21/129. Bronchial atresia with relapsing pulmonary infection in a middle-aged man.Congenital bronchial atresia (CBA) is a rare disorder, first reported in 1953. Less than 100 cases are reported in the literature, mostly in young, asymptomatic male patients with involvement of the apical-posterior segment of the left upper lobe. patients may complain of fever, cough, or shortness of breath, symptoms that result from post-obstructive, sometimes recurrent, infections. Chest radiography and computed tomography reveal a tubular branching density representing mucus impaction or mucocele with surrounding focal hyperinflation. Surgical excision is reserved for symptomatic cases. We report an unusual case of CBA in a middle-aged man with a history of relapsing infections, who was found to have an atretic superior segment of the left lower lobe, with surrounding areas of organizing pneumonia.- - - - - - - - - - ranking = 1keywords = ms (Clic here for more details about this article) |
22/129. Runner's anemia.Macrocytic anemia occurring in patients with fatigue suggests numerous diagnoses, ranging from nutritional deficiencies to a myelodysplastic syndrome. A careful history-taking is critically important for recognition of runner's anemia, which is due to plasma volume expansion, with hemolysis from the pounding of feet on pavement, and hemoglobinuria. Gastrointestinal blood loss may also contribute to anemia in long-distance runners. Early recognition of runner's anemia in patients with a complex presentation of anemia is important in circumventing many diagnostic tests. Runner's anemia should be considered when, amidst a constellation of signs and symptoms, mild anemia is well tolerated by an avid runner.- - - - - - - - - - ranking = 1keywords = ms (Clic here for more details about this article) |
23/129. Psychogenic hemifacial spasm.Facial spasms that distort facial expression are typically due to facial dystonia, tics, and hemifacial spasm (HFS). Psychogenic facial spasms, however, have not been well characterized. The authors sought to 1) determine prevalence of psychogenic facial spasm in patients referred for evaluation of HFS and 2) draw attention to clinical characteristics and potential diagnostic pitfalls. Among 210 consecutive patients referred for evaluation of HFS, 5 (2.4%) received diagnoses of psychogenic facial spasm. All patients were female; mean age was 34.6 years (range 26-45) and mean symptom duration 1.1 years (range 2 wk-2 yr). Onset was left-sided in 3 patients, and the lid was the initial site affected in 2 patients. This series of patients shows that facial spasms, although usually of neurovascular etiology, may be the initial or only manifestation of a psychogenic movement disorder, often associated with an underlying depression.- - - - - - - - - - ranking = 3keywords = ms (Clic here for more details about this article) |
24/129. A suspected case of proximal diabetic neuropathy predominantly presenting with scapulohumeral muscle weakness and deep aching pain.A 48-year-old man with a 14-year history of type 2 diabetes with proliferative diabetic retinopathy and distal symmetrical diabetic polyneuropathy visited our hospital. Eight months later, he subacutely developed difficulty in both shoulder movement and trouble standing up from a squatting position. This was accompanied by severe bilateral shoulder and thigh pain. magnetic resonance imaging of the brain, cervical and lumbar spine, computed tomography of the shoulder and X-ray films of the cervical spine and shoulder revealed no abnormality. cerebrospinal fluid showed a mild elevation of protein (0.93 g/l) without cell infiltration. Antiganglioside antibodies and point mutation of mitochondrial dna at position 3243 were not found. Neuropathology of the sural nerve showed a moderate myelinated fiber loss, active axonal degeneration, but onion-bulb formation, endoneurial or epineurial vasculitis were not observed. electromyography revealed neurogenic changes in the proximal upper limb muscles. Nerve conduction studies revealed mild bilateral slowing in nerve conduction velocity in both of the upper and lower limbs. The diagnosis of this patients was suspected to be a proximal diabetic neuropathy (diabetic amyotrophy). The pain and muscle weakness had persisted more severely in the shoulder than in the thigh throughout the clinical course. His unbearable symptoms could be partially alleviated by an administration of a selective serotonin reuptake inhibitor, fluvoxamine maleate. Proximal diabetic neuropathy is a rare disabling type of neuropathy, which is characterized with subacute bilateral muscle weakness and wasting in the proximal part of the lower limbs. The involvement of the scapulohumeral region observed in this case is very unusual in proximal diabetic neuropathy.- - - - - - - - - - ranking = 2keywords = ms (Clic here for more details about this article) |
25/129. Delayed post-traumatic tamponade together with rupture of the tricuspid valve in a 15 year old boy.With the increase in the number of high speed motor vehicle accidents, blunt, non-penetrating trauma to the heart has become an important health problem. An unusual case is reported of a 15 year old boy urgently referred with cardiac tamponade and a new systolic murmur four months after a car accident. The problems of the diagnosis and possible causes of late cardiac tamponade and tricuspid regurgitation following this type of accident are discussed.- - - - - - - - - - ranking = 1keywords = ms (Clic here for more details about this article) |
26/129. Familial association of autonomic and gastrointestinal symptoms.Autonomic dysfunction occurs in the adult population with irritable bowel syndrome, but this association is not recognized in children. A mother and son with functional abdominal pain unresponsive to conventional treatment had complete resolution of symptoms with treatment directed at the autonomic dysfunction identified by testing. The authors recommend autonomic testing in patients with functional abdominal pain and suggest that autonomic dysfunction plays a direct and intrinsic role in the mechanism of these disorders and their symptoms.- - - - - - - - - - ranking = 6keywords = ms (Clic here for more details about this article) |
27/129. Management of a patient with post-polio syndrome.PURPOSE: To describe the current understanding of the management of patients with post-polio syndrome (PPS) and relate the research to a case study. DATA SOURCES: Standard neurology textbooks, current review and research articles, and a case study. CONCLUSIONS: More than 15 years following a diagnosis of poliomyelitis, a new onset of weakness, fatigue, joint pain, decreased endurance, muscle atrophy, gait disturbance, respiratory and swallowing problems, cold intolerance, and difficulties with activities of daily living might indicate a neurologic disorder called PPS. IMPLICATIONS FOR PRACTICE: Non-post-polio causes of weakness, fatigue or pain must be excluded before making a diagnosis of PPS. Approaches to management vary depending on the symptoms and level of disability. Reducing physical and emotional stress, energy conservation, adequate rest, modification of work and home environments, joint protection, and the use of orthoses, adaptive equipment, or mobility aids can reduce fatigue and preserve function.- - - - - - - - - - ranking = 2keywords = ms (Clic here for more details about this article) |
28/129. The unknown mechanism of the overtraining syndrome: clues from depression and psychoneuroimmunology.When prolonged, excessive training stresses are applied concurrent with inadequate recovery, performance decrements and chronic maladaptations occur. Known as the overtraining syndrome (OTS), this complex condition afflicts a large percentage of athletes at least once during their careers. There is no objective biomarker for OTS and the underlying mechanism is unknown. However, it is not widely recognised that OTS and clinical depression [e.g. major depression (MD)] involve remarkably similar signs and symptoms, brain structures, neurotransmitters, endocrine pathways and immune responses. We propose that OTS and MD have similar aetiologies. Our examination of numerous shared characteristics offers insights into the mechanism of OTS and encourages testable experimental hypotheses. Novel recommendations are proposed for the treatment of overtrained athletes with antidepressant medications, and guidelines are provided for psychological counselling.- - - - - - - - - - ranking = 1keywords = ms (Clic here for more details about this article) |
29/129. Engraftment syndrome: a common cause for rash and fever following autologous hematopoietic stem cell transplantation for multiple sclerosis.Autologous hematopoietic stem cell transplantation (HSCT) is currently being evaluated as a therapy for patients with progressive multiple sclerosis (MS) at risk of debilitating neurological impairment. While preliminary results from a few studies have been reported, little is known about toxicities or outcome of HSCT for MS. We report a relatively frequent triad of non-infectious fever, rash and fatigue or lassitude that may also be associated with pruritis, pulmonary symptoms, and eosinophilia and frequently occurs around engraftment. This syndrome occurred in 26% of our series of patients (5/19) undergoing HSCT for multiple sclerosis. The engraftment syndrome is usually self-limited but may require intervention with systemic corticosteroids.- - - - - - - - - - ranking = 5012.4741241525keywords = multiple sclerosis, sclerosis, ms (Clic here for more details about this article) |
30/129. Conscientiousness and work performance while suffering from acute mountain sickness: a case report.A 52-yr-old male scientist who participated in a geophysical survey in Antarctica from a field camp located at 3538 m (11,600 ft) experienced specific symptoms of acute mountain sickness (AMS) by Mission Day 9, and full syndrome AMS by Mission Day 12. He was treated at the field camp and evacuated to sea level on the next available flight (Mission Day 15). The concerns of this highly conscientious individual that initial signs of illness, such as fatigue with exertion, could be misinterpreted by others as poor work performance are described. The report focuses on individual personality and group processes that could lead to nondisclosure of symptoms, and the need, particularly in long-duration missions in which evacuation is difficult or impossible, to sensitize personnel to the importance of recognizing and reporting potential health problems.- - - - - - - - - - ranking = 3keywords = ms (Clic here for more details about this article) |
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