Browsing by Subject "Weakness"

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    Chest pain while gardening: a Stanford type A dissection involving the aortic root extending into the iliac arteries-an uncommon and potentially catastrophic disease process
    (BioMed Central, 2019-08-30) Taylor, Gregory M.; Barney, Michael W.; McDowell, Eric L.; Emergency Medicine, School of Medicine
    BACKGROUND: An aortic dissection is an uncommon and potentially catastrophic disease process that carries with it a high morbidity and mortality. The inciting event is a tear in the intimal lining of the aorta. This allows passage of blood through the tear and into the aortic media, resulting in the creation of a false lumen. CASE PRESENTATION: We describe the case of a 71-year-old male with a history of hypertension that suffered a Stanford type A dissection with an intimal flap beginning at the level of the aortic root and extending into the bilateral iliac arteries. His clinical presentation was further complicated by shock, cardiac tamponade, severe coagulopathy, an ischemic right lower extremity, infarction of his thoracic spinal cord, and subacute infarcts secondary to malperfusion and embolic disease. Despite maximal intervention, the patient continued to clinically decline and ultimately died on day 5. CONCLUSION: The clinical presentation of an acute aortic dissection is often atypical and mimics other common disease processes. The signs and symptoms largely depend on the extent of the aortic dissection and the presence or absence of malperfusion. With a mortality increasing by 1-2% for every hour until definitive treatment, early recognition and prompt operative intervention are crucial for patient survival.
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    End-to-Side Nerve Transfer for the Management of Chronic Leg Compartment Ankle Dorsiflexion Weakness
    (Thieme, 2022) Rodriguez-Collazo, Edgardo R.; Raja, Asim A. Z.; Ward, Shawn Christopher; Oexeman, Stephanie; Khan, Arshad A.; Orthopaedic Surgery, School of Medicine
    Background: A proximal deep peroneal nerve (DPN) injury can significantly impact the functional capacity of the leg, to include compromised motor function of the tibialis anterior (TA) muscle. Clinical examination can range from weakness in ankle dorsiflexion, to complete foot drop. Diagnostic nerve conduction velocity (NCV) testing can demonstrate abnormalities at select areas of impingement (or) entrapment (i.e., regions affected by a demyelinating compression mono-neuropathy), along the proximal course of the common peroneal nerve. Methods: We retrospectively report on 17 patients with clinical weakness involving ankle dorsiflexion. All patients underwent surgical end-to-side anastomosis, transferring a muscular nerve branch from the superficial peroneal nerve (SPN) to a segment of the DPN responsible for TA muscle innervation. Outcomes were based on comparisons of preoperative and postoperative DPN motor function to the TA muscle, standardized to the British Medical Research Council Scale for Muscle Strength. Preoperative scores were generally M2 or below. Results: Postoperative outcome scores of M4 to M5 were considered good (or) successful. 94.1% of patients demonstrated successful outcomes. Conclusion: An end-to-side SPN motor branch anastomosis, into the motor branch of the DPN responsible for TA muscle innervation, can be a viable treatment option for weakness in ankle dorsiflexion. All reported cases involved a compromised segment of deep peroneal nerve within the proximal one-third of the leg.