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Bawaskar HS, Bawaskar PH, Bawaskar PH. 'Gym Tonic' and Quadriparesis. J Assoc Physicians India 2019; 67:85-86. [PMID: 31571464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We report a case of acute onset quadriparesis which occurred after consumption of some drugs which were illicitly prescribed to our young patient by his gym instructor. The deadly concoction of so-called gym-tonic (Cyproheptadine and dexamethasone) led to hypokalaemic paralysis in our patient.
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Kreutzträger M, Kopp MA, Liebscher T. Acute transient spinal paralysis and cardiac symptoms following an accidental epidural potassium infusion - a case report. BMC Anesthesiol 2017; 17:135. [PMID: 28985715 PMCID: PMC5639603 DOI: 10.1186/s12871-017-0425-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 09/26/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND To describe a case of an accidental epidural potassium infusion leading to an acute transient spinal paralysis and cardiac symptoms and review the literature on that topic. CASE PRESENTATION We report the case of an accidental infusion of 900 mg potassium chloride 7.45% (KCl) into the epidural space, which occurred during epidural analgesia in a 74-year-old patient suffering from immobilization due to lumbar back pain as well as from a paralytic Ileus. The event was resulting in vegetative symptoms, such as tachycardia and hypertension accompanied by a motor complete tetraplegia (AIS B) sub C2 with respiratory depression. The endotracheal intubation was necessary. The patient was treated with 40 mg dexamethasone intravenously, as well an epidural lavage with sodium chloride solution 0.9% (NaCl) through the epidural catheter. The neurologic symptoms completely resolved within five days. An elevation of troponin-T values and a reduced left ventricular ejection fraction (LVEF) of 40% accompanied by transient pectanginous pain were documented. An exertional dyspnea remained. CONCLUSIONS A symptom complex with elevated sympathetic nervous system activity up to a stress cardiomyopathy is possible following epidural potassium infusion. Additionally, generalized pain and muscle spasticity evolve and a progressive acute spinal cord injury syndrome can occur within minutes, accompanied by respiratory depression. Treatment consists of early intensive care and the symptomatic therapy of the associated symptoms, leading in most of the reported cases to a good clinical outcome.
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Affiliation(s)
- Martin Kreutzträger
- Treatment Centre for Spinal Cord Injuries, Trauma Hospital Berlin, Warener Straße 7, 12683 Berlin, Germany
| | - Marcel A. Kopp
- Spinal Cord Injury Research, Department of Neurology and Experimental Neurology, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Thomas Liebscher
- Treatment Centre for Spinal Cord Injuries, Trauma Hospital Berlin, Warener Straße 7, 12683 Berlin, Germany
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Abstract
Ephedrine decongestant products are widely used. Common side effects include palpitations, nervousness, and headache. More severe adverse reactions include cardiomyopathy and vasospasm. We report the case of an otherwise healthy 37-year-old woman who presented with acute-onset quadriplegia and heart failure. She had a normal chest radiograph on admission, but developed marked pulmonary edema and bilateral effusions the next day. Echocardiography revealed a left ventricular ejection fraction of 0.18 and no obvious intrinsic pathologic condition such as foramen narrowing on spinal imaging. Laboratory screening was positive for methamphetamines in the urine, and the patient admitted to having used, over the past several weeks, multiple ephedrine-containing products for allergy-symptom relief. She was ultimately diagnosed with an acute catecholamine-induced cardiomyopathy and spinal artery vasospasm consequential to excessive use of decongestants. Her symptoms resolved completely with supportive care and appropriate heart-failure management. An echocardiogram 2 weeks after admission showed improvement of the left ventricular ejection fraction to 0.33. Ten months after the event, the patient was entirely asymptomatic and showed further improvement of her ejection fraction to 0.45. To our knowledge, ours is the first report of spinal artery vasospasm resulting in quadriplegia in a human being after ephedrine ingestion.
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Berenguer-Potenciano M, Villora-Morcillo N, Nunez-Enamorado N, Perez-Alonso V, Camacho-Salas A, Simon-De Las Heras R. [Therapeutic response to pyridoxine and pyridostigmine in a paediatric case of severe peripheral and cranial polyneuropathy due to vincristine]. Rev Neurol 2015; 60:91-92. [PMID: 25583593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Krzesinski F, Cuppens B, Gerard C, Delhez A, Nogue A, Ghuysen A, D'Orio VD. [A wing clipping beverage]. Rev Med Liege 2014; 69:531-535. [PMID: 25796746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Chronic consumption of soda energizing caffeine has known a growing success. Its deleterious effects, however, are often ignored. We report a case of tetraparesis associated with chronic excessive consumption of cola. The development of muscle weakness is variable, resulting from a hyperpolarization of excitable membranes. The outcome is most often favorable after potassium supplementation and interruption of the offending beverage consumption. The mechanisms involved are multiple and involve both a leakage of fecal and urinary potassium and a potassium entry into the intracellular compartment. Other mechanisms related to caffeine are also involved. It therefore appears mandatory to assess the consumption of such beverages in the presence of hypokalemia and muscle weakness.
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Ciszowski K, Mietka-Ciszowska A. [Rare consciousness disturbances in toxicological practice: akinetic mutism, somnambulism, locked-in syndrome, and psychogenic coma]. Przegl Lek 2013; 70:607-612. [PMID: 24466703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The toxicity of xenobiotics can result inrare disorders of consciousness, such as akinetic mutism and somnambulism as well as syndromes mimicking consciousness disturbances, such as locked-in syndrome and psychogenic coma. Akinetic mutism is a condition characterized by a lack of spontaneous movements and little or no vocalization. Somnambulism include performing of complex motor activity in an automatic manner during deep sleep, without any awareness of its execution. The locked-in syndrome is a state with quadriplegia coexisting with cranial nerves palsies and mutism, but with fully preserved consciousness. Psychogenic coma is a condition in which the patient has preserved level of consciousness and awareness, but does not communicate with theenvironment and does not exhibit the external manifestations of consciousness. This paper presents the etiology, clinical characteristics, as well as diagnostic and therapeutic issues for the above syndromes.
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Affiliation(s)
- Krzysztof Ciszowski
- Klnika Toksykologii i Chorób Srodowiskowych, Wydziału Lekarskiego, Collegium Medicum Uniwersytetu Jagiellońskiego w Krakowie.
| | - Aneta Mietka-Ciszowska
- Oddział Toksykologii i Chorób Wewnetrznych z Pododdzialem Detoksykacji, Szpitala Specjalistycznego im. Ludwika Rydygiera w Krakowie
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Lumeij JT. Ethanol poisoning as a differential diagnosis in a hunter's dog with tetraplegia. Tijdschr Diergeneeskd 2009; 134:932-933. [PMID: 20055025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A 4.5-month-old German pointer was presented with tetraplegia. Based on the physical examination, a tentative diagnosis of idiopathic polyneuropathy or synaptic disorder was made. Later that day additional information from the owner revealed that the dog might have ingested sloe berries that had been used to make sloe gin. Ethanol poisoning was added to the differential diagnosis. The dog's locomotion recovered in the course of 24 hours. Faecal analysis revealed that the animal had ingested at least 127 gin-saturated sloe berries and it was estimated that the blood ethanol concentration would have been at least 0.75 per thousand. The aetiology, diagnosis, and treatment of ethanol poisoning in dogs is reviewed.
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Affiliation(s)
- J T Lumeij
- Division of Zoological Medicine, Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Yalelaan 108, 3584 CM Utrecht, The Netherlands.
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Hamidah A, Raja Lope RJ, Abdul Latiff Z, Anuar ZM, Jamal R. Prevention of neurotoxicity by high-dose folinic acid rescue after high-dose methotrexate and intrathecal methotrexate without compromising cure inspite of previous transient leukoencephalopathy after intrathecal methotrexate. Ann Acad Med Singap 2009; 38:743-744. [PMID: 19736586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Abstract
Methylenedioxymethamphetamine (MDMA), commonly known as Ecstasy, is a hallucinogenic compound structurally related to amphetamine. Ecstasy's severe neurological toxicity includes seizures, subarachnoidal hemorrhage, cerebral infarction, intracranial bleeding and cerebral venous thrombosis. We describe the first case of spinal cord damage presenting as acute quadriplegia and respiratory insufficiency in a healthy adolescent following Ecstasy recreational usage.
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Affiliation(s)
- Lee H Goldstein
- Clinical Pharmacology and Toxicology Unit, Assaf Harofeh Medical Center, Tel Aviv University, Zerifin, Israel
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Beigmohammadi MT, Aghdashi M, Najafi A, Mojtahedzadeh M, Karvandian K. Quadriplegia due to lead-contaminated opium--case report. Middle East J Anaesthesiol 2008; 19:1411-1416. [PMID: 18942257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE Utilization of lead-contaminated opium may lead to severe motor neuron impairment and quadriplegia. CASE REPORT Forty years oriented old male, opium addict, was admitted to the ICU, with headache, nausea and abdominal pain, and weakness in his lower and upper extremities without definitive diagnosis. The past medical and occupational history was negative. Laboratory investigation showed; anemia (Hb 7.7 g/dl), slightly elevated liver function tests, elevated total bilirubin, and ESR. Abdominal sonography and brain CT scan were normal. EMG and NCV results and neurologic examination were suggestive for Guillain-Barre. He underwent five sessions of plasmapheresis. Blood lead level was > 200 microg/dl. He received dimercaprol (BAL) and calcium disodium edetate (CaEDTA) for two five days session. Upon discharge from ICU all laboratory tests were normal and blood lead level was reduced, but he was quadriplegic. CONCLUSION The delayed treatment of lead poisoning may lead to irreversible motor neuron defect.
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Affiliation(s)
- Mohammad Taghi Beigmohammadi
- Department of Anesthesiology & Intensive Care, Imam Khomeini Hospital, Tehran Univ. of Medical Sciences, Tehran, Iran.
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Abstract
We report an obstetric patient who developed unusual neurological complications after an epidural injection of a local anesthetic and a narcotic in a seemingly faultless manner. Ten minutes after receiving a loading dose, the patient developed aphonia, quadriplegia, and facial palsy while retaining normal consciousness and stable hemodynamics. The episode spontaneously resolved 40 minutes later. We wish to draw attention to anesthesiologists of the possibility that even in the presence of a negative aspiration test or without noticeable dural puncture, the injected drugs may enter the intrathecal or subdural space instead of pooling entirely in the epidural compartment. Once an unexpected high block and unusual symptoms or signs are noted, a prompt differential diagnosis must be made and treatment initiated as soon as possible.
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Affiliation(s)
- Feng-Lin Liu
- Department of Anesthesiology, Wan-Fang Medical Center, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Abstract
BACKGROUND Central pontine myelinolysis (CPM) usually presents in chronic alcoholics and in patients in whom hyponatraemia has been corrected rapidly. However, CPM may occur in other clinical circumstances, including patients with severe hypoglycaemia. We describe the occurrence of CPM and quadriplegia in a patient who experienced fluoroquinolone-associated severe hypoglycaemia. CASE REPORT A 63-year-old man with Type 2 diabetes mellitus was admitted to hospital for resection of a large liposarcoma. Renal-dose levofloxacin was utilized as part of an antimicrobial regimen to treat post-operative peritonitis. On days 6-8 of levofloxacin therapy, the patient experienced recurrent hypoglycaemia despite total parenteral nutrition, 10% dextrose containing fluids and cessation of insulin therapy 3 days prior to the first hypoglycaemic episode. Hypoglycaemia resolved within 24 h of stopping levofloxacin. After a final and severe hypoglycaemic event, the patient developed quadriplegia and tonic left deviation of gaze. Magnetic resonance imaging revealed a high-intensity lesion in the central pons consistent with CPM. CONCLUSIONS Fluoroquinolones should be considered as a potential cause of hypoglycaemia. Severe hypoglycaemia has the potential to cause white matter lesions in the pons. Putative mechanisms include failure of membrane ion channels, oligodendrocyte apoptosis and oxidative stress of glucose reperfusion. Fluoroquinolone-associated hypoglycaemia and hypoglycaemia-induced quadriplegia are both rare and we believe this is the first case report linking the two events.
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Affiliation(s)
- S Vallurupalli
- Department of Internal Medicine, University of Illinois College of Medicine at Urbana-Champaign, IL, USA.
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Jung GJ, Gil HW, Yang JO, Lee EY, Hong SY. Severe hypermagnesemia causing quadriparesis in a CAPD patient. Perit Dial Int 2008; 28:206. [PMID: 18332462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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Abstract
Acute peripheral neuropathy caused by a disulfiram overdose is very rare and there is no report of it leading to vocal fold palsy. A 49-year-old woman was transferred to our department because of quadriparesis, lancinating pain, sensory loss, and paresthesia of the distal limbs. One month previously, she had taken a single high dose of disulfiram (130 tablets of ALCOHOL STOP TAB, Shin-Poong Pharm. Co., Ansan, Korea) in a suicide attempt. She was not an alcoholic. For the first few days after ingestion, she was in a confused state and had mild to moderate ataxia and giddiness. She noticed hoarseness and distally accentuated motor and sensory dysfunction after she had recovered from this state. A nerve conduction study was consistent with severe sensorimotor axonal polyneuropathy. Laryngeal electromyography (thyroarytenoid muscle) showed ample denervation potentials. Laryngoscopy revealed asymmetric vocal fold movements during phonation. Her vocal change and weakness began to improve spontaneously about 3 weeks after transfer. This was a case of acute palsy of the recurrent laryngeal nerve and superimposed severe acute sensorimotor axonal polyneuropathy caused by high-dose disulfiram intoxication.
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Affiliation(s)
- Jong Seok Bae
- Department of Neurology, Inje University, College of Medicine, Busan, Republic of Korea.
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Garrab K, Hellara I, Douki W, Younes M, Ben Amor M, Bergaoui N, Najjar MF. [Skeletal fluorosis: a case report]. Ann Biol Clin (Paris) 2007; 65:574-6. [PMID: 17913679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Accepted: 07/23/2007] [Indexed: 05/17/2023]
Abstract
The authors report a case of skeletal fluorosis described in a 60 years old man living in south-west Tunisian. The main clinical sign is a severe functional legs disability. Radiographic examination has shown a diffused osteocondensation, with cervical spine degenerative discopathy, a pelvis bilateral osteoarthritis and an interosseous membrane ossification of forearms and legs. The skeletal fluorosis diagnosis has been confirmed by high serum and urinary fluoride levels.
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Affiliation(s)
- K Garrab
- Laboratoire de biochimie-toxicologie, Service de rhumatologie, Hôpital universitaire Fattouma Bourguiba, Monastir, Tunisie
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Sein Anand J, Chodorowski Z, Wiśniewski M, Gólska A. A cocaine-associated quadriplegia and motor aphasia after first use of cocaine. Przegl Lek 2007; 64:316-7. [PMID: 17724897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
UNLABELLED A 31-year-old female who have snorted one "line" of cocaine hydrochloride (approximately 35 mg), for the first time in her life, was admitted to the hospital because of acute onset of right hemiplegia and left hemiparesis evolving into quadriplegia. Motor aphasia, right eye-ball divergent strabismus and right mouth recess lowering were also observed. CONCLUSIONS A first time mucosal administration of cocaine hydrochloride even in low dose can cause severe neurological complications like quadriplegia and aphasia. Cocaine-associated stroke can be a diagnostic problem in the emergency room. Unconscious patients or those with acute onset of neurological disorders can form a real diagnostic challenge, especially when there is no evidence of previous drug taking.
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Affiliation(s)
- Jacek Sein Anand
- Department of Internal Medicine, Geriatry and Clinical Toxicology, Medical University of Gdańsk.
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Abstract
We report a 34-year-old woman who developed clinical botulism after the cosmetic use of an unapproved botulinum toxin type A. Electrophysiologic findings demonstrated complete denervation with complete electrical silence. She had a lengthy recovery but was able to ambulate by discharge.
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Affiliation(s)
- N Souayah
- Departments of Neurology, New Jersey Medical School of the University of Medicine and Dentistry of New Jersey, Newark, NJ 07101, USA.
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Gómez-Arguelles JM, Sebastián-De la Cruz F, Godino-Durán JA, Vari A, Aragón E, Oliviero A. [Spastic quadriplegia secondary to intoxication with inorganic arsenic]. Rev Neurol 2006; 43:570-1. [PMID: 17072816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Heckmann JG, Maihöfner C, Lanz S, Rauch C, Neundörfer B. Transient tetraplegia after cervical facet joint injection for chronic neck pain administered without imaging guidance. Clin Neurol Neurosurg 2006; 108:709-11. [PMID: 16102894 DOI: 10.1016/j.clineuro.2005.07.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Revised: 06/20/2005] [Accepted: 07/07/2005] [Indexed: 11/25/2022]
Abstract
We report about a patient in whom transient tetraplegia with intact proprioception occurred immediately after infiltration of a facet joint at the C6 level guided by anatomical landmarks. After positioning the patient supine and applying atropine and oxygen, respiration and circulation were stable and all symptoms resolved within the next 30 min. The type of neurological pattern and the course of disease suggest an inadvertent injection into a cervical radicular artery that reinforces the anterior spinal artery. This complication is potentially serious and may be permanently disabling or life threatening. It should be considered by any clinician performing "blind" zygapophysial joint injections in the cervical spine. Using imaging guidance should help prevent this type of complication.
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Affiliation(s)
- Josef G Heckmann
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
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Macario A, Chow JL, Dexter F. A Markov computer simulation model of the economics of neuromuscular blockade in patients with acute respiratory distress syndrome. BMC Med Inform Decis Mak 2006; 6:15. [PMID: 16539706 PMCID: PMC1431518 DOI: 10.1186/1472-6947-6-15] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2005] [Accepted: 03/15/2006] [Indexed: 11/17/2022] Open
Abstract
Background Management of acute respiratory distress syndrome (ARDS) in the intensive care unit (ICU) is clinically challenging and costly. Neuromuscular blocking agents may facilitate mechanical ventilation and improve oxygenation, but may result in prolonged recovery of neuromuscular function and acute quadriplegic myopathy syndrome (AQMS). The goal of this study was to address a hypothetical question via computer modeling: Would a reduction in intubation time of 6 hours and/or a reduction in the incidence of AQMS from 25% to 21%, provide enough benefit to justify a drug with an additional expenditure of $267 (the difference in acquisition cost between a generic and brand name neuromuscular blocker)? Methods The base case was a 55 year-old man in the ICU with ARDS who receives neuromuscular blockade for 3.5 days. A Markov model was designed with hypothetical patients in 1 of 6 mutually exclusive health states: ICU-intubated, ICU-extubated, hospital ward, long-term care, home, or death, over a period of 6 months. The net monetary benefit was computed. Results Our computer simulation modeling predicted the mean cost for ARDS patients receiving standard care for 6 months to be $62,238 (5% – 95% percentiles $42,259 – $83,766), with an overall 6-month mortality of 39%. Assuming a ceiling ratio of $35,000, even if a drug (that cost $267 more) hypothetically reduced AQMS from 25% to 21% and decreased intubation time by 6 hours, the net monetary benefit would only equal $137. Conclusion ARDS patients receiving a neuromuscular blocker have a high mortality, and unpredictable outcome, which results in large variability in costs per case. If a patient dies, there is no benefit to any drug that reduces ventilation time or AQMS incidence. A prospective, randomized pharmacoeconomic study of neuromuscular blockers in the ICU to asses AQMS or intubation times is impractical because of the highly variable clinical course of patients with ARDS.
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Affiliation(s)
- Alex Macario
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA 94305, USA
- Health Research & Policy, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - John L Chow
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Franklin Dexter
- Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa, 52242, USA
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Abstract
Immune-mediated neuropathies associated with non-Hodgkin's lymphoma are rare and can be difficult to delineate from neuropathies of other etiologies. We report the clinical and pathological findings of a 36-year-old patient with fulminant quadriplegic neuropathy, left facial nerve palsy, and Burkitt-like lymphoma. Features of the neuropathy, which occurred during induction chemotherapy with a total cumulative dose of 4 mg vincristine, suggested axonal Guillain-Barré syndrome. There was no evidence of direct malignant infiltration of the peripheral nervous system. We hypothesize that immune mechanisms triggered by the lymphoma initiated damage to the peripheral nervous system and enhanced its vulnerability to the toxic effects of vincristine.
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Affiliation(s)
- Julia Wanschitz
- Clinical Department of Neurology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.
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Mozaffar T, Haddad F, Zeng M, Zhang LY, Adams GR, Baldwin KM. Molecular and cellular defects of skeletal muscle in an animal model of acute quadriplegic myopathy. Muscle Nerve 2006; 35:55-65. [PMID: 16967495 DOI: 10.1002/mus.20647] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Muscle denervation and concomitant high-dose dexamethasone treatment in rodents produces characteristic pathologic features of severe muscle atrophy and selective myosin heavy filament (MyHC) depletion, identical to those seen in acute quadriplegic myopathy (AQM), also known as critical illness myopathy. We tested the hypothesis that defective pre-translational processes contribute to the atrophy and selective MyHC depletion in this model. We examined the effects of combined glucocorticoid-denervation treatment on MyHC and actin mRNA populations; we also studied mRNA expression of the myogenic regulatory factors (MRFs), primary transcription factors for MyHC. Adult female rats were subjected to proximal sciatic denervation followed by high-dose dexamethasone (DD) treatment (5 mg/kg body weight daily) for 7 days. Disease controls included rats treated with denervation alone (DN) or dexamethasone alone (DX). At 1 week the plantaris atrophied by approximately 42% in DD muscles. DD treatment resulted in selective MyHC protein depletion; actin protein concentration was not significantly changed. Despite an increase in total RNA concentration in DN and DD muscles, MyHC and actin mRNA concentrations were significantly decreased in these muscles. MyHC mRNA showed a significantly more extensive depletion relative to actin mRNA in DD muscles. Glucocorticoid treatment did not influence a denervation-induced increase in the mRNA expression of the MRFs. We conclude that a deleterious interaction between glucocorticoid and denervation treatments in skeletal muscle is responsible for pre-translational defects that reduce actin and MyHC mRNA substrates in a disproportionate fashion. The resultant selective MyHC depletion contributes to the severe muscle atrophy.
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Affiliation(s)
- Tahseen Mozaffar
- Department of Neurology, University of California, Irvine, 101 City Drive South, Building 22C, Route 13, Orange, California 92868, USA.
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Kihaile PE, Aoki K, Kimura N, Pei W, Misumi J. Are sperm parameters the best indicator of 2,5-hexanedione reproductive toxicity in male rats? Reprod Toxicol 2005; 20:515-9. [PMID: 15941647 DOI: 10.1016/j.reprotox.2005.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2003] [Revised: 02/02/2005] [Accepted: 03/02/2005] [Indexed: 11/26/2022]
Abstract
In this study on 40 male Wistar rats of approximately 3-weeks-old, the effects of 2,5-hexanedione on sperm principal parameters were examined by subcutaneously administering 100, 200 and 400 mg/(kgday) for 12 weeks. Other indicators of 2,5-hexanedione intoxication were examined: testes, epididymides, body weight, limb paralysis and histology. The sperm motility was adversely affected in all of the three treatment groups. No sperm motility at all was observed in the 200 and 400 mg/(kgday) treatment groups and rapid progressive motility was significantly reduced in the 100 mg/(kgday) group (P<0.05). The sperm concentration and morphology, testes, epididymides and body weight were significantly affected in the 200 and 400 mg/(kgday) groups but not in the 100 mg/(kgday) group (P<0.05). All the rats in the 400 mg/(kgday) group could not move due to leg paralysis, whereas only 50% of the rats in the 200mg/(kgday) group and none in the 100 mg/(kgday) were affected. Histological examination of the testes in the 400, 200 and 100 mg/(kgday) groups revealed Sertoli cell-only syndrome in 70, 30 and 0% of the rats, respectively. In conclusion, this study has shown that sperm motility was the most significantly sensitive indicator of 2,5-hexanedione intoxication in all the treatment groups.
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Affiliation(s)
- Paul E Kihaile
- Division of Preventive Medicine, Department of Human Environmental and Social Medicine, Faculty of Medicine, Oita University, Oita 879-5593, Japan.
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Tröger U, Lins H, Scherrmann JM, Wallesch CW, Bode-Böger SM. Tetraparesis associated with colchicine is probably due to inhibition by verapamil of the P-glycoprotein efflux pump in the blood-brain barrier. BMJ 2005; 331:613. [PMID: 16148013 PMCID: PMC1215555 DOI: 10.1136/bmj.38568.639688.f7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Uwe Tröger
- Institute of Clinical Pharmacology, Otto-von-Guericke-University, Leipziger Strasse 44, D-39120 Magdeburg, Germany.
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27
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Abstract
STUDY DESIGN Case report. OBJECTIVE A review of the literature about spinal cord infarction with epidural steroid injections and report of one case. SUMMARY OF BACKGROUND DATA A 53-year-old man with a history of chronic cervical pain and multilevel degenerative disc disease with multiple posterior disc protrusions on cervical imaging. The patient received a left C6 tranforaminal injection for therapeutic pain relief, with fluoroscopic confirmation of left C6 nerve root sheath spread of injectable contrast. Approximately 10 to 15 minutes post-procedure, he noted weakness in his left arm and bilateral lower limbs. Initial cervical magnetic resonance imaging revealed no cord signal change, but a follow-up study 24 hours later demonstrated patchy increased T2 and short tau inversion recovery signal in the cervical cord from the odontoid to C4-C5 vertebral levels. This was consistent with a diffuse vascular infarct to the cervical cord, resulting in motor-incomplete tetraplegia. RESULTS This is one of a few reported cases of spinal cord infarction after cervical epidural injections. No direct cord trauma occurred. Previously reported risk factors of spinal infarction, such as hypotension and large injectate volumes, were noncontributory in this case. CONCLUSIONS Cervical epidural injections, despite careful localization, carry a risk of vascular infarction to the spinal cord, even in the absence of direct cord trauma. The etiology of these infarctions and identifying those patients at risk remain uncertain.
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Affiliation(s)
- Michael A Ludwig
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.
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28
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Abstract
The authors report a 24-year-old man who developed encephalopathy and rapid quadriplegia following ingestion of a solution containing diethylene glycol (DEG). As quadriparesis evolved, motor response amplitudes were markedly reduced with preserved conduction velocities. Studies during clinical recovery revealed marked motor conduction velocity slowing and prolonged distal latencies. These data indicate that DEG intoxication may cause a primary acute axonal sensorimotor polyneuropathy with demyelinating physiology during recovery.
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MESH Headings
- Adult
- Brain Diseases, Metabolic/chemically induced
- Brain Diseases, Metabolic/diagnosis
- Brain Diseases, Metabolic/physiopathology
- Cranial Nerve Diseases/chemically induced
- Cranial Nerve Diseases/diagnosis
- Cranial Nerve Diseases/physiopathology
- Cranial Nerves/drug effects
- Cranial Nerves/pathology
- Cranial Nerves/physiopathology
- Electromyography
- Ethylene Glycols/poisoning
- Humans
- Kidney/drug effects
- Kidney/pathology
- Kidney/physiopathology
- Kidney Failure, Chronic/chemically induced
- Kidney Failure, Chronic/diagnosis
- Kidney Failure, Chronic/physiopathology
- Magnetic Resonance Imaging
- Male
- Nerve Fibers, Myelinated/drug effects
- Nerve Fibers, Myelinated/pathology
- Neural Conduction/drug effects
- Neural Conduction/physiology
- Peripheral Nerves/drug effects
- Peripheral Nerves/pathology
- Peripheral Nerves/physiopathology
- Peripheral Nervous System Diseases/chemically induced
- Peripheral Nervous System Diseases/diagnosis
- Peripheral Nervous System Diseases/physiopathology
- Quadriplegia/chemically induced
- Quadriplegia/diagnosis
- Quadriplegia/physiopathology
- Recovery of Function/physiology
- Reflex, Abnormal/drug effects
- Reflex, Abnormal/physiology
- Wallerian Degeneration/chemically induced
- Wallerian Degeneration/diagnosis
- Wallerian Degeneration/physiopathology
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Affiliation(s)
- M J Hasbani
- Department of Neurology, University of Pennsylvania School of Medicine, 3400 Spruce St., 3 West Gates, Philadelphia, PA 19104-4283, USA.
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29
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Amaya-Villar R, Garnacho-Montero J, García-Garmendía JL, Madrazo-Osuna J, Garnacho-Montero MC, Luque R, Ortiz-Leyba C. Steroid-induced myopathy in patients intubated due to exacerbation of chronic obstructive pulmonary disease. Intensive Care Med 2004; 31:157-61. [PMID: 15580474 DOI: 10.1007/s00134-004-2509-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2003] [Accepted: 10/28/2004] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To determine incidence, risk factors and impact on various outcome parameters of the development of acute quadriplegic myopathy in a selected population of critically ill patients. SETTING A prospective cohort study carried out in the intensive care unit of a tertiary-level university hospital. PATIENTS All patients admitted due to acute exacerbation of chronic obstructive pulmonary disease who required intubation and mechanical ventilation, and received high doses of intravenous corticosteroids. INTERVENTIONS A neurophysiological study was performed in all cases at the onset of weaning. Muscular biopsy was taken when the neurophysiological study revealed a myopathic pattern. MEASUREMENTS AND RESULTS Twenty-six patients were enrolled in the study. Nine patients (34.6%) developed myopathy. Only seven patients were treated with muscle relaxants. Histology confirmed the diagnosis in the three patients who underwent muscle biopsy. APACHE II score at admission, the rate of sepsis and the total doses of corticosteroids were significantly higher in patients with myopathy compared with those patients that did not develop it. Myopathy is associated with an increase in the duration of mechanical ventilation [15.4 (9.2) versus 5.7 (3.9) days; p<0.006], the length of ICU stay [23.6 (10.7) versus 11.4 (7.05) days; p<0.003] and hospital stay [33.3 (19.2) versus 21.2 (16.1) days; p<0.034)]. Myopathy was not associated with increased mortality. CONCLUSIONS In the population under study, severity of illness at admission, the development of sepsis and the total dose of corticosteroids are factors associated with the occurrence of myopathy after the administration of corticosteroids. Myopathy was associated with prolonged mechanical ventilation and in-hospital stay.
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Affiliation(s)
- Rosario Amaya-Villar
- Intensive Care Unit, University Hospital Virgen del Rocío, Avenida Manuel Siurot s/n, 41013 Seville, Spain.
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30
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31
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Fodale V, Praticò C, Girlanda P, Baradello A, Lucanto T, Rodolico C, Nicolosi C, Rovere V, Santamaria LB, Dattola R. Acute motor axonal polyneuropathy after a cisatracurium infusion and concomitant corticosteroid therapy. Br J Anaesth 2004; 92:289-93. [PMID: 14722188 DOI: 10.1093/bja/aeh040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A 40-yr-old male was admitted to the intensive care unit following blunt chest trauma. He had multiple rib fractures, bilateral pneumothoraces, and acute respiratory failure requiring mechanical ventilation. Sedation was achieved with midazolam and morphine, and later with propofol. The patient was paralysed with a continuous infusion of cisatracurium 1.42-5.75 micro g kg(-1) min(-1). Methylprednisolone 125 mg i.v. every 12 h was also started. After discontinuation of the cisatracurium infusion 7 days later, the patient manifested a flaccid quadriplegia with absence of deep-tendon reflexes. No sensory deficits were observed. Electromyography (EMG), repetitive nerve stimulation testing, and single fibre EMG (SFEMG) were performed at regular intervals after stopping cisatracurium. Clinical symptoms and electrophysiological examinations supported the diagnosis of acute motor axonal polyneuropathy related to concomitant administration of cisatracurium and corticosteroid therapy.
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Affiliation(s)
- V Fodale
- Section of Anesthesia and Intensive Care Unit, Department of Neuroscience, Psychiatric and Anesthesiological Sciences, University of Messina, Policlinico Universitario G.Martino, I-98125 Messina, Italy.
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32
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Toyokura M, Fujii C, Urano T, Nishiya K, Ishida A. A case with acute quadriplegic myopathy following intensive care for idiopathic interstitial pneumonia. Tokai J Exp Clin Med 2003; 28:97-101. [PMID: 15055401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
We reported a patient who developed acute quadriplegic myopathy (AQM) following treatment with a combination of high-dose steroid and nondepolarizing blocking agent for idiopathic interstitial pneumonia (IIP). Few cases of AQM with IIP have been reported in the literature. The HP progressed rapidly in our patient, but the high-dose steroid therapy was effective. The rehabilitative intervention comprised of passive range-of-motion exercise, functional training, and muscle strengthening. After the initial presentation with severe weakness, the AQM gradually improved and the patient regained full physical function in 8 months. The clinical course was almost identical to that of AQM patients with other lung diseases. Though unlikely to influence the improvement of muscle weakness in AQM patients, the lung diseases associated with AQM may require specific consideration in determining suitable rehabilitation programs and observing patients before and after full recovery from dysmobility.
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Affiliation(s)
- Minoru Toyokura
- Department of Rehabilitation Medicine, Tokai University Oiso Hospital, Nakagun, Kanagawa, Japan.
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33
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Abstract
We report a case of severe hypokalemia and flaccid muscle paralysis following a suicide attempt associating the calcium channel blocker amlodipine, the antidepressant fluoxetine and barium carbonate. Despite rapid correction of severe, life-threatening hypokalemia, areflexic quadriplegia persisted, suggesting a direct effect of barium on muscle cells. Continuous veno-venous hemodiafiltration (CVVHDF) was initiated. We determined barium concentration in the urine, plasma, and hemodiafiltrate during CVVHDF. We subsequently calculated the amounts of barium eliminated both by the CVVHDF and the kidneys. CVVHDF triples the measured barium elimination, reduced serum barium half-life by a factor of three, stabilized serum potassium levels, and rapidly improved motor strength, with complete neurological recovery within 24 h. Presentation and treatment of barium intoxication are discussed.
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Affiliation(s)
- Marc Koch
- Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Brussels, Belgium.
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34
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Caird J, Brett F, McDonald K, Phillips J. Paralysed by streptokinase. Ir Med J 2003; 96:117-8. [PMID: 12793477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Affiliation(s)
- J Caird
- Department of Anatomy, RCSI, Dublin.
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35
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Abstract
Thallium poisoning is known for its diverse manifestations and these can delay the diagnosis if a clear history of poisoning is not forthcoming. A 42 year old man presented on the third day of illness with flaccid quadriparesis and paresthesia, which were confused with Guillain-Barré syndrome. Because of associated loose motions, skin lesions, and liver and kidney dysfunction arsenic poisoning was considered. In the second week he developed ophthalmoplegia, nystagmus, and neck tremor and later developed alopecia, and thallium poisoning was suspected. His serum thallium level on the 18th day of illness was 40 980 micro g/ml. He was subjected to haemodialysis, potassium supplementation, laxatives, and B complex supplementation. He showed significant improvement after haemodialysis and at three months he was able to walk with support. At six months of follow up he was independent for activities of daily living. Severe paresthesia, ophthalmoplegia, cerebellar and extrapyramidal signs, and alopecia are highly suggestive of thallium poisoning. Haemodialysis may be effective even in the third week of poisoning.
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Affiliation(s)
- U K Misra
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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36
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Abstract
BACKGROUND hyperkalaemic paralysis is a rare, treatable, and potentially fatal entity presenting with flaccid motor weakness. CASE REPORT a patient with acute hyperkalaemic paralysis caused by erroneous oral potassium supplementation in the context of chronic renal failure. The clinical picture of quadriplegia was initially interpreted as spinal cord injury due to a pathological cervical fracture. DISCUSSION the diagnosis of hyperkalaemic paralysis requires a high index of suspicion. Instructions for over-the-counter supplements must be clear and concise to prevent life-threatening medication errors.
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Affiliation(s)
- Oliver J Muensterer
- Department of Surgery, University of Munich, Lindwurmstrasse 4, 80337 Munich, Germany.
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37
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Fioredda F, Micalizzi C, Lanciotti M, Dufour C, Lamba LD, Fiocchi I. Reversible vincristine-related flaccid paralysis in a child with acute lymphoblastic leukemia. Med Pediatr Oncol 2002; 39:141-2. [PMID: 12116067 DOI: 10.1002/mpo.10072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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38
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Reinohs M, Straube T, Baum P, Berrouschot J, Wagner A. Recurrent reversible cerebral edema after long term immunosuppression with tacrolimus. J Neurol 2002; 249:780-1. [PMID: 12173578 DOI: 10.1007/s00415-002-0703-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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39
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Sherman PM, Belden CJ, Nelson DA. Magnetic resonance imaging findings in a case of cytarabine-induced myelopathy. Mil Med 2002; 167:157-60. [PMID: 11873541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
A 44-year-old white male with an isolated central nervous system relapse of acute lymphoblastic leukemia was treated with intrathecal cytarabine. He developed Staphylococcus epidermidis meningitis, which was treated successfully with intrathecal vancomycin. Four weeks after the initiation of intrathecal cytarabine, the patient developed progressive ascending paralysis to the upper cervical level. Initial magnetic resonance imaging of the brain and spine were normal, and cerebrospinal fluid evaluation showed no evidence of ongoing infection and clearance of lymphoblasts. Three weeks later, magnetic resonance imaging demonstrated marked edema and peripheral enhancement of the spinal cord, consistent with cytarabine toxicity.
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Affiliation(s)
- Paul M Sherman
- Department of Radiology, Wilford Hall Medical Center, 2200 Bergquist Drive, Suite 1, Lackland Air Force Base, TX 78236-5300, USA
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40
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Kumamoto T. [Necrotizing myopathies]. Ryoikibetsu Shokogun Shirizu 2002:239-42. [PMID: 11596379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- T Kumamoto
- Third Department of Internal Medicine, Oita Medical University
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41
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Abstract
FK506-induced polyneuropathies are rarely encountered. We report a case of axonal sensorimotor polyneuropathy in a lung transplant recipient that occurred during a FK506 overdosage. Onset was acute in the form of severe areflexic tetraparesis and resolution was observed after reduction of dosage. Because of increasing use of FK506 in solid organ transplantation, caution should be paid with FK506 dosage monitoring in cases of peripheral nervous system symptoms.
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Affiliation(s)
- Y Boukriche
- Department of Neurology, Beaujon Hospital, 100 Boulevard du Général Leclerc 92110, Clichy, France
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42
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Abstract
It is reported a case of quadriplegia occurring in a 67-year-old women after she commits suicide with flunitrazepam. The patient stayed during around twenty hours unconscious, in the sitting position, with an extreme flexion of the neck on the left side. After injection of flumazenil the patient's consciousness was restored. Nevertheless a complete sensitive and motor deficit at the C4 and C5 level was then observed. Several diagnosis such as peripheral neuropathy, infectious disease, or arterial occlusion were eliminated and we finally postulated that the regulation of the spinal blood flow had likely been disturbed by the prolonged flexion of the neck, the hypotension and the putative respiratory depression. The fact that the patient suffered from cervicarthrosis would have already impaired the spinal blood flow regulation and consequently had probably damaged the spinal cord. No clinical improvement of the quadriplegia was noticed and the patient died in the intensive care unit thirteen days after admission. Such an exceptional complication after a toxic coma remind us the necessity to avoid long lasting vicious position of the cervical spine in anaesthesia and emergency practice.
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Affiliation(s)
- F Morazin
- Département d'anesthésie-réanimation, CHU Jean Verdier, 93143 Bondy, France
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43
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Koley TK, Goyal AK, Gupta MD. Barium carbonate poisoning mimicking Guillain-Barre syndrome. J Assoc Physicians India 2001; 49:656-7. [PMID: 11584944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Areflexic quadriplegia due to barium carbonate (rat poison) poisoning is described in two young patients. These cases very closely resembled Guillain-Barre syndrome. The various effects of barium carbonate along with the pathogenesis of hypokalaemic paralysis are highlighted.
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Affiliation(s)
- T K Koley
- Department of Medicine, Hindu Rao Hospital, Delhi
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44
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Abstract
Thyrotoxic periodic paralysis is a rare endocrine disorder most prevalent among individuals of Asian descent that presents as proximal muscle weakness, hypokalemia, and signs of hyperthyroidism. We present an unusual patient with previous normal thyroid function who had abused thyroxine as antiobesity pills and developed periodic paralysis affecting the upper and lower limbs.
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Affiliation(s)
- Y C Chen
- Department of Medicine, Chang Gung Memorial Hospital, Kweishan, Taoyuan, Taiwan
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45
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Abstract
A 76 year old woman presented with a quadriparesis associated with hyperkalaemia. She had a 10 month history of treatment with oral diclofenac sodium. On admission she had hyperkalaemic metabolic acidosis with a normal anion gap and mild renal impairment. Her weakness resolved after withdrawal of diclofenac and medical correction of her hyperkalaemia. Non-steroidal anti-inflammatory drugs are known to cause hyperkalaemic acidosis and should be used with caution, especially in the presence of renal impairment.
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Affiliation(s)
- P Patel
- Department of Health Care of the Elderly, Glan Clwyd Hospital, Bodelwyddan, Rhyl, Denbighshire LL18 5UJ, UK
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46
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Abstract
Two major entities continue to be controversial in the field of clinical myotoxicity: the various myopathies that are induced by the cholesterol-lowering agents and the acute quadriplegic myopathy of intensive care. Both conditions are relatively common, but their pathogenesis is unclear. The problematic issues related to these disorders are presented, with suggested topics for future research.
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Affiliation(s)
- Z Argov
- Department of Neurology, Hadassah University Hospital and the Hebrew University-Hadassah Medical School, Jerusalem, Israel.
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47
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Abstract
OBJECTIVE To report a case of fulminant neuropathy with severe quadriparesis associated with vincristine chemotherapy. CASE SUMMARY A 48-year-old white man with acute lymphoblastic leukemia was started on an induction chemotherapeutic regimen that included intravenous vincristine. He received a total of 6 mg of vincristine over two weeks during induction chemotherapy. Over the next two weeks, he developed a fulminant peripheral neuropathy with severe quadriparesis. DISCUSSION Although commonly associated with peripheral neuropathy, vincristine neurotoxicity only rarely involves instances of fulminant peripheral neuropathy with severe quadriparesis. Guillain-Barré syndrome is also associated with leukemia and may present as a fulminant peripheral neuropathy with severe quadriparesis. CONCLUSIONS Fulminant neuropathy with severe quadriparesis occurring in patients with leukemia being treated with vincristine (and who do not have coexistent Charcot-Marie-Tooth disease) is more likely due to Guillain-Barré syndrome than to vincristine neurotoxicity.
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Affiliation(s)
- S S Moudgil
- Department of Neurology, West Virginia University Health Sciences Center, Morgantown 26506, USA
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48
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Abstract
The toxic effects of a gas depend on the time of exposure, concentration and its chemical nature. Pressurized liquids and gases exert an additional cold thermal injury and this may complicate the clinical picture. A patient who had an accidental exposure to liquid ammonia over a prolonged period, manifesting in cutaneous, respiratory and ocular damage in addition to a severe cold thermal injury (frostbite) with a fatal outcome is presented. The patient had flaccid quadriparesis and episodes of bradycardia, which has not been reported previously. These manifestations raise the possibility of the systemic toxicity in patients with prolonged exposure to ammonia.
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Affiliation(s)
- A George
- Al-Babtain Centre for Plastic, Reconstructive Surgery and Burns, Ibn Sina Hospital, P.O. Box 25427, Safat, Kuwait
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49
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Abstract
This patient presented with clinical features consistent with acute cervical myelopathy or Guillain–Barré syndrome but ventricular arrhythmias on the electrocardiogram alerted the authors to a possible toxic cause. The history of drug ingestion was then elucidated, indicating aconitine poisoning from herbal medicine. Aconitine-containing plants are the most frequently encountered herbal agents that cause serious toxicity in Hong Kong (Chan et al, 1993).
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Affiliation(s)
- W Mak
- Department of Medicine, Queen Mary Hospital, University of Hong Kong
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50
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Sato T, Takahashi K, Okuma Y, Mizuno Y, Noto K, Katae M, Dambara T, Fukuchi Y. [A senile case of acute necrotizing myopathy presenting prolonged severe muscle paralysis due to high dose glucocorticoid and muscle relaxant]. Nihon Ronen Igakkai Zasshi 2000; 37:250-4. [PMID: 10879076 DOI: 10.3143/geriatrics.37.250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
An 82-year old man was admitted with dyspnea, productive cough and wheezing. In addition to antibiotics (meropenem trihydrate 0.5 g/day), glucocorticoids (hydrocortisone 1.250 mg, methylpredonisolone 4.250 mg) were administered for the severe bronchospasms. Since his respiratory condition deteriorated, he underwent mechanical ventilation using a muscle relaxant (vecuronium bromide, total dose 776 mg) in combination with high dose glucocorticoid. As his pneumonia improved on the 10th hospital day, we started weaning him from the ventilator. However, we were unable to complete weaning from the ventilator because of prolonged quadriplegia and paralysis of the respiratory muscles. A few days later, myoglobinuria appeared. Electrophysiological examinations suggested the involvement of both neuromuscular junctions and muscles. Muscle biopsy showed rhabdomyolysis. Acute necrotizing myopathy was diagnosed due to high doses of glucocorticoid, muscle relaxant, or both. He required about 3 months to be weaned from the mechanical ventilation, and another 3 months to leave the hospital. Based on our experience, we should consider acute myopathy as an adverse effect of glucocorticoids, muscle relaxants or both in elderly patients who require mechanical ventilation.
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Affiliation(s)
- T Sato
- Department of Respiratory Medicine and Neurology, Juntendo University School of Medicine, Tokyo, Japan
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