuity (BCVA) and capillary perfusion density (CPD) of radial peripapillary capillaries and the moth-eaten eara of the peripapillary superficial capillary plexus and deep capillary plexus at 1 day (D1) before the first PRP treatment and 7 days (D7), 14 days (D14), and 30 days (D30) after the first PRP injection. Ocular and systemic adverse effects were assessed.
RESULTS
In the PRP group, a better BCVA occurred at D30 (adjusted = 0.005, compared with D1, recovered from 0.67 ± 0.59 to 0.43 ± 0.59), and a significant improvement in CPD was observed at D30 (adjusted < 0.001, = 0.027, = 0.027, compared with D1, D7, D14, in sequence, the value was 35.97 ± 4.65, 38.73 ± 4.61, 39.05 ± 5.26, 42.71 ± 4.72, respectively). CPD at D7 in the PRP group was better than that in the control group ( = 0.043). However, neither BCVA nor the moth-eaten area index were significantly different (all > 0.5) between the two groups. The main adverse effect was local discomfort resolved within 1 week, and no other systemic adverse events occurred.
CONCLUSION
Tenon capsule injection of PRP was a safe treatment for AION and could improve capillary perfusion of the optic nerve head and might be helpful in increasing short-term vision in patients with acute NAION.
PubMed: 38576708
DOI: 10.3389/fmed.2024.1344107 -
Folia Morphologica Apr 2024The brachial plexus consists of nerves that supply the upper limb and some nerves of the back, torso, and neck. It is formed by the ventral rami of C5 to T1 (in some...
The brachial plexus consists of nerves that supply the upper limb and some nerves of the back, torso, and neck. It is formed by the ventral rami of C5 to T1 (in some cases, C4 or T2 also contribute). The anterior rami of the spinal nerves unite to the roots, trunks, divisions, cords, and terminal branches that innervate muscles and skin. An example is associated with terminal branches of the long nerves. Knowledge of this variation is necessary for enabling surgeons, orthopedists, and neurologists to avoid injury during surgical exploration in the arm or axilla region, and for achieving correct diagnoses, because such variability can evoke nonspecific responses. Awareness of this anastomosis is also mandatory for anesthetists performing anesthesia in the upper limb region. The aim of this article is to describe anastomoses between long nerves from the brachial plexus and to consider their clinical significance.
PubMed: 38567934
DOI: 10.5603/fm.93685 -
Journal of Spine Surgery (Hong Kong) Mar 2024Cervical spondylotic myelopathy (CSM) is defined as compression of the spinal cord in the neck, resulting in problems with fine motor skills, hand numbness, pain or... (Review)
Review
Cervical spondylotic myelopathy (CSM) is defined as compression of the spinal cord in the neck, resulting in problems with fine motor skills, hand numbness, pain or stiffness of the neck, and difficulty walking due to loss of balance. Brachial plexus (BP) neuropathies arise due to compression to any distal branches arising from C5-T1, whereas cervical radiculopathy involves compression at the nerve root in the neck. Such conditions can present with variable degrees of musculoskeletal pain, weakness, sensory changes, and reflex changes. The pronounced convergence in symptomatic manifestation within these conditions can pose a formidable challenge to clinicians, particularly in primary care. Thus, the primary objective of this paper is to enhance clarity and distinction among these pathological conditions. This objective is pursued through comprehensive delineation of the dermatomal and myotomal distributions characteristic of each condition. Furthermore, a meticulous examination is undertaken to elucidate physical indicators and maneuvers that exhibit a notably high sensitivity in detecting these conditions. Accurate diagnosis and treatment of each nerve pathology is important as long-term spinal cord compression and its roots may result in permanent disability and severely impact one's quality of life. As such, this systematic review serves as a guide that aids clinicians in differentiating the aforementioned conditions based on anatomy, physical exam findings, and imaging studies. Furthermore, this study aims to outline common peripheral nerve neuropathies in the upper extremities and ways to mitigate these pathologies using the least to most invasive treatment modalities.
PubMed: 38567008
DOI: 10.21037/jss-23-39 -
Case Reports in Ophthalmology 2024Nanophthalmos is characterized by a short axial length, a thick choroid, and a thick sclera. Unilateral symptomatic disc swelling in nanophthalmos presents both a...
INTRODUCTION
Nanophthalmos is characterized by a short axial length, a thick choroid, and a thick sclera. Unilateral symptomatic disc swelling in nanophthalmos presents both a diagnostic and a therapeutic challenge.
CASE PRESENTATION
A healthy 59-year-old man reported a two-week-long abrupt vision reduction in his right eye. 20/100 best spectacle (+17.25 diopter) corrected visual acuity, unilateral widespread disc enlargement, central scotoma, and a slight color vision disruption without an afferent pupillary defect were among the positive findings in the right eye. Workup for neuro-ophthalmology was negative. Numerous consultations did not suggest any form of treatment for the patient. Review of the optical coherence tomography (OCT) indicated a small, crowded optic nerve head and substantial diffuse choroidal thickening with dome-shaped temporal peripapillary area with choroidal expansion. In addition to circumferential anterior four-quadrant 95%-deep sclerectomy from recti insertion to the vortices, radial nasal posterior sclerotomy reaching the optic nerve sheath was performed on the patient. After the procedure, 2 weeks later, the patient's vision returned, and it persisted until the 6-month follow-up. By OCT, the two eyes were comparable as far as disc contour and nerve fiber layer thickness.
CONCLUSION
This form of sclerectomy, which aims at decompressing the oncotic choroidal pressure, is an effective treatment for compressive optic neuropathy in the context of nanophthalmos. Could sclerectomy assist in treating other optic neuropathies associated with peripapillary pachychoroid?
PubMed: 38566820
DOI: 10.1159/000537829 -
European Radiology Experimental Apr 2024In contrast to the brain, fibers within peripheral nerves have distinct monodirectional structure questioning the necessity of complex multidirectional gradient vector...
BACKGROUND
In contrast to the brain, fibers within peripheral nerves have distinct monodirectional structure questioning the necessity of complex multidirectional gradient vector schemes for DTI. This proof-of-concept study investigated the diagnostic utility of reduced gradient vector schemes in peripheral nerve DTI.
METHODS
Three-Tesla magnetic resonance neurography of the tibial nerve using 20-vector DTI (DTI) was performed in 10 healthy volunteers, 12 patients with type 2 diabetes, and 12 age-matched healthy controls. From the full DTI dataset, three reduced datasets including only two or three vectors along the x- and/or y- and z-axes were built to calculate major parameters. The influence of nerve angulation and intraneural connective tissue was assessed. The area under the receiver operating characteristics curve (ROC-AUC) was used for analysis.
RESULTS
Simplified datasets achieved excellent diagnostic accuracy equal to DTI (ROC-AUC 0.847-0.868, p ≤ 0.005), but compared to DTI, the reduced models yielded mostly lower absolute values of DTI scalars: median fractional anisotropy (FA) ≤ 0.12; apparent diffusion coefficient (ADC) ≤ 0.25; axial diffusivity ≤ 0.96, radial diffusivity ≤ 0.07). The precision of FA and ADC with the three-vector model was closest to DTI. Intraneural connective tissue was negatively correlated with FA and ADC (r ≥ -0.49, p < 0.001). Small deviations of nerve angulation had little effect on FA accuracy.
CONCLUSIONS
In peripheral nerves, bulk tissue DTI metrics can be approximated with only three predefined gradient vectors along the scanner's main axes, yielding similar diagnostic accuracy as a 20-vector DTI, resulting in substantial scan time reduction.
RELEVANCE STATEMENT
DTI bulk tissue parameters of peripheral nerves can be calculated with only three predefined gradient vectors at similar diagnostic performance as a standard DTI but providing a substantial scan time reduction.
KEY POINTS
• In peripheral nerves, DTI parameters can be approximated using only three gradient vectors. • The simplified model achieves a similar diagnostic performance as a standard DTI. • The simplified model allows for a significant acceleration of image acquisition. • This can help to introduce multi-b-value DTI techniques into clinical practice.
Topics: Humans; Diffusion Tensor Imaging; Anisotropy; Diabetes Mellitus, Type 2; Peripheral Nerves; Diffusion Magnetic Resonance Imaging
PubMed: 38561526
DOI: 10.1186/s41747-024-00444-2 -
Ophthalmology Science 2024To measure mechanical strain of the lamina cribrosa (LC) after intraocular pressure (IOP) change produced 1 week after a change in glaucoma medication.
OBJECTIVE
To measure mechanical strain of the lamina cribrosa (LC) after intraocular pressure (IOP) change produced 1 week after a change in glaucoma medication.
DESIGN
Cohort study.
PARTICIPANTS
Adult glaucoma patients (23 eyes, 15 patients) prescribed a change in IOP-lowering medication.
INTERVENTION
Noninvasive OCT imaging of the eye.
MAIN OUTCOME MEASURES
Deformation calculated by digital volume correlation of OCT scans of the LC before and after IOP lowering by medication.
RESULTS
Among 23 eyes, 17 eyes of 12 persons had IOP lowering ≥ 3 mmHg (reduced IOP group) with tensile anterior-posterior strain = 1.0% ± 1.1% ( = 0.003) and compressive radial strain () = -0.3% ± 0.5% ( = 0.012; random effects models accounting inclusion of both eyes in some persons). Maximum in-plane principal (tensile) strain and maximum shear strain in the reduced-IOP group were as follows: = 1.7% ± 1.0% and = 1.4% ± 0.7%, respectively (both < 0.0001 vs. zero). Reduced-IOP group strains and were significantly larger with greater % IOP decrease ( < 0.0001 and < 0.0001, respectively). The compliances of the , , and strain responses, defined as strain normalized by the IOP decrease, were larger with more abnormal perimetric mean deviation or visual field index values (all ≤ 0.02). Strains were unrelated to age (all ≥ 0.088). In reduced-IOP eyes, mean LC anterior border posterior movement was only 2.05 μm posteriorly ( = 0.052) and not related to % IOP change ( = 0.94, random effects models). Only was significantly related to anterior lamina depth change, becoming more negative with greater posterior LC border change ( = 0.015).
CONCLUSIONS
Lamina cribrosa mechanical strains can be effectively measured by changes in eye drop medication using OCT and are related to degree of visual function loss in glaucoma.
FINANCIAL DISCLOSURES
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
PubMed: 38560276
DOI: 10.1016/j.xops.2024.100473 -
Trauma Case Reports Jun 2024
PubMed: 38550964
DOI: 10.1016/j.tcr.2024.100992 -
Medicina (Kaunas, Lithuania) Mar 2024: We aimed to investigate changes in the radial peripapillary capillary (RPC) network using optical coherence tomography angiography (OCTA) in patients who recovered...
: We aimed to investigate changes in the radial peripapillary capillary (RPC) network using optical coherence tomography angiography (OCTA) in patients who recovered from coronavirus disease 2019 (COVID-19). : This was a prospective study of patients hospitalized due to COVID-19 bilateral pneumonia between March and May 2021. The control group included healthy individuals matched for age and sex. Two months after discharge, the patients underwent ophthalmological examination, including optical coherence tomography (OCT) imaging. The RPC network and retinal nerve fiber layer (RNFL) of the optic disc (RNFL optic disc) were automatically evaluated and compared between the study groups. Additionally, the RPC parameters were compared between the men and women in the COVID-19 group, and correlations between the RPC and RNFL optic disc parameters were assessed. : A total of 63 patients (120 eyes) with bilateral pneumonia caused by severe acute respiratory syndrome coronavirus 2 infection were examined. No ophthalmic symptoms were reported by the patients. No significant differences were observed in the RPC parameters between the patients from the COVID-19 group and the 43 healthy controls. Moreover, the RPC parameters did not differ between the men and women in the COVID-19 group. A positive correlation was found between the RPC and RNFL optic disc parameters in the COVID-19 patients ( < 0.001). : No changes in the RPC network were observed among the patients with COVID-19 bilateral pneumonia in the early period after hospital discharge. However, a longer follow-up is needed to monitor COVID-19-related changes in the microvasculature of the optic nerve head.
Topics: Male; Humans; Female; Optic Disk; Retinal Vessels; Tomography, Optical Coherence; Prospective Studies; Visual Fields; Retinal Ganglion Cells; COVID-19; Pneumonia; Angiography
PubMed: 38541228
DOI: 10.3390/medicina60030502 -
Scientific Reports Mar 2024This study aimed to quantitatively assess the thickness of the peripapillary retinal nerve fiber layer (pRNFL) thickness, as well as the microvascular alterations in the...
This study aimed to quantitatively assess the thickness of the peripapillary retinal nerve fiber layer (pRNFL) thickness, as well as the microvascular alterations in the macula and peripapillary regions, in optic nerve hypoplasia (ONH) patients compared to normal controls. This was achieved through the utilization of spectral-domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCTA), with a specific focus on elucidating the association between these structural alterations and visual acuity. We included a total of 17 eyes of 12 ONH patients, and 34 eyes of age-matched 34 healthy controls. The pRNFL thickness was quantified using SD-OCT, while OCTA facilitated the visualization and measurement of the microvascular structure images of the superficial retinal capillary plexus (SRCP), deep retinal capillary plexus (DRCP), and radial peripapillary capillary (RPC) segment in the macula and peripapillary area. pRNFL thickness was measured for eight sectors (superior, temporal, inferior, nasal, superotemporal, superonasal, inferotemporal, and inferonasal). SRCP, DRCP, and RPC were measured for four sectors (superior, temporal, inferior, and nasal). Age, gender, and spherical equivalent refractive errors were statistically adjusted for the analysis. Associations of structural parameters with visual acuity in ONH patients were analyzed using Spearman correlation analysis. pRNFL thickness was significantly thinner in ONH patients than in controls for all sectors. Vessel densities of temporal and nasal sectors in DRCP were significantly higher in ONH patients, but vessel densities of the inferior sector in RPC were significantly lower than those in controls. For all sectors, pRNFL thickness was strongly associated with visual acuity in ONH patients. ONH patients showed significant pRNFL thinning and microvascular alterations compared to controls, and pRNFL thickness was strongly associated with visual function. OCT and OCTA are useful tools for evaluating optic disc hypoplasia and its functional status.
Topics: Humans; Optic Disk; Optic Nerve Hypoplasia; Tomography, Optical Coherence; Visual Acuity; Angiography; Retinal Vessels; Fluorescein Angiography
PubMed: 38532111
DOI: 10.1038/s41598-024-57118-7