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Pseudo Bulbar Palsy: a Rare Cause of Extubation Failure
Letters to the Editor 2. Deepak N A, Patel ND. Differential diagnosis of acute liver failure in Access this article online India. Ann Hepatol 2006;5:150‑6. Quick Response Code: 3. Singh V, Bhalla A, Sharma N, Mahi SK, Lal A, Singh P, et al. Website: Pathophysiology of jaundice in amoebic liver abscess. Am J Trop Med www.ijccm.org Hyg 2008;78:556‑9. 4. Kamarasu K, Malathi M, Rajagopal V, Subramani K, Jagadeeshramasamy D, Mathai E, et al. Serological evidence for wide DOI: distribution of spotted fevers & typhus fever in Tamil Nadu. Indian J 10.4103/ijccm.IJCCM_244_18 Med Res 2007;126:128‑30. 5. Poomalar GK, Rekha R. Scrub typhus in pregnancy. J Clin Diagn Res 2014;8:1‑3. How to cite this article: Mahto SK, Sheoran A, Goel A, Agarwal N. This is an open access journal, and articles are distributed under the terms of the Creative Uncommon cause of acute liver failure with encephalopathy. Indian J Crit Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to Care Med 2018;22:619‑20. remix, tweak, and build upon the work non‑commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. © 2018 Indian Journal of Critical Care Medicine | Published by Wolters Kluwer ‑ Medknow Pseudo Bulbar Palsy: A Rare Cause of Extubation Failure Sir, Extubation Failure (EF) following weaning trials is a well known entity in Intensive Care Units (ICUs). The varied prevalence (2%–25%) of EF depends on the population studied and the time frame (24–72 h) included for analysis.[1] Airway edema and nonresolution of the primary disease are a common cause. -
Ulnar Claw-Hand Related Neglected Post-Traumatic Anterior Shoulder Joint Dislocation
Open Access Library Journal 2017, Volume 4, e3454 ISSN Online: 2333-9721 ISSN Print: 2333-9705 Ulnar Claw-Hand Related Neglected Post-Traumatic Anterior Shoulder Joint Dislocation Hermawan Nagar Rasyid Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin Teaching Hospital, Bandung, Indonesia How to cite this paper: Rasyid, H.N. Abstract (2017) Ulnar Claw-Hand Related Neglected Post-Traumatic Anterior Shoulder Joint Shoulder joint is the most frequently dislocated joint. Humeral head disloca- Dislocation. Open Access Library Journal, tion pushed the nerve toward medial side. Neglected shoulder dislocation is 4: e3454. difficult to manage and requires extensive procedures to obtain good func- https://doi.org/10.4236/oalib.1103454 tional outcome. In the case of negligence, it is often found loss of the anterior Received: February 13, 2017 capsule due to absorption of the capsule. Nerve lesions, in particular the ulnar Accepted: March 17, 2017 nerve, often do not receive attention. Clinically, it often occurred from neura- Published: March 20, 2017 praxia to severe condition like claw-hand deformity. In my experience of a Copyright © 2017 by author and Open neglected case, there was a 53-year-old woman who presented to the ortho- Access Library Inc. paedic clinic with a left anterior shoulder fracture dislocation following a fall This work is licensed under the Creative onto the right shoulder and upper right arm. She had treated herself at home Commons Attribution International for around six months before visiting the clinic. She also complained of some License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ deformities on her ring and little fingers, known as ulnar claw-hand. -
Hirayama Disease
VIDEO CASE SOLUTION VIDEO CASE SOLUTION Hirayama Disease BY AZIZ SHAIBANI, MD, FACP, FAAN, FANA Last month’s case presented a 21-year-old shrimp peeler who developed weakness of his fingers five years earlier that pro- gressed to a point where he was unable to perform his job. CPK and 530 U/L and EMG revealed chronic diffuse denerva- tion of the arms and muscles with normal sensory and motor responses. Watch the exam at PracticalNeurology.com. Chronic unilateral or bilateral pure motor weakness of the hand and muscles in a young patient is not common. DIFFERENTIAL DIAGNOSIS • Cervical cord pathology such as Syringomyelia: dissociated sensory loss is typically present. • Brachial plexus pathology: sensory findings are usually present. • Motor neurons disease: ALS, spinal muscular atrophy (SMA). – Cervical Spines are usually investigated before neuromuscular referrals are made. – The lack of pain, radicular or sensory symptoms and normal sensory SNAPS and cervical MRIs ruled out most of the mentioned possibilities except: • distal myopathy (usually not unilaterial) and spinal muscular atrophy. • EMG/NCS demonstration of chronic distal denervation with normal sensory responses and no demyelinating features lim- ited the diagnosis to MND. • Segmental denervation pattern further narrows the diagnosis to Hirayama disease (HD). HIRAYAMA DISEASE • HD is a sporadic and focal form of SMA that affects predominantly males between the ages of 15 and 25 years. • Weakness and atrophy usually starts unilaterally in C8-T1 muscles of the hands and forearm (typically in the dominant hand). – In roughly one-third of cases, the other hand is affected and weakness may spread to the proximal muscles. -
Physical Therapy Improved Hand Function in a Patient with Traumatic Peripheral Lesion: a Case Study
American Medical Journal 3 (2): 161-168, 2012 ISSN 1949-0070 © 2012 Science Publications Physical Therapy Improved Hand Function in a Patient with Traumatic Peripheral Lesion: A Case Study 1,2 Marco Orsini, 2,3 Julio Guilherme Silva, 3Clynton Lourenco Correa, 4Diego Rogrigues, 5Acary Bulle Oliveira, 4Valeria Marques Coelho, 4Debora Gollo, 1Antonio Marcos da Silva Catharino, 6Dionis Machado, 6Victor Hugo do Vale Bastos, 1Marco Antonio Araujo Leite, 7Gabriela Guerra Leal Souza, 1Carlos Henrique Melo Reis and 2Sara Lucia Silveira de Menezes 1Departament of Neurology, Nova Iguacu University, Hospital Geral de Nova Iguacu, Nova Iguacu, RJ, Brazil 2Master’s Program in Science of Rehabilitation, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, RJ, Brazil 3Department of Medical Clinic, Faculty of Medicine, School of Physiotherapy, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil 4Fluminense Rehabilitation Association, Niteroi, RJ, Brazil 5Department of the, Neuromuscular Disease Federal University of Sao Paulo (UNIFESP), Vila Mariana, Sao Paulo, Brazil 6Department of the Physical Therapy Federal University of Piaui (UFPI), Parnaiba, Piaui, Brazil 7Department of Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto, MG, Brazil Abstract: Problem statement: Nerves are frequently injured by traumatic lesions, such as crushing, compression (entrapment), stretching, partial and total extraction, resulting in damages to the transmission of nerve impulses and to the reduction or loss of sensitivity, to the motility and to the reflexes of the innervated area. The objective of this study was to evaluate the results of a rehabilitation program that lasted three months in the process of traumatic injury recovery of the median and ulnar nerves in a 52 year-old patient. -
An Unusual Cause of Pseudomedian Nerve Palsy
Hindawi Publishing Corporation Case Reports in Neurological Medicine Volume 2011, Article ID 474271, 3 pages doi:10.1155/2011/474271 Case Report An Unusual Cause of Pseudomedian Nerve Palsy Zina-Mary Manjaly, Andreas R. Luft, and Hakan Sarikaya Department of Neurology, University Hospital Zurich, Frauenklinikstraße 26, 8091 Zurich,¨ Switzerland Correspondence should be addressed to Zina-Mary Manjaly, [email protected] Received 20 July 2011; Accepted 9 August 2011 Academic Editors: J. L. Gonzalez-Guti´ errez,´ V. Rajajee, and Y. Wakabayashi Copyright © 2011 Zina-Mary Manjaly et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We describe a patient who presented with an acute paresis of her distal right hand suggesting a peripheral median nerve lesion. However, on clinical examination a peripheral origin could not be verified, prompting further investigation. Diffusion-weighted magnetic resonance imaging revealed an acute ischaemic lesion in the hand knob area of the motor cortex. Isolated hand palsy in association with cerebral infarction has been reported occasionally. However, previously reported cases presented predominantly as ulnar or radial palsy. In this case report, we present a rather rare finding of an acute cerebral infarction mimicking median never palsy. 1. Case median nerve, which was normal (Figure 1(c)). Magnetic resonance imaging (MRI) on the same day revealed a small A 60-year-old woman presented to the emergency depart- diffusion restriction in a part of the left precentral gyrus that ffi ment with di culty in moving the thumb, index, and middle is known as “the hand knob” area (Figure 1(d))[2]. -
Melioidosis: a Potentially Life Threatening Infection
CONTINUING MEDICAL EDUCATION Melioidosis: A Potentially Life Threatening Infection SH How, MMed*, CK Liam, FRCP*· *Department of Internal Medicine, Kulliyyah of Medicine, International Islamic University Malaysia, FO.Box 141, 27510, Kuantan, Pahang, Malaysia, **Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, MalaysIa Introduction example in Thailand, it is most commonly seen in the north-eastern region with an incidence of 4.4 per Melioidosis is caused by the gram-negative bacillus, 100,000 population per year'. In Northern Australia, Burkholderia pseudomallei, a common soil and fresh the incidence is higher (16.5 per 100,000 populations water saprophyte in tropical and subtropical regions. It 4 per yearY than that in Thailand • The incidence in is endemic in tropical Australial and in Southeast Asian Pahang and Singapore is 6.1 per 100, 000 population 23 4 countries, particularly Malaysia , Thailand and per year3 and 1.7 per 100,000 population per yearS, Singapores. However, only few doctors in these respectively. However, the true incidence may be endemic areas are fully aware of this infection. Hence, higher than that reported as most of these studies the management of this infection is often not included culture-confirmed cases only. Furthermore, appropriate and suboptimal. A recent study in Pahang some patients with mild infection from the rural areas has shown the incidence of this infection in Pahang3 is may not present to the hospital. More and more 4 comparable with that in northern Thailand • The melioidosis cases are being reported from previously overall mortality from this infection remains extremely unreported parts of the world especially southern high despite recent advancement in its treatment. -
Classification of Finger Posture in Drop Finger Due to Cervical Foraminal Stenosis: a Mini-Review
hysical M f P ed l o ic a in n r e u & o R J l e a h International Journal of Physical n a b o i t i l i a ISSN: 2329-9096t a n r t i e o t n n I Medicine & Rehabilitation Mini Review Classification of Finger Posture in Drop Finger Due to Cervical Foraminal Stenosis: A Mini-Review Mitsuru Furukawa1*, Michihiro Kamata2 1Department of Orthopedic Surgery, Murayama Medical Center, Tokyo, Japan; 2Department of Orthopedic Surgery, Keiyu Hospital, Kanagawa, Japan ABSTRACT Few reports have been published examining cervical foraminal stenosis as the cause of drop finger. This mini-review, therefore, will provide a summary of the findings of articles published on this topic, written in both English and Japanese. Cervical foraminal stenosis is difficult to diagnose from imaging findings alone; thus, physical examination findings are often needed to make a firm diagnosis. Numbness of the fingers, the extent of interscapular pain, and finger posture can be used to differentiate drop finger due to cervical foraminal stenosis from other diseases. It is crucial to provide sufficient explanation to the patient before a decompression surgery is performed because the recovery of muscle strength is often incomplete and the improvement may be small. Keywords: Drop finger; Cervical foraminal stenosis; C7 nerve root; C8 nerve root ABBREVIATIONS: RESULTS CFS: cervical foraminal stenosis; PION; Posterior Interosseous The search obtained three case reports, one clinical feature, and Nerve; ECR; Extensor Carpi Radialis; EDM; Extensor Digiti one surgical outcome from PubMed, whereas two case reports Minimi; EIP; Extensor Indicis Proprius and two reviews came from the Japan Medical Abstracts Society. -
Table of Contents
TABLE OF CONTENTS 1. INTRODUCTION . Faculty . Program 2. GUIDELINES . Fellowship Appointments . Fellow Selection 3. REQUIREMENTS . UAB Child Neurology Training Requirements . Call Requirements . Moonlighting Policy . ACGME Duty Hours . Policy on Fatigue . ABPN Training Requirements 4. GOALS AND OBJECTIVES . Overall Program Goals and Objectives . Adult Year PG3-PG4 . Inpatient PG4 . Inpatient PG5 . Outpatient . Neuromuscular . Epilepsy . Neuropathology . Psychiatry . Conferences . Required Research Survey Course 5. CURRICULUM IN CHILD NEUROLOGY . Purpose . Structure . Content 6. SALARY AND BENEFITS 7. CRITERIA FOR ADVANCEMENT . Educational Expectations . Disciplinary Procedures . Grievance Procedure 8. EVALUATIONS . Supervision of Fellows Policy . Fellow Evaluations . Attending Evaluations . Program Evaluations . Peer and Self Evaluations . Healthcare Professional Evaluations INTRODUCTION: Child Neurology is a specialty of both pediatrics and neurology which focuses on the nervous system of the pediatric population. The practice of child neurology requires competence and training in both pediatrics and neurology in order to understand and treat disorders of the pediatric nervous system. This manual outlines the goals and expectations as well as logistics of the Child Neurology training program at The University of Alabama at Birmingham. A. Clinical competence requires: 1. A solid fund of basic and clinical knowledge and the ability to maintain it at current levels for a lifetime of continuous education. 2. The ability to perform an adequate history and physical examination. 3. The ability to appropriately order and interpret diagnostic tests. 4. Adequate technical skills to carry out selected diagnostic procedures. 5. Clinical judgment to critically apply the above data to individual patients. 6. Attitudes conducive to the practice of neurology, including appropriate interpersonal interactions with patients and families, professional colleagues, supervisory faculty and all paramedical personnel. -
EM Guidemap - Myopathy and Myoglobulinuria
myopathy EM guidemap - Myopathy and myoglobulinuria Click on any of the headings or subheadings to rapidly navigate to the relevant section of the guidemap Introduction General principles ● endocrine myopathy ● toxic myopathy ● periodic paralyses ● myoglobinuria Introduction - this short guidemap supplements the neuromuscular weakness guidemap and offers the reader supplementary information on myopathies, and a short section on myoglobulinuria - this guidemap only consists of a few brief checklists of "causes of the different types of myopathy" that an emergency physician may encounter in clinical practice when dealing with a patient with acute/subacute muscular weakness General principles - a myopathy is suggested when generalized muscle weakness involves large proximal muscle groups, especially around the shoulder and proximal girdle, and when the diffuse muscle weakness is associated with normal tendon reflexes and no sensory findings - a simple classification of myopathy:- Hereditary ● muscular dystrophies ● congenital myopathies http://www.homestead.com/emguidemaps/files/myopathy.html (1 of 13)8/20/2004 5:14:27 PM myopathy ● myotonias ● channelopathies (periodic paralysis syndromes) ● metabolic myopathies ● mitochondrial myopathies Acquired ● inflammatory myopathy ● endocrine myopathies ● drug-induced/toxic myopathies ● myopathy associated with systemic illness - a myopathy can present with fixed weakness (muscular dystrophy, inflammatory myopathy) or episodic weakness (periodic paralysis due to a channelopathy, metabolic myopathy -
Hand Surgery: a Guide for Medical Students
Hand Surgery: A Guide for Medical Students Trevor Carroll and Margaret Jain MD Table of Contents Trigger Finger 3 Carpal Tunnel Syndrome 13 Basal Joint Arthritis 23 Ganglion Cyst 36 Scaphoid Fracture 43 Cubital Tunnel Syndrome 54 Low Ulnar Nerve Injury 64 Trigger Finger (stenosing tenosynovitis) • Anatomy and Mechanism of Injury • Risk Factors • Symptoms • Physical Exam • Classification • Treatments Trigger Finger: Anatomy and MOI (Thompson and Netter, p191) • The flexor tendons run within the synovial tendinous sheath in the finger • During flexion, the tendons contract, running underneath the pulley system • Overtime, the flexor tendons and/or the A1 pulley can get inflamed during finger flexion. • Occassionally, the flexor tendons and/or the A1 pulley abnormally thicken. This decreases the normal space between these structures necessary for the tendon to smoothly glide • In more severe cases, patients can have their fingers momentarily or permanently locked in flexion usually at the PIP joint (Trigger Finger‐OrthoInfo ) Trigger Finger: Risk Factors • Age: 40‐60 • Female > Male • Repetitive tasks may be related – Computers, machinery • Gout • Rheumatoid arthritis • Diabetes (poor prognostic sign) • Carpal tunnel syndrome (often concurrently) Trigger Finger: Subjective • C/O focal distal palm pain • Pain can radiate proximally in the palm and distally in finger • C/O finger locking, clicking, sticking—often worse during sleep or in the early morning • Sometimes “snapping” during flexion • Can improve throughout the day Trigger Finger: -
Is the Diagnosis Written in the Palm?
CLINICAL Is the diagnosis written in the palm? Compression neuropathy from a walking frame Anupam Datta Gupta ANSWER 1 cause significant functional limitations. The diagnosis is compression neuropathy In late cases where the hand muscles of the right ulnar nerve and bilateral have already undergone atrophy, the CASE carpal tunnel syndrome at the wrist. motor recovery of those muscles, even A man aged 72 years requires a walking Pigmentation, callosity and atrophy on the after surgical decompression, may frame for mobility because of weakness ulnar side (hypothenar) of the right hand be incomplete. For early diagnosis of of both legs secondary to poliomyelitis. are indicative of ulnar nerve compression compression neuropathies, it is important He presents to the rehabilitation around the Guyon’s tunnel. This is either to routinely look at the hands of patients medicine outpatient clinic with soreness caused or exacerbated by the excessive who are taking increased weight through and weakness of both hands, which he pressure around the wrist during walking their hands because of a lower extremity developed following the use of the walking with the frame. Wasting of the first web problem and using mobility aids. If not frame. He also complains of loss of grip space caused by denervation of the picked up early, compression neuropathies strength and tingling of his hands. He is first dorsal interosseous and adductor can compound the disability. using the heel of the hand to manipulate pollicis muscles is a telltale sign of ulnar objects. Examination reveals skin neuropathy. On the left hand, the pressure ANSWER 3 pigmentation and callosities on the ulnar areas are around the carpal tunnel, causing To establish a diagnosis, the patient side of both palms, distal to the wrist crease median nerve compression. -
Cranial Nerve Disorders 11/05/2012
Version 2.0 Cranial Nerve Disorders 11/05/2012 General Lesion possible locations: muscle, NMJ, nerve outside or inside brainstem Conditions that can affect any CN: DM, MS, Tumours, Sarcoid, Vasculitis (e.g. PAN), SLE, Syphilis, chronic meningitis (tends to pick off lower CN one by one). Olfactory (I) Nerve • Anatomy: Olfactory cells are a series of bipolar neurones which pass through the cribriform plate to the olfactory bulb. • Signs: Reduced taste and smell, but not to ammonia which stimulates the pain fibres carried in the trigeminal nerve. • Causes: Trauma; frontal lobe tumour; meningitis. Optic (II) Nerve • Anatomy: The optic nerve fibres are the axons of the retinal ganglion cells. Fibres from the nasal parts of retina decussate at optic chiasm, join with the non-decussating fibres and pass back in optic tracts to visual cortex. • Signs and causes: o Visual field defects: Field defects start as small areas of visual loss (scotomas). Monocular blindness: Lesions of one eye or optic nerve eg MS, giant cell arteritis. Bilateral blindness: Methyl alcohol, tobacco amblyopia; neurosyphilis. Bitemporal hemianopia: Optic chiasm compression eg internal carotid artery aneurysm, pituitary adenoma or craniopharyngioma Homonymous hemianopia: Affects half the visual field contralateral to the lesion in each eye. Lesions lie beyond the optic chiasm in the tracts, radiation or occipital cortex e.g. stroke, abscess, tumour. o Pupillary Abnormalities see pupillary abnormalities article. o Optic neuritis (pain on moving eye, loss of central vision, afferent pupillary defect, papilloedema). Causes: demyelination; rarely sinusitis, syphilis, collagen vascular disorders. o Optic atrophy (pale optic discs and reduced acuity): MS; frontal tumours; Friedreich's ataxia; retinitis pigmentosa; syphilis; glaucoma; Leber's optic atrophy; optic nerve compression.