Early Postoperative Rehabilitation for a Postpartum Woman with Motor Paralysis due to Spinal Cord Tumor Who Could Raise a Newborn Child after Emergent Delivery and Tumor Removal：A Case Report / The Japanese Journal of Rehabilitation Medicine

We report a case of a 32-weeks pregnant woman in her early 30s. The patient experienced pregnancy-related low back pain and difficulty walking due to rapid muscular weakness in her lower limbs. She was diagnosed with lower limb paralysis caused by the spinal cord tumor and underwent emergency cesarean section for maternal indication, followed by laminectomy and tumor removal. After 3 days of surgery, rehabilitation interventions, including early mobilization, muscle strengthening training, balance training, and activities of daily living (ADL) training, were performed to improve voluntary movement and muscle strength in her lower limbs and ADL. Prior to rehabilitation, the patient showed lower limb muscle weakness in manual muscle test 1 (MMT1) due to motor paralysis, required assistance for walking, and expressed anxiety about the degree of recovery of her physical functions and her role as a mother. After approximately 1 month of rehabilitation, the patient was able to perform ADL independently and was discharged from the hospital with physical functions that allowed her to take care of her newborn baby. It is important to provide positive rehabilitation intervention from the early postoperative period, according to the guidelines for the disability caused by primary diseases, as well as care and movement guidance before discharge, considering the changes in mental and physical symptoms during the postpartum period in a woman with a spinal cord tumor.

Early Postoperative Rehabilitation for a Postpartum Woman with Motor Paralysis due to Spinal Cord Tumor Who Could Raise a Newborn Child after Emergent Delivery and Tumor Removal：A Case Report / The Japanese Journal of Rehabilitation Medicine

We report a case of a 32-weeks pregnant woman in her early 30s. The patient experienced pregnancy-related low back pain and difficulty walking due to rapid muscular weakness in her lower limbs. She was diagnosed with lower limb paralysis caused by the spinal cord tumor and underwent emergency cesarean section for maternal indication, followed by laminectomy and tumor removal. After 3 days of surgery, rehabilitation interventions, including early mobilization, muscle strengthening training, balance training, and activities of daily living (ADL) training, were performed to improve voluntary movement and muscle strength in her lower limbs and ADL. Prior to rehabilitation, the patient showed lower limb muscle weakness in manual muscle test 1 (MMT1) due to motor paralysis, required assistance for walking, and expressed anxiety about the degree of recovery of her physical functions and her role as a mother. After approximately 1 month of rehabilitation, the patient was able to perform ADL independently and was discharged from the hospital with physical functions that allowed her to take care of her newborn baby. It is important to provide positive rehabilitation intervention from the early postoperative period, according to the guidelines for the disability caused by primary diseases, as well as care and movement guidance before discharge, considering the changes in mental and physical symptoms during the postpartum period in a woman with a spinal cord tumor.

Regeneración aberrante del III nervio craneal por aneurisma cerebral bilateral. Reporte de caso / Aberrant regeneration of the III cranial nerve due to bilateral cerebral aneurism

RESUMEN Los trastornos de la motilidad ocular constituyen motivo de consulta periódica en Oftalmología. La regeneración aberrante, trastorno muy poco reportado, es considerada la sincinesia oculomotora de mayor invalidez y complejidad. Diversas condiciones neuroftalmológicas están implicadas en la etiopatogenia de la enfermedad, la mayoría de las cuales puede ocasionar la muerte. El manejo de los síntomas y signos provocados por paradójicos movimientos oculares conjugados es difícil. Se reportó un caso con remisión tardía a neuroftalmología por diagnóstico inicial y evolución desfavorable. La historia psicofísica arrojó diagnóstico definitivo de regeneración aberrante del III nervio craneal secundario, a aneurisma cerebral de la carótida interna bilateral, agravado por reanastomosis quirúrgica. Una rigurosa, obligatoria e impostergable historia neuroftalmológica, se impone ante toda parálisis del III nervio craneal para brindar un diagnóstico etiológico preciso y de esta forma proteger la vida.

ABSTRACT The disturbances in ocular motility are the cause of periodical consultation in Ophthalmology. The aberrant regeneration, a scarcely reported disturbance, is considered the oculomotor synkinesis of highest disability and complexness. Several neuro-ophthalmologic conditions are implicated in the disease ethiopathogeny, and most of them could lead to death. The management of the symptoms and signs caused by paradoxical conjugated ocular movements is difficult. A case is reported of late remission to Neuro-ophthalmology due to unfavorable diagnosis and evolution. The psycho-physical history led to a definitive diagnosis of aberrant regeneration of the III secondary cranial nerve, to cerebral aneurism of the bilateral internal carotid, worsened by surgical re-anastomosis. In front of any paralysis of the III cranial nerve, it is necessary a rigorous, obligatory and immediate neuro-ophthalmological history to arrive to a precise etiological diagnosis, protecting life in that way.

Clinical features and prognosis of segmental zoster paralysis of limbs / 中华神经科杂志

Objective@#To describe clinical features and prognosis of segmental zoster paralysis of limbs. @*Methods@#Three patients with segmental zoster paralysis of limbs in Huashan Hospital from January 2018 to January 2019 were reported, and a total of 23 patients (including the presenting three patients) until January 2019 in China were summarized. @*Results@#Case 1: A 72-year-old man developed right foot drop three days after herpes zoster in the right lower limb (L4-5,S1). The electrophysiological study showed incomplete common peroneal nerve injury. He was treated with anti-virus drug, mecobalamine and steroids, and achieved a complete recovery after six months. Case 2: A 62-year-old woman developed difficulty raising the right arm one week after herpes zoster in the right shoulder and upper limb (C5-6). The electrophysiological study showed incomplete axillary nerve injury. He was treated with mecobalamine and ginkgo leaf preparation, and achieved an almost full recovery after six months. Case 3: A 86-year-old woman developed left hand weakness two weeks after herpes zoster in the left upper limb, chest and back (C7-8,T1-3). The electrophysiological study was not performed. She was treated with mecobalamine and ginkgo leaf preparation and got achieved an almost full recovery after three months. @*Conclusions@#Segmental zoster paralysis of limbs was most commonly seen in the elders, within weeks after rash eruptions. Focal motor paralysis appeared in the same segment where the skin eruptions occurred, with the upper limbs being more commonly affected than the lower ones. The electrophysiological study usually showed terminal nerve injuries. The prognosis was relatively good and most of the patients achieved functional recovery.

Guillain-Barre syndrome with preserved reflexes and normal cerebrospinal fluid: a case study.

Guillain-Barre syndrome (GBS) is an acute fulminant polyradiculopathy, which typically manifests as areflexic paralysis with variable sensory and autonomic involvement. Typical cerebrospinal fluid (CSF) picture consists of an elevated CSF protein without pleocytosis (albumin-cytologic dissociation). There have been many case reports of atypical presentations of GBS; with normo-reflexia or even hyper-reflexia from Chinese/Japanese and European population but only a few from Indian Subcontinent. Also the typical CSF picture if not found, makes the diagnosis of GBS even more difficult. A 24-year‑old man presented with weakness of all 4 limbs of 4 days duration with the antecedent history of loose stools and fever. On examination, there was flaccid paralysis involving all the 4 limbs (lower limb weakness more than the upper limb) with preserved reflexes, no sensory or cranial nerve deficit, no bladder-bowel involvement; and a normal CSF study at presentation, which 1 week later showed albumin-cytologic dissociation. On electro-diagnostic studies, it was proven as a case of acute motor axonal neuropathy. Patient was managed with routine empirical antibiotics and intravenous methyl prednisone; after 3 weeks, patient was discharged in a stable condition without any residual deficit. Our understanding about the GBS has changed manifolds over the last few decades with many atypical variants being reported across the world. This case study is to lay stress on the fact that even in the absence of typical clinical features and a normal CSF study the diagnostic possibility of GBS should be kept if there is strong clinical suspicion.

Changes in the Affected Side Motor Function According to the Severity of Motor Paralysis in Hemiplegic Stroke Patients during Convalescent Rehabilitation / The Japanese Journal of Rehabilitation Medicine

Objective : We analyzed changes in the affected side motor function according to the region and severity of motor paralysis in patients during convalescent rehabilitation. Methods : The subjects recruited were 1,903 hemiplegic patients with primary stroke from a supratentorial unilateral lesion, for which a full-time integrated treatment (FIT) program was implemented. We excluded patients with severe complications, those in whom the stroke recurred or its condition rapidly changed during hospitalization, and those in whom the duration from the onset to admission to our hospital was 61 days or longer. The remaining 1,634 patients served as the study subjects, from among whom we chose 917 patients who had been hospitalized for 8 weeks or longer. The affected side motor function was assessed using 5 motor items of the Stroke Impairment Assessment Set (SIAS) every 2 weeks starting from admission. Results and Conclusion : The affected side motor function significantly improved from admission to a convalescent rehabilitation ward through to week 8 in stroke patients, who were actively engaged in daily routines and had mainly walking and ADL exercise. In addition, improvement was more likely to occur for the lower-limb compared to upper-limb, as well as for the proximal compared to distal motor function. This tendency was more marked for more severe cases of paralyses.

A Case of Motor Paralysis of the Limb Caused by Herpes Zoster / 대한피부과학회지

Herpes zoster is a common viral disease that accompanies segmental, painful vesicular eruptions along the dermatome. Motor involvement can also occasionally occur in this disease entity and its reported incidence is between 0.5% and 5%. However, the impairment of motor function often goes unrecognized, probably because of severe pain that is a more prominent feature than motor weakness. We experienced an 83-year-old female patient with herpes zoster infection of the right C5-7 dermatomes, who showed right upper extremity paralysis. We examined the limb using motor nerve conduction velocity (MNCV) test and concluded that herpes zoster caused patient's motor paralysis. After 4 months, her motor paralysis was completely recovered spontaneously.

Asociación de la púrpura trombocitopénica inmunológica y el síndrome de Guillain-Barré: a propósito de un caso / Association of immunologic thrombocytopenia and the Guillain-Barré syndrome: with regard to a case

La púrpura trombocitopénica inmunológica es una enfermedad autoinmune, benigna, de aparición frecuente, caracterizada por la presencia de anticuerpos dirigidos contra las glicoproteínas de la membrana plaquetaria que producen una disminución del recuento plaquetario y manifestaciones hemorrágicas cutáneo-mucosas. El diagnóstico de esta entidad se realiza por exclusión de otras causas de trombocitopenia. El síndrome de Guillain-Barré es también una enfermedad de naturaleza autoinmune donde la pérdida de la tolerancia inmunológica trae como consecuencia la aparición de anticuerpos dirigidos contra los gangliósidos de los nervios periféricos. Se presenta una paciente femenina de 40 años con diagnóstico de una púrpura trombocitopénica inmunológica crónica que comenzó con una parálisis motora ascendente, sin toma respiratoria, parálisis facial y dolor intenso en las regiones dorsal y lumbar. Fue diagnosticada como un síndrome de Guillain-Barré e inmediatamente se comenzó tratamiento con vitaminoterapia y esteroides a altas dosis. Después de varios meses de seguimiento y rehabilitación presentó una evolución satisfactoria con remisión de todos los síntomas neurológicos

The immunologic thrombocytopenic purpura is an autoimmune, benign, of frequent appearance disease characterized by the presence of antibodies directed to glycoproteins of platelet membrane producing a decrease of platelet count and cutaneous-mucosal hemorrhagic manifestations. The Guillain-BarrÚ syndrome is also a disease autoimmune by origin where the loss of immunological tolerance causes the appearance of antibodies directed to gangliosides of peripheral nerves. This is the case of female patient aged 40 diagnosed with a chronic immunologic thrombocytopenic purpura beginning with an ascendant motor paralysis, without respiratory compromise, facial paralysis and intense pain in dorsal and lumbar regions and also a diagnosis of Guillain-BarrÚ syndrome with immediate treatment based on vitamin-therapy and high dose of steroids. After some months of follow-up and rehabilitation there was a satisfactory evolution with remission of all neurological symptoms

A Case of Unilateral Motor Paralysis of the Shoulder caused by Herpes Zoster

Herpes zoster is a characteristic, segmental, cutaneous eruption associated with sensory axonal neuropathy, but complication of motor involvement can also occasionally occur. In many cases, the loss of motor function goes unrecognized because the extent of impairment is mild. However, if it is severe, motor weakness may lead to clinical problems. We report a case of ipsilateral shoulder paralysis caused by herpes zoster infection of the left C4-6 dermatomes in which motor weakness invaded major motion of the unilateral upper limb. An electromyography and motor nerve conduction test revealed that axonal degeneration of the upper trunk level of the brachial plexus developed secondary to herpes zoster infection. Therefore, we highlight there is possibility of severe motor deficit of a corresponding site after herpes zoster.

A Case of Motor Paralysis Caused by Herpes Zoster / 대한피부과학회지

Herpes zoster, caused by reactivation of varicella zoster virus lying dormant in the ganglion of the dorsal root, is characterized by segmental rash, pain, and sensory symptoms. Motor symptomatology is less well known and is most often related to central nervous system disease, although true lower motor neuron afflication is also thought to exist. Subclinical motor involvement is relatively more common than clinical motor weakness and is easily detected by using electromyography (EMG). An 81-year-old male patient with herpes zoster on the left shoulder, left upper arm and forearm had complained progressive weakness of the limb. On physical examination, he was noted to have groups of small vesicles on erythematous base following C4 to C6 dermatomal distribution over the left upper limb. We examined the limb using EMG and motor nerve conduction velocity (MNCV) studies. Thereafter we concluded he had motor paralysis caused by herpes zoster.

A Case of Motor Paralysis Caused by Herpes Zoster / 대한피부과학회지

Motor loss caused by herpes zoster is less well known but occurs in a significant number of cases, probably far more frequent than is recognized because the weakness is readily obscured by pain. The incidence of herpetic motor involvement was reported to be between 0.5% and 31%. A 65-year-old male patient with herpes zoster on the right lower limb had complained with progressive weakness of the limb, during treatment. We examined the limb using electromyographic(EMG) and motor nerve conduction velocity(MNCV) studies. Thereafter we concluded he had motor paralysis caused by herpes zoster. The weakness progressed to the complete motor loss of the right limb. Presenty, he still suffers from the paralysis of the right limb.

A Case of Motor Paralysis of the Limb caused by Herpes Zoster

Segmentally distributed cutaneous eruptions and neuralgia are common manifestations of herpes zoster. However, motor loss is another aspect of this manifestation, which is less well known and considered a rare finding. In many cases the loss of motor function may be easily overlooked because the pain is the more prominent feature and the weakness probably goes unrecognized with only a mild impairment of the motor function. We experienced a 71-year-old male patient with a herpes zoster-related motor paralysis of right arm whose clinical features of a weak limb mimicked other spinal motor diseases and confirmed motor involvement using electromyographic (EMG) and motor nerve conduction velocity (MNCV) studies.

Ocular motor nerve paralysis in herpes zoster ophthalmicus / 대한피부과학회지

Only few studies focused on ocular motor paralysis in herpes zoster ophthalmicus. The manifestation of ptosis and paralysis of ocular motor nerve or one of its branches is rarely seen. However, careful examinations with regard to external ocular movements and iris would be helpful to detect the ocular motor paralysis. We report a case of ocular motor paralysis resulting from herpes zoster ophthalmicus. A 66-year-old woman was treated with acyclovir and steroid for an ophthalmic herpes zoster. Ptosis and impairment of gaze except lateral gaze appeared after the periorbital edema subsided. She showed moderately edematous cornea, corneal erosion, chemosis, but no definite dendritic lesions. The paralytic lesions cleared four months later.

Ocular motor nerve paralysis in herpes zoster ophthalmicus / 대한피부과학회지

Only few studies focused on ocular motor paralysis in herpes zoster ophthalmicus. The manifestation of ptosis and paralysis of ocular motor nerve or one of its branches is rarely seen. However, careful examinations with regard to external ocular movements and iris would be helpful to detect the ocular motor paralysis. We report a case of ocular motor paralysis resulting from herpes zoster ophthalmicus. A 66-year-old woman was treated with acyclovir and steroid for an ophthalmic herpes zoster. Ptosis and impairment of gaze except lateral gaze appeared after the periorbital edema subsided. She showed moderately edematous cornea, corneal erosion, chemosis, but no definite dendritic lesions. The paralytic lesions cleared four months later.