Neslihan Aksu, Burak Abay*, Taner Aksu, and Serdar Tuncer
Introduction: Subacromial impingement syndrome (SAIS) is the most common disorder of the shoulder, and may seldom be secondary to scapulothoracic muscle weakness due to the injury of the nerves innervating these muscles. Spinal accessory nerve (SAN) lesions may coexist with dorsal scapular nerve (DSN) injuries, which are commonly misdiagnosed. This is the first report in the literature that describes simultaneous palsies of SAN and DSN.
Case presentation: A 26-year-old Caucasian male with asymmetric shoulders reported pain when abducting his right arm to shoulder level and a decreased range of movement in right shoulder after two weeks of an accident carrying a heavy air-conditioner on his right shoulder. His right trapezius muscle showed signs of atrophy, with loss of the nuchal ridge and droping of the right shoulder girdle, internal rotation of the shoulder, and a wide area of dysesthesia on the neck. He was unable to shrug the effected shoulder, with presence of subacromial impingement signs. Plain radiographs and MRI scans were revealed no abnormalities. SAN and DSN palsy caused by compression of the posterior cervical triangle were diagnosed.
Conclusions: Nerve injury should be considered in the differential diagnosis of impingement syndrome. The DSN and SAN are in close proximity at the posterior cervical triangle, and when there is SAN palsy, an accompanying DSN injury should be ruled out due to the close proximity of these two nerves. This knowledge is important for planning of physical therapy and during follow-ups and also for the surgical exploration if it is necessary.
Rile Wu*, Jun Ren, Wenjun Ji, Junwei Gao, Yawen Pan, Yoko Kato and Yasuhiro Yamada
A duplicated middle cerebral artery (DMCA) aneurysm is characterized by the presence of an aneurysm at the bifurcation of the original and duplicated middle cerebral arteries. The authors reported a very rare case that had a DMCA aneurysm and underwent multimodality treatment. The patient was 49-year-old male and presented with headache. His examinations revealed an aneurysm at the origin of the DMCA. The aneurysm was treated with surgical clipping under the endoscope-assisted microsurgery-integrated indocyanine green video-angiography. The patient was uneventful and discharged on postoperative day 10. That is the first case reported in the literature having such aneurysms treated with multimodality treatment.
Lidija Sapina*, Gordana Lojen, Zeljka Janjetovic, and Zeljka Vukovic Arar
In the article we showed the patient, a woman with unruptured giant aneurysm of basilar artery, we showed the done examinations, and therapy dilemmas about what to do in the given case. We found in literature a number of exampleswhich suggest operation treatment, but of embolisation too, some suggest conservative treatment.
Jose Alejandro Mendoza*, Federico Arturo Silva, Marlen Yovana Pachón, Ligia Clemencia Rueda, Luis Alberto Lopez Romero, and Mónica Perez
Background: Post-stroke aphasia is one of the major disabilities and a risk factor for other complications, is also associated with increased mortality, depression and impairments in communication. Repetitive Transcranial Magnetic Stimulation (rTMS) is an alternative. We propose the review of literature published until now of rTMS.
Methods: We included articles published on PubMed and EMBASE, we included studies if were: randomized controlled blinded clinical trials, meta-analyses or crossover designs of rTMS alone or with speech therapy or any other therapy tested with rTMS. One author included these if: report baseline assessment and one or more posterior assessments; overall results and subtest report; statistically significant results showed by p value. We also assessed the risk of bias of each article.
Main results: We included 15 articles, the average age was62.42 ± 4.04; most used low frequency stimulation (1 Hz), most used a coil of 70mm, 77% applied 10 sessions, most did a Speech language therapy. From overall test result:66% studies improved Aphasia; room subtest results: only 1 study improved listening, speaking and reading; 2 studies improved writing, 80% studies improved naming skills, Two studies improved writing and description, 3 studies improved compression and expression, 46% improved repetition.47% of studies used Boston battery, 33% used Aachen Aphasia Test.
Conclusions: The articles included showed improvement of scale results for aphasia in post-stroke patients, mainly due to improvement in naming and repetition skills.
LJ Irastorza* and JM Bellon
Objectives: To evaluate personality dimensions especially emotional dysregulation (ED), in adults with attention deficit and hyperactivity disorder (ADHD) and to investigate differences in ADHD types and ED between patients and controls.
Method: We performed a cross-sectional study of patients with ADHD and controls. The study population comprised 78 outpatients attending Arganda Mental Health Center (MHC) (Arganda del Rey, Spain) and 27 control patients, who were also attending MHC. The study was performed from January 2013 to August 2016. A review of ED and personality dimensions in ADHD is shown.
Results: The DERS (Difficulties in emotion regulation scale) and CAARS (Conners' Adult ADHD Rating Scale) dimensions of ED were associated with ADHD. Some NEO-PI-R (Revised NEO Personality Inventory) personality dimensions are seen in both ADHD subtypes.
Conclusion: In adult ADHD, several dimensions are compatible with ED. Some ED subscales (eg, awareness, clarity and no acceptance) are not specific to ADHD. High neuroticism and low conscientiousness are personality dimensions in adults with ADHD.