Differential diagnosis of atypical focal peripheral neuropathy: Case report

Carpal tunnel syndrome (CTS) is the most frequent form of focal peripheral neuropathy but is commonly misdiagnosed. The aim of this case report was to describe the differential diagnosis of CTS and atypical focal peripheral neuropathy in a 34-year-old female. Although the patient's medical diagnosis was CTS, she did not report night pain, did not exhibit hand atrophy, had no sensory loss, did not meet the five criteria of the clinical prediction rule for CTS, and demonstrated symptoms associated with radial and median nerve pain. The patient's concordant symptoms were associated with wrist passive accessory stiffness and functional activities that required repetitive end range movements. Interventions included treatment of two priority impairments: 1) pain and 2) wrist accessory stiffness. After five treatments, the patient no longer reported pain with activities and was able to return to work with no restrictions. Although the patient in this case report exhibited isolated features consistent with CTS, compelling cumulative evidence suggested a distinct diagnosis. Limited evidence exists to support the use of mobilization, strengthening, and pain reduction-based modalities for the treatment of focal peripheral neuropathy; subsequently, treatments must be individually effective when targeted toward the patient's priority impairments. The diagnosis of CTS is challenging because there are a variety of possible clinical presentations. Using evidence-based indices, such as the clinical prediction rule for CTS and other comparative history and physical measures, should improve the likelihood of accurate diagnosis and treatment.     

抗髓鞘相关糖蛋白抗体阳性IgM相关性周围神经病1例报告

<正>抗髓鞘相关糖蛋白（myelin-associated glycoprotein, MAG）抗体阳性IgM相关性周围神经病（peripheral neuropathy,PN）在临床并不常见，易被漏诊或误诊为其他PN或M蛋白相关性疾病。现将我科收治的1例抗MAG抗体阳性PN患者诊治情况报告如下，以提高临床医师对该病的认识。     

超声诊断糖尿病周围神经病变

目的 探讨超声在糖尿病周围神经病变(DPN)诊断中的应用价值。方法 收集我院DPN患者40例(DPN组),选取正常对照30名(正常对照组),观察两组坐骨神经、腓总神经、胫神经的连续性和神经内部回声,测量并比较两组神经的前后径(D₁)和横径(D₂),并计算横截面积(CSA)。结果 正常对照组神经纵断面声像图呈束条状高或中等回声,内含多数平行、被高回声分开断续的线状低回声;横断面呈圆形、卵圆形高回声,其内分布细点状低回声。DPN组表现为受累神经肿大、增粗,内部回声减低,神经内平行线状结构消失。DPN组坐骨神经、腓总神经、胫神经的D₁、D₂、CSA均较正常对照组明显增加,差异均有统计学意义(P均<0.01)。结论 超声能够清晰显示DPN患者受累神经结构、位置以及病变范围,对DPN有较高的诊断价值,并可指导临床选择治疗和手术方案。     

超声诊断糖尿病局限性胫神经病变1例

<正>患者女,70岁,自诉4 d前无明显诱因下出现于右下肢(右大腿外侧、右小腿前方)疼痛、麻木,疼痛为针刺样,疼痛感从下向上传,间断性发作,约2 h发作一次,行走时症状减轻,休息平卧时症状加重,无腰背部疼痛,无头晕、恶心,无腹痛、腹泻。自行保守治疗后症状缓解不明显。体格检查:腰背部无明显压痛、叩痛,腰椎活动度可,右下肢皮肤未见静脉曲张和色素沉着,皮肤结构完整,未见破溃及流脓。双下肢足背动脉及胫前动脉波     

Differential diagnosis of shoulder and cervical pain: a case report

Patients are frequently referred to physical therapy with the diagnosis of shoulder and arm pain. During examination and evaluation of the patient, the physical therapist must consider all potential causes of the patient’s symptoms. Three questions are used as the conceptual basis for a diagnosis-based clinical decision rule in the management of mechanical and non-mechanical musculoskeletal pain when addressing the differential diagnosis of a patient’s condition. This single patient case report describes the use of these three questions in the differential diagnosis of shoulder and arm pain. A 44-year-old male was referred with a diagnosis of shoulder impingement syndrome. Each of the three questions for differential diagnosis was addressed, and clinical tests and examination findings were used to differentiate the origin of the patient’s symptoms. The intervention provided is outlined along with the patient’s response to the different treatment strategies provided. This case identifies the need for a systematic method of differential diagnosis so that patients are appropriately managed.     

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.     

超声诊断不典型痛风并评估疗效一例

正患者,男性,47岁,双手近端指间关节、掌指关节、双腕关节、双踝关节肿痛10年余,曾诊断为"类风湿关节炎(rheumatoid arthritis,RA)",间断服用甲氨蝶呤、泼尼松以及非甾体类抗炎药等缓解疼痛,效果不佳。于2018年9月因突发脑梗死于唐山市工人医院神经内科住院治疗,住院期间全身多关节肿痛加重,伴高烧,经多种     

The effects of dry needling and neurodynamic exercise on idiopathic peripheral neuropathy: A case report

A single patient (male, 67) with a medical diagnosis of idiopathic peripheral neuropathy (G60.9) was referred to physical therapy. The patient presented with signs and symptoms consistent with peripheral neuropathy, including bilateral single leg balance deficits, sensation impairments, and antalgic gait. Treatment consisted of dry needling (DN) with electrical stimulation and a home exercise program involving a neurodynamic exercise to be performed daily. Dry needling included the use of thin filiform needles to stimulate the underlying structures directed at eliciting a change within the tissues. The needles were left in situ and connected to an electrical stimulation unit. The neurodynamic exercise used in this case study was designed to target the distal branches of the sciatic nerve. The patient was directed to complete 3 sets of 10 repetitions in the slumped position and moving between ankle plantar flexion and dorsiflexion. The patient was treated for a total of 4 visits over a 5-week period. The Foot and Ankle Ability Measure (FAAM), Numeric Pain Rating Scale (NPRS), Romberg Test, and sensation testing were collected at baseline and then again after the 4th treatment. A Global Rating of Change (GROC) score was obtained at the end of treatment. After the 4th visit, functional self-report scores were not improved (93.75%–86.9% at completion), while NPRS decreased to 2 from a baseline rating of 4. The eyes closed portion of the Rhomberg balance test improved from 5 s on the right limb to 15 s and from 8 s to 20 s on the left limb. Sharp/dull sensation testing of the L4 dermatome also improved from 2 out of 5 correctly selected on the left lower limb to 5 out of 5. At the S1 level, sensation improved on the left lower limb from 2 out of 5 to 4 out of 5 and from 2 out of 5 on the right lower limb to 5 out of 5. The patient's GROC score was rated as quite a bit better (+5). The outcomes of this case study suggest that clinicians may consider the addition of DN with electrical stimulation and neurodynamic exercises to the treatment of this patient population given the sizeable and rapid improvements in pain, balance, and sensation testing following only 4 treatments.     

超声诊断不典型肝包虫病1例

患者女,38岁,以"义诊时超声检查发现肝脏包块"入院.患者来自肝包虫流行区,有牛、羊、犬密切接触史,无不适主诉.入院查体无阳性发现.     

传染性非典型肺炎--附首例报告

目的：报道广州呼吸疾病研究所处理首例传染性非典型肺炎的临床诊断和治疗经验。方法：回顾性分析该例的临床资料及治疗经过。结果：该病人有2个多月呼吸道疾病失，病情突然加剧，表现为间质性肺炎及急性呼吸窘迫综合征，白细胞计数基本正常，但淋巴细胞比例偏低，经多种抗生素治疗无明显疗效。使用肾上腺皮质激素及机械通气等对症治疗78日痊愈出院。8位医护人员被感染。结论：该例为传染性非典型肺炎，起病突然及病情发展凶险，可能为一种新病原体感染，值得引起重视。     

A case of 5-fluorouracil-induced peripheral neuropathy

The standard adjuvant therapy for rectal cancer is 5-fluorouracil (5-FU) often combined with radiotherapy. Well-documented side effects of 5-FU include nausea, vomiting and diarrhoea, leukopenia and thrombocytopenia, hand-foot syndrome, mucositis, and cardiotoxicity. Peripheral neurotoxicity has only rarely been reported. We report a patient with a stage II rectal carcinoma who developed a mild axonal sensorimotor neuropathy at the end of a 5-FU therapy.     

Pure trigeminal motor neuropathy: a case report

Pure trigeminal motor neuropathy is a trigeminal motor paralysis unaccompanied by signs of trigeminal sensory or other cranial nerve involvement. We present a case of a 38-year-old man complaining of progressive weakness and wasting of the right masticatory muscles after a bout of mild cold symptoms. No sensory symptoms were present. History, neurologic examination, electrophysiologic studies, and magnetic resonance imaging of the brain led to the diagnosis of pure trigeminal motor neuropathy. The cause may have been an autoimmune reaction to a viral infection.     

Mental nerve neuropathy: case report and review

Mental nerve neuropathy (MNN) or "numb chin syndrome" is a rare neurologic symptom most often associated with malignancy. Patients typically develop paresthesia or numbness localized to the chin and lower lip and will often seek care at their local emergency department. Pain and expansion of the lower jaw may also be present. We report a case of MNN associated with a metastatic lesion in the mandible. The purpose of this article is to highlight the importance of recognizing MNN, a potentially life-threatening symptom of metastatic carcinoma, and enable clinicians to properly diagnose MNN, which may mimic other conditions that affect the mandible.     

Mycophenolate mofetil‐induced peripheral neuropathy in the treatment of membranous glomerulonephropathy: A case report

Mycophenolate mofetil (MMF) as an immunosuppressive agent is widely used in the management of Membranous Glomerulonephropathy (MGN). In this report, we described a 66‐year‐old male MGN case treated with MMF and revealed acquired sensory‐motor axonal polyneuropathy, which is rare and has not been reported before.     

Myositis ossificans causing ulnar neuropathy: a case report

Myositis ossificans (MO) can compress peripheral nerves and cause neuropathy. We herein describe a patient with ulnar neuropathy caused by MO at the medial elbow. A 28-year-old man with a drowsy mentality and multiple organ damage following a traffic accident was admitted to our hospital. After 3 weeks of postoperative care, the patient’s mental status recovered. However, he complained of severe sharp pain in his left medial forearm and fourth and fifth fingers. He exhibited weak fifth finger abduction and wrist adduction. Severe elbow joint pain was elicited during range-of-motion testing of his left elbow. Ultrasound also showed an edematous, enlarged, hypoechoic ulnar nerve lying above the MO, and the MO outwardly displaced the ulnar nerve. Elbow radiographic examination, computed tomography, and magnetic resonance imaging revealed MO development and compression of the left ulnar nerve. The patient underwent surgery; the following day, his left medial forearm pain completely disappeared with slight improvement in the motor weakness of fifth finger abduction. Ultrasound is a useful tool to easily evaluate the presence of MO and compression of peripheral nerves caused by MO.     

HIV相关性周围神经病诊治进展

周围神经病是人类免疫缺陷病毒（human immunodeficiency virus, HIV）感染者最常见的神经系统疾病,临床表现以远端对称性周围神经病、急性炎症性脱髓鞘性多发性神经病或慢性炎症性脱髓鞘性多发性神经病及多发性单神经病最为常见,严重影响患者的生活质量。本文旨在通过分析HIV相关性周围神经病（HIV peripheral neuropathy,HIV PN）的病理生理变化及发病机制,深入了解HIV PN的临床表现,总结其诊治经验,从而指导临床医师正确认识、合理预防、规范诊治该病。