Complete recovery from segmental zoster paresis confirmed by magnetic resonance imaging:A case report

BACKGROUND Segmental zoster paresis,depending on the affected area,can present with severe clinical manifestations and render patients unable to perform activities of daily living.Therefore,it is necessary to diagnose and treat such a condition rapidly.No studies have reported using magnetic resonance imaging(MRI)to identify clinical abnormalities associated with this condition or its complete recovery.This rare case report evaluated the changes in MRI findings before and after the patient’s motor symptoms recovered.CASE SUMMARY A 79-year-old woman with a history of rheumatoid arthritis and psoriasis visited the hospital for skin rashes and pain in the C5-T2 segments.The diagnosis was herpes zoster infection,and treatment was initiated.However,motor weakness suddenly occurred 14 d after the initial symptom presentation.We confirmed abnormal findings in the nerves and muscles invaded by the shingles using electromyography and MRI.After 17 mo,the patient’s symptoms had completely normalized,and MRI confirmed that there were no abnormalities.CONCLUSION MRI can be a useful diagnostic modality for segmental zoster paresis and patient evaluation during recovery from motor complications.

Transient Ipsilateral Lower Limb Paresis after Interscalene Brachial Plexus Block

We describe a partial motor block of ipsilateral lower limb after interscalene block with the injection of 40 ml of 0.5% bupivacaine and 2% lignocaine with adrenaline. Immediately after the block, patient reported a right motor hemi syndrome which was transient. We concluded that the neurological symptom was caused by the technique of interscalene brachial plexus block may be as a result of excessive lateral deviation of the neck with a compromised collateral circulation.

Waggle needling Yanglingquan(GB34) enhances cerebral blood flow and ameliorates condition of spastic paresis in rats with middle cerebral artery occlusion induced by surgical nylon suture

OBJECTIVE:To evaluate the therapeutic efficacy and the influence on cerebral blood supply of waggle needling Yanglingquan(GB34) on spastic paresis(SP) rats after middle cerebral artery occlusion(MCAO) induced and investigate its mechanism of relieving neurobehavior deficiency.METHODS:SP rat model was produced by permanent MCAO.Rats were divided into five groups:blank control group(Control),sham operation group(Sham),model group(Model),waggle needling group(WN) and perpendicular needling group(PN).SP rats were treated with acupuncture from day 3 after MCAO,once a day for 6 d.The modified neurological severity score(m NSS) and modified Ashworth scale(MAS) were conducted on days 0,1,3,5,7 and 9.Cerebral blood flow(CBF) in ischemic cortex was measured by laser speckle imaging 5 min pre ischemia,5 min post ischemia,and after intervention on day 9.All rats were sacrificed at day 9 and the protein and m RNA expressions of γ2 subunit of the γ-aminobutyric acid receptor A(GABAAγ2) and K+-Cl-cotransporter 2(KCC2) in the ischemic cortex and lumber enlargement was measured by Western blotting and real-time quantitative polymerase chain reaction.RESULTS:Both Control and Sham groups showed no changes in m NSS and MAS scores and in the regional CBF.Compared with Model group,both WN and PN treatments significantly ameliorated neurological deficit(P < 0.01),decreased muscle tone(P < 0.05),and enhanced CBF(P < 0.001) in SP rats;moreover,WN showed superior effects than PN(P < 0.001).In line with the improvement in neurobehavior,acupuncture interventions up-regulated the expressions of GABAAγ2 and KCC2 in the ischemic cortex as well as lumber enlargement(P < 0.01) in SP rats,and those changes were more obvious in WN(P < 0.05).CONCLUSIONS:Acupuncture at Yanglingquan(GB34) enhanced cerebral blood flow and ameliorated SP in permanent MCAO rats,while waggle needling was superior to regular perpendicular needling.Waggle needling Yanglingquan(GB34) would be a potential complementary therapy for SP.

Effects of Polygala fallax Hemsl Water Extract on a Mouse Model of Gastric Motility Disorders

[Objectives]To explore the effects of Polygona fallax Hemsl water extract on gastrointestinal motility in normal mice and gastric motility disorder model mice and approximate mechanism.[Methods]Using normal mice and mice with gastric motility disorders(modeled with atropine),the effects of different mass concentration groups of P.fallax Hemsl water extract(0.125,0.250,0.500 g/mL)and domperidone groups on gastric residual rate,small intestine propulsion rate,serum motilin(MLT),vasoactive intestinal peptide(VIP),and tissue morphology were studied.[Results]There was a highly significant difference(P<0.01)in the small intestine propulsion rate of liquid in normal mice among the different concentration groups of P.fallax Hemsl water extract compared to the blank group.The small intestine propulsion rate and gastric residue rate of semi-solid paste were statistically significant compared to the blank group(P<0.05).Among them,there was a highly significant difference between the high concentration group(67.75%±7.65%,46.5%±10.62%)and the medium concentration group(60.90%±5.87%,59.27%±7.82%)(P<0.01).There was statistical significance in normal mouse serum MLT content in the high concentration group(P<0.05).There was no effect on serum VIP levels in normal mice;no effect on the morphology of stomach and intestinal tissues of normal mice.The small intestine propulsion rate and gastric residue rate of liquid and semi-solid paste in mice with gastric motility disorders were statistically significant compared to the atropine group,with extremely significant differences(P<0.01).[Conclusions]P.fallax Hemsl water extract has a promoting effect on gastrointestinal motility.One of the specific mechanisms by which P.fallax Hemsl promotes gastrointestinal motility in normal mice may be related to the content of MLT in mouse serum.The mechanism of action in atropine induced gastric paresis mice may be related to the reactivation of M receptors,and the action mechanism of P.fallax Hemsl does not change the original histological basis.It can be inferred that P.fallax Hemsl water extract has a synergistic effect on promoting gastrointestinal motility through other mechanisms,but it is not fully understood and further in-depth research is needed.

Hemiparesis in carotid cavernous fistulas (CCFs): a case report and review of the literature

Carotid-cavernous fistulas (CCFs) are abnormal arteriovenous anastamoses between the carotid artery and the cavernous sinus. These fistulas may be classified by cause (spontaneous or traumatic), flow velocity (high or low), or pathogenesis (direct or indirect). The most commonly adopted classification is that described by Barrow based on arterial supply. Traumatic CCFs are almost always direct shunts between the internal carotid artery (ICA) and the cavernous sinus. General features of CCFs, which may be apparent with any lesion, including bruit, headache, loss of vision, altered mental status and neurological deficits. Some fistulae may present primarily with hemorrhage before any evaluation can be performed. However, hemiparesis has been rarely observed. Only a literature review of Murata et al reported a case of hemiparesis caused by posttraumatic CCF, in which the fistula resulted in venous hypertension and subsequent brainstem congestion. While in our case, cerebral infarction was caused by total steal of the blood flow. The patient recovered after occlusion of the fistula with a detachable balloon.

Action observation as a tool for neurorehabilitation to moderate motor deficits and aphasia following stroke

The mirror neuron system consists of a set of brain areas capable of matching action observation with action execution. One core feature of the mirror neuron system is the activation of motor areas by action observation alone. This unique capacity of the mirror neuron system to match action perception and action execution stimulated the idea that mirror neuron system plays a crucial role in the understanding of the content of observed actions and may participate in procedural learning. These features bear a high potential for neurorehabilitation of motor deficits and of aphasia following stroke. Since the first articles exploring this principle were published, a growing number of follow-up studies have been conducted in the last decade. Though, the combination of action observation with practice of the observed actions seems to constitute the most powerful approach. In the present review, we present the existing studies analyzing the effects of this neurorehabJlitative approach in clinical settings especially in the rehabilitation of stroke associated motor deficits and give a perspective on the ongoing trials by our research group. The data obtained up to date showed significant positive effect of action observation on recovery of motor functions of the upper limbs even in the chronic state after stroke, indicating that our approach might become a new standardized add-on feature of modern neurorehabilitative treatment schemes.

Neurovascular complications due to the Hippocrates method for reducing anterior shoulder dislocations

In spite of the fact that the Hippocrates method hardly has been evaluated in a scientific manner and numerous associated iatrogenic complications have been reported, this method remains to be one of the most common techniques for reducing anterior shoulder dislocations. We report the case of a 69-year-old farmer under coumarin anticoagulant therapy who sustained acute first time anterior dislocation of his dominant right shoulder. By using the Hippocrates method with the patient under general anaesthesia, the brachial vein was injured and an increasing hematoma subsequently caused brachial plexus paresis by pressure. After surgery for decompression and vascular suturing, symptoms declined rapidly, but brachial plexus paresis still was not fully reversible after 3 mo of follow-up. The hazardousness of using the Hippocrates method can be explained by traction on the outstretched arm with force of the operator's body weight, direct trauma to the axillary region by the physician's heel, and the topographic relations of neurovascular structures and the dislocated humeral head. As there is a variety of alternative reduction techniques which have been evalu-ated scientifically and proofed to be safe, we strongly caution against the use of the Hippocrates method as a first line technique for reducing anterior shoulder dislocations, especially in elder patients with fragile vessels or under anticoagulant therapy, and recommend the scapular manipulation technique or the Milch technique, for example, as a first choice.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy in a Chinese pedigree A case report using brain magnetic resonance imaging and biospy

The present study enrolled a Chinese family that comprised 34 members and spanned three generations. Eight members were diagnosed with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, and disease diagnoses corresponded with autosomal incomplete dominance inheritance. The primary clinical manifestations included paralysis, dysarthria, and mild cognitive deficits. Magnetic resonance imaging revealed diffuse leukoencephalopathy with involvement of bilateral anterior temporal lobes, in particular the pons. In addition, multiple cerebral infarction was identified in the proband. Sural nerve biopsy findings of the proband revealed granular osmophilic material deposits in the extracellular matrix, which were adjacent to smooth muscle cells of dermal arterioles. Screening exons 2-4 for NOTCH 3 mutations by direct sequencing did not reveal any abnormalities.