Patients with coronavirus disease 2019 (COVID-19) often develop acute respiratory failure and acute respiratory distress syndrome (ARDS) that requires intensive care unit (ICU) hospitalization and ...invasive mechanical ventilation, associated with a high mortality rate. In addition, many patients fail early weaning attempts, further increasing ICU length of stay and mortality. COVID-19 related ARDS can be complicated by neurological involvement with mechanisms of direct central nervous system (CNS) infection and with overlapping para-infective mechanisms of the peripheral nervous system (PNS). We aimed to evaluate the possible involvement of the brainstem and PNS in patients with COVID-19 related ARDS and difficulty in weaning from mechanical ventilation. We evaluated electroencephalogram (EEG), brainstem auditory evoked potentials (BAEPs), electroneurography of the four limbs and the phrenic nerve in 10 patients with respiratory insufficiency due to SARS-CoV-2. All were admitted to intensive care unit and were facing prolonged weaning from mechanical ventilation. All ten patients showed a mild diffuse non-specific slowing of brain electrical activity on the EEG. Four patients had an acute motor axonal neuropathy with absent or reduced amplitude phrenic nerve CMAP while four patients showed impairment of the BAEPs. A patient with peripheral nerve impairment suggestive of Guillain-Barré syndrome (GBS) underwent an intravenous immunoglobulin (IVIg) cycle that led to an improvement in the weaning process and progressive motor improvement. The inclusion of a comprehensive neurological evaluation in COVID-19 patients in ICU facilitated the early identification and effective management of Nervous System involvement.
OBIETTIVO L’utilizzo del Goniometro Ulnare ha l’obiettivo standardizzare il metodo di rilevazione della Velocità di Conduzione Motoria (VCM) del nervo Ulnare mantenendo il gomito flesso ad ...un’angolazione standardizzata, favorendo così una più agevole e precisa misurazione. MATERIALI E METODI Le stimolazioni sono state eseguite da due diversi operatori; ogni operatore ha eseguito l'esame senza e con l'uso del Goniometro Ulnare, rilevando la Velocità di conduzione motoria polso-sotto gomito e la velocità sovragomito (above-elbow AE) sottogomito (below-elbow, BE). Abbiamo calcolato il grado di omogeneità tra le misurazioni e il coefficiente di correlazione intraclasse. RISULTATI Valutando 30 partecipanti di ambo i sessi con sintomi parestetici degli arti superiori e 30 volontari sani e asintomatici, la ripetibilità delle misurazioni tra operatori è stata modesta senza l'uso del supporto (ICC = 0,152) mentre si è riscontrato un buon accordo quando gli operatori hanno utilizzato il supporto (ICC = 0,499).. CONCLUSIONI I risultati più evidenti dello studio sono stati la riduzione della differenza tra operatori utilizzando il goniometro Ulnare, l’aumento della riproducibilità della misurazione e della specificità del test.
OBJECTIVE The use of the Ulnar Goniometer standardizes the method of detecting the Motor Conduction Velocity (MCV) of the Ulnar nerve by keeping the elbow flexed at a fixed angle, thus enabling an ...easier and more precise measurement. MATERIALS AND METHODS The stimulations were performed by two independent operators. We evaluated 30 participants of both genders with paresthetic symptoms of the upper limbs and 30 healthy and asymptomatic volunteers. Each operator performed the examination without and with the use of the Ulnar Goniometer, detecting the velocity of motor conduction wrist-below elbow and the speed above-elbow (AE) below-elbow (BE). Agreement between the measurements was assessed with intraclass correlation coefficient (ICC). RESULTS The repeatability of the measurements between operators was modest without the use of the support (ICC = 0.152) while a good agreement was found when the operators used the support (ICC = 0.499). DISCUSSION AND CONCLUSIONS The most obvious results of the study were the reduction of the difference between operators using the Ulnar goniometer, the increase in the repeatability of the measurements and the specificity of the test.
OBJECTIVE Our study aims to extend the previous research and compare two diagnostic methods performed on the ulnar nerve to validate the use of the ulnar goniometer in electromyographic diagnostic ...practice. Comparing the electroneurographic method, obtained through conduction velocity (CV) studies with ultrasound of the ulnar nerve in the area above the elbow and at the wrist, we aim to quantify the reliability of the ulnar goniometer compared to the diagnostic method ultrasound of the nerve. MATERIALS AND METHODS The operator examined with the use of the Ulnar Goniometer, detecting the wrist-below-elbow motor conduction speed and the above-elbow speed (AE), below-elbow speed (BE) and subsequently performed an ultrasound examination of the ulnar nerve in the forearm and elbow. We calculated the degree of homogeneity between measurements. RESULTS Evaluating 30 participants of both genders with typical paresthetic symptoms of ulnar nerve compression at the elbow, 100% of the measurements show that a decrease in Motor Conduction Velocity (MCV) below 50 m/s is associated with an increase in Cross-Sectional Area (CSA). Additionally, in 89% of cases, a reduction in MCV wBE and BEAE by more than 10 m/s is correlated with an increase in CSA. DISCUSSION AND CONCLUSIONS The measurement of the angle below the elbow (BE) and above the elbow (AE) using the Ulnar Goniometer provides us with a slowed Motor Conduction Velocity (MCV) that is by ultrasound data showing an increase in the Cross-Sectional Area (CSA) of the ulnar nerve in that segment, as observed in Cubital Tunnel Syndrome (CTS).
Obbiettivo Il nostro studio mira a estendere la ricerca precedente e confrontare due metodi diagnostici eseguiti sul nervo ulnare per convalidare l'uso del goniometro ulnare nella pratica ...elettromiografica come strumento ausiliario diagnostico. Confrontando il metodo elettro-neurografico, ottenuto attraverso studi sulla velocità di conduzione (VC), con l'ecografia del nervo ulnare al canale cubitale e in corrispondenza del terzo medio dell’avambraccio, miriamo a quantificare l'affidabilità del goniometro ulnare rispetto al metodo diagnostico dell'ecografia del nervo. Materiali E Metodi l'operatore ha eseguito l'esame con l'uso del Goniometro Ulnare, rilevando la velocità di conduzione motoria dal polso al gomito e la velocità sopra il gomito (AE), sotto il gomito (BE) e successivamente ha eseguito l'ecografia del nervo ulnare nell'avambraccio e nel gomito. Abbiamo calcolato il grado di omogeneità tra le misurazioni. Risultati Valutando 30 partecipanti di entrambi i sessi con sintomi parestesici tipici di compressione del nervo ulnare al gomito, Il 100% delle misurazioni mostra che una diminuzione di MCV al di sotto di 50 m/s è associata a un aumento di CSA. Inoltre, nell'89% dei casi, una riduzione di MCV wBE e BEAE di più di 10 m/s è correlata a un aumento di CSA. Discussione e Conclusioni La misurazione dell'angolo sotto il gomito (BE) e sopra il gomito (AE) utilizzando il Goniometro Ulnare ci fornisce una Velocità di Conduzione Motoria (MCV) rallentata che è in accordo con i dati ecografici che mostrano un aumento della cosiddetta Cross Sectional Area (CSA) ossia la sezione trasversale misurata in mm2 del nervo ulnare in quel segmento, come accade nella Sindrome del Tunnel Cubitale (CTS).
In recent years, several studies have reported a relatively high frequency of polyneuropathy in patients with Parkinson’s disease (PD), in particular, in patients receiving levodopa-carbidopa ...intestinal gel (LCIG) infusion. In spite of the several patients investigated with nerve conduction studies, no study has prospectively explored a possible central nervous system involvement of patients receiving LCIG infusion. We prospectively evaluated eight PD patients receiving LCIG infusion, who underwent neurophysiological evaluations with nerve conduction studies, visual, somatosensory and motor evoked potentials before LCIG infusion, and 1 and 6 months after. At 6 months follow-up, we found significant reduction in sural nerve SNAP amplitude, increase of central sensory conduction time N22-P40, and increases of central motor conduction time recorded from I dorsal interosseous and tibialis anterior. In PD patients with LCIG infusion, we found a subclinical neurophysiological impairment of both peripheral and central nervous system.
