Melkersson-rosenthal: reporte de caso clínico de una neurodermatosis infrecuente / Melkersson-rosenthal syndrome: case report of an uncommon neurodermatosis

Resumen: El síndrome de Melkersson-Rosenthal (SMR) es una entidad clínica rara, de patogénesis desconocida. Se manifiesta característicamente por edema orofacial recidivante, lengua fisurada y parálisis recurrente del nervio facial. Representando así undesafío diagnóstico y terapéutico, además de generar importante compromiso social al individuo acometido. El presente artículo tiene como objetivo describir el caso de un paciente de 15años de edad que presentó: edema labial, lengua fisurada y queilitis granulomatosa al examen histopatológico, llevándose a consideración la hipótesis del síndrome citado, con resultados satisfactorios al tratamiento establecido.

Abstract: Melkersson-Rosenthal syndrome (MRS) is a rare clinical entity with an unknown pathogenesis. It clinically manifests in orofacial edema, plicated tongue and recurrent paralysis of the facial nerve. It represents a diagnostic and therapeutic challenge, and has an important psycosocial impact on the affected individual. This study describes the case of a 15-year-old patient who presented with labial edema, plicated tongue and granulomatous cheilitis on histopathological examination, for which a diagnosis of MRS was proposed. The patient showed a good response to treatment.

Cervical brucellar spondylitis causing incomplete limb paralysis

Abstract Brucellosis, a zoonosis with worldwide distribution, is a systemic infection caused by bacteria of the genus Brucella. Meanwhile, brucellosis often causes complications, such as osteoarticular involvement, and spondylitis is the most prevalent and important clinical form. Here, is a case of cervical brucellar spondylitis causing incomplete limb paralysis in a middle-aged male. The diagnosis was based on clinical history, and supported by Brucella serology and magnetic resonance imaging. Quadruple antibacterial treatment continued for four weeks. In this case, the epidural abscess causing spinal cord compression resolved without surgery. In addition, the patient had recovered from most of the neurologic deficits.

Sudden motor and sensorial loss due to retroperitoneal hematoma during postoperative periods: a case report / Súbita perda sensitiva e motora devido a hematoma retroperitoneal durante os períodos de pós-operatório: relato de caso

Abstract A 68 year-old male patient was hospitalized for radical prostatectomy. He had no abnormal medical history including neurological deficit before the operation. Prior to general anesthesia, an epidural catheter was inserted in the L3-4 interspace for intraoperative and postoperative analgesia. After surgery for nine hours, he developed confusion and flaccid paralysis of bilateral lower extremities occurred. No pathology was detected from cranial computed tomography and diffusion magnetic resonance imaging no pathology was detected. His thoracic/lumbar magnetic resonance imaging. Intraabdominal pressure was shown to be 25 mmHg, and abdominal ultrasonography revealed progression in the inflammation/edema/hematoma in the perirenal region. The Bromage score was back to 1 in the right foot on the 24th hour and in the left foot on the 26th hour. Paraplegia developed in patients after epidural infusion might be caused by potentiated local anesthetic effect due to retroperitoneal hematoma and/or elevated intra-abdominal pressure.

Resumo Paciente do sexo masculino, 68 anos, hospitalizado para prostatectomia radical. O paciente não tinha história médica anormal, inclusive nem déficit neurológico, antes da operação. Antes da anestesia geral, um cateter peridural foi inserido no espaço intermédio L3-4 para analgesia no intra e pós-operatório. Após a cirurgia, que durou nove horas, o paciente desenvolveu confusão e paralisia flácida bilateral dos membros inferiores. Tomografia computadorizada de crânio e imagem de difusão por ressonância magnética não detectaram lesão. Os achados nas imagens de ressonância magnética torácica/lombar eram normais. A pressão intra-abdominal era de 25 mmHg e o ultrassom abdominal revelou progressão de inflamação/edema/hematoma na região perirrenal. O escore de Bromage voltou a 1 no pé direito na 24a hora e no pé esquerdo na 26a hora. A paraplegia desenvolvida nos pacientes após a infusão epidural pode ter sido causada por um efeito potencializado do anestésico local devido a hematoma retroperitoneal e/ou pressão intra-abdominal elevada.

Abscesso espinhal epidural por disseminação hematogênica: relato de caso / Spinal Epidural Abscess by Hematogenous Spread: Case Report

Abscesso espinhal epidural é uma doença rara de diagnóstico difícil, sendo que o principal fator prognóstico é o diagnóstico breve. A maioria dos pacientes, porém, tem o diagnóstico tardio, quando já existem sintomas neurológicos que podem permanecer após o tratamento. Na maioria dos casos, os sintomas iniciais são dor nas costas, febre e paralisia. O tratamento é feito à base de antibioticoterapia empírica e, caso não haja contraindicação, descompressão e drenagem cirúrgica. Relata-se o caso de uma paciente que sofreu paralisia súbita nos membros inferiores. Inicialmente, havia suspeita de mielite transversa, mas a evolução do caso permitiu o diagnóstico de abscesso espinhal epidural emT6, T7 e T8, causada por disseminação hematogênica de Staphylococcus aureus.

Spinal epidural abscess is a rare and difficult disease to diagnose, and the main prognostic factor is the early diagnosis. Most patients, however, have their diagnosis delayed to when they already have neurological symptoms that may remain after treatment. In most cases, the initial symptoms are back pain, fever and paralysis. Treatment is based on empirical antibiotic therapy and, if there is no contraindication, decompression and surgical drainage. We report the case of a patient who suffered sudden paralysis of the inferior members. Initially suspected as transversemyelitis, the case evolved, allowing the diagnosis of spinal epidural abscess in T6, T7 and T8, caused by hematogenous spread of Staphylococcus aureus.

Parálisis aislada del nervio circunflejo en deportistas de contacto / Isolated axillary nerve palsy in contact sports

Introducción: La parálisis del nervio circunflejo es la más frecuente entre los nervios periféricos del hombro. Esta lesión de difícil diagnóstico, implica una seria complicación en los deportes de contacto. El objetivo de éste trabajo es reportar los resultados del tratamiento conservador de 18 casos de parálisis aislada del nervio circunflejo causada por traumatismos directos del hombro en deportistas de contacto, sin luxación glenohumeral. Material y Método: Se evaluaron retrospectivamente con un seguimiento mínimo de 2 años, 18 jugadores de rugby, con diagnóstico de parálisis post-traumática del nervio circunflejo. Se evaluó la recuperación de la función, la fuerza y sensibilidad del músculo deltoides y el tiempo en retorno a la actividad deportiva. Todos los pacientes fueron evaluados con el score de ASES. Resultados: La función y la fuerza del músculo deltoides se recuperaron totalmente en 13 pacientes...

Incidence of Deep Vein Thrombosis after Spinal Cord Injury in Korean Patients at Acute Rehabilitation Unit

Deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) remain significant causes of morbidity, mortality in patients with spinal cord injury (SCI). Since incidence of DVT after SCI in Korean population has not been much studied, we retrospectively analyzed the medical records of 185 SCI patients admitted for acute rehabilitation unit to investigate the incidence of DVT. Color Doppler ultrasonography was performed to screen for the occurrence of DVT at the time of initial presentation to acute rehabilitation unit. Primary study outcome was the incidence of DVT. Possible risk factors for DVT including the epidemiologic characteristics, completeness of motor paralysis, cause of injury, spasticity, surgery, and active cancer were analyzed. The incidence of DVT after SCI was 27.6%. In multiple logistic regression analysis, absence of spasticity was a significant independent risk factor (P<0.05) for occurrence of DVT. Symptomatic pulmonary embolism was evident in 7 patients without an episode of sudden death. Therefore, it is concluded that the incidence of DVT after SCI in Korean patients is comparable with that in Western populations. This result suggests that pharmacologic thromboprophylaxis should be considered in Korean patients with SCI.

Polio / Polio

Polio continúa endémica en: Nigeria, Afganistán Pakistán e India. La iniciativa global de erradicación de polio de la OMS estableció que para 2013 no debe haber ningún niño paralítico en el mundo por el virus salvaje o por el virus derivado de la vacuna. En esta revisión se describen ambas vacunas contra el polio, la oral y la inactivada, su inmunogenicidad, seguridad y las condiciones a cumplir por un paíspara que cambie su esquema de vacunación de polio oral a inactivada. La vacuna polio oral ha permitido la erradicación de la enfermedaden varios continentes incluyendo América; sin embargo conlleva riesgos, tales como polio paralítica asociada a vacuna (VAP-siglas en inglés-) y parálisis producida por polio virus derivado de la vacuna (VDP-siglas en inglés-). La Vacuna Polio Inactivada (VPI) es segura e inmunogénica, puede ser administrada en combinaciones vacunales. Para que un país cambie a VPI debe tener cobertura y esquemaóptimo de esta vacuna, 90% de, cobertura de DTP3, vigilancia adecuada de parálisis flácida, no estar próximo en la actualidad o recientemente a un país con polio endémico. Altas coberturas vacunales son esenciales par asegurar una inmunidad adecuada de lapoblación

Polio remains endemic in Nigeria, Afghanistan, Pakistan, India. Strategic plan of Global Poliomyelitis Eradication Initiative (GPEI) of the WHO is that by 2013 no child will be paralyzed by a wild or vaccine derived poliovirus. This paper describes both oral and inactivated vaccine, safety concerns with the use of OPV, immunogenicity of IPV and the conditions to be full filled in order for a country to deliverIPV as a regular vaccine schedule. Oral polio vaccine has successfully contributed to global polio eradication in several continents including America. However, it carries risks, such as Vaccine Derived Poliovirus (VDP) and Vaccine Associated Paralytic Polio (VAPP). Inactivated Poliovirus Vaccine (IPV) is safe and immunogenic; it may be administered as monovalent or in a combined shot. Countries opting to switch from OPV to IPV should have: optimal IPV coverage and schedule, 90% of DTP 3 coverage, good surveillance of flaccid paralysis cases, and should not be near a country with endemic polio recently or at the present time. Are neither currently or were notrecently polio endemic nor has close contacts with such areas. High immunization coverage is essential to ensure adequate populationimmunity

Distal renal tubular acidosis, hypokalemic paralysis, nephrocalcinosis, primary hypothyroidism, growth retardation, osteomalacia and osteoporosis leading to pathological fracture: a case report

Renal tubular acidosis [RTA] is a constellation of syndromes arising from different derangements of tubular acid transport. Recent advances in the biology of urinary acidification have allowed us to discern various molecular mechanisms responsible for these syndromes. RTA often presents as renal stone disease with nephrocalcinosis, ricket/osteomalacia and growth retardation in children with ultimate short stature in adulthood. The case reported here has features of distal renal tubular acidosis [dRTA], hypokalemic paralysis, primary hypothyroidism, growth retardation, osteomalacia and osteopenia leading to stress fracture. All these features presenting in a single case [as in our case] is a rare occurrence, so far other cases of distal renal tubular acidosis [dRTA] have been reported

overlooked complication of vancomycin induced acute flaccid paralysis in a child with acute leukemia: a case report

Vancomycin is a glycopeptide antibiotic which is commonly used to treat methicillin-resistant staphylococcal infections. It is commonly used in pediatric oncology wards for children with febrile neutropenia. We report a very rare side effect of vancomycin induced myopathy in a child with acute lymphoblastic leukemia. To the best of our knowledge, this is the first case reported from Oman

Guillain Barre syndrome [GBS], the leading cause of acute flaccid paralysis at peoples medical college hospital Nawabshah

To identify and treat the acute flaccid paralysis in interior of Sindh reported at PMCH Nawabshah. Retrospective, with proper date and record. Medicine and ICU Department at Peoples Medical College Hospital Nawabshah from 31[st] January to 31[st] October 2009. Patients of all 3 medical units were involved in the study during this period. 50 patients with acute flaccid paralysis [AFP] were admitted in Intensive Care Unit of Peoples medical college Hospital Nawabshshah with support of all emergency measures and were evaluated. 50 patients presented with AFP during study period. 40 were males and 10 were females. GBS was the leading cause of AFP. Majority of the patients were young, out come was excellent. 2 patients died due to respiratory failure. GBS is the leading cause of AFP in adults in interior of the Sindh while facilities for treatment are limited, which need to be extended in the hospitals situated in interior of Pakistan i.e. ICU and plasmopharesis

Mecanismos patogénicos de la parálisis braquial congénita: [revisión] / Pathogenic mechanisms of congenital brachial palsy: [review]

Antecedentes: Se define clásicamente a la parálisis braquial congénita como la paresia flácida de una extremidad superior secundaria al estiramiento traumático del plexo braquial durante el parto, en la extracción del hombro anterior, en relación a la distocia de hombro. Numerosas series han reportado la falta de relación entre la parálisis braquial congénita y el estiramiento traumático del plexo braquial durante la distocia de hombro. Objetivo: Realizar una revisión de la literatura para identificar las causas relacionadas con la parálisis braquial congénita. Resultados: Hasta en un 50 por ciento de los casos la parálisis braquial congénita no se asocia a distocia de hombro. Estos casos, son de peor pronóstico, afectan principalmente al hombro posterior y se presentan en recién nacidos de menor peso al nacer, pudiendo presentarse en un parto cesárea. La parálisis braquial congénita no asociada a distocia de hombro reconoce múltiples mecanismos patogénicos como: postura viciosa fetal in útero, tracción del hombro posterior por el promontorio sacro, neoplasias fetales, tumores uterinos, y otras. Conclusión: La parálisis braquial congénita, debe ser entendida como un síndrome, clínicamente caracterizado por parálisis flácida de una de las extremidades superiores detectada en el recién nacido, que responde a diferentes mecanismos patogénicos y de pronóstico variable según el caso.

Background: Classically congenital brachial palsy was defined as a flaccid paresis of the upper limb, secondary to traumatic brachial plexus stretching during delivery of the anterior shoulder in the context of shoulder dystocia. Numerous series have reported the lack of relationship between congenital brachial palsy and traumatic stretching of the brachial plexus during shoulder dystocia, in a significant number of cases. Objective: To review the literature to identify the causes related to congenital brachial palsy. Results: Up to 50 percent of cases of congenital brachial palsy are not associated to shoulder dystocia. These cases, have worse prognosis, mainly affect the posterior shoulder, presents in infants of lower birth weight and may even be in a cesarean delivery. Congenital brachial palsy not associated with shoulder dystocia recognizes multiple pathogenic mechanisms such as: vicious fetal position in utero, traction of the posterior shoulder on the sacral promontory, fetal tumors, uterine tumors, and others. Conclusion: Congenital brachial palsy, should be understood as a syndrome, clinically characterized by flaccid paresis/paralysis of one upper limb detected in the newborn, being the consequence of different pathogenic mechanisms and having variable prognosis.

Post-epidural unilateral paralysis of intercostal muscles in child

Morbidity after paediatric epidural anaesthesia is unusual. We report a case of transient motor nerve root block in an eleven years old girl receiving epidural analgesia postoperatively following anterior instrumented spinal fusion for scoliosis. The epidural catheter was placed within the T8-T9 inter-space under general anaesthesia. Postoperatively the child developed unilateral paradoxical chest wall movement which was felt to be due to transient motor nerve roots blockade from the epidural analgesia, resulting from migration of catheter though uncommon, the complication needs to be considered in the differential of respiratory compromise postoperatively

Postoperative Complications of Thyroid Cancer in a Single Center Experience

The aim of this study was to investigate the complications following surgical treatment of thyroid cancer and the association between the extent of surgery and complication rates. A total of 2,636 patients who underwent surgery due to thyroid cancer were retrospectively reviewed to identify surgical complications. Complication rates were assessed according to the extent of surgery, which was classified as follows; less-than-total thyroidectomy with central compartment node dissection (CCND) (Group I, n=636), total thyroidectomy with CCND (Group II, n=1,390), total thyroidectomy plus ipsilateral neck dissection (Group III, n=513), and total thyroidectomy plus bilateral neck dissection (Group IV, n=97). The most common surgical complication was symptomatic hypoparathyroidism, of which 28.4% of cases were transient and 0.3% permanent. The other surgical complications included vocal cord palsy (0.7% transient, and 0.2% permanent), hematoma (0.5%), seroma (4.7%), chyle fistula (1.8%), and Horner's syndrome (0.2%). The complication rates increased significantly with increasing the extent of surgery from Group I to Group IV. The more extensive surgery makes more complications, such as hypoparathyroidism, seroma, and others.