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Neurology
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
MotorSpastic paraparesis or quadriparesis: an UMN syndrome causing bilateral limb weakness: if cervical lesion – upper and lower limbs affected, i.e. quadriparesis.if cervical lesion - upper and lower limbs affected, i.e. quadriparesis.There may be LMN signs at the level of the lesion only.
Neurodegeneration, ataxia, and retinitis pigmentosa (NARP)
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
The syndrome in these patients is characterized by developmental delay, some after a period of normal development, and hypotonia followed by psychomotor regression; some have had ataxia or dystonic posturing [8]. Spastic quadriparesis has been reported [3]. Brainstem dysfunction leads to ophthalmoplegia, apnea, ventilator dependence, or death [3]. Neuroimaging reveals symmetric areas of decreased density on computed tomography (CT) or MRI in the basal ganglia, brainstem, periventricular and periaqueductal areas (Figure 53.6). Blood concentrations of lactate were increased as high as 7 mmol/L with a mean concentration of 4.6 mmol/L [3]. A CSF concentration of 7.12 mmol/L was reported [11]. Neuropathologic examination revealed reduction in the size of the caudate, globus pallidus, putamen, and cerebellum. Microscopic examination showed gliosis and demyelination of white matter and spongiform changes with relative preservation of neurons in the basal ganglia, thalamus, hypothalamus, and medulla [8]. Some patients have had hypertrophic cardiomyopathy [3].
Introduction to brain damage part two
Published in Barbara A. Wilson, Samira Kashinath Dhamapurkar, Anita Rose, Surviving Brain Damage After Assault, 2016
Barbara A. Wilson, Samira Kashinath Dhamapurkar, Anita Rose
Locked-in syndrome (LIS): This condition usually is the result of brainstem pathology, which disrupts the voluntary control of movement. However, the sustained damage does not disturb wakefulness or awareness. Individuals who are diagnosed as “locked in” usually experience significant if not full body paralysis, but they are fully conscious. Such individuals are able to communicate consistently and reliably using movements of the eyes or by movements of the eyelids. The American Congress of Rehabilitation Medicine (1995) said that the LIS had five characteristics, namely (i) sustained eye opening, (ii) preserved basic cognitive abilities, (iii) aphonia or severe hypophonia (loss of voice), (iv) quadriplegia or quadriparesis and (v) a vertical or lateral eye movement or blinking of the upper eyelid as the primary means of communication. In order to determine whether someone has LIS, one can ask a series of yes/no questions, ask the person to blink once for yes and twice for no (or eyes up for yes and down for no) and see if the responses are accurate.Laureys and colleagues (2005) published an excellent chapter on what it is like to have this syndrome.
Surgical treatment of pineal cysts in non-hydrocephalic and neurologically intact patients: selection of surgical candidates and clinical outcome
Published in British Journal of Neurosurgery, 2019
Andrzej Koziarski, Andrzej Podgórski, Grzegorz M. Zieliński
There exists substantial controversy regarding the safety and efficacy of using the sitting position. We believe that in spite of the fact that its use has been widely criticized due to the well-known potential complications, namely venous air embolism, hemodynamic instability, pneumocephalus, or exceptionally rare quadriparesis, the sitting position offers indeniable advantages to the neurosurgeon and should not be easily dismissed. Anatomical orientation, decreased intracranial pressure, enhanced visualisation of deep structures by gravity and improved control of bleeding have led us to adhere to its use. Lindroos et al.21 who analyzed more than 300 operations involving a suboccipital craniotomy in the sitting position acknowledged the risk of air embolism and hypotension but did not recognize the need to abort its use considering adequate perioperative measures and good cooperation of the anesthesiologist and the surgeon. Sitting position has been used in our centre for virtually all posterior fossa operations since early 1980s with only occasional perioperative issues and no major complications. In the particular case of pineal region surgery we think that even a small expansion of the operative corridor between the tentorium and the cerebellar hemispheres obtained in the sitting position by gravitational retraction of the cerebellum is of utmost importance, as confirmed by Hernesniemi.22
Five-year motor functional outcome in children with acquired brain injury. Yet to the end of the story?
Published in Developmental Neurorehabilitation, 2018
Elena Beretta, Erika Molteni, Sara Galbiati, Giuseppe Stefanoni, Sandra Strazzer
Considering the primary motor impairment, more than half of the patients had a diagnosis of quadriparesis at admission, and 27.2% presented with hemiparesis. A depiction of the corresponding primary motor impairment at discharge is provided in Supplementary Figure 1. Of the 261 patients who received a diagnosis of quadriparesis at admission, 80.1% remained in the same state at discharge; of the 135 patients admitted with hemiparesis, 77.0% remained in the same condition at discharge. Table 2 shows that 70.4% of patients regained the ability to walk. Overall, the time from event to the recovery of gait (with or without assistive devices or orthoses) was 7.6 months. However, half of patients still had balance impairment at the time of discharge, and 66.1% could walk only if aided by assistive devices.
Spinal cord involvement in COVID-19: A review
Published in The Journal of Spinal Cord Medicine, 2023
Ravindra Kumar Garg, Vimal Kumar Paliwal, Ankit Gupta
We identified 30 case reports describing clinical data of 33 isolated cases, of which 14 patients were aged 60 years or older (ranging from 3 to 70 years of age), and 18 patients had pre-existing comorbidities. Chest imaging revealed lung abnormalities in 18 patients, while only 12 reported respiratory symptoms. Nineteen patients had sensory-motor paraplegia, and the rest had quadriparesis. In 8 patients, there was either areflexic paraparesis or quadriparesis. On neuroimaging, 17 patients demonstrated longitudinally extensive transverse myelitis, while in only 3 cases, neuroimaging changes of the spinal cord were a part of acute disseminated encephalomyelitis syndrome.