Practice Paper 6: Answers
Anthony B. Starr, Hiruni Jayasena, David Capewell in Get ahead! Medicine, 2016
Poliomyelitis is caused by the poliovirus. Transmission is primarily through faeco-oral routes and is more common in developing countries. The virus infects the grey matter of the nervous system, especially the anterior horn cells in the lumbar region. Initial infection causes a mild fever and headache, progressing to aseptic meningitis. Weakness then starts in one muscle group and can progress to widespread paresis. Respiratory failure occurs if the intercostal muscles are affected. Diagnosis is confirmed by culturing poliovirus from cerebrospinal fluid (CSF) or stool. Management is with bed rest (as exercise worsens or precipitates paralysis) and ventilation if required. Any muscle weakness that remains after 1 month of initial infection is likely to remain permanent. Prevention of poliomyelitis is with immunization by a live vaccine.
General principles of management of upper motor neuron paralysis
Benjamin Joseph, Selvadurai Nayagam, Randall Loder, Ian Torode in Paediatric Orthopaedics, 2016
This chapter discusses the principles of management of static encephalopathies. Spastic paralysis in children is most commonly seen in cerebral palsy. However, it can occur following meningitis, encephalitis, traumatic brain injury and asphyxiation. Apart from these forms of static encephalopathies, rare forms of progressive encephalopathies can occur in children. Spasticity is one of the most important manifestations of motor system involvement following brain damage due to injury or disease. It may be defined as a velocity- dependent hyperactivity of stretch reflexes. If untreated, the spastic muscle may undergo myostatic contracture. Paresis of one group of muscles or spasticity in the opposing group can result in muscle imbalance which, in turn, can produce deformity at the intervening joint. Spasticity and muscle imbalance result in deformities at joints, which further compromise function of the limbs. Although the deformities are initially due to muscle contractures, over a period of time, adaptive bony changes will superven.
Two Patients With Nonvisual Dreaming
Mark Solms in The Neuropsychology of Dreams, 1997
This patient was a 26-year-old dextral female and homemaker with 7 years’ formal education. Her difficulties began with headache, insidious develop ment of left-sided paresis, somatosensory defect, and a slowly progressive loss of vision in the left field that culminated in sudden onset of blindness and global aphasia. Computerized tomography (CT) identified a high-density mass (arterio-venous malformation; AVM) in the right parietal lobe, with an abnormal vessel in the right lateral ventricle. There was considerable sur rounding edema that extended across the midline into the posterior quadrant of the left hemisphere (see fig. 11.1). Four-vessel angiography demonstrated that the AVM was draining primarily from the posterior cerebral circulation.
Shoulder pain and concomitant hand oedema among stroke patients with pronounced arm paresis
Published in The European Journal of Physiotherapy, 2013
Mats Isaksson, Lars Johansson, Ingrid Olofsson, Eva Eurenius
Background: The aim of this prospective study was to identify clinical factors associated with the development of shoulder pain in stroke patients with pronounced arm paresis. Methods: At stroke onset, 485 patients were initially assessed in 2007–2009. Sixty-three patients with pronounced arm paresis completed the study, and 21 of these developed shoulder pain. Clinical findings were recorded fortnightly by the attending physiotherapist during hospital stay. Results: Hand oedema on the paretic side was more common in patients developing shoulder pain compared with those who did not develop shoulder pain. The onset of shoulder pain was associated with concomitant hand oedema. High NIHSS score was associated with developing shoulder pain. Patients with a history of shoulder pain developed pain earlier than those without previous shoulder pain. Patients with haemorrhagic stroke were significantly more prone to developing shoulder pain. Conclusions: One-third of the stroke patients with pronounced arm paresis developed shoulder pain. Concomitant hand oedema seems to be an additional symptom of shoulder injury. Patients with low general status are more vulnerable to develop post-stroke shoulder pain.
Prediction of lower extremity motor recovery in persons with severe lower extremity paresis after stroke
Published in Brain Injury, 2018
Sheau-Ling Huang, Bang-Bin Chen, I-Ping Hsueh, Jiann-Shing Jeng, Chia-Lin Koh, Ching-Lin Hsieh
Objective: To investigate the extent of motor recovery and predict the prognosis of lower extremity (LE) recovery in patients with severe LE paresis after stroke Methods: 137 patients with severe LE paresis after stroke were recruited from a local medical centre. Voluntary LE movement was assessed with the LE subscale of the Stroke Rehabilitation Assessment of Movement (STREAM-LE). Univariate and stepwise regression analyses were used to investigate 25 clinical variables (including demographic, neuroimaging, and behavioural variables) for finding the predictors of LE recovery. Results: The STREAM-LE at discharge (DCSTREAM-LE) of the participants covered a very wide range (0–19). Specifically, 5.1% of the participants were nearly completely recovered, 11.7% were moderately recovered, 36.5% were slightly recovered, and 46.7% remained severely paralysed. ‘Score of STREAM-LE at admission (ADSTREAM-LE)’ and ‘volume of lesion and oedema’) were significant predictors of LE movement at discharge, explaining 25.1% of the variance of the DCSTREAM-LE (p
A Case of Recurrent Herpes Zoster Leg Paresis Without Rash
Published in Journal of Pain & Palliative Care Pharmacotherapy, 2010
Sofia Mourgela, Antonios Sakellaropoulos, Konstantina Tavouxoglou
Acute herpes zoster neuralgia is a benign infection affecting the sensory part of the nervous system with a painful vesicular eruption. The authors report a case of a 48-year-old woman patient with right leg paresis followed by herpetic rash. Needle electromyography revealed pathologic findings while lumbar magnetic resonance imaging (MRI) revealed no pathologic findings. The patient was managed with strengthening exercises as well as pain relief for neuralgia. The potential role of antiviral pharmacotherapy in such a case is discussed. The authors describe this case because zoster paresis should be one of the differential diagnoses of girdle muscle weakness and because the rash followed the leg paresis. The clinical implications of the case are discussed, since the patient presented from time to time with relapses of the disease without prominent rash.
Related Knowledge Centers
- Paraparesis
- Spinal Cord Diseases
- Paralysis
- Intracranial Hypertension
- Neurologic Manifestations
- Peripheral Nervous System Diseases
- Muscular Diseases