Development of Unilateral Piriformis Syndrome in a Female with Congenital Leg Length Discrepancy

Background: This is a rare case of piriformis syndrome. We discuss the patient’s symptoms, imaging study results, laboratory examination findings, and prescribed treatment in an attempt to determine the possible mechanisms or reasons for this patient’s development of piriformis syndrome. Methods: The patient is a 22-year-old female soldier who was admitted for lower back pain with soreness radiating to her right buttock and right lower extremity. We found that she had leg length discrepancy under X-ray finding. She was diagnosed piriformis syndrome by physical examination and Magenetic Resonance Image. Results: We performed scanography for lower extremities revealed a left femur length of 42.7 cm, a right femur length of 43.3 cm, a left tibia length of 33.2 cm, and a right tibia length of 33.6 cm;her left lower extremity was 1 cm shorter than her right. The MRI of sacrum also reveals hypertrophy of right piriformis muscle. Conclusions: Piriformis syndrome might be caused by short-term compensation in congenital leg length discrepancy. The patient with leg length discrepancy changed posture when standing, walking, and running. These compensation postures could lead to abnormality position of bones where there is insertion of the muscle.

Effects of intravascular photobiomodulation on motor deficits and brain perfusion images in intractable myasthenia gravis: A case report

BACKGROUND Myasthenia gravis(MG)is an autoimmune disorder caused by neuromuscular junction failure characterized by muscle weakness and fatigability.We herein report a case of MG that received intravascular laser irradiation of blood(ILIB)interventions and regained muscle power and better quality of life.To our knowledge,no previous study has investigated the benefits of ILIB treatment on patients with MG.We also evaluated the changes in brain perfusion scan and the MG activities of daily living(MG-ADL)and quantitative MG(QMG)scales.CASE SUMMARY A 59-year-old man presented to our outpatient hospital experiencing ptosis,diplopia,fibromyalgia,muscle fatigue,and fluctuating weakness in his limbs for 1 year.Based on his history,physical examination,and laboratory investigations,the final diagnosis was a flare-up of MG with poor endurance and muscle fatigue.The patient agreed to receive ILIB.Brain single-photon emission computed tomography(SPECT)was performed both before and after ILIB therapy.After receiving three courses of ILIB,the brain SPECT images showed greatly increased perfusion of the frontal lobe and anterior cingulate gyri.The patient’s MG-ADL scale score decreased markedly from 17/24 to 3/24.The QMG scale score also decreased remarkably from 32/39 to 9/39.The symptoms of MG became barely detectable and the patient was able to perform his activities of daily living and regain muscle power.CONCLUSION ILIB might have beneficial effects on MG,and brain SPECT images provided direct evidence of a positive correlation between ILIB and clinical performance.

Effects of intravascular laser phototherapy on delayed neurological sequelae after carbon monoxide intoxication as evaluated by brain perfusion imaging:A case report and review of the literature

BACKGROUND Delayed neurological sequelae(DNS)caused by carbon monoxide(CO)intoxication poses considerable treatment challenges for clinical practitioners.In this report,we used nuclear medicine imaging and the Mini-Mental State Examination(MMSE)to evaluate the effectiveness of intravascular laser irradiation of blood(ILIB)therapy for the management of DNS.CASE SUMMARY A 51-year-old woman presented to our medical center experiencing progressive bradykinesia,rigidity of limbs,gait disturbance,and cognitive impairment.Based on her neurological deficits,laboratory tests and imaging findings,the patient was diagnosed with delayed neurological sequelae of CO intoxication.She received intensive rehabilitation and ILIB therapy during 30 sessions over 2 mo after diagnosis.Brain single-photon emission computed tomography was performed both prior to and after ILIB therapy.The original hypoperfusion area in bilateral striata,bilateral frontal lobe,right parietal lobe,and bilateral cerebellum showed considerable improvement after completion of therapy.The patient’s MMSE score also increased markedly from 6/30 to 25/30.Symptoms of DNS became barely detectable,and the woman was able to carry out her daily living activities independently.CONCLUSION ILIB therapy could facilitate recovery from delayed neurological sequelae in patients with CO intoxication,as demonstrated by improved cerebral blood flow and functional outcomes in our patient.

Olecranon Bursitis Causing Reflex Sympathetic Dystrophy Syndrome in a Hemiplegic Extremity

Olecranon bursitis is rarely seen in patients with stroke, but reflex sympathetic dystrophy syndrome is not. Here, we report a stroke case, which represented the clinical symptom of reflex sympathetic dystrophy syndrome after development of olecranon bursitis in few days, and describe his clinical association between both conditions. Sonographicpicture of the right elbow in this case is shown.

Original Article: Prognostic Factors of Long-Term Outcome and Functional Status Following Spontaneous Cerebellar Hemorrhage

Cerebellar hemorrhage (CH) has a higher early mortality rate compared with other types of intracranial hemorrhage and the survivors often suffer from momentous disability. Hence, the prognostic factors of long-term outcome beyond 6 months after CH are clinically valuable, however only three studies were reported in the literature. Sixty-one patients with CH were retrospectively analyzed at least 6 months after hemorrhage. The long-term outcome of all patients and long-term functional status of survivors beyond 6 months (the patients who died within 6 months after hemorrhage were excluded) were assessed using the modified Rankin Scale (mRS): favorable outcome (mRS 0 - 2) and unfavorable outcome (mRS 3 - 6). All of the prognostic factors were analyzed by univariate and multivariate Cox proportional hazards regression models. There were 16 (26.2%) patients in the favorable outcome group and 45 (73.8%) in the unfavorable outcome group with respect of long-term outcome in all patients. The radiological brainstem compression (HR = 3;p = 0.015) was shown to be an independent predictor. On the other hand, 46 out of 61 (75.4%) patients survived beyond 6 months. In total, 16 (34.7%) patients had a favorable functional status, and 65.3% (30/46) had a persistent unfavorable functional status. Moreover, only age 365 years (HR = 3;p = 0.019) was an independent predictor. Radiological brainstem compression and age 365 were respectively shown to be a strong prognostic factor for long-term outcome and functional status among survivors beyond 6 months after hemorrhage in patients with CH.