90 research outputs found
Idiopathic Bilateral Simultaneous Facial Nerve Palsy (B-FNP)
Background: Bilateral facial nerve palsy (B-FNP) is a rare clinical manifestation with incidence of 1 per 5 million people. Furthermore, it approximately accounts for 0.3 â 2 % of facial palsy cases. This B-FNP case is intricate in the diagnosis, finding the aetiology, and treatment that need hospitalization. Case Report: A male 64-year-old with bilateral facial nerve palsy that happened suddenly followed by difficulty in closing both eyes and facial abnormality without clear cause within 7 days of onset. Risk factor is hypertension stage 2. During neurological examination, there was bilateral peripheral facial nerve palsy grade IV in right side and grade III in the left side (House Brackmann grading system) that was not followed by other cranial nerve abnormality and motoric examination is normal. Supporting examinations such as lumbar puncture, thorax photo, and head MRI with contrast shows normal result. ENMG examination shows absent of blink reflex. Prednisone 60 mg orally was given with tapering off dosage 10 mg per day. Patient was hospitalized for 12 days and was discharge with good clinical improvement with bilateral peripheral facial nerve paralysis grade II in right side and grade I in left side. Conclusion: Bilateral facial nerve paralysis is a rare clinical manifestation and challenging in diagnosis. It is important to have a differential diagnosis in cases with bilateral cranial nerve palsy. Careful physical examination and appropriate supporting examinations such as laboratory and radiology in necessary to evaluate the underlying cause
Two Immigrants with Tuberculosis of the Ear, Nose, and Throat Region with Skull Base and Cranial Nerve Involvement
We report two immigrants with tuberculosis of the skull base and a review of the literature. A Somalian man presented with bilateral otitis media, hearing loss, and facial and abducens palsy. Imaging showed involvement of both mastoid and petrous bones, extending via the skull base to the nasopharynx, suggesting tuberculosis which was confirmed by characteristic histology and positive auramine staining, while Ziehl-Neelsen staining and PCR were negative. A Sudanese man presented with torticollis and deviation of the uvula due to paresis of N. IX and XI. Imaging showed a retropharyngeal abscess and lysis of the clivus. Histology, acid-fast staining, and PCR were negative. Both patients had a positive Quantiferon TB Gold in-tube result and improved rapidly after empiric treatment for tuberculosis. Cultures eventually yielded M. tuberculosis. These unusual cases exemplify the many faces of tuberculosis and the importance to include tuberculosis in the differential diagnosis of unexplained problems
Serum and cerebrospinal fluid brain damage markers neurofilament light and glial fibrillary acidic protein correlate with tick-borne encephalitis disease severityâa multicentre study on Lithuanian and Swedish patients
Background and purpose:
Our aim was to examine the correlation between biomarkers of neuronal and glial cell damage and severity of disease in patients with tick-borne encephalitis.//
Methods:
One hundred and fifteen patients with tick-borne encephalitis diagnosed in Lithuania and Sweden were prospectively included, and cerebrospinal fluid (CSF) and serum samples were obtained shortly after hospitalization. Using pre-defined criteria, cases were classified as mild, moderate or severe tick-borne encephalitis. Additionally, the presence of spinal nerve paralysis (myelitis) and/or cranial nerve affection were noted. Concentrations of the brain cell biomarkers glial fibrillary acidic protein (GFAP), YKL-40, S100B, neurogranin, neurofilament light (NfL) and tau were analysed in CSF and, in addition, NfL, GFAP and S100B levels were measured in serum. The Jonckheere-Terpstra test was used for group comparisons of continuous variables and Spearman's partial correlation test was used to adjust for age.//
Results:
Cerebrospinal fluid and serum concentrations of GFAP and NfL correlated with disease severity, independent of age, and with the presence of nerve paralysis. The markers neurogranin, YKL-40, tau and S100B in CSF and S100B in serum were detected, but their concentrations did not correlate with disease severity.//
Conclusions:
Neuronal cell damage and astroglial cell activation with increased NfL and GFAP in CSF and serum were associated with a more severe disease, independent of age. Increased GFAP and NfL concentrations in CSF and NfL in serum were also indicative of spinal and/or cranial nerve damage. NfL and GFAP are promising prognostic biomarkers in tick-borne encephalitis, and future studies should focus on determining the association between these biomarkers and long-term sequelae
EmlĹtumor intracranialis metasztĂĄzisainak eredmĂŠnyes szisztĂŠmĂĄs palliatĂv kemoterĂĄpiĂĄja | Effective systemic palliative chemotherapy for intracranial metastases of breast cancer
Absztrakt
A szerzĹk kĂŠt esetet mutatnak be. A 69 ĂŠves nĹbetegnĂŠl helyileg elĹrehaladott ĂŠs
pulmonalis, illetve multiplex cerebralis metasztĂĄzisokat adĂł triple negatĂv
ductalis emlĹdaganatot diagnosztizĂĄltak. A tĂźnetmentes cerebralis metasztĂĄzisok
komplett radiolĂłgiai remissziĂłjĂĄt ĂŠszleltĂŠk szisztĂŠmĂĄs carboplatin-docetaxel (75
mg/m2) kemoterĂĄpia mellett. A beteg kĂŠsĹbb palliatĂv
koponyabesugĂĄrzĂĄst ĂŠs 2. vonalĂş kemoterĂĄpiĂĄt kapott. A diagnĂłzistĂłl szĂĄmĂtva
mĂĄsfĂŠl ĂŠvet ĂŠlt, rĂŠszlegesen megĹrzĂśtt ĂśnĂĄllĂłsĂĄggal. Az 57 ĂŠves nĹbetegnĂŠl
meningitis carcinomatosĂĄt, nyirokcsomĂł- ĂŠs multiplex ossealis metasztĂĄzist adĂł
hormonĂŠrzĂŠkeny lobularis emlĹdaganatot mutattak ki. A nyirokcsomĂł-metasztĂĄzis
megjelenĂŠse elĹtt intrathecalis methotrexat kemoterĂĄpiĂĄt alkalmaztak, amely
mellett neurolĂłgiai tĂźnetei megszĹąntek. A zsigeri metasztĂĄzis kifejlĹdĂŠsekor
szisztĂŠmĂĄs ifosfamid (1000 mg/m2, 1â3. nap) â etoposid (100
mg/m2, 1â3. nap) kemoterĂĄpiĂĄt kapott, amely mellett a
nyirokcsomóåttÊt komplett klinikai remissziójåt Ês a neurológiai tßnetmentessÊg
stabilitĂĄsĂĄt ĂŠszleltĂŠk. A meningitis carcinomatosa diagnĂłzisĂĄtĂłl szĂĄmĂtva tĂśbb
mint egy ĂŠvet ĂŠlt, ĂśnĂĄllĂł ĂŠletvitellel. MindkĂŠt eset a szisztĂŠmĂĄs kemoterĂĄpia
lehetsĂŠges hatĂĄsossĂĄgĂĄt mutatja intracranialis metasztĂĄzisokat adĂł emlĹdaganatok
kezelĂŠsĂŠben. Orv. Hetil., 2016, 157(45), 1809â1813.
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Abstract
The authors present the history of two patients. The first patient, a 69-year-old
woman was diagnosed with locally invasive triple negative breast cancer with
pulmonary and cerebral metastases. Complete radiological remission of the
clinically asymptomatic cerebral metastases was detected under systemic
chemotherapy with carboplatin-docetaxel (75 mg/m2). Later, the
patient received whole brain radiotherapy and a second line of chemotherapy. The
overall survival was 20 months from the diagnosis of cerebral metastases with
conservation of partial autonomy. The second patient, a 57-year-old woman was
diagnosed as having hormone sensitive lobular breast cancer with leptomeningeal,
lymphonodular and multiple osseal metastases. Before the appearance of the
lymphonodular metastasis the patient received intrathecal methotrexate
chemotherapy for the leptomeningeal carcinomatosis. Her neurological symptoms
completely disappeared. At the onset of the lymphonodular metastasis systemic
chemotherapy with ifosfamide (1000 mg/m2, D1â3) â etoposide (100
mg/m2, D1â3) was started allowing complete clinical remission of
the lymphadenomegaly and stability of the asymptomatic neurological status. The
overall survival was 13 months from the diagnosis of leptomeningeal
carcinomatosis with conservation of autonomy. The two cases support potential
efficacy of systemic chemotherapy for intracranial metastases of breast cancer.
Orv. Hetil., 2016, 157(45), 1809â1813
Contrasting disease patterns in seropositive and seronegative neuromyelitis optica: A multicentre study of 175 patients
BACKGROUND: The diagnostic and pathophysiological relevance of antibodies to aquaporin-4 (AQP4-Ab) in patients with neuromyelitis optica spectrum disorders (NMOSD) has been intensively studied. However, little is known so far about the clinical impact of AQP4-Ab seropositivity. OBJECTIVE: To analyse systematically the clinical and paraclinical features associated with NMO spectrum disorders in Caucasians in a stratified fashion according to the patients' AQP4-Ab serostatus. METHODS: Retrospective study of 175 Caucasian patients (AQP4-Ab positive in 78.3%). RESULTS: Seropositive patients were found to be predominantly female (p 1 myelitis attacks in the first year were identified as possible predictors of a worse outcome. CONCLUSION: This study provides an overview of the clinical and paraclinical features of NMOSD in Caucasians and demonstrates a number of distinct disease characteristics in seropositive and seronegative patients
Bell's Palsy - Medical Treatment and Influence of Prognostic Factors
Bellâs palsy is an acute onset of peripheral facial nerve dysfunction. Despite extensive research the aetiology is unclear. The most prevailing theory is that reactivation of viruses such as Herpes simplex type-1 or Varicella zoster may cause Bellâs palsy. The natural course is favourable but at least 30% of patients will suffer sequelae such as residual paresis, synkinesis and/or contracture. The most commonly used medical treatment to reduce sequelae has been corticosteroids and/or antiviral agents, the usefulness of which has been debated since earlier studies have shown diverging results. The aim of this thesis was to evaluate the effect of treatment with prednisolone and/or valaciclovir in a large number of Bellâs palsy patients and study how prognostic factors such as age, severity of palsy at baseline, and time to treatment start may influence outcome. Data from the Scandinavian Bellâs Palsy Study (SBPS), a prospective, randomised, double-blind, placebo-controlled multicentre study with 12-month follow-up, were evaluated. In total, 829 patients, aged 18â75, were included in the intention to treat (ITT) analysis: 210 patients received prednisolone plus placebo, 207 valaciclovir plus placebo, 206 prednisolone plus valaciclovir and 206 placebo plus placebo. Outcome was measured using the Sunnybrook facial grading system (SFGS) and House-Brackmann scale (HBS) at baseline and each follow-up. Follow-ups were scheduled for day 11â17 and 1, 2, 3, 6 and 12 months after palsy onset. Significantly better outcome was seen in patients treated with prednisolone (72%) compared with patients who did not receive prednisolone (57%) (P<0.0001). Time to complete recovery was also significantly shorter in patients treated with prednisolone compared with patients not treated with prednisolone (P<0.0001). Synkinesis at 12 months was less frequent in patients treated with prednisolone (14%) compared with patients not receiving prednisolone (29%) (P<0.0001). Where treatment started within 48 hours, patients in the prednisolone group had shorter time to complete recovery, higher complete recovery rates and less synkinesis compared with the group not treated with prednisolone. Patients aged âĽ40 years had significantly higher complete recovery rates if treated with prednisolone. This was not seen in patients <40 years, but synkinesis was less prevalent in patients <40 years old given prednisolone. All patients, regardless of severity at baseline, showed significantly higher complete recovery rates if treated with prednisolone compared with no prednisolone. In patients with moderate and mild palsy at baseline, significantly fewer prednisolone-treated patients had synkinesis at 12 months. Valaciclovir alone showed no effect on recovery rates, time to recovery or synkinesis and did not show any additive effect to prednisolone. In conclusion, prednisolone treatment in Bellâs palsy is recommended for use in adult patients regardless of severity of palsy and age, and should be started as early as possible, as long as no contraindications for steroid treatment is present
Fragile bones in patients with stroke? : bone mineral density in acute stroke patients and changes during one year of follow up
This thesis highlights several clinically important questions related to bone loss the first
year following stroke and with regard to bone mass at stroke onset:
Lack of mobility and weight bearing early after stroke is an important factor for the
greater bone loss in the proximal femur on the paretic side. Relearning to walk within the first
two month after stroke, even with support of another person may, however, reduce the bone
loss after immobilisation.
The reduction in BMD in the femoral neck appears mainly to occur in the lower part of
the neck and on the paretic side. It depends on when or if the patients start to walk after
stroke, but also on the amount of body weight born through the paretic leg. Thus, measuring
the lower part of the femoral neck may give a better estimate of the impact of gait and weight
bearing than measuring the total femoral neck.
During the first year after stroke bone mineral is lost in the proximal humerus of the
paretic arm, but the loss depends on the initial degree of the paresis. However, stroke patients
who regain almost normal arm function within one year, despite being severely impaired
initially, loose less bone mineral than patients where a severe paresis persists.
Female, but not male, stroke patients have lower femoral neck BMD than population
controls. At present it is unclear if low BMD actually increases the risk of stroke in women or
reflects a poor health with both high stroke risk and low BMD
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