Neurotoxin-Induced Paralysis: A Case of Tick Paralysis in a 2-Year-Old Child

BackgroundTick paralysis is an arthropod-transmitted disease causing potentially lethal progressive ascending weakness. The presenting symptoms of tick paralysis overlap those of acute inflammatory diseases of the peripheral nervous system and spinal cord; thus, the condition is often misdiagnosed, leading to unnecessary treatments and prolonged hospitalization.PatientA 2-year-old girl residing in northern New York and having no history of travel to areas endemic to ticks presented with rapidly progressing ascending paralysis, hyporeflexia, and intact sensory examination. Investigation included blood and serum toxicology screens, cerebrospinal fluid analysis, and brain imaging. With all tests negative, the child's condition was initially mistaken for botulism; however, an engorged tick was later found attached to the head skin. Following tick removal, the patient's weakness promptly improved with no additional interventions.ConclusionOur patient illustrates the importance of thorough skin examination in all cases of acute progressive weakness and the necessity to include tick paralysis in the differential diagnosis of paralysis, even in nonendemic areas.     

Cortical microinfarcts on 7T MRI in patients with spontaneous intracerebral hemorrhage

In patients with spontaneous intracerebral hemorrhage (ICH) coexisting abnormalities on brain imaging can provide clues on the etiology of the underlying small vessel disease. We examined cortical cerebral microinfarcts as a novel marker of coexistent vascular damage in ICH. Twelve patients with spontaneous ICH and 15 controls underwent 7Tesla magnetic resonance imaging (MRI). Microinfarcts were present in 9 of 12 patients with spontaneous ICH, and in 5 of 15 controls. This explorative study shows, for the first time, that microinfarcts appear to be a very common vascular comorbidity in spontaneous ICH. Future larger studies should further assess the etiological significance of these lesions.     

原发性肝癌自发性破裂出血的急诊处治体会

目的 总结原发性肝癌自发性破裂出血急诊处治的经验,提高对该病的认识、诊断及治疗水平.方法 回顾分析资阳市第一人民医院2008年10月-2012年12月共收治11例原发性肝癌自发性破裂病例的临床资料.结果 3例患者给予内科保守治疗,其中1例死亡,2例患者出血停止,后行肝动脉化疗栓塞术;8例患者行急诊手术.手术仍是急诊处治的主要方法,术后效果明确,1例肝肿瘤切除术后1d死亡,1例术后3d出现大量腹水转入上级医院进一步治疗,余6例术后顺利出院,随访生存期在3个月以上.结论 原发性肝癌自发性破裂出血在急诊诊治过程中要注意减少误诊、漏诊,诊断明确后,在纠正休克的同时,可根据病情积极选择手术探查,手术方式可选择肿瘤切除术、单纯止血纱布填塞缝合止血术,以最短的时间挽救患者的生命.     

面神经电图和瞬目反射在面神经炎中的应用

目的:探讨面神经电图和瞬目反射对面神经炎的诊断和预后评估的价值。方法:对42例面神经炎患者在发病10 d内进行面神经电图和瞬目反射的检测,并在治疗3个月后对24例患者进行复查。结果:瞬目反射患侧R1、R2和R2’缺如12例,R1、R2和R2’潜伏期延长30例,异常率100%。患侧面神经运动潜伏期延长及波幅降低28例,缺如1例,异常率为69.1%。瞬目反射异常率明显高于面神经电图(P<0.01)。复查时,R1瞬目反射各波缺如的8例患者中2例可检出波形,好转率为25%;原来R1延长的16例患者中10例恢复正常,好转率为62.5%;后一类患者的好转率明显高于前一类患者(P<0.05)。结论:瞬目反射可以作为面神经炎早期诊断的客观指标,对判断面神经受损程度和预后评估有重要作用。     

反复自然流产的表观遗传学机制研究进展

反复自然流产(recurrent spontaneous abortion,RSA)在育龄人群中的发病率约为3%~5%,其中,近50%的RSA属不明原因的反复流产(unexplained recurrent spontaneous abortion,URSA)。近年来表观遗传学及其相关研究已成为生命科学的前沿领域,研究表明表观遗传调节不仅参与基因表达调控,而且在胚胎植入和胎儿发育过程中发挥重要作用。因此,从表观遗传学角度,深入揭示其在RSA发病中的作用及其调控途径,将有助于阐明RSA的发病机制,并能为临床治疗提供有价值的信息和思路。     

Effectiveness of electrical stimulation for rehabilitation of facial nerve paralysis

Background: Despite no significant advantage being demonstrated for its use and no standardization of treatment guidelines, electrical stimulation is still applied by therapists to treat facial paralysis. The aim of this investigation was to determine whether electrical stimulation therapy for patients with acute or chronic facial nerve paralysis improves time to, and rates of full recovery and facial function compared with no intervention.

Method: A systematic review of randomized and quasi-randomized controlled trials through Scopus, Medline, PEDro, Embase, CINAHL, Pubmed, and Cochrane Library search engines for studies published up until August 2016. Reference lists were reviewed for further studies. Review Manager was used to extract data and review quality of the studies. Studies were assessed for randomization of participants, allocation concealment, blinding of participants, assessors and physiotherapists, presence and reporting of outcome data.

Results: Five studies were included for analysis – four during acute recovery and one in chronic facial nerve paralysis. In acute facial nerve paralysis, two studies found no benefit of electrical stimulation and two studies found improvement. A meta-analysis on changes in the House–Brackmann Score after treatment, rates of full recovery and time to full recovery showed no statistically significant difference between intervention and control groups. In chronic facial nerve paralysis, one study found improvements after extensive electrical stimulation on the Facial Paralysis Recovery Profile.

Conclusions: There is no evidence to support the use of electrical stimulation during the acute phase of recovery after Bell’s palsy and there is low-level evidence for patients with chronic symptoms. Furthermore, there is no evidence available on the use of electrical stimulation for other causes of facial nerve paralysis.