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Journal of Cancer Research and... 2012Acute lymphoblastic leukemia (ALL) is one of the most common malignancies of childhood, which is treated with high doses of methotrexate (MTX), as it crosses the...
Acute lymphoblastic leukemia (ALL) is one of the most common malignancies of childhood, which is treated with high doses of methotrexate (MTX), as it crosses the blood-brain barrier and can be administered intravenously and via intrathecal route to eradicate leukemic cells from central nervous system (CNS). Additionally, high doses of MTX not only prevent CNS recurrence but also hematologic relapses. Although, standard treatment protocol for ALL includes multimodality therapy, MTX is usually associated with neurotoxicity and affects periventricular deep white matter region. Methotrexate-induced 'acute toxic leukoencephalopathy' has varying clinical manifestations ranging from acute neurological deficit to seizures or encephalopathy. Diffusion weighted magnetic resonance imaging (DW-MRI) is widely available and routinely used in clinical practice to identify acute stroke and also to distinguish acute stroke from non-stroke like conditions. We report a local teenage Chinese girl who developed 2 discrete episodes of left upper and lower limb weakness with left facial nerve paresis after receiving the 2 nd and 3 rd cycle of high dose of intravenous and intrathecal methotrexate, without having cranial irradiation. After each episode of her neurological deficit, the DW-MRI scan showed focal restricted diffusion in right centrum semiovale. Her left sided focal neurological deficit and facial nerve paresis almost completely subsided on both these occasions within 3 days of symptom onset. Follow-up DW-MRI, after her neurological recovery, revealed almost complete resolution of previously noted restricted diffusion in right centrum semiovale, while the lesion was not evident on concurrent T2W (T2-weighted) and FLAIR (Fluid-Attenuated Inversion recovery) sequences, nor showed any post contrast enhancement on post gadolinium enhanced T1W (T1-weighted) sequences. No residual neurological deficit or intellectual impairment was identified on clinical follow up over a 2 year period.
Topics: Adolescent; Female; Humans; Leukoencephalopathies; Methotrexate; Paresis; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Recovery of Function
PubMed: 22842379
DOI: 10.4103/0973-1482.98993 -
Journal of Rehabilitation Medicine Nov 2009To review the rationale, criteria of application, potentialities and limits of the available procedures for upper limb rehabilitation in virtual reality setups. (Comparative Study)
Comparative Study Review
AIM
To review the rationale, criteria of application, potentialities and limits of the available procedures for upper limb rehabilitation in virtual reality setups.
METHODS
Classification of the available virtual reality setups and comparison among published studies, with focus on the criteria of motor impairment and recovery assessment, rehabilitation procedures, and efficacy.
RESULTS AND CONCLUSION
The studies completed to date support application of virtual reality methods in the treatment of the paretic upper limb after stroke, but the superiority of virtual reality methods in comparison with conventional procedures currently in use is still unproven. Larger samples, adequate controlled study design and follow-up, greater homogeneity in the selection criteria and parameters measuring severity of stroke, motor impairment and recovery are necessary.
Topics: Humans; Motor Activity; Paresis; Recovery of Function; Robotics; Stroke; Stroke Rehabilitation; Treatment Outcome; Upper Extremity; User-Computer Interface
PubMed: 19841832
DOI: 10.2340/16501977-0405 -
Journal of Feline Medicine and Surgery May 2009Weakness is recognized somewhat infrequently in cats, but is an important manifestation of neurological disease. The clinician must perform a complete neurological... (Review)
Review
PRACTICAL RELEVANCE
Weakness is recognized somewhat infrequently in cats, but is an important manifestation of neurological disease. The clinician must perform a complete neurological examination to determine the neuroanatomic basis for the weakness. As for all species, the neuroanatomic diagnosis allows the clinician to generate an appropriate differential diagnosis, to design a diagnostic plan, to prognosticate, and ultimately to develop a treatment plan.
CLINICAL CHALLENGES
The cause(s) of neurological weakness in the cat may be difficult to determine without access to advanced imaging modalities, cerebrospinal fluid analysis or electrodiagnostics. However, an accurate neuroanatomic diagnosis allows the clinician to pursue preliminary anomalous (vertebral anomalies), metabolic (eg, diabetes mellitus, electrolyte abnormalities) and neoplastic differentials via blood work, vertebral column and thoracic radiography, and abdominal ultrasound. Subsequently, referral to a specialty veterinary hospital may be warranted to pursue advanced neurodiagnostics.
AUDIENCE
This review provides a framework for generating a neuroanatomic and differential diagnosis in the weak cat. It also discusses the pathogenesis and clinical signs associated with the most common neurological differentials for feline paresis. As such, it is aimed at both primary health care and specialty veterinarians.
PATIENT GROUP
The neurological conditions discussed in this review cause weakness in cats of all age groups.
Topics: Animals; Cat Diseases; Cats; Diagnosis, Differential; Diagnostic Techniques, Neurological; Motor Neuron Disease; Neurologic Examination; Paresis
PubMed: 19389637
DOI: 10.1016/j.jfms.2009.03.005 -
Annals of Medicine Dec 2023Motor recovery following a stroke is related to the initial stroke severity and corticospinal tract integrity. One of the outcomes representing corticospinal tract...
BACKGROUND
Motor recovery following a stroke is related to the initial stroke severity and corticospinal tract integrity. One of the outcomes representing corticospinal tract integrity is the motor evoked potential (MEP). This study aimed to investigate the predictive value of MEP for motor recovery in patients with acute ischemic stroke.
PATIENTS AND METHODS
Patients with hemiparesis secondary to initial acute ischemic stroke were enrolled. MEPs of the upper limb were assessed as preserved (MEP+) or absent (MEP-) response ≤10 days post-stroke. Fugl-Meyer assessment (FMA) was performed at baseline and post-stroke at 30 and 90 days. A modified Rankin scale (mRS) was conducted at 90 days post-stroke. Patients were divided into two groups according to the highest FMA score of MEP- patients. Generalized estimating equations and logistic regression were used for our study analysis.
RESULTS
Sixty-one participants were included in this study. The highest FMA score of MEP- patients ≤10 days after stroke was 38. Among patients with an initial FMA score ≤38, FMA scores at 30 and 90 days post-stroke were significantly higher in MEP + patients than in MEP- patients. Proportional recovery at 30 and 90 days post-stroke was significantly higher in MEP + patients than in MEP- patients. MEP + patients had a higher percentage of good functional outcomes than MEP- patients, without statistical difference. Among patients with initial FMA score >38, FMA scores were 60.4 ± 4.8 and 63.9 ± 2.9 and proportional recovery was 65.2 ± 27.0% and 83.7 ± 24.6% at 30 and 90 days post-stroke, respectively.
CONCLUSIONS
Among patients with moderate-to-severe ischemic stroke, MEP + patients had better motor recoveries (approximately 70%) than MEP- patients at 90 days post-stroke. MEP + patients had better functional outcomes than MEP- patients.
Topics: Humans; Ischemic Stroke; Evoked Potentials, Motor; Stroke; Paresis
PubMed: 37345693
DOI: 10.1080/07853890.2023.2225144 -
Deutsches Arzteblatt International Feb 2009Obstetric brachial plexus palsy is rare, but the limb impairments are manifold and often long-lasting. Physiotherapy, microsurgical nerve reconstruction, secondary joint... (Review)
Review
BACKGROUND
Obstetric brachial plexus palsy is rare, but the limb impairments are manifold and often long-lasting. Physiotherapy, microsurgical nerve reconstruction, secondary joint corrections, and muscle transpositions are employed with success. The role of conservative and operative treatment options should be regularly reviewed.
METHODS
Selective literature review (evidence levels 3 and 4) and analysis of personal clinical operative and scientific experience over the past 15 years.
RESULTS
Children with upper and total plexus palsy displaying nerve root avulsions and/or -ruptures are treated today by early primary nerve reconstruction in the first few months of life followed by secondary corrections, with good functional results. The late complications, with muscle weakness, impaired motion patterns, and joint dysplasia, are often underrated.
CONCLUSIONS
The potential for scientific analysis is limited, due to the rarity and interindividual variability of the lesions and the varying effects on function and growth. Expectations and compliance are different in every patient. Surgical techniques are not yet standardized. Knowledge of the consequences for joint growth and congruence is inadequate. Today, functional improvement can be achieved by surgery in most clinical manifestations of obstetric brachial plexus palsy, within the framework of an interdisciplinary treatment concept.
Topics: Brachial Plexus Neuropathies; Child; Clinical Trials as Topic; Humans; Incidence; Infant; Infant, Newborn; Paresis; Prognosis; Treatment Outcome
PubMed: 19562016
DOI: 10.3238/arztebl.2009.0083 -
The Medical Journal of Malaysia Oct 2007We report a case of 50-year-old man who was presented with recurrent episodes of left sided hemiparesis. CT scan and MRI brain revealed a large intraventricular fatty...
We report a case of 50-year-old man who was presented with recurrent episodes of left sided hemiparesis. CT scan and MRI brain revealed a large intraventricular fatty lesion. Histopathological examination showed a picture of angiolipoma.
Topics: Angiolipoma; Cerebral Ventricle Neoplasms; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Paresis; Radiography
PubMed: 18551942
DOI: No ID Found -
Journal of Rehabilitation Research and... 2006Locomotor training with a treadmill and harness support is a promising, task-oriented approach to restoring gait function in individuals with poststroke hemiparesis.... (Review)
Review
Locomotor training with a treadmill and harness support is a promising, task-oriented approach to restoring gait function in individuals with poststroke hemiparesis. However, a scientific basis for the proper selection of training parameters is lacking. Considerable latitude exists in the application of locomotor training, and training protocols vary widely between experimenters and clinical settings. Recent studies indicate that the prescription of certain parameters, including body-weight support (BWS) and treadmill speed, can affect treatment outcome in hemiparetic individuals. As an initial step toward developing a basis for selection of parameters, we reviewed the literature for studies that quantified the immediate (i.e., within session) biomechanical effects of adjusting BWS, treadmill speed, support stiffness, and handrail hold during treadmill walking in hemiparetic and nondisabled subjects. We then summarized results from personal investigations of these parameters. Based on the currently available evidence, we discuss the scientific rationale for selecting certain training parameters for individuals with poststroke hemiparesis and outline future directions for research.
Topics: Exercise Therapy; Humans; Orthotic Devices; Paresis; Stroke; Stroke Rehabilitation; Walking
PubMed: 17123188
DOI: 10.1682/jrrd.2005.04.0063 -
Journal of Neuroengineering and... Mar 2008Evaluation of how Motor Imagery and conventional therapy (physiotherapy or occupational therapy) compare to conventional therapy only in their effects on clinically... (Review)
Review
BACKGROUND
Evaluation of how Motor Imagery and conventional therapy (physiotherapy or occupational therapy) compare to conventional therapy only in their effects on clinically relevant outcomes during rehabilitation of persons with stroke.
DESIGN
Systematic review of the literature
METHODS
We conducted an electronic database search in seven databases in August 2005 and also hand-searched the bibliographies of studies that we selected for the review. Two reviewers independently screened and selected all randomized controlled trials that compare the effects of conventional therapy plus Motor Imagery to those of only conventional therapy on stroke patients. The outcome measurements were: Fugl-Meyer Stroke Assessment upper extremity score (66 points) and Action Research Arm Test upper extremity score (57 points). Due to the high variability in the outcomes, we could not pool the data statistically.
RESULTS
We identified four randomized controlled trials from Asia and North America. The quality of the included studies was poor to moderate. Two different Motor imagery techniques were used (three studies used audiotapes and one study had occupational therapists apply the intervention). Two studies found significant effects of Motor Imagery in the Fugl-Meyer Stroke Assessment: Differences between groups amounted to 11.0 (1.0 to 21.0) and 3.2 (-4 to 10.3) respectively and in the Action Research Arm Test 6.1 (-6.2 to 18.4) and 15.8 (0.5 to 31.0) respectively. One study did not find a significant effect in the Fugl-Meyer Stroke Assessment and Color trail Test (p = 0.28) but in the task-related outcomes (p > 0.001).
CONCLUSION
Current evidence suggests that Motor imagery provides additional benefits to conventional physiotherapy or occupational therapy. However, larger and methodologically sounder studies should be conducted to assess the benefits of Motor imagery.
Topics: Humans; Imagery, Psychotherapy; Imagination; Movement; Movement Disorders; Outcome Assessment, Health Care; Paresis; Randomized Controlled Trials as Topic; Stroke; Stroke Rehabilitation; Treatment Outcome
PubMed: 18341687
DOI: 10.1186/1743-0003-5-8 -
BMC Cancer Jan 2014When treating cerebral metastases all involved multidisciplinary oncological specialists have to cooperate closely to provide the best care for these patients. For the... (Comparative Study)
Comparative Study
BACKGROUND
When treating cerebral metastases all involved multidisciplinary oncological specialists have to cooperate closely to provide the best care for these patients. For the resection of brain metastasis several studies reported a considerable risk of new postoperative paresis. Pre- and perioperative chemotherapy (Ctx) or radiotherapy (Rtx) alter vasculature and adjacent fiber tracts on the one hand, and many patients already present with paresis prior to surgery on the other hand. As such factors were repeatedly considered risk factors for perioperative complications, we designed this study to also identify risk factors for brain metastases resection.
METHODS
Between 2006 and 2011, we resected 206 brain metastases consecutively, 56 in eloquent motor areas and 150 in non-eloquent ones. We evaluated the influences of preoperative paresis, previous Rtx or Ctx as well as recursive partitioning analysis (RPA) class on postoperative outcome.
RESULTS
In general, 8.7% of all patients postoperatively developed a new permanent paresis. In contrast to preoperative Ctx, previous Rtx as a single or combined treatment strategy was a significant risk factor for postoperative motor weakness. This risk was even increased in perirolandic and rolandic lesions. Our data show significantly increased risk of new deficits for patients assigned to RPA class 3. Even in non-eloquently located brain metastases the risk of new postoperative paresis has not to be underestimated. Despite the microsurgical approach, our cohort shows a high rate of unexpected residual tumors in postoperative MRI, which supports recent data on brain metastases' infiltrative nature but might also be the result of our strict study protocol.
CONCLUSIONS
Surgical resection is a safe treatment of brain metastases. However, preoperative Rtx and RPA score 3 have to be taken into account when surgical resection is considered.
Topics: Aged; Brain Neoplasms; Cerebral Cortex; Female; Humans; Kaplan-Meier Estimate; Magnetic Resonance Imaging; Male; Metastasectomy; Middle Aged; Motor Activity; Neoplasm, Residual; Neurologic Examination; Neurosurgical Procedures; Paresis; Pyramidal Tracts; Retrospective Studies; Risk Factors; Treatment Outcome
PubMed: 24422871
DOI: 10.1186/1471-2407-14-21 -
Agri : Agri (Algoloji) Dernegi'nin... Jul 2023Herpes zoster (HZ) is a segmental vesicular eruption, pain, and sensorial symptoms. Segmental motor weakness can rarely be seen as a complication of HZ. Here, we present...
Herpes zoster (HZ) is a segmental vesicular eruption, pain, and sensorial symptoms. Segmental motor weakness can rarely be seen as a complication of HZ. Here, we present two cases of motor paresis associated with HZ, case 1 was L2 and L3 segmental motor paresis with femoral neuropathy and case 2 was L5 and S1 segmental motor paresis with sensorial ganglion involvement. In both cases after electrotherapy, exercise program, and medication for pain, there were no motor weakness and pain. Zoster motor paresis is a rare complication that responds to treatment and physicians should be careful about its presence in clinical follow-up.
Topics: Humans; Paresis; Herpes Zoster; Pain; Lower Extremity; Upper Extremity
PubMed: 37493485
DOI: 10.14744/agri.2021.70846