Review of various intraoperative neurophysiologic monitoring techniques

IONM is use to monitoring nervous tissues (including brain, spinal cord, cranial nerves and peripheral nerves) in real-time during surgeries, alert neurological injuries and corrective measures and prevent disability. There are various IONM monitoring techniques including evoke potentials (SSEP, BAEP, MEP), EMG (Free-running and triggered), NAP (Nerve action potential) and Electroencephalography (EEG) to monitor the functional integrity of neural structures. SSEP evaluates integrity of posterior column-medial lemniscus pathway. SSEP is clinical use in spinal cord surgeries, vascular surgeries (carotid endarterectomy, cerebral aneurysm surgery etc), and localization of sensor motor cortex. BAEP evaluates integrity of peripheral and central auditory pathway. BAEP is clinical use in CP angle tumors surgery (acoustic neuroma ,meningioma), microvascular decompression of CN-VII for hemifacial spasm, CN-V for trigeminal neuralgia, CN-IX for glossopharyngeal neuralgia, skull base surgery, Suboccipital decompression (e.g. fractures/dislocation C-1vertebra, chiari malformation). MEP evaluates integrity of motor pathway. MEP is sensitive to neuromuscular blocker anesthetic medications. Clinical utility of MEP including any surgery risking motor pathway injury include tumor near the motor cortex or corticospinal tract, intracranial aneurysm clipping, posterior fossa surgery, tethered cord or cauda equina surgeries, spinal deformity or fracture surgery, vertebral tumor resections, and anterior cervical discectomy, descending aortic procedures, spinal arteriovenous malformation interventions and carotid endarterectomy. EMG (free running and triggered) evaluates integrity of innervating nerves and electrical activity of muscles. Clinical utility of facial and other cranial nerve monitoring in posterior fossa surgery (eg, acoustic neuroma), selective dorsal rhizotomy, tethered cord release , Pedicle screw placement and Anal or urinary sphincter function monitoring

Spectrum of neuromuscular injuries in victims of bomb blasts

Introduction: Bomb blast (BB) injuries outside war zones were a rare phenomenon until recently. With the spreading wave of terrorism across the globe, BB related trauma is resurfacing. Explosions can produce unique patterns of neuromuscular injury. No recent data exists categorizing such injuries. Methods: Medical records and electrodiagnostic findings of 20 patients with BB related neuromuscular injuries (NMI) were reviewed retrospectively. Results: Most common site of injury was the lower extremities (55%) with majority presenting clinically with foot drop (40%) or weakness (30%). 9/17 patients (45%) had associated shrapnel or penetrating trauma. 6/20 patients had associated fractures. The most common finding was of mononeuropathies. Discussion: As we re-enter an era of war, we need to recreate awareness of the possible spectrum of NMI. Awareness of such injuries will lead to early identification of nerve trauma and the possibility of reduction in overall disability if treated appropriately soon after the injury

Utility of intraoperative neurophysiological monitering (ionm) in various surgeries at a tertery care hospital in karachi, pakistan.

Utility of real time multimodal intraoperative neurophysiological monitoring in different intracranial, spinal and peripheral nerve at a tertiary care hospital in Karachi Pakistan.Study design: A retrospective observational study Place and duration of study: Patients admitted in neurology and neurosurgery services as well as out-patients presenting to the clinical neurophysiology lab at the Aga Khan University Hospital Karachi between January 2012 to December 2013.Methodology: The study consisted of 14 patients undergoing different intracranial, spinal and peripheral nerve surgeries including correction of spinal scoliosis, spinal cord lesion ,acoustic neuroma resection and plexus and peripheral nerve repaired. Among the electrophysiological methods patients were monitored using including SSEP, BAEP and EMG (free-running and triggered). EMG was done on Nihon Kohden Viking Quest from Nicolet Co. For SSEPs GillioNT from EB Neuro Co, and for NIOM carefusion from Nicolet Co was used.Results: Mean age of patients was 39 years (4-70 years). SSEP, BAEP and EMG (free-running and triggered) were recorded, during various surgeries. Of total 14 patients, no patient expressed a significant alert to prompt reversal of ongoing intervention. No patients awoke with a new neurological deficit and none had significant intraoperative SSEP /EMG alerts. Conclusion: Neurophysiologic intraoperative monitoring appears to be the modern standard of care for monitoring functional integrity and minimizing the risk of iatrogenic damage to the central and peripheral nervous system

A rare presentation of acute flaccid myelitis in covid-19 patient: a case report

SARS-CoV-2 virus enters human cells via ACE-2 receptors and causes multiple organs dysfunction. These ACE-2 receptors are in cells surface of human lung, liver, heart, kidney and blood vessels. The expression of ACE2 receptors in cortical neurons, glial cells and spinal cord cells create nervous system susceptible to SARS-CoV-2 attack and may be a source of different neurological deficits including myelitis in COVID-19 patients