Case 19-2017 — A 53-Year-Old Woman with Leg Numbness and Weakness

David, William S.; Bowley, Michael P.; Mehan, William A.; Shin, John H.; Gerstner, Elizabeth R.; DeWitt, John

doi:10.1056/nejmcpc1701762

Cited by 4 publications

(5 citation statements)

References 35 publications

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“…Tuberculosis placed a huge burden on developing countries (1). Spinal tuberculosis usually presents as back pain, but in severe cases, it also caused neurological impairment (5,10). In this case, treatment of the patient usually required surgical intervention (11).…”

Section: Discussionmentioning

confidence: 99%

Multiple Spinal Tuberculosis with Severe Kyphosis: A Case Report

Chen

Liu

et al. 2022

Front. Surg.

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BackgroundThe purpose of this study was to analyze the clinical efficacy of a patient with multiple tuberculosis of the spine combined with severe kyphosis.Case SummaryA 56-year-old male patient presented with low back pain with numbness and fatigue in both lower extremities for 5 months. Chest and back showed intermittent acid pain. The patient had not a history of constitutional symptoms. Preoperative X-ray and CT examination revealed multiple vertebral segmental bone destruction, multiple abscess calcification, and severe kyphosis. Preoperative MRI examination showed that the tuberculous abscess broke through the spinal canal and compressed the spinal cord and nerve roots. The patient underwent posterior lumbar abscess debridement, expanded decompression of the spinal canal, and nerve lysis in our hospital. The operation time was 70 min, and the intraoperative blood loss was 200 ml. The postoperative drainage volume was 250 ml. The patient was hospitalized for a total of 13 days, and the patient’s vital signs were stable before and after surgery. The patient was satisfied with the treatment.ConclusionFor the patient with multiple spinal tuberculosis complicated with severe kyphosis and multiple calcified abscesses in this study, we considered performing abscess debridement to relieve the symptoms of back pain and achieved good clinical efficacy.

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Section: Discussionmentioning

confidence: 99%

Multiple Spinal Tuberculosis with Severe Kyphosis: A Case Report

Chen

Liu

et al. 2022

Front. Surg.

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“…8 GBS-like features are a common presentation that, with the frequent lack of signs of systemic disease such as fever, weight loss, and night sweats, makes the diagnosis challenging, especially in children, where this condition is even rarer. 9 Weakness, ataxia, headache, or seizures are presenting signs in a few cases.…”

Section: Discussionmentioning

confidence: 99%

“…CSF shows leukocytosis with lymphocytic predominance, moderate to highly elevated protein level (above 200 mg/dL) in most of cases, and hypoglycorrhachia below 50 mg/dL in more than half of cases. 8,9 These CSF findings must raise the differential diagnosis of TB, neurosarcoidosis, and neoplastic infiltration by carcinoma, lymphoma, or leukemia. 5,8,9 In TB, neurologic impairment is usually associated with symptoms such as fever, headaches, and extraneurologic involvement.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 These CSF findings must raise the differential diagnosis of TB, neurosarcoidosis, and neoplastic infiltration by carcinoma, lymphoma, or leukemia. 5,8,9 In TB, neurologic impairment is usually associated with symptoms such as fever, headaches, and extraneurologic involvement. 9 In neurosarcoidosis, elevated protein level in CSF and hypoglycorrhachia are not so severe and pain is usually more prominent than weakness when the peripheral nervous system is involved.…”

Section: Discussionmentioning

confidence: 99%

“…5,8,9 In TB, neurologic impairment is usually associated with symptoms such as fever, headaches, and extraneurologic involvement. 9 In neurosarcoidosis, elevated protein level in CSF and hypoglycorrhachia are not so severe and pain is usually more prominent than weakness when the peripheral nervous system is involved. 10 Histology is the key for the final diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Reasoning: Rapidly progressive gait disorder and cranial nerves involvement in a 9-year-old boy

Lipp¹,

Adam²,

Brouland³

et al. 2020

Neurology

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A previously healthy 9-year-old boy presented with a history of fatigue for 3 weeks, pain in both calves for 2 days, and a mild cough, without fever. His medical history was negative and vaccinations were up to date. Examination by his pediatrician only showed decreased deep tendon reflexes (DTR) in both lower limbs. Blood count (white blood cells [WBC] 5.4 G/L, hemoglobin [Hb] 138 g/L, thrombocytes [Tc] 251 G/L), thyroid-stimulating hormone (1.76 mU/L), creatine kinase (CK) level (104 U/L), and erythrocyte sedimentation rate (3 mm/h) were all normal. Epstein-Barr virus monotest was negative and blood serology suggested a past infection. Walking difficulties with inability to climb stairs appeared on the following days. On admission (day 1), 1 week after leg pain onset, blood pressure was 108/73 mm Hg (90th percentile), heart rate 122/min (90th percentile), and respiratory rate 20/min (50th percentile). The child had no headaches. Given his young age, pain description was not possible, but it was neither paroxysmal nor triggered by touch and did not prevent sleep. Muscles were painless on palpation, there were no enlarged lymph nodes or organs, and testes were normal, as was lung auscultation. Neurologic examination showed mild proximal weakness of both upper and lower limbs (strength 4/5 Medical Research Council grade). DTR were decreased at 1 + on upper limbs, 0 on lower limbs. Cranial nerves examination showed ptosis and limited adduction and elevation of the left eye, limited abduction of the right eye, and right facial weakness. Funduscopy was normal. There were no meningeal, pyramidal, or cerebellar signs. Abdominal and cremasteric reflexes were present and sphincter function was unaffected. Pain, temperature, proprioception, vibration, and light touch sensation were normal. Questions for consideration: 1. What is your differential diagnosis? 2. What further testing would you propose? GO TO SECTION 2

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Skin‐Inspired Antibacterial Conductive Hydrogels for Epidermal Sensors and Diabetic Foot Wound Dressings

Zhao

Song

et al. 2019

Adv Funct Materials

412

298

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Recently, artificial intelligence research has driven the development of stretchable and flexible electronic systems. Conductive hydrogels are a class of soft electronic materials that have emerging applications in wearable and implantable biomedical devices. However, current conductive hydrogels possess fundamental limitations in terms of their antibacterial performance and a mechanical mismatch with human tissues, which severely limits their applications in biological interfaces. Here, inspired by animal skin, a conductive hydrogel is fabricated from a supramolecular assembly of polydopamine decorated silver nanoparticles (PDA@Ag NPs), polyaniline, and polyvinyl alcohol, namely PDA@Ag NPs/CPHs. The resultant hydrogel has many desirable features, such as tunable mechanical and electrochemical properties, eye‐catching processability, good self‐healing ability as well as repeatable adhesiveness. Remarkably, PDA@Ag NPs/CPHs exhibit broad antibacterial activity against Gram‐negative and Gram‐positive bacteria. The potential application of this versatile hydrogel is demonstrated by monitoring large‐scale movements of the human body in real time. In addition, PDA@Ag NPs/CPHs have a significant therapeutic effect on diabetic foot wounds by promoting angiogenesis, accelerating collagen deposition, inhibiting bacterial growth, and controlling wound infection. To the best of the authors' knowledge, this is the first time that conductive hydrogels with antibacterial ability are developed for use as epidermal sensors and diabetic foot wound dressing.

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Case 19-2017 — A 53-Year-Old Woman with Leg Numbness and Weakness

Cited by 4 publications

References 35 publications

Multiple Spinal Tuberculosis with Severe Kyphosis: A Case Report

Multiple Spinal Tuberculosis with Severe Kyphosis: A Case Report

Clinical Reasoning: Rapidly progressive gait disorder and cranial nerves involvement in a 9-year-old boy

Skin‐Inspired Antibacterial Conductive Hydrogels for Epidermal Sensors and Diabetic Foot Wound Dressings

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