Iatrogenic lesions of peripheral nerves Löscher, W. N.; Wanschitz, J.; Iglseder, S. ...
Acta neurologica Scandinavica,
November 2015, Letnik:
132, Številka:
5
Journal Article
Recenzirano
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Iatrogenic nerve lesions (INLs) are an integral part of peripheral neurology and require dedicated neurologists to manage them. INLs of peripheral nerves are most frequently caused by surgery, ...immobilization, injections, radiation, or drugs. Early recognition and diagnosis is important not to delay appropriate therapeutic measures and to improve the outcome. Treatment can be causative or symptomatic, conservative, or surgical. Rehabilitative measures play a key role in the conservative treatment, but the point at which an INL requires surgical intervention should not be missed or delayed. This is why INLs require close multiprofessional monitoring and continuous re‐evaluation of the therapeutic effect. With increasing number of surgical interventions and increasing number of drugs applied, it is quite likely that the prevalence of INLs will further increase. To provide an optimal management, more studies about the frequency of the various INLs and studies evaluating therapies need to be conducted. Management of INLs can be particularly improved if those confronted with INLs get state‐of‐the‐art education and advanced training about INLs. Management and outcome of INLs can be further improved if the multiprofessional interplay is optimized and adapted to the needs of the patient, the healthcare system, and those responsible for sustaining medical infrastructure.
Aim: To investigate dysarthria in severe traumatic brain injury following an acceleration/deceleration trauma and to correlate results with the severity of head trauma.
Methods: Oral diadochokinesis ...by testing alternating (/pa/, /ta/and/ka/) and sequential motion rates (/pataka/and/tana/) and contextual speech, which comprises narrative speech and text reading, were examined in 15 patients in the chronic stage after severe closed head trauma with diffuse axonal injury. A possible influence of the severity of brain injury, expressed by the duration of post-traumatic amnesia, was examined.
Results: Oral diadochokinesis of alternating motion rates and velocity of narrative speech were significantly reduced in traumatic brain injury. Both parameters correlated highly significantly with each other and correlated with the severity of brain injury described by the duration of post-traumatic amnesia. Reading speed was not comparable with narrative speech. Reading speed did not correlate with diffuse axonal injury but was strongly influenced by parameters that also influenced mental abilities.
Conclusion: Oral diadochokinetic abilities of alternating motion rates and velocity of narrative speech represent a possible additional prognostic parameter for the outcome of traumatic brain injury in diffuse axonal injury.
Wilson's disease is a disorder of biliary copper excretion that may result in severe neurological symptoms and advanced liver disease. The wide variation of phenotypic disease expression cannot be ...fully explained by the different mutations of the Wilson disease gene. In neurological disorders, such as Alzheimer's disease, temporal lobe epilepsy and cerebral trauma, the presence of the apolipoprotein E (ApoE) allele ϵ4 is associated with an increased vulnerability of the brain to the effects of the disease, whereas the presence of the ApoE genotype ϵ3/3 appears to provide moderate neuroprotection. We examined whether this hypothesis holds true for the development of neurological symptoms in patients with Wilson's disease. The ApoE genotype and the H1069Q mutation (the most common in Wilson's disease) status were determined by polymerase chain reaction-based mutation assays in 121 well-characterized, symptomatic index patients with Wilson's disease. An investigation profile was established in which the patients were grouped according to the clinical symptoms at presentation, the ApoE genotypes and the status of the H1069Q mutation. Fifty-nine per cent of the 121 patients had the allele combination ApoE ϵ3/3 (21% ApoE ϵ3/4, 19% ApoE ϵ3/2, 1% ApoE ϵ4/2). The distribution of ApoE genotypes did not deviate from known distributions in healthy European subjects. Within the group of 40 H1069Q-homozygous patients, the onset of symptoms was significantly delayed in patients with the ApoE ϵ3/3 genotype (25 ± 6 years at presentation) compared with patients with the ApoE ϵ3/4 genotype (20 ± 3 years at presentation). In this study, the ApoE genotype was established as an important factor delaying the onset of neurological and hepatic symptoms, but not modifying phenotypic disease expression in a homogenous group of patients with Wilson's disease (all H1069Q-homozygotes, similar genetic background). The presence of ApoE ϵ3/3 attenuates clinical manifestations in Wilson's disease by mechanisms which might involve the antioxidant and membrane-stabilizing properties of the ApoE 3 protein.
Case report of SCIWORA following trivial trauma in childhood and review of the literature.
To describe a case of 'spinal cord injuries without radiographic abnormality (SCIWORA)', which was diagnosed ...2 years after the event, and define its relevance from a differential diagnostic and medico-legal viewpoint.
An Austrian neuro-traumatological rehabilitation and workers' insurance appraisal center.
A 12-year-old patient is presented who suffered an ischemic spinal lesion of unknown origin on her way home from school. The patient was reinvestigated as part of an insurance appraisal 2 years later. The aim of this investigation was to elucidate the origin of the spinal cord lesion, in particular, whether it was because of accidental trauma or because of a preexisting condition (eg vascular malformation).
SCIWORA due to a trivial trauma was diagnosed during the reinvestigation. This was of importance for the patient because of accident insurance coverage.
In children developing a quadroparesis following a minor trauma, spinal cord injury without radiographic abnormality must be considered in the differental diagnosis.
To examine the generator of frontal somatosensory evoked potentials by studying patients with traumatic brain injury in the chronic phase.
A prospective, non-comparative case series.
Median nerve ...somatosensory evoked potentials were performed in 26 survivors of severe traumatic brain injury, which had taken place at a mean of 7 months before. Potentials of short latency somatosensory evoked potentials were recorded simultaneously over the frontal and parietal scalp.
Frontally recorded latencies N18, P20 and N13 recorded from C2 correlated highly significantly with the duration of coma (p<0.01), a history of raised intracranial pressure (p<0.05) and with each other (p<0.01) in traumatic brain injury patients.
These findings indicate that frontally recorded N18, P20 and N13 recorded from C2 are generated in part in the brainstem, which becomes damaged by increased intracranial pressure due to secondary injury in severe traumatic brain injury.
Sixty-seven patients surviving spontaneous subarachnoid haemorrhage (SAH) have been followed up for 2-12 years (mean: 7 years) in order to determine prognostic factors concerning the long-term ...disability in familial and social functioning. A correlation was found between the severity of the neurological deficit at the time of admission and the degree of familial and social disability at the end of the observation period. In addition, the Barthel-Index on discharge was shown to be of prognostic value for readjustment for social--but not for familial--functioning. Other clinical variables in the acute stage, however, including source of bleeding, sex, age, interval between SAH and admission, level of consciousness, cognitive functions, as well as initial Hunt and Hess grading and Glasgow Coma Scale scoring, did not influence the long-term social prognosis. Furthermore, residual neurological signs, cognitive dysfunctions, and the Glasgow Outcome score on discharge were not related to the extent of social handicap in the long-term outcome. At the end of the observation period, significant correlations were found between the presence of persisting neurological and cognitive deficits but also disability in ADL functions and occupational capacity and the decline in familial and social functioning.
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