Segmental zoster paresis(SZP)is a rare complication in herpes zoster infection,with its symptoms often neglected due to the co-existence of pain.Here we reported a case of SZP.Also,we analyzed 42 Chinese SZP cases in literature,which revealed that the male to female ratio of SZP patients was 13∶8,and the median age of disease onset was 65 years.The most commonly affected region is upper limb.The diagnosis depends mainly on typical medical history and clinical symptoms.Although there is no definite therapy for SZP,the antiviral therapy is the most commonly used treatment,which achieved complete recovery in 78.6% of the patients and partial recovery in 14.3% of the patients.
Aged ; Female ; Herpes Zoster/diagnosis* ; Humans ; Male ; Paresis/etiology* ; Upper Extremity/physiopathology*

BACKGROUND AND PURPOSE: The most-common initial manifestation of Miller Fisher syndrome (MFS) is diplopia due to acute ophthalmoplegia. However, few studies have focused on ocular motility findings in MFS. This study aimed to determine the pattern of extraocular muscle (EOM) paresis in MFS patients. METHODS: We consecutively recruited MFS patients who presented with ophthalmoplegia between 2010 and 2015. The involved EOMs and the strabismus pattern in the primary position were analyzed. Antecedent infections, other involved cranial nerves, and laboratory findings were also reviewed. We compared the characteristics of the patients according to the severity of ophthalmoplegia between complete ophthalmoplegia (CO) and incomplete ophthalmoplegia (IO). RESULTS: Twenty-five patients (15 males and 10 females) with bilateral ophthalmoplegia were included in the study. The most-involved and last-to-recover EOM was the lateral rectus muscle. CO and IO were observed in 11 and 14 patients, respectively. The patients were aged 59.0±18.4 years (mean±SD) in the CO group and 24.9±7.4 years in the IO group (p<0.01), and comprised 63.6% and 21.4% females, respectively (p=0.049). Elevated cerebrospinal fluid protein was identified in 60.0% of patients with CO and 7.7% of patients with IO (p=0.019) for a mean follow-up time from the initial symptom onset of 3.7 days. CONCLUSIONS: The lateral rectus muscle is the most-involved and last-to-recover EOM in ophthalmoplegia. The CO patients were much older and were more likely to be female and have an elevation of cerebrospinal fluid protein than the IO patients.
Cerebrospinal Fluid ; Cranial Nerves ; Diplopia ; Female ; Follow-Up Studies ; Guillain-Barre Syndrome ; Humans ; Jupiter ; Male ; Miller Fisher Syndrome ; Ophthalmoplegia ; Paresis ; Strabismus

Traumatic cervical epidural hematoma (EDH) with no osseous fracture or underlying hematological abnormalities is a rare disorder that sometimes requires emergent surgical decompressive therapy. A 47-year-old woman was admitted to our emergency room due to severe neck pain and rapid onset hemiparesis after a car accident. Plain cervical radiographs and computed tomography scan did not reveal any abnormality. However, magnetic resonance imaging (MRI) revealed a large posterior EDH compressing the spinal cord extensively from C3 to C5. Emergent hematoma removal was performed following laminectomy, and subsequently the patient showed substantial clinical improvement. Complete removal of the hematoma was confirmed by MRI at 10 days after surgery. Here, the authors present a discussion of the etiology, pathogenesis, and prognosis of this rare pathologic entity.
Emergency Service, Hospital ; Female ; Hematoma ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Middle Aged ; Neck Pain ; Paresis ; Prognosis ; Spinal Cord

A 53-year old man who had a left hemiparesis from head injury of traffic accident 20 years ago visited an emergency room with suddenly developed semi-comatose mental status. Brain CT showed 8.6-cm sized solid and cystic mass on right temporal lobe that was associated with hemorrhage. Solid lesion showed a strong enhancement after an administration of contrast media. Because of severe mass effect, emergency operation was performed. The mass was an intraparenchymal lesion with yellowish cystic fluid and the firm reddish-brown solid lesion was hemorrhagic. The lesion was totally resected. Pathologically, anaplastic solitary fibrous tumor/hemangiopericytoma was diagnosed with 70/10 high power fields. Postoperative radiotherapy of 50 Gy was done. Postoperative 2 months later, the patient was recovered to alert mental state. We report this unusual case of non-dural based intraparenchymal solitary fibrous tumor/hemangiopericytoma with high mitotic index and acute massive hemorrhage. Rapid tumor growth of hypervascular tumor might have a chance of bleeding.
Accidents, Traffic ; Brain ; Brain Neoplasms ; Central Nervous System ; Cerebral Hemorrhage ; Contrast Media ; Craniocerebral Trauma ; Emergencies ; Emergency Service, Hospital ; Hemangiopericytoma ; Hemorrhage ; Humans ; Mitotic Index ; Paresis ; Radiotherapy ; Solitary Fibrous Tumors ; Temporal Lobe

Supratentorial extraventricular anaplastic ependymoma (SEAE) in adults is a relatively rare intracranial tumor. Because of the very low prevalence, only a few cases have been reported. According to a recent study, SEAE is associated with a poor prognosis and there is no definite consensus on optimal treatment. We report a case of an adult SEAE patient who had no recurrence until seven years after a gross total resection (GTR) followed by conventional radiotherapy. A 42-year-old male had a persistent mild headache, left facial palsy, dysarthria, and left hemiparesis. Preoperative neuroimaging revealed an anaplastic astrocytoma or supratentorial ependymoma in the right frontal lobe. A GTR was performed, followed by adjuvant radiotherapy. Histologic and immunohistochemical results revealed anaplastic ependymoma. After seven years of initial therapy, a regular follow-up MRI showed a 3-cm-sized partially cystic mass in the same area as the initial tumor. The patient underwent a craniotomy, and a GTR was performed. Histopathologic examination revealed recurrence of the SEAE. External radiotherapy was performed. The patient has been stable without any disease progression or complications for 12 months since the surgery for recurrent SEAE.
Adult ; Astrocytoma ; Consensus ; Craniotomy ; Disease Progression ; Dysarthria ; Ependymoma ; Facial Paralysis ; Follow-Up Studies ; Frontal Lobe ; Headache ; Humans ; Magnetic Resonance Imaging ; Male ; Neuroimaging ; Paresis ; Prevalence ; Prognosis ; Radiotherapy ; Radiotherapy, Adjuvant ; Recurrence ; Supratentorial Neoplasms

OBJECTIVE: To investigate the effects of combination functional electrical stimulation (FES) and standing frame training on standing balance in stroke patients. METHODS: Patients who had hemiparesis and postural instability after stroke were randomly assigned to one of the two groups; study group underwent FES on the quadriceps and tibialis anterior muscle simultaneously with standing balance training. The control group received standing frame training and FES separately. Both the groups received their respective therapies for 3 weeks. Stability index in Biodex Balance master system, Berg Balance Scale (BBS), manual muscle test, the Korean version of Modified Barthel Index, and Korean version of Mini-Mental State Examination were used to evaluate the effects of the treatment. RESULTS: In total, 30 patients were recruited to the study group and 30 to the control group. Three weeks after treatment, both the groups showed improvement in postural stability scores and physical and cognitive functions. When changes in postural stability were compared between the groups, the study group showed more significant improvement than the control group with regards to the scores of BBS and the stability indices. CONCLUSION: In this study, we found the therapeutic effectiveness of combined therapy of FES and standing frame in subacute stroke patients. The presented protocol is proposed as time-saving and can be applied easily in the clinical setting. Thus, the proposed combined therapy could be a useful method for improving standing balance in subacute stroke patients.
Cognition ; Electric Stimulation ; Humans ; Methods ; Paresis ; Rehabilitation ; Stroke

Late-onset Brown-Séquard syndrome (BSS) is a rare condition resulting from a spinal cord injury that develops weeks to years after a blunt trauma. Acute-onset BSS after a blunt injury has been rarely reported. Here, we report on a case of BSS, in a 58-year-old man, that developed immediately after a motor vehicle accident. Upon admission, loss of right thoracic motion, complete right paresis, and loss of pain and temperature sensations below the C3 level on the left side were observed. Magnetic resonance imaging showed hyperintensities within the cervical spinal cord at the C2–C3 level, confirming the diagnosis of BSS. Thoracic motion rapidly recovered, but other neurological sequelae persisted. BSS related to cervical cord injury should be suspected when patients develop hemiparesis and contralateral sensory loss immediately after a blunt trauma. Likewise, clinicians should be aware that unilateral loss of thoracic motion could be an important sign of BSS.
Brown-Sequard Syndrome ; Cervical Cord ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Motor Vehicles ; Paresis ; Sensation ; Spinal Cord Injuries ; Wounds, Nonpenetrating

BACKGROUND AND OBJECTIVES: Video head impulse tests (vHITs) and caloric tests are widely used to assess the loss of vestibular function in acute vestibular neuritis. Although previous studies have reported on the results of each test, longitudinal comparison of these tests is rare. In the present study, vHITs and caloric tests were performed in patients with unilateral vestibular neuritis during the acute phase and after a long follow-up period (>6 months). The goal of this study was to evaluate the changes in vHIT and caloric test results and to analyze the relationships between them. SUBJECTS AND METHOD: Between September 2013 and December 2015, charts from 13 patients with unilateral vestibular neuritis were retrospectively reviewed. Among the 13 patients, caloric tests and vHITs were performed in 9 and 10 patients, respectively. Results of the vHITs and caloric tests were analyzed and the changes were compared. RESULTS: During the acute phase of vestibular neuritis, the results of the caloric test showed an increase in canal paresis (CP), and the results of the vHIT showed a decrease in horizontal gain. Although subjective symptoms improved in all patients after a long follow-up period (mean: 13.9 months), the occurrence of CP determined from the caloric test was not significantly changed (p=0.889). On the other hand, the mean horizontal gain of the vHIT had improved significantly (p < 0.05). CONCLUSION: While CP determined from the caloric test did not change after a long follow-up period, the decreased horizontal gain in the vHIT was significantly recovered in patients with unilateral vestibular neuritis.
Caloric Tests* ; Follow-Up Studies ; Hand ; Head Impulse Test ; Head* ; Humans ; Methods ; Paresis ; Retrospective Studies ; Vestibular Neuronitis*

BACKGROUND AND OBJECTIVES: Generally, the benign mixed tumors of the submandibular gland are successfully removed via transcervical approach. Recently, however, an alternative to the standard transcervical approach, such as an intraoral approach, has been reported. The surgical results of intraoral excisions for submandibular mixed tumors are discussed here. SUBJECTS AND METHOD: A retrospective review was carried out for 24 patients with submandibular mixed tumors who were past 3 years of follow-up. Surgical morbidities and benefits were studied using these data. RESULTS: All patients successfully received an excision of the submandibular gland with tumor via an intraoral approach. Early postoperative complications of temporary lingual sensory paresis were developed in 75% of patients, followed by 54% of patients with temporary limitation of tongue movement. In contrast, there were no permanent paresis. Late complications were developed in two cases of mild deviation of tongue due to scar contracture on the floor of mouth, whereas two cases of tumor recurrence and one case of post-gustatory sweating syndrome were observed after surgery. CONCLUSION: This approach might be safe, if used with proper expertise, for the treatment of submandibular mixed tumors. The main advantages of this approach are that no external scars nor permanent injury are incurred to the related nerves. However, disadvantages are temporary lingual paresis and temporary limitation of tongue movement. Unfortunately, there were two cases showing recurrence after surgery and thus required more follow-up.
Cicatrix ; Contracture ; Follow-Up Studies ; Humans ; Methods ; Mouth Floor ; Paresis ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Submandibular Gland ; Sweat ; Sweating ; Tongue

Thiamine (vitamin B₁) is a water-soluble vitamin that is not endogenously synthesized in humans. It is absorbed by the small intestine, where it is activated. Its active form acts as a coenzyme in many energy pathways. We report a rare case of thiamine deficiency in a 3.5-year old boy with short bowel syndrome secondary to extensive bowel resection due to necrotizing enterocolitis during his neonatal age. The patient was parenteral nutrition-dependent since birth and had suffered from recurrent central catheter-related bloodstream infections. He developed confusion with disorientation and unsteady gait as well as profound strabismus due to bilateral paresis of the abductor muscle. Based on these and a very low thiamine level he was diagnosed and treated for Wernicke encephalopathy due to incomplete thiamine acquisition despite adequate administration. He fully recovered after thiamine administration. After 1999 eight more cases have been reported in the PubMed mostly of iatrogenic origin.
Child ; Enterocolitis, Necrotizing ; Gait Disorders, Neurologic ; Humans ; Intestine, Small ; Male ; Parenteral Nutrition, Total ; Paresis ; Parturition ; Short Bowel Syndrome ; Strabismus ; Thiamine Deficiency ; Thiamine ; Vitamins ; Wernicke Encephalopathy