ABSTRACT
ABSTRACT: This report aimed to describe a case of peripheral neuropathy in a copper-deficient goat, and highlights the clinical, and pathological features of the disease. The goat had low body score, hyporexia, alopecia, achromotrichia, left hindlimb protraction, paralysis with dragging of digit and difficulty to stand up and microcytic normochromic anemia. Copper concentration in serum was markedly lower (2.0µmol L-1) whereas the iron serum content was significantly increased (51.0µmol L-1). The main gross alteration was the reduction of the quadriceps vastus laterallis muscle volume. Histologically, there was atrophy of the quadriceps vastus laterallis muscle and presence of satellite cells, infiltration of lymphocytes, macrophages and replacement of the fibers by connective tissue. In the femoral nerve, there was axonal degeneration with myelin sheath expansion and presence of vacuoles, usually in chains and containing axonal debris or macrophages. Clinical, laboratorial and pathologic findings are consistent with peripheral neuropathy due to a severy copper deficiency.
RESUMO: Este trabalho tem como objetivo descrever um caso de neuropatia periférica em um caprino com deficiência de cobre e destaca as características clínicas e patológicas da doença. O caprino apresentava baixo escore corporal, hiporexia, alopecia, acromotriquia, protração do membro posterior esquerdo, com arrastar de pinça do membro posterior, dificuldade para se levantar e anemia microcítica normocrômica. A concentração sérica de cobre estava significantemente baixa (2.0µmol L-1), enquanto a concentração de ferro estava alta (51.0µmol L-1). O principal achado de necropsia consistiu em redução do volume do músculo quadríceps vasto lateral. Histologicamente, havia atrofia do músculo quadríceps vasto lateral, infiltrado linfocítico, presença de células satélites, macrófagos e substituição das fibras musculares por tecido conjuntivo. No nervo femoral, havia degeneração axonal com dilatação da bainha de mielina e presença de vacúolos, geralmente em cadeia, contendo, ocasionalmente, restos axonais ou macrófagos. Os achados clínicos, laboratoriais e patológicos são compatíveis com neuropatia periférica devido à deficiência severa de cobre.
ABSTRACT
Recently, percutaneous epidural neuroplasty has become widely used to treat radicular pain caused by spinal stenosis or a herniated intervertebral disc. A 19-year-old female patient suffering from left radicular pain caused by an L4-L5 intervertebral disc herniation underwent percutaneous epidural neuroplasty of the left L5 nerve root using a Racz catheter. After the procedure, the patient complained of acute motor weakness in the right lower leg, on the opposite site to where the neuroplasty was conducted. Emergency surgery was performed, and swelling of the right L5 nerve root was discovered. The patient recovered her motor and sensory functions immediately after the surgery. Theoretically, the injection of a large volume of fluid in a patient with severe spinal stenosis during epidural neuroplasty can increase the pressure on the opposite side of the epidural space, which may cause injury of the opposite nerve by barotrauma from a closed compartment. Practitioners should be aware of this potential complication.
Subject(s)
Female , Humans , Young Adult , Barotrauma , Catheters , Constriction, Pathologic , Emergencies , Epidural Space , Hemiplegia , Intervertebral Disc , Leg , Lower Extremity , Sensation , Spinal StenosisABSTRACT
Vertebral artery dissection (VAD) is one of important causes of posterior circulation strokes in young age patients. Typical presentations of VAD are occipital headache or posterior neck pain, with various signs arising from brainstem or cerebellar infarctions. Muscular weakness or sensory change of an ipsilateral arm owing to cervical nerve root involvement in association with the VAD has been reported very rarely. Herein we describe two unusual manifestations of extracranial VAD, which presented with monoplegia of single upper limb.
Subject(s)
Humans , Arm , Brain Stem , Headache , Hemiplegia , Infarction , Muscle Weakness , Neck Pain , Radiculopathy , Stroke , Upper Extremity , Vertebral Artery Dissection , Vertebral ArteryABSTRACT
The performance and the satisfaction of the patient were quantitatively compared with the use of the volar dorsal orthosis in order to position the spastic hand. Thirty patients wearing the orthosis for eight hours daily were evaluated by the Canadian Occupational Performance Measure and the box and blocks test, for a three-month period. Five activities were selected (among daily life activities, productive activities, and leisure activities) by the patients, which were impaired by spasticity. There was an improvement related to performance after use of orthosis, with an average of 1.4±0.5 to 6.3±0.8 (p<0.01). Patient satisfaction average after wearing the orthosis was of 1.7±0.4 to 6.3±0.6 (p<0.01). In this casuistic, the use of orthosis for wrist and finger spasticity has shown an improvement in the functional performance and patient satisfaction.
Comparou-se quantitativamente o desempenho e a satisfação do paciente com o uso da órtese dorsal volar para posicionamento da mão espástica. Foram analisados 30 pacientes que fizeram uso da órtese por 8 horas diárias, avaliados por meio da Medida Canadense de Desempenho Ocupacional e teste caixa e blocos, no intervalo de 3 meses. Foram selecionadas 5 atividades (entre as atividades de vida diária, produtivas e de lazer) pelos pacientes que estavam comprometidas pela espasticidade. Obteve-se melhora em relação ao desempenho após o uso da órtese, com média de 1,4±0,5 para 6,3±0,8 (p<0,01). Quanto à média da satisfação foi de 1,7±0,4 para 6,3±0,6 (p<0,01) com o uso da órtese. Nesta casuística, o uso da órtese de punho e dedos para espasticidade apresentou melhora no desempenho funcional e satisfação do paciente.
Subject(s)
Female , Humans , Male , Activities of Daily Living , Hand/physiopathology , Muscle Spasticity/rehabilitation , Orthotic Devices , Muscle Spasticity/etiology , Muscle Spasticity/physiopathology , Patient Satisfaction , Prospective Studies , Stroke/complications , Stroke/physiopathology , Stroke/rehabilitationABSTRACT
We report an extremely rare case of traumatic cervical spinal subdural hematoma not related to intracranial injury. There has been no report on traumatic cervical spinal subdrual hematoma not related to intracranial injury. A 27-year-old female patient was admitted to our emergency room due to severe neck pain and right arm motor weakness after car collision. On admission, she presented with complete monoplegia and hypoesthesia of right arm. Magnetic resonance imaging (MRI) revealed subdural hematoma compressing spinal cord. Lumbar cerebrospinal fluid (CSF) analysis revealed 210,000 red blood cells/mm3. She was managed conservatively by administrations of steroid pulse therapy and CSF drainage. Her muscle power of right arm improved to a Grade III 16 days after admission. Follow-up MRI taken 16th days after admission revealed almost complete resolution of the hematoma. Here, the authors report a traumatic cervical spinal SDH not associated with intracranial injury.