16 research outputs found
Partial Recurrent Laryngeal Nerve Paralysis or Paresis? In Search for the Accurate Diagnosis
“Partial paralysis” of the larynx is a term often used to describe a hypomobile vocal fold as is the term “paresis.” We present a case of a dysphonic patient with a mobility disorder of the vocal fold, for whom idiopathic “partial paralysis” was the diagnosis made after laryngeal electromyography, and discuss a proposition for a different implementation of the term
Clinical and neurophysiological study of peroneal nerve mononeuropathy after substantial weight loss in patients suffering from major depressive and schizophrenic disorder: Suggestions on patients' management
Abstract Background Peroneal nerve is susceptible to injuries due to its anatomical course. Excessive weight loss, which reduces the fatty cushion protecting the nerve, is considered a common underlying cause of peroneal palsy. Other predisposing factors, such as prolonged postures, traumas of the region or concomitant pathologies (for example diabetes mellitus) contribute to the nerve damage. This study aims to reveal the multiple predisposing factors of peroneal nerve mononeuropathy after substantial weight loss that coexist in psychiatric patients and to make suggestions on their management. Methods Nine psychiatric inpatients, major depressive or schizophrenic, with foot drop underwent a complete clinical neurological and neurophysiological examination. All had excessive weight loss, which was completed in a short period of time and had not resulted from a well-balanced low-calorie diet, but was due to their psychiatric illness. Data regarding predisposing factors to peroneal nerve mononeuropathy were gathered, such as habitual leg crossing, squatting or other prolonged postures. Results The clinical examination and the neurophysiological evaluation in all patients were indicative of a focal lesion of the peroneal nerve at the fibular head. Conclusion Patients with major depressive and schizophrenic disorders gather multiple predisposing factors to peroneal palsy, adequate to classify them at a high risk group. The better focus of the attendant medical and nursing staff on this condition, the early clinical and neurophysiologic evaluation and surgical interventions may enable an improved management and prognosis of these patients.</p
Oxaliplatin-induced neuropathy: a long-term clinical and neurophysiologic follow-up study
Acute oxaliplatin neurotoxicity and chronic sensory cumulative neuropathy were investigated in a long-term study of 31 consecutive patients with advanced colorectal cancer. Our results improve the knowledge of acute neurotoxicity and support the finding of the persistence of the sensory nerve deficits for years after the cessation of oxaliplatin therapy. Background Oxaliplatin is an effective drug used mainly for advanced colorectal cancer. Neurotoxicity is the major side effect of oxaliplatin. The present clinical and neurophysiologic study was conducted to evaluate patients receiving oxaliplatin therapy. Patients and Methods Thirty-one consecutive patients with colorectal cancer who received oxaliplatin therapy were followed up for more than 3 years. The patients underwent clinical and neurophysiologic tests for large and small fiber function at every visit. Results Most of the patients received oxaliplatin-based chemotherapy at the initial dose of 130 mg/m2 for 6 to 8 cycles, normally every 3 weeks. Acute neurotoxicity with cold and mechanical hyperalgesia was reported by the vast majority of patients after each cycle of therapy and was confirmed by the quantitative sensory, filament, and axon reflex test. Chronic sensory cumulative neuropathy developed in most of the patients after the middle of therapy with numbness and was assessed using clinical scales, nerve conduction studies, and the vibration threshold. Our results support the persistence of the sensory nerve deficits for years after cessation of oxaliplatin therapy. Conclusion Our study has confirmed the results of a few previous long-term studies concerning the persistence of chronic large sensory fiber neuropathy and the influence of the cumulative dose of oxaliplatin on the development and severity of the chronic neuropathy. Our findings have improved the knowledge about the acute oxaliplatin-induced neurotoxicity using the C-fiber axon reflex response. © 2016 Elsevier Inc
Differential sensitivity of thick and thin fibers to HIV and therapy-induced neuropathy
The study assessed HIV-related and anti-retroviral therapy-induced
neuropathy in myelinated and unmyelinated nerve fibers. One hundred
consecutive HIV patients were examined clinically and standard nerve
conduction velocities were measured. In addition, electrically induced
sympathetic skin response (SSR) was assessed in the palms and soles. The
difference in delay of SSR in palms and soles (Delta SSR) was calculated
as an indirect measure of C-fiber conduction velocity. Thick fiber
conduction velocities significantly decreased with age and increasing
stage of the disease, whereas no effect of stage was found for Delta SSR
(p=0.6). In contrast, medication of at least one of the most known
neurotoxic drugs zalcitabine, stavudine, or didanosine did not result in
significantly lower conduction velocities in thick fibers (51.29 +/- 3.4
m/s vs. 50.86 +/- 3.5 m/s), but was related to an increased Delta SSR.
Delta SSR allows an indirect measurement of C-fiber conduction velocity.
In HIV this measure of unmyelinated sympathetic fibers was most
sensitive to anti-viral treatment whereas conduction velocity of
myelinated somatic fibers was more sensitive to disease-related
neuropathy. The results suggest that HIV neuropathy preferably affects
myelinated and anti-retroviral therapy unmyelinated fibers. (c) 2007
Elsevier B.V. All rights reserved
Urinary frequency in a case of Neuro-Behcet disease involving the brainstem - Clinical, electrophysiological and urodynamic features
Micturitional disturbances are reported in 5-20% of patients with
Behcet disease (BD) affecting the central nervous system. However,
corresponding data regarding urodynamic and electrophysiological
findings are limited.
A patient with known BD presented with dysarthria, diplopia and urinary
frequency (36 times/day). MRI revealed an extensive lesion involving the
lateral and tegmental pons, reaching the pontomedullary junction.
Auditory evoked potentials indicated left-side lesion between superior
olivary nucleus and superior colliculus. Blink reflex examination
indicated a location caudal to the left trigeminal root. Pudendal nerve
somatosensory evoked potentials and transcranial magnetic stimulation of
the perineal muscles were slightly affected. Bulbocavernosus reflex
latencies were normal. EMG of the bulbocavernosus muscles showed a
normal maximal voluntary contraction activity. Urodynamic studies
revealed normal urine volume, maximum flow rate and residual volume.
After intravenous administration of methylprednisolone diplopia and
dysarthria resolved within 3 weeks. Urinary frequency remained almost
unchanged for the first 8 weeks, but clearly improved during the
following months. We assume that the present case of urinary frequency
is the result of vasculitic lesion affecting the pontine micturition
inhibitory area on the ground of Neuro-Behcet disease. (C) 2007 Elsevier
B.V. All rights reserved
Polyneuropathy induced by HIV disease and antiretroviral therapy
Objective: To investigate the underlying mechanisms of polyneuropathy
induced by HIV infection or antiretroviral drugs.
Methods: We tested 100 HIV patients (59 with AIDS). Ninety-three
patients received antiretroviral drugs. Forty-four were treated with
neurotoxic compounds (ddI, ddC, d4T). Nerve conduction velocities and
the sympathetic skin response (SSR) in palms and soles were measured in
all patients. In skin biopsies (ankle and thigh), the intraepidermal
nerve fiber density (IENFD) and the number of epidermal fibers without
contact to the basal membrane (fragments) were quantified using PGP9.5
staining.
Results: Severity of the disease (CD4 + count) correlated to conduction
velocities of peroneal (p < 0.01, Spearmans rank correlation), sural (p
< 0.01) and median nerves (p < 0.05/p < 0.001, sensory/motor). In
contrast, the duration of neurotoxic treatment did not impair conduction
velocities (p > 0.3) but correlated to reduced IENFD in the ankle (r =
-0.24, p < 0.05). Despite their reduced IENFD, patients with long
neurotoxic treatment had a high number of fragments irrespective of
their CD4 + count.
Conclusions: Neurotoxic treatment appears to primarily impair thin fiber
conduction, whereas HIV neuropathy is linked to large fiber impairment
and reduction of fragments of nerve fibers.
Significance: These findings emphasize the differential pattern of
polyneuropathy in HIV patients caused by the infection or induced by
antiretroviral treatment. (C) 2012 International Federation of Clinical
Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved