The ongoing global administration of vaccines for coronavirus disease 2019 (COVID-19) means that increasing numbers of patients are likely to present with post-vaccination complications. We describe the first reported case of neuralgic amyotrophy (NA) involving the lumbosacral plexus occurring after AstraZeneca COVID-19 vaccination. The patient presented with acute-onset leg paralysis following administration of the vaccine. Based on the clinical, electrodiagnostic, and radiologic findings, the patient was diagnosed with post-vaccination NA. We speculate that the COVID-19 vaccine elicited an immune-mediated inflammatory response to the injected antigen due to inflammatory immunity in a patient with predisposed susceptibility to NA.
Adhesive capsulitis of the shoulder joint is a common disease characterized by pain at the insertional area of the deltoid muscle and decreased range of motion. The pathophysiological process involves fibrous inflammation of the capsule and intraarticular adhesion of synovial folds leading to capsular thickening and contracture. Regarding the multidirectional limitation of motion, a limitation in external rotation is especially prominent, which is related to not only global fibrosis but also to a localized tightness of the anterior capsule. Ultrasound and magnetic resonance imaging studies can be applied to rule out other structural lesions in the diagnosis of adhesive capsulitis. Hydraulic distension of the shoulder joint capsule provides pain relief and an immediate improvement in range of motion by directly expanding the capsule along with the infusion of steroids. However, the optimal technique for hydraulic distension is still a matter of controversy, with regards to the infusion volume and rupture of the capsule. By monitoring the real-time pressure-volume profile during hydraulic distension, the largest possible fluid volume can be infused without rupturing the capsule. The improvement in clinical outcomes is shown to be greater in capsule-preserved hydraulic distension than in capsule-ruptured distension. Moreover, repeated distension is possible, which provides additional clinical improvement. Capsule-preserved hydraulic distension with maximal volume is suggested to be an efficacious treatment option for persistent adhesive capsulitis.
Objective: Venous thromboembolism is a serious life-threatening complication of S SCI. Measurement of D-dimer levels is used as a screening test for deep vein thrombosis. However, trauma, surgery, and motor weakness are known as factors that affect D-dimer levels. Thus, the aim of this study was to examine the correlation between D-dimer levels and deep vein thrombosis in relation to the comorbidities in acute spinal cord injury. Design: A retrospective observational study was conducted at a hospital's rehabilitation department. Forty-five patients without pharmacologic thromboembolic thromboprophylaxis 5−90 days after the onset of injury were enrolled. Results: Fourteen patients (31%) were diagnosed with deep vein thrombosis using duplex ultrasonography. The mean ± SD D-dimer levels were 2.15 ± 2.74 and 6.98 ± 7.46 μg/ml in the deep vein thrombosis-negative and deep vein thrombosis-positive groups, respectively. The lower limb motor index scores significantly correlated with D-dimer levels regardless of the time between the onset of spinal cord injury and D-dimer testing. Patients with trauma had significantly increased D-dimer levels compared with patients without trauma. Conclusion: Although D-dimer levels have limitations with regard to the positive prediction of acute spinal cord injury, it is a useful screening parameter for deep vein thrombosis. Trauma and lower limb motor weakness should be considered when analyzing D-dimer levels.
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