Neurological complications of herpes zoster

We report 31 cases of herpes zoster (HZ) with neurological complications: 14 with cranial nerve deficits, 1 with cranial nerve deficit associated with segmental motor disorder, 3 with segmental motor, deficits, 2 with meningoencephalitis, 2 with meningoencephalitis associated with cranial neuropaty or myelitis, 2 with meningitis, 2 with hemiplegia contralateral to the ophthalmic HZ, 1 with hemiplegia and motor deficit and finally 1 with hemiplegia and a cranial neuropathy. Smoking was the putative risk factor in 53% of our patients together with diabetes, which has already been mentioned in the literature. We frequently observed more than one complication in succession (19.3%) that could not easily be related to the cutaneous distribution. Acyclovir had no demonstrable positive effects on neurological complication in our patients.

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Sommario Riportiamo 31 casi di HZ complicato: 14 casi di deficit di nervi cranici, 1 caso con deficit di un nervo cranico più deficit di moto segmentario, 3 deficit di moto, 2 meningo-encefaliti, 1 meningo-encefalite con deficit di un nervo cranico ed 1 complicata da mielite, 2 meningiti, 2 mieliti, 2 emiplegie controlaterali a HZ oftalmico, 1 emiplegia controlaterale più deficit motorio ed 1 con deficit di nervo cranico. Come possibile fattore favorente le complicazioni proponiamo il fumo di sigaretta (presente come unico elemento nel 53% dei pazienti), oltre al diabete già menzionato in numerose casistiche. Molto frequenti nella nostra casistica le associazioni di più complicazioni diverse in successione temporale (19,3%) anche non facilmente spiegabili in senso topografico. Non dimostrabile nei nostri pazienti l’influenza positiva della terapia con acyclovir.

     

γ-Aminobutyric acid-induced potentiation of cortical hemiplegia

A novel model of hemiplegia in young and aged rats is described. Osmotic minipumps were used to deliver a chronic (7 days), localized application of γ-aminobutyric acid (GABA) (100 μg/μl/h), to the somatomotor cortex of unrestrained rats. This resulted in an easily quantifiable, contralateral and reversible motor syndrome in both young and aged animals. In the young group, the motor deficit cleared over a 5-day period, while in the aged animals it persisted for at least a 2-week period. Control animals treated with saline-filled minipumps did not develop a long-lasting motor deficit. The GABA-induced facilitation of hemiplegia due to small motor cortex lesions and the age effects on behavioral recovery of function are discussed. Cortical inhibitory mechanisms may play a role in debilitating syndromes such as stroke or post-epileptic paralysis.     

Focal brain dysfunction in a 41-year old man with familial alternating hemiplegia

The acute pathophysiologic changes during hemiplegic spells and the long-term outcome of alternating hemiplegia remain obscure. In a 41-year-old male with familial alternating hemiplegia we found an increase in right frontal cerebral blood flow 3 h into a 5-h left hemiplegic episode. A repeat high-resolution brain SPECT study performed 26 h after the resolution of the left hemiplegia revealed normalization of the frontal blood flow accompanied by hyperperfusion in the right parietal lobe. An interictal SPECT scan several weeks later showed no asymmetries. Head CT and MRI scans were negative. Neuropsychologic assessment and neurologic examination revealed evidence of a diffuse disorder which predominantly involved the right hemisphere. To our knowledge, there are no previous correlative studies of serial highresolution brain SPECT with MRI, or of detailed neuropsychologic assessment, in adult patients with such an advanced course of alternating hemiplegia of childhood.     

Ipsilateral Hemiplegia in a Lateral Medullary Infarct– Opalski''s Syndrome

A 42-year-old man was admitted complaining of the sudden onset of headache, vomiting, vertigo, and gait disturbance. The authors found hemiparesis of his right limbs, right Homer's syndrome, and decreased pain and temperature sensation of his right face and left limbs. Diffusion-weighted imaging (DWI) showed an acute small infarct located on the right side of the lateral lower medulla. This is the first report of Opalski's syndrome with lower medullary infarction detected by DWI.     

抗痉挛治疗对脑卒中偏瘫患者肢体功能恢复的疗效分析

目的探讨抗痉挛治疗对偏瘫肢体运动功能的影响。方法40例脑卒中偏瘫患者均采用以促通技术为主的神经肌肉再训练方法进行训练,并对治疗前后状态进行比较。结果瘫侧上下肢运动功能均有不同程度的改善,显效率上肢达47.5%,下肢达60%;有效率上肢达95%,下肢达97.5%。训练前后存在显著性差异(P<0.01)。结论抗痉挛治疗是促进肢体运动功能恢复的有效途径。     

家属康复教育对脑卒中偏瘫病人生活质量的影响

目的探讨予家属实施康复教育后对脑卒中偏瘫病人生活质量的影响。方法将98例脑卒中偏瘫病人随机分为2组,即康复教育组（观察组）和常规护理组（对照组）。康复教育组除行神经内科常规护理外,还教会家属康复训练方法,由家属一对一地指导病人康复训练。对照组仅给予神经内科常规护理。采用生活质量评定量表对病人进行护理前后评定。结果康复教育组病人生活质量较对照组明显提高（P〈0.01）。结论对家属进行康复教育,让家属指导病人康复训练,能使康复护理更具有针对性、规范性,从而提高病人的生活质量。     

三位一体化的健康教育方式在脑卒中偏瘫患者中的应用

目的：评价三位一体化健康教育方式对脑卒中偏瘫患者运动功能恢复的影响。方法：将59例诊断为脑卒中的患者按入院时间顺序分为干预组（30例）与对照组（29例）。干预组患者实施三位一体化健康教育方式,对照组采用常规的健康教育方式及发放健康教育手册。于患者出院后的3、6个月分别评价其日常生活活动能力、肢体功能运动状态。出院后第六个月评估患者的肌力情况。结果：干预后患者日常生活活动能力、肢体运动功能状态指标及肌力优于对照组,差异具有统计学意义（P＜0.05）。结论：应用三位一体化健康教育方式能够提高患者日常生活活动能力、提高患者上下肢肌力和有效的改善脑卒中偏瘫患者运动功能。     

表面肌电在脑卒中患者肢体功能障碍评价中的意义

摘要 目的：探讨表面肌电图评定脑卒中偏瘫患者肢体功能障碍的临床应用价值。 方法：计算机检索中国生物医学文献数据库、万方、维普等中文期刊,MEDLINE、EMBASE等英文期刊,利用纳入、排除标准对所收集文献进行筛选。采用RevMan 5.0软件进行Meta分析。 结果：8篇文献纳入研究。综合效应量：协同收缩率（CR）WMD=17.31,95%CI 5.78—28.84,P＜0.01;力矩WMD=-10.95,95%CI -13.40—-8.51,P＜0.00001。 结论：表面肌电图客观定量评价脑卒中偏瘫患者肢体功能状况,指导其临床康复。