Learning Exercise: Imbalance of Electrolytes
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Hemimasticatory Spasm Treated with Botulinum Toxin
Arq Neuropsiquiatr 2002;60(2-A):288-289 HEMIMASTICATORY SPASM TREATED WITH BOTULINUM TOXIN Case report Hélio A.G. Teive1, Élcio J. Piovesan2, Francisco M.B. Germiniani3, Carlos Henrique A. Camargo3, Daniel Sá3, Rosana H. Scola4, Lineu C. Werneck5 ABSTRACT - We describe a female patient with hemimasticatory spasm, a rare movement disorder due to dysfunction of the motor trigeminal nerve of unknown origin. This patient had an excellent response to botulinum toxin therapy. KEY WORDS: hemimasticatory spasm, paroxysmal spasms, botulinum toxin. Espasmo hemimastigatório tratado com toxina botulínica: relato de caso RESUMO - Relatamos o caso de paciente feminina com espasmo hemimastigatório, distúrbio do movimento raro decorrente de disfunção da porção motora do nervo trigeminal, de etiologia desconhecida. A paciente teve excelente resposta clínica ao tratamento com toxina botulínica. PALAVRAS-CHAVE: espasmo hemimastigatório, espasmos paroxísticos, toxina botulínica. Hemimasticatory spasm (HMS) represents a rare spontaneously. She also complained of difficulty in talk- movement disorder due to a dysfunction of the mo- ing and swallowing when she had the spasms. tor trigeminal nerve of unknown origin. It is frequen- Neurological examination was normal except for in- tly misdiagnosed as hemifacial spasm, which is a tense contraction of the masseter and temporal muscles disorder due to dysfunction of the facial nerve1-3. on the right with severe facial pain when the patient had the spasms. Routine laboratory tests (WBC, biochemistry, The most striking features of HMS are the excruciat- VDRL, ERS) and ceruloplasmine were all normal. ing pain that accompanies the spasm itself and the The patient also had a previous history of irregular fact that initially masticatory movements act as a menstrual cycles and even amenorrhea for more than 1-3 trigger for the spasm . -
Hyponatremia and Hypernatremia MICHAEL M
This is a corrected version of the article that appeared in print. Diagnosis and Management of Sodium Disorders: Hyponatremia and Hypernatremia MICHAEL M. BRAUN, DO, Madigan Army Medical Center, Tacoma, Washington CRAIG H. BARSTOW, MD, Womack Army Medical Center, Fort Bragg, North Carolina NATASHA J. PYZOCHA, DO, Madigan Army Medical Center, Tacoma, Washington Hyponatremia and hypernatremia are common findings in the inpatient and outpatient settings. Sodium disorders are associated with an increased risk of morbidity and mortality. Plasma osmolality plays a critical role in the patho- physiology and treatment of sodium disorders. Hyponatremia and hypernatremia are classified based on volume status (hypovolemia, euvolemia, and hypervolemia). Sodium disorders are diagnosed by findings from the history, physical examination, laboratory studies, and evaluation of volume status. Treatment is based on symptoms and underlying causes. In general, hyponatremia is treated with fluid restriction (in the setting of euvolemia), isotonic saline (in hypovolemia), and diuresis (in hypervolemia). A combination of these therapies may be needed based on the presentation. Hypertonic saline is used to treat severe symptomatic hyponatremia. Medications such as vaptans may have a role in the treatment of euvolemic and hypervolemic hyponatremia. The treatment of hypernatremia involves correcting the underlying cause and correcting the free water deficit. Am( Fam Physician. 2015;91(5):299-307. Copy- right © 2015 American Academy of Family Physicians.) More online yponatremia is a common elec- a worse prognosis in patients with liver cir- at http://www. trolyte disorder defined as a rhosis, pulmonary hypertension, myocardial aafp.org/afp. serum sodium level of less than infarction, chronic kidney disease, hip frac- CME This clinical content 135 mEq per L.1-3 A Dutch sys- tures, and pulmonary embolism.1,8-10 conforms to AAFP criteria Htematic review of 53 studies showed that the for continuing medical Etiology and Pathophysiology education (CME). -
Perioral Twitching During Smiling - a Rare Form of Essential Tremor
Clinical Video Neurological Case Reports Published: 02 Dec, 2020 Perioral Twitching during Smiling - A Rare form of Essential Tremor Lea Pollak* Department of Neurology, Neurological Clinic, Kupat Cholim Macabi, Israel Abstract Involuntary movements of facial muscles such as jaw tremor, oromandibular dyskinesia, dystonia, facial myoclonus or hemifacial spasm are common in clinical practice. A 52-year old woman with a 15 year history of upper limb tremor complained of recent spread of the tremor to her face. On examination a moderate kinetic and action, mildly asymmetric tremor of the arms was present. On voluntary and spontaneous smiling bilateral twitching of the buccal muscles was observed. Keywords: Periorbital twitching; Essential tremor; Tardive dyskinesia Introduction Involuntary movements of facial muscles such as jaw tremor, oromandibular dyskinesia, dystonia, facial myoclonus or hemifacial spasm are common in clinical practice. Isolated tremor induced by mild contraction of smiling muscles smiling tremor is extremely rare and was reported by some authors to be associated with Parkinson disease while others related this condition to essential tremor [1-3]. Clinical Video A 52-year old woman with a 15 year history of upper limb tremor complained of recent spread of the tremor to her face. Her medical history comprised Crohn's disease treated with adalimumab and depression treated with sertraline and perphenazine during the last ten years. On examination a moderate kinetic and action, mildly asymmetric tremor of the arms was present. On voluntary and spontaneous smiling bilateral twitching of the buccal muscles was observed (video 1). The twitching disappeared on rest and forced smiling. There were no extra pyramidal signs or involuntary OPEN ACCESS movements of the jaw, lips or tongue (Figure 1). -
Isolated Corpus Callosal Infarction Secondary to Pericallosal Artery Disease Presenting As Alien Hand Syndrome N C Suwanwela, N Leelacheavasit
533 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.72.4.536 on 1 April 2002. Downloaded from SHORT REPORT Isolated corpus callosal infarction secondary to pericallosal artery disease presenting as alien hand syndrome N C Suwanwela, N Leelacheavasit ............................................................................................................................. J Neurol Neurosurg Psychiatry 2002;72:533–536 held a paper with both hands, the left hand would try to pull Two patients are described with the callosal type of alien the paper against the right. Some actions indicating mirror hand syndrome. Both presented with abnormal feelings in movement were also seen. For example, when he moved his the left upper limb and intermanual conflict without clinical right hand backwards, he felt that the left hand was pulled evidence of callosal apraxia or frontal lobe dysfunction back in the same manner. On examination, he was alert. such as motor deficit or reflexive grasping. Imaging studies Motor power of the arms and legs was full. There was no pin- disclosed subacute infarction in the body and splenium of prick sensory loss or inattention, on double simultaneous the corpus callosum due to pericallosal artery disease. stimulation test. Proprioceptive sense was normal. He could These patients were unique in their presentation as a not identify his left hand fingers or objects placed in his left callosal type of alien hand syndrome secondary to ischae- hand with his eyes closed, but was able to do so under visual mic stroke. observation. There was no apraxia of the left hand on verbal command, in imitation, and in actual object use. Frontal lobe releasing signs such as reflexive grasping, palmomental reflex, and snout reflex were absent. -
Deformities of the Hands and Feet in Parkinsonism and Their Reversibility by Operation
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.26.1.33 on 1 February 1963. Downloaded from J. Neurol. Neurosurg. Psychiat., 1963, 26, 33 Deformities of the hands and feet in Parkinsonism and their reversibility by operation PETER GORTVAI From the National Hospital for Nervous Diseases, Queen Square, London Charcot (1877) described some aspects of the typical method using a small instrument which screws deformities of the hands and feet seen in Parkinson's directly into the skull and depends on localization disease. He likened the deformity of the hands to that of the target in the brain on the measurement of sometimes observed in chronic progressive rheu- angles in two planes. The lesions in the ventrolateral matism. He said that the differential diagnosis is nucleus of the thalamus were made by the injection usually made with ease, because in cases of Parkin- of 0 5 to 1 ml. of a mixture of Etopalin (Ciba) and sonism 'there is found neither the articular tume- kaolin. faction and stiffness, nor the osseous deposits and cracking sounds observed in nodose rheumatism'. DESCRIPTION OF THE DEFORMITIES guest. Protected by copyright. He describes the deformity of the toes as a 'griffe' (or claw), on account of the extension of the first and THE HANDS In its early and commonest stage the concomitant flexion of the second phalanges. deformity amounts to no more than a characteristic Hughlings Jackson (1899) also mentions deformity posture of the affected hand (Fig. 1). The fingers are of hands seen in some cases of Parkinsonism. He held extended at the interphalangeal joints and remarked that 'in paralysis agitans the interossei are flexed some 40° to 700 at the metacarpo-phalangeal the muscles of the hand which are preponderatingly joints. -
The Association Between Hypocalcemia and Outcome in COVID-19 Patients: a Retrospective Study
The Association Between Hypocalcemia and Outcome in COVID-19 Patients: a Retrospective Study Bhagwan Singh Patidar All India Institute of Medical Sciences Tapasyapreeti Mukhopadhayay All India Institute of Medical Sciences Arulselvi Subramanian ( [email protected] ) All India Institute of Medical Sciences https://orcid.org/0000-0001-7797-6683 Riicha Aggarwal All India Institute of Medical Sciences Kapil Dev Soni All India Institute of Medical Sciences Neeraj Nischal All India Institute of Medical Sciences Debasis Sahoo All India Institute of Medical Sciences Surbhi Surbhi All India Institute of Medical Sciences Ravindra Mohan Pandey All India Institute of Medical Sciences Naveet Wig All India Institute of Medical Sciences Rajesh Malhotra All India Institute of Medical Sciences Anjan Trikha All India Institute of Medical Sciences Research Article Keywords: Calcium, Coronavirus, Laboratory parameters, Mortality, NLR, Pandemic Posted Date: March 16th, 2021 DOI: https://doi.org/10.21203/rs.3.rs-302159/v1 Page 1/14 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 2/14 Abstract Background: Calcium has been shown to have a vital role in the pathophysiology of SARS-CoV and MERS-CoV diseases but less is known about hypocalcemia in COVID-19 patients and its association with the disease severity and the nal outcome. Therefore, this study was conducted with an aim to assess the clinical features in the COVID-19 patients having hypocalcemia and to observe its impact on COVID- 19 disease severity and nal outcome. Method: In this retrospective study, consecutive COVID-19 patients of all age groups were enrolled. -
Versus High-Chloride-Containing Hypertonic Solution for the Treatment
Sadan et al. Journal of Intensive Care (2020) 8:32 https://doi.org/10.1186/s40560-020-00449-0 RESEARCH Open Access Low-chloride- versus high-chloride- containing hypertonic solution for the treatment of subarachnoid hemorrhage– related complications: The ACETatE (A low ChloriE hyperTonic solution for brain Edema) randomized trial Ofer Sadan1*, Kai Singbartl2, Jacqueline Kraft1, Joao McONeil Plancher1, Alexander C. M. Greven3, Prem Kandiah1, Cederic Pimentel1, C. L. Hall1, Alexander Papangelou4, William H. Asbury5, John J. Hanfelt6 and Owen Samuels1 Abstract Background: Recent reports have demonstrated that among patients with subarachnoid hemorrhage (SAH) treated with hypertonic NaCl, resultant hyperchloremia has been associated with the development of acute kidney injury (AKI). We report a trial comparing the effect of two hypertonic solutions with different chloride contents on the resultant serum chloride concentrations in SAH patients, with a primary outcome aimed at limiting chloride elevation. Methods: A low ChloridE hyperTonic solution for brain Edema (ACETatE) trial is a single-center, double-blinded, double-dummy, randomized pilot trial comparing bolus infusions of 23.4% NaCl and 16.4% NaCl/Na-acetate for the treatment of cerebral edema in patients with SAH. Randomization occurred when patients developed hyperchloremia (serum Cl− ≥ 109 mmol/L) and required hyperosmolar treatment. Results: We enrolled 59 patients, of which 32 developed hyperchloremia and required hyperosmolar treatment. 15 patients were randomized to the 23.4% NaCl group, and 17 patients were randomized to the 16.4% NaCl/Na- acetate group. Although serum chloride levels increased similarly in both groups, the NaCl/Acetate group showed a significantly lower Cl− load at the end of the study period (978mEq vs. -
Movement Disorders in Metabolic Disorders
Current Neurology and Neuroscience Reports (2019) 19: 7 https://doi.org/10.1007/s11910-019-0921-3 NEUROLOGY OF SYSTEMIC DISEASES (J BILLER, SECTION EDITOR) Movement Disorders in Metabolic Disorders José Luiz Pedroso1 & Orlando G. Barsottini1 & Alberto J. Espay2 Published online: 9 February 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Purpose of Review We provide a review of the movement disorders that complicate selected metabolic disorders, including the abnormal movements that may appear during or after their treatment. Recent Findings Movement disorders may be underrecognized when arising in the context of a broad range of metabolic disorders. Summary Abnormal movements may occur as the initial manifestation of a systemic disease, at any time during its course, or as a result of the medical interventions required for its management. Ascertaining movement phenome- nology in acute and subacute presentations may assist in the determination of the specific underlying metabolic disorder. The management of movement disorders associated with metabolic disorders depends on the underlying pathophysiology. Keywords Movement disorders . Abnormal movements . Metabolic disorders . Electrolytes . Internal medicine Introduction such as disorders of consciousness, headache, and sei- zures [3]. The metabolic origin can also be suspected Movement disorders such as parkinsonism, tremor, dys- when movement abnormalities appear in emergency set- tonia, chorea, and myoclonus most often arise in several tings or in intensive care units [4]. neurodegenerative or structural diseases of the basal Some common metabolic disorders, such as organ ganglia [1]. They may also be part of the clinical man- failure (particularly liver or renal insufficiency), endocri- ifestations of systemic metabolic disorders, as the initial nological diseases (e.g., hyperglycemia), and electrolyte feature, complicating its course, or as a result of the disturbances, are frequently present with neurological corrective treatment [2•]. -
Clinical Physiology Aspects of Chloremia in Fluid Therapy: a Systematic Review David Astapenko1,2* , Pavel Navratil2,3, Jiri Pouska4,5 and Vladimir Cerny1,2,6,7,8,9
Astapenko et al. Perioperative Medicine (2020) 9:40 https://doi.org/10.1186/s13741-020-00171-3 REVIEW Open Access Clinical physiology aspects of chloremia in fluid therapy: a systematic review David Astapenko1,2* , Pavel Navratil2,3, Jiri Pouska4,5 and Vladimir Cerny1,2,6,7,8,9 Abstract Background: This systematic review discusses a clinical physiology aspect of chloride in fluid therapy. Crystalloid solutions are one of the most widely used remedies. While generally used in medicine for almost 190 years, studies focused largely on their safety have only been published since the new millennium. The most widely used solution, normal saline, is most often referred to in this context. Its excessive administration results in hyperchloremic metabolic acidosis with other consequences, including higher mortality rates. Methods: Original papers and review articles eligible for developing the present paper were identified by searching online in the electronic MEDLINE database. The keywords searched for included hyperchloremia, hypochloremia, and compound words containing the word “chloride,” infusion therapy, metabolic acidosis, renal failure, and review. Results: A total of 21,758 papers published before 31 May 2020 were identified; of this number, 630 duplicates were removed from the list. Upon excluding articles based on their title or abstract, 1850 papers were screened, of which 63 full-text articles were assessed. Conclusions: According to the latest medical concepts, dyschloremia (both hyperchloremia and hypochloremia) represents a factor indisputably having a negative effect on selected variables of clinical outcome. As infusion therapy can significantly impact chloride homeostasis of the body, the choice of infusion solutions should always take into account the potentially adverse impact of chloride content on chloremia and organ function. -
The Medical Management of Fibrodysplasia Ossificans Progressiva: Current Treatment Considerations
THE MEDICAL MANAGEMENT OF FIBRODYSPLASIA OSSIFICANS PROGRESSIVA: CURRENT TREATMENT CONSIDERATIONS The International Clinical Consortium on Fibrodysplasia Ossificans Progressiva1 May 2011 From The Center for Research in FOP and Related Disorders, The University of Pennsylvania School of Medicine, Philadelphia, PA 19104 Corresponding Editor: Frederick S. Kaplan, M.D. Isaac and Rose Nassau Professor of Orthopaedic Molecular Medicine Director, Center for Research in FOP & Related Disorders The Perelman School of Medicine - The University of Pennsylvania Department of Orthopaedic Surgery 3737 Market Street – Sixth Floor Philadelphia, PA 19104, USA Tel: (office) 215-294-9145 Fax: 215-222-8854 Email: [email protected] Reprint Requests: [email protected] Associate Editors: Eileen M. Shore, Ph.D. Robert J. Pignolo, M.D., Ph.D. [Kaplan FS, Shore EM, Pignolo RJ (eds), name of individual consortium member, and The International Clinical Consortium on FOP. The medical management of fibrodysplasia ossificans progressiva: current treatment considerations. Clin Proc Intl Clin Consort FOP 4:1-100, 2011] 1See Section X (pages 84-100) for Complete Author Listing. ` 1 ABSTRACT…………………………………………………………………………………………… 5 I. THE CLINICAL AND BASIC SCIENCE BACKGROUND OF FOP……………..…………….. 6 A. Introduction………………………………………………………………..…..…..…………………. 6 B. Classic Clinical Features of FOP……………………………………………………..……………. 6 C. Other Skeletal Anomalies in FOP…………………………………………………………… 6 D. Radiographic Features of FOP……………………………………………………….…….... 7 E. Histopathology of FOP Lesions………………………………………………………………. 7 F. Laboratory Findings in FOP………………………………………………………………… 8 G. The Immune System & FOP…………………………………………………………………. 8 H. Misdiagnosis of FOP………………………………………………………………………………… 8 I. Epidemiologic, Genetic & Environmental Factors in FOP……………………..…………. 9 J. FOP & the BMP Signaling Pathway………………………………………………………… 9 K. The FOP Gene………………………………………………………………..………………. 9 L. Structural and Functional Consequences of the FOP Mutation…………………………… 10 M. -
Hypocalcaemic Tetany After Total Thyroidectomy Original Article
Faridpur Med. Coll. J. 2015;10(2):59-62 Original Article Hypocalcaemic Tetany After Total Thyroidectomy NN Biswas1, WA Chaudhury2, JA Khan3, AC Biswas4, KM Arif5, S Ghosh6, S Akter7 Abstract: Hypocalcaemic tetany is one the commonest complication after total thyroidectomy. It may cause significant morbidity. Early detection and treatment have better out come. The main objective of the study is to find the incidence of hypcalcaemic tetany in post operative period after total thyroidectomy and average interval period of hypocalcaemia following surgery. This was an observational study conducted in the department of Otolaryngology & head-Neck Surgery Sylhet M.A.G. Osmani Medical College Hospital during 1st January 2006 to 31st December 2007. Pre-operative routine investigation, Thyroid Function test, Ultrasonography thyroid gland and cytological evaluation by FNAC were done in all patients. Ten patient developed hypocalcaemia after surgery. Among them only one suffered from permanent hypocalcaemia. Most of the patient developed symptoms about 48 hours after surgery. The Incidence and time interval of development of hypocalcaemic tetany after total thyroidectomy found in the series fully coincides with the results of other researchers globally. Key words: Tetany, Total Thyroidectomy, Hypocalcaemic. Introduction: Total thyroidectomy is a logical treatment for patients with thyroid disease in whom the pathologic process Calcium is the sedater of nerve. It is the free, ionized involves both lobes of the thyroid or difficult is a calcium in the body fluids that is necessary for nerve significant consideration as in benign multinodular conduction, muscle contraction and blood coagulation. A goitre, Grave's disease and cancer. Meticulous and decrease in extracellular Ca++ exerts a net excitatory clean cut identification of parathyroid with its effect on nerve and muscle cells. -
Spinal and Bulbar Muscular Atrophy
Spinal and bulbar muscular atrophy Description Spinal and bulbar muscular atrophy, also known as Kennedy disease, is a disorder of specialized nerve cells that control muscle movement (motor neurons). These nerve cells originate in the spinal cord and the part of the brain that is connected to the spinal cord (the brainstem). Spinal and bulbar muscular atrophy mainly affects males and is characterized by muscle weakness and wasting (atrophy) that usually begins in adulthood and worsens slowly over time. Muscle wasting in the arms and legs results in cramping; leg muscle weakness can also lead to difficulty walking and a tendency to fall. Certain muscles in the face and throat (bulbar muscles) are also affected, which causes progressive problems with swallowing and speech. Additionally, muscle twitches (fasciculations) are common. Some males with the disorder experience unusual breast development ( gynecomastia) and may be unable to father a child (infertile). Frequency This condition affects fewer than 1 in 150,000 males and is very rare in females. Causes Spinal and bulbar muscular atrophy results from a particular type of mutation in the AR gene. This gene provides instructions for making a protein called an androgen receptor. This receptor attaches (binds) to a class of hormones called androgens, which are involved in male sexual development. Androgens and androgen receptors also have other important functions in both males and females, such as regulating hair growth and sex drive. The AR gene mutation that causes spinal and bulbar muscular atrophy is the abnormal expansion of a DNA segment called a CAG triplet repeat. Normally, this DNA segment is repeated up to about 36 times.