Bilateral common peroneal neuropathy due to rapid and marked weight loss after biliary surgery: A case report

BACKGROUNDThe causes of peroneal neuropathy are various, but are rarely due to weight loss. Bilateral peroneal neuropathy caused by weight loss after surgery has been reported only after bariatric surgery and there were no reports associated with other abdominal surgery. In this report, we describe a case of the bilateral peroneal neuropathy that occurred due to marked weight loss after biliary surgery.CASE SUMMARYA 58-year-old male did not receive adequate nutritional support after biliary surgery, and showed a massive weight loss over a short period of time (body mass index; 24.1 kg/m² to 20.5 kg/m² for 24 d). Then, foot drop occurred on both sides. Physical examination, electromyography (EMG) and magnetic resonance imaging studies were conducted and he was diagnosed as bilateral common peroneal neuropathy around the fibular head level. The patient was treated electrical stimulation therapy on both lower legs along with exercise therapy, and received sufficient oral nutritional support. The patient gradually recovered to his original weight, and the power of the dorsiflexor of bilateral ankles improved after conservative treatment. In addition, the follow-up EMG showed signs of improvement.CONCLUSIONAny abdominal surgery that may have rapid and marked weight loss can lead to peroneal neuropathy as a complication.     

The relation of social support and depression in patients with chronic low back pain

Purpose: Depression is a common condition in adults with low back pain (LBP), and is associated with poorer patient outcomes. Social support is a modifiable factor that may influence depressive symptoms in people with LBP and, if so, could be a consideration in LBP management when depression is an issue. The aim of this study was to examine social support as a prognostic factor for depressive symptoms and recovery from depression in patients with LBP.

Method: Patients with LBP (n?=?483), recruited from four imaging centers in Canada, completed an initial survey following imaging and a follow-up survey one year later, including the Medical Outcomes Study (MOS) Social Support Survey and the Center for Epidemiologic Studies Depression Scale. Multivariable regression analyses were used to examine the relationship between social support and depression.

Results: More social support (overall functional social support) at baseline was associated with recovery from depression (OR?=?0.24; 95% CI 0.10, 0.55) and less depressive symptoms (β?=?1.68; 95% CI?=?0.36, 3.00) at one-year follow-up. In addition, associations were found between specific aspects (subscales) of social support and the two depression outcomes.

Conclusions: Functional social support as a prognostic factor for depression and possible target of LBP management warrants further investigation.

• Implications for Rehabilitation

• Depression is a common condition in adults with low back pain (LBP), and is associated with poorer patient outcomes.

• This study provides evidence for social support as a prognostic factor for depressive symptoms and recovery from depression in patients with LBP problems.

• Management of pain conditions may be enhanced by a better understanding of modifiable risk factors for depression, such as social support.

     

Radial nerve recovery following closed nailing of humeral shaft fractures without radial nerve exploration: A retrospective study

BACKGROUNDRadial nerve palsy due to humeral shaft fracture is the most common peripheral nerve injury associated with long bone fractures. An antegrade nailing surgical technique is becoming popular for the fixation of these fractures with minimal invasiveness. We analyzed nerve recovery in patients with humeral shaft fracture and radial nerve palsy treated with humeral nail fixation without nerve exploration.AIMTo assess the radial nerve recovery rate and time from humeral shaft fracture with surgical treatment using close nailing.METHODSWe retrospectively collected data of patients who underwent undergone surgical nail fixation for humeral shaft fractures between October 1, 2016, and March 31, 2020. Subsequently, we analyzed the primary or secondary radial nerve palsy recovery rate and radial nerve motor function recovery time.RESULTSThe study included 70 patients who underwent surgical treatment for closed- or Gustilo type I open humeral shaft fractures using a nail fixation technique without radial nerve exploration. The patients suffered from primary (n = 5) and secondary (n = 5) radial nerve palsy. A 100% radial nerve recovery rate was achieved. The mean recovery time was 4.3 mo.CONCLUSIONThe study results indicate full recovery of radial nerve palsies from humeral shaft fracture using close nailing treatment. Surgeons need not be concerned about the occurrence of permanent nerve palsies.     

Near-normal gait pattern with peroneal electrical stimulation as a neuroprosthesis in the chronic phase of stroke: a case report

van Swigchem R, Weerdesteyn V, van Duijnhoven HJ, den Boer J, Beems T, Geurts AC. Near-normal gait pattern with peroneal electrical stimulation as a neuroprosthesis in the chronic phase of stroke: a case report.In recent years, the use of functional electrical stimulation (FES) of the peroneal nerve has increased as an alternative for an ankle-foot orthosis (AFO) to treat stroke-related drop foot. We present a chronic stroke patient demonstrating an almost normal gait pattern with peroneal FES as a neuroprosthesis. A 60-year-old survivor of a right hemisphere infarction 21 months ago, who regularly used a polypropylene AFO, was provided with a surface-based peroneal FES device for severe drop foot. In a second instance, he received an implanted FES system because of skin problems with the surface stimulator. With both FES devices, the patient achieved an adequate foot elevation. Moreover, his hip and knee flexion angles during walking increased to normal values and his ankle push-off power increased. His gait pattern became almost symmetrical and less variable than with the AFO. Furthermore, his ability to avoid a sudden obstacle improved to normal values with FES. Our patient showed benefits from peroneal FES beyond what can be attributed to improved foot lift alone. With regard to the potential working mechanisms underlying this response to FES, biomechanical benefits related to improved ankle push-off are suggested as the main mechanism.     

Long Thoracic Nerve Palsy

Abstract

This 27 year old male with a diagnosis of right thoracic nerve palsy with serratus anterior muscle weakness was referred to physical therapy for evaluation and treatment. At the time of his injury, he was employed as a delivery truck driver for a beverage supply company. Seven months after Injury he feels his functionality has returned to about 95 percent.     

Management of an intracranial hypotension patient with diplopia as the primary symptom: A case report

BACKGROUNDIntracranial hypotension (IH) is a disorder involving cerebrospinal fluid (CSF) hypovolemia due to spontaneous or traumatic spinal CSF leakage and is easily being misdiagnosed or missed, especially in these patients without the prototypical manifestation of an orthostatic headache. At present, the management of IH with both cranial nerve VI palsy and bilateral subdural hematomas (SDHs) is still unclear.CASE SUMMARYA 67-year-old male Chinese patient complained of diplopia on the left side for one and a half mo. Computed tomography revealed bilateral SDHs and a midline shift. However, neurotrophic drugs were not effective, and 3 d after admission, he developed a non-orthostatic headache and neck stiffness. Enhanced magnetic resonance imaging revealed dural enhancement as an additional feature, and IH was suspected. Magnetic resonance myelography was then adopted and showed CSF leakage at multiple sites in the spine, confirming the diagnosis of having IH. The patient fully recovered following multiple targeted epidural blood patch (EBP) procedures.CONCLUSIONIH is a rare disease, and to the best of our knowledge, IH with diplopia as its initial and primary symptom has never been reported. In this study, we also elucidated that it could be safe and effective to treat IH patients with associated cranial nerve VI palsy and bilateral SDHs using repeated EBP therapy.     

Application of a wearable switch to perform a mouse left click for a child with mix type of cerebral palsy: a single case study

Abstract

Purpose: Children with cerebral palsy may face difficulties using handheld pointing devices, due to involuntary muscle movements. This study aimed at describing the idea of the new wearable sensor switch and assessing its feasibility as an access solution in a case of mixed-type cerebral palsy.

Methods: The study participant was a 17-year-old male with mixed-type cerebral palsy characterized by chorea-athetotic movements and bilateral spasticity with gross motor function classification system level V. He exhibited sudden and irregular involuntary upper limb movements when sitting. Because spastic finger movements limited his ability to use a handheld mouse, he used a trackball near his neck as a pointing device (previous input method). The wearable switch system using a stretchable strain sensor was introduced; the sensor was attached to a groove worn on the dorsal regions of the right hand crossing the proximal interphalangeal and metacarpophalangeal joints of the middle finger (new input method). The switch turned on when the subject flexed his middle finger.

Results: The user successfully turned the switch on and typed almost the same numbers of characters per trial compared with the previous input method. The speed of his head movements during typing reduced (p?<?.01), and his sitting posture was nearly upright during computer operation (p?<?.01). No involuntary movement, requiring physical assistance, was observed when using the wearable switch.

Conclusion: The new switch system can be a new option for people with difficulty using standard handheld input devices due to paralysis and involuntary muscle movements.

• Implications for rehabilitation

• Cerebral palsy is a major cause of motor dysfunction and spasticity and dyskinesia in the fingers and upper limbs may prevent children with cerebral palsy from using handheld input devices.

• Wearable devices may be useful for children with cerebral palsy who have limited access to handheld pointing devices.

• We developed a new wearable switch to control devices using a flexible stretchable sensor.

• The wearable switch contributed to the improvement of sitting posture and reduction of neck burden during the typing task at the speed equivalent to that using the previous method in a child with mixed type of cerebral palsy exhibiting choreoathetotic movements and bilateral spasticity.

     

Stem cells treatment for sciatic nerve injury

Introduction: Sciatic nerve injury is common and usually results in degeneration of the distal axons and muscle denervation. Chronic muscle atrophy and fibrosis limit the recovery of muscle function and severely compromises efforts to restore muscle function. Despite early diagnosis and modern surgical techniques there is still poor functional recovery.

Areas covered: Stem cell transplantation has been investigated as a promising treatment strategy for peripheral nerve injury, and has demonstrated utility in limiting neuronal damage. The focus has been on the isolation of stem cells from bone-marrow and adipose tissue in addition to embryonic and neuronal stem cells. Transplantation of these cells into transected sciatic nerve in animal models demonstrates clinical improvement, inducing vigorous nerve regeneration accompanied by myelin synthesis. Cell replacement, trophic factor production, extracellular matrix molecule synthesis, guidance, remyelination, microenvironmental stabilization and immune modulation have been postulated as possible mechanisms for stem cell implantation.

Expert opinion: Although further research is still needed, this therapeutic approach will probably become a routine treatment technique in the coming years, especially with bone marrow mesenchymal stem cells. We believe that the most promising results were noted for the use of stem cells of this origin in the treatment of sciatic nerve injury.     

糖尿病足患者足底神经CT形态特点及其临床意义

目的 分析前交叉韧带（ACL）重建术后所致滑膜增厚的关节病变,比较关节感染与粘连的MRI征象差异。方法 回顾性分析25例ACL重建术后滑膜增厚患者临床及MRI资料,诊断均经关节镜等检查证实,其中11例关节感染,14例关节粘连,与首次关节镜下ACL重建术的时间间隔分别为0.3~2.5个月、6~19个月。结果 MRI滑膜增厚病变分别为关节感染和关节粘连。关节感染MRI征象除滑膜增厚外,还可见关节中至大量积液、软组织不同程度肿胀、股骨远端及胫骨近端骨髓水肿、ACL假体纤维连续（5例表现为信号增高）以及骨道假性增宽（5例）。术后关节粘连MRI征象除滑膜增厚外,还可见部分增厚滑膜内见条带状短T2信号,主要累及髌上囊、内外侧隐窝、髌下脂肪垫、髁间窝等部位,关节无或仅见少量积液,ACL假体均连续,3例表现为假体信号增高、边缘毛糙,骨道均无明显增宽。在关节感染与关节粘连间,关节积液、软组织肿胀、骨髓水肿、骨道假性增宽各征象差异有统计学意义（P均<0.05）。结论 关节感染主要表现为滑膜增厚、关节积液,关节腔呈高信号,而关节粘连表现为滑膜增厚、关节腔呈等/稍高信号;关节感染主要发生于术后早期,关节粘连主要发生于术后中晚期。     

Bilateral musculocutaneous neuropathy: A case report

BACKGROUNDIsolated musculocutaneous nerve injury is a rare condition. Herein, we report the first case of bilateral musculocutaneous neuropathy after vigorous stretching of both upper extremities with normal results of sensory nerve action potential. Clinicians should be aware of this rare condition that can appear bilaterally. In addition, the interpretation of the aberrant electrodiagnostic study results of this case was discussed.CASE SUMMARYA 29-year-old male complaining of bilateral forearm tingling and upper extremity weakness visited the outpatient clinic. The symptoms began 6 mo prior, and he visited another hospital before visiting our department. The diagnosis was not made even after cervical spine magnetic resonance imaging, electrodiagnostic study, brain magnetic resonance imaging, and arteriography were conducted. The patient performed unique exercises that stretched the pectoralis minor and coracobrachialis muscles. On the follow-up electrodiagnostic study, abnormal spontaneous activities in the bilateral biceps and brachialis muscles were observed. The patient was diagnosed with bilateral musculocutaneous neuropathy. Steroid pulse therapy was administered for approximately 6 wk. After treatment, his muscle strength returned to the predisease condition.CONCLUSIONClinicians should be aware of this condition, have adequate understanding of anatomy, and advise to correct inappropriate exercises.     

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.     

Corrigendum to “Effects of laser acupuncture in a patient with a 12-year history of facial paralysis: A case report” [Complement. Ther. Med. 43 (April) (2019) 306–310]

BackgroundTraumatic facial palsy, whether accidental or iatrogenic, is a common cause of facial paralysis. Laser acupuncture therapy (LAT) is a non-invasive, pain-free method to stimulate traditional acupuncture points with non-thermal laser irradiation. Low-level laser therapy has proven beneficial in the regeneration of peripheral nerves. This case report describes the feasibility of this innovative treatment in a patient with a 12-year history of traumatic facial palsy and severe sequelae.Case summaryA52-year-old male presented with a severe left-sided facial paralysis that had lasted for 12 years. At initial presentation, the man could not fully close his left eye and had difficulty eating solid foods. The paralysis of his left-sided facial muscles had resulted in dysarthria. He was administered 30 LAT sessions in the Acupuncture Department of China Medical University Hospital, Taichung, Taiwan, over a 4-month period. His recovery was monitored by scores on the Facial Disability Index, the Sunnybrook Facial Nerve Grading System and measurements of the vertical palpebral distance in his left eye. Photographs were taken after every treatment. On the 10^th treatment, a change in closure of the left eye was noticed and facial muscle strength was improved. After 22 treatments, the patient could fully close his left eye.ConclusionLAT significantly improved the sequelae of long-term facial paralysis in this patient. Large-scale prospective studies are needed to confirm this observation.     

Speech production,intelligibility and oromotor function in seven individuals with Möbius sequence

Abstract

Purpose: Möbius sequence is a rare disease characterized by congenital facial and abducent nerve palsy. Other cranial nerves may be affected. Cleft palate, intellectual disability and neuropsychiatric disorders are associated with the diagnosis. The aim was to explore speech production, intelligibility and oromotor function in a group of individuals with Möbius sequence.

Method: Three children (5–11 years) and four adults (26–54 years) were recruited to the study via the Swedish Möbius syndrome association. In addition to cranial nerve dysfunction, two had a hearing impairment, one Asperger syndrome and one a cleft palate. Perceptual assessments included an evaluation of intelligibility in single words and spontaneous speech, the percentage of phonemes correct (PPC) and screening of orofacial functions (NOT-S). Objective measurements were used for the evaluation of nasality, lip force and tongue force.

Result: Three individuals had severely impaired intelligibility, two slightly impaired and two had fully intelligible speech. The PPC varied between 59.3–100%. Five individuals had bilateral facial palsy, two unilateral facial palsy and six tongue impairment. One had a slightly increased nasalance score. Compensatory strategies were being effectively used.

Conclusion: This case series contributes more in-depth knowledge of speech production, intelligibility and oromotor function in this rare condition.     

Fatal ischemic stroke following Tityus serrulatus scorpion sting in a patient with essential thrombocythemia

Context: Stroke following scorpion stings is rare. We report a fatal envenomation involving multiple, extensive brain infarcts in a patient with a previous diagnosis of essential thrombocythemia (ET) who was stung by Tityus serrulatus (T. serrulatus).

Case details: A 44-year-old woman with a diagnosis of low-risk ET (platelets <1,000,000/mm³, age <60 years and no history of thrombosis; positive JAK2V617F mutation) was admitted to a local ED 1?h after being stung by T. serrulatus on the left foot. She developed signs of severe envenomation, including several episodes of profuse vomiting, pallor and confusion soon after the sting, followed by shock (BP: 90/60 to 60/40?mmHg) and was treated with scorpion antivenom, vasopressors and mechanical ventilation. A brain computed tomography (CT) scan (54-h poststing) revealed diffuse bilateral cerebellar hypodensity, with partial involvement of both occipital lobes and thalamus, obstructive hydrocephaly with signs of cerebrospinal fluid extravasation, and ascending transtentorial herniation, suggestive of bilateral ischemia involving the posterior cerebral circulation. External ventricular drainage resulted in no improvement and brain death was confirmed on day 10.

Discussion: Several mechanisms have been proposed to explain stroke following scorpion stings, such as sympathetic stimulation, myocardial dysfunction, hypotension/shock, arrhythmias and coagulopathy. Ischemic stroke is one of the most serious complications of ET. The risk factors for thrombotic/ischemic events in patients with ET include age (≥60 years) and previous vascular events. Severe scorpion envenomation resulting in myocardial dysfunction and systemic inflammatory response syndrome may increase the overall risk of arterial thrombosis in this patient.