We report the case of a 59-year-old woman who developed acute macroglossia following prolonged prone positioning for management of COVID-19. We found that Biotene mixed in glycerin was effective at removing keratinised lingual plaques and better tolerated than Biotene alone. Additionally, uniform tongue compression applied via tubular elastic dressing yielded more efficacious results than uneven tongue compression via Coban.
Charcot-Marie-Tooth disease comprises a vast array of defects in myelin integrity that causes progressive peripheral sensorimotor neuropathy. It is the most prevalent inherited peripheral neuropathy, and it can affect the management of coexisting medical conditions. We report the case of a 25-year-old woman who had undergone successful Fontan surgery during childhood, but her Fontan circulation failed as a result of diaphragmatic paresis caused by Charcot-Marie-Tooth disease type 1A. This diagnosis precluded cardiac transplantation.
HISTORY: 56 year old male referred to clinic for treatment of severe mid back pain which was present for the last month without associated trauma. Pain consistently occurred at night and was not relieved with medications. He endorsed some tingling bilaterally in his hands and feet. His urination flow had been slower and he noticed increased bowel urgency without incontinence. Since the pain had started, his exercise capacity went from biking 35 miles every other day to having a difficult time walking on the sidewalk as his legs felt heavy and he had poor balance. PHYSICAL EXAMINATION: Tenderness at T7-T8 spinous process. Wide-based gait. Lost balance easily when walking on toes and heels. 5/5 upper extremity strength bilaterally. 4/5 strength bilaterally with knee flexion, knee extension, plantarflexion, EHL, dorsiflexion. Reduced sensation to pinprick and light touch below knees bilaterally. 1+ reflexes bilaterally at patella, achilles, triceps, biceps, and brachioradialis. No clonus. Babinski negative. +Romberg. Negative straight leg raise and seated slump test. DIFFERENTIAL DIAGNOSIS: 1. Thoracic or cervical myelopathy 2. Thoracic or cervical cord compression from malignant lesion 3. Acute/chronic inflammatory demyelinating polyneuropathy 4. Transverse myelitis 5. Mononeuritis multiplex TESTS AND RESULTS Cervical MRI: C5-C6 severe spinal canal stenosis and flattening of the cord. Thoracic MRI: A 6-mm spinal cord lesion at the T8 level compatible with a cavernous malformation. Patient was urgently referred to Neurosurgery for evaluation of cervical spinal stenosis and thoracic cavernous malformation. He was directly admitted for further evaluation of demyelinating neuropathy or transverse myelitis. Work-up demonstrated: Brain MRI: Unremarkable EMG/NCS: Abnormal motor responses at bilateral peroneal, bilateral ulnar, right median, and right tibial nerves. Lumbar Puncture: albuminocytologic dissociation FINAL WORKING DIAGNOSIS Acute inflammatory demyelinating polyneuropathy TREATMENT AND OUTCOMES He received 3 doses of IVIG and his back pain resolved immediately. One week after his last IVIG dose, his gait & stair climbing normalized. There was minor residual numbness and weakness in hands and feet. Two months after admission, he returned to baseline exercise habits.
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