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PubMedDate not supplied

Rehabilitation outcomes of patients who have developed Guillain-Barré syndrome.

The objective of this study was to determine associations between early variables (requirement for ventilator support, anemia, indicators of abnormal peripheral nerve function (proprioception, vibratory, fine touch/pinprick, deep-tendon reflexes, cranial nerve involvement, dysautonomia, electrodiagnostic findings), plasmapheresis, age, and gender) and outcome variables (length of acute hospitalization, length of inpatient rehabilitation, Functional Independence Measure (FIM) Rasch converted scores, and acute and rehabilitation charges) in Guillain Barré Syndrome (GBS). The design of the study was a retrospective case review of 39 GBS admissions (as defined by National Institute of Neurologic Disorders and Stroke clinical criteria) to an inpatient rehabilitation unit at a university tertiary care rehabilitation center during a three-year period. The average length of stay for 39 patients requiring transfer to the inpatient rehabilitation unit (40% of all acute care GBS admissions) was 34 days in acute care and 26 days in rehabilitation. The average adjusted charges for inpatient rehabilitation (1993 dollars) was $31,636.28. Those who required ventilator support before rehabilitation v those who did not had an admission mean FIM Rasch converted motor score of 26.6 v a score of 38.3 (P = 0.0469), gained only 10.3 points on their FIM Rasch converted motor score v 27.7 points (P = 0.0001), and had a mean acute length of stay of 66.2 days v 19.3 days (P = 0.0029). Patients requiring ventilator support were more likely to have dysautonomia (P = 0.0009). Thirty-one of 39 patients with GBS (79%) had anemia. No correlation was found between hematocrit or hemoglobin and motor function recovery as assessed via the Rasch transformed FIM motor scores. There was an association between autonomic dysfunction and an increased acute care length of stay (P = 0.0325) and total length of hospital stay (P = 0.0203). Cranial nerve dysfunction resulted in an increase in the acute care length of stay (P = 0.0266), the total length of hospital stay (P = 0.0123), and adjusted hospital charges while undergoing inpatient rehabilitation (P = 0.0235). For patients with GBS necessitating admission to inpatient rehabilitation, the requirement of prior ventilator support most strongly predicts an extended length of stay for inpatient rehabilitation.

Adolescent↗
PubMedDate not supplied

Continuously infused intrathecal baclofen for spastic/dystonic hemiplegia: a preliminary report.

The objective of this study was to determine whether the continuous intrathecal delivery of baclofen will control spastic hypertonia associated with long-standing hemiplegia from acquired brain injury. Six hemiparetic patients (average age, 50 (range, 42-66) yr) with more than 6 mo of disabling lower limb spastic hypertonia on one side caused by either a unilateral traumatic brain injury or a stroke were recruited in a consecutive manner. The setting was a tertiary care outpatient and inpatient rehabilitation center directly attached to a university hospital. Patients were screened via a randomized, double-blind, placebo-controlled, crossover design to receive either an intrathecally administered bolus injection of normal saline or 50 microg of baclofen. Data for Ashworth rigidity scores, spasm scores, and deep tendon reflex scores were collected on the affected upper limb and lower limb side. Those who dropped an average of two points on their affected lower limb side Ashworth scores were then offered computer-controlled pump implantation for continuous intrathecal administration of baclofen. Differences over time were assessed via descriptive statistics and Wilcoxon's signed-rank test. After 3 mo of treatment, the average lower limb Ashworth score on the affected side decreased from 3.7 +/- 1.0 to 1.9 +/- 0.6 standard deviation (SD) (P < 0.0001), the reflex score from 1.8 +/- 1.3 to 0.5 +/- 0.8 SD (P = 0.0208), and the spasm score from 1.3 +/- 1.2 to 0.8 +/- 1.3 SD (P > 0.05). The average upper limb Ashworth score on the affected side decreased from 3.4 +/- 0.9 to 2.1 +/- 0.9 SD (P = 0.0002), the reflex score from 2.3 +/- 0.5 to 1.7 +/- 0.5 SD (P > 0.050, and the spasm score from 0.8 +/- 1.3 to 0 +/- 0 SD (P > 0.05). The average intrathecally administered dose of baclofen that was required to attain these effects was 205.3 microg, which was continuously infused for 24 h. Continuous intrathecal infusion of baclofen is capable of maintaining a reduction in the dystonia on the hemiparetic side without significantly affecting motor strength on the normal side.

Adult↗
PubMedDate not supplied

Myotoxicity and neurotoxicity during clozapine treatment.

Some recent studies have shown that clozapine (CLZ) has myopathic side effects and causes alterations in motor force control. The aim of this study was to evaluate the neurologic and electrophysiologic characteristics of patients with schizophrenia who are undergoing long-term CLZ treatment. Ninety-four patients with schizophrenia treated with CLZ for 18.2 +/- 15.5 months were studied retrospectively and prospectively (40% and 60%, respectively) for serum creatine kinase (CK) levels before and after initiation of CLZ treatment. An electrodiagnostic study was performed on patients with CK elevation above normal limits, complained of general weakness or muscle pains, and/or had abnormal clinically significant findings. In 13 patients (13.8%), abnormal CK levels were found. Six patients complained of some muscular weakness. In two patients, clinical assessment revealed mild general muscular weakness; one revealed decreased tendon reflexes and, in both, CK levels were above 1,750 IU/L. On electrophysiologic examinations performed in the six patients with abnormal neurologic findings, the motor and sensory nerve conduction velocity were within normal range in all but one patient, who exhibited some prolongation of distal latency in the lower limbs. In two patients, the electromyography demonstrated a myopathic pattern. In 2.1% of medically healthy patients with schizophrenia treated with clozapine on a long-term basis, signs of myotoxicity were found. It seems warranted to discontinue CLZ therapy in patients who exhibit abnormal CK levels and myopathic features during treatment. Further studies are needed to provide more objective data on the impact of CLZ treatment on muscle tissue.

Adult↗
PubMed1998

Extraordinary changes in behavior in an infant after a brief separation.

A previously healthy 8-month-old infant experienced a dramatic change in affect, motor patterns, and appetite after a brief (4-day) separation from her parents. She went from being a happy, interactive, and engaging child to being withdrawn, with limited vocalization, spontaneous motor activity, or interest in her environment. For the first 3 days after her parents returned home, she refused solid food and most of the formula or water she was offered. Over the following week, her appetite increased minimally. Her parents were concerned about her apathy, excessive quietness, and lack of interest in food, toys, or their own attempts to engage her in play. At the pediatrician's office, she was significantly less interactive and playful compared with previous visits. Her temperature, heart rate, and respiratory rate were normal. Although there were no objective signs of dehydration, her weight was 8 ounces less than the previous recorded weight 1 month ago. Results of the physical examination were normal, with the exception of neurological and behavioral findings. She had mild, generalized decreased tone and strength, with normal deep tendon reflexes, a sad facial appearance with sustained furrowing of the lines in her forehead, difficulty in eliciting a social smile, and limited spontaneous sounds. There was an absence of focal neurological findings, a flat open anterior fontanel, and a head circumference measurement consistent with previous recorded results. There were no cutaneous bruises, and findings of her funduscopic examination did not reveal retinal hemorrhage. Before the 4-day holiday, child care was provided almost exclusively by her mother at home. On only two previous occasions, at 4 and 6 months of age, this first child of 20-year-old high school graduate parents was cared for by a neighbor when the parents went out to a movie theater. She cried for about 10 minutes when the parents left on these occasions. Her mother stated that she felt anxious about leaving the child for several days, but she and her husband decided that they needed a break and planned the 4-day vacation. Child care was provided by the neighbor, who did not notice any unusual behavior or refusal to feed while in her care during the parents' absence.

Anxiety, Separation↗
PubMed2000

"What can I do to enhance the development of a premature infant with chronic lung disease?".

CASE. Timmy was born at 32 weeks of gestation after an uncomplicated pregnancy until there was a spontaneous rupture of the membranes and preterm labor associated with chorioamnionitis. A 2-month hospitalization in the neonatal intensive care unit (NICU) was associated with pneumonia, a Grade II intraventricular hemorrhage, chronic lung disease, and a slow weight gain in the nursery. He was discharged to home with plans for ongoing care by his pediatrician. The primary care pediatrician attended a multidisciplinary conference with the NICU staff and Timmy's parents. At the time of discharge from the nursery, at 38 weeks postconceptual age, Timmy still required oral diuretics and supplemental oxygen, as well as other medications such as iron. Timmy's respiratory rates were between 40 and 60 breaths per minute at rest, with mild intercostal retractions. He was discharged with a cardiorespiratory monitor. The discharge examination revealed mild to moderate symmetrical hypotonia with intact deep tendon reflexes, shoulder girdle weakness, and a mild head lag. Timmy would regard a human face and a bright object and would follow them briefly. He became active and would thrash his extremities with minimal tactile, bright light, or auditory stimulation. Typically, he settled slowly with swaddling and a pacifier. Nursing was slow to develop; he was currently receiving one half of his calories at the breast and the remainder of his calories from bottle-feeding of fortified expressed breast milk. As she prepared for the first office visit with Timmy and his parents, the pediatrician asked herself, "What can I do to enhance the developmental outcome for this child?"

Bronchopulmonary Dysplasia↗
PubMed2000

Safety of neck rotation for ear surgery in children with Down syndrome.

OBJECTIVE: Seek information about spinal cord safety for children with Down syndrome positioned for ear surgery. STUDY DESIGN: Prospective consecutive patients, each serving as his or her own control. METHODS: Somatosensory evoked potentials were recorded from 17 children who were undergoing elective otolaryngological surgery. None of the patients had neurological symptoms or physical examination findings suggesting cervical spinal cord embarrassment. Specifically, muscle tone was normal or mildly reduced globally, consistent with Down syndrome, and deep tendon reflexes were normal and not appreciably different in the upper and lower extremities. On plain lateral radiographs obtained in the neutral, flexed, and extended positions, the patients' cervical spines were normal. RESULTS: When the anesthetized children had their necks placed in either right or left 60 degrees rotation, no significant change in somatosensory latency or amplitude was found. With more than 99.999% certainty, neurologically intact children with Down syndrome with normal plain cervical spine radiographs were not exposed to extra risks by 60 degrees neck rotation during surgery. CONCLUSION: Patients with Down syndrome who are neurologically intact and who have normal lateral neck radiographs do not appear at great risk with neck rotation.

Adolescent↗
PubMed2004

Spastic diplegia and other motor disturbances in infants receiving interferon-alpha.

OBJECTIVE: To determine how frequently the use of -interferon (-IFN) is associated with the development of spastic diplegia. STUDY DESIGN AND METHODS: Meta-analysis of 600 English manuscripts published January 1991 to June 2002 reporting -IFN use in infants/children. We identified 3,113 children 18 years of age or younger and an estimated 3,055 children 12 years of age or younger who received -IFN therapy. Sixty-nine percent were treated for chronic hepatitis and 14% for vascular neoplasms. OUTCOME MEASURE: Neurologic examination to confirm spastic diplegia or a motor developmental disturbance other than spastic diplegia such as hyperactive deep tendon reflexes, gait disturbances, or impaired fine motor control. RESULTS: Including our index case, 11 of 441 children with vascular lesions developed spastic diplegia and an additional 16 of 441 developed a motor developmental disturbance. All of these children were less than 1 year of age at initiation of therapy. Mean age of initiation and duration of -IFN therapy were not significantly different between groups (P >.05); however, motor developmental disturbances improved with cessation of therapy, whereas spastic diplegia did not. No child receiving treatment for chronic hepatitis developed neurologic complications; however, only 49 children were less than 1 year of age at initiation of therapy. CONCLUSION: -IFN should not be used in infants under 1 year of age unless life-threatening conditions do not respond to any other form of treatment. If -IFN must be used, children should have monthly neurologic examinations. If a motor developmental disturbance is detected and -IFN therapy can be discontinued, it should be.

Adolescent↗
PubMed1990

Hydrosyringomyelia associated with a Chiari I malformation in children and adolescents.

The clinical presentation, radiological features, and results of surgical treatment were analyzed in 17 cases of hydrosyringomyelia associated with a Chiari malformation, in children and adolescents younger than 20 years of age. The initial symptoms were a skeletal abnormality (71%), such as scoliosis (11 patients) or pes cavus (1 patient), pain or numbness (24%), and motor weakness (6%). Frequently seen signs on admission were sensory deficit (100%), scoliosis (85%), muscle weakness (64%), muscle atrophy (35%), and lower cranial nerve palsy (35%). The characteristic neurological findings were unilateral sensory and motor deficits (65%) with decreased or absent deep tendon reflexes on the same side. The localization of the syrinx on the axial section varied according to the level, even in the same patient. In 11 patients with unilateral sensory disturbances or unilateral sensory and motor deficits, the syrinx was located in the region corresponding to the posterolateral portion on the same side as that of sensory disturbance at the cervical or thoracic level. On the other hand, in 6 patients with bilateral sensory and motor deficits, the syrinx was located in the central portion and extended into the posterolateral portion of the more affected side. A syringosubarachnoid shunt was placed in 16 patients, foramen magnum decompression without closure of the obex was performed in 1 patient, ventriculoperitoneal shunt in 1 patient, terminal syringostomy in 1 patient, and foramen magnum decompression with terminal syringostomy in 1 patient. In 15 of 17 patients (88%), the neurological symptoms improved after an average follow-up of 4 years and 1 month. We think that as a surgical treatment, placement of a syringosubarachnoid shunt is effective.

Adolescent↗
PubMedDate not supplied

Clinical characteristics of infant botulism in the United States: a study of the non-California cases.

We reviewed the clinical features of 99 cases of infant botulism reported to the Centers for Disease Control from states other than California for the period 1976 to 1980. There were no toxin-specific differences in the distribution of ages at onset or sex of the cases. For 76 (76%) patients for whom data were available the most common presenting symptoms were poor feeding (43%) and constipation (24%). Weak suck, poor head control, floppiness, weakness in extremities, difficulty swallowing, altered cry and constipation were reported in over three-fourths of the infants for whom data were available. Loss of facial expression, extraocular muscle paralysis, dilated pupils and depression of deep tendon reflexes occurred significantly more frequently among infants with type B botulism than among those with type A botulism. Ventilatory assistance was required for 61% of infants receiving aminoglycosides after the onset of weakness compared to only 26% of those infants not receiving aminoglycosides (P = 0.01). Infant botulism presents a characteristic clinical picture and should be suspected when an infant presents with weakness.

Aminoglycosides↗
PubMed1993

An ultrastructural study of the retina in human late infantile neuroaxonal dystrophy.

A case involving a girl who died at 11 years of age and who had developed normally until the age of 18 months, at which time further psychomotor maturation stopped and then regressed, is reported. The patient appeared hypotonic and showed loss of deep tendon reflexes, as well as bulbar signs and increasing immobility. Visual impairment resulted in blindness at the age of 7 years. Her disease was diagnosed as late infantile neuroaxonal dystrophy (LINAD) after examination of sural nerve biopsy samples and after autopsy. Under electron microscopy, retinal axons were filled with tubulocisternal profiles and occasional large lamellar clefts close to or distant from synaptic complexes. These lesions, typical of LINAD, were largely found in interior layers of the retina rather than in outer ones. As photoreceptors were preserved and their synaptic contacts within the outer nuclear layer appeared somewhat intact, blindness in LINAD is of the neuronal type, possibly all along the pathway from the bipolar retinal layer to the striate cortex. The findings also indicate that only particular types of axons or synaptic complexes may be involved in LINAD, and that the formation of lesions characteristic of LINAD is not ubiquitous within the retina. The cause for this selective involvement of retinal structures in LINAD remains to be resolved.

Axons↗
PubMed2002

Treatment of craniocervical spine lesion with osteogenesis imperfecta: a case report.

STUDY DESIGN: A case report of craniocervical spine lesions including basilar impression, atlantoaxial dislocation, and syringomyelia, with osteogenesis imperfecta is presented, and the literature is reviewed. OBJECTIVE: To discuss the problems involved in the surgical management of craniocervical spine lesion with osteogenesis imperfecta. SUMMARY OF BACKGROUND DATA: Osteogenesis imperfecta is known to have various spine lesions as complications. However, few reports have described craniocervical lesions associated with osteogenesis imperfecta. METHODS: A 14-year-old girl with osteogenesis imperfecta, Silence classification IVB, experienced difficulty walking, with marked motor disturbance and muscle weakness in the extremities. Deep tendon reflexes were exaggerated bilaterally in the upper and lower extremities, and positive Babinski reflex and ankle clonus were observed bilaterally. Basilar impression, atlantoaxial dislocation, and syringomyelia were shown by plain radiography, tomography, three-dimensional computed tomography, and magnetic resonance imaging. RESULTS: In the reported patient, posterior fossa decompression and atlantoaxial posterior fusion could not be performed because the foramen magnum and upper cervical spine invaginated to the base of the skull. Therefore, occipitocervical spine fusion using titanium loop and wires was performed at the reduced position of the atlantoaxial dislocation, resulting in improvement of neurologic deficits. CONCLUSIONS: For patients with atlantoaxial dislocation, syringomyelia, and basilar impression without clinical symptoms or signs of brain stem compression, occipitocervical spine fusion alone at the reduction of the atlantoaxial dislocation may be indicated because these procedures improve neurologic deficits and prevent postoperative development of basilar impression and enlargement of syringomyelia.

Adolescent↗
PubMed2004

Distal-type cervical spondylotic amyotrophy: assessment of pathophysiology from radiological findings on magnetic resonance imaging and epidurally recorded spinal cord responses.

STUDY DESIGN: Six cases with distal-type cervical spondylotic amyotrophy are reported. OBJECTIVE: To investigate the pathophysiology of distal-type cervical spondylotic amyotrophy from magnetic resonance imaging and intraoperative evoked spinal cord responses. SUMMARY OF BACKGROUND DATA: Cervical spondylotic amyotrophy had a characteristic clinical symptom of severe muscular atrophy with no or insignificant sensory deficit. Selective ventral root lesions or intrinsic spinal cord lesions have been proposed as the pathophysiology of cervical spondylotic amyotrophy, but they have not been well understood. METHOD: Six patients with distal-type cervical spondylotic amyotrophy were described, and their magnetic resonance imaging and evoked spinal cord potentials after median nerve, motor cortex, and spinal cord stimulation were investigated. RESULTS: Sagittal T2-weighted magnetic resonance imaging showed high signal intensity change within the spinal cord at C4-C5, C5-C6, and C6-C7. All patients underwent laminoplasty. The attenuation of postsynaptic potentials with preserved presynaptic potentials at C4-C5, C5-C6, and C6-C7 was characteristic in the evoked spinal cord potentials after median nerve stimulation. The amplitude of the evoked spinal cord potentials after median nerve stimulation was preserved at C2-C3. This means that lateral posterior column in the spinal cord had less or no involvement in distal-type cervical spondylotic amyotrophy. Concomitant hyperactivity of the patellar tendon reflex was correlated with the abnormality in the evoked spinal cord potentials after transcranial electric stimulation. CONCLUSIONS: The results suggest a longitudinal gray matter lesion as one pathophysiologic feature, and that less damage to the lateral posterior column is the reason for the preservation of sensory function in the patients with distal-type cervical spondylotic amyotrophy described in this study.

Aged↗
PubMed1988

The effect of pancreas transplantation on diabetic polyneuropathy.

Neuromuscular function was evaluated in long-term type I diabetic patients who retained a functioning pancreas graft. A group of 34 patients was examined at 1 year and another group of 11 patients at 2 years after pancreas transplantation. In this report the clinical and electrophysiological course of motor features of polyneuropathy are described. Before pancreas transplantation, clinical evidence of polyneuropathy was present in all patients. The mean motor nerve conduction velocities (NCV) were below normal and the mean amplitude of the evoked muscle action potentials (MAP) were in the low normal range. The observed abnormalities of muscle strength and tendon reflexes had not progressed in these intervals. Motor NCV improved slightly and MAP amplitude was essentially unchanged. These preliminary results indicate that the progression of diabetic polyneuropathy may be halted by successful pancreas transplantation.

Adolescent↗
PubMed1998

Neurological aspects of adult phenylketonuria.

Phenylketonuria, an autosomal recessively transmitted disorder of amino acid metabolism, is caused by a deficiency of hepatic phenylalanine hydroxylase converting phenylalanine to tyrosine. Thus, phenylalanine accumulates to plasma levels exceeding 1200 mumol/l. Untreated phenylketonuria is characterized by microcephaly, epilepsy, severe mental retardation and, in some cases, progressive supranuclear motor disturbances. These symptoms can largely be prevented by the early start of a phenylalanine-restricted diet. Neurological investigations of treated patients reveal only minor neurological signs, such as tremor or brisk deep tendon reflexes. Magnetic resonance imaging shows white matter abnormalities. However, in single patients, progressive neurological symptoms occurred. Thus, the long-term prognosis of treated phenylketonuria is still under discussion.

Adult↗
PubMed1996

Epidural hematoma of a cauda equina in a child with hemophilia A.

PURPOSE: The presenting signs, treatment, and outcome of an epidural hematoma of the cauda equina in a child with severe hemophilia are reported for the first time. PATIENTS AND METHODS: A 20-month-old boy with severe hemophilia A (factor VIII <0.01 U/ml) presented with a 12-day history of refusal to stand and constipation of 5-7 days duration. He had normal deep tendon reflexes with normal sensation and withdrawal to pinprick of his lower extremities bilaterally. He stood on his right leg, but had inversion of his left foot and refused to bear weight on his left leg. MRI revealed an epidural hematoma of the cauda equina and a distended bladder. Factor VIII replacement therapy and lumbosacral laminectomy with evacuation of the hematoma resulted in recovery of a normal gait, but bladder dysfunction persisted for 11 months. Clean intermittent catheterization (CIC) was required until bladder function returned. RESULTS: Complete neurologic recovery occurred 11 months after presentation CONCLUSION: This case demonstrates the following points: (a) an epidural hematoma of the cauda equina in a child with severe hemophilia can present with neurologic findings that are as subtle as those seen in normal children; (b) CIC can be performed safely over an extended period without factor VIII replacement; and (c) complete recovery is possible, despite prolonged bladder dysfunction and a 12-day interval between the onset of symptoms and treatment.

Cauda Equina↗
PubMedDate not supplied

Kasabach-merritt phenomenon: a retrospective study of treatment with vincristine.

PURPOSE: Kasabach-Merritt phenomenon (KMP) is characterized by profound thrombocytopenia, microangiopathic hemolytic anemia, a consumptive coagulopathy, and an enlarging vascular lesion. The syndrome develops in infancy and is associated with a high morbidity and mortality rate. The purpose of this study was to assess the effectiveness of vincristine in the treatment of KMP. METHODS: We retrospectively reviewed the clinical and laboratory data of 15 patients with KMP treated with vincristine at 9 institutions across the United States, South America, and Europe. RESULTS: All 15 patients had profound thrombocytopenia and consumption of fibrinogen at presentation. Ten patients had biopsies of their lesions, and results included five (33.3%) kaposiform hemangioendotheliomas, three (20%) tufted angiomas, one lesion (6.7%) with features of both kaposiform hemangioendothelioma and tufted angioma, and one (6.7%) unclassified vascular tumor. All 15 patients had an increase in platelet count of at least 20,000 with an average response time of 4.0 weeks after initiation of vincristine therapy. Thirteen patients had an increase in fibrinogen level of 50 mg/dL with an average response time of 3.4 weeks. In 13 patients there was a significant decrease in the size of the vascular lesion. The average duration of treatment was 21.5 (+/-12.6) weeks. Four patients (26%) relapsed. All four were successfully treated with a second course of vincristine. Complications included one patient with abdominal pain, one patient with transient loss of deep tendon reflexes, and one patient with irritability. CONCLUSION: Vincristine presents a safe and sometimes effective treatment option in the management of KMP.

Antineoplastic Agents, Phytogenic↗
PubMed2002

Critical illness polyneuropathy.

Critical illness polyneuropathy (CIP) is a syndrome that was first extensively described in the early 1980s, mainly in patients with failure to wean from mechanical ventilation. The syndrome is further characterized by limb muscle weakness, usually more pronounced distally than proximally, and is often accompanied by atrophy. The facial musculature is often strikingly spared. Reduced or absent deep-tendon reflexes and loss of peripheral sensation to light touch and pin prick often accompany the syndrome. Involvement of the phrenic nerve has been shown to further contribute to delayed weaning from the ventilator in many patients. The electrophysiologic studies are consistent with a predominantly motor and, often to a lesser extent, sensory axonal polyneuropathy. The incidence of CIP is high, with often more than 50% of patients in major medical and surgical critical care units suffering from the syndrome. The systemic inflammatory response syndrome (SIRS) is strongly associated with CIP and, among the multiorgan failure often seen in SIRS, CIP is thought to represent a neurologic manifestation of SIRS. The neurologic effects of SIRS are thought to be mediated by released mediators like cytokines and free radicals, affecting the microcirculation of the central and peripheral nervous system. Examination of the peripheral nervous system is often unreliable, and the only way to establish a definitive diagnosis is by performing electrophysiologic studies. Morbidity and mortality rates are high. If the underlying problem causing sepsis and/or SIRS can be treated successfully, full recovery from CIP can occur. This recovery often occurs in a matter of weeks in milder cases and in months in more severe cases. Knowledge of CIP is essential for intensivists and other specialists who care for critically ill patients. This review summarizes the current available literature on this topic.

Algorithms↗
PubMed2002

Hysterical paralysis: a report of three cases and a review of the literature.

STUDY DESIGN: Three cases of hysterical paralysis are reported and the literature is reviewed. OBJECTIVE: To report and discuss three cases of psychogenic paraplegia in order to increase the awareness and assist in the diagnosis and treatment of this uncommon disorder. SUMMARY OF BACKGROUND DATA: Hysterical paralysis, a form of conversion disorder, is an uncommon psychogenic, nonorganic loss of motor function precipitated by a traumatic event. The prevalence of conversion disorder in the general population reportedly is between 5 and 22 per 100,000 persons. The pursuit of a diagnosis for the hysterical paraplegic patient necessarily consumes valuable resources and time. If early recognition can be facilitated, these resources may be conserved. METHODS: The medical records for three healthy young women who presented to the authors' service reporting complete loss of lower extremity function were reviewed retrospectively along with the related laboratory, electrodiagnostic, and imaging studies. Two of the women were involved in motor vehicle accidents. One had a history of a previous hysterical seizure. Inconsistencies in physical examination and studies were noted. RESULTS: All three patients had normal laboratory, electrodiagnostic, and imaging studies. Discrepancies included complete loss of motor control and sensation in the lower extremities in the face of normal deep tendon reflexes as well as incontinence of bowel and bladder despite intact rectal tone. The patients spontaneously recovered and ambulated out of the hospital without assistance after their normal test results and physical examination inconsistencies were presented to them. CONCLUSIONS: Hysterical paraplegia is a type of conversion disorder. It is a diagnosis of exclusion that typically presents as mono-, hemi-, para-, or quadriplegia. The pursuit of a diagnosis for the hysterical paraplegic patient necessarily consumes valuable resources and time. The typical patient is a female from a low socioeconomic background with limited education. The DSM-IV-TR criteria must be met to fulfill the diagnosis of conversion disorder. Electrodiagnostic and imaging studies can aid in the diagnosis. Treatment revolves around explaining the normal diagnostic results to the patients and guiding them to appropriate psychiatric and physiotherapy. Rapid recovery should be expected, but can take up to 6 months.

Accidents, Traffic↗