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Abstract Pituitary apoplexy refers to a rare clinical syndrome consisting of signs and symptoms that occur due to rapid expansion of the contents of the sella turcica. It can occur spontaneously or associated with pituitary tumors. It can have a broad clinical spectrum, but usually presents with severe headache, visual impairment and hypopituitarism. Sudden onset of symptoms associated to imagiologic confirmation makes the diagnosis. Surgical treatment is advised when there is important compression of the optic tract. We present a case report and a review of the literature on pituitary apoplexy in pregnancy. The cases were reviewed to obtain information on maternal characteristics, clinical presentation, diagnostic studies, therapeutic modalities and maternal and fetal outcomes. Our review found 36 cases of pituitary apoplexy in pregnancy. Most of the cases occurred in the second trimester of pregnancy and headache was the most frequent symptom at presentation. Surgical therapy was required in more than half of the patients. In what respect maternal and fetal outcomes, there were 3 cases of preterm delivery and one case of maternal death. Our clinical case and literature review reinforces the importance of an early diagnosis to avoid potential adverse consequences.
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Humans , Female , Pregnancy , Adult , Pituitary ApoplexyABSTRACT
Resumen La infección por coronavirus (SARS-CoV-2/COVID-19) es responsable de un diverso rango de manifestaciones extrapulmonares entre las cuales se destaca el compromiso neurológico directo o indirecto. La apoplejía hipofisaria es una entidad médica y neuroquirúrgica de gravedad variable que suele asociarse a la presencia de un adenoma subyacente. Un escaso número de reportes han vinculado estas dos enfermedades entre sí. Este trabajo describe un caso de apoplejía hipofisaria manifestada clínicamente en for ma concomitante al diagnóstico de COVID 19, en un paciente con macroadenoma hipofisario desconocido y su manejo terapéutico, revisando los mecanismos potencialmente subyacentes al nexo entre ambas entidades.
Abstract Coronavirus disease (SARS-CoV-2/COVID-19) is responsible for a wide variety of extrapulmonary manifestations, among which direct or indirect neurological compromise stands out. Pituitary apoplexy is a clinical and neurosurgical entity of variable severity, usually associated with a pituitary adenoma. Literature is scarce regarding the association between these diseases. This paper reports a case of pituitary apoplexy, manifested concomitantly to the diagnosis of COVID 19 in a patient with unknown pituitary macroadenoma, and its therapeutic management, reviewing the mechanisms potentially underlying the link between both entities.
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【Objective】 To investigate the efficacy of autologous ozoneized blood transfusion(AOBT) in improving consciousness and motor function in convalescent stroke patients. 【Methods】 A total of 44 patients who were diagnosed as convalescent cerebral apoplexy and received treatment in Rehabilitation Department of our hospital from August 2016 to September 2021 were randomly divided into the experimental group and control group by blind method. The experimental group (n=22) received general rehabilitation training (such as exercises, occupational therapy, acupuncture and transcranial magnetic stimulation) plus AOBT (200 mL venous phlebotomy at the median elbow), once every 2 to 3 days and 12 occasions as a course of treatment; the control group solely recieved general rehabilitation training. The consciousness (GCS score) and ability of daily living (Barthel index score) score of the two groups before and after treatment were statistically compared, and Ueda motor function grade, Brunnstrom stage and muscle tone grade were observed and evaluated. 【Results】 After the treatment, the experimental group and the control were compared as follows: 1) the GCS score and Barthel score was 14.82±0.39 vs 12.41±2.52, 61.14±12.24 vs 52.05±11.72(P<0.05); 2) The recovery rate of motor function was 95.45% (21/22) vs 63.64% (14/22) (P<0.05); 3) The total recovery rate of muscle tone was 90.91% (20/22) vs 63.64% (14/22) (P<0.05). 【Conclusion】 AOBT, with somewhat high safety and effectiveness, can improve the state of consciousness, motor function and muscle tone in convalescent patients with stroke.
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Objective:To explore the application of Tongdu Tiaoshen acupuncture in patients with hemiplegia after stroke.Methods:Randomized controlled trial. A total of 70 patients who met the inclusion criteria for post-stroke hemiplegia in our hospital from January 2020 to December 2021 were divided into two groups, with 35 cases in each group, according to the random number table. The control group was given conventional treatment combined with rehabilitation exercise therapy, and the observation group was given Tongdu Tiaoshen acupuncture on the basis of the above, and both groups were treated continuously for 1 month. Compare of the two groups Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), National Institutes of Health Stroke Scale (NIHSS), Activity of Daily Living (ADL) score; Brunnstrom stage method was used to assess the patient's motor ability, and Holden walking function grade was used to assess the patient's walking ability. The activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time(TT), and serum fibrinogen (FIB), D-dimer (D-D), plasminogen activator inhibitor 1 (PAI-1) levels were observed by ELISA. Adverse events were recorded and clinical efficacy was evaluated.Results:The total effective rates of the observation group and the control group were 97.14% (34/35) and 77.14% (27/35), respectively, and the difference between the two groups was statistically significant ( χ2=6.25, P=0.012). After treatment, the scores of FMA and ADL in the observation group were significantly higher than those in the control group ( t values were 9.23 and 9.54, respectively, P<0.01), the MAS and NIHSS scores were significantly lower than those in the control group ( t values were 10.23 and 11.97, respectively, P<0.01). After treatment, the distribution of patients in Brunnstrom stage Ⅴ and Ⅵand Holden functional walking stage Ⅳ and Ⅴ in the observation group was significantly higher than those in the control group ( χ2 values were 11.96 and 11.27, respectively, P<0.05). After treatment, APTT, PT and TT in the observation group were significantly longer than those in the control group ( t values were 10.37, 13.57 and 6.54, respectively, P<0.01); serum FIB, D-D and PAI-1 levels were significantly lower than those in the control group ( t values were 12.85, 11.94 and 27.39, respectively, P<0.01). No adverse reactions occurred in both groups. Conclusion:The treatment of post-stroke hemiplegia with Tongdu Tiaoshen acupuncture can improve the effect of clinical treatment and the ability of daily life, neurological function, limb function, movement and walking ability, and stabilize the clotting state.
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Objective:To explore the effect of Qixian Tongluo Prescription fumigation on nerve function and rehabilitation effect in patients with hemiplegia after cerebral infarction of qi-deficiency blood stasis syndrome.Methods:Randomized controlled trial. Sixty-eight patients with hemiplegia after cerebral infarction of qi-deficiency blood stasis syndrome in the hospital were enrolled between October 2020 and December 2021. According to random odd-even numbering method, participants were divided into the control group (routine western medicine) and the observation group (Qixian Tongluo Prescription fumigation on basis of control group), 34 in each group. All were continuously treated for 8 weeks. TCM syndromes were scored before and after treatment. The severity of neurological impairment was evaluated by National Institutes of Health Stroke Scale (NIHSS). The severity of limb movement disorder was evaluated by Fugl-Meyer Assessment (FMA). The levels of central nervous specific protein (S-100β), neuron-specific enolase (NSE), endothelin (ET), nitric oxide (NO), C-reactive protein (CRP) and superoxide dismutase (SOD) were detected by ELISA. The clinical response rate was assessed.Results:There were significant differences in total response rate between the observation group and the control group [94.12% (32/34) vs. 76.47% (26/34); χ2=4.22, P=0.040]. After treatment, scores of hemiplegia, shortness of breath, palpitation and limbs swelling in observation group were significantly lower than those in the control group ( t=3.44, 2.37, 2.72, 3.89, P<0.05 or P<0.01), NIHSS score was significantly lower than that of the control group ( t=6.56, P<0.01), and FMA scores of upper and lower limbs were significantly higher than those in the control group ( t=2.17, 2.78, P<0.05). After treatment, levels of serum S-100β [(0.69±0.27) μg/L vs. (0.85±0.36) μg/L, t=2.07], NSE [(8.36±3.69) μg/L vs. (11.34±4.93) μg/L, t=2.82] and ET [(53.16±12.12) ng/L vs. (61.25±11.31) ng/L, t=2.85] in observation group were significantly lower than those in the control group ( P<0.05 or P<0.01), while NO [(82.26±14.53) μmol/L vs. (70.16±12.27) μmol/L, t=3.71] was significantly higher than that of the observation group ( P<0.01). The level of serum CRP in observation group was significantly lower than that of the control group ( t=2.74, P<0.01), and SOD activity was significantly higher than that of the control group ( t=2.49, P<0.05). Conclusion:Qixian Tongluo Prescription fumigation can promote the recovery of nerve function and vascular endothelial function in patients with hemiplegia after cerebral infarction, improve limb disorders and clinical effect.
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Objective:To evaluate the effect of scalp acupuncture combined with repeated transcranial magnetic stimulation (rTMS) on dysphagia after ischemic stroke.Methods:Prospective cohort study. A total of 94 patients with dysphagia after ischemic stroke in our hospital who met the inclusion criteria from December 2020 to February 2022 were randomly divided into two groups with 47 patients in each group. The control group was treated with rTMS and conventional acupuncture, while the scalp acupuncture group was treated with rTMS and scalp acupuncture (scalp acupuncture+seven points at the skull base). Both groups were treated for 4 weeks. Before and after treatment, Traditional Chinese Medicine (TCM) symptoms were scored, and the morphology, movement and food swallowing process of the patient's swallowing anatomy were observed with fiber optic endoscopy (FEES), and assessed by the leakage aspiration scale (PAS). The Yilang Fujishima swallowing efficacy evaluation and standard swallowing assessment (SSA) were used to evaluate swallowing function. The dysphagia quality of life scale (SWAL-QOL) were used to evaluate patients' quality of life. Magnetic resonance diffusion tensor imaging (DTI) scanning was performed to observe the anisotropy fraction (FA value) of the selected region of interest (ROI).Results:During the treatment period, each group dropped off 1 patient, and 92 patients entered the statistics. After treatment, the scores of salivation, food retention, eating and drinking cough in the scalp acupuncture group were significantly lower than those in the control group ( t values were 6.87, 4.90, 5.01, respectively, P<0.01), and the PAS grading was significantly better than that in the control group ( χ2=7.80, P=0.025), the swallowing efficacy evaluation and SWAL-QOL score of Yilang Fujishima were significantly higher than those of the control group ( t=6.81, 5.98, P<0.01), and the SSA score was significantly lower than that of the control group ( t=5.68, P<0.01). The FA values of parieto occipital cortex (0.47 ± 0.06 vs. 0.42 ± 0.04, t=3.16), insular cortex (0.44 ± 0.07 vs. 0.40 ± 0.05, t=3.00) and posterior limb of internal capsule (0.58 ± 0.04 vs. 0.54 ± 0.05, t=2.80) of ROI in the head acupuncture group after treatment were significantly higher than those in the control group ( P<0.05). Conclusion:The scalp acupuncture combined with rTMS can improve the swallowing function of patients with dysphagia after ischemic stroke and improve their quality of life.
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Introducción: La apoplejía hipofisaria es un síndrome que se produce como consecuencia de una lesión isquémica o hemorrágica en la glándula pituitaria dando lugar a un déficit de hormonas hipofisarias. Se manifiesta en forma de deterioro neurológico con cefalea en trueno como síntoma prínceps, siendo la irritación meníngea una manifestación infrecuente. Métodos: Presentamos el caso de una mujer de 53 años con antecedente de madroadenoma productor de prolactina que comienza con cefalea, náuseas y deterioro de nivel de consciencia. Se detecta un hipopituitarismo incompleto con nivel de cortisol normal. El líquido cefalorraquídeo (LCR) es consistente con una pleocitosis aséptica sin respuesta a terapias antibióticas. Asocia paresia oculomotora y una RM craneal revela sangrado en el adenoma hipofisario con compromiso de seno cavernoso. Resultados: la sospecha inicial es una meningoencefalitis bacteriana por la fiebre, estupor y LCR con pleocitosis, si bien no se identifica microorganismo y no hay respuesta a antibióticos. El LCR de la apoplejía muestra una pleocitosis aséptica por irritación meníngea del espacio subaracnoideo por el sangrado y la necrosis de la glándula. El hipopituitarismo puede ser parcial o completo, siendo más frecuente el déficit selectivo. Especial atención merece el déficit de ACTH por la morbimortalidad que conlleva el fallo adrenal. La oftalmoparesia traduce implicación de seno cavernoso por incremento en la presión selar. Conclusiones: Destacamos la importancia de tener una sospecha diagnóstica de apoplejía ante un cuadro neurológico agudo para dirigir las investigaciones pertinentes con determinación hormonal y así iniciar una terapia sustitutiva temprana y una actitud neuroquirúrgica en caso de ser necesaria; precisando un manejo multidisciplinar.
Introduction: Pituitary apoplexy is a syndrome that occurs as a result of an ischemic or hemorrhagic lesion in the pituitary gland, leading to a deficiency of pituitary hormones. It manifests in the form of neurological deterioration with thunderclap headache as the main symptom, with meningeal irritation being an infrequent manifestation. Methods: We present the case of a 53-year-old woman with a history of prolactin-producing madroadenoma that began with headache, nausea and impaired level of consciousness. Incomplete hypopituitarism with normal cortisol level is detected. Cerebrospinal fluid (CSF) is consistent with an aseptic pleocytosis unresponsive to antibiotic therapy. It is associated with oculomotor paresis and a cranial MRI reveals bleeding in the pituitary adenoma with involvement of the cavernous sinus. Results: the initial suspicion is bacterial meningoencephalitis due to fever, stupor and CSF with pleocytosis, although no microorganism is identified and there is no response to antibiotics. CSF from stroke shows aseptic pleocytosis due to meningeal irritation of the subarachnoid space from bleeding and necrosis of the gland. Hypopituitarism can be partial or complete, selective deficiency being more frequent. ACTH deficiency deserves special attention due to the morbidity and mortality that adrenal failure entails. Ophthalmoparesis translates involvement of the cavernous sinus due to an increase in sellar pressure. Conclusions: We emphasize the importance of having a suspected diagnosis of apoplexy in case of an acute neurological condition, to direct the pertinent investigations with hormonal determination and thus initiate early replacement therapy and a neurosurgical approach if necessary; requiring a multidisciplinary management.
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A 17-year-old underweight boy came with a classical emergency of diabetic ketoacidosis associated with two additional clinical features; persistently low blood pressure despite adequate fluid resuscitation and hypogonadal features with Tanner stage 3 pubic hair, absent facial, and axillary hair along with a high-pitched voice. These findings triggered an endocrine workup which revealed hypogonadotropic hypogonadism. Suspecting primary pituitary pathology, an magnetic resonance imaging brain, was done which showed a well-defined hyperintense lesion in the pituitary suggestive of pituitary apoplexy. In the absence of headache, diplopia, and visual field defects, this incidental finding posed a dilemma regarding the diagnosis and management of diabetic ketoacidosis in the presence of apoplexy.
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A thunderclap headache (TCH) is defined as an excruciating headache which occurs abruptly like "thunder," reaches its maximum point in less than a minute, and should be considered a medical emergency. Below, we present the clinical case of a 49-year-old Colombian patient who developed a thunderclap headache as the initial sign of pituitary apoplexy. He progressed satisfactorily, with no evidence of sequelae, highlighting the early diagnosis of a potentially fatal entity. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2336).
La cefalea tipo trueno (CT) es considerada un dolor de cabeza intolerable, el cual se produce de forma abrupta como un "trueno", alcanza su punto máximo en menos de un minuto después de su aparición, y debe considerarse una emergencia médica. A continuación presentamos el caso clínico de un paciente colombiano, de 49 años quien presenta cefalea tipo trueno como manifestación inicial de apoplejía hipofisaria, con adecuada evolución y sin evidencia secuelar, resaltando el diagnóstico temprano en una entidad potencialmente mortal. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2336).
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Headache during pregnancy is a common complaint in the emergency room. In pregnancy, pituitary disorders include both hormone active and hormone inactive tumors. Apoplexy may be the first clinical presentation of an underlying pituitary tumor. Red flag signs of presenting symptoms, to be assessed for identifying life-threatening etiology. Various pathophysiological mechanisms have been passed for pituitary apoplexy in pregnancy. Magnetic resonance imaging of the brain is the gold standard investigation. The mainstay of management is the initiation of steroids. Transnasal transsphenoidal removal of the tumor is the definitive treatment that requires a multidisciplinary approach. The indications of surgery are the presence of symptoms due to compression and endocrine abnormalities; however, gestational period should be taken into consideration. We report a case of headache in antenatal women who presented to our emergency room diagnosed with pituitary apoplexy managed with steroids and early surgery, and discharged with good clinical outcome. We recommend a methodical approach to common symptoms that assist in diagnosing forgotten etiology.
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Resumen ANTECEDENTES: La apoplejía hipofisaria es un infarto o hemorragia súbita en un tumor o tejido sano de la glándula pituitaria. El 80% de los casos es en pacientes con un adenoma hipofisario. El cuadro clínico se caracteriza por: cefalea, alteraciones visuales, náuseas y vómito; además, insuficiencia hipofisaria, que puede ser potencialmente mortal para la madre y el feto. El tratamiento conservador incluye analgésicos, corticosteroides y agonistas dopaminérgicos en caso de prolactinoma. El tratamiento quirúrgico de elección es la resección transesfenoidal. CASO CLÍNICO: Paciente de 35 años, con antecedentes de tres embarazos, un aborto y prolactinoma diagnosticado a los 22 años, en tratamiento con cabergolina. Acudió a consulta debido a cefalea a las 17 semanas de embarazo que se exacerbó a las 28.4 semanas. En la resonancia magnética se observó que la hipófisis medía 17 x 12 x 7 mm, con datos de hemorragia subaguda; con base en ello se diagnosticó: apoplejía hipofisaria. Se indicó tratamiento conservador con antiinflamatorios no esteroideos, opioides y corticosteroides; sin embargo, ante el deterioro del cuadro clínico se decidió la resección transeptal-transesfenoidal endoscópica del adenoma hipofisiario, a las 30.5 semanas de embarazo. La paciente evidenció una mejoría significativa y permaneció asintomática hasta la finalización del embarazo a las 37.5 semanas. CONCLUSIONES: Si bien la apoplejía hipofisaria es de baja incidencia en el embarazo se torna en un factor de riesgo de muerte; por ello, el ginecoobstetra debe tener conocimiento de las posibles implicaciones en el embarazo, ofrecer atención multidisciplinaria y considerar que el tratamiento quirúrgico es una opción segura en el embarazo.
Abstract BACKGROUND: Pituitary apoplexy is a sudden infarction or hemorrhage in a tumor or healthy tissue of the pituitary gland. Eighty percent of cases are in patients with a pituitary adenoma. The clinical picture is characterized by headache, visual disturbances, nausea and vomiting, and pituitary insufficiency, which can be life-threatening for the mother and fetus. Conservative treatment includes analgesics, corticosteroids and dopaminergic agonists in case of prolactinoma. The surgical treatment of choice is transsphenoidal resection. CLINICAL CASE: 35-year-old female patient with a history of three pregnancies, one miscarriage and prolactinoma diagnosed at 22 years of age, under treatment with cabergoline. She came for consultation due to headache at 17 weeks of pregnancy that was exacerbated at 28.4 weeks. Magnetic resonance imaging showed that the pituitary gland measured 17 x 12 x 7 mm, with evidence of subacute hemorrhage; based on this, a diagnosis of pituitary apoplexy was made. Conservative treatment with non-steroidal anti-inflammatory drugs, opioids and corticosteroids was indicated; however, due to the deterioration of the clinical picture, endoscopic transseptal-transsphenoidal resection of the pituitary adenoma was decided at 30.5 weeks of pregnancy. The patient showed significant improvement and remained asymptomatic until the end of pregnancy at 37.5 weeks. CONCLUSIONS: Although pituitary apoplexy is of low incidence in pregnancy, it becomes a risk factor for death; therefore, the obstetrician/gynecologist should be aware of the possible implications in pregnancy, offer multidisciplinary care and consider that surgical treatment is a safe option in pregnancy.
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Objective:To observe the clinical effect of internal administration of Traditional Chinese Medicine (TCM) and external application of hot election bag combined with acupuncture on urinary retention after stroke with kidney qi deficiency type.Methods:A total of 106 patients admitted to Chengde Hospital of Traditional Chinese Medicine from January 2017 to December 2020 who met the inclusion criteria were randomly divided into 2 groups according to the random number table method, with 53 in each group. The control group was treated with conventional western medicine therapy and bladder function training, while the observation group was treated with TCM, acupuncture and external application on the basis of the control group. Both groups were treated for 28 days. Before and after treatment, TCM syndrome scores were performed, and the maximum urinary capacity and residual urine volume were recorded by abdominal B-ultrasound to evaluate the bladder function of the patients. The improvement time of urinary pain, first urination time, catheter indwelling time, length of hospital stay and adverse reactions during treatment were observed and recorded, and the clinical efficacy was evaluated.Results:The total effective rate was 96.2% (51/53) in the observation group and 84.9% (45/53) in the control group, and the difference between the two groups was statistically significant ( χ2=3.98, P=0.046). The residual urine volume of the observation group after treatment [(54.23±6.23) ml vs. (91.24±11.25) ml, t=20.95] was significantly lower than that of the control group ( P<0.01), and the maximum urinary bladder volume [(366.23±30.23) ml vs. (259.63±26.23) ml, t=19.39] was significantly higher than that of the control group ( P<0.01). After treatment, the TCM syndrome score of the observation group was significantly lower than that of the control group ( t=13.25, P<0.01), and the bladder function score of the observation group was significantly lower than that of the control group ( t=13.53, P<0.01). The improvement time of urinary pain, first urination time, catheter indwelling time and hospital stay in the observation group were significantly lower than those in the control group ( t=5.73, 17.91, 6.76, 9.67, all Ps <0.01). No adverse reactions occurred in the two groups during treatment. Conclusion:The combination of TCM, hot compress therapy and acupuncture plus routine therapy can treat the patients with urinary retention after stroke and kidney qi deficiency type with good bladder function, improved symptoms and fast recovery and safety.
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Objective:To observe the effect of self-designed Buqi Huoxue Decoction on the rehabilitation of patients with stroke sequelae and qi deficiency and blood stasis syndrome.Methods:A total of 116 patients with stroke sequelae treated from October 2019 to October 2020 were selected and divided into observation group and the control group by randomized digital tables, 58 patients in each group. The control group was given the conventional treatment, and the observation group combined self-designed Buqi Huoxue Decoction and conventional treatment. Both groups were treated for 3 months. The soluble vascular cell adhesion molecule-1 (sVCAM-1), nito-oxide (NO), endothelin (ET-1), endothelial-derived hyperpolarization factor (EDHF), insulin-like growth factor (IGF-II), interleukin-1β (IL-1β), interleukin-6 (IL-6) levels were detected by ELISA. The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the degree of neurological deficit, motor function was evaluated by the Fugl-Meyer motor function scale (FMA), patients' daily living ability was assessed by daily living ability assessment table (ADL), the QLQ-C30 was used to evaluate the QoL of patients. The TCM syndrome scores were evaluated. The clinical response was compared between the two groups.Results:The total response rate was 94.8%(55/58) in the observation group and 81.0%(47/58) in the control group. There was significant difference between the two groups ( χ2=3.98, P=0.046). After treatment, the scores of TCM syndrome and NIHSS of pruritus in the observation group were significantly lower than those in the control group ( t values were 5.61, 5.21, respectively, all Ps<0.01). After treatment, the scores of FMA, ADL QLQ-C30 of pruritus in the observation group were significantly higher than those in the control group ( t values were 3.61, 3.13, 9.38, respectively, all Ps<0.01). After treatment, the NO[(87.61±19.18) μmol/L vs. (77.93±17.26) μmol/L, t=2.81], EDHF [(21.14±6.14) μmol/L vs. (16.61±4.52) μmol/L, t=4.45] levels in the observation group were significantly higher than those in the control group ( P<0.01). After treatment, the sVCAM-1[(309.58±30.11) μg/L vs. (354.16±33.04) μg/L, t=7.46], ET-1 [(50.07±18.23)ng/L vs. (66.31±17.89)ng/L, t=4.76] levels in the observation group were significantly lower than those in the control group ( P<0.01). After treatment, IL-1β, IGF-Ⅱ, IL-6 levels in the observation group were significantly lower than those in the control group ( t values were 4.66, 8.14 7.43, respectively, all Ps<0.01). Conclusion:The treatment of self-designed Buqi Huoxue Decoction can improve the vascular endothelial function, inhibit the inflammation, reduce the nerve function damage, improve the limb movement function, daily life ability, quality of life and the clinical symptoms.
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Tongue acupuncture therapy is an external treatment method of "micro acupuncture system" based on the theory of Zang Fu meridians and holographic theory. It acts on the tongue and can be used for the treatment of swallowing disorder after stroke. It has the advantages of improving tongue and pharyngeal function, high safety, simplicity and quickness. It is often used in combination with rehabilitation training, Traditional Chinese Medicine therapy or other acupuncture methods in clinic, and has achieved good curative effects.
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Objective:To explore the influence of acupoint catgut embedding combined with exercise therapy on the rehabilitation effect of patients with upper limb spasticity after stroke and qi deficiency and blood stasis type.Methods:A total of 76 patients with qi deficiency and blood stasis type of upper limb spasticity after stroke who met the inclusion criteria in the hospital were enrolled between May 2018 and May 2020, and they were divided into two groups according to the random number table method, with 38 in each group. The control group was given conventional rehabilitation treatment, while the observation group was combined with acupoint catgut embedding and exercise therapy intervention on the basis of the control group. The degree of elbow spasm was assessed by Modified Ashworth Scale and hemiplegic hand function was evaluated by Hemiplegic Hand Function Classification Scale. Simplified Fugl-Meyer Scale was used to evaluate the limb motor ability and Modified Barthel Index was used for ability of daily living, and the adverse events during treatment were recorded.Results:After treatment, the improvement degree of elbow spasm in observation group was significantly better than that in control group ( Z=2.29, P=0.022), and the hemiplegic hand function classification was significantly better than that in control group ( Z=2.08, P=0.038). After treatment, the scores of upper and lower extremities and total score of Fugl-Meyer Scale in observation group were significantly higher than those in control group ( t=7.17, 7.40, 11.39, all Ps<0.001). While the scores of hemiplegia, faintness, shortness of breath and sallow complexion in observation group were significantly lower than those in control group ( t=7.82, 12.87, 12.55, 7.95, all Ps<0.001). The Barthel index in observation group was significantly higher than that in control group at 6 and 12 months of follow-up ( t=4.82. 6.45, all Ps<0.001). Conclusion:Acupoint catgut embedding combined with exercise therapy for intervention can improve the hemiplegic hand function, and enhance the limb motor function and daily living ability of patients with qi deficiency and blood stasis type of upper limb spasticity after stroke.
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Objective:To explore the curative effect of Buyang Huanwu Decoction combined with suspension exercise training for the patients with cerebral infarction combined and lower limb hemiplegia.Methods:According to random number table method, 94 patients with cerebral infarction and lower limb hemiplegia meeting the inclusion criteria were divided into the control group and the observation group between January 2017 and February 2021, 47 in each group. The control group was treated with suspension exercise training, while observation group was additionally treated with Buyang Huanwu Decoction on the basis of the control group treatment. All were treated for 6 weeks and then followed up for 3 months. Before and after treatment, the Traditional Chinese Medicine (TCM) syndromes scores were recorded. The severity of nerve function injury was evaluated by National Institutes of Health Stroke Scale (NIHSS). The lower limb function was evaluated by Fugl-Meyer Assessment (FMA). The balance function was evaluated by Berg Balance Scale (BBS). The activities of daily life were assessed by Barthel Index (BI). The whole blood high shear viscosity, plasma viscosity and hematocrit were detected by full-automatic hemorheology analyzer. The levels of plasma total cholesterol (TC), triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) were detected by full-automatic analyzer. All were followed up for 3 months. The prognosis of patients was assessed by modified Rankin scale (mRS). The adverse reactions during treatment were recorded.Results:After treatment, scores of TCM syndromes and NIHSS in observation group were significantly lower than those in control group ( t=5.35, 4.54, P<0.01), while scores of FMA, BBS and BI were significantly higher than those in control group ( t=3.40, 3.10, 7.57, P<0.01). The whole blood high-shear viscosity, plasma viscosity and hematocrit in observation group were significantly lower than those in control group ( t=2.94, 3.81, 4.23, P<0.05 or P<0.01), and levels of TC, TG and LDL-C were significantly lower than those in control group ( t=4.10, 4.27, 3.61, P<0.01). The differences in good prognosis rate between observation group and control group were statistically significant [74.47% (35/47) vs. 51.06% (24/47); χ2=5.51, P=0.019]. Conclusion:The Buyang Huanwu Decoction combined with suspension exercise training can relieve clinical symptoms, recover lower limb function, improve activities of daily life and prognosis in cerebral infarction combined with lower limb hemiplegia.
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ObjectiveTo explore the common syndromes of patients with cerebral infarction in rural areas of eastern Henan based on latent structure model and factor analysis，and provide reference for clinical differentiation of cerebral infarction. MethodThe data samples of patients with cerebral infarction in rural areas in eastern Henan were preprocessed. With Lantern 5.0 of latent structure method and LTM-EAST algorithm of two-step latent tree analysis， the manifest variable latent structure model of related symptoms was built to interpret different latent nodes， and common syndromes of cerebral infarction were obtained via comprehensive cluster analysis. SPSS 20.0 was used for factor analysis and cluster analysis of related symptoms to infer the distribution of syndrome types. ResultThe data of 888 patients with cerebral infarction were included， involving symptoms， tongue and pulse （88 in total）. The 65 symptoms with a frequency of ≥5% were constructed into a latent structure model， and 31 latent variables were obtained. The Bayesian information criterion （BIC） score was -15 367.17. Based on professional knowledge， s6 common syndrome types were found， namely， syndrome of upward disturbance of wind-fire， Qi deficiency and blood stasis syndrome， syndrome of phlegm and blood stasis blocking collaterals， syndrome of phlegm-heat and fu-organ excess， syndrome of wind phlegm obstructing collaterals， and syndrome of stirring wind due to yin deficiency. In factor analysis， the symptoms with a frequency of >10% were selected， and 13 common factors were obtained and used for systematic cluster analysis. And 5 syndrome types were inferred： syndrome of wind phlegm obstructing collaterals， syndrome of phlegm-heat and fu-organ excess， Qi deficiency and blood stasis syndrome， syndrome of combined phlegm and blood stasis， and syndrome of yin deficiency and internal heat. According to the determination criteria of syndrome types in traditional Chinese medicine （TCM）， 6 common syndrome types of cerebral infarction were finally determined. ConclusionAccording to the severity of the disease， the common syndromes of patients with cerebral infarction in rural areas of Eastern Henan were divided into the following categories： apoplexy involving channel and collateral： syndrome of upward disturbance of wind fire， syndrome of wind phlegm obstructing collaterals， and syndrome of stirring wind due to yin deficiency. Apoplexy involving zang and fu-viscera： syndrome of phlegm-heat and fu-organ excess， and syndrome of phlegm and blood stasis blocking collaterals. Recovery period： Qi deficiency and blood stasis syndrome. This study was basically consistent with the syndrome law in TCM theory， and provided reference for further establishing syndrome diagnostic criteria of cerebral infarction.
ABSTRACT
Pituitary apoplexy (PA) is a clinical diagnosis comprising a sudden onset of headache, neurological deficits, endocrine disturbances, altered consciousness, visual loss, or ophthalmoplegia. However, clinically, the presentation of PA is extremely variable and occasionally fatal. While meningitis and cerebral infarcts are themselves serious diseases, they are rarely seen as manifestations of PA and are exceedingly rare when present together. We present the case of a 20-year-old male with a rapid progression of symptoms of meningitis, PA and stroke. The present article seeks to emphasize a rare manifestation of PA with an attempt to understand the intricacies of its evaluation and management.
Subject(s)
Humans , Male , Adult , Pituitary Apoplexy/surgery , Pituitary Apoplexy/etiology , Meningitis, Bacterial/complications , Stroke/complications , Spinal Puncture/methods , Pituitary Apoplexy/diagnostic imaging , Cerebral Infarction/complications , Endoscopy/methodsABSTRACT
ABSTRACT Objective: To analyze the clinical, laboratory, and radiological findings and management of patients with clinical pituitary apoplexy and to screen for aryl hydrocarbon receptor-interacting protein (AIP) mutations. Subjects and methods: The clinical findings were collected from the medical records of consecutive sporadic pituitary adenoma patients with clinical apoplexy. Possible precipitating factors, laboratory data, magnetic resonance imaging (MRI) findings and treatment were also analyzed. Peripheral blood samples were obtained for DNA extraction from leukocytes, and the entire AIP coding region was sequenced. Results: Thirty-five patients with pituitary adenoma were included, and 23 (67%) had non-functioning pituitary adenomas. Headache was observed in 31 (89%) patients. No clear precipitating factor was identified. Hypopituitarism was observed in 14 (40%) patients. MRI from 20 patients was analyzed, and 10 (50%) maintained a hyperintense signal in MRI performed more than three weeks after pituitary apoplexy (PA). Surgery was performed in ten (28%) patients, and 25 (72%) were treated conservatively with good outcomes. No AIP mutation was found in this cohort. Conclusion: Patients with stable neuroophthalmological impairments can be treated conservatively if no significant visual loss is present. Our radiological findings suggest that hematoma absorption lasts more than that observed in other parts of the brain. Additionally, our study suggests no benefits of AIP mutation screening in sporadic patients with apoplexy.
Subject(s)
Humans , Pituitary Neoplasms/genetics , Pituitary Neoplasms/diagnostic imaging , Pituitary Apoplexy/etiology , Pituitary Apoplexy/genetics , Adenoma/genetics , Adenoma/diagnostic imaging , Referral and Consultation , Genetic Testing , Intracellular Signaling Peptides and Proteins/genetics , MutationABSTRACT
OBJECTIVE: To explore the value of nerve trunk stimulation in the rehabilitation of lower limb function in the patients with cerebral apoplexy at convalescence stage. METHODS: According the random number table, the patients with the lower limb dysfunction of cerebral apoplexy at convalescence stage were divided into a control group and a treatment group, 42 cases in each group. The drug therapy and the routine rehabilitation training were provided in the two groups. Additionally, in the treatment group, the nerve trunk stimulation therapy was adopted， in which, Chize (LU5，stimulating point of radial nerve), Neiguan (PC6, stimulating point of median nerve), Xiaohai (SI8, stimulating point of ulnar nerve) were selected. In the control group, acupuncture intervention was supplemented. Before and after treatment, the peak torque (PT) of the lower flexor-extensor muscle of the knee joint, gait parameters，the score of the modified Ashworth spasm scale (MAS), the score of Fugl-Meyer motor assessment (FMA) and the score of Fugl-Meyer balance scale (FBS) were recorded. RESULTS: After the treatment, the PT of the lower flexor-extensor muscle of the knee joint，the scores of FMA and FBS，the step speed and frequency were all increased, the score of MAS and the difference in the stride between the left and the right were decreased as compared with those before treatment (P<0.01). After the treatment, The PT of the lower flexor-extensor muscle of the knee joint，the scores of FMA and FBS，the step speed and frequency in the treatment group were higher than those in the control group (P<0.01). The score of MAS and the difference in the stride between the left and the right in the treatment group were lower than those in the control group (P<0.01). CONCLUSION: Nerve trunk stimulation therapy quite effectively increases the muscle strength and relieves the muscle tension as well as improves the motor function, the balance and the walking pattern of the lower limbs. This therapy is significantly valuable in the rehabilitation of the lower limbs in the patients with cerebral apoplexy at convalescence stage.