Postpartum lumbosacral radiculopathy: a neuraxial anaesthesia complication or an intrinsic obstetric palsy?

Postpartum lumbosacral radiculopathy: a neuraxial anaesthesia complication or an intrinsic obstetric palsy?

Posted on by Patrick

Postpartum peripheral nerve issues are an unusual obstetrical complication, with most instances ensuing from intrinsic obstetric palsies. We current the case of a full-term nulliparous pregnant 33-year-old girl with a vacuum-assisted vaginal supply as a result of a protracted second stage of labour and occipitoposterior place of the fetal head. For analgesia, a mixed spinal-epidural approach was used. 4 hours after supply, the affected person skilled a painless uneven motor deficit and hypoesthesia within the decrease limbs, adopted by sphincter disturbance. Emergent MRI was unremarkable. Electromyography confirmed indicators of a bilateral lumbosacral radiculopathy. The affected person skilled a gradual restoration over the next 2 months.

Though a definitive aetiological prognosis couldn’t be confirmed, a lumbosacral polyradiculopathy as a result of intrinsic obstetric complication was thought of. The affected person offered a number of danger components identified to be related to intrinsic obstetric palsies. Obstetricians and anaesthesiologists have an necessary function in stopping and diagnosing postpartum peripheral nerve disorderswe current a case of CIDP with hypertrophic nerves and evaluate it to earlier studies. The principle scientific findings had been insidious onset, gait ataxia and sensory signs. Electrodiagnostic research confirmed very sluggish nerve conduction velocities, a number of conduction blocks, distal CMAP length improve and absence of F-waves.

The protein degree within the cerebrospinal fluid was very excessive. Nerve ultrasound confirmed swelling of all peripheral nerves outdoors entrapment websites, with vital variability inside totally different segments of the identical nerve; nerves had been massively enlarged (as much as 10-fold regular values). Mind MRI confirmed hypertrophic cranial nerves, with gadolinium-enhancement. Spinal MRI confirmed hypertrophy of spinal roots and cauda equine, with gadolinium enhancement. Genetic take a look at (PMP22 duplication/deletion, Complete Exome Sequencing panel for neuropathies) resulted detrimental.

The affected person had a relapsing-remitting course and responded to immunoglobulin remedy. Spinal twine compression secondary to nerve root hypertrophy is commonly attributed to hereditary neuropathies. Nevertheless, to keep away from misdiagnosis, uncommon immune-mediated neuropathy reminiscent of persistent inflammatory demyelinating polyradiculoneuropathy (CIDP) shouldn’t be neglected. This report presents a case of multilevel nerve root hypertrophy resulting in vital twine compression from CIDP. Within the current report, the authors display {that a} myxopapillary ependymoma might current as an remoted gluteal mass hooked up to the coccygeal nerve, with out frank CNS involvement.

Ageing promotes pathological alpha-synuclein propagation and autonomic dysfunction in wild-type rats

Neuronal aggregates of misfolded alpha-synuclein protein are discovered within the mind and periphery of sufferers with Parkinson’s illness. Braak and colleagues have hypothesized that the preliminary formation of misfolded alpha-synuclein might begin within the intestine, after which unfold to the mind by way of peripheral autonomic nerves hereby affecting a number of organs, together with the guts and gut. Age is taken into account the best danger issue for Parkinson’s illness, however the impact of age on the formation of pathology and its propagation has not been studied intimately.

We aimed to research whether or not propagation of alpha-synuclein pathology from the intestine to the mind is extra environment friendly in outdated versus younger wild-type rats, upon gastrointestinal injection of aggregated alpha-synuclein. Our outcomes display a sturdy age-dependent gut-to-brain and brain-to-gut unfold of alpha-synuclein pathology alongside the sympathetic and parasympathetic nerves, leading to age-dependent dysfunction of the guts and abdomen, as noticed in sufferers with Parkinson’s illness.

Furthermore, alpha-synuclein pathology is extra densely packed and immune to enzymatic digestion in outdated rats, indicating an age-dependent maturation of alpha-synuclein aggregates. Our research is the primary to supply an in depth investigation of alpha-synuclein pathology in a number of organs inside one animal mannequin, together with the mind, pores and skin, coronary heart, gut, spinal twine and autonomic ganglia. Taken collectively, our findings counsel that age is an important issue for alpha-synuclein aggregation and full propagation to coronary heart, abdomen and pores and skin, much like sufferers.

On condition that age is the best danger issue for human Parkinson’s illness, it appears probably that older experimental animals will yield probably the most related and dependable findings. These outcomes have necessary implications for future analysis to optimize diagnostics and therapeutics in Parkinson’s illness and different age-associated synucleinopathies. Elevated emphasis ought to be positioned on utilizing aged animals in preclinical research and to elucidate the character of age-dependent interactions. Moreover, an interdisciplinary method to surgical resection of this lesion seems to symbolize an efficient remedy modality.

Postpartum lumbosacral radiculopathy: a neuraxial anaesthesia complication or an intrinsic obstetric palsy?

Surgical administration of a uncommon myxopapillary ependymoma of the gluteal area: A case report

Ependymomas are uncommon tumors originating from neuroepithelial cells lining the wall of the ventricles or central canal of the spinal twine. Whereas these tumors primarily happen inside the central nervous system (CNS), there are occasional studies in kids and younger grownup sufferers with a main tumor incidence outdoors of the CNS. Ependymomas of the sacrococcygeal area have been occasionally described within the literature with no normal of care established. We current a case report and evaluate of the literature concerning this uncommon entity.

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 A 24-year-old girl offered with proper gluteal ache worsened by sitting and a palpable delicate tissue mass of the sacrococcygeal area. Magnetic resonance imaging revealed a 3.7 cm cystic mass centered in the correct gluteal area. She underwent a biopsy at an out of doors establishment, with histology revealing myxopapillary ependymoma. The affected person was referred to our hospital and underwent an interdisciplinary neurosurgical and orthopedic oncology en bloc resection of the ependymoma, which intraoperatively appeared to originate from the coccygeal nerve.

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