BACKGROUND This report delves into the diagnostic and therapeutic journey undertaken by a patient with Sneddon's syndrome(SS)and cerebral venous sinus thrombosis(CVST).Particular emphasis is placed on the comprehe...BACKGROUND This report delves into the diagnostic and therapeutic journey undertaken by a patient with Sneddon's syndrome(SS)and cerebral venous sinus thrombosis(CVST).Particular emphasis is placed on the comprehensive elucidation of SS's clinical manifestations,the intricate path to diagnosis,and the exploration of potential underlying mechanisms.CASE SUMMARY A 26-year-old woman presented with recurrent episodes of paroxysmal unilateral limb weakness accompanied by skin mottling,seizures,and cognitive impairment.Digital subtraction angiography revealed CVST.Despite negative antiphospholipid antibody results,skin biopsy indicated chronic inflammatory cell infiltration.The patient was treated using anticoagulation,antiepileptic therapy,and supportive care,which resulted in symptom improvement.The coexistence of SS and CVST is rare and the underlying pathophysiology remains uncertain.This case underscores the challenge in diagnosis and highlights the need for early clinical differentiation to facilitate accurate assessment and prompt intervention.CONCLUSION This article has reported and analyzed the clinical data,diagnosis,treatment,and prognosis of a case of SS with CVST and reviewed the relevant literature to improve the clinical understanding of this rare condition.展开更多
BACKGROUND： Clinical diagnosis of various neurological disorders involving the sensory nerves depends primarily on subjective description, which cannot be quantitatively evaluated, and is also less reproducible and s...BACKGROUND： Clinical diagnosis of various neurological disorders involving the sensory nerves depends primarily on subjective description, which cannot be quantitatively evaluated, and is also less reproducible and specific. Quantitative sensory testing methods can overcome these shortcomings and is currently used to identify the function of the C- and A-fibers. OBJECTIVE： To apply the quantitative sensory testing method for analyzing changes in temperature sensation, cryalgesia, thermalgesia, and vibration sense on the skin surface of hemiplegic patients with post-stroke shoulder-hand syndrome, and to analyze the relationship between these changes and shoulder-hand syndrome. DESIGN, TIME AND SETTING： A non-randomized, concurrent, control study was performed at the Clinic and Inpatient Department of the Third Xiangya Hospital, Central South University, between June 2000 and April 2001. PARTICIPANTS： Thirty post-stroke, hemiplegic patients were divided into shoulder-hand syndrome and control groups, according to whether patients exhibited shoulder-hand syndrome, with 15 patients in each group. METHODS： A TSA2001 quantitative sensory testing device （Medoc, Israel） was used for quantitative sensory testing. All sensory testing employed limits, testing temperature sense on the palm thenar eminence and vibration sense on the thumb metacarpal. Cold threshold was ≤ 28 ℃, warmth threshold was ≥ 36 ℃, cold-evoked pain threshold was ≤ 5 ℃, heat-evoked pain threshold was ≥ 51 ℃, vibration threshold was ≥ 5 μm/s; if a patient met one of these items, he/she was considered to be hypoanesthesia. MAIN OUTCOME MEASURES： Cold, warm, cold-evoked pain, heat-evoked pain and vibration threshold changes on skin from the paralyzed upper extremity was measured in the shoulder-hand syndrome and control groups. RESULTS： Incidence of sensory disability in the shoulder-hand syndrome group increased more significantly than in the control group （P 〈 0.05）, with the primary manifestations being decreased cold threshold （P 〈 0.05） and increased warmth threshold （P 〈 0.05）. The value differences between cold and cold-evoked pain thresholds, as well as between warmth and heat-evoked pain thresholds, decreased significantly in the shoulder-hand syndrome group （P 〈 0.05）. There were no significant differences between the two groups in cold-evoked pain, heat-evoked pain, or vibration thresholds. CONCLUSION： The primary manifestations of sensory impairment in hemiplegic patients with post-stroke shoulder-hand syndrome were displayed as thermohypesthesia and hyperalgesia. Functional impairments of nerve fibers that control pain and temperature sense may play an important role in the pathogenesis of post-stroke shoulder-hand syndrome.展开更多
Shoulder-hand syndrome(SHS)is one of the common complications of ischemic stroke.The pathogenesis is not completely clear and the therapeutic effects are not very satisfactory.As one of the Five-Shu acupoints(the gene...Shoulder-hand syndrome(SHS)is one of the common complications of ischemic stroke.The pathogenesis is not completely clear and the therapeutic effects are not very satisfactory.As one of the Five-Shu acupoints(the general terms of acupoints that the twelve meridians are located below the elbow and knee of the body),Jing acupoints is distributed at the end of fingers and toes where the twelve meridians of the human body pass by,and has the functions of stimulating the meridians and dredging the channels and collaterals.For the effects of discharging neurons,promoting cerebral blood flow and improving the brain micro-circulation,Jing acupoints bloodletting therapy can effectively relieve the clinical symptoms of the patients with SHS after stroke.Sangzhi(Mori Ramulus),with the ability of dredging the meridian and relieving the pain,is also has certain treatment functions to the SHS.In clinical practice,the combination of Jing acupoints bloodletting and Sangzhi(Mori Ramulus)have been widely used in the treatment of various diseases,and in terms of their mechanism of action,the combined treatment has a positive effect on post-stroke SHS,but there are few reports on this.Therefore,it is worth affirming the efficacy of combined treatment of SHS after stroke.This article elaborates the theoretical basis of Jing acupoints bloodletting on SHS after stroke,and the research progress of Sangzhi(Mori Ramulus)in treating SHS after stroke,which provide the theoretical guidance for the combination.展开更多
Background:Shoulder-hand syndrome(SHS)is one of the common complications after stroke,which is difficult to cure once it occurs.Early risk identification is an effective measure to prevent and treat SHS,but there is n...Background:Shoulder-hand syndrome(SHS)is one of the common complications after stroke,which is difficult to cure once it occurs.Early risk identification is an effective measure to prevent and treat SHS,but there is no effective tool to assess the risk assessment of SHS.Objective:To develop a validated tool to assess the risk of SHS occurrence after stroke.Methods:This was an observational study with a 3-step process:(1)Literature review to establish initial indicators;(2)Application of a modified Delphi method for two rounds of correspondence,with final indicators obtained by modifying each round based on expert opinion;(3)Application of hierarchical analysis to determine the weights of each indicator.Results:The initial literature review constructed4 primary indicators and 24 secondary indicators;after the first round of Delphi,a total of 10 secondary indicators were deleted and 6 secondary indicators were added,and the final indicators included 3 primary indicators and 15 secondary indicators,and in the second round,consensus was reached;by AHP analysis,the highest weight was given to existing risk factors(0.5584),followed by relevant medical history(0.3196);lastly,demographic factors(0.1220),and the scores of other secondary indicators met the requirements.Conclusion:This study establishes and constructs a post-stroke SHS risk assessment tool,which provides a basis for early identification of SHS and early intervention.Meanwhile,this study provides a methodological reference for the development of other indicatorssets.展开更多
Strokes and cerebral vascular accidents (CVAs) and related disease events are an unfortunate circumstance that inflicts individuals around the world and impacts people every day as individuals and their caregivers. Th...Strokes and cerebral vascular accidents (CVAs) and related disease events are an unfortunate circumstance that inflicts individuals around the world and impacts people every day as individuals and their caregivers. The consequences of these strokes or CVA events are life-changing for all those involved. As a result of long-term disability related to strokes, the caregiver may undergo many emotional, psychological, and physical factors that impact their daily lives. There is a relatively short period of time to react to the necessary change and as a result there may be differences in coping associated with these unexpected health circumstances. Many stoke victims experience motor, cognitive, emotional, and psycho-social deficits and their caregivers may not be prepared for these abrupt life altering effects. The impact for caregivers, factors impacting strokes, and solutions for care will be addressed in the paper. Evidence suggests that post fatigue stroke (PFS) may be triggered by a dysfunction of the stress system. Family caregivers with a low level of social engagement may be more likely to perceived stress, and increased risk for caregiver role strain.展开更多
Objective To observe the correlation between analgesic effect and duration of analgesic effect of superficial needling for shoulder pain of shoulderhand syndrome（SHS） after stroke, so as to screen the best time peri...Objective To observe the correlation between analgesic effect and duration of analgesic effect of superficial needling for shoulder pain of shoulderhand syndrome（SHS） after stroke, so as to screen the best time period of analgesia. Methods A total of 120 patients with SHS after stroke（stage I） were recruited and superficial needling therapy was applied. Two obvious tenderness points on the affected shoulder of patients were found out. The site 80–100 mm down each tenderness point was selected for superficial needling. Bimanual needling technique was applied after inserting needles. The surrounding of tenderness points was pinched and grasped by left hand above the needling, and the technique of green dragon swaying tail was applied by right hand. The needles at each acupoint were manipulated for3 min and retained for 30 min. The analgesic effect was evaluated dynamically by visual analogue scale（VAS） in 120 patients before treatment, immediately after treatment, 30 min after treatment, 1 h after treatment and 24 h after treatment. The analgesic effects at different time were statistically analyzed by generalized estimating equation. Results The mean values of VAS were 7.483, 3.950, 4.767, 5.917 and 7.217, respectively, before treatment, immediately after treatment, 30 min after treatment, 1 h after treatment and 24 h after treatment. The difference of analgesic effect at different time was statistically significant（P〈0.01）; the difference of analgesic effect of superficial needling in treatment of SHS after stroke was significant between immediately after treatment and 30 min after treatment（both P〈0.05）, while there was no significant difference between 1 h after treatment and 24 h after treatment（both P〈0.05）. Conclusion Analgesic effect of superficial needling for shoulder pain of SHS after stroke was different at different time points and decreased over time; analgesic effect was the most significant immediately after treatment and the optimal duration of analgesic effect was from immediately to 30 min after superficial needling therapy.展开更多
目的 探讨扶阳急救汤加减治疗急性脑梗死患者的疗效及对患者中医证候评分、卒中量表评分和凝血功能的影响。方法 将2020年6月—2022年6月安徽中医药大学附属太和中医院收治的120例急性脑梗死患者随机等分为观察组和对照组。对照组给予...目的 探讨扶阳急救汤加减治疗急性脑梗死患者的疗效及对患者中医证候评分、卒中量表评分和凝血功能的影响。方法 将2020年6月—2022年6月安徽中医药大学附属太和中医院收治的120例急性脑梗死患者随机等分为观察组和对照组。对照组给予抗血小板聚集等治疗措施,观察组在此基础上联合扶阳急救汤加减治疗。两组均持续治疗2周。比较两组患者的临床疗效、中医证候评分、美国国立卫生研究院卒中量表(National Institute of Health stroke scale, NIHSS)评分、凝血功能及3个月后改良RANKIN量表(Modified Rankin Scale, mRS)评分。结果 治疗后,观察组总有效率较高(P<0.05)。治疗1周、2周后,两组中医证候主证、次证、总积分和NIHSS评分逐渐明显降低(P<0.05),且观察组显著低于对照组(P<0.05)。治疗2周后,对照组凝血酶原时间(Prothrombin time, PT)、活化的部分凝血活酶时间(Activated partial thromboplastin time, APTT)、纤维蛋白原(Fibrinogen, FIB)、凝血酶时间(Thrombin time, TT)水平较治疗前差异无统计学意义(P>0.05),观察组PT、TT水平较治疗前差异无统计学意义(P>0.05),APTT及FIB水平则明显降低(P<0.05),且显著低于对照组(P<0.05)。治疗后3个月,观察组mRS评分显著低于对照组(P<0.05)。结论 扶阳急救汤加减治疗可以更好地促进痰瘀阻络证型急性脑梗死患者神经功能及中医证候的恢复,提高患者近期疗效及长期生活质量,且并未影响凝血功能,有较好的安全性,值得临床应用。展开更多
文摘BACKGROUND This report delves into the diagnostic and therapeutic journey undertaken by a patient with Sneddon's syndrome(SS)and cerebral venous sinus thrombosis(CVST).Particular emphasis is placed on the comprehensive elucidation of SS's clinical manifestations,the intricate path to diagnosis,and the exploration of potential underlying mechanisms.CASE SUMMARY A 26-year-old woman presented with recurrent episodes of paroxysmal unilateral limb weakness accompanied by skin mottling,seizures,and cognitive impairment.Digital subtraction angiography revealed CVST.Despite negative antiphospholipid antibody results,skin biopsy indicated chronic inflammatory cell infiltration.The patient was treated using anticoagulation,antiepileptic therapy,and supportive care,which resulted in symptom improvement.The coexistence of SS and CVST is rare and the underlying pathophysiology remains uncertain.This case underscores the challenge in diagnosis and highlights the need for early clinical differentiation to facilitate accurate assessment and prompt intervention.CONCLUSION This article has reported and analyzed the clinical data,diagnosis,treatment,and prognosis of a case of SS with CVST and reviewed the relevant literature to improve the clinical understanding of this rare condition.
基金This study belongs under the sub-topic of"Treatment and assessment of stroke under biol-ogy-psychology-society pattern" that has received the Third-class Award of Medical Science and Technology of Hu’nan Province, No. 200203-U-08
文摘BACKGROUND： Clinical diagnosis of various neurological disorders involving the sensory nerves depends primarily on subjective description, which cannot be quantitatively evaluated, and is also less reproducible and specific. Quantitative sensory testing methods can overcome these shortcomings and is currently used to identify the function of the C- and A-fibers. OBJECTIVE： To apply the quantitative sensory testing method for analyzing changes in temperature sensation, cryalgesia, thermalgesia, and vibration sense on the skin surface of hemiplegic patients with post-stroke shoulder-hand syndrome, and to analyze the relationship between these changes and shoulder-hand syndrome. DESIGN, TIME AND SETTING： A non-randomized, concurrent, control study was performed at the Clinic and Inpatient Department of the Third Xiangya Hospital, Central South University, between June 2000 and April 2001. PARTICIPANTS： Thirty post-stroke, hemiplegic patients were divided into shoulder-hand syndrome and control groups, according to whether patients exhibited shoulder-hand syndrome, with 15 patients in each group. METHODS： A TSA2001 quantitative sensory testing device （Medoc, Israel） was used for quantitative sensory testing. All sensory testing employed limits, testing temperature sense on the palm thenar eminence and vibration sense on the thumb metacarpal. Cold threshold was ≤ 28 ℃, warmth threshold was ≥ 36 ℃, cold-evoked pain threshold was ≤ 5 ℃, heat-evoked pain threshold was ≥ 51 ℃, vibration threshold was ≥ 5 μm/s; if a patient met one of these items, he/she was considered to be hypoanesthesia. MAIN OUTCOME MEASURES： Cold, warm, cold-evoked pain, heat-evoked pain and vibration threshold changes on skin from the paralyzed upper extremity was measured in the shoulder-hand syndrome and control groups. RESULTS： Incidence of sensory disability in the shoulder-hand syndrome group increased more significantly than in the control group （P 〈 0.05）, with the primary manifestations being decreased cold threshold （P 〈 0.05） and increased warmth threshold （P 〈 0.05）. The value differences between cold and cold-evoked pain thresholds, as well as between warmth and heat-evoked pain thresholds, decreased significantly in the shoulder-hand syndrome group （P 〈 0.05）. There were no significant differences between the two groups in cold-evoked pain, heat-evoked pain, or vibration thresholds. CONCLUSION： The primary manifestations of sensory impairment in hemiplegic patients with post-stroke shoulder-hand syndrome were displayed as thermohypesthesia and hyperalgesia. Functional impairments of nerve fibers that control pain and temperature sense may play an important role in the pathogenesis of post-stroke shoulder-hand syndrome.
文摘Shoulder-hand syndrome(SHS)is one of the common complications of ischemic stroke.The pathogenesis is not completely clear and the therapeutic effects are not very satisfactory.As one of the Five-Shu acupoints(the general terms of acupoints that the twelve meridians are located below the elbow and knee of the body),Jing acupoints is distributed at the end of fingers and toes where the twelve meridians of the human body pass by,and has the functions of stimulating the meridians and dredging the channels and collaterals.For the effects of discharging neurons,promoting cerebral blood flow and improving the brain micro-circulation,Jing acupoints bloodletting therapy can effectively relieve the clinical symptoms of the patients with SHS after stroke.Sangzhi(Mori Ramulus),with the ability of dredging the meridian and relieving the pain,is also has certain treatment functions to the SHS.In clinical practice,the combination of Jing acupoints bloodletting and Sangzhi(Mori Ramulus)have been widely used in the treatment of various diseases,and in terms of their mechanism of action,the combined treatment has a positive effect on post-stroke SHS,but there are few reports on this.Therefore,it is worth affirming the efficacy of combined treatment of SHS after stroke.This article elaborates the theoretical basis of Jing acupoints bloodletting on SHS after stroke,and the research progress of Sangzhi(Mori Ramulus)in treating SHS after stroke,which provide the theoretical guidance for the combination.
基金This research was supported by Harbin Medical University Innovative Scientific Research Funding Project(No.2020-kyywf-1487).
文摘Background:Shoulder-hand syndrome(SHS)is one of the common complications after stroke,which is difficult to cure once it occurs.Early risk identification is an effective measure to prevent and treat SHS,but there is no effective tool to assess the risk assessment of SHS.Objective:To develop a validated tool to assess the risk of SHS occurrence after stroke.Methods:This was an observational study with a 3-step process:(1)Literature review to establish initial indicators;(2)Application of a modified Delphi method for two rounds of correspondence,with final indicators obtained by modifying each round based on expert opinion;(3)Application of hierarchical analysis to determine the weights of each indicator.Results:The initial literature review constructed4 primary indicators and 24 secondary indicators;after the first round of Delphi,a total of 10 secondary indicators were deleted and 6 secondary indicators were added,and the final indicators included 3 primary indicators and 15 secondary indicators,and in the second round,consensus was reached;by AHP analysis,the highest weight was given to existing risk factors(0.5584),followed by relevant medical history(0.3196);lastly,demographic factors(0.1220),and the scores of other secondary indicators met the requirements.Conclusion:This study establishes and constructs a post-stroke SHS risk assessment tool,which provides a basis for early identification of SHS and early intervention.Meanwhile,this study provides a methodological reference for the development of other indicatorssets.
文摘Strokes and cerebral vascular accidents (CVAs) and related disease events are an unfortunate circumstance that inflicts individuals around the world and impacts people every day as individuals and their caregivers. The consequences of these strokes or CVA events are life-changing for all those involved. As a result of long-term disability related to strokes, the caregiver may undergo many emotional, psychological, and physical factors that impact their daily lives. There is a relatively short period of time to react to the necessary change and as a result there may be differences in coping associated with these unexpected health circumstances. Many stoke victims experience motor, cognitive, emotional, and psycho-social deficits and their caregivers may not be prepared for these abrupt life altering effects. The impact for caregivers, factors impacting strokes, and solutions for care will be addressed in the paper. Evidence suggests that post fatigue stroke (PFS) may be triggered by a dysfunction of the stress system. Family caregivers with a low level of social engagement may be more likely to perceived stress, and increased risk for caregiver role strain.
基金Supported by State Administration of Traditional Chinese Medicine of the People’s Republic of China "Twelfth FiveYear Plan" key specialty construction projectMajor scientific project of Changning District Science and Technology Commission:CNKW2013Z05+1 种基金Traditional Chinese medicine scientific research fund project of Shanghai Municipal Commission of Health and Family Planning:2014LQ021ATCM of Shanghai style heritage research base project of Shanghai Municipal Health Bureau:ZYSNXD-CCHPGC-JD-004
文摘Objective To observe the correlation between analgesic effect and duration of analgesic effect of superficial needling for shoulder pain of shoulderhand syndrome（SHS） after stroke, so as to screen the best time period of analgesia. Methods A total of 120 patients with SHS after stroke（stage I） were recruited and superficial needling therapy was applied. Two obvious tenderness points on the affected shoulder of patients were found out. The site 80–100 mm down each tenderness point was selected for superficial needling. Bimanual needling technique was applied after inserting needles. The surrounding of tenderness points was pinched and grasped by left hand above the needling, and the technique of green dragon swaying tail was applied by right hand. The needles at each acupoint were manipulated for3 min and retained for 30 min. The analgesic effect was evaluated dynamically by visual analogue scale（VAS） in 120 patients before treatment, immediately after treatment, 30 min after treatment, 1 h after treatment and 24 h after treatment. The analgesic effects at different time were statistically analyzed by generalized estimating equation. Results The mean values of VAS were 7.483, 3.950, 4.767, 5.917 and 7.217, respectively, before treatment, immediately after treatment, 30 min after treatment, 1 h after treatment and 24 h after treatment. The difference of analgesic effect at different time was statistically significant（P〈0.01）; the difference of analgesic effect of superficial needling in treatment of SHS after stroke was significant between immediately after treatment and 30 min after treatment（both P〈0.05）, while there was no significant difference between 1 h after treatment and 24 h after treatment（both P〈0.05）. Conclusion Analgesic effect of superficial needling for shoulder pain of SHS after stroke was different at different time points and decreased over time; analgesic effect was the most significant immediately after treatment and the optimal duration of analgesic effect was from immediately to 30 min after superficial needling therapy.
文摘目的 探讨扶阳急救汤加减治疗急性脑梗死患者的疗效及对患者中医证候评分、卒中量表评分和凝血功能的影响。方法 将2020年6月—2022年6月安徽中医药大学附属太和中医院收治的120例急性脑梗死患者随机等分为观察组和对照组。对照组给予抗血小板聚集等治疗措施,观察组在此基础上联合扶阳急救汤加减治疗。两组均持续治疗2周。比较两组患者的临床疗效、中医证候评分、美国国立卫生研究院卒中量表(National Institute of Health stroke scale, NIHSS)评分、凝血功能及3个月后改良RANKIN量表(Modified Rankin Scale, mRS)评分。结果 治疗后,观察组总有效率较高(P<0.05)。治疗1周、2周后,两组中医证候主证、次证、总积分和NIHSS评分逐渐明显降低(P<0.05),且观察组显著低于对照组(P<0.05)。治疗2周后,对照组凝血酶原时间(Prothrombin time, PT)、活化的部分凝血活酶时间(Activated partial thromboplastin time, APTT)、纤维蛋白原(Fibrinogen, FIB)、凝血酶时间(Thrombin time, TT)水平较治疗前差异无统计学意义(P>0.05),观察组PT、TT水平较治疗前差异无统计学意义(P>0.05),APTT及FIB水平则明显降低(P<0.05),且显著低于对照组(P<0.05)。治疗后3个月,观察组mRS评分显著低于对照组(P<0.05)。结论 扶阳急救汤加减治疗可以更好地促进痰瘀阻络证型急性脑梗死患者神经功能及中医证候的恢复,提高患者近期疗效及长期生活质量,且并未影响凝血功能,有较好的安全性,值得临床应用。
