Muscular atrophy and weakness in the lower extremities in Behçet’s disease: A case report and review of literature

BACKGROUND In Behçet’s disease(BD),very few cases of muscular involvement have been reported previously.The natural history and therapeutic protocol for muscular involvement in BD are obscure due to the low incidence of peripheral neuropathy or myopathy in BD.The purpose of our study was to report a rare case of BD with chronic,focal forms of neuromyopathy and review the relevant literature.CASE SUMMARY We herein report the case of a 54-year-old man who presented with progressive muscular atrophy and weakness of both thighs 2 years after the presentation of the cardinal symptoms of BD.The past medical history,electrophysiological study,neurological examination,blood tests,magnetic resonance imaging study,and histological exam were performed for the differential diagnosis.Relevant literature on muscular involvement in BD was reviewed.Neurological examination revealed that muscular involvement was predominantly localized in the proximal parts of the lower extremities.Heterogeneous enhancement of several thigh muscles was observed on magnetic resonance imaging,which corresponded with the clinical manifestations.Histological study of one of the enhanced muscles showed denervation atrophy of the muscle with superimposed myopathic changes,while electrophysiological studies only suggested denervation.CONCLUSION To our knowledge,this is the first case of neurogenic muscular atrophy with a specific set of clinical,radiological,electrophysiological,and histological findings reported in BD.

Iatrogenic giant pseudomeningocele of the cervical spine:A case report

BACKGROUND Only a few cases of giant pseudomeningoceles have been reported in the literature.Herein,we report a giant pseudomeningocele of the cervical spine that was found after cervical laminectomy for an epidural hematoma following epidural blockade.CASE SUMMARY A 47-year-old man presented with recurrent neck pain and posterior neck swelling after spinal surgery.Magnetic resonance imaging of the cervical spine revealed fluid collection(5.6 cm×6.6 cm×11.2 cm)at the C3-6 level;this proved to be a pseudomeningocele.Symptoms related to the pseudomeningocele resolved following dural repair and fat graft transplantation.CONCLUSION Although rare,pseudomeningocele is a possibility in patients with recurrent back pain,radicular pain,or a persistent headache following spinal surgery.Continuous attention should be paid throughout the spinal procedure,whether conservative or non-conservative.

Review on the characteristics of liver-pacifying medicinal in relation to the treatment of stroke: from scientific evidence to traditional medical theory

OBJECTIVE: To analyze the characteristics of liver pacifying medicinal in the treatment of brain disease to provide scientific evidence in clinical usage on stroke.METHODS: MEDLINE/Pub Med, Google Scholar,and China National Knowledge Infrastructure Database were used as the literature sources. The Scientific name, Latin pharmaceutical name,Chinese name of 7 kinds of liver pacifying medicinal including Gouteng(Ramulus Uncariae Rhynchophyllae cum Uncis), Tianma(Rhizoma Gastrodiae), Juemingzi(Semen Cassiae Obtusifoliae),Quanxie(Scorpio), Wugong(Scolopendra), Jiangcan(Bombyx Batryticatus), and Dilong(Pheretima Aspergillum) were used as the keywords to search the databases for relevant publications up to July2016. Their major compounds were also used as the keywords. The papers were selected based on the pharmacological activities and mechanisms of action related to brain diseases and subsequently,were analyzed and reviewed. We first described the origin, efficacy, and clinical indications of selected medicines, then brain disease specific activities focusing on stroke after the description of the general pharmacological activities.RESULTS: On the basis of the literature of scientific studies and clinical use in traditional medicine, we found and discussed the characteristics of liver pacifying medicinal in stroke treatment. First, liver-pacifying medicinal,or their components, might pass through the blood-brain barrier and act directly on neurons or on the neural network to provide protective effects against brain disease. Second, although it could be used throughout the disease duration,treatment of stroke might be more effective from the subacute up to the convalescent phase than the acute phase.CONCLUSION: We can suggest that live pacifying medicinal has beneficial pharmacological activities directly or indirectly on neurons in brain disease and is useful for the treatment of stroke from subacute to convalescent phase.