ABSTRACT
Peripheral nerve injuries after being struck by lightning have been documented. Here, we report a case of cauda equina syndrome induced by lightning. A 27-year-old man presented with numbness, a burning sensation in the saddle region, and increased urinary urgency after being struck by lightning. He had absent Achilles reflexes and paresthesia in the saddle region upon neurological examination, and magnetic resonance imaging of the spine was normal. Electrophysiological studies indicated involvement of bilateral L5, S1, and S2 myotomes and revealed cauda equina lesions.
Peripheral nerve injury induced by lightning is rare, and the evaluation of people with neurological complaints using electromyography will help determine the true incidence.
Subject(s)
Cauda Equina Syndrome , Cauda Equina , Lightning Injuries , Male , Humans , Adult , Cauda Equina Syndrome/etiology , Cauda Equina Syndrome/pathology , Lightning Injuries/complications , Lightning Injuries/pathology , Electromyography , Cauda Equina/diagnostic imaging , Cauda Equina/pathology , Magnetic Resonance ImagingABSTRACT
INTRODUCTION: Our aim was to evaluate the association between polypharmacy and certain physical performance measures used to assess ambulation in early-stage Alzheimer patients. MATERIALS AND METHODS: This cross-sectional study was conducted in the dementia outpatient clinic of a tertiary care center. The usage of five or more drugs per day was accepted as polypharmacy and patients with moderate and severe dementia were excluded. Usual gait speed (UGS), timed up and go (TUG), and chair sit-to-stand test (CSST) were applied to assess physical performance status. RESULTS: There were 134 participants in our study (67.9% female, mean age 80.2 ± 7.9 years) and 75 (56%) patients were polypharmacy patients. The patients with polypharmacy showed poor physical performance compared to the patients without polypharmacy (UGS p = .005, TUG p < .001, CSST p < .001). The parameters that were significantly higher and more common in the polypharmacy group were body mass index (p = .026), hypertension (p = .013), diabetes mellitus (p = .018), ischemic heart disease (p < .001), atrial fibrillation (p = .030), depression (p = .012), and hypothyroidism (p = .007). In multivariate analyses, polypharmacy was independently associated with slow UGS [Odds ratio (OR) 1.248 (95%) confidence interval (CI) 1.145-1.523, p = .007]; long TUG [OR 1.410 (95%) CI 1.146-1.736, p = .001]; and long CSST [OR 1.892 (95%) CI 1.389-2.578, p < .001]. CONCLUSION: Our study demonstrated the association of polypharmacy with poor physical performance in patients with early stage Alzheimer's disease. Prospective long-term studies investigating the relationship of polypharmacy and drug subgroups with physical performance in elderly patients with Alzheimer's disease would be appropriate.
Subject(s)
Alzheimer Disease , Humans , Female , Aged , Aged, 80 and over , Male , Polypharmacy , Cross-Sectional Studies , Prospective Studies , Physical Functional PerformanceABSTRACT
INTRODUCTION: Muscle weakness and easy fatigability are the clinical hallmarks of myasthenia gravis (MG). However, fatigue perception, which can be seen quite often in myasthenic patients, and its effect on the quality of life, irrespective of motor deficit, has not been elucidated yet. The aim is to evaluate the frequency of fatigue in myasthenic patients with nearly full muscle strength and the effect of fatigue on quality of life by assessing its correlation with other symptoms. METHODS: Fifty-three patients with ocular or mild generalized MG in remission or minimal manifestations completed the questionnaires measuring the severity of MG and quality of life (MG Composite Scale and MG-Activities of Daily Living Profile). Both patient group and control group (53 healthy volunteers)completed the scales assessing fatigue [Fatigue Assessment Scale (FAS) and Fatigue Impact Scale (FIS)], depression [Beck Depression Inventory (BDI)] and sleep (Epworth Sleepiness Scale). Disease severity was assessed using MG Foundation of America (MGFA) and MGFA Post-Intervention Status classifications. RESULTS: FAS, FIS physical and BDI scores were significantly higher in patients compared to the control group (p = 0.003, p = 0.001, and p = 0.003, respectively) and fatigue was associated with depression and daytime sleepiness. Inpatient group, depressive symptoms and daytime sleepiness were higher in females (p = 0.019 and p = 0.013). The mean values of FIS total and cognitive scores were higher in patients with generalized MG (p = 0.033 and p = 0.045). Fatigue scores correlated with motor signs. DISCUSSION: Fatigue can be seen in MG independently from muscle weakness and is an important symptom worsening the quality of life.
