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Ricciardi D, Lavorgna L, Cirillo G, Tedeschi G, Bonavita S. Unilateral polymicrogyria, hemispheric atrophy and spastic hemiparesis: rare etiologies for a common condition. Acta Neurol Belg 2021; 121:789-790. [PMID: 33151517 DOI: 10.1007/s13760-020-01537-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/21/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Dario Ricciardi
- I Division of Neurology and Neurophysiopathology, University of Campania "Luigi Vanvitelli", P.za Miraglia 2, 80138, Naples, Italy.
| | - Luigi Lavorgna
- I Division of Neurology and Neurophysiopathology, University of Campania "Luigi Vanvitelli", P.za Miraglia 2, 80138, Naples, Italy
| | - Giovanni Cirillo
- I Division of Neurology and Neurophysiopathology, University of Campania "Luigi Vanvitelli", P.za Miraglia 2, 80138, Naples, Italy.
- Division of Human Anatomy, Laboratory of Morphology of Neuronal Networks, University of Campania "Luigi Vanvitelli", P.za Miraglia 2, 80138, Naples, Italy.
| | - Gioacchino Tedeschi
- I Division of Neurology and Neurophysiopathology, University of Campania "Luigi Vanvitelli", P.za Miraglia 2, 80138, Naples, Italy
| | - Simona Bonavita
- I Division of Neurology and Neurophysiopathology, University of Campania "Luigi Vanvitelli", P.za Miraglia 2, 80138, Naples, Italy
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Lee HJ, Cha HS, Hahm MH, Lee H, Kim SS, Chang Y. Improved white matter integrity after contralateral seventh cervical nerve transfer measured by tractographic representation. Clin Neurol Neurosurg 2021; 206:106715. [PMID: 34088540 DOI: 10.1016/j.clineuro.2021.106715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Abstract
Contralateral C7 (CC7) nerve transfer surgery was shown to significantly improve the spasticity condition and the motor function of paralyzed arms. However, the involvement of the white matter tract in the recovery process is not well established. We here investigated the possible biologic explanation for this phenomenon. A 62-year-old female patient, who suffered from spastic hemiparesis due to intracranial hemorrhage, underwent CC7 transfer surgery 13 years after the initial stroke event. Six months after the surgery, the patient's Modified Ashworth Scale and Fugl-Myere score improved, even though no specific rehabilitation programs were applied. Diffusion tensor imaging (DTI) was performed before and 6 months after the surgery. The pre-surgery DTI showed both ipsilesional and contralesional CST from the cerebral peduncles to the cortices. After surgery, however, only the contralesional CST was observed. In conclusion, functional alterations of the brain white matter tract after CC7 nerve transfer surgery possibly provided a neurophysiological substrate for ameliorating the spasticity and improving the motor function in a spastic hemiplegia patient.
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Affiliation(s)
- Hyun-Joo Lee
- Department of Orthopedic Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Hyun-Sil Cha
- Department of Medical & Biological Engineering, Kyungpook National University, Daegu, Republic of Korea
| | - Myong-Hun Hahm
- Department of Radiology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Huijoong Lee
- Department of Radiology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Sang Soo Kim
- KimSangSoo Micro Clinic, Seoul, Republic of Korea.
| | - Yongmin Chang
- Department of Medical & Biological Engineering, Kyungpook National University, Daegu, Republic of Korea; Department of Radiology, Kyungpook National University Hospital, Daegu, Republic of Korea; Department of Molecular Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
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Abstract
Mills' syndrome is an idiopathic, slowly progressive, spastic hemiparesis. We describe three cases that have been under review for a minimum of 11 years (range 11-19). In all patients, symptoms started in a leg, with a mean age of onset of 59 years (range 53-63). The only abnormality on laboratory investigations was a mildly elevated CSF protein in one case. MRI demonstrated focal T2 hyper-intensity located eccentrically in the cervical cord ipsilateral to the symptomatic side. No cerebral abnormality was demonstrated. Whilst visual and somatosensory evoked potentials were unremarkable, motor evoked potentials were abnormal in all patients: central motor conduction times were significantly prolonged unilaterally in two patients and bilaterally but asymmetrically in the third. Beta-band (15-30 Hz) intermuscular coherence, a potentially more sensitive method of assessing upper motor neuron integrity, was absent unilaterally in one patient and bilaterally in the other two. One patient developed amyotrophy and thus a picture of amyotrophic lateral sclerosis after 16 years, suggesting that Mills' syndrome is part of the motor neuron disease spectrum. Both amyotrophy and subclinical contralateral upper motor neuron disease can therefore be features of Mills' syndrome. However, even with the most sensitive electrodiagnostic techniques, unilateral upper motor neuron disease can remain the only abnormality for as long as 10 years. We conclude that whilst Mills' syndrome should be classified as a motor neuron disorder, it is a distinct nosological entity which can be distinguished from amyotrophic lateral sclerosis, upper motor neuron-dominant amyotrophic lateral sclerosis and primary lateral sclerosis. We propose diagnostic criteria for Mills' syndrome, and estimate a point prevalence of at least 1.2:1,000,000 based on our well-defined referral population in the North of England.
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Affiliation(s)
- Stephan R Jaiser
- Institute of Neuroscience, Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.,Department of Neurology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.,Department of Clinical Neurophysiology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Dipayan Mitra
- Institute of Neuroscience, Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.,Department of Neuroradiology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Timothy L Williams
- Department of Neurology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Mark R Baker
- Institute of Neuroscience, Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK. .,Department of Neurology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK. .,Department of Clinical Neurophysiology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
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