BACKGROUND Neuralgic amyotrophy(NA)is a rare disease with sudden upper limb pain followed by affected muscle weakness.The most commonly affected area in NA is the upper part of the brachial plexus,and the paraspinal m...BACKGROUND Neuralgic amyotrophy(NA)is a rare disease with sudden upper limb pain followed by affected muscle weakness.The most commonly affected area in NA is the upper part of the brachial plexus,and the paraspinal muscles are rarely affected(1.5%),making these cases difficult to distinguish from cervical radiculopathy.CASE SUMMARY A 76-year-old male presented to the emergency department with left hip pain post-fall.After undergoing left femoral neck fracture surgery,he experienced sudden left shoulder pain for 10 days with subsequent left arm weakness.Cervical spine computed tomography revealed mild right asymmetric intervertebral disc bulging with a decreased C5-6disc space.Three weeks later,an electrodiagnostic study confirmed brachial plexopathy findings involving the cervical root.Magnetic resonance neurography was performed for a differential diagnosis.Contrast enhancement was identified at the upper trunk of the brachial plexus,including the C5 nerve root.A suprascapular nerve hourglass-like focal constriction(HLFC)was also identified,confirming NA.After being diagnosed with NA,the patient received 15 mg prednisolone,twice daily,for 3 weeks.Physical therapy was initiated,including left arm strengthening exercises and electrical stimulation therapy.Left shoulder muscle strength significantly improved one CONCLUSION NA's unique features like HLFC and paraspinal involvement are crucial for accurate diagnosis,avoiding confusion with cervical radiculopathy.展开更多
Hepatitis E virus(HEV)is an important cause of repeated waterborne outbreaks of acute hepatitis.Recently,several extrahepatic manifestations(EHMs)have been described in patients with HEV infection.Of these,neurologica...Hepatitis E virus(HEV)is an important cause of repeated waterborne outbreaks of acute hepatitis.Recently,several extrahepatic manifestations(EHMs)have been described in patients with HEV infection.Of these,neurological disorders are the most common EHM associated with HEV.The involvement of both the peripheral nervous system and central nervous system can occur together or in isolation.Patients can present with normal liver function tests,which can often be misleading for physicians.There is a paucity of data on HEV-related neurological manifestations;and these data are mostly described as case reports and case series.In this review,we analyzed data of 163 reported cases of HEV-related neurological disorders.The mechanisms of pathogenesis,clinico-demographic profile,and outcomes of the HEV-related neurological disorders are described in this article.Nerve root and plexus disorder were found to be the most commonly reported disease,followed by meningoencephalitis.展开更多
Rationale: Parsonage-Turner syndrome is a rare syndrome of unknown etiology, affecting mainly the lower motor neurons of the brachial plexus.Chikungunya fever is a mosquito-borne viral disease characterized by acute f...Rationale: Parsonage-Turner syndrome is a rare syndrome of unknown etiology, affecting mainly the lower motor neurons of the brachial plexus.Chikungunya fever is a mosquito-borne viral disease characterized by acute fever and polyarthritis/polyarthralgia.Patient concerns: A 54-year-old Brazilian male patient who presented with a 2-day history of fever(temperature 38.8 ℃), arthralgia, erythematous rash, diffuse osteomuscular pain and headache, which evolved into left shoulder pain associated with morning stiffness.Diagnosis: Parsonage-Turner syndrome and chikungunya fever.Interventions: Symptomatic treatment(a combination of short-acting dypirone(500 mg every 6 h) and slow-release opioids(tramadol 100 mg every 4 h) and physiotherapy/rehabilitation with improvement.Outcomes: The patient was improved and discharged, remaining with symptomatic treatment and physiotherapy/rehabilitation.Lessons: To the best of our knowledge, there were no reports of Parsonage-Turner syndrome following chikungunya virus infection.Awareness of the possibility of this rare association is important.The present case report highlights the importance of awareness of this association as a new cause of morbidity in patients with chikungunya virus infection.展开更多
Background： Amyotrophic lateral sclerosis （ALS） and some mimic disorders, such as distal-type cervical spondylotic amyotrophy （LISA）, Hirayama disease （HD）, and spinobulbar muscular atrophy （SBMA） may present...Background： Amyotrophic lateral sclerosis （ALS） and some mimic disorders, such as distal-type cervical spondylotic amyotrophy （LISA）, Hirayama disease （HD）, and spinobulbar muscular atrophy （SBMA） may present with intrinsic hand muscle atrophy. This study aimed to investigate different patterns of small hand muscle involvement in ALS and some mimic disorders. Methods： We compared the abductor digiti minimi/abductor pollicis brevis （ADM/APB） compound muscle action potential （（＇MAP） ratios between 200 ALS patients, 95 patients with distal-type CSA, 88 HD patients, 43 SBMA patients, and 150 normal controls. Results： The ADM/APB （？MAP amplitude ratio was significantly higher in the ALS patients （P 〈 0.001） than that in the normal controls. The ADM/APB CMAP amplitude ratio was significantly reduced in the patients with distal-type CSA （P 〈 0,001 ） and the H I） patients （P 〈 0.001 ） compared with that in the normal controls. The patients with distal-type CSA had significantly lower APB CMAP amplitude than the HD patients （P- 0.004）. The ADM/APB CMAP amplitude ratio was significantly lower in the HD patients （P 〈 0.001 ） than that in the patients with distal-type CSA. The ADM/APB CMAP amplitude ratio of the SBMA patients was similar to that of the normal controls （P = 0.862）. An absent APB CMAP and an abnormally high ADM/APB CMAP amplitude ratio （_〉4.5） were observed exclusively in the ALS patients. Conclusions： The different patterns of small hand muscle atrophy between the ALS patients and the patients with mimic disorders presumably reflect distinct pathophysiological mechanisms underlying different disorders, and may aid in distinguishing between ALS and mimic disorders.展开更多
文摘BACKGROUND Neuralgic amyotrophy(NA)is a rare disease with sudden upper limb pain followed by affected muscle weakness.The most commonly affected area in NA is the upper part of the brachial plexus,and the paraspinal muscles are rarely affected(1.5%),making these cases difficult to distinguish from cervical radiculopathy.CASE SUMMARY A 76-year-old male presented to the emergency department with left hip pain post-fall.After undergoing left femoral neck fracture surgery,he experienced sudden left shoulder pain for 10 days with subsequent left arm weakness.Cervical spine computed tomography revealed mild right asymmetric intervertebral disc bulging with a decreased C5-6disc space.Three weeks later,an electrodiagnostic study confirmed brachial plexopathy findings involving the cervical root.Magnetic resonance neurography was performed for a differential diagnosis.Contrast enhancement was identified at the upper trunk of the brachial plexus,including the C5 nerve root.A suprascapular nerve hourglass-like focal constriction(HLFC)was also identified,confirming NA.After being diagnosed with NA,the patient received 15 mg prednisolone,twice daily,for 3 weeks.Physical therapy was initiated,including left arm strengthening exercises and electrical stimulation therapy.Left shoulder muscle strength significantly improved one CONCLUSION NA's unique features like HLFC and paraspinal involvement are crucial for accurate diagnosis,avoiding confusion with cervical radiculopathy.
文摘Hepatitis E virus(HEV)is an important cause of repeated waterborne outbreaks of acute hepatitis.Recently,several extrahepatic manifestations(EHMs)have been described in patients with HEV infection.Of these,neurological disorders are the most common EHM associated with HEV.The involvement of both the peripheral nervous system and central nervous system can occur together or in isolation.Patients can present with normal liver function tests,which can often be misleading for physicians.There is a paucity of data on HEV-related neurological manifestations;and these data are mostly described as case reports and case series.In this review,we analyzed data of 163 reported cases of HEV-related neurological disorders.The mechanisms of pathogenesis,clinico-demographic profile,and outcomes of the HEV-related neurological disorders are described in this article.Nerve root and plexus disorder were found to be the most commonly reported disease,followed by meningoencephalitis.
文摘Rationale: Parsonage-Turner syndrome is a rare syndrome of unknown etiology, affecting mainly the lower motor neurons of the brachial plexus.Chikungunya fever is a mosquito-borne viral disease characterized by acute fever and polyarthritis/polyarthralgia.Patient concerns: A 54-year-old Brazilian male patient who presented with a 2-day history of fever(temperature 38.8 ℃), arthralgia, erythematous rash, diffuse osteomuscular pain and headache, which evolved into left shoulder pain associated with morning stiffness.Diagnosis: Parsonage-Turner syndrome and chikungunya fever.Interventions: Symptomatic treatment(a combination of short-acting dypirone(500 mg every 6 h) and slow-release opioids(tramadol 100 mg every 4 h) and physiotherapy/rehabilitation with improvement.Outcomes: The patient was improved and discharged, remaining with symptomatic treatment and physiotherapy/rehabilitation.Lessons: To the best of our knowledge, there were no reports of Parsonage-Turner syndrome following chikungunya virus infection.Awareness of the possibility of this rare association is important.The present case report highlights the importance of awareness of this association as a new cause of morbidity in patients with chikungunya virus infection.
文摘Background： Amyotrophic lateral sclerosis （ALS） and some mimic disorders, such as distal-type cervical spondylotic amyotrophy （LISA）, Hirayama disease （HD）, and spinobulbar muscular atrophy （SBMA） may present with intrinsic hand muscle atrophy. This study aimed to investigate different patterns of small hand muscle involvement in ALS and some mimic disorders. Methods： We compared the abductor digiti minimi/abductor pollicis brevis （ADM/APB） compound muscle action potential （（＇MAP） ratios between 200 ALS patients, 95 patients with distal-type CSA, 88 HD patients, 43 SBMA patients, and 150 normal controls. Results： The ADM/APB （？MAP amplitude ratio was significantly higher in the ALS patients （P 〈 0.001） than that in the normal controls. The ADM/APB CMAP amplitude ratio was significantly reduced in the patients with distal-type CSA （P 〈 0,001 ） and the H I） patients （P 〈 0.001 ） compared with that in the normal controls. The patients with distal-type CSA had significantly lower APB CMAP amplitude than the HD patients （P- 0.004）. The ADM/APB CMAP amplitude ratio was significantly lower in the HD patients （P 〈 0.001 ） than that in the patients with distal-type CSA. The ADM/APB CMAP amplitude ratio of the SBMA patients was similar to that of the normal controls （P = 0.862）. An absent APB CMAP and an abnormally high ADM/APB CMAP amplitude ratio （_〉4.5） were observed exclusively in the ALS patients. Conclusions： The different patterns of small hand muscle atrophy between the ALS patients and the patients with mimic disorders presumably reflect distinct pathophysiological mechanisms underlying different disorders, and may aid in distinguishing between ALS and mimic disorders.
