Peripheral neuropathy

周围神经病变
  • 文章类型: Journal Article
    IgLON5自身免疫是一种新型抗体介导的疾病,其特征是血清和/或脑脊液(CSF)对IgLON5抗体呈阳性。抗IgLON5疾病主要表现为睡眠障碍,运动障碍和脑干综合征。在这项研究中,我们报告了一例抗IgLON5疾病的患者,他表现为腹胀,腹痛,间歇性排尿困难和便秘,四肢间歇性闪电疼痛,抗IgLON5病不典型,易导致误诊。在进行自身抗体筛查后,我们考虑抗IgLON5病。患者开始接受静脉注射地塞米松的免疫治疗,静脉注射免疫球蛋白(IVIG)和口服硫唑嘌呤。治疗后,这些表现几乎解决了。抗IgLON5疾病的临床表现是多样的,可能存在不同的组合,这很容易导致误诊。早期识别和使用免疫抑制剂治疗这种自身免疫性疾病可能会导致更好的结果。
    IgLON5 autoimmunity is a novel antibody-mediated disorder characterized by serum and/or cerebrospinal fluid (CSF) positivity for IgLON5 antibody. Anti-IgLON5 disease mainly manifests as sleep disturbances, movement disorders and brainstem syndromes. In this study, we report the case of a patient with anti-IgLON5 disease who presented with abdominal distension, abdominal pain, intermittent dysuria and constipation, and intermittent lightning pain in the extremities, which are atypical of anti-IgLON5 disease and could easily lead to misdiagnosis. After performing autoantibody screening, we considered anti-IgLON5 disease. The patient was started on a course of immunotherapy with intravenous dexamethasone, intravenous immunoglobulin (IVIG) and oral azathioprine. Following treatment, the manifestations nearly resolved. The clinical manifestations of anti-IgLON5 disease are diverse and may present in different combinations, which can easily lead to misdiagnosis. Early recognition and treatment of this autoimmune disease with immunosuppressive agents may lead to better outcomes.
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  • 文章类型: Case Reports
    恶性贫血,源于维生素B12缺乏和影响内在因子产生的自身免疫过程,由于模糊的初始症状,在早期诊断中提出了挑战。该病例报告介绍了并发HLA-B27关节病的患者中恶性贫血诱发的周围神经病变的独特发生。强调自身免疫机制的复杂相互作用。虽然HLA-B27通常与恶性贫血无关,该病例强调了探索特定HLA单倍型对于了解自身免疫性疾病的细微差别表现的重要性.在有恶性贫血迹象的个体中,全面筛查抗内在因子和抗壁细胞抗体至关重要,尤其是那些有HLA-B27关节病病史的人,指导量身定制的管理策略。本报告有助于不断探索恶性贫血中复杂的自身免疫景观。
    Pernicious anemia, stemming from Vitamin B12 deficiency and autoimmune processes affecting intrinsic factor production, presents challenges in early diagnosis due to vague initial symptoms. This case report introduces a unique occurrence of pernicious anemia-induced peripheral neuropathy in a patient with concurrent HLA-B27 arthropathy, highlighting the complex interplay of autoimmune mechanisms. While HLA-B27 is not typically associated with pernicious anemia, the case underscores the importance of exploring specific HLA haplotypes in understanding the nuanced manifestation of autoimmune disorders. Comprehensive screening for anti-intrinsic factor and anti-parietal cell antibodies is crucial in individuals with signs of pernicious anemia, especially those with a history of HLA-B27 arthropathy, guiding tailored management strategies. This report contributes to the ongoing exploration of the intricate autoimmune landscape in pernicious anemia.
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  • 文章类型: Case Reports
    虽然周围神经阻滞被认为是非常安全的,相当数量的患者,这种麻醉技术可能是特别有吸引力的应用可能存在的周围神经病,使他们面临进一步神经损伤的风险。我们介绍了一例74岁的男性,具有多种周围神经病变的危险因素,该患者在罗哌卡因po坐骨神经阻滞后出现足下垂。我们建议罗哌卡因的血管收缩特性可能导致先前存在的神经元缺血,从而进一步损害已经受损的神经。
    Although peripheral nerve blocks are deemed very safe, a significant number of patients for whom this anesthetic technique may be particularly appealing to apply may present with preexisting peripheral neuropathies, putting them at risk for further nerve damage. We present a case with a 74-year-old male with several risk factors for peripheral neuropathy who developed a foot drop following a popliteal sciatic nerve block with ropivacaine. We suggest that the vasoconstrictive properties of ropivacaine may have contributed to a preexisting neuronal ischemia, thus further damaging an already compromised nerve.
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  • 文章类型: Journal Article
    由于有效药物的可获得性有限,耐多药结核病(MDR-TB)和广泛耐药前结核病(Pre-XDR-TB)的治疗仍然具有挑战性。利奈唑胺已成为这些病例的有希望的治疗选择。然而,它的长期使用会导致并发症,如周围和视神经病变。针灸,中国传统医学的基石,已被证明是有效的治疗周围神经病变(PN)。这项研究探讨了针灸治疗利奈唑胺引起的周围神经病变(LIPN)的潜在益处。
    四个病人,年龄27至60岁,诊断为LIPN,接受每日针灸治疗。主要终点是评估针灸在减轻患者与LIPN相关的神经性疼痛中的功效。这主要是使用针灸治疗前后的简短形式McGill疼痛问卷(SF-MPQ)得分的变化来测量的。
    其中三名患者症状明显缓解,而一个人经历了边际改善。治疗范围为7至18个疗程。具体来说,第一例患者报告实质性缓解,得分从33降低到13;第二例患者观察到最小变化;第三例患者在八次治疗后得分从10急剧下降到2;最后一例患者在五次治疗后得分从21降低到12,但未继续治疗进行第二次评估.
    针灸是治疗LIPN的一种有前途的方法。然而,需要进行更大,更彻底的研究来确定其全部潜力。
    UNASSIGNED: The treatment of multidrug-resistant tuberculosis (MDR-TB) and pre-extensively drug-resistant tuberculosis (pre-XDR-TB) remains challenging due to the limited availability of effective drugs. Linezolid has emerged as a promising therapeutic option for these cases. However, its long-term use can lead to complications such as peripheral and optic neuropathies. Acupuncture, a cornerstone of traditional Chinese medicine, has been shown to be effective in the treatment of peripheral neuropathy (PN). This study examines the potential benefits of acupuncture in the treatment of linezolid-induced peripheral neuropathy (LIPN).
    UNASSIGNED: Four patients, aged 27 to 60 years, diagnosed with LIPN, underwent daily acupuncture treatments. The main endpoint was to assess the efficacy of acupuncture in reducing neuropathic pain associated with LIPN in patients. This was primarily measured using changes in the Short Form McGill Pain Questionnaire (SF-MPQ) scores before and after acupuncture treatment.
    UNASSIGNED: Three of the patients experienced significant symptom remission, while one experienced marginal improvement. Treatments ranged from 7 to 18 sessions. Specifically, the first patient reported substantial relief with a score reduction from 33 to 13; the second patient observed minimal change; the third patient\'s score decreased dramatically from 10 to 2 after eight sessions; the last patient had a score reduction from 21 to 12 after five sessions, but did not continue treatment for a second assessment.
    UNASSIGNED: Acupuncture is a promising therapeutic approach for LIPN. However, larger and more thorough studies are needed to determine its full potential.
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  • 文章类型: Case Reports
    遗传性神经病伴压力性麻痹(HNPP)患者的妊娠可能会带来独特的挑战。这是由于神经系统症状的潜在恶化以及在产前需要谨慎管理,产时,和产后。在这个案例报告中,我们将讨论通过剖宫产分娩有HNPP病史的年轻孕妇的成功治疗。我们还将回顾有关HNPP孕妇管理的现有文献,专注于多学科的投入和策略,以最大程度地减少分娩和分娩期间并发症的风险。报告HNPP中的妊娠病例对于提高临床医生的认识和优化患者护理非常重要。
    Pregnancy in patients with hereditary neuropathy with liability to pressure palsy (HNPP) can present unique challenges. This is due to the potential exacerbation of neurological symptoms and the need for careful management during the antepartum, intrapartum, and postpartum periods. In this case report, we will discuss the successful management of a young pregnant female with a history of HNPP delivered by cesarean section. We will also review the existing literature on the management of pregnant patients with HNPP, focusing on the multidisciplinary input and strategies to minimize the risk of complications during labor and delivery. Reporting cases of pregnancy in HNPP is important for increasing awareness among clinicians and optimizing patient care.
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    文章类型: Case Reports
    糖尿病可能首次出现其经典特征或可能被识别或不被识别的长期并发症。糖尿病及其并发症的知识,社会文化信仰和感知,传统治疗师的光顾可能会影响演示时间,因此,结果。我们报道了一个尼日利亚女性食品供应商的案例,昏迷入院,治疗败血症性左手溃疡和偶发糖尿病。她有无痛性周围神经病变,这给了她处理热物体的能力。这被误解为来自仁慈精神的特殊礼物,直到她遭受热损伤,左手伤口无法愈合。她向一位传统的治疗师介绍,这延迟了医院的介绍。她最终昏迷被送往医院,并发现了相关的糖尿病。她对高血糖昏迷和败血症以及伤口护理进行了适当的管理,并根据适当的药物和生活方式措施出院到门诊患者。
    Diabetes mellitus may for the first time present with its classical features or with long term complications which may or may not be recognised. Knowledge of diabetes mellitus and its complications, sociocultural beliefs and perception, patronage of traditional healers may influence time of presentation and hence, outcomes. We report the case of a female Nigerian food vendor, who was admitted in coma and managed for septic left-hand ulcer and incidental diabetes mellitus. She had painless peripheral neuropathy, which gave her the \'\'ability\'\' to handle hot objects. This was misconstrued as some special gift derived from a benevolent spirit, until she sustained thermal injury and a non-healing wound on her left hand. She presented to a traditional healer which delayed hospital presentation. She was eventually brought to hospital in coma and related diabetes mellitus was found. She was appropriately managed for hyperglycaemic coma and sepsis as well as wound care and was discharged to the out patients\' services on appropriate drugs and life style measures.
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  • 文章类型: Case Reports
    麻风病,由麻风分枝杆菌复合体引起的,表现为慢性感染。它的标志表现涉及神经皮肤综合征,以周围神经受累和皮肤病变为特征。神经并发症显着导致麻风病人的残疾。周围神经病变可急性或慢性表现,轴突或脱髓鞘形式,可以表现为单神经病,多发性单神经病,或者多发性神经病。不同的临床表现强调了在周围神经病的鉴别诊断中考虑麻风病的重要性。启用适当的调查方法。皮肤和神经活检,狭缝皮肤涂片,神经传导研究是确定麻风病周围神经受累的重要诊断工具。在本文中,我们介绍了三例麻风病伴周围神经受累,讨论他们的临床谱,诊断方法,和管理。
    Leprosy, caused by the Mycobacterium leprae complex, manifests as a chronic infection. Its hallmark presentation involves the neurocutaneous syndrome, characterized by peripheral nerve involvement and dermatologic lesions. Neurological complications significantly contribute to disability in leprosy patients. Peripheral neuropathy may manifest acutely or chronically, in either axonal or demyelinating forms, and can present as mononeuropathy, mononeuropathy multiplex, or polyneuropathy. The diverse clinical presentations emphasize the importance of considering leprosy in the differential diagnosis of peripheral neuropathy, enabling appropriate investigative approaches. Skin and nerve biopsies, slit skin smears, and nerve conduction studies serve as crucial diagnostic tools for identifying peripheral nerve involvement in leprosy. In this paper, we present three cases of leprosy with peripheral nerve involvement, discussing their clinical spectrum, diagnostic approach, and management.
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  • 文章类型: Journal Article
    一名44岁男子因发烧入院。他出现了昏迷和呼吸衰竭,需要机械通风。甲泼尼龙和静脉注射免疫球蛋白治疗疑似自身免疫性脑炎后,他的意识和呼吸状态有所改善。然而,他表现出明显的四透析和颈部以下的感觉受损。脊柱MRI显示整个脊髓肿胀,提示脊髓炎.所有四肢的深肌腱反射减弱,一项神经传导研究证实了运动性轴突多发性神经病。随后,他发烧和头痛。脑MRI显示基底神经节和脑干的FLAIR高信号。CSF分析抗胶质纤维酸性蛋白(GFAP)抗体呈阳性,导致GFAP星形细胞病的诊断。尽管类固醇的再给药改善了他上肢的肌肉力量并减少了感觉减弱的范围,严重的偏瘫仍然存在。严重的GFAP星形细胞病可能与多发性神经病有关。对这种情况的早期发现和治疗干预可能导致更好的预后。
    A 44-year-old man was admitted due to a fever. He developed unconsciousness and respiratory failure, necessitating mechanical ventilation. After the administration of methylprednisolone and intravenous immunoglobulin for suspected autoimmune encephalitis, his consciousness and respiratory state improved. However, he exhibited pronounced tetraparalysis and impaired sensation below the neck. A spinal MRI revealed swelling of the entire spinal cord, indicating myelitis. Deep tendon reflexes were diminished in all extremities, and a nerve conduction study confirmed motor-dominant axonal polyneuropathy. Subsequently, he developed a fever and headache. Brain MRI demonstrated FLAIR hyperintensities in the basal ganglia and brain stem. CSF analysis for anti-glial fibrillary acidic protein (GFAP) antibody turned out positive, leading to the diagnosis of GFAP astrocytopathy. Although the steroid re-administration improved muscle strength in his upper limbs and reduced the range of diminished sensation, severe hemiparalysis remained. Severe GFAP astrocytopathy can be involved with polyneuropathy. Early detection and therapeutic intervention for this condition may lead to a better prognosis.
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  • 文章类型: Case Reports
    一氧化碳(CO)是一种没有气味或颜色的气体,在暴露导致昏迷或死亡之前很难发现。一氧化碳中毒是世界上最常见和最致命的中毒之一。一氧化碳中毒是全球常见且通常致命的中毒形式。CO的毒性作用是组织缺氧,导致全身并发症.此外,一氧化碳中毒后可能出现严重的神经系统症状和迟发性并发症.然而,CO中毒后周围神经病变相对罕见。以前,只有一例一氧化碳中毒后的单侧神经丛病变,伴有横纹肌溶解和认知功能障碍,已被报道。在这份报告中,描述了一氧化碳中毒后孤立的单侧臂丛神经病变。这种情况下的关键机制可能是CO诱导的脊髓缺血。立即给予高压氧治疗(HBOT)对于预防急性CO中毒后的周围神经病变至关重要。急性CO中毒后应立即进行高压氧治疗(HBOT),以预防周围神经病变。此外,急性一氧化碳中毒后的周围神经病变可能受益于持续的康复训练.
    Carbon monoxide (CO) is a gas that has no odor or color, making it difficult to detect until exposure leads to coma or death. CO poisoning is one of the most common and deadly poisonings around the world. CO poisoning is a common and often fatal form of poisoning worldwide. A toxic effect of CO is tissue hypoxia, which leads to systemic complications. Additionally, there may be severe neurological symptoms and delayed complications following CO poisoning. However, peripheral neuropathy is relatively rare after CO poisoning. Previously, only one case of unilateral plexopathy after CO poisoning, accompanied by rhabdomyolysis and cognitive dysfunction, has been reported. In this report, an isolated unilateral brachial plexopathy following CO intoxication is described. A key mechanism in this case may be CO-induced spinal cord ischemia. Immediate administration of hyperbaric oxygen therapy (HBOT) is crucial to prevent peripheral neuropathy after acute CO intoxication. Hyperbaric oxygen therapy (HBOT) should be administered immediately after acute CO intoxication to prevent peripheral neuropathy. Additionally, peripheral neuropathy following acute CO intoxication may benefit from consistent rehabilitation training.
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  • 文章类型: Case Reports
    该病例报告描述了一种独特的情况,其中抗分枝杆菌引起的周围神经病变(PN)最终导致严重的双侧足部冻伤。在结核病治疗的背景下探索药物诱发的周围神经病变(DIPN),强调异烟肼(INH)等药物的作用及其引起PN的潜力。该报告强调了在接受抗分枝杆菌治疗的患者中识别PN的重要性。早期识别和正确管理PN对于预防并发症至关重要。值得注意的是,该报告主张对患者进行有关药物副作用的教育,并避免有害做法,比如冰浸泡,减轻神经性疼痛。重点是需要对患者进行多学科护理,并着重于预防策略,以改善患者的预后并避免严重的衰弱并发症。
    This case report describes a unique scenario in which antimycobacterial-induced peripheral neuropathy (PN) culminates in severe bilateral foot frostbite. Drug-induced peripheral neuropathy (DIPN) is explored in the context of TB treatment, highlighting the role of medications such as isoniazid (INH) and their potential to cause PN. The report highlights the importance of identifying PN in patients undergoing antimycobacterial treatment. Early recognition and proper management of PN is crucial to prevent complications. Notably, the report advocates for patient education regarding medication side effects and avoiding harmful practices, such as ice immersion, to alliviate neuropathic pain. Emphasis is directed towards the need for a multidisciplinary approach to patient care and a focus on preventative strategies to improve patient outcomes and avoid severe debilitating complications.
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