Normative Value of the Cross-Sectional Area of the Median Nerve at the Carpal Tunnel Inlet and Distal Forearm in the Singapore Population.

Ultrasonography is often used in the diagnosis of carpal tunnel syndrome (CTS). However, we were unable to find normative data regarding the cross-sectional area (CSA) of the median nerve in the Singapore population as measured by ultrasound. The aims of this study were to establish normative values of the CSA of the median nerve at the carpal tunnel inlet in a healthy population, 5 cm proximal to the carpal tunnel inlet, and to determine if the CSA correlated with side, age, gender or race.

Antiplatelets or anticoagulants? Secondary prevention in cervical artery dissection: an updated meta-analysis.

Background: Extracranial artery dissection involving either internal carotid artery or vertebral artery is a major cause of stroke in adults under 50 years of age. There is no conclusive evidence whether antiplatelets or anticoagulants are better suited in the treatment of extracranial artery dissection.

Objectives: To determine whether antiplatelets or anticoagulants have advantage over the other in the treatment of extracranial artery dissection for secondary prevention of recurrent ischemic events or death.

Novel Autoantibodies in Idiopathic Small Fiber Neuropathy.

Objective: Small fiber neuropathy (SFN) is clinically and etiologically heterogeneous. Although autoimmunity has been postulated to be pathophysiologically important in SFN, few autoantibodies have been described. We aimed to identify autoantibodies associated with idiopathic SFN (iSFN) by a novel high-throughput protein microarray platform that captures autoantibodies expressed in the native conformational state.

Vogt-Koyanagi-Harada Syndrome - A Neurologist's Perspective.

Vogt-Koyanagi-Harada (VKH) syndrome is an immune-mediated granulomatous disease which affects melanin-rich organs like eyes, skin, nervous system, and ears. Neurological and auditory manifestations usually precede the involvement of other sites. Patients may manifest with "complete" or "incomplete" syndrome.

Clinical profile and impact of comorbidities in patients with very-late-onset myasthenia gravis.

Introduction/aims: The purpose of this study was to evaluate the clinical profile of myasthenia gravis (MG) in older patients and determine the impact of medical comorbidities on their MG status and outcome.

Methods: This was a retrospective chart review of patients with a symptom onset of MG at or after 65 years of age. Correlations were made between demographics, clinical characteristics, the Myasthenia Gravis Foundation of America (MGFA) severity scale scores, and Myasthenia Gravis Impairment Index (MGII) scores with two outcome measures: MGFA Post-Intervention Status (MGFA-PIS) and Simple Single Question (SSQ).

Neutrophil-to-Lymphocyte Ratio Predicts Development of Immune-Related Adverse Events and Outcomes from Immune Checkpoint Blockade: A Case-Control Study.

The utility of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) utility in predicting immune-related adverse events (irAEs) and survival have not been well studied in the context of treatment with immune checkpoint inhibitors (ICIs). We performed a case-control study of cancer patients who received at least one dose of ICI in a tertiary hospital. We examined NLR and PLR in irAE cases and controls.

Telephone consultation for myasthenia gravis care during the COVID-19 pandemic: Assessment of a novel virtual myasthenia gravis index.

Introduction/aims: The aim of the study was to determine the association between the virtual Myasthenia Gravis Impairment Index (vMGII) with other patient-reported outcomes (PROs) of myasthenia gravis (MG) and its usefulness in telephone consultations with MG patients.

Methods: This was a retrospective case series in which vMGII score along with virtual Single Simple Question (vSSQ), virtual Patient-Acceptable Symptom State PASS (vPASS) response, and patient disease status based on Myathenia Gravis Foundation of America postintervention status were collected during telephone consultation along with the MGII, SSQ, and PASS responses during the preceding in-person clinic visits.

Results: In 214 patients, the mean difference of vMGII between the vPASS "Yes" and "No" groups was -14.

Limb Hypothermia for Preventing Paclitaxel-Induced Peripheral Neuropathy in Breast Cancer Patients: A Pilot Study.

Background: Peripheral neuropathy (PN) due to paclitaxel is a common dose-limiting toxicity with no effective prevention or treatment. We hypothesize that continuous-flow limb hypothermia can reduce paclitaxel-induced PN.

Patients And Methods: An internally controlled pilot trial was conducted to investigate the neuroprotective effect of continuous-flow limb hypothermia in breast cancer patients receiving weekly paclitaxel.

Nerve ultrasound in electrophysiologically verified tarsal tunnel syndrome.

Introduction: Tarsal tunnel syndrome (TTS) arises from tibial nerve damage under the flexor retinaculum of the fibro-osseus tunnel at the medial malleolus. It is notoriously difficult to diagnose, as many other foot pathologies result in a similar clinical picture. We examined the additional value of nerve ultrasound in patients with tarsal tunnel syndrome confirmed by nerve conduction.

Role of combined B-mode and Doppler sonography in evaluating neurolymphomatosis.

Objective: To highlight the potential usefulness of nerve ultrasonography to identify lymphomatous peripheral nerve infiltration in patients with lymphoma.

Methods: We performed electrodiagnostic studies and nerve ultrasonography in 3 patients with lymphoma presenting with focal peripheral neuropathy.

Results: In all 3 patients, electrodiagnostic studies proved focal involvement of the peripheral nerves.

Neurogenic orthostatic hypotension - management update and role of droxidopa.

Orthostatic hypotension (OH) is defined as a significant decrease in blood pressure (BP) during the first 3 minutes of standing or a head up on a tilt table. Symptoms of OH are highly variable, ranging from mild light-headedness to recurrent syncope. OH occurs due to dysfunction of one or more components of various complex mechanisms that interplay closely to maintain BP in a normal range during various physiological and associated disease states.

Combined Doppler and B-mode sonography in carpal tunnel syndrome.

An intraoperatively enlarged engorged median nerve has been described as typical of patients with carpal tunnel syndrome (CTS). Although many studies of CTS have addressed median nerve enlargement, little is known about the usefulness of Doppler methods in detecting median nerve engorgement combined with nerve cross-sectional area (CSA). In a retrospective study of hands referred for evaluation of possible CTS, patients were clinically graded into Highly-likely or Indeterminate CTS.

Familial amyloidotic polyneuropathy with muscle, vitreous, leptomeningeal, and cardiac involvement: phenotypic, pathological, and MRI description.

Familial amyloidotic polyneuropathy (FAN type 1) is a rare systemic disease that causes severe and disabling peripheral neuropathy. We describe the phenotypic, radiological, and pathological characteristics of a patient with familial amyloid polyneuropathy type 1 who had evidence of motor-sensory-autonomic neuropathy, ocular vitreous deposits, diffuse leptomeningeal involvement, and hypertrophic cardiomyopathy. Muscle involvement, an infrequently reported feature, was also observed.

An unhappy patient following successful sonothrombolysis in vertebrobasilar thrombosis: dilemma with final diagnosis.

Acute vertebrobasilar thrombosis is often associated with high mortality and prolonged disability. Therapeutic route and the time window for systemic thrombolysis in acute settings remain uncertain. We describe a case of severe acute ischemic stroke due to vertebrobasilar thrombosis who achieved rapid arterial recanalization and remarkable clinical recovery during ultrasound enhanced intravenous thrombolysis, initiated at 4.

High resolution ultrasonography in the diagnosis of ulnar nerve lesions with particular reference to post-traumatic lesions and sites outside the elbow.

Objective: Recent studies suggest that high resolution ultrasonography (HRU) is useful in evaluating ulnar neuropathy (UN) at the elbow. These studies do not include UN outside the elbow and lesions related to previous trauma. We investigate diagnostic utility of HRU in UN at any location of traumatic and non-traumatic etiology.