Testiranje na antineuronska protutijela u neuobičajenom slučaju ponovljene Bellove paralize

The term Bell\u27s palsy (BP) is nowadays reserved for peripheral facial nerve paralysis without well-defined etiology and pathogenesis. BP is not a life threatening condition but it has a potential cosmetic mutilatory effect, and there is also a possibility of serious ophthalmologic complications (corneal ulcers). Recurrent paralyses are noted in 7% - 8% of BP cases. Only two patients with four BP episodes out of 170 patients, and only one patient with more than four BP episodes out of 2414 BP cases have been reported in the literature. The highest number of BP recurrences found in the available literature is nine. A brief review of the epidemiology and etiopathogenesis of BP is presented, a case of unusual recurrent BP is reported, and the immune pathomechanisms are discussed.Pojam Bellove paralize (BP) danas označava perifernu paralizu ličnoga živca nejasne etiologije i patogeneze. BP nije stanje koje bi ugrozilo život bolesnika, ali može imati znatne estetske posljedice te izazvati ozbiljne oftalmološke komplikacije (ulceracije rožnice). Ponovljene paralize javljaju se u 7% - 8% slučajeva BP. U literaturi je opisano samo dvoje bolesnika s četiri epizode BP od ukupno 1700 bolesnika, te samo jedan bolesnik s više od četiri epizode BP od ukupno 2414 slučajeva BP. U dostupnoj literaturi, najveći broj ponovljenih BP je devet. U radu se daje kratak pregled epidemiologije i etiopatogeneze BP, uz prikaz neuobičajenog slučaja ponovljene BP, uključujući raspravu o imunološkim patomehanizmima

Diffusion magnetic resonance imaging reveals tract‐specific microstructural correlates of electrophysiological impairments in non‐myelopathic and myelopathic spinal cord compression

ABSTRACT: Background and purpose: Non- myelopathic degenerative cervical spinal cord compres-sion (NMDC) frequently occurs throughout aging and may progress to potentially irre-versible degenerative cervical myelopathy (DCM). Whereas standard clinical magnetic resonance imaging (MRI) and electrophysiological measures assess compression sever-ity and neurological dysfunction, respectively, underlying microstructural deficits still have to be established in NMDC and DCM patients. The study aims to establish tract- specific diffusion MRI markers of electrophysiological deficits to predict the progression of asymptomatic NMDC to symptomatic DCM. Methods: High-resolution 3 T diffusion MRI was acquired for 103 NMDC and 21 DCM patients compared to 60 healthy controls to reveal diffusion alterations and relation-ships between tract-specific diffusion metrics and corresponding electrophysiological measures and compression severity. Relationship between the degree of DCM disability, assessed by the modified Japanese Orthopaedic Association scale, and tract-specific mi-crostructural changes in DCM patients was also explored. Results: The study identified diffusion-derived abnormalities in the gray matter, dor-sal and lateral tracts congruent with trans-synaptic degeneration and demyelination in chronic degenerative spinal cord compression with more profound alterations in DCM than NMDC. Diffusion metrics were affected in the C3-6 area as well as above the com-pression level at C3 with more profound rostral deficits in DCM than NMDC. Alterations in lateral motor and dorsal sensory tracts correlated with motor and sensory evoked po-tentials, respectively, whereas electromyography outcomes corresponded with gray mat-ter microstructure. DCM disability corresponded with microstructure alteration in lateral columns. Conclusions: Outcomes imply the necessity of high- resolution tract-specific diffusion MRI for monitoring degenerative spinal pathology in longitudinal studies

Erratum: Diffusion magnetic resonance imaging reveals tract‐specific microstructural correlates of electrophysiological impairments in non‐myelopathic and myelopathic spinal cord compression

ABSTRACT: Background and purpose: Non- myelopathic degenerative cervical spinal cord compres-sion (NMDC) frequently occurs throughout aging and may progress to potentially irre-versible degenerative cervical myelopathy (DCM). Whereas standard clinical magnetic resonance imaging (MRI) and electrophysiological measures assess compression sever-ity and neurological dysfunction, respectively, underlying microstructural deficits still have to be established in NMDC and DCM patients. The study aims to establish tract- specific diffusion MRI markers of electrophysiological deficits to predict the progression of asymptomatic NMDC to symptomatic DCM. Methods: High-resolution 3 T diffusion MRI was acquired for 103 NMDC and 21 DCM patients compared to 60 healthy controls to reveal diffusion alterations and relation-ships between tract-specific diffusion metrics and corresponding electrophysiological measures and compression severity. Relationship between the degree of DCM disability, assessed by the modified Japanese Orthopaedic Association scale, and tract-specific mi-crostructural changes in DCM patients was also explored. Results: The study identified diffusion-derived abnormalities in the gray matter, dor-sal and lateral tracts congruent with trans-synaptic degeneration and demyelination in chronic degenerative spinal cord compression with more profound alterations in DCM than NMDC. Diffusion metrics were affected in the C3-6 area as well as above the com-pression level at C3 with more profound rostral deficits in DCM than NMDC. Alterations in lateral motor and dorsal sensory tracts correlated with motor and sensory evoked po-tentials, respectively, whereas electromyography outcomes corresponded with gray mat-ter microstructure. DCM disability corresponded with microstructure alteration in lateral columns. Conclusions: Outcomes imply the necessity of high- resolution tract-specific diffusion MRI for monitoring degenerative spinal pathology in longitudinal studies