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Acta Neurologica Taiwanica Sep 2017Acute neuromuscular weakness related to hypokalemia is a readily treatable disorder associated with diverse aetiologies. In this study we aim to report clinical pattern...
OBJECTIVE
Acute neuromuscular weakness related to hypokalemia is a readily treatable disorder associated with diverse aetiologies. In this study we aim to report clinical pattern and biochemical features to identify the different aetiologies of the hypokalemic neuromuscular weakness.
METHODS
Retrospective reviews of the medical record were analysed. Evaluation included demography, clinical features, investigations performed to ascertain the aetiologies. All the patients were categorised in to 3 groups; Idiopathic hypokalemic paralysis (IHP), dengue associated hypokalemic paralysis (DHP) and secondary group (SG) which included renal tubular acidosis (RTA- 1 and 2), thyrotoxic periodic paralysis (TPP) and Gitelman's syndrome (GS).
RESULTS
Forty patients were analysed and the mean age was 31.78 (range, 14-60) years and 35 (87.5%) were male.The underlying aetiologies comprised of IHP in 20, DHP in 12, RTA-2 in 4, RTA-1 in 2, TPP, GS in one each. Weakness on Medical Research Council (MRC) grade was 2.6±1.19 (range 0-4). Comparison of various clinical and laboratory parameters revealed that more patient in IHP and SG had recurrent attack (p=0.001). DHP group had low platelet (p=0.001), high creatine phosphokinase (CPK) (p=0.01) and serum glutamic oxaloacetic transaminase (SGOT) (p=0.008). SG had significantly lower serum potassium (p=0.04) and more time to improve (p=0.02). Recovery time correlated negatively with serum potassium (r=-0.44, p=0.004) and grade of weakness (r= 0.42,p=0.007).
CONCLUSION
In half of the patients, secondary causes were identified. After IHP, the DHP emerged as second common cause in post monsoon season. SG had significantly lower serum potassium, recurrent attack and more time to improve.
Topics: Acute Disease; Adolescent; Adult; Female; Humans; Hypokalemia; Male; Middle Aged; Neuromuscular Diseases; Paralysis; Potassium; Retrospective Studies; Young Adult
PubMed: 29468618
DOI: No ID Found -
PloS One 2019To assess the health-related quality of life (HRQoL) and mental health of adolescents with cerebral palsy (CP) in rural Bangladesh. (Clinical Trial)
Clinical Trial
AIM
To assess the health-related quality of life (HRQoL) and mental health of adolescents with cerebral palsy (CP) in rural Bangladesh.
METHODS
Case-control study of adolescents with CP (10 to ≤18-years) and age and sex matched controls without disability. Primary caregivers were included for proxy report. HRQoL was measured with Bengali versions CP Quality of Life-Teens (CPQoL-Teens) and KIDSCREEN-27. Mental health was measured with Strengths and Difficulties Questionnaire (SDQ).
RESULTS
154 cases and 173 controls matched on age and sex participated (mean age 15.1 (1.6) and 14.9 (1.6) respectively; female n = 48, n = 55 respectively, p>0.05). CPQoL-Teens was administered to adolescents with CP only; mean outcomes ranged from 38.5 (27.4) to 71.5 (16.1) and 'feelings about functioning' was poorest domain for both self- and proxy-report groups. KIDSCREEN-27 was administered to adolescents with CP and controls; adolescents with CP mean outcomes ranged from 25.9 (12.2) to 48.7 (10.56) and were significantly poorer than controls, mean difference 4.3 (95% CI 0.7 to 7.8) to 16.7 (95% CI 14.5 to 18.5), p<0.05. 'Peers and social support' was poorest domain for all groups. In regards to mental health, adolescents with CP reported significantly poorer mean SDQ than peers without disability, mean difference 0.7 (95% CI 0.3 to 1.1) to 7.8 (95% CI 6.7 to 8.9), p<0.05; and were for self-report 7.8 (95% CI 2.6 to 23.0) and proxy-report 12.0 (95% CI 6.9 to 20.9) times more likely to report 'probable' range 'total difficulties' score. Individual item analysis of CPQoL-Teens and KIDSCREEN-27 identified unique areas of concern for adolescents with CP related to pain, friendships, physical activity and energy, what may happen later in life, and feelings about having CP. Financial resources were of concern for both cases and controls.
INTERPRETATION
Adolescents with CP in rural Bangladesh are at high risk of poor HRQoL and mental health problems. Effort to reduce the disparity between adolescents with CP and those without disability should consider wellbeing holistically and target dimensions including physical, psychological and social wellbeing. Specific interventions to alleviate modifiable aspects of HRQoL including pain, social isolation, and physical in-activity are recommended.
Topics: Adolescent; Bangladesh; Case-Control Studies; Child; Delivery of Health Care; Female; Humans; Male; Mental Health; Paralysis; Quality of Life; Registries; Rural Population; Surveys and Questionnaires
PubMed: 31185015
DOI: 10.1371/journal.pone.0217675 -
Journal of Applied Physiology... Feb 2003Hemisection of the cervical spinal cord rostral to the level of the phrenic nucleus interrupts descending bulbospinal respiratory pathways, which results in a paralysis... (Review)
Review
Hemisection of the cervical spinal cord rostral to the level of the phrenic nucleus interrupts descending bulbospinal respiratory pathways, which results in a paralysis of the ipsilateral hemidiaphragm. In several mammalian species, functional recovery of the paretic hemidiaphragm can be achieved by transecting the contralateral phrenic nerve. The recovery of the paralyzed hemidiaphragm has been termed the "crossed phrenic phenomenon." The physiological basis for the crossed phrenic phenomenon is as follows: asphyxia induced by spinal hemisection and contralateral phrenicotomy increases central respiratory drive, which activates a latent crossed respiratory pathway. The uninjured, initially latent pathway mediates the hemidiaphragm recovery by descending into the spinal cord contralateral to the hemisection and then crossing the midline of the spinal cord before terminating on phrenic motoneurons ipsilateral and caudal to the hemisection. The purpose of this study is to review work conducted on the crossed phrenic phenomenon and to review closely related studies focusing particularly on the plasticity associated with the response. Because the review deals with recovery of respiratory muscles paralyzed by spinal cord injury, the clinical relevance of the reviewed studies is highlighted.
Topics: Animals; Diaphragm; Neural Pathways; Neuronal Plasticity; Paralysis; Phrenic Nerve; Recovery of Function; Respiratory Mechanics; Spinal Cord Injuries
PubMed: 12531916
DOI: 10.1152/japplphysiol.00847.2002 -
The Journal of Physiology Jul 19711. The effects of tetanus toxin have been investigated both on central nervous and peripheral neuromuscular systems of goldfish.2. Tetanus toxin kills goldfish when...
1. The effects of tetanus toxin have been investigated both on central nervous and peripheral neuromuscular systems of goldfish.2. Tetanus toxin kills goldfish when administered in minute doses. The lethal effect is temperature dependent. Unlike mammals, in which tetanus toxin produces spastic paralysis and convulsions, the tetanus-intoxicated goldfish die with an apparently flaccid paralysis.3. Inhibition and excitation were investigated on the Mauthner cells of goldfish which had been paralysed with tetanus toxin for at least 24 hr, and which were subsequently kept alive for up to 3 days by perfusing the gills with oxygenated water. In such fish, antidromically and orthodromically excited Mauthner cells were quite normal, and there was no apparent effect on either the collateral inhibition or the crossed VIIIth nerve inhibition.4. Local injection of sublethal doses of tetanus toxin into the pectoral fin muscles produced local paralysis of the fin. Nerve-muscle preparations were isolated from such goldfish; in tetanus toxin-paralysed fins, the muscle no longer responded to stimulation of its nerve. The nerve compound action potential was still present and the muscle still responded vigorously to direct electrical stimulation.5. It is concluded that the major part of the lethal action of the toxin in the fish must be ascribed to a peripheral effect, the blocking of neuromuscular transmission. The inhibitory neuronal systems acting on the Mauthner cells of the goldfish, in apparent contrast to those acting on mammalian spinal neurones, are highly insensitive to tetanus toxin.
Topics: Action Potentials; Animals; Cerebellum; Chlorides; Cyprinidae; Diffusion; Electric Stimulation; Muscle Contraction; Muscles; Neuromuscular Junction; Neurons; Paralysis; Perfusion; Pons; Synaptic Transmission; Tetanus Toxin
PubMed: 4326308
DOI: 10.1113/jphysiol.1971.sp009494 -
Ugeskrift For Laeger Jan 2020This review summaries the knowledge of the treatment of peroneal nerve palsy. Isolated peroneal nerve palsy is often seen after fracture of the knee or knee dislocation.... (Review)
Review
This review summaries the knowledge of the treatment of peroneal nerve palsy. Isolated peroneal nerve palsy is often seen after fracture of the knee or knee dislocation. In cases with chronic peroneal nerve palsy and foot drop, tendon transfer of the posterior tibial muscle tendon to the dorsum of the foot is a possibility to be considered. This procedure is indicated for isolated peroneal nerve palsy with good ankle mobility, good strength of the posterior tibial muscle and no chance of spontaneous remission.
Topics: Humans; Knee Dislocation; Paralysis; Peroneal Nerve; Peroneal Neuropathies; Tendon Transfer
PubMed: 31928619
DOI: No ID Found -
Hawai'i Journal of Health & Social... Mar 2022Femoral nerve palsy is a rare but devastating complication of anterior total hip arthroplasty. Its etiology is still unknown, but several studies have suggested that...
Femoral nerve palsy is a rare but devastating complication of anterior total hip arthroplasty. Its etiology is still unknown, but several studies have suggested that anterior acetabular retractors may place the femoral nerve at increased risk. This study hypothesized that hip extension and traction places tension on the femoral nerve, offering an additional explanation for the development of femoral nerve palsy. A spring device was secured across 6 transected femoral nerves from 5 lower extremity cadavers and the hip was extended and pulled into traction with and without retractor placement. The change in spring length was used to determine femoral nerve tension. The average spring length changed +8.83 mm with hip extension, +3.73 mm with traction, -0.7 mm with traction and placement of the anterior acetabular retractor, and -1.15 mm with extension and placement of the femoral retractor. Femoral nerve tension was greatest with hip extension followed by traction. Acetabular and femoral retractor placement decreased average femoral nerve tension in both traction and hip extension. This may be due to medialization of the femoral nerve by the retractors, reducing the overall distance traveled, and thereby reducing tension. Previous studies have found femoral nerve pressure to be greatest during anterior acetabular retractor placement. It is likely that both pressure and tension contribute to femoral nerve palsy. Careful retractor placement, staying safely on anterior acetabular bone, and efficient femoral preparation to decrease time under hip extension and traction may help to minimize the risk of femoral nerve palsy.
Topics: Acetabulum; Arthroplasty, Replacement, Hip; Cadaver; Femoral Nerve; Humans; Paralysis
PubMed: 35340935
DOI: No ID Found -
Journal of Nippon Medical School =... May 2023Common peroneal nerve (C-PN) entrapment neuropathy is the most common peripheral nerve neuropathy of the legs. C-PN decompression surgery is less invasive but may result...
OBJECTIVE
Common peroneal nerve (C-PN) entrapment neuropathy is the most common peripheral nerve neuropathy of the legs. C-PN decompression surgery is less invasive but may result in neurological complications. We report a rare case of nerve paralysis immediately after C-PN decompression surgery.
CASE REPORT
An 85-year-old man presented with leg numbness and pain. An electrophysical study revealed C-PN entrapment in the affected area and he underwent surgical decompression. Immediately after the procedure he complained of slight paralysis without pain (manual muscle test: 3/5), which gradually worsened and was complete at 60 min after surgery. We re-opened the skin incision 3 hours after the first operation and found that a subcutaneous suture had been applied to the connective tissue near the C-PN, resulting in marked compression of the nerve. After release of the suture his paralysis improved immediately. We confirmed that there was no other nerve compression and finished the operation. His paralysis disappeared completely.
CONCLUSION
Peripheral nerve surgery, including C-PN decompression surgery, is less invasive, and the risk of complications is low. However, because the C-PN is located in the shallow layer under the skin, an excessively deep suture in the subcutaneous layer may compress the nerve and elicit nerve palsy. Therefore, careful postoperative follow-up is necessary because early decompression leads to good surgical results.
Topics: Male; Humans; Aged, 80 and over; Peroneal Neuropathies; Peripheral Nervous System Diseases; Paralysis; Pain; Decompression, Surgical
PubMed: 35082210
DOI: 10.1272/jnms.JNMS.2023_90-201 -
Lakartidningen Jul 2021Patients with Covid-19 can experience neurological complications, for example cranial nerve palsy. We present a case with a patient treated for severe Covid-19...
Patients with Covid-19 can experience neurological complications, for example cranial nerve palsy. We present a case with a patient treated for severe Covid-19 infection. She was intubated for 16 days and was ventilated in the prone-position for several hours a day during her care in the intensive care unit (ICU). She developed paralysis of the left facial nerve, observed while intubated. After extubation the patient was hoarse and had dysphagia and examination showed paralysis of the left hypoglossal nerve with the tongue deviating to the left and of the left vagus nerve causing a paralysis of the left vocal cord. It is impossible to know whether the paralysis of the three cranial nerves was due to direct damage by the Covid-19 virus or due to compression of the nerves during the ICU care. As facial nerve palsy has been shown to be more common in patients with Covid-19, we believe that the paralysis in our patient was due to a combination of both.
Topics: COVID-19; Cranial Nerve Diseases; Cranial Nerves; Female; Humans; Paralysis; SARS-CoV-2
PubMed: 34228809
DOI: No ID Found -
Clinical Physiology and Functional... Mar 2019M-mode ultrasonography might be useful for detecting hemidiaphragm paralysis. The objective of the present study was to describe the motion recorded by M-mode...
BACKGROUND
M-mode ultrasonography might be useful for detecting hemidiaphragm paralysis. The objective of the present study was to describe the motion recorded by M-mode ultrasonography of both diaphragmatic leaves in patients with a pre-established diagnosis of hemidiaphragm paralysis.
METHODS
A study was conducted in 26 patients (18 men, 8 women) with unilateral diaphragmatic paralysis. They were referred to two different rehabilitation centres after thoracic surgery in 23 cases and cardiac interventional procedures in three cases. The pulmonary function tests and the study of the diaphragmatic motion using M-mode ultrasonography were recorded.
RESULTS
The pulmonary function tests showed a restrictive pattern. The M-mode ultrasonography reported either the absence of motion or a weak paradoxical (cranial) displacement (less than 0·5 cm) of the paralysed hemidiaphragm during quiet breathing. A paradoxical motion was recorded in all patients during voluntary sniffing, reaching around -1 cm. During deep breathing, a paradoxical motion at the beginning of the inspiration was observed. Thereafter, a re-establishment of the motion in the craniocaudal direction was recorded. The excursions measured on the healthy side, during quiet breathing and voluntary sniffing, were increased in patients suffering from contralateral hemidiaphragm paralysis, when compared with 170 healthy volunteers.
CONCLUSIONS
To detect diaphragmatic dysfunction in patients at risk, it would be useful to study diaphragmatic motion by M-mode ultrasonography during quiet breathing, voluntary sniffing and deep breathing.
Topics: Adult; Aged; Diaphragm; Female; France; Humans; Lung; Male; Middle Aged; Organ Motion; Predictive Value of Tests; Reproducibility of Results; Respiration; Respiratory Function Tests; Respiratory Paralysis; Ultrasonography
PubMed: 30325572
DOI: 10.1111/cpf.12549 -
Neurology India 2014Paralytic rabies closely simulates Guillain-Barre syndrome or ascending myelitis often causing clinical dilemma. Two such patients were managed in our hospital whose... (Review)
Review
Paralytic rabies closely simulates Guillain-Barre syndrome or ascending myelitis often causing clinical dilemma. Two such patients were managed in our hospital whose magnetic resonance imaging (MRI) revealed characteristic findings revealing T2 hyper intensity in central spinal cord and in posterior brainstem and hypothalamus. These MRI findings are helpful in the diagnosis of rabies in appropriate setting. We also review the literature on MRI changes in paralytic rabies.
Topics: Adolescent; Fatal Outcome; Humans; Magnetic Resonance Imaging; Male; Paralysis; Rabies
PubMed: 25591681
DOI: 10.4103/0028-3886.149394