Aim:Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and is one of the most common requests for electrodiagnosis. We aimed to note the relationship of subjective symptom severity of CTS, with objective electrophysiological severity and psychological status of patients.Patients and Methods:One hundred and forty-four consecutive patients of CTS referred to neurophysiology laboratory of a tertiary care hospital over 1 year were prospectively studied. Boston CTS Assessment Questionnaire (BCTSAQ) and visual analog scale (VAS) were used to assess subjective symptom severity. Psychological status was assessed by Hospital Anxiety and Depression Scale (HADS). Electrophysiological severity of CTS was estimated by median motor distal latency and median to ulnar peak sensory latency difference across the wrist. Each parameter in both hands was scored from 0 to 3 depending on the severity grade, and a composite electrophysiological severity score (CEPSS) was calculated for each patient by summing up the scores in both hands. Statistical analysis was done by Spearman's rank correlation test.Results:There was significant correlation of BCTSAQ with VAS (P = 0.001), HADS anxiety score (P < 0.001), and HADS depression score (P = 0.01). CEPSS had no significant correlation with VAS (P = 0.103), HADS anxiety score (P = 0.211), or HADS depression score (P = 0.55). CEPSS had a borderline correlation with BCTSAQ (P = 0.048).Conclusions:While the subjective symptoms of CTS are well correlated with psychological factors, their correlation with objective electrophysiological severity is weak. Hence, prompt treatment of psychological comorbidity is important in symptomatic management of CTS; decision about surgical intervention should be based on electrophysiological severity rather than symptom severity.
Mononeuritis multiplex involves inflammation of two or more nerves, typically in unrelated parts of the body. It has been well described in bleeding disorders like idiopathic thrombocytopenic purpura (ITP) and Hemophilia. Acquired amegakaryocytic thrombocytopenia (AAT) is a bleeding diathesis characterized by thrombocytopenia but with reduced number of megakaryocytes in the bone marrow, as against ITP. Though AAT is a well described entity, peripheral nervous system manifestations have not been described so far. We report a young man who has presented with bleeding diathesis and mononeuritis multiplex due to AAT. The mechanism of development of mononeuritis multiplex and treatment options are discussed.
Background:The objective of the study was to compare the actual results of intravenous thrombolytic therapy (IVTT) in acute ischemic stroke with results anticipated by neurologists in practice.Methods:Neurologists practicing in Thrissur metropolitan region, covering a population of 1.8 million, were telephonically surveyed about the number of yearly IVTT and their expert opinion/comment about effects of thrombolysis. This was compared with the results of IVTT from a single institution in the same region from 2012 to 2016.Results:Eight neurologists in the region give approximately 140–150 IVTT per year. Nearly 20%–40% (median 32%) patients have good outcome, 5%–10% (median 9%) have intracerebral hematoma (ICH), and 25%–35% (median 30%) have death/bad outcome. Two neurologists from a tertiary care hospital in the region treated 122 cases of ischemic strokes with IVTT from 2012 to 2016. Age ranged from 8 to 88 years and 88 were males. Average delay in reaching hospital was 138.1 min and the door-to-needle time was 56.3 min. There were 26 cases of posterior-circulation strokes and 14 cases of cardioembolic strokes. At presentation, average National Institute of Health Stroke Scale (NIHSS) was 14.7; Modified Rankin Scale (mRS) 0.4; and CT Alberta Stroke Program Early Computerized Tomography Scores was 9.5. Good and sustained benefit (GSB) (>4 reduction in NIHSS at 24 h and 7 days) was there in 49% and no improvement (NI)/worsening in 36%. mRS 0–2 at discharge/30 days was documented in 57.3%. Symptomatic ICH was 10% (12/122) and mortality rate was 11.5% (14/122). GSB in posterior circulation strokes was 69.2% and NI/worsening in only 7.7%. mRS was 0–2 in 77% of posterior circulation strokes.Conclusion:Contrary to the popular belief of the practicing neurologists, IVTT has a high percentage of good outcome with a reasonable bleeding risk and low rates of absolute futility.
Micro-Embolic Signals (MES) detected by Trans-Cranial Doppler (TCD) in symptomatic carotid stenosis (CS) are considered a marker of subsequent stroke. We aimed to investigate the role of antiplatelet and antithrombotic agents in abolishing the MES in recently symptomatic CS. Materials and Methods: Transient ischemic attack/stroke patients with 50%CS or unstable carotid plaque, who were prospectively enrolled within 48hours of symptom onset, underwent bilateral middlecerebral artery one-hour TCD emboli monitoring within 48hours. Those with MES underwent second monitoring at 48hours of the initial study. Treatment given during the interval period was recorded. Results: Out of 73 patients enrolled from April 2016 to March 2019, 22 (17 males, mean age 67.4years) had ipsilateral MES on initial TCD (30.1%). Ten were on a single-antiplatelet agent (aspirin/clopidogrel) and one was on dual (aspirin&clopidogrel) therapy prior to this. Single-antiplatelet agent was started after TCD in seven, dual-agents in six and unfractionated-heparin in seven patients. Second TCD showed no MES in 14 patients. Only one out of three on a single antiplatelet agent alone had abolition of MES while all ten patients on dual-antiplatelet agents had a complete suppression (p=0.027,Chi-square test). Although heparin suppressed MES in 5/7 patients, all five had additional dual-agent therapy. MES was not abolished in one patient treated with heparin alone and another one on a combination of heparin and single-antiplatelet agent. Conclusion: Aspirin/Clopidogrel combination is very effective in suppressing arterial emboli in recently symptomatic carotid stenosis whereas unfractionated-heparin, single-antiplatelet agent or their combination is not useful for the same.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.