Ophthalmic herpes zoster with contralateral hemiparesis: a case report

Summary Neurological complications following rubella are only rarely encountered. However, in many cases severe neurological impairment may occur, leading to permanent disability. In a recent epidemic of rubella in Israel during the years 1978–1979, 20 patients with severe neurological complications have been seen. We report on 5 cases of which 3 are described in detail. Considering the efficacy of immunization against rubella, we suggest that in countries such as England and Israel in which periodic epidemics of rubella occur, a generalized plan of immunization should be undertaken during the first years of life. Such an approach will prevent the neurological complication of congenital, as well as acquired, rubella infection.

---

Zusammenfassung Obwohl neurologische Komplikationen nur selten nach Rubella erscheinen, sind sie in vielen Fällen schwer und können zu permanenten neurologischen Schäden führen. In einer Rubella-Epidemie, die kürzlich in Israel auftrat (1978–1979), wurden 20 Fälle von schweren neurologischen Komplikationen festgestellt. Wir berichten über 5 dieser Fälle, 3 von ihnen in ausführlicher Weise. Nachdem Rubella-Impfung sehr wirksam ist, schlagen wir vor, daß in Ländern wie Israel oder England, in denen Epidemien von Zeit zu Zeit auftreten, ein allgemeiner Impfungsplan für die ersten Lebensjahre eingeführt wird. So ein Plan kann die neurologischen Komplikationen nach kongenitaler oder erworbener Rubella verhindern.

     

Acute and subacute myelopathy

Myelopathy is a term referring to any pathologic process affecting the spinal cord, and encompasses a broad spectrum of etiologies. The first step is to categorize myelopathy, according to the time to reach maximum deficit. Myelopathies are commonly classified as acute, subacute or chronic, for which the etiologies are totally different. Myelopathy is considered acute when the symptoms progress to their nadir in maximum 21 days after onset. Due to heterogeneity in pathogenesis, and the overlap in the clinical and imaging presentation among etiologies, acute myelopathy is considered as a diagnostic dilemma. A simple and efficient algorithm for timely identification of the underlying cause is thus useful. In this review, we provide a simplified approach for the differential diagnosis among all causes of acute myelopathies, and describe the principal clinical and imaging features of the main etiologies in adults, including recently characterized antibody-mediated myelitis, and its mimics.     

Case series of two patients with Fibrocartilaginous Embolism mimicking Transverse Myelitis of the Spinal Cord

Fibrocartilaginous Embolism (FCE) refers to the extrusion of some of the fibro-cartilaginous nucleus pulposus material from within the inter-vertebral disc to eventually embolize into one of the spinal cord vessels with resultant spinal cord infarction. According to a 2016 review, AbdelRazek et al. (2106) [1] there are 41 pathologically confirmed and 26 clinically suspected cases in the literature till the end of 2015. We add two more clinically diagnosed cases.     

Intractable hiccup caused by spinal cord lesions in demyelination disease

Abstract

Objective

This study aimed to summarize the clinical features of patients who presented intractable hiccup (IH) without brain and medulla oblongata (MO) lesions.

Method

This study included six patients who were diagnosed with inflammatory demyelinating myelitis, categorized as neuromyelitis optica (NMO), multiple sclerosis (MS), and myelitis. Patients who presented IH with cervical lesions but without MO lesions were also included. Clinical profiles, laboratory data, and magnetic resonance imaging findings were analyzed.

Results

Three out of six patients were diagnosed with NMO, whereas the remaining three were diagnosed with acute myelitis, recurrent myelities, and MS, respectively. The duration of hiccup was from 2 to 23 days (average = 9.33 ± 8.64 days). Five patients (83.33%, patients 1–5) had long segmental lesions and one had a patchy lesion. None of these patients had any MO lesions. Half of them were successfully treated with high-dose methylprednisolone combined with gamma-aminobutyric acid (GABA) inhibitor.

Conclusion

IH occurred in patients without MO lesion. However, the mechanism remained unclear. Immune factors of demyelinating neuropathy stimulated the hiccup reflex arch. Cervical cord lesions may activate the hiccup center. In general, IH can be controlled by IVMP combined with GABA inhibitor. Unilateral phrenic nerve block may elicit no effect.     

儿童急性非特异性脊髓炎临床特点及预后

目的 总结儿童急性非特异性脊髓炎的临床特点,分析影响疾病预后的相关因素.方法 收集2003年1月至2012年12月于重庆医科大学附属儿童医院新诊为急性非特异性脊髓炎的75例患儿临床资料,总结疾病临床特点,在部分病例预后随访的基础上,对可能影响预后的危险因素采用SPSS 19.0软件行统计学分析,探讨疾病预后不良的相关因素.结果 本组患儿中,男37例,女38例,发病年龄有两个集中段,分别为1～4岁及9～13岁.75例(100.0％)患儿均有不同程度的肢体瘫痪,以截瘫最多见(62.7％,47/75例);44例(59.0％)伴感觉功能异常,39例有确切的感觉平面;60例(80.0％)有二便功能障碍;38例(50.7％)伴根痛,7例(9.3％)病程中出现球麻痹症状,50例(66.7％)病初1周内伴发热.70例患儿行脊髓磁共振成像(MRI)检查,61例提示信号异常,均有T2相长信号改变.40例成功随访患儿中,预后良好者32例,预后不良者8例.与预后不良相关的因素有发生脊髓休克(P=0.001)、脊髓休克持续时间≥2周(P=0.015)、极期神经功能缺损评分低[(9.25±0.89)比(14.03±2.87),P=0.000]、极期≥12 d(P =0.004)、疾病达峰时间≤24 h(P=0.029)、病初发热(P =0.029)以及女性(P=0.021).结论 急性非特异性脊髓炎以肢体瘫痪为主要表现,二便障碍较感觉异常发生率更高,部分患儿病程中可出现球麻痹表现,脊髓MRI检查常有T2相长信号改变.同时,临床工作中应早期识别本病的预后不良因素,以便对个体预后进行初步评估并指导临床治疗.     

Clinical Application of Moxibustion on Guanyuan （CV 4）

Guanyuan （CV 4） is located 3 cun below the umbilicus, on the midline of abdomen. It is the Front-Mu Point of the Small Intestine, a crossing point of Three Yin Meridians of Foot and Conception Vessel. It can warm the kidney to invigorate yang, tonify the Yuan-Primordial qi, dredge and regulate Thoroughfare and Conception Vessels,     

广州管圆线虫病患者头颈部MR检查

目的 分析广州管圆线虫感染人体后有症状患者的头颈部MRI表现.方法 对74例有症状患者进行MRI和CT检查.MRI检查包括常规T1WI、T2WI、T2-FLAIR序列以及静脉注射钆对比剂后T1WI增强扫描.脑部CT检查均为平扫, 分析CT和MRI所见.对影像表现异常的患者,MR 随访1~3次.结果 33例患者MRI表现异常,包括单纯软脑膜异常强化17例,单纯脑实质异常信号3例,单纯脊髓异常信号1例,脑实质与软脑膜同时受累11例,脊髓与软脊膜同时受累1例.脑实质与脊髓内病变多表现为长T1、长T2信号,灶性分布;T1WI增强扫描时病灶多呈结节状强化.5例脑实质和脊髓的长T1、长T2异常信号无强化表现.结论 头颈部MRI检查有助于了解中枢神经系统广州管圆线虫病的病变程度,但绝大多数MRI所见缺乏特征性.     

24例急性脊髓炎病人的护理对策

目的：帮助患者了解本病的各种护理问题,提高救治成功率。方法：运用护理程序对病人及家属进行生理、心理方面的评估,分析发现护理问题、制定护理计划并实施。结果：病人功能恢复良好,治愈好转率83.3%。结论：预防各种并发症,做好全方位护理工作,可降低病死率,有助于病情转归。