Chandra Wirawan, Ni Made Dwita Pratiwi, I Komang Arimbawa, I Wayan Widyantara
Background. Guillain-Barré Syndrome (GBS) is an autoimmune reaction against peripheral nerves that manifests clinically as acute polyradiculoneuropathy. Classic sensory-motor, pure motor, paraparesis, pharyngeal-cervical-brachial, Bickerstaff brainstem encephalitis, pure sensory, bilateral facial palsy with paresthesia, and Miller-Fisher syndrome are all known variants of GBS. This case report seeks to describe a case of GBS with involvement of the cranial nerves. Case report. A 39-year-old right-handed Balinese woman presented with LMN (Lower Motor Neuron) type paraparesis with ascending paralysis and involvement of cranial nerves III through XII. The results of the LCS (Liquor Cerebro-Spinal) demonstrate albuminocytological dissociation. According to the patient’s EMNG (electromyoneurography) findings, Guillain-Barré Syndrome was of the AMAN (acute motor axonal neuropathy) variety. The patient was diagnosed with multiple cranial neuropathies and GBS of the AMAN type. EGRIS (Erasmus GBS Respiratory Insufficiency Score) was 3, and EGOS (Erasmus GBS Obstructive Sleep Apnea Score) was also 3. Following IVIG (Intravenous Immunoglobulin) treatment, the patient exhibited clinical improvement (Hughes score decreased from 4 to 2). Discussion. The patient exhibits clinical manifestations of flaccid tetraparesis and multiple cranial nerve paresis. The clinical condition of the patient did not meet the criteria for GBS clinical variation. Symptoms of flaccid tetraparesis that do not involve the senses are classified as the motor-only variant. This patient’s differential diagnosis includes the possibility of MFS and ophthalmoplegia. This patient, however, had flaccid tetraparesis and no ataxia. Electromyoneurography (EMNG) examination produces AMAN-type GBS. The patient was diagnosed with one of the clinical variants of GBS, AMAN-type GBS with multiple cranial neuropathies. Conclusion. A case of GBS of the AMAN type accompanied by multiple cranial neuropathies has been reported.
{"title":"Guillian-Barré Syndrome with multiple cranial neuropathies","authors":"Chandra Wirawan, Ni Made Dwita Pratiwi, I Komang Arimbawa, I Wayan Widyantara","doi":"10.37897/rjn.2023.2.14","DOIUrl":"https://doi.org/10.37897/rjn.2023.2.14","url":null,"abstract":"Background. Guillain-Barré Syndrome (GBS) is an autoimmune reaction against peripheral nerves that manifests clinically as acute polyradiculoneuropathy. Classic sensory-motor, pure motor, paraparesis, pharyngeal-cervical-brachial, Bickerstaff brainstem encephalitis, pure sensory, bilateral facial palsy with paresthesia, and Miller-Fisher syndrome are all known variants of GBS. This case report seeks to describe a case of GBS with involvement of the cranial nerves. Case report. A 39-year-old right-handed Balinese woman presented with LMN (Lower Motor Neuron) type paraparesis with ascending paralysis and involvement of cranial nerves III through XII. The results of the LCS (Liquor Cerebro-Spinal) demonstrate albuminocytological dissociation. According to the patient’s EMNG (electromyoneurography) findings, Guillain-Barré Syndrome was of the AMAN (acute motor axonal neuropathy) variety. The patient was diagnosed with multiple cranial neuropathies and GBS of the AMAN type. EGRIS (Erasmus GBS Respiratory Insufficiency Score) was 3, and EGOS (Erasmus GBS Obstructive Sleep Apnea Score) was also 3. Following IVIG (Intravenous Immunoglobulin) treatment, the patient exhibited clinical improvement (Hughes score decreased from 4 to 2). Discussion. The patient exhibits clinical manifestations of flaccid tetraparesis and multiple cranial nerve paresis. The clinical condition of the patient did not meet the criteria for GBS clinical variation. Symptoms of flaccid tetraparesis that do not involve the senses are classified as the motor-only variant. This patient’s differential diagnosis includes the possibility of MFS and ophthalmoplegia. This patient, however, had flaccid tetraparesis and no ataxia. Electromyoneurography (EMNG) examination produces AMAN-type GBS. The patient was diagnosed with one of the clinical variants of GBS, AMAN-type GBS with multiple cranial neuropathies. Conclusion. A case of GBS of the AMAN type accompanied by multiple cranial neuropathies has been reported.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136364120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yang Xu, Wong Eng Hwa, Rusli Bin Nordin, Abdul Kareem Meera Mohaideen, Benjamin Samraj Prakash Earnest, Wong Yin How
Stroke is the second leading cause of death and the third primary cause of disability in adults all over the world. The increasing incidence of stroke seriously affects the lives of patients, especially those who are disabled after stroke. It cost a lot of money for the treatment and adds a heavy burden to the families of stroke patients. Ischemic stroke patients account for the majority of stroke patients. Due to the lack of effective treatment methods for ischemic stroke, prevention is currently considered to be the best measure. Strengthening the study of the risk factors for ischemic stroke and control the risk factors to reduce the morbidity and mortality of ischemic stroke is very important. However, the studies on risk factors for ischemic stroke are limited and the researchers’ views are inconsistent, the studies on some risk factors or potential risk factors for ischemic stroke didn’t have an in-depth studies and lack being taking seriously. Some independent biochemical risk factors for ischemic stroke that can be applied to guide clinical work and help patients to improve their disease conditions are lacking. The article aims to summarize the biochemistry risk factors or potential biochemistry risk factors for ischemic stroke, especially those studied in recent five years, in order to help researchers to facilitate them for making further studies on exploring their association.
{"title":"Biochemistry risk factors for ischemic stroke","authors":"Yang Xu, Wong Eng Hwa, Rusli Bin Nordin, Abdul Kareem Meera Mohaideen, Benjamin Samraj Prakash Earnest, Wong Yin How","doi":"10.37897/rjn.2023.2.12","DOIUrl":"https://doi.org/10.37897/rjn.2023.2.12","url":null,"abstract":"Stroke is the second leading cause of death and the third primary cause of disability in adults all over the world. The increasing incidence of stroke seriously affects the lives of patients, especially those who are disabled after stroke. It cost a lot of money for the treatment and adds a heavy burden to the families of stroke patients. Ischemic stroke patients account for the majority of stroke patients. Due to the lack of effective treatment methods for ischemic stroke, prevention is currently considered to be the best measure. Strengthening the study of the risk factors for ischemic stroke and control the risk factors to reduce the morbidity and mortality of ischemic stroke is very important. However, the studies on risk factors for ischemic stroke are limited and the researchers’ views are inconsistent, the studies on some risk factors or potential risk factors for ischemic stroke didn’t have an in-depth studies and lack being taking seriously. Some independent biochemical risk factors for ischemic stroke that can be applied to guide clinical work and help patients to improve their disease conditions are lacking. The article aims to summarize the biochemistry risk factors or potential biochemistry risk factors for ischemic stroke, especially those studied in recent five years, in order to help researchers to facilitate them for making further studies on exploring their association.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136365189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Utami, P. Dewi, I. Budiarsa, Aaa Suryapraba Indradewi Karang
Pandemic is a phenomenon that has been occurring for decades. In the past two years, the world has again faced a pandemic situation due to coronavirus disease-19 (COVID-19) caused by severe acute respiratory syndrome coronavirus (SARS-CoV). The COVID-19 pandemic has brought the world to a standstill. People also experience psychological stress conditions in the form of anxiety, worry, and anger due to the social impacts caused by the COVID-19 pandemic as has happened in other countries. Social distancing regulations lead to an increase in psychiatric symptoms, including stress, anxiety, depression, and sleep disturbances. Sleep disturbances can also have a negative impact on health, quality of work, and the risk of bad behavior or events in the workplace, as well as the risk of work-related accidents or injuries. There is a correlation between the SARS-CoV-2 pandemic and the neuroendocrine stress axis. The ability of an organism to adapt to the stressors encountered involves the sympathoadrenal system and the hypothalamic-pituitary-adrenal (HPA) axis. The interactions between these two systems play an important role in adaptation. Excessive or chronic activation of the endocrine stress axis, which also causes feedback loop disruption, triggers and contributes to a variety of stress disorders and conditions in humans, including anxiety, sleep disorders, post-traumatic stress disorder, major depressive disorder, and job burnout.
{"title":"Stress and sleep disturbances in COVID-19 pandemic, current neurology and psychology aspects: a narrative review","authors":"D. Utami, P. Dewi, I. Budiarsa, Aaa Suryapraba Indradewi Karang","doi":"10.37897/rjn.2023.2.2","DOIUrl":"https://doi.org/10.37897/rjn.2023.2.2","url":null,"abstract":"Pandemic is a phenomenon that has been occurring for decades. In the past two years, the world has again faced a pandemic situation due to coronavirus disease-19 (COVID-19) caused by severe acute respiratory syndrome coronavirus (SARS-CoV). The COVID-19 pandemic has brought the world to a standstill. People also experience psychological stress conditions in the form of anxiety, worry, and anger due to the social impacts caused by the COVID-19 pandemic as has happened in other countries. Social distancing regulations lead to an increase in psychiatric symptoms, including stress, anxiety, depression, and sleep disturbances. Sleep disturbances can also have a negative impact on health, quality of work, and the risk of bad behavior or events in the workplace, as well as the risk of work-related accidents or injuries. There is a correlation between the SARS-CoV-2 pandemic and the neuroendocrine stress axis. The ability of an organism to adapt to the stressors encountered involves the sympathoadrenal system and the hypothalamic-pituitary-adrenal (HPA) axis. The interactions between these two systems play an important role in adaptation. Excessive or chronic activation of the endocrine stress axis, which also causes feedback loop disruption, triggers and contributes to a variety of stress disorders and conditions in humans, including anxiety, sleep disorders, post-traumatic stress disorder, major depressive disorder, and job burnout.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43961438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hanaa Khazaal Jaber Al-Hasan, Ahmed Abduljawad Al-Salim, Sarah A. Haji
Background. Due to dysfunction of the facial nerve (CN VII), Bell’s palsy occurs which is a facial paralysis of unknown cause, but viral infection is suspected. The study aims to determine the prevalence of facial nerve palsy in a private clinic in Basrah. Methods. The study was conducted at a private clinic and involved sixty-five patients with facial nerve palsy. It was a cross-sectional study in which any patient who attended the clinic and exhibited signs and symptoms of lower motor neuron facial nerve palsy underwent an examination to confirm the diagnosis and, if confirmed, were included in the study. While patients with other neurological disorders were excluded. Data collection started between October 1, 2022, and April 30, 2023. A total of 65 patients from the private clinic—males and females—aged from 4 to 70 years old were confirmed as having lower motor neuron facial nerve palsy. Results. This study at a private clinic found that Bell’s palsy was the most common facial paralysis, affecting more males than females and most of the patients in the age range of 18-39 years, also affecting mostly the left side, with onset more frequent during hot and cool weather conditions. Diabetes was significantly related to the onset of Bell’s palsy and weather temperature at the time of the clinic visit. Conclusion. Bell’s palsy has a peak age prevalence in the second and third decades of life, and temperature variations have no effect on the occurrence of Bell’s Palsy. Further studies are needed for an accurate estimation of the number of cases, to assess the severity, impact, and efficacy of Bell’s palsy management.
{"title":"Prevalence of facial nerve palsy in the neuro-medicine private clinic","authors":"Hanaa Khazaal Jaber Al-Hasan, Ahmed Abduljawad Al-Salim, Sarah A. Haji","doi":"10.37897/rjn.2023.2.13","DOIUrl":"https://doi.org/10.37897/rjn.2023.2.13","url":null,"abstract":"Background. Due to dysfunction of the facial nerve (CN VII), Bell’s palsy occurs which is a facial paralysis of unknown cause, but viral infection is suspected. The study aims to determine the prevalence of facial nerve palsy in a private clinic in Basrah. Methods. The study was conducted at a private clinic and involved sixty-five patients with facial nerve palsy. It was a cross-sectional study in which any patient who attended the clinic and exhibited signs and symptoms of lower motor neuron facial nerve palsy underwent an examination to confirm the diagnosis and, if confirmed, were included in the study. While patients with other neurological disorders were excluded. Data collection started between October 1, 2022, and April 30, 2023. A total of 65 patients from the private clinic—males and females—aged from 4 to 70 years old were confirmed as having lower motor neuron facial nerve palsy. Results. This study at a private clinic found that Bell’s palsy was the most common facial paralysis, affecting more males than females and most of the patients in the age range of 18-39 years, also affecting mostly the left side, with onset more frequent during hot and cool weather conditions. Diabetes was significantly related to the onset of Bell’s palsy and weather temperature at the time of the clinic visit. Conclusion. Bell’s palsy has a peak age prevalence in the second and third decades of life, and temperature variations have no effect on the occurrence of Bell’s Palsy. Further studies are needed for an accurate estimation of the number of cases, to assess the severity, impact, and efficacy of Bell’s palsy management.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136365185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Samar Iltaf Mairaj, Abdullah Mohammed Al-Salti, Farzad Fatehi
We herein report an unusual case of a 58-year-old man with polycythemia presented with sudden right leg and right arm weakness. He was treated for a stroke but continued to worsen, leading to quadriparesis. He was referred to the emergency department after experiencing progressive weakness in all four limbs for five days. No prior history of fever, cough, chest pain, diarrhea, backache, or trauma was found. The patient had normal neurological examination, MRC scores, and bilateral weak hand grips. Sensory examination was normal. The patient had normal blood tests, electrolytes and brain MRI. CSF examination revealed protein an albumin-cytological dissociation pattern. An electrodiagnostic study showed evidence of acute motor axonal polyneuropathy. The patient received IVIg for five days, and symptoms improved significantly.
{"title":"Case report: Guillain – Barré Syndrome presentation mimicking stroke. An atypical presentation","authors":"Samar Iltaf Mairaj, Abdullah Mohammed Al-Salti, Farzad Fatehi","doi":"10.37897/rjn.2023.2.15","DOIUrl":"https://doi.org/10.37897/rjn.2023.2.15","url":null,"abstract":"We herein report an unusual case of a 58-year-old man with polycythemia presented with sudden right leg and right arm weakness. He was treated for a stroke but continued to worsen, leading to quadriparesis. He was referred to the emergency department after experiencing progressive weakness in all four limbs for five days. No prior history of fever, cough, chest pain, diarrhea, backache, or trauma was found. The patient had normal neurological examination, MRC scores, and bilateral weak hand grips. Sensory examination was normal. The patient had normal blood tests, electrolytes and brain MRI. CSF examination revealed protein an albumin-cytological dissociation pattern. An electrodiagnostic study showed evidence of acute motor axonal polyneuropathy. The patient received IVIg for five days, and symptoms improved significantly.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136365197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Zabihi, Seyed Reza Ahmadi Mehrabadi, Atefeh Barkhordari, Zahra Movahedian, G. Dastjerdi, M. Asadi, Mehdi Somali Ahmadabadi
Introduction. The effect of venlafaxine and psychotherapy including acceptance and commitment therapy (ACT) enriched with compassion focus therapy (CFT) was evaluated on depression, anxiety, and stress in opioid-addicted patients undergoing methadone maintenance treatment (MMT). Method. This study is a randomized clinical trial with a pre-test and post-test design. Sixty opioid-addicted patients undergoing MMT were selected by voluntary sampling, and they were divided into three groups including VNF, receiving venlafaxine (75 mg/day); ACF, receiving ACT enriched with CFT, and VACF, receiving a combination of venlafaxine and ACT enriched with CFT. The ACT enriched with CFT for participants was performed by a psychiatrist weekly. Patients were evaluated based on the anxiety-stress-depression questionnaire after 28 days of intervention. Results. The findings showed that all three intervention methods effectively affected depression, anxiety, and stress. Regarding stress, the difference in means between the two groups of VACF and ACF, as well as between VNF and ACF, was significant (P<0.05). The combined treatment of ACT enriched with CFT and venlafaxine had a more substantial effect on the research variables, i.e., depression, anxiety, and stress, compared to other interventions (P<0.05). Conclusion. The ACT enriched with CFT intervention and venlafaxine effectively reduces depression, anxiety, and stress in opioid-addicted patients undergoing MMT.
{"title":"Venlafaxine plus acceptance and commitment therapy enriched with compassion focus therapy in opioid-addicted patients undergoing methadone maintenance treatment: a clinical trial","authors":"M. Zabihi, Seyed Reza Ahmadi Mehrabadi, Atefeh Barkhordari, Zahra Movahedian, G. Dastjerdi, M. Asadi, Mehdi Somali Ahmadabadi","doi":"10.37897/rjn.2023.1.7","DOIUrl":"https://doi.org/10.37897/rjn.2023.1.7","url":null,"abstract":"Introduction. The effect of venlafaxine and psychotherapy including acceptance and commitment therapy (ACT) enriched with compassion focus therapy (CFT) was evaluated on depression, anxiety, and stress in opioid-addicted patients undergoing methadone maintenance treatment (MMT). Method. This study is a randomized clinical trial with a pre-test and post-test design. Sixty opioid-addicted patients undergoing MMT were selected by voluntary sampling, and they were divided into three groups including VNF, receiving venlafaxine (75 mg/day); ACF, receiving ACT enriched with CFT, and VACF, receiving a combination of venlafaxine and ACT enriched with CFT. The ACT enriched with CFT for participants was performed by a psychiatrist weekly. Patients were evaluated based on the anxiety-stress-depression questionnaire after 28 days of intervention. Results. The findings showed that all three intervention methods effectively affected depression, anxiety, and stress. Regarding stress, the difference in means between the two groups of VACF and ACF, as well as between VNF and ACF, was significant (P<0.05). The combined treatment of ACT enriched with CFT and venlafaxine had a more substantial effect on the research variables, i.e., depression, anxiety, and stress, compared to other interventions (P<0.05). Conclusion. The ACT enriched with CFT intervention and venlafaxine effectively reduces depression, anxiety, and stress in opioid-addicted patients undergoing MMT.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46449820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Manengku Nasahu Saben Nara, R. Pinzon, Esdras Ardi Pramudita
Objective. Investigate the relationship between platelet profiles, in this case PDW and MPV at hospital admission, which can be predictors of clinical outcome 30 days after ischemic stroke. Methods. This research is an analytic study with a retrospective cohort method. Secondary data in the form of medical records at the neuro polyclinic of Bethesda Hospital Yogyakarta in 2019 - 2020. The number of subjects was 74, grouped as good outcome (mRS 0-2) and poor outcome (mRS 3-6). Data analysis used was t-test, Pearson’s test, Fisher’s test, ROC, and multivariable logistic regression model. Results. In this study, both PDW (p = 0.982) and MPV (p = 0.174) were not significantly associated (p > 0.05) with poor outcomes on the chi-square test. ROC curve analysis showed that the PDW cutoff value was >11.1 fl [(Area Under Curve (AUC) ROC was 0.638, with 95% CI = 0.518-0.746, and p-value 0.835)] and the MPV cutoff value was ≤9,8 fl [(Area Under Curve (AUC) ROC was 0.521, with 95% CI = 0.402-0.639, and p-value 0.137)] which was also not statistically significant (p > 0.05). From these results, multivariable logistic regression analysis was performed which found that MPV ≤9,8 fl was associated with a small 30-day clinical outcome [(Odds Ratio (OR) = 0.110, 95% CI = 0.013-0.953, p = 0.007)]. While PDW >11.1 fl did not have a significant relationship after regression analysis was carried out where p > 0.05 was obtained. Conclusion. Increased PDW and MPV values at hospital admission did not increase the risk of 30-day disability in ischemic stroke patients.
{"title":"Characteristics of the platelet profile as a predictor of 30-day clinical outcome in ischemic stroke patients","authors":"Manengku Nasahu Saben Nara, R. Pinzon, Esdras Ardi Pramudita","doi":"10.37897/rjn.2023.1.10","DOIUrl":"https://doi.org/10.37897/rjn.2023.1.10","url":null,"abstract":"Objective. Investigate the relationship between platelet profiles, in this case PDW and MPV at hospital admission, which can be predictors of clinical outcome 30 days after ischemic stroke. Methods. This research is an analytic study with a retrospective cohort method. Secondary data in the form of medical records at the neuro polyclinic of Bethesda Hospital Yogyakarta in 2019 - 2020. The number of subjects was 74, grouped as good outcome (mRS 0-2) and poor outcome (mRS 3-6). Data analysis used was t-test, Pearson’s test, Fisher’s test, ROC, and multivariable logistic regression model. Results. In this study, both PDW (p = 0.982) and MPV (p = 0.174) were not significantly associated (p > 0.05) with poor outcomes on the chi-square test. ROC curve analysis showed that the PDW cutoff value was >11.1 fl [(Area Under Curve (AUC) ROC was 0.638, with 95% CI = 0.518-0.746, and p-value 0.835)] and the MPV cutoff value was ≤9,8 fl [(Area Under Curve (AUC) ROC was 0.521, with 95% CI = 0.402-0.639, and p-value 0.137)] which was also not statistically significant (p > 0.05). From these results, multivariable logistic regression analysis was performed which found that MPV ≤9,8 fl was associated with a small 30-day clinical outcome [(Odds Ratio (OR) = 0.110, 95% CI = 0.013-0.953, p = 0.007)]. While PDW >11.1 fl did not have a significant relationship after regression analysis was carried out where p > 0.05 was obtained. Conclusion. Increased PDW and MPV values at hospital admission did not increase the risk of 30-day disability in ischemic stroke patients.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44506886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background. Piriformis syndrome is a common cause of low back pain sometimes underdiagnosed due to a lack of distinguishing symptoms and patterns. Two methods of ultrasound-guided intramuscular injection (using a local anesthetic agent and combined with corticosteroids) have become the treatments of choice. However, some studies suggest these methods may result in recurrence even though data regarding the prevalence of recurrence and triggering factors are still lacking. Objective. To identify the prevalence of and factors triggering the recurrence of piriformis syndrome treated with steroid and local anesthetic injections. Methods. This is a prospective cohort following patients diagnosed with piriformis syndrome and treated with either a local anesthetic or a combination with the addition of corticosteroids. Demographic, risk factors, and the onset of pain recurrence data were taken and analyzed. Results. From the 66 patients included in this study, 68.2% (n:45) reported recurrence of pain, with the majority occurring within the first three months post-injection. Subjects treated with combination therapy had a pain-free interval 13.45 weeks longer than subjects treated with a local anesthetic injection. There were no significant differences in risk factors between both groups. Conclusion. Recurrence of piriformis syndrome was most commonly found within the first and third months of treatment. Both methods did not differ significantly, even though combination therapy tends to give longer pain-relief intervals.
{"title":"Recurrence of piriformis syndrome: One year follow up post ultrasound guided injection therapy","authors":"Yusak Mangara Tua Siahaan, V. Sungono, P. Tiffani","doi":"10.37897/rjn.2023.1.8","DOIUrl":"https://doi.org/10.37897/rjn.2023.1.8","url":null,"abstract":"Background. Piriformis syndrome is a common cause of low back pain sometimes underdiagnosed due to a lack of distinguishing symptoms and patterns. Two methods of ultrasound-guided intramuscular injection (using a local anesthetic agent and combined with corticosteroids) have become the treatments of choice. However, some studies suggest these methods may result in recurrence even though data regarding the prevalence of recurrence and triggering factors are still lacking. Objective. To identify the prevalence of and factors triggering the recurrence of piriformis syndrome treated with steroid and local anesthetic injections. Methods. This is a prospective cohort following patients diagnosed with piriformis syndrome and treated with either a local anesthetic or a combination with the addition of corticosteroids. Demographic, risk factors, and the onset of pain recurrence data were taken and analyzed. Results. From the 66 patients included in this study, 68.2% (n:45) reported recurrence of pain, with the majority occurring within the first three months post-injection. Subjects treated with combination therapy had a pain-free interval 13.45 weeks longer than subjects treated with a local anesthetic injection. There were no significant differences in risk factors between both groups. Conclusion. Recurrence of piriformis syndrome was most commonly found within the first and third months of treatment. Both methods did not differ significantly, even though combination therapy tends to give longer pain-relief intervals.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43862105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Asih, I. W. G. Artawan Eka Putra, Felicia Nike, Putri Ayu Ratnasari
Objectives. Lacunar stroke or cerebral small vessel disease accounts for 15-30% of all ischemic stroke. The golden standard to identify lacunar stroke is by using MR imaging with diffusion-weighted imaging (DWI) sequence. In prior studies LDL-c and platelet count were described as contributing factors in lacunar stroke event. The aim of this study is to examine whether LDL-c and platelet value may have a contribution in lacunar stroke finding. Methods. In cross-sectional study, we consecutively collected patients older than 18 years old who had undergone brain MRI and had their LDL-c and platelet count laboratory results and we also took their history of diabetes mellitus and hypertension to evaluate risk factor association. Outcomes. We collected 93 patients who underwent brain MRI obtained lacunar stroke in 20 patients (21.5%) and non-lacunar stroke findings in 78.5%. We found no significant association between LDL-c and platelets with lacunar stroke findings in brain MRI. However we found that lacunar stroke findings had significant association with hypertension with P < 0.05. Conclusion. LDL-c and platelets were not statistically significant in lacunar stroke findings in brain MRI, while hypertension was the risk factor associated with lacunar stroke event.
{"title":"The relationship between LDL-c and platelet count with lacunar stroke findings on brain MRI","authors":"M. Asih, I. W. G. Artawan Eka Putra, Felicia Nike, Putri Ayu Ratnasari","doi":"10.37897/rjn.2023.1.6","DOIUrl":"https://doi.org/10.37897/rjn.2023.1.6","url":null,"abstract":"Objectives. Lacunar stroke or cerebral small vessel disease accounts for 15-30% of all ischemic stroke. The golden standard to identify lacunar stroke is by using MR imaging with diffusion-weighted imaging (DWI) sequence. In prior studies LDL-c and platelet count were described as contributing factors in lacunar stroke event. The aim of this study is to examine whether LDL-c and platelet value may have a contribution in lacunar stroke finding. Methods. In cross-sectional study, we consecutively collected patients older than 18 years old who had undergone brain MRI and had their LDL-c and platelet count laboratory results and we also took their history of diabetes mellitus and hypertension to evaluate risk factor association. Outcomes. We collected 93 patients who underwent brain MRI obtained lacunar stroke in 20 patients (21.5%) and non-lacunar stroke findings in 78.5%. We found no significant association between LDL-c and platelets with lacunar stroke findings in brain MRI. However we found that lacunar stroke findings had significant association with hypertension with P < 0.05. Conclusion. LDL-c and platelets were not statistically significant in lacunar stroke findings in brain MRI, while hypertension was the risk factor associated with lacunar stroke event.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44756493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction. Stroke is the most common cause of mortality and morbidity. Pontine infarction leads to an ischemic stroke in pontine. Variability of its clinical presentation depends on the location of infarct. One of them is Foville syndrome, which features contralateral motor hemiparesis or hemiplegia, ipsilateral cranial nerve palsy, and facial palsy. There were few cases reported especially in Indonesia. We report a case of an elderly female with Foville syndrome due to stroke in Peripontine caused by infarction. Case presentation. A 63-years-old female presented with acute vertigo, sudden deafness, slurred speech, and hemiparesis on the right side of her body. The onset was 14 hours before hospital admission. The patient had a history of poor controlled diabetes and hypertension. The results of the neurological examination showed left facial nerve weakness, facial numbness, peripheral deafness in the left ear, and right-side weakness of body. Radiological examination of the Head CT-scan showed lesions in the left paramedian pontine region, bilateral cerebellum and multiple lacunar infarction. Patient was given dual antiplatelet therapy, and vascular risk factor medication. Pasien was discharged after 8 days under treatment with minor disability. Conclusion. We report a rare case of Foville syndrome due to pontine infarction. Clinical signs and symptoms correlate well with anatomic involvement. The treatments depend on the etiologies and risk factors.
{"title":"Foville syndrome due to peripontine infarction: A case report","authors":"R. Pinzon, Wahyuning Angger Mulyowati","doi":"10.37897/rjn.2023.1.14","DOIUrl":"https://doi.org/10.37897/rjn.2023.1.14","url":null,"abstract":"Introduction. Stroke is the most common cause of mortality and morbidity. Pontine infarction leads to an ischemic stroke in pontine. Variability of its clinical presentation depends on the location of infarct. One of them is Foville syndrome, which features contralateral motor hemiparesis or hemiplegia, ipsilateral cranial nerve palsy, and facial palsy. There were few cases reported especially in Indonesia. We report a case of an elderly female with Foville syndrome due to stroke in Peripontine caused by infarction. Case presentation. A 63-years-old female presented with acute vertigo, sudden deafness, slurred speech, and hemiparesis on the right side of her body. The onset was 14 hours before hospital admission. The patient had a history of poor controlled diabetes and hypertension. The results of the neurological examination showed left facial nerve weakness, facial numbness, peripheral deafness in the left ear, and right-side weakness of body. Radiological examination of the Head CT-scan showed lesions in the left paramedian pontine region, bilateral cerebellum and multiple lacunar infarction. Patient was given dual antiplatelet therapy, and vascular risk factor medication. Pasien was discharged after 8 days under treatment with minor disability. Conclusion. We report a rare case of Foville syndrome due to pontine infarction. Clinical signs and symptoms correlate well with anatomic involvement. The treatments depend on the etiologies and risk factors.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49058001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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