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Sample records for torticollis

  1. [Bilateral torticollis].

    Science.gov (United States)

    Kustos, T; Magdics, M

    1993-12-19

    Bilateral torticollis is a very rare form of a well known deformity i.e. muscular torticollis. This malformation might present a differential diagnostic problem both for orthopaedic surgeons and ophthalmologists, as well as, for neurologists. In agreement with the literature, the role of an injury during labour or defective embriogenesis is suggested to play a part.

  2. Surgical management of spasmodic torticollis

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    Wael Fouad

    2011-12-01

    Full Text Available Introduction: Spasmodic torticollis (ST is a neuromuscular disorder characterized by uncontrolled clonic and intermittently tonic spasm of the neck muscles. Objective: This retrospective study was done to study clinical picture and to evaluate the surgical results of different surgical procedures in 11 patients who had spasmodic torticollis. Methods: The male to female ratio was 1–2 (4 males and 7 females and their ages ranged from 18 to 65 years. The X-ray of the cervical spine was performed before the operation to exclude cervical disorders that can cause symptoms similar to spasmodic torticollis. MRI of the head and neck was performed in all patients, without finding significant brain lesions. Electromyography of the cervical muscles was performed preoperatively and postoperatively. All cases underwent surgery in the form of variable combinations of ventral rhizotomy of C1, C2+ selective peripheral denervation of neck muscles involved according to the type of torticollis. Mean postoperative follow up period was 24 months. Results: There was no operative mortality. As regards the morbidity, one patient had deficiency of shoulder elevation that was transient and improved after 3 months; one patient had wound infection that responded well to antibiotics after culture and sensitivity. Postoperative dysphagia was found in two cases that improved in one of them after two months. At the last follow up examination period, excellent results were obtained in 55% of patients, good results in 18% of patients, fair results in 18% of patients, and poor results in 9% of cases. Conclusion: There is no standard surgical procedure for treatment of ST; this is adapted to each patient according to type of torticollis. Better results were obtained in simple torticollis (excellent results in 100%, than in complex type (excellent and good results in 33.3%. Keywords: Focal dystonia, Spasmodic torticollis, Anterior rhizotomy, Selective denervation

  3. Spasmodic torticollis: the dental connection.

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    Sims, Anthony B; Stack, Brendan C; Demerjian, G Gary

    2012-07-01

    Spasmodic torticollis or cervical dystonia (CD) is the most common form of focal dystonia and is characterized by sustained abnormal muscle contractions in the head and neck area resulting in abnormal positioning or posturing of the head. The dystonic muscle spasms associated with spasmodic torticollis may affect any combination of neck muscles. Three cases are reported of spasmodic torticollis that were treated by a dental appliance with individual varying occlusal heights to open the maxillomandibular vertical dimension. Upon increasing the vertical dimension of occlusion, there was a slowing and/or discontinuance of the symptoms of cervical dystonia. The proposed hypothesis for this reversal is that there may be neuritis of the auriculotemporal branch of the trigeminal nerve, which has direct input into the reticular formation (RF), and it may activate the cells of the pontine region of the RF known for the control and deviation of head posture. There is growing clinical evidence that temporomandibular joint (TMJ) dysfunction may be a factor in this neurological and painful disorder when it coexists.

  4. Benign paroxysmal torticollis in infancy

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    Dimitrijević Lidija

    2006-01-01

    Full Text Available Background. Benign paroxysmal torticollis (BPT is an episodic functional disorder of unknown etiology, characterized by the periods of torticollic posturing of the head, that occurs in the early months of life in healthy children. Case report. We reported two patients with BPT. In the first patient the symptoms were observed at the age of day 20, and disappeared at the age of 3 years. There were 10 episodes, of which 2 were followed by vomiting, pallor, irritability and the abnormal trunk posture. In the second patient, a 12-month-old girl, BPT started from day 15. She had 4 episodes followed by vomiting in the first year. Both girls had the normal psychomotor development. All diagnostical tests were normal. Conclusion. The recognition of BPT, as well as its clinical course may help to avoid not only unnecessary tests and the treatment, but also the anxiety of the parents.

  5. Is it an acute Mastoiditis with Torticollis?

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    Antonio Greco

    2014-03-01

    Full Text Available Retropharyngeal abscess is uncommonly after acute pharyngitis,. We reported a case of a deep neck abscess with torticollis in a youngwoman, misdiagnosed. Retropharyngeal abscess with mediastinal extension is a rare life-threatening complication with a mortalityrate as high as 40%.When a patient shows a torticollis with fever we must suspect a deep neck infection could be present and it is necessary to perform aTC or MRI of the neck. A retropharyngeal abscess rarely occurs but must be suspected otherwise the abscess can advance toward themediastine and cause a mediastinitis that could be very dangerous for patient’s healthy.

  6. Body Concept, Disability, and Depression in Patients with Spasmodic Torticollis

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    M. Jahanshahi

    1990-01-01

    Full Text Available Eighty-five patients with idiopathic spasmodic torticollis were compared with an equally chronic group of 49 cervical spondylosis sufferers in terms of body concept, depression, and disability. The torticollis patients were significantly more depressed and disabled and had a more negative body concept. Depression had different determinants in the two groups. Extent of disfigurement was a major predictor of depression in torticollis. Neuroticism accounted for the greatest proportion of the variance of depression in cervical spondylosis.

  7. Proton MR spectroscopy in idiopathic spasmodic torticollis

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    Federico, F.; Lucivero, V.; Simone, I.L.; Defazio, G.; De Salvia, R.; Mezzapesa, D.M.; Petruzzellis, M.; Tortorella, C.; Livrea, P. [Dept. of Neurology and Psychiatry, Bari (Italy)

    2001-07-01

    Single-voxel proton magnetic resonance spectroscopy ({sup 1}H-MRS), localised to the basal ganglia, was used to determine changes in metabolite levels in idiopathic spasmodic torticollis (IST). We examined nine patients and 13 healthy subjects. The mean values ({+-} SD) of peak area ratios were: IST: N-acetyl-aspartate (NAA)/choline-containing compounds (Cho) 1.79 {+-} 0.39, NAA/creatine and phosphocreatine compounds (Cr) 1.61 {+-} 0.38, Cho/Cr 0.91 {+-} 0.19; controls: NAA/Cho 2.07 {+-} 0.35, NAA/Cr 1.82 {+-} 0.31, Cho/Cr 0.89 {+-} 0.12. Statistical analysis showed that NAA/Cho and NAA/Cr were significantly lower in patients than in controls (P = 0.0304 and 0.0431, respectively). These results indicate a reduction in NAA, and suggest striatal involvement in the pathogenesis IST. (orig.)

  8. Isolated Torticollis May Present as an Atypical Presentation of Meningitis

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    Roger Chirurgi

    2012-01-01

    Full Text Available Background. Bacterial meningitis is a life-threatening medical emergency that requires urgent diagnosis and treatment. Diagnosis is infrequently missed if the patient presents with the classic symptoms of fever, headache, rash, nuchal rigidity, or Kernig or Brudzinski sign. However, it may be less obvious in neonates, elderly, or immunocompromised patients. Meningitis which presents as isolated torticollis, without any other signs or symptoms, is exceedingly rare. Objective. To identify an abnormal presentation of meningitis in an adult immunocompromised patient. Case Report. We present a case of an adult diabetic male who presented multiple times to the ED with complaint of isolated torticollis, who ultimately was diagnosed with bacterial meningitis. Conclusion. We propose that in the absence of sufficient explanation for acute painful torticollis in an immunocompromised adult patient, further evaluation, possibly including a lumbar puncture may be warranted.

  9. An apparatus for a complimentary treatment of spasmodic torticollis.

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    Saito, I; Weiss, T

    1988-07-01

    We have developed an apparatus for treating spasmodic torticollis that can be used at home both during intensive therapy and follow-up. The refractoriness of spasmodic torticollis requires patients to practice biofeedback training partly on a home basis. However, it is usually difficult for spasmodic torticollis patients to provide and handle electromyographic (EMG) biofeedback training instruments. The present apparatus has 2 parts: first, a harness with a light source which is fixed on both shoulders; second, a photoreceptor, operant system for rewarding effect, and a digital recorder. The light is adjusted to strike the photoreceptor on the forehead when headposition is normal. Subjects are asked to keep the operant system--e.g. a radio--activated. They are trained in various postures as sitting, standing and walking. This apparatus provides a chance of home training to augment and maintain the effect during therapeutic sessions and the follow-up period.

  10. Benefit of physiotherapeutic treatment in children with torticollis

    DEFF Research Database (Denmark)

    Hautopp, Lena Conny; Wester, Susanne; Bang, Birgitte

    2014-01-01

    and related pathology have been developed and validated. The aim of the present study was to monitor a cohort of children with torticollis using a standardised protocol including valid and reliable measurements. METHODS: A total of 136 infants diagnosed with torticollis and referred to physiotherapeutic...... months at inclusion and seven months at the end of the treatment period that comprised a median of five treatment sessions. Initially, 52% and 54% presented with ROM deficits in rotation and lateral flexion, respectively. After treatment, these parts were reduced to 6% and 14%, and the magnitudes...... in the majority (90%) of children with torticollis with less than ten physiotherapeutic treatment sessions. FUNDING: not relevant. TRIAL REGISTRATION: not relevant....

  11. Traumatic neuroma after torticollis surgery: a rare occurrence

    African Journals Online (AJOL)

    2 Serrano Falcón C, Serrano Falcn MDM, Ruiz Villaverde R, Linares Solano J,. Serrano Ortega S. Amputation neuromas after neck surgery. Dermatol Online. J 2005; 11:2. 3 Lee IJ, Lim SY, Song HS, Park MC. Complete tight fibrous band release and resection in congenital muscular torticollis. J Plast Reconstr Aes Surg ...

  12. Therapeutic effects of flunitrazepan in dystonias and torticollis preliminary communication

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    Raul Marino Jr.

    1993-06-01

    Full Text Available A new form of clinical treatment is proposed for dystonias and torticollis using flunitrazepan (FN, a powerful agonist of all benzodiazepine receptors of GABA neurons. FN has a specific effect in dystonic patients, specially those in which the hypnotic effect of this drug is absent or diminished, thus suggesting the existence of two different neurochemical categories of dystonias.

  13. Comparison between the incidence of right and left sided congenital torticollis

    International Nuclear Information System (INIS)

    Aslam, S.; Bashir, M.S.; Hussain, S.I.

    2013-01-01

    Congenital torticollis is an intriguing condition of unknown origin, characterized by unilateral shortening and tightness of the sternocleidomastoid muscle. Patients usually present with head tilt, facial asymmetry and plagiocephaly. A sternomastoid mass or tumor may or may not be clinically apparent. Untreated, cervical function and facial cosmesis may be severely compromised. Objective: My study is aimed at establishing a comparison between the incidence of right versus left sided congenital torticollis. Method: This observational study included 30 patients of congenital torticollis that completed the questionnaire. The data was collected from patients coming to the Physiotherapy and Orthopedic departments of Children Hospital, Lahore. Results: Results showed that right side was involved in 19 (63.3%) patients and left side was involved in 11 (36.7%) patients. Out of 30 patients, 14 (46.7%) were male, of which 8 had right sided congenital torticollis and 6 had left sided congenital torticollis, and 16 (53.3%) were female, of which right sided congenital torticollis and 5 had left sided congenital torticollis. Conclusion: Hence it is concluded that incidence of right sided congenital torticollis is more common than left sided congenital torticollis. The incidence of con-genital torticollis is higher in females than in males. (author)

  14. Effectiveness of Physical Therapy as an Adjunctive Treatment for Trauma-induced Chronic Torticollis in Raptors.

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    Nevitt, Benjamin N; Robinson, Narda; Kratz, Gail; Johnston, Matthew S

    2015-03-01

    Management of trauma-induced chronic torticollis in raptors has historically been challenging. Euthanasia is common in affected birds because of their inability to maintain normal cervical position, although they may be able to function normally. To assess effectiveness of physical therapy of the neck and head as an adjunct treatment for this condition, a case-control study was done in raptors admitted to the Rocky Mountain Raptor Program from 2003 to 2010. Eleven cases were identified with a diagnosis of chronic torticollis resulting from traumatic brain injury. Five cases were treated with physical therapy of the head and neck, and 6 control cases did not receive any physical therapy for the torticollis. Of the control cases, 0 of 6 had resolution of the torticollis, 0 of 6 were released, and 5 of 6 were euthanatized. Of the treated cases, 4 of 5 had complete resolution of the torticollis and 5 of 5 were released. Resolution of torticollis differed significantly between cases receiving physical therapy and controls. These results indicate that physical therapy should be used as an adjunctive therapy in cases of chronic torticollis induced by trauma in raptors because it results in better resolution of the torticollis and increased likelihood of release.

  15. Surgical management of idiopathic torticollis secondary to a fibrotic band

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    Christopher David Jones

    2012-09-01

    Full Text Available Congenital muscular torticollis (CMT is the third commonest congenital deformity, commonly presenting in the first week of life. Due to contracture and shortening of the sternocleidomastoid muscle, the head is tilted towards the affected side; however there may also be a varying degree of rotation towards the contralateral side. Most infants with CMT can be managed non-surgically, however if this is unsuccessful surgery may be necessary, with many different techniques described. In this case report, we describe a 17-year old woman with persistent left sided CMT despite botulinum toxin paralysis that was successfully treated with surgery.

  16. The helical three-dimensional CT in the diagnosis of torticollis with occipitocondylar hypoplasia

    International Nuclear Information System (INIS)

    Ilkko, E.; Tikkakoski, T.; Pyhtinen, J.

    1998-01-01

    Congenital anomalies of the atlanto-occipital and atlantoaxial joints are rare. Those most commonly reported are atlantoaxial instability, basilar impression, anomalies of the odontoid process, laxity of the transverse atlantal ligament and atlanto-occipital fusion. Occipital condylar hypoplasia is infrequent and difficult to recognise. We recently diagnosed it using helical 3D CT in association with torticollis in two patients. The first patient had a several year history of torticollis. The second patient had acute cervical lymphadenitis associated with post-operative torticollis. 3D CT distinctly revealed atlantoaxial subluxation with hypoplasia of the occipital condyles in both cases. (Copyright (c) 1998 Elsevier Science B.V., Amsterdam. All rights reserved.)

  17. The helical three-dimensional CT in the diagnosis of torticollis with occipitocondylar hypoplasia

    International Nuclear Information System (INIS)

    Ilkko, E.; Tikkakoski, T.; Pyhtinen, J.

    1998-01-01

    Congenital anomalies of the atlanto-occipital and atlantoaxial joints are rare. Those most commonly reported are atlantoaxial instability, basilar impression, anomalies of the odontoid process, laxity of the transverse atlantal ligament and atlanto-occipital fusion. Occipital condylar hypoplasia is infrequent and difficult to recognise. We recently diagnosed it using helical 3D CT in association with torticollis in two patients. The first patient had a several year history of torticollis. The second patient had acute cervical lymphadenitis associated with post-operative torticollis. 3D CT distinctly revealed atlantoaxial subluxation with hypoplasia of the occipital condyles in both cases

  18. Hemivertebra of the cervical spine: an uncommon background for neck pain, cervical scoliosis, and torticollis.

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    Kapetanakis, Stylianos; Gkasdaris, Grigorios; Nastoulis, Evangelos; Stavrev, Vladimir

    2017-10-01

    A 15-year-old female patient presented with neck pain accompanied by cervical scoliosis, on the existence of torticollis. Although rare, hemivertebra of the cervical spine is a congenital deformation associated with these three clinical features.

  19. Endoscopic release of congenital muscular torticollis with radiofrequency in teenagers.

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    Wang, Jun-Liang; Qi, Wei; Liu, Yu-Jie

    2018-05-03

    Congenital muscular torticollis (CMT) is due to contracture of the sternocleidomastoid muscle which may cause activity limitations of the neck, tilt of the head, craniofacial asymmetry, and deformity of the skull. The authors present their experience of arthroscopic tight fibrous band release with radiofrequency in teenagers under local anesthesia and evaluate the clinical results. A total of 69 patients who underwent arthroscopic release of CMT with radiofrequency under local anesthesia by a single surgeon could participate in this study. Before operation, surface landmarks of sternocleidomastoid muscle, bone, and neurovascular structures were marked. Local infiltrating anesthesia of the surgical region was then performed. Through a working space created by blunt dissection, the arthroscopy and radiofrequency devices were introduced. Then, the clavicular and sternal heads of the sternocleidomastoid muscle were identified and gradually transected. The patients were followed up postoperatively with Cheng's scoring system. There were 31 male patients and 38 female patients. The mean age of the patients was 16.1 years. The mean length of follow-up in this series was 36.7 months (range, 28 to 67 months). During the operation, 62 patients (89.9%) had no pain, 6 patients (8.7%) felt mild pain, and only 1 patient (1.4%) regarded the procedure as very painful. At all follow-up periods, there were no repeat arthroscopies for any of these patients. At the final follow-up, the average rotation deficit improved from 22.5° to 4.1° postoperatively, and the average lateral bending deficit improved from 14.6° to 3.3° (p radiofrequency under local anesthesia provides surgeons with an alternative to traditional open techniques for the management of congenital muscular torticollis (CMT). Our date shows that this method is minimally invasive and provides good functional recovery with a lower risk of complications.

  20. Retropharyngeal abscess complicated with torticollis: case report and review of the literature.

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    Hasegawa, Jun; Tateda, Masaru; Hidaka, Hiroshi; Sagai, Shun; Nakanome, Ayako; Katagiri, Katsunori; Seki, Masahiro; Katori, Yukio; Kobayashi, Toshimitsu

    2007-09-01

    Retropharyngeal abscess commonly develops among infants and small children, and is associated with the severe inflammation of the retropharyngeal lymph nodes located in the retropharyngeal space. Retropharyngeal abscess causes cervical pain, swelling, contracture of the neck, and in rare cases inflammatory torticollis, all of which result from an inflammatory process that irritates the cervical muscles, nerves or vertebrae. Here we report a rare case of retropharyngeal abscess with a complication of torticollis. A 4-year-old girl suffered from severe retropharyngeal abscess spreading through the deep cervical fascia, as judged by magnetic resonance imaging of the neck. Blood analysis showed high degree of inflammatory reactions, and so the patient was transferred to our hospital ward. The inflammation caused spasms of the prevertebral muscles, eventually leading to torticollis. The surgical drainage was performed immediately under general anesthesia, and an anti-inflammation therapy with intravenously administered meropenem trihydrate and clindamycin was used together with traction therapy to relieve the symptoms of the patient. We must be careful about the existence of epidural abscess and infectious spondylitis when the retropharyngeal abscess causes torticollis. In conclusion, an anti-inflammation therapy using antibiotics, along with traction therapy, was effective to relieve the symptoms. In addition to repeated clinical examinations, cooperation with orthopedists and careful follow-up are necessary. We also discussed the relationship between acute torticollis and retropharyngeal abscess.

  1. [A patient with muscular torticollis caused by nodular fasciitis in the sternocleidomastoid muscle (SCM)].

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    Hemmi, Shoji; Murakami, Tatufumi; Shirabe, Teruo; Sunada, Yoshihide

    2002-09-01

    Nodular fasciitis is a benign pseudosarcomatous proliferative lesion which is frequently misdiagnosed as malignant tumor clinically and microscopically. It usually occurs as a rapidly enlarging subcutaneous mass on the upper extremities, especially on the forearm. Here we report a patient showing muscular torticollis caused by nodular fasciitis in the sternocleidomastoid muscle (SCM). A 17-year-old woman was hospitalized because of rapidly progressive torticollis. The right SCM was markedly enlarged and firm on palpation. Muscle biopsy taken from the right SCM revealed massive proliferation of spindle shaped fibroblasts infiltrating into the endomysium. These findings coincided with the intramuscular nodular fasciitis. However, different from typical nodular fasciitis, no apparent nodule formation was found in this patient. Instead, diffuse proliferative lesion extended widely into the neck soft tissue. To our knowledge, this is the first report of muscular torticollis caused by nodular fasciitis involving the SCM.

  2. Shear wave sonoelastography in infants with congenital muscular torticollis.

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    Park, Gi Young; Kwon, Dong Rak; Kwon, Dae Gil

    2018-02-01

    Congenital muscular torticollis (CMT) is characterized by shortening or excessive contraction of the sternocleidomastoid muscle (SCM). The main purpose of this study was to evaluate the feasibility of quantifying SCM stiffness using acoustic radiation force impulse (ARFI) sonoelastography in infants with CMT. Twenty infants with an SCM thickness greater than 10 mm with or without involvement of the entire SCM length (limitation of neck rotation passive range of motion [PROM]: group 1S >30°, group 1M = 15°-30°) and 12 infants with an SCM thickness smaller than 10 mm with or without involvement of any part of SCM (group 2) were included. The SCM thickness was measured using real time B-mode ultrasound, and the local SCM shear wave velocity (SWV) and subcutaneous fat layer using ARFI sonoelastography. The neck rotation PROM was significantly greater in group 1S (36.5° ± 5.3°) than in group 1M (18.8° ± 4.9°; P SCM in the affected side (2.96 ± 0.99 m/s) was significantly higher than that in the unaffected side (1.50 ± 0.30 m/s; P SCM was significantly higher in group 1S than in group 1M. There was significant correlation between the degree of PROM deficit of neck rotation and the SWV of the affected SCM (r = .75; P SCM in relationship to the limitation of neck rotation PROM in infants with CMT, if there was no difference in SCM thickness among infants.

  3. [Treatment of adult congenital muscular torticollis by multiple sternocleidomastoid head amputation].

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    Fu, Ronggang; Yin, Xiuqing; Yu, Rong

    2012-02-01

    To investigate the therapeutic method and effectiveness of multiple sternocleidomastoid head amputation for adult congenital muscular torticollis. Between March 2009 and February 2011, 19 patients with congenital muscular torticollis were treated with multiple sternocleidomastoid head amputation. There were 13 males and 6 females, aged 16-32 years (mean, 23.5 years). The X-ray films showed that 12 cases were accompanied with some extent cervical lateral bending and wedge change. Ten patients were with ipsilateral facial bradygenesis. Four patients had received single sternocleidomastoid head amputation. All of the 19 patients were treated with multiple sternocleidomastoid head amputation, then plaster support and neck collar were used after operation for 3-6 months. The wounds of all the 19 patients healed primarily, without infection or hematoma. Sixteen patients were followed up 5 months to 2 years (mean, 8 months). The head and neck malformations were ameliorated significantly. The effectiveness was assessed 2 weeks later, in 7 patients without cervical vertebral malformation results were excellent; in 12 patients with cervical vertebral malformation, the results were excellent in 1 case, good in 7 cases, and fair in 4 cases. The length between mastoid process and sternoclavicular joints was elongated (1.88 +/- 0.30) cm significantly after operation in patients without cervical vertebral malformation (t = 6.24, P = 0.00), showing no significant difference when compared with normal value (t = 1.87, P = 0.11); the length was elongated (3.38 +/- 0.30) cm significantly (t = 11.37, P = 0.00) after operation in patients with cervical vertebral malformation, but it was significant shorter than normal value (t = 12.19, P = 0.00). Multiple sternocleidomastoid head amputation is a safe and effective method for adult congenital muscular torticollis, which can improve the neck rotation function.

  4. A botulinum toxin A treatment algorithm for de novo management of torticollis and laterocollis

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    Kupsch, Andreas; Müngersdorf, Martina; Paus, Sebastian; Stenner, Andrea; Jost, Wolfgang

    2011-01-01

    Objectives Few studies have investigated the injection patterns for botulinum toxin type A for the treatment of heterogeneous forms of cervical dystonia (CD). This large, prospective, open-label, multicentre study aimed to evaluate the effectiveness and safety of 500 U botulinum toxin A for the initial treatment according to a standardised algorithm of the two most frequent forms of CD, predominantly torticollis and laterocollis. Design Patients (aged ≥18 years) with CD not previously treated with botulinum neurotoxin therapy were given one treatment with 500 U Dysport, according to a defined intramuscular injection algorithm based on clinical assessment of direction of head deviation, occurrence of shoulder elevation, occurrence of tremor (all evaluated using the Tsui rating scale) and hypertrophy of the sternocleidomastoid muscle. Results In this study, 516 patients were enrolled, the majority of whom (95.0%) completed treatment. Most patients had torticollis (78.1%). At week 4, mean Tsui scores had significantly decreased by −4.01, −3.76 and −4.09 points in the total, torticollis and laterocollis populations, respectively. Symptom improvement was equally effective between groups. Tsui scores remained significantly below baseline at week 12 in both groups. Treatment was well tolerated; the most frequent adverse events were muscular weakness (13.8%), dysphagia (9.9%) and neck pain (6.6%). Conclusions Dysport 500 U is effective and well tolerated for the de novo management of a range of heterogeneous forms of CD, when using a standardised regimen that allows tailored dosing based on individual symptom assessment. Clinical trials information (NCT00447772; clinicaltrials.gov) PMID:22021883

  5. The fate of facial asymmetry after surgery for "muscular torticollis" in early childhood

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    Dinesh Kittur

    2016-01-01

    Full Text Available Aims and Objectives: To study wheather the facial features return to normal after surgery for muscular torticollis done in early childhood. Materials and Methods: This is a long-term study of the fate of facial asymmetry in four children who have undergone operation for muscular torticollis in early childhood. All the patients presented late, i.e., after the age of 4 years with a scarred sternomastoid and plagiocephaly, so conservative management with physiotherapy was not considered. All the patients had an x-ray of cervical spine and eye and dental checkup before making a diagnosis of muscular torticollis. Preoperative photograph of the patient′s face was taken to counsel the parents about the secondary effect of short sternomastoid on facial features and the need for surgery. After division of sternomastoid muscle and release of cervical fascia when indicated, the head was maintained in a hyperextended position supported by sand bags for three days. Gradual physiotherapy was then started followed by wearing of a Minerva collar that the child wore for a maximum period of time in 24 h. Physiotherapy was continued three times a day till the range of movements of the head returned to normal. During the follow-up, serial photographs were taken to note the changes in the facial features. Results: In all four patients, the asymmetry of the face got corrected and the facial features returned to normal. Conclusion: Most of the deformity of facial asymmetry gets corrected in the first two years after surgery. By adolescence, the face returns to normal.

  6. Imaging of childhood torticollis due to atlanto-axial rotatory fixation.

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    Maheshwaran, S; Sgouros, S; Jeyapalan, K; Chapman, S; Chandy, J; Flint, G

    1995-12-01

    Atlanto-axial rotatory fixation is a rare cause of childhood torticollis. It may occur spontaneously or may be associated with trauma, upper respiratory tract infection or congenital abnormality of the cervical spine. Presentation is usually with persistent torticollis and "cock robin" deformity of the neck. In this paper the radiological experience in three patients is presented. Investigations included plain radiographs, plain anteroposterior tomography, CT and MRI. Displacement of the lateral mass of the atlas and the eccentric position of the odontoid peg can be seen in the plain films. CT scan can exclude fractures and confirm atlanto-axial rotation. The superimposition of CT images is demonstrated as a way of diagnosing subluxation. MRI offers better soft tissue differentiation and allows assessment of the integrity of the transverse ligament. This has an important bearing on the prognosis and may influence surgical treatment. It is important to recognise the plain film features of this uncommon condition and confirm the diagnosis with CT or MRI. The treatment options are discussed with particular reference to long term outcome.

  7. The utility of EMG interference pattern analysis in botulinum toxin treatment of torticollis: A randomised, controlled and blinded study

    DEFF Research Database (Denmark)

    Werdelin, L; Dalager, T; Fuglsang-Frederiksen, Anders

    2011-01-01

    OBJECTIVE: The significance of electromyography (EMG) guidance in botulinum toxin (BT) treatment has been much debated. The aim of this study was to evaluate if EMG guidance in the treatment of torticollis in BT-naive patients had a better outcome than treatment after clinical evaluation alone...

  8. The classification of idiopathic spasmodic torticollis: three types based on social adaptation and frustration tolerance.

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    Kashiwase, H; Kato, M

    1997-12-01

    In this study, idiopathic spasmodic torticollis (ST) has been classfied into three types from the opinion of social adaptation and the differences of frustration tolerance. The three types were as follows: type I (overadaptive type), type II (maladaptive type), and type III (compatible type). Type I is a typical psychosomatic with high frustration tolerance. Type II is personality disorder with low frustration tolerance. In type III, frustration tolerance varies depending on social circumstances (i.e., different at home and at the office). In type I, the prognosis of ST is generally unfavorable, since it is associated with recurrence and prolongation of the symptoms. In type II, the prognosis of ST is generally favorable. However, type II patients experience relationship or social difficulties. One characteristic of type III is that the onset of symptoms is usually found in an older person because of proper use of frustration tolerance at home and at the office.

  9. Striatal [[sup 11]C]-N-methyl-spiperone binding in patients with focal dystonia (torticollis) using positron emission tomography

    Energy Technology Data Exchange (ETDEWEB)

    Leenders, K [Paul Scherrer Inst. (PSI), Villigen (Switzerland); Hartvig, P [Hospital Pharmacy, Univ. Hospital, Uppsala (Sweden); Forsgren, L; Holmgren, G; Almay, B [Dept. of Neurology, Umeaa Univ., Umeaa (Sweden); Eckernaes, S A [Dept. of Neurology, Univ. Hospital, Uppsala (Sweden); Lundqvist, H; Laangstroem, B [Uppsala Univ. PET-Center, Uppsala (Sweden)

    1993-01-01

    Specific binding of [[sup 11]C]-N-methyl-spiperone to striatal dopamine D2 receptors was assessed using positron emission tomography (PET) in 6 patients with adult-onset focal dystonia (predominantly spasmodic torticollis) and in 5 healthy subjects. No significant difference in average specific striatal tracer uptake between patients and healthy subjects was found. However, in the 5 patients showing lateralisation of clinical signs a trend to higher striatal tracer uptake in the contralateral hemisphere was observed. (authors).

  10. Para-axillary subcutaneous endoscopic approach in torticollis: tips and tricks in the surgical technique.

    Science.gov (United States)

    Tokar, Baran; Karacay, Safak; Arda, Surhan; Alici, Umut

    2015-04-01

    An obvious scar on the neck may appear following the open surgery for congenital muscular torticollis (CMT). The cosmetic result may displease the patient and the family. In this study, we describe a minimally invasive technique, para-axillary subcutaneous endoscopic approach (PASEA) in CMT. A total of 11 children (seven girls and four boys with the age range between 1 and 15 years) were operated for torticollis by PASEA. All patients had facial asymmetry and head and neck postural abnormality. Following an incision at the ipsilateral para-axillary region, a subcutaneous cavernous working space is formed toward sternocleidomastoid (SCM) muscle. The muscle and fascia are cut by cautery under endoscopic vision. The patients had postoperative 2nd-week and 3rd-month visits. The incision scar, inspection, and palpation findings of the region, head posture, and shoulder position of the affected side were considered in evaluation of the cosmetic outcome. Preoperative and postoperative range of motion of the head and neck were compared for functional outcome. We preferred single incision surgery in our last two patients; the rest had double para-axillary incision for port insertion. Incomplete transection of the muscle was not observed. There was no serious complication. Postoperatively, head posture and shoulder elevation were corrected significantly. Range of motion of the head was improved. Postoperatively, all the patients had rotation capacity with more than 30 degrees. The range of postoperative flexion and extension movements was between 45 and 60 degrees. The open surgery techniques of CMT causes visible lifelong incision scar on the neck. PASEA leaves a cosmetically hidden scar in the axillary region. A single incision surgery is also possible. A well-formed cavernous working space is needed. External manual palpation, delicate dissection, and cutting of SCM muscle with cautery are the important components of the procedure. Surgeons having experience in pediatric

  11. Sexual well-being in patients with blepharospasm, spasmodic torticollis and hemifacial spasm: a pilot study

    Directory of Open Access Journals (Sweden)

    Paola Perozzo

    2016-10-01

    Full Text Available Mood, anxiety and other psychological symptoms are common in dystonic patients suffering from blepharospam (BSP and spasmodic torticollis (ST. Since sexual well-being is an important aspect of mental health, here, we investigated whether these patients may also experience a worsening of their sexual life. In particular, quality of sexual life was evaluated in patients suffering from BSP (N=30, ST (N=30, and in a control group of patient with Hemifacial spasm (HFS; N=30, undergoing botulinum toxin type A therapy. A group of 30 age-matched healthy volunteers constituted an additional control group. Patients were evaluated just before the periodic injection of botulinum toxin. Sexual functioning was assessed using the Sexual Functioning Inventory (SFI, a reduced form of the Gollombok Rust Inventory, previously employed in patients with Parkinson’s disease. Depression (Beck Depression Inventory and anxiety (STAI-X1/X2 were also assessed. Results revealed that sexual functioning was significantly affected in patients with BSP, ST, and HFS with respect to healthy controls. Dystonic patients manifested more sexual dysfunction than patients with HFS. Overall, females had a poorer quality of sexual life than males and, among females, women with BSP were the most dysfunctional. Psychological symptoms were present in patients with dystonia, but not in patients with HFS. As discussed in the paper, several factors might be taken into account to explain worse quality of sexual life in patients with dystonia compared to patients with hemifacial spasm. Among them an important role might be played by the central origin of dystonia pathophysiology (i.e. altered activity of cortico-striato-thalamic-cortical circuits. Future investigations are necessary to further explore these preliminary findings, considering that this is the first time that sexual well-being is evaluated in patients with BSP, ST and HFS, and comparable data are not available.

  12. Implementation of a Quality Improvement Initiative: Improved Congenital Muscular Torticollis Outcomes in a Large Hospital Setting.

    Science.gov (United States)

    Strenk, Mariann L; Kiger, Michelle; Hawke, Jesse L; Mischnick, Amy; Quatman-Yates, Catherine

    2017-06-01

    The American Physical Therapy Association (APTA) published a guideline for congenital muscular torticollis (CMT) in 2013. Our division adopted the guideline as the institutional practice standard and engaged in a quality improvement (QI) initiative to increase the percentage of patients who achieved resolution of CMT within 6 months of evaluation. The aims of this report are to describe the QI activities conducted to improve patient outcomes and discuss the results and implications for other institutions and patient populations. This was a quality improvement study. In alignment with the Chronic Care Model and Model of Improvement, an aim and operationally defined key outcome and process measures were established. Interventions were tested using Plan-Do-Study-Act cycles. A CMT registry was established to store and manage data extracted from the electronic record over the course of testing. Statistical process control charts were used to monitor progress over time. The QI initiative resulted in an increase in the percentage of patients who achieved full resolution of CMT within a 6-month episode of care from 42% to 61% over an 18-month period. Themes that emerged as key drivers of improvement included: (1) timely, optimal access to care, (2) effective audit and clinician feedback, and (3) accurate, timely documentation. The initiative took place at a single institution with a supportive culture and strong QI resources, which may limit direct translation of interventions and findings to other institutions and patient populations. Improvement science methodologies provided the tools and structure to improve division-wide workflow and increase consistency in the implementation of the APTA CMT guideline. In doing so, significant CMT population outcome improvements were achieved. © 2017 American Physical Therapy Association

  13. Comparison of Clinical Findings of Congenital Muscular Torticollis Between Patients With and Without Sternocleidomastoid Lesions as Determined by Ultrasonography.

    Science.gov (United States)

    Han, Mi-Hyang; Kang, Jin Young; Do, Hyun Jung; Park, Hyun Suk; Noh, Hyun Jin; Cho, Yun-Hwa; Jang, Dae-Hyun

    2017-08-02

    To compare clinical findings for patients with congenital muscular torticollis (CMT) between those with and without a sternocleidomastoid (SCM) lesion. Medical records of 182 patients with CMT were retrospectively reviewed and the patients were divided into SCM lesion and nonlesion groups by ultrasonographic results. Intrauterine position, age, duration of therapy, rotation/tilting side, and the passive range of motion and angle of the neck were compared. There were 74 SCM lesion and 108 nonlesion cases. The mean age at the first visit was 55.3 days in the SCM lesion group and 146.6 days in the nonlesion group. The mean therapy time in the nonlesion group was 66.5 days, significantly shorter than for the SCM lesion group (117.5 d). Tilting and rotation of the head in the same direction was observed only in the nonlesion group (n=9, 8.3%). Rotational limitation of the affected muscle side was 22.6 degree in the SCM lesion and 3.6 degree in the nonlesion group, and the tilting limitation was 19.2 degree in the SCM lesion and 10.4 degree in the nonlesion group. The nonlesion group had a better prognosis with shorter treatment duration. This group was more limited in head tilting than in head rotation, and the pattern of head rotation/tilting in the same direction was observed only in this group. These findings suggest that pathophysiological mechanisms and clinical characteristics may differ between CMT patients with and without SCM lesions. Level II-prognostic studies, retrospective study.

  14. Cervical Dystonia (Spasmodic Torticollis)

    Science.gov (United States)

    ... Many people who have cervical dystonia also experience neck pain that can radiate into the shoulders. The disorder also can cause headaches. In some people, the pain from cervical dystonia can be exhausting and disabling. Causes In ...

  15. Surgical management of spasmodic torticollis

    African Journals Online (AJOL)

    Wael Fouad

    2011-08-23

    Aug 23, 2011 ... A magnetic resonance. (MR) scan of the head and ... 30 degrees. Muscle relaxant is not used except at the induction of anesthesia. .... tween the trigeminal nerve and the motor neurons of the acces- sory and upper cervical ...

  16. Late presentation of congenital muscular torticollis in siblings

    Directory of Open Access Journals (Sweden)

    Sam Aruputha John, MS, MCh (ped surgery, India

    2017-05-01

    Management for CMT starts during the early infancy and physiotherapy is the main treatment for this condition. But some of these CMT children may need surgical intervention to prevent further deterioration of cranial deformity and facial asymmetry. If these children are neglected and present later in life, they will have severe facial deformity with its associated sequelae. These patients are usually managed by other specialities worldwide. But awareness of these conditions is required among paediatric surgeons, as some of these children may be referred to them for treatment. In our case report we have also described various other modalities of treatment for this condition.

  17. Assessment of follow-up sonography and clinical improvement among infants with congenital muscular torticollis.

    Science.gov (United States)

    Park, H-J; Kim, S S; Lee, S-Y; Lee, Y-T; Yoon, K; Chung, E-C; Rho, M-H; Kwag, H-J

    2013-04-01

    Infants grow rapidly, which causes the SCM to thicken physiologically. Therefore some cases of physiologically-thickened SCM can be confused with a poor response to physical therapy. There have been only a few quantitative ultrasonographic studies on the clinical outcome of rehabilitation for CMT. Our aim was to evaluate whether a new sonographic assessment method that uses the muscular thickness ratio of the SCM can help quantify the outcome of rehabilitation therapy for patients with CMT. We evaluated 48 patients (male/female, 17:31; mean age, 3.9 months) who were diagnosed with CMT and who underwent initial and follow-up sonography. The ratio of the thickness of the involved SCM to the thickness of the intact SCM (SCM thickness ratio) was calculated. A scoring system based on the range of motion of the neck was used to assess clinical improvement. The correlations between clinical improvement and the thickness of the involved muscle, the difference in involved muscle thickness, the SCM thickness ratio, and the difference in the SCM thickness ratio were evaluated with Spearman rank correlations. Follow-up Cheng scores were higher than initial scores; this difference indicates clinical resolution (follow-up, 4.90; initial, 3.38). The SCM thickness ratio at follow-up was lower than that at the initial evaluation (follow-up, 1.29-1.34; initial, 1.65-1.77). Intra- and interobserver agreements were excellent. Most variables were moderately correlated with clinical improvement (correlation coefficients, 0.36-0.509). R1 showed the highest correlation with clinical improvement (0.481 and 0.509), followed by the initial maximal thickness of the SCM (0.434 and 0.488). ΔP (P1-P2) and ΔR showed similar correlation coefficients with clinical improvement. Measurement of the SCM thickness ratio appears to overcome the problem of a false-positive diagnosis of clinical aggravation of CMT resulting from physiologic growth. R1 and ΔR are accurate objective measurements, which can be used in the management of CMT.

  18. The Sonographic Correlation between The Sternocleidomastoid Muscle Thickness and the Prognosis of Congenital Muscular Torticollis

    International Nuclear Information System (INIS)

    Lim, Dae Keon; Kwon, Woo Cheol; Cha, Seung Whan; Yoo, Ho Seok; Lim, Sang Hyeok; Park, Jeong Mee; Kim, Myung Soon

    2009-01-01

    We wanted to predict the prognosis of patients with CMT by the A/N ratio of the thickness and the circumference of the SCM muscle on ultrasonography, and we wanted to correlate the echogenecity of the affected muscle and the prognosis. Ultrasonography was performed on 24 patients from June 2004 to March 2007. We measured the thickness and the cross sectional circumference of the SCM muscle at three levels; below the mastoid process, at the level of the carotid artery bifurcation and at the level of the sternum and clavicle. The ratio of the affected side to the normal side (the A/N ratio) of the SCM muscle was calculated. We performed followed up ultrasonography at 2 months intervals until the end of treatment. The Wilcoxon signed-rank test was used to correlate the A/N ratio before and after the treatment. Spearman's rank test was used to correlate the A/N ratio and the total treatment duration. Paired T-tests were used to correlate the echogenecity of the SCM muscle and the treatment duration divided by less than or greater than 12 months. With measuring the thickness of the SCM muscle, the A/N ratio after treatment (1.36) was decreased compared with the initial A/N ratio (2.31) (p<0.05). The correlation between the A/N ratio of the thickness with the total treatment duration was statistically significant (p<0.05). The echogenecity of the affected SCM muscle was not correlated with the duration of treatment. The A/N ratio of the thickness of the SCM muscle is useful to predict the prognosis of patients with CMT

  19. An overlap case of Parry–Romberg syndrome and en coup de sabre with striking ocular involvement and anti-double-stranded DNA positivity

    Directory of Open Access Journals (Sweden)

    Hatice Atas

    2018-01-01

    Full Text Available Parry–Romberg syndrome (PRS may overlap localized scleroderma (morphea lesions with linear depression (en coup de sabre [ECDS]. Overlap case with PRS and ECDS was presented. Enophthalmos, uveitis, ocular torticollis, keratic linear precipitates, and anti-double-stranded DNA positivity were identified. Subendothelial keratic precipitates detected by an in vivo laser scanning confocal microscopy were the first profiled in the literature. Patients must be evaluated and followed up carefully by their clinics to prevent misdiagnosis and unnecessary procedures such as surgery of ocular torticollis as muscular torticollis.

  20. Identification of a novel 15.5 kb SHOX deletion associated with ...

    Indian Academy of Sciences (India)

    ANGELOS ALEXANDROU

    She had right-sided torticollis and postu- ral tremor mainly involving the .... Repeatmasker and USCS human genome browser tracks were used to identify ..... a Cypriot patient with severe intellectual disability and a jugular fossa malformation: ...

  1. Atlantoaxial Rotatory Fixed Dislocation: Report on a Series of 32 Pediatric Cases.

    Science.gov (United States)

    Wang, Shenglin; Yan, Ming; Passias, Peter G; Wang, Chao

    2016-06-01

    Retrospective case series of atlantoaxial rotatory fixed dislocation (AARFD). To describe clinical features and the surgical treatment of AARFD. The classification and treatment strategy for atlantoaxial rotatory fixation (AARF) were previously described and remained controversial. AARF concomitant with atlantoaxial dislocation has different clinical features and treatment strategy with the most AARF. Due to deficiency of the transverse ligament or odontoid, the atlantoaxial remains unstable even after the torticollis relieved or cured. Because of the rarity, treatment strategy for this special condition has not been specialized and fully explored in the literatures. Thirty-two children with AARFD (sustained torticollis more than 6 weeks and atlanto-dental internal more than 5 mm) were retrospectively reviewed. Treatment methodology, pearls, and pitfalls of the treatment were discussed. Thirty-two cases had sustained torticollis for an average of 5.7 months. ADI of them ranged from 8 to 22 mm, with a mean of 11.3 mm. Eight cases presented with signs and symptoms of spinal cord dysfunction. All 32 cases underwent surgery and had no spinal cord or vertebral artery injury. The surgery included posterior reduction and fusion (reducible dislocation and torticollis, 16 cases), and transoral release followed by posterior reduction and fusion (irreducible dislocation and torticollis, 16 cases). The average follow-up time was 42 months. Solid fusion and torticollis healing were achieved in 31 patients (96.9%) as detected radiologically. Two cases (6.3%, 2/32) suffered complications (cerebrospinal fluid leakage and recurred torticollis followed by revision). AARFD had distinct clinical features relative to common presentations of AARF. Because of deficiency of the transverse ligament or odontoid and subsequent atlantoaxial dislocation, surgical treatments are applied for this condition, including transoral release and posterior C1-2 reduction and fusion. AARFD cases

  2. Case report

    African Journals Online (AJOL)

    ebutamanya

    2015-01-22

    Jan 22, 2015 ... children hospital, Faculty of Medicine, Mohammed V University Rabat, Morocco. &Corresponding ... nontraumatic torticollis if patient had a recent surgery in the head or neck area or undergone an upper respiratory tract infection. In this paper, a ... with this persisting mode of treatment in Africa. Pan African ...

  3. Atlantoaxial subluxation after otoplasty.

    LENUS (Irish Health Repository)

    Kelly, E J

    2012-02-03

    A case of iatrogenic atlantoaxial subluxation after bilateral otoplasty is presented. Cineradiography was required for definitive diagnosis. Bed rest and Halter traction successfully resolved the condition. Great care is required while turning the head during skin preparation, draping, planning, and surgery, especially in young children. A high index of suspicion is necessary when a child develops torticollis after otoplasty.

  4. Browse Title Index

    African Journals Online (AJOL)

    Items 51 - 100 of 3061 ... Vol 8, No 1 (2011), Acute myocardial infarction in young adults with Antiphospholipid syndrome: report of two cases and literature review, Abstract PDF. L Abid, F Frikha, Z Bahloul, S Kammoun. Vol 21, No 1 (2015), Acute nontraumatic torticollis in a patient with right lower quadrant pain: case report ...

  5. Williams Syndrome with a “Twist”

    Directory of Open Access Journals (Sweden)

    Despoina Maritsi

    2010-01-01

    Full Text Available Williams syndrome is a rare genetic condition with multisystemic involvement, caused by a microscopic deletion in the chromosome band 7q11.23. We describe the first case of a toddler with Williams syndrome who developed Benign Paroxysmal Torticollis (BPT, a benign dystonic disorder of unknown aetiology.

  6. Concentration-dependent actions of piperidine alkaloids on the inhibition of fetal movement in day 40 pregnant goats and comparison to cell-based models

    Science.gov (United States)

    Anabasine and anabaseine are potent and effective agonists at nicotinic acetylcholine receptors (nAChR). Anabasine in livestock species is teratogenic and has been shown to cause developmental defects that include arthrogyrposis, kyposis, lordosis, scoliosis, and torticollis. We have postulated that...

  7. Case report

    African Journals Online (AJOL)

    ebutamanya

    2015-06-25

    Jun 25, 2015 ... Abstract. Acute febrile torticollis in children is a rare and a special clinical picture of variable causes. It may indicate an inflammatory or an infectious pathology affecting any of the anatomical structures of the neck. Treatment is quite clearly defined, and it may be a therapeutic emergency. It is a condition that ...

  8. Muscle selection for treatment of cervical dystonia with botulinum toxin : A systematic review

    NARCIS (Netherlands)

    Nijmeijer, S. W. R.; Koelman, J. H. T. M.; Kamphuis, D. J.; Tijssen, M. A. J.

    Rationale: Cervical dystonia, also called spasmodic torticollis, is the most common form of (primary) dystonia. Intramuscular injections with botulinum toxin are the first line of treatment for cervical dystonia. To optimise the treatment response to botulinum toxin correct muscles should be

  9. Muscle selection for treatment of cervical dystonia with botulinum toxin - A systematic review

    NARCIS (Netherlands)

    Nijmeijer, S. W. R.; Koelman, J. H. T. M.; Kamphuis, D. J.; Tijssen, M. A. J.

    2012-01-01

    Rationale: Cervical dystonia, also called spasmodic torticollis, is the most common form of (primary) dystonia. Intramuscular injections with botulinum toxin are the first line of treatment for cervical dystonia. To optimise the treatment response to botulinum toxin correct muscles should be

  10. Topical Botulinum Toxin

    OpenAIRE

    Collins, Ashley; Nasir, Adnan

    2010-01-01

    Nanotechnology is a rapidly growing discipline that capitalizes on the unique properties of matter engineered on the nanoscale. Vehicles incorporating nanotechnology have led to great strides in drug delivery, allowing for increased active ingredient stability, bioavailability, and site-specific targeting. Botulinum toxin has historically been used for the correction of neurological and neuromuscular disorders, such as torticollis, blepharospasm, and strabismus. Recent dermatological indicati...

  11. Antibiogram and heavy metal tolerance of bullfrog bacteria in Malaysia

    OpenAIRE

    Tee, L.W.; Najiah, M.

    2011-01-01

    Bacterial isolates from 30 farmed bullfrogs (Lithobates catesbeianus) weighing 500-600 g at Johore, Malaysia with external clinical signs of ulcer, red leg and torticollis were tested for their antibiograms and heavy metal tolerance patterns. A total of 17 bacterial species with 77 strains were successfully isolated and assigned to 21 antibiotics and 4 types of heavy metal (Hg2+, Cr6+, Cd2+, Cu2+). Results revealed that bacteria were resistant against lincomycin (92%), oleandomycin (72.7%) an...

  12. Surgical treatment of children with non-traumatic old atlanto-axial rotatory fixation

    Directory of Open Access Journals (Sweden)

    A. V. Gubin

    2015-01-01

    Full Text Available Atlanto-axial rotatory fixation (AORF develops on the background of acute torticollis. Widely adopted terms such as C1 subluxation or atlantooccipital rotational subluxation do not reflect the core of this pathology and carry negative weight in the diagnostics and treatment of AORF. Retrospective analysis of the diagnostics and treatment outcome of 5 children with confirmed AORF diagnosis and literature review were performed. Clinical method, radiography and functional computer tomography were used to verify the diagnosis. De-rotational halo-traction and open correction with screw fixation were applied for treatment. Head position was managed to be improved in all patients. In one case the reduction was performed using correction in suboccipital segments and in other 4 cases the correction and fixation by Harms and de-rotational halo-traction allowed to correct torticollis. The pain syndrome had been arrested completely. Disease outcome resulted in formation of C1-C2 fibrous or bone fusion regardless the method of treatment. The patients with neglected AORF represent a great challenge for diagnostics and treatment. When conservative treatment fails it is necessary to involve de-rotational halo-traction with possible application of open reduction and posterior fusion. The purpose of treatment is to eliminate torticollis and pain using creation of proper C1-C2 alignment. The motions in atlantooccipital joint do not restore due to formation of the fibrous or bone fusion.

  13. [Sotos syndrome associated with focal dystonia].

    Science.gov (United States)

    Bravo, M; Chacón, J; Bautista, E; Pérez-Camacho, I; Trujillo, A; Grande, M A

    Sotos syndrome is a form of infantile gigantism characterized by excessive body size from the time of birth, particular facies, acromegalic changes and signs of non-progressive cerebral involvement. The etiology is unknown. Diagnosis is based on somatometric data and the particular phenotype traits. Biochemical and endocrine studies are normal. Torticollis is a focal dystonia and therefore more common in adults. A 20 year old woman with macrosomic features since birth presented with: weight 104 kg, height 182 cm; prognathism, hypertelorism, a broad over hanging forehead with a high hair line; large ears, hands and feet; torticollis towards the right with elevation and anteroversion of the right shoulder which caused symptomatic scoliosis. She was bradypsychic and rather slow in speech. The complementary tests done (cerebral and cervical CT and MR, bone gammography, evoked potentials, EMG-ENG, sural nerve biopsy, biopsy of skin and muscle, EEG and hormone and biochemistry studies) were normal. The torticollis was treated with botulinus toxin and improved considerably, as did the scoliosis. To date, dystonia has not been described in association with Sotos syndrome. This may be a causal association, or even perhaps hereditary, since the patient's mother had dystonia (in the form of blepharospasm).

  14. Atlantoaxial rotatory fixation as a rare complication from head positioning in otologic surgery: Report of two cases in young children.

    Science.gov (United States)

    Sakaida, Hiroshi; Akeda, Koji; Sudo, Akihiro; Takeuchi, Kazuhiko

    2017-01-01

    Atlantoaxial rotatory fixation is a condition in which the first and second vertebrae of the cervical spine become interlocked in a rotated position. This condition can result in serious consequences and thus have a significant impact on patients, especially when diagnosis and treatment are delayed. Some cases of atlantoaxial rotatory fixation have been described in association with otologic surgery or plastic surgery involving the ear. We present the cases of two pediatric patients who developed atlantoaxial rotatory fixation following otologic surgery and we review the relevant literature. One patient was a 7-year-old boy who underwent tympanoplasty for cholesteatoma. The other patient was a 5-year-old girl with profound sensorineural hearing loss who underwent cochlear implantation. Both patients developed atlantoaxial rotatory fixation on the day after surgery, and they were treated conservatively. Our literature search using relevant terms identified 12 similar published cases. Thus, a total of 14 patients, including our 2 patients, were evaluated. Most of the patients were children and typically they complained of painful torticollis and exhibited a characteristic posture called the "cock-robin" position on the day after surgery. Mostly, the direction of torticollis was opposite to the side of surgery. Most of the patients received conservative treatment alone, but three underwent surgical treatment. The correlation between the direction of torticollis and the side of surgery suggests that rotation of the head during surgery has an impact on development of postoperative atlantoaxial rotatory fixation. Thus, children undergoing otologic surgery are thought to be at a risk of postoperative atlantoaxial rotatory fixation. Although rare, the surgical team needs to be aware of this adverse event and pay close attention to this possibility throughout the perioperative period. Perioperative management should include informed consent, preoperative assessment of the

  15. Congenital deformity in calves induced by the maternal consumption of lupin

    Energy Technology Data Exchange (ETDEWEB)

    Shupe, J.L.; Binns, W.; James, L.F.; Keeler, R.F.

    1968-01-01

    A congenital skeletal deformity called crooked calf syndrome occurs in many of the beef cattle-producing areas of the western United States. This deformity is characterized by arthrogryposis, torticollis, scoliosis, and cleft palate. The condition is non-hereditary, and is due to the consumption of lupin by the dam. The most severe and characteristic deformities are produced between the 40th and 70th days of gestation. Experimental analyses were performed to ascertain the teratogenic effect of lupin plants, lupin and lead, and lead alone upon cattle.

  16. Congenital defects of C1 arches and odontoid process in a child with Down′s syndrome: A case presentation

    Directory of Open Access Journals (Sweden)

    Catherine Hatzantonis

    2016-01-01

    Full Text Available We present the case of a 2-year-old child with Down′s syndrome who presented to our unit with torticollis. Imaging studies revealed the rare occurrence of anterior and posterior C1 arch defects, absent odontoid process, and atlantoaxial subluxation. We managed her conservatively for 3 years without neurological deficits or worsening of atlantoaxial subluxation. We discuss the rare occurrences of anterior and posterior arch defects of the atlas, the radiological presentations of axis defects in patients, and the occurrence of atlantoaxial instability in patients with Down′s syndrome. Management options with consideration to surgery in asymptomatic and symptomatic patients are also discussed.

  17. Rapid Spontaneous Resolution of Fibromatosis Colli in a 3-Week-Old Girl

    Directory of Open Access Journals (Sweden)

    Paolo Adamoli

    2014-01-01

    Full Text Available Fibromatosis colli is an uncommon benign, congenital fibrous tumor or pseudotumor of the sternocleidomastoid muscle that manifests in infancy. In some of these patients tightening of the muscle results in torticollis. We report the case of a 3-week-old child, who presented with a neck mass localized in the left side with reduced mobility of the head. The diagnosis of fibromatosis colli was raised by ultrasound sonography. The mass regressed spontaneously within 3 months without surgical or physical treatment.

  18. Osteoma of paranasal sinuses of a horse

    International Nuclear Information System (INIS)

    Schumacher, J.; Smith, B.L.; Morgan, S.J.

    1988-01-01

    A 2-year-old Quarter Horse gelding was examined for torticollis, facial protuberances over the frontal and maxillary sinuses, and persistent nasal discharge unresponsive to antibiotics. Radiograph revealed an osseous mass in the right paranasal sinuses. Histologic examination of the biopsied mass led to a diagnosis of osteoma. The mass was removed surgically in sections from the right frontal and maxillary sinuses through separate bone flaps, and sinuses were irrigated with saline solution for 8 days after surgery. Two weeks after surgery, radiography revealed small osseous opacities in the right paranasal sinuses. These opacities remained unchanged in radiographs obtained up to 23 months after surgery

  19. Late-presenting developmental dysplasia of the hip in Jordanian males. A retrospective hospital based study

    Directory of Open Access Journals (Sweden)

    Omar Q. Samarah

    2016-02-01

    Full Text Available Objectives: To describe the pattern of developmental dysplasia of the hip (DDH in late presenting Jordanian male patients and identify the risk factors and associated findings. Methods: This is a retrospective study of 1145 male patients who attended the Pediatric Orthopedic Clinic for a DDH check up. This study was carried out in the Orthopedic Section, Special Surgery Department, Faculty of Medicine, The University of Jordan, Amman, Jordan between March 2011 and October 2014. Data was collected from medical records, and x-ray measurements were evaluated. Results: Of the 1145 male patients, 43 (3.75% with 70 involved hips were diagnosed with late- presenting DDH. Being a first-born baby resulted in 41.9% increased risk for DDH. Cesarian delivery was significantly associated with an increased risk of hip dislocation (p=0.004 while normal delivery was significantly associated with acetabular dysplasia (p=0.004. No predictable risk factors were found in 44.2% patients with DDH. Bilateral cases were more common than unilateral cases: (26 [60.5%] versus 17 [39.5%]. Limited abduction was a constant finding in all dislocated hips (p less than 0.001. Associated conditions, such as club foot and congenital muscular torticollis were not observed. Conclusion: Cesarian section is a significant risk for dislocated hips while normal delivery is significantly associated with acetabular dysplasia. Bilateral DDH is more common than the unilateral. Club foot and torticollis were not observed in this series.

  20. [Papillary oedema revealing Arnold Chiari malformation type 1: about a case].

    Science.gov (United States)

    Imane, Mouhoub; Asmae, Maadane; Toufik, Ramdani; Rachid, Sekhsoukh

    2016-01-01

    Arnold Chiari malformation type 1 is defined as a herniation of the cerebellar tonsils into the foramen magnum of more than 5 mm. Symptoms are most commonly dominated by occipital headache, torticollis and sometimes swallowing disorders. Ophthalmologically abnormal convergences, oculomotor palsy and diplopia are the main clinical signs. We report the case of a 9 year old child, who presented with visual loss evolving since 6 months. Ophthalmologic examination showed visual acuity of 4/10 in both eyes, retained ocular motility and rotational nystagmus. The examination of the anterior segment of the eye showed megalocornea with no evidence of goniodysgenesis, iridodonesis associated with atrophy of the dilator muscle and microcoria with lazy photomotor reflex. Normal intraocular pressure was 14 mmHg. Ocular fundus examination, despite difficulties in performing it, objectified bilateral papilledema (stage II). General physical examination showed torticollis, scoliosis and a tetra-pyramidal syndrome. MRI showed Chiari malformation type I associated with hydrocephalus and syringomyelia. Neurosurgical intervention based on internal CSF drainage with occipitocervical osteo-dural decompression was proposed. The evolution was favorable with regression of clinical signs. Ophthalmologically, there was a regression of papilledema but visual acuity remained stationary. The occurrence of papilledema associated with Chiari malformation type 1 is rare, it has been only reported in 2% of symptomatic patients. Its pathophysiology is still poorly understood. The originality of our study consists in the association of cerebellar malformations with ocular malformations including megalocornea and microcoria which make ophthalmologic examination more difficult to perform.

  1. Clinical-pathomorphological correlation in patients with symptomatic dystonias

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    Ivanović Nataša

    2002-01-01

    Full Text Available Symptomatic dystonia can be the result of various metabolic, degenerative diseases, the consumption of certain medications or exposure to toxic agents. However, only symptomatic dystonia with focal structural lesion provides a significant "window" for, at least indirect, perception of aetiopa-thogenesis and pathomorphological substratum of idiopathic dystonia. Our study included 57 patients with symptomatic dystonia, which as a base had focal or multifocal lesions, of whom 7 patients had generalized dystonia, 18 hemidystonia, 6 segmental dystonia, 7 torticollis, 6 blepharospasm, 7 hand dystonia, 3 spasmodic dysphonia, and 3 had oromandibular dystonia. Stroke was highly statistically the most frequent cause of structural lesions (33/57 or 58%. Relevant pathomorphological changes were present in 50/57 (88% patients, of whom 25 (50% had lesion in the lenticular nucleus (including individual damage of the putamen and globus pallidus, 12/50 (24% had damage of the thalamus and 6/50 (12% had damage of the brainstem. Generalized dystonia was most frequently associated with bilateral lesion of the putamen, hemidystonia with lesion of contralateral putamen, torticollis with damage of the caudate nucleus, hand dystonia with lesion of the thalamus and blepharospasm with lesion of the upper brainstem.

  2. A case study of occipital outgrowth: a rare suboccipital abnormality.

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    Mushkin, A Y; Gubin, A V; Ulrich, E V; Snischuk, V P

    2016-05-01

    To describe the clinical and radiological characteristics of uncommon upper cervical spine abnormality in children. Clinical and diagnostic characteristics of three patients aged 6-12 years with a similar uncommon type of occipital anomaly are described. The patients were admitted in 2007, 2009, and 2014, respectively. All patients were clinically and radiologically examined. In each case the massive, additional unilateral outgrowth of the occipital bone (os occipitale) was visualized. The signs and symptoms included torticollis, acute brain ischemia, and limited head motion. Two of the three patients underwent surgical treatment: an occipital-cervical fusion was performed in the first patient, and the outgrowth was removed in the second patient. After 1 year of follow-up the results were estimated as good for both patients, with better functional outcome for the second patient. The parents of the third patient did not consent for the surgical treatment. The unique features of this abnormality distinguish it from previous descriptions of the manifestation of pro-atlas, atlas, or atlanto-occipital synostosis. The presented abnormality had different manifestation of various severity in each case, from torticollis to acute vascular disorder. Clinical case series. IV.

  3. How Many Dystonias? Clinical Evidence.

    Science.gov (United States)

    Albanese, Alberto

    2017-01-01

    Literary reports on dystonia date back to post-Medieval times. Medical reports are instead more recent. We review here the early descriptions and the historical establishment of a consensus on the clinical phenomenology and the diagnostic features of dystonia syndromes. Lumping and splitting exercises have characterized this area of knowledge, and it remains largely unclear how many dystonia types we are to count. This review describes the history leading to recognize that focal dystonia syndromes are a coherent clinical set encompassing cranial dystonia (including blepharospasm), oromandibular dystonia, spasmodic torticollis, truncal dystonia, writer's cramp, and other occupational dystonias. Papers describing features of dystonia and diagnostic criteria are critically analyzed and put into historical perspective. Issues and inconsistencies in this lumping effort are discussed, and the currently unmet needs are critically reviewed.

  4. Co-infection of Sarcocystis sp. and Hadjelia truncata in fantail pigeons (Columba livia domestica

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    M. Khordadmehr

    2018-03-01

    Full Text Available Hadjelia truncata belongs to the family Habronematidae which affects different groups of birds such as Columbiformes. A large number of Sarcocystis sp. may infect birds as intermediate hosts, but wild Columbiformes, include pigeons, are rarely affected. The present study describes mixed infection of two pigeon flocks with sarcocystosis and nematodiasis (H. truncata which had neurologic and gas-trointestinal clinical signs. The common clinical signs included progressive weight loss, pectoral muscle atrophy, white diarrhoea, depression, torticollis, paralysis, trembling, and 23.4% mortality. At necropsy, a large number of nematodes were detected in the gizzards and diagnosed as H. truncata in parasitological studies. For greater certainty, histopathological examination was conducted routinely. Different development stage of this nematode associated with severe inflammatory cells infiltration and necrosis were observed in tissue sections. Accidentally, the large number of Sarcocystis cysts was observed in tunica muscularis mucosa of gizzard associated with infiltration of inflammatory cells, hyaline degeneration and necrosis around degenerated cysts.

  5. An unusual case of rapidly progressive contractures: Case report and brief review

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    Subasree R

    2008-01-01

    Full Text Available An 8-year-old boy, diagnosed as cervical dystonia, was referred to our tertiary center. After a trivial trauma he had developed painful lumps in the axial region, which was followed by restricted movements of neck, shoulder, and abdominal muscles over 4 months. He had kyphoscoliosis, torticollis, rigid abdomen, and multiple muscle contractures. He also had short great toes. A detailed skeletal survey showed calcification in the soft tissues surrounding the shoulder anterior chest wall, thorax, and paraspinal muscles; there was also beaking of vertebrae, which was confirmed by CT thorax. This report showcases the diagnostic challenge posed by myositis ossificans progressiva, which can rarely cause rapidly progressing muscle contractures. A brief review of literature is also presented.

  6. Congenital skeletal malformations and cleft palate induced in goats by ingestion of Lupinus, Conium and Nicotiana species.

    Science.gov (United States)

    Panter, K E; Keeler, R F; Bunch, T D; Callan, R J

    1990-01-01

    Three piperidine alkaloid containing plants, Conium maculatum (poison-hemlock), Nicotiana glauca (tree tobacco) and Lupinus formosus (lunara lupine), induced multiple congenital contractures (MCC) and palatoschisis in goat kids when their dams were gavaged with the plant during gestation days 30-60. The skeletal abnormalities included fixed extension or flexure of the carpal, tarsal, and fetlock joints, scoliosis, lordosis, torticollis and rib cage abnormalities. Clinical signs of toxicity included those reported in sheep, cattle and pigs--ataxia, incoordination, muscular weakness, prostration and death. One quinolizidine alkaloid containing plant, Lupinus caudatus (tailcup lupine), on the other hand, which is also known to cause MCC in cows, caused only slight signs of toxicity in pregnant goats and no teratogenic effects in their offspring.

  7. Reticuloendotheliosis in a wild turkey (Meleagris gallopavo) from coastal Georgia.

    Science.gov (United States)

    Hayes, L E; Langheinrich, K A; Witter, R L

    1992-01-01

    An emaciated wild turkey (Meleagris gallopavo) exhibiting neurologic signs was found on Ossabaw Island, Chatham County, Georgia (USA) on 11 April 1989. The neurologic abnormalities observed included ataxia, drooping wings, head tremors, torticollis, and circling. At necropsy, discrete yellowish-white nodules, varying in size from 2 to 5 mm, were present in the spleen. White nodular lesions approximately 2 mm in diameter were observed beneath the mucosal surface of the distal esophagus. Histopathologic examination of the splenic nodules disclosed large numbers of primitive lymphoreticular cells with leptochromatic nuclei and abundant, slightly basophilic cytoplasms. The mitotic index in these cells was moderate to high. Similar neoplastic cells composed the masses observed in the esophagus. Multifocal, mild perivascular cuffing with mononuclear cells was found in the lumbar spinal cord, brain, and brain stem. Reticuloendotheliosis virus, subtype 3, was isolated from samples of the spleen and liver.

  8. [Micromotor recording of writing pressure during intracerevral stimulation at stereotactic operations (author's transl)].

    Science.gov (United States)

    Schneider, H

    1975-12-22

    Eight cases of spastic torticollis were examined during the course of stereotactic operations with the writing pressure apparatus of Steinwachs while the ventrolateral thalamus was stimulated. When 50 stimuli per sec are given, the significant changes of motor function in writing are the following: slowing of writing speed, an increase in writing pressure, greater changes of pressure amplitude with tendences to parallel course. With 25 stimuli per sec, simular results may appear, but smaller amplitude changes and lowering of writing pressure may also occur. When 8 stimuli per sec are given, no changes of pressure patterns in writing were found. Three typical cases are described. It is concluded that the recording of fine pressure changes in writing may indicate alterations of cerebral motor regulations although specific changes for certain thalamic stimulus locations were lacking.

  9. Bruck syndrome: a case report

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    Дмитрий Степанович Буклаев

    2015-09-01

    Full Text Available The article describes the clinical case of an infant with Bruck syndrome. The clinical and radiological analyses showed the presence of systemic osteoporosis with pathological fractures; contractures of the elbow, knee, and ankle joints; delay of physical and motor development; and signs of hypoplasia in some of the muscle groups. There was also a right-sided congenital muscular torticollis. X-ray analysis revealed a moderate antecurvation deformity of the lower legs and femurs, with cortical thinning. Laboratory data detected an abnormal beta-cross lap increase.Treatment of osteoporosis by inhibitors of osteoclastic resorption (pamidronate had a positive effect, and the elimination of flexion contractures at the elbow using plaster bandages with the distraction device also resulted in a positive effect.

  10. Topical botulinum toxin.

    Science.gov (United States)

    Collins, Ashley; Nasir, Adnan

    2010-03-01

    Nanotechnology is a rapidly growing discipline that capitalizes on the unique properties of matter engineered on the nanoscale. Vehicles incorporating nanotechnology have led to great strides in drug delivery, allowing for increased active ingredient stability, bioavailability, and site-specific targeting. Botulinum toxin has historically been used for the correction of neurological and neuromuscular disorders, such as torticollis, blepharospasm, and strabismus. Recent dermatological indications have been for the management of axillary hyperhydrosis and facial rhytides. Traditional methods of botulinum toxin delivery have been needle-based. These have been associated with increased pain and cost. Newer methods of botulinum toxin formulation have yielded topical preparations that are bioactive in small pilot clinical studies. While there are some risks associated with topical delivery, the refinement and standardization of delivery systems and techniques for the topical administration of botulinum toxin using nanotechnology is anticipated in the near future.

  11. Early Illustrations of Geste Antagoniste in Cervical and Generalized Dystonia

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    Broussolle, Emmanuel; Laurencin, Chloé; Bernard, Emilien; Thobois, Stéphane; Danaila, Teodor; Krack, Paul

    2015-01-01

    Background Geste antagoniste, or sensory trick, is a voluntary maneuver that temporarily reduces the severity of dystonic postures or movements. We present a historical review of early reports and illustrations of geste antagoniste. Results In 1894, Brissaud described this phenomenon in Paris in patients with torticollis. He noted that a violent muscular contraction could be reversed by a minor voluntary action. He considered the improvement obtained by what he called “simple mannerisms, childish behaviour or fake pathological movements” was proof of the psychogenic origin of what he named mental torticollis. This concept was supported by photographical illustrations of the patients. The term geste antagoniste was used by Brissaud’s pupils, Meige and Feindel, in their 1902 monograph on movement disorders. Other reports and illustrations of this sign were published in Europe between 1894 and 1906. Although not mentioned explicitly, geste antagoniste was also illustrated in a case report of generalized dystonia in Oppenheim’s 1911 seminal description of dystonia musculorum deformans in Berlin. Discussion Brissaud-Meige’s misinterpretation of the geste antagoniste unfortunately anchored the psychogenic origin of dystonia for decades. In New York, Herz brought dystonia back into the realm of organic neurology in 1944. Thereafter, it was given prominence by other authors, notably Fahn and Marsden in the 1970–1980s. Nowadays, neurologists routinely investigate for geste antagoniste when a dystonic syndrome is suspected, because it provides a further argument in favor of dystonia. The term alleviating maneuver was proposed in 2014 to replace sensory trick or geste antagoniste. This major sign is now part of the motor phenomenology of the 2013 Movement Disorder Society’s classification of dystonia. PMID:26417535

  12. Comparative study of unilateral versus bilateral inferior oblique recession/anteriorization in unilateral inferior oblique overaction.

    Science.gov (United States)

    Mostafa, Attiat M; Kassem, Rehab R

    2018-05-01

    To compare the effect of, and the rate of subsequent development of iatrogenic antielevation syndrome after, unilateral versus bilateral inferior oblique graded recession-anteriorization to treat unilateral inferior oblique overaction. Thirty-four patients with unilateral inferior oblique overaction were included in a randomized prospective study. Patients were equally divided into 2 groups. Group UNI underwent unilateral, group BI bilateral, inferior oblique graded recession-anteriorization. A successful outcome was defined as orthotropia, or within 2 ∆ of a residual hypertropia, in the absence of signs of antielevation syndrome, residual inferior oblique overaction, V-pattern, dissociated vertical deviation, or ocular torticollis. A successful outcome was achieved in 11 (64.7%) and 13 (76.5%) patients in groups UNI and BI, respectively (p = 0.452). Antielevation syndrome was diagnosed as the cause of surgical failure in 6 (35.3%) and 2 (11.8%) patients, in groups UNI and BI, respectively (p = 0.106). The cause of surgical failure in the other 2 patients in group BI was due to persistence of ocular torticollis and hypertropia in a patient with superior oblique palsy and a residual V-pattern and hypertropia in the other patient. The differences between unilateral and bilateral inferior oblique graded recession-anteriorization are insignificant. Unilateral surgery has a higher tendency for the subsequent development of antielevation syndrome. Bilateral surgery may still become complicated by antielevation syndrome, although at a lower rate. In addition, bilateral surgery had a higher rate of undercorrection. Further studies on a larger sample are encouraged.

  13. Features of treatment of cervical dystonia associated with head tremor with botulinum toxin type A drugs under electro myographic control

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    A. N. Korenko

    2016-01-01

    Full Text Available The study was aimed to evaluate the efficacy and safety of injections of botulinum toxin typeA (BTA in the neck muscles under electromyographic control and without it to reduce head tremor, muscle tone and dystonic postures, as well as pain in patients with cervical dystonia (CD. 49 patients with CD and dystonic head tremor who received injections of BTA were examined. 33 (67 % patients received Dysport in an average dose of 695 (627; 762 units, 15 (31 % patients received Xeomin in an average dose of 262 (227; 297 units and 1 (2 % patient received 300 units of Botox. 16 (33 % patients received injections under EMGcontrol. The level of symptoms of CD and tremor before and 4 weeks after the treatment were measured by the TWSTRS and Tsui scales. Evaluation of the treatment efficacy was carried out using the patientreported Clinical Global Improvement (CGI scale, and the presence or absence of head tremor after injection was also recorded. The TWSTRS score decreased from 39 (36, 42 to 24 (21, 26, the TZUI score decreased from 9.8 (9, 10 to 4.9 (4, 6 in 4 weeks after injection (p <0.001. The level of tremor measured by Tsui scale decreased from 2.1 (1.7, 2.4 and 0.7 points (0,5; 0,9 (p <0.001. In 24 (49 % cases, complete disappearance of tremor was noted in 4 weeks after injection. Complete regression of tremor was observed significantly more frequently in patients with torticollis who received injections with EMG-control in 10(71 % cases vs. 8(32 % without it (p <0.05. 28(57 % patients noted moderate or significant improvement on the CGI scale. Pain decreased from 5.4 (3.9, 6.9 points to 2.4 (1.3, 3.6 (p <0.001 according to section 3 of TWSTRS scale, pain completely regressed in 15 (52 % patients. BTA injections are highly effective and safe treatment of CD symptoms such as dystonic posture, pain and dystonic tremor. BTA injections in the neck muscles under EMGcontrol can improve outcome in patients with torticollis associated with

  14. [Childhood periodic syndromes].

    Science.gov (United States)

    Cuvellier, J-C; Lépine, A

    2010-01-01

    This review focuses on the so-called "periodic syndromes of childhood that are precursors to migraine", as included in the Second Edition of the International Classification of Headache Disorders. Three periodic syndromes of childhood are included in the Second Edition of the International Classification of Headache Disorders: abdominal migraine, cyclic vomiting syndrome and benign paroxysmal vertigo, and a fourth, benign paroxysmal torticollis is presented in the Appendix. The key clinical features of this group of disorders are the episodic pattern and intervals of complete health. Episodes of benign paroxysmal torticollis begin between 2 and 8 months of age. Attacks are characterized by an abnormal inclination and/or rotation of the head to one side, due to cervical dystonia. They usually resolve by 5 years. Benign paroxysmal vertigo presents as sudden attacks of vertigo, accompanied by inability to stand without support, and lasting seconds to minutes. Age at onset is between 2 and 4 years, and the symptoms disappear by the age of 5. Cyclic vomiting syndrome is characterized in young infants and children by repeated stereotyped episodes of pernicious vomiting, at times to the point of dehydration, and impacting quality of life. Mean age of onset is 5 years. Abdominal migraine remains a controversial issue and presents in childhood with repeated stereotyped episodes of unexplained abdominal pain, nausea and vomiting occurring in the absence of headache. Mean age of onset is 7 years. Both cyclic vomiting syndrome and abdominal migraine are noted for the absence of pathognomonic clinical features but also for the large number of other conditions to be considered in their differential diagnoses. Diagnostic criteria, such as those of the Second Edition of the International Classification of Headache Disorders and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, have made diagnostic approach and management easier. Their diagnosis

  15. Localization of dystonic muscles using {sup 18}F-FDG PET/CT in idiopathic cervical dystonia

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    Choi, J. Y.; Seung, D. H.; Kim, D. H.; Kim, E. S.; Sohn, Y. I.; Choi, Y.; Choi, E. S.; Lee, K. H.; Kim, B. T. [Samsung Medical Center, Seoul (Korea, Republic of)

    2007-07-01

    Chemodenervation with botulinum toxin (BT) is regarded as a first-line treatment for idiopathic cervical dystonia (ICD), sometimes referred to as spasmodic torticollis. Moreover, because effective treatment involves the injection of BT into most dystonic muscles, the accurate localization of dystonic muscles is clinically important. In this preliminary study, we investigated whether {sup 18}F-FDG PET/CT is useful for localizing dystonic cervical muscles in ICD by comparing disease severity after and before BT injection into muscles determined to be hypermetabolic by PET/CT. Six consecutive patients (all males; age 37 16 y) underwent {sup 18}F-FDG PET/CT once (n = 4) or twice (n = 2) in a supine (n = 5) or sitting position (n = 3) during the {sup 18}F-FDG uptake period. Dystonic muscles suitable for BT injection therapy were defined as those showing diffusely increased {sup 18}F-FDG uptake. To evaluate response to BT injection, the Tsui scale and the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) were applied. On PET/CT, hypermetabolic cervical muscles were identified in all 6 patients (3 in a supine position and 3 in a sitting position during {sup 18}F-FDG uptake periods). In 2 patients who underwent PET/CT in a supine and in a sitting position during 18F-FDG uptake, abnormal hypermetabolic muscles were observed only by PET/CT in a sitting position with patients heads and necks in the assumed abnormal involuntary posture. Symptoms were significantly improved, according to the Tsui (10.0 2.9 to 1.8 1.3, 82% reduction) and TWSTRS scales (severity: 21.3 2.1 to 5.8 5.3, 73% reduction; disability: 19.8 1.9 to 3.8 3.8, 81 % reduction) in all 4 patients who underwent BT injection therapy guided by PET/CT and who were clinically follow-up. {sup 18}F-FDG PET/CT is potentially useful for identifying dystonic cervical muscles in patients with ICD.

  16. Clinicopathological Effects of Prolonged Intoxication of Aflatoxin B1 in Broiler Chicken

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    Zahid Hussain1, Muhammad Zargham Khan2, Muhammad Kashif Saleemi2*, Ahrar Khan2 and Shahid Rafique3

    2016-11-01

    Full Text Available In this study pure Aflatoxin B1 (AFB1 was given to broiler birds at the rate of 50, 100, 200, 400 and 800µg/kg feed for 28 days. Birds of experimental groups intoxicated with 50, 100 and 200µg/kg feed did not show any clinical and behavior alteration. Birds of experimental groups intoxicated with 400 and 800µg/kg showed depression, ruffled feathers and had decreased feed intake, increased water consumption with soft to watery feces. Birds fed 800µg/kg AFB1 for 28 days also exhibited nervous signs (torticollis. Mortality occurred in all treatment groups with the exception of those given 50 and 100µg/kg AFB1 for 28 days. Clinical signs and mortality percentages score increased with the increase in AFB1 levels. Dose related significantly decreased in relative organs weight were recorded in all groups with the exception of birds given 50 and 100µg/kg AFB1 for 28 days. Significantly increased scores of gross lesions were recorded with increasing dietary levels of AFB1. The present study concluded that, AFB1 at level of 50µg/kg feed did not show any behavioral, gross and pathological effect on broilers when fed continuously for 28 day. In other groups pathological changes were seen in dose related manner. Severe changes were seen in higher dose levels.

  17. Topiramate-associated acute, bilateral, angle-closure glaucoma: case report

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    Lucas Barasnevicius Quagliato

    2013-02-01

    Full Text Available This paper describes a topiramate induced acute bilateral angle-closure glaucoma. This rare adverse effect is an idiosyncratic reaction characterized by uveal effusion and lens forward displacement, leading to increased intraocular pressure and vision loss. We describe a 55 year-old white woman with migraine, spasmodic torticollis and essential tremor, who developed bilateral acute angle-closure glaucoma, one week after starting topiramate 25 mg/day. She was seen at the Ophthalmology Emergency Department of the Fundação João Penido Burnier (Campinas, SP, Brazil with a 4 hours history of blurry vision, ocular pain and bright flashes vision. Slit lamp examination revealed moderate conjunctival injection and corneal edema, and shallow anterior chambers. Intraocular pressure was 48 mmHg in both eyes. Fundoscopic examination findings were normal. She was treated with timolol, brimonidine, dorzolamide, pilocarpine, prednisone acetate eye drops and acetazolamide. One hour after those measures, as the intraocular pressure was 30 mmHg, she received a manitol intravenous injection and the intraocular pressure normalized. After 24 hours an iridotomy with Yag laser was performed. Topiramate was discontinued and she was totally recovered after one week.

  18. Evaluation of the efficacy of deep brain stimulation in the surgical treatment of cervical dystonia.

    Science.gov (United States)

    Calheiros-Trigo, Francisca; Linhares, Paulo

    2014-01-01

    Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is a promising therapeutic option for patients with medically refractory dystonia. We present the results after 1 year of DBS of the GPi in 4 patients with cervical dystonia. Four patients with medically refractory cervical dystonia who underwent stereotactic pallidal DBS surgery between June 2010 and November 2011 were included in this retrospective study. Preoperative and postoperative evaluations at 3, 6 and 12 months after surgery were performed using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). The 4 patients experienced a sustained improvement, with a mean TWSTRS reduction of 74.25%, at 12 months follow-up. Disability improved by 80.5% (mean) at 1 year follow-up. No stimulation-related side effects were reported. Pallidal DBS is a valid and effective second-line treatment for patients with cervical focal dystonia. Our results support its use in patients with an insufficient response to medical treatment. Copyright © 2013 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  19. Duane Syndrome. Presentation of a case.

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    Pedra Palmero Aragón

    2010-04-01

    Full Text Available It was carried out an observational descriptive prospective longitudinal study including the period from march 2008 till june 20, 2008 in the Ophthalmology Service of the Provincial Educational Pediatric Hospital: “José Martí Pérez” in Sancti Spiritus, with the objective to identify the clinical and epidemiological characteristics of a patient with Duane Syndrome who went to consultation without receiving previous ophthalmological attention, the diagnosis age was determined, which was tardy, bracket the most affected eye and the kind of Duane, and also if there was any refractive defect and the presence of amblyopia , identifying the criteria for being operated, for collecting data a format was completed by the specialists, which included observation, interrogatory, ophthalmological medical record of the ill person and pictures, these elements allowed us to make a correct analysis. With the previous information we arrived as a conclusion that is all about a patient with 28 years of age who lives in Sancti Spiritus Municipality, with White skin, male, carried on the Duane Syndrome type I, unilateral left. A light Hypermetropia was presented in both eyes as a refractive defect, accompanied by a light bilateral amplyopia in the right eye and moderate in the left eye. It is necessary to stay that the patient was under surgical criterium by esotropia of more than 15 degrees in PPM and unacceptable torticollis although the time of evolution; there were no difficulties related to the surgical act. The postoperative picture can reflect the result of the surgery.

  20. Neck Pain in a 12-Year-Old Female: An Unusual Diagnosis.

    Science.gov (United States)

    Toto, Regina L; Zuckerbraun, Noel S; Manole, Mioara D

    2016-08-01

    Neck pain in the pediatric population has a broad differential diagnosis, ranging from benign to imminently life-threatening causes. Trauma and infection represent the most common etiologies of pediatric neck pain in the pediatric emergency department (PED) setting. Malignancy, though a rare cause of pediatric neck pain, is important to consider in patients with acquired torticollis or focal neurologic signs. We describe the case of a previously healthy 12-year-old female who presented to the PED with neck pain radiating down her upper extremities. The physical examination revealed diminished strength in her upper extremities compared to her lower extremities. Further evaluation revealed lymphadenopathy in the cervical and mediastinal areas and an epidural tumor in the cervical spinal column. The ultimate diagnosis was Hodgkin lymphoma presenting in an unusual manner with cervical spinal cord compression. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Neck pain is a common chief complaint among pediatric patients in the emergency setting. This case of spinal cord compression caused by malignancy illustrates the necessity of detailed spinal imaging in patients with neck pain and "red flag" signs, including but not limited to an abnormal neurologic examination. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. DDH Epidemiology Revisited: Do We Need New Strategies?

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    Amir R. Vafaee

    2017-11-01

    Full Text Available Background: Although the developmental dysplasia of the hip (DDH is well known to pediatric orthopedists, its etiology has still remained unknown and despite dedication of a vast majority of research, the results are still inadequate and confusing. The exact incidence of DDH and its relationship with known risk factors in Iran is still unknown. Here we represent the results of one year study on the incidence and related conditions of DDH. Methods: Sonography was performed on the hip joints of 1073 full term healthy newborns at Imam Khomeini Hospital from March 2013 to March 2014. The results were classified according to Graf’s classification. Pathologic hips were cross checked by the known risk factors for DDH. Results: A significant correlation was found between DDH and breech presentation (P=0.000, torticollis (P=0.004, metatarsus adductus (P=0.024. Conclusion: The incidence of DDH is significantly high in the studied group of neonates, suggesting reevaluation of current approach to DDH. The screening protocols need to be improved with the help of trained pediatricians and other health professions.

  2. Primary abductor hip contracture as diagnostic, prognostic and therapeutic problem in child hip pathology

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    Pajić Miloš

    2007-01-01

    Full Text Available Coxa obliqua represents a special functional entity in the pathology of the child hip. Authors have confirmed the results of S.L. Weissman and B. Strinovic which claimed that the abductor contracture of the hip was a primary congenital condition that developed as a result of intrauterine malposition, leading later to the contralateral adductor contracture. Critical period for the development of complications was between 6 and 8 month after birth, adductor contracture might keep persisting together with the development of acetabular dysplasia, and later on with ipsilateral subluxation. This malformation has usually been diagnosed within 3 and 6 months of age. It could be connected with some other signs of malposition, such as plagiocephaly, torticollis or infantile thoracic C scoliosis. For the diagnosis of coxa obliqua, the examination of hips in the prone position was very important and the ultrasonic and radiological examinations were crucial. The applied treatment used to be exclusively physical rehabilitation. Wide diapering has been contraindicated. In this study, we included 2,500 newborns, 1,300 boys and 1,200 girls (5,000 hips. In 22 cases of coxa obliqua (10‰, the excellent results were obtained in 96% of cases. In two unsuccessfully treated cases, a contralateral dysplasia developed, and in one untreated, subluxation. The authors are advocating a systematic and early detection and treatment of the primary coxa obliqua. .

  3. Primary Occipital Ewing’s Sarcoma with Subsequent Spinal Seeding

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    Ali Alqahtani

    2017-01-01

    Full Text Available Ewing’s sarcoma is a primary bone cancer that mainly affects the long bones. This malignancy is particularly common in pediatric patients. Primary cranial involvement accounts for 1% of cases, with occipital involvement considered extremely rare. In this case study, primary occipital Ewing’s sarcoma with a posterior fossa mass and subsequent relapse resulting in spinal seeding is reported. A 3-year-old patient presented with a 1-year history of left-sided headaches, localized over the occipital bone with progressive torticollis. Computed tomography (CT imaging showed a mass in the left posterior fossa compressing the brainstem. The patient then underwent surgical excision followed by adjuvant chemoradiation therapy. Two years later, the patient presented with severe lower back pain and urinary incontinence. Whole-spine magnetic resonance imaging (MRI showed cerebrospinal fluid (CSF seeding from the L5 to the S4 vertebrae. Primary cranial Ewing’s sarcoma is considered in the differential diagnosis of children with extra-axial posterior fossa mass associated with destructive permeative bone lesions. Although primary cranial Ewing’s sarcoma typically has good prognosis, our patient developed metastasis in the lower spine. Therefore, with CNS Ewing’s sarcoma, screening of the entire neural axis should be taken into consideration for early detection of CSF seeding metastasis in order to decrease the associated morbidity and mortality.

  4. Skeletal response to diet with soya bean seeds used as primary source of protein in growing broiler chickens.

    Science.gov (United States)

    Olkowski, B; Charuta, A; Radzki, R; Bieńko, M; Toczko, R

    2016-08-01

    The study was conducted using 120 commercial broiler chicks (Ross 308) randomly allocated to two experimental groups. The experimental diets, differing only in protein source, either solvent-extracted soya bean meal (SBM) or traditional (non-genetically modified) full-fat soya bean seeds (FFS), were prepared using practical corn-based formulation designed to meet nutritional requirements of broilers. Performance parameters were monitored weekly. Also, the subjects were evaluated daily for overt changes in skeletal anatomy and gait physiology. Randomly selected chickens from each group (seven males and seven females) were euthanized at 2, 3, 4 and 6 weeks of age, and bone specimens were collected for further study. Bone mineral density (BMD) and bone mineral content (BMC) were determined in tibiotarsal bones. Broilers fed FFS diet showed retarded growth rate and decreased feed intake (both p chickens from the FFS group in comparison with the SBM group. The chickens fed the FFS diet showed higher incidence of skeletal pathology including angular deformities and torticollis (both p chickens. Journal of Animal Physiology and Animal Nutrition © 2016 Blackwell Verlag GmbH.

  5. Vertigo in childhood: proposal for a diagnostic algorithm based upon clinical experience.

    Science.gov (United States)

    Casani, A P; Dallan, I; Navari, E; Sellari Franceschini, S; Cerchiai, N

    2015-06-01

    The aim of this paper is to analyse, after clinical experience with a series of patients with established diagnoses and review of the literature, all relevant anamnestic features in order to build a simple diagnostic algorithm for vertigo in childhood. This study is a retrospective chart review. A series of 37 children underwent complete clinical and instrumental vestibular examination. Only neurological disorders or genetic diseases represented exclusion criteria. All diagnoses were reviewed after applying the most recent diagnostic guidelines. In our experience, the most common aetiology for dizziness is vestibular migraine (38%), followed by acute labyrinthitis/neuritis (16%) and somatoform vertigo (16%). Benign paroxysmal vertigo was diagnosed in 4 patients (11%) and paroxysmal torticollis was diagnosed in a 1-year-old child. In 8% (3 patients) of cases, the dizziness had a post-traumatic origin: 1 canalolithiasis of the posterior semicircular canal and 2 labyrinthine concussions, respectively. Menière's disease was diagnosed in 2 cases. A bilateral vestibular failure of unknown origin caused chronic dizziness in 1 patient. In conclusion, this algorithm could represent a good tool for guiding clinical suspicion to correct diagnostic assessment in dizzy children where no neurological findings are detectable. The algorithm has just a few simple steps, based mainly on two aspects to be investigated early: temporal features of vertigo and presence of hearing impairment. A different algorithm has been proposed for cases in which a traumatic origin is suspected.

  6. Actions of piperidine alkaloid teratogens at fetal nicotinic acetylcholine receptors.

    Science.gov (United States)

    Green, Benedict T; Lee, Stephen T; Panter, Kip E; Welch, Kevin D; Cook, Daniel; Pfister, James A; Kem, William R

    2010-01-01

    Teratogenic alkaloids are found in many species of plants including Conium maculatum L., Nicotiana glauca, Nicotiana tabaccum, and multiple Lupinus spp. Fetal musculoskeletal defects produced by alkaloids from these plants include arthrogyropisis, scoliosis, torticollis, kyposis, lordosis, and cleft palate. A pharmacodynamic comparison of the alkaloids ammodendrine, anabasine, anabaseine, anagyrine, and coniine in SH-SY5Y cells and TE-671 cells was made. These alkaloids and their enantiomers were more effective in depolarizing TE-671 cells which express the human fetal-muscle type nicotinic acetylcholine receptor (nAChR) relative to SH-SY5Y cells which predominately express autonomic nAChRs. The rank order of potency in TE-671 cells was: anabaseine>(+)-anabasine>(-)-anabasine > (+/-)-anabasine>anagyrine>(-)-coniine > (+/-)-coniine>(+)-coniine>(+/-)-ammodendrine>(+)-ammodendrine. The rank order potency in SH-SY5Y cells was: anabaseine>(+)-anabasine>(-)-coniine>(+)-coniine>(+)-ammodendrine>anagyrine>(-)-anabasine>(+/-)-coniine>(+/-)-anabasine>(-)-ammodendrine. The actions of these alkaloids at nAChRs in both cell lines could be distinguished by their maximum effects in depolarizing cell membrane potential. The teratogenic action of these compounds may be related to their ability to activate and subsequently desensitize nAChRs.

  7. A Symptomatic Displaced Os Odontoideum: A Case Report

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    Farshad Nikouei

    2016-05-01

    Full Text Available Introduction Os odontoideum (OO is a form of odontoid anomaly presented by a separate ossicle with a smooth, sclerotic border not fused with C2 body. The current paper reports a boy with irreducible displaced os odontoideum with severe neurologic deficit after a minor trauma. Case Presentation A 16-year-old boy admitted in the center due to neck pain and torticollis with neurologic deficit. He had a history of multiple minor traumas. Advanced imaging assessment demonstrated displaced os odontoideum with minimal space available for cord (SAC and myelomalacia. After unsuccessful closed reduction a 2-stage operation was planned: first, the anterior transoral release and odontoid resection with subsequent halo-traction and second, the posterior atlanto-axial instrumented fusion with bilateral C1 hook and C2 pedicular screws. Conclusions Congenital anomalies of the odontoid are associated with C1-C2 instability that can be subluxated or dislocated with minor trauma and cause permanent neurologic deficit or even death. When acute cervical spine trauma is imaged, os odontoideum should be distinguished from an acute dens fracture with a multimodality imaging approach including computed tomography (CT, magnetic resonance imaging (MRI and radiography. Here is the report of a rare case with irreducible displaced os odontiodeum treated him with anterior release, odontoid resection and posterior C1-C2 instrumented fusion.

  8. Quantification of C2 cervical spine rotatory fixation by X-ray, MRI and CT

    Energy Technology Data Exchange (ETDEWEB)

    Gradl, Georg [Chirurgische Klinik und Poliklinik der Universitaet Rostock, Abteilung Unfall- und Wiederherstellungschirurgie, Rostock (Germany); Maier-Bosse, Tamara; Staebler, Axel [Institut fuer Radiologische Diagnostik der Universitaet Muenchen, Klinikum Grobetahadern, Munich (Germany); Penning, Randolph [Institut fuer Rechtsmedizin der Universitaet Muenchen, Munich (Germany)

    2005-02-01

    Atlanto-axial rotatory displacement is known to be a cause of childhood torticollis and may as well be responsible for chronic neck pain after rear-end automobile collisions. The objective was to determine whether quantification of C2 malrotation is possible by plain radiographs in comparison to CT as the golden standard. MR imaging was evaluated as to whether it was of equal value in the detection of bony landmarks. C2 vertebra of five human cadaveric cervical spine specimens, ligamentously intact, were rotated using a Steinmann pin in steps of 5 up to 15 right and 15 left. Plain radiographs, CT and MRI images were taken in each rotational step. Data were analyzed for quantification of C2 rotation by three independent examiners. A rotation of 5 led to a spinous process deviation (SPD) from the midline of 3 mm as measured on an a.p. plain radiograph. A coefficient of rotation was calculated (1.62 mm{sup -1}). Data analyzed by three examiners revealed a small coefficient of variation (0.03). MRI and CT measurements showed comparable results for the quantification of rotation; however, in both techniques the 15 rotation was underestimated. Quantification of upper cervical spine malrotation was possible on plain radiographs using the SPD and a rotation coefficient. MRI and CT were equally successful in the assessment of C2 malrotation. (orig.)

  9. Adolescent health in medieval Serbia: signs of infectious diseases and risk of trauma.

    Science.gov (United States)

    Djurić, M; Janović, A; Milovanović, P; Djukić, K; Milenković, P; Drasković, M; Roksandic, M

    2010-04-01

    Although pattern of health in adults has been frequently assessed in past human populations, health status of adolescents as a distinct life stage has usually been overlooked. Inconsistency in number and meaning of recognised age categories in anthropological literature, as well as chronological age ranges used to define them, further complicate the interpretation of adolescent health. In this study, we analysed signs of pathological conditions on skeletal remains of 81 adolescents from a medieval site of Stara Torina (northern Serbia). Diagnostic palaeopathological procedures comprised gross examination, digital radiography, and histological analysis. Skeletal signs of anaemia such as cribra orbitalia and other porotic phenomena as well as signs of non-specific bone infection were observed frequently, while evidence of bone trauma was recorded in a very low percentage of individuals. In addition, we recorded two conditions relatively rarely observed in palaeopathological contexts: a case of skull and vertebral asymmetry indicative of congenital muscular torticollis, and a case of a fibrous cortical defect on distal femur. Comparison with available information from other medieval adolescent samples from Serbia demonstrated that while mortality was relatively constant throughout the sample, Stara Torina showed a much higher occurrence of bone disease. Characteristics of observed skeletal conditions, supported by available historical reports, suggest that the health of medieval adolescents in the examined population was most significantly affected by infectious processes. Copyright 2010 Elsevier GmbH. All rights reserved.

  10. STUDY OF POSTURAL ABNORMALITIES OF MALE STUDENTS OF SAHAND UNIVERSITY OF TECHNOLOGY

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    Hefzollesan Mehrdad

    2013-04-01

    Full Text Available The present study has been accomplished in order to examine the prevalence of postural abnormalities of male students. The statistical community was the whole male students in the university. From this community 300 students within the ages range of 18 - 22 were selected randomly as the investigation subjects. Data were obtained by a questionnaire, podoscope, a digital camera (taking photos of the subjects from Anterior, Posterior and lateral views and the software for corrective exercises provided by Iran ministry of education. After that the investigation was finished the abundance percentage was used to express the postural abnormalities percentage of the research subjects. The results show that cervical lordosis and flat foot are the most prevalent abnormalities with18.66 and 17.66 percent respectively, and torticollis and knee hyperextension have less prevalence in investigation subjects. The results show that among all of the participants in the investigation, 140 students (46.66 % have no abnormalities, 160 students (53.34 % have at least one, and 70 students (23.33 % have more than one. From this study it is obvious that the prevalence of the postural abnormalities among the statistical subjects is high. Therefore the need to a serious program concerning the abnormalities, especially ordering corrective exercises and also preparing the way for students to have physical activities seems to be inevitable.

  11. Isolation of Ornithobacterium rhinotracheale from the brains of commercial broiler breeder chickens with meningitis and encephalitis

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    Banani, M

    2015-10-01

    Full Text Available Ornithobacterium rhinotracheale (ORT has been identified as one of the respiratory bacterial pathogens in turkey and chicken flocks. Four live birds displaying severe torticollis were submitted from a 13-week-old commercial broiler breeder chicken flock located in Mazandaran province. These birds were suspected to pasteurellosis by the farm veterinarian. No other marked gross lesion except emaciation was seen. Histopathologic examination of the brains showed mild to moderate meningeal vasculitis, perivascular cuffing with lymphocytes, degeneration and necrosis of purkinje cells in the cerebellum. Viral culture of the brains especially for Newcastle disease and avian influenza viruses was negative. Bacterial culture of the brains onto the blood agar revealed pure growth of Ornithobacterium rhinotracheale. In this study molecular confirmation of ORT by using of a very specific polymerase chain reaction (PCR was carried out. Amplification products of a 784 bp region of the 16S rRNA gene of ORT confirmed the bacterium identification. This is the first field case of ORT isolation from the brain of commercial chickens in Iran. These data suggest that this bacterium should be considered in differential diagnosis in cases of avian nervous signs. Further studies are necessary to confirm if ORT is a primary pathogen in such cases.

  12. Penentuan Secara Imunopatologi Organ Target Virus Flu Burung Menggunakan Streptavidin Biotin (DETERMINATION OF TARGET ORGANS OF AVIAN INFLUENZA VIRUS USING IMMUNOPATHOLOGICAL IMMUNOHISTOCHEMISTRY STREPTAVIDIN-BIOTIN

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    Niken Yunita

    2018-01-01

    Full Text Available Avian influenza is a viral disease in poultry caused by avian influenza virus (AIV subtype H5N1 with varying clinical signs are often similar to the clinical signs of other viral infections, such as Newcastle disease virus (NDV. The mechanism of disease pathogenesis to express clinical signs tightly correlated to the determination of the target organ seen from AIV H5N1 antigens distribution in organs, such as respiratory tract, brain and gastrointestinal tract. Immunopathological immunohistochemistry streptavidin-biotin (IHC SB is a method for sensitive and accurate in detecting antigens of AIV on the tissues. In the present study, it was determined whether in laying hens with clinical signs of torticollis and curled toe paralysis, and pathologic anatomic lesions in the form of petechial and foci necrotic hemorrhages tested with immunopathological IHC SB is positive AIV H5N1 infection. IHC SB study results showed that the AIV H5N1 antigen were found in tissues of the lung, brain, duodenum and proventriculus. Based on these results, we can conclude that the IHC SB is a method that is highly sensitive and accurate to detect H5N1 antigens and its distribution in the host.

  13. Hemato-biochemical and pathological changes on avian influenza in naturally infected domestic ducks in Egypt

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    Essam A. Mahmoud

    2015-10-01

    Full Text Available Aim: Few studies have been made in regard to avian influenza (AI in ducks, thus the aim of this work was planned to investigate the hematological, biochemical, and pathological changes in domestic Egyptian ducks naturally infected with AI. Materials and Methods: 30 duck from private backyards 3-month-old 15 were clinically healthy (Group 1 and the other fifteen (Group 2 were naturally diseased with AI (H5N1. The disease was diagnosed by polymerase chain reaction as H5N1. Results: Duck showed cyanosis, subcutaneous edema of head and neck with nervous signs (torticollis. Hematological studies revealed a microcytic hypochromic anemia. Biochemical studies revealed a significant decrease in total protein, albumin and globulin concentration with significant increase of activities of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, Υ-glutamyl transpeptidase, lactic acid dehydrogenase and creatine phsphokinase. Prominent increase in creatinine and uric acid in addition to hypocalcemia and hyperphosphatemia were significantly detected in the infected ducks. Histopathological finding confirm these investigations. Conclusion: The highly pathogenic AIV (A/H5N1 became more severe infectious to ducks than before and causes nervous manifestations and blindness which were uncommon in ducks. Besides the significant increases of hepatic enzymes, brain, heart, and renal markers as a response to virus damage to these organs.

  14. Experimental intraocular infection of exotic cockerels with field strain of velogenic Newcastle disease virus in Nigeria

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    Samaila Jonathan Badau

    2015-12-01

    Full Text Available Experimental intraocular (conjunctival infection of exotic cockerels with a new field strain of viscerotropic velogenic Newcastle Disease Virus (NDV was conducted to explore the concurrence of some pathological changes with humoral immune responses. After the NDV infection of 4-week-old cockerels, pathologic changes and antibody responses were observed. The clinical signs observed after the artificial inoculation included inappetence, depression, diarrhea, dyspnea, wing and leg paralysis, torticollis and weight loss. Morbidity due to the NDV was 100%, but mortality was 80% by day 18-21 post-infection. Early hyperthermia followed by terminal hypothermia, decreased packed cell volume (PCV, and 231.4 folds peak-antibody response were observed. Necrotic and/or inflammatory lesions were present in the proventriculus, intestine, liver, spleen, kidney and brain. Neurologic and digestive tract perturbations occurred in 10% and 85% of cases, respectively. The disease consistently caused stunted growth, decreased PCV, and necro-inflammatroy lesions concurrent with antibody response, suggesting probable involvement of immune-mediated mechanisms and cell membrane desialylation by viral neuraminidase in the pathogenesis.

  15. Post eclamptic aneurysmal rupture subarachnoid haemorrhage diagnosed in the puerperium

    International Nuclear Information System (INIS)

    Coolen, Teresa

    2006-01-01

    The incidence of subarachnoid and/or intracerebral haemorrhage in women during pregnancy is rare. The risk depends on the stage of pregnancy, but seems to be highest during the late third trimester, during delivery and in the puerperium. Headache can be a symptom of both preeclampsia, subarachnoid haemorrhage and other pathologies or conditions. It is essential for pregnant women with a suspected ruptured aneurysm to be investigated and treated without delay, irrespective of fear of harm to the foetus, to avoid complications from aneurysm rupture. This case study presents a 39-year-old woman who was 35 weeks and 3 days pregnant with known preeclampsia. She endured a headache for the three days leading up to the delivery with associated diplopia on the third day, but these symptoms were thought to be related to her preeclampsia. Over the three hours following childbirth, her headache became more severe and she suffered from vomiting, loss of vision, torticollis and seizures. Computed tomography (CT) of her head revealed a subarachnoid haemorrhage while CT angiography of the Circle of Willis failed to reveal an aneurysm and 4-vessel angiography only demonstrated an area slightly suspicious for the presence of an aneurysm. 3D rotational angiography clearly demonstrated a 1-2 mm aneurysm superior to the left terminal internal carotid artery. In this case, 3D rotational angiography proved to be a valuable additional technique. This patient underwent surgery for her ruptured aneurysm and has made an excellent recovery

  16. A case of Klippel-Feil syndrome with renal agenesis

    Directory of Open Access Journals (Sweden)

    Mehmet Karakoç

    2010-05-01

    Full Text Available Klippel-Feil syndrome (KFS is is a rare syndrome that characterized by fusion of at least two congenital vertebrae in the cervical region. The most common characteristics of KFS are short neck, low nuchal hair line and restricted joint mobility of the cervical region.Addititonal features are scoliosis, sipina bifida, cervical rib, Sprengel deformity and facial asymmetry, and renal and cardiac anomalies. In this report a 10 years old girl was admitted with complaints of short stature and abnormal neck curvature. Physical examination of the patient revealed short neck, low nuchal hair line, and Sprengel’s deformity, height hard palate, facial asymmetry and torticollis. Cervical paravertebral muscle spasm was found on the left as (+ / right (+ +. Muscle tone, muscle strength, reflexes and sensory examination were found to be normal. Radiological examination of the C4-5 and C6-7 cervical region revealed the loss of inteverebral disc spaces and block vertebra. Also there was hemivertebra anomaly and aplasia of odontoid process. Abdominal and pelvic ultrasound examination revelaed absence of right kidney. Echocardiographical examination gave no abnormality. The case was presented in order to draw attention to KFS with renal agenesia in the light of current literature.

  17. Headache Attributed to Craniocervical Dystonia - A Little Known Headache.

    Science.gov (United States)

    Bezerra, Marcos Eugenio Ramalho; Rocha-Filho, Pedro Augusto Sampaio

    2017-02-01

    Craniocervical dystonia is a focal or segmental dystonia in its distribution, classically known as spasmodic torticollis when in its pure cervical presentation. Although craniocervical dystonia has been recognized as a possible cause of headache since the publication of the second version of International Classification of Headache Disorders, there are few studies about this entity. This was a narrative review. Craniocervical dystonia was associated with muscle pain in 67-89% of the cases. Headaches of any kind affected approximately 60% of patients with craniocervical dystonia, and were located mainly in the occipital and cervical regions. Headache attributed to craniocervical dystonia specifically was rarely found, and it was described in only one patient out of 80 in one study. Treatment with botulinum neurotoxin is considered to be the first-line treatment for focal dystonias, including craniocervical dystonia, and besides reducing clinical severity, impairment, and pain scores among the patients with craniocervical dystonia, there were also descriptions of improvements in headaches attributed to craniocervical dystonia and other headaches associated with this dystonia. Headache attributed to craniocervical dystonia has been poorly studied. There is a need for more studies to evaluate its characteristics and treatment. © 2016 American Headache Society.

  18. Outcomes in patients with esotropic duane retraction syndrome and a partially accommodative component

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    Ramesh Kekunnaya

    2013-01-01

    Full Text Available Background: The management of Duane retraction syndrome (DRS is challenging and may become more difficult if an associated accommodative component due to high hyperopia is present. The purpose of this study is to review clinical features and outcomes in patients with partially accommodative esotropia and DRS. Setting and Design: Retrospective, non-comparative case series. Materials and Methods: Six cases of DRS with high hyperopia were reviewed. Results: Of the patients studied, the mean age of presentation was 1.3 years (range: 0.5-2.5 years. The mean amount of hyperopia was + 5D (range: 3.50-8.50 in both eyes. The mean follow up period was 7 years (range: 4 months-12 years. Five cases were unilateral while one was bilateral. Four cases underwent vertical rectus muscle transposition (VRT and one had medial rectus recession prior to presentation; all were given optical correction. Two (50% of the four patients who underwent vertical rectus transposition cases developed consecutive exotropia, one of whom did not have spectacles prescribed pre-operatively. All other cases (four had minimal residual esotropia and face turn at the last follow-up with spectacle correction. Conclusion: Patients with Duane syndrome can have an accommodative component to their esotropia, which is crucial to detect and correct prior to surgery to decrease the risk of long-term over-correction. Occasionally, torticollis in Duane syndrome can be satisfactorily corrected with spectacles alone.

  19. Antibiogram and heavy metal tolerance of bullfrog bacteria in Malaysia

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    M. Najiah

    2011-10-01

    Full Text Available Bacterial isolates from 30 farmed bullfrogs (Lithobates catesbeianus weighing 500-600 g at Johore, Malaysia with external clinical signs of ulcer, red leg and torticollis were tested for their antibiograms and heavy metal tolerance patterns. A total of 17 bacterial species with 77 strains were successfully isolated and assigned to 21 antibiotics and 4 types of heavy metal (Hg2+, Cr6+, Cd2+, Cu2+. Results revealed that bacteria were resistant against lincomycin (92%, oleandomycin (72.7% and furazolidone (71.4% while being susceptible to chloramphenicol and florfenicol at 97.4%. The multiple antibiotic resistance (MAR index for C. freundii, E. coli and M. morganii was high with the value up to 0.71. Bacterial strains were found to exhibit 100 % resistance to chromium and mercury. High correlation of resistance against both antibiotics and heavy metals was found (71.4 to 100% between bullfrog bacteria isolates, except bacteria that were resistant to kanamycin showed only 25% resistance against Cu2+. Based on the results in this study, bacterial pathogens of bullfrog culture in Johore, Malaysia, were highly resistant to both antibiotics and heavy metals.

  20. A 15-Month-Old Boy With Respiratory Distress and Parapharyngeal Abscess: A Case Report

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    Behdad Gharib

    2017-01-01

    Full Text Available Parapharyngeal abscess is a life-threatening disease. Upper respiratory tract infection is the main cause in children. We present a 15-month-old boy admitted to the emergency ward with the chief complaint of difficulty in breathing caused by parapharyngealabscess. His condition deteriorated gradually, and he transferred to the operation theater quickly for abscess drainage and because of the difficulty in orotracheal intubation; a tracheostomy was performed. His respiratory condition deteriorated 2 days after PICU admission, and the medical team noticed an unexplainable respiratory distress. A chest x ray obtained and showed a right side pneumothorax and subcutaneous emphysema around theneck area. The case presented here, had not been diagnosed at the first examination; however, there were enough clinical clues (such as respiratory distress, drooling, torticollis, bulging of theneck, previous viral respiratory infection, possible pharyngeal trauma. The story of this case reminds us the importance of the precise physical exam and history taking which could be life-saving.

  1. kinesiotaping reduces pain and modulates sensory function in patients with focal dystonia: a randomized crossover pilot study.

    Science.gov (United States)

    Pelosin, Elisa; Avanzino, Laura; Marchese, Roberta; Stramesi, Paola; Bilanci, Martina; Trompetto, Carlo; Abbruzzese, Giovanni

    2013-10-01

    Pain is one of the most common and disabling "nonmotor" symptoms in patients with dystonia. No recent study evaluated the pharmacological or physical therapy approaches to specifically treat dystonic pain symptoms. To evaluate the effectiveness of KinesioTaping in patients with cervical dystonia (CD) and focal hand dystonia (FHD) on self-reported pain (primary objective) and on sensory functions (secondary objective). Twenty-five dystonic patients (14 with CD and 11 FHD) entered a randomized crossover pilot study. The patients were randomized to 14-day treatment with KinesioTaping or ShamTaping over neck (in CD) or forearm muscles (in FHD), and after a 30-day washout period, they received the other treatment. The were 3 visual analog scales (VASs) for usual pain, worst pain, and pain relief. Disease severity changes were evaluated by means of the Toronto Western Spasmodic Torticollis Rating Scale (CD) and the Writer's Cramp Rating Scale (FHD). Furthermore, to investigate possible KinesioTaping-induced effects on sensory functions, we evaluated the somatosensory temporal discrimination threshold. Treatment with KinesioTape induced a decrease in the subjective sensation of pain and a modification in the ability of sensory discrimination, whereas ShamTaping had no effect. A significant, positive correlation was found in both groups of patients between the improvement in the subjective sensation of pain and the reduction of somatosensory temporal discrimination threshold values induced by KinesioTaping. These preliminary results suggest that KinesioTaping may be useful in treating pain in patients with dystonia.

  2. [Effects of an hydrotherapy program in the treatment of cervical dystonia. A pilot study].

    Science.gov (United States)

    Useros-Olmo, Ana Isabel; Collado-Vázquez, Susana

    2010-12-01

    Cervical dystonia may also cause limitation in articulation mobility and alteration of the balance, both accompanied with pain. AIM. To evaluate if hydrotherapy produces decrease of pain, increase in mobility and balance in patients diagnosed with cervical dystonia. A pre-post treatment pilot study was carried out without group control, with a sample of 16 patients (13 female and 3 male) diagnosed with cervical dystonia. The patients received an hydrotherapy treatment consisted of three individual sessions and three grupal sessions of aquatic exercises. In the pre-treatment phase the disability, severity and pain were evaluated by means of the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS); the balance was evaluated by means of the Get up and Go and Tinetti tests. In addition, the range of active mobility of the neck was measured with tape. The test were measured pre and post-treatment. The Student t showed a significant difference (p hydrotherapy can be related a positive influence in cervical dystonia, producing neck mobility and balance improvements and pain decrease. Future studies are necessary.

  3. Primary Occipital Ewing's Sarcoma with Subsequent Spinal Seeding.

    Science.gov (United States)

    Alqahtani, Ali; Amer, Roaa; Bakhsh, Eman

    2017-01-01

    Ewing's sarcoma is a primary bone cancer that mainly affects the long bones. This malignancy is particularly common in pediatric patients. Primary cranial involvement accounts for 1% of cases, with occipital involvement considered extremely rare. In this case study, primary occipital Ewing's sarcoma with a posterior fossa mass and subsequent relapse resulting in spinal seeding is reported. A 3-year-old patient presented with a 1-year history of left-sided headaches, localized over the occipital bone with progressive torticollis. Computed tomography (CT) imaging showed a mass in the left posterior fossa compressing the brainstem. The patient then underwent surgical excision followed by adjuvant chemoradiation therapy. Two years later, the patient presented with severe lower back pain and urinary incontinence. Whole-spine magnetic resonance imaging (MRI) showed cerebrospinal fluid (CSF) seeding from the L5 to the S4 vertebrae. Primary cranial Ewing's sarcoma is considered in the differential diagnosis of children with extra-axial posterior fossa mass associated with destructive permeative bone lesions. Although primary cranial Ewing's sarcoma typically has good prognosis, our patient developed metastasis in the lower spine. Therefore, with CNS Ewing's sarcoma, screening of the entire neural axis should be taken into consideration for early detection of CSF seeding metastasis in order to decrease the associated morbidity and mortality.

  4. Antibiogram and heavy metal tolerance of bullfrog bacteria in Malaysia.

    Science.gov (United States)

    Tee, L W; Najiah, M

    2011-01-01

    Bacterial isolates from 30 farmed bullfrogs (Lithobates catesbeianus) weighing 500-600 g at Johore, Malaysia with external clinical signs of ulcer, red leg and torticollis were tested for their antibiograms and heavy metal tolerance patterns. A total of 17 bacterial species with 77 strains were successfully isolated and assigned to 21 antibiotics and 4 types of heavy metal (Hg(2+), Cr(6+), Cd(2+), Cu(2+)). Results revealed that bacteria were resistant against lincomycin (92%), oleandomycin (72.7%) and furazolidone (71.4%) while being susceptible to chloramphenicol and florfenicol at 97.4%. The multiple antibiotic resistance (MAR) index for C. freundii, E. coli and M. morganii was high with the value up to 0.71. Bacterial strains were found to exhibit 100 % resistance to chromium and mercury. High correlation of resistance against both antibiotics and heavy metals was found (71.4 to 100%) between bullfrog bacteria isolates, except bacteria that were resistant to kanamycin showed only 25% resistance against Cu(2+). Based on the results in this study, bacterial pathogens of bullfrog culture in Johore, Malaysia, were highly resistant to both antibiotics and heavy metals.

  5. Quantification of C2 cervical spine rotatory fixation by X-ray, MRI and CT

    International Nuclear Information System (INIS)

    Gradl, Georg; Maier-Bosse, Tamara; Staebler, Axel; Penning, Randolph

    2005-01-01

    Atlanto-axial rotatory displacement is known to be a cause of childhood torticollis and may as well be responsible for chronic neck pain after rear-end automobile collisions. The objective was to determine whether quantification of C2 malrotation is possible by plain radiographs in comparison to CT as the golden standard. MR imaging was evaluated as to whether it was of equal value in the detection of bony landmarks. C2 vertebra of five human cadaveric cervical spine specimens, ligamentously intact, were rotated using a Steinmann pin in steps of 5 up to 15 right and 15 left. Plain radiographs, CT and MRI images were taken in each rotational step. Data were analyzed for quantification of C2 rotation by three independent examiners. A rotation of 5 led to a spinous process deviation (SPD) from the midline of 3 mm as measured on an a.p. plain radiograph. A coefficient of rotation was calculated (1.62 mm -1 ). Data analyzed by three examiners revealed a small coefficient of variation (0.03). MRI and CT measurements showed comparable results for the quantification of rotation; however, in both techniques the 15 rotation was underestimated. Quantification of upper cervical spine malrotation was possible on plain radiographs using the SPD and a rotation coefficient. MRI and CT were equally successful in the assessment of C2 malrotation. (orig.)

  6. Condylus tertius with atlanto-axial rotatory fixation: an unreported association

    Energy Technology Data Exchange (ETDEWEB)

    Udare, Ashlesha Satish [M.G.M. Hospital, Department of Radiology, Kamothe, Navi Mumbai (India); Global Hospital Super Speciality and Transplant Centre, Department of Radiology, Mumbai (India); Navi Mumbai, Maharashtra (India); Bansal, Divya; Patel, Bhavin [M.G.M. Hospital, Department of Radiology, Kamothe, Navi Mumbai (India); Mondel, Prabath Kumar [P.D. Hinduja Hospital, Department of Radiology, Mahim, Mumbai (India); Aiyer, Siddharth [Shatabdi Hospital, Department of Orthopedics, Chembur, Mumbai (India)

    2014-04-15

    The ''condylus tertius'' or the ''third occipital condyle'' is an embryological remnant of the proatlas sclerotome. Anatomically, it is attached to the basion and often articulates with the anterior arch of the atlas and the odontoid apex; hence, it is also called the ''median occipital condyle''. It is a rare anomaly of the cranio-vertebral junction (CVJ) that can lead to instability and compression of important surrounding neurovascular structures. We report a case of a 16-year-old boy who presented with suboccipital neck pain, torticollis and right sided hemiparesis. Plain radiographs revealed an increased atlanto-dental interspace (ADI) with a retroflexed odontoid. Open mouth view showed asymmetry of the articular processes of the atlas with respect to the dens. Computed tomography (CT) of the CVJ delineated the third occipital condyle. Furthermore, on dynamic CT study, a type 3 atlanto-axial rotatory fixation (AARF) was clearly demonstrated. Magnetic resonance imaging (MRI) of the CVJ revealed severe right-sided spinal cord compression by the retroflexed and rightward deviated dens. It also revealed disruption of the left alar and transverse ligaments. The patient was treated with 8 weeks of cranial traction and reasonable alignment was obtained. This was followed by C1-C2 lateral mass screw fixation and C1-C2 interlaminar wiring to maintain the alignment. A review of the literature did not reveal any cases of condylus tertius associated with non-traumatic AARF. An accurate knowledge of the embryology and imaging features of this rare CVJ anomaly is useful in the prompt diagnosis and management of such patients. (orig.)

  7. Implementation of different histochemical methods in diagnostics of brain Aspergillosis in turkey chicks

    Directory of Open Access Journals (Sweden)

    Kureljušić Branislav

    2011-01-01

    Full Text Available Aspergillosis is a frequent fungal disease in different species of birds and mammals caused by fungi of the genus Aspergillus. It is characterized by inflammatory changes primarily in the respiratory system, even though it sometimes takes on a generalized form when several organ systems are affected. Mucotic-granulomatous meningoencephalitis with a predominant localization in the cerebellum has been described in turkeys, ducks and geese. Within this paper, examinations have been performed on a flock of broiler turkeys aged 12 days who had sustained evident neurological disorders in the form of ataxy, torticollis, paresis, and paralysis of the hind extremities and wings. In three of the ten autopsied chicks the macroscopic findings indicated granulomatous encephalitis of the cerebellum. A white-coloured granuloma, around 3mm in diameter, was situated cranioventrally and was clearly visible on the sagital section of the cerebellum. Mucological examinations of the cerebellum lesion resulted in the isolation of the fungi Aspergillus fumigatus. Haematoxylin-eosin (HE, Grocott and PAS methods were used for the evaluation of histopathological changes and proving Aspergillus fumigatusa hyphae. The microscopic examination of brain tissue sections stained with the HE method revealed the existence of a granuloma with a centrally placed necrotic area. The necrotic area was infiltrated with heterophilic granulocytes and surrounded by macrophage, giant cells and lymphocytes. A connective tissue capsule was located on the periphery of the granuloma. The fungi hyphae, as integral parts of the granuloma, were difficult to observe, and in some samples stained using the HE method they could not be seen at all. On the other hand, sections stanied using the Grocott and PAS methods showed prominent septed and branched hyphae in different parts of the granuloma. With the objective of making an etiological diagnosis of mucotic diseases, it is necessary to apply several

  8. AbobotulinumtoxinA in the management of cervical dystonia in the United Kingdom: a budget impact analysis

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    Abogunrin S

    2015-09-01

    Full Text Available Seye Abogunrin,1 Sarah Brand,2 Kamal Desai,3 Jerome Dinet,4 Sylvie Gabriel,5 Timothy Harrower61Meta Research, Evidera, London, UK; 2Health Economics, Evidera, Bethesda, MD, USA; 3Health Economics, Evidera, London, UK; 4Health Economics and Outcomes Research (Global, 5Global Market Access and Pricing, Ipsen Pharma, Boulogne-Billancourt, France; 6Royal Devon and Exeter NHS Foundation Trust, Exeter, UKBackground: Cervical dystonia (CD can be effectively managed by a combination of botulinum neurotoxin A (BoNT-A and conventional therapy (skeletal muscle relaxants and rehabilitative therapy, but the costs of different interventions in the UK vary.Methods: A budget impact model was developed from the UK payer perspective with a 5-year time horizon to evaluate the effects of changing market shares of abobotulinumtoxinA, nabotulinumtoxinA, and incobotulinumtoxinA, and best supportive care from the UK payer perspective. Epidemiological and resource use data were retrieved from the published literature and clinical expert opinion. Deterministic sensitivity analyses were performed to determine the parameters most influential on the budgetary findings under base case assumptions.Results: Under base case assumptions, an increased uptake of abobotulinumtoxinA showed an accumulated savings of £2,250,992 by year 5. Treatment per patient per year with onabotulinumtoxinA and incobotulinumtoxinA costs more when compared to treatment with abobotulinumtoxinA. One-way sensitivity analyses showed that the prevalence of CD, dose per injection of each of the BoNT-As, and time to reinjection of incobotulinumtoxinA and abobotulinumtoxinA influenced the base case findings most.Conclusion: There is potential for cost savings associated with the greater use of abobotulinumtoxinA rather than other BoNT-A treatments, permitting more patients to benefit more from effective BoNT-A treatment with a fixed budget. Keywords: cervical dystonia, torticollis, botulinum toxin A, budget

  9. The extracellular domain of myelin oligodendrocyte glycoprotein elicits atypical experimental autoimmune encephalomyelitis in rat and Macaque species.

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    Alan D Curtis

    Full Text Available Atypical models of experimental autoimmune encephalomyelitis (EAE are advantageous in that the heterogeneity of clinical signs appears more reflective of those in multiple sclerosis (MS. Conversely, models of classical EAE feature stereotypic progression of an ascending flaccid paralysis that is not a characteristic of MS. The study of atypical EAE however has been limited due to the relative lack of suitable models that feature reliable disease incidence and severity, excepting mice deficient in gamma-interferon signaling pathways. In this study, atypical EAE was induced in Lewis rats, and a related approach was effective for induction of an unusual neurologic syndrome in a cynomolgus macaque. Lewis rats were immunized with the rat immunoglobulin variable (IgV-related extracellular domain of myelin oligodendrocyte glycoprotein (IgV-MOG in complete Freund's adjuvant (CFA followed by one or more injections of rat IgV-MOG in incomplete Freund's adjuvant (IFA. The resulting disease was marked by torticollis, unilateral rigid paralysis, forelimb weakness, and high titers of anti-MOG antibody against conformational epitopes of MOG, as well as other signs of atypical EAE. A similar strategy elicited a distinct atypical form of EAE in a cynomolgus macaque. By day 36 in the monkey, titers of IgG against conformational epitopes of extracellular MOG were evident, and on day 201, the macaque had an abrupt onset of an unusual form of EAE that included a pronounced arousal-dependent, transient myotonia. The disease persisted for 6-7 weeks and was marked by a gradual, consistent improvement and an eventual full recovery without recurrence. These data indicate that one or more boosters of IgV-MOG in IFA represent a key variable for induction of atypical or unusual forms of EAE in rat and Macaca species. These studies also reveal a close correlation between humoral immunity against conformational epitopes of MOG, extended confluent demyelinating plaques in

  10. The extracellular domain of myelin oligodendrocyte glycoprotein elicits atypical experimental autoimmune encephalomyelitis in rat and Macaque species.

    Science.gov (United States)

    Curtis, Alan D; Taslim, Najla; Reece, Shaun P; Grebenciucova, Elena; Ray, Richard H; Rosenbaum, Matthew D; Wardle, Robert L; Van Scott, Michael R; Mannie, Mark D

    2014-01-01

    Atypical models of experimental autoimmune encephalomyelitis (EAE) are advantageous in that the heterogeneity of clinical signs appears more reflective of those in multiple sclerosis (MS). Conversely, models of classical EAE feature stereotypic progression of an ascending flaccid paralysis that is not a characteristic of MS. The study of atypical EAE however has been limited due to the relative lack of suitable models that feature reliable disease incidence and severity, excepting mice deficient in gamma-interferon signaling pathways. In this study, atypical EAE was induced in Lewis rats, and a related approach was effective for induction of an unusual neurologic syndrome in a cynomolgus macaque. Lewis rats were immunized with the rat immunoglobulin variable (IgV)-related extracellular domain of myelin oligodendrocyte glycoprotein (IgV-MOG) in complete Freund's adjuvant (CFA) followed by one or more injections of rat IgV-MOG in incomplete Freund's adjuvant (IFA). The resulting disease was marked by torticollis, unilateral rigid paralysis, forelimb weakness, and high titers of anti-MOG antibody against conformational epitopes of MOG, as well as other signs of atypical EAE. A similar strategy elicited a distinct atypical form of EAE in a cynomolgus macaque. By day 36 in the monkey, titers of IgG against conformational epitopes of extracellular MOG were evident, and on day 201, the macaque had an abrupt onset of an unusual form of EAE that included a pronounced arousal-dependent, transient myotonia. The disease persisted for 6-7 weeks and was marked by a gradual, consistent improvement and an eventual full recovery without recurrence. These data indicate that one or more boosters of IgV-MOG in IFA represent a key variable for induction of atypical or unusual forms of EAE in rat and Macaca species. These studies also reveal a close correlation between humoral immunity against conformational epitopes of MOG, extended confluent demyelinating plaques in spinal cord and

  11. Children of parents irradiated prior to conception - a longterm study (results 1986)

    Energy Technology Data Exchange (ETDEWEB)

    Herrmann, T.; Rupprecht, E.; Voigtmann, L.; Kuchheuser, W.

    1988-11-01

    Five or ten years after a first examination, 55 children were submitted to a check-up investigation of their physical and intellectual development. The group of twenty irradiated fathers received an average dose to the gonads of 0.55 Gy (0.01 to 6.4 Gy), the group of twenty irradiated mothers 0.72 Gy (0.01 to 8.0 Gy). In all parents the most frequent finding was Hodgkin's disease, which was diagnosed as a neoplams in 23 cases. The proof of paternity was made with a 86% accuracy for ten out of twenty fathers by determination of HLA types. A conception was demonstrated beyond all doubt after a dose to the testicles of 1.2 Gy in the irradiated fathers and after a dose to the ovaries of 3.0 Gy in the irradiated mothers. The offspring of the F/sub 1/ generation showed no modification in the sex ratio. A rate of 5.5% of severe malformations was found (trisomy E, bradyacousia of the inner ear, cleft hands and feet). 24% of the children had malformations which needed a treatment (hernias, torticollis, hip dysplasia). 18 out of 55 children (33%) presented abnormalities in the widest sense of the word. Three children (5.5%) were premature infants, and there is a general tendency towards shortened pregnancy (-3.6 days). Hernias (7/55) are a frequent finding. In children of both sexes, carporadiography shows a delayed development which is not compensated in the check-up examinations at five or ten years, but does not cause an underdevelopment in body height as compared to great normal collectives. The results suggest a slightly increased malformation rate among children whose parents were treated by radiotherapy. Above all the connective and supporting tissue seems involved. Some proposals are made how to give a radiogenetic advice to tumor patients who want to have children.

  12. Detection and molecular characterization of Newcastle disease virus in peafowl (Pavo cristatus) in Haryana State, India.

    Science.gov (United States)

    Kumar, Aman; Maan, Sushila; Mahajan, Nand Kishore; Rana, Virender Pratap; Jindal, Naresh; Batra, Kanisht; Ghosh, Arnab; Mishra, Shiv Kumar; Kapoor, Sanjay; Maan, Narender Singh

    2013-12-01

    Present study was undertaken to investigate the cause of deaths of peafowls in Haryana State. In total, 145 birds were sick and 28 birds were reported dead during July to September 2012. Some of the sick birds were showing signs of shaking of heads, torticollis and paresis. Blood and cloacal swab samples from sick birds along with brain and intestinal tissues from dead birds were collected for further investigation. Although post-mortem examination showed no typical lesions of Newcastle disease virus (NDV) yet raised HI tires against NDV in some serum samples and clinical signs indicated the presence of NDV. One of the brain tissues (NDV/IND2012/01) from the field case was processed and adapted to Vero cell line for virus isolation. The fusion (F) gene based nested RT-PCR (RT-nPCR) confirmed the presence of NDV in all field samples and cell culture isolate. Sequencing of the partial F gene amplicons (216 bp) using the PCR primers as sequencing primers confirmed the PCR results. The deduced amino acid sequences of partial F gene were found to have the amino acid motif (111)GRRQKR/F(117) in the fusion protein cleavage site (FPCS). This amino acid motif is indicative of the velogenic nature of these NDVs. Phylogenetic studies have shown that the virus belonged to class II genotype VII very closely related to virus isolates originated from outbreaks in Western Europe, Israel, Indonesia, Taiwan and India. Phylogenetic grouping of the virus and sequence of FPCS is indicative of pathogenic potential of virus strain circulating in peacocks in Haryana.

  13. A randomized trial of specialized versus standard neck physiotherapy in cervical dystonia.

    Science.gov (United States)

    Counsell, Carl; Sinclair, Hazel; Fowlie, Jillian; Tyrrell, Elaine; Derry, Natalie; Meager, Peter; Norrie, John; Grosset, Donald

    2016-02-01

    Anecdotal reports suggested that a specialized physiotherapy technique developed in France (the Bleton technique) improved primary cervical dystonia. We evaluated the technique in a randomized trial. A parallel-group, single-blind, two-centre randomized trial compared the specialized outpatient physiotherapy programme given by trained physiotherapists up to once a week for 24 weeks with standard physiotherapy advice for neck problems. Randomization was by a central telephone service. The primary outcome was the change in the total Toronto Western Spasmodic Torticollis Rating (TWSTR) scale, measured before any botulinum injections that were due, between baseline and 24 weeks evaluated by a clinician masked to treatment. Analysis was by intention-to-treat. 110 patients were randomized (55 in each group) with 24 week outcomes available for 84. Most (92%) were receiving botulinum toxin injections. Physiotherapy adherence was good. There was no difference between the groups in the change in TWSTR score over 24 weeks (mean adjusted difference 1.44 [95% CI -3.63, 6.51]) or 52 weeks (mean adjusted difference 2.47 [-2.72, 7.65]) nor in any of the secondary outcome measures (Cervical Dystonia Impact Profile-58, clinician and patient-rated global impression of change, mean botulinum toxin dose). Both groups showed large sustained improvements compared to baseline in the TWSTR, most of which occurred in the first four weeks. There were no major adverse events. Subgroup analysis suggested a centre effect. There was no statistically or clinically significant benefit from the specialized physiotherapy compared to standard neck physiotherapy advice but further trials are warranted. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Early Botulinum Toxin Injections in Infants With Musculoskeletal Disorders: A Systematic Review of Safety and Effectiveness.

    Science.gov (United States)

    Bourseul, Jean-Sébastien; Molina, Anais; Lintanf, Mael; Houx, Laetitia; Chaléat-Valayer, Emmanuelle; Pons, Christelle; Brochard, Sylvain

    2018-06-01

    To report current evidence regarding the safety of intramuscular botulinum toxin injection (BTI) in children with orthopedic- and neurologic-related musculoskeletal disorders >2 years of age. PubMed, Cochrane Library, and ScienceDirect, Google Scholar, and Web of Science. Two reviewers independently selected studies based on predetermined inclusion criteria. Data relating to the aim were extracted. Methodologic quality was graded independently by 2 reviewers using the Physiotherapy Evidence Database scale for randomized controlled trials (RCTs) and the Downs and Black evaluation tool for non-RCTs. Level of evidence was determined using the modified Sackett scale. Data of 473 infants were analyzed. Fifty-five infants had cerebral palsy, 112 had obstetric brachial plexus palsy, 257 had clubfoot, and 44 had congenital torticollis. No studies reported any severe adverse event that could be attributed to the BTI. The rate of mild to moderate adverse events reported varied from 5% to 25%. Results regarding efficacy were preliminary, dependent on the pathology, and limited by the small number of studies and their low levels of evidence. BTI is already widely used as an early treatment for this age group. The safety profile of BTI in infants appears similar to that of older children and risks appear more related to the severity of the pathology and the location of the injections than to the toxin itself. Regarding effectiveness, other studies with higher levels of evidence should be carried out for each specific pathology. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  15. Visual control improves the accuracy of hand positioning in Huntington’s disease

    Directory of Open Access Journals (Sweden)

    Emilia J. Sitek

    2017-08-01

    Full Text Available Background: The study aimed at demonstrating dependence of visual feedback during hand and finger positioning task performance among Huntington’s disease patients in comparison to patients with Parkinson’s disease and cervical dystonia. Material and methods: Eighty-nine patients participated in the study (23 with Huntington’s disease, 25 with Parkinson’s disease with dyskinesias, 21 with Parkinson’s disease without dyskinesias, and 20 with cervical dystonia, scoring ≥20 points on Mini-Mental State Examination in order to assure comprehension of task instructions. Neurological examination comprised of the motor section from the Unified Huntington’s Disease Rating Scale for Huntington’s disease, the Unified Parkinson’s Disease Rating Scale Part II–IV for Parkinson’s disease and the Toronto Western Spasmodic Torticollis Rating Scale for cervical dystonia. In order to compare hand position accuracy under visually controlled and blindfolded conditions, the patient imitated each of the 10 examiner’s hand postures twice, once under the visual control condition and once with no visual feedback provided. Results: Huntington’s disease patients imitated examiner’s hand positions less accurately under blindfolded condition in comparison to Parkinson’s disease without dyskinesias and cervical dystonia participants. Under visually controlled condition there were no significant inter-group differences. Conclusions: Huntington’s disease patients exhibit higher dependence on visual feedback while performing motor tasks than Parkinson’s disease and cervical dystonia patients. Possible improvement of movement precision in Huntington’s disease with the use of visual cues could be potentially useful in the patients’ rehabilitation.

  16. Pathogenesis of highly pathogenic avian influenza A/turkey/Turkey/1/2005 H5N1 in Pekin ducks (Anas platyrhynchos) infected experimentally.

    Science.gov (United States)

    Löndt, Brandon Z; Nunez, Alejandro; Banks, Jill; Nili, Hassan; Johnson, Linda K; Alexander, Dennis J

    2008-12-01

    Asian H5N1 (hereafter referred to as panzootic H5N1) highly pathogenic avian influenza (HPAI) virus has caused large numbers of deaths in both poultry and wild-bird populations. Recent isolates of this virus have been reported to cause disease and death in commercial ducks, which has not been seen with other HPAI viruses. However, little is known about either the dissemination of this H5N1 within the organs or the cause of death in infected ducks. Nineteen 4-week-old Pekin ducks were infected with 10(6.7) median egg infectious doses of HPAI A/turkey/Turkey/1/05 (H5N1, clade 2.2) in 0.1ml via the intranasal and intraocular routes. Cloacal and oropharyngeal swabs were taken daily before three animals were selected randomly and killed humanely for postmortem examination, when samples of tissues were taken for real-time reverse transcriptase-polymerase chain reaction, histopathological examination and immunohistochemistry. Clinical signs were first observed 4 days post infection (d.p.i.) and included depression, reluctance to feed, in-coordination and torticollis resulting in the death of all the birds remaining on 5d.p.i. Higher levels of virus shedding were detected from oropharyngeal swabs than from cloacal swabs. Real-time reverse transcriptase-polymerase chain reaction and immunohistochemistry identified peak levels of virus at 2d.p.i. in several organs. In the spleen, lung, kidney, caecal tonsils, breast muscle and thigh muscle the levels were greatly reduced at 3d.p.i. However, the highest viral loads were detected in the heart and brain from 3d.p.i. and coincided with the appearance of clinical signs and death. Our experimental results demonstrate the systemic spread of this HPAI H5N1 virus in Pekin ducks, and the localization of virus in the brain and heart tissue preceding death.

  17. The effect of age on the pathogenesis of a highly pathogenic avian influenza (HPAI) H5N1 virus in Pekin ducks (Anas platyrhynchos) infected experimentally.

    Science.gov (United States)

    Löndt, Brandon Z; Núñez, Alejandro; Banks, Jill; Alexander, Dennis J; Russell, Christine; Richard-Löndt, Angela C; Brown, Ian H

    2010-01-01

    Highly pathogenic avian influenza (HPAI) H5N1 viruses have recently displayed increased virulence for wild waterfowl. To study the effect of host age on the shedding and tissue dissemination of a HPAI H5N1 virus in infected Pekin ducks. Pekin ducks in two age-matched groups (n = 18), 8 and 12 weeks old (wo) were each infected with 10(6) EID(50)/0.1 ml of HPAI A/turkey/Turkey/1/05 (H5N1, clade 2.2). Each day for 5 days, birds were monitored clinically, and cloacal and oropharyngeal swabs collected, before three birds from each group were selected randomly for post-mortem examination. Tissue samples were collected for examination by real-time RT-PCR, histopathology and immunohistochemistry (IHC). Severe clinical signs, including incoordination and torticollis were observed in the 8 wo group resulting in 100% mortality by 4 dpi. Mild clinical signs were observed in the 12 wo group with no mortality. Real-time RT-PCR and IHC results demonstrated the systemic spread of H5N1 virus in birds of both age groups. Higher levels of virus shedding were detected in oropharyngeal swabs than in cloacal swabs, with similar levels of shedding detected in both age groups. Variations in level and temporal dissemination of virus within tissues of older ducks, and the presence of the virus in brain and heart were observed, which coincided with the appearance of clinical signs preceding death in younger birds. These results are consistent with reports of natural infections of wild waterfowl and poultry possibly indicating an age-related association with dissemination and clinical outcome in ducks following infection with H5N1 HPAI virus.

  18. Multiple cervical hemivertebra resection and staged thoracic pedicle subtraction osteotomy in the treatment of complicated congenital scoliosis.

    Science.gov (United States)

    Zhuang, Qianyu; Zhang, Jianguo; Wang, Shengru; Guo, Jianwei; Qiu, Guixing

    2016-05-01

    To present our experience of staged correction with multiple cervical hemivertebra resection and thoracic pedicle subtraction osteotomy (PSO) treating a rare and complicated congenital scoliosis. A 14-year-old male presented with progressive torticollis and spine deformity. The malformation developed since birth, and back pain after long-time sitting or exercise arose since 6 months before, which was unsuccessfully treated by physiotherapy. X-ray showed a right cervical curve of 60° and a left compensatory thoracic curve of 90°. Three-dimensional computed tomography (3-D CT) scan revealed three semi-segmented hemivertebrae (C4, C5 and C6) on the right side. Based on our staged strategy, the three consecutive cervical hemivertebrae, as the major pathology causing the deformity, were firstly resected by the combined posterior and anterior approach. Six months later, T6 PSO osteotomy was used to correct the structural compensatory thoracic curve. The cervical curve was reduced to 23° while the thoracic curve to 60° after the first-stage surgery, and the thoracic curve was further reduced to 30° after the second-stage surgery. The radiograph at 5-year follow-up showed that both the coronal and sagittal balance were well restored and stabilized, with the occipital tilt reduced from 12° to 0°. Our strategy may provide an option for similar cases with multiple consecutive cervical hemivertebrae and a large structural compensatory thoracic curve, which proved to achieve excellent correction in both the coronal and sagittal planes with acceptable neurologic risk.

  19. Children of parents irradiated prior to conception - a longterm study (results 1986)

    International Nuclear Information System (INIS)

    Herrmann, T.; Rupprecht, E.; Voigtmann, L.; Kuchheuser, W.; Medizinische Akademie, Dresden; Medizinische Akademie, Magdeburg

    1988-01-01

    Five or ten years after a first examination, 55 children were submitted to a check-up investigation of their physical and intellectual development. The group of twenty irradiated fathers received an average dose to the gonads of 0.55 Gy (0.01 to 6.4 Gy), the group of twenty irradiated mothers 0.72 Gy (0.01 to 8.0 Gy). In all parents the most frequent finding was Hodgkin's disease, which was diagnosed as a neoplams in 23 cases. The proof of paternity was made with a 86% accuracy for ten out of twenty fathers by determination of HLA types. A conception was demonstrated beyond all doubt after a dose to the testicles of 1.2 Gy in the irradiated fathers and after a dose to the ovaries of 3.0 Gy in the irradiated mothers. The offspring of the F 1 generation showed no modification in the sex ratio. A rate of 5.5% of severe malformations was found (trisomy E, bradyacousia of the inner ear, cleft hands and feet). 24% of the children had malformations which needed a treatment (hernias, torticollis, hip dysplasia). 18 out of 55 children (33%) presented abnormalities in the widest sense of the word. Three children (5.5%) were premature infants, and there is a general tendency towards shortened pregnancy (-3.6 days). Hernias (7/55) are a frequent finding. In children of both sexes, carporadiography shows a delayed development which is not compensated in the check-up examinations at five or ten years, but does not cause an underdevelopment in body height as compared to great normal collectives. The results suggest a slightly increased malformation rate among children whose parents were treated by radiotherapy. Above all the connective and supporting tissue seems involved. Some proposals are made how to give a radiogenetic advice to tumor patients who want to have children. (orig.) [de

  20. Functional Aspects of Gait in Essential Tremor: A Comparison with Age-Matched Parkinson's Disease Cases, Dystonia Cases, and Controls.

    Science.gov (United States)

    Louis, Elan D; Rao, Ashwini K

    2015-01-01

    An understanding of the functional aspects of gait and balance has wide ramifications. Individuals with balance disorders often restrict physical activity, travel, and social commitments to avoid falling, and loss of balance confidence, itself, is a source of disability. We studied the functional aspects of gait in patients with essential tremor (ET), placing their findings within the context of two other neurological disorders (Parkinson's disease [PD] and dystonia) and comparing them with age-matched controls. We administered the six-item Activities of Balance Confidence (ABC-6) Scale and collected data on number of falls and near-falls, and use of walking aids in 422 participants (126 ET, 77 PD, 46 dystonia, 173 controls). Balance confidence was lowest in PD, intermediate in ET, and relatively preserved in dystonia compared with controls. This ordering reoccurred for each of the six ABC-6 items. The number of near-falls and falls followed a similar ordering. Use of canes, walkers, and wheelchairs was elevated in ET and even greater in PD. Several measures of balance confidence (ABC-6 items 1, 4, 5, and 6) were lower in torticollis cases than in those with blepharospasm, although the two groups did not differ with respect to falls or use of walking aids. Lower balance confidence, increased falls, and greater need for walking aids are variably features of a range of movement disorder patients compared to age-matched controls. While most marked among PD patients, these issues affected ET patients as well and, to a small degree, some patients with dystonia.

  1. Síndrome de Duane: A propósito de 17 casos Duane's syndrome: Apropos of 17 cases

    Directory of Open Access Journals (Sweden)

    Rosa M Naranjo Fernández

    2002-12-01

    Full Text Available Se realizó un estudio descriptivo retrospectivo de 17 pacientes con diagnóstico de Síndrome de Duane que asistieron a la consulta de Oftalmología Pediátrica y Estrabismo desde el año 1997 al 2000, donde se analizaron las siguientes variables: sexo, tipo de Duane, ojo afectado, criterio quirúrgico y defecto refractivo. El 88 % correspondió al sexo femenino, el tipo de Duane I y el ojo izquierdo se presentó en el 76 % de los casos; presentaron criterio quirúrgico el 64 % por esotropía y tortícolis y encontramos defecto refractivo en el 65 % de la muestra estudiada. Encontramos resultados semejantes en cuanto al sexo, tipo de Duane, ojo afectado y criterio quirúrgico con las observaciones realizadas por diferentes autores, el defecto refractivo más frecuente fue el astigmatismo hipermetrópicoA descriptive and retrospective study was conducted among 17 patients with diagnosis of Duane's Syndrome that were seen at the consultation room of Pediatric Ophthalmology and Strabismus, from 1997 to 2000. The following variables were used: sex, type of Duane, affected eye, surgical criterion and refractive defect. 88 % were females, corresponded to type I Duane, the left eye was affected in 76 % of the cases, 64 % presented critical criterion by esotropia and torticollis, and the refractive defect was detected in 65 % of the studied sample. Similar results as regards sex, type of Duane, affected eye and surgical criterion were found in the observations made by other authors. The hypermetropic astigmatism was the commonest refractive defect

  2. Condylus tertius with atlanto-axial rotatory fixation: an unreported association

    International Nuclear Information System (INIS)

    Udare, Ashlesha Satish; Bansal, Divya; Patel, Bhavin; Mondel, Prabath Kumar; Aiyer, Siddharth

    2014-01-01

    The ''condylus tertius'' or the ''third occipital condyle'' is an embryological remnant of the proatlas sclerotome. Anatomically, it is attached to the basion and often articulates with the anterior arch of the atlas and the odontoid apex; hence, it is also called the ''median occipital condyle''. It is a rare anomaly of the cranio-vertebral junction (CVJ) that can lead to instability and compression of important surrounding neurovascular structures. We report a case of a 16-year-old boy who presented with suboccipital neck pain, torticollis and right sided hemiparesis. Plain radiographs revealed an increased atlanto-dental interspace (ADI) with a retroflexed odontoid. Open mouth view showed asymmetry of the articular processes of the atlas with respect to the dens. Computed tomography (CT) of the CVJ delineated the third occipital condyle. Furthermore, on dynamic CT study, a type 3 atlanto-axial rotatory fixation (AARF) was clearly demonstrated. Magnetic resonance imaging (MRI) of the CVJ revealed severe right-sided spinal cord compression by the retroflexed and rightward deviated dens. It also revealed disruption of the left alar and transverse ligaments. The patient was treated with 8 weeks of cranial traction and reasonable alignment was obtained. This was followed by C1-C2 lateral mass screw fixation and C1-C2 interlaminar wiring to maintain the alignment. A review of the literature did not reveal any cases of condylus tertius associated with non-traumatic AARF. An accurate knowledge of the embryology and imaging features of this rare CVJ anomaly is useful in the prompt diagnosis and management of such patients. (orig.)

  3. West Nile virus in raptors from Virginia during 2003: clinical, diagnostic, and epidemiologic findings.

    Science.gov (United States)

    Joyner, Priscilla H; Kelly, Sean; Shreve, Allison A; Snead, Sarah E; Sleeman, Jonathan M; Pettit, Denise A

    2006-04-01

    Sixty-one birds of prey admitted to The Wildlife Center of Virginia (WCV; Waynesboro, Virginia, USA) from June to November 2003 were tested for West Nile virus (WNV) infection. Choanal and/or cloacal swabs were obtained and submitted to Virginia's Division of Consolidated Laboratory Services (Richmond, Virginia, USA) for analysis with real-time reverse transcriptase polymerase chain reaction (RT-PCR). Forty birds of prey were positive for WNV by RT-PCR. Five avian families and nine species of raptors were represented, with great horned owls (Bubo virginianus) and red-tailed hawks (Buteo jamaicensis) most frequently affected. Presenting clinical signs were consistent with previous reports of WNV infection in raptors; however, these differed between species. Of WNV positive birds, nonspecific signs of illness were the most common clinical findings, particularly in red-tailed hawks; signs included dehydration (n = 20), emaciation (n = 18), and depression (n = 15). Neurologic abnormalities were frequently identified, especially in great horned owls, and included head tremors (n = 17), ataxia (n = 13), head incoordination (n = 7), torticollis (n = 3), nystagmus (n = 3), and head tilt (n = 3). Great horned owls exhibited anemia and leukocytosis with heterophilia, eosinophilia, and monocytosis consistent with chronic inflammation. Red-tailed hawks were anemic with a heterophilic leukocytosis and regenerative left shift. The majority of WNV cases occurred during August and September; there was a marked increase in the number of raptors admitted to WCV during these months followed by a marked decrease during October, November, and December. This pattern differed from mean monthly admissions during the previous 10 years and suggests a negative impact on local raptor populations. The effects of WNV on avian populations are largely unknown; however, because of their ecological importance, further investigation of the effects of WNV on raptor populations is warranted.

  4. Neurovirulence of H5N1 infection in ferrets is mediated by multifocal replication in distinct permissive neuronal cell regions.

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    Jennifer R Plourde

    Full Text Available Highly pathogenic avian influenza A (HPAI, subtype H5N1, remains an emergent threat to the human population. While respiratory disease is a hallmark of influenza infection, H5N1 has a high incidence of neurological sequelae in many animal species and sporadically in humans. We elucidate the temporal/spatial infection of H5N1 in the brain of ferrets following a low dose, intranasal infection of two HPAI strains of varying neurovirulence and lethality. A/Vietnam/1203/2004 (VN1203 induced mortality in 100% of infected ferrets while A/Hong Kong/483/1997 (HK483 induced lethality in only 20% of ferrets, with death occurring significantly later following infection. Neurological signs were prominent in VN1203 infection, but not HK483, with seizures observed three days post challenge and torticollis or paresis at later time points. VN1203 and HK483 replication kinetics were similar in primary differentiated ferret nasal turbinate cells, and similar viral titers were measured in the nasal turbinates of infected ferrets. Pulmonary viral titers were not different between strains and pathological findings in the lungs were similar in severity. VN1203 replicated to high titers in the olfactory bulb, cerebral cortex, and brain stem; whereas HK483 was not recovered in these tissues. VN1203 was identified adjacent to and within the olfactory nerve tract, and multifocal infection was observed throughout the frontal cortex and cerebrum. VN1203 was also detected throughout the cerebellum, specifically in Purkinje cells and regions that coordinate voluntary movements. These findings suggest the increased lethality of VN1203 in ferrets is due to increased replication in brain regions important in higher order function and explains the neurological signs observed during H5N1 neurovirulence.

  5. Surgical treatment of superior oblique palsy: Predictors of outcome

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    Pilar Merino Sanz

    2017-01-01

    Full Text Available Purpose: The purpose of this study was to evaluate the incidence and outcome of surgically treated superior oblique palsy (SOP and the factors involved in its resolution. Methods: We performed a retrospective study of 76 patients who underwent surgery for SOP. We recorded data from the physical examination and the number and type of procedures performed. Favorable outcome was defined as resolution of or improvement in torticollis (≤5° and diplopia in primary position (PP and downgaze or as vertical deviation (VD <5 prism diopters (pd in PP and 10 pd in the oblique diagnostic position. Results: Mean age was 33.12 years. Congenital SOP was the most frequent type (65.8%. Mean preoperative VD was 15.89 ± 9.94 pd, decreasing to 3.07 ± 4.36 pd after surgery. Associated horizontal deviation was recorded in 51.32% of cases. The mean number of procedures was 1.37 ± 0.62 (range 1–4, with 69.7% of patients requiring only one procedure. The mean number of muscles operated on was 1.96 ± 1.01 (inferior oblique being the most frequent. A greater reduction in VD after surgery was observed in patients with congenital SOP (P = 0.04. Although none of the factors evaluated influenced surgical outcome, amblyopic patients had a greater risk of reoperation (P = 0.04. A favorable outcome was achieved in 75% of cases. Mean follow-up was 37.08 months. Conclusion: Congenital SOP was twice as frequent as acquired SOP and although surgery was successful in most cases, a greater reduction in VD was obtained in congenital cases. Amblyopia was identified as a risk factor for reoperation.

  6. Case report: Physical therapy management of axial dystonia.

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    Voos, Mariana Callil; Oliveira, Tatiana de Paula; Piemonte, Maria Elisa Pimentel; Barbosa, Egberto Reis

    2014-01-01

    Few studies have described physical therapy approaches to provide functional independence and reduce pain in individuals with dystonia. This report describes the physical therapy treatment of a 46-year-old woman diagnosed with idiopathic segmental axial dystonia. For two years, the patient was treated with kinesiotherapy (active and resisted movements and stretching of neck and trunk muscles), abdominal taping (kinesiotaping techniques), functional training, and sensory tricks. She was assessed with parts I, II and III of Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS-I, TWSTRS-II and TWSTRS-III), Berg Balance Scale (BBS), Six-Minute Walk Test (6-MWT), and the motor domain of Functional Independence Measure (FIM-motor) before and after the two-year treatment and after the one year follow-up. Postural control and symmetry improved (TWSTRS-I: from 30 to 18), functional independence increased (TWSTRS-II: from 27 to 15; BBS: from 36 to 46; 6-MWT: from 0 to 480 meters (m); FIM-motor: from 59 to 81), and the pain diminished (TWSTRS-III: from 12 to 5). The functional improvement was retained after one year (TWSTRS-I: 14/35; TWRTRS-II: 12/30; TWRTRS-III: 5/20; BBS: 48/56; 6-MWT: 450 m; FIM-motor: 81/91). This program showed efficacy on providing a better control of the dystonic muscles and thus the doses of botulinum toxin needed to treat them could be reduced. Outcomes support the therapeutic strategies used to deal with this type of dystonia.

  7. Occipital plagiocephaly: deformation or lambdoid synostosis? I. morphometric analysis and results of unilateral lambdoid craniectomy

    International Nuclear Information System (INIS)

    Dias, M.S.; Klein, D.M.; Backstrom, J.W.

    1997-01-01

    Between 1987 and 1992, 30 infants aged 1.4-13 months (mean 7.3 months) underwent unilateral lambdoid strip craniectomy at the Children's Hospital of Buffalo for occipital plagiocephaly. Males outnumbered females (22:8) and right-sided occipital flattening was significantly more common than left-sided flattening (25:5). The deformity was noticed at an average age of 3.2 months; 16% of the infants had an asymmetry at birth. Positional preferences (a distinct tendency to lie preferentially on the back, in most cases with the head turned to the ipsilateral side) were described in 79% of infants for whom this information was available, and torticollis was present in 10%. Pre-and post-operative CT scans were analyzed using several morphometric measurements. Asymmetries were measured between the flattened and contralateral sides, both posteriorly and anteriorly, using a translucent grid placed over the CT slice showing maximum asymmetry. The average maximum asymmetry between the flattened and contralateral sides was 24% posteriorly and 16% anteriorly. Significant improvements were seen postoperatively, with both anterior and posterior asymmetries improving by an average of one third (p < 0.05). However, when compared with CT scans from a control group of infants without synostosis, the operated group showed persistent and significant asymmetries postoperatively. The morphometric measurements described allow an objective and reproducible means of assessing the results of various treatments for this disorders. The improvements following unilateral lambdoid craniectomy are difficult to interpret in isolation; we suggest that future efforts be directed toward similarly assessing the results of both nonoperative treatments such as positional changes and molding helmets, and more aggressive surgical treatments that have been advocated for this disorders. (authors)

  8. Repetitive transcranial magnetic stimulation in cervical dystonia: effect of site and repetition in a randomized pilot trial.

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    Sarah Pirio Richardson

    Full Text Available Dystonia is characterized by abnormal posturing due to sustained muscle contraction, which leads to pain and significant disability. New therapeutic targets are needed in this disorder. The objective of this randomized, sham-controlled, blinded exploratory study is to identify a specific motor system target for non-invasive neuromodulation and to evaluate this target in terms of safety and tolerability in the cervical dystonia (CD population. Eight CD subjects were given 15-minute sessions of low-frequency (0.2 Hz repetitive transcranial magnetic stimulation (rTMS over the primary motor cortex (MC, dorsal premotor cortex (dPM, supplementary motor area (SMA, anterior cingulate cortex (ACC and a sham condition with each session separated by at least two days. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS score was rated in a blinded fashion immediately pre- and post-intervention. Secondary outcomes included physiology and tolerability ratings. The mean change in TWSTRS severity score by site was 0.25 ± 1.7 (ACC, -2.9 ± 3.4 (dPM, -3.0 ± 4.8 (MC, -0.5 ± 1.1 (SHAM, and -1.5 ± 3.2 (SMA with negative numbers indicating improvement in symptom control. TWSTRS scores decreased from Session 1 (15.1 ± 5.1 to Session 5 (11.0 ± 7.6. The treatment was tolerable and safe. Physiology data were acquired on 6 of 8 subjects and showed no change over time. These results suggest rTMS can modulate CD symptoms. Both dPM and MC are areas to be targeted in further rTMS studies. The improvement in TWSTRS scores over time with multiple rTMS sessions deserves further evaluation.

  9. Efficacy and Safety of IncobotulinumtoxinA in Subjects Previously Treated with Botulinum Toxin versus Toxin-Naïve Subjects with Cervical Dystonia

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    Hubert Fernandez

    2013-05-01

    Full Text Available Background: To determine whether botulinum toxin treatment history affected the outcomes of a study comparing the safety and efficacy of incobotulinumtoxinA with placebo in subjects with cervical dystonia (CD.Methods: This was a prospective, double‐blind, randomized, placebo‐controlled, multicenter trial in botulinum toxin‐treated or toxin‐naïve CD subjects. Subjects received a fixed dose of either 120 U or 240 U of incobotulinumtoxinA or placebo. The primary outcome measure was change from baseline to Week 4 in the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS total score. Treatment‐emergent adverse events (TEAEs were also evaluated. This report represents a subgroup analysis of botulinum toxin‐treated or toxin‐naïve subjects.Results: Participants (N = 233; 38.6% toxin‐naïve had a mean age of 52.8 years. IncobotulinumtoxinA significantly improved TWSTRS total scores from baseline to Week 4 in both dose groups versus placebo, and the improvement persisted through the end of the study (≤20 weeks. Both the previously toxin‐treated and toxin‐naïve subjects demonstrated significant improvements in TWSTRS total scores at Week 4 compared to baseline. The most frequent TEAEs in the incobotulinumtoxinA groups were dysphagia, neck pain, and muscular weakness, which were generally mild. TEAEs were more common in the 240 U group and toxin‐naïve subjects. Discussion: Overall, incobotulinumtoxinA was safe and effective in CD, regardless of toxin therapy history. A lower starting dose may be better tolerated among toxin‐naïve subjects without sacrificing efficacy.

  10. Head shape at age 36 months among children with and without a history of positional skull deformation.

    Science.gov (United States)

    Collett, Brent R; Leroux, Brian G; Wallace, Erin R; Gallagher, Emily; Shao, Jason; Speltz, Matthew L

    2018-03-01

    unaffected controls and approximately 30% had persistent PPB. Within the case group, head shape at 36 months was similar for untreated patients with PPB and for those who received helmet treatment and for patients with and without a history of torticollis. CONCLUSIONS Although head shape continues to improve, children with a history of skull deformation in infancy continue to exhibit measureable cranial flattening and asymmetry through age 36 months.

  11. Toxico-Neurological Effects of Piroxicam in Monogastric Animals

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    Saganuwan Alhaji Saganuwan

    2016-01-01

    Full Text Available Piroxicam is a benzothiazine compound with anti-inflammatory, antipyretic, and analgesic properties. Because of the very high efficacy of piroxicam and its increasing use in the treatment of carcinomas in dogs and cats, there is a need for acute toxicity study of piroxicam in monogastric animals and its potential for causing secondary poisoning in puppies. Piroxicam manufactured by Shanxi Federal Pharmaceutical Co, Ltd. was used for this study. Revised up-and-down procedure was used for the estimation of median lethal dose in mouse (259.4 ± 51.9 mg/kg, rat (259.4 ± 69.6 mg/kg, rabbit (707.5 ± 130.8 mg/kg, cat (437.5 ± 128.1 mg/kg, guinea pig (218.7 ± 64.1 mg/kg, monkey (733.3 ± 83.3 mg/kg, broiler (285.3 ± 62.5 mg/kg, hen (638.3 ± 115.4 mg/kg, turkey (707.5 ± 130.8 mg/kg, pigeon (375 ± 55.9 mg/kg, and duck (311.3 ± 46.6 mg/kg. The acute toxicity signs of piroxicam at doses 207.5 mg/kg and above observed in the animals are torticollis, opisthotonos, somnolence, lethargy, diarrhea, gastroenteritis, generalized internal bleeding, anemia, congestion of the lung and liver, flaccid paralysis, cheesy lung, urinary incontinence, engorged urinary bladder, convulsive jerking of the limbs, lying in ventral recumbency, gasping for air, roaring, and death. Three out of six puppies died after being fed the carcasses of poisoned turkey, duck, and hen administered piroxicam at doses of 1000, 415, and 1000 mg/kg, respectively. White flaky cheesy materials observed in turkeys were also observed in the gastrointestinal content of the puppies. Paleness of carcasses, watery crop content, dryness of pericardium, gastroenteritis, intestinal perforation, and whitish pericardium were observed in broilers. There were effusions in thoracic and abdominal cavities as seen in all other carcasses poisoned primarily by piroxicam. Administration of atropine (0.02 mg/kg led to survival of the remaining puppies. In conclusion, piroxicam is very to moderately toxic in

  12. Pathogenicity of Highly Pathogenic Avian Influenza Virus H5N1 in Naturally Infected Poultry in Egypt.

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    Ibrahim Thabet Hagag

    Full Text Available Highly pathogenic avian influenza virus (HPAIV H5N1 has been endemic in Egypt since 2006, and there is increasing concern for its potential to become highly transmissible among humans. Infection by HPAIV H5N1 has been described in experimentally challenged birds. However, the pathogenicity of the H5N1 isolated in Egypt has never been reported in naturally infected chickens and ducks. Here we report a 2013 outbreak of HPAIV H5N1 in commercial poultry farms and backyards in Sharkia Province, Egypt. The main symptoms were ecchymosis on the shanks and feet, cyanosis of the comb and wattles, subcutaneous edema of the head and neck for chickens, and nervous signs (torticollis for ducks. Within 48-72 hrs of the onset of illness, the average mortality rates were 22.8-30% and 28.5-40% in vaccinated chickens and non-vaccinated ducks, respectively. Tissue samples of chickens and ducks were collected for analyses with cross-section immunohistochemistry and real-time RT-PCR for specific viral RNA transcripts. While viral RNA was detected in nearly all tissues and sera collected, viral nucleoprotein was detected almost ubiquitously in all tissues, including testis. Interestingly, viral antigen was also observed in endothelial cells of most organs in chickens, and clearly detected in the trachea and brain in particular. Viral nucleoprotein was also detected in mononuclear cells of various organs, especially pulmonary tissue. We performed phylogenetic analyses and compared the genomic sequences of the hemagglutinin (HA and nonstructural proteins (NS among the isolated viruses, the HPAIV circulated in Egypt in the past and currently, and some available vaccine strains. Further analysis of deduced amino acids of both HA and NS1 revealed that our isolates carried molecular determinants of HPAIV, including the multibasic amino acids (PQGERRRK/KR*GLF in the cleavage site in HA and glutamate at position 92 (D92E in NS1. This is the first report of the pathogenicity

  13. Epizootic of ovine congenital malformations associated with Schmallenberg virus infection.

    Science.gov (United States)

    van den Brom, R; Luttikholt, S J M; Lievaart-Peterson, K; Peperkamp, N H M T; Mars, M H; van der Poel, W H M; Vellema, P

    2012-02-01

    Epizootic outbreaks of congenital malformations in sheep are rare and have, to the best of our knowledge, never been reported before in Europe. This paper describes relevant preliminary findings from the first epizootic outbreak of ovine congenital malformations in the Netherlands. Between 25 November and 20 December 2011, congenital malformations in newborn lambs on sheep farms throughout the country were reported to the Animal Health Service in Deventer. Subsequently, small ruminant veterinary specialists visited these farms and collected relevant information from farmers by means of questionnaires. The deformities varied from mild to severe, and ewes were reported to have given birth to both normal and deformed lambs; both male and female lambs were affected. Most of the affected lambs were delivered at term. Besides malformed and normal lambs, dummy lambs, unable to suckle, were born also on these farms. None of the ewes had shown clinical signs during gestation or at parturition. Dystocia was common, because of the lambs' deformities. Lambs were submitted for post-mortem examination, and samples of brain tissue were collected for virus detection. The main macroscopic findings included arthrogryposis, torticollis, scoliosis and kyphosis, brachygnathia inferior, and mild-to-marked hypoplasia of the cerebrum, cerebellum and spinal cord. Preliminary data from the first ten affected farms suggest that nutritional deficiencies, intoxication, and genetic factors are not likely to have caused the malformations. Preliminary diagnostic analyses of precolostral serum samples excluded border disease virus, bovine viral diarrhoea virus, and bluetongue virus. In December 2011, samples of brain tissue from 54 lambs were sent to the Central Veterinary Institute of Wageningen University Research, Lelystad. Real-time PCR detected the presence of a virus, provisionally named the Schmallenberg virus, in brain tissue from 22 of the 54 lambs, which originated from seven of eight

  14. The positive expression of genotype VII Newcastle disease virus (Malaysian isolate in Japanese quails (Coturnix coturnix japonica

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    Lizma Felisha Mazlan

    2017-05-01

    Full Text Available Aim: Genotype VII Newcastle disease virus (NDV is the most predominant NDV strains that circulating in Malaysia; thus, this study was aimed to determine the susceptibility of Japanese quails toward genotype VII NDV. Clinical signs, gross pathological lesions of organs, positive detection of virus in organs and cloacal swabs, as well as the expression of the antibody titer, were used as parameters to assess the susceptibility of Japanese quails following infection of genotype VII NDV. Materials and Methods: About 20 quails were divided into three groups (n=8 for Groups A and B; n=4 for the control group. The quails in the Groups A and B were infected via intraocular route with 0.03 ml of 103.5 ELD50 and 107.0 ELD50 of NDV strain IBS 002, respectively, while the control group received 1x phosphate-buffered saline. Cloacal swabs and necropsy were taken on day 7 post-infection for all quails were subjected to one-step reverse transcription real-time quantitative polymerase chain reaction (RT-qPCR for detection of virus and examination for gross pathological lesion, respectively. Blood serums of infected quails were taken on day 10, 14, and 21 post-day infections and were subjected for hemagglutination inhibition (HI assay. Results: Depression and ruffled feathers, trachea rales, leg paralysis, and torticollis were shown in some of the quails in both infected groups. Based on statistical analysis, there was no significant difference (p>0.05 in clinical signs between the infected groups. The results for RT-qPCR were found to be negative for all groups, and no gross pathological lesions of organs observed for quails in both infected groups. Trachea, proventriculus, and cecal tonsil were taken for the detection of NDV by RT-qPCR, and some of the organ samples showed positive detection of virus in both infected groups. HI assay showed an increase in mean titers of antibody across time and between infected groups. Conclusion: In summary, Japanese quails

  15. Solitary Langerhans cell histiocytosis of the occipital condyle: a case report and review of the literature.

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    Teranishi, Yu; Shin, Masahiro; Yoshino, Masanori; Saito, Nobuhito

    2016-02-01

    torticollis, and CT showed remission of the lesion and marked regeneration of the left occipital condyle. Within our knowledge, this is the first reported case of LCH involving the occipital condyle. Although very rare, our case indicated that LCH can be an alternative in the differential diagnosis of osteolytic lesions in the craniocervical junction, in which early bone regeneration with sufficient cervical stability is expected after chemotherapy. In cases of pediatric osteolytic lesions, when they initially presented with apparent cervical instability, craniocervical fusion may possibly become unnecessary after a series of treatments. Thus, the effort to maximally preserve the musculoskeletal structure should be made until its histological diagnosis is finally confirmed.

  16. The investigation of the lateral atlanto-dental interval of atlanto-axial joint by multi-slice spiral CT

    International Nuclear Information System (INIS)

    Cui Wei; Peng Lei; Wang Jincai; Liu Jihua; Feng Weihua

    2010-01-01

    Objective: To explore imaging features of the lateral atlanto-dental interval (LADI) of atlanto-axial joint and its value in the diagnosis of atlanto-axial joint dislocation/subluxation. Methods: Two hundred and forty healthy volunteers without atlanto-axial joint dysfunction and 32 patients with torticollis and/or functional impairment at atlanto-axial.joint were enrolled into this study. All subjects were examined with multi-slice CT in both neutral and max rotation positions to the left/right. Clinical endpoints including VBLADI, variance range of the VBLADI and asymmetric conditions were evaluate. χ 2 test is used to evaluate the variance of incidence of bilateral LADI asymmetry in different age groups, Pearson-test (2-tailed) is used to evaluate the correlation between VBLADI and rotary function of atlanto-axial joint, precise test of fourfold table is used to compare normal group with patient groups. Results: (1) In the normal control group: asymmetry of bilateral LADI were observed in 204 among 240 (85.00%) healthy volunteers including 60 youngsters ( 95% of ∣ VBLADI ∣ were 0.850 mm, 2.450 mm in the young ( 95% in the young and in the adult respectively. There was no correlation between VBLADI(-2.146 to 2.114 mm, Median 0.000 mm) and LA (22.949° to 44.649°, Median 34.500°), RA (25.284° to 45.334°, Median 35.300°), VLRA (-11.643° to 8.623°, median 0.000°) respectively in normal people (r=-0.030, -0.005, 0.026, P>0.05). (2) In the study with 32 patients including 25 youngsters ( 95% in group AALSD and group AACD than in abnormal group (P<0.01), but there is no difference between group AARD and normal group (P=0.738). Conclusion: The imaging finding of 'asymmetry of bilateral LADI' may be either a physiological variation or a pathological condition, clinical manifestations and other imaging findings should be evaluated to make a diagnosis. (authors)

  17. The course of cervical dystonia with head tremor during botulinum toxin type A treatment

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    A. N. Korenko

    2017-01-01

    Full Text Available Objective: to evaluate the efficacy and safety of botulinum toxin type A (BTA injections into the neck muscles to reduce dystonic postures, head tremor, and pain syndrome in patients with cervical dystonia (CD within the first 8 cycles of treatment.Patients and methods. The investigation included 76 patients (26 (34% men and 50 (66% women with CD and dystonic head tremor, who were given BTA injections into the neck muscles for the first time. All the 76 patients received at least one cycle of BTA therapy. At the same type, 18 of these patients received 4 cycles of injections and 36 patients had 8 cycles. Injections were given when the symptoms of CD recurred or increased and the patient needed to be retreated. The interval between the injection cycles was arbitrary, but not less than 12 weeks. The doses of BTA agents per treatment cycle were as follows: Dysport was 400 to 1000 U, xeomin was 50 to 300 U, and Botox 200 to 300 U. The symptoms of CD were assessed using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS and the Tsui scale before the first injection of BTA and injection cycles 4 and 8; the presence or absence of head tremor was recorded.Results. The TWSTRS severity of CD symptoms decreased from 38 [36; 41] to 30 [27; 33] scores by injection cycle 4 (p < 0.001 and to 26 [23; 27] scores by cycle 8 (p<0.01. The Tsui severity of CD reduced from 9.3 [9; 10] to 7.2 [7; 8] scores by injection cycle 4 (p<0.001 and to 6.7 [6; 7] scores by cycle 8. The Tsui tremor scores decreased from 1.9 [1.6; 2.1] to 1.4 [1.1; 1.6] scores by injection cycle 4 and to 1.1 [0.9;1.4] scores by cycle 8 (p<0.01. Tremor completely disappeared in 6 (11% of patients by injection cycle 4 and in 6 (18% patients by cycle 8. According to Section 3 of the TWSTRS, pain intensity was reduced from 9.9 [8.9; 11.0] to 5.0 [3.3; 6.6] scores by injection cycle 4 (p<0.001 and to 2.1 [0.7; 3.6] scores by cycle 8 (p < 0.01; pain regressed completely in 12 (41

  18. Patho-epidemiological study on Genotype-XIII Newcastle disease virus infection in commercial vaccinated layer farms

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    J. H. Khorajiya

    2015-03-01

    -3 weeks and reduced with appearance of torticollis. Gross lesions were characterized by multifocal to diffuse hemorrhages around proventricular glands, necrotic (diphtheritic haemorrhagic ulcers throughout the intestine, disseminated multiple foci of necrosis and pin-point hemorrhages in the spleen parenchyma. The microscopic lesions include focal to diffuse hemorrhages, diffuse infiltration of mononuclear cells, necrosis, and degeneration in visceral organs. All the 13 farm samples (n=13 resulted in death of all the embryos following incubation up to 72 h post-inoculation. All the 13 allantois fluids from field samples along with F and R2B vaccine sample were found positive for HA activity, which was further confirmed by HI using known NDV serum. The values of ICPI were 2.0 which were indicative of velogenic nature of the field NDV strain. Conclusion: The study indicated that presently available live and attenuated vaccines which include Genotype-II NDV have failed in protecting the flocks against Genotype-XIII and resulted in outbreaks with mortality above 50%. ICPI score of 2.0 confirmed that the present outbreaks were due to Genotype-XIII NDV, which is velogenic in nature.

  19. Cost-effectiveness analysis of abobotulinumtoxinA for the treatment of cervical dystonia in the United Kingdom

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    Muthukumar M

    2017-04-01

    Full Text Available Madhusubramanian Muthukumar,1 Kamal Desai,1 Seye Abogunrin,2 Timothy Harrower,3 Sylvie Gabriel,4 Jerome Dinet5 1Modelling and Simulation, 2Meta Research, Evidera, London, 3Royal Devon and Exeter NHS Foundation Trust, Exeter, UK; 4Global Market Access and Pricing, 5Health Economics and Outcomes Research (Global, Ipsen Pharma, Boulogne-Billancourt, France Background: Cervical dystonia (CD involves painful involuntary contraction of the neck and shoulder muscles and abnormal posture in middle-aged adults. Botulinum neurotoxin type A (BoNT-A is effective in treating CD but little is known about its associated cost-effectiveness.Objective: To evaluate the cost-effectiveness of abobotulinumtoxinA for treating CD from the UK payer perspective.Methods: A Markov model was developed to evaluate the cost-effectiveness of abobotulinumtoxinA versus best supportive care (BSC in CD, with a lifetime horizon and health states for response, nonresponse, secondary nonresponse, and BSC in patients with CD (mean age: 53 years; 37% male. Clinical improvement measured using Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS was mapped to utility using data from a randomized trial of abobotulinumtoxinA. Health care resource use, costs, and other inputs were from the British National Formulary, Personal Social Services Research Unit, published literature, or expert opinion. Costs and outcomes were discounted at 3.5% per annum.Results: In the base case, the incremental lifetime quality-adjusted life-years (QALYs gained from abobotulinumtoxinA arm versus BSC was 0.253 per patient, whereas the incremental cost was £7,160, leading to an incremental cost-effectiveness ratio (ICER of £30,468 per QALY. One-way sensitivity analyses showed that these results were sensitive to the proportion of responders to abobotulinumtoxinA at first injection, duration between injections, the number of reinjections allowed among primary nonresponders, and any difference in

  20. Safety of home parenteral nutrition during pregnancy.

    Science.gov (United States)

    Theilla, Miriam; Ławiński, Michał; Cohen, Jonathan; Hadar, Eran; Kagan, Ilya; Perkewick, Marek; Singer, Pierre

    2017-02-01

    Few studies have examined the effect of total parenteral nutrition which is lipid-based given throughout pregnancy to patients unable to obtain adequate nutrition by the oral route. In this study we examined the use of lipid-based home parenteral nutrition (HPN) in 7 pregnant women, commenced either before or during pregnancy, and their intra-pregnant course as well as a 2-year follow-up of their offspring is described. HPN was formulated on an individual basis and protein administered in a dose of 0.8-1.1 g/kg during the three trimesters. Lipid emulsions included long chain triglycerides or olive-oil based formulae and all patients received trace elements. Data were collected during the course of pregnancy and at birth while infants were followed for a period of between 6 months and 2 years using medical records and questionnaires. In total, we studied 9 pregnancies (in 7 women). HPN was administered for a median of 9 months (range 3-9 months). The mean energy provided during the 1st, 2nd and 3rd trimester was 9297 ± 2797 kcal/week, 9148 ± 2629 kcal/week and 8564 ± 4059 kcal/week resp. The mean increase in weight during the pregnancy was 9 ± 5 Kg. The only complications noted during the pregnancy consisted of 3 episodes of catheter-related infections which were successfully treated by antibiotics. The infants were born after a mean of 38.00 ± 1.55 weeks of gestation, with a mean first minute Apgar score of 8.7 ± 1.8 which increased to 9.8 ± 0.4 after 10 min. The mean infant birth weight was 2.45 ± 0.37 kg. No complications were noted at birth apart from one infant who suffered from torticollis which resolved spontaneously. During follow up, a decrease in hemoglobin related to low iron levels was noted in 1 infant, 2 infants were noted to be allergic to pollen and one underwent a scrotal hernia reduction. No developmental problems have been observed, neither physiological nor psychomotor, over the 2-year follow-up period. The authors

  1. Toxina botulínica no blefaroespasmo, no espasmo hemifacial e na distonia cervical: resultados em 33 pacientes Botulinum toxin in blepharospasm, hemifacial spasm and cervical dystonia: results in 33 patients

    Directory of Open Access Journals (Sweden)

    Sérgio Ap. Novis

    1995-09-01

    Full Text Available Avaliamos os resultados terapêuticos obtidos com o emprego de toxina botulínica do tipo A em 33 pacientes com distonia (12 com blefaroespamo; 10 com espasmo hemifacial e 11 com torcicolo espasmódico. Utilizamos uma escala de pontuação de gravidade antes de cada aplicação, sendo reavaliados duas semanas após, seguindo a mesma escala. Entre os com blefaroespasmo, oito eram mulheres e quatro homens; a média de idade foi 57,7 anos; a média do tempo de doença de quatro anos; três tinham história similar na família; nove eram essenciais e três fizeram uso de neurolépticos (distonia tardia. A dose média empregada ficou em 51,3 U, com a duração média do efeito benéfico de 2,8 meses. Do total de 22 aplicações (injeções e reinjeções, 14 (63,7% tiveram resultado ótimo, 5 (22,7% bom e três (13,6% nulo. Naqueles com espasmo hemifacial, oito eram mulheres e dois homens; a média de idade foi 52,6 anos; a média do tempo de doença 7,4 anos; oito eram essenciais e dois pós-páralíticos. A dose média empregada ficou em 32 U. Do total de 15 aplicações, todos (100% tiveram resultado ótimo, com a duração média do efeito benéfico de 3,4 meses. Nos pacientes com distonia cervical, oito eram homens e três mulheres; a média de idade foi 44,2 anos; a média do tempo de doença 12,2 anos; seis eram essenciais, três fizeram uso de neuroléptico e dois tinham história familiar. A dose média empregada ficou em 238,6 U, com a duração média do efeito benéfico de 4,7 meses. Do total de 20 aplicações, 18 (90% tiveram resultado bom, 1 (5% regular e 1 (5% nulo. Ptose palpebral, paresia facial e disfagia foram os efeitos colaterais mais encontrados. Concluímos que a toxina botulínica revelou-se eficaz no tratamento destas condições.The effects of botulinum toxin type A were studied in 33 patients with dystonia (12 blepharospasms, 10 hemifacial spasms and 11 spasmodic torticollis. A rate scale was used to evaluate the severity

  2. Botulinum toxin type A versus botulinum toxin type B for cervical dystonia.

    Science.gov (United States)

    Duarte, Gonçalo S; Castelão, Mafalda; Rodrigues, Filipe B; Marques, Raquel E; Ferreira, Joaquim; Sampaio, Cristina; Moore, Austen P; Costa, João

    2016-10-26

    , with a higher probability of benefit from BtA treatment. None of the trials were free of for-profit bias, nor did they provide information regarding registered study protocols. All trials evaluated the effect of a single Bt treatment session, and not repeated treatment sessions, using doses from 100 U to 250 U of BtA (all onabotulinumtoxinA, or Botox, formulations) and 5000 U to 10,000 U of BtB (rimabotulinumtoxinB, or Myobloc/Neurobloc).We found no difference between the two types of botulinum toxin in terms of overall efficacy, with a mean difference of -1.44 (95% CI -3.58 to 0.70) points lower on the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) for BtB-treated participants, measured at two to four weeks after injection. The proportion of participants with adverse events was also not different between BtA and BtB (BtB versus BtA risk ratio (RR) 1.40; 95% CI 1.00 to 1.96). However, when compared to BtA, treatment with BtB was associated with an increased risk of one adverse events of special interest, namely treatment-related sore throat/dry mouth (BtB versus BtA RR of 4.39; 95% CI 2.43 to 7.91). Treatment-related dysphagia (swallowing difficulties) was not different between BtA and BtB (RR 2.89; 95% CI 0.80 to 10.41). The two types of botulinum toxin were otherwise clinically non-distinguishable in all the remaining outcomes. The previous version of this review did not include any trials, since these were still ongoing at the time. Therefore, with this update we are able to change the conclusions of this review. There is low quality evidence that a single treatment session of BtA (specifically onabotulinumtoxinA) and a single treatment session of BtB (rimabotulinumtoxinB) are equally effective and safe in the treatment of adults with certain types of cervical dystonia. Treatment with BtB appears to present an increased risk of sore throat/dry mouth, compared to BtA. Overall, there is no clinical evidence from these single-treatment trials to support or